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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

Deschasaux M 1 , Huybrechts I 2 , Murphy N 2 , Julia C 1 , Hercberg S 1 , Srour B 1 Show all authors , Kesse-Guyot E 1 , Latino-Martel P 1 , Biessy C 2 , Casagrande C 2 , Jenab M 2 , Ward H 3 , Weiderpass E 4 , Dahm CC 5 , Overvad K 5 , Kyrø C 6 , Olsen A 6 , Affret A 7 , Boutron-Ruault MC 7 , Mahamat-Saleh Y 7 , Kaaks R 8 , Kühn T 8 , Boeing H 9 , Schwingshackl L 9 , Bamia C 10 , Peppa E 10 , Trichopoulou A 10 , Masala G 11 , Krogh V 12 , Panico S 13 , Tumino R 14 , Sacerdote C 15 , Bueno-de-Mesquita B 16 , Peeters PH 17 , Hjartåker A 18 , Rylander C 4 , Skeie G 4 , Ramón Quirós J 19 , Jakszyn P 20 , Salamanca-Fernández E 21 , Huerta JM 22 , Ardanaz E 22 , Amiano P 22 , Ericson U 23 , Sonestedt E 24 , Huseinovic E 25 , Johansson I 26 , Khaw KT 27 , Wareham N 28 , Bradbury KE 29 , Perez-Cornago A 29 , Tsilidis KK 30 , Ferrari P 2 , Riboli E 3 , Gunter MJ 2 , Touvier M 1

Affiliations 

  • 1 Nutritional Epidemiology Research Team (EREN), Sorbonne Paris Cité Epidemiology and Statistics Research Centre (CRESS), Inserm U1153, Inra U1125, Cnam, COMUE Sorbonne Paris Cité, Paris 13 University, Bobigny, France
  • 2 Nutrition and Metabolism Section, International Agency for Research on Cancer, World Health Organization, Lyon, France
  • 3 Faculty of Medicine, School of Public Health, Imperial College London, London, United Kingdom
  • 4 Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
  • 5 Aarhus University, Department of Public Health, Section for Epidemiology, Aarhus C, Denmark
  • 6 Danish Cancer Society Research Center, Copenhagen, Denmark
  • 7 CESP, INSERM U1018, Univ. Paris-Sud, UVSQ, Université Paris-Saclay, Paris, France
  • 8 Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
  • 9 Department of Epidemiology, German Institute of Human Nutrition (DIfE), Potsdam-Rehbrücke, Germany
  • 10 Hellenic Health Foundation, Athens, Greece
  • 11 Cancer Risk Factors and Life-Style Epidemiology Unit, Cancer Research and Prevention Institute-ISPO, Florence, Italy
  • 12 Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
  • 13 Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy
  • 14 Cancer registry and histopathology unit, "CIVIC-M.P. AREZZO" Hospital, ASP Ragusa, Italy
  • 15 Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Turin, Italy
  • 16 Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
  • 17 Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
  • 18 Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
  • 19 Public Health Directorate, Asturias, Spain
  • 20 Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, L´Hospitallet de Llobregat, Barcelona, Spain
  • 21 Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
  • 22 CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
  • 23 Diabetes and Cardiovascular disease, Genetic Epidemiology, Department of Clinical Sciences, Lund University, Malmö, Sweden
  • 24 Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
  • 25 Department of Internal Medicine and Clinical Nutrition, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  • 26 Department of Odontology, Umea University, Umea, Sweden
  • 27 University of Cambridge, School of Clinical Medicine, Addenbrooke's Hospital, Cambridge, United Kingdom
  • 28 MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
  • 29 Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
  • 30 Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, United Kingdom
PLoS Med, 2018 Sep;15(9):e1002651.
PMID: 30226842 DOI: 10.1371/journal.pmed.1002651

Abstract

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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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