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                  <mods:namePart>Touvier, Mathilde</mods:namePart>
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                  <mods:dateAccessioned encoding="iso8601">2025-05-24T19:14:38Z</mods:dateAccessioned>
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                  <mods:dateIssued encoding="iso8601">2018-09</mods:dateIssued>
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               <mods:identifier type="uri">http://hdl.handle.net/20.500.14342/5268</mods:identifier>
               <mods:identifier type="doi">https://doi.org/10.1371/journal.pmed.1002651</mods:identifier>
               <mods:abstract>Background&#xd;
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.&#xd;
&#xd;
Methods and findings&#xd;
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 &lt; 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 &lt; 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.&#xd;
&#xd;
Conclusions&#xd;
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.</mods:abstract>
               <mods:language>
                  <mods:languageTerm authority="rfc3066">eng</mods:languageTerm>
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               <mods:accessCondition type="useAndReproduction">© L'autor/a Attribution 4.0 International</mods:accessCondition>
               <mods:subject>
                  <mods:topic>Càncer</mods:topic>
               </mods:subject>
               <mods:subject>
                  <mods:topic>Aliments</mods:topic>
               </mods:subject>
               <mods:subject>
                  <mods:topic>Alimentació</mods:topic>
               </mods:subject>
               <mods:subject>
                  <mods:topic>Factors de risc</mods:topic>
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               <mods:titleInfo>
                  <mods:title>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</mods:title>
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