Sixteen-year trends in fruit consumption and related socioeconomic inequalities among adolescents in Western European countries.

PURPOSE: To investigate time trends in daily fruit consumption among Western European adolescents and in related socioeconomic inequalities. METHODS: We used nationally representative data from 18 countries participating in five rounds (2002 to 2018) of the cross-sectional "Health Behaviour in School-aged Children" (HBSC) survey (n = 458,973). The questionnaire, standardised across countries and rounds, was self-administered at school by 11-, 13- and 15-year-old adolescents. Daily fruit consumption was assessed using a short food frequency questionnaire (sFFQ). Socioeconomic inequalities were measured using the Family Affluence Scale (FAS). Multilevel logistic regressions were applied to study linear time trends in daily fruit consumption, overall, by country and by FAS. RESULTS: Between 2002 and 2018, daily fruit consumption increased in 10 countries (OR range, 1.04 to 1.13, p < 0.05) and decreased in 3 (OR range 0.96 to 0.98, p < 0.05). In all survey years combined, prevalence of daily fruit consumption was significantly higher among high FAS groups (42.6%) compared to medium (36.1%) and low FAS groups (31.7%; all countries: p < 0.001). Between 2002 and 2018, socioeconomic inequalities in fruit consumption increased in Austria, Germany, Italy, Netherlands, Scotland, Sweden, and Switzerland. Only in Norway FAS inequalities decreased while the prevalence increased. CONCLUSION: The prevalence of daily fruit consumption generally increased among adolescents between 2002 and 2018 in Western European countries, yet socioeconomic inequalities increased in some countries. Public health interventions should continue to promote fruit consumption with special attention to lower socioeconomic groups.

Long-term trends in the consumption of sugary and diet soft drinks among adolescents: a cross-national survey in 21 European countries.

PURPOSE: To assess country-level trends in the prevalence of daily consumption of sugary (2002-2018) and diet (2006-2018) soft drinks among European adolescents, overall and by family material affluence. METHODS: We used 2002, 2006, 2010, 2014 and 2018 data from the 'Health Behaviour in School-aged Children' survey. Nationally representative samples of adolescents completed a standardised questionnaire at school, including a short food frequency questionnaire (n = 530,976 and 21 countries for sugary soft drinks; n = 61,487 and 4 countries for diet soft drinks). We classified adolescents into three socioeconomic categories for each country and survey year, using the Family Affluence Scale. Multilevel logistic models estimated time trends, by country. RESULTS: Sugary soft drinks: the prevalence of daily consumption (≥ 1×/day) declined in 21/21 countries (Plinear trends ≤ 0.002). Absolute [range - 31.7 to - 3.4% points] and relative [range - 84.8 to - 22.3%] reductions varied considerably across countries, with the largest declines in Ireland, England and Norway. In 3/21 countries, the prevalence of daily consumption decreased more strongly in the most affluent adolescents than in the least affluent ones (P ≤ 0.002). Daily consumption was more prevalent among the least affluent adolescents in 11/21 countries in 2018 (P ≤ 0.002). Diet soft drinks: overall, daily consumption decreased over time in 4/4 countries (Plinear trends ≤ 0.002), more largely among the most affluent adolescents in 1/4 country (P ≤ 0.002). CONCLUSIONS: Daily consumption of sugary and diet soft drinks in European adolescents decreased between 2002 (2006 for diet drinks) and 2018. Public health interventions should continue discouraging daily soft drink consumption, particularly among adolescents from lower socioeconomic groups.

Sixteen-year trends in adolescent consumption of sugar-sweetened soda in six European countries with a soda tax and comparison countries: a repeated cross-sectional survey analysis.

