Based on composite food samples representative of the whole diet, prepared as consumed, total diet studies (TDSs) are amongst the most cost-effective approaches to assess population dietary exposure to chemicals residues and contaminants, and to provide representative data for health risk assessment. The third French TDS was launched in 2018. From the most recent French dietary survey, 276 foods were selected based on consumption and contamination levels, thus covering over 90% of the French diet. Stratification by season (3, 6 or 12-month-periods) and agricultural type (organic vs. conventional) led to collecting 719 composite samples. Each sample was made up of 12 pooled subsamples of the same food, representative of the food supply and habits of the French population and prepared as consumed according to the typical household practices. Food collection took place in 2021-2022 in three French departments. Substitution rules were applied when necessary to increase the likelihood of finding a product or to replace unavailable items (e.g. from supermarket, retailed shop…), that allowed collection of 98% of the expected subsamples. It is intended that the food composite samples will be analyzed for approximately 300 chemicals to update concentration levels, estimate dietary exposure, and support health risk assessment in France.

Background:Plant-based diets offer co-benefits for human health and the environment, but assessments often consider only specific aspects. This study comprehensively examines the links between diet-related environmental pressures and risk of chronic diseases as well as mortality. Methods:Data from a population study of 34,077 participants to the NutriNet-Santé French cohort were used. Dietary data were collected using a food frequency questionnaire, distinguishing between organic and conventional foods, and were merged with food production environmental indicators. The associations between greenhouse gas emissions (GHGe), energy demand, land occupation (LO), ecological infrastructures (EI), water use, and pesticide treatment frequency and a synthetic environmental pressures index (EPI) and incidence of cancer, cardiovascular diseases (overall, coronary and cerebrovascular diseases), type 2 diabetes and mortality were estimated using weighted multivariable cox proportional risk model. Findings:Over a mean median follow-up of 8.39 years (IQR = 5.62, 256,891 person-year), the diet's overall environmental pressures (EPI) was positively associated with the risk of all tested chronic diseases except stroke. The HR for 1 SD increment ranging from 1.15 (95% CI = 1.03-1.28) for cancer (all locations) to 1.50 (95% CI = 1.29-1.73) for coronary heart disease and type 2 diabetes, but no association with stroke or death was detected. Interpretation:Diets with low overall environmental pressures are associated with important health benefits, suggesting that food systems with lower environmental impacts could be key drivers of both environmental and health sustainability. Funding:Data were collected in the context of the BioNutriNet and TRANSFood projects supported by the French National Research Agency (ANR-13-ALID-0001 and ANR-21-CE21-0011-01).

Although food-based dietary guidelines (FBDG) include guidelines for meat consumption, they most often do not explicitly include environmental considerations. For instance, in France, FBDG recommend consuming no more than 500 g of red meat and 150 g of processed meat per week. This study uses modeling to investigate the range of greenhouse gas emissions (GHGe) that can be achieved under FBDG compliance. The study analyzed data collected in 2014 from 29,413 NutriNet-Santé participants to assess their adherence to the French FBDG. GHGe, cumulative energy demand (CED), and land occupation (LO) for organic and conventional foods were obtained from the DIALECTE database. First, diets adequate in nutrients, culturally acceptable, and consistent with FBDG were modeled while minimizing or maximizing GHGe. Then, the spectrum of diets between minimum and maximum GHGe was explored while minimizing total departure from the observed diet with a gradual constraint on GHGE using the same other constraints. Environmental, economic (monetary cost), nutritional, and health criteria (Health risk score denoting long-term risk for health associated with diet) were then estimated for each diet. The average observed adequacy to FBDG was low (19

