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Association between nutritional profiles of foods underlying Nutri-Score front-of-pack labels and mortality: EPIC cohort study in 10 European countries Deschasaux, Mélanie Huybrechts, Inge Julia, Chantal Hercberg, Serge Egnell, Manon Srour, Bernard Kesse-Guyot, Emmanuelle Latino-Martel, Paule Biessy, Carine Casagrande, Corinne Murphy, Neil Jenab, Mazda Ward, Heather A. Weiderpass, Elisabete Overvad, Kim Tjønneland, Anne Rostgaard-Hansen, Agnetha Linn Boutron-Ruault, Marie-Christine Mancini, Francesca Romana Mahamat-Saleh, Yahya Kühn, Tilman Katzke, Verena Bergmann, Manuela M. Schulze, Matthias B. Trichopoulou, Antonia Karakatsani, Anna Peppa, Eleni Masala, Giovanna Agnoli, Claudia Santucci de Magistris, Maria Tumino, Rosario Sacerdote, Carlotta Boer, Jolanda M. A. Verschuren, W. M. Monique van der Schouw, Yvonne T. Skeie, Guri Braaten, Tonje Redondo, M. Luisa Agudo, Antonio Petrova, Dafina Colorado-Yohar, Sandra Barricarte, Aurelio Amiano, Pilar Sonestedt, Emily Ericson, Ulrika Otten, Julia Sundström, Björn Wareham, Nicholas J. Forouhi, Nita G Vineis, Paolo Tsilidis, Konstantinos K. Knuppel, Anika Papier, Keren Ferrari, Pietro Riboli, Elio Gunter, Marc J. Touvier, Mathilde Nutrició Mortalitat Nutrition Mortality Objective: 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. 2021-02-24T19:08:50Z 2021-02-24T19:08:50Z 2020-09-16 2021-02-16T08:45:49Z info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Reproducció del document publicat a: https://doi.org/10.1136/bmj.m3173 BMJ, 2020, vol. 370 https://doi.org/10.1136/bmj.m3173 cc by-nc (c) Deschasaux et al., 2020 http://creativecommons.org/licenses/by-nc/3.0/es/ info:eu-repo/semantics/openAccess BMJ Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))