Joint association of food nutritional profile by Nutri-Score front-of-pack label and ultra-processed food intake with mortality: Moli-sani prospective cohort study
Bonaccio M, Di Castelnuovo A, Ruggiero E, Costanzo S, Grosso G, De Curtis A, Cerletti C, Donati MB, de Gaetano G, Iacoviello L, Moli-sani Study Investigators
BMJ (Clinical research ed.) · 61 citations
Review labels
Neutral facts our review recorded about how this study was done. They describe method, never whether we like the result.
How it was studied
- Design
- Cohort study (indexed by PubMed)
- Studied in
- People
- Main outcome
- Clinical events such as disease or death
- Intake measured by
- Not stated
Who paid for it
- Funding
- Possibly industry funded
- Government
- Ministero della Salute
- Nonprofit
- Associazione Italiana per la Ricerca sul Cancro
Based on 2 listed funder(s) and full-text disclosure statement.
Publication
- Published
- 2022-08-31 · BMJ · vol. 378 · p. e070688
- Cited
- 88 citations · more than 100% of similar papers · 15.4× the field average
- Impact
- Top 10% most cited in its field
- References
- 67 works
- Access
- Open access (hybrid journal) · CC-BY-NC
- Research areas
- Consumer Attitudes and Food Labeling · Nutritional Studies and Diet · Food composition and properties
- Keywords
- Medicine, Hazard ratio, Confidence interval, Proportional hazards model, Prospective cohort study, Cohort, Demography, Cohort study, Internal medicine
- MeSH
- humans, cardiovascular diseases, prospective studies, eating, adult, middle aged, female, male, fast foods, nutrients
10 authors
From IT
- Marialaura Bonaccio · correspondingIstituto Neurologico Mediterraneo
- Augusto Filippo Di CastelnuovoClinica Mediterranea
- Emilia RuggieroIstituto Neurologico Mediterraneo
- Simona CostanzoIstituto Neurologico Mediterraneo
- Giuseppe GrossoUniversity of Catania
- Amalia De CurtisIstituto Neurologico Mediterraneo
Abstract
Objective
To jointly analyse two food dimensions, the Food Standards Agency Nutrient Profiling System (FSAm-NPS), used to derive the Nutri-Score front-of-pack label, and the NOVA classification in relation to mortality.
Design
Prospective cohort study.
Setting
Moli-sani Study, Italy 2005-10.
Participants
22 895 participants (mean age 55 (SD 12) years; 48% men).
Main outcomes measures
Associations between dietary exposures and mortality risk, assessed using multivariable cause specific Cox proportional hazard models controlled for known risk factors.
Results
A total of 2205 deaths occurred during 272 960 person years of follow-up. In the highest quarter of the FSAm-NPS index compared with the lowest quarter, multivariable adjusted hazard ratios for all cause and cardiovascular mortality were 1.19 (95% confidence interval 1.04 to 1.35; absolute risk difference 4.3%, 95% confidence interval 1.4% to 7.2%) and 1.32 (1.06 to 1.64; 2.6%, 0.3% to 4.9%), respectively. The hazard ratios were 1.19 (1.05 to 1.36; absolute risk difference 9.7%, 5.0% to 14.3%) and 1.27 (1.02 to 1.58; 5.0%, 1.2% to 8.8%), respectively, for all cause and cardiovascular mortality when the two extreme categories of ultra-processed food intake were compared. When these two indices were analysed jointly, the magnitude of the association of the FSAm-NPS dietary index with all cause and cardiovascular mortality was attenuated by 22.3% and 15.4%, respectively, whereas mortality risks associated with high ultra-processed food intake were not altered.
Conclusions
Adults with the lowest quality diet, as measured using the FSAm-NPS dietary index (underpinning the Nutri-Score), and the highest ultra-processed food consumption (NOVA classification) were at the highest risk for all cause and cardiovascular mortality. A significant proportion of the higher mortality risk associated with an elevated intake of nutrient poor foods was explained by a high degree of food processing. In contrast, the relation between a high ultra-processed food intake and mortality was not explained by the poor quality of these foods.
Abstract via Europe PMC. Copyright remains with the authors or publisher (CC BY-NC).
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