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However, evidence assessing its validity and applicability remains limited, particularly in Spanish populations.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>\n                      To investigate the prospective association between diet quality, assessed using the\n                      <jats:italic>u<\/jats:italic>\n                      NS-NPM dietary index (DI), and the risk of all-cause and cause-specific mortality in older adults at high cardiovascular risk.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A prospective analysis within the PREDIMED cohort, with 7,212 participants aged 55\u201380 years at high cardiovascular risk was conducted. Diet was assessed by validated food frequency questionnaires, and the\n                      <jats:italic>u<\/jats:italic>\n                      NS-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\n                      <jats:italic>u<\/jats:italic>\n                      NS-NPM DI, adjusting for relevant confounders.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u20132.28; p-trend\u2009=\u20090.007) and a higher risk of cardiovascular mortality (HR: 3.21; 95% CI: 1.29\u20137.95; p-trend\u2009=\u20090.002) 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\u20133.07), although the trend was not statistically significant p-trend\u2009=\u2009169). For cancer mortality, no significant association was observed (HR for highest vs. lowest quintile: 1.16; 95% CI: 0.69\u20131.92 p-trend\u2009=\u20090.695).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      In this Mediterranean cohort of older adults at high cardiovascular risk, lower dietary quality, assessed with the\n                      <jats:italic>u<\/jats:italic>\n                      NS-NPM DI, was prospectively associated with higher risks of all-cause, cardiovascular, and other-cause mortality. These findings support the\n                      <jats:italic>u<\/jats:italic>\n                      NS-NPM DI as a valuable tool for diet quality assessment.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00394-026-03946-4","type":"journal-article","created":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T12:20:23Z","timestamp":1774354823000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Mortality risk in relation to diet quality assessed by the 2023 nutri-score nutrient profiling model: a prospective analysis"],"prefix":"10.1007","volume":"65","author":[{"given":"Nadine","family":"Khoury","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose C\u00e1ndido","family":"Fern\u00e1ndez-Cao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noushin","family":"Mohammadifard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel \u00c1ngel","family":"Martinez-Gonz\u00e1lez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dolores","family":"Corella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Montserrat","family":"Fit\u00f3","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ram\u00f3n","family":"Estruch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas","family":"Tojal-Sierra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrique G\u00f3mez","family":"Gracias","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miquel","family":"Fiol","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9","family":"Lapetra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Llu\u00eds","family":"Serra-Majem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xavier","family":"Pint\u00f3","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zenaida","family":"V\u00e1zquez-Ruiz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose V.","family":"Sorli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helmut","family":"Schr\u00f6der","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordi","family":"Salas-Salvad\u00f3","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy","family":"Babio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,24]]},"reference":[{"key":"3946_CR1","unstructured":"World Health Organization (WHO). 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Environ Int 186. https:\/\/doi.org\/10.1016\/J.ENVINT.2024.108565","DOI":"10.1016\/J.ENVINT.2024.108565"}],"container-title":["European Journal of Nutrition"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00394-026-03946-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00394-026-03946-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00394-026-03946-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T14:38:32Z","timestamp":1780756712000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00394-026-03946-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,24]]},"references-count":43,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["3946"],"URL":"https:\/\/doi.org\/10.1007\/s00394-026-03946-4","relation":{},"ISSN":["1436-6207","1436-6215"],"issn-type":[{"value":"1436-6207","type":"print"},{"value":"1436-6215","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,24]]},"assertion":[{"value":"6 