12th European Public Health Conference 2019–01: Parallel Programme
and a year after completed coaching than at start. Calculating
QALY, we can see that the impact the coach makes on our
clients is cost effective and one person being coached saves the
amount in hospital costs that we can use to coach 30 more.
We have learned that online meetings are more cost effective
and practical for this type of concept. Our clients feel more
relaxed and open to the process at a location of their choosing
and it saves time for them, time they might not have taken
otherwise - therefore, we can help more people. Meetings
online enables us to reach all over the Västra Götaland region,
and not only the close proximity where the coaches are located.
Key messages:
 Online health coaching supports our health care and helps
the citizens to improve their lifestyle habits and their overall
health.
 The online method is cost effective and it saves money for
both health care and society.
Egg consumption and risk of total and cause-specific
mortality in a Mediterranean population
Licia Iacoviello
E Ruggiero1, A Di Castelnuovo2, S Costanzo1, M Persichillo1, A
De Curtis1, C Cerletti1, MB Donati1, G de Gaetano1, L Iacoviello1,3,
M Bonaccio1
1
Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli,
Italy
2
Cardiocentro, Mediterranea, Naples, Italy
3
Department of Medicine and Surgery, University of Insubria, Varese, Italy
Contact: licia.iacoviello@moli-sani.org
Background:
The relation between egg intake and health outcomes is
controversial. We aimed to evaluate the association of egg
consumption and risk of mortality in a large sample of an
adult Mediterranean population.
Methods:
We prospectively analyzed 22,849 men and women aged 35
y, recruited within the Moli-sani Study (2005-2010). Dietary
data were collected by the EPIC food frequency questionnaire,
egg intake was expressed as g/d and used as ordered quintiles.
Hazard ratios (HR) with 95% confidence interval (95%CI)
were calculated by multivariable Cox-regression and compet-
ing risk models.
Results:
Over a median follow up of 8.2 y, a total of 1,237 deaths were
ascertained. Mean weekly intake was 1.8 eggs (13 g/d) and
regular consumers (27 g/d corresponding to more than 2 eggs
per week) were more likely to report less risk factors (e.g.
history of cardiovascular disease, diabetes, smoking habit).
After adjustment for possible confounders, eating eggs >2
times/week) was associated with increased risk of all-cause
mortality (HR = 1.21; 95%CI 1.02-1.44 for Q4 vs Q1) and
coronary heart disease/cerebrovascular mortality
(HR = 1.51;1.04-2.18, for Q4 vs Q1) in a non-stepwise
manner; eating more than three eggs per week increased risk
of cardiovascular mortality by 33% (HR = 1.33;95%CI 1.00-
1.76 for Q5 vs Q1), while no association was found with cancer
death or mortality for other causes. Dietary cholesterol
explained up to 37% of the excess of CVD mortality risk
associated with the highest egg intake (>3 eggs/week).
Conclusions:
Regular egg intake (>2 times/week) was associated with
increased risk of CVD mortality in a general Mediterranean
population, and part of this association was likely due to its
cholesterol content.
Key messages:
 Eating egg regularly is not associated with health benefits,
rather it appears to increase CVD mortality risk.
 High dietary cholesterol content is likely to be on the
pathway between egg intake and increased CVD mortality.
155
Nutritional quality of food consumed (graded by the
FSAm-NPS / Nutri-Score) and mortality in Europe
Mélanie Deschasaux
Downloaded from https://academic.oup.com/eurpub/article-abstract/29/Supplement_4/ckz185.415/5624171 by Kangwon National University, Samcheok Campus user on 13 April 2020
M Deschasaux1,5, I Huybrechts2, N Murphy2, C Julia1,3, S Hercberg1,3,
B Srour1, P Ferrari2, E Riboli4, M Gunter2, M Touvier1
1
Nutritional Epidemiology Research Team (EREN), Inserm U1153, Inra
U1125, Cnam, Paris 13 University (CRESS), Bobigny, France
2
Nutrition and Metabolism Section, International Agency for Research on
Cancer, Lyon, France
3
Public Health Department, Avicenne Hospital (AP-HP), Bobigny, France
4
Faculty of Medicine, School of Public Health, Imperial College London,
London, UK
5
on behalf of all EPIC collaborators, Bobigny, France
Contact: m.deschasaux@eren.smbh.univ-paris13.fr
Background:
Unhealthy diets are major contributors for non-communicable
diseases (NCDs) and related deaths. To help consumers make
healthier food choices, political authorities are considering
implementing a simple label to reflect the nutritional quality of
food products. The Nutri-Score, based on the nutrient
profiling system of the Food Standards Agency (FSAm-NPS),
was chosen by several countries in Europe (France, Belgium,
Spain). Yet, its implementation is only voluntary per EU
regulation. Scientific evidence is therefore needed regarding
the relevance of the FSAm-NPS at the European level. Hence,
our objective is to study how the nutritional quality of foods
consumed graded by the FSAm-NPS relates to NCDs-related
mortality in European populations.
