Etudes sur la validation de l’algorithme du Nutri-Score en France

Capacité discriminante et cohérence avec les recommandations alimentaires

- Two Dimensions of Nutritional Value : Nutri-Score and NOVA
Nutrients 2021, 13(8), 2783
Carmen Romero Ferreiro, David Lora Pablos and Agustín Gómez de la Cámara

Abstract
Front-of-pack labels can improve the ability of consumers to identify which foods are healthier, making them a useful public health tool. Nutri-Score is a front-of-pack labelling system adopted by several European countries. This system ranks foods according to their nutritional quality, but does not consider other dimensions such as the degree of food processing. The aim of this study is to compare the nutritional quality (as assessed by Nutri-Score) and the ultra-processing (as assessed by the NOVA classification) of foods in the Open Food Facts database. A simple correspondence analysis was carried out to study the relationship between the two systems. Ultra-processed foods (NOVA 4) were found in all Nutri-Score categories, ranging from 26.08% in nutritional category A, 51.48% in category B, 59.09% in category C, 67.39% in category D to up to 83.69% in nutritional category E. Given the negative effect that the consumption of ultra-processed foods has on different aspects of health, front-of-pack labelling with Nutri-Score should at least be accompanied by complementary labelling indicating the level of processing, such as the NOVA classification.

- Application of the British Food Standards Agency nutrient profiling system in a French food composition database
British Journal of Nutrition 112, no 10 (2014) : 1699 1705.
Julia C, Kesse-Guyot E, Touvier M, Méjean C, Fezeu L, et Hercberg S.

Abstract
Nutrient profiling systems are powerful tools for public health initiatives, as they aim at categorising foods according to their nutritional quality. The British Food Standards Agency (FSA) nutrient profiling system (FSA score) has been validated in a British food database, but the application of the model in other contexts has not yet been evaluated. The objective of the present study was to assess the application of the British FSA score in a French food composition database. Foods from the French NutriNet-Santé study food composition table were categorised according to their FSA score using the Office of Communication (OfCom) cut-off value (’healthier’ ≤ 4 for foods and ≤ 1 for beverages ; ’less healthy’ >4 for foods and >1 for beverages) and distribution cut-offs (quintiles for foods, quartiles for beverages). Foods were also categorised according to the food groups used for the French Programme National Nutrition Santé (PNNS) recommendations. Foods were weighted according to their relative consumption in a sample drawn from the NutriNet-Santé study (n 4225), representative of the French population. Classification of foods according to the OfCom cut-offs was consistent with food groups described in the PNNS : 97·8 % of fruit and vegetables, 90·4 % of cereals and potatoes and only 3·8 % of sugary snacks were considered as ’healthier’. Moreover, variability in the FSA score allowed for a discrimination between subcategories in the same food group, confirming the possibility of using the FSA score as a multiple category system, for example as a basis for front-of-pack nutrition labelling. Application of the FSA score in the French context would adequately complement current public health recommendations.

PMID : 25277084
DOI : 10.1017/S0007114514002761

- Performance of a five category front-of-pack labelling system–the 5-colour nutrition label–to differentiate nutritional quality of breakfast cereals in France
BMC public health 15, no 1 (2015) : 179.
Julia C, Kesse-Guyot E, Ducrot P, Péneau S, Touvier M, Méjean C, et al