OBJECTIVE: To examine changes in the proportions of daily, weekly and occasional consumers of sugar-sweetened soda in six European countries that introduced/updated a tax between 2001-2002 and 2017-2018 and in neighbouring comparison countries (without a tax). DESIGN: Repeated cross-sectional surveys. SETTING: Health Behaviour in School-aged Children study, spanning five survey years (school years 2001-2002 to 2017-2018). PARTICIPANTS: Nationally representative samples of 13-year- and 15-year-old adolescents (n 236 623, 51·0 % girls). RESULTS: Tax sizes (€0·02/l to €0·22/l) and pre-tax soda consumption were heterogeneous across countries. Prevalence of daily soda consumption reduced in the survey year following tax implementation in Latvia (from 17·9 to 11·9 %, P = 0·01), Finland (4·2 to 2·5 %, P = 0·001), Belgium (35·1 to 27·8 %, P < 0·001) and Portugal (17·4 to 14·9 %, P = 0·02), but not in Hungary (29·8 to 31·3 %, P = 0·47) or France (29·4 to 28·2 %, P = 0·27). However, reductions were similar (Finland) or smaller (Belgium, Portugal) than those in the comparison countries, except in Latvia where the reduction was larger (Pinteraction < 0·001). Prevalence of weekly soda consumption remained stable (Finland, Hungary and France) or increased (Latvia, Belgium); only Portugal experienced a decline (P < 0·001), which was larger than in the comparison country (Pinteraction < 0·001). Prevalence of occasional soda consumption (<1x/week) did not rise after implementation of the tax in Latvia, Finland, Hungary, France or Belgium, or the rise was similar to the comparison country in Portugal (Pinteraction = 0·15). CONCLUSIONS: Countries with a soda tax did not experience larger beneficial changes in post-tax adolescent consumption frequency of soda than comparison countries. Further studies, with different taxation types, are needed in the adolescent population.

The cost of diets according to diet quality and sociodemographic characteristics in children and adolescents in Belgium.

This study aims to estimate cost variations according to diet quality and sociodemographic characteristics in children. Data (n = 1,596; 5-17 y) from the Belgian National Food Consumption Survey were used. The "Kidmed index" and dietary patterns (DP) identified through principal component analysis were used to assess diet quality. Daily diet cost was estimated after linking the consumed foods with the GfK ConsumerScan panel food prices. The mean diet cost was 4.68€/day (SEM: 0.05). Adjusted for covariates and energy intake, the mean diet cost was 9.1% higher in the highest Kidmed adherence (vs. the lowest) and 6.2% higher in the tercile T3 (vs. T1) of the "Healthy" DP score. It was 4.8% lower in the T3 (vs. T1) for the "Junk food" DP score. Diet cost was higher in 12-17 year-olds (vs. 5-11 years) and in medium and high educated household (vs. the lowest). These findings support policies to make healthy diets more affordable.

Dietary disparities among adolescents according to individual and school socioeconomic status: a multilevel analysis.

This study aimed to estimate disparities in dietary habits according to the individual and contextual socioeconomic status (SES), while taking into account school nutrition-related characteristics. Data came from the 2018 cross-sectional "Health Behaviour in School-aged Children" (HBSC) survey. Multilevel multiple logistic regressions were performed. Over two-thirds of the observed variance was explained by individual and school characteristics, with SES being the main contributors. For example, 76.9% of the variance in daily sugar-sweetened beverage (SSB) intake was explained by individual and school characteristics. Adolescents of a secondary or lower parental education level were more likely to consume SSB daily than those of a post-secondary level (aOR = 1.46 (1.29-1.66)). Compared to those in a high SES school, the odds to consume SSB daily was higher for adolescents in low SES schools (aOR = 2.37(1.90-2.96)). These findings support the need for schools to pursue a consistent nutrition policy, with an increased support in low socioeconomic populations.

Ten-year changes in diet quality among adolescents and young adults (Food Consumption Survey 2004 and 2014, Belgium).

PURPOSE: To estimate the 10-year change in the overall nutritional quality of adolescent and young adult's diet, as measured by the modified Nutrient Profiling System of the British Food Standards Agency individual Dietary Index (FSAm-NPS-DI) which funds the Nutri-Score development, and in different components of this score, overall and according to the individual characteristics. METHODS: Two 24-h dietary recalls were carried out in 15- to 39-year-old respondents included in the Belgian Food Consumption Surveys in 2004 (n = 1186) and 2014 (n = 952). The weighted mean individual FSAm-NPS-DI was computed from all foods and beverages consumed, converted into a scale from 0 to 100 (from the poorest to the most favorable diet), and compared between survey years. Subject characteristics associated with the score, along with the mean daily intake of food groups, energy, and nutrients were explored in multiple linear regressions stratified by survey year and age group. RESULTS: The weighted mean daily FSAm-NPS-DI significantly increased between 2004 and 2014 [2004: 55.3 (SEM: 0.2) vs. 2014: 57.4 (0.5), P < 0.001 in 15- to 18-year olds; 55.0 (0.6) vs. 58.1 (0.4), P < 0.001 in 19- to 25-year olds; 57.1 (0.4) vs. 58.5 (0.3), P < 0.01 in 26- to 39-year olds]. SFA intake decreased in all age groups, and sugar-sweetened beverage, sugar, sodium, and fiber intakes decreased among 15‒18-year olds. The nutritional quality changed unevenly according to sociocultural characteristics, levels of education and regions being the main sources of disparities. CONCLUSION: The quality of diet improved overall between 2004 and 2014 among young people in Belgium, an uneven change that need to be confirmed in future surveys, following the implementation of the Nutri-Score.

