L’alimentation serait responsable d’environ 30% des décès dus aux maladies cardiovasculaires. © Mathilde Touvier
Cardiovascular diseases are the leading cause of mortality in Western Europe, accounting for 1/3 of deaths in 2019. Diet is thought to be responsible for around 30% of such deaths. Nutrition-related prevention policies therefore constitute a major public health challenge for these diseases.
In an article to be published on 11 September 2024 in Lancet Regional Health – Europe, researchers from the Nutritional Epidemiology Research Team (CRESS-EREN), with members from Inserm, Inrae, Cnam, Université Sorbonne Paris Nord and Université Paris Cité, in collaboration with researchers from the International Agency for Research on Cancer (WHO-IARC), report an increased risk of cardiovascular diseases associated with the consumption of foods that rank less favourably on the Nutri-Score scale (new 2024 version) within the European cohort EPIC. A total of 345,533 participants from the cohort, spread across 7 European countries and followed for 12 years, were included in the analyses.
Officially adopted in France in 2017 (and in 6 other European countries since), the Nutri-Score aims to provide rapid information on the nutritional quality of foods and drinks to help and encourage consumers to compare them and choose those that offer a better nutritional quality. In parallel, it encourages manufacturers to improve the nutritional quality of their products.
The Nutri-Score has 5 categories, ranging from A (dark green – higher nutritional quality) to E (dark orange – lower nutritional quality). An algorithm ranks each product according to its levels – per 100 g – of energy, sugars, saturated fatty acids and salt (to limit) and proteins, fruits, vegetables and pulses (to favour).
A number of studies published in international scientific journals have shown the validity of Nutri-Score in characterising the nutritional quality of foods and its efficacy in guiding consumers towards more nutritious choices (over 140 publications). In particular, links between the consumption of foods with a less favourable Nutri-Score (lower nutritional quality) and an increased risk of cardiovascular diseases have so far been observed in French studies (SU.VI.MAX and NutriNet-Santé cohorts). Studies in France, UK, Spain and Italy have also seen similar associations with an increased risk of various chronic diseases as well as higher mortality.
In this new study, the researchers focused on the latest version of the Nutri-Score algorithm (updated in 2024, see box), linked to the risk of cardiovascular diseases, in a large population spread across 7 European countries, with the aim of providing new scientific evidence for validating the Nutri-Score on a European scale. It follows two studies published in 2018 and 2020 in the same population on cancer risk and mortality.
A total of 345 533 participants from the EPIC (European Prospective Investigation into Cancer and Nutrition) cohort were included in the analyses. During the follow-up (12 years, between 1992 and 2010), 16 214 participants developed a cardiovascular disease (6 565 of whom had myocardial infarction and 6 245 stroke). The findings show that the participants consuming on average more foods with less favourable Nutri-Score, reflecting lower nutritional quality, were at increased risk of cardiovascular diseases, particularly myocardial infarction and stroke. These associations were significant after a large number of sociodemographic and lifestyle factors were taken into account.
‘These findings confirm the relevance of Nutri-Score as a public health tool to guide consumers in their food choices with the goal of preventing chronic diseases’, emphasises Inserm researcher Mélanie Deschasaux-Tanguy.
‘They also provide key elements to support the adoption of Nutri-Score as a mandatory nutritional logo in Europe’, explains Mathilde Touvier, Inserm research director.
A new version of the Nutri-Score in 2024
Changes to the calculation of the Nutri-Score[2] were recently proposed by the international scientific committee responsible for its monitoring in order to improve its consistency with nutritional recommendations. This new version of the Nutri-Score is expected to come into force in 2024 with a gradual roll-out in the months to come. However, due to European labelling regulations, manufacturers are under no obligation to use Nutri-Score on their packaging.
While many companies and brands (over 1,400 in France) have so far committed to using Nutri-Score on their products, harmonisation at European level is needed to ensure the mandatory implementation of a single logo that is effective and useful for citizens. This harmonisation is envisaged as part of the European Commission’s Farm to Fork strategy.
[1] https://sante.gouv.fr/prevention-en-sante/preserver-sa-sante/nutrition/nutri-score/etudes-et-rapports-scientifiques/
[2] https://theconversation.com/en-2024-le-nutri-score-evolue-pourquoi-et-que-faut-il-en-retenir-221697
To find out more: watch the Inserm program “Nutri-Score, we tell you everything” (french only).