Abstract
BACKGROUND :
Breakfast cereals exhibit a wide variability in nutritional quality, and differences are not easily grasped by consumers. A simplified nutritional information system might contribute to help consumers make healthier food choices. A five-category colour label based on the Food Standards Agency Nutrient profiling system (FSA score) has been proposed in France to be implemented on the front-of-pack of foods (the five-colour nutrition label - 5-CNL). Objectives were to evaluate the ability of the 5-CNL to discriminate nutritional quality between types of breakfast cereals, within a category and in equivalent products, as well as its ability to change through product reformulation.
METHODS :
Nutritional information was collected through an Internet and supermarket research for N = 433 breakfast cereals (N = 380 complete data included in the analyses). Breakfast cereals were categorized according to common attributes in terms of processing and/or ingredients used. The FSA score and 5-CNL category allocation were computed for each cereal. Nutrient content and FSA score were compared across types of cereals. Distribution within the 5-CNL categories was assessed across types of cereals and for equivalent products. Impact of reformulation (reduction of 5 and 10% in simple sugar, saturated fat and sodium) on the 5-CNL category allocation was compared to original allocation with Bapkhar’s tests of homogeneity of marginal distribution.
RESULTS :
Variability in nutritional quality of breakfast cereals was high, as reflected by the FSA score (range -7- 22 for a theoretical range of -15-40) and the 5-CNL (all five categories represented). The 5-CNL allowed for discrimination across types of cereals, within categories of breakfast cereals and for equivalent products (at least 3 categories of the 5-CNL represented). Reformulation scenarios allowed for significant change in 5-CNL allocation : 5% reduction in sugar lead to a modification of the label for 4.21% of products while a reduction of 10% of sugar, saturated fat and sodium lead to a modification of the label for 19.2% of products.
CONCLUSION :
The 5-CNL adequately discriminates between breakfast cereals. It would therefore be an adequate tool for consumer information on nutritional quality of foods in the French context.

PMID : 25885583
PMCID : PMC4349460
DOI : 10.1186/s12889-015-1522-y

- Discriminating nutritional quality of foods using the 5-Color nutrition label in the French food market : consistency with nutritional recommendations
Nutrition journal 14, no 1 (2015) : 100.
Julia C, Ducrot P, Péneau S, Deschamps V, Méjean C, Fézeu L, et al.

Abstract
PURPOSE :
Our objectives were to assess the performance of the 5-Colour nutrition label (5-CNL) front-of-pack nutrition label based on the Food Standards Agency nutrient profiling system to discriminate nutritional quality of foods currently on the market in France and its consistency with French nutritional recommendations.
METHODS :
Nutritional composition of 7777 foods available on the French market collected from the web-based collaborative project Open Food Facts were retrieved. Distribution of products across the 5-CNL categories according to food groups, as arranged in supermarket shelves was assessed. Distribution of similar products from different brands in the 5-CNL categories was also assessed. Discriminating performance was considered as the number of color categories present in each food group. In the case of discrepancies between the category allocation and French nutritional recommendations, adaptations of the original score were proposed.
RESULTS :
Overall, the distribution of foodstuffs in the 5-CNL categories was consistent with French recommendations : 95.4% of ’Fruits and vegetables’, 72.5% of ’Cereals and potatoes’ were classified as ’Green’ or ’Yellow’ whereas 86.0% of ’Sugary snacks’ were classified as ’Pink’ or ’Red’. Adaptations to the original FSA score computation model were necessary for beverages, added fats and cheese in order to be consistent with French official nutritional recommendations.
CONCLUSION :
The 5-CNL label displays a high performance in discriminating nutritional quality of foods across food groups, within a food group and for similar products from different brands. Adaptations from the original model were necessary to maintain consistency with French recommendations and high performance of the system.

PMCID : PMC4587869
DOI : 10.1186/s12937-015-0090-4

Association avec la qualité du régime

- Development and Validation of an Individual Dietary Index Based on the British Food Standard Agency Nutrient Profiling System in a French Context
The Journal of nutrition 144, no 12 (2014) : 2009 17.
Julia C, Touvier M, Méjean C, Ducrot P, Péneau S, Hercberg S, et al.

