Abstract
Background: Nutri-Score is a scientifically validated 5-color front-of-pack nutrition label reflecting the nutrient profile of foods. It has been implemented in several European countries on a voluntary basis, pending the revision of the European labeling regulation. Hence, scientific evidence is needed regarding the ability of the nutrient profile underlying the Nutri-Score (uNS-NPS, 2023-updated version) to characterize healthier foods. Our objective was therefore to study the prospective association between the nutritional quality of diet characterized by the uNS-NPS and the risk of cardiovascular diseases in a large European population. Methods: Our analyses included 345,533 participants from the European Prospective Investigation into Cancer and Nutrition study (EPIC, 1992–2010, 7 European countries). Food intakes were assessed at baseline using country-specific dietary questionnaires. The uNS-NPS was calculated as a continuous scale for each food, based on its 100 g content of energy, sugars, saturated fatty acids, salt, fibre, and protein and percentage content of fruit, vegetables, and pulses. A dietary index was derived at the individual level (uNS-NPS DI: energy-weighted mean of uNS-NPS scores of all foods consumed by a participant). Cardiovascular events during follow-up were retrieved using country-specific methods (self-report, registry data). Multi-adjusted Cox models were computed. Findings: Overall, 16,214 first cardiovascular events were reported (median follow-up: 12.3 years; 4,103,133 person-years). The consumption of foods with a higher uNS-NPS score (reflecting a lower overall nutritional quality of diet) was associated with higher risks of total cardiovascular events (Hazards Ratio (HR) for an increment of 1 standard deviation: 1.03 (95% Confidence Interval 1.01–1.05)), especially myocardial infarction (HR = 1.03 (1.01–1.07)), and stroke (HR = 1.04 (1.01–1.07)). Interpretation: In this large prospective study among European adults, a higher risk of cardiovascular diseases (total and several subtypes) was observed in individuals consuming a diet with a lower nutritional value, as graded by the uNS-NPS score. This brings new evidence on the relevance of the updated nutrient profile underlying the Nutri-Score to characterize foods with a healthier nutrient profile. Funding: EPIC-CVD was supported byEU FP7,ERC, UKMRC,British Heart Foundation, and UKNIHR.
Originalsprog | Engelsk |
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Artikelnummer | 101006 |
Tidsskrift | The Lancet Regional Health - Europe |
Vol/bind | 46 |
Antal sider | 13 |
ISSN | 2666-7762 |
DOI | |
Status | Udgivet - 2024 |
Bibliografisk note
Funding Information:EPIC-CVD was supported by EU FP7, ERC, UK MRC, British Heart Foundation, and UK NIHR.The authors thank all EPIC participants and staff for their outstanding contribution to the study. We acknowledge the use of data from the EPIC-Aarhus cohort (PI Kim Overvad), EPIC-Ragusa cohort (Hyblean Association for Epidemiological Research, AIRE\u2014ONLUS Ragusa, Italy, PI Rosario Tumino), EPIC-Asturias (PI J. Ram\u00F3n Quir\u00F3s) and EPIC-Guipuzcoa (PI Pilar Amiano). This work was performed within the framework of the Nutrition And Cancer Research Network (NACRe, https://www6.inra.fr/nacre/). IARC disclaimer: Where authors are identified as personnel of the International Agency for Research on Cancer/World Health Organization, the authors alone are responsible for the views expressed in this article and they do not necessarily represent the decisions, policy or views of the International Agency for Research on Cancer/World Health Organization. Funding: M. Deschasaux-Tanguy was supported by a grant from the Fondation pour la Recherche M\u00E9dicale (ARF201809007046). EPIC-CVD has been supported by the European Union Framework 7 (HEALTH-F2-2012-279233), the European Research Council (268834), the UK Medical Research Council (G0800270 and