Prospective association between a dietary quality index based on a nutrient profiling system and cardiovascular disease risk

Background Public health strategies are essential to guide consumers' choices and produce a substantial population impact on cardiovascular disease risk prevention through nutrition. Our aim was to investigate the prospective association between the Food Standards Agency nutrient profiling system dietary index (FSA-NPS DI) and cardiovascular disease risk. The FSA-NPS has been proposed to serve as a basis for a five-colour nutrition label suggested in France to be put on the front of pack of food products. Methods and results A total of 6515 participants to the SU.VI.MAX cohort (1994-2007), who completed at least six 24-hour dietary records during the first two years of the study, were followed for a median of 12.4 years (25th-75th percentiles: 11.0-12.6). Multivariable Cox proportional hazards models were used to characterise the associations between FSA-NPS DI (continuous and sex-specific quartiles) and the incidence of cardiovascular diseases. Interactions with individual characteristics were tested; 181 major cardiovascular events were reported (59 myocardial infarctions, 43 strokes, 79 anginas). A higher FSA-NPS DI, characterising poorer food choices, was associated with an overall increase in cardiovascular disease risk (HRfor a 1-point increment=1.14 (1.03-1.27); HRQ4vs.Q1=1.61 (1.05-2.47), Ptrend Q4-Q1=0.03). This association tended to be stronger in smokers (HRfor a 1-point increment=1.39 (1.11-1.73); P-interaction=0.01) and those less physically active (HRfor a 1-point increment=1.26 (1.08-1.46); P-interaction=0.04). Conclusions Our results suggest that poorer food choices, as reflected by a higher FSA-NPS DI, may be associated with a significant increase in cardiovascular risk, especially in at-risk individuals (smokers and physically inactive persons). This score could be a useful tool for public health prevention strategies. Clinical trial registration ClinicalTrials.gov identifier: NCT00272428.