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Ultra-processed food intake and risk of cardiovascular disease: prospective cohort study (NutriNet-Santé).
Srour, B, Fezeu, LK, Kesse-Guyot, E, Allès, B, Méjean, C, Andrianasolo, RM, Chazelas, E, Deschasaux, M, Hercberg, S, Galan, P, et al
BMJ (Clinical research ed.). 2019;:l1451
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Abstract
OBJECTIVE To assess the prospective associations between consumption of ultra-processed foods and risk of cardiovascular diseases. DESIGN Population based cohort study. SETTING NutriNet-Santé cohort, France 2009-18. PARTICIPANTS 105 159 participants aged at least 18 years. Dietary intakes were collected using repeated 24 hour dietary records (5.7 for each participant on average), designed to register participants' usual consumption of 3300 food items. These foods were categorised using the NOVA classification according to degree of processing. MAIN OUTCOME MEASURES Associations between intake of ultra-processed food and overall risk of cardiovascular, coronary heart, and cerebrovascular diseases assessed by multivariable Cox proportional hazard models adjusted for known risk factors. RESULTS During a median follow-up of 5.2 years, intake of ultra-processed food was associated with a higher risk of overall cardiovascular disease (1409 cases; hazard ratio for an absolute increment of 10 in the percentage of ultra-processed foods in the diet 1.12 (95% confidence interval 1.05 to 1.20); P<0.001, 518 208 person years, incidence rates in high consumers of ultra-processed foods (fourth quarter) 277 per 100 000 person years, and in low consumers (first quarter) 242 per 100 000 person years), coronary heart disease risk (665 cases; hazard ratio 1.13 (1.02 to 1.24); P=0.02, 520 319 person years, incidence rates 124 and 109 per 100 000 person years, in the high and low consumers, respectively), and cerebrovascular disease risk (829 cases; hazard ratio 1.11 (1.01 to 1.21); P=0.02, 520 023 person years, incidence rates 163 and 144 per 100 000 person years, in high and low consumers, respectively). These results remained statistically significant after adjustment for several markers of the nutritional quality of the diet (saturated fatty acids, sodium and sugar intakes, dietary fibre, or a healthy dietary pattern derived by principal component analysis) and after a large range of sensitivity analyses. CONCLUSIONS In this large observational prospective study, higher consumption of ultra-processed foods was associated with higher risks of cardiovascular, coronary heart, and cerebrovascular diseases. These results need to be confirmed in other populations and settings, and causality remains to be established. Various factors in processing, such as nutritional composition of the final product, additives, contact materials, and neoformed contaminants might play a role in these associations, and further studies are needed to understand better the relative contributions. Meanwhile, public health authorities in several countries have recently started to promote unprocessed or minimally processed foods and to recommend limiting the consumption of ultra-processed foods. STUDY REGISTRATION ClinicalTrials.gov NCT03335644.
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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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Plain language summary
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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Are self-reported unhealthy food choices associated with an increased risk of breast cancer? Prospective cohort study using the British Food Standards Agency nutrient profiling system.
Deschasaux, M, Julia, C, Kesse-Guyot, E, Lécuyer, L, Adriouch, S, Méjean, C, Ducrot, P, Péneau, S, Latino-Martel, P, Fezeu, LK, et al
BMJ open. 2017;(6):e013718
Abstract
OBJECTIVES French authorities are considering the implementation of a simplified nutrition labelling system on food products to help consumers make healthier food choices. One of the most documented candidates (Five-Colour Nutrition Label/Nutri-score) is based on the British Food Standards Agency Nutrient Profiling System (FSA-NPS), a score calculated for each food/beverage using the 100 g amount of energy, sugar, saturated fatty acid, sodium, fibres, proteins, and fruits and vegetables. To assess its potential public health relevance, studies were conducted on the association between the nutritional quality of the diet, measured at the individual level by an energy-weighted mean of all FSA-NPS scores of foods usually consumed (FSA-NPS dietary index (FSA-NPS DI)), and the risk of chronic diseases. The present study aimed at investigating the relationship between the FSA-NPS DI and breast cancer risk. DESIGN Prospective study. SETTING Population based, NutriNet-Santé cohort, France. PARTICIPANTS 46 864 women aged ≥35 years who completed ≥3 24-hour dietary records during their first 2 year of follow-up. PRIMARY OUTCOME MEASURE Associations between FSA-NPS DI and breast cancer risk (555 incident breast cancers diagnosed between 2009 and 2015) were characterised by multivariable-adjusted Cox proportional hazard models. RESULTS A higher FSA-NPS DI (lower nutritional quality of the diet) was associated with an increased breast cancer risk (HR1-point increment=1.06 (1.02-1.11), p=0.005; HRQ5vs.Q1=1.52 (1.11-2.08), p trend=0.002). Similar trends were observed in premenopausal and postmenopausal women (HR1-point increment=1.09 (1.01-1.18) and 1.05 (1.00-1.11), respectively).This study was based on an observational cohort using self-reported dietary data, thus residual confounding cannot be entirely ruled out. Finally, this holistic approach does not allow investigating which factors in the diet most specifically influence breast cancer risk. CONCLUSIONS These results suggested that unhealthy food choices, as characterised by the FSA-NPS, may be associated with an increase in breast cancer risk, supporting the potential public health relevance of using this profiling system in the framework of public health nutritional measures.
