Association between nutritional profiles of foods underlying Nutri-Score front-of-pack labels and mortality: EPIC cohort study in 10 European countries

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  • Mélanie Deschasaux, Sorbonne Paris Nord University, Inserm, Inrae, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre - University of Paris (CRESS), Bobigny, French network for Nutrition And Cancer Research (NACRe network), Frankrig
  • Inge Huybrechts, French network for Nutrition And Cancer Research (NACRe network), International Agency for Research on Cancer, World Health Organization, Lyon, Frankrig
  • Chantal Julia, Sorbonne Paris Nord University, Inserm, Inrae, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre - University of Paris (CRESS), Bobigny, Department of Public Health, Hôpitaux Universitaires Paris Seine-Saint-Denis (AP-HP), Bobigny, Frankrig
  • Serge Hercberg, Sorbonne Paris Nord University, Inserm, Inrae, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre - University of Paris (CRESS), Bobigny, French network for Nutrition And Cancer Research (NACRe network), Department of Public Health, Hôpitaux Universitaires Paris Seine-Saint-Denis (AP-HP), Bobigny, Frankrig
  • Manon Egnell, Sorbonne Paris Nord University, Inserm, Inrae, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre - University of Paris (CRESS), Bobigny, Frankrig
  • Bernard Srour, Sorbonne Paris Nord University, Inserm, Inrae, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre - University of Paris (CRESS), Bobigny, French network for Nutrition And Cancer Research (NACRe network), Frankrig
  • Emmanuelle Kesse-Guyot, Sorbonne Paris Nord University, Inserm, Inrae, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre - University of Paris (CRESS), Bobigny, French network for Nutrition And Cancer Research (NACRe network), Frankrig
  • Paule Latino-Martel, Sorbonne Paris Nord University, Inserm, Inrae, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre - University of Paris (CRESS), Bobigny, French network for Nutrition And Cancer Research (NACRe network), Frankrig
  • Carine Biessy, International Agency for Research on Cancer, World Health Organization, Lyon, Frankrig
  • Corinne Casagrande, International Agency for Research on Cancer, World Health Organization, Lyon, Frankrig
  • Neil Murphy, French network for Nutrition And Cancer Research (NACRe network), Sorbonne Paris Nord University, Inserm, Inrae, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre - University of Paris (CRESS), Bobigny, Frankrig
  • Mazda Jenab, French network for Nutrition And Cancer Research (NACRe network), Sorbonne Paris Nord University, Inserm, Inrae, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre - University of Paris (CRESS), Bobigny, Frankrig
  • Heather A Ward, School of Public Health, Faculty of Medicine, Imperial College London, London, W6 8RP, UK., Storbritannien
  • Elisabete Weiderpass, International Agency for Research on Cancer, World Health Organization, Lyon, Frankrig
  • Kim Overvad
  • Anne Tjønneland, Københavns Universitet, Danish Cancer Society Research Center, The Danish Cancer Society, Copenhagen, Danmark
  • Agnetha Linn Rostgaard-Hansen, UNIT of Diet, Genes and Environment, Danish Cancer Society Research Centre, Copenhagen, Denmark., Danmark
  • Marie-Christine Boutron-Ruault, Inserm, CESP, U1018, Villejuif, France; Univ Paris-Sud, UMRS 1018, Villejuif, France; Gustave Roussy Institute, F-94800 Villejuif, France., Frankrig
  • Francesca Romana Mancini, Inserm, CESP, U1018, Villejuif, France; Univ Paris-Sud, UMRS 1018, Villejuif, France; Gustave Roussy Institute, F-94800 Villejuif, France., Frankrig
  • Yahya Mahamat-Saleh, Inserm, CESP, U1018, Villejuif, France; Univ Paris-Sud, UMRS 1018, Villejuif, France; Gustave Roussy Institute, F-94800 Villejuif, France., Frankrig
  • Tilman Kühn, Division of Cancer Epidemiology, German Cancer Research Centre (DKFZ), 69120 Heidelberg, Germany., Tyskland
  • Verena Katzke, Division of Cancer Epidemiology, German Cancer Research Centre (DKFZ), 69120 Heidelberg, Germany., Tyskland
  • Manuela M Bergmann, German Institute of Human Nutrition Potsdam-Rehbruecke, Potsdam, Germany., Tyskland
  • Matthias B Schulze, German Institute of Human Nutrition Potsdam-Rehbruecke, Potsdam, Germany., Tyskland
