Christina C. Dahm

Nutritional quality of food as represented by the FSAm-NPS nutrient profiling system underlying the Nutri-Score label and cancer risk in Europe: Results from the EPIC prospective cohort study

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

  • Mélanie Deschasaux, Nutritional Epidemiology Research Team (EREN), Sorbonne Paris Cité Epidemiology and Statistics Research Centre (CRESS), Inserm U1153, Inra U1125, Cnam, COMUE Sorbonne Paris Cité, Paris 13 University, Bobigny, France., France
  • Inge Huybrechts, Section of Nutrition and Metabolism, International Agency for Research on Cancer, World Health Organization, Lyon, France., France
  • Neil Murphy, Section of Nutrition and Metabolism, International Agency for Research on Cancer, World Health Organization, Lyon, France., France
  • Chantal Julia, Department of Public Health, Avicenne Hospital (AP-HP), Bobigny, France., France
  • Serge Hercberg, Department of Public Health, Avicenne Hospital (AP-HP), Bobigny, France., France
  • Bernard Srour, Nutritional Epidemiology Research Team (EREN), Sorbonne Paris Cité Epidemiology and Statistics Research Centre (CRESS), Inserm U1153, Inra U1125, Cnam, COMUE Sorbonne Paris Cité, Paris 13 University, Bobigny, France., France
  • Emmanuelle Kesse-Guyot, Nutritional Epidemiology Research Team (EREN), Sorbonne Paris Cité Epidemiology and Statistics Research Centre (CRESS), Inserm U1153, Inra U1125, Cnam, COMUE Sorbonne Paris Cité, Paris 13 University, Bobigny, France., France
  • Paule Latino-Martel, Nutritional Epidemiology Research Team (EREN), Sorbonne Paris Cité Epidemiology and Statistics Research Centre (CRESS), Inserm U1153, Inra U1125, Cnam, COMUE Sorbonne Paris Cité, Paris 13 University, Bobigny, France., France
  • Carine Biessy, Section of Nutrition and Metabolism, International Agency for Research on Cancer, World Health Organization, Lyon, France., France
  • Corinne Casagrande, Section of Nutrition and Metabolism, International Agency for Research on Cancer, World Health Organization, Lyon, France., France
  • Mazda Jenab, Section of Nutrition and Metabolism, International Agency for Research on Cancer, World Health Organization, Lyon, France., France
  • Heather Ward, Faculty of Medicine, School of Public Health, Imperial College London, London, United Kingdom., United Kingdom
  • Elisabete Weiderpass, Genetic Epidemiology Group, Folkhälsan Research Centre and Faculty of Medicine, University of Helsinki, Helsinki, Finland., Finland
  • Christina C Dahm
  • Kim Overvad
  • Cecilie Kyrø, Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark., Denmark
  • Anja Olsen
  • Aurélie Affret, Institut Gustave Roussy, Villejuif, France., France
  • Marie-Christine Boutron-Ruault, Institut Gustave Roussy, Villejuif, France., France
  • Yahya Mahamat-Saleh, Institut Gustave Roussy, Villejuif, France., France
  • Rudolf Kaaks, Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany., Germany
  • Tilman Kühn, Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany., Germany
  • Heiner Boeing, Department of Epidemiology, German Institute of Human Nutrition (DIfE) 14558 Potsdam-Rehbrücke, Nuthetal, Germany., Germany
  • Lukas Schwingshackl, Department of Epidemiology, German Institute of Human Nutrition (DIfE) 14558 Potsdam-Rehbrücke, Nuthetal, Germany., Germany
  • Christina Bamia, WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Dept. of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece., Greece
  • Eleni Peppa, Hellenic Health Foundation, Athens, Greece., Greece
  • Antonia Trichopoulou, WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Dept. of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece., Greece
  • Giovanna Masala, Cancer Risk Factors and Life-Style Epidemiology Unit, Cancer Research and Prevention Institute-ISPO, 50139 Florence, Italy., Italy
  • Vittorio Krogh, Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milano, Italy., Italy
  • Salvatore Panico, Dipartimento di Medicina Clinica e Chirurgia, Federico II University, 80138 Naples, Italy. spanico@unina.it., Italy
  • Rosario Tumino, Civic-M.P. Arezzo Hospital, Italy
  • Carlotta Sacerdote, Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Turin, Italy., Italy
  • Bas Bueno-de-Mesquita, Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia;, Malaysia
  • Petra H Peeters, Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3584 Utrecht, The Netherlands., Netherlands
  • Anette Hjartåker, Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway., Norway
  • Charlotta Rylander, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, 9037 Tromsø, Norway., Norway
  • Guri Skeie, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, 9037 Tromsø, Norway., Norway
  • J Ramón Quirós, Public Health Directorate, Asturias, Spain., Spain
  • Paula Jakszyn, Facultat de Ciències de la Salut Blanquerna, Universitat Ramon Llull, Barcelona, Spain., Spain
  • Elena Salamanca-Fernández, CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain., Spain
  • José María Huerta, Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia, Spain., Spain
  • Eva Ardanaz, IdiSNA, Navarra Institute for Health Research, Pamplona, Spain., Spain
  • Pilar Amiano, Public Health Department of Gipuzkoa, Basque Government, San Sebastian, Spain., Spain
  • Ulrika Ericson, Lund University, Sweden
  • Emily Sonestedt, Lund University, Sweden
  • Ena Huseinovic, Department of Internal Medicine and Clinical Nutrition, The Sahlgrenska Academy, University of Gothenburg, SE-405 30 Gothenburg, Sweden. ena.huseinovic@gu.se., Sweden
  • Ingegerd Johansson, Department of Odontology, Umea University, Umea, Sweden., Sweden
  • Kay-Tee Khaw, University of Cambridge, United Kingdom
  • Nick Wareham, MRC Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, PO Box 285, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom., United Kingdom
  • Kathryn E Bradbury, Cancer Epidemiology Unit, Nuffield Department of Population Health University of Oxford, United Kingdom., United Kingdom
  • Aurora Perez-Cornago, Cancer Epidemiology Unit, Nuffield Department of Population Health University of Oxford, United Kingdom., United Kingdom
  • Konstantinos K Tsilidis, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece, Greece
  • Pietro Ferrari, Section of Nutrition and Metabolism, International Agency for Research on Cancer, World Health Organization, Lyon, France., France
  • Elio Riboli, Faculty of Medicine, School of Public Health, Imperial College London, London, United Kingdom., United Kingdom
  • Marc J Gunter, Section of Nutrition and Metabolism, International Agency for Research on Cancer, World Health Organization, Lyon, France., France
  • Mathilde Touvier, Nutritional Epidemiology Research Team (EREN), Sorbonne Paris Cité Epidemiology and Statistics Research Centre (CRESS), Inserm U1153, Inra U1125, Cnam, COMUE Sorbonne Paris Cité, Paris 13 University, Bobigny, France., France

