Association between nutritional profiles of foods underlying Nutri-Score front-of-pack labels and mortality: EPIC cohort study in 10 European countries. (16th September 2020)

• Record Type: Journal Article
• Authors: Deschasaux, Mélanie; Huybrechts, Inge; Julia, Chantal; Hercberg, Serge; Egnell, Manon; Srour, Bernard; Kesse-Guyot, Emmanuelle; Latino-Martel, Paule; Biessy, Carine; Casagrande, Corinne; Murphy, Neil; Jenab, Mazda; Ward, Heather A; Weiderpass, Elisabete; Overvad, Kim; Tjønneland, Anne; Rostgaard-Hansen, Agnetha Linn; Boutron-Ruault, Marie-Christine; Mancini, Francesca Romana; Mahamat-Saleh, Yahya; Kühn, Tilman; Katzke, Verena; Bergmann, Manuela M; Schulze, Matthias B; Trichopoulou, Antonia; Karakatsani, Anna; Peppa, Eleni; Masala, Giovanna; Agnoli, Claudia; De Magistris, Maria Santucci; Tumino, Rosario; Sacerdote, Carlotta; Boer, Jolanda MA; Verschuren, WM Monique; van der Schouw, Yvonne T; Skeie, Guri; Braaten, Tonje; Redondo, M Luisa; Agudo, Antonio; Petrova, Dafina; Colorado-Yohar, Sandra M; Barricarte, Aurelio; Amiano, Pilar; Sonestedt, Emily; Ericson, Ulrika; Otten, Julia; Sundström, Björn; Wareham, Nicholas J; Forouhi, Nita G; Vineis, Paolo; Tsilidis, Konstantinos K; Knuppel, Anika; Papier, Keren; Ferrari, Pietro; Riboli, Elio; Gunter, Marc J; Touvier, Mathilde;
• Is Part Of: BMJ. Volume 370(2020)
• Publication Date: 2020-09-16
• Subjects: Medicine -- Periodicals; Medicine -- Periodicals; Medicine; Periodicals; 610
• DOI: 10.1136/bmj.m3173
• Languages: English
• ISSNs: 0007-1447

Abstract

Abstract: 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.