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

被引：68

作者：

Deschasaux, Melanie ^{[1
]}

Huybrechts, Inge ^{[2
]}

Murphy, Neil ^{[2
]}

Julia, Chantal ^{[1
,3
]}

Hercberg, Serge ^{[1
,3
]}

Srour, Bernard ^{[1
]}

Kesse-Guyot, Emmanuelle ^{[1
]}

Latino-Martel, Paule ^{[1
]}

Biessy, Carine ^{[2
]}

Casagrande, Corinne ^{[2
]}

Jenab, Mazda ^{[2
]}

Ward, Heather ^{[4
]}

Weiderpass, Elisabete ^{[5
,6
,7
,8
,9
]}

Dahm, Christina C. ^{[10
]}

Overvad, Kim ^{[10
]}

Kyro, Cecilie ^{[11
]}

Olsen, Anja ^{[11
]}

Affret, Aurelie ^{[12
,13
]}

Boutron-Ruault, Marie-Christine ^{[12
,13
]}

Mahamat-Saleh, Yahya ^{[12
,13
]}

Kaaks, Rudolf ^{[14
]}

Kuehn, Tilman ^{[14
]}

Boeing, Heiner ^{[15
]}

Schwingshackl, Lukas ^{[15
]}

Bamia, Christina ^{[16
,17
]}

Peppa, Eleni ^{[16
]}

Trichopoulou, Antonia ^{[16
,17
]}

Masala, Giovanna ^{[18
]}

Krogh, Vittorio ^{[19
]}

Panico, Salvatore ^{[20
]}

Tumino, Rosario ^{[21
]}

Sacerdote, Carlotta ^{[22
,23
]}

Buen-de-Mesquita, Bas ^{[24
,25
,26
,27
]}

Peeters, Petra H. ^{[28
]}

Hjartaker, Anette ^{[29
]}

Rylander, Charlotta ^{[5
]}

Skeie, Guri ^{[5
]}

Ramon Quiros, J. ^{[30
]}

Jakszyn, Paula ^{[31
,32
]}

Salamanca-Fernandez, Elena ^{[33
,34
]}

Maria Huerta, Jose ^{[34
,35
]}

Ardanaz, Eva ^{[34
,36
,37
]}

Amiano, Pilar ^{[34
,38
]}

Ericson, Ulrika ^{[39
]}

Sonestedt, Emily ^{[40
]}

Huseinovic, Ena ^{[41
]}

Johansson, Ingegerd ^{[42
]}

Khaw, Kay-Tee ^{[43
]}

Wareham, Nick ^{[44
]}

Bradbury, Kathryn E. ^{[45
]}

机构：

[1] Paris 13 Univ, COMUE Sorbonne Paris Cite, Inra U1125,Nutr Epidemiol Res Team EREN, Cnam,Inserm U1153,Sorbonne Paris Cite Epidemiol &, Bobigny, France

[2] WHO, Int Agcy Res Canc, Nutr & Metab Sect, Lyon, France

[3] Avicenne Hosp, AP HP, Dept Publ Hlth, Bobigny, France

[4] Imperial Coll London, Sch Publ Hlth, Fac Med, London, England

[5] UiT Arctic Univ Norway, Fac Hlth Sci, Dept Community Med, Tromso, Norway

[6] Canc Registry Norway, Inst Populat Based Canc Res, Dept Res, Oslo, Norway

[7] Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden

[8] Univ Helsinki, Genet Epidemiol Grp, Folkhalsan Res Ctr, Helsinki, Finland

[9] Univ Helsinki, Fac Med, Helsinki, Finland

[10] Aarhus Univ, Sect Epidemiol, Dept Publ Hlth, Aarhus C, Denmark

[11] Danish Canc Soc Res Ctr, Copenhagen, Denmark

[12] Univ Paris Sud, UVSQ, Univ Paris Saclay, INSERM U1018,CESP, Paris, France

[13] Gustave Roussy, Villejuif, France

[14] German Canc Res Ctr, Div Canc Epidemiol, Heidelberg, Germany

[15] German Inst Human Nutr Potsdam Rehbrucke, Dept Epidemiol, Potsdam, Germany

[16] Hellenic Hlth Fdn, Athens, Greece

[17] Natl & Kapodistrian Univ Athens, Sch Med, Dept Hyg Epidemiol & Med Stat, Unit Nutr Epidemiol & Nutr Publ Hlth,WHO Collabor, Athens, Greece

