Association between an individual dietary index based on the British Food Standard Agency Nutrient Profiling System and asthma symptoms

AbstractThe role of diet in asthma is still debated. In France, a front-of-pack (FOP) nutrition label based on a modified Food Standards Agency Nutrient Profiling System/High Council for Public Health (FSAm-NPS/HCSP) has recently been implemented to help consumers to make healthier food choices during purchase. At the individual level, the FSAm-NPS dietary index (DI) has been shown to reflect the nutritional quality of the diet. The aim of the present study was to investigate the association between the FSAm-NPS DI and the asthma symptom score. In total, 34 323 participants (25 823 women and 8500 men) from the NutriNet-Santé cohort were included. The overall nutritional quality of the diet was assessed using the FSAm-NPS DI. Increasing FSAm-NPS DI reflects decreasing overall diet quality. Asthma was defined by the asthma symptom score (sum of five questions). Negative binomial regression was used to evaluate the association between the FSA-NPS DI and the asthma symptom score. Overall, mean participant’s age was 54 ± 14 years, and about 27 % reported at least one asthma symptom. We observed a significant positive association between less healthy diet, as expressed by higher FSAm-NPS DI, and the asthma symptom score. The adjusted OR were 1·27 (95 % CI 1·17, 1·38) among women and 1·31 (95 % CI 1·13, 1·53) among men. Unhealthy food choices, as reflected by a higher FSAm-NPS DI, were associated with greater asthma symptoms. These results reinforce the relevance of public health approach to orient consumers towards healthier food choices by using a clear and easy-to-understand FOP nutrition label based on the FSAm-NPS, such as the Nutri-Score.

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Associations between dietary scores with asthma symptoms and asthma control in adults

European Respiratory Journal ◽

10.1183/13993003.02572-2017 ◽

2018 ◽

Vol 52 (1) ◽

pp. 1702572 ◽

Cited By ~ 13

Author(s):

Roland M. Andrianasolo ◽

Emmanuelle Kesse-Guyot ◽

Moufidath Adjibade ◽

Serge Hercberg ◽

Pilar Galan ◽

...

Keyword(s):

Asthma Control ◽

Symptom Score ◽

Asthma Symptom ◽

Healthy Eating Index ◽

Negative Association ◽

Asthma Control Test ◽

Asthma Symptoms ◽

Adherence Score ◽

Asthma Symptom Score

Associations between asthma and the nutritional quality of diet remain poorly understood. We investigated the associations between overall quality of diet evaluated by three dietary scores (the Alternate Healthy Eating Index 2010 (AHEI-2010), the literature-based adherence score to Mediterranean diet (MEDI-LITE) and the modified Programme National Nutrition Santé Guideline Score (mPNNS-GS)) and the asthma symptom score and asthma control.In 2017, 34 766 participants from the NutriNet-Santé cohort answered a detailed respiratory questionnaire. Asthma was defined by the asthma symptom score (as the sum of five questions) and asthma control by the asthma control test (ACT).Roughly 25% of participants reported at least one asthma symptom and for the three dietary scores we observed a statistically significant negative association between a healthier diet and the asthma symptom score (for AHEI-2010, the adjusted OR was 0.79 (95% CI 0.75–0.84) for women and 0.67 (95% CI 0.60–0.75) for men). Among participants with asthma (n=2609) we also observed a negative association between a healthier diet and poorly controlled asthma. This was significant in men (OR 0.39 (95% CI 0.18–0.84) for the AHEI-2010) and borderline significant in women (OR 0.73 (95% CI 0.53–1.01) for the AHEI-2010; p=0.06 for trend).Healthier diet behaviours were associated with fewer asthma symptoms and greater asthma control.

