Cardiovascular disease is the leading cause of death in Western Europe, accounting for a third of deaths in 2019. Diet is believed to be responsible for around 30% of such deaths. Nutrition-related prevention policies therefore pose a major public health challenge for these diseases.
In an article published on September 11, 2024 in Lancet Regional Health — Europe, researchers from the Nutritional Epidemiology Research Team (CRESS-EREN), with members from Inserm, Inrae, Cnam, Université Sorbonne Paris Nord and Université Paris Cité, in collaboration with researchers from the International Agency for Research on Cancer (WHO-IARC), report an increased risk of cardiovascular disease associated with the consumption of foods that score less favorably on the Nutri-Score scale (new version 2024) within the European EPIC cohort. A total of 345,533 participants from the cohort, spread across 7 European countries and followed for 12 years, were included in the analyses.
The Nutri-Score was officially introduced in France in 2017 (and in six other European countries since) and aims to provide rapid information on the nutritional quality of foods and drinks to help and encourage consumers to compare and choose between that provide better nutritional quality. . At the same time, 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 based on its content – per 100 g – of energy, sugars, saturated fatty acids and salt (to limit) and proteins, fruit, vegetables and legumes (to prefer).
A number of studies published in international scientific journals have demonstrated the validity of Nutri-Score in characterizing the nutritional quality of foods and its effectiveness in guiding consumers towards more nutritious choices (over 140 publications). In particular, links have been observed so far in French studies (SU.VI.MAX and NutriNet-Santé cohorts) between the consumption of foods with a less favorable Nutri-Score (lower nutritional quality) and an increased risk of cardiovascular disease. Studies in France, Britain, Spain and Italy have also seen similar associations with increased risk of several chronic diseases and 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 disease, in a large population spread across 7 European countries, with aim to provide 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 of the EPIC (European prospective study on cancer and nutrition) cohort were included in the analyses. During follow-up (12 years, between 1992 and 2010), 16,214 participants developed cardiovascular disease (of whom 6,565 had a myocardial infarction and 6,245 had a stroke). The findings show that participants who consumed more foods on average with a less favorable Nutri-Score, which reflects lower diet quality, were at increased risk of cardiovascular disease, particularly myocardial infarction and stroke. These associations were significant after taking into account a host of sociodemographic and lifestyle factors.
“These findings confirm the relevance of Nutri-Score as a public health tool to guide consumers in their food choices with the aim of preventing chronic diseases,” emphasizes Inserm researcher Mélanie Deschasaux-Tanguy.
“They also provide important elements to support the adoption of Nutri-Score as a mandatory nutritional logo in Europe,” explains Mathilde Touvier, research director of Inserm.
A new version of the Nutri-Score in 2024
Changes to the calculation of the Nutri-Score have recently been proposed by the international scientific committee responsible for its monitoring, to improve its consistency with dietary recommendations. This new version of the Nutri-Score is expected to come into effect in 2024 and be gradually rolled out over the coming months. However, due to European labeling regulations, manufacturers are not required to use Nutri-Score on their packaging.
Although many companies and brands (more than 1,400 in France) have so far committed to using Nutri-Score on their products, harmonization at European level is needed to ensure the mandatory implementation of a single logo that is effective and useful for citizens . This harmonization is being considered as part of that of the European Commission From farm to fork strategy.
