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This study aimed to investigate the association between NPC\/N and mortality among overweight and obese adults. Data were obtained from the National Health and Nutrition Examination Survey (1999\u20132018), with mortality follow-up through December 31, 2019. Among 22,892 participants, 3,332 all-cause deaths occurred over up to 20\u00a0years of follow-up. Kaplan\u2013Meier curves showed that the intermediate NPC\/N group (90\u2013160\u00a0kcal\/g) had lower mortality than both the low (&lt;\u200990\u00a0kcal\/g) and high (\u2265\u2009160\u00a0kcal\/g) groups (log-rank test\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.012). Restricted cubic spline analysis demonstrated a U-shaped association between NPC\/N and all-cause mortality, with the risk nadir at approximately 120\u00a0kcal\/g (\n                    <jats:italic>P<\/jats:italic>\n                    for non-linearity\u2009=\u20090.027,\n                    <jats:italic>P<\/jats:italic>\n                    for overall\u2009=\u20090.022). In fully adjusted models, NPC\/N was inversely associated with all-cause mortality below the nadir (HR\u2009=\u20090.61, 95% CI: 0.39\u20130.94,\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.030) and positively associated above it (HR\u2009=\u20091.12, 95% CI: 1.01\u20131.25,\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.040); log-likelihood ratio test\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.006. These suggest that both lower and higher NPC\/N are associated with increased mortality.\n                  <\/jats:p>","DOI":"10.1038\/s41598-026-62034-z","type":"journal-article","created":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T14:26:52Z","timestamp":1783780012000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["U-shaped association between non-protein calorie-to-nitrogen ratio and mortality in adults with overweight and obesity: a population-based cohort study"],"prefix":"10.1038","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6537-7306","authenticated-orcid":false,"given":"Yan","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiang","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guimei","family":"Wei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xueyan","family":"Shen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Peng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,11]]},"reference":[{"key":"62034_CR1","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1056\/NEJMoa2415879","volume":"393","author":"C Global Cardiovascular Risk","year":"2025","unstructured":"Global Cardiovascular Risk, C. et al. 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