Abstract
BACKGROUND :
Nutrient profiling systems could be useful public health tools as a basis for front-of-package nutrition labeling, advertising regulations, or food taxes. However, their ability beyond characterization of foods to adequately characterize individual diets necessitates further investigation.
OBJECTIVES :
The objectives of this study were 1) to calculate a score at the individual level based on the British Food Standard Agency (FSA) food-level nutrient profiling system of each food consumed, and 2) to evaluate the validity of the resulting diet-quality score against food group consumption, nutrient intake, and sociodemographic and lifestyle variables.
METHODS :
A representative sample of the French population was selected from the NutriNet-Santé Study (n = 4225). Dietary data were collected through repeated 24-h dietary records. Sociodemographic and lifestyle data were self-reported. All foods consumed were characterized by their FSA nutrient profile, and the energy intake from each food consumed was used to compute FSA-derived aggregated scores at the individual level. A score of adherence to French nutritional recommendations [Programme National Nutrition Santé guideline score (PNNS-GS)] was computed as a comparison diet-quality score. Associations between food consumption, nutritional indicators, lifestyle and sociodemographic variables, and quartiles of aggregated scores were investigated using ANOVAs and linear regression models.
RESULTS :
Participants with more favorable scores consumed higher amounts of fruits [difference Δ = 156 g/d between quartile 1 (less favorable) and quartile 4 (most favorable), P < 0.001], vegetables (Δ = 85 g/d, P < 0.001), and fish, and lower amounts of snack foods (Δ = -72 g/d, P < 0.001 for sugary snacks) ; they also had higher vitamin and mineral intakes and lower intakes of saturated fat. Participants with more favorable scores also had a higher adherence to nutritional recommendations measured with the PNNS-GS (Δ = 2.13 points, P < 0.001). Women, older subjects, and higher-income subjects were more likely to have more favorable scores.
CONCLUSION :
Our results show adequate validity of the FSA nutrient profiling system to characterize individual diets in a French context. The NutriNet-Santé Study was registered in the European Clinical Trials Database (EudraCT) as 2013-000929-31.
© 2014 American Society for Nutrition.
KEYWORDS :
dietary behavior ; dietary score ; nutrient profiling system ; nutrition policy ; validation studies

PMID : 25411035
DOI : 10.3945/jn.114.199679

- Score de qualité nutritionnelle des aliments de la Food Standards Agency appliqué aux consommations alimentaires individuelles des adultes en France
BEH N° 24-25 - 7 juillet 2015
Deschamps V, Julia C, Salanave B, Verdot C, Hercberg S, Castetbon K.

Résumé
Introduction : En France, la mise en place d’un système d’information nutritionnelle simplifiée basé sur le score de qualité nutritionnelle élaboré au Royaume-Uni par la Food Standards Agency (FSA) est actuellement en discussion. Notre objectif était de mesurer la pertinence de l’application du score FSA aux comportements alimentaires individuels afin de quantifier les apports en aliments et en nutriments favorables à la santé ou non chez les adultes en France.
Méthodes : Enquête nationale représentative reposant sur un échantillonnage complexe à trois degrés, l’Étude nationale nutrition santé (ENNS) comportait un recueil de données de consommations alimentaires par trois rappels des 24 heures. Après exclusion des sous-déclarants, les analyses ont porté sur un total de 2 754 adultes (1 014 hommes, 1 740 femmes) âgés de 18 à 74 ans. Le score a été appliqué à l’ensemble des aliments et boissons de l’étude. Un score agrégé au niveau individuel a été calculé en tenant compte de l’énergie apportée par chacun des aliments consommés et de leur score FSA. Les consommations de groupes d’aliments et les apports en nutriments ont été décrits par quartiles de distribution de ce score individuel.

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- Validation of the FSA nutrient profiling system dietary index in French adults—findings from SUVIMAX study
European journal of nutrition 55, no 5 (2016) : 1901 10.
Julia C, Méjean C, Touvier M, Péneau S, Lassale C, Ducrot P, et al.

Abstract
PURPOSE :
Population-wide nutritional recommendations give guidance on food groups’ consumption, though a wide variability in nutritional quality within groups may subsist. Nutrient profiling systems may help capturing such variability. We aimed to apply and validate a dietary index based on the British Food Standards Agency nutrient profiling system (FSA-NPS DI) in French middle-aged adults.
METHODS :
Dietary data were collected through repeated 24-h dietary records in participants of the Supplémentation en Vitamines et Minéraux Antioxydants study (N = 5882). An aggregated dietary index at the individual level was computed using the FSA-NPS for each food consumed as well as compliance to the French nutritional guidelines using the Programme National Nutrition Santé-Guideline Score (PNNS-GS). Cross-sectional associations between FSA-NPS DI and nutrient intake, PNNS-GS, socio-demographic factors, lifestyle and nutritional biomarkers were computed using ANOVAs.
RESULTS :
The FSA-NPS DI was able to characterize the quality of the diets at the individual level in terms of nutrient intake and of adherence to nutritional recommendations : +37.6 % in beta-carotene intakes between subjects with a healthier diet versus subjects with a poorer diet, +42.8 % in vitamin C intakes ; +17 % in PNNS-GS, all P < 0.001. FSA-NPS-DI was also associated with nutritional status at the biological level : +21.4 % in beta-carotene levels between subjects with a healthier diet versus subjects with a poorer diet, +12.8 % in vitamin C levels, all P < 0.001.
CONCLUSIONS :
The FSA-NPS DI is a useful and validated tool to discriminate individuals according to the quality of the diet, accounting for nutritional quality within food groups. Taking into account nutritional quality of individual foods allows monitoring change in dietary patterns beyond food groups.
KEYWORDS :
Biomarkers ; Dietary index ; Nutrient profiling ; Nutritional recommendations