Dietary diversity is vital for public health nutrition, yet the co-benefits of increasing dietary species richness (DSR) on human and environmental health remain unassessed. Here we explore associations between DSR and greenhouse gas emissions, land use, nutrient adequacy and mortality rates among European Investigation into Cancer and Nutrition (EPIC) study participants. Total DSR was positively associated with probability of adequate nutrient intake diet scores and inversely related to mortality rates; similar results were observed for plant DSR. Animal DSR was inversely associated with probability of adequate nutrient intake diet scores and neutrally associated with mortality rates. Neutral associations for total DSR and positive associations for animal DSR were found with greenhouse gas emissions and land use. Conversely, plant DSR was inversely associated with greenhouse gas emissions and land use. These findings from Europe suggest modest benefits of dietary plant biodiversity for nutrient adequacy and environmental health, with stronger inverse associations with mortality rates, while highlighting the potential adverse environmental impacts of diets rich in animal-sourced foods.

BACKGROUND:Meat and dairy substitutes are gaining popularity, but their expected overall impact on health remains unclear. OBJECTIVES:We aimed to simulate the complete substitution of meat, milk, and dairy desserts with plant-based substitutes (PBSs) to assess the impact on nutrient deficiency risk and chronic disease-related mortality. METHODS:Using individual baseline dietary data from adults in the latest French national survey (N = 2121; INCA3), we simulated isoenergetic diets where all meat, milk, and dairy desserts were replaced by an equivalent amount of PBSs. We constructed mean PBS profiles of varying nutritional quality (high, average, and low) based on the nutrient compositions of 96 PBSs and legumes. Intermediate scenarios (meat-only or dairy-only substitution) were also analyzed. Deficiency risk was assessed using the nutrient security of the diet (SecDiet) probabilistic system, and the number of deaths averted was projected using the Preventable Risk Integrated ModEl. RESULTS:On average, PBS did not increase overall risk of deficiency (SecDiet score: 0.90 ± 0.11 to 0.91 ± 0.11, compared with 0.91 ± 0.11 in the observed diet). However, replacing meat and dairy products increased risk of riboflavin and vitamin B-12 deficiency. Using meat PBS-with reduced consumption of red and processed meat, increased fiber, and improved fatty acid intake-would be the most effective in reducing premature deaths from cardiometabolic diseases and cancer. However, meat PBS led to higher sodium intake, which would slightly offset these benefits. Overall, replacing meat and dairy with PBS would avert between 3721 (95% uncertainty interval: 2712, 4713) and 6671 (95% uncertainty interval: 5527, 7778) deaths from chronic diseases annually, depending on the quality of the PBS (nutrient content and energy density). CONCLUSIONS:As modeled, full substitution of animal products with PBS can result in limited increases in deficiency risk, and decreases in chronic disease-related mortality, with meat replacement providing most of the benefits. Expected effects vary widely depending on the nutritional quality of the substitutes.

OBJECTIVE:To compare the initial and the updated versions of the front-of-pack label Nutri-Score (related to the nutritional content) with the NOVA classification (related to the degree of food processing) at the food level. DESIGN:Using the OpenFoodFacts database - 129,950 food products - we assessed the complementarity between the Nutri-Score (initial and updated) with the NOVA classification through a correspondence analysis. Contingency tables between the two classification systems were used. SETTINGS:The food offer in France. PARTICIPANTS:Not applicable. RESULTS:With both versions (i.e. initial and updated) of the Nutri-Score, the majority of ultra-processed products received medium to poor Nutri-Score ratings (between 77·9 % and 87·5 % of ultra-processed products depending on the version of the algorithm). Overall, the update of the Nutri-Score algorithm led to a reduction in the number of products rated A and B and an increase in the number of products rated D or E for all NOVA categories, with unprocessed foods being the least impacted (-3·8 percentage points (-5·2 %) rated A or B and +1·3 percentage points (+12·9 %) rated D or E) and ultra-processed foods the most impacted (-9·8 percentage points (-43·4 %) rated A or B and +7·8 percentage points (+14·1 %) rated D or E). Among ultra-processed foods rated favourably with the initial Nutri-Score, artificially sweetened beverages, sweetened plant-based drinks and bread products were the most penalised categories by the revision of Nutri-Score while low-sugar flavoured waters, fruit and legume preparations were the least affected. CONCLUSION:These results indicate that the update of the Nutri-Score reinforces its coherence with the NOVA classification, even though both systems measure two distinct health dimensions at the food level.

