The 2023 Nordic Nutrition Recommendations (NNR23) emphasize both planetary health and disease prevention through food-based guidelines(1). While previous planetary health diets may not guarantee sufficient micronutrient intake(2), these dietary patterns focusing on human and planetary health have shown positive associations between higher adherence and lower mortality(3). However, the health effects of adhering to the NNR2023 have not been investigated. This study aims to construct a diet score to investigate adherence to NNR2023, micronutrient adherence, and the association with mortality.

We constructed a diet score based on NNR2023 with 15 food components [1]. Points were given proportionally between 0 and 1 points, reflecting the level of compliance with each food component, with a maximum possible score of 15 points. We then followed men aged 45-79 from the Cohort of Swedish Men (n=48,850) (COSM) and women aged 48–83 years from the Swedish Mammography Cohort (n=39,984) (SMC), with extensive information collected on diet and lifestyle in 1997, 2009 and 2019(4). Cases were retrieved through the Swedish Patient Register using the Swedish Personal Identification Number and The Death Register(4). Participants were followed until death or administrative end of follow-up on 31stof December 2019. Micronutrient intake was derived from reported food intake and dichotomized at the recommended intake for vitamins and adequate mineral intake. Multi-variable Cox proportional hazards regression models were used to estimate hazard ratios (HRs) with 95 % confidence intervals (CIs) using age as the underlying timescale.

Participants with the highest adherence to NNR2023 (>10 points, median (10 points), HR 0.77, 95% CI 0.74-0.80) exhibited a lower risk of all-cause mortality compared to those with the lowest adherence (<8 points, median (7.6 points)). Age- and sex-specific micronutrient recommendations for calcium, folate, and magnesium were more likely to be met for those with the highest adherence. However, vitamin D intake was lower in women, and calcium was lower in men under the age of 70. When analyzed as a restricted cubic spline, results indicate lower mortality risk with increasing adherence.

High adherence to NNR2023 is beneficial for achieving adequate micronutrient intake and reducing overall mortality.