The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.
School of Public Health, University of California, Berkeley, CA, United States.
Am J Clin Nutr. 2024 Jan;119(1):145-163. doi: 10.1016/j.ajcnut.2023.10.013. Epub 2023 Oct 18.
Nutrient profiling systems (NPSs) use algorithms to evaluate the nutritional quality of foods and beverages. Criterion validation, which assesses the relationship between consuming foods rated as healthier by the NPS and objective measures of health, is essential to ensure the accuracy of NPSs.
We examined and compared NPSs that have undergone criterion validity testing in relation to diet-related disease risk and risk markers.
Academic databases were searched for prospective cohort and cross-sectional studies published before November, 2022. NPSs were eligible if they incorporated multiple nutrients or food components using an algorithm to determine an overall summary indicator (e.g., a score or rank) for individual foods. Studies were included if they assessed the criterion validity of an eligible NPS. Validation evidence was first summarized in narrative form by NPS, with random effects meta-analysis where ≥2 prospective cohort studies assessed the same NPS and outcomes.
Of 4519 publications identified, 29 describing 9 NPSs were included in the review. The Nutri-Score NPS was assessed as having substantial criterion validation evidence. Highest compared with lowest diet quality as defined by the Nutri-Score was associated with significantly lower risk of cardiovascular disease (hazard ratio [HR]: 0.74; 95% confidence interval [CI]: 0.59, 0.93; n = 6), cancer (HR: 0.75; 95% CI: 0.59, 0.94; n = 5), all-cause mortality (HR: 0.74; 95% CI; 0.59, 0.91; n = 4) and change in body mass index (HR: 0.68; 95% CI: 0.50, 0.92; n = 3). The Food Standards Agency NPS, Health Star Rating, Nutrient Profiling Scoring Criterion, Food Compass, Overall Nutrition Quality Index, and the Nutrient-Rich Food Index were determined as having intermediate criterion validation evidence. Two other NPSs were determined as having limited criterion validation evidence.
We found limited criterion validation studies compared with the number of NPSs estimated to exist. Greater emphasis on conducting and reporting on criterion validation studies across varied contexts may improve the confidence in existing NPSs.
营养成分评分系统（NPS）使用算法来评估食品和饮料的营养价值。为了确保 NPS 的准确性，对其进行标准验证（评估通过 NPS 评定为更健康的食物与客观健康指标之间的关系）是至关重要的。
我们研究并比较了已经经过标准有效性测试的与饮食相关疾病风险和风险标志物相关的 NPS。
我们在学术数据库中搜索了 2022 年 11 月前发表的前瞻性队列研究和横断面研究。如果 NPS 采用算法纳入多种营养成分或食物成分来确定个体食物的综合指标（例如分数或等级），则该 NPS 符合入选标准。如果研究评估了合格 NPS 的标准有效性，则将纳入研究。首先通过 NPS 以叙述形式总结验证证据，当≥2 项前瞻性队列研究评估了相同的 NPS 和结局时，进行随机效应荟萃分析。
在 4519 篇已确定的文献中，有 29 篇描述了 9 种 NPS 的文献符合综述要求。Nutri-Score NPS 被评估为具有大量的标准验证证据。Nutri-Score 定义的最高与最低饮食质量相比，与心血管疾病风险显著降低相关（风险比 [HR]：0.74；95%置信区间 [CI]：0.59，0.93；n = 6）、癌症（HR：0.75；95% CI：0.59，0.94；n = 5）、全因死亡率（HR：0.74；95% CI：0.59，0.91；n = 4）和体重指数变化（HR：0.68；95% CI：0.50，0.92；n = 3）。食品标准局 NPS、星级评分、营养成分评分标准、食物指南针、整体营养质量指数和富含营养的食物指数被确定为具有中等标准验证证据。另外两个 NPS 被确定为具有有限的标准验证证据。
与估计存在的 NPS 数量相比，我们发现标准验证研究的数量有限。在不同的情况下，更多地关注进行和报告标准验证研究可能会提高对现有 NPS 的信心。
