The British Journal of Medicine (BMJ) publishes an Italian scientific study (Bonaccio et al., 2022) where the effectiveness of the NutriScore system to distinguish nutritionally imbalanced foods on the label is confirmed. (1)
Consumption of the foods thus identified-more so than that of ultra-processed foods-is correlated with a higher prevalence of premature mortality. Based on data collected from 22,285 thousand adults in Italy in the Moli-Sani cohort study.
1) Moli-sani, the large cohort study.
Moli-sani is a major cohort study conducted by the Neuromed Mediterranean Neurological Institute-an Institute for Hospitalization and Treatment of Scientific Character (IRCCS) based in Pozzilli (Isernia, Molise)-during 2005-2010.
The objective of this study is to identify risk factors (environmental, genetic, biomolecular) of chronic degenerative diseases. Cancer and cardiovascular disease, hypertension, diabetes, dyslipidemia, obesity, and metabolic syndrome. (2)
2) Correlation between ultra-processed foods and premature mortality.
A previous study (Bonaccio et al., 2021) as part of Moli-Sani identified a correlation between the consumption of ultra-processed foods-identified through the NOVA 4 system-and the risk of premature mortality.
Researchers have shown:
- an inverse association between the level of adherence to the Mediterranean diet and the consumption of these foods, predominantly HFSS(High In Fats, Sugar and Sodium),
- the correlation between the consumption of ultra-processed foods and the occurrence of NCDs(Non-Communicable Diseases) such as stroke and cardiovascular disease. (3)
3) Correlations between foods with poor nutritional profiles and premature mortality.
New scientific research (Bonaccio et al., 2022), again based on the Moli-sani cohort study, identifies correlations between:
- The consumption of ultra-processed foods, identified with the NOVA 4 system,
- Intakes of foods with poor nutritional profiles, identified through the NutriScore system, and
- premature mortality, both from cardiovascular diseases and events and from all causes.
3.1) Method
The food consumption of the study participants was processed on the basis of responses to the Food Frequency Questionnaires (FFQs), selected for absence of outliers (data deficiency or implausibility). They were calculated as follows:
- daily intakes of ultra-processed foods (NOVA 4), as well as their share of total daily food and beverage consumption,
- nutritional profiles of these foods, according to the criteria adopted in the Nutri-Score system (FSAm-NPS. Food Standards Agency Nutrient Profiling System).
3.2) Nutritional profiles
Nutritional profiles of foods, as developed and updated over the years, are based on scoring the following factors:
- nutrients and matrices to be favored (C). 0-15 points are related to both dietary fiber and protein contents and the percentages of fruits, vegetables, legumes, and nuts in foods,
- Energy value and nutrients to keep track of (A). 0-40 points go to total sugars, saturated fat, sodium and calories (kcal).
A food’s overall score is obtained by subtracting the sum of the matrices and nutrients to be favored (C) from the sum of the nutrients and calories to be controlled (A). It can range from -15 (most balanced food) to +40 (unbalanced nutritional profile). Based on this NutriScore score, NutriScore ranks foods in five categories, A through E, with a color grading from green to orange.
3.3) Results
The first major aspect in the findings of this study concerns the inverse relationship between the level of adherence to the Mediterranean diet and the consumption of both ultra-processed foods and foods with poor nutritional profiles. That is, NutriScore system favors, rather than penalizes, the foods on which the Mediterranean diet is based. Which in turn is associated with longevity and well-being, as noted. (4)
NutriScore (i.e., the food nutrition profiling system on which it is based, FSAm-NPS) was found to be more effective than NOVA 4 in identifying foods related to cardiovascular disease mortality. However, both systems were found to be useful in distinguishing foods with markers associated with all-cause mortality, and mortality from cardiovascular disease. (5)
4) Interim Conclusions
The introduction of a mandatory Front-of-Pack Nutrition Labeling (FOPNL) system meets a need for public health protection.
The NutriScore system is now the only one that can provide concrete and useful information to improve the diets of European populations, to improve their quality of life.
We all insist, including through the petition, that the Swedish presidency of the EU Council urge the Commission to immediately propose mandatory application of NutriScore on every food label in the EU.
Dario Dongo and Andrea Adelmo Della Penna
Notes
(1) Marialaura Bonaccio, Augusto Di Castelnuovo, Emilia Ruggiero, Simona Costanzo, Giuseppe Grosso, Amalia De Curtis, Chiara Cerletti, Maria Benedetta Donati, Giovanni de Gaetano, Licia Iacoviello (2022). Joint association of food nutritional profile by Nutri-Score front-of-pack label and ultra-processed food intake with mortality: Moli-sani prospective cohort study. BMJ 378:e070688, https://doi.org/10.1136/bmj-2022-070688
(2) A description of the Moli-sani cohort study can be found on the website dedicated to it https://www.moli-sani.org/
(3) See Dario Dongo, Andrea Adelmo Della Penna. Ultraprocessed food, disease and premature mortality. Study in Italy. FT (Food Times). 11.12.21
(4) Marta Strinati. Mediterranean diet, first long-term preclinical study. FT (Food Times). 26.4.19
(5) The food consumption of the participants in the study under review (see note 1) is characterized by an average intake of the ultra-processed foods on the diet of 10.8 percent in quantity, 18.3 percent in energy intake (calories). With an average score of 7.4.
Dario Dongo, lawyer and journalist, PhD in international food law, founder of WIISE (FARE - GIFT - Food Times) and Égalité.
Graduated in Food Technologies and Biotechnologies, qualified food technologist, he follows the research and development area. With particular regard to European research projects (in Horizon 2020, PRIMA) where the FARE division of WIISE Srl, a benefit company, participates.
