Officially adopted in France in 2017 (and in 6 other European countries since), the Nutri-Score aims to provide rapid information on the nutritional quality of foods and drinks to help and encourage consumers to compare them and choose those that offer a better nutritional quality. In parallel, it encourages manufacturers to improve the nutritional quality of their products.

The Nutri-Score has 5 categories, ranging from A (dark green - higher nutritional quality) to E (dark orange - lower nutritional quality). An algorithm ranks each product according to its levels - per 100 g - of energy, sugars, saturated fatty acids and salt (to limit) and proteins, fruits, vegetables and pulses (to favour).

A number of studies published in international scientific journals have shown the validity of Nutri-Score in characterising the nutritional quality of foods and its efficacy in guiding consumers towards more nutritious choices (over 140 publications). In particular, links between the consumption of foods with a less favourable Nutri-Score (lower nutritional quality) and an increased risk of cardiovascular diseases have so far been observed in French studies (SU.VI.MAX and NutriNet-Santé cohorts). Studies in France, UK, Spain and Italy have also seen similar associations with an increased risk of various chronic diseases as well as higher mortality.

In this new study, the researchers focused on the latest version of the Nutri-Score algorithm (updated in 2024, see box), linked to the risk of cardiovascular diseases, in a large population spread across 7 European countries, with the aim of providing new scientific evidence for validating the Nutri-Score on a European scale. It follows two studies published in 2018 and 2020 in the same population on cancer risk and mortality.

A total of 345 533 participants from the EPIC (European Prospective Investigation into Cancer and Nutrition) cohort were included in the analyses. During the follow-up (12 years, between 1992 and 2010), 16 214 participants developed a cardiovascular disease (6 565 of whom had myocardial infarction and 6 245 stroke). The findings show that the participants consuming on average more foods with less favourable Nutri-Score, reflecting lower nutritional quality, were at increased risk of cardiovascular diseases, particularly myocardial infarction and stroke. These associations were significant after a large number of sociodemographic and lifestyle factors were taken into account.

'These findings confirm the relevance of Nutri-Score as a public health tool to guide consumers in their food choices with the goal of preventing chronic diseases', emphasises Inserm researcher Mélanie Deschasaux-Tanguy.

'They also provide key elements to support the adoption of Nutri-Score as a mandatory nutritional logo in Europe', explains Mathilde Touvier, Inserm research director.

Sources

Nutritional quality of diet characterized by the Nutri-Score profiling system and cardiovascular disease risk: a prospective study in 7 European countries

Mélanie Deschasaux-Tanguy¹, Inge Huybrechts², Chantal Julia^1,3, Serge Hercberg^1,3, Barthélémy Sarda¹, Morgane Fialon¹, Nathalie Arnault¹, Bernard Srour¹, Emmanuelle Kesse-Guyot¹, Léopold K. Fezeu¹, Carine Biessy², Corinne Casagrande², Bertrand Hemon², Elisabete Weiderpass², Maria G. M. Pinho^2,4,5, Neil Murphy², Heinz Freisling², Pietro Ferrari², Anne Tjønneland^6,7, Kristina Elin Nielsen Petersen⁶, Verena Katzke⁸, Rudolf Kaaks⁸, Matthias B. Schulze^9,10, Giovanna Masala¹¹, Valeria Pala¹², Salvatore Panico¹³, Fulvio Ricceri^14,15, W. M. Monique Verschuren¹⁶, Jolanda M. A. Boer¹⁶, Yvonne T van der Schouw¹⁷, Guri Skeie¹⁸, Antonio Agudo^19,20, Esther Molina-Montes^21,22,23,24, José María Huerta^21,25, Conchi Moreno-Iribas^21,26,27, Ulrika Ericson²⁸, Emily Sonestedt²⁸, Anna Strid²⁹, Viktor Oskarsson³⁰, Tammy Y. N. Tong³¹, Alicia K. Heath³², Elom K. Aglago³², John Danesh³³, Elio Riboli³², Marc J. Gunter², Mathilde Touvier¹

¹ Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center for Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017 Bobigny, France

² International Agency for Research on Cancer, World Health Organization, Lyon, France

³ Department of Public Health, Hôpitaux Universitaires Paris Seine-Saint-Denis (AP-HP), Bobigny, France

⁴ Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, Amsterdam, Netherlands

⁵Amsterdam Public Health, Health Behaviors and Chronic Diseases, Amsterdam, Netherlands

⁶ Danish Cancer Society Research Center, Copenhagen, Denmark

⁷ Department of Public Health, University of Copenhagen, Copenhagen, Denmark

⁸ Department of Cancer Epidemiology, German Cancer research Center (DKFZ), Heidelberg, Germany

⁹ Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany

¹⁰ Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany

¹¹ Clinical Epidemiology Unit, Institute for cancer research, prevention and clinical network (ISPRO), Florence, Italy

¹² Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy

¹³ School of Medicine, Federico II University, Naples, Italy

¹⁴ Centre for Biostatistics, Epidemiology, and Public Health, Department of Clinical and Biological Sciences, University of Turin, Italy

¹⁵ Unit of Epidemiology, Regional Health Service ASL TO3, Grugliasco (TO), Italy

¹⁶ Department Life Course and Health, Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands

¹⁷ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands

¹⁸ Department of Community Medicine, Faculty of Health Sciences, University of Tromsø (UiT) - The Arctic University of Norway, Tromsø, Norway

¹⁹ Unit of Nutrition and Cancer, Catalan Institute of Oncology - ICO, L'Hospitalet de Llobregat, Spain

²⁰ Nutrition and Cancer Group; Epidemiology, Public Health, Cancer Prevention and Palliative Care Program; Bellvitge Biomedical Research Institute - IDIBELL, L'Hospitalet de Llobregat, Spain

²¹ CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain;

²² Department of Nutrition and Food Science, Campus of Cartuja, University of Granada, Granada, Spain

²³ Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain

²⁴ Institute of Nutrition and Food Technology (INYTA) 'José Mataix', Biomedical Research Centre, University of Granada, Granada, Spain

²⁵ Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain.

²⁶ Navarra Public Health Institute, Pamplona, Spain

²⁷ Navarra Institute for Health Research (IdiSNA), Pamplona, Spain

²⁸ Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden

²⁹ Department of Internal Medicine and Clinical Nutrition, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

³⁰ Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden

³¹ Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom

³² School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom

³³ Department of Public Health and Primary Care, University of Cambridge, United Kingdom

The Lancet Regional Health - Europe

DOI: 10.1016/j.lanepe.2024.101006

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