Marques Chloé, Frenoy Pauline, Laouali Nasser, Shah Sanam, Severi Gianluca, Mancini Francesca Romana
Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, 12 Avenue Paul Vaillant Couturier, Villejuif, 94805, France.
Department of Statistics, Computer Science, Applications "G. Parenti", University of Florence, Florence, Italy.
Nutr J. 2025 Mar 15;24(1):43. doi: 10.1186/s12937-025-01099-4.
Diet is a modifiable risk factor for non-communicable diseases which are the major causes of death worldwide. French dietary guidelines, updated in 2017, provide recommendations for a healthier diet. We aimed to study the association between adherence to these dietary guidelines and mortality in the E3N (Etude Epidémiologique auprès de femmes de l'Education Nationale) French cohort. A secondary objective was to investigate the role of dietary exposure to chemical contaminants in this association.
We studied 72 585 women of the E3N prospective cohort, which completed a food frequency questionnaire in 1993. We estimated adherence to French dietary guidelines using the simplified "Programme National Nutrition Santé-guidelines score 2" (sPNNS-GS2, range -20.4 to 12.6). We estimated the association between sPNNS-GS2 and all-cause or cause-specific mortality using Cox proportional hazard models. Causes of death were coded and validated by the French Epidemiology Center on Medical Causes of Death (Inserm-CépiDc).
During follow-up (1993-2014), we identified 6 441 deaths. The mean sPNNS-GS2 was 3.8 (SD 3.0). In the fully adjusted model, we found a non-linear association between sPNNS-GS2 and all-cause, all-cancer, breast cancer and lung cancer mortality (p-values for the overall association < 0.001), with a diminution of the risk as sPNNS-GS2 increases up to its median or 65 percentile (depending on the outcome), and then a plateau (for all-cause and breast cancer mortality) or an inversion of the trend (for all-cancer and lung cancer mortality). Furthermore, we identified a linear inverse association with cardiovascular diseases mortality (HR [95%CI]: 0.86 [0.76; 0.97]), and no association with colorectal cancer mortality. We observed similar results when additionally adjusting on dietary exposure to chemical contaminants.
This study conducted in a large prospective cohort following more than 70 000 women for over 20 years suggested that higher adherence to French dietary guidelines was associated with a reduced risk of mortality from all-cause, cardiovascular diseases, all-cancer, breast cancer, and lung cancer, except for high values of adherence for lung cancer mortality. These results contribute to informing on the importance of following the French nutritional recommendations.
饮食是非传染性疾病的一个可改变的风险因素，而非传染性疾病是全球主要的死亡原因。2017年更新的法国饮食指南提供了更健康饮食的建议。我们旨在研究E3N（法国国民教育女性流行病学研究）队列中遵循这些饮食指南与死亡率之间的关联。第二个目标是调查饮食中化学污染物暴露在这种关联中的作用。
我们研究了E3N前瞻性队列中的72585名女性，她们于1993年完成了一份食物频率问卷。我们使用简化的“国家营养与健康计划指南评分2”（sPNNS-GS2，范围为-20.4至12.6）来估计对法国饮食指南的遵循情况。我们使用Cox比例风险模型估计sPNNS-GS2与全因或特定原因死亡率之间的关联。死亡原因由法国医学死因流行病学中心（Inserm-CépiDc）编码和验证。
在随访期间（1993 - 2014年），我们确定了6441例死亡。sPNNS-GS2的平均值为3.8（标准差3.0）。在完全调整模型中，我们发现sPNNS-GS2与全因、所有癌症、乳腺癌和肺癌死亡率之间存在非线性关联（总体关联的p值<0.001），随着sPNNS-GS2增加至中位数或第65百分位数（取决于结局），风险降低，然后出现平台期（对于全因和乳腺癌死亡率）或趋势反转（对于所有癌症和肺癌死亡率）。此外，我们确定了与心血管疾病死亡率的线性负相关（HR [95%CI]：0.86 [0.76; 0.97]），与结直肠癌死亡率无关联。在对饮食中化学污染物暴露进行额外调整时，我们观察到了类似的结果。
这项对7万多名女性进行了20多年随访的大型前瞻性队列研究表明，更高程度地遵循法国饮食指南与全因、心血管疾病、所有癌症、乳腺癌和肺癌死亡率风险降低相关，但肺癌死亡率在高遵循度时除外。这些结果有助于说明遵循法国营养建议的重要性。
