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Health impacts of Food Compass among US adults

Image: dima_goroziya, Compass hand travel, Pixabay, Pixabay Licence

The Food Compass scoring system is an algorithm developed by researchers at Tufts University to assess the healthfulness of different food types. It has attracted some controversy on social media because of its counterintuitive rankings of some foods. This paper finds that following a diet that scores higher on the Food Compass system is linked to better outcomes on several aspects of health as well as all-cause mortality.

Specifically, US adults who consume diets that score more highly on the Food Compass system have more favourable measurements of Body Mass Index, blood pressure, LDL and HDL cholesterol, HbA1c (a biomarker for blood sugar stability) and fasting plasma glucose, as well as lower prevalence of metabolic syndrome, cancer and lung disease, and lower all-cause mortality (a 7% reduction for each standard deviation increase in individual Food Compass score). The authors argue that this demonstrates the validity of Food Compass for measuring the healthfulness of different foods and beverages. 

The paper accounted for several potential confounding factors including age, sex, ethnicity, education, income, smoking and alcohol use, but the authors note that some residual confounding factors might remain.



The Food Compass is a nutrient profiling system (NPS) to characterize the healthfulness of diverse foods, beverages and meals. In a nationally representative cohort of 47,999 U.S. adults, we validated a person’s individual Food Compass Score (i.FCS), ranging from 1 (least healthful) to 100 (most healthful) based on cumulative scores of items consumed, against: (a) the Healthy Eating Index (HEI) 2015; (b) clinical risk factors and health conditions; and (c) all-cause mortality. Nationally, the mean (SD) of i.FCS was 35.5 (10.9). i.FCS correlated highly with HEI-2015 (R = 0.81). After multivariable-adjustment, each one SD (10.9 point) higher i.FCS associated with more favorable BMI (−0.60 kg/m2 [−0.70,−0.51]), systolic blood pressure (−0.69 mmHg [−0.91,−0.48]), diastolic blood pressure (−0.49 mmHg [−0.66,−0.32]), LDL-C (−2.01 mg/dl [−2.63,−1.40]), HDL-C (1.65 mg/d [1.44,1.85]), HbA1c (−0.02% [−0.03,−0.01]), and fasting plasma glucose (−0.44 mg/dL [−0.74,−0.15]); lower prevalence of metabolic syndrome (OR = 0.85 [0.82,0.88]), CVD (0.92 [0.88,0.96]), cancer (0.95 [0.91,0.99]), and lung disease (0.92 [0.88,0.96]); and higher prevalence of optimal cardiometabolic health (1.24 [1.16,1.32]). i.FCS also associated with lower all-cause mortality (HR = 0.93 [0.89,0.96]). Findings were similar by age, sex, race/ethnicity, education, income, and BMI. These findings support validity of Food Compass as a tool to guide public health and private sector strategies to identify and encourage healthier eating.



O’Hearn, M., Erndt-Marino, J., Gerber, S., Lauren, B.N., Economos, C., Wong, J.B., Blumberg, J.B. and Mozaffarian, D., 2022. Validation of Food Compass with a healthy diet, cardiometabolic health, and mortality among US adults, 1999–2018. Nature Communications, 13(1), pp.1-14.


Read the full paper here. See also the TABLE explainer What is a healthy sustainable eating pattern?

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