Relationship between sensory liking for fat, sweet or salt and cardiometabolic diseases: mediating effects of diet and weight status.

PURPOSE: Previous works have been suggested that individual sensory liking is a predictor of dietary intake and weight status, and may consequently influence development of cardiometabolic diseases (CMDs). We investigated the association between sensory liking for fat-and-salt, fat-and-sweet, sweet or salt and the onset of hypertension, diabetes and cardiovascular diseases (CVDs) over 6 years in adults, and the mediating effects of dietary intake and body mass index (BMI). METHODS: We examined the CMDs risk among 41,332 (for CVD and diabetes) and 37,936 (for hypertension) French adults (NutriNet-Santé cohort). Liking scores, individual characteristics, diet and anthropometry were assessed at baseline using questionnaires. Health events were collected during 6 years. Associations between sensory liking and CMDs risk, and the mediating effect of diet and BMI, were assessed using Cox proportional hazards models. RESULTS: Sensory liking for fat-and-salt was associated with an increased risk of diabetes, hypertension and CVD [hazard ratios (HR) for 1-point increment of the sensory score: HR 1.30 (95% CI 1.18, 1.43), HR 1.08 (1.04, 1.13) and HR 1.10 (1.02, 1.19), respectively]. BMI and dietary intake both explained 93%, 98% and 70%, of the overall variation of liking for fat-and-salt liking in diabetes, hypertension and CVD, respectively. Liking for fat-and-sweet and liking for salt were also associated with an increased risk of diabetes [HR 1.09 (1.01, 1.17) and HR 1.09 (1.01, 1.18), respectively], whereas liking for sweet was associated with a decreased risk [HR 0.76 (0.69, 0.84)]. CONCLUSIONS: Higher liking for fat-and-salt is significantly associated with CMDs risk, largely explained by dietary intake and BMI. Our findings may help to guide effective targeted measures in prevention.

Combining breastfeeding and work: findings from the Epifane population-based birth cohort.

BACKGROUND: Return to work is often cited as a reason for early cessation of breastfeeding (BF). Our objectives were to study the time span during which women employed prior to pregnancy returned to work according to BF duration category, and to identify sociodemographic, behavioral and pregnancy characteristics of women who continued BF after returning to work. METHODS: Information on BF mode and work status was prospectively collected in a French nation-wide birth cohort up to 1 year after delivery. Time of return to work according to BF category was addressed using Kaplan-Meier curves and Poisson regression adjusted on co-variates. Multiple logistic regression enabled to identify characteristics associated with the combination of BF with work. RESULTS: Among 2480 women holding jobs prior to pregnancy, 82.0% returned to work within a year postpartum. Women who breastfed > 4 months returned at median of 6.5 months, whereas those who did not breastfeed at all returned to their jobs at 4.0 months, those who had breastfed for less than 1 month returned at 4.5 months, and those who had breastfed for 1 to 4 months returned at 4.0 months. Around one-third of women (34.5%) combined BF and work, and breastfed for a longer duration (median: 213 days, vs. 61 days for women who stopped BF before returning to work). Women born outside of France or who were self-employed were more likely to combine BF and work, while intermediate employees, manual workers, women who quitted smoking during pregnancy, who had smoked before and during pregnancy, or who had given birth by cesarean section were less likely to combine BF and work. CONCLUSION: Women who had breastfed for less than 4 months, or not at all, returned to their jobs at comparable times. This suggests that working women should be encouraged to breastfeed, even for a short duration. Moreover, only one-third of working women succeeded in combining BF and work, highlighting the need for a support system that would encourage flexibility.

Socio-economic and cultural disparities in diet among adolescents and young adults: a systematic review.

