BACKGROUND The French dietary guidelines were updated in 2017, and an adherence score to the new guidelines (Programme National Nutrition Santé Guidelines Score 2 [PNNS-GS2]) has been developed and validated recently. Since overweight and obesity are key public health issues and have been related to major chronic conditions, this prospective study aimed to measure the association between PNNS-GS2 and risk of overweight and obesity, and to compare these results with those for the modified Programme National Nutrition Santé Guidelines Score (mPNNS-GS1), reflecting adherence to 2001 guidelines. METHODS AND FINDINGS Participants (N = 54,089) were recruited among French adults (≥18 years old, mean baseline age = 47.1 [SD 14.1] years, 78.3% women) in the NutriNet-Santé web-based cohort. Mean (SD) score was 1.7 (3.3) for PNNS-GS2 and 8.2 (1.6) for mPNNS-GS1. Selected participants were those included between 2009 and 2014 and followed up to September 2018 (median follow-up = 6 years). Collected data included at least three 24-hour dietary records over a 2-year period following inclusion, baseline sociodemographics, and anthropometric data over time. In Cox regression models, PNNS-GS2 was strongly and linearly associated with a lower risk of overweight and obesity (HR for quintile 5 versus quintile 1 [95% CI] = 0.48 [0.43-0.54], p < 0.001, and 0.47 [0.40-0.55], p < 0.001, for overweight and obesity, respectively). These results were much weaker for mPNNS-GS1 (HR for quintile 5 versus quintile 1 = 0.90 [0.80-0.99], p = 0.03, and 0.98 [0.84-1.15], p = 0.8, for overweight and obesity, respectively). In multilevel models, PNNS-GS2 was negatively associated with baseline BMI and BMI increase over time (β for a 1-SD increase in score [95% CI] = -0.040 [-0.041; -0.038], p < 0.001, and -0.00080 [-0.00094; -0.00066], p < 0.001, respectively). In "direct comparison" models, PNNS-GS2 was associated with a lower risk of overweight and obesity, lower baseline BMI, and lower BMI increase over time than mPNNS-GS1. Study limitations include possible selection bias, reliance on participant self-report, use of arbitrary cutoffs in data analyses, and residual confounding, but robustness was tested in sensitivity analyses. CONCLUSIONS Our findings suggest that adherence to the 2017 French dietary guidelines is associated with a lower risk of overweight and obesity. The magnitude of the association and the results of the direct comparison reinforced the validity of the updated recommendations. TRIAL REGISTRATION The NutriNet-Santé Study ClinicalTrials.gov (NCT03335644).

中文翻译：

---

遵守 2017 年法国饮食指南和成人体重增加：一项队列研究。

背景 法国饮食指南于 2017 年进行了更新，最近制定并验证了新指南的遵守评分（国家营养保健计划评分 2 [PNNS-GS2]）。由于超重和肥胖是关键的公共卫生问题，并且与主要慢性病相关，因此这项前瞻性研究旨在衡量 PNNS-GS2 与超重和肥胖风险之间的关联，并将这些结果与修改后的国民营养计划的结果进行比较Santé 指南评分 (mPNNS-GS1)，反映对 2001 年指南的遵守情况。方法和结果 NutriNet-Santé 网络队列中招募了法国成年人（≥18 岁，平均基线年龄 = 47.1 [SD 14.1] 岁，78.3% 为女性）参与者 (N = 54,089)。PNNS-GS2 的平均 (SD) 分数为 1.7 (3.3)，mPNNS-GS1 的平均 (SD) 分数为 8.2 (1.6)。选定的参与者是 2009 年至 2014 年期间纳入的参与者，并随访至 2018 年 9 月（中位随访时间 = 6 年）。收集的数据包括纳入后 2 年内至少 3 个 24 小时饮食记录、基线社会人口统计数据和一段时间内的人体测量数据。在 Cox 回归模型中，PNNS-GS2 与较低的超重和肥胖风险呈强线性相关（五分位数 5 与五分位数 1 的 HR [95% CI] = 0.48 [0.43-0.54]，p < 0.001 和 0.47 [0.40] -0.55]，p < 0.001，分别针对超重和肥胖）。mPNNS-GS1 的这些结果要弱得多（对于超重和肥胖，五分位数 5 与五分位数 1 的 HR 分别 = 0.90 [0.80-0.99]，p = 0.03，和 0.98 [0.84-1.15]，p = 0.8）。在多水平模型中，PNNS-GS2 与基线 BMI 和 BMI 随着时间的推移而增加呈负相关（得分 1-SD 增加的β [95% CI] = -0.040 [-0.041; -0.038]，p < 0.001，并且 - 0.00080 [-0.00094; -0.00066]，p < 0.001，分别）。在“直接比较”模型中，与 mPNNS-GS1 相比，PNNS-GS2 与较低的超重和肥胖风险、较低的基线 BMI 以及较低的 BMI 随时间增加相关。研究的局限性包括可能的选择偏差、对参与者自我报告的依赖、数据分析中任意截断的使用以及残余混杂，但在敏感性分析中测试了稳健性。结论 我们的研究结果表明，遵守 2017 年法国饮食指南与降低超重和肥胖风险相关。关联的程度和直接比较的结果增强了更新建议的有效性。试验注册 NutriNet-Santé 研究 ClinicalTrials.gov (NCT03335644)。