The Lancet Regional Health. Europe (Nov 2024)
Nutritional quality of diet characterized by the Nutri-Score profiling system and cardiovascular disease risk: a prospective study in 7 European countriesResearch in context
- 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 Petersen,
- Verena 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
Affiliations
- Mélanie Deschasaux-Tanguy
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center for Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017, Bobigny, France; Corresponding author.
- Inge Huybrechts
- International Agency for Research on Cancer, World Health Organization, Lyon, France
- Chantal Julia
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center for Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017, Bobigny, France; Department of Public Health, Hôpitaux Universitaires Paris Seine-Saint-Denis (AP-HP), Bobigny, France
- Serge Hercberg
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center for Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017, Bobigny, France; Department of Public Health, Hôpitaux Universitaires Paris Seine-Saint-Denis (AP-HP), Bobigny, France
- Barthélémy Sarda
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center for Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017, Bobigny, France
- Morgane Fialon
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center for Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017, Bobigny, France
- Nathalie Arnault
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center for Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017, Bobigny, France
- Bernard Srour
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center for Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017, Bobigny, France
- Emmanuelle Kesse-Guyot
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center for Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017, Bobigny, France
- Léopold K. Fezeu
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center for Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017, Bobigny, France
- Carine Biessy
- International Agency for Research on Cancer, World Health Organization, Lyon, France
- Corinne Casagrande
- International Agency for Research on Cancer, World Health Organization, Lyon, France
- Bertrand Hemon
- International Agency for Research on Cancer, World Health Organization, Lyon, France
- Elisabete Weiderpass
- International Agency for Research on Cancer, World Health Organization, Lyon, France
- Maria G.M. Pinho
- International Agency for Research on Cancer, World Health Organization, Lyon, France; Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, Amsterdam, Netherlands; Amsterdam Public Health, Health Behaviors and Chronic Diseases, Amsterdam, Netherlands
- Neil Murphy
- International Agency for Research on Cancer, World Health Organization, Lyon, France
- Heinz Freisling
- International Agency for Research on Cancer, World Health Organization, Lyon, France
- Pietro Ferrari
- International Agency for Research on Cancer, World Health Organization, Lyon, France
- Anne Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Kristina Elin Nielsen Petersen
- Danish Cancer Society Research Center, Copenhagen, Denmark
- Verena Katzke
- Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Rudolf Kaaks
- Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Matthias B. Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany
- Giovanna Masala
- Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
- Valeria Pala
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
- Salvatore Panico
- School of Medicine, Federico II University, Naples, Italy
- Fulvio Ricceri
- Centre for Biostatistics, Epidemiology, and Public Health, Department of Clinical and Biological Sciences, University of Turin, Italy; Unit of Epidemiology, Regional Health Service ASL TO3, Grugliasco, Turion, Italy
- W.M.Monique Verschuren
- Department Life Course and Health, Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- Jolanda M.A. Boer
- Department Life Course and Health, Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- Yvonne T. van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Guri Skeie
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø (UiT) - The Arctic University of Norway, Tromsø, Norway
- Antonio Agudo
- Unit of Nutrition and Cancer, Catalan Institute of Oncology - ICO, L'Hospitalet de Llobregat, Spain; Nutrition and Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Bellvitge Biomedical Research Institute - IDIBELL, L'Hospitalet de Llobregat, Spain
- Esther Molina-Montes
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Nutrition and Food Science, Campus of Cartuja, University of Granada, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Institute of Nutrition and Food Technology (INYTA) ‘José Mataix’, Biomedical Research Centre, University of Granada, Granada, Spain
- José María Huerta
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain
- Conchi Moreno-Iribas
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; Navarra Public Health Institute, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
- Ulrika Ericson
- Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Emily Sonestedt
- Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Anna Strid
- Department of Internal Medicine and Clinical Nutrition, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Viktor Oskarsson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Tammy Y.N. Tong
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Alicia K. Heath
- School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
- Elom K. Aglago
- School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
- John Danesh
- Department of Public Health and Primary Care, University of Cambridge, United Kingdom
- Elio Riboli
- School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
- Marc J. Gunter
- International Agency for Research on Cancer, World Health Organization, Lyon, France
- Mathilde Touvier
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center for Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017, Bobigny, France
- Journal volume & issue
-
Vol. 46
p. 101006
Abstract
Summary: 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.