Prospective association between adherence to the 2017 French dietary guidelines and risk of death, CVD and cancer in the NutriNet-Sante cohort

Non-communicable diseases, such as cancers and CVD, represent a major public health concern, and diet is an important factor in their development. French dietary recommendations were updated in 2017, and an adherence score, the Programme National Nutrition Sante Guidelines Score (PNNS-GS2), has been developed and validated using a standardised procedure. The present study aimed to analyse the prospective association between PNNS-GS2 and the risk of death, cancer and CVD. Our sample consisted of French adults included in the prospective NutriNet-Sante cohort (n 67 748, 75 634 and 80 269 for the risk of death, cancer and CVD, respectively). PNNS-GS2 (range: -infinity to 14 center dot 25) was calculated from the 24-h dietary records of the first 2 years of monitoring. Association between PNNS-GS2 (in quintiles, Q) and the risk of death, cancer and CVD was studied using Cox models adjusted for the main confounding factors. The sample included 78 % of women, aged on average 44 center dot 4 years (sd 14 center dot 6) with on average 6 center dot 6 (sd 2 center dot 3) dietary records. Average PNNS-GS2 was 1 center dot 5 (sd 3 center dot 4) and median follow-up was 6 center dot 6 years for cancers and 6 center dot 2 years for CVD and deaths. PNNS-GS2 was significantly associated with the risk of death (hazard ratio (HR)(Q5vsQ1): 0 center dot 77 (95 % CI 0 center dot 60, 1 center dot 00), 828 cases), cancer (HRQ5vsQ1 = 0 center dot 80 (95 % CI 0 center dot 69, 0 center dot 92), 2577 cases) and CVD (HRQ5vsQ1 0 center dot 64 (95 % CI 0 center dot 51, 0 center dot 81), 964 cases). More specifically, PNNS-GS2 was significantly associated with colorectal and breast cancer risks but not prostate cancer risk. Our results suggest that strong adherence to the 2017 French dietary recommendations is associated with a lower risk of death, cancer or CVD. This reinforces the validity of these new recommendations and will help to promote their dissemination.