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

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

British Journal Of Nutrition ◽

10.1017/s0007114519000655 ◽

2019 ◽

Vol 122 (1) ◽

pp. 63-70 ◽

Cited By ~ 2

Author(s):

Roland M. Andrianasolo ◽

Chantal Julia ◽

Raphaëlle Varraso ◽

Manon Egnell ◽

Mathilde Touvier ◽

...

Keyword(s):

Public Health ◽

Symptom Score ◽

Nutritional Quality ◽

Asthma Symptom ◽

Food Choices ◽

Asthma Symptoms ◽

Dietary Index ◽

Nutrient Profiling ◽

Asthma Symptom Score

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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Body mass index and risk of all-cause mortality in normotensive and hypertensive adults: The Rural Chinese Cohort Study

Public Health Nutrition ◽

10.1017/s1368980021001592 ◽

2021 ◽

pp. 1-25

Author(s):

Qionggui Zhou ◽

Xuejiao Liu ◽

Yang Zhao ◽

Pei Qin ◽

Yongcheng Ren ◽

...

Keyword(s):

Cohort Study ◽

Population Based ◽

Normal Weight ◽

Sensitivity Analyses ◽

Hypertension Status ◽

Moderation Effect ◽

Increased Risk ◽

All Cause Mortality ◽

Chinese Cohort ◽

The Impact

Abstract Objective: The impact of baseline hypertension status on the BMI–mortality association is still unclear. We aimed to examine the moderation effect of hypertension on the BMI–mortality association using a rural Chinese cohort. Design: In this cohort study, we investigated the incident of mortality according to different BMI categories by hypertension status. Setting: Longitudinal population-based cohort Participants: 17,262 adults ≥18 years were recruited from July to August of 2013 and July to August of 2014 from a rural area in China. Results: During a median 6-year follow-up, we recorded 1109 deaths (610 with and 499 without hypertension). In adjusted models, as compared with BMI 22-24 kg/m2, with BMI ≤18, 18-20, 20-22, 24-26, 26-28, 28-30 and >30 kg/m2, the HRs (95% CI) for mortality in normotensive participants were 1.92 (1.23-3.00), 1.44 (1.01-2.05), 1.14 (0.82-1.58), 0.96 (0.70-1.31), 0.96 (0.65-1.43), 1.32 (0.81-2.14), and 1.32 (0.74-2.35) respectively, and in hypertensive participants were 1.85 (1.08-3.17), 1.67 (1.17-2.39), 1.29 (0.95-1.75), 1.20 (0.91-1.58), 1.10 (0.83-1.46), 1.10 (0.80-1.52), and 0.61 (0.40-0.94) respectively. The risk of mortality was lower in individuals with hypertension with overweight or obesity versus normal weight, especially in older hypertensives (≥60 years old). Sensitivity analyses gave consistent results for both normotensive and hypertensive participants. Conclusions: Low BMI was significantly associated with increased risk of all-cause mortality regardless of hypertension status in rural Chinese adults, but high BMI decreased the mortality risk among individuals with hypertension, especially in older hypertensives.

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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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Acute cardiovascular events and all-cause mortality in patients with hyperthyroidism: a population-based cohort study

Acta Endocrinologica ◽

10.1530/eje-16-0576 ◽

2017 ◽

Vol 176 (1) ◽

pp. 1-9 ◽

Cited By ~ 19

Author(s):

Olaf M Dekkers ◽

Erzsébet Horváth-Puhó ◽

Suzanne C Cannegieter ◽

Jan P Vandenbroucke ◽

Henrik Toft Sørensen ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cohort Study ◽

Ischemic Stroke ◽

Cardiovascular Events ◽

Population Based ◽

Arterial Embolism ◽

Registration System ◽

Increased Risk ◽

All Cause Mortality

Objective Several studies have shown an increased risk for cardiovascular disease (CVD) in hyperthyroidism, but most studies have been too small to address the effect of hyperthyroidism on individual cardiovascular endpoints. Our main aim was to assess the association among hyperthyroidism, acute cardiovascular events and mortality. Design It is a nationwide population-based cohort study. Data were obtained from the Danish Civil Registration System and the Danish National Patient Registry, which covers all Danish hospitals. We compared the rate of all-cause mortality as well as venous thromboembolism (VTE), acute myocardial infarction (AMI), ischemic and non-ischemic stroke, arterial embolism, atrial fibrillation (AF) and percutaneous coronary intervention (PCI) in the two cohorts. Hazard ratios (HR) with 95% confidence intervals (95% CI) were estimated. Results The study included 85 856 hyperthyroid patients and 847 057 matched population-based controls. Mean follow-up time was 9.2 years. The HR for mortality was highest in the first 3 months after diagnosis of hyperthyroidism: 4.62, 95% CI: 4.40–4.85, and remained elevated during long-term follow-up (>3 years) (HR: 1.35, 95% CI: 1.33–1.37). The risk for all examined cardiovascular events was increased, with the highest risk in the first 3 months after hyperthyroidism diagnosis. The 3-month post-diagnosis risk was highest for atrial fibrillation (HR: 7.32, 95% CI: 6.58–8.14) and arterial embolism (HR: 6.08, 95% CI: 4.30–8.61), but the risks of VTE, AMI, ischemic and non-ischemic stroke and PCI were increased also 2- to 3-fold. Conclusions We found an increased risk for all-cause mortality and acute cardiovascular events in patients with hyperthyroidism.

