Nutritional Quality Of Diet Research Articles

The share of ultra-processed foods determines the overall nutritional quality of diet in British vegetarians.

The aim of this study was to describe the dietary intake of British vegetarians according to the Nova classification and to evaluate the association between the consumption of ultra-processed foods and the nutritional quality of the diet. We used data from the UK national survey (2008/2019). Food collected through a 4-d record were classified according to the Nova system. In all tertiles of the energy contribution of ultra-processed foods, differences in the average nutrient intake, as well as in the prevalence of inadequate intake, were analysed, considering the values recommended by international authorities. Ultra-processed foods had the highest dietary contribution (56·3 % of energy intake), followed by fresh or minimally processed foods (29·2 %), processed foods (9·4 %) and culinary ingredients (5 %). A positive linear trend was found between the contribution tertiles of ultra-processed foods and the content of free sugars (β 0·25, P < 0·001), while an inverse relationship was observed for dietary fibre (β -0·26, P = 0·002), potassium (β -0·38, P < 0·001), Mg (β -0·31, P < 0·001), Cu (β -0·22, P < 0·003), vitamin A (β -0·37, P < 0·001) and vitamin C (β -0·22, P < 0·001). As the contribution of ultra-processed foods to total energy intake increased (from the first to the last tertile of consumption), the prevalence of inadequate intake of free sugars increased (from 32·9 % to 60·7 %, respectively), as well as the prevalence of inadequate fibre intake (from 26·1 % to 47·5 %). The influence of ultra-processed foods on the vegetarian diet in the UK is of considerable magnitude, and the consumption of this food was associated with poorer diet quality.

Food prices in New Zealand: implications for feeding people better

ABSTRACT There are ongoing concerns about food security, particularly around food affordability and the nutritional quality of diets in New Zealand. While recent food price inflation has sparked conversations about overall affordability, less attention has been directed toward understanding how variations in price increases across different food categories might impact nutrition and health. Using data from Statistics New Zealand on the prices of 85 food items between 2014 and 2023, we estimated 12-month moving averages of relative real prices of sweetened foods vis-à-vis those of five other food categories: dairy, fruits, vegetables, processed meats, and unprocessed meats. Non-parametric Mann-Kendall tests and linear regressions were used to assess the trends in relative food prices. The data show that sweetened foods have become relatively inexpensive over this period. On the premise that both absolute and relative prices are important in determining dietary choices and that these choices impact health, we consider the possible negative implications of these trends. Possible reasons for the recent trends and policies to meet the challenges they pose are discussed.

Habitual Dietary Intake and Adherence to Dietary Guidelines of Patients with Inflammatory Bowel Diseases

Inflammatory bowel disease (IBD) belongs to a group of autoimmune conditions characterized by chronic inflammation and mucosal ulceration of the gastrointestinal tract. The etiology of IBD is complex. The etiological factors include environmental factors, among which diet is important. The aim of this study was to evaluate the diet of IBD patients. This case–control study was carried out on 82 patients with IBD; the control group consisted of 80 clinically healthy subjects. Food intake was assessed using a 24 h recall and frequency food questionnaire. Energy intake in the IBD group was insufficient and significantly lower than in the control group. The energy intake in the group of patients with active IBD was significantly lower than in the group of subjects in remission. The total fat and protein intake was significantly lower in the IBD group compared to the healthy subjects. IBD patients were characterized by underconsumption of all food groups analyzed, except for the intake of red meat and poultry. Our study showed inadequate intake of energy and most nutrients in IBD patients, even during the remission period. The study indicates the need for routine assessment of dietary intake and nutrition among IBD patients, as well as potential dietary interventions aimed at improving the energy and nutritional quality of diet in order to optimize treatment outcomes and prevent the development of accompanying diseases.

