Development of the Nordic Nutrition Recommendations 2023 Food-Based Diet Score and Its Association with All-Cause Mortality in Two Swedish Cohorts.

Background: The 2023 Nordic Nutrition Recommendations (NNR23) presented a dual focus on disease prevention and planetary health.

Objectives: We aimed to develop a food-based diet score measuring adherence to NNR23 and assess its association with all-cause mortality in a Swedish population.

Methods: We developed a novel diet score with 15 food components representing NNR23. Each component was scored between 0 and 1 point on a continuous scale, 1 being full adherence, based on participants' intakes. The study population included women (48-83 y old) from the Swedish Mammography Cohort (n = 39,984) and men (45-79 y old) from the Cohort of Swedish Men (n = 48,850), who completed food frequency questionnaires in 1997, 2009, and 2019 and were followed up although linkage to the National Death Register. Multivariable adjusted Cox proportional hazards regression models with age as the underlying timescale were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for the association between adherence to NNR23 and all-cause mortality, as well as cardiovascular- and cancer-specific deaths.

Results: The median NNR23 score was 9.5 (p10, p90; 8.3, 11) for women and 8.9 (p10, p90; 7.4, 10) for men; no participant achieved full adherence. During a median 18.8 y of follow-up, 30,142 participants died. Participants with the highest adherence (>10 points) at baseline had a 23% lower all-cause mortality (HR 0.77; 95% CI: 0.74, 0.80) compared with the lowest adherence group (<8 points). Results were similar for cardiovascular- and cancer-specific mortality. For long-term average food intake, we found an even lower mortality risk when comparing the highest adherence with the lowest adherence (HR 0.38; 95% CI: 0.37, 0.40).

Conclusions: With a new food-based diet score representing NNR23, we found that higher compared with lower adherence to NNR23 was associated with lower mortality in a Swedish population.