Prospective association between a dietary quality index based on a nutrient profiling system and cardiovascular disease risk

Abstract

Background

Public health strategies are essential to guide consumers’ choices and produce a substantial population impact on cardiovascular disease risk prevention through nutrition. Our aim was to investigate the prospective association between the Food Standards Agency nutrient profiling system dietary index (FSA-NPS DI) and cardiovascular disease risk. The FSA-NPS has been proposed to serve as a basis for a five-colour nutrition label suggested in France to be put on the front of pack of food products.

Methods and results

A total of 6515 participants to the SU.VI.MAX cohort (1994–2007), who completed at least six 24-hour dietary records during the first two years of the study, were followed for a median of 12.4 years (25th–75th percentiles: 11.0–12.6). Multivariable Cox proportional hazards models were used to characterise the associations between FSA-NPS DI (continuous and sex-specific quartiles) and the incidence of cardiovascular diseases. Interactions with individual characteristics were tested; 181 major cardiovascular events were reported (59 myocardial infarctions, 43 strokes, 79 anginas). A higher FSA-NPS DI, characterising poorer food choices, was associated with an overall increase in cardiovascular disease risk (HR_{for a 1-point increment} = 1.14 (1.03–1.27); HR_Q4vs.Q1 = 1.61 (1.05–2.47), P_{trend Q4-Q1} = 0.03). This association tended to be stronger in smokers (HR_{for a 1-point increment} = 1.39 (1.11–1.73); P_interaction = 0.01) and those less physically active (HR_{for a 1-point increment} = 1.26 (1.08–1.46); P_interaction = 0.04).

Conclusions

Our results suggest that poorer food choices, as reflected by a higher FSA-NPS DI, may be associated with a significant increase in cardiovascular risk, especially in at-risk individuals (smokers and physically inactive persons). This score could be a useful tool for public health prevention strategies.

Clinical trial registration

ClinicalTrials.gov identifier: NCT00272428.

Keywords

Cardiovascular risk FSA-NPS nutrient profiling system nutrition policy prospective study

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References

Mozaffarian

Appel

Van

. Components of a cardioprotective diet: new insights. Circulation 2011; 123: 2870–2891.

Moeller

Reedy

Millen

. Dietary patterns: challenges and opportunities in dietary patterns research an Experimental Biology workshop, April 1, 2006. J Am Diet Assoc 2007; 107: 1233–1239.

Waijers

Feskens

Ocke

. A critical review of predefined diet quality scores. Br J Nutr 2007; 97: 219–231.

Estaquio

Kesse-Guyot

Deschamps

. Adherence to the French Programme National Nutrition Sante Guideline Score is associated with better nutrient intake and nutritional status. J Am Diet Assoc 2009; 109: 1031–1041.

Kesse-Guyot

Touvier

Henegar

. Higher adherence to French dietary guidelines and chronic diseases in the prospective SU.VI.MAX cohort. Eur J Clin Nutr 2011; 65: 887–894.

Arambepola

Scarborough

Rayner

. Validating a nutrient profile model. Public Health Nutr 2008; 11: 371–378.

Azais-Braesco

Goffi

Labouze

. Nutrient profiling: comparison and critical analysis of existing systems. Public Health Nutr 2006; 9: 613–622.

Julia

Touvier

Mejean

. Development and validation of an individual dietary index based on the British Food Standard Agency nutrient profiling system in a French context. J Nutr 2014; 144: 2009–2017.

Julia

Mejean

Touvier

. Validation of the FSA nutrient profiling system dietary index in French adults – findings from SUVIMAX study. Eur J Nutr 2015.

10.

Julia

Kesse-Guyot

Touvier

. Application of the British Food Standards Agency nutrient profiling system in a French food composition database. Br J Nutr 2014; 112: 1699–1705.

11.

Julia

Kesse-Guyot

Ducrot

. Performance of a five category front-of-pack labelling system – the 5-colour nutrition label - to differentiate nutritional quality of breakfast cereals in France. BMC Public Health 2015; 15: 179–179.

12.

Julia

Ducrot

Lassale

. Prospective associations between a dietary index based on the British Food Standard Agency nutrient profiling system and 13-year weight gain in the SU.VI.MAX cohort. Prev Med 2015; 81: 189–194.

13.

Julia

Fezeu

Ducrot

. Nutrient profile of foods consumed with the use of the British Food Standards Agency Nutrient Profiling System is associated with metabolic syndrome in the SUpplementation en VItamines et Mineraux AntioXydants Cohort. J Nutr 2015; 145(10): 2355–2361.

14.

Donnenfeld

Julia

Kesse-Guyot

. Prospective association between cancer risk and an individual dietary index based on the British Food Standards Agency Nutrient Profiling System. Br J Nutr 2015; 114(10): 1–9.