Insegurança alimentar e nutricional e qualidade da dieta no Brasil

ABSTRACT Objective Verify association between the perception of food insecurity and the diet quality of the Brazilian population, applying The Brazilian Food Insecurity Scale and the Brazilian Healthy Eating Index Revised. Methods Cross-sectional study using data from the Householder Budget Survey collected in 2017/18 with two 24-hour recalls. A multinomial regression model was used with Odds Ratio and a 95% confidence interval, with the final model being the insertion of variables according to the theoretical model of hierarchy adopted. Results A total of 57,920 households were analyzed, and of these, 39.22% lived with some degree of Food Insecurity. There was a significant difference between female heads of the household, mixed race and black race, households with adults and children and living in rural regions as the three levels of AI [Food insecure] (p=&lt;0.001), with a greater chance of food insecurity in these households. The average Brazilian Healthy Eating Index Revised for the 46,152 individuals was 54.23 points for those who were not food insecure, and 54.11 points for those who experienced severe food insecurity. Conclusion It is concluded that there is an association between the perception of food insecurity and the nutritional quality of the diet of the Brazilian population, which can lead to malnutrition and obesity.

Effects of multirepresentation-based creative problem-solving learning model on students critical thinking and diet nutritional quality

Effects of multirepresentation-based creative problem-solving learning model on students critical thinking and diet nutritional quality

Identification of three dietary groups in French university students and their associations with nutritional quality and environmental impact.

The student period is associated with changes in eating habits, usually leading to diets of lower nutritional quality. However, some variability may exist in students' dietary patterns. We aimed to describe French students' diets and identify dietary groups that may vary in nutritional quality and environmental impact. A representative sample of French students (N = 582) for age, sex and scholarship status completed an online 125-item food frequency questionnaire. The nutritional quality of diets was assessed by a score of adherence to the French nutritional guidelines (sPNNS-GS2 score, ranging from-17 to 11.5) and its environmental impact by greenhouse gas emissions for an isocaloric diet (GHGE). An ascending hierarchical classification analysis on food and beverage intakes led to three dietary groups. Between-group differences in food consumption, dietary indicators and sociodemographic characteristics were investigated using ANOVA models. The average sPNNS-GS2 score of students' diets was -0.8 ± 2.8, representing a 57% coverage of French nutritional recommendations, and GHGE were 5.4 ± 1.7 kg eCO2/2000 kcal. The three dietary groups were: a healthy diet group (20% of the sample) with the highest nutritional quality and high GHGE, which included older students with a higher level of physical activity; a Western diet group (40%) with the worst nutritional quality and high GHGE, which included more students who lived with their parents; and a frugal diet group (40%) with the lowest energy intake, intermediate nutritional quality, and low GHGE, which included more students who lived alone. None of the dietary groups optimized both nutritional quality and environmental impact simultaneously, which suggests an apparent incompatibility in the student population between these two sustainability dimensions. These findings emphasize the need for tailored public health policies that acknowledge the diversity of student eating patterns and address specific individual barriers to healthy and sustainable diets.

Sustainability assessment of waste and wastewater recovery for edible mushroom production through an integrated nexus. A case study in Lazio

With a global population of eight billion people, improving the sustainability and nutritional quality of diets has become critical. Mushrooms offer a promising solution because of their nutritional value and ability to be grown from agricultural residues, in line with the circular economy. This study, therefore, focuses on assessing the environmental compatibility of Agaricus bisporus mushroom production in Italy, the world's third largest per capita consumer, by using a Life Cycle Assessment (LCA) and an integrated Water-Energy-Nitrogen-Carbon-Food (WENCF) nexus analysis. The LCA results reveal that for a functional unit of 23,000 kg of the substrate, the production process emits 2.55 × 104 kg of CO2 eq. Sensitivity analysis shows that changing input quantities can reduce environmental impacts by about 5 %. In addition, one scenario evaluates the environmental effects of recycling resources by introducing water and ammonium sulfate from scratch instead of continuous recycling, along with water purification. The study shows that sustainable food production can mitigate resource depletion, climate-altering emissions, and intersectoral competition. Using agro residues for mushroom cultivation and optimizing resource management contribute to environmental sustainability. This approach could not only improve the resilience and efficiency of the food system but could also improve the sustainability of diets. In conclusion, this study highlights the importance of adopting sustainable and circular approaches in mushroom production to address global challenges related to food sustainability.

