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Emily Sonestedt

Emily Sonestedt

Associate senior lecturer

Emily Sonestedt

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


  • Mélanie Deschasaux
  • Inge Huybrechts
  • Neil Murphy
  • Chantal Julia
  • Serge Hercberg
  • Bernard Srour
  • Emmanuelle Kesse-Guyot
  • Paule Latino-Martel
  • Carine Biessy
  • Corinne Casagrande
  • Mazda Jenab
  • Heather Ward
  • Elisabete Weiderpass
  • Christina C. Dahm
  • Kim Overvad
  • Cecilie Kyrø
  • Anja Olsen
  • Aurélie Affret
  • Marie Christine Boutron-Ruault
  • Yahya Mahamat-Saleh
  • Rudolf Kaaks
  • Tilman Kühn
  • Heiner Boeing
  • Lukas Schwingshackl
  • Christina Bamia
  • Eleni Peppa
  • Antonia Trichopoulou
  • Giovanna Masala
  • Vittorio Krogh
  • Salvatore Panico
  • Rosario Tumino
  • Carlotta Sacerdote
  • Bas Bueno-de-Mesquita
  • Petra H. Peeters
  • Anette Hjartåker
  • Charlotta Rylander
  • Guri Skeie
  • J. Ramón Quirós
  • Paula Jakszyn
  • Elena Salamanca-Fernández
  • José María Huerta
  • Eva Ardanaz
  • Pilar Amiano
  • Ulrika Ericson
  • Emily Sonestedt
  • Ena Huseinovic
  • Ingegerd Johansson
  • Kay Tee Khaw
  • Nick Wareham
  • Kathryn E. Bradbury
  • Aurora Perez-Cornago
  • Konstantinos K. Tsilidis
  • Pietro Ferrari
  • Elio Riboli
  • Marc J. Gunter
  • Mathilde Touvier

Summary, in English

Background: Helping consumers make healthier food choices is a key issue for the prevention of cancer and other diseases. In many countries, political authorities are considering the implementation of a simplified labelling system to reflect the nutritional quality of food products. The Nutri-Score, a five-colour nutrition label, is derived from the Nutrient Profiling System of the British Food Standards Agency (modified version) (FSAm-NPS). How the consumption of foods with high/low FSAm-NPS relates to cancer risk has been studied in national/regional cohorts but has not been characterized in diverse European populations. Methods and findings: This prospective analysis included 471,495 adults from the European Prospective Investigation into Cancer and Nutrition (EPIC, 1992–2014, median follow-up: 15.3 y), among whom there were 49,794 incident cancer cases (main locations: breast, n = 12,063; prostate, n = 6,745; colon-rectum, n = 5,806). Usual food intakes were assessed with standardized country-specific diet assessment methods. The FSAm-NPS was calculated for each food/beverage using their 100-g content in energy, sugar, saturated fatty acid, sodium, fibres, proteins, and fruits/vegetables/legumes/nuts. The FSAm-NPS scores of all food items usually consumed by a participant were averaged to obtain the individual FSAm-NPS Dietary Index (DI) scores. Multi-adjusted Cox proportional hazards models were computed. A higher FSAm-NPS DI score, reflecting a lower nutritional quality of the food consumed, was associated with a higher risk of total cancer (HRQ5 versus Q1 = 1.07; 95% CI 1.03–1.10, P-trend < 0.001). Absolute cancer rates in those with high and low (quintiles 5 and 1) FSAm-NPS DI scores were 81.4 and 69.5 cases/10,000 person-years, respectively. Higher FSAm-NPS DI scores were specifically associated with higher risks of cancers of the colon-rectum, upper aerodigestive tract and stomach, lung for men, and liver and postmenopausal breast for women (all P < 0.05). The main study limitation is that it was based on an observational cohort using self-reported dietary data obtained through a single baseline food frequency questionnaire; thus, exposure misclassification and residual confounding cannot be ruled out. Conclusions: In this large multinational European cohort, the consumption of food products with a higher FSAm-NPS score (lower nutritional quality) was associated with a higher risk of cancer. This supports the relevance of the FSAm-NPS as underlying nutrient profiling system for front-of-pack nutrition labels, as well as for other public health nutritional measures.


  • Diabetes - Cardiovascular Disease
  • EpiHealth: Epidemiology for Health
  • EXODIAB: Excellence of Diabetes Research in Sweden
  • Nutrition Epidemiology

Publishing year





PLoS Medicine





Document type

Journal article


Public Library of Science (PLoS)


  • Cancer and Oncology
  • Nutrition and Dietetics
  • Public Health, Global Health, Social Medicine and Epidemiology



Research group

  • Diabetes - Cardiovascular Disease
  • Nutrition Epidemiology


  • ISSN: 1549-1676