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Spontaneous resolution of atopic dermatitis incidental to participation in benralizumab clinical trial for severe, uncontrolled asthma: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02663-2 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

David N. Pham

Keyword(s):

Atopic Dermatitis ◽

Symptom Score ◽

Asthma Symptom ◽

Spontaneous Resolution ◽

Cell Surface Receptor ◽

Food Allergies ◽

Uncontrolled Asthma ◽

Exacerbation Rate ◽

Asthma Symptoms ◽

Asthma Symptom Score

Abstract Background T cell-mediated eosinophilia is associated with numerous conditions—including atopic dermatitis, food allergies, and asthma—collectively known as the “atopic march.” Benralizumab is a recombinant, humanized, afucosylated monoclonal antibody directed against the ⍺ chain of the eosinophil cell surface receptor IL-5R. Benralizumab treatment causes near-complete depletion of circulating eosinophils and was approved in 2017 for add-on, maintenance treatment of severe asthma with an eosinophilic phenotype, based on the results of the CALIMA and SIROCCO pivotal trials. Benralizumab is not currently approved for the treatment of eosinophilic conditions besides asthma; however, during the CALIMA trial, spontaneous resolution of atopic dermatitis was observed in a patient, concurrent with reduction in her asthma symptoms. Case presentation In January 2015, a 14-year-old Asian girl with severe, uncontrolled asthma was enrolled in CALIMA. The patient’s baseline eosinophil blood count was 1200 cells/μL, her pre-bronchodilator forced expiratory volume in 1 second (FEV1) was 1.9 L and FEV1/forced vital capacity (FVC) ratio was 71.4%, and her post-bronchodilator FEV1 was 3.2 L (FEV1/FVC of 115.9%). Her overall baseline asthma symptom score was 3.9 and her asthma exacerbation rate in the prior year was 4. She also displayed a pronounced, pruritic, chronic, inflammatory rash consistent with atopic dermatitis across her face. The investigator was blinded to the patient’s treatment group during treatment; however, her asthma symptoms diminished over the course of the study (FEV1 at 56 weeks, 3.01 L/110.5% (pre) and 3.25 L/119.3% (post); overall asthma symptom score 2.1; one influenza-associated exacerbation). Furthermore, her atopic dermatitis symptoms resolved spontaneously within the first 5 months of the study. After unblinding, the patient was confirmed to have been randomized to an active treatment arm, and her blood eosinophil count had dropped below the limit of detection after the first study dose. Conclusions Given the potential shared mechanisms between eosinophilic asthma and atopic dermatitis, it is plausible that benralizumab-induced eosinopenia factored into the resolution of the patient’s atopic dermatitis. Further clinical studies are warranted to determine whether benralizumab or other drugs targeted against IL-5/IL-5R may be useful in managing multiple conditions associated with eosinophilia.

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Association between dietary fibre intake and asthma (symptoms and control): results from the French national e-cohort NutriNet-Santé

British Journal Of Nutrition ◽

10.1017/s0007114519001843 ◽

2019 ◽

Vol 122 (9) ◽

pp. 1040-1051 ◽

Cited By ~ 1

Author(s):

Roland M. Andrianasolo ◽

Serge Hercberg ◽

Emmanuelle Kesse-Guyot ◽

Nathalie Druesne-Pecollo ◽

Mathilde Touvier ◽

...

Keyword(s):

Asthma Control ◽

Symptom Score ◽

Dietary Fibre ◽

Asthma Symptom ◽

Fibre Intake ◽

Asthma Symptoms ◽

Insoluble Fibre ◽

Dietary Fibre Intake ◽

Total Dietary Fibre ◽

Asthma Symptom Score

AbstractDespite growing evidence suggesting a potential health benefit of high fibre intake for the prevention of chronic inflammatory diseases, studies regarding the role of total dietary fibre intake, types and sources of fibre on asthma are lacking. The present study aimed to investigate the cross-sectional association of dietary fibre intakes and source of fibre with the asthma symptom score and asthma control. A total of 35 380 participants from the NutriNet-Santé cohort were included. Asthma was defined by the asthma symptom score and asthma control by the asthma control test. Fibre intake (g/d) was categorised according to sex-specific quintiles. Multi-adjusted negative binomial regressions were used to evaluate the association between dietary fibre with the asthma symptom score and logistic regressions with asthma control. Participants were aged on average 54 years. After adjustment for confounders, higher intake of total, soluble, insoluble fibres from cereals, fruit and seeds were significantly negatively associated with the asthma symptom score both among women and men; OR for the highest quintile of total dietary fibre compared with the lowest quintile were 0·73 (95 % CI 0·67, 0·79) in women and 0·63 (95 % CI 0·55, 0·73) in men. We also found inverse significant associations between total, soluble and insoluble fibre with uncontrolled asthma; OR for participants in the highest quintile of total dietary fibre was 0·72 (95 % CI 0·55, 0·95) in women and 0·45 (95 % CI 0·26, 0·79) in men. Our results suggested that higher intake of dietary fibre, mostly insoluble fibre and fibre from cereals, was associated with fewer asthma symptoms and greater asthma control.