THE ASSOCIATION BETWEEN COLORECTAL CANCER AND INDEX OF NUTRITIONAL QUALITY (INQ); A CASE-CONTROL STUDY.

•Is the Index of Nutritional Quality (INQ) associated with colon cancer? •This study compared the INQ of various dietary components between colorectal cancer patients and healthy controls. A total of 480 participants were enrolled in the study (160 patients with colorectal cancer as a case group and 320 healthy control). The results showed that CRC is significantly associated with INQ for some micronutrients. INQ can be considered as an indicator to assess clinical nutritional problems. Background - The nutritional quality of diet may influence the risk of colorectal cancer (CRC). This study compared the Index of Nutritional Quality (INQ) of various dietary components between colorectal cancer patients and healthy controls. Methods - A total of 480 participants were enrolled in the study (160 patients with colorectal cancer as a case group and 320 healthy control). An analysis was conducted on the general characteristics of the participants, their medical histories, anthropometric indicators, physical activity, alcohol consumption, reproductive history, smoking and food intake. A valid food frequency questionnaire was used to assess nutrient intake and INQ was calculated from daily nutrient intake. Results - A Significant inverse association was found between CRC and INQ for vitamins A (OR=0.01, CI: 0.01-0.01), K (OR=0.04, CI: 0.01-0.15), and B12 (OR=0.71, CI: 0.51-0.98), B5 (OR=0.43, CI: 0.00-0.01), zinc (OR=0.35, CI: 0.13-0.95), and phosphorus (OR=0.17, 0.19-0.94). The association between the INQ of vitamin B12 and zinc with colorectal cancer was disappeared after age adjustment. There was a significant negative association between CRC with the INQ of vitamins A, K, B5, phosphorus, and calcium after further adjustments for gender, BMI, menopausal status, and total energy intake. Conclusion -CRC is significantly associated with INQ for some micronutrients. INQ can be considered as an indicator to assess clinical nutritional problems.

Differences in Cost-Effectiveness of Adherence to Nutritional Recommendations: Why, Where, and What?

Cost-effectiveness analysis of diets may comprise an important tool to promote food security; however, studies show divergent evidence regarding the relationship between diet quality and cost in diverse populations. Thus, this study assesses differences in cost-effectiveness ratios regarding adherence to nutritional recommendations using data representative of the population level in Sao Paulo municipality, Brazil. Information from adolescents and adult individuals (n = 1742) was used to estimate diet quality and cost in 2015. Differences in cost-effectiveness ratios were investigated through application of two diet quality indexes and exploration of individuals' personal and contextual characteristics. Results indicated that higher diet cost was associated with higher adherence to nutritional recommendations at the national level and inversely associated with adherence to international recommendations. Purchasing foods in street markets was linked to healthier diets at lower costs, and protein consumption was associated with higher diet cost regardless of diet quality; however, diet quality was linked to type of protein consumed by individuals. Differences in cost-effectiveness ratios were attributable to methodological choices in measuring dietary quality (why); individuals' personal and contextual characteristics, in particular, access to retail equipment (where); and certain food choices (what). Therefore, cost-effectiveness analyses should be tailored to policy goals and local environments to ensure proper assessment of nutrition programs and to foster improvements in nutritional diet quality at lower cost.

Abstract MP33: Ultra-processed Food Attenuates The Association Of Nutri-score Front-of-pack Label With All-cause Mortality Risk In The Moli-sani Study Cohort