PMID : 26293977
DOI : 10.1007/s00394-015-1006-y

- The 5-CNL front-of-pack nutrition label appears an effective tool to achieve food substitutions towards healthier diets across dietary profiles
PloS one 11, no 6 (2016) : e0157545.
Julia C, Méjean C, Péneau S, Camille Buscail, Benjamin Alles, Fezeu L, Touvier M, Hercberg S, et Kesse-Guyot E.

Abstract
BACKGROUND :
Front-of-pack (FOP) nutrition labels are considered helpful tools to help consumers making healthier food choices, thus improving their diet. In France, the implementation of a FOP nutrition label-the 5-Colour Nutrition Label (5-CNL)-is currently under consideration. Our objective was to investigate dietary profiles in a French adult population using the 5-CNL, and to assess its potential impact in improving the diet through substitution of foods.
METHODS AND FINDINGS :
Subjects included in the NutriNet-Santé cohort, who had completed three 24-h dietary records were included in this cross-sectional analysis. Mutually exclusive clusters of individuals were identified using the percentage of energy derived from foods of each of the 5-CNL colours as input variables. Three scenarios of substitution of foods for healthier alternative using the 5-CNL were tested. Food group and dietary intakes, socio-demographic and lifestyle data were compared across clusters using ANOVAs or Chi-square tests, as appropriate. We identified three mutually exclusive dietary profiles : ’Healthy’ (N = 28 095, 29.3% of the sample), with high consumption of fruit, vegetables, whole cereals and fish ; ’Western’ (N = 33 386, 34.8%) ; with high consumption of sweetened beverages, breakfast cereal, cheese, fatty and sugary foods ; ’Traditional’ (N = 34 461, 35.1%), with high consumption of potatoes, bread, meat and dairy desserts. Overall, substitutions strategies led to an increase in the number of subjects reaching the recommended intakes in energy, macro and micronutrients. Increases were particularly high in the ’Western’ pattern for lipids and saturates intakes : from 16.2% reaching the recommended amount for lipids (13.5% for saturates) to 60.6% and 85.7% respectively.
CONCLUSION :
The use of the 5-CNL as an indicator of food choice meaningfully characterizes clusters of dietary habits and appears as an effective tool to help improving the nutritional quality of the diet.

PMID : 27322033
PMCID : PMC4913953
DOI :10.1371/journal.pone.0157545

Association avec les évènements de santé

- The Nutrient Profile of Foods Consumed Using the British Food Standards Agency Nutrient Profiling System Is Associated with Metabolic Syndrome in the SU. VI. MAX Cohort
The Journal of nutrition 145, no 10 (2015) : 2355 61.

Abstract
BACKGROUND :
Metabolic syndrome (MetS), comprising high waist circumference, blood pressure, glycemia, and triglycerides, and lower HDL cholesterol could in part be prevented by adequate nutrition. Nutrient profiling systems could be useful public health tools to help consumers make healthier food choices. An individual dietary index (DI) based on nutrient profiling of foods consumed could characterize dietary patterns in relation to the onset of MetS.
OBJECTIVE :
The objective of this study was to prospectively investigate the association between the Food Standards Agency (FSA) Nutrient Profiling System (NPS) DI and the onset of MetS in a middle-aged French cohort.
METHODS :
Participants from the SUpplémentation en VItamines et Minéraux AntioXydants cohort (SU.VI.MAX, n = 3741) were included in the present study. The FSA NPS DI was computed by using dietary data from 24 h records at inclusion. MetS was identified at baseline and at year 13 of follow-up with the use of self-reported medication, data from clinical investigations, and biological measurements. A prospective association between the FSA NPS DI (in quartiles and continuous) and the onset of MetS was investigated by using logistic regression.
RESULTS :
Poorer diets identified with the use of the FSA NPS DI were significantly associated with a higher risk of developing MetS (OR for poorer vs. healthier FSA NPS DI : 1.43 ; 95% CI : 1.08, 1.89 ; P-trend across quartiles = 0.02). The FSA NPS DI was significantly associated with the systolic blood pressure (SBP) and diastolic blood pressure (DBP) components of MetS (difference between healthier vs. poorer FSA NPS DI : 2.16 mm Hg for SBP and 1.5 mm Hg for DBP, P-trend across quartiles = 0.02).
CONCLUSION :
The FSA NPS DI was prospectively associated with the onset of MetS in a middle-aged French population. The application of NPSs in public health initiatives may help the population make healthier food choices, which might reduce the risk of developing MetS.
KEYWORDS :
a priori dietary score ; cohort study ; dietary patterns ; metabolic syndrome ; nutrient profiling system

