ArticleBMJ (Clinical research ed.)2020
Association between nutritional profiles of foods underlying Nutri-Score front-of-pack labels and mortality: EPIC cohort study in 10 European countries.
Article in BMJ (Clinical research ed.), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 57 papers, 2 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
57 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- The Role of Diet, Alcohol, BMI, and Physical Activity in Cancer Mortality: Summary Findings of the EPIC Study.Nutrients · 2021Pooled it
- Pooled it
- Trial
- A Randomized Controlled Study to Test Front-of-Pack (FOP) Nutrition Labels in the Kingdom of Saudi Arabia.Nutrients · 2023Trial
- A randomized trial to evaluate the impact of Singapore's forthcoming Nutri-grade front-of-pack beverage label on food and beverage purchases.The international journal of behavioral nutrition and physical activity · 2023Trial
- Labels Affect Food Choices, but in What Ways?Nutrients · 2022Trial
- Trial
- Beyond Nutrient Profiling: Strengths, Limitations, and Emerging Challenges for Nutri-Score and Related Front-of-Pack Labeling Systems.Nutrients · 2026Review
- Mortality risk in relation to diet quality assessed by the 2023 nutri-score nutrient profiling model: a prospective analysis.European journal of nutrition · 2026Article
- Alignment with front-of-package labeling policy and risk of hospitalization: evidence from Canadian National Nutrition Survey linked to routinely collected health administrative databases.The American journal of clinical nutrition · 2026Article
- Application of a Food-Based Nutritional Profiling System to Assess Diet Quality in Diet-Level Data: Evidence on Construct and Convergent Validity from the Hatoyama Cohort Study and Kusatsu Cohort Study.Current developments in nutrition · 2026Article
- Updated nutrient profiling system underlying nutri-score (Uns-Nps) and colorectal cancer risk.European journal of clinical nutrition · 2025Article
- Nutritional quality and on-package marketing of pre-packaged foods and non-alcoholic beverages for sale in Senegalese supermarkets.BMC public health · 2025Article
- Food Is Medicine: Diet Assessment Tools in Adult Inflammatory Bowel Disease Research.Nutrients · 2025Review
- Improvements to the Nutri-Score to address challenges identified in a Nordic setting.Food & nutrition research · 2025Article
- Assessing the healthfulness of pre-packaged beverages and investigating sugar thresholds for revising front-of-pack labels: a case study in Thailand.Frontiers in nutrition · 2025Article
- Development of the Ajinomoto Group Nutrient Profiling System for Japanese Meals.Frontiers in nutrition · 2025Article
- Nutri-score and cardiovascular risk: new insights from the EPIC cohorts.The Lancet regional health. Europe · 2024Article
- Nutritional quality of diet characterized by the Nutri-Score profiling system and cardiovascular disease risk: a prospective study in 7 European countries.The Lancet regional health. Europe · 2024Article
- Development of a Nutrient Profile Model for Dishes in Japan Version 1.0: A New Step towards Addressing Public Health Nutrition Challenges.Nutrients · 2024Article
Corrections and comments
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Authors and funding
57 authors.
Funding
Abstract
objectiveTo 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.
designPopulation based cohort study.
settingEuropean Prospective Investigation into Cancer and Nutrition (EPIC) cohort from 23 centres in 10 European countries.
participants521 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 measureAssociations between the FSAm-NPS dietary index score and mortality, assessed using multivariable adjusted Cox proportional hazards regression models.
resultsAfter 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.
conclusionsIn 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.
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