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Paleolithic Diet Fraction: A Measure of Adherence to the Paleolithic diet

Rydhög, Björn LU (2026) In Lund University, Faculty of Medicine Doctoral Dissertation Series
Abstract
Abstract:
Background: A measure of adherence to the Paleolithic diet not based on population-relative food group intakes was lacking. The aim of this thesis was to evaluate the usefulness of the Paleolithic Diet Fraction (PDF), a novel measure of adherence to the Paleolithic diet, calculated as the fraction of total food group intake derived from Paleolithic food groups.

Methods: PDF was calculated from four-day weighed food records in Papers I, II, and IV, and from a modified diet history method including seven-day food records in Paper III. Papers I and II examined associations between PDF and cardiometabolic outcomes in post hoc analyses of randomized controlled trials (RCTs) comparing the Paleolithic diet with a... (More)
Abstract:
Background: A measure of adherence to the Paleolithic diet not based on population-relative food group intakes was lacking. The aim of this thesis was to evaluate the usefulness of the Paleolithic Diet Fraction (PDF), a novel measure of adherence to the Paleolithic diet, calculated as the fraction of total food group intake derived from Paleolithic food groups.

Methods: PDF was calculated from four-day weighed food records in Papers I, II, and IV, and from a modified diet history method including seven-day food records in Paper III. Papers I and II examined associations between PDF and cardiometabolic outcomes in post hoc analyses of randomized controlled trials (RCTs) comparing the Paleolithic diet with a Mediterranean-like diet and a diabetes diet, respectively. Paper III examined associations between PDF and mortality, and cardiovascular disease incidence in 24,104 participants of the Malmö Diet and Cancer cohort study. Paper IV examined associations between PDF and cardiometabolic outcomes, and correlations between PDF and the population-relative, food group intake–based Paleolithic Diet Score (PDS), in a post hoc analysis of an RCT without significant findings when comparing healthy diets with and without cereal grains.

Results: PDF was around 80% for the Paleolithic diet in Papers I and II, and between 30–50% for other diets in Papers I–IV. In Papers I and II, higher PDF was associated with healthier levels of cardiometabolic outcomes such as glycemic control, waist circumference, body weight, and blood lipids. In Paper III, PDF was inversely associated with mortality and cardiovascular disease incidence. In Paper IV, there were moderate to strong correlations between PDF and PDS, and neither was associated with cardiometabolic outcomes.

Conclusion: The PDF was demonstrated to be a feasible, reliable, and valid measure of adherence to the Paleolithic diet across diverse populations and study designs. (Less)
Abstract (Swedish)
Bakgrund: Ett mått på följsamhet till paleolitisk kost som inte baseras på populationsrelativa intag av livsmedelsgrupper har hittills saknats. Syftet med denna avhandling var att utvärdera användbarheten av Paleolithic Diet Fraction (PDF), ett nytt mått på följsamhet till paleolitisk kost, beräknat som andelen av det totala intaget av livsmedelsgrupper som utgörs av paleolitiska livsmedelsgrupper.

Metod: PDF beräknades utifrån fyradagars vägda kostregistreringar i artiklar I, II och IV samt utifrån en modifierad kosthistorisk metod med sju dagars kostregistrering i artikel III. I artiklar I och II undersöktes samband mellan PDF och kardiometabola utfall i post hoc analyser av randomiserade kontrollerade studier (RCT) där... (More)
Bakgrund: Ett mått på följsamhet till paleolitisk kost som inte baseras på populationsrelativa intag av livsmedelsgrupper har hittills saknats. Syftet med denna avhandling var att utvärdera användbarheten av Paleolithic Diet Fraction (PDF), ett nytt mått på följsamhet till paleolitisk kost, beräknat som andelen av det totala intaget av livsmedelsgrupper som utgörs av paleolitiska livsmedelsgrupper.

Metod: PDF beräknades utifrån fyradagars vägda kostregistreringar i artiklar I, II och IV samt utifrån en modifierad kosthistorisk metod med sju dagars kostregistrering i artikel III. I artiklar I och II undersöktes samband mellan PDF och kardiometabola utfall i post hoc analyser av randomiserade kontrollerade studier (RCT) där paleolitisk kost jämfördes med medelhavsliknande kost respektive diabeteskost. I artikel III analyserades samband mellan PDF och mortalitet samt incidens av hjärt kärlsjukdom i 24 104 deltagare i Malmö Kost Cancer kohorten. I artikel IV undersöktes samband mellan PDF och kardiometabola utfall samt korrelationer mellan PDF och det populationsrelativa, livsmedelsgruppsbaserade måttet Paleolithic Diet Score (PDS), i en post hoc analys av en RCT utan signifikanta skillnader mellan hälsosamma koster med och utan spannmålsprodukter.