Abstract Objective: To identify patterns of food taxes acceptability among French adults, and to investigate population characteristics associated with them. Design: Cross-sectional data from the NutriNet-Santé e-cohort. Participants completed an ad-hoc web-based questionnaire to test patterns of hypothetical food taxes acceptability (i.e., overall perception combined with reasons for supporting or not) on 8 food types: fatty foods, salty foods, sugary foods, fatty and salty foods, fatty and sugary products, meat products, foods/beverages with unfavorable front-of-pack nutrition label, “ultra-processed foods” (UPF). Sociodemographic and anthropometric characteristics, and dietary intakes (24h-records) were self-reported. Latent class analysis was used to identify patterns of food taxes acceptability. Settings: NutriNet-Santé prospective cohort study. Participants: Adults (n= 27,900) engaged in the French NutriNet-Santé e-cohort. Results: The percentage of participants in favour of taxes ranged from 11.5% for fatty products to 78.0% for ultra-processed foods. Identified patterns were 1) “Support all food taxes” (16.9%), 2) “Support all but meat and fatty products taxes” (28.9%), 3) “Against all but UPF, Nutri-score, and salty products taxes” (26.5%), 4) “Against all food taxes” (8.6%), 5) “No opinion” (19.1%). Pattern 4 had higher proportions of participants with low socioeconomic status, body mass index above 30 kg/m2 and who had consumption of foods targeted by the tax above the median. Conclusion: Results provide strategic information for policy-makers responsible for designing food taxes and may help identify determinants of support for or opposition to food taxes in relation to individual or social characteristics or products taxed.

Background Nutri-Score is a scientifically validated 5-color front-of-pack nutrition label reflecting the nutrient profile of foods. It has been implemented in several European countries on a voluntary basis, pending the revision of the European labeling regulation. Hence, scientific evidence is needed regarding the ability of the nutrient profile underlying the Nutri-Score (uNS-NPS, 2023-updated version) to characterize healthier foods. Our objective was therefore to study the prospective association between the nutritional quality of diet characterized by the uNS-NPS and the risk of cardiovascular diseases in a large European population. Methods Our analyses included 345,533 participants from the European Prospective Investigation into Cancer and Nutrition study (EPIC, 1992-2010, 7 European countries). Food intakes were assessed at baseline using country-specific dietary questionnaires. The uNS-NPS was calculated as a continuous scale for each food, based on its 100 g content of energy, sugars, saturated fatty acids, salt, fibre, and protein and percentage content of fruit, vegetables, and pulses. A dietary index was derived at the individual level (uNS-NPS DI: energy-weighted mean of uNS-NPS scores of all foods consumed by a participant). Cardiovascular events during follow-up were retrieved using country-specific methods (self-report, registry data). Multi-adjusted Cox models were computed. Findings Overall, 16,214 first cardiovascular events were reported (median follow-up: 12.3 years; 4,103,133 person-years). The consumption of foods with a higher uNS-NPS score (reflecting a lower overall nutritional quality of diet) was associated with higher risks of total cardiovascular events (Hazards Ratio (HR) for an increment of 1 standard deviation: 1.03 (95% Confidence Interval 1.01-1.05)), especially myocardial infarction (HR = 1.03 (1.01-1.07)), and stroke (HR = 1.04 (1.01-1.07)). Interpretation In this large prospective study among European adults, a higher risk of cardiovascular diseases (total and several subtypes) was observed in individuals consuming a diet with a lower nutritional value, as graded by the uNS-NPS score. This brings new evidence on the relevance of the updated nutrient profile underlying the Nutri-Score to characterize foods with a healthier nutrient profile. Copyright (c) 2024 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC license (http://creativecommons.org/licenses/by-nc/4.0/).

