To compare the initial and the updated versions of the front-of-pack label Nutri-Score (related to the nutritional content) with the NOVA classification (related to the degree of food processing) at the food level.

Using the OpenFoodFacts database – 129,950 food products – we assessed the complementarity between the Nutri-Score (initial and updated) with the NOVA classification through a correspondence analysis. Contingency tables between the two classification systems were used.

The food offer in France.

Not applicable.

With both versions (i.e. initial and updated) of the Nutri-Score, the majority of ultra-processed products received medium to poor Nutri-Score ratings (between 77·9 % and 87·5 % of ultra-processed products depending on the version of the algorithm). Overall, the update of the Nutri-Score algorithm led to a reduction in the number of products rated A and B and an increase in the number of products rated D or E for all NOVA categories, with unprocessed foods being the least impacted (–3·8 percentage points (–5·2 %) rated A or B and +1·3 percentage points (+12·9 %) rated D or E) and ultra-processed foods the most impacted (–9·8 percentage points (–43·4 %) rated A or B and +7·8 percentage points (+14·1 %) rated D or E). Among ultra-processed foods rated favourably with the initial Nutri-Score, artificially sweetened beverages, sweetened plant-based drinks and bread products were the most penalised categories by the revision of Nutri-Score while low-sugar flavoured waters, fruit and legume preparations were the least affected.

These results indicate that the update of the Nutri-Score reinforces its coherence with the NOVA classification, even though both systems measure two distinct health dimensions at the food level.

Identifying youths most at risk to COVID-19-related mental illness is essential for the development of effective targeted interventions.

To compare trajectories of mental health throughout the pandemic in youth with and without prior mental illness and identify those most at risk of COVID-19-related mental illness.

Data were collected from individuals aged 18–26 years (N = 669) from two existing cohorts: IMAGEN, a population-based cohort; and ESTRA/STRATIFY, clinical cohorts of individuals with pre-existing diagnoses of mental disorders. Repeated COVID-19 surveys and standardised mental health assessments were used to compare trajectories of mental health symptoms from before the pandemic through to the second lockdown.

Mental health trajectories differed significantly between cohorts. In the population cohort, depression and eating disorder symptoms increased by 33.9% (95% CI 31.78–36.57) and 15.6% (95% CI 15.39–15.68) during the pandemic, respectively. By contrast, these remained high over time in the clinical cohort. Conversely, trajectories of alcohol misuse were similar in both cohorts, decreasing continuously (a 15.2% decrease) during the pandemic. Pre-pandemic symptom severity predicted the observed mental health trajectories in the population cohort. Surprisingly, being relatively healthy predicted increases in depression and eating disorder symptoms and in body mass index. By contrast, those initially at higher risk for depression or eating disorders reported a lasting decrease.

Healthier young people may be at greater risk of developing depressive or eating disorder symptoms during the COVID-19 pandemic. Targeted mental health interventions considering prior diagnostic risk may be warranted to help young people cope with the challenges of psychosocial stress and reduce the associated healthcare burden.

To assess in 2021 the acceptance and perception of the French tax on sweetened beverages, following its revision in 2018, and factors associated with a higher level of acceptance.

A cross-sectional survey within the NutriNet-Santé cohort study. Participants were invited to complete a self-reported questionnaire in March 2021. Weighting was applied to the sample to allow inferences on the French population. Individual characteristics associated with support for the tax were investigated using logistic regression modelling.

NutriNet-Santé prospective cohort study.

Adults engaged in the NutriNet-Santé cohort, aged 18 years or older (n 28 344), living in mainland France.

Almost two-thirds (63·4 %) of the participants were aware of the existence of a tax on sweetened beverages, although less than a quarter had specific knowledge regarding its design and the 2018 revision. In turn, 64·7 % of participants expressed a favourable opinion towards the taxation scheme. This proportion was higher if tax revenues were used to finance health-related measures (respectively 68·8 % of favourable opinion if used to finance a reduction in prices of healthy products and 76·4 % if used to finance the healthcare system). Multivariable analyses showed that support towards the tax varied among subgroups of the population. Groups who tended to be less financially affected by the measure and those who perceived sugar-sweetened beverages as having detrimental effects were more likely to support the tax.

