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The impact of the Nutri-Score front-of-pack nutrition label on purchasing intentions of unprocessed and processed foods: post-hoc analyses from three randomized controlled trials.
Egnell, M, Galan, P, Fialon, M, Touvier, M, Péneau, S, Kesse-Guyot, E, Hercberg, S, Julia, C
The international journal of behavioral nutrition and physical activity. 2021;18(1):38
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In order to prevent nutrition-related chronic diseases, Front-of-Pack nutrition Labels (FoPL) have been identified as efficient tools to encourage consumers towards healthier food choices and to promote food reformulation. The aim of this study was to investigate the impact of the Nutri-Score, compared to the current labelling situation in France (i.e., Reference Intakes (RIs) or no label), on food purchasing intentions. This study is a post-hoc analysis of three randomised controlled studies in three specific populations; students (N = 1866), low-income individuals (N = 336) and subjects suffering from cardiometabolic diseases (N = 1180). Results show that overall, participants (students, low-income individuals and subjects suffering from cardiometabolic diseases) simulating purchases with the Nutri-Score affixed on pre-packed foods were more likely to have higher proportions of unpacked products (especially unprocessed fruits and meat) in their shopping cart. Furthermore, Nutri-Score influenced the type of food purchased; less ultra-processed foods which have been found to be often of lower nutritional quality. Authors conclude that Nutri-Score may have a positive impact on food purchases which would discourage the purchase of pre-packed processed products.
Abstract
BACKGROUND The Nutri-Score summary graded front-of-pack nutrition label has been identified as an efficient tool to increase the nutritional quality of pre-packed food purchases. However, no study has been conducted to investigate the effect of the Nutri-Score on the shopping cart composition, considering the type of foods. The present paper aims to investigate the effect of the Nutri-Score on the type of food purchases, in terms of the relative contribution of unpacked and pre-packed foods, or the processing degree of foods. METHODS Between September 2016 and April 2017, three consecutive randomized controlled trials were conducted in three specific populations - students (N = 1866), low-income individuals (N = 336) and subjects suffering from cardiometabolic diseases (N = 1180) - to investigate the effect of the Nutri-Score on purchasing intentions compared to the Reference Intakes and no label. Using these combined data, the proportion of unpacked products in the shopping carts, as well as the distribution of products across food categories taking into account the degree of processing (NOVA classification) were assessed by trials arm. RESULTS The shopping carts of participants simulating purchases with the Nutri-Score affixed on pre-packed foods contained higher proportion of unpacked products - especially raw fruits and meats, i.e. with no FoPL -, compared to participants purchasing with no label (difference of 5.93 percentage points [3.88-7.99], p-value< 0.0001) or with the Reference Intakes (difference of 5.27[3.25-7.29], p-value< 0.0001). This higher proportion was partly explained by fewer purchases of pre-packed processed and ultra-processed products overall in the Nutri-Score group. CONCLUSIONS These findings provide new insights on the positive effect of the Nutri-Score, which appears to decrease purchases in processed products resulting in higher proportions of unprocessed and unpacked foods, in line with public health recommendations.
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Organic food consumption and gluten-free diet, is there a link? Results in French adults without coeliac disease.
Perrin, L, Allès, B, Julia, C, Hercberg, S, Touvier, M, Lairon, D, Baudry, J, Kesse-Guyot, E
The British journal of nutrition. 2021;125(9):1067-1078
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The gluten-free diet (GFD) is a medical response for people with coeliac disease, a systemic autoimmune disorder for which GFD is the only available effective treatment. The aim of this study was to compare the consumption of organic products (as a whole and by food group) in individuals (partially or totally) avoiding gluten or not, and their places of food purchases of organic food. Results indicate a positive association between gluten avoidance and contribution of organic food to the diet. A gradient was also observed with total avoiders consuming more of organic food than partial avoiders. This contribution was higher for all types of products, except milk and dairy products. Furthermore, the results appear consistent with the motives reported by individuals avoiding gluten. Authors conclude that their findings underline a strong positive correlation between gluten avoidance and organic food consumption.
Abstract
The rising popular belief that gluten is unhealthy has led to growth in gluten avoidance in people without coeliac disease. Little information is available on their dietary profiles and their dietary behaviours. Our aim was to compare the consumption of organic foods between gluten avoiders and non-avoiders, and their places of food purchase. We described their sociodemographic and dietary profiles. The study population included participants of the NutriNet-Santé cohort who completed both a food exclusion questionnaire and an organic semi-quantitative FFQ (n 23 468). Food intake and organic food consumption ratios were compared using multivariable adjusted ANCOVA models. Associations between gluten avoidance and organic food consumption as well as places of food purchase were investigated with multivariable logistic regression. Participants avoiding gluten were more likely to be women and had a healthier dietary profile. Organic food consumption was higher among gluten avoiders (48·50 % of total diet for total avoiders, 17·38 % for non-avoiders). After adjustments for confounders, organic food consumption and purchase in organic stores were positively associated with gluten avoidance: adjusted OR (aOR)Q5 v.Q1 organic food = 4·95; 95 % CI 3·70, 6·63 and aORorganic stores v.supermarkets = 1·82; 95 % CI 1·42, 2·33 for total avoiders. Our study highlights that individuals avoiding gluten are high organic consumers and frequently purchase their foods in organic stores which propose an extended offer of gluten-free food. Further research is needed to determine the underlying common motivations and the temporality of the dietary behaviours of healthy people avoiding gluten.
