Long-term adherence to the new Nordic Nutrition Recommendations in relation to cardiovascular events and cardiometabolic biomarkers

AIMS: Little evidence exists on the health implications of adherence to a diet in line with the updated Nordic Nutrition Recommendations (NNR2023). We estimated the association between long-term adherence to NNR2023 and (i) incidence of cardiovascular disease (CVD), and (ii) biomarkers of cardiometabolic health. METHODS: The study population consisted of 76,028 participants from the Swedish Mammography Cohort (SMC) and Cohort of Swedish Men, and 4,267 women in a clinical sub-cohort of SMC. Data from food frequency questionnaires were used to assess NNR2023 adherence at baseline (in 1997) and upon re-investigation in 2009 and 2019. Time-varying multivariable Cox proportional hazards regression models were used to estimate the association between NNR2023 adherence and incidence of major adverse cardiovascular events (MACE) - a composite of acute myocardial infarction, stroke, and CVD mortality - as well as specific CVD events. Quantile regression was used to assess the association between NNR2023 adherence and cardiometabolic biomarkers. RESULTS: During a mean follow-up of 18.7 years (1.48 million person-years), we identified 24,041 cases of MACE. Participants in the highest vs lowest quartile of NNR2023 adherence had 17% (hazard ratio: 0.83; 95% confidence interval: 0.80, 0.86) lower risk of MACE, as well as lower risks of the individual MACE components. Higher NNR2023 adherence was associated with a more favourable blood lipid profile and insulin sensitivity (all p-values < 0.05). CONCLUSION: This study provides evidence for a positive impact of adherence to NNR2023 on cardiovascular health.