Bullón-Vela Vanessa, Sayón-Orea Carmen, Gómez-Donoso Clara, Martínez J A, Martínez-González Miguel A, Bes-Rastrollo Maira
Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain.
Navarra Institute for Health Research, Pamplona, Spain.
Front Nutr. 2022 Oct 21;9:951738. doi: 10.3389/fnut.2022.951738. eCollection 2022.
Front-of-Pack (FoP) nutrition labelling has been established as a policy, empowering consumers to choose healthy food options for preventing diet-related non-communicable diseases. This study aimed to evaluate the association between the nutrient profile underlying the Chilean warning label score and all-cause mortality and to conduct a calibration with the Nutri-Score in a large cohort of Spanish university graduates.
This prospective cohort study analysed 20,666 participants (8,068 men and 12,598 women) with a mean (standard deviation) age of 38 years (±12.4) from the SUN cohort. Dietary food intake was assessed by a validated semi-quantitative food-frequency questionnaire at baseline and after 10 years of follow-up. The warning label score was calculated by considering the threshold of nutrients (sugar, saturated fat, and sodium) and energy density per 100 g/ml of product, as established by Chilean Legislation. Participants were classified according to quartiles of consumption of daily label score: Q1 (≤5.0), Q2 (>5.0-7.1), Q3 (>7.1-9.8), and Q4 (>9.8). Time-dependent, multivariable-adjusted Cox models were applied. To compare the performance of the warning label score and Nutri-Score to predict mortality, we used the Akaike information criterion (AIC) and Bayesian information criterion (BIC) methods.
During a median of 12.2 years of follow-up, 467 deaths were identified. A higher score in the warning label values (lower nutritional quality) was associated with an increased risk of all-cause mortality [HR (95% CI) Q4 vs. Q1: 1.51 (1.07-2.13); -trend = 0.010] and cancer mortality [HR (95% CI) Q4 vs. Q1: 1.91 (1.18-3.10); -trend = 0.006]. However, no statistically significant association was found for cardiovascular mortality. Furthermore, the warning label score and Nutri-Score exhibited comparable AIC and BIC values, showing similar power of prediction for mortality.
A diet with a higher warning label score (>9.8 per day) was a good predictor of all cases and cancer mortality in a large Spanish cohort of university graduates. Also, the warning label score was capable to predict mortality as well as the Nutri-Score. Our findings support the validity of the warning label score as a FoP nutrition labelling policy since it can highlight less healthy food products.
包装正面（FoP）营养标签已成为一项政策，使消费者能够选择健康的食物选项，以预防与饮食相关的非传染性疾病。本研究旨在评估智利警告标签评分所依据的营养成分与全因死亡率之间的关联，并在一大群西班牙大学毕业生中对营养评分进行校准。
这项前瞻性队列研究分析了SUN队列中的20666名参与者（8068名男性和12598名女性），其平均（标准差）年龄为38岁（±12.4）。在基线和随访10年后，通过经过验证的半定量食物频率问卷评估饮食摄入量。根据智利法律规定的每100克/毫升产品中营养素（糖、饱和脂肪和钠）的阈值以及能量密度计算警告标签评分。参与者根据每日标签评分的四分位数进行分类：Q1（≤5.0）、Q2（>5.0 - 7.1）、Q3（>7.1 - 9.8）和Q4（>9.8）。应用了时间依赖性多变量调整的Cox模型。为了比较警告标签评分和营养评分预测死亡率的性能，我们使用了赤池信息准则（AIC）和贝叶斯信息准则（BIC）方法。
在中位12.2年的随访期间，共确定了467例死亡病例。警告标签值较高（营养质量较低）与全因死亡率增加相关[风险比（95%置信区间）Q4与Q1：1.51（1.07 - 2.13）；-趋势 = 0.010]以及癌症死亡率增加相关[风险比（95%置信区间）Q4与Q1：1.91（1.18 - 3.10）；-趋势 = 0.006]。然而，未发现与心血管疾病死亡率有统计学显著关联。此外，警告标签评分和营养评分的AIC和BIC值相当，显示出对死亡率的预测能力相似。
在一大群西班牙大学毕业生中，警告标签评分较高（每天>9.8）的饮食是所有病例和癌症死亡率的良好预测指标。此外，警告标签评分预测死亡率的能力与营养评分相当。我们的研究结果支持警告标签评分作为一种FoP营养标签政策的有效性，因为它可以突出不太健康的食品。