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Relative Influence of Socioeconomic, Psychological and Sensory Characteristics, Physical Activity and Diet on 5-Year Weight Gain in French Adults.
Lampuré, A, Castetbon, K, Hanafi, M, Deglaire, A, Schlich, P, Péneau, S, Hercberg, S, Méjean, C
Nutrients. 2017;(11)
Abstract
Individual characteristics, dietary intake and physical activity influence weight status; however, the contribution of each factor to weight change has not been studied. The objective was to confirm a conceptual framework by simultaneously assessing the relative influence of socioeconomic, psychological and sensory characteristics, physical activity, and dietary intake on five-year weight gain in French adults. Individual characteristics, physical activity, and dietary data were assessed at baseline in 8014 participants in the NutriNet-Santé cohort. Self-reported anthropometric data were collected at baseline and five years later. Structural equation models, stratified by baseline body mass index (BMI), were used to perform analyses. Dietary restraint was a direct predictor of weight gain, with a stronger effect than age or intake of energy-dense foods, both in non-overweight and overweight participants. In non-overweight individuals only, intake of nutrient-dense foods and physical activity were inversely associated with weight gain. Regarding dietary intake, fat liking was the most important predictor of nutrient-dense food intake and was also related to energy-dense food intake. In these models, dietary restraint appears to be a direct predictor of weight gain and fat liking is a strong determinant of dietary intake. The influence of dietary restraint on weight gain, not explained by diet, warrants further investigation.
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Food Choice Motives When Purchasing in Organic and Conventional Consumer Clusters: Focus on Sustainable Concerns (The NutriNet-Santé Cohort Study).
Baudry, J, Péneau, S, Allès, B, Touvier, M, Hercberg, S, Galan, P, Amiot, MJ, Lairon, D, Méjean, C, Kesse-Guyot, E
Nutrients. 2017;(2)
Abstract
The purpose of this study was to examine food choice motives associated with various organic and conventional dietary patterns among 22,366 participants of the NutriNet-Santé study. Dietary intakes were estimated using a food frequency questionnaire. Food choice motives were assessed using a validated 63-item-questionnaire gathered into nine food choice motive dimension scores: "absence of contaminants", "avoidance for environmental reasons", "ethics and environment", "taste", "innovation", "local and traditional production", "price", "health" and "convenience". Five consumers' clusters were identified: "standard conventional food small eaters", "unhealthy conventional food big eaters", "standard organic food small eaters", "green organic food eaters" and "hedonist moderate organic food eaters". Relationships between food choice motive dimension scores and consumers' clusters were assessed using analysis of covariance (ANCOVA) models adjusted for sociodemographic factors. "Green organic food eaters" had the highest mean score for the "health" dimension, while "unhealthy conventional food big eaters" obtained the lowest mean score for the "absence of contaminants" dimension. "Standard organic food small eaters", "green organic food eaters" and "hedonist moderate organic food eaters" had comparable scores for the "taste" dimension. "Unhealthy conventional food big eaters" had the highest mean score for the "price" dimension while "green organic food eaters" had the lowest mean scores for the "innovation" and "convenience" dimensions. These results provide new insights into the food choice motives of diverse consumers' profiles including "green" and "hedonist" eaters.
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Association between Motives for Dish Choices during Home Meal Preparation and Weight Status in the NutriNet-Santé Study.
