Objective To jointly analyse two food dimensions, the Food Standards Agency Nutrient Profiling System (FSAm-NPS), used to derive the Nutri-Score front-of-pack label, and the NOVA classification in relation to mortality. Design Prospective cohort study. Setting Moli-sani Study, Italy 2005-10. Participants 22 895 participants (mean age 55 (SD 12) years; 48% men). Main outcomes measures Associations between dietary exposures and mortality risk, assessed using multivariable cause specific Cox proportional hazard models controlled for known risk factors. Results A total of 2205 deaths occurred during 272 960 person years of follow-up. In the highest quarter of the FSAm-NPS index compared with the lowest quarter, multivariable adjusted hazard ratios for all cause and cardiovascular mortality were 1.19 (95% confidence interval 1.04 to 1.35; absolute risk difference 4.3%, 95% confidence interval 1.4% to 7.2%) and 1.32 (1.06 to 1.64; 2.6%, 0.3% to 4.9%), respectively. The hazard ratios were 1.19 (1.05 to 1.36; absolute risk difference 9.7%, 5.0% to 14.3%) and 1.27 (1.02 to 1.58; 5.0%, 1.2% to 8.8%), respectively, for all cause and cardiovascular mortality when the two extreme categories of ultra-processed food intake were compared. When these two indices were analysed jointly, the magnitude of the association of the FSAm-NPS dietary index with all cause and cardiovascular mortality was attenuated by 22.3% and 15.4%, respectively, whereas mortality risks associated with high ultra-processed food intake were not altered. Conclusions Adults with the lowest quality diet, as measured using the FSAm-NPS dietary index (underpinning the Nutri-Score), and the highest ultra-processed food consumption (NOVA classification) were at the highest risk for all cause and cardiovascular mortality. A significant proportion of the higher mortality risk associated with an elevated intake of nutrient poor foods was explained by a high degree of food processing. In contrast, the relation between a high ultra-processed food intake and mortality was not explained by the poor quality of these foods. The data underlying this article will be shared on reasonable request to the corresponding author. The data are stored in an institutional repository (), and access is restricted by the ethical approvals and the legislation of the European Union.

中文翻译：

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Nutri-Score 包装正面标签和超加工食品摄入量与死亡率的联合关联：Moli-sani 前瞻性队列研究

目的 联合分析两个食品维度，食品标准局营养分析系统 (FSAm-NPS)，用于推导 Nutri-Score 包装正面标签，以及与死亡率相关的 NOVA 分类。设计前瞻性队列研究。设置 Moli-sani 研究，意大利 2005-10。参与者 22 895 名参与者（平均年龄 55 (SD 12) 岁；48% 为男性）。主要结果衡量饮食暴露与死亡风险之间的关联，使用针对已知风险因素控制的多变量原因特定 Cox 比例风险模型进行评估。结果 在 272 960 人年的随访期间，共有 2205 人死亡。在 FSAm-NPS 指数的最高四分之一与最低四分之一相比，全因和心血管死亡率的多变量调整风险比为 1.19（95% 置信区间为 1.04 至 1.35；绝对风险差异分别为 4.3%、95% 置信区间 1.4% 至 7.2% 和 1.32（1.06 至 1.64；2.6%、0.3% 至 4.9%）。全因死亡率和心血管死亡率的风险比分别为 1.19（1.05 至 1.36；绝对风险差异 9.7%、5.0% 至 14.3%）和 1.27（1.02 至 1.58；5.0%、1.2% 至 8.8%）比较了极端类别的超加工食品摄入量。当对这两个指数进行联合分析时，FSAm-NPS 饮食指数与全因死亡率和心血管死亡率的关联程度分别降低了 22.3% 和 15.4%，而与高超加工食品摄入量相关的死亡风险并未降低改变了。结论 使用 FSAm-NPS 膳食指数（支持 Nutri-Score）衡量的饮食质量最低的成年人，和最高的超加工食品消费（NOVA 分类）是全因死亡率和心血管死亡率最高的风险。与营养不良食物摄入量增加相关的较高死亡率风险的很大一部分是由高度的食品加工解释的。相比之下，超加工食品摄入量高与死亡率之间的关系并不能用这些食品的质量差来解释。这篇文章的基础数据将在合理的要求下分享给相应的作者。数据存储在机构存储库中（相比之下，超加工食品摄入量高与死亡率之间的关系并不能用这些食品的质量差来解释。这篇文章的基础数据将在合理的要求下分享给相应的作者。数据存储在机构存储库中（相比之下，超加工食品摄入量高与死亡率之间的关系并不能用这些食品的质量差来解释。这篇文章的基础数据将在合理的要求下分享给相应的作者。数据存储在机构存储库中（)，并且访问受到道德批准和欧盟立法的限制。