title: Prospective association between a dietary quality index based on a nutrient profiling system and cardiovascular disease risk.
abstract: 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.
  
  
  
  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 (HRfor a 1-point increment = 1.14 (1.03-1.27); HRQ4vs.Q1 = 1.61 (1.05-2.47), Ptrend Q4-Q1 = 0.03). This association tended to be stronger in smokers (HRfor a 1-point increment = 1.39 (1.11-1.73); Pinteraction = 0.01) and those less physically active (HRfor a 1-point increment = 1.26 (1.08-1.46); Pinteraction = 0.04).
  
  
  
  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.
  
  
  
  ClinicalTrials.gov identifier: NCT00272428.
authors.affiliation: Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre de Recherche en Epidémiologie et Statistiques, France s.adriouch@eren.smbh.univ-paris13.fr.
authors.forename: Solia
authors.initials: S
authors.lastname: Adriouch
authors.affiliation: Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre de Recherche en Epidémiologie et Statistiques, France Département de Santé Publique, Hôpital Avicenne, France.
authors.forename: Chantal
authors.initials: C
authors.lastname: Julia
authors.affiliation: Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre de Recherche en Epidémiologie et Statistiques, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Kesse-Guyot
authors.affiliation: Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre de Recherche en Epidémiologie et Statistiques, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Méjean
authors.affiliation: Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre de Recherche en Epidémiologie et Statistiques, France.
authors.forename: Pauline
authors.initials: P
authors.lastname: Ducrot
authors.affiliation: Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre de Recherche en Epidémiologie et Statistiques, France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Péneau
authors.affiliation: Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre de Recherche en Epidémiologie et Statistiques, France.
authors.forename: Mathilde
authors.initials: M
authors.lastname: Donnenfeld
authors.affiliation: Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre de Recherche en Epidémiologie et Statistiques, France.
authors.forename: Mélanie
authors.initials: M
authors.lastname: Deschasaux
authors.affiliation: Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre de Recherche en Epidémiologie et Statistiques, France.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Menai
authors.affiliation: Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre de Recherche en Epidémiologie et Statistiques, France Département de Santé Publique, Hôpital Avicenne, France.
authors.forename: Serge
authors.initials: S
authors.lastname: Hercberg
authors.affiliation: Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre de Recherche en Epidémiologie et Statistiques, France.
authors.forename: Mathilde
authors.initials: M
authors.lastname: Touvier
authors.affiliation: Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre de Recherche en Epidémiologie et Statistiques, France.
authors.forename: Léopold K
authors.initials: LK
authors.lastname: Fezeu
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000517:prevention & control; D004032:Diet / Q000592:standards*; D015930:Diet Records; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D005518:Food Preferences; D005544:Forecasting; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008019:Life Style; D008297:Male; D008875:Middle Aged; D018673:Nutrition Policy; D009752:Nutritional Status; D009753:Nutritive Value; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends
keywords: Cardiovascular risk; FSA-NPS; nutrient profiling system; nutrition policy; prospective study