Ducrot, P, Fassier, P, Méjean, C, Allès, B, Hercberg, S, Péneau, S
Nutrients. 2016;(7)
Abstract
Although home cooking has been associated with a lower body mass index in a few studies, no data exists on the motives behind food dish choices during home meal preparation and on their association with overweight. This study aimed to evaluate this association in 50,003 participants from the NutriNet-Santé cohort. Dimensions underlying the importance of 27 criteria possibly influencing dish choices were determined using an exploratory factor analysis. The association between dish choice motives and overweight (including obesity) was estimated using logistic regression models adjusted for sociodemographic and lifestyle characteristics. Five dimensions of dishes choice motives emerged: healthy diet (e.g., "nutritional balance of the dish"), constraints (e.g., "my cooking skills"), pleasure (e.g., "originality of the dish"), specific diets (e.g., "my health status"), and organization (e.g., "what I planned to eat"). A negative association was observed between the healthy diet factor and being overweight (OR = 0.65 (95% CI (confidence interval): 0.62-0.67)), whereas a positive association appeared for factors regarding pleasure (OR = 1.14 (95% CI: 1.10-1.19)) and specific diets (OR = 1.19 (95% CI: 1.17-1.22)). No significant associations were observed for constraints and organization. The significant associations between dish choice motives and overweight suggested the interest of focusing on these motives in order to promote healthier food choices during home cooking.
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Associations between liking for fat, sweet or salt and obesity risk in French adults: a prospective cohort study.
Lampuré, A, Castetbon, K, Deglaire, A, Schlich, P, Péneau, S, Hercberg, S, Méjean, C
The international journal of behavioral nutrition and physical activity. 2016;:74
Abstract
BACKGROUND Individual sensory liking appears to be an important determinant of dietary intake and may consequently influence weight status. Cross-sectional studies have shown positive association between fat liking and weight status and equivocal results regarding salt and sweet liking. Moreover, the contribution of dietary intake to explain this relationship has not been studied yet. We investigated the prospective association between sensory liking for fat, sweet or salt and the onset of obesity over 5 years in adults, and the mediating effect of dietary intake. METHODS We prospectively examine the risk of obesity among 24,776 French adults participating in the NutriNet-Santé cohort study. Liking scores and dietary data were assessed at baseline using a validated web-based questionnaire and 24 h records, respectively. Self-reported anthropometric data were collected using web-based questionnaire, each year during 5 years. Associations between quartiles of liking for fat, sweet or salt and obesity risk, and the mediating effect of diet were assessed by multivariate Cox proportional hazards models stratified by gender, adjusted for sociodemographic and lifestyle factors. RESULTS In both genders, sensory liking for fat was associated with an increased risk of obesity (hazard ratios for quartile 4 compared to quartile 1, men: HR(Q4vs.Q1) = 2.39 (95% CI 1.39,4.11) P-trend = 0.0005, women: HR(Q4vs.Q1) = 2.02 (1.51,2.71) P-trend = <0.0001). Dietary intake explained 32% in men and 52% in women of the overall variation of liking for fat in obesity. Sensory liking for sweet was associated with a decreased risk of obesity (men: HR(Q4vs.Q1) = 0.51 (0.31,0.83) P-trend = 0.01, women: HR(Q4vs.Q1) = 0.72 (0.54,0.96) P-trend = 0.035). No significant association between salt liking and the risk of obesity was found. CONCLUSIONS Unlike sweet and salt liking, higher liking for fat appears to be a major risk factor of obesity, largely explained by dietary intake. Our findings emphasize the need to centrally position sensory liking in obesity prevention.
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Association between Mindfulness and Weight Status in a General Population from the NutriNet-Santé Study.
Camilleri, GM, Méjean, C, Bellisle, F, Hercberg, S, Péneau, S
PloS one. 2015;(6):e0127447
Abstract
BACKGROUND Mindfulness is defined as non-judgmental awareness of the present moment. There is some evidence of the efficacy of mindfulness-based interventions in weight loss. However, this psychological concept has only been rarely explored in observational studies, and no study to date has examined the association between dispositional mindfulness and weight status in a large population-based sample. OBJECTIVE We aimed to examine the relationship between mindfulness scores and weight status in a large sample of the adult general population in France. DESIGN AND METHODS A total of 14,400 men and 49,228 women aged ≥18 y participating in the NutriNet-Santé study were included in this cross-sectional analysis. We collected mindfulness data using the Five Facet Mindfulness Questionnaire as well as self-reported weight and height. The association between weight status and dispositional mindfulness, as well as its subscales (observing, describing, acting with awareness, non-judging and non-reactivity), was assessed using multinomial logistic regression models adjusted for socio-demographic and lifestyle factors. RESULTS Women with higher dispositional mindfulness scores were less likely to be overweight (excluding obesity) (OR quartile 4 vs. 1 = 0.84, 95% CI: 0.79-0.90) and obese (OR quartile 4 vs. 1 = 0.71, 95% CI: 0.65-0.78). In addition, overall, in this group, all subscales were inversely associated with weight status, with the strongest association found for the "observing" subscale. In men, higher mindfulness was associated only with lower odds of obesity (OR quartile 4 vs. 1 = 0.81 (0.69, 0.96)), and only the "observing" and "non-reactivity" subscales were significantly inversely associated with weight status. CONCLUSION Results support the interest of a shift in perspective that takes into account positive psychological and cognitive factors such as dispositional mindfulness in the investigation of obesity and its associated factors.