Introduction: The Nutri-Score front-of-pack label rates foods according to their nutritional quality while the NOVA classification is focused on degree of food processing; both systems are reported to separately predict mortality in population-based studies. Hypothesis: We tested the following hypotheses: a) both the Nutri-Score and ultra-processed food (UPF) classification predict mortality in a cohort of Italians from the general population; b) UPF accounts for a proportion of the excess of all-cause mortality risk associated with increased levels of the Nutri-Score. Methods: Longitudinal analysis on 22,913 Italian men and women (mean age 54±12 y) from the Moli-sani Study (enrolled between 2005 and 2010) followed for 11.2 y (median). Food intake was assessed by a 188-item food frequency questionnaire. The Food Standards Agency nutrient profiling system (FSAm-NPS) score, used to derive the Nutri-Score, was calculated for each food based on its amount of energy, saturated fat, sugar, sodium, fibre, protein, fruits, vegetables, legumes and nuts per 100 g of product. The FSAm-NPS dietary index was calculated for each participant as an energy weighted mean of the FSAm-NPS score of all foods consumed: increased values indicated lower nutritional quality of diet at individual level. UPF was defined by the NOVA classification according to degree of processing, and categorized as quartiles of the ratio (%) between UPF (g/d) and total food eaten (g/d). Results: The FSAm-NPS dietary index and UPF moderately correlated (Pearson’s’ correlation coefficient=0.34), suggesting that these two indices likely cover different, although complementary, dimensions. Multivariable-adjusted hazard ratios [HRs] for all-cause mortality were 1.18 (95%CI 1.03-1.36 Q4 vs Q1) and 1.25 (1.08-1.44 Q4 vs Q1) for the FSAm-NPS dietary index and UPF, respectively. When the two indices were analyzed simultaneously, the magnitude of the association between the FSAm-NPS dietary index with mortality was significantly reduced (HR=1.13; 0.97-1.30 Q4 vs Q1) with UPF explaining 27.5% (p&lt;.0001) of the excess of all-cause mortality risk associated with FSAm-NPS index. At variance, the association of elevated UPF intake with mortality was unchanged when adjusted for FSAm-NPS index (HR=1.24; 1.07-1.43 Q4 vs Q1). Conclusions: The higher all-cause mortality risk associated with excessive intake of nutrient-poor foods, as reflected by the FSAm-NPS dietary index underpinning the NutriScore front-of-pack label, is largely explained by the degree of food processing of these foods. Food labelling systems developed to help consumers make healthier food choices should account for the degree of food processing in addition to nutritional content.

Who We Seek and What We Eat? Sources of Food Choice Inspirations and Their Associations with Adult Dietary Patterns before and during the COVID-19 Lockdown in New Zealand.

Research shows the shaping of food choices often occurs at home, with the family widely recognised as significant in food decisions. However, in this digital age, our eating habits and decision-making processes are also determined by smartphone apps, celebrity chefs, and social media. The ‘COVID Kai Survey’ online questionnaire assessed cooking and shopping behaviours among New Zealanders during the 2020 COVID-19 ‘lockdown’ using a cross-sectional study design. This paper examines how sources of food choice inspirations (cooking-related advice and the reasons for recipe selection) are related to dietary patterns before and during the lockdown. Of the 2977 participants, those influenced by nutrition and health experts (50.9% before; 53.9% during the lockdown) scored higher for the healthy dietary pattern. Participants influenced by family and friends (35% before; 29% during the lockdown) had significantly higher scores for the healthy and the meat dietary patterns, whereas participants influenced by celebrity cooks (3.8% before; 5.2% during the lockdown) had significantly higher scores in the meat dietary pattern. There was no evidence that associations differed before and during the lockdown. The lockdown was related to modified food choice inspiration sources, notably an increase in ‘comforting’ recipes as a reason for recipe selection (75.8%), associated with higher scoring in the unhealthy dietary pattern during the lockdown. The lockdown in New Zealand saw an average decrease in nutritional quality of diets in the ‘COVID Kai Survey’, which could be partly explained by changes in food choice inspiration sources.

