by Jenna Koroly, MS, RD, CSOWM, CDN
Food labels can be overwhelming, as they contain nutrition facts, ingredients, numbers in grams and numbers in percentages. Knowing exactly what to look for, paired with both regulated and unregulated front of the package health claims, may make finding the most nutritious options unclear to many. The following study presents a front of the package labeling system developed in Europe in order to make choosing foods with high nutritional content easier for the consumer. With the New Year upon us, many will set resolutions involving becoming more health conscious, and understanding what our food is made of is a big step in the right direction.
Nutritional Quality of Food as Represented by the FSAm-NPS Nutrient Profiling System Underlying the Nutri-Score Label and Cancer Risk in Europe: Results from the EPIC Prospective Cohort Study
Journal: PLoS Medicine
This prospective cohort study included over 470,000 individuals from the European Prospective Investigation into Cancer and Nutrition (EPIC). Participants were from 10 European countries: Denmark, France, Germany, Greece, Italy, the Netherlands, Norway, Spain, Sweden, and the UK. The authors studied the relationship between Food Standards Agency Nutrient Profiling System, modified version (FSAm-NPS) scores and cancer risk.
The Nutri-Score is a food labeling system based on the FSAm-NPS to categorize products into five different colors depending on nutritional quality. The FSA-NPS (original) assigns scores to food products based on energy, sugar, saturated fat, sodium, fiber, protein, and fruits/vegetables/legumes/nuts, while the FSAm-NPS (modified) also adapts point allocation based on beverages, cheese, and added fats consumed.
FSAm-NPS scores were calculated for each food, food frequency questionnaires (FFQs) were administered, and an FSAm-NPS Dietary Index (FSAm-NPS DI) score was calculated for each participant, with higher scores reflecting lower nutritional quality.
The authors found:
1. Those with higher FSAm-NPS DI scores were consistently more likely to have unhealthy dietary intakes (higher intakes of alcohol, energy, and red and processed meat; lower intakes of fiber, vegetables, fruit, fish, and lean meat).
2. Participants from Greece, Italy, Spain, Norway, and the UK (Oxford center, including a high proportion of vegetarians) were more likely to have lower scores; Denmark and the Netherlands were more likely to have middle-range scores; and France, Germany, UK (Cambridge center), and Sweden were more likely to have higher scores.
3. A higher FSAm-NPS DI score was associated with a higher risk of total cancer (colorectal, upper digestive tract and stomach, lung for men, and liver and postmenopausal breast for women).
4. A borderline significant association was observed for kidney cancer and prostate cancers, and no association was observed for bladder, pancreatic, endometrial, uterine, or ovarian cancer.
For the Patient and Caregiver
The Nutri-Score system began being implemented as the official nutrition label on the front of food products in France in 2017, although it is optional and thus is used by voluntary uptake by food manufacturers. It is color-coded and assigns the food product a letter A through E depending on its nutritional quality based on the FSAm-NPS score. Without a standardized system such as this, which we do not have in the United States, it is crucial for patients and caregivers to read the food labels on the back of products, focusing on specific nutrients, such as sugar, fiber, and protein. If the foods don’t have labels (as most whole foods do not), make use of online databases, such as The USDA’s Food Composition Database. Working with a Registered Dietitian will guide you on what to look for on the nutrition label, and individualize these recommendations based on your past medical history.
For the Healthcare Team
Discussing what to look for on food labels with patients and caregivers provides individuals with tools they can carry with them and use to guide their own food product choices. Educate patients in this way to empower them about making their own food choices as they will know what to look for in the grocery store, at restaurants, and in their own kitchen cabinets. Becoming aware of nutrition policy proposals in the United States and advocating for clearer front of the package food labeling ground in evidence-based nutrition research can help direct individuals to products associated with lower risk of certain chronic diseases. This can provide clearer guidance for specific patient populations as they choose products, including cancer, cardiovascular disease, and diabetes.
[i] Deschasaux M, Huybrechts I, Murphy N, Julia C, Hercberg S, Srour B, et al. (2018) Nutritional quality of food as represented by the FSAmNPS nutrient profiling system underlying the NutriScore label and cancer risk in Europe: Results from the EPIC prospective cohort study. PLoS Med 15(9): e1002651. https://doi.org/10.1371/journal.pmed.1002651