Food Quality Scores and Nutrient Ratios Correlate with Healthier Weight and Blood Pressure in a Representative US Cohort

BackgroundRising prevalence of chronic cardiometabolic conditions may be partly driven by shifts in dietary patterns. Nutrient profiling systems (NPSs) aim to guide healthier food choices through labeling and consumer-facing technologies but vary in accessibility and how well they distinguish food healthfulness. ObjectivesThe primary objective was to compare a ratio-based, web-enabled NPS, Nutrient Consume Score (NCS), and its underlying nutrient ratios, with four leading NPSs--Nutri-Score (NS), Health Star Rating (HS), NOVA Classification (NC), and Food Compass 2.0 (FC)--by examining associations with obesity and blood pressure. Secondary objectives included assessing associations with cardiometabolic biomarkers and identifying food categories contributing most to each score. MethodsNHANES 2015-2016 data for adults aged [≥]20 years were analyzed. Dietary intake was assessed via 24-hour recalls, and NPS scores were calculated. Multivariable regression models adjusted for sociodemographic and health factors examined associations with obesity, blood pressure, and cardiometabolic biomarkers. Compositional analysis evaluated food categories driving the scores. ResultsThe ratio-based NCS performed favorably compared with others. All NPSs significantly associated with healthier weight, while blood pressure associations were more variable. Including alcohol and adjusting for bioactives strengthened the ratio-based NCSs association with weight outcomes. Across NPSs, food categories contributing to high and low scores were broadly consistent, generally reflecting minimally processed foods for high scores and more processed foods for low scores. ConclusionsThe Nutrient Consume Score (NCS) showed favorable associations with weight and blood pressure relative to other NPSs, highlighting its potential for improving diet-related risk factors for chronic conditions. As a web-enabled NPS, NCS may be well suited for consumer-facing technologies, such as smartphones, and could facilitate interventional trials to assess the causal impact of diet quality on cardiometabolic outcomes.