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Nutritional quality of food as represented by the FSAm-NPS nutrient profiling system underlying the Nutri-Score label and cancer risk in Europe : Results from the EPIC prospective cohort study

Deschasaux, Mélanie; Huybrechts, Inge; Murphy, Neil; Julia, Chantal; Hercberg, Serge; Srour, Bernard; Kesse-Guyot, Emmanuelle; Latino-Martel, Paule; Biessy, Carine and Casagrande, Corinne, et al. (2018) In PLoS Medicine 15(9).
Abstract

Background: Helping consumers make healthier food choices is a key issue for the prevention of cancer and other diseases. In many countries, political authorities are considering the implementation of a simplified labelling system to reflect the nutritional quality of food products. The Nutri-Score, a five-colour nutrition label, is derived from the Nutrient Profiling System of the British Food Standards Agency (modified version) (FSAm-NPS). How the consumption of foods with high/low FSAm-NPS relates to cancer risk has been studied in national/regional cohorts but has not been characterized in diverse European populations. Methods and findings: This prospective analysis included 471,495 adults from the European Prospective Investigation... (More)

Background: Helping consumers make healthier food choices is a key issue for the prevention of cancer and other diseases. In many countries, political authorities are considering the implementation of a simplified labelling system to reflect the nutritional quality of food products. The Nutri-Score, a five-colour nutrition label, is derived from the Nutrient Profiling System of the British Food Standards Agency (modified version) (FSAm-NPS). How the consumption of foods with high/low FSAm-NPS relates to cancer risk has been studied in national/regional cohorts but has not been characterized in diverse European populations. Methods and findings: This prospective analysis included 471,495 adults from the European Prospective Investigation into Cancer and Nutrition (EPIC, 1992–2014, median follow-up: 15.3 y), among whom there were 49,794 incident cancer cases (main locations: breast, n = 12,063; prostate, n = 6,745; colon-rectum, n = 5,806). Usual food intakes were assessed with standardized country-specific diet assessment methods. The FSAm-NPS was calculated for each food/beverage using their 100-g content in energy, sugar, saturated fatty acid, sodium, fibres, proteins, and fruits/vegetables/legumes/nuts. The FSAm-NPS scores of all food items usually consumed by a participant were averaged to obtain the individual FSAm-NPS Dietary Index (DI) scores. Multi-adjusted Cox proportional hazards models were computed. A higher FSAm-NPS DI score, reflecting a lower nutritional quality of the food consumed, was associated with a higher risk of total cancer (HRQ5 versus Q1 = 1.07; 95% CI 1.03–1.10, P-trend < 0.001). Absolute cancer rates in those with high and low (quintiles 5 and 1) FSAm-NPS DI scores were 81.4 and 69.5 cases/10,000 person-years, respectively. Higher FSAm-NPS DI scores were specifically associated with higher risks of cancers of the colon-rectum, upper aerodigestive tract and stomach, lung for men, and liver and postmenopausal breast for women (all P < 0.05). The main study limitation is that it was based on an observational cohort using self-reported dietary data obtained through a single baseline food frequency questionnaire; thus, exposure misclassification and residual confounding cannot be ruled out. Conclusions: In this large multinational European cohort, the consumption of food products with a higher FSAm-NPS score (lower nutritional quality) was associated with a higher risk of cancer. This supports the relevance of the FSAm-NPS as underlying nutrient profiling system for front-of-pack nutrition labels, as well as for other public health nutritional measures.

