Nuts and Nutri-Score: could they get along better?

Bridging the gap between dietary guidelines and intakes.

Dr Emilio Ros

Endocrinology and Nutrition Service and Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain


Common nuts (tree nuts and peanuts) are energy-dense foods that nature has gifted with a complex matrix of beneficial nutrients and bioactives, including unsaturated fatty acids, high-quality protein, fiber, non-sodium minerals, tocopherols, phytosterols,

and potent phenolic antioxidants. These nut components synergize to favorably influence metabolic and vascular physiology pathways that result in many health benefits, foremost lower rates of cardiovascular disease incidence and mortality. There is increasing evidence that nuts beneficially impact other health outcomes, including cancer incidence and mortality, cognitive function, depression, and all-cause mortality.

Randomized controlled trials consistently show nuts have a cholesterol-lowering

effect. Nut consumption also confers modest improvements on glycemic control, blood pressure, endothelial function, and inflammation. Although nuts are energy-dense foods, they do not predispose to obesity, and in fact may even help in weight loss. First level evidence from the PREDIMED trial shows that, in the context of a Mediterranean diet, consumption of 30 g/d of nuts (walnuts, almonds, and hazelnuts) significantly lowered the risk of a composite endpoint of major adverse cardiovascular events (myocardial infarction, stroke, and death from cardiovascular disease) by nearly 30% after intervention for 5 y. Impressively, the nut-supplemented diet reduced stroke risk by 45%. A daily handful of raw nuts, if possible unpeeled and otherwise unprocessed, may be incorporated into any plant-based diet to further cardiovascular and overall well-being and promote healthy aging.


Born in Girona, Spain in 1945. Founder and former head of the Lipid Clinic, Endocrinology Service, Hospital Clínic, Barcelona. Emeritus Investigator, Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS,) Barcelona.

Former principal investigator and now associate member of the research group “Nutrition, Lipids and Cardiovascular Risk”, CIBEROBN, Instituto de Salud Carlos III, Spain. Received MD degree 1968 and PhD 1991, University of Barcelona. Postgraduate training in USA (1970-1976).

American Board of Internal Medicine and American Board of Gastroenterology, Boston 1973-75. Member and founder of the Spanish Arteriosclerosis Society (SEA); member of European and International Atherosclerosis Societies and American College of Cardiology.

Awards to best scientific career in Nutrition from Fundación Danone 2013, SEA 2014, and Catalan Nutrition Center 2015. Has published more than 460 original papers, over 140 review papers, 30 editorials, and 95 scientific textbook chapters (h index 82; ORCID identifier 0000-0002-2573-1294). He has been a speaker at many scientific conferences and professor at many courses focused on nutrition, lipid metabolism, atherosclerosis, and cardiovascular prevention.

Research interests: nutrition in the prevention of cardiovascular diseases and cognitive decline, with especial interest in the Mediterranean diet and walnuts; plant sterols; blood membrane fatty acids; genetic dyslipidemias; cardiovascular risk assessment; and vascular imaging techniques, especially carotid ultrasound.

He also led the nutritional intervention of the landmark PREDIMED trial of Mediterranean diet for primary cardiovascular prevention.

Prof. Jean-Michel Lecerf

Nutritionist, specialist in endocrinology and metabolic diseases, and head of the Nutrition & Physical Activity Department at the Institut Pasteur de Lille (IPL)


Nutritional labelling is requested by the consumers in order to improve their knowledge about the nutritional content and qualities of foods. This is a justified request because it is quite difficult to understand and translate the current nutritional composition table into a useful information.

            Nutriscore is derived from a system developed by the British Food safety Agency and is based on a complex calculation including “good” (fruits, vegetables, pulses, nuts, rapeseed, walnut and olive oils, fibre, to which proteins are added in some cases) nutrients or foods, and “bad” (sodium, saturated fatty acids, sugars, energy) nutrients. The final score is translated into letters from A to E and colours (green to red). It has been tested and compared to other Front-of-Pack labels and it appears as the most understandable and efficient to help consumers to make choices which get closer toa well-balanced diet, and to the French recommendations from the PNNS (Health National Nutrition Program). It can help consumers who want to compare foods in the same categories. The second objective of these Front-of-Pack labels is to encourage the food industry to improve the recipes of processed foods.

            However some improvements are needed:

  • About consumers’ information: A good nutrition is coming from a varied diet. No food product is intrinsically “bad”. It depends on the amount eaten and on the frequency of consumption. A diet exclusively composed of Nutri-Score “A” foods could not be well-balanced. Messages should be systematically added concerning diversity and amounts of foods. Indeed, the size of the portion is not sufficiently taken into consideration.
  • About the algorithm. Some nutrients are not taken into account, such as iron, iodine, calcium, magnesium, polyunsaturated fatty acids (omega 6 and 3), or polyphenols, although they are important due to their roles in the organism and to the high prevalence of deficiencies or inadequate intakes in the population.
  • About the complexity of the foods: Processed food products, and especially industrial ones, may contain specific ingredients and additives with sometimes uncertain effects on health; this is often related to changes in the food structure, the so-called “matrix effect” which would also need to be taken into account. For instance, dairy products are rich in saturated fatty acids but have an opposite effect compared to saturated fatty acids from meat products on cardiometabolic diseases.

Although nutritional information is only one among many ways to influence purchasing and eating behaviours, a Front of Pack Labelling is necessary to facilitate consumer’s choices. However, it should be improved by incorporating other nutritional features.


Jean-Michel Lecerf was a Medical Doctor and Endocrinologist, in the Internal Medicine Department of the University Hospital of Lille from 1982 to 2020.

He is Head of the Nutrition Department of Institut Pasteur de Lille since 1982 and Head of the Centre Prévention Santé Longévité of Institut Pasteur de Lille.

He is the author and co-author of 900 medical and scientific papers whom 300 with reviewer committee. He also authored 20 books in the field of nutrition, diabetes, dyslipidemia, obesity, cardiovascular-risk. He is member of many scientific societies (French Society of Nutrition (SFN), French Society of Diabetes (SFD), Académie d’Agriculture de France) and scientific advisory boards. He is also an expert for the French Agency of Food Security (ANSES), the French Haute Autorité de Santé (HAS), the Fonds Français Alimentation Santé (FFAS) and the Association Française de Normalisation (AFNOR).

Dr. Véronique Braesco

CEO, VAB-nutrition
Agronomic engineer, PhD in human nutrition

Véronique Braesco is an agronomic engineer, with a PhD in human nutrition.

She had an academic career in the French National Institute for Agronomic Research, where she worked as a research fellow and then director, in the Human Food Research Department, on the topic of fat-soluble vitamins.

Then, she led nutrition research for Danone Group from 2000 to 2003, in charge of designing and implementing scientific strategies in nutrition and health and to contribute to the development of innovative products. She was later director at the CRNH (Centre for Research into Human Nutrition) in Auvergne (France) until 2007.

In 2007, strengthened by her experiences in both public and private sectors, Véronique Braesco founded VAB-nutrition, a consultancy and service company dedicated to food and food-related industries. VAB-nutrition brings its scientific experience and expertise to support its clients in (re)shaping their position in the health and nutrition area, developing added-value products and creating distinctive communications.

During her career, she sat at several expert committees both national and international (EFSA, WHO). Especially, regarding nutrient profiling, she has been involved in several working groups (ANSES, IFN…) and authored several scientific contributions.

She has also written over a hundred scientific articles on nutrition.