The revised French sugar-sweetened beverage tax appeared to be favourably received and perceived by the public.

To investigate clustering of risk behaviours in adolescents with excess weight.

Cross-sectional analysis of baseline data from the PRALIMAP-INÈS trial. Information on food frequency consumption (fruit, vegetables, sugary products and beverages), physical activity, sedentary behaviour (week and weekend days), smoking and alcohol consumption (current frequency and intoxication episodes) and socio-demographic data was collected using self-reported questionnaires. Behavioural risk factors were entered as categorical variables in a two-step clustering procedure: multiple correspondence analysis followed by hierarchical clustering. Associations between cluster membership and socio-demographic variables were investigated using multivariable multinomial logistic regression.

French PRALIMAP-INÈS trial.

Adolescents with excess weight.

A total of 1391 participants (13–18 years old, 58·2 % female) were included in the analysis, which resulted in the identification of four groups of participants, including, respectively, 543 (39·0 %), 373 (26·8 %), 246 (17·7 %) and 229 (16·5 %) participants. Clusters 1 and 4 showed associations of rather healthy behaviours (high physical activity and low consumption of sugary products; high consumption of fruit and vegetables, respectively), while clusters 2 and 3 showed associations of rather unhealthy behaviours (high sedentary behaviour and low consumption of fruit and vegetables; smoking and alcohol consumption, respectively). Both social status and family structure were associated with cluster membership.

Risk behaviour patterns in adolescents with excess weight were clustered in both healthier and less healthy ways, with a complex interplay with socio-demographic factors.

Dietary indexes measure the adherence of individuals to a set of nutritional recommendations. However, the health gains associated with adherence to various dietary indexes may vary. Our objective was to compare the magnitude of estimated avoided deaths by chronic diseases obtained by improving diet quality in the French population, measured by a variety of dietary indexes.

Simulation study based on observational data.

Weighted data from a French population-based cohort study.

In participants from the NutriNet-Santé cohort, we computed dietary scores reflecting the adherence to various recommendations (Medi-Lite, Healthy Diet Indicator (HDI), Programme National Nutrition Santé/National Nutrition and Health Program – Guidelines Score, Diet Quality Index (DQI), Alternative Healthy Eating Index (AHEI) and the modified Food Standards Agency nutrient profiling system dietary index (FSAm-NPS DI)). Quintiles of the food groups’ consumption and dietary intakes were used as input in a simulation model (Preventable Risk Integrated ModEl (PRIME)), yielding the number of delayed or avoided deaths in nutrition-related non-communicable diseases, comparing between very high or very low nutritional quality of the diet and medium nutritional quality.

A modification of dietary intakes from medium quality to very low quality (i.e. from the middle quintile to the quintile with the lowest nutritional quality) was associated with an increased number of deaths ranging from 3485 (95 % uncertainty interval (CI) 4002, 2987) for HDI and 3379 (95 % CI 3881, 2894) for FSAm-NPS DI to 838 (95 % CI 1163, 523) for Medi-Lite. Conversely, a modification of dietary intakes from medium quality to very high quality was associated with a decrease in the number of deaths ranging from 1995 (95 % CI 1676, 2299) for Probability of Adequate Nutrient intake diet, 1986 (95 % CI 1565, 2361) for DQI-International, 1931 (95 % CI 1499, 2316) for FSAm-NPS DI and 858 (95 % CI 499, 1205) for HDI.

Our results provide some insights as the potential impact of following various dietary guidelines to reduce mortality from nutrition-related diseases.

The new score of adherence to the 2017 French food-based dietary guidelines (PNNS-GS2) has previously been validated. Overweight and obesity being major risk factors for morbidity and mortality and highly related to diet, this study therefore aimed to study their prospective association with PNNS-GS2. A secondary objective was to compare these results to those obtained with PNNS-GS, reflecting 2001 recommendations.

