Inside the Baltic diet: Foods, nutrients, and traditional staples
Cardiometabolic benefits
Modern challenges to traditional Baltic eating patterns
References
Further reading
Rooted in Nordic food traditions, the Baltic Sea diet may offer a practical, sustainable way to improve metabolic health while reducing reliance on processed foods.
Image Credit: Yaroshenko Maryna / Shutterstock.com
Inside the Baltic Sea diet: Foods, nutrients, and traditional staples
The Baltic Sea diet is a research-defined healthy Nordic dietary pattern. Its Pyramid and Score were developed in Finland as tools to describe and measure adherence, while the broader healthy Nordic diet emerged through multiple Nordic research and policy initiatives.1,9 It draws primarily on foods typical of Denmark, Finland, Iceland, Norway, and Sweden. Common food components include whole grains such as rye, oats, and barley, as well as local fruits and vegetables, including bilberries, lingonberries, apples, pears, root vegetables, and cabbage. Protein sources include legumes, salmon, herring, and mackerel; low-fat dairy products are also consumed in moderate amounts, whereas red and processed meats, sweets, and saturated fats should be consumed sparingly.2,4,6
The Baltic Sea Diet Score (BSDS) is a research index rather than a fixed meal plan. It scores nine components: Nordic fruits and berries; vegetables; rye, oats, and barley; low-fat milk; fish; the ratio of polyunsaturated to saturated and trans fats; red and processed meat; total fat; and alcohol. Because its alcohol component awards a point for intake at or below specified thresholds, the score should not be interpreted as advice to begin drinking alcohol.1,3,5 Sodium intake is not directly scored by the BSDS, so a high score does not necessarily represent a low-sodium diet; one Finnish analysis found no association with hypertension despite somewhat higher sodium intake at greater adherence.5
Rye bread and other whole-grain rye, oat, and barley foods are major sources of dietary fiber; oats and barley also provide viscous fiber. Fatty fish like salmon, herring, and mackerel are rich sources of long-chain omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), while temperate berries supply polyphenols and other bioactive compounds. These characteristics provide biologically plausible explanations for cardiometabolic effects, but dietary-pattern studies do not establish that any single food or nutrient mediates the observed outcomes.2,6
Rapeseed oil is used instead of butter or lard, which shifts the fat profile toward a more cardioprotective composition.9 In a Finnish cross-sectional study, higher BSDS values were associated with higher intakes of carbohydrate, fiber, iron, vitamins A, C, and D, and folate, together with lower intakes of saturated fat and alcohol. A favorable ratio of polyunsaturated to saturated and trans fats is also built into the score itself, and these compositional associations do not demonstrate that the BSDS caused nutrient intake to change.1
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The relationship between adherence to the Baltic dietary pattern and cardiometabolic outcomes has been examined in numerous cross-sectional analyses, prospective cohort studies, randomized controlled trials, and meta-analyses. Overall, the evidence generally supports small cardiometabolic benefits, while some findings are inconsistent, and confidence in the evidence is commonly low to moderate rather than definitive.5,6
In a systematic review and meta-analysis of 15 prospective cohort studies involving over one million participants, dose-response models across the observed ranges of Nordic diet scores estimated a 7% reduction in total cardiovascular disease incidence, 26% reduction in cardiovascular disease mortality, 12% reduction in coronary heart disease incidence, 13% reduction in stroke incidence, and 9% reduction in type 2 diabetes incidence. These estimates combined several definitions of Nordic dietary patterns rather than evaluating the BSDS alone; evidence certainty was moderate for cardiovascular mortality and low for the other clinical outcomes.6 Across six randomized trials involving 717 adults with cardiometabolic risk factors, pooled mean differences included reductions of 0.26 mmol/L in LDL cholesterol, 0.69 mmol/L in non-HDL cholesterol, 0.15 g/L in apolipoprotein B, 2 kg in body weight, 7.83 pmol/L in fasting insulin, and 3.35 mmHg in systolic blood pressure. No effect was found for HDL cholesterol, fasting glucose, or C-reactive protein, and the evidence for LDL cholesterol was of low certainty and substantial heterogeneity.6