Background: Food biodiversity in human diets has potential co-benefits for both public health and sustainable food systems. However, current evidence on the potential relationship between food biodiversity and cancer risk, and particularly gastrointestinal cancers typically related to diet, remains limited. This study evaluated how dietary species richness (DSR) was associated with gastrointestinal cancer risk in a pan-European population. Methods: Associations between DSR and subsequent gastrointestinal cancer risk were examined among 450,111 adults enrolled in the European Prospective Investigation into Cancer and Nutrition cohort (EPIC, initiated in 1992), free of cancer at baseline. Usual dietary intakes were assessed at recruitment with country-specific dietary questionnaires. DSR of an individual's yearly diet was calculated based on the absolute number of unique biological species in each food and drink item. Associations between DSR and cancer risk were assessed by multivariable Cox proportional hazards regression models. Findings: During a median follow-up time of 14.1 years (SD=3.9), 10,705 participants were diagnosed with gastrointestinal cancer. Hazard ratios (HRs) and 95 % confidence intervals (CIs) comparing overall gastrointestinal cancer risk in the highest versus lowest quintiles of DSR indicated inverse associations in multivariable-adjusted models [HR (95 % CI): 0.77 (0.69-0.87); P-value < 00001] (Table 2). Specifically, inverse associations were observed between DSR and oesophageal squamous cell carcinoma, proximal colon, colorectal, and liver cancer risk (p-trend<0.05 for all cancer types). Interpretation: Greater food biodiversity in the diet may lower the risk of certain gastrointestinal cancers. Further research is needed to replicate these novel findings and to understand potential mechanisms.

BACKGROUND:Mindful eating (ME) is a promising approach for promoting healthy eating. Although an association between ME and healthier eating habits has been indicated in the literature, data remain limited. The aim of this cross-sectional study was to investigate the association between ME and several nutritional indicators, including overall diet quality, consumption of ultra-processed foods (UPF), organic foods, food groups, and intake of energy and nutrients in a large population sample. METHODS:In 2023, 13,759 participants of the NutriNet-Santé cohort study completed the Mind-Eat Scale, assessing total ME (range: 1-5), and its six sub-dimensions, and at least three 24-h dietary records. Multivariable linear regressions were performed to analyze the association between ME (independent variable) and various indices reflecting the nutritional quality of the diet: two scores reflecting the adherence to the French dietary guidelines (sPNNS-GS2) and the Mediterranean diet (MEDI-LITE score), the consumption of UPF (using the NOVA classification), organic foods and food groups, and energy and nutrient intake (dependent variables), adjusted for socio-demographic and lifestyle characteristics. RESULTS:ME was positively associated with French dietary guideline (β = 0.33; 95%CI: 0.30, 0.45) and Mediterranean diet (β = 0.37; 95%CI: 0.30, 0.45) scores and with organic food consumption (β = 9.72; 95%CI: 8.84, 10.60). Furthermore, ME was negatively associated with energy intake (β = -36.79; 95%CI: 50.92, -22.67) and UPF consumption (β = -1.55; 95%CI: 1.81, -1.29). ME was also associated with the intake of several food groups and nutrients. CONCLUSION:Overall, ME was associated with a healthier diet. These results suggest that ME could be an interesting lever for promoting healthy eating habits. Further studies are required to better understand the relationships between ME, dietary intake, and health, particularly through the use of longitudinal studies.

