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Consumption of Foods With Lower Nutri-Scores Associated With Higher Mortality

17 Sep 2020 | By Inserm (Newsroom) | Public health

New study looks at the link between nutritional quality of foods and mortality. © Adobe Stock

Consuming food products that rank lower on the nutritional quality score underlying the Nutri-Score logo is associated with higher mortality, according to the European cohort EPIC. These findings, obtained by researchers from Inserm, Inrae, Cnam and Université Sorbonne Paris Nord, in collaboration with researchers from the International Agency for Research on Cancer (WHO/IARC), confirm the relevance of Nutri-Score in the context of public health policy. The study was published on September 17, 2020 in the British Medical Journal (BMJ).

While it is now well established that a diet lower in sugars, saturated fats, salt and energy and higher in fiber, fruit and vegetables is better for health – helping to prevent the risk of chronic conditions, such as cancer or cardiovascular diseases – putting these recommendations into practice remains a major challenge.

With this in mind, the Nutri-Score logo was developed to help consumers choose foods with a better nutritional quality at the point of purchase and to incentivize manufacturers to improve the nutritional quality of their products. Nutri-Score is a front-of-pack label that uses 5 colors and provides information on the nutritional quality of food products: from category A (dark green) indicating higher nutritional quality to category E (dark orange) indicating lower nutritional quality. The colors used by Nutri-Score are attributed on the basis of Food Standards Agency nutrient profiling system, modified version (FSAm-NPS) scores, which reflect the nutritional profile of foods according to their content (per 100 g) in terms of energy, sugars, saturated fatty acids, sodium, protein, fiber and fruit and vegetables.

A number of studies published in international scientific journals have shown the validity of the FSAm-NPS score in characterizing the nutritional quality of food products as well as the efficacy of Nutri-Score in guiding consumers towards more nutritious choices. In particular, links between the consumption of foods whose FSAm-NPS scores indicate higher nutritional quality (reflected in higher Nutri-Scores) and better health have so far been observed in France (SU.VI.MAX and NutriNet-Santé cohorts), the United Kingdom (Whitehall II and EPIC-Norfolk cohorts) and Spain (SUN cohort).

The aim of the new study published in the BMJ and conducted by the Nutritional Epidemiology Research Team (EREN) at the Epidemiology and Statistics Research Center – Université de Paris (Inserm/Inrae/Cnam/Université Sorbonne Paris Nord) was to look for links between the FSAm-NPS scores of the foods consumed and mortality within a very broad population distributed across 10 European countries. It follows on from a study published in 2018, which was conducted in the same population in relation to cancer risk.

In total, 501,594 participants from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort were included in the analyses. During the 1992 to 2015 follow-up period, 53,112 participants died of non-accidental causes (including cancer and diseases of the circulatory, respiratory and digestive systems).

The researchers show that those participants who consumed on average more foods with FSAm-NPS scores indicating lower nutritional quality (reflected in lower Nutri-Scores), presented higher mortality (total mortality and mortality linked to cancer and diseases of the circulatory, respiratory and digestive systems).

Findings which were statistically significant once a large number of sociodemographic and lifestyle characteristics were taken into account.

Nutri-Score was officially adopted in France in 2017 and since then by various other European countries (Belgium, Spain, Germany, Netherlands, Switzerland and Luxembourg). Nevertheless, under current European labeling regulations the inclusion of this logo is optional and as such depends on the willingness of the food manufacturers. Although over 350 companies and brands so far have undertaken to include Nutri-Score on their products, one crucial point remains the necessity, in the near future, for Europe-wide harmonization making it mandatory to implement an effective and useful logo for consumers. This harmonization is envisaged for the year 2022 as part of the Farm to Fork strategy presented in May by the European Commission.

“In this context, our findings, combined with the various other findings available on the subject, help to show not just the capacity of FSAm-NPS and Nutri-Score to characterize the nutritional quality of foods but also the relevance of their use in the context of public health policies aimed at guiding consumers towards healthier food choices in order to prevent chronic diseases,” emphasize Inserm researchers Mélanie Deschasaux and Mathilde Touvier, who coordinated the study.

