Journal Article

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

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

2025

Overview

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 65 th 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 oneSTD [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.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Aged / Breast cancer / breast neoplasms / Cardiovascular diseases / Cause of Death / Chemical contaminants / chemical pollutants / Chemical pollution / Clinical Nutrition / Cohort / Cohort analysis / Cohort Studies / Colorectal cancer / Colorectal carcinoma / colorectal neoplasms / Contaminants / Death / Diabetes / Diet / Diet, Healthy / dietary exposure / Dietary guidelines / Energy intake / Epidemiology / Female / Food / food frequency questionnaires / France / France - epidemiology / Fruits / Guidelines / Health aspects / Health care / Health Promotion and Disease Prevention / Humans / Life Sciences / Lung cancer / lung neoplasms / Medical research / Medicine / Medicine & Public Health / Medicine, Experimental / Middle Aged / Mortality / Mortality risk / Natural & organic foods / Neoplasms - mortality / Nutrients / Nutrition Policy / Nutrition research / Nutritional guidelines / Patient compliance / Patient Compliance - statistics & numerical data / PCB / PNNS / Polychlorinated biphenyls / Proportional Hazards Models / Prospective Studies / Public health / Questionnaires / Risk Factors / risk reduction / Santé publique et épidémiologie / Women / Womens health