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Association between nutritional profiles of foods underlying Nutri-Score front-of-pack labels and mortality: EPIC cohort study in 10 European countries

BMJ ◽

10.1136/bmj.m3173 ◽

2020 ◽

pp. m3173 ◽

Cited By ~ 1

Author(s):

Mélanie Deschasaux ◽

Inge Huybrechts ◽

Chantal Julia ◽

Serge Hercberg ◽

Manon Egnell ◽

...

Keyword(s):

Cohort Study ◽

Nutritional Quality ◽

Saturated Fatty Acids ◽

Food Choices ◽

Index Score ◽

European Countries ◽

Dietary Index ◽

Increased Risk ◽

All Cause Mortality

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.

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Nutritional quality of food consumed (graded by the FSAm-NPS / Nutri-Score) and mortality in Europe

European Journal of Public Health ◽

10.1093/eurpub/ckz185.414 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

M Deschasaux ◽

I Huybrechts ◽

N Murphy ◽

C Julia ◽

S Hercberg ◽

...

Keyword(s):

Public Health ◽

Nutritional Quality ◽

Proportional Hazards ◽

Scientific Evidence ◽

Food Products ◽

Food Choices ◽

Cox Proportional Hazards ◽

Quality Of Food ◽

Health Applications

Abstract Background Unhealthy diets are major contributors for non-communicable diseases (NCDs) and related deaths. To help consumers make healthier food choices, political authorities are considering implementing a simple label to reflect the nutritional quality of food products. The Nutri-Score, based on the nutrient profiling system of the Food Standards Agency (FSAm-NPS), was chosen by several countries in Europe (France, Belgium, Spain). Yet, its implementation is only voluntary per EU regulation. Scientific evidence is therefore needed regarding the relevance of the FSAm-NPS at the European level. Hence, our objective is to study how the nutritional quality of foods consumed graded by the FSAm-NPS relates to NCDs-related mortality in European populations. Methods Our prospective analyses included 501,594 adults from the EPIC cohort (1992-2015, median follow-up: 17.2y). Usual food intakes were assessed with standardized country-specific methods. The FSAm-NPS was calculated using the 100g content of each food in energy, sugar, saturated fatty acid, sodium, fibres, proteins, and fruits/vegetables/legumes/nuts. Multi-adjusted Cox proportional hazards models were computed. Results The consumption of foods with a higher FSAm-NPS score (lower nutritional quality) was associated with a higher risk of mortality overall (n = 50,743 events: HRQ5vs.Q1=1.06 [95%CI: 1.02-1.09], P-trend<0.001) and by cancer (n = 21,971 events: HRQ5vs.Q1=1.06 [1.01-1.11], P-trend=0.003), respiratory diseases (n = 2,796 events: HRQ5vs.Q1=1.33 [1.16-1.52], P-trend<0.001) and cardiovascular diseases, although more weakly (n = 12,407 events: HRQ5vs.Q1=1.05 [0.98,1.11], P-trend=0.04). Conclusions In this large multinational European cohort, consuming foods with a higher FSAm-NPS score was associated with higher mortality, supporting the relevance of the FSAm-NPS to grade the nutritional quality of food products for public health applications (e.g, Nutri-Score) to guide the consumers towards healthier food choices. Key messages The consumption of food products with a lower nutritional quality as graded by the FSAm-NPS score was associated with higher mortality in the large multinational European EPIC cohort. This adds support to the relevance of the FSAm-NPS to grade the nutritional quality of foodstuffs for public health applications (e.g. Nutri-Score label) to help consumers make healthier food choices.