15.

Hercberg

Galan

Preziosi

. The SU.VI.MAX Study: a randomized, placebo-controlled trial of the health effects of antioxidant vitamins and minerals. Arch Intern Med 2004; 164: 2335–2342.

16.

Le Moullec N, Deheeger M, Preziosi P, et al. Validation du manuel photo utilisé pour l'enquête alimentaire de l'étude SU.VI.MAX. [Validation of the food portion size booklet used in the SU.VI.MAX study]. (in French). Cah Nutr Diet 1996; 31: 158–164.

17.

Hercberg S. Table de composition SU.VI.MAX des aliments. [SU.VI.MAX food composition table] (in French). Paris: Les éditions INSERM/Economica, 2005.

18.

Julia

Ducrot

Peneau

. Discriminating nutritional quality of foods using the 5-Color nutrition label in the French food market: consistency with nutritional recommendations. Nutr J 2015; 14: 100–100.

19.

Desquilbet

Mariotti

. Dose-response analyses using restricted cubic spline functions in public health research. Stat Med 2010; 29: 1037–1057.

20.

Chiuve

Sampson

Willett

. The association between a nutritional quality index and risk of chronic disease. Am J Prev Med 2011; 40: 505–513.

21.

Lichtenstein

Carson

Johnson

. Food-intake patterns assessed by using front-of-pack labeling program criteria associated with better diet quality and lower cardiometabolic risk. Am J Clin Nutr 2014; 99: 454–462.

22.

Katz

Njike

Rhee

. Performance characteristics of NuVal and the Overall Nutritional Quality Index (ONQI). Am J Clin Nutr 2010; 91: 1102S–1108S.

23.

Dauchet

Amouyel

Hercberg

. Fruit and vegetable consumption and risk of coronary heart disease: a meta-analysis of cohort studies. J Nutr 2006; 136: 2588–2593.

24.

Wang

Ouyang

Liu

. Fruit and vegetable consumption and mortality from all causes, cardiovascular disease, and cancer: systematic review and dose-response meta-analysis of prospective cohort studies. BMJ 2014; 349: g4490–g4490.

25.

Threapleton

Greenwood

Evans

. Dietary fibre intake and risk of cardiovascular disease: systematic review and meta-analysis. BMJ 2013; 347: f6879–f6879.

26.

Fung

Malik

Rexrode

. Sweetened beverage consumption and risk of coronary heart disease in women. Am J Clin Nutr 2009; 89: 1037–1042.

27.

Ludwig

. The glycemic index: physiological mechanisms relating to obesity, diabetes, and cardiovascular disease. JAMA 2002; 287: 2414–2423.

28.

Hooper

Summerbell

Thompson

. Reduced or modified dietary fat for preventing cardiovascular disease. Cochrane Database Syst Rev 2011; 7: CD002137–CD002137.

29.

Estruch

Ros

Martinez-Gonzalez

. Mediterranean diet for primary prevention of cardiovascular disease. N Engl J Med 2013; 369: 676–677.

30.

Garcia-Lopez

Martinez-Gonzalez

Basterra-Gortari

. Adherence to the Mediterranean dietary pattern and heart rate in the SUN project. Eur J Prev Cardiol 2014; 21: 521–527.

31.

McCullough

Feskanich

Stampfer

. Adherence to the Dietary Guidelines for Americans and risk of major chronic disease in women. Am J Clin Nutr 2000; 72: 1214–1222.

32.

McCullough

Feskanich

Rimm

. Adherence to the Dietary Guidelines for Americans and risk of major chronic disease in men. Am J Clin Nutr 2000; 72: 1223–1231.

33.

Atkins

Whincup

Morris

. High diet quality is associated with a lower risk of cardiovascular disease and all-cause mortality in older men. J Nutr 2014; 144: 673–680.

34.

Buckland

Gonzalez

Agudo

. Adherence to the Mediterranean diet and risk of coronary heart disease in the Spanish EPIC Cohort Study. Am J Epidemiol 2009; 170: 1518–1529.

35.

Huijbregts

Feskens

Rasanen

. Dietary pattern and 20 year mortality in elderly men in Finland, Italy, and The Netherlands: longitudinal cohort study. BMJ 1997; 315(7099): 13–17.

36.

Huijbregts

de Vegt

Feskens

Dietary patterns and mortality in an elderly poupulation in the Netherlands. A comparison between cluster analysis and the healthy diet indicator. In: Huijbregts

(ed). Dietary patterns and health in the elderly, The Netherlands: Wageningen University, 1997, pp. 33–42.

37.

Lachman

Peters

Lentjes

. Ideal cardiovascular health and risk of cardiovascular events in the EPIC-Norfolk prospective population study. Eur J Prev Cardiol 2015.

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