[18] Canc Res & Prevent Inst ISPO, Canc Risk Factors & Life Style Epidemiol Unit, Florence, Italy

[19] Fdn IRCCS Ist Nazl Tumori, Epidemiol & Prevent Unit, Milan, Italy

[20] Univ Naples Federico II, Dipartimento Med Clin & Chirurgia, Naples, Italy

[21] ASP Ragusa, Canc Registry & Histopathol Unit, CIVIC MP AREZZO, Ragusa, Italy

[22] Citta Salute & Sci Univ Hosp, Unit Canc Epidemiol, Turin, Italy

[23] Ctr Canc Prevent CPO, Turin, Italy

[24] Natl Inst Publ Hlth & Environm RIVM, Dept Determinants Chron Dis DCD, Bilthoven, Netherlands

[25] Univ Med Ctr, Dept Gastroenterol & Hepatol, Utrecht, Netherlands

[26] Imperial Coll London, Sch Publ Hlth, Dept Epidemiol & Biostat, London, England

[27] Univ Malaya, Fac Med, Dept Social & Prevent Med, Kuala Lumpur, Malaysia

[28] Univ Utrecht, Univ Med Ctr Utrecht, Dept Epidemiol, Julius Ctr Hlth Sci & Primary Care, Utrecht, Netherlands

[29] Univ Oslo, Inst Basic Med Sci, Dept Nutr, Oslo, Norway

[30] Publ Hlth Directorate, Asturias, Spain

[31] Catalan Inst Oncol, Canc Epidemiol Res Programme, Unit Nutr Environm & Canc, Barcelona, Spain

[32] Univ Ramon Llull, Fac Ciencies Salut Blanquerna, Barcelona, Spain

[33] Univ Granada, Hosp Univ Granada, Inst Invest Biosanitaria Ibs GRANADA, Escuela Andaluza Salud Publ, Granada, Spain

[34] CIBER Epidemiol & Salud Publ CIBERESP, Madrid, Spain

[35] IMIB Arrixaca, Dept Epidemiol Murcia Reg Hlth Council, Murcia, Spain

[36] Navarra Publ Hlth Inst, Pamplona, Spain

[37] Navarra Inst Hlth Res, IdiSNA, Pamplona, Spain

[38] Basque Govt, Publ Hlth Dept Gipuzkoa, San Sebastian, Spain

[39] Lund Univ, Dept Clin Sci, Diabet & Cardiovasc Dis Genet Epidemiol, Malmo, Sweden

[40] Lund Univ, Dept Clin Sci Malmo, Nutr Epidemiol, Malmo, Sweden

[41] Univ Gothenburg, Sahlgrenska Acad, Dept Internal Med & Clin Nutr, Gothenburg, Sweden

[42] Umea Univ, Dept Odontol, Umea, Sweden

[43] Univ Cambridge, Addenbrookes Hosp, Sch Clin Med, Cambridge, England

[44] Univ Cambridge, Inst Metab Sci, MRC Epidemiol Unit, Cambridge, England

[45] Univ Oxford, Canc Epidemiol Unit, Nuffield Dept Populat Hlth, Oxford, England

[46] Univ Ioannina, Sch Med, Dept Hyg & Epidemiol, Ioannina, Greece

来源：

PLOS MEDICINE | 2018年 / 15卷 / 09期

基金：

英国医学研究理事会;

关键词：

FRONT-OF-PACKAGE; DIETARY INDEX; PROSPECTIVE ASSOCIATION; VALIDATION; IMPACT;

D O I：

10.1371/journal.pmed.1002651

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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.

引用

页数：21