Association between nutritional profiles of foods underlying Nutri-Score front-of-pack labels and mortality: EPIC cohort study in 10 European countries
Creators: name: Deschasaux, Mélanie
name: Huybrechts, Inge
name: Julia, Chantal
name: Hercberg, Serge
name: Egnell, Manon
name: Srour, Bernard
name: Kesse-Guyot, Emmanuelle
name: Latino-Martel, Paule
name: Biessy, Carine
name: Casagrande, Corinne
name: Murphy, Neil
name: Jenab, Mazda
name: Ward, Heather A
name: Weiderpass, Elisabete
name: Overvad, Kim
name: Tjønneland, Anne
name: Rostgaard-Hansen, Agnetha Linn
name: Boutron-Ruault, Marie-Christine
name: Mancini, Francesca Romana
name: Mahamat-Saleh, Yahya
name: Kühn, Tilman
name: Katzke, Verena
name: Bergmann, Manuela M
name: Schulze, Matthias B
name: Trichopoulou, Antonia
name: Karakatsani, Anna
name: Peppa, Eleni
name: Masala, Giovanna
name: Agnoli, Claudia
name: De Magistris, Maria Santucci
name: Tumino, Rosario
name: Sacerdote, Carlotta
name: Boer, Jolanda MA
name: Verschuren, WM Monique
name: Van Der Schouw, Yvonne T
name: Skeie, Guri
name: Braaten, Tonje
name: Redondo, M Luisa
name: Agudo, Antonio
name: Petrova, Dafina
name: Colorado-Yohar, Sandra M
name: Barricarte, Aurelio
name: Amiano, Pilar
name: Sonestedt, Emily
name: Ericson, Ulrika
name: Otten, Julia
name: Sundström, Björn
name: Wareham, Nicholas J
name: Forouhi, Nita G
name: Vineis, Paolo
name: Tsilidis, Konstantinos K
name: Knuppel, Anika
name: Papier, Keren
name: Ferrari, Pietro
name: Riboli, Elio
name: Gunter, Marc J
name: Touvier, Mathilde
Publisher: name: Apollo - University of Cambridge Repository
Year: 2020
Subjects: Research

description: 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&lt;0.001 for trend) and mortality from cancer (1.08, 1.03 to 1.13, P&lt;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&lt;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.