Prospective associations between the nutritional quality of foods consumed (graded by the FSAm-NPS underlying the Nutri-Score) and mortality in Europe

AbstractIn 2017, 11 million deaths related to non-communicable diseases (NCDs) were attributable to dietary risk factors (GBD, 2019). Helping consumers make healthier food choices hence appears as one key strategy to prevent NCDs-related mortality. To this end, political authorities are considering implementing a simple label to reflect the nutritional quality of food products. The five-colour Nutri-Score label, derived from the Nutrient Profiling System of the British Food Standards Agency (FSAm-NPS), has been chosen by several countries in Europe (France, Belgium, Spain). Yet, its implementation is still voluntary per EU labelling regulation. Scientific evidence is therefore needed regarding the relevance of the FSAm-NPS at the European level. Following on our results showing an increased risk of cancer related to the consumption of foods with a high FSAm-NPS score in the EPIC cohort, our objective is now to focus on NCDs-related mortality. Our prospective analyses included 501,594 adults from the EPIC cohort (1992–2015, median follow-up: 17.2 years). Mortality events occurring < 2 years after recruitment were excluded, leaving 50,743 death events (main causes: cancer, n = 21,971; cerebro/cardiovascular diseases, n = 12,407; respiratory diseases, n = 2,796). 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 individual FSAm-NPS Dietary Index (DI) is obtained as an energy-weighted mean of the FSAm-NPS scores of all food items usually consumed by a participant. Cox proportional hazards models adjusted for confounding factors, including personal history of cancer, cardiovascular diseases and diabetes were computed. Fine and Gray models were also tested to take into account competing events for cause-specific mortality analyses. A higher FSAm-NPS DI score, reflecting a lower nutritional quality of the diet, was associated with a higher mortality risk overall (HRQ5vs.Q1 = 1.06 [95%CI: 1.02–1.09], P-trend < 0.001) and by cancer (HRQ5vs.Q1 = 1.06 [1.01–1.11], P-trend = 0.003) and respiratory diseases (HRQ5vs.Q1 = 1.33 [1.16–1.52], P-trend < 0.001), with similar results in competing events analyses. Associations with cerebro-/cardiovascular diseases mortality were weaker (HRQ5vs.Q1 = 1.05 [0.98,1.11], P-trend = 0.04) and no longer statistically significant in competing events analyses. In this large multinational European cohort, the consumption of food products with a higher FSAm-NPS score (lower nutritional quality of the foods consumed) was associated with a higher mortality risk, supporting the relevance of the FSAm-NPS to grade the nutritional quality of food products for public health applications (e.g, Nutri-Score) aiming to guide the consumers towards healthier food choices.

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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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Nutritional quality of biscuits, breakfast cereals and sweet snacks sold in Italy: the Food Labelling of Italian Products (FLIP) study

Proceedings of The Nutrition Society ◽

10.1017/s0029665120005194 ◽

2020 ◽

Vol 79 (OCE2) ◽

Author(s):

Donato Angelino ◽

Alice Rosi ◽

Margherita Dall'Asta ◽

Nicoletta Pellegrini ◽

Daniela Martini

Keyword(s):

Nutritional Quality ◽

Principal Component ◽

Product Category ◽

Food Products ◽

Food Labelling ◽

Breakfast Cereals ◽

Nutrient Contents ◽

Italian Market ◽

Quality Of Food

AbstractIn Europe, the label information on food is regulated by the Reg. (EU) n.1169/2011 but many other regulated declarations (e.g. nutrition or heath claims (NHC), presence of gluten) can be provided on the pack. All this information could influence the perception of food quality and thus the consumers’ intention-to-buy. However, whether the nutritional quality of food products is comparable among products with different characteristics (e.g. presence/absence of NHC, gluten free (GF) declaration, brand) has been barely studied.Based on these premises, the Food Labelling of Italian Products (FLIP) Study aims to systematically investigate the overall nutritional quality of the main food categories sold on the Italian market. The present work focused on sweet cereal-based products (biscuits, breakfast cereals, and sweet snacks).Products were selected from the website of thirteen retailers present on the Italian market and data were collected from the complete images of all the sides of the pack. Then, biscuits, breakfast cereals, and sweet snacks were further sub-grouped for specific comparisons considering i) descriptive name reported, ii) presence/absence of GF declaration, iii) presence/absence of NHC declaration, iv) brand/own label. Data of energy, nutrient and salt contents per 100 grams of product for each product category were considered and comparisons among the sub-groups were performed (Mann Whitney test or Kruskal Wallis one-way ANOVA based on two or multiple independent samples, respectively) (ver. 25.0, SPSS Inc., Chicago, IL, USA). In addition, a Principal Component Analysis was performed for all products and for each product sub-category by considering energy and nutrient contents per 100 grams of product to better describe the inter-product nutritional variability.A total of 814 biscuits, 371 breakfast cereals and 476 sweet snacks were included. Limited differences were found between branded and own label products and between GF and gluten-containing products. Conversely, interesting differences were observed between products with and without NHC. For instance, biscuits with nutrition claims resulted with an overall lower content of total energy, total fats and sugars compared to product without these claims, in agreement with previous investigations. Finally, a high inter-product variability was observed among the different sub-categories for the three product categories.Future researches performed within the FLIP study will allow to have a clearer picture about the nutritional quality of food products sold in Italy and to understand if specific food characteristics might be considered as a “marker” of the overall quality of food products