Resultat: PDF uppgick till cirka 80 procent för paleolitisk kost i artiklar I och II samt till mellan 30 och 50 procent för övriga koster i artiklar I–IV. I artiklar I och II var högre PDF associerad med gynnsammare nivåer av kardiometabola utfall såsom glykemisk kontroll, midjeomfång, kroppsvikt och blodlipider. I artikel III var PDF invers associerad med mortalitet och incidens av hjärt kärlsjukdom. I artikel IV observerades måttliga till starka korrelationer mellan PDF och PDS, och inget av måtten var associerat med kardiometabola utfall.

Slutsats: PDF visade sig vara ett genomförbart, reproducerbart och giltigt mått på följsamhet till paleolitisk kost, tillämpbart över olika populationer och studiedesigner. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • Professor Winkvist, Anna, Department of Internal Medicine and Clinical Nutrition, University of Gothenburg
organization
alternative title
Paleolitisk Diet Fraktion : Ett mått på följsamhet till paleolitisk kost
publishing date
type
Thesis
publication status
published
subject
keywords
cardiometabolic diseases, dietary adherence, dietary assessment, mortality, Paleolithic diet, Paleolithic Diet Fraction, type 2 diabetes
in
Lund University, Faculty of Medicine Doctoral Dissertation Series
issue
2026:7
pages
93 pages
publisher
Lund University, Faculty of Medicine
defense location
Agardh föreläsningssal, CRC, Jan Waldenströms gata 35, Skånes Universitetssjukhus i Malmö. Join by Zoom: https://lu-se.zoom.us/j/63575669649
defense date
2026-02-20 13:00:00
ISSN
1652-8220
ISBN
978-91-8021-805-4
language
English
LU publication?
yes
id
c876d703-eb41-46ba-9111-a398c3e3c1fc
date added to LUP
2026-01-20 12:31:11
date last changed
2026-01-29 13:44:43
@phdthesis{c876d703-eb41-46ba-9111-a398c3e3c1fc,
  abstract     = {{Abstract: <br/>Background: A measure of adherence to the Paleolithic diet not based on population-relative food group intakes was lacking. The aim of this thesis was to evaluate the usefulness of the Paleolithic Diet Fraction (PDF), a novel measure of adherence to the Paleolithic diet, calculated as the fraction of total food group intake derived from Paleolithic food groups. <br/><br/>Methods: PDF was calculated from four-day weighed food records in Papers I, II, and IV, and from a modified diet history method including seven-day food records in Paper III. Papers I and II examined associations between PDF and cardiometabolic outcomes in post hoc analyses of randomized controlled trials (RCTs) comparing the Paleolithic diet with a Mediterranean-like diet and a diabetes diet, respectively. Paper III examined associations between PDF and mortality, and cardiovascular disease incidence in 24,104 participants of the Malmö Diet and Cancer cohort study. Paper IV examined associations between PDF and cardiometabolic outcomes, and correlations between PDF and the population-relative, food group intake–based Paleolithic Diet Score (PDS), in a post hoc analysis of an RCT without significant findings when comparing healthy diets with and without cereal grains. <br/><br/>Results: PDF was around 80% for the Paleolithic diet in Papers I and II, and between 30–50% for other diets in Papers I–IV. In Papers I and II, higher PDF was associated with healthier levels of cardiometabolic outcomes such as glycemic control, waist circumference, body weight, and blood lipids. In Paper III, PDF was inversely associated with mortality and cardiovascular disease incidence. In Paper IV, there were moderate to strong correlations between PDF and PDS, and neither was associated with cardiometabolic outcomes. <br/><br/>Conclusion: The PDF was demonstrated to be a feasible, reliable, and valid measure of adherence to the Paleolithic diet across diverse populations and study designs.}},
  author       = {{Rydhög, Björn}},
  isbn         = {{978-91-8021-805-4}},
  issn         = {{1652-8220}},
  keywords     = {{cardiometabolic diseases; dietary adherence; dietary assessment; mortality; Paleolithic  diet; Paleolithic Diet Fraction; type 2 diabetes}},
  language     = {{eng}},
  number       = {{2026:7}},
  publisher    = {{Lund University, Faculty of Medicine}},
  school       = {{Lund University}},
  series       = {{Lund University, Faculty of Medicine Doctoral Dissertation Series}},
  title        = {{Paleolithic Diet Fraction: A Measure of Adherence to the Paleolithic diet}},
  url          = {{https://lup.lub.lu.se/search/files/240081402/Avhandling_Bj_rn_Rydh_g_LUCRIS.pdf}},
  year         = {{2026}},
}