Nutritional quality of diet characterized by the Nutri-Score profiling system and cardiovascular disease risk: a prospective study in 7 European countries

Mélanie Deschasaux-Tanguy*, Inge Huybrechts, Chantal Julia, Serge Hercberg, Barthélémy Sarda, Morgane Fialon, Nathalie Arnault, Bernard Srour, Emmanuelle Kesse-Guyot, Léopold K. Fezeu, Carine Biessy, Corinne Casagrande, Bertrand Hemon, Elisabete Weiderpass, Maria G.M. Pinho, Neil Murphy, Heinz Freisling, Pietro Ferrari, Anne Tjønneland, Kristina Elin Nielsen PetersenVerena Katzke, Rudolf Kaaks, Matthias B. Schulze, Giovanna Masala, Valeria Pala, Salvatore Panico, Fulvio Ricceri, W. M.Monique Verschuren, Jolanda M.A. Boer, Yvonne T. van der Schouw, Guri Skeie, Antonio Agudo, Esther Molina-Montes, José María Huerta, Conchi Moreno-Iribas, Ulrika Ericson, Emily Sonestedt, Anna Strid, Viktor Oskarsson, Tammy Y.N. Tong, Alicia K. Heath, Elom K. Aglago, John Danesh, Elio Riboli, Marc J. Gunter, Mathilde Touvier

*Corresponding author for this work

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Abstract

Background: Nutri-Score is a scientifically validated 5-color front-of-pack nutrition label reflecting the nutrient profile of foods. It has been implemented in several European countries on a voluntary basis, pending the revision of the European labeling regulation. Hence, scientific evidence is needed regarding the ability of the nutrient profile underlying the Nutri-Score (uNS-NPS, 2023-updated version) to characterize healthier foods. Our objective was therefore to study the prospective association between the nutritional quality of diet characterized by the uNS-NPS and the risk of cardiovascular diseases in a large European population. Methods: Our analyses included 345,533 participants from the European Prospective Investigation into Cancer and Nutrition study (EPIC, 1992–2010, 7 European countries). Food intakes were assessed at baseline using country-specific dietary questionnaires. The uNS-NPS was calculated as a continuous scale for each food, based on its 100 g content of energy, sugars, saturated fatty acids, salt, fibre, and protein and percentage content of fruit, vegetables, and pulses. A dietary index was derived at the individual level (uNS-NPS DI: energy-weighted mean of uNS-NPS scores of all foods consumed by a participant). Cardiovascular events during follow-up were retrieved using country-specific methods (self-report, registry data). Multi-adjusted Cox models were computed. Findings: Overall, 16,214 first cardiovascular events were reported (median follow-up: 12.3 years; 4,103,133 person-years). The consumption of foods with a higher uNS-NPS score (reflecting a lower overall nutritional quality of diet) was associated with higher risks of total cardiovascular events (Hazards Ratio (HR) for an increment of 1 standard deviation: 1.03 (95% Confidence Interval 1.01–1.05)), especially myocardial infarction (HR = 1.03 (1.01–1.07)), and stroke (HR = 1.04 (1.01–1.07)). Interpretation: In this large prospective study among European adults, a higher risk of cardiovascular diseases (total and several subtypes) was observed in individuals consuming a diet with a lower nutritional value, as graded by the uNS-NPS score. This brings new evidence on the relevance of the updated nutrient profile underlying the Nutri-Score to characterize foods with a healthier nutrient profile. Funding: EPIC-CVD was supported by EU FP7, ERC, UK MRC, British Heart Foundation, and UK NIHR.

Original languageEnglish
Article number101006
Number of pages13
JournalThe Lancet Regional Health - Europe
Volume46
Early online date10 Sept 2024
DOIs
Publication statusPublished - Nov 2024

Keywords

  • Cardiovascular disease risk
  • Europe
  • Food labelling
  • Nutrient profile
  • Nutrition
  • Prospective study

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