Researcher Contact


Chargée de Recherche Inserm

Equipe de Recherche en Epidémiologie Nutritionnelle EREN (Inserm/Inrae /Cnam /Université Sorbonne Paris Nord)

e-mail : rf.31sirap-vinu.hbms.nere@xuasahcsed.m

Mathilde TOUVIER

Directrice de recherche Inserm

Equipe de Recherche en Epidémiologie Nutritionnelle EREN (Inserm/Inrae /Cnam /Université Sorbonne Paris Nord)

e-mail : rf.31sirap-vinu.hbms.nere@reivuot.m

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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

Mélanie Deschasaux1,2 Inge Huybrechts2,3 Chantal Julia1,4 Serge Hercberg1,2,4 Manon Egnell1 Bernard Srour1,2 Emmanuelle Kesse-Guyot1,2 Paule Latino-Martel1,2 Carine Biessy3 Corinne Casagrande3 Neil Murphy2,3 Mazda Jenab2,3 Heather A Ward5 Elisabete Weiderpass3,6 Kim Overvad7 Anne Tjønneland8,9 Agnetha Linn Rostgaard-Hansen9 Marie-Christine Boutron-Ruault10,11 Francesca Romana Mancini10,11 Yahya Mahamat-Saleh10,11 Tilman Kühn12 Verena Katzke12 Manuela M Bergmann13,14 Matthias B Schulze13,14 Antonia Trichopoulou15 Anna Karakatsani15,16 Eleni Peppa15 Giovanna Masala17 Claudia Agnoli18 Maria Santucci De Magistris19 Rosario Tumino20 Carlotta Sacerdote21 Jolanda MA Boer22 WM Monique Verschuren22,23 Yvonne T van der Schouw23 Guri Skeie6 Tonje Braaten6 M Luisa Redondo24 Antonio Agudo25 Dafina Petrova26,27,28 Sandra M Colorado-Yohar28,29,30 Aurelio Barricarte28,31,32 Pilar Amiano28,33 Emily Sonestedt34 Ulrika Ericson34 Julia Otten35 Björn Sundström35 Nicholas J Wareham36 Nita G Forouhi36 Paolo Vineis37 Konstantinos K Tsilidis38,39 Anika Knuppel40 Keren Papier40 Pietro Ferrari2,3 Elio Riboli,5 Marc J Gunter2,3 Mathilde Touvier1,2

1 Sorbonne Paris Nord University, Inserm, Inrae, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre – University of Paris (CRESS), Bobigny, France

2 French network for Nutrition And Cancer Research (NACRe network), France

3 International Agency for Research on Cancer, World Health Organization, Lyon, France

4 Department of Public Health, Hôpitaux Universitaires Paris Seine-Saint-Denis (AP-HP), Bobigny, France

5 Faculty of Medicine, School of Public Health, Imperial College London, London, UK

6 Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway

7 Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus C, Denmark

8 Department of Public Health, University of Copenhagen, Copenhagen, Denmark

9 Danish Cancer Society Research Centre, Diet, Genes and Environment, Copenhagen, Denmark

10 CESP, INSERM U1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, Paris, France

11 Gustave Roussy, Villejuif, France

12 Division of Cancer Epidemiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany

13 Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany

14 Institute of Nutrition Science, University of Potsdam, Nuthetal, Germany

15 Hellenic Health Foundation, Athens, Greece

16 2nd Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Haidari, Greece

17 Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy

18 Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

19 AOU Federico II, Naples, Italy

20 Cancer Registry and Histopathology Department, Provincial Health Authority ASP Ragusa, Italy

21 Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Centre for Cancer Prevention (CPO), Turin, Italy

22 National Institute for Public Health and the Environment, Bilthoven, Netherlands

23 Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands

24 Public Health Directorate, Asturias, Spain

25 Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology – ICO, Group of Research on Nutrition and Cancer, Bellvitge Biomedical Research Institute – IDIBELL, L’Hospitalet of Llobregat, Barcelona, Spain

26 Andalusian School of Public Health (EASP), Granada, Spain

27 Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain

28 CIBER of Epidemiology and Public Health (CIBERESP), Spain

29 Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain

30 Research Group on Demography and Health, National Faculty of Public Health, University of Antioquia, Medellín, Colombia

31 Navarra Public Health Institute, Pamplona, Spain

32 Navarra Institute for Health Research (IdiSNA), Pamplona, Spain

33 Public Health Division of Gipuzkoa, Biodonostia Health Research Institute, Ministry of Health of the Basque Government, San Sebastian, Spain

34 Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden

35 Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden

36 MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK

37 MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK

38 Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK

39 Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece

40 Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK


British Medical Journal