Compte tenu de l’augmentation de la prévalence du diabète de type 2 (DT2) dans le monde, il est important de mieux comprendre ses facteurs de risque et de protection, afin d’orienter les futures politiques de prévention et de prise en charge. Les études observationnelles à grande échelle sont utiles à cet égard. L’étude NutriNet-Santé est une cohorte prospective française en ligne, lancée en 2009, ayant permis la publication de 12 articles originaux portant sur les facteurs de risque du DT2. Parmi ces 12 études, 11 sont prospectives (suivi moyen : 4 à 9 ans) sur des échantillons de 33 256 à 107 377 participants. La consommation d’aliments ultra-transformés, l’exposition à certains mélanges de pesticides ou une première prise alimentaire tardive ont été associées à un risque plus élevé de DT2. Au contraire, une plus forte adéquation aux recommandations nutritionnelles françaises ou une consommation importante d’aliments issus de l’agriculture biologique étaient associées à un risque plus faible de DT2. D’autres études en relation avec le DT2 sont en cours dans la cohorte NutriNet-Santé, portant sur l’adhésion à des régimes durables, l’exposition à certains additifs et contaminants liés à la transformation des aliments, ou les troubles de santé mentale.

Background: To help consumers to make healthier food choices, 7 European countries have implemented the front -of -pack nutrition label Nutri-Score. The algorithm was updated in 2022-2023 by the Nutri-Score European scientific committee, based on the current scientific knowledge. Objectives: The aim of this study was to investigate the consistency of the newly internationally developed algorithm with the French foodbased dietary guidelines (FBDG) and compare the respective performances of the initial and updated algorithm. Methods: Three complementary French food composition databases were used to access extensive coverage of the food supply in France (n 1/4 46,752): the Oqali, OpenFoodFacts, and CIQUAL databases. Based on the French FBDG, a list of 41 criteria was defined by which the consistency between French FBDG and the Nutri-Score was assessed (eg, consumption of fresh vegetables is promoted in FBDG, thus the Nutri-Score should rate favorably such products). Results: Of all criteria, the initial algorithm met 63% (26/41) of them, whereas the revised algorithm met 85% (35/41) of them. Improvements achieved by the updated version of the Nutri-Score in alignment with the FBDG were particularly observed for high -fat products (ie, fatty fish, nuts, and seeds), sweet products (ie, ice creams and sweet spreads), salty products (ie, savory snacks and salted nuts), dairy beverages, and beverages with artificial sweeteners. Conclusions: The Nutri-Score's updated nutrient profiling system appears to rate foods more consistently regarding the French dietary guidelines and improved the currently existing system. This work supports the implementation of the updated nutrient profiling system underlying Nutri-Score.

Background Experimental studies have suggested potential detrimental effects of emulsifiers on gut microbiota, inflammation, and metabolic perturbations. We aimed to investigate the associations between exposures to food additive emulsifiers and the risk of type 2 diabetes in a large prospective cohort of French adults. Methods We analysed data from 104 139 adults enrolled in the French NutriNet-Sant & eacute; prospective cohort study from May 1, 2009, to April 26, 2023; 82 456 (79 center dot 2%) were female and the mean age was 42 center dot 7 years (SD 14 center dot 5). Dietary intakes were assessed with three 24 h dietary records collected over three non-consecutive days, every 6 months. Exposure to additive emulsifiers was evaluated through multiple food composition databases and ad-hoc laboratory assays. Associations between cumulative time-dependent exposures to food additive emulsifiers and the risk of type 2 diabetes were characterised with multivariable proportional hazards Cox models adjusted for known risk factors. The NutriNet-Sant & eacute; study is registered at ClinicalTrials.gov (NCT03335644). Findings Of 104 139 participants, 1056 were diagnosed with type 2 diabetes during follow-up (mean follow-up duration 6 center dot 8 years [SD 3 center dot 7]). Intakes of the following emulsifiers were associated with an increased risk of type 2 diabetes: total carrageenans (hazard ratio [HR] 1 center dot 03 [95% CI 1 center dot 01-1 center dot 05] per increment of 100 mg per day, p<0 center dot 0001), carrageenans gum (E407; HR 1 center dot 03 [1 center dot 01-1 center dot 05] per increment of 100 mg per day, p<0 center dot 0001), tripotassium phosphate (E340; HR 1 center dot 15 [1 center dot 02-1 center dot 31] per increment of 500 mg per day, p=0 center dot 023), acetyl tartaric acid esters of monoglycerides and diglycerides of fatty acids (E472e; HR 1 center dot 04 [1 center dot 00-1 center dot 08] per increment of 100 mg per day, p=0 center dot 042), sodium citrate (E331; HR 1 center dot 04 [1 center dot 01-1 center dot 07] per increment of 500 mg per day, p=0 center dot 0080), guar gum (E412; HR 1 center dot 11 [1 center dot 06-1 center dot 17] per increment of 500 mg per day, p<0 center dot 0001), gum arabic (E414; HR 1 center dot 03 [1 center dot 01-1 center dot 05] per increment of 1000 mg per day, p=0 center dot 013), and xanthan gum (E415, HR 1 center dot 08 [1 center dot 02-1 center dot 14] per increment of 500 mg per day, p=0 center dot 013). Interpretation We found direct associations between the risk of type 2 diabetes and exposures to various food additive emulsifiers widely used in industrial foods, in a large prospective cohort of French adults. Further research is needed to prompt re-evaluation of regulations governing the use of additive emulsifiers in the food industry for better consumer protection. Copyright (c) 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC-BY-NC 4.0 license.