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Nutri-Score: The Most Efficient Front-of-Pack Nutrition Label to Inform Portuguese Consumers on the Nutritional Quality of Foods and Help Them Identify Healthier Options in Purchasing Situations

Nutrients ◽

10.3390/nu13124335 ◽

2021 ◽

Vol 13 (12) ◽

pp. 4335

Author(s):

Francisco Goiana-da-Silva ◽

David Cruz-e-Silva ◽

Catarina Nobre-da-Costa ◽

Alexandre Morais Nunes ◽

Morgane Fialon ◽

...

Keyword(s):

Nutritional Quality ◽

Food Choices ◽

P Value ◽

Portuguese Population ◽

Food Category ◽

Nutrition Labels ◽

Label Condition ◽

Promising Strategy ◽

Ranking Task

Several studies have identified Front-of-Pack Nutrition Labels (FoPLs) as a promising strategy to improve the nutritional quality of consumers’ food choices and encourage manufacturers to offer healthier products. This study aims to fill the evidence gap regarding the most effective FoPL among the Portuguese population. In total, 1059 Portuguese participants were recruited through a web panel provider and asked to declare their intended food choices and to rank three sets of products (pizza, cakes and breakfast cereals) according to their nutritional quality, first in the absence of any labelling, and then with a FoPL displayed on-pack (five FoPLs tested). Finally, participants were asked to answer nine statements related to perceptions of FoPLs. Results showed that participants improved their food choices, depending on the FoPL and the food category. All FoPLs led to a higher percentage of correct responses on the ranking task compared to the no label condition. The Nutri-Score was among the FoPLs producing the greatest improvement across all food categories compared to the reference intakes (OR = 6.45 [4.43–9.39], p-value < 0.0001) and facilitating the highest percentage to correctly rank products according to nutritional quality. This study suggests that, among the available options, Nutri-Score is the most efficient FoPL to inform Portuguese consumers of the nutritional quality of foods and help them identify healthier options in mock purchasing situations.

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Organoleptic and nutritional characteristics of fillets of pirapitinga fed different protein sources in a biofloc system

Pesquisa Agropecuária Brasileira ◽

10.1590/s1678-3921.pab2020.v55.01795 ◽

2020 ◽

Vol 55 ◽

Author(s):

Hernán Antonio Alzate Díaz ◽

Adriana Patricia Muñoz Ramírez ◽

Maurício Gustavo Coelho Emerenciano ◽

Sandra Clemencia Pardo Carrasco

Keyword(s):

Fatty Acids ◽

Soybean Meal ◽

Nutritional Quality ◽

Saturated Fatty Acids ◽

Monounsaturated Fatty Acids ◽

Protein Sources ◽

Nutritional Characteristics ◽

Biofloc Technology ◽

Sensory Analyses

Abstract: The objective of this work was to assess the organoleptic and nutritional quality of fillets of cultured pirapitinga (Piaractus brachypomus), fed diets with either partial or total substitution of fishmeal, and to determine the nutritional quality of the biofloc meal. Fish were cultured in 500-L tanks with 84 fish m-3, treated with biofloc technology (BFT), and fed three isoproteic diets (24% crude protein, CP) formulated with the following protein sources: soybean meal (SM); soybean meal + fishmeal (SM+FM); and soybean meal + spirulina (SM+SP). After 84 days of culture, microbiological, nutritional, and sensory analyses were carried out on fillets with skin and without scales. There were not significant differences for dry matter, CP, moisture, and fat content between treatments. The fatty acid profile showed 21.3±1.03% polyunsaturated fatty acids (PUFAs = ω-3 + ω-6), 37.11±1.29% monounsaturated fatty acids (MUFAs), and 41.58±1.34% saturated fatty acids (SFAs). The protein sources soybean meal and spirulina do not affect the fillet quality of pirapitinga nor the nutritional quality of biofloc meal.

