New findings from a large European cohort show that the updated Nutri-Score more accurately identifies poor-quality diets linked to higher heart attack and stroke risks, offering stronger evidence for its role as a public health tool.
Nutritional quality of diet characterized by the Nutri-Score profiling system and cardiovascular disease risk: a prospective study in 7 European countries. Image Credit: Lightspring / Shutterstock
A study published in The Lancet Regional Health—Europe deciphers the association between the nutritional quality of diet assessed by the updated 2023 Nutri-Score profiling system and the risk of cardiovascular disease in a large European population.
Background
Cardiovascular disease is a leading cause of mortality in Western Europe, accounting for almost 35% of all deaths occurring in that region. An unhealthy diet is the second leading risk factor for cardiovascular disease, responsible for 30% of disease-specific deaths.
Health authorities in European countries have developed dietary guidelines to set standards for recommended food groups and nutrient intakes and to prevent diet-related chronic diseases.
Front-of-pack nutrition levels serve as useful complementary information for customers at the time of purchase. This information can help customers choose healthy food items and avoid items of poor nutritional quality.
The Nutri-Score is one of the most scientifically validated front-of-pack nutrition labels in the European region, which provides the overall nutritional quality of food items with five colors and letters.
The nutrient profiling system, initially developed by the UK Food Standards Agency, calculates the Nutri-Score. In 2023, the Nutri-Score algorithm was updated to provide more accurate alignment with dietary guidelines, allowing for finer discrimination of food quality, which may result in improved diet ranking across populations.
In this study, scientists have explored the associations between the nutritional quality of diet characterized by the updated Nutri-Score profiling system and the risk of cardiovascular disease in a large European population.
Study design
The study included 345,533 participants from the European Prospective Investigation into Cancer and Nutrition study, a pan-European multi-center prospective cohort study involving more than 520,000 participants from ten European countries.
Participants' food intakes were determined at baseline using country-specific dietary questionnaires. Nutri-Score was calculated as a continuous scale for each food, based on its 100 grams of energy, sugars, saturated fatty acids, salt, fiber, and protein and the percentage of fruit, vegetables, and pulses. A dietary index was calculated at the individual level using the Nutri-Score of all food items consumed by a participant.
Self-reported and country-specific registry data were used to retrieve cardiovascular events during the follow-up.
Important observations
The analysis of baseline characteristics revealed that participants with higher Nutri-Score-based dietary indices, which reflect a poor-quality diet, are more likely to have smoking habits, a physically inactive lifestyle, a lower body mass index (BMI), and a lower prevalence of chronic cardiometabolic diseases.
During the average study follow-up period of 12.3 years, 16,214 cardiovascular events occurred. These events included 11,009 coronary heart disease events and 6669 cerebrovascular events.
A significant positive association was observed between the Nutri-Score dietary index and the risk of cardiovascular diseases, including myocardial infarction, cerebrovascular diseases, and stroke. Interestingly, a threshold effect was observed for myocardial infarction, with associations only apparent at the highest levels of the Nutri-Score dietary index.
Regarding absolute risk reduction, the findings revealed that participants with the lowest dietary index scores (highest quality diet) have 126 cases per 100,000 person-years less than those with the highest dietary index scores.
The study also highlighted country-specific variations, with stronger associations between Nutri-Score and cardiovascular outcomes in countries like Denmark, Sweden, and the UK, where participants showed higher Nutri-Score dietary index scores.
No significant impact of gender, physical activity level, and alcohol intake was observed on the association between Nutri-Score dietary index and cardiovascular disease risk. However, BMI and smoking status showed an interactive effect.
Specifically, a more apparent association between Nutri-Score dietary index and cerebrovascular events and stroke was observed in overweight or obese participants. In contrast, the associations with cardiovascular, coronary heart disease, and myocardial infarction were more pronounced in current smokers.
Study significance
The study finds that consumption of food items with lower nutritional quality, as graded by the updated Nutri-Score profiling system, can increase the risk of cardiovascular diseases, particularly myocardial infarction and stroke.
Previous studies based on the former version of the Nutri-Score profiling system have produced mixed results, with the majority reporting no association between nutritional quality of diet and cardiovascular disease risk. The improved findings in this study are likely attributed to the use of the updated 2023 Nutri-Score, which evaluates nutritional quality on a more continuous and refined scale. This allows for better categorization of food items and a more accurate ranking of participants' diets.
Regarding cardiovascular disease-related mortality risk, existing evidence indicates that poor nutritional quality of diet, as characterized by the former or other modified versions of the Nutri-score profiling system, is associated with increased disease-specific mortality.
The robustness of the findings was confirmed through multiple sensitivity analyses, further strengthening the evidence for the updated Nutri-Score as a reliable tool for characterizing diet quality and its impact on cardiovascular risk.
Overall, the current study findings highlight the relevance and usefulness of the updated Nutri-Score profiling system in characterizing the nutritional and health values of food items consumed by individuals living in multicultural European countries.
The scientists believe the Nutri-Score profiling system has the potential to serve as a public health tool, offering consumers a hopeful guide for making food choices that can prevent chronic diseases.
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