Associations of the Baltic Sea diet with obesity-related markers of inflammation

Figures & data

Table I. Age- and sex-adjusted means (and SE) or percentages for participants’ characteristics by the BSDS quintiles in the DILGOM study and the HBCS.

	DILGOM (n = 4579) BSDS quintiles							HBCS (n = 1911) BSDS quintiles
Characteristics	1	SE	3	SE	5	SE	P^a	1	SE	3	SE	5	SE	P^a
BSDS^b,c	7.4	0.04	13.5	0.04	19.0	0.04	< 0.001	7	0.1	13	0.1	19	0.1	< 0.001
Age, y^d	46.9	0.4	53.1	0.4	58.4	0.5	< 0.001	61.2	0.1	61.5	0.1	61.8	0.2	< 0.01
Women participants, %^e	51.6		52.1		48.7		0.49	49.6		42.5		54.4		0.47
Study years	12.4	0.1	12.6	0.1	13.0	0.1	< 0.001	11.6	0.2	12.3	0.2	12.9	0.2	< 0.001
Current smokers, %	25.8		14.5		8.8		< 0.001	39.9		21.8		11.1		< 0.001
Physically inactive participants, %	30.1		15.8		10.0		< 0.001	18.1		10.2		5.3		< 0.001
BMI, kg/m^2	27.1	0.2	26.8	0.2	26.7	0.2	0.19	27.7	0.2	27.3	0.2	27.4	0.3	0.71
Waist circumference, cm	92.6	0.4	91.2	0.4	90.1	0.5	0.10	96.5	0.6	94.9	0.6	94.0	0.7	< 0.05
Beta-blockers, %	19.7		20.6		19.0		0.66	16.5		17.6		19.8		0.19
Calcium channel-blockers, %	8.7		8.5		8.0		0.79	8.7		11.4		8.0		0.92
ACE channel-blockers, %	9.0		9.7		8.1		0.27	10.7		10.1		10.5		0.98
Oral diabetes medication, %	5.0		4.0		6.0		0.32	5.0		3.9		9.0		< 0.05
Insulin users, %	1.0		1.0		1.0		0.12	2.0		1.1		3.3		0.15

BSDS = Baltic Sea Diet Score; DILGOM = Dietary, Lifestyle, and Genetic Determinants of Obesity and Metabolic Syndrome; HBCS = Helsinki Birth Cohort Study; SE = standard error.

^aP-value for trend was derived from linear regression (continuous variables) or logistic regression (categorical variables) using median values of BSDS quintiles in continuous form.

^bBaltic Sea Diet Score components: fruits and berries (berries, apples, and pears), vegetables (tomatoes, cucumbers, cabbages, roots, legumes, and lettuce), cereals (rye, oats, and barley), low-fat milk (fat-free and < 2% fat), meat products (beef, pork, processed meat, and sausage), fish, ratio of polyunsaturated fatty acids to saturated and trans-fatty acids, total fat content of the diet (as percentages of total energy intake), alcohol (as ethanol). Scoring by quartiles 0–3 points: positive scoring (the more consumed, the higher points) was used for other score components except meat products, which were scored negatively (the more consumed the lower points). Men consuming 20 g or less of alcohol and women consuming 10 g or less of alcohol were given 1 point; otherwise a score of 0 was given.

^cValues are additionally adjusted for daily intake of energy.

^dValues are adjusted only for sex.

^eValues are only adjusted for age.

Table II. Participants’ mean (SE) concentrations of markers of inflammation by the BSDS quintiles in the DILGOM study (n = 4579).