Measuring cost and affordability of current vs. healthy diets in Argentina: an application of linear programming and the INFORMAS protocol

BackgroundFood cost and affordability is one of the main barriers to improve the nutritional quality of diets of the population. However, in Argentina, where over 60% of adults and 40% of children and adolescents are overweight or obese, little is known about the difference in cost and affordability of healthier diets compared to ordinary, less healthy ones.MethodsWe implemented the “optimal approach” proposed by the International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support (INFORMAS). We modelled the current diet and two types of healthy diets, one equal in energy with the current diet and one 6.3% lower in energy by linear programming. Cost estimations were performed by collecting food product prices and running a Monte Carlo simulation (10,000 iterations) to obtain a range of costs for each model diet. Affordability was measured as the percentage contribution of diet cost vs. average household income in average, poor and extremely poor households and by income deciles.ResultsOn average, households must spend 32% more money on food to ensure equal energy intake from a healthy diet than from a current model diet. When the energy intake target was reduced by 6.3%, the difference in cost was 22%. There are no reasonably likely situations in which any of these healthy diets could cost less or the same than the current unhealthier one. Over 50% of households would be unable to afford the modelled healthy diets, while 40% could not afford the current diet.ConclusionsDifferential cost and affordability of healthy vs. unhealthy diets are germane to the design of effective public policies to reduce obesity and NCDs in Argentina. It is necessary to implement urgent measures to transform the obesogenic environment, making healthier products more affordable, available and desirable, and discouraging consumption of nutrient-poor, energy-rich foods.

Feeding selection of sheep and alpaca on puna tussock rangelands grazed previously by cattle

Sequential grazing by several livestock species has potential benefits in biodiversity conservation, resource use efficiency, animal productivity and profitability. Our objective was to assess diet composition and nutritional quality for alpacas and sheep in mono grazing and sequential grazing of either species after cattle, on puna tussock rangelands in Peru. Four experimental plots in each of two blocks were randomly assigned to one of four treatments: mono grazing by sheep, mono grazing by alpaca, sequential grazing of cattle followed by sheep, and sequential grazing of cattle followed by alpaca. Simulated diet (hand plucked that mimicked the animal´s foraging) and vegetation samples were collected in the wet and dry seasons. The botanical composition was determined by a macroscopy point technique, diet selection by the Ivlev´s elective index, and diet nutritional quality by routine forage analyses (digestibility, crude protein, and neutral detergent fiber). Both the alpacas and sheep selected less tall tussock grasses and more forbs in the sequential grazing than in mono grazing in both the wet and dry seasons, and more leaf and green biomass in sequential grazing than mono grazing in the dry season. This grazing behavior was reflected in greater avoidance of the tall grasses and higher preference for leaf and green biomass in the sequential grazing than in mono grazing. The differences in diet selection between the different grazing managements resulted in a diet higher in crude protein in sequential grazing than in mono grazing. Sequential grazing of cattle followed by either alpacas or sheep modified the diet selection of the two latter species, improving the nutritional quality of the diet.

Gluten-free Foods and Their Contribution to Total Diet in Patients with Celiac Disease

Background. Gluten-free diet continues being the most effective treatment of celiac disease but current evidence on its nutritional characteristics and metabolic effects rises concerns. Objectives. To assess the total diet of adult celiac patients and the contribution of gluten-free foods to it, in Chilean celiac patients. Methodology. Sociodemographic and clinical characteristics were registered and a food frequency questionnaire including detailed data about gluten-free foods was applied to 71 celiac patients older than 12 years of age receiving medical care at INTA, University of Chile, in Santiago. Total food intake, dietary adequacy and diet nutritional quality was calculated using descriptive statistics. Principal Findings. Of 71 patients, 81.6% were female, 93% were 19-65 years of age and 65% were on GFD for 2 years or more. Nutritional status classified in underweight and overweight/obesity in 2.9% and 35.7%, respectively. 2.8% patients declared to consume willingly gluten containing bread. The whole diet was normocaloric, normoproteic, hyperlipidic and hypoglucidic (FAO/WHO); when calculations were based for individuals’ requirements, 65% of cases consumed excess calories, proteins, and carbohydrates. Gluten-free foods contributed to 17.7%, 11.6%, 11.5% and 23.9% of the total daily intake of calories, protein, lipids, and carbohydrates, respectively. GFF were characterized by having a low protein content. Conclusions. Although the whole diet appeared close to WHO/FAO recommendations when calculated as average for the study group, 65% of participants consumed excess calories, proteins, lipids, and carbohydrates when calculations were made on individual basis. There was neither moderate-severe undernutrition nor overweight/obesity in the group studied. It is interesting that both the total diet quality and the nutritional status of the celiac patients assessed were better than those described in the general local population.