BACKGROUND: Helping consumers make healthier food choices is a key issue for the prevention of cancer and other diseases. In many countries, political authorities are considering the implementation of a simplified labelling system to reflect the nutritional quality of food products. The Nutri-Score, a five-colour nutrition label, is derived from the Nutrient Profiling System of the British Food Standards Agency (modified version) (FSAm-NPS). How the consumption of foods with high/low FSAm-NPS relates to cancer risk has been studied in national/regional cohorts but has not been characterized in diverse European populations.

METHODS AND FINDINGS: This prospective analysis included 471,495 adults from the European Prospective Investigation into Cancer and Nutrition (EPIC, 1992-2014, median follow-up: 15.3 y), among whom there were 49,794 incident cancer cases (main locations: breast, n = 12,063; prostate, n = 6,745; colon-rectum, n = 5,806). Usual food intakes were assessed with standardized country-specific diet assessment methods. The FSAm-NPS was calculated for each food/beverage using their 100-g content in energy, sugar, saturated fatty acid, sodium, fibres, proteins, and fruits/vegetables/legumes/nuts. The FSAm-NPS scores of all food items usually consumed by a participant were averaged to obtain the individual FSAm-NPS Dietary Index (DI) scores. Multi-adjusted Cox proportional hazards models were computed. A higher FSAm-NPS DI score, reflecting a lower nutritional quality of the food consumed, was associated with a higher risk of total cancer (HRQ5 versus Q1 = 1.07; 95% CI 1.03-1.10, P-trend < 0.001). Absolute cancer rates in those with high and low (quintiles 5 and 1) FSAm-NPS DI scores were 81.4 and 69.5 cases/10,000 person-years, respectively. Higher FSAm-NPS DI scores were specifically associated with higher risks of cancers of the colon-rectum, upper aerodigestive tract and stomach, lung for men, and liver and postmenopausal breast for women (all P < 0.05). The main study limitation is that it was based on an observational cohort using self-reported dietary data obtained through a single baseline food frequency questionnaire; thus, exposure misclassification and residual confounding cannot be ruled out.

CONCLUSIONS: In this large multinational European cohort, the consumption of food products with a higher FSAm-NPS score (lower nutritional quality) was associated with a higher risk of cancer. This supports the relevance of the FSAm-NPS as underlying nutrient profiling system for front-of-pack nutrition labels, as well as for other public health nutritional measures.

Original languageEnglish
JournalPLOS Medicine
Volume15
Issue9
Pages (from-to)e1002651
Number of pages21
ISSN1549-1277
DOIs
Publication statusPublished - 18 Sep 2018

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