Methods:
Our prospective analyses included 501,594 adults from the
EPIC cohort (1992-2015, median follow-up: 17.2y). Usual
food intakes were assessed with standardized country-specific
methods. The FSAm-NPS was calculated using the 100g
content of each food in energy, sugar, saturated fatty acid,
sodium, fibres, proteins, and fruits/vegetables/legumes/nuts.
Multi-adjusted Cox proportional hazards models were
computed.
Results:
The consumption of foods with a higher FSAm-NPS score
(lower nutritional quality) was associated with a higher risk of
mortality overall (n = 50,743 events: HRQ5vs.Q1 = 1.06
[95%CI: 1.02-1.09], P-trend<0.001) and by cancer
(n = 21,971 events: HRQ5vs.Q1 = 1.06 [1.01-1.11], P-
trend = 0.003), respiratory diseases (n = 2,796 events:
HRQ5vs.Q1 = 1.33 [1.16-1.52], P-trend<0.001) and cardiovas-
cular diseases, although more weakly (n = 12,407 events:
HRQ5vs.Q1 = 1.05 [0.98,1.11], P-trend = 0.04).
Conclusions:
In this large multinational European cohort, consuming foods
with a higher FSAm-NPS score was associated with higher
mortality, supporting the relevance of the FSAm-NPS to grade
the nutritional quality of food products for public health
applications (e.g, Nutri-Score) to guide the consumers towards
healthier food choices.
Key messages:
 The consumption of food products with a lower nutritional
quality as graded by the FSAm-NPS score was associated
with higher mortality in the large multinational European
EPIC cohort.
 This adds support to the relevance of the FSAm-NPS to
grade the nutritional quality of foodstuffs for public health
applications (e.g. Nutri-Score label) to help consumers make
healthier food choices.
Consumption of ultra-processed foods and the risk of
overweight, obesity, and weight trajectories
Bernard Srour
B Srour1,4, M Beslay1,4, B Allès1, E Chazelas1, M Deschasaux1,
S Hercberg1,2, CA Monteiro3, E Kesse-Guyot1, M Touvier1,5, C Julia1,2,5
1
Inserm, Nutritional Epidemiology Research Team (EREN) - INSERM -
University of Paris 13, Bobigny, France
2
APHP, Public Health Department, Avicenne Hospital APHP, Bobigny, France
3
University of Sao Paulo, University of Sao Paulo - Department of Nutrition
and Public Health, Sao Paulo, Brazil
156 European Journal of Public Health, Vol. 29, Supplement 4, 2019
Contact: b.srour@eren.smbh.univ-paris13.fr
Previous epidemiological studies found associations between
the consumption of ultra-processed foods (UPF) and the risk
of obesity-related outcomes. The aim of this study is to
investigate the associations between UPF consumption and the
risk of overweight and obesity, and weight trajectories, in in
the French large scale NutriNet-Santé cohort.
Methods:
Overall, 110260 participants aged at least 18 years from the
French NutriNet-Santé cohort (2009-2019) were included.
Dietary intakes were collected using repeated 24h dietary
records, merged with a food composition database of 3300
different products, categorized according to their degree of
processing by the NOVA classification. Associations between
UPF intake and risks of overweight and obesity were assessed
using Cox proportional hazard models. Associations between
UPF intake and weight trajectories were assessed using linear
mixed models for repeated measures with random slope and
intercept.