Elevated high-sensitivity C-reactive protein (hs-CRP) is an established predictor of cardiovascular events; however, an association between diet and hs-CRP alone does not demonstrate a reduction in cardiovascular events. In a 2014 meta-analysis of three cross-sectional Finnish studies, Finnish men and women in the highest BSDS quintile had 42% and 27% lower odds of elevated hs-CRP, respectively, as compared to those in the lowest quintile. These associations persisted after adjusting for age, physical activity, education, smoking, and body mass index (BMI). Women in the highest BSDS quintile also had higher odds of low HDL cholesterol, and no associations were found for the other measured cardiometabolic risk factors; the cross-sectional design prevents causal interpretation.5
In a cross-sectional FINRISK 2007 analysis of 4,720 Finnish adults, men in the highest BSDS quintile had 52% lower odds of elevated waist circumference than those with the lowest scores. The corresponding association in women was not statistically significant; no association with BMI was found, and reverse causality cannot be excluded.3
Moreover, among a population of 225 newly diagnosed type 2 diabetes cases and 450 controls, higher BSDS scores were significantly associated with lower odds of diabetes in both unadjusted and fully adjusted analysis models, with an adjusted odds ratio of 0.48 (95% confidence interval 0.32–0.89).4 The investigators used a modified 0–24-point BSDS that excluded alcohol and assigned points according to intake tertiles, limiting direct comparability with the original 0–25-point Finnish score.4 Because the study used self-reported dietary data and a case-control design, recall and selection bias, residual confounding, and uncertain temporal ordering limit causal interpretation.4 High fiber intake, unsaturated fats, fish, and plant bioactives are plausible contributors, but the study did not test them as mediators.2,6 A separate cross-sectional study of 969 adults in northern Sweden found that higher BSDS values were associated with modestly higher plasma betaine and lower total homocysteine; estimated differences were approximately 1–5% per standard-deviation difference in diet score. These exploratory biomarkers do not establish clinical benefit or causality.7
The Nordic Nutrition Recommendations (NNR) Explained
Modern challenges to traditional Baltic eating patterns
High processed-meat intake and low intakes of fruit and whole grains were identified as leading dietary risks in Baltic and Nordic countries. The Global Burden of Disease Study 2023 modeled 38,450 diet-attributable deaths and 735,284 disability-adjusted life-years across the region in 2023, with a higher burden in the Baltic countries and Greenland than in the Nordic countries. These estimates had wide 95% uncertainty intervals, ranging from 10,749 to 59,386 deaths, and should not be interpreted as directly counted cases. This underscores the importance of evidence-based dietary strategies for long-term metabolic and cardiovascular health.8
However, the practical accessibility of foods emphasized by the Baltic Sea diet outside the Baltic and Nordic region may constrain adoption in some settings. Rye bread, Baltic herring, lingonberries, and freshwater fish may not be universally available, affordable, or culturally familiar, which can limit direct transfer of the dietary pattern.6,9
Nevertheless, it is essential to understand the translational value of these dietary principles, as oats, barley, fatty fish, root vegetables, berries, and rapeseed oil have analogs in many food cultures. The high-fiber, unsaturated-fat, plant-forward, and low-processed-meat principles are transferable, even when the exact foods differ.6,9
Various approaches can be adopted to follow the Baltic Sea dietary pattern, such as selecting whole grains over refined carbohydrates, prioritizing fatty fish as a protein source, consuming generous quantities of fruits and vegetables, limiting red and processed meats, and using unsaturated plant oils, while recognizing that rapeseed or canola oil is the characteristic Baltic Sea and Nordic choice, whereas olive oil is characteristic of the Mediterranean pattern. These principles align closely with broader evidence-based dietary guidelines and are consistent with cardiometabolic dietary guidance, although the effects of specific substitutions should not be assumed to be identical.6,9
References
- Kanerva, N., Kaartinen, N. E., Schwab, Uet al. (2014). The Baltic Sea Diet Score: a tool for assessing healthy eating in Nordic countries. Public Health Nutrition 17(8), 1697–1705. DOI: 10.1017/S1368980013002395. https://www.cambridge.org/core/journals/public-health-nutrition/article/baltic-sea-diet-score-a-tool-for-assessing-healthy-eating-in-nordic-countries/E56FD0C0709E8303A49241D2314A42F2
- Nouripour, F. & Hejazi, N. (2019). Nordic diet and cardio-metabolic diseases: a review. International Journal of Nutrition Sciences 4(3); 105-108. DOI: 10.30476/IJNS.2019.82686.1025. https://ijns.sums.ac.ir/article_45414.html.
