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Objective: To compare temporal trends, over a 20-year period, in dietary habits between a county (Västerbotten) with a cardiovascular disease (CVD) prevention program and a county (Norrbotten) without such a program.

Design: Cross-sectional data from the Northern Sweden MONICA study (survey period 1994, 1999, 2004, 2009, 2014). Dietary habits were assessed by a semi-quantitative food frequency questionnaire.

Setting: Counties of Norrbotten and Västerbotten, Northern Sweden.

Participants: Five thousand four hundred Swedish adults (mean age 56.9 years; 51.2% women) from Västerbotten (47%) and Norrbotten (53%).

Results: No differences in temporal trend for estimated percentage of energy intake from total carbohydrates, total fat, total protein, and alcohol were observed between the counties (p for interaction ≥0.33). There were no between-county difference in temporal trends for overall diet quality (assessed by the Healthy Diet Score; p for interaction = 0.36). Nor were there any between-county differences for intake of whole grain products, fruits, vegetables, fish, sweetened beverages or fried potatoes (p for interaction ≥ 0.09). Consumption of meat (p for interaction = 0.05) increased to a greater extent in Norrbotten from 2009 and onwards, mainly in men (sex-specific analyses, p for interaction = 0.04). Men in Västerbotten decreased their intake of sweets to a greater extent than men in Norrbotten (p for interaction <0.01).

Conclusions: Over a 20-year period in northern Sweden, only small differences in dietary habits were observed in favor of a county with a CVD prevention program compared to a county without such a program.