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Association Between the Non-HDL-Cholesterol-to-HDL-Cholesterol Ratio and 28-Day Mortality in Septic Patients: A Cohort Study Based on the eICU Collaborative Research Database

10.21203/rs.3.rs-700309/v1 ◽

2021 ◽

Author(s):

Le Chang ◽

Xinglin Chen ◽

Cheng Lian

Keyword(s):

Cohort Study ◽

High Density Lipoprotein ◽

High Density Lipoprotein Cholesterol ◽

Collaborative Research ◽

Density Lipoprotein ◽

Hdl Cholesterol ◽

Lipoprotein Cholesterol ◽

Research Database ◽

Increased Risk ◽

All Cause Mortality

Abstract Background: Dyslipidemia contributes to the development and progression of cardiovascular disease. However, the potential association between non-high-density lipoprotein-cholesterol-to-high-density lipoprotein-cholesterol (nonHDLc/HDLc) ratio and mortality in septic patients is unclear.Methods: This was a retrospective cohort study of patients with sepsis in the eICU Collaborative Research Database (eICU-CRD) from 208 distinct ICUs across the United States between 2014 and 2015. All-cause mortality within 28-days after ICU admission. A multivariable logistic regression model was used to estimate the risk of death.Result: Of the 724 patients with a median age of 68 years, 43 (5.94%) died within 28 days after ICU admission. The association between the nonHDLc/HDLc ratio and the risk of all cause mortality was J shaped, and a high level was associated with increased risk of all cause mortality. The mortality rate increased when the nonHDLc/HDLc ratio higher than the turning point (≥3.41) with an adjusted odds ratio (OR) of 1.34 (95% CI: 1.07–1.67, P=0.010) for every 1 increment of nonHDLc/HDLc ratio. With the per-SD increase in the nonHDLc/HDLc ratio, the OR of mortality was 1.79 (95% CI: 1.15–2.80, P=0.010) when the nonHDLc/HDLc ratio was ≥3.41. The trend of sensitivity analysis was consistent with the main analysis.Conclusion: For patients with sepsis, the association between the nonHDLc/HDLc ratio and the 28-day mortality risk was J shaped. A higher level of nonHDLc/HDLc ratio was associated with an increased risk of 28-day mortality. These findings need to be confirmed in other studies.

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P1515IMPACT OF POLYPHARMACY ON ALL-CAUSE MORTALITY, ALL-CAUSE HOSPITALIZATION AND CARDIOVASCULAR EVENTS IN INITIAL JAPANESE HEMODIALYSIS PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1515 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Tatsunori Toida ◽

Reiko Toida ◽

Shou Ebihara ◽

Shigehiro Uezono ◽

Hiroyuki Komatsu ◽

...

Keyword(s):

Cohort Study ◽

Clinical Outcomes ◽

Cardiovascular Events ◽

Chronic Renal Disease ◽

Risk Index ◽

Hemodialysis Patients ◽

Drug Prescriptions ◽

Increased Risk ◽

All Cause Mortality

Abstract Background and Aims Polypharmacy (PP) is common in end-stage chronic renal disease patients, largely because of the existence of multiple comorbid conditions. PP has the potential for harm and benefits, and the association between PP and mortality and morbidity in hemodialysis patients currently remains unclear. We examined the association of PP and the risk of clinical outcomes, such as all-cause mortality, all-cause hospitalization and cardiovascular events, in initial hemodialysis patients at admission and discharge. Method Study design: Cohort study. Setting: Participants: One hundred and fifty-two initial hemodialysis patients (female vs. male, 88 vs. 64; mean age, 70.3 years) were enrolled between February 2015 and March 2018 at the Nobeoka Prefectural Hospital and Chiyoda Hospital. Predictor: Patients were divided into 2 groups according to PP (6 or more drug prescriptions, or less) during admission and discharge for the initiation of hemodialysis. Outcomes: All-cause mortality, all-cause hospitalization and cardiovascular events (hospitalization due to stroke, ischemic heart disease or peripheral artery disease) during the mean 2.8-year follow-up. Measurements: Hazard ratios (HRs) were estimated using Cox’s model for the relationships between PP and the clinical outcomes, and adjusted for potential confounders, including age, sex, body mass index, systolic and diastolic blood pressure, Charlson comorbidity risk index, hemoglobin, serum levels of albumin, albumin-corrected Ca, phosphate, parathyroid hormone, C-reactive protein and NT-proBNP; and use of erythropoietin stimulating agents. The group with 5 or less drug prescriptions was set as reference. Results Among the patients in this cohort study, the number of prescribed drugs per patient averaged 7.4 at admission and 6.9 at discharge for initial hemodialysis. One hundred (65.8%) and 94 patients (61.8%) had PP at admission and discharge, respectively. During follow-up, 20 patients died, 71 patients were hospitalized and 25 patients had cardiovascular events. PP at admission is significantly associated with cardiovascular events (HR 8.50, 95%CI 1.45-49.68). Furthermore, PP at discharge is significantly associated with all-cause hospitalization and cardiovascular events (HR 1.95, 95%CI 1.01-3.70; HR 53.16, 95%CI 2.70-104.62, respectively). However, PP is not significantly associated with all-cause mortality at admission or discharge. Conclusion Among Japanese patients starting hemodialysis, PP may be associated with clinical outcomes. However, it remains unclear whether PP is the direct cause of the outcomes or is simply a marker for increased risk of outcomes.

