Document Type : Review Article


1 Student Research Committee AND Department of Nutrition Community, School of Nutrition, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Department of Community Nutrition, National Nutrition and Food Technology Research Institute, School of Nutrition Sciences and Food Technology, Shahid Behehshti University of Medical Sciences, Tehran, Iran


BACKGROUND: Cardiovascular disease (CVD) includes a group of heart and coronary disorders that can be prevented by promoting the quality of an individual’s diet. The Recommended Food Score (RFS) and Healthy Nordic Food Index (HNFI) are suggested for the assessment of diet quality and as indicators of dietary exposures related to disease. The aim of this study was to systematically review the association of the RFS and the HNFI with CVD and stroke.METHODS: Articles were identified by searching PubMed, Google Scholar, and ScienceDirect using relevant keywords for articles published until December 2018. The inclusion criteria were all types of observational studies and English language. Non-English and irrelevant studies were excluded.RESULTS: In total, 14 studies met the inclusion criteria. Of the 7 studies that investigated the association between the RFS and CVD, 6 articles showed a lower risk of CVD in individuals who obtained a higher RFS and lower non-RFS (n-RFS) score. Studies that investigated the relation between RFS and stroke (n = 2) showed that achieving a higher RFS could decrease the risk of stroke. Of the 4 studies that assessed the relationship between HNFI and CVD, 3 showed that adherence to HNFI were related with lower risk of CVD/stroke. However, one study did not show any relationship.CONCLUSION: A higher RFS may result in a decrease in the risk of CVD and stroke. Due to the inconsistency of the findings related to HNFI, more studies are needed to approve the negative relationship between HNFI and CVD.