Mélanie Deschasaux-Tanguy
Inserm staff scientist
Nutritional Epidemiology Research team CRESS-EREN, U1153 Inserm / Inrae / Cnam / Université Sorbonne Paris Nord and Université Paris Cité
z.qrfpunfnhk@rera.fzou.havi-cnevf13.se
Mathilde Touvier
Inserm research director
Leader of the Nutritional Epidemiology Research team CRESS-EREN, U1153 Inserm / Inrae / Cnam / Université Sorbonne Paris Nord and Université Paris Cité
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, 11 September, 2024
DOI : 10.1016/j.lanepe.2024.101006
Mélanie Deschasaux-Tanguy1, Inge Huybrechts2, Chantal Julia1,3, Serge Hercberg1,3, Barthélémy Sarda1, Morgane Fialon1, Nathalie Arnault1, Bernard Srour1, Emmanuelle Kesse-Guyot1, Léopold K. Fezeu1, Carine Biessy2, Corinne Casagrande2, Bertrand Hemon2, Elisabete Weiderpass2, Maria G. M. Pinho2,4,5, Neil Murphy2, Heinz Freisling2, Pietro Ferrari2, Anne Tjønneland6,7, Kristina Elin Nielsen Petersen6, Verena Katzke8, Rudolf Kaaks8, Matthias B. Schulze9,10, Giovanna Masala11, Valeria Pala12, Salvatore Panico13, Fulvio Ricceri14,15, W. M. Monique Verschuren16, Jolanda M. A. Boer16, Yvonne T van der Schouw17, Guri Skeie18, Antonio Agudo19,20, Esther Molina-Montes21,22,23,24, José María Huerta21,25, Conchi Moreno-Iribas21,26,27, Ulrika Ericson28, Emily Sonestedt28, Anna Strid29, Viktor Oskarsson30, Tammy Y. N. Tong31, Alicia K. Heath32, Elom K. Aglago32, John Danesh33, Elio Riboli32, Marc J. Gunter2, Mathilde Touvier1
1 Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center for Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017 Bobigny, France
2 International Agency for Research on Cancer, World Health Organization, Lyon, France
3 Department of Public Health, Hôpitaux Universitaires Paris Seine-Saint-Denis (AP-HP), Bobigny, France
4 Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, Amsterdam, Netherlands
5Amsterdam Public Health, Health Behaviors and Chronic Diseases, Amsterdam, Netherlands
6 Danish Cancer Society Research Center, Copenhagen, Denmark
7 Department of Public Health, University of Copenhagen, Copenhagen, Denmark
8 Department of Cancer Epidemiology, German Cancer research Center (DKFZ), Heidelberg, Germany
9 Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
10 Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany
11 Clinical Epidemiology Unit, Institute for cancer research, prevention and clinical network (ISPRO), Florence, Italy
12 Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
13 School of Medicine, Federico II University, Naples, Italy
14 Centre for Biostatistics, Epidemiology, and Public Health, Department of Clinical and Biological Sciences, University of Turin, Italy
15 Unit of Epidemiology, Regional Health Service ASL TO3, Grugliasco (TO), Italy
16 Department Life Course and Health, Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
17 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
18 Department of Community Medicine, Faculty of Health Sciences, University of Tromsø (UiT) – The Arctic University of Norway, Tromsø, Norway
19 Unit of Nutrition and Cancer, Catalan Institute of Oncology – ICO, L’Hospitalet de Llobregat, Spain
20 Nutrition and Cancer Group; Epidemiology, Public Health, Cancer Prevention and Palliative Care Program; Bellvitge Biomedical Research Institute – IDIBELL, L’Hospitalet de Llobregat, Spain
21 CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain;
22 Department of Nutrition and Food Science, Campus of Cartuja, University of Granada, Granada, Spain
23 Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
24 Institute of Nutrition and Food Technology (INYTA) ‘José Mataix’, Biomedical Research Centre, University of Granada, Granada, Spain
25 Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain.
26 Navarra Public Health Institute, Pamplona, Spain
27 Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
28 Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
29 Department of Internal Medicine and Clinical Nutrition, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
30 Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
31 Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
32 School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
33 Department of Public Health and Primary Care, University of Cambridge, United Kingdom
