TY - JOUR
T1 - Association between nutritional profiles of foods underlying Nutri-Score front-of-pack labels and mortality
T2 - EPIC cohort study in 10 European countries
AU - Deschasaux, Mélanie
AU - Huybrechts, Inge
AU - Julia, Chantal
AU - Hercberg, Serge
AU - Egnell, Manon
AU - Srour, Bernard
AU - Kesse-Guyot, Emmanuelle
AU - Latino-Martel, Paule
AU - Biessy, Carine
AU - Casagrande, Corinne
AU - Murphy, Neil
AU - Jenab, Mazda
AU - Ward, Heather A.
AU - Weiderpass, Elisabete
AU - Overvad, Kim
AU - Tjønneland, Anne
AU - Rostgaard-Hansen, Agnetha Linn
AU - Boutron-Ruault, Marie Christine
AU - Mancini, Francesca Romana
AU - Mahamat-Saleh, Yahya
AU - Kühn, Tilman
AU - Katzke, Verena
AU - Bergmann, Manuela M.
AU - Schulze, Matthias B.
AU - Trichopoulou, Antonia
AU - Karakatsani, Anna
AU - Peppa, Eleni
AU - Masala, Giovanna
AU - Agnoli, Claudia
AU - De Magistris, Maria Santucci
AU - Tumino, Rosario
AU - Sacerdote, Carlotta
AU - Boer, Jolanda Ma
AU - Verschuren, Wm Monique
AU - van der Schouw, Yvonne T.
AU - Skeie, Guri
AU - Braaten, Tonje
AU - Redondo, M. Luisa
AU - Agudo, Antonio
AU - Petrova, Dafina
AU - Colorado-Yohar, Sandra M.
AU - Barricarte, Aurelio
AU - Amiano, Pilar
AU - Sonestedt, Emily
AU - Ericson, Ulrika
AU - Otten, Julia
AU - Sundström, Björn
AU - Wareham, Nicholas J.
AU - Forouhi, Nita G.
AU - Vineis, Paolo
AU - Tsilidis, Konstantinos K.
AU - Knuppel, Anika
AU - Papier, Keren
AU - Ferrari, Pietro
AU - Riboli, Elio
AU - Gunter, Marc J.
AU - Touvier, Mathilde
N1 - (Ekstern)
PY - 2020
Y1 - 2020
N2 - Objective: To determine if the Food Standards Agency nutrient profiling system (FSAm-NPS), which grades the nutritional quality of food products and is used to derive the Nutri-Score front-of-packet label to guide consumers towards healthier food choices, is associated with mortality. Design: Population based cohort study. Setting: European Prospective Investigation into Cancer and Nutrition (EPIC) cohort from 23 centres in 10 European countries. Participants: 521 324 adults; at recruitment, country specific and validated dietary questionnaires were used to assess their usual dietary intakes. A FSAm-NPS score was calculated for each food item per 100 g content of energy, sugars, saturated fatty acids, sodium, fibre, and protein, and of fruit, vegetables, legumes, and nuts. The FSAm-NPS dietary index was calculated for each participant as an energy weighted mean of the FSAm-NPS score of all foods consumed. The higher the score the lower the overall nutritional quality of the diet. Main outcome measure: Associations between the FSAm-NPS dietary index score and mortality, assessed using multivariable adjusted Cox proportional hazards regression models. Results: After exclusions, 501 594 adults (median follow-up 17.2 years, 8 162 730 person years) were included in the analyses. Those with a higher FSAm-NPS dietary index score (highest versus lowest fifth) showed an increased risk of all cause mortality (n=53 112 events from non-external causes; hazard ratio 1.07, 95% confidence interval 1.03 to 1.10, P<0.001 for trend) and mortality from cancer (1.08, 1.03 to 1.13, P<0.001 for trend) and diseases of the circulatory (1.04, 0.98 to 1.11, P=0.06 for trend), respiratory (1.39, 1.22 to 1.59, P<0.001), and digestive (1.22, 1.02 to 1.45, P=0.03 for trend) systems. The age standardised absolute rates for all cause mortality per 10 000 persons over 10 years were 760 (men=1237; women=563) for those in the highest fifth of the FSAm-NPS dietary index score and 661 (men=1008; women=518) for those in the lowest fifth. Conclusions: In this large multinational European cohort, consuming foods with a higher FSAm-NPS score (lower nutritional quality) was associated with a higher mortality for all causes and for cancer and diseases of the circulatory, respiratory, and digestive systems, supporting the relevance of FSAm-NPS to characterise healthier food choices in the context of public health policies (eg, the Nutri-Score) for European populations. This is important considering ongoing discussions about the potential implementation of a unique nutrition labelling system at the European Union level.
AB - Objective: To determine if the Food Standards Agency nutrient profiling system (FSAm-NPS), which grades the nutritional quality of food products and is used to derive the Nutri-Score front-of-packet label to guide consumers towards healthier food choices, is associated with mortality. Design: Population based cohort study. Setting: European Prospective Investigation into Cancer and Nutrition (EPIC) cohort from 23 centres in 10 European countries. Participants: 521 324 adults; at recruitment, country specific and validated dietary questionnaires were used to assess their usual dietary intakes. A FSAm-NPS score was calculated for each food item per 100 g content of energy, sugars, saturated fatty acids, sodium, fibre, and protein, and of fruit, vegetables, legumes, and nuts. The FSAm-NPS dietary index was calculated for each participant as an energy weighted mean of the FSAm-NPS score of all foods consumed. The higher the score the lower the overall nutritional quality of the diet. Main outcome measure: Associations between the FSAm-NPS dietary index score and mortality, assessed using multivariable adjusted Cox proportional hazards regression models. Results: After exclusions, 501 594 adults (median follow-up 17.2 years, 8 162 730 person years) were included in the analyses. Those with a higher FSAm-NPS dietary index score (highest versus lowest fifth) showed an increased risk of all cause mortality (n=53 112 events from non-external causes; hazard ratio 1.07, 95% confidence interval 1.03 to 1.10, P<0.001 for trend) and mortality from cancer (1.08, 1.03 to 1.13, P<0.001 for trend) and diseases of the circulatory (1.04, 0.98 to 1.11, P=0.06 for trend), respiratory (1.39, 1.22 to 1.59, P<0.001), and digestive (1.22, 1.02 to 1.45, P=0.03 for trend) systems. The age standardised absolute rates for all cause mortality per 10 000 persons over 10 years were 760 (men=1237; women=563) for those in the highest fifth of the FSAm-NPS dietary index score and 661 (men=1008; women=518) for those in the lowest fifth. Conclusions: In this large multinational European cohort, consuming foods with a higher FSAm-NPS score (lower nutritional quality) was associated with a higher mortality for all causes and for cancer and diseases of the circulatory, respiratory, and digestive systems, supporting the relevance of FSAm-NPS to characterise healthier food choices in the context of public health policies (eg, the Nutri-Score) for European populations. This is important considering ongoing discussions about the potential implementation of a unique nutrition labelling system at the European Union level.
U2 - 10.1136/bmj.m3173
DO - 10.1136/bmj.m3173
M3 - Journal article
C2 - 32938660
AN - SCOPUS:85091127853
VL - 370
JO - The BMJ
JF - The BMJ
SN - 0959-8146
M1 - m3173
ER -