  • Antonia Trichopoulou, Hellenic Health Foundation, Athens, Greece., Grækenland
  • Anna Karakatsani, “ATTIKON” University Hospital, Hellenic Health Foundation, Athens, Greece., Grækenland
  • Eleni Peppa, Hellenic Health Foundation, Athens, Greece., Grækenland
  • Giovanna Masala, Institute for Cancer Research, Italien
  • Claudia Agnoli, Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy., Italien
  • Maria Santucci De Magistris, AOU Federico II Naples, Italy., Italien
  • Rosario Tumino, Cancer Registry and Histopathology Department , Provincial Health Authority (ASP), Ragusa, Italy., Italien
  • Carlotta Sacerdote, Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Centre for Cancer Prevention (CPO), Turin, Italien
  • Jolanda Ma Boer, Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands., Holland
  • Wm Monique Verschuren, Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands., Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, Netherlands., Holland
  • Yvonne T van der Schouw, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, Netherlands., Holland
  • Guri Skeie, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norge
  • Tonje Braaten, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norge
  • M Luisa Redondo, Public Health Directorate, Asturias, Spain., Spanien
  • Antonio Agudo, Catalan Institute of Oncology-ICO, Spanien
  • Dafina Petrova, Andalusian School of Public Health (EASP), Granada, Instituto de Investigación Biosanitaria (ibs.GRANADA), CIBER of Epidemiology and Public Health (CIBERESP), Spain., Spanien
  • Sandra M Colorado-Yohar, CIBER of Epidemiology and Public Health (CIBERESP), Spain., Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain., Research Group on Demography and Health, National Faculty of Public Health, University of Antioquia, Medellín, Colombia., Spanien
  • Aurelio Barricarte, CIBER of Epidemiology and Public Health (CIBERESP), Spain., Navarre Public Health Institute, Pamplona, Navarra Institute for Health Research (IdiSNA), Pamplona, Spain., Spanien
  • Pilar Amiano, Biodonostia Health Research Institute, CIBER of Epidemiology and Public Health (CIBERESP), Spain., Spanien
  • Emily Sonestedt, Department of Nephrology in Lund, Clinical Sciences Lund, Skåne University Hospital and Lund University, Lund, Sweden., Sverige
  • Ulrika Ericson, Department of Nephrology in Lund, Clinical Sciences Lund, Skåne University Hospital and Lund University, Lund, Sweden., Sverige
  • Julia Otten, University of Umeå, Umeå, Sweden., Sverige
  • Björn Sundström, University of Umeå, Umeå, Sweden., Sverige
  • Nicholas J Wareham, University of Cambridge, School of Clinical Medicine., Storbritannien
  • Nita G Forouhi, University of Cambridge, School of Clinical Medicine., Storbritannien
  • Paolo Vineis, MRC/HPA Centre for Environment and Health, School of Public Health, Imperial College London, London, UK., Storbritannien
  • Konstantinos K Tsilidis, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece, Storbritannien
  • Anika Knuppel, Cancer Epidemiology Unit, Nuffield Department of Population Health University of Oxford, United Kingdom., Storbritannien
  • Keren Papier, Cancer Epidemiology Unit, Nuffield Department of Population Health University of Oxford, United Kingdom., Storbritannien
  • Pietro Ferrari, French network for Nutrition And Cancer Research (NACRe network), International Agency for Research on Cancer, World Health Organization, Lyon, Frankrig
  • Elio Riboli, Faculty of Medicine, School of Public Health, Imperial College London, London, United Kingdom., Storbritannien
  • Marc J Gunter, French network for Nutrition And Cancer Research (NACRe network), World Health Organization
  • ,
  • Mathilde Touvier, Sorbonne Paris Nord University, Inserm, Inrae, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre - University of Paris (CRESS), Bobigny, French network for Nutrition And Cancer Research (NACRe network), Frankrig

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.

OriginalsprogEngelsk
Artikelnummerm3173
TidsskriftB M J
Vol/bind370
Antal sider13
ISSN0959-8146
DOI
StatusUdgivet - 16 sep. 2020

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© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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