Association between nutritional profiles of foods underlying Nutri-Score front-of-pack labels and mortality:EPIC cohort study in 10 European countries

In: 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 , H A , Weiderpass , E , Overvad , K , Tjønneland , A , Rostgaard-Hansen , A L , Boutron-Ruault , M-C , Mancini , F R , Mahamat-Saleh , Y , Kühn , T , Katzke , V , Bergmann , M M , Schulze , M B , Trichopoulou , A , Karakatsani , A , Peppa , E , Masala , G , Agnoli , C , De Magistris , M S , Tumino , R , Sacerdote , C , Boer , J M , Verschuren , W M , van der Schouw , Y T , Skeie , G , Braaten , T , Redondo , M L , Agudo , A , Petrova , D , Colorado-Yohar , S M , Barricarte , A , Amiano , P , Sonestedt , E , Ericson , U , Otten , J , Sundström , B , Wareham , N J , Forouhi , N G , Vineis , P , Tsilidis , K K , Knuppel , A , Papier , K , Ferrari , P , Riboli , E , Gunter , M J & Touvier , M 2020 , ' Association between nutritional profiles of foods underlying Nutri-Score front-of-pack labels and mortality : EPIC cohort study in 10 European countries ' , B M J , vol. 370 , m3173 . https://doi.org/10.1136/bmj.m3173

Open Access

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.