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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.
PLoS Med. 2018 09; 15(9):e1002651.PM

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 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.

Authors+Show Affiliations

Nutritional Epidemiology Research Team (EREN), Sorbonne Paris Cité Epidemiology and Statistics Research Centre (CRESS), Inserm U1153, Inra U1125, Cnam, COMUE Sorbonne Paris Cité, Paris 13 University, Bobigny, France.Nutrition and Metabolism Section, International Agency for Research on Cancer, World Health Organization, Lyon, France.Nutrition and Metabolism Section, International Agency for Research on Cancer, World Health Organization, Lyon, France.Nutritional Epidemiology Research Team (EREN), Sorbonne Paris Cité Epidemiology and Statistics Research Centre (CRESS), Inserm U1153, Inra U1125, Cnam, COMUE Sorbonne Paris Cité, Paris 13 University, Bobigny, France. Department of Public Health, Avicenne Hospital (AP-HP), Bobigny, France.Nutritional Epidemiology Research Team (EREN), Sorbonne Paris Cité Epidemiology and Statistics Research Centre (CRESS), Inserm U1153, Inra U1125, Cnam, COMUE Sorbonne Paris Cité, Paris 13 University, Bobigny, France. Department of Public Health, Avicenne Hospital (AP-HP), Bobigny, France.Nutritional Epidemiology Research Team (EREN), Sorbonne Paris Cité Epidemiology and Statistics Research Centre (CRESS), Inserm U1153, Inra U1125, Cnam, COMUE Sorbonne Paris Cité, Paris 13 University, Bobigny, France.Nutritional Epidemiology Research Team (EREN), Sorbonne Paris Cité Epidemiology and Statistics Research Centre (CRESS), Inserm U1153, Inra U1125, Cnam, COMUE Sorbonne Paris Cité, Paris 13 University, Bobigny, France.Nutritional Epidemiology Research Team (EREN), Sorbonne Paris Cité Epidemiology and Statistics Research Centre (CRESS), Inserm U1153, Inra U1125, Cnam, COMUE Sorbonne Paris Cité, Paris 13 University, Bobigny, France.Nutrition and Metabolism Section, International Agency for Research on Cancer, World Health Organization, Lyon, France.Nutrition and Metabolism Section, International Agency for Research on Cancer, World Health Organization, Lyon, France.Nutrition and Metabolism Section, International Agency for Research on Cancer, World Health Organization, Lyon, France.Faculty of Medicine, School of Public Health, Imperial College London, London, United Kingdom.Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway. Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. Genetic Epidemiology Group, Folkhälsan Research Centre and Faculty of Medicine, University of Helsinki, Helsinki, Finland.Aarhus University, Department of Public Health, Section for Epidemiology, Aarhus C, Denmark.Aarhus University, Department of Public Health, Section for Epidemiology, Aarhus C, Denmark.Danish Cancer Society Research Center, Copenhagen, Denmark.Danish Cancer Society Research Center, Copenhagen, Denmark.CESP, INSERM U1018, Univ. Paris-Sud, UVSQ, Université Paris-Saclay, Paris, France. Gustave Roussy, Villejuif, France.CESP, INSERM U1018, Univ. Paris-Sud, UVSQ, Université Paris-Saclay, Paris, France. Gustave Roussy, Villejuif, France.CESP, INSERM U1018, Univ. Paris-Sud, UVSQ, Université Paris-Saclay, Paris, France. Gustave Roussy, Villejuif, France.Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.Department of Epidemiology, German Institute of Human Nutrition (DIfE), Potsdam-Rehbrücke, Germany.Department of Epidemiology, German Institute of Human Nutrition (DIfE), Potsdam-Rehbrücke, Germany.Hellenic Health Foundation, Athens, Greece. WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Dept. of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.Hellenic Health Foundation, Athens, Greece.Hellenic Health Foundation, Athens, Greece. WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Dept. of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.Cancer Risk Factors and Life-Style Epidemiology Unit, Cancer Research and Prevention Institute-ISPO, Florence, Italy.Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy.Cancer registry and histopathology unit, "CIVIC-M.P. AREZZO" Hospital, ASP Ragusa, Italy.Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Turin, Italy.Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands. Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands. Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, United Kingdom. Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.Public Health Directorate, Asturias, Spain.Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, L´Hospitallet de Llobregat, Barcelona, Spain. Facultat de Ciències de la Salut Blanquerna, Universitat Ramón Llull, Barcelona, Spain.Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain. CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain.CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. Navarra Public Health Institute, Pamplona, Spain. IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. Public Health Department of Gipuzkoa, Basque Government, San Sebastian, Spain.Diabetes and Cardiovascular disease, Genetic Epidemiology, Department of Clinical Sciences, Lund University, Malmö, Sweden.Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.Department of Internal Medicine and Clinical Nutrition, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.Department of Odontology, Umea University, Umea, Sweden.University of Cambridge, School of Clinical Medicine, Addenbrooke's Hospital, Cambridge, United Kingdom.MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom.Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, United Kingdom. Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece.Nutrition and Metabolism Section, International Agency for Research on Cancer, World Health Organization, Lyon, France.Faculty of Medicine, School of Public Health, Imperial College London, London, United Kingdom.Nutrition and Metabolism Section, International Agency for Research on Cancer, World Health Organization, Lyon, France.Nutritional Epidemiology Research Team (EREN), Sorbonne Paris Cité Epidemiology and Statistics Research Centre (CRESS), Inserm U1153, Inra U1125, Cnam, COMUE Sorbonne Paris Cité, Paris 13 University, Bobigny, France.

