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

Journal volume & issue
Vol. 46
p. 101006

Abstract

Read online

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.

Keywords