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@ARTICLE{Deschasaux:163216,
      author       = {M. Deschasaux and I. Huybrechts and C. Julia and S.
                      Hercberg and M. Egnell and B. Srour and E. Kesse-Guyot and
                      P. Latino-Martel and C. Biessy and C. Casagrande and N.
                      Murphy and M. Jenab and H. A. Ward and E. Weiderpass and K.
                      Overvad and A. Tjønneland and A. L. Rostgaard-Hansen and
                      M.-C. Boutron-Ruault and F. R. Mancini and Y. Mahamat-Saleh
                      and T. Kühn$^*$ and V. Katzke$^*$ and M. M. Bergmann and M.
                      B. Schulze and A. Trichopoulou and A. Karakatsani and E.
                      Peppa and G. Masala and C. Agnoli and M. S. De Magistris and
                      R. Tumino and C. Sacerdote and J. M. Boer and W. M.
                      Verschuren and Y. T. van der Schouw and G. Skeie and T.
                      Braaten and M. L. Redondo and A. Agudo and D. Petrova and S.
                      M. Colorado-Yohar and A. Barricarte and P. Amiano and E.
                      Sonestedt and U. Ericson and J. Otten and B. Sundström and
                      N. J. Wareham and N. G. Forouhi and P. Vineis and K. K.
                      Tsilidis and A. Knuppel and K. Papier and P. Ferrari and E.
                      Riboli and M. J. Gunter and M. Touvier},
      title        = {{A}ssociation between nutritional profiles of foods
                      underlying {N}utri-{S}core front-of-pack labels and
                      mortality: {EPIC} cohort study in 10 {E}uropean countries.},
      journal      = {The BMJ},
      volume       = {370},
      issn         = {1756-1833},
      address      = {London},
      publisher    = {British Medical Association56099},
      reportid     = {DKFZ-2020-01910},
      pages        = {m3173},
      year         = {2020},
      abstract     = {To determine if the Food Standards Agency nutrient
                      profiling system (FSAm-NPS), which grades the nutritional
                      quality of food products and is used to derive the
                      Nutri-Score front-of-packet label to guide consumers towards
                      healthier food choices, is associated with
                      mortality.Population based cohort study.European Prospective
                      Investigation into Cancer and Nutrition (EPIC) cohort from
                      23 centres in 10 European countries.521 324 adults; at
                      recruitment, country specific and validated dietary
                      questionnaires were used to assess their usual dietary
                      intakes. A FSAm-NPS score was calculated for each food item
                      per 100 g content of energy, sugars, saturated fatty acids,
                      sodium, fibre, and protein, and of fruit, vegetables,
                      legumes, and nuts. The FSAm-NPS dietary index was calculated
                      for each participant as an energy weighted mean of the
                      FSAm-NPS score of all foods consumed. The higher the score
                      the lower the overall nutritional quality of the
                      diet.Associations between the FSAm-NPS dietary index score
                      and mortality, assessed using multivariable adjusted Cox
                      proportional hazards regression models.After exclusions, 501
                      594 adults (median follow-up 17.2 years, 8 162 730 person
                      years) were included in the analyses. Those with a higher
                      FSAm-NPS dietary index score (highest versus lowest fifth)
                      showed an increased risk of all cause mortality (n=53 112
                      events from non-external causes; hazard ratio 1.07, $95\%$
                      confidence interval 1.03 to 1.10, P<0.001 for trend) and
                      mortality from cancer (1.08, 1.03 to 1.13, P<0.001 for
                      trend) and diseases of the circulatory (1.04, 0.98 to 1.11,
                      P=0.06 for trend), respiratory (1.39, 1.22 to 1.59,
                      P<0.001), and digestive (1.22, 1.02 to 1.45, P=0.03 for
                      trend) systems. The age standardised absolute rates for all
                      cause mortality per 10 000 persons over 10 years were 760
                      (men=1237; women=563) for those in the highest fifth of the
                      FSAm-NPS dietary index score and 661 (men=1008; women=518)
                      for those in the lowest fifth.In this large multinational
                      European cohort, consuming foods with a higher FSAm-NPS
                      score (lower nutritional quality) was associated with a
                      higher mortality for all causes and for cancer and diseases
                      of the circulatory, respiratory, and digestive systems,
                      supporting the relevance of FSAm-NPS to characterise
                      healthier food choices in the context of public health
                      policies (eg, the Nutri-Score) for European populations.
                      This is important considering ongoing discussions about the
                      potential implementation of a unique nutrition labelling
                      system at the European Union level.},
      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:32938660},
      doi          = {10.1136/bmj.m3173},
      url          = {https://inrepo02.dkfz.de/record/163216},
}