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

Deschasaux-Tanguy, Mélanie ; Huybrechts, Inge ; Julia, Chantal ; Hercberg, Serge ; Sarda, Barthélémy ; Fialon, Morgane ; Arnault, Nathalie ; Srour, Bernard ; Kesse-Guyot, Emmanuelle and Fezeu, Léopold K. , et al. (2024) In The Lancet Regional Health - Europe 46.
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... (More)

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 byEU FP7,ERC, UKMRC,British Heart Foundation, and UKNIHR.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Cardiovascular disease risk, Europe, Food labelling, Nutrient profile, Nutrition, Prospective study
in
The Lancet Regional Health - Europe
volume
46
article number
101006
publisher
Elsevier
external identifiers
  • pmid:39529812
  • scopus:85204691430
ISSN
2666-7762
DOI
10.1016/j.lanepe.2024.101006
language
English
LU publication?
yes
id
d55163ff-1ef7-43e4-b070-d7ab2a015ce2
date added to LUP
2024-11-27 12:29:40
date last changed
2025-07-10 20:06:38
@article{d55163ff-1ef7-43e4-b070-d7ab2a015ce2,
  abstract     = {{<p>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 byEU FP7,ERC, UKMRC,British Heart Foundation, and UKNIHR.</p>}},
  author       = {{Deschasaux-Tanguy, Mélanie and Huybrechts, Inge and Julia, Chantal and Hercberg, Serge and Sarda, Barthélémy and Fialon, Morgane and Arnault, Nathalie and Srour, Bernard and Kesse-Guyot, Emmanuelle and Fezeu, Léopold K. and Biessy, Carine and Casagrande, Corinne and Hemon, Bertrand and Weiderpass, Elisabete and Pinho, Maria G.M. and Murphy, Neil and Freisling, Heinz and Ferrari, Pietro and Tjønneland, Anne and Nielsen Petersen, Kristina Elin and Katzke, Verena and Kaaks, Rudolf and Schulze, Matthias B. and Masala, Giovanna and Pala, Valeria and Panico, Salvatore and Ricceri, Fulvio and Verschuren, W. M.Monique and Boer, Jolanda M.A. and van der Schouw, Yvonne T. and Skeie, Guri and Agudo, Antonio and Molina-Montes, Esther and Huerta, José María and Moreno-Iribas, Conchi and Ericson, Ulrika and Sonestedt, Emily and Strid, Anna and Oskarsson, Viktor and Tong, Tammy Y.N. and Heath, Alicia K. and Aglago, Elom K. and Danesh, John and Riboli, Elio and Gunter, Marc J. and Touvier, Mathilde}},
  issn         = {{2666-7762}},
  keywords     = {{Cardiovascular disease risk; Europe; Food labelling; Nutrient profile; Nutrition; Prospective study}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{The Lancet Regional Health - Europe}},
  title        = {{Nutritional quality of diet characterized by the Nutri-Score profiling system and cardiovascular disease risk : a prospective study in 7 European countries}},
  url          = {{http://dx.doi.org/10.1016/j.lanepe.2024.101006}},
  doi          = {{10.1016/j.lanepe.2024.101006}},
  volume       = {{46}},
  year         = {{2024}},
}