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.

Recent changes in sociodemographic characteristics, dietary behaviors and clinical parameters of adults receiving food assistance in France.

BACKGROUND: In 2004-2005, a survey carried out on food recipients in France revealed an alarming nutritional situation. In 2011-2012, and using a protocol similar to that of 2004-2005, our objective was to update the description of sociodemographic characteristics, dietary behaviors and clinical parameters of food assistance recipients and to analyze changes since 2004-2005. METHODS: Both surveys included multistage random sampling of adults benefitting from structures that supply food pantries and charitable grocery stores. Data on sociodemographic characteristics and dietary behaviors were collected along with weight, height and blood pressure measurements. Comparisons between the 2004-2005 (n = 883) and 2011-2012 (n = 1,058) survey observations were made, adjusting for socio-demographic changes which had occurred in the meantime. RESULTS: Since 2004-2005, proportions of food recipients ≥55 years (13.1-19.1 %), born in France (29.2-36.8 %) and employed (5.5-11.7 %) have increased; food insufficiency has decreased (95-74 %). For over half of the recipients, canned (52.4 %) and non-perishable (50.9 %) foods were obtained only from food assistance. Frequency of consumption significantly increased even after adjustment for socio-demographic changes; this was the case for dairy products (for twice a day consumption, 30.2-36.4 %), fruits and vegetables (three times a day, 7.8-13.9 %), and meat, eggs and fish (twice a day, 9.4-19.2 %). In 2011-2012, 15.6 % of men and 36.0 % of women were obese, while 44.5 and 35.1 % had high blood pressure, respectively. CONCLUSIONS: Between 2004-2005 and 2011-2012 in France, consumption of staple foods has been slightly improved in food assistance recipients. However, prevalence of cardiovascular risk factors remains high, which underlines the need for long-term efforts at better quality of foods delivered.

Validation of a Web-based, self-administered, non-consecutive-day dietary record tool against urinary biomarkers.

New technologies are promising for the use of short-term instruments for dietary data collection; however, innovative tools should be validated against objective biomarkers. The aim of the present study was to investigate the validity of a Web-based, self-administered dietary record (DR) tool using protein, K and Na intakes against 24 h urinary biomarkers (24 h U). Of the total participants, 199 adult volunteers (104 men and 95 women, mean age 50·5 (23-83 years)) of the NutriNet-Santé Study were included in the protocol. They completed three non-consecutive-day DR and two 24 h U on the first and third DR days. Relative differences between reported (DR) and measured (24 h U) intakes were calculated from the log ratio (DR/24 h U) for protein, K and Na intakes: -14·4,+2·6 and -2·1 % for men; and -13·9, -3·7 and -8·3 % for women, respectively. The correlations between reported and true intakes were 0·61, 0·78 and 0·47 for men and 0·64, 0·42 and 0·37 for women for protein, K and Na, respectively. Attenuation factors, that represent attenuation of the true diet-disease relationship due to measurement error (a value closer to 1 indicating lower attenuation), ranged from 0·23 (Na, women) to 0·60 (K, men). We showed that the Web-based DR tool used in the NutriNet-Santé cohort study performs well in estimating protein and K intakes and fairly well in estimating Na intake. Furthermore, three non-consecutive-day DR appear to be valid for estimating usual intakes of protein and K, although caution is advised regarding the generalisability of these findings to other nutrients and general population.

[Chronic diseases: recent trends, challenges and prospects for change]. / Les maladies chroniques : tendances récentes, enjeux et perspectives d'évolution.

INTRODUCTION: The objectives were to describe available sources for epidemiological surveillance of chronic diseases, recent trends, and underlying phenomena for these changes and to deduce possible scenarios for the future. METHODS: Based on the examples of coronary heart disease, stroke, diabetes, chronic obstructive pulmonary disease (COPD) and lung cancer, the authors describe recent trends in mortality and hospitalizations in the general population. RESULTS: Exceptfor diabetes, the morbidity and mortality of the diseases considered have globally declined over the last decade. However, trends varied according to age and gender and an increase in mortality from myocardial infarction, COPD and lung cancer was observed among women under the age of 55. Overall, decreased morbidity and mortality can be explained by improvements in primary prevention (blood pressure, cholesterol, smoking among men...) and prevention of recurrences and complications. DISCUSSION: It is unclear whether these improvements will continue in the future. Aging, obesity, diabetes and smoking among women should negatively impact the medium-term morbidity and life expectancy (especially disability-free life expectancy). It is still difficult to predict future trends, as other factors could attenuate (electronic cigarettes, bariatric surgery...) or, on the contrary exacerbate (increased social inequalities in times of economic crisis, continued increase in smoking among women, diabetes...) these trends.

Factors associated with compliance with barrier gestures and social distancing measures in France.

BACKGROUND: The COVID-19 pandemic led many countries to drastically limit social activities. The objective of this study is to describe the factors associated with compliance with protective measures and social distancing in the general adult population in France, between March and December 2020 (first and second waves of the epidemic), before vaccination began at the end of December 2020. METHOD: The data come from the CoviPrev repeated cross-sectional descriptive survey, conducted between March 2020 and December 2022 in metropolitan France. The data collected from March to December 2020 (19 survey waves), from a panel representative of the general population, were used. Three periods were defined: the first epidemic wave (March-April