  1. World Health Organization. Cardiovascular diseases (CVDs) [Online]. [cited 2017]; Available from: URL:
  2. Crichton GE, Elias MF, Davey A, Sauvageot N, Delagardelle C, Beissel J, et al. Cardiovascular health: A cross-national comparison between the Maine Syracuse Study (Central New York, USA) and ORISCAV-LUX (Luxembourg). BMC Public Health 2014; 14: 253.
  3. Mendis S, Abegunde D, Yusuf S, Ebrahim S, Shaper G, Ghannem H, et al. WHO study on Prevention of REcurrences of Myocardial Infarction and StrokE (WHO-PREMISE). Bull World Health Organ 2005; 83(11): 820-9.
  4. Larsson SC, Akesson A, Wolk A. Healthy diet and lifestyle and risk of stroke in a prospective cohort of women. Neurology 2014; 83(19): 1699-704.
  5. Akesson A, Larsson SC, Discacciati A, Wolk A. Low-risk diet and lifestyle habits in the primary prevention of myocardial infarction in men: A population-based prospective cohort study. J Am Coll Cardiol 2014; 64(13): 1299-306.
  6. Lassale C, Gunter MJ, Romaguera D, Peelen LM, Van der Schouw YT, Beulens JW, et al. Diet quality scores and prediction of all-cause, cardiovascular and cancer mortality in a pan-European cohort
  7. study. PLoS One 2016; 11(7): e0159025.
  8. Michels KB, Wolk A. A prospective study of variety of healthy foods and mortality in women. Int J Epidemiol 2002; 31(4): 847-54.
  9. Olsen A, Egeberg R, Halkjaer J, Christensen J, Overvad K, Tjonneland A. Healthy aspects of the Nordic diet are related to lower total mortality.
  10. J Nutr 2011; 141(4): 639-44.
  11. Santo K, Hyun K, de Keizer L, Thiagalingam A, Hillis GS, Chalmers J, et al. The effects of a lifestyle-focused text-messaging intervention on adherence to dietary guideline recommendations in patients with coronary heart disease: An analysis of the TEXT ME study. Int J Behav Nutr Phys Act 2018; 15(1): 45.
  12. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. PLoS Med 2009; 6(7): e1000100.
  13. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med 2009; 6(7): e1000097.
  14. Hansen CP, Overvad K, Kyro C, Olsen A, Tjonneland A, Johnsen SP, et al. Adherence to a Healthy Nordic Diet and Risk of Stroke: A Danish Cohort Study. Stroke 2017; 48(2): 259-64.
  15. Gunge VB, Andersen I, Kyro C, Hansen CP, Dahm CC, Christensen J, et al. Adherence to a healthy Nordic food index and risk of myocardial infarction in middle-aged Danes: The diet, cancer and health cohort study. Eur J Clin Nutr 2017; 71(5): 652-8.
  16. Roswall N, Sandin S, Lof M, Skeie G, Olsen A, Adami HO, et al. Adherence to the healthy Nordic food index and total and cause-specific mortality among Swedish women. Eur J Epidemiol 2015; 30(6): 509-17.
  17. Roswall N, Sandin S, Scragg R, Lof M, Skeie G, Olsen A, et al. No association between adherence to the healthy Nordic food index and cardiovascular disease amongst Swedish women: A cohort study. J Intern Med 2015; 278(5): 531-41.
  18. Crichton GE, Elias MF, Robbins MA. Cardiovascular health and arterial stiffness: The Maine-Syracuse Longitudinal Study. J Hum Hypertens 2014; 28(7): 444-9.
  19. Coelho LG, Candido AP, Machado-Coelho GL, de Freitas SN. Food habits and risk of cardiovascular disease in schoolchildren from Ouro Preto, Minas Gerais. Rev Nutr Campinas 2015; 28(2): 133-42.
  20. Crichton GE, Elias MF, Davey A, Alkerwi A.
  21. Cardiovascular health and cognitive function: The Maine-Syracuse Longitudinal Study. PLoS One 2014; 9(3): e89317.
  22. Kaluza J, Hakansson N, Brzozowska A, Wolk A. Diet quality and mortality: A population-based prospective study of men. Eur J Clin Nutr 2009; 63(4): 451-7.
  23. McCullough ML, Feskanich D, Stampfer MJ, Giovannucci EL, Rimm EB, Hu FB, et al. Diet quality and major chronic disease risk in men and women: Moving toward improved dietary guidance. Am J Clin Nutr 2002; 76(6): 1261-71.
  24. Larsson SC, Akesson A, Wolk A. Overall diet quality and risk of stroke: A prospective cohort study in women. Atherosclerosis 2014; 233(1): 27-9.
  25. Kant AK, Schatzkin A, Graubard BI, Schairer C. A prospective study of diet quality and mortality in women. JAMA 2000; 283(16): 2109-15.
  26. Harris KA, Kris-Etherton PM. Effects of whole grains on coronary heart disease risk. Curr Atheroscler Rep 2010; 12(6): 368-76.
  27. Riserus U. Healthy Nordic diet and cardiovascular disease. J Intern Med 2015; 278(5): 542-4.
  28. Li Y, Roswall N, Sandin S, Strom P, Adami HO, Weiderpass E. Adherence to a healthy Nordic food index and breast cancer risk: Results from a Swedish cohort study. Cancer Causes Control 2015; 26(6): 893-902.
  29. Mozaffarian D, Wu JH. Omega-3 fatty acids and cardiovascular disease: Effects on risk factors, molecular pathways, and clinical events. J Am Coll Cardiol 2011; 58(20): 2047-67.
  30. Fuhrman B, Elis A, Aviram M. Hypocholesterolemic effect of lycopene and
  31. beta-carotene is related to suppression of cholesterol synthesis and augmentation of LDL receptor activity in macrophages. Biochem Biophys Res Commun 1997; 233(3): 658-62.
  32. Fiedor J, Burda K. Potential role of carotenoids as antioxidants in human health and disease. Nutrients 2014; 6(2): 466-88.
  33. Leder L, Kolehmainen M, Narverud I, Dahlman I, Myhrstad MC, de Mello VD, et al. Effects of a healthy Nordic diet on gene expression changes in peripheral blood mononuclear cells in response to an oral glucose tolerance test in subjects with metabolic syndrome: A SYSDIET sub-study. Genes Nutr 2016; 11: 3.
  34. Poulsen SK, Due A, Jordy AB, Kiens B, Stark KD, Stender S, et al. Health effect of the New Nordic Diet in adults with increased waist circumference: A 6-mo randomized controlled trial. Am J Clin Nutr 2014; 99(1): 35-45.