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

Mélanie Deschasaux, Inge Huybrechts, Neil Murphy, Chantal Julia, Serge Hercberg, Bernard Srour, Emmanuelle Kesse-Guyot, Paule Latino-Martel, Carine Biessy, Corinne Casagrande, Mazda Jenab, Heather Ward, Elisabete Weiderpass, Christina C Dahm, Kim Overvad, Cecilie Kyrø, Anja Olsen, Aurélie Affret, Marie-Christine Boutron-Ruault, Yahya Mahamat-SalehRudolf Kaaks, Tilman Kühn, Heiner Boeing, Lukas Schwingshackl, Christina Bamia, Eleni Peppa, Antonia Trichopoulou, Giovanna Masala, Vittorio Krogh, Salvatore Panico, Rosario Tumino, Carlotta Sacerdote, Bas Bueno-de-Mesquita, Petra H Peeters, Anette Hjartåker, Charlotta Rylander, Guri Skeie, J Ramón Quirós, Paula Jakszyn, Elena Salamanca-Fernández, José María Huerta, Eva Ardanaz, Pilar Amiano, Ulrika Ericson, Emily Sonestedt, Ena Huseinovic, Ingegerd Johansson, Kay-Tee Khaw, Nick Wareham, Kathryn E Bradbury, Aurora Perez-Cornago, Konstantinos K Tsilidis, Pietro Ferrari, Elio Riboli, Marc J Gunter, Mathilde Touvier

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)e1002651
JournalPLoS Medicine
Issue number9
Publication statusPublished - Sep 2018


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