OBJECTIVE: To explore dietary differences according to socio-economic and sociocultural characteristics of adolescents and young adults. DESIGN: A systematic review was conducted. SETTING: The main search source was MEDLINE, consulted between January 2012 and March 2017. Quality of selected studies was assessed based on dietary measurement method, sample selection, socio-economic indicator choice and statistical modelling. PARTICIPANTS: Cross-sectional and longitudinal studies, assessing relationships between socio-economic status and dietary intake (patterns, scores and food groups) in the 10- to 40-year-old general population of high-income countries, were selected. RESULTS: Among the 7250 reports identified, forty were selected, seventeen of which were of high quality; their conclusions, related only to adolescents, were combined and presented. The most favourable dietary patterns, higher dietary scores, greater consumption of fruits, vegetables and dairy products, and lower consumption of sugary sweetened beverages and energy-dense foods, were associated with better parental socio-economic status, particularly in terms of higher education. Migrant status was associated with plant-based patterns, greater consumption of fruits and vegetables and of sugary sweetened beverages and energy-dense foods. For the other food groups, and for young adults, very few high-quality studies were found. CONCLUSIONS: The socio-economic gradient in adolescent diets requires confirmation by higher-grade studies of a wider set of food groups and must be extended to young adult populations. Future nutritional interventions should involve the most vulnerable adolescent populations, taking account of socio-economic status and migration.

Estimating sodium intake from spot urine samples at population level: a validation and application study in French adults.

The aim of this study was to assess the validity of the predictive INTERSALT equation using spot urine samples to estimate 24-h urinary Na (24-hUNa) excretion and daily Na intake among the French adult population. Among 193 French adults ('validation sample'), we assessed the validity by comparing predicted 24-hUNa excretion from spot urine and measured 24-hUNa excretion from 24-h urine collections. Spearman correlation coefficients and Bland-Altman plots were used and we calculated calibration coefficients. In a nationally representative sample of 1720 French adults ('application sample'), the calibrated predictive equation was then applied to the spot urine Na values to estimate 24-hUNa excretion and daily Na intake. In that sample, predicted Na intake was compared with that estimated from 24-h dietary recalls. Results were adjusted and corrected using calibration coefficients. In the validation sample, the measured 24-hUNa excretion was on average 14 % higher than the predicted 24-hUNa (+13 % for men and +16 % for women). Correlation between measured and predicted 24-hUNa excretion was moderate (Spearman r 0·42), and the Bland-Altman plots showed underestimation at lower excretion level and overestimation at higher level. In the application study, estimated daily salt intake was 8·0 g/d using dietary recalls, 8·1 g/d using predicted INTERSALT equation and 9·3 g/d after applying calibration coefficients calculated in the validation study. Despite overall underestimation of 24-hUNa excretion by spot urinary Na, the use of predictive INTERSALT equation remains an acceptable alternative in monitoring global Na intake/excreted in the French population but its use is not advised at the individual level.

Perceived social support from teachers and classmates does not moderate the inverse association between body mass index and health-related quality of life in adolescents.

PURPOSE: The current study investigated the association between body mass index (BMI) and health-related quality of life (HRQoL) among a large and non-clinical sample of adolescents, and tested the possible moderating effect of perceived teacher and classmate support on this association. METHODS: French-speaking Belgian adolescents (n = 11,342) self-reported height and weight, HRQoL (KIDSCREEN-10), as well as their perception of teacher and classmate relationships. Adjusting for sociodemographics, linear regression analyses with HRQoL as the outcome variable were performed for boys and girls separately. Interactions between BMI and teacher support, and between BMI and classmate support were included to examine the effect of this support on the association between BMI and HRQoL. RESULTS: Obesity was associated with lower HRQoL for boys (ß = - 2.14, p = 0.002) and for girls (ß = - 2.96, p = 0.001), while only overweight girls showed a significant impaired HRQoL compared with normal-weight ones (ß = - 0.94, p = 0.01). In both sexes, lower perceived teacher and classmate support was associated with lower HRQoL. Interactions between BMI and perceived teacher relationships, and between BMI and perceived classmate relationships, were not significant for boys as for girls. CONCLUSIONS: Perceived school-related social support constitutes an important dimension of adolescent well-being, suggesting the relevance of considering it for promoting greater HRQoL in overweight and obese youth. Future studies are needed to confirm the absence of moderating effect of this support and explore its effect on other weight-related factors, like body image, weight misperception and bullying, associated with decreased HRQoL in adolescents.