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Linear programming can help identify practical solutions to improve the nutritional quality of food aid

Public Health Nutrition ◽

10.1017/s1368980007000511 ◽

2008 ◽

Vol 11 (4) ◽

pp. 395-404 ◽

Cited By ~ 33

Author(s):

Zo J Rambeloson ◽

Nicole Darmon ◽

Elaine L Ferguson

Keyword(s):

Linear Programming ◽

Nutritional Quality ◽

Fruits And Vegetables ◽

Saturated Fatty Acids ◽

National Level ◽

Food Aid ◽

Food Banks ◽

Food Bank ◽

Quality Of Food

AbstractObjectivesTo assess the nutritional quality of food aid delivered by food banks in France and to identify practical modifications to improve it.DesignNational-level data were collected for all food aid distributed by French food banks in 2004, and its nutrient content per 2000 kcal was estimated and compared with French recommendations for adults. Starting with the actual donation and allowing new foods into the food aid donation, linear programming was used to identify the minimum changes required in the actual donation to achieve the French recommendations.ResultsFrench food-bank-delivered food aid does not achieve the French recommendations for dietary fibre, ascorbic acid, vitamin D, folate, magnesium, docosahexaenoic acid, α-linolenic acid and the percentage of energy from saturated fatty acids. Linear programming analysis showed that these recommendations are achievable if more fruits, vegetables, legumes and fish were collected and less cheese, refined cereals and foods rich in fat, sugar and/or salt. In addition, new foods not previously collected are needed, particularly nuts, wholemeal bread and rapeseed oil. These changes increased the total edible weight (42%) and economic value (55%) of the food aid donation, with one-third of its edible weight coming from fruits and vegetables, one-third from staples, one-quarter from dairy products and approximately a tenth from meat/fish/eggs.ConclusionsImportant changes in the types and amounts of food collected will improve the nutritional quality of food-bank-delivered food aid in France. Such changes are recommended to improve the diets of deprived French populations.

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Cutaneous lupus erythematosus and systemic lupus erythematosus are associated with clinically significant cardiovascular risk: a Danish nationwide cohort study

Lupus ◽

10.1177/0961203316651739 ◽

2016 ◽

Vol 26 (1) ◽

pp. 48-53 ◽

Cited By ~ 7

Author(s):

J Halskou Hesselvig ◽

O Ahlehoff ◽

L Dreyer ◽

G Gislason ◽

K Kofoed

Keyword(s):

Systemic Lupus Erythematosus ◽

Cohort Study ◽

Cardiovascular Risk ◽

Lupus Erythematosus ◽

Cutaneous Lupus Erythematosus ◽

Low Grade ◽

Systemic Lupus ◽

Increased Risk ◽

All Cause Mortality ◽

Cutaneous Lupus

Systemic lupus erythematosus (SLE) is a well-known cardiovascular risk factor. Less is known about cutaneous lupus erythematosus (CLE) and the risk of developing cardiovascular disease (CVD). Therefore, we investigated the risk of mortality and adverse cardiovascular events in patients diagnosed with SLE and CLE. We conducted a cohort study of the entire Danish population aged ≥ 18 and ≤ 100 years, followed from 1997 to 2011 by individual-level linkage of nationwide registries. Multivariable adjusted Cox regression models were used to estimate the hazard ratios (HRs) for a composite cardiovascular endpoint and all-cause mortality, for patients with SLE and CLE. A total of 3282 patients with CLE and 3747 patients with SLE were identified and compared with 5,513,739 controls. The overall HR for the composite CVD endpoint was 1.31 (95% CI 1.16–1.49) for CLE and 2.05 (95% CI 1.15–3.44) for SLE. The corresponding HRs for all-cause mortality were 1.32 (95% CI 1.20–1.45) for CLE and 2.21 (95% CI 2.03–2.41) for SLE. CLE and SLE were associated with a significantly increased risk of CVD and all-cause mortality. Local and chronic inflammation may be the driver of low-grade systemic inflammation.

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