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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  • Mélanie Deschasaux
  • Inge Huybrechts
  • Chantal Julia
  • Serge Hercberg
  • Manon Egnell
  • Bernard Srour
  • Emmanuelle Kesse-Guyot
  • Paule Latino-Martel
  • Carine Biessy
  • Corinne Casagrande
  • Neil Murphy
  • Mazda Jenab
  • Heather A. Ward
  • Elisabete Weiderpass
  • Kim Overvad
  • Marie Christine Boutron-Ruault
  • Francesca Romana Mancini
  • Yahya Mahamat-Saleh
  • Tilman Kühn
  • Verena Katzke
  • Manuela M. Bergmann
  • Matthias B. Schulze
  • Antonia Trichopoulou
  • Anna Karakatsani
  • Eleni Peppa
  • Giovanna Masala
  • Claudia Agnoli
  • Maria Santucci De Magistris
  • Rosario Tumino
  • Carlotta Sacerdote
  • Jolanda Ma Boer
  • Wm Monique Verschuren
  • Yvonne T. van der Schouw
  • Guri Skeie
  • Tonje Braaten
  • M. Luisa Redondo
  • Antonio Agudo
  • Dafina Petrova
  • Sandra M. Colorado-Yohar
  • Aurelio Barricarte
  • Pilar Amiano
  • Emily Sonestedt
  • Ulrika Ericson
  • Julia Otten
  • Björn Sundström
  • Nicholas J. Wareham
  • Nita G. Forouhi
  • Paolo Vineis
  • Konstantinos K. Tsilidis
  • Anika Knuppel
  • Keren Papier
  • Pietro Ferrari
  • Elio Riboli
  • Marc J. Gunter
  • Mathilde Touvier

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.

Original languageEnglish
Article numberm3173
JournalB M J
Number of pages13
Publication statusPublished - 2020

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