Pub Type(s)

Journal Article
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30226842

Citation

Deschasaux, Mélanie, et al. "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." PLoS Medicine, vol. 15, no. 9, 2018, pp. e1002651.
Deschasaux M, Huybrechts I, Murphy N, et al. 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. PLoS Med. 2018;15(9):e1002651.
Deschasaux, M., Huybrechts, I., Murphy, N., Julia, C., Hercberg, S., Srour, B., Kesse-Guyot, E., Latino-Martel, P., Biessy, C., Casagrande, C., Jenab, M., Ward, H., Weiderpass, E., Dahm, C. C., Overvad, K., Kyrø, C., Olsen, A., Affret, A., Boutron-Ruault, M. C., ... Touvier, M. (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. PLoS Medicine, 15(9), e1002651. https://doi.org/10.1371/journal.pmed.1002651
Deschasaux M, et al. 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. PLoS Med. 2018;15(9):e1002651. PubMed PMID: 30226842.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Deschasaux,Mélanie, AU - Huybrechts,Inge, AU - Murphy,Neil, AU - Julia,Chantal, AU - Hercberg,Serge, AU - Srour,Bernard, AU - Kesse-Guyot,Emmanuelle, AU - Latino-Martel,Paule, AU - Biessy,Carine, AU - Casagrande,Corinne, AU - Jenab,Mazda, AU - Ward,Heather, AU - Weiderpass,Elisabete, AU - Dahm,Christina C, AU - Overvad,Kim, AU - Kyrø,Cecilie, AU - Olsen,Anja, AU - Affret,Aurélie, AU - Boutron-Ruault,Marie-Christine, AU - Mahamat-Saleh,Yahya, AU - Kaaks,Rudolf, AU - Kühn,Tilman, AU - Boeing,Heiner, AU - Schwingshackl,Lukas, AU - Bamia,Christina, AU - Peppa,Eleni, AU - Trichopoulou,Antonia, AU - Masala,Giovanna, AU - Krogh,Vittorio, AU - Panico,Salvatore, AU - Tumino,Rosario, AU - Sacerdote,Carlotta, AU - Bueno-de-Mesquita,Bas, AU - Peeters,Petra H, AU - Hjartåker,Anette, AU - Rylander,Charlotta, AU - Skeie,Guri, AU - Ramón Quirós,J, AU - Jakszyn,Paula, AU - Salamanca-Fernández,Elena, AU - Huerta,José María, AU - Ardanaz,Eva, AU - Amiano,Pilar, AU - Ericson,Ulrika, AU - Sonestedt,Emily, AU - Huseinovic,Ena, AU - Johansson,Ingegerd, AU - Khaw,Kay-Tee, AU - Wareham,Nick, AU - Bradbury,Kathryn E, AU - Perez-Cornago,Aurora, AU - Tsilidis,Konstantinos K, AU - Ferrari,Pietro, AU - Riboli,Elio, AU - Gunter,Marc J, AU - Touvier,Mathilde, Y1 - 2018/09/18/ PY - 2018/04/13/received PY - 2018/08/09/accepted PY - 2018/9/19/entrez PY - 2018/9/19/pubmed PY - 2019/4/10/medline SP - e1002651 EP - e1002651 JF - PLoS medicine JO - PLoS Med. VL - 15 IS - 9 N2 - 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. SN - 1549-1676 UR - https://www.unboundmedicine.com/medline/citation/30226842/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_ L2 - http://dx.plos.org/10.1371/journal.pmed.1002651 DB - PRIME DP - Unbound Medicine ER -