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