14
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

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

      research-article
      1 , 2 , , 2 , 3 , 1 , 4 , 1 , 2 , 4 , 1 , 1 , 2 , 1 , 2 , 1 , 2 , 3 , 3 , 2 , 3 , 2 , 3 , 5 , 3 , 7 , 8 , 9 , 9 , 10 , 11 , 10 , 11 , 10 , 11 , 12 , 12 , 13 , 14 , 13 , 14 , 15 , 15 , 16 , 15 , 17 , 18 , 19 , 20 , 21 , 22 , 22 , 23 , 23 , 6 , 6 , 24 , 25 , 26 , 27 , 28 , 28 , 29 , 30 , 28 , 31 , 32 , 28 , 33 , 34 , 34 , 35 , 35 , 36 , 36 , 37 , 38 , 39 , 40 , 40 , 2 , 3 , 5 , 2 , 3 , 1 , 2
      The BMJ
      BMJ Publishing Group Ltd.

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          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.

          Related collections

          Most cited references35

          • Record: found
          • Abstract: not found
          • Article: not found

          Web Site and R Package for Computing E-values

            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            The EPIC Project: rationale and study design. European Prospective Investigation into Cancer and Nutrition.

            The most consistent result of epidemiological studies on diet and cancer is that a diet rich in vegetables, fruit and, more generally, in plant foods is associated with a reduced risk of cancer at several anatomical sites. Epidemiological studies have been less consistent regarding the putative increase in risk related to consumption of fat or meat. In addition it has not been possible to identify clearly the biological role of specific nutrients or non-nutrient food components in the prevention or causation of cancer. Limitations in the precision and validity of traditional dietary intake measurements and limited use of biomarkers combined with narrow ranges of variations in dietary habits within single populations, have been the main reasons for the limited success in identifying more specific diet and cancer links. EPIC is a multi-centre prospective cohort study designed to investigate the relation between diet, nutritional and metabolic characteristics, various lifestyle factors and the risk of cancer. The study is based in 22 collaborating centres in nine European countries and includes populations characterized by large variations in dietary habits and cancer risk. Data are collected on diet, physical activity, sexual maturation and reproductive history, lifetime consumption of alcohol and tobacco, previous and current illnesses and current medication. Following a common protocol and using identical equipment, blood samples are collected, aliquoted into plasma, serum, white blood cells and erythrocytes, and stored in liquid nitrogen at -196 degrees C for future laboratory analyses on cancer cases and matched healthy controls. Anthropometric measurements are taken according to a standard protocol. It is planned to include around 400,000 middle-aged men and women. The collection of questionnaire data, anthropometric measurements and blood samples is under way. Almost 340,000 subjects had been included in the study by mid-1996, and recruitment is expected to be almost complete by 1997. Follow-up for cancer incidence and total mortality has started and it is expected that about 23000 cancer cases will be identified during the first 10 years of follow-up.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              The science on front-of-package food labels.

              The U.S. Food and Drug Administration and Institute of Medicine are currently investigating front-of-package (FOP) food labelling systems to provide science-based guidance to the food industry. The present paper reviews the literature on FOP labelling and supermarket shelf-labelling systems published or under review by February 2011 to inform current investigations and identify areas of future research. A structured search was undertaken of research studies on consumer use, understanding of, preference for, perception of and behaviours relating to FOP/shelf labelling published between January 2004 and February 2011. Twenty-eight studies from a structured search met inclusion criteria. Reviewed studies examined consumer preferences, understanding and use of different labelling systems as well as label impact on purchasing patterns and industry product reformulation. The findings indicate that the Multiple Traffic Light system has most consistently helped consumers identify healthier products; however, additional research on different labelling systems' abilities to influence consumer behaviour is needed.
                Bookmark

