British Journal of Nutrition

Full Papers

Dietary Surveys and Nutritional Epidemiology

Associations of the Baltic Sea diet with cardiometabolic risk factors – a meta-analysis of three Finnish studies

Noora Kanervaa1a2 c1, Niina E. Kaartinena1, Harri Rissanena3, Paul Knekta3, Johan G. Erikssona1a4a5a6, Katri Sääksjärvia3, Jouko Sundvalla1 and Satu Männistöa1

a1 Department of Chronic Disease Prevention, National Institute for Health and Welfare, PO Box 30, FI-00271 Helsinki, Finland

a2 Department of Public Health, University of Helsinki, Helsinki, Finland

a3 Department of Health, Functional Capacity and Welfare, National Institute for Health and Welfare, Helsinki, Finland

a4 Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland

a5 Unit of General Practice, Helsinki University Central Hospital, Helsinki, Finland

a6 Folkhälsan Research Center, Helsinki, Finland


Dyslipidaemia, hypertension and low-grade inflammation increase the risk of CVD. In the present meta-analysis, we examined whether adherence to a healthy Nordic diet, also called the Baltic Sea diet, may associate with a lower risk of these cardiometabolic risk factors. In 2001–2007, three cross-sectional Finnish studies were conducted: the Dietary, Lifestyle and Genetic Determinants of Obesity and Metabolic Syndrome study (n 4776); Health 2000 Survey (n 5180); Helsinki Birth Cohort Study (n 1972). The following parameters were assessed in these three studies: blood pressure, total, HDL- and LDL-cholesterol, TAG and high-sensitivity C-reactive protein (hs-CRP); a validated FFQ was used to assess the participants' dietary intakes. The Baltic Sea Diet Score (BSDS) was developed based on the healthy Nordic diet. All studies assessed confounding variables, such as physical activity and BMI, based on standardised questionnaires and measurements. The random-effects meta-analysis provided summary estimates for OR and 95 % CI by the BSDS quintiles. In the meta-analysis, the risk of elevated hs-CRP concentration was lower among men (OR 0·58, 95 % CI 0·43, 0·78) and women (OR 0·73, 95 % CI 0·58, 0·91) in the highest BSDS quintile than among those in the lowest BSDS quintile. In contrast, the risk of lowered HDL-cholesterol concentration was higher among women (OR 1·67, 95 % CI 1·12, 2·48) in the highest BSDS quintile than among those in the lowest BSDS quintile. However, no other associations were found. In conclusion, the associations between the adherence to the healthy Nordic diet and cardiometabolic risk factors are equivocal. Longitudinal studies are needed to further examine this hypothesis.

(Received September 10 2013)

(Revised April 01 2014)

(Accepted April 22 2014)

(Online publication May 27 2014)

Key Words:

  • Baltic Sea diet;
  • Nordic diet;
  • C-reactive protein;
  • Meta-analyses;
  • Pooling


c1 Corresponding author: N. Kanerva, email


  Abbreviations: BSDS, Baltic Sea Diet Score; DILGOM, Dietary, Lifestyle and Genetic Determinants of Obesity and Metabolic Syndrome; E%, percentage of total energy intake; EI, energy intake; HBCS, Helsinki Birth Cohort Study; HDL-C, HDL-cholesterol; hs-CRP, high-sensitivity C-reactive protein; LDL-C, LDL-cholesterol