Association between intake of less-healthy foods defined by the United Kingdom's nutrient profile model and cardiovascular disease: A population-based cohort study

• Published in: PLoS medicine 2018-01, Vol.15 (1), p.e1002484-e1002484
• Main Authors: Mytton, Oliver T, Forouhi, Nita G, Scarborough, Peter, Lentjes, Marleen, Luben, Robert, Rayner, Mike, Khaw, Kay Tee, Wareham, Nicholas J, Monsivais, Pablo
• Format: Article
• Language: English
• Subjects: Adult; Aged; Beverages; Biology and Life Sciences; Cancer; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - etiology; Cardiovascular Diseases - mortality; Care and treatment; Children; Cohort analysis; Development and progression; Diabetes; Diet; Diet, Healthy - statistics & numerical data; Disease prevention; Eating; Epidemiology; Female; Food; Food consumption; Food intake; Fruits; Funding; Health aspects; Health care; Health risk assessment; Health risks; Humans; Incidence; Laboratories; Male; Medicine and Health Sciences; Middle Aged; Mortality; Nutrients; Nutrition research; Population; Population studies; Population-based studies; Prevalence; Primary care; Proportional Hazards Models; Prospective Studies; Public health; Risk Factors; Sensitivity; Socioeconomics; Sodium; Studies; Sugar; Systematic review; United Kingdom - epidemiology; Vegetables
• ISSN: 1549-1676; 1549-1277; 1549-1676
• DOI: 10.1371/journal.pmed.1002484

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). 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 conf