                Author and article information

                Contributors
                Role: researcher
                Role: scientist
                Role: associate professor
                Role: professor
                Role: doctoral student
                Role: epidemiologist
                Role: senior researcher
                Role: senior researcher
                Role: senior statistician
                Role: senior statistician
                Role: scientist
                Role: scientist
                Role: researcher
                Role: director
                Role: professor
                Role: research head
                Role: doctoral student
                Role: team head
                Role: postdoctoral researcher
                Role: doctoral student
                Role: group head
                Role: postdoctoral researcher
                Role: researcher
                Role: professor
                Role: professor
                Role: associate professor
                Role: nutritionist
                Role: medical epidemiologist
                Role: scientist
                Role: nutritionist
                Role: senior pathologist
                Role: medical epidemiologist
                Role: senior epidemiologist
                Role: professor
                Role: professor
                Role: professor
                Role: associate professor
                Role: scientist
                Role: unit head
                Role: postdoctoral researcher
                Role: postdoctoral researcher
                Role: epidemiologist, head of service
                Role: epidemiologist
                Role: associate professor
                Role: associate professor
                Role: endocrinologist
                Role: postdoctoral researcher
                Role: professor
                Role: professor
                Role: professor
                Role: senior lecturer
                Role: nutritional epidemiologist
                Role: nutritional epidemiologist
                Role: group head
                Role: professor
                Role: section head
                Role: team head
                Journal
                BMJ
                BMJ
                BMJ-UK
                bmj
                The BMJ
                BMJ Publishing Group Ltd.
                0959-8138
                1756-1833
                2020
                16 September 2020
                : 370
                : m3173
                Affiliations
                [1 ]Sorbonne Paris Nord University, Inserm, Inrae, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre – University of Paris (CRESS), Bobigny, France
                [2 ]French network for Nutrition And Cancer Research (NACRe network), France
                [3 ]International Agency for Research on Cancer, World Health Organization, Lyon, France
                [4 ]Department of Public Health, Hôpitaux Universitaires Paris Seine-Saint-Denis (AP-HP), Bobigny, France
                [5 ]Faculty of Medicine, School of Public Health, Imperial College London, London, UK
                [6 ]Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
                [7 ]Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus C, Denmark
                [8 ]Department of Public Health, University of Copenhagen, Copenhagen, Denmark
                [9 ]Danish Cancer Society Research Centre, Diet, Genes and Environment, Copenhagen, Denmark
                [10 ]CESP, INSERM U1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, Paris, France
                [11 ]Gustave Roussy, Villejuif, France
                [12 ]Division of Cancer Epidemiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany
                [13 ]Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
                [14 ]Institute of Nutrition Science, University of Potsdam, Nuthetal, Germany
                [15 ]Hellenic Health Foundation, Athens, Greece
                [16 ]2nd Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Haidari, Greece
                [17 ]Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
                [18 ]Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
                [19 ]AOU Federico II, Naples, Italy
                [20 ]Cancer Registry and Histopathology Department, Provincial Health Authority ASP Ragusa, Italy
                [21 ]Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Centre for Cancer Prevention (CPO), Turin, Italy
                [22 ]National Institute for Public Health and the Environment, Bilthoven, Netherlands
                [23 ]Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
                [24 ]Public Health Directorate, Asturias, Spain
                [25 ]Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology - ICO, Group of Research on Nutrition and Cancer, Bellvitge Biomedical Research Institute - IDIBELL, L'Hospitalet of Llobregat, Barcelona, Spain
                [26 ]Andalusian School of Public Health (EASP), Granada, Spain
                [27 ]Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain
                [28 ]CIBER of Epidemiology and Public Health (CIBERESP), Spain
                [29 ]Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
                [30 ]Research Group on Demography and Health, National Faculty of Public Health, University of Antioquia, Medellín, Colombia
                [31 ]Navarra Public Health Institute, Pamplona, Spain
                [32 ]Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
                [33 ]Public Health Division of Gipuzkoa, Biodonostia Health Research Institute, Ministry of Health of the Basque Government, San Sebastian, Spain
                [34 ]Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
                [35 ]Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
                [36 ]MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK
                [37 ]MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
                [38 ]Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
                [39 ]Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
                [40 ]Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
                Author notes
                Correspondence to: M Deschasaux m.deschasaux@ 123456eren.smbh.univ-paris13.fr
                Author information
                http://orcid.org/0000-0002-3359-420X
                Article
                desm053086
                10.1136/bmj.m3173
                7491938
                32938660
                cdaea790-8446-47cf-8e00-f57ba072db7c
                © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                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/.

                History
                : 03 August 2020
                Categories
                Research

                Medicine
                Medicine

                Comments

                Comment on this article