PMID : 26290007
DOI :10.3945/jn.115.213629

- Prospective associations between a dietary index based on the British Food Standard Agency nutrient profiling system and 13-year weight gain in the SU. VI. MAX cohort
Preventive medicine 81 (2015) : 189 94.
Julia C, Ducrot P, Lassale C, Fézeu L, Méjean C, Péneau S, et al.

Abstract
BACKGROUND/OBJECTIVES :
The scoring of the nutritional quality of individual foods using nutrient profiling systems (NPS) has been suggested as a basis for public health preventive measures. Used for front-of-package labeling, such scoring would help consumers in making healthier food choices. An individual dietary score based on the Food Standards Agency NPS has been developed (FSA-NPS-DI), but its long term association with weight gain has not been investigated. Our objectives were to investigate long-term associations between the FSA-NPS DI and weight gain and overweight/obesity onset in a middle-aged French population.
SUBJECTS/METHODS :
Subjects included in the French SU.VI.MAX cohort with at least three dietary records at baseline and available anthropometric measurements at baseline and at a 13-year follow-up examination were included in the study. FSA-NPS DI at baseline was computed for each subject. Association between FSA-NPS DI and weight and BMI gain were investigated with ANCOVA and associations with overweight/obesity onset with logistic regression models.
RESULTS :
Higher baseline FSA-NPS DI (reflecting a poorer diet) was associated with higher weight and BMI gain (beta Q4 versus Q1=0.70 ; (95%CI 0.01 ; 1.38), P for trend=0.04). A 16% higher risk of obesity for a 1 point increase of FSA-NPS DI was observed only in men.
CONCLUSIONS :
Our results suggest that a shift in nutritional quality of the foods and beverages within an individual’s diet, as expressed by the FSA-NPS DI would be associated with lower weight gain in the long term. Using the FSA-NPS as a basis for food labeling might therefore contribute to tackle obesity.
Copyright © 2015. Published by Elsevier Inc.
KEYWORDS :
Cohort study ; Dietary score ; Nutrient profiling systems ; Obesity ; Weight gain

PMID : 26348449
DOI : 10.1016/j.ypmed.2015.08.022

- Prospective associations of the original Food Standards Agency nutrient profiling system and three variants with weight gain, overweight and obesity risk : results from the French NutriNet-Santé cohort
British journal of nutrition, septembre 2020
Egnell M, Seconda L, Neal B, Mhurchu CN, Rayner M, Jones A, et al.

Abstract
Background :
In health promotion, Nutrient Profiling Systems (NPSs) are frequently used to classify foods according to their nutritional composition. However, their validity requires further investigation, including their prospective associations with health. The study aimed to investigate the associations of the original Food Standards Agency-NPS and three variants (Food Standards Australia New Zealand Nutrient Profiling Scoring Criterion (NPSC), Health Star Rating NPS and the French NPS (HCSP-NPS)), with weight status.
Methods :
Dietary indices based on each of the four NPSs applied at the food level were computed at the individual level to characterize the dietary quality of 71,403 French individuals from the NutriNet-Santé cohort. Associations of these indices with weight gain were assessed using mixed models, and with overweight and obesity risks using Cox models.

