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Background <p>Diet is a modifiable risk factor for non-communicable diseases which are the major causes of death worldwide. French dietary guidelines, updated in 2017, provide recommendations for a healthier diet. We aimed to study the association between adherence to these dietary guidelines and mortality in the E3N (Etude Epidémiologique auprès de femmes de l'Education Nationale) French cohort. A secondary objective was to investigate the role of dietary exposure to chemical contaminants in this association.</p> Methods <p>We studied 72&#xa0;585 women of the E3N prospective cohort, which completed a food frequency questionnaire in 1993. We estimated adherence to French dietary guidelines using the simplified “<i>Programme National Nutrition Santé</i>—guidelines score 2” (sPNNS-GS2, range -20.4 to 12.6). We estimated the association between sPNNS-GS2 and all-cause or cause-specific mortality using Cox proportional hazard models. Causes of death were coded and validated by the French Epidemiology Center on Medical Causes of Death (Inserm-CépiDc).</p> Results <p>During follow-up (1993–2014), we identified 6&#xa0;441 deaths. The mean sPNNS-GS2 was 3.8 (SD 3.0). In the fully adjusted model, we found a non-linear association between sPNNS-GS2 and all-cause, all-cancer, breast cancer and lung cancer mortality (<i>p</i>-values for the overall association &lt; 0.001), with a diminution of the risk as sPNNS-GS2 increases up to its median or 65<sup>th</sup> percentile (depending on the outcome), and then a plateau (for all-cause and breast cancer mortality) or an inversion of the trend (for all-cancer and lung cancer mortality). Furthermore, we identified a linear inverse association with cardiovascular diseases mortality (HR<sub>oneSTD</sub> [95%CI]: 0.86 [0.76; 0.97]), and no association with colorectal cancer mortality. We observed similar results when additionally adjusting on dietary exposure to chemical contaminants.</p> Conclusions <p>This study conducted in a large prospective cohort following more than 70&#xa0;000 women for over 20&#xa0;years suggested that higher adherence to French dietary guidelines was associated with a reduced risk of mortality from all-cause, cardiovascular diseases, all-cancer, breast cancer, and lung cancer, except for high values of adherence for lung cancer mortality. These results contribute to informing on the importance of following the French nutritional recommendations.</p>

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Adherence to French dietary guidelines is associated with a reduced risk of mortality in the E3N French prospective cohort

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年3月15日

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  • Chloé Marques,
  • Pauline Frenoy,
  • Nasser Laouali,
  • Sanam Shah,
  • Gianluca Severi,
  • Francesca Romana Mancini

摘要

Background

Diet is a modifiable risk factor for non-communicable diseases which are the major causes of death worldwide. French dietary guidelines, updated in 2017, provide recommendations for a healthier diet. We aimed to study the association between adherence to these dietary guidelines and mortality in the E3N (Etude Epidémiologique auprès de femmes de l'Education Nationale) French cohort. A secondary objective was to investigate the role of dietary exposure to chemical contaminants in this association.

Methods

We studied 72 585 women of the E3N prospective cohort, which completed a food frequency questionnaire in 1993. We estimated adherence to French dietary guidelines using the simplified “Programme National Nutrition Santé—guidelines score 2” (sPNNS-GS2, range -20.4 to 12.6). We estimated the association between sPNNS-GS2 and all-cause or cause-specific mortality using Cox proportional hazard models. Causes of death were coded and validated by the French Epidemiology Center on Medical Causes of Death (Inserm-CépiDc).

Results

During follow-up (1993–2014), we identified 6 441 deaths. The mean sPNNS-GS2 was 3.8 (SD 3.0). In the fully adjusted model, we found a non-linear association between sPNNS-GS2 and all-cause, all-cancer, breast cancer and lung cancer mortality (p-values for the overall association < 0.001), with a diminution of the risk as sPNNS-GS2 increases up to its median or 65th percentile (depending on the outcome), and then a plateau (for all-cause and breast cancer mortality) or an inversion of the trend (for all-cancer and lung cancer mortality). Furthermore, we identified a linear inverse association with cardiovascular diseases mortality (HRoneSTD [95%CI]: 0.86 [0.76; 0.97]), and no association with colorectal cancer mortality. We observed similar results when additionally adjusting on dietary exposure to chemical contaminants.

Conclusions

This study conducted in a large prospective cohort following more than 70 000 women for over 20 years suggested that higher adherence to French dietary guidelines was associated with a reduced risk of mortality from all-cause, cardiovascular diseases, all-cancer, breast cancer, and lung cancer, except for high values of adherence for lung cancer mortality. These results contribute to informing on the importance of following the French nutritional recommendations.