法国巴黎大学Mélanie Deschasaux团队研究了使用食品包装前营养评分标注营养状况与死亡率的相关性。2020年9月16日，该研究发表在《英国医学杂志》上。

食品标准局的营养状况分析系统（FSAm-NPS）对食品营养质量进行评级，并据此推出营养评分的包装前标签，为了确定该标签指导消费者选择更健康的食品是否与死亡率相关，研究组进行了一项基于人群的队列研究。

研究组在10个欧洲国家/地区的23个医学中心对癌症和营养（EPIC）队列进行了一项前瞻性调查，共招募了521324名成人参与者，均使用特定国家/地区经验证的饮食调查表来评估日常饮食摄入量。采用每项食物列表中每100克所含的能量、糖、饱和脂肪酸、钠、纤维和蛋白质，以及水果、蔬菜、豆类和坚果的含量来计算FSAm-NPS分数。分数越高，饮食的总体营养质量越低。主要结局为FSAm-NPS饮食指数评分与死亡率之间的相关性。

中位随访17.2年后，共有501594名成年人的数据被纳入最终分析。FSAm-NPS饮食指数得分最高五分位与最低五分位的参与者相比，全因死亡风险显著增加（风险比为1.07），因癌症（1.08）、循环系统（1.04）、呼吸系统（1.39）和消化系统疾病（1.22）导致的死亡率显著增加。FSAm-NPS饮食指数得分最高五分位的人群中，年龄标准化的绝对全因死亡率为每10万人10年内死亡760人，而最低五分位的人群中为661人。

总之，食用FSAm-NPS分数较高（营养质量较低）的食物会导致全因死亡以及癌症、循环系统、呼吸系统和消化系统疾病的死亡风险增加。

附：英文原文

Title: Association between nutritional profiles of foods underlying Nutri-Score front-of-pack labels and mortality: EPIC cohort study in 10 European countries

Author: Mélanie Deschasaux, Inge Huybrechts, Chantal Julia, Serge Hercberg, Manon Egnell, Bernard Srour, Emmanuelle Kesse-Guyot, Paule Latino-Martel, Carine Biessy, Corinne Casagrande, Neil Murphy, Mazda Jenab, Heather A Ward, Elisabete Weiderpass, Kim Overvad, Anne Tjnneland, Agnetha Linn Rostgaard-Hansen, Marie-Christine Boutron-Ruault, Francesca Romana Mancini, Yahya Mahamat-Saleh, Tilman Kühn, Verena Katzke, Manuela M Bergmann, Matthias B Schulze, Antonia Trichopoulou, Anna Karakatsani, Eleni Peppa, Giovanna Masala, Claudia Agnoli, Maria Santucci De Magistris, Rosario Tumino, Carlotta Sacerdote, Jolanda MA Boer, WM Monique Verschuren, Yvonne T van der Schouw, Guri Skeie, Tonje Braaten, M Luisa Redondo, Antonio Agudo, Dafina Petrova, Sandra M Colorado-Yohar, Aurelio Barricarte, Pilar Amiano, Emily Sonestedt, Ulrika Ericson, Julia Otten, Bjrn Sundstrm, Nicholas J Wareham, Nita G Forouhi, Paolo Vineis, Konstantinos K Tsilidis, Anika Knuppel, Keren Papier, Pietro Ferrari, Elio Riboli, Marc J Gunter, Mathilde Touvier

Issue&Volume: 2020/09/16

Abstract:

Objective To 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.

Design Population based cohort study.

Setting European Prospective Investigation into Cancer and Nutrition (EPIC) cohort from 23 centres in 10 European countries.

Participants 521324 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 measure Associations between the FSAm-NPS dietary index score and mortality, assessed using multivariable adjusted Cox proportional hazards regression models.

Results After exclusions, 501594 adults (median follow-up 17.2 years, 8162730 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=53112 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 10000 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.

Conclusions In 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.

DOI: 10.1136/bmj.m3173

Source: https://www.bmj.com/content/370/bmj.m3173