October 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 February 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 March 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare the following financial interests\/personal relationships which may be considered as potential competing interests: Jordi Salas-Salvado reports financial support and travel were provided by International Nut and Dried Fruit Foundation. Jordi Salas-Salvado reports supplies of olive oil, almonds, hazelnuts and walnuts to give for free to PREDIMED participants provided by Olive Trees Communal Heritage Foundation, Borges SA, La Morella nuts and the Walnut Commision, respectively. Jose V Sorli reports financial support was provided by Carlos III Health Institute. Jordi Salas-Salvado reports financial support was provided by Carlos III Health Institute. Jordi Salas-Salvado reports financial support was provided by European Commission. Ramon Estruch reports financial support was provided by Fundaci\u00f3n Bosch I Gimpera. Jose V Sorli reports financial support was provided by Biomedical Research Network Center of the Pathophysiology of Obesity and Nutrition. Emilio Ros reports financial support was provided by California Walnut Commission. Emilio Ros reports financial support and travel were provided by Sociedad Espa\u00f1ola de Arteriosclerosis. Emilio Ros reports financial support was provided by Fundaci\u00f3n Dieta Mediterr\u00e1nea. Emilio Ros reports travel was provided by Imperial College London. Emilio Ros reports travel was provided by Wine Information Council. Emilio Ros reports financial support was provided by Alexion (Advisory Board). Ramon Estruch reports financial support was provided by Carlos III Health Institute. Ramon Estruch reports financial support was provided by National Institute of Health. Ramon Estruch reports financial support was provided by European Commission. Ramon Estruch reports was provided by Patrimonio Comunal Olivarero. Ramon Estruch reports was provided by California Walnut Commission. Ramon Estruch reports financial support was provided by Cerveza y Salud. Ramon Estruch reports financial support was provided by Dallant Industries. Ramon Estruch reports travel was provided by Brewers of Europe. Ramon Estruch reports travel was provided by Pernaud Richart. Ramon Estruch reports travel was provided by Wine and Culinary International Forum. Ramon Estruch reports financial support was provided by Grand-Fountain Laboratories. Ramon Estruch reports travel was provided by Karolinska Institute. Ramon Estruch reports travel was provided by Fundaci\u00f3n Iberoamericana de Nutrici\u00f3n. Ramon Estruch reports travel was provided by Italian Pavilion, EXPO Dubai 2020. Ramon Estruch reports travel was provided by Cretan Lifestyle. Ramon Estruch reports administrative support and travel were provided by Labelling reform. Ramon Estruch reports travel was provided by The Pontifical Academy of Sciences. Ramon Struch reports travel was provided by Cardioprev Study. Rosa M Lamuela-Raventos reports financial support was provided by Carlos III Health Institute. Rosa M Lamuela-Raventos reports financial support was provided by European Commission. Rosa M Lamuela-Raventos reports financial support was provided by National Institute of Health. Rosa M Lamuela-Raventos reports financial support was provided by Escoveritas SA. Rosa M Lamuela-Raventos reports financial support was provided by Patrimonio Communal Olivarero. Rosa M Lamuela-Raventos reports equipment, drugs, or supplies was provided by California Walnut Commission. Rosa M Lamuela-Raventos reports financial support was provided by The Peanut Institute. Rosa M Lamuela-Raventos reports financial support was provided by Oli migjorn. Rosa M Lamuela-Raventos reports financial support was provided by UNIDECO SA. Rosa M Lamuela-Raventos reports travel was provided by Wine in Moderation. Rosa M Lamuela-Raventos reports travel was provided by ADVENTIA SA. Rosa M Lamuela-Raventos reports travel was provided by Cretan Lifestyle. Rosa M Lamuela-Raventos reports travel was provided by Tecnol\u00f3gico de Monterrey. Emilio Ros reports a relationship with Alexion (Advisory Board that includes: board membership and consulting or advisory. Jordi Salas-Salvado reports a relationship with Danone Institute that includes: board membership. Jordi Salas-Salvado reports a relationship with International Nut and Dried Fruit Foundation World Forum For nutrition research and Dissemination that includes: board membership. Ramon Estruch reports a relationship with The Alcohol and Breast Cancer (ABC) Trial that includes: board membership. Rosa M Lamuela-Raventos reports a relationship with Fundaci\u00f3n Dieta Mediterr\u00e1nea that includes: board membership. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interest"}}],"article-number":"102"}}