- Prospective association between cancer risk and an individual dietary index based on the British Food Standards Agency Nutrient Profiling System
British Journal of Nutrition 114, no 10 (2015) : 1702 10.
Donnenfeld M, Julia C, Kesse-Guyot E, Méjean C, Ducrot P, Péneau S, et al.

Abstract
The Food Standards Agency Nutrient Profiling System (FSA-NPS) constitutes the basis for the Five-Colour Nutrition Label suggested in France to be put on the front-of-pack of food products. At the individual level, a dietary index (FSA-NPS DI) has been derived and validated and corresponds to a weighted mean of all FSA-NPS scores of foods usually consumed by the individual, reflecting the nutritional quality of his/her diet. Our aim was to investigate the association between the FSA-NPS DI and cancer risk in a large cohort. This prospective study included 6435 participants to the SUpplémentation en VItamines et Minéraux AntioXydants cohort (1994-2007) who completed at least six 24 h dietary records during the first 2 years of follow-up. FSA-NPS DI was computed for each subject (higher values representing lower nutritional quality of the diet). After a median follow-up of 12·6 years, 453 incident cancers were diagnosed. Associations were characterised by multivariate Cox proportional hazards models. The FSA-NPS DI was directly associated with overall cancer risk (hazard ratio (HR)for a 1-point increment=1·08 (95 % CI 1·01, 1·15), P trend=0·02 ; HRQ5 v. Q1=1·34 (95 % CI 1·00, 1·81), P trend=0·03). This association tended to be more specifically observed in subjects with moderate energy intake (≤median, HRfor a 1-point increment=1·10 (95 % CI 1·01-1·20), P trend=0·03). No association was observed in subjects with higher energy intake (P trend=0·3). Results were not statistically significant for breast and prostate cancer risks. For the first time, this study investigated the prospective association between the FSA-NPS individual score and cancer risk. The results suggest that unhealthy food choices may be associated with a 34 % increase in overall cancer risk, supporting the public health relevance of developing front-of-pack nutrition labels based on this score.
KEYWORDS :
Cancer risk ; FSA-NPS DI Food Standards Agency Nutrient Profiling System Dietary Index ; Food Standards Agency Nutrient Profiling System ; HR hazard ratio ; Nutrient profiling systems ; Nutrition policy ; Prospective studies ; SU.VI.MAX SUpplémentation en VItamines et Minéraux AntioXydants

PMID : 26393396
DOI : 10.1017/S0007114515003384

- Are self-reported unhealthy food choices associated with an increased risk of breast cancer ? Prospective cohort study using the British Food Standards Agency nutrient profiling system
BMJ open 7, no 6 (2017) : e013718.
Deschasaux M, Julia C, Kesse-Guyot E, Lécuyer L, Adriouch S, Méjean C, et al.

Abstract
OBJECTIVES :
French authorities are considering the implementation of a simplified nutrition labelling system on food products to help consumers make healthier food choices. One of the most documented candidates (Five-Colour Nutrition Label/Nutri-score) is based on the British Food Standards Agency Nutrient Profiling System (FSA-NPS), a score calculated for each food/beverage using the 100 g amount of energy, sugar, saturated fatty acid, sodium, fibres, proteins, and fruits and vegetables. To assess its potential public health relevance, studies were conducted on the association between the nutritional quality of the diet, measured at the individual level by an energy-weighted mean of all FSA-NPS scores of foods usually consumed (FSA-NPS dietary index (FSA-NPS DI)), and the risk of chronic diseases. The present study aimed at investigating the relationship between the FSA-NPS DI and breast cancer risk.
DESIGN :
Prospective study.
SETTING :
Population based, NutriNet-Santé cohort, France.
PARTICIPANTS :
46 864 women aged ≥35 years who completed ≥3 24-hour dietary records during their first 2 year of follow-up.
PRIMARY OUTCOME MEASURE :
Associations between FSA-NPS DI and breast cancer risk (555 incident breast cancers diagnosed between 2009 and 2015) were characterised by multivariable-adjusted Cox proportional hazard models.
RESULTS :
A higher FSA-NPS DI (lower nutritional quality of the diet) was associated with an increased breast cancer risk (HR1-point increment=1.06 (1.02-1.11), p=0.005 ; HRQ5vs.Q1=1.52 (1.11-2.08), p trend=0.002). Similar trends were observed in premenopausal and postmenopausal women (HR1-point increment=1.09 (1.01-1.18) and 1.05 (1.00-1.11), respectively).This study was based on an observational cohort using self-reported dietary data, thus residual confounding cannot be entirely ruled out. Finally, this holistic approach does not allow investigating which factors in the diet most specifically influence breast cancer risk.
CONCLUSIONS :
These results suggested that unhealthy food choices, as characterised by the FSA-NPS, may be associated with an increase in breast cancer risk, supporting the potential public health relevance of using this profiling system in the framework of public health nutritional measures.
© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

