Adhering to Nordic diet and supplements cuts risk of early death in half

Created July 2025

Development of the Nordic Nutrition Recommendations 2023 food-based diet score and its association with all-cause mortality in two Swedish cohorts

The Journal of Nutrition, Nutritional Epidemiology - https://doi.org/10.1016/j.tjnut.2025.06.030

Background and objective

The 2023 Nordic Nutrition Recommendations (NNR23) presented a dual focus on disease prevention and planetary health. We aimed to develop a food-based diet score measuring adherence to NNR23 and assess its association with all-cause mortality in a Swedish population.

Methods

We developed a novel diet score with 15 food components representing NNR23. Each component was scored between 0 and 1 point on a continuous scale, 1 being full adherence, based on participants’ intakes. The study population included women (48–83 years old) from the Swedish Mammography Cohort (SMC, n=39,984) and men (45-79 years old) from the Cohort of Swedish Men (COSM, n=48,850), who completed food frequency questionnaires (FFQ) in 1997, 2009 and 2019 and were followed up though linkage to the National Death Register. Multivariable adjusted Cox proportional hazards regression models with age as the underlying timescale were used to estimate hazard ratios (HRs) with 95 % confidence intervals (CIs) for the association between adherence to NNR23 and all-cause mortality, as well as cardiovascular- and cancer-specific deaths.

Results

The median NNR23 score was 9.5 (p10, p90; 8.3, 11) for women and 8.9 (p10, p90; 7.4, 10) for men; no participant achieved full adherence. During a median 18.8 years of follow-up 30,142 participants died. Participants with the highest adherence (>10 points) at baseline had a 23% lower all-cause mortality (HR 0.77, 95% CI 0.74, 0.80) compared to the lowest adherence group (<8 points). Results were similar for cardiovascular- and cancer-specific mortality. For long-term average food intake, we found an even lower mortality risk when comparing highest adherence with lowest adherence (HR 0.38, 95% CI 0.37, 0.40).

Conclusion

With a new food-based diet score representing NNR23, we found that higher compared to lower adherence to NNR23 was associated with lower mortality in a Swedish population.

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NNR2023 - Most Important Dietary Items – Perplexity AI July 2025

The Nordic Nutrition Recommendations 2023 (NNR2023) provides comprehensive dietary guidance for Nordic and Baltic countries, examining 36 nutrients and 15 food groups while integrating environmental considerations for the first time 1 2 3.

Core Dietary Recommendations

NNR2023 advocates for a predominantly plant-based diet characterized by: 1 4 5

High intake of: vegetables, fruits, berries, pulses, potatoes, and whole grains
Ample amounts of: fish and nuts
Moderate intake of: low-fat dairy products
Limited intake of: red meat and poultry
Minimal intake of: processed meat, alcohol, and processed foods high in fats, salt, and sugar

Key Food Groups (15 Total)

Increase: 6

Vegetables (500-800g daily) 2
Fruits and berries (500-800g daily) 2
Pulses/legumes (significant daily intake) 6
Potatoes (as staple food) 6
Whole grains (minimum 90g daily) 2
Nuts (20-30g daily) 6
Fish and seafood (300-450g weekly, including 200g fatty fish) 6

Exchange: 6
Refined cereals → whole grain products
Butter/butter-based spreads → vegetable oils
High-fat dairy → low-fat dairy
Processed foods → whole foods with low added fats, salt, sugar

Limit: 6
Red meat (maximum 350g weekly) 6
Processed meat (minimal intake) 6
Sugar-sweetened beverages 6
Alcohol (no safe limit established) 6
Processed foods high in fats, salt, sugar 6

Essential Nutrients (including vitamins and minerals – 36 Total)

Macronutrients: 6

Fats: 25-40% energy (E%)
Carbohydrates: 45-60% E%
Proteins: 10-20% E%
Dietary fiber: ≥25-35g daily
Added/free sugars: <10% E%

Critical Vitamins: 6
Vitamin D: 10μg daily (20μg for >70 years)
Vitamin C: 95-110mg daily
Folate: 330μg daily
Vitamin B12: 4μg daily
Vitamin A: 700-800μg RE daily
Vitamin E, K, thiamin, riboflavin, niacin, B6, biotin, pantothenic acid, choline

Essential Minerals: 6
Iron: 9-15mg daily (higher for women of reproductive age)
Calcium: 950-1000mg daily
Zinc: 9.7-12.7mg daily
Iodine: 150μg daily
Selenium: 75-90μg daily
Potassium: 3.5g daily
Magnesium: 300-350mg daily
Sodium: 2.3g daily maximum
Phosphorus, copper, manganese, molybdenum, fluoride

Significant Changes from NNR2012

Nine nutrients saw reference value changes >20%: 7 6

Vitamin E, vitamin B6, folate, vitamin B12, vitamin C, thiamin, calcium, zinc, selenium

New adequate intake (AI) values established for: 7 6
Vitamin K, biotin, pantothenic acid, choline, sodium, manganese, molybdenum, fluoride

Environmental Integration, improved longevity

For the first time, NNR2023 considers environmental sustainability alongside health, promoting dietary shifts that reduce greenhouse gas emissions while maintaining nutritional adequacy 1 8. The recommendations emphasize replacing animal-based foods with plant-based alternatives, particularly increasing legume consumption and reducing red meat intake 9 6.

Most impactful dietary changes for longevity include: 10

Increasing legumes (18% life expectancy gain)
Increasing nuts (17% gain)
Increasing whole grains (12% gain)
Reducing processed meat (14% gain)
Reducing added sugars (13% gain)

This comprehensive framework serves as the scientific foundation for national dietary guidelines across eight Nordic and Baltic countries, representing the most extensive nutrition recommendations update in the region's 40-year history 1 4.

References

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