	BSDS quintiles
Markers of inflammation	1	SE	2	SE	3	SE	4	SE	5	SE	P^a
Leptin, pg/mL
Model 1^b	9490	1.03	9600	1.03	8890	1.03	8740	1.03	8600	1.03	0.002
Model 2^c	8930	1.03	9460	1.02	9040	1.03	8970	1.03	9076	1.03	0.82
Model 3^d	8880	1.02	9240	1.02	8960	1.02	9210	1.02	9260	1.02	0.23
HMW-adiponectin, ng/mL
Model 1	3710	1.02	3640	1.02	3630	1.02	3580	1.02	3460	1.03	0.044
Model 2	3750	1.02	3650	1.02	3630	1.02	3560	1.02	3420	1.03	0.011
Model 3	3760	1.02	3680	1.02	3630	1.02	3530	1.02	3400	1.03	0.003
Model 4^e	3750	1.02	3680	1.02	3620	1.02	3530	1.02	3420	1.03	0.005
Model 5^f	3740	1.02	3680	1.02	3620	1.02	3530	1.02	3420	1.03	0.006
TNF-α, pg/mL
Model 1	5.87	1.02	5.59	1.02	5.71	1.02	5.58	1.02	5.56	1.02	0.08
Model 2	5.81	1.02	5.58	1.02	5.73	1.02	5.61	1.02	5.61	1.02	0.30
Model 3	5.81	1.02	5.57	1.02	5.72	1.02	5.62	1.02	5.62	1.02	0.37
IL-6, pg/mL
Model 1	3.19	1.04	2.52	1.04	2.84	1.05	2.72	1.05	2.68	1.05	0.055
Model 2	3.07	1.04	2.5	1.04	2.87	1.05	2.77	1.05	2.77	1.05	0.44
Model 3	3.07	1.04	2.49	1.04	2.86	1.05	2.79	1.05	2.79	1.05	0.56
hs-CRP, mg/L
Model 1	1.21	1.03	1.14	1.03	1.12	1.03	1.06	1.03	0.93	1.04	< 0.001
Model 2	1.14	1.03	1.12	1.03	1.14	1.03	1.09	1.03	0.98	1.04	0.003
Model 3	1.14	1.03	1.11	1.03	1.13	1.03	1.11	1.03	1.00	1.03	0.010
Model 4	1.14	1.03	1.11	1.03	1.13	1.03	1.11	1.03	1.00	1.03	0.009
Model 5	1.13	1.03	1.12	1.03	1.12	1.03	1.11	1.03	0.99	1.03	0.006

BSDS = Baltic Sea Diet Score; DILGOM = Dietary, Lifestyle, and Genetic Determinants of Obesity and Metabolic Syndrome; HMW-adiponectin = high-molecular-weight adiponectin; hs-CRP = high-sensitivity C-reactive protein; IL-6 = interleukin 6; TNF-α = tumor necrosis factor-alpha.

^aP for trend across quintile groups was assessed with linear regression using quintiles’ median values as continuous form.

^bModel 1 is adjusted for age, sex, and intake of energy.

^cModel 2 is Model 1 adjusted for educational attainment, smoking status, and leisure time physical activity.

^dModel 3 is Model 2 adjusted for waist circumference.

^eModel 4 is Model 3 adjusted for oral diabetes medication and insulin injections (HMW-adiponectin) or for statin medication (hs-CRP).

^fModel 5 is Model 4 adjusted with other markers of inflammation which were significantly associated with the BSDS in Model 1.

Table III. Participants’ mean (SE) hs-CRP concentrations (mg/L) by the BSDS component quartiles in the DILGOM study and HBCS.

	BSDS component quartiles^a,b
BSDS components	1	SE	2	SE	3	SE	4	SE	P^c
DILGOM (n = 4458)
Fruits and berries	1.18^c	1.03^c	1.09	1.03	1.10	1.03	1.03	1.03	0.003
Vegetables	1.11	1.03	1.11	1.03	1.06	1.03	1.12	1.03	0.89
Cereals	1.14	1.03	1.12	1.03	1.08	1.03	1.05	1.03	0.046
Low-fat milk^d	1.10	1.03	1.10	1.03	1.09	1.02	1.09	1.03	0.84
Fish	1.16	1.03	1.11	1.03	1.05	1.03	1.08	1.03	0.12
Meat products	1.19	1.03	1.10	1.03	1.07	1.03	1.03	1.03	0.001
Fat ratio^e	1.11	1.03	1.09	1.03	1.12	1.03	1.07	1.03	0.45
Total fat, E%	1.11	1.03	1.09	1.03	1.15	1.03	1.04	1.03	0.19
Alcohol^f	1.05	1.03	1.09	1.03	1.12	1.03	1.15	1.03	0.019
HBCS (n = 1773)
Fruits and berries	1.50	1.05	1.52	1.04	1.43	1.04	1.32	1.05	0.023
Vegetables	1.40	1.05	1.55	1.04	1.45	1.04	1.37	1.05	0.34
Cereals	1.52	1.05	1.51	1.04	1.44	1.04	1.31	1.05	0.021
Low-fat milk^d	1.43	1.04	1.35	1.05	1.48	1.04	1.52	1.05	0.14
Fish	1.58	1.05	1.39	1.04	1.40	1.05	1.41	1.05	0.23
Meat products	1.58	1.05	1.50	1.04	1.44	1.04	1.26	1.05	0.003
Fat ratio^e	1.45	1.04	1.42	1.04	1.55	1.04	1.35	1.05	0.39
Total fat, E%	1.51	1.04	1.44	1.04	1.46	1.04	1.36	1.04	0.11
Alcohol^f	1.38	1.04	1.29	1.05	1.53	1.05	1.59	1.05	0.045

BSDS = Baltic Sea Diet Score; DILGOM = Dietary, Lifestyle and Genetic Determinants of Obesity and Metabolic Syndrome; HBCS = Helsinki Birth Cohort Study; hs-CRP = high-sensitivity C-reactive protein.

