Original and revised Nutri-Score adherence and the association with CVD risk in the EPIC-NL cohort

Abstract

Introduction: The Nutri-Score label did not fully comply with dietary guidelines, so the Nutri-Score algorithm got revised in 2023. The effects of the revised Nutri-Score on cardiovascular disease (CVD) risk are not yet established. Consequently the use of the revised Nutri-Score would be justified if the association with CVD risk is greater than its association with the original Nutri-Score.

Aim: Our objective was to study the association of original and revised Nutri-Score adherence with CVD risk, coronary heart disease (CHD) risk, and stroke risk. Additionally, the difference in risk association between original and revised Nutri-Score adherence was investigated.

Method: This population-based prospective cohort study included 36,612 EPIC-NL participants. At recruitment, a baseline questionnaire and a Food Frequency Questionnaire (FFQ) were administered. For each food and beverage item in the FFQ, both the original and revised Nutri-Score were calculated (FSAm-NPS score, ranging -15 to +40). Then, original as well as revised Nutri-Score adherence were calculated on individual level (FSAm-NPS DI-score). Cox regression analyses were performed, adjusted for potential confounders.

Results: During a median survival time of 15.0 years, 4,401 first CVD events occurred (incl. 2,452 first CHD events and 886 first stroke events). Overall, no associations were found between FSAm-NPS DI-score of the original Nutri-Score and risks for CVD (HR for a 1-point lower DI-score =1.00 (95% CI 0.99–1.02)), CHD (HR for a 1-point lower score=1.01 (0.98-1.03)), and stroke (HR for a 1-point lower score =1.00 (0.96–1.04)). Similar results were found for the revised Nutri-Score. However, for the original Nutri-Score a significant increased risk was found for CHD in overweight and obese participants (HR for a 1-point lower score =1.04 (1.01-1.07)). This was similar for the revised Nutri-Score, with an additional significant increased risk for CVD in overweight and obese participants (HR for a 1-point lower score =1.02 (1.00-1.05)).

Conclusion: In this Dutch cohort study, lower FSAm-NPS DI-scores were not associated with lower risks for overall CVD, CHD, and stroke. However, our results suggest that overweight and obese individuals might have an increased risk for CVD and CHD by consuming food products with better Nutri-Scores. Yet, no large differences can be seen between the original and revised Nutri-Score.