- Kanerva, N., Kaartinen, N. E., Schwab, U., et al. (2013). Adherence to the Baltic Sea diet consumed in the Nordic countries is associated with lower abdominal obesity. The British Journal of Nutrition 109(3); 520-528. DOI: 10.1017/S0007114512001262. https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/adherence-to-the-baltic-sea-diet-consumed-in-the-nordic-countries-is-associated-with-lower-abdominal-obesity/130D1CD8275BECDDDC05285C268472E4.
- Abdelgawwad El-Sehrawy, A. A. M., Jawad, M., Hammood, Y. M., et al. (2025). Association between Baltic sea diet and healthy Nordic diet index with risk of type 2 diabetes mellitus: a case-control study. Frontiers in Endocrinology 16; 1510427. DOI: 10.3389/fendo.2025.1510427. https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2025.1510427/full
- Kanerva, N., Kaartinen, N. E., Rissanen, H., et al. (2014). Associations of the Baltic Sea diet with cardiometabolic risk factors--a meta-analysis of three Finnish studies. The British Journal of Nutrition 112(4); 616-626. DOI: 10.1017/S0007114514001159. https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/associations-of-the-baltic-sea-diet-with-cardiometabolic-risk-factors-a-metaanalysis-of-three-finnish-studies/1D9E520CF31D452A6F4B516CFBFC19E6.
- Massara, P., Zurbau, A., Glenn, A. J., et al. (2022). Nordic dietary patterns and cardiometabolic outcomes: a systematic review and meta-analysis of prospective cohort studies and randomised controlled trials. Diabetologia 65(12); 2011-2031. DOI: 10.1007/s00125-022-05760-z. https://link.springer.com/article/10.1007/s00125-022-05760-z.
- Hesselink, A., Winkvist, A., Lindahl, B., et al. (2023). Healthy Nordic diet and associations with plasma concentrations of metabolites in the choline oxidation pathway: a cross-sectional study from Northern Sweden. Nutrition Journal 22(1); 26. DOI: 10.1186/s12937-023-00853-w. https://link.springer.com/article/10.1186/s12937-023-00853-w.
- GBD 2023 Nordic and Baltic Diet Collaborators (2026). The burden of dietary risk factors in the Nordic and Baltic countries: a systematic analysis for the Global Burden of Disease Study 2023. The Lancet Regional Health – Europe 61, 101543. DOI: 10.1016/j.lanepe.2025.101543. https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(25)00335-7/fulltext.
- Krznarić, Ž., Karas, I., Ljubas Kelečić, D., & Vranešić Bender, D. (2021). The Mediterranean and Nordic Diet: A Review of Differences and Similarities of Two Sustainable, Health-Promoting Dietary Patterns. Frontiers in Nutrition 8, 683678. DOI: 10.3389/fnut.2021.683678. https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2021.683678/full
Further Reading
Last Updated: Jul 16, 2026