Department of Medicine and Surgery, Research Center in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, Varese-Como, Italy.
Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli (IS), Italy.
Am J Clin Nutr. 2024 Mar;119(3):756-768. doi: 10.1016/j.ajcnut.2023.12.017. Epub 2023 Dec 23.
Nutrient profiling systems are increasingly used to characterize the healthfulness of foods for front-of-package (FOP) labeling, which have been proposed as an effective public health strategy to help people make healthier food choices.
This study aimed to review available evidence from cohort studies that evaluated the association of dietary indices underpinning FOP nutrition labels with all-cause mortality and incidence of cardiovascular diseases (CVDs) or cancer.
PubMed, Web of Science, and Scopus were systematically searched up to October 2023. We included articles if they were prospective cohort studies, if the exposure was any dietary index underpinning FOP nutrition labels [e.g., the modified Food Standard Agency-Nutrient Profiling System (FSAm-NPS) and the Health Star Rating System], and if outcomes were all-cause mortality or incidence of or mortality due to CVD and cancer. Random-effects models were used to calculate the pooled hazard ratios (HRs) and 95% CIs.
We identified 11 records (7 unique prospective studies), which were included in the systematic review. The meta-analysis comprised 8 studies analyzing the FSAm-NPS dietary index (DI) as exposure. The pooled HRs associated with a 2-unit increase in the FSAm-NPS DI of all-cause mortality, CVD, and cancer risk were 1.06 (95% confidence interval [CI]: 0.99, 1.13; I: 80%), 1.08 (95% CI: 1.00, 1.18; I: 70%), and 1.09 (95% CI: 1.00, 1.19; I: 77%), respectively. The Chilean Warning Label score and the Health Star Rating systems were examined by 1 study each and were significantly associated with the outcomes.
DIs underpinning most common FOP nutrition labels and reflecting nutrient-poor diets show a tendency toward an increased incidence of CVD and cancer, but the observed effects are quite modest in magnitude. Further studies at the population level are needed to support the widely shared hypothesis that FOP labels, possibly in conjunction with other interventions, may contribute to reduce noncommunicable disease risk. This meta-analysis was registered at PROSPERO as CRD42021292625.
营养成分标识系统越来越多地用于描述食品的健康状况，以便在包装正面（FOP）进行标签标注，这被认为是一种有效的公共卫生策略，可以帮助人们做出更健康的食物选择。
本研究旨在综述队列研究中评估 FOP 营养标签所依据的饮食指数与全因死亡率和心血管疾病（CVD）或癌症发生率之间关联的现有证据。
系统检索了 PubMed、Web of Science 和 Scopus，截至 2023 年 10 月。如果研究是前瞻性队列研究、暴露因素是 FOP 营养标签所依据的任何饮食指数[例如，改良食品标准局-营养成分标识系统（FSAm-NPS）和健康星级评分系统]，且结局是全因死亡率或 CVD 和癌症的发生率或死亡率，则将其纳入研究。使用随机效应模型计算合并的危险比（HRs）和 95%置信区间（CI）。
我们确定了 11 项记录（7 项独特的前瞻性研究），将其纳入系统综述。荟萃分析包括 8 项研究，分析了 FSAm-NPS 饮食指数（DI）作为暴露因素。与 FSAm-NPS DI 增加 2 个单位相关的全因死亡率、CVD 和癌症风险的合并 HR 分别为 1.06（95%CI：0.99，1.13；I²：80%）、1.08（95%CI：1.00，1.18；I²：70%）和 1.09（95%CI：1.00，1.19；I²：77%）。智利警示标签评分和健康星级评分系统分别由 1 项研究进行了检查，与结局显著相关。
最常见的 FOP 营养标签所依据的饮食指数反映了营养贫乏的饮食，与 CVD 和癌症发生率增加有一定的关联，但观察到的影响幅度相当小。需要在人群水平上开展进一步的研究，以支持 FOP 标签可能与其他干预措施一起有助于降低非传染性疾病风险的广泛共识假设。本荟萃分析已在 PROSPERO 注册，注册号为 CRD42021292625。