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A Comparison of the Nutritional Quality of Food Products Advertised in Grocery Store Circulars of High- versus Low-Income New York City Zip Codes

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph110100537 ◽

2013 ◽

Vol 11 (1) ◽

pp. 537-547 ◽

Cited By ~ 9

Author(s):

Danna Ethan ◽

Corey Basch ◽

Sonali Rajan ◽

Lalitha Samuel ◽

Rodney Hammond

Keyword(s):

New York ◽

New York City ◽

Low Income ◽

York City ◽

Nutritional Quality ◽

Food Products ◽

Grocery Store ◽

Quality Of Food

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Online Consumer Survey Comparing Different Front-of-Pack Labels in Greece

Nutrients ◽

10.3390/nu14010046 ◽

2021 ◽

Vol 14 (1) ◽

pp. 46

Author(s):

Lamprini Kontopoulou ◽

George Karpetas ◽

Εvangelos C. Fradelos ◽

Ioanna V. Papathanasiou ◽

Foteini Malli ◽

...

Keyword(s):

Nutritional Quality ◽

Online Survey ◽

Multinomial Logistic Regression ◽

Food Choices ◽

Nutrition Labeling ◽

Nutrition Labels ◽

Logistic Regression Models ◽

Traffic Lights ◽

Quality Of Food

According to the WHO, front-of-pack nutrition labeling provides simplified nutrition information in the form of symbols, colors or words that can help consumers understand the nutritional quality of food, thus leading them to healthier food choices. It is considered of the utmost importance to explore the knowledge and understanding of consumers about this form of nutrition labeling. The aim of this study was to investigate the understanding and perceptions of Greek consumers in response to five different front-of-pack nutrition labels (FoPLs): the Multiple Traffic Lights, Health Star Rating System, Guideline Daily Amounts, Warning Symbols and Nutri-Score. From April 2021 to June 2021, 1278 participants from Greece took part in an online survey where they were asked to rank three products according to their nutritional quality. The classification process was performed first without FoPLs and then with FoPLs. The ability to classify products according to their nutritional quality was evaluated with multinomial logistic regression models, and the Nutri-Score label presented greater improvements when compared to the GDA label for Greek consumers. The Nutri-Score seemed to better help the Greek consumers rank foods according to their nutritional value.

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Objective understanding of the front-of-pack nutrition label Nutri-Score by European consumers

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.902 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

M Egnell ◽

Z Talati ◽

P Galan ◽

V Andreeva ◽

S Vandevijvere ◽

...

Keyword(s):

Nutritional Quality ◽

Food Choices ◽

Nutrition Labels ◽

Logistic Regression Models ◽

Traffic Lights ◽

Nutrition Labelling ◽

Food Packages ◽

Objective Understanding ◽

Quality Of Food

Abstract Background The effectiveness of Front-of-Pack nutrition Labels (FoPL) may be influenced by national context. In light of the ongoing efforts to harmonize nutrition labelling across Europe, the study aimed to compare the effectiveness of five FoPLs (Health Star Rating system [HSR], Multiple Traffic Lights [MTL], Nutri-Score, Reference Intakes [RIs], Warning symbol) in 12 European consumers. Methods In 2018-2019, for three food categories, approximately 1,000 participants per country were asked to select which food they would prefer to purchase between three products with distinct nutritional quality, and then to rank the products nutritional quality. Participants completed these tasks first with no FoPL and then, after randomization to one of the five FoPLs, with a FoPL on food packages. Associations between FoPLs and change in (i) nutritional quality of food choices, and (ii) ability to correctly rank the products nutritional quality were assessed with multivariable logistic regression models. Results Compared with the RIs, the Nutri-Score (OR = 3·23[2·75-3·81]; p < 0.0001), followed by the MTL (OR = 1·68[1·42-1·98]; p < 0.0001), was the most effective FoPL in helping participants identify the foods nutritional quality, overall and in each of the 12 countries. Differences between FoPLs regarding food choice modifications were smaller, but the effect of the Nutri-Score was slightly higher in eliciting healthier food choices overall compared with the RIs, followed by the Warning symbol, MTL and HSR. Conclusions These findings from an online experiment provide insights on the Nutri-Score's effectiveness in multiple European countries in the context of FoPL harmonization in Europe. Key messages The comparison of the effectiveness of front-of-pack labels highlighted the relative performance of various types of labels, the Nutri-Score showing a higher performance than other schemes. The higher performance of the Nutri-Score was identified for objective understanding and to a lesser extent food choices.

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