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PLoS Medicine
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1549-1277
DOI
10.1371/journal.pmed.1002651
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English
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@article{d5abfdd9-6b43-4384-a36a-ac2f8b7c93a5,
  abstract     = {<p>Background: Helping consumers make healthier food choices is a key issue for the prevention of cancer and other diseases. In many countries, political authorities are considering the implementation of a simplified labelling system to reflect the nutritional quality of food products. The Nutri-Score, a five-colour nutrition label, is derived from the Nutrient Profiling System of the British Food Standards Agency (modified version) (FSAm-NPS). How the consumption of foods with high/low FSAm-NPS relates to cancer risk has been studied in national/regional cohorts but has not been characterized in diverse European populations. Methods and findings: This prospective analysis included 471,495 adults from the European Prospective Investigation into Cancer and Nutrition (EPIC, 1992–2014, median follow-up: 15.3 y), among whom there were 49,794 incident cancer cases (main locations: breast, n = 12,063; prostate, n = 6,745; colon-rectum, n = 5,806). Usual food intakes were assessed with standardized country-specific diet assessment methods. The FSAm-NPS was calculated for each food/beverage using their 100-g content in energy, sugar, saturated fatty acid, sodium, fibres, proteins, and fruits/vegetables/legumes/nuts. The FSAm-NPS scores of all food items usually consumed by a participant were averaged to obtain the individual FSAm-NPS Dietary Index (DI) scores. Multi-adjusted Cox proportional hazards models were computed. A higher FSAm-NPS DI score, reflecting a lower nutritional quality of the food consumed, was associated with a higher risk of total cancer (HR<sub>Q5</sub> versus <sub>Q1</sub> = 1.07; 95% CI 1.03–1.10, P-trend &lt; 0.001). Absolute cancer rates in those with high and low (quintiles 5 and 1) FSAm-NPS DI scores were 81.4 and 69.5 cases/10,000 person-years, respectively. Higher FSAm-NPS DI scores were specifically associated with higher risks of cancers of the colon-rectum, upper aerodigestive tract and stomach, lung for men, and liver and postmenopausal breast for women (all P &lt; 0.05). The main study limitation is that it was based on an observational cohort using self-reported dietary data obtained through a single baseline food frequency questionnaire; thus, exposure misclassification and residual confounding cannot be ruled out. Conclusions: In this large multinational European cohort, the consumption of food products with a higher FSAm-NPS score (lower nutritional quality) was associated with a higher risk of cancer. This supports the relevance of the FSAm-NPS as underlying nutrient profiling system for front-of-pack nutrition labels, as well as for other public health nutritional measures.</p>},
  articleno    = {e1002651},
  author       = {Deschasaux, Mélanie and Huybrechts, Inge and Murphy, Neil and Julia, Chantal and Hercberg, Serge and Srour, Bernard and Kesse-Guyot, Emmanuelle and Latino-Martel, Paule and Biessy, Carine and Casagrande, Corinne and Jenab, Mazda and Ward, Heather and Weiderpass, Elisabete and Dahm, Christina C. and Overvad, Kim and Kyrø, Cecilie and Olsen, Anja and Affret, Aurélie and Boutron-Ruault, Marie Christine and Mahamat-Saleh, Yahya and Kaaks, Rudolf and Kühn, Tilman and Boeing, Heiner and Schwingshackl, Lukas and Bamia, Christina and Peppa, Eleni and Trichopoulou, Antonia and Masala, Giovanna and Krogh, Vittorio and Panico, Salvatore and Tumino, Rosario and Sacerdote, Carlotta and Bueno-de-Mesquita, Bas and Peeters, Petra H. and Hjartåker, Anette and Rylander, Charlotta and Skeie, Guri and Ramón Quirós, J. and Jakszyn, Paula and Salamanca-Fernández, Elena and Huerta, José María and Ardanaz, Eva and Amiano, Pilar and Ericson, Ulrika and Sonestedt, Emily and Huseinovic, Ena and Johansson, Ingegerd and Khaw, Kay Tee and Wareham, Nick and Bradbury, Kathryn E. and Perez-Cornago, Aurora and Tsilidis, Konstantinos K. and Ferrari, Pietro and Riboli, Elio and Gunter, Marc J. and Touvier, Mathilde},
  issn         = {1549-1277},
  language     = {eng},
  number       = {9},
  publisher    = {Public Library of Science},
  series       = {PLoS Medicine},
  title        = {Nutritional quality of food as represented by the FSAm-NPS nutrient profiling system underlying the Nutri-Score label and cancer risk in Europe : Results from the EPIC prospective cohort study},
  url          = {http://dx.doi.org/10.1371/journal.pmed.1002651},
  volume       = {15},
  year         = {2018},
}