Deschasaux, MélanieHuybrechts, IngeJulia, ChantalHercberg, SergeEgnell, ManonSrour, BernardKesse-Guyot, EmmanuelleLatino-Martel, PauleBiessy, CarineCasagrande, CorinneMurphy, NeilJenab, MazdaWard, Heather A.Weiderpass, ElisabeteOvervad, KimTjønneland, AnneRostgaard-Hansen, Agnetha LinnBoutron-Ruault, Marie-ChristineMancini, Francesca RomanaMahamat-Saleh, YahyaKühn, TilmanKatzke, VerenaBergmann, Manuela M.Schulze, Matthias B.Trichopoulou, AntoniaKarakatsani, AnnaPeppa, EleniMasala, GiovannaAgnoli, ClaudiaSantucci de Magistris, MariaTumino, RosarioSacerdote, CarlottaBoer, Jolanda M. A.Verschuren, W. M. Moniquevan der Schouw, Yvonne T.Skeie, GuriBraaten, TonjeRedondo, M. LuisaAgudo, AntonioPetrova, DafinaColorado-Yohar, SandraBarricarte, AurelioAmiano, PilarSonestedt, EmilyEricson, UlrikaOtten, JuliaSundström, BjörnWareham, Nicholas J.Forouhi, Nita GVineis, PaoloTsilidis, Konstantinos K.Knuppel, AnikaPapier, KerenFerrari, PietroRiboli, ElioGunter, Marc J.Touvier, Mathilde2021-02-242021-02-242020-09-16https://hdl.handle.net/2445/174284Objective: 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.13 p.application/pdfengcc by-nc (c) Deschasaux et al., 2020http://creativecommons.org/licenses/by-nc/3.0/es/NutricióMortalitatNutritionMortalityinfo:eu-repo/semantics/article2021-02-16info:eu-repo/semantics/openAccess