Consumption of Ultra-Processed Foods by Pesco-Vegetarians, Vegetarians, and Vegans: Associations with Duration and Age at Diet Initiation

BackgroundThere is a growing availability of industrial plant-based meat and dairy substitutes that can be classified as ultra-processed foods (UPFs). Very little is known about the consumption of UPFs by vegetarians. ObjectiveThe aim of this cross-sectional study, from the NutriNet-Santé cohort, was to describe the contribution of UPFs to different vegetarian diets, in relation to the nutritional quality of their diet, and determinants of UPF consumption, including duration and age at vegetarian diet initiation. MethodsThe study population (n = 21,212) was divided into 4 groups: 19,812 meat eaters, 646 pesco-vegetarians, 500 vegetarians, and 254 vegans. Daily food intakes were collected using repeated 24-h dietary records. Vegetarian diets were described by the proportion of energy from UPFs and the nutritional quality of the diet using healthy and unhealthy plant-based diet indices (PDIs). In a subsample without meat eaters (n = 1,400), a multivariable linear regression model was performed to study the association between UPF consumption and its determinants. ResultsHigher avoidance of animal-based foods was associated with a higher consumption of UPFs (P < 0.001), with UPFs supplying 33.0%, 32.5%, 37.0%, and 39.5% of energy intakes for meat eaters, pesco-vegetarians, vegetarians, and vegans. The nutritional quality of diets was also associated with the level of animal-based foods avoidance (P < 0.001), with healthy PDIs at 53.5, 60.6, 61.3 and 67.9 for meat-eaters, pesco-vegetarians, vegetarians, and vegans. Short duration and young age at diet initiation were associated with an increased consumption of UPFs (βage at initiation = −0.003, P = 0.001; βduration = −0.002, P < 0.001). ConclusionsNot all vegetarian diets necessarily have health benefits, because of potential adverse effects of UPFs on nutritional quality and healthiness of diet. UPF consumption by vegetarians and their diet characteristics should be considered in future studies on the links between vegetarianism and health. This trial was registered at https://www.clinicaltrials.gov/ as NCT03335644.

Early consumption of ultra-processed foods among children under 2 years old in Brazil.

To evaluate the complementary food consumption according to the extent and purpose of food processing based on NOVA classification among children aged 6-24 months of Federal District, Brazil. We performed a cross-sectional study using a 24-h recall to estimate the daily energy intake and nutrients according to NOVA classification. We conducted a linear regression to assess the association between the processed and ultra-processed foods (UPF) energy intake and the daily energy intake from saturated fat, daily energy intake from total sugars and daily intake of sodium. Federal District, Brazil. Five hundred and thirty-eight children aged between 6 and 24 months attended at Primary Health Care Units from March 2017 to March 2018. On average, children aged from 6 to 12 and from 12 to 24 months consumed 2393 and 4054 kJ/d, respectively, and processed and UPF represented one-third of dietary energy intake. Group 2 (processed and UPF) was higher carbohydrate contributors, and lower protein, fibre and most micronutrient contributors, when compared with Group 1 (unprocessed, minimally processed foods and processed culinary ingredients). In addition, the higher the energy intake from processed and UPF, the higher was the daily energy intake from saturated fat, daily energy intake from total sugar and daily intake of sodium. Children are being exposed early to processed and UPF and their share affect the diet's nutritional quality.

