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Montericcio A, Bonaccio M, Ghulam A, Di Castelnuovo A, Gianfagna F, de Gaetano G, Iacoviello L. Dietary indices underpinning front-of-pack nutrition labels and health outcomes: a systematic review and meta-analysis of prospective cohort studies. Am J Clin Nutr 2024; 119:756-768. [PMID: 38145705 DOI: 10.1016/j.ajcnut.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 12/13/2023] [Accepted: 12/22/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND Nutrient profiling systems are increasingly used to characterize the healthfulness of foods for front-of-package (FOP) labeling, which have been proposed as an effective public health strategy to help people make healthier food choices. OBJECTIVE This study aimed to review available evidence from cohort studies that evaluated the association of dietary indices underpinning FOP nutrition labels with all-cause mortality and incidence of cardiovascular diseases (CVDs) or cancer. METHODS PubMed, Web of Science, and Scopus were systematically searched up to October 2023. We included articles if they were prospective cohort studies, if the exposure was any dietary index underpinning FOP nutrition labels [e.g., the modified Food Standard Agency-Nutrient Profiling System (FSAm-NPS) and the Health Star Rating System], and if outcomes were all-cause mortality or incidence of or mortality due to CVD and cancer. Random-effects models were used to calculate the pooled hazard ratios (HRs) and 95% CIs. RESULTS We identified 11 records (7 unique prospective studies), which were included in the systematic review. The meta-analysis comprised 8 studies analyzing the FSAm-NPS dietary index (DI) as exposure. The pooled HRs associated with a 2-unit increase in the FSAm-NPS DI of all-cause mortality, CVD, and cancer risk were 1.06 (95% confidence interval [CI]: 0.99, 1.13; I2: 80%), 1.08 (95% CI: 1.00, 1.18; I2: 70%), and 1.09 (95% CI: 1.00, 1.19; I2: 77%), respectively. The Chilean Warning Label score and the Health Star Rating systems were examined by 1 study each and were significantly associated with the outcomes. CONCLUSIONS DIs underpinning most common FOP nutrition labels and reflecting nutrient-poor diets show a tendency toward an increased incidence of CVD and cancer, but the observed effects are quite modest in magnitude. Further studies at the population level are needed to support the widely shared hypothesis that FOP labels, possibly in conjunction with other interventions, may contribute to reduce noncommunicable disease risk. This meta-analysis was registered at PROSPERO as CRD42021292625.
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Affiliation(s)
- Alberto Montericcio
- Department of Medicine and Surgery, Research Center in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, Varese-Como, Italy
| | - Marialaura Bonaccio
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli (IS), Italy.
| | - Anwal Ghulam
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli (IS), Italy
| | | | - Francesco Gianfagna
- Department of Medicine and Surgery, Research Center in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, Varese-Como, Italy; Mediterranea Cardiocentro, Napoli, Italy
| | - Giovanni de Gaetano
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli (IS), Italy
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli (IS), Italy; Department of Medicine and Surgery LUM University "Giuseppe Degennaro," Casamassima (BA), Italy
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Aguenaou H, Babio N, Deschasaux-Tanguy M, Galan P, Hercberg S, Julia C, Jones A, Karpetas G, Kelly B, Kesse-Guyot E, Kontopoulou L, Labonté ME, Ni Mhurchu C, Pravst I, Pettigrew S, Riboli E, Salas-Salvadó J, Srour B, Touvier M, Vandevijvere S. Comment on Muzzioli et al. Are Front-of-Pack Labels a Health Policy Tool? Nutrients 2022, 14, 771. Nutrients 2022; 14:2165. [PMID: 35631306 PMCID: PMC9145939 DOI: 10.3390/nu14102165] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/27/2022] [Indexed: 02/06/2023] Open
Abstract
As scientists working and publishing in the field of front-of-pack nutrition labelling (FOPNL) for many years, we have read with interest and concern the narrative review regarding their effectiveness by Muzzioli et al. [...].
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Affiliation(s)
- Hassan Aguenaou
- Joint Research Unit in Nutrition and Food, RDC-Nutrition AFRA/IAEA, Ibn Tofail University-CNESTEN, Rabat, Kenitra 14000, Morocco;
| | - Nancy Babio
- Departament de Bioquimica i Biotecnologia, Unitat de Nutrició Humana. (IISPV), Universitat Rovira i Virgili, 43201 Reus, Spain; (N.B.); (J.S.-S.)
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), 28014 Madrid, Spain
| | - Mélanie Deschasaux-Tanguy
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center—University of Paris (CRESS), 93017 Bobigny, France; (M.D.-T.); (P.G.); (S.H.); (E.K.-G.); (B.S.); (M.T.)
| | - Pilar Galan
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center—University of Paris (CRESS), 93017 Bobigny, France; (M.D.-T.); (P.G.); (S.H.); (E.K.-G.); (B.S.); (M.T.)
| | - Serge Hercberg
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center—University of Paris (CRESS), 93017 Bobigny, France; (M.D.-T.); (P.G.); (S.H.); (E.K.-G.); (B.S.); (M.T.)
- Public Health Department, Avicenne Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), 93000 Bobigny, France
| | - Chantal Julia
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center—University of Paris (CRESS), 93017 Bobigny, France; (M.D.-T.); (P.G.); (S.H.); (E.K.-G.); (B.S.); (M.T.)
- Public Health Department, Avicenne Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), 93000 Bobigny, France
| | - Alexandra Jones
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia; (A.J.); (S.P.)
| | - Georgios Karpetas
- Laboratory Teaching Staff, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larissa, Greece;
| | - Bridget Kelly
- Early Start, School of Health & Society, University of Wollongong, Wollongong, NSW 2522, Australia;
| | - Emmanuelle Kesse-Guyot
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center—University of Paris (CRESS), 93017 Bobigny, France; (M.D.-T.); (P.G.); (S.H.); (E.K.-G.); (B.S.); (M.T.)
| | - Lamprini Kontopoulou
- Laboratory Teaching Staff, Nursing Department, University of Thessaly, 41500 Larissa, Greece;
| | - Marie-Eve Labonté
- Centre Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods (INAF), Université Laval, Québec City, QC G1V 0A6, Canada;
- School of Nutrition, Université Laval, Québec City, QC G1V 0A6, Canada
| | - Cliona Ni Mhurchu
- National Institute for Health Innovation, The University of Auckland, Auckland 1142, New Zealand;
| | - Igor Pravst
- Nutrition and Public Health Research Group, Nutrition Institute, Trzaska Cesta 40, 1000 Ljubljana, Slovenia;
| | - Simone Pettigrew
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia; (A.J.); (S.P.)
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, Imperial College London, London W2 1PG, UK;
| | - Jordi Salas-Salvadó
- Departament de Bioquimica i Biotecnologia, Unitat de Nutrició Humana. (IISPV), Universitat Rovira i Virgili, 43201 Reus, Spain; (N.B.); (J.S.-S.)
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), 28014 Madrid, Spain
| | - Bernard Srour
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center—University of Paris (CRESS), 93017 Bobigny, France; (M.D.-T.); (P.G.); (S.H.); (E.K.-G.); (B.S.); (M.T.)
| | - Mathilde Touvier
- Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center—University of Paris (CRESS), 93017 Bobigny, France; (M.D.-T.); (P.G.); (S.H.); (E.K.-G.); (B.S.); (M.T.)
| | - Stefanie Vandevijvere
- Department of Epidemiology and Public Health, Service of Lifestyle and Chronic Diseases, 1050 Brussels, Belgium;
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