The Recommended Food Score and Healthy Nordic Food Index in cardiovascular disease and stroke: A systematic review

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.