Mytton, Oliver T, Forouhi, Nita G, Scarborough, Peter, Lentjes, Marleen, Luben, Robert, Rayner, Mike, Khaw, Kay Tee, Wareham, Nicholas J, Monsivais, Pablo, Mytton, Oliver T [0000-0003-3218-9912], Forouhi, Nita G [0000-0002-5041-248X], Luben, Robert [0000-0002-5088-6343], Rayner, Mike [0000-0003-0479-6483], Wareham, Nicholas J [0000-0003-1422-2993], Monsivais, Pablo [0000-0002-7088-6674], and Apollo - University of Cambridge Repository
Background In the United Kingdom, the Food Standards Agency-Ofcom nutrient profiling model (FSA-Ofcom model) is used to define less-healthy foods that cannot be advertised to children. However, there has been limited investigation of whether less-healthy foods defined by this model are associated with prospective health outcomes. The objective of this study was to test whether consumption of less-healthy food as defined by the FSA-Ofcom model is associated with cardiovascular disease (CVD). Methods and findings We used data from the European Prospective Investigation of Cancer (EPIC)-Norfolk cohort study in adults (n = 25,639) aged 40–79 years who completed a 7-day diet diary between 1993 and 1997. Incident CVD (primary outcome), cardiovascular mortality, and all-cause mortality (secondary outcomes) were identified using record linkage to hospital admissions data and death certificates up to 31 March 2015. Each food and beverage item reported was coded and given a continuous score, using the FSA-Ofcom model, based on the consumption of energy; saturated fat; total sugar; sodium; nonsoluble fibre; protein; and fruits, vegetables, and nuts. Items were classified as less-healthy using Ofcom regulation thresholds. We used Cox proportional hazards regression to test for an association between consumption of less-healthy food and incident CVD. Sensitivity analyses explored whether the results differed based on the definition of the exposure. Analyses were adjusted for age, sex, behavioural risk factors, clinical risk factors, and socioeconomic status. Participants were followed up for a mean of 16.4 years. During follow-up, there were 4,965 incident cases of CVD (1,524 fatal within 30 days). In the unadjusted analyses, we observed an association between consumption of less-healthy food and incident CVD (test for linear trend over quintile groups, p < 0.01). After adjustment for covariates (sociodemographic, behavioural, and indices of cardiovascular risk), we found no association between consumption of less-healthy food and incident CVD (p = 0.84) or cardiovascular mortality (p = 0.90), but there was an association between consumption of less-healthy food and all-cause mortality (test for linear trend, p = 0.006; quintile group 5, highest consumption of less-healthy food, versus quintile group 1, HR = 1.11, 95% CI 1.02–1.20). Sensitivity analyses produced similar results. The study is observational and relies on self-report of dietary consumption. Despite adjustment for known and reported confounders, residual confounding is possible. Conclusions After adjustment for potential confounding factors, no significant association between consumption of less-healthy food (as classified by the FSA-Ofcom model) and CVD was observed in this study. This suggests, in the UK setting, that the FSA-Ofcom model is not consistently discriminating among foods with respect to their association with CVD. More studies are needed to understand better the relationship between consumption of less-healthy food, defined by the FSA-Ofcom model, and indices of health., Using data from the EPIC-Norfolk cohort study, Oliver Mytton and colleagues examine the association between intake of less healthy foods defined by the UK's nutrient profile model and cardiovascular disease., Author summary Why was this study done? The Food Standards Agency (FSA)-Ofcom model is used in the UK to identify ‘less-healthy’ foods in order to restrict their advertising to children. Variants of the FSA-Ofcom model, as well as other nutrient profiling models, are increasingly being used to regulate food retailing or marketing for the purposes of improving health; yet, very few of these models have been validated. The FSA-Ofcom model has been shown to classify foods in a way that is consistent with professional opinion, but there has been limited assessment of its association with health outcomes. What did the researchers do and find? We used the European Prospective Investigation of Cancer (EPIC)-Norfolk study to test the prospective association of less-healthy food consumption with incident cardiovascular disease, cardiovascular mortality, and all-cause mortality. Each item of food or drink reported in a participant’s 7-day diet diary was given a score based on its nutrient composition and then categorised as either ‘less-healthy’ or ‘healthy’. Participants (n = 22,292) were allocated to 1 of 5 groups based on their consumption of less-healthy food (as a proportion of total dietary energy). After adjustment for confounding factors, we found no association between consumption of less-healthy food and incident cardiovascular disease (n = 4,965) or cardiovascular mortality (n = 2,555) The findings were robust to a variety of sensitivity analyses, including adjustment for exclusion based on different cardiovascular risk factors. What do these findings mean? Whilst no single study is definitive and our findings are in contrast to similar work in a French cohort, these findings suggest that the FSA-Ofcom model is not consistently discriminating among foods with respect to their associations with cardiovascular disease in the UK context. Public health officials and scientists may want to review whether and how the FSA-Ofcom scoring system could be improved for use in the UK and elsewhere. There is a robust evidence base concerning the health risks associated with the consumption of many foods that are often labelled ‘unhealthy’ (e.g., red meat, sugar-sweetened beverages, and takeaway food), and it would be inappropriate to use this study to undermine present dietary advice for the public.