The sample included French adults recruited in the prospective NutriNet-Santé cohort (N = 31,804 and 42,471 for overweight and obesity analyses respectively). The PNNS-GS and the PNNS-GS2 were calculated from repeated 24-hour dietary records collected during the first 2 years of follow-up, and weights were recorded after them in various questionnaires (N = 7.7 weight values on average, SD = 2.3). The association between the scores (as continuous and in quintiles, Q) and the risk of overweight or obesity was modelled by a Cox regression. Events were defined as having a BMI higher than 25 or 30, for overweight and obesity respectively. Comparison to the association with the PNNS-GS was performed using the mPNNS-GS, a modified PNNS-GS without the “physical activity” component. Models were adjusted for age (time scale), gender, size, energy intake, physical activity, socio-professional category, smoking, cohabitation, monthly income and alcohol consumption

Mean scores were 2.2 (SD = 3.2) for PNNS-GS2 and 8.2 (SD = 1.6) for the mPNNS-GS in the “overweight” sample, and 1.9 (SD = 3.3) for the PNNS-GS2 and 8.2 (SD = 1.6) for mPNNS-GS in the “obesity” sample. In our cohort, PNNS-GS2 was significantly associated with the risk obesity, both in quintiles (HRQ5vsQ1 [95%IC] = 0.43 [0.36–0.51]), with a very linear pattern across quintiles (p for trend < 0.0001), and continuously (HR1 point ofPNNS-GS2 [95%IC] = 0.90 [0.88–0.92]). Results were very similar for overweight. On the other hand, mPNNS-GS associations were not significant, whatever the outcome.

The strong association of PNNS-GS2 with the risk of overweight and obesity reinforces its construct validity. Its apparent superiority over the mPNNS-GS contributes to the relevance of the 2017 dietary guidelines.

The consumption of ultra-processed foods has been increasing during the last decades, and has been previously associated with increased risks of mortality and several chronic diseases such as cancer, cardiovascular diseases, hypertension, and dyslipidemia. The objective of this study is to assess the prospective associations between consumption of ultra-processed foods and the risk of type 2 diabetes (T2D).

Overall, 104707 participants aged at least 18 years (median age 41.5 years) from the French NutriNet-Santé cohort (2009–2019) were included. Dietary intakes were collected using repeated 24 hour dietary records (5.7/subject in average), designed to register participants' usual consumption for 3300 different food items. These were categorized according to their degree of processing by the NOVA classification. Associations between ultra-processed food intake and risk of type 2 diabetes were assessed using multivariable Cox proportional hazard models adjusted for known risk factors (sociodemographic, anthropometric, lifestyle, medical history and nutritional factors).

Ultra-processed sugary products, fruits and vegetables, and beverages were the highest contributors of the ultra-processed category (respectively 27.9, 18.5 and 15.6%). Ultra-processed food intake was associated with a higher risk of T2D (n = 821 incident cases; hazard ratio for an absolute increment of 10 in the percentage of ultra-processed foods in the diet = 1.15 (95% confidence interval 1.06 to 1.25); P = 0.0009, median follow-up: 6.0y, 582252 person-years). These results remained statistically significant after adjustment for other metabolic comorbidities, for several markers of the nutritional quality of the diet (red meat and sugary drinks consumption, intakes of saturated fatty acids, sodium, sugar, dietary fiber or Healthy/Western patterns derived by principal component analysis) and after a large range of sensitivity analyses.

In this large observational prospective study, higher consumption of ultra-processed foods in the diet was associated with a higher risk of type 2 diabetes. These results need to be confirmed in other populations and settings, and causality remains to be established. Various dimensions of processing such as nutritional composition of the final product, food additives, contact materials, and neoformed contaminants might play a role in these associations and further studies are needed to better understand their relative contribution. Meanwhile, public health authorities in several countries recently started to recommend privileging unprocessed/minimally processed foods and limiting ultra-processed food consumption.

Study Registration: Clinicaltrials.gov NCT03335644.