Food choice motives and the nutritional quality of diet during the COVID-19 lockdown in France

To limit the transmission of COVID-19, nationwide lockdown was imposed in France between March, 17th and May 10th, 2020. This disruption in individuals’ daily routines likely altered food consumption habits. We examined how changes in food choice motives related to changes in nutritional quality during the lockdown compared to before. A convenience sample of 938 French adults completed online questionnaires on the Qualtrics platform at the end of April 2020. Participants were retrospectively asked about their food choice motives and food consumption during the month before and in the first month of the lockdown. The importance of nine food choice motives was assessed: health, convenience, sensory appeal, natural content, ethical concern, weight control, mood, familiarity, and price, scoring from 1 to 4. Food intakes were recorded using a food frequency questionnaire including 110 foods, 12 non-alcoholic beverages and 4 alcoholic beverages. Adherence to the French dietary recommendations before and during the lockdown was estimated using the simplified PNNS-GS2, scoring from −17 to 11.5. The nutritional quality of diet was lower during the lockdown compared to before (−0.32, SD 2.28, p < 0.001). Food choice motives significantly changed and an increase in the importance of weight control was associated with increased nutritional quality (β = 0.89, p < 0.001, partial η2 = 0.032), whereas an increase in the importance of mood was associated with decreased nutritional quality (β = −0.43, p = 0.021, partial η2 = 0.006). The lockdown period in France was related to a decrease in nutritional quality of diet on average, which could be partly explained by changes in food choice motives. The lockdown was indeed related to modification of food choice motives, notably with an increase of mood as a food choice motive for 48% of the participants, but also with an increase of health (26%), ethical concern (21%) and natural content (19%) suggesting a growing awareness of the importance of sustainable food choices in some participants.

The Nutri-Score in France and beyond: development, validation and transfer

Abstract The Nutri-Score is a summary graded front-of-pack nutritional label, providing a synthetic information to consumers on the overall nutritional quality of a food product, based on its composition in several key unfavourable (energy, saturates, sugars, salt) and favourable (proteins, fibers, fruit, vegetables, nuts, legumes and certain vegetable oils (olive, rapeseed and nuts)). The Nutri-Score was developed by a team of independent scientists, and initially proposed in France in 2014. Following intense opposition by industry and considerable arguments, a 2-yearlong debate, the Nutri-Score was selected to be the official French front-of-pack nutrition label. In parallel, more than 40 publications in peer-reviewed journals investigated its validity on multiple dimensions, further supporting its implementation. Following the implementation of the Nutri-Score, consumer groups' pressure and a growing interest from the public pushed manufacturers to adopt the label, with more than 300 pledges of adoption from industry in 2020. After France, neighbouring countries (Belgium, Spain, Switzerland, Germany and the Netherlands) have now also adopted the scheme, prompting new challenges for development at a larger scale. The implementation of the system in France was made possible by strong public support for such a measure - relayed by consumer groups and disseminated in the media and a strong political will from the Health ministry to put together a validated and helpful system, which finally prevailed upon economic interests. Sustained support from consumers in particular helped turn the tide from a relatively low engagement of stakeholders towards the acknowledgement of the Nutri-Score as a standard for front-of-pack labelling in France and several EU countries. The Nutri-Score is an example of a public health measure informed by scientific evidence that may have a clear impact on the nutritional quality of diets in the population.

Prospective associations of four nutrient profiles with weigh gain, overweight and obesity risk

