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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

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Title: 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
Authors: Deschasaux, M
Huybrechts, I
Murphy, N
Julia, C
Hercberg, S
Srour, B
Kesse-Guyot, E
Latino-Martel, P
Biessy, C
Casagrande, C
Jenab, M
Ward, H
Weiderpass, E
Dahm, CC
Overvad, K
Kyro, C
Olsen, A
Affret, A
Boutron-Ruault, M-C
Mahamat-Saleh, Y
Kaaks, R
Kuehn, T
Boeing, H
Schwingshackl, L
Bamia, C
Peppa, E
Trichopoulou, A
Masala, G
Krogh, V
Panico, S
Tumino, R
Sacerdote, C
Buen-de-Mesquita, B
Peeters, PH
Hjartaker, A
Rylander, C
Skeie, G
Ramon Quiros, J
Jakszyn, P
Salamanca-Fernandez, E
Maria Huerta, J
Ardanaz, E
Amiano, P
Ericson, U
Sonestedt, E
Huseinovic, E
Johansson, I
Khaw, K-T
Wareham, N
Bradbury, KE
Perez-Cornago, A
Tsilidis, KK
Ferrari, P
Riboli, E
Gunter, MJ
Touvier, M
Item Type: Journal Article
Abstract: 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.
Issue Date: 18-Sep-2018
Date of Acceptance: 9-Aug-2018
URI: http://hdl.handle.net/10044/1/63375
DOI: https://dx.doi.org/10.1371/journal.pmed.1002651
ISSN: 1549-1277
Publisher: Public Library of Science (PLoS)
Journal / Book Title: PLoS Medicine
Volume: 15
Issue: 9
Copyright Statement: © 2018 Deschasaux et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Keywords: Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
CARDIOVASCULAR-DISEASE RISK
FRONT-OF-PACKAGE
DIETARY INDEX
PROSPECTIVE ASSOCIATION
SU.VI.MAX COHORT
FRENCH ADULTS
VALIDATION
DATABASE
PROJECT
FRANCE
11 Medical And Health Sciences
Publication Status: Published
Article Number: ARTN e1002651
Appears in Collections:Faculty of Medicine
Epidemiology, Public Health and Primary Care



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