Recently, Food-Based Dietary Guidelines (FBDG) have introduced the sustainability concept relying on health and environmental issues related diet. In 2017, the French FBDG were updated including, beyond healthy diet for human, environmental protection and the promotion of organic food.

The aim of the present analysis was to describe sustainable indicators (nutrition, environment, economic, sanitary exposure and long-term) according to adherence to the 2017 FBDG.

The sample included a total of 28,240 from the NutriNet-Santé cohort having completed an, in the framework of the BioNutriNet project, an organic food frequency questionnaire allowing to estimate organic and conventional food consumption for 264 items. After matching, several databases were compiled to evaluate environmental impacts (greenhouse gas emissions, cumulative energy demand and land occupation and the pReCiPe score aggregating the three individual indicators), purchase costs of the diet and dietary exposure to pesticides, all data accounting for farming systems. A recently validated adherence score estimating compliance with the 2017 FBDG (programme national nutrition santé guidelines-score, PNNS-GS 2) was used and the quintiles were computed for comparison purpose of multiple sustainable. Numbers of averted or avoided deaths by adhering to the FBDG were also estimated using the PRIME.

A higher PNNS-GS2 scores is positively correlated to a high plant-based diet, a lower energy intake and a higher cost (+ 0.91€/d). It was associated with lower environmental impacts (ΔQ5vsQ1pReCiPe: -50% for PNNS-GS2). Higher PNNS-GS2 was associated with lower exposure to all pesticides except those used in organic farming and led to a reduction of about 20,000 averted or delayed deaths.

Our results suggest that 2017 FBDG are in line with the sustainable despite a slight higher cost. Such dietary guidelines, if largely adopted, may help in health promotion and reducing environmental protection in a context of an alarming climatic change.

The food-based dietary guidelines having been revised in March 2017, it appeared necessary to update the National Nutrition Health Program - Guidelines Score (PNNS-GS), the diet quality score developed according to the 2001 recommendations. This study was therefore aimed at developing and validating the PNNS-GS2, the diet quality score based on the new recommendations.

Our sample included 80,965 French adults enrolled in the prospective NutriNet-Santé cohort. Collected data included 24-hour dietary records over two years, socio-demographic data, and (in a sub-sample of 16,938 individuals) clinical and biological indicators. The cut-offs and weights of the components of the PNNS-GS2 were developed collegially by nutrition experts who were involved in the update of the recommendations. The score has 13 components for a theoretical value ranging from -∞ to 13.5 points. Nutritional, socio-demographic, clinical, and biological data were described according to the PNNS-GS2 quintile. The face, content, construct and criterion validities were also evaluated.

In our sample, mean PNNS-GS2 was 2.1 (SD = 3.1) in women and -0.3 (SD = 3.6) in men. A high PNNS-GS2 (and therefore a better adherence to the new recommendations) was positively associated with (mean difference Q5-Q1) a high age (Δwomen = + 8.4 / Δmen = + 4.7 years), higher educational level (Δwomen = + 3.9 / Δmen = + 7.4% with a university level), more physical activity (Δwomen = + 13.3 / Δmen = + 3.5% with ≥ 60 min/day) and a larger proportion of non-smokers (Δwomen = + 9.7 / Δmen = + 13.7%). A high PNNS-GS2 was also positively associated with a higher fiber intake (Δwomen = + 8.7 / Δmen = + 10.7 g/d) or vitamin C (Δwomen = + 36.6 / Δmen = + 43.8 mg/d), and negatively with mean arterial pressure (Δwomen = -3.0 / Δmen = -2.8 mmHg) and plasma LDL-cholesterol concentrations (Δwomen = -0.07 / Δmen = -0.06 g/L) and triglycerides (Δwomen = -0.1 / Δmen = -0.16 g/L). All tests were significant (p < 0.05).

Associations observed between the PNNS-GS2 and socio-demographic, nutritional and clinico-biological factors are consistent and corroborate its validity. Further studies will be needed to estimate its association with mortality and morbidity.