PMID : 28600360
PMCID : PMC5577898
DOI : 10.1136/bmjopen-2016-013718

- Prospective association between a dietary quality index based on a nutrient profiling system and cardiovascular disease risk
European journal of preventive cardiology 23, no 15 (2016) : 1669-76.
Adriouch S, Julia C, Kesse-Guyot E, Méjean C, Ducrot P, Péneau S, et al.

Abstract
BACKGROUND :
Public health strategies are essential to guide consumers’ choices and produce a substantial population impact on cardiovascular disease risk prevention through nutrition. Our aim was to investigate the prospective association between the Food Standards Agency nutrient profiling system dietary index (FSA-NPS DI) and cardiovascular disease risk. The FSA-NPS has been proposed to serve as a basis for a five-colour nutrition label suggested in France to be put on the front of pack of food products.
METHODS AND RESULTS :
A total of 6515 participants to the SU.VI.MAX cohort (1994-2007), who completed at least six 24-hour dietary records during the first two years of the study, were followed for a median of 12.4 years (25th-75th percentiles : 11.0-12.6). Multivariable Cox proportional hazards models were used to characterise the associations between FSA-NPS DI (continuous and sex-specific quartiles) and the incidence of cardiovascular diseases. Interactions with individual characteristics were tested ; 181 major cardiovascular events were reported (59 myocardial infarctions, 43 strokes, 79 anginas). A higher FSA-NPS DI, characterising poorer food choices, was associated with an overall increase in cardiovascular disease risk (HRfor a 1-point increment = 1.14 (1.03-1.27) ; HRQ4vs.Q1 = 1.61 (1.05-2.47), Ptrend Q4-Q1 = 0.03). This association tended to be stronger in smokers (HRfor a 1-point increment = 1.39 (1.11-1.73) ; Pinteraction = 0.01) and those less physically active (HRfor a 1-point increment = 1.26 (1.08-1.46) ; Pinteraction = 0.04).
CONCLUSIONS :
Our results suggest that poorer food choices, as reflected by a higher FSA-NPS DI, may be associated with a significant increase in cardiovascular risk, especially in at-risk individuals (smokers and physically inactive persons). This score could be a useful tool for public health prevention strategies.
KEYWORDS :
Cardiovascular risk ; FSA-NPS ; nutrient profiling system ; nutrition policy ; prospective study

PMID : 27000099
DOI : 10.1177/2047487316640659

- Association between a dietary quality index based on the food standard agency nutrient profiling system and cardiovascular disease risk among French adults
International journal of cardiology 234 (2017) : 22 27.
Adriouch S, Julia C, Kesse-Guyot E, Ducrot P, Péneau S, Méjean C, et al.

Abstract
BACKGROUND :
In France, the implementation of a front-of-pack (FOP) nutrition label-the 5-Colour Nutrition Label (5-CNL) is currently under consideration as a strategic tool to allow consumers making healthier food choices. This FOP label is based on the British Food Standards Agency Nutrient Profiling System (FSA-NPS), reflecting the overall nutritional quality of foods. At the individual level, an energy-weighted mean of all FSA-NPS scores of foods usually consumed has been elaborated (FSA-NPS DI). Our objective was to investigate the prospective association between the FSA-NPS DI and cardiovascular disease (CVD) risk.
METHODS :
75,801 participants to the NutriNet-Santé cohort, who completed at least three 24h dietary records during the first 2y of the follow-up, were followed between 2009 and 2016. Multivariable Cox proportional hazards models were used to characterize the associations between FSA-NPS DI and the incidence of CVDs.
RESULTS :
509 major cardiovascular events were diagnosed (262 coronary heart diseases and 247 strokes). A higher FSA-NPS DI, characterizing lower dietary quality, was associated with increased CVD risk (HRfor a 1-point increment=1.08 (1.03-1.13) ; HRQ4vs.Q1=1.40 (1.06-1.84), Ptrend Q4-Q1=0.01). This association tended to be stronger in overweight subjects (HRfor a 1-point increment=1.12 (1.04-1.19) ; Pinteraction=0.003).
CONCLUSIONS :
These results suggest that lower dietary quality, as reflected by a higher FSA-NPS DI, may be associated with a significant increase in cardiovascular risk, especially in at-risk individuals (overweight population). They support the public health relevance of developing a front-of-pack nutrition label based on this score.
Copyright © 2017 Elsevier B.V. All rights reserved.
KEYWORDS :
Cardiovascular risk ; FSA-NPS ; Nutrient profiling system ; Nutrition policy ; Prospective study