Background Food reformulation is promoted as a tool to improve the nutritional quality of population diets. However, the potential impact of industry-wide reformulation on dietary intake has been investigated minimally.Objectives The aim was to estimate the impact on the French population nutrient intakes of industry-wide reformulation towards healthier products using the updated nutrient profiling system underpinning the front-of-pack nutrition label Nutri-Score (uNS-NPS).Methods Dietary data were retrieved from the Nutrinet-Santé cohort at baseline (N=100 418), providing detailed information regarding participants’ food choices (N>3000 generic food items). Each individual food from 24 hours dietary record was matched with French food market data from OpenFoodFacts database (N=119 073 products). Three scenarios were constructed using nutrient content of currently existing food products: (1) all products available (baseline situation); (2) only existing products of better nutritional quality were available as potential substitutes and (3) only existing products of poorer quality were available. The assessment of the nutritional quality was based on the uNS-NPS score. Finally, dietary intakes were calculated for each scenario after random attribution of healthier/less healthy products as dietary choices. Monte-Carlo iterations (n=300) were conducted to generate uncertainty intervals.Results After simulation of reformulation using scenario 2, reduction in daily intake in comparison with the baseline situation was observed for energy (–55 kcal/day, –2.9%), saturated fat (–2.4g/day, –7.6%), sugar (–4.8g/day, –5.3%) and salt (–0.54g/day, –8.3%) and increase was observed for fibre (+1.0g/day, +4.9%). Improvements in diet quality were observed regardless of the overall quality of diet. The most important contributors to diet improvement were the followings: (1) sugars: sugary products, sweet bakery products and dairy products; (2) saturated fat: sweet bakery products, dairy products and prepared dishes and (3) salt: bread, prepared dishes, vegetable preparations and soups.Conclusion Widespread reformulation of food offer appeared to be an opportunity for improving nutritional status at population level in France.

The main objective of this study was to evaluate the association of the insomnia-anxiety comorbidity with incident type 2 diabetes (T2D) in a large prospective cohort. We selected adults without diabetes at baseline from the French NutriNet-Santé cohort who had completed the trait anxiety subscale of the Spielberger State-Trait Anxiety Inventory (STAI-T, 2013–2016) and a sleep questionnaire (2014); insomnia was defined according to established criteria. Using multivariable Cox models, we compared T2D risk across 4 groups: no insomnia or anxiety (reference), insomnia alone, anxiety alone (STAI-T ≥ 40), and comorbid anxiety and insomnia. Among 35,014 participants (mean baseline age: 52.4 ± 14.0 years; 76% women), 378 (1.1%) developed T2D over a mean follow-up of 5.9 ± 2.1 years. Overall, 28.5% of the sample had anxiety alone, 7.5%—insomnia alone, and 12.5%—both disorders. In the fully-adjusted model, a higher T2D risk was associated with anxiety-insomnia comorbidity (HR = 1.40; 95% CI 1.01, 1.94), but not with each disorder separately, compared to the group without insomnia or anxiety. The findings supported a positive association between anxiety-insomnia comorbidity and incident T2D among general-population adults. Future research using clinical diagnoses of mental disorders could confirm the findings and guide diabetes prevention programs.

