Association of a healthy beverage score with total mortality in the adult population of Spain: A nationwide cohort study.

BACKGROUND: Despite the substantial evidence of the relationship between diet and mortality, the role of beverage consumption patterns is not well known. The aim of this study was to assess the association of the adherence to a Healthy Beverage Score (HBS) and all-cause mortality in a representative sample of the Spanish adult population. METHODS AND FINDINGS: We conducted an observational cohort study using data from the Study on Nutrition and Cardiovascular Risk in Spain (ENRICA), which included 12,161 community-dwelling individuals aged ≥18 years recruited in 2008 to 2010 and followed until January 2022. At baseline, food consumption was collected using a validated diet history. The HBS consists of 7 items, each of which is scored from 1 to 4 (highest adherence). The HBS ranges from 7 to 28 points with a higher score representing a healthier pattern. Adherence was assigned as a higher consumption of low-fat milk, and coffee and tea, a lower consumption of whole-fat milk, no consumption of fruit juice, artificially sweetened beverages, or sugar-sweetened beverages, and no or moderate consumption of alcohol. Total mortality was ascertained by linkage to the Spanish National Death Index. Statistical analyses were performed with Cox models and adjusted for the main confounders, including sociodemographic, lifestyle, dietary variables, and morbidity. After a mean follow-up of 12.5 years (SD: 1.7; range: 0.5 to 12.9), a total of 967 deaths occurred. For all-cause mortality, the fully adjusted hazard ratio (HR) for the highest versus lowest sex-specific quartiles of HBS was 0.72 (95% confidence interval [0.57, 0.91], p linear-trend = 0.015), corresponding to an 8.3% reduction in the absolute risk of death. A linear relationship between the risk of death and the adherence to the HBS was observed using restricted cubic splines. The results were robust to sensitivity analyses. The main limitation was that repeated measurements on beverage consumption were not available and beverage consumption could have changed during follow-up. CONCLUSIONS: In this study, we observed that higher adherence to the HBS was associated with lower total mortality. Adherence to a healthy beverage pattern could play a role in the prevention of premature mortality.

Five-color Nutri-Score labeling and mortality risk in a nationwide, population-based cohort in Spain: the Study on Nutrition and Cardiovascular Risk in Spain (ENRICA).

BACKGROUND: The 5-color Nutri-Score (5-CNS) front-of-package labeling system classifies products according to their nutritional quality, so healthier choices are easier when shopping. OBJECTIVES: We examined the association between 5-CNS-based food consumption and long-term mortality in a Spanish, adult population. METHODS: We recruited 12,054 individuals, representative of the Spanish population aged ≥18 years, in 2008-10 and followed up with them to 2017. Habitual food consumption was collected at baseline with a validated computerized dietary history, conducted by trained interviewers. Based on nutritional quality, foods consumed were categorized into 5 labels [A/Green (best quality), B, C, D, and E/Red (worst quality)] using an established algorithm. For each individual, a 5-CNS dietary index (DI) was calculated by summing up the amount of g/day from the foods consumed by their corresponding nutritional quality rate (e.g., A rated 1 and E rated 5) and dividing it by kg of weight. The associations between baseline 5-CNS DI and mortality were analyzed using multivariate-adjusted Cox models. RESULTS: After a mean follow-up of 8.7 years, 514 deaths occurred (140 cardiovascular and 144 cancer deaths). The all-cause mortality HR for the highest versus the lowest quartile of baseline 5-CNS DI was 1.93 (95% CI, 1.34-2.79; P-trend, 0.001). The association was slightly higher for cardiovascular mortality and was similar for cancer. Those with the highest intake of foods labeled as D or E also had a higher all-cause mortality risk than those with the lowest intake (HR, 2.15; 95% CI, 1.56-2.97; P-trend < 0.001). Further, the isocaloric replacement of food products labeled as D or E with fresh foods decreases the risk of death. CONCLUSIONS: The consumption of poor nutritional quality 5-CNS-labeled food products was associated with higher mortality in Spain. Pending further studies, these findings provide additional evidence to reinforce food policies on the use of this simple labeling tool at a country level.