Mortality risk in relation to diet quality assessed by the 2023 nutri-score nutrient profiling model: a prospective analysis

Abstract

Background: The updated Nutri-Score nutrient profiling model (uNS-NPM), revised in 2023, aims to better align with dietary guidelines and improve health outcomes prediction. However, evidence assessing its validity and applicability remains limited, particularly in Spanish populations. Objective: To investigate the prospective association between diet quality, assessed using the uNS-NPM dietary index (DI), and the risk of all-cause and cause-specific mortality in older adults at high cardiovascular risk. Methods: A prospective analysis within the PREDIMED cohort, with 7,212 participants aged 55–80 years at high cardiovascular risk was conducted. Diet was assessed by validated food frequency questionnaires, and the uNS-NPM DI was computed to quantify overall dietary quality. Time-dependent Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause, cardiovascular, cancer, and other-cause mortality across quintiles of the average cumulative uNS-NPM DI, adjusting for relevant confounders. Results: Over a median follow-up of 6 years, 425 deaths occurred (103 cardiovascular, 169 cancers, 153 other causes). Participants in the highest quintile of the uNS-NPM DI (reflecting poorer diet quality) had a higher risk of all-cause mortality (HR: 1.64; 95% CI: 1.19–2.28; p-trend = 0.007) and a higher risk of cardiovascular mortality (HR: 3.21; 95% CI: 1.29–7.95; p-trend = 0.002) compared to those participants in the lowest quintile. Participants in the highest quintile of uNS-NPM DI had also an increased risk of death from other causes (HR: 1.84; 95% CI: 1.11–3.07), although the trend was not statistically significant p-trend = 169). For cancer mortality, no significant association was observed (HR for highest vs. lowest quintile: 1.16; 95% CI: 0.69–1.92 p-trend = 0.695). Conclusions: In this Mediterranean cohort of older adults at high cardiovascular risk, lower dietary quality, assessed with the uNS-NPM DI, was prospectively associated with higher risks of all-cause, cardiovascular, and other-cause mortality. These findings support the uNS-NPM DI as a valuable tool for diet quality assessment.