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Evaluating the healthiness of chain-restaurant menu items using crowdsourcing: a new method

Public Health Nutrition ◽

10.1017/s1368980016001804 ◽

2016 ◽

Vol 20 (1) ◽

pp. 18-24 ◽

Cited By ~ 3

Author(s):

Lenard I Lesser ◽

Leslie Wu ◽

Timothy B Matthiessen ◽

Harold S Luft

Keyword(s):

Public Health ◽

Nutritional Quality ◽

Large Scale ◽

Registered Dietitian ◽

Food Items ◽

Large Scale Data ◽

Nutrient Profiling ◽

The Cost ◽

Scale Data

AbstractObjectiveTo develop a technology-based method for evaluating the nutritional quality of chain-restaurant menus to increase the efficiency and lower the cost of large-scale data analysis of food items.DesignUsing a Modified Nutrient Profiling Index (MNPI), we assessed chain-restaurant items from the MenuStat database with a process involving three steps: (i) testing ‘extreme’ scores; (ii) crowdsourcing to analyse fruit, nut and vegetable (FNV) amounts; and (iii) analysis of the ambiguous items by a registered dietitian.ResultsIn applying the approach to assess 22 422 foods, only 3566 could not be scored automatically based on MenuStat data and required further evaluation to determine healthiness. Items for which there was low agreement between trusted crowd workers, or where the FNV amount was estimated to be >40 %, were sent to a registered dietitian. Crowdsourcing was able to evaluate 3199, leaving only 367 to be reviewed by the registered dietitian. Overall, 7 % of items were categorized as healthy. The healthiest category was soups (26 % healthy), while desserts were the least healthy (2 % healthy).ConclusionsAn algorithm incorporating crowdsourcing and a dietitian can quickly and efficiently analyse restaurant menus, allowing public health researchers to analyse the healthiness of menu items.

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Prospective association between cancer risk and an individual dietary index based on the British Food Standards Agency Nutrient Profiling System

British Journal Of Nutrition ◽

10.1017/s0007114515003384 ◽

2015 ◽

Vol 114 (10) ◽

pp. 1702-1710 ◽

Cited By ~ 29

Author(s):

Mathilde Donnenfeld ◽

Chantal Julia ◽

Emmanuelle Kesse-Guyot ◽

Caroline Méjean ◽

Pauline Ducrot ◽

...

Keyword(s):

Cancer Risk ◽

Energy Intake ◽

Nutritional Quality ◽

Dietary Index ◽

Nutrient Profiling ◽

Food Standards ◽

Prospective Association ◽

The Individual

AbstractThe Food Standards Agency Nutrient Profiling System (FSA-NPS) constitutes the basis for the Five-Colour Nutrition Label suggested in France to be put on the front-of-pack of food products. At the individual level, a dietary index (FSA-NPS DI) has been derived and validated and corresponds to a weighted mean of all FSA-NPS scores of foods usually consumed by the individual, reflecting the nutritional quality of his/her diet. Our aim was to investigate the association between the FSA-NPS DI and cancer risk in a large cohort. This prospective study included 6435 participants to the SUpplémentation en VItamines et Minéraux AntioXydants cohort (1994–2007) who completed at least six 24 h dietary records during the first 2 years of follow-up. FSA-NPS DI was computed for each subject (higher values representing lower nutritional quality of the diet). After a median follow-up of 12·6 years, 453 incident cancers were diagnosed. Associations were characterised by multivariate Cox proportional hazards models. The FSA-NPS DI was directly associated with overall cancer risk (hazard ratio (HR)for a 1-point increment=1·08 (95 % CI 1·01, 1·15), Ptrend=0·02; HRQ5 v. Q1=1·34 (95 % CI 1·00, 1·81), Ptrend=0·03). This association tended to be more specifically observed in subjects with moderate energy intake (≤median, HRfor a 1-point increment=1·10 (95 % CI 1·01-1·20), Ptrend=0·03). No association was observed in subjects with higher energy intake (Ptrend=0·3). Results were not statistically significant for breast and prostate cancer risks. For the first time, this study investigated the prospective association between the FSA-NPS individual score and cancer risk. The results suggest that unhealthy food choices may be associated with a 34 % increase in overall cancer risk, supporting the public health relevance of developing front-of-pack nutrition labels based on this score.

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Comparison of a Barcode-Based Smartphone Application to a Questionnaire to Assess the Use of Cleaning Products at Home and Their Association with Asthma Symptoms

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18073366 ◽

2021 ◽

Vol 18 (7) ◽

pp. 3366

Author(s):

Pierre Lemire ◽

Sofia Temam ◽

Sarah Lyon-Caen ◽

Catherine Quinot ◽

Etienne Sévin ◽

...