MR/L003120/1), the British Heart Foundation (SP/09/002 and RG/08/014 and RG13/13/30194), and the UK National Institute for Health Research. The coordination of EPIC is financially supported by the International Agency for Research on Cancer (IARC) and also by the Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London which has additional infrastructure support provided by the NIHR Imperial Biomedical Research Centre (BRC). The national cohorts are supported by the Danish Cancer Society (Denmark), Ligue Contre le Cancer (France), Institut Gustave Roussy (France), Mutuelle G\u00E9n\u00E9rale de l'Education Nationale (France), Institut National de la Sant\u00E9 et de la Recherche M\u00E9dicale (INSERM, France), German Cancer Aid (Germany), German Cancer Research Center (DKFZ, Germany), German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE, Germany), Federal Ministry of Education and Research (BMBF, Germany), Associazione Italiana per la Ricerca sul Cancro (AIRC, Italy), Compagnia di SanPaolo (Italy), National Research Council (Italy), Dutch Ministry of Public Health, Welfare and Sports (VWS, Netherlands), Netherlands Cancer Registry (NKR, Netherlands), LK Research Funds (Netherlands), Dutch Prevention Funds (Netherlands), Dutch ZON (Zorg Onderzoek Nederland, Netherlands), World Cancer Research Fund (WCRF, Netherlands), Statistics Netherlands (Netherlands), Health Research Fund (FIS, Spain), Instituto de Salud Carlos III (ISCIII, Spain), Regional Governments of Andaluc\u00EDa, Asturias, Basque Country, Murcia and Navarra (Spain), Catalan Institute of Oncology (ICO, Spain), Swedish Cancer Society (Sweden), Swedish Research Council and County Councils of Sk\u00E5ne and V\u00E4sterbotten (Sweden), Cancer Research UK (UK), Medical Research Council (UK).
Funding Information:
The national cohorts are supported by: Danish Cancer Society (Denmark); Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle G\u00E9n\u00E9rale de l\u2019Education Nationale, Institut National de la Sant\u00E9 et de la Recherche M\u00E9dicale (INSERM) (France); German Cancer Aid, German Cancer Research Center (DKFZ), German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Federal Ministry of Education and Research (BMBF) (Germany); Associazione Italiana per la Ricerca sul Cancro-AIRC-Italy, Compagnia di SanPaolo and National Research Council (Italy); Dutch Ministry of Public Health, Welfare and Sports (VWS), Netherlands Cancer Registry (NKR), LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund (WCRF), Statistics Netherlands (The Netherlands); Health Research Fund (FIS) - Instituto de Salud Carlos III (ISCIII), Regional Governments of Andaluc\u00EDa, Asturias, Basque Country, Murcia and Navarra, and the Catalan Institute of Oncology - ICO (Spain); Swedish Cancer Society, Swedish Research Council and County Councils of Sk\u00E5ne and V\u00E4sterbotten (Sweden); Cancer Research UK (C8221/A29017 to EPIC-Oxford), Medical Research Council (MR/M012190/1 to EPIC-Oxford) (United Kingdom). The EPIC-Norfolk study (DOI 10.22025/2019.10.105.00004) has received funding from the Medical Research Council (MR/N003284/1 and MC-UU_12015/1) and Cancer Research UK (C864/A14136).
Funding Information:
M. Deschasaux-Tanguy was supported by a grant from the Fondation Recherche M\u00E9dicale (ARF201809007046). EPIC-CVD has been supported by the European Union Framework 7 (HEALTH-F2-2012-279233), the European Research Council (268834), the UK Medical Research Council (G0800270 and MR/L003120/1), the British Heart Foundation (SP/09/002 and RG/08/014 and RG13/13/30194), and the UK National Institute of Health Research. The coordination of EPIC is financially supported by the International Agency for Research on Cancer (IARC) and also by the Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London which has additional infrastructure support provided by the NIHR Imperial Biomedical Research Centre (BRC).
Publisher Copyright:
© 2024 The Authors