PMID : 28258849
DOI : 10.1016/j.ijcard.2017.02.092

- Association of the Dietary Index Underpinning the Nutri-Score Label with Oral Health : Preliminary Evidence from a Large, Population-Based Sample
Nutrients. 2019 Aug 23 ;11(9)
Andreeva VA, Egnell M, Galan P, Feron G, Hercberg S, Julia C.

Abstract
The 2017 implementation in France of the front-of-package nutrition label known as ’Nutri-Score’ was intended as a public health strategy to help individuals make healthier food choices at the point of purchase and thus help reduce chronic disease on the population level. Nutri-Score and the associated individual-level dietary index are based on the British Food Standards Agency Nutrient Profiling System (FSAm-NPS-DI). Prior research has shed light on the relation between the
dietary index and various physical health outcomes, yet no studies have explored the link with oral health. We analyzed the cross-sectional association of the dietary index with oral health in a population-based sample of 33,231 adults from the French NutriNet-Santé cohort. Oral health (main dependent variable) was assessed in 2016 with the General Oral Health Assessment Index ; FSAm-NPS-DI (main independent variable) was calculated using ≥3 non-consecutive 24-h dietary records, following established methodology ; lower scores corresponded to better diet quality. Age-specific associations were explored via multivariable linear regression. Fully-adjusted models showed modest yet significant associations between the dietary index and oral health in younger (18-59
years) and older (60+ years) participants, with the strength of the model being more pronounced in the former compared with the latter age group (F value : 28.5 versus 6.3, both p < 0.0001). Higher diet quality was associated with a somewhat lower risk of oral health problems. Albeit preliminary, the findings support the relevance of dietary indices underpinning nutrition labels such as the Nutri-Score. Future research is needed to confirm the associations.

PII : E1998.
DOI : 10.3390/nu11091998

- Associations between dietary scores with asthma symptoms and asthma control in adults.
Eur Respir J. juill 2018 ;52(1):1702572
Andrianasolo RM, Kesse-Guyot E, Adjibade M, Hercberg S, Galan P, Varraso R.

Abstract
Associations between asthma and the nutritional quality of diet remain poorly understood. We investigated the associations between overall quality of diet evaluated by three dietary scores (the Alternate Healthy Eating Index 2010 (AHEI-2010), the literature-based adherence score to Mediterranean diet (MEDI-LITE) and the modified Programme National Nutrition Santé Guideline Score (mPNNS-GS)) and the asthma symptom score and asthma control.
In 2017, 34 766 participants from the NutriNet-Santé cohort answered a detailed respiratory questionnaire. Asthma was defined by the asthma symptom score (as the sum of five questions) and asthma control by the asthma control test (ACT).
Roughly 25% of participants reported at least one asthma symptom and for the three dietary scores we observed a statistically significant negative association between a healthier diet and the asthma symptom score (for AHEI-2010, the adjusted OR was 0.79 (95% CI 0.75–0.84) for women and 0.67 (95% CI 0.60–0.75) for men). Among participants with asthma (n=2609) we also observed a negative association between a healthier diet and poorly controlled asthma. This was significant in men (OR 0.39 (95% CI 0.18–0.84) for the AHEI-2010) and borderline significant in women (OR 0.73 (95% CI 0.53–1.01) for the AHEI-2010 ; p=0.06 for trend).