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 -