Results:
UPF intake was associated with a higher risk of overweight
(n = 7063 incident cases; hazard ratio for an absolute
increment of 10 in the percentage of ultra-processed foods in
the diet = 1.11 (1.08-1.14); P < 0.0001) and obesity (n = 3066
incident cases; HR = 1.09 (1.05-1.13); P < 0.0001). Higher
consumers of UPF (4th quartile) were more likely to present an
2
Lawson Health Research Institute, Western University, London, Ontario,
Canada
3
Department of Psychiatry, Western University, London, Ontario, Canada
4
Department of Paediatrics, Western University, London, Ontario, Canada
Downloaded from https://academic.oup.com/eurpub/article-abstract/29/Supplement_4/ckz185.415/5624171 by Kangwon National University, Samcheok Campus user on 13 April 2020
5
Department of Family Medicine, Western University, London, Ontario,
Canada
6
Department of Population Health, Luxembourg Institute of Health,
Strassen, Luxembourg
Contact: saverio.stranges@uwo.ca
Background:
Sleep difficulties are an unmet public health problem, affecting
large segments of the population around the world. Poor sleep
quality and reduced sleep duration impact over half of older
adults and are associated with adverse health outcomes like
multiple chronic diseases (multimorbidity) and reduced
longevity.
Methods:
A cross-sectional analysis of the Canadian Longitudinal Study
on Aging (CLSA), a national health survey of community-
dwelling adults and older adults. A total of 30,011 participants
had physiological and psychosocial data collected at baseline.
Sleep measures included self-reported sleep duration (short:
<6 hours, normal: 6-8 hours, long: >8 hours) and sleep quality
(dissatisfied/very dissatisfied, neutral, satisfied/very satisfied).
To capture multimorbidity, a primary definition was oper-
ationalized with 17 chronic conditions, whereas a secondary
definition was operationalized with 9 chronic conditions to
capture both the primary care and public health perspective.
increase in body mass index over time ( = 0.04, P < 0.0001).
These results remained statistically significant after adjustment
for several markers of the nutritional quality of the diet (fruits
and vegetables and sugary drinks consumption, intakes of
saturated fatty acids, sodium, sugar, dietary fiber or Healthy/
Western patterns) and after a large range of sensitivity analyses.
Conclusions:
In this large observational prospective study, higher consump-
tion of UPF was associated with a higher risk of overweight
and obesity. Public health authorities in several countries
recently started to recommend privileging unprocessed/mini-
mally processed foods and limiting UPF consumption.
Key messages:
 The consumption of ultra-processed food is associated with
an increased risk of overweight and obesity. As the French
Public Helath agency recommends, their consumption
should be limited.
 Nutritional composition, food additives, contact materials,
or neoformed contaminants might play a role in these
associations and further studies are needed to understand
their relative contribution.
Relationship between sleep patterns and
multimorbidity in the Canadian Longitudinal Study on
Aging
Saverio Stranges
K Nicholson1, R Rodrigues1, K Anderson1,2,3, P Wilk1,2,4, G Guaiana1,3,
S Stranges1,5,6
1
Department of Epidemiology & Biostatistics, Western University, London,
Ontario, Canada
6.B. Health of refugees in Europe
Difference in access to health care for newly arrived
refugees in Germany: a natural quasi-experiment
Judith Wenner
J Wenner1, K Rolke1, O Razum1
1
Bielefeld University, School of Public Health, Department of Epidemiology
& International Public Health, Bielefeld, Germany
Contact: judith.wenner@uni-bielefeld.de
Background:
Providing quantitative evidence on structural access barriers to
health care for newly arrived refugees constitutes a challenge
Results:
In our sample, 50.9% were female (average age: 62.7 years) and
49.1% were male (average age: 63.2 years). The majority
reported a normal sleep duration and approximately half
reported being either satisfied or very satisfied with sleep
quality. About 70% were living with multimorbidity using the
primary care definition (females: 71.7%; males 64.3%), while
about 30% were living with multimorbidity using the public
health definition (females: 34.8%; males: 28.9%). The adjusted
analyses indicated the odds of multimorbidity increased for
those who reported short or long sleep duration, as well as
dissatisfaction with sleep quality, across age groups and both
females and males.
Conclusions:
Disrupted sleep may be an additional behavioural risk factor
for a number of chronic diseases, in the context of aging
populations. It is necessary to understand the potential impact
of sleep on the risk of multimorbidity, and this research will
build knowledge in this important area.
Key messages:
 This research will utilize a national health survey to examine
and report the characteristics of sleep quality and sleep
duration among approximately 30,000 community-dwelling
adults in Canada.
 This research will explore relationships between sleep
duration, sleep quality and multimorbidity (controlling for
confounding factors) among community-dwelling adults in
Canada.
due to a lack of suitable data. The coexistence of two different
local access models in Germany allows for a comparative
analysis of the association between access policies and realized
access. Our study compares these two models to establish
whether they lead to differences in access to care among
refugees.
Methods:
Municipalities in Germany’s largest federal state of North
Rhine-Westphalia (NRW) have implemented different access
models to which refugees are quasi-randomly assigned. We