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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



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