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The Nutrient Profile of Foods Consumed Using the British Food Standards Agency Nutrient Profiling System Is Associated with Metabolic Syndrome in the SU.VI.MAX Cohort.
Julia, C, Fézeu, LK, Ducrot, P, Méjean, C, Péneau, S, Touvier, M, Hercberg, S, Kesse-Guyot, E
The Journal of nutrition. 2015;(10):2355-61
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BACKGROUND Metabolic syndrome (MetS), comprising high waist circumference, blood pressure, glycemia, and triglycerides, and lower HDL cholesterol could in part be prevented by adequate nutrition. Nutrient profiling systems could be useful public health tools to help consumers make healthier food choices. An individual dietary index (DI) based on nutrient profiling of foods consumed could characterize dietary patterns in relation to the onset of MetS. OBJECTIVE The objective of this study was to prospectively investigate the association between the Food Standards Agency (FSA) Nutrient Profiling System (NPS) DI and the onset of MetS in a middle-aged French cohort. METHODS Participants from the SUpplémentation en VItamines et Minéraux AntioXydants cohort (SU.VI.MAX, n = 3741) were included in the present study. The FSA NPS DI was computed by using dietary data from 24 h records at inclusion. MetS was identified at baseline and at year 13 of follow-up with the use of self-reported medication, data from clinical investigations, and biological measurements. A prospective association between the FSA NPS DI (in quartiles and continuous) and the onset of MetS was investigated by using logistic regression. RESULTS Poorer diets identified with the use of the FSA NPS DI were significantly associated with a higher risk of developing MetS (OR for poorer vs. healthier FSA NPS DI 1.43; 95% CI: 1.08, 1.89; P-trend across quartiles = 0.02). The FSA NPS DI was significantly associated with the systolic blood pressure (SBP) and diastolic blood pressure (DBP) components of MetS (difference between healthier vs. poorer FSA NPS DI 2.16 mm Hg for SBP and 1.5 mm Hg for DBP, P-trend across quartiles = 0.02). CONCLUSION The FSA NPS DI was prospectively associated with the onset of MetS in a middle-aged French population. The application of NPSs in public health initiatives may help the population make healthier food choices, which might reduce the risk of developing MetS.
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Liking for fat is associated with sociodemographic, psychological, lifestyle and health characteristics.
Lampuré, A, Deglaire, A, Schlich, P, Castetbon, K, Péneau, S, Hercberg, S, Méjean, C
The British journal of nutrition. 2014;(8):1353-63
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Sensory liking influences dietary behaviour, but little is known about specifically associated individual profiles. The aim of the present study was to investigate the associations between liking for fat-and-salt and fat-and-sweet sensations and sociodemographic, economic, psychological, lifestyle and health characteristics in a large sample. Individual characteristics and liking scores were collected by a questionnaire among 37,181 French adults. Liking scores were constructed using a validated preference questionnaire. Multinomial logistic regression models were used to assess the associations between liking levels and individual characteristics. In both sexes, subjects belonging to low-level occupational categories (OR 1·39, 95% CI 1·16, 1·67 in men; OR 1·28, 95% CI 1·16, 1·41 in women), highly uncontrolled eaters (men: OR 2·90, 95% CI 2·60, 3·23; women: OR 2·73, 95% CI 2·27, 3·30) and obese subjects (men: OR 1·45, 95% CI 1·14, 1·84; women: OR 1·47, 95% CI 1·29, 1·68) were more likely to have a strong liking for the fat-and-sweet sensation, whereas older individuals (men: OR 0·13, 95% CI 0·10, 0·16; women: OR 0·11, 95% CI 0·09, 0·14) and highly cognitive restrainers (men: OR 0·52, 95% CI 0·44, 0·63; women: OR 0·60, 95% CI 0·55, 0·66) were less likely to have a strong liking. Regarding liking for the fat-and-salt sensation, the same associations were found and specific relationships were also highlighted: current smokers and heavy drinkers were more likely to strongly prefer the fat-and-salt sensation compared with non-smokers and abstainers or irregular alcohol consumers. The relationship between individual characteristics and a liking for fat sensation provides new and original information that may be useful for a better understanding of the associations between sensory liking and individual behaviour.