Keyword(s):

Symptom Score ◽

Measurement Errors ◽

Asthma Symptom ◽

Respiratory Health ◽

Smartphone Application ◽

Epidemiological Research ◽

Logistic Regression Models ◽

Asthma Symptoms ◽

Cleaning Products ◽

Asthma Symptom Score

Household disinfectant and cleaning products (HDCPs) assessment is challenging in epidemiological research. We hypothesized that a newly-developed smartphone application was more objective than questionnaires in assessing HDCPs. Therefore, we aimed to compare both methods, in terms of exposure assessments and respiratory health effects estimates. The women of the SEPAGES birth cohort completed repeated validated questionnaires on HDCPs and respiratory health and used an application to report HDCPs and scan products barcodes, subsequently linked with an ingredients database. Agreements between the two methods were assessed by Kappa coefficients. Logistic regression models estimated associations of HDCP with asthma symptom score. The 101 participants (18 with asthma symptom score ≥1) scanned 617 different products (580 with available ingredients list). Slight to fair agreements for sprays, bleach and scented HDCP were observed (Kappa: 0.35, 0.25, 0.11, respectively). Strength of the associations between HDCP and asthma symptom score varied between both methods but all odds ratios (OR) were greater than one. The number of scanned products used weekly was significantly associated with the asthma symptom score (adjusted-OR [CI 95%]: 1.15 [1.00–1.32]). This study shows the importance of using novel tools in epidemiological research to objectively assess HDCP and therefore reduce exposure measurement errors.

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Prospective associations of four nutrient profiles with weigh gain, overweight and obesity risk

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.1285 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

M Egnell ◽

B Neal ◽

C Ni Mhurchu ◽

M Rayner ◽

A Jones ◽

...

Keyword(s):

Weight Gain ◽

Nutritional Quality ◽

Overweight And Obesity ◽

Important Indicator ◽

Nutrient Profiling ◽

Nutrition Policies ◽

Food Standards ◽

Increased Risk ◽

Dietary Indices

Abstract Background Nutrient Profiling Systems (NPSs), including the UK Food Standards Agency NPS and its variants are used to classify foods according to their nutritional composition for nutrition policies. The prospective validity of these NPSs requires however further investigation. The study investigates the associations of the original Food Standards Agency (FSA)-NPS and three variants - the Food Standards Australia New Zealand Nutrient Profiling Scoring Criterion (NPSC), the Health Star Rating (HSR) system NPS and the French NPS (HCSP-NPS) -, which are used as a basis for nutrition policies, with weight status. Methods Dietary indices based on each of the four investigated NPSs applied at the food level were computed at the individual level to characterize the diet quality of 71,178 French individuals from the NutriNet-Santé cohort. Associations of these Dietary Indices (DIs) (as tertiles) with weight gain were assessed using multivariable mixed models, and with overweight and obesity risks using multivariable Cox models. Results For the four NPSs, participants with a lower diet nutritional quality were more likely to have an increase in body mass index over time (median follow-up of 3.14 ± 2.76 years, beta coefficients positive, all p ≤ 0.0001), and an increased risk of overweight (HRT3vs.T1=1.27 [1.17-1.37] for the HCSP-DI, followed by the original FSA-DI with HRT3vs.T1=1.18 [1.09-1.28], the NPSC-DI with HRT3vs.T1=1.14 [1.06-1.24] and the HSR-DI, HRT3vs.T1=1.12 [1.04-1.21]). Whilst differences were small, the HCSP-DI appeared to show significantly greater association with risk of overweight compared to other NPS. Conclusions Less healthy diets defined using the Food Standards Agency-NPS and related systems were all associated with weight gain and overweight risk. Demonstrating this association with health outcomes is an important indicator of one validity dimension of NPSs and supports their use in public policies for the prevention of diet-related chronic diseases. Key messages Nutrient profile models of foods and beverages allow capturing the nutritional quality of diets and are prospectively associated with weight gain and obesity. The French NPS which underpins the front-of-pack Nutri-Score appeared to have a small but significant higher performance.

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