TY - JOUR
T1 - Nutritional quality of diet characterized by the Nutri-Score profiling system and cardiovascular disease risk
T2 - a prospective study in 7 European countries
AU - Deschasaux-Tanguy, Mélanie
AU - Huybrechts, Inge
AU - Julia, Chantal
AU - Hercberg, Serge
AU - Sarda, Barthélémy
AU - Fialon, Morgane
AU - Arnault, Nathalie
AU - Srour, Bernard
AU - Kesse-Guyot, Emmanuelle
AU - Fezeu, Léopold K.
AU - Biessy, Carine
AU - Casagrande, Corinne
AU - Hemon, Bertrand
AU - Weiderpass, Elisabete
AU - Pinho, Maria G.M.
AU - Murphy, Neil
AU - Freisling, Heinz
AU - Ferrari, Pietro
AU - Tjønneland, Anne
AU - Nielsen Petersen, Kristina Elin
AU - Katzke, Verena
AU - Kaaks, Rudolf
AU - Schulze, Matthias B.
AU - Masala, Giovanna
AU - Pala, Valeria
AU - Panico, Salvatore
AU - Ricceri, Fulvio
AU - Verschuren, W. M.Monique
AU - Boer, Jolanda M.A.
AU - van der Schouw, Yvonne T.
AU - Skeie, Guri
AU - Agudo, Antonio
AU - Molina-Montes, Esther
AU - Huerta, José María
AU - Moreno-Iribas, Conchi
AU - Ericson, Ulrika
AU - Sonestedt, Emily
AU - Strid, Anna
AU - Oskarsson, Viktor
AU - Tong, Tammy Y.N.
AU - Heath, Alicia K.
AU - Aglago, Elom K.
AU - Danesh, John
AU - Riboli, Elio
AU - Gunter, Marc J.
AU - Touvier, Mathilde
N1 - Publisher Copyright:
© 2024 The Authors
PY - 2024/11
Y1 - 2024/11
N2 - 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.
AB - 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.
KW - Cardiovascular disease risk
KW - Europe
KW - Food labelling
KW - Nutrient profile
KW - Nutrition
KW - Prospective study
UR - http://www.scopus.com/inward/record.url?scp=85204691430&partnerID=8YFLogxK
U2 - 10.1016/j.lanepe.2024.101006
DO - 10.1016/j.lanepe.2024.101006
M3 - Article
AN - SCOPUS:85204691430
SN - 2666-7762
VL - 46
JO - The Lancet Regional Health - Europe
JF - The Lancet Regional Health - Europe
M1 - 101006
ER -