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Consumption of ultra-processed foods and cancer risk: results from NutriNet-Santé prospective cohort.
Fiolet, T, Srour, B, Sellem, L, Kesse-Guyot, E, Allès, B, Méjean, C, Deschasaux, M, Fassier, P, Latino-Martel, P, Beslay, M, et al
BMJ (Clinical research ed.). 2018;360:k322
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Foods that are heavily processed tend to have high levels of total fat, sugar and salt and low levels of fibre and vitamins. They also tend to have high levels of contaminants (caused for example by high heat treatment), food additives and plastic packaging exposure. This large prospective population-based cohort study assessed the association between ultra-processed food consumption and the incidence of cancer. The study found that ultra-processed food intake was associated with a higher overall cancer risk and a higher breast cancer risk. A 10% increase in the consumption of ultra-processed foods was associated with an increase of more than 10% greater risk of overall and breast cancer risk. The authors call for further studies to better understand the different elements of food processing and their association to cancer risk.
Abstract
OBJECTIVE To assess the prospective associations between consumption of ultra-processed food and risk of cancer. DESIGN Population based cohort study. SETTING AND PARTICIPANTS 104 980 participants aged at least 18 years (median age 42.8 years) from the French NutriNet-Santé cohort (2009-17). Dietary intakes were collected using repeated 24 hour dietary records, designed to register participants' usual consumption for 3300 different food items. These were categorised according to their degree of processing by the NOVA classification. MAIN OUTCOME MEASURES Associations between ultra-processed food intake and risk of overall, breast, prostate, and colorectal cancer assessed by multivariable Cox proportional hazard models adjusted for known risk factors. RESULTS Ultra-processed food intake was associated with higher overall cancer risk (n=2228 cases; hazard ratio for a 10% increment in the proportion of ultra-processed food in the diet 1.12 (95% confidence interval 1.06 to 1.18); P for trend<0.001) and breast cancer risk (n=739 cases; hazard ratio 1.11 (1.02 to 1.22); P for trend=0.02). These results remained statistically significant after adjustment for several markers of the nutritional quality of the diet (lipid, sodium, and carbohydrate intakes and/or a Western pattern derived by principal component analysis). CONCLUSIONS In this large prospective study, a 10% increase in the proportion of ultra-processed foods in the diet was associated with a significant increase of greater than 10% in risks of overall and breast cancer. Further studies are needed to better understand the relative effect of the various dimensions of processing (nutritional composition, food additives, contact materials, and neoformed contaminants) in these associations. STUDY REGISTRATION Clinicaltrials.gov NCT03335644.
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Supplementation with B vitamins or n-3 fatty acids and depressive symptoms in cardiovascular disease survivors: ancillary findings from the SUpplementation with FOLate, vitamins B-6 and B-12 and/or OMega-3 fatty acids (SU.FOL.OM3) randomized trial.
Andreeva, VA, Galan, P, Torrès, M, Julia, C, Hercberg, S, Kesse-Guyot, E
The American journal of clinical nutrition. 2012;96(1):208-14
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Depression is associated with poorer outcomes in people with heart disease. Substantial evidence suggests a link between dietary factors and mental health. The objective of this study was to examine the effects of supplementation with B vitamins or omega-3 (n-3) fatty acids on depressive symptoms in people with heart disease. Adults aged 45-80 years with cardiovascular disease were randomly assigned to receive 0.56mg folate (as 5-methyl-tetrahydrofolate), 3mg vitamin B6 and 0.02mg vitamin B12 ; 600mg EPA and DHA (in a 2:1 ratio); B vitamins plus n-3 fatty acids; or a placebo. Depressive symptoms were measured at years 3 and 5 using the Geriatric Depression Scale. There was no association between supplementation with B vitamins and depressive symptoms. However, men who took n-3 fatty acid supplements had a 28% higher risk of experiencing symptoms of depression. There was no such association observed in women. The authors concluded that the results of the study do not support the use of B vitamin or n-3 supplements for the prevention of depression in CVD survivors.
Abstract
BACKGROUND Dietary factors might affect depressive symptoms. OBJECTIVE In secondary data analyses, we examined effects of supplementation with B vitamins or n-3 (omega-3) fatty acids on depressive symptoms in cardiovascular disease survivors. DESIGN The SUpplementation with FOLate, vitamins B-6 and B-12 and/or OMega-3 fatty acids (SU.FOL.OM3) trial was a secondary prevention trial (2003-2009; n = 2501) in which individuals aged 45-80 y were randomly assigned, by using a 2 × 2 factorial design, to receive 0.56 mg 5-methyl-tetrahydrofolate and vitamins B-6 (3 mg) and B-12 (0.02 mg); EPA and DHA (600 mg) in a 2:1 ratio; B vitamins and n-3 fatty acids; or a placebo. Depressive symptoms were evaluated at years 3 and 5 with the 30-item Geriatric Depression Scale (GDS). Overall and sex-specific ORs and 95% CIs were estimated in 2000 participants by using factorial logistic regression. RESULTS After a median of 4.7 y of supplementation, there was no association between allocation to receive B vitamins and depressive symptoms. However, the allocation to receive n-3 fatty acids was positively associated with depressive symptoms (GDS >10) in men (adjusted OR: 1.28; 95% CI: 1.03, 1.61) but not in women. CONCLUSIONS We showed no beneficial effects of a long-term, low-dose supplementation with B vitamins or n-3 fatty acids on depressive symptoms in cardiovascular disease survivors. The adverse effects of n-3 fatty acids in men merit confirmation.