The consumption of foods with higher scores on the British Food Standards Agency nutrient profiling system (FSAm-NPS), reflecting a lower nutritional quality, is associated with an increased risk of developing cancer, according to a study published this week in PLOS Medicine. The study, conducted by Mélanie Deschasaux of the French National Institute for Health and Medical Research (INSERM U1153/Inra/Cnam/Paris 13 University-EREN), France and colleagues, in association with the WHO-IARC, suggests broad potential for the use of FSAm-NPS-based package labeling (e.g. Nutri-Score) to promote healthy food choices in European settings.
Helping consumers make healthier food choices is a key challenge for the prevention of cancer and other chronic diseases. European authorities are considering implementing a unique nutrition label as a system to reflect the nutritional quality of food products, among which the five-color Nutri-Score derived from the FSAm-NPS, used in France and recently endorsed by Belgian authorities. How the consumption of foods with high/low FSAm-NPS scores relates to cancer risk has been studied in national and regional cohorts but has not been characterized in diverse European populations.
In their study, Deschasaux and colleagues analyzed food intake data from 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). The researchers assigned each participant's diet a FSAm-NPS Dietary Index (DI), and computed multi-adjusted Cox proportional hazards models to describe any associations between the FSAm-NPS DI and cancer risks.
Absolute cancer rates in those with high and low (quintiles 5 and 1) FSAm-NPS DI were 81.4 and 69.5 cases/10,000 person-years, respectively. The researchers found that a higher FSAm-NPS DI, reflecting a lower nutritional quality of food consumed, was associated with a higher risk of total cancer (HR for Q5 versus Q1: 1.07; 95% CI: 1.03-1.10, P-trend < 0.001). Higher FSAm-NPS DI 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 was the use of self-reported dietary data, collected once at baseline.
The authors state, "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."
Peer-reviewed / Observational Study / People
This work was funded by a research grant from the French National Cancer Institute (INCa)-Cancéropôle Ile-de-France (Convention n° 2017-1-PL SHS-01-INSERM ADR 5-1, PI: M. Touvier, Co-PI M. Deschasaux). The coordination of EPIC is financially supported by the European Commission (DG-SANCO) and the International Agency for Research on Cancer. The national cohorts are supported by Danish Cancer Society (Denmark); Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle Générale de l'Education Nationale, Institut National de la Santé et de la Recherche Médicale (Inserm), (France); Deutsche Krebshilfe, Deutsches Krebsforschungszentrum and Federal Ministry of Education and Research (Germany); the Hellenic Health Foundation (Greece); Associazione Italiana per la Ricerca sul Cancro-AIRC-Italy and National Research Council (Italy); Dutch Ministry of Public Health, Welfare, and Sports (VWS), Netherlands Cancer Registry (NKR), LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund (WCRF), Statistics Netherlands (the Netherlands); Health Research Fund (FIS), PI13/00061 to Granada, Regional Governments of Andalucía, Asturias, Basque Country, Murcia (no. 6236) and Navarra, ISCIII RETIC (RD06/0020; Spain); Swedish Cancer Society, Swedish Scientific Council and County Councils of Skåne and Västerbotten (Sweden); Cancer Research UK (14136 to EPIC-Norfolk; C570/A16491 and C8221/A19170 to EPIC-Oxford), Medical Research Council (1000143 to EPIC-Norfolk, MR/M012190/1 to EPIC-Oxford United Kingdom). Researchers were independent from funders. Funders had no role in the study design, the collection, analysis, and interpretation of data, the writing of the report, and the decision to submit the article for publication.
The authors have declared that no competing interests exist.
Deschasaux M, Huybrechts I, Murphy N, Julia C, Hercberg S, Srour B, et al. (2018) 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. PLoS Med 15(9): e1002651. https:/
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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
Nutrition and Metabolism Section, International Agency for Research on Cancer, World Health Organization, France
Department of Public Health, Avicenne Hospital (AP-HP), Bobigny, France
Faculty of Medicine, School of Public Health, Imperial College London, London, United Kingdom
Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
Department of Research, Cancer Registry of Norway, Institute of Population Based Cancer Research, Oslo, Norway
Department of Medical Epidemiology and Biostatistics, Karolinska
Institutet, Stockholm, Sweden
Genetic Epidemiology Group, Folkha¨lsan Research Centre and Faculty of
Medicine, University of Helsinki, Helsinki, Finland
Aarhus University, Department of Public Health, Section for Epidemiology, Aarhus C, Denmark
Danish Cancer Society Research Center, Copenhagen, Denmark,
11 CESP, INSERM U1018, Univ. Paris-Sud, UVSQ, Université Paris-Saclay, France
Gustave Roussy, Villejuif, France
Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
Department of Epidemiology, German Institute of Human Nutrition (DIfE), Potsdam-Rehbrücke, Germany
Hellenic Health Foundation, Athens, Greece
WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Dept. of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
Cancer Risk Factors and Life-Style Epidemiology Unit, Cancer Research and Prevention Institute-ISPO, Florence, Italy
Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy
Cancer registry and histopathology unit, "CIVIC-M.P. AREZZO" Hospital, ASP Ragusa, Italy
Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Turin, Italy
Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands
Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, United Kingdom
Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
Public Health Directorate, Asturias, Spain
Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, L´Hospitallet de Llobregat, Barcelona, Spain
Facultat de Ciències de la Salut Blanquerna, Universitat Ramón Llull, Barcelona, Spain
Escuela Andaluza de Salud Pu´blica. Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
Navarra Public Health Institute, Pamplona, Spain
IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
Public Health Department of Gipuzkoa, Basque Government, San Sebastian, Spain
Diabetes and Cardiovascular disease, Genetic Epidemiology, Department of Clinical Sciences, Lund University, Malmö, Sweden
Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
Department of Internal Medicine and Clinical Nutrition, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
Department of Odontology, Umea university, Umea, Sweden, 41 University of Cambridge, School of Clinical Medicine, Addenbrooke's Hospital, Cambridge, United Kingdom
MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
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