Abstract Background Nutrient Profiling Systems (NPSs), including the UK Food Standards Agency NPS and its variants are used to classify foods according to their nutritional composition for nutrition policies. The prospective validity of these NPSs requires however further investigation. The study investigates the associations of the original Food Standards Agency (FSA)-NPS and three variants - the Food Standards Australia New Zealand Nutrient Profiling Scoring Criterion (NPSC), the Health Star Rating (HSR) system NPS and the French NPS (HCSP-NPS) -, which are used as a basis for nutrition policies, with weight status. Methods Dietary indices based on each of the four investigated NPSs applied at the food level were computed at the individual level to characterize the diet quality of 71,178 French individuals from the NutriNet-Santé cohort. Associations of these Dietary Indices (DIs) (as tertiles) with weight gain were assessed using multivariable mixed models, and with overweight and obesity risks using multivariable Cox models. Results For the four NPSs, participants with a lower diet nutritional quality were more likely to have an increase in body mass index over time (median follow-up of 3.14 ± 2.76 years, beta coefficients positive, all p ≤ 0.0001), and an increased risk of overweight (HRT3vs.T1=1.27 [1.17-1.37] for the HCSP-DI, followed by the original FSA-DI with HRT3vs.T1=1.18 [1.09-1.28], the NPSC-DI with HRT3vs.T1=1.14 [1.06-1.24] and the HSR-DI, HRT3vs.T1=1.12 [1.04-1.21]). Whilst differences were small, the HCSP-DI appeared to show significantly greater association with risk of overweight compared to other NPS. Conclusions Less healthy diets defined using the Food Standards Agency-NPS and related systems were all associated with weight gain and overweight risk. Demonstrating this association with health outcomes is an important indicator of one validity dimension of NPSs and supports their use in public policies for the prevention of diet-related chronic diseases. Key messages Nutrient profile models of foods and beverages allow capturing the nutritional quality of diets and are prospectively associated with weight gain and obesity. The French NPS which underpins the front-of-pack Nutri-Score appeared to have a small but significant higher performance.

Change in disparities of dietary quality score (FSAm-NPS) in adolescents and young adults between 2004 and 2014 in Belgium

AbstractIntroductionThe transition from adolescence toward adulthood is a critical period regarding changes in dietary behaviours. Moreover at these ages, socio-economic and regional disparities in food group consumption are observed. The aim of our study was to determine how the nutritional quality of diet, measured by the modified Nutrient Profiling System of the British Food Standards Agency (FSAm-NPS), evolved between 2004 and 2014, according to socio-economic and regional characteristics of adolescents and young adults living in Belgium.Material and methodsTwo non-consecutive 24-hour dietary recalls were carried out in two nationally-representative samples of 15-to-39-year-old respondents included in the Belgian Food Consumption Surveys in 2004 (n = 1,186) and 2014 (n = 952). Weighting factor (according to age, gender, day of recall, season and province) and sample design were considered. The weighted mean individual FSAm-NPS was computed from all foods and beverages consumed and converted into a scale from 0 (less favourable diet) to 100 (more favourable diet). Slope (SII) and Relative (RII) Index of Inequality were compared between 2004 and 2014 in three age groups (15–18 y, 19–25 y and 26–39 y), adjusting for gender, energy intake, and other socio-economic and regional characteristics.ResultsIn the three age groups, the weighted mean FSAm-NPS significantly increased between 2004 and 2014 (2004: 55.2 (SEM: 0.2) vs. 2014: 57.3 (0.5), p &lt; 0.001 in 15–18-year-olds; 54.9 (0.6) vs. 58.0 (0.4), p &lt; 0.001 in 19–25-year-olds; 56.9 (0.3) vs 58.3 (0.3), p &lt; 0.01 in 26–39-year-olds). While a significant FSAm-NPS gradient was observed according to household education among 15–18- and 26–39-year-olds in 2004 (adjusted SII: 2.56 (95% CI: 1.08–4.04) and 2.73 (0.34–5.12), respectively; RII: 1.05 (1.02–1.08) and 1.05 (1.01–1.09)), no significant difference was found in 2014. Conversely, no significant score disparity was observed according to household type in 2004, but disparities appeared in 2014: index of inequality were significant among subjects aged 19–25 y (SII: 3.89 (0.62–7.17); RII: 1.07 (1.01–1.13)) and 26–39 y (SII: 2.74 (0.31–5.17); RII: 1.05 (1.01–1.09)), the FSAm-NPS being more favourable for those living in two-parent families. The FSAm-NPS was generally higher for subjects living in Flanders than those in Wallonia (significant SII and RII only among 26–39-year-olds), the magnitude of regional disparities remaining stable over time.DiscussionOverall FSAm-NPS improved during this 10-year period, but differentially according to family structure and household education. However, statistical power was weakened by the limited sample size. Additional investigations of changes in food group consumption disparities will complement our interpretations.