@article{3103874,
    title = "Association between nutritional profiles of foods underlying Nutri-Score front-of-pack labels and mortality: EPIC cohort study in 10 European countries",
    author = "Deschasaux, M. and Huybrechts, I. and Julia, C. and Hercberg, S. and Egnell, M. and Srour, B. and Kesse-Guyot, E. and Latino-Martel, P. and Biessy, C. and Casagrande, C. and Murphy, N. and Jenab, M. and Ward, H.A. and Weiderpass, E. and Overvad, K. and Tjønneland, A. and Rostgaard-Hansen, A.L. and Boutron-Ruault, M.-C. and Mancini, F.R. and Mahamat-Saleh, Y. and Kühn, T. and Katzke, V. and Bergmann, M.M. and Schulze, M.B. and Trichopoulou, A. and Karakatsani, A. and Peppa, E. and Masala, G. and Agnoli, C. and De Magistris, M.S. and Tumino, R. and Sacerdote, C. and Boer, J.M.A. and Monique Verschuren, W.M. and Van Der Schouw, Y.T. and Skeie, G. and Braaten, T. and Luisa Redondo, M. and Agudo, A. and Petrova, D. and Colorado-Yohar, S.M. and Barricarte, A. and Amiano, P. and Sonestedt, E. and Ericson, U. and Otten, J. and Sundström, B. and Wareham, N.J. and Forouhi, N.G. and Vineis, P. and Tsilidis, K.K. and Knuppel, A. and Papier, K. and Ferrari, P. and Riboli, E. and Gunter, M.J. and Touvier, M.",
    journal = "The BMJ",
    year = "2020",
    volume = "370",
    publisher = "BMJ Publishing Group",
    issn = "2057-0066",
    doi = "10.1136/bmj.m3173",
    keywords = "adult;  aged;  all cause mortality;  Article;  cohort analysis;  dietary intake;  European;  female;  follow up;  food industry;  food intake;  food packaging;  food standard;  hazard ratio;  human;  major clinical study;  male;  mortality;  mortality rate;  mortality risk;  nutrient profiling;  nutrition labeling;  nutritional assessment;  nutritional value;  outcome assessment;  priority journal;  Europe;  food preference;  middle aged;  nutritional value;  proportional hazards model;  questionnaire, Adult;  Cohort Studies;  Europe;  Female;  Food Labeling;  Food Preferences;  Humans;  Male;  Middle Aged;  Mortality;  Nutrition Assessment;  Nutritive Value;  Proportional Hazards Models;  Surveys and Questionnaires",
    abstract = "Objective To determine if the Food Standards Agency nutrient profiling system (FSAm-NPS), which grades the nutritional quality of food products and is used to derive the Nutri-Score front-of-packet label to guide consumers towards healthier food choices, is associated with mortality. Design Population based cohort study. Setting European Prospective Investigation into Cancer and Nutrition (EPIC) cohort from 23 centres in 10 European countries. Participants 521 324 adults; at recruitment, country specific and validated dietary questionnaires were used to assess their usual dietary intakes. A FSAm-NPS score was calculated for each food item per 100 g content of energy, sugars, saturated fatty acids, sodium, fibre, and protein, and of fruit, vegetables, legumes, and nuts. The FSAm-NPS dietary index was calculated for each participant as an energy weighted mean of the FSAm-NPS score of all foods consumed. The higher the score the lower the overall nutritional quality of the diet. Main outcome measure Associations between the FSAm-NPS dietary index score and mortality, assessed using multivariable adjusted Cox proportional hazards regression models. Results After exclusions, 501 594 adults (median follow-up 17.2 years, 8 162 730 person years) were included in the analyses. Those with a higher FSAm-NPS dietary index score (highest versus lowest fifth) showed an increased risk of all cause mortality (n=53 112 events from non-external causes; hazard ratio 1.07, 95% confidence interval 1.03 to 1.10, P<0.001 for trend) and mortality from cancer (1.08, 1.03 to 1.13, P<0.001 for trend) and diseases of the circulatory (1.04, 0.98 to 1.11, P=0.06 for trend), respiratory (1.39, 1.22 to 1.59, P<0.001), and digestive (1.22, 1.02 to 1.45, P=0.03 for trend) systems. The age standardised absolute rates for all cause mortality per 10 000 persons over 10 years were 760 (men=1237; women=563) for those in the highest fifth of the FSAm-NPS dietary index score and 661 (men=1008; women=518) for those in the lowest fifth. Conclusions In this large multinational European cohort, consuming foods with a higher FSAm-NPS score (lower nutritional quality) was associated with a higher mortality for all causes and for cancer and diseases of the circulatory, respiratory, and digestive systems, supporting the relevance of FSAm-NPS to characterise healthier food choices in the context of public health policies (eg, the Nutri-Score) for European populations. This is important considering ongoing discussions about the potential implementation of a unique nutrition labelling system at the European Union level. © 2019 Author(s) (or their employer(s)). Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ."
}