Eating foods with low nutritional quality ratings linked to cancer risk in large European cohort

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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."Research ArticlePeer-reviewed / Observational Study / PeopleFunding: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.Competing Interests:The authors have declared that no competing interests exist.Citation: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://doi.org/10.1371/journal.pmed.1002651 Image Credit: Marco Verch, FlickrAuthor Affiliations: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, FranceNutrition and Metabolism Section, International Agency for Research on Cancer, World Health Organization, FranceDepartment of Public Health, Avicenne Hospital (AP-HP), Bobigny, FranceFaculty of Medicine, School of Public Health, Imperial College London, London, United KingdomDepartment of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, NorwayDepartment of Research, Cancer Registry of Norway, Institute of Population Based Cancer Research, Oslo, NorwayDepartment of Medical Epidemiology and Biostatistics, KarolinskaInstitutet, Stockholm, SwedenGenetic Epidemiology Group, Folkha¨lsan Research Centre and Faculty ofMedicine, University of Helsinki, Helsinki, FinlandAarhus University, Department of Public Health, Section for Epidemiology, Aarhus C, DenmarkDanish Cancer Society Research Center, Copenhagen, Denmark,11 CESP, INSERM U1018, Univ. Paris-Sud, UVSQ, Université Paris-Saclay, FranceGustave Roussy, Villejuif, FranceDivision of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, GermanyDepartment of Epidemiology, German Institute of Human Nutrition (DIfE), Potsdam-Rehbrücke, GermanyHellenic Health Foundation, Athens, GreeceWHO 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, GreeceCancer Risk Factors and Life-Style Epidemiology Unit, Cancer Research and Prevention Institute-ISPO, Florence, ItalyEpidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, ItalyDipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, ItalyCancer registry and histopathology unit, "CIVIC-M.P. AREZZO" Hospital, ASP Ragusa, ItalyUnit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Turin, ItalyDepartment for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, The NetherlandsDepartment of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The NetherlandsDepartment of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, United KingdomDepartment of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, MalaysiaDepartment of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The NetherlandsDepartment of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, NorwayPublic Health Directorate, Asturias, SpainUnit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, L´Hospitallet de Llobregat, Barcelona, SpainFacultat de Ciències de la Salut Blanquerna, Universitat Ramón Llull, Barcelona, SpainEscuela Andaluza de Salud Pu´blica. Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, SpainCIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, SpainDepartment of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, SpainNavarra Public Health Institute, Pamplona, SpainIdiSNA, Navarra Institute for Health Research, Pamplona, SpainPublic Health Department of Gipuzkoa, Basque Government, San Sebastian, SpainDiabetes and Cardiovascular disease, Genetic Epidemiology, Department of Clinical Sciences, Lund University, Malmö, SwedenNutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, Malmö, SwedenDepartment of Internal Medicine and Clinical Nutrition, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, SwedenDepartment of Odontology, Umea university, Umea, Sweden, 41 University of Cambridge, School of Clinical Medicine, Addenbrooke's Hospital, Cambridge, United KingdomMRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, United KingdomCancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United KingdomDepartment of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, GreeceIn your coverage please use this URL to provide access to the freely available paper: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002651 PLOS