TY - JOUR
T1 - Association between nutritional profiles of foods underlying Nutri-Score front-of-pack labels and mortality: 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 - EPIC cohort study
PY - 2020/9/16
Y1 - 2020/9/16
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, 95.03 to 1.10, Plt;0.001 for trend) and mortality from cancer (1.08, 1.03 to 1.13, Plt;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, Plt;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, 95.03 to 1.10, Plt;0.001 for trend) and mortality from cancer (1.08, 1.03 to 1.13, Plt;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, Plt;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 - Article
SN - 1756-1833
VL - 370
JO - BMJ
JF - BMJ
M1 - m3173
ER -