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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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Title: | Association between nutritional profiles of foods underlying Nutri-Score front-of-pack labels and mortality: EPIC cohort study in 10 European countries. |
Authors: | Deschasaux, M Huybrechts, I Julia, C Hercberg, S Egnell, M Srour, B Kesse-Guyot, E Latino-Martel, P Biessy, C Casagrande, C Murphy, N Jenab, M Ward, HA Weiderpass, E Overvad, K Tjønneland, A Rostgaard-Hansen, AL Boutron-Ruault, M-C Mancini, FR Mahamat-Saleh, Y Kühn, T Katzke, V Bergmann, MM Schulze, MB Trichopoulou, A Karakatsani, A Peppa, E Masala, G Agnoli, C De Magistris, MS Tumino, R Sacerdote, C Boer, JM Verschuren, WM Van der Schouw, YT Skeie, G Braaten, T Redondo, ML Agudo, A Petrova, D Colorado-Yohar, SM Barricarte, A Amiano, P Sonestedt, E Ericson, U Otten, J Sundström, B Wareham, NJ Forouhi, NG Vineis, P Tsilidis, KK Knuppel, A Papier, K Ferrari, P Riboli, E Gunter, MJ Touvier, M |
Item Type: | Journal Article |
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. |
Issue Date: | 16-Sep-2020 |
Date of Acceptance: | 3-Aug-2020 |
URI: | http://hdl.handle.net/10044/1/83015 |
DOI: | 10.1136/bmj.m3173 |
ISSN: | 1759-2151 |
Publisher: | BMJ |
Start Page: | 1 |
End Page: | 13 |
Journal / Book Title: | BMJ |
Volume: | 370 |
Copyright Statement: | © 2020 The Author(s). This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/ by-nc/4.0/. |
Keywords: | Humans Nutrition Assessment Mortality Proportional Hazards Models Cohort Studies Food Preferences Nutritive Value Food Labeling Adult Middle Aged Europe Female Male Surveys and Questionnaires General & Internal Medicine 1103 Clinical Sciences 1117 Public Health and Health Services |
Publication Status: | Published online |
Conference Place: | England |
Open Access location: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7491938/ |
Online Publication Date: | 2020-09-16 |
Appears in Collections: | School of Public Health |
This item is licensed under a Creative Commons License