BACKGROUND:The transition period from adolescence to early adulthood is critical for developing new nutritional behaviors, making higher education students an important target group for public health nutrition interventions. Given the complexity of nutrition-related behaviors and their various determinants, involving the student population (the future beneficiaries of interventions) and the partners engaged in their implementation when designing campus nutrition interventions is essential. Citizens' assemblies are deliberative processes which are more and more frequently organized to co-create solutions to complex problems. This study aims 1) to design and implement a student citizens' assembly using participatory research methods, 2) to describe its process and evaluate its transferability, 3) to evaluate changes in dietary habits, knowledge and citizen practices among students participating in this assembly. METHODS:This study will take place at a French university (University Sorbonne Paris Nord, USPN) located in socio-economically disadvantaged suburbs of Paris. The student citizens' assembly will gather a mini-public of 30 students enrolled at the time of the study and a co-creation team of academic and non-academic partners involved in student life, nutrition, physical activity, or public policies. The aim of the assembly is to co-create a set of concrete proposals that would enhance USPN students' access to sustainable diets and physical activity. The protocol is based on a continuous process evaluation and a pre-post design among the mini-public. A mixed-method framework combining quantitative and qualitative approaches will be developed. This study will make use of (i) field observations of the intervention process and transferability, (ii) data collected by questionnaires on pre- and post- dietary habits, knowledge and citizen practices of the mini-public, and (iii) pre-post interviews with a subsample of the same mini-public. DISCUSSION:Relying on participatory research methods, this study will provide new insights into involving higher education students and diverse partners in co-creating campus nutrition interventions. Through the collaborative work of researchers, higher education students, university representatives, public institutions, and local and community actors, this study will provide evidence-based guidance for designing innovative and contextually-relevant nutrition interventions in the higher education setting. TRIAL REGISTRATION:This research was registered at the ClinicalTrial.gov (NCT06580795; registration date: 2024-08-30; https://www. CLINICALTRIALS:gov/study/NCT06580795 ).

ABSTRACT Objectives: Consideration of future consequences (CFC) distinguishes individuals who adopt behaviors based on immediate needs and concerns from individuals who consider the future consequences of their behaviors. We aimed to assess the association between CFC and diet, and testing the mediating role of food choice motives on this relationship. Design: Individuals (age≥18 years) completed the CFC-12 questionnaire in 2014, at least three 24-h dietary records, and a food choice motive questionnaire. A multiple mediator analysis allowed to assess the mediating effect of food choice motives on the cross-sectional association between CFC and diet, adjusted for socio-demographic factors. Setting: Data from the NutriNet-Santé cohort study. Participants: 27,330 participants. Results: CFC was associated with all food choice motives (P < 0.001), with the strongest positive associations for avoidance for environmental reasons, absence of contaminants and health motives, and the strongest negative associations for innovation and convenience). Positive total effects were found between CFC and the consumption of healthy food groups (fruits and vegetables, whole-grain foods, legumes); and negative total effects for alcohol, meat and poultry and processed meat (P < 0.001). CFC was positively associated with diet quality (P < 0.001). Across food groups, major mediators of these relationships were higher health (8.4-32.6%), higher environmental (13.7-22.1 %) and lower innovation (7.3-25.1 %) concerns. Conclusions: CFC was associated with healthier dietary intake, essentially mediated by a greater motivation of future-oriented participants for self-centered and altruistic outcomes, including health and environment. Focusing on the awareness of future benefits in public health interventions might lead to healthier dietary behaviors.