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@ARTICLE{Deschasaux:140839,
      author       = {M. Deschasaux and I. Huybrechts and N. Murphy and C. Julia
                      and S. Hercberg and B. Srour and E. Kesse-Guyot and P.
                      Latino-Martel and C. Biessy and C. Casagrande and M. Jenab
                      and H. Ward and E. Weiderpass and C. C. Dahm and K. Overvad
                      and C. Kyrø and A. Olsen and A. Affret and M.-C.
                      Boutron-Ruault and Y. Mahamat-Saleh and R. Kaaks$^*$ and T.
                      Kühn$^*$ and H. Boeing and L. Schwingshackl and C. Bamia
                      and E. Peppa and A. Trichopoulou and G. Masala and V. Krogh
                      and S. Panico and R. Tumino and C. Sacerdote and B.
                      Bueno-de-Mesquita and P. H. Peeters and A. Hjartåker and C.
                      Rylander and G. Skeie and J. Ramón Quirós and P. Jakszyn
                      and E. Salamanca-Fernández and J. M. Huerta and E. Ardanaz
                      and P. Amiano and U. Ericson and E. Sonestedt and E.
                      Huseinovic and I. Johansson and K.-T. Khaw and N. Wareham
                      and K. E. Bradbury and A. Perez-Cornago and K. K. Tsilidis
                      and P. Ferrari and E. Riboli and M. J. Gunter and M.
                      Touvier},
      title        = {{N}utritional quality of food as represented by the
                      {FSA}m-{NPS} nutrient profiling system underlying the
                      {N}utri-{S}core label and cancer risk in {E}urope: {R}esults
                      from the {EPIC} prospective cohort study.},
      journal      = {PLoS medicine},
      volume       = {15},
      number       = {9},
      issn         = {1549-1676},
      address      = {Lawrence, Kan.},
      publisher    = {PLoS},
      reportid     = {DKFZ-2018-01594},
      pages        = {e1002651 -},
      year         = {2018},
      abstract     = {Helping consumers make healthier food choices is a key
                      issue for the prevention of cancer and other diseases. In
                      many countries, political authorities are considering the
                      implementation of a simplified labelling system to reflect
                      the nutritional quality of food products. The Nutri-Score, a
                      five-colour nutrition label, is derived from the Nutrient
                      Profiling System of the British Food Standards Agency
                      (modified version) (FSAm-NPS). How the consumption of foods
                      with high/low FSAm-NPS relates to cancer risk has been
                      studied in national/regional cohorts but has not been
                      characterized in diverse European populations.This
                      prospective analysis included 471,495 adults from the
                      European Prospective Investigation into Cancer and Nutrition
                      (EPIC, 1992-2014, median follow-up: 15.3 y), among whom
                      there were 49,794 incident cancer cases (main locations:
                      breast, n = 12,063; prostate, n = 6,745; colon-rectum, n =
                      5,806). Usual food intakes were assessed with standardized
                      country-specific diet assessment methods. The FSAm-NPS was
                      calculated for each food/beverage using their 100-g content
                      in energy, sugar, saturated fatty acid, sodium, fibres,
                      proteins, and fruits/vegetables/legumes/nuts. The FSAm-NPS
                      scores of all food items usually consumed by a participant
                      were averaged to obtain the individual FSAm-NPS Dietary
                      Index (DI) scores. Multi-adjusted Cox proportional hazards
                      models were computed. A higher FSAm-NPS DI score, reflecting
                      a lower nutritional quality of the food consumed, was
                      associated with a higher risk of total cancer (HRQ5 versus
                      Q1 = 1.07; $95\%$ CI 1.03-1.10, P-trend < 0.001). Absolute
                      cancer rates in those with high and low (quintiles 5 and 1)
                      FSAm-NPS DI scores were 81.4 and 69.5 cases/10,000
                      person-years, respectively. Higher FSAm-NPS DI scores were
                      specifically associated with higher risks of cancers of the
                      colon-rectum, upper aerodigestive tract and stomach, lung
                      for men, and liver and postmenopausal breast for women (all
                      P < 0.05). The main study limitation is that it was based on
                      an observational cohort using self-reported dietary data
                      obtained through a single baseline food frequency
                      questionnaire; thus, exposure misclassification and residual
                      confounding cannot be ruled out.In this large multinational
                      European cohort, the consumption of food products with a
                      higher FSAm-NPS score (lower nutritional quality) was
                      associated with a higher risk of cancer. This supports the
                      relevance of the FSAm-NPS as underlying nutrient profiling
                      system for front-of-pack nutrition labels, as well as for
                      other public health nutritional measures.},
      cin          = {C020},
      ddc          = {610},
      cid          = {I:(DE-He78)C020-20160331},
      pnm          = {313 - Cancer risk factors and prevention (POF3-313)},
      pid          = {G:(DE-HGF)POF3-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:30226842},
      pmc          = {pmc:PMC6143197},
      doi          = {10.1371/journal.pmed.1002651},
      url          = {https://inrepo02.dkfz.de/record/140839},
}