The Norsjö and Västerbotten Intervention Programme (VIP)

History
They started in 1985 in a small town called Norsjö about 6000 inhabitant. Then they enlarged it to the whole county 1990.
So the different papers and mine text goes a little forward an back on both.

Found scientific papers

  1. What is the “golden standard” for assessing population-based interventions?—problems of dilution bias
  2. The Västerbotten Intervention Programme: background, design and implications
  3. Prevention of cardiovascular disease in Sweden: The Norsjö community intervention programme—Motives, methods and intervention components
  4. Associations among 25-year trends in diet, cholesterol and BMI from 140,000 observations in men and women in Northern Sweden
  5. The strange Västerbotten Intervention Programme (in Swedish, A blog)
  6. A reversal of decreasing trends in population cholesterol levels in Västerbotten County, Sweden

Background
Taken from one of the above articles
The VIP was first developed in the small municipality of Norsjö in 1985. Subsequently, it was successively implemented across the county and is now integrated into ordinary primary care routines. A population-based strategy directed towards the public is combined with a strategy to reach all middle-aged persons individually at ages 40, 50 and 60 years, by inviting them to participate in systematic risk factor screening and individual counselling about healthy lifestyle habits. Blood samples for research purposes are stored at the Umeå University Medical Biobank.

Method
Make one thing clear this is a life style intervention. That is, they invite people to health screening and counselling about their health. So people with overweight where told to lose weight, stop smoking, move around more and also eat less fat. And of course the cholesterol lowering drugs and other things to lower blood pressure where put in the equation.

This together with extensive information about fat and low fat products campaign in shops and schools. Educating nurses and doctors to look for high risk subjects. That is for people 30 BMI  or above.

Then they have food questioners. We know how good those are. You just been to doctor and told that you should not eat certain things. Do you write truthfully about what you eat afterwards?

The blood samples are tested for serum (total) cholesterol and triglyceride.

Discussion
I find it very questionable that the researchers are so locked in on serum cholesterol, it is such as they have no idea that it as very little if anything to do with any risk for hearth decease. For any one who want to learn about what cholesterol is I recommend to read all 9 parts of Peter Attia’s
The straight dope on cholesterol – Part I

They do on other hand also look on triglyceride. But talk less about it. Why?

For me this tells me a lot:
In Sweden, a population intervention in the municipality of Norsjö focused on dietary changes and succeeded between 1985 and 1990 in reducing the level of serum cholesterol in the population by nearly 20% more than in the reference areas The results on CHD morbidity and mortality may, however, have been eliminated by a negative social development in the municipality during the 1990s. The unemployment rate, for example, rose much more in Norsjö than in the surrounding areas in the early 1990s.

They think they do a good job because they lowered something that should not be lowered and when they do not get the result they except are they blaming other factors.

To continue:
Of all those aged 25–64 years living in Norsjö in 1985, the starting point of the programme, 121 persons died between 1990 and 1995. Of those, 23% were living outside the municipality at the time of death and were therefore not included in the analysis

8% of those who died during the period 1990–95 were not living in the municipality at the start of the project in 1985

Don’t you think that issues like this would screw up your data?

So it is a life style intervention. Not a randomized study, and they changed many parameters. It is then completely wrong to put the finger on only one of them as they try to do all the time. Especially when they seem to forget to tell you that the where other things changed at the same time.

Even the outcome is multiple:
..interventions focusing on behavioural lifestyle changes will most probably affect the risks of several diseases. Smoking is the ultimate example, affecting the risk of probably more than 20 diseases. Interventions aiming at changing dietary habits or physical exercise will not only affect CHD, they may also influence the risk of stroke, diabetes, certain cancer sites and osteoporosis.

To me a good example is that if I randomized smokers into 2 groups, randomization is not done in the VIP, but would be better science if they did. Telling one group to continue smoking and the other to stop and also drink much more water a day. Also take up jogging or other exercise.

Then when we look on the result many ears later, and if the intervention group would show better morbidity and mortality result I would proudly proclaim that it was the extra water that did it. Would you believe me? It is a case of bad science, as we would not which of the changed parameters was causing the improvements.One or more?  It does not matter if you know that quit smoking will benefit your health. Assume that you do not know it. Then the  example makes more sense.

And here they do not have any morbidity and mortality improvements. Just serum cholesterol values that is of very little interest.

The paper
Associations among 25-year trends in diet, cholesterol and BMI from 140,000 observations in men technically complain that the people in the VIP project have for some years been eating more butter.
As pointed out by
The strange Västerbotten Intervention Programme (in Swedish)
My translation:
Interesting enough, they only show result on average of whole population. Not on what happens with the cholesterol and weight with those that report eating more fat and less carbohydrates.

a study that is not usable to proof anything.

I do like to point out that when they try to put people in groups for low carb and high fat do they usually fail for example to understand that an hamburger is not LCHF

I should give them credit for something. And that is as I explained before. They also measure triglyceride’s

So below are those values. Pity we do not get anything about LDL, VDL and HDL. Values that could tell us something.

Looking and comparing the changes of serum cholesterol and triglyceride’s over time, do I now understand why they seem to lock on to the former. The changes are large. And among people who seem to have their understanding of what cholesterol is from the science of the 70′s , this could be seen as an improvement.

Triglyceride’s on other hand have changed very little, or you could say it fluctuate a lot.

VIP Serum Chole and trig

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