^aModel is adjusted for sex, age, educational attainment, smoking status, leisure-time physical activity, and waist circumference.

^bStudy and sex specific cut-off quartiles were used. Participants in the higher quartiles of presumably beneficial effect were assigned higher points than participants in the lowest quartiles. In contrast, participants in the lower quartiles of presumably detrimental effects were assigned higher points than persons in the highest quartiles.

^cP value for trend was obtained from linear regression using food intake quartiles’ median values as continuous variable in the model.

^dFat-free milk and milk < 2% of fat.

^eRatio of polyunsaturated fatty acids to saturated and trans-fatty acids.

^fIn component specific analyses, alcohol consumption was cut in quartiles from lowest intake (first quartile; median < 1 g/d) to moderate intake (fourth quartile; median = 15 g/d). This was done in order to obtain wider range to alcohol intake.

Table IV. Participants’ mean (SE) concentrations of markers of inflammation by the BSDS quintiles in the HBCS (n = 1911).

	BSDS quintiles
Markers of inflammation	1	SE	2	SE	3	SE	4	SE	5	SE	P^a
Leptin, pg/mL
Model 1^b	12000	1.05	12600	1.05	11500	1.05	12200	1.05	11600	1.06	0.72
Model 2^c	11900	1.05	12500	1.05	11500	1.05	12200	1.05	11800	1.06	0.87
Model 3^d	11600	1.05	12600	1.05	11700	1.05	11900	1.05	12300	1.06	0.69
HMW-adiponectin, ng/mL
Model 1	4860	1.04	4420	1.04	5100	1.04	4640	1.04	4380	1.05	0.23
Model 2	4870	1.04	4420	1.04	5100	1.04	4620	1.04	4360	1.05	0.14
Model 3	4920	1.04	4410	1.04	5030	1.04	4690	1.04	4310	1.05	0.13
TNF-α, pg/mL
Model 1	8.89	1.05	9.27	1.05	8.66	1.05	8.78	1.05	8.48	1.07	0.50
Model 2	8.86	1.05	9.27	1.05	8.68	1.05	8.68	1.05	8.52	1.07	0.51
Model 3	8.83	1.05	9.27	1.05	8.70	1.05	8.65	1.05	8.56	1.07	0.55
IL-6, pg/mL
Model 1	20.6	1.12	21.6	1.12	22.6	1.12	16.8	1.12	17.8	1.15	0.20
Model 2	19.9	1.12	21.5	1.12	23.0	1.12	17.2	1.12	18.6	1.15	0.42
Model 3	19.9	1.12	21.5	1.12	23.0	1.12	17.1	1.12	18.6	1.15	0.43
hs-CRP, mg/L
Model 1	1.67	1.05	1.57	1.05	1.45	1.05	1.29	1.05	1.20	1.06	< 0.001
Model 2	1.58	1.05	1.54	1.05	1.45	1.05	1.34	1.05	1.23	1.06	0.002
Model 3	1.53	1.05	1.54	1.05	1.47	1.05	1.33	1.05	1.29	1.06	0.005
Model 4^e	1.53	1.05	1.54	1.05	1.47	1.05	1.33	1.05	1.29	1.06	0.006
Model 5^f	1.54	1.05	1.53	1.05	1.49	1.05	1.33	1.05	1.28	1.06	0.004

BSDS = Baltic Sea Diet Score; HBCS = Helsinki Birth Cohort Study; HMW-adiponectin = high-molecular-weight adiponectin; hs-CRP = high-sensitivity C-reactive protein; IL-6 = interleukin 6; TNF-α = tumor necrosis factor-alpha.

^aP for trend across quintile groups was assessed with linear regression using quintile median values as continuous form.

^bModel 1 is adjusted for age, sex, and intake of energy.

^cModel 2 is Model 1 adjusted for educational attainment, smoking status, and leisure time physical activity.

^dModel 3 is Model 2 adjusted for waist circumference.

^eModel 4 is Model 3 adjusted for statin medication (hs-CRP).

^fModel 5 is Model 4 adjusted with other markers of inflammation which were significantly associated with the BSDS in Model 1.