Higher adherence to French dietary guidelines and chronic diseases in the prospective SU.VI.MAX cohort

Randomized, double-blind, placebo-controlled SU.VI.MAX trial of daily antioxidant vitamin/mineral supplementation. Participants were adults from the general population: women aged 35–60 years and men aged 45–60 years at baseline; initial enrollment included 7,713 women and 5,028 men; primary prevention with long-term follow-up (up to 13 years).

Daily antioxidant vitamins and minerals supplementation at nutritional doses for 7.5 years.

Higher adherence to the PNNS Guidelines Score (PNNS-GS) was associated with a lower risk of cardiovascular disease (HR 0.65; 95% CI 0.42-1.00; P for trend 0.04) over a mean follow-up of 11.6 years. No significant associations with cancer or all-cause mortality overall. A significant interaction with smoking showed higher cancer risk in smokers in the highest PNNS-GS quartile (HR 2.50; 95% CI 1.10-5.68; P for trend 0.02). Conclusion: better adherence to French nutritional guidelines may reduce cardiovascular disease risk; no overall impact on cancer or mortality, though smoking status may modify cancer risk in high-adherence individuals.

Volunteer, health-conscious study population, limiting generalizability; potential selection bias; analyses restricted to those with PNNS-GS data; limited power for cancer/mortality outcomes due to sample size and mean follow-up ~11.6 years; potential residual confounding from smoking.