Key result
High adherence to Nordic Nutrition Recommendations is linked to ~17% lower MACE risk.
Why the study?
Little evidence exists on the health implications of adherence to a diet aligning with the updated Nordic Nutrition Recommendations (NNR2023).
Does long-term adherence to the updated Nordic Nutrition Recommendations (NNR2023) reduce the incidence of major adverse cardiovascular events in Swedish adults?
Cohort (n=76,028)
Does long-term adherence to the updated Nordic Nutrition Recommendations (NNR2023) reduce the incidence of major adverse cardiovascular events in Swedish adults?
Hazard Ratio: 0.83 (95% CI 0.8–0.86)
Long-term adherence to the updated Nordic Nutrition Recommendations (NNR2023) is associated with a significantly lower risk of major adverse cardiovascular events and improved cardiometabolic biomarkers.
Supports NNR2023 adherence in prevention counseling; extends observational consensus but leaves causality open pending RCTs.
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.
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Pitt et al. (2026) conducted a cohort in Cardiovascular disease (n=76,028). Adherence to the updated Nordic Nutrition Recommendations (NNR2023) vs. Lowest quartile of NNR2023 adherence was evaluated on Major adverse cardiovascular events (MACE) – a composite of acute myocardial infarction, stroke, and CVD mortality (HR 0.83, 95% CI 0.80, 0.86). Highest adherence to the updated Nordic Nutrition Recommendations (NNR2023) was associated with a 17% lower risk of major adverse cardiovascular events compared to the lowest adherence (HR 0.83; 95% CI 0.80-0.86).
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