Association between a dietary quality index based on the food standard agency nutrient profiling system and cardiovascular disease risk among French adults

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 (HR_{for a 1-point increment}=1.08 (1.03-1.13); HR_Q4vs.Q1=1.40 (1.06-1.84), P_{trend Q4-Q1}=0.01). This association tended to be stronger in overweight subjects (HR_{for a 1-point increment}=1.12 (1.04-1.19); P_interaction=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.

Keywords: Cardiovascular risk; FSA-NPS; Nutrient profiling system; Nutrition policy; Prospective study.