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

## TL;DR

A 2023 diet quality model called uNS-NPM was linked to higher mortality risk in older adults with heart disease, especially for all-cause and cardiovascular deaths.

## Contribution

This study is the first to validate the 2023 uNS-NPM model in a Spanish cohort and show its association with mortality risks.

## Key findings

- Higher uNS-NPM diet scores were linked to a 64% increased all-cause mortality risk.
- Cardiovascular mortality risk was 221% higher in the highest diet quality quintile.
- No significant link was found between uNS-NPM scores and cancer mortality.

## Abstract

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.

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.

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.

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).

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.

The online version contains supplementary material available at 10.1007/s00394-026-03946-4.