Environmental correlates of physical activity among children 10 to 13 years old in Wallonia (Belgium).

BACKGROUND: In Belgium, as in many other countries, the juvenile practice of physical activity is insufficient. A growing attention has been paid to environmental factors that may influence physical activity but with inconsistent findings. This study aims to estimate the association between daily life environment characteristics and physical activity among children 10 to 13 years old in Wallonia (Belgium). METHODS: Data were collected using a self-administered questionnaire among 1940 children (HBSC survey). Associations between factors related to the children's living environment and physical activity (vigorous physical activity (VPA) ≥ twice a week; global physical activity (GPA) defined as VPA ≥ twice a week and moderate-to-vigorous physical activity ≥1 h/day) were estimated using logistic regressions adjusted for potential confounders. RESULTS: Nearly three-quarters of the children practiced VPA ≥ twice a week, but only one in five practiced GPA consistent with recommendations. After adjustment, children living in a neighborhood with playgrounds or parks were more likely to achieve a recommended level of GPA (OR: 1.34 [1.04-1.73]), as were children who reported that other youngsters were present in their neighborhood with whom they could play outside (OR: 1.50 [1.12-1.99]). The presence of neighborhood children was also positively associated with VPA (OR: 1.80 [1.42-2.29]); in stratified analyses, the association was significant only among boys (OR: 1.95 [1.34-2.82]). Moreover, and only in girls (OR: 1.66 [1.10-2.49]), a feeling of safety in one's neighborhood was positively associated with VPA. No association was found between VPA and the existence of a yard or a garden at home to go playing outside. CONCLUSION: Our results argue for developing actions aimed at creating living environments more favorable to children's daily physical activity. More specifically, they help better understand the environment of Belgian children and thus contribute to better identify their needs.

Feelings about the timing of first sexual intercourse and health-related quality of life among adolescents.

BACKGROUND: Early sexual intercourse (SI) may have long-lasting negative impacts on health-related quality of life (HRQoL). So far, these impacts have been studied using age for defining early SI instead of feelings about its timing. The present study examined the association between feelings about the timing of first SI and current HRQoL. METHODS: Data came from the 2014 cross-sectional Health Behaviour in School-aged Children (HBSC) study in French-speaking Belgium. Among participants aged 16-20 years who already had SI, 1778 were included in analyses. Univariate and multivariate logistic regressions were performed, including potential confounders. RESULTS: One quarter of adolescents (26.4%) had poor HRQoL, 19.8% expressed a negative feeling about the timing of first SI and 19.6% did not think about it. Compared with adolescents who thought first SI happened at the right time or wished it had happened sooner, adolescents who had a negative feeling about the timing and those who did not think about it were more likely to have a poor HRQoL (cOR = 1.67 (1.28-2.17) and cOR = 1.37 (1.05-1.80), respectively). After adjustment, associations were no more significant (aOR = 1.22 (0.91-1.63) and aOR = 1.22 (0.91-1.64)). Sex disparity in expressing a negative feeling mostly explained the difference between crude and adjusted analyses. CONCLUSION: Further research is needed to better understand such a complex relationship. The high proportion of adolescents having poor HRQoL and negative feeling about the timing of first SI shows how important it is to find out effective prevention for both domains.

Influence of food preparation behaviors on 5-year weight change and obesity risk in a French prospective cohort.

