PLoS Medicine (Sep 2018)

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.

  • Mélanie Deschasaux,
  • Inge Huybrechts,
  • Neil Murphy,
  • Chantal Julia,
  • Serge Hercberg,
  • Bernard Srour,
  • Emmanuelle Kesse-Guyot,
  • Paule Latino-Martel,
  • Carine Biessy,
  • Corinne Casagrande,
  • Mazda Jenab,
  • Heather Ward,
  • Elisabete Weiderpass,
  • Christina C Dahm,
  • Kim Overvad,
  • Cecilie Kyrø,
  • Anja Olsen,
  • Aurélie Affret,
  • Marie-Christine Boutron-Ruault,
  • Yahya Mahamat-Saleh,
  • Rudolf Kaaks,
  • Tilman Kühn,
  • Heiner Boeing,
  • Lukas Schwingshackl,
  • Christina Bamia,
  • Eleni Peppa,
  • Antonia Trichopoulou,
  • Giovanna Masala,
  • Vittorio Krogh,
  • Salvatore Panico,
  • Rosario Tumino,
  • Carlotta Sacerdote,
  • Bas Bueno-de-Mesquita,
  • Petra H Peeters,
  • Anette Hjartåker,
  • Charlotta Rylander,
  • Guri Skeie,
  • J Ramón Quirós,
  • Paula Jakszyn,
  • Elena Salamanca-Fernández,
  • José María Huerta,
  • Eva Ardanaz,
  • Pilar Amiano,
  • Ulrika Ericson,
  • Emily Sonestedt,
  • Ena Huseinovic,
  • Ingegerd Johansson,
  • Kay-Tee Khaw,
  • Nick Wareham,
  • Kathryn E Bradbury,
  • Aurora Perez-Cornago,
  • Konstantinos K Tsilidis,
  • Pietro Ferrari,
  • Elio Riboli,
  • Marc J Gunter,
  • Mathilde Touvier

DOI
https://doi.org/10.1371/journal.pmed.1002651
Journal volume & issue
Vol. 15, no. 9
p. e1002651

Abstract

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BackgroundHelping 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 findingsThis 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 ConclusionsIn 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.