BACKGROUND: Food preparation behaviors may markedly determine dietary intake and consequently influence weight status. However, the few available studies have found equivocal results. No study has prospectively investigated the association between food preparation behaviors and weight change over time. We estimated the associations of food preparation behaviors with the 5-year relative weight change and the risk of developing obesity in 12,851 French adults participating in the NutriNet-Santé cohort study. The mediating effect of dietary intake was also addressed. METHODS: Frequency and time for meal preparation, cooking skills, preparation from scratch, kitchen equipment, cooking enjoyment, willingness to cook better/more frequently and dietary intake were assessed at baseline using web-based questionnaire and 24 h records, respectively. Self-reported anthropometric data were collected using questionnaire, at baseline and after 5 years of follow-up. Associations of such behaviors with 5-year relative weight change and the mediation analyses were assessed through multivariate linear regression models, and obesity risk was analyzed with logistic regression, stratified by sex and adjusted for age, household composition, education, occupation, income, physical activity, smoking and history of dieting. RESULTS: In women, preparation from scratch was prospectively associated with a decreased risk of obesity over the 5-year follow-up (OR = 1.32 (1.08; 2.32)) after adjustment. After including dietary mediating factors, the association between preparation from scratch and obesity risk in women did not remain significant (P = 0.08). This association appeared to be partly mediated by dietary factors with a difference of 59% of the estimate, in the group with the low score, between the adjusted model and those with mediators (OR = 1.13 (0.71; 1.77)). Regarding 5-year relative weight change, after adjustment for confounding factors, all associations between indicators of food preparation behaviors and weight change became non significant. CONCLUSIONS: In the context from reduced time spent preparing meals that could have an impact on dietary quality and health in industrialized countries, our prospective study does not show effect of food preparation behaviors on 5-year relative weight change and obesity risk, except for preparation from scratch on obesity risk in women. Our study provides useful information about the long term implications of food preparation behaviors on health and should be corroborated by future studies, particularly on the effect of food preparation behaviors on chronic diseases such as incident diabetes, hypertension or cardiovascular diseases, compared with other determinants. TRIAL REGISTRATION: NCT03335644 on ClinicalTrials.gov.

Association between breakfast composition and abdominal obesity in the Swiss adult population eating breakfast regularly.

BACKGROUND: Evidence from experimental and observational studies is limited regarding the most favorable breakfast composition to prevent abdominal fat accumulation. We explored the association between breakfast composition (a posteriori derived dietary patterns) and abdominal obesity among regular breakfast eaters from a Swiss population-based sample. METHODS: The cross-sectional survey assessed diet using two 24-h dietary recalls in a nationally representative sample of adults aged 18 to 75 years. We derived dietary patterns using principal component analysis based on the intake of 22 breakfast-specific food groups. All regular breakfast eaters were predicted an individual score for each identified pattern, and then classified into tertiles (T1, T2, T3). We defined abdominal obesity as waist-to-hip ratio (WHR) ≥ 0.9 in men and ≥ 0.85 in women. Logistic models were adjusted for sociodemographic characteristics, relevant nutrition- and health-related behaviors, and diet quality during the rest of the day. RESULTS: Of the 2019 included survey participants, 1351 (67%) were regular breakfast eaters. Among them, we identified three breakfast types: 1) 'traditional' - white bread, butter, sweet spread, 2) 'prudent' - fruit, unprocessed and unsweetened cereal flakes, nuts/seeds, yogurt, and 3) 'western' - processed breakfast cereals, and milk. The 'prudent' breakfast was negatively associated with abdominal obesity. After full adjustment, including diet quality during the rest of the day, the association was weaker (T3 vs. T1: OR 0.72, 95% CI: 0.47 to 1.08). People taking a 'prudent' breakfast (in T3) had 1.2% lower WHR compared to people taking a breakfast distant from 'prudent' (in T1) (P = 0.02, fully adjusted model with continuous log-WHR). We found no association between 'traditional' or 'western' breakfasts and WHR (OR 1.00, 95% CI: 0.67 to 1.50 and OR 1.16, 95% CI: 0.79 to 1.71, respectively). Findings were in the same directions for the three breakfast types when defining obesity with waist circumference, waist-to-height ratio, or body mass index (≥ 30 kg/m2, for 'prudent' breakfast: OR 0.51, 95% CI: 0.31 to 0.85). CONCLUSIONS: Regular breakfast consumers had less abdominal obesity if their breakfast was composed of fruit, natural cereal flakes, nuts/seeds and yogurt. This association was partly explained by their healthier diet during the rest of the day. TRIAL REGISTRATION: ISRCTN16778734 .

Socio-economic and demographic factors associated with snacking behavior in a large sample of French adults.

BACKGROUND: Few studies have specifically focused on demographic and socio-economic characteristics associated with snacking in adults, whereas their identification could be useful for defining effective public health measures. The aim of our study was to assess the associations of these factors with daily snacking behavior and its dietary quality. METHODS: This cross-sectional study included 84,692 women and 23,491 men from the NutriNet-Santé cohort study. Occurrence of snacking, energy intake from snacks, snack nutrient, and energy densities were assessed using 24-h dietary records of weekdays at baseline. Associations between socio-economic and demographic factors (age, presence of children in the household, education, income, occupation), and snacking behavior were examined using multivariable logistic regression and analysis of covariance, stratified by sex and adjusted for total daily energy intake. RESULTS: Older individuals were more likely to snack during the day in both sexes while individuals with primary education (OR = 0.79 (0.71;0.87) in women; OR = 0.71 (0.60;0.83) in men), female employees (OR = 0.94 (0.89;0.99), and self-employed women were less likely to snack during the day. Older individuals, in particular middle-aged subjects, had higher snack nutrient density, and lower energy intake and density from snacks compared with younger adults. Presence of a child in the household was associated with higher energy density, lower nutrient density (in women), and lower energy intake from snacks (in men), compared with those who lived without a child in household. In low income individuals and manual workers, snacks had lower nutrient density and higher energy content than in higher socioeconomic categories. At last, energy intake from daily snacking occasions was higher in women with low education level. CONCLUSIONS: Although snacking was less prevalent in low socioeconomic categories and young adults, their snacks had higher energy content and were of poorer nutrient density. Such findings provide useful information on mechanisms of social disparities in dietary behavior. TRIAL REGISTRATION: This study was conducted according to the guidelines laid down in the Declaration of Helsinki. All procedures were approved by the Institutional Review Board of the French Institute for Health and Medical Research (IRB Inserm No0000388FWA00005831) and the French Data Protection Authority (Commission Nationale Informatique et Libertés No.908450 and No.909216). Clinical Trial no. NCT03335644.

Energy, nutrient and food content of snacks in French adults.

BACKGROUND: Snacking raises concern since it may lead to an additional energy intake and poor nutrient quality. A snacking occasion can be defined as any eating occasion apart from main meals, regardless of the amount or type of foods consumed. We described the frequency of snacking occasions according to daily timing in French adults, and compared them between each other, and with the main meals, in terms of energy intake, energy and nutrient density, and food content. METHODS: This cross-sectional analysis included 104,265 adults from the NutriNet-Santé cohort. Food intake was estimated using 24-h records of weekdays. For each eating occasion, nutrient density and energy content and density were computed. RESULTS: After weighting, 47.6% of our sample were men and mean age was 45.6 (15.3). Overall, 68% of participants ate at least one snack during the reported record, mainly in the morning or afternoon. Overall snack had a lower nutrient density [22.8 (SD = 278.3)] than main meals [25.8 (36.9) to 30.0 (30.4)]; but higher energy density [222.2 (163.3) kcal/100 g] than meals [133.9 (57.3) to 175.9 (99.6) kcal/100 g]. Morning snack was the snacking occasion with the lowest energy density [211 kcal/100 g], the lowest energy intake [104.1 kcal] and the highest nutrient density [60.1]. Afternoon and evening snacks had the highest energy loads [192.4 kcal and 207.6 kcal], but low nutrient scores [16 and 13, respectively]. The main food groups contributing to energy intake from snacks were fatty-sweet and sugary foods, fruit, hot beverages, and bread. CONCLUSIONS: Our findings highlight the frequency of snacking and the varying nutritional quality of snacks over the day. The morning snack was shown to be healthier than afternoon and evening snacks. TRIAL REGISTRATION: This study was conducted according to guidelines laid down in the Declaration of Helsinki, and all procedures were approved by the Institutional Review Board of the French Institute for Health and Medical Research (IRB Inserm No. 0000388FWA00005831) and the French Data Protection Authority (Commission Nationale Informatique et Libertés No. 908450 and No. 909216). Electronic informed consent was obtained from all participants (Clinical Trial no. NCT03335644 ).

Association between maternal prepregnancy obesity and breastfeeding duration: Data from a nationwide prospective birth cohort.

Association of maternal obesity with shorter breastfeeding duration may involve different factors and might be modified by parity. In a national birth cohort, we aimed to estimate the association between prepregnancy body mass index (pBMI) and breastfeeding duration after adjustment for sociodemographic, pregnancy, and other characteristics and assess the effect modification of parity in such associations. In 2012, 3,368 mother-infant dyads were randomly included at birth in the French Epifane cohort. Breastfeeding information was collected in maternity wards and by phone interview at 1, 4, 8, and 12 months postpartum. Poisson regression analyses estimated the association of pBMI with the number of days of "any breastfeeding" (ABF) and "exclusive breastfeeding" (EBF) in unadjusted and adjusted models. Interactions between parity and pBMI were tested. Obesity before pregnancy was independently associated with shorter ABF duration (incidence rate ratio [IRR] = 0.86, 95%CI [0.74, 0.99]) compared to normal-weight status. Parity showed an effect modification only with EBF duration. Among primiparae, no association was found for obesity, but overweight was significantly associated with shorter EBF duration independently of all covariates (IRR = 0.74 [0.58, 0.95]). Among multiparas, obesity was associated with shorter EBF duration after controlling for sociodemographic factors (IRR = 0.71 [0.53, 0.95]). This association was no longer statistically significant after controlling for other covariates. Obesity appears to be a strong risk factor in shorter ABF duration. Furthermore, parity is a key factor in the relationship of pBMI to shorter EBF duration. Overweight primiparous and obese multiparous women need additional support to prolong breastfeeding duration.

Associations between transition to retirement and changes in dietary intakes in French adults (NutriNet-Santé cohort study).

BACKGROUND: Few studies have focused on the influence of retirement on dietary behaviors. Our study aimed at assessing the associations between transition to retirement and changes in dietary intake in French adults, particularly according to spousal retirement and baseline income. METHODS: This prospective study included 577 French participants from the NutriNet-Santé cohort who retired over a 5-year follow-up (2009-2014 or 2010-2015). At baseline and every year, dietary intakes were assessed using 24 h records. Repeated measures of dietary intake were analysed using mixed models adjusted for energy with random effects of time and period (before and after retirement) to assess changes following retirement for each gender. RESULTS: After retirement, intakes of saturated fatty acids and sodium increased in both genders. Women showed specific changes after retirement: decrease in the score of adherence to recommendations and in intakes of fruits, proteins, vitamins; increase in intakes of fatty sweet products. In men with the lowest income at baseline, specific changes in intake were associated with retirement such as decrease in intake of dairy products and increase in intake of lipids. CONCLUSIONS: Transition to retirement was associated with unhealthier dietary intakes. These results may help defining interventions during this vulnerable life-period. TRIAL REGISTRATION: This study was conducted according to guidelines laid down in the Declaration of Helsinki and all procedures were approved by the Institutional Review Board of the French Institute for Health and Medical Research (IRB Inserm No. 0000388FWA00005831) and the French Data Protection Authority (Commission Nationale Informatique et Libertés No. 908450 and No. 909216). Electronic informed consents were obtained from all participants.

Social disparities in food preparation behaviours: a DEDIPAC study.

BACKGROUND: The specific role of major socio-economic indicators in influencing food preparation behaviours could reveal distinct socio-economic patterns, thus enabling mechanisms to be understood that contribute to social inequalities in health. This study investigated whether there was an independent association of each socio-economic indicator (education, occupation, income) with food preparation behaviours. METHODS: A total of 62,373 adults participating in the web-based NutriNet-Santé cohort study were included in our cross-sectional analyses. Cooking skills, preparation from scratch and kitchen equipment were assessed using a 0-10-point score; frequency of meal preparation, enjoyment of cooking and willingness to cook better/more frequently were categorical variables. Independent associations between socio-economic factors (education, income and occupation) and food preparation behaviours were assessed using analysis of covariance and logistic regression models stratified by sex. The models simultaneously included the three socio-economic indicators, adjusting for age, household composition and whether or not they were the main cook in the household. RESULTS: Participants with the lowest education, the lowest income group and female manual and office workers spent more time preparing food daily than participants with the highest education, those with the highest income and managerial staff (P < 0.0001). The lowest educated individuals were more likely to be non-cooks than those with the highest education level (Women: OR = 3.36 (1.69;6.69); Men: OR = 1.83 (1.07;3.16)) while female manual and office workers and the never-employed were less likely to be non-cooks (OR = 0.52 (0.28;0.97); OR = 0.30 (0.11;0.77)). Female manual and office workers had lower scores of preparation from scratch and were less likely to want to cook more frequently than managerial staff (P < 0.001 and P < 0.001). Women belonging to the lowest income group had a lower score of kitchen equipment (P < 0.0001) and were less likely to enjoy cooking meal daily (OR = 0.68 (0.45;0.86)) than those with the highest income. CONCLUSION: Lowest socio-economic groups, particularly women, spend more time preparing food than high socioeconomic groups. However, female manual and office workers used less raw or fresh ingredients to prepare meals than managerial staff. In the unfavourable context in France with reduced time spent preparing meals over last decades, our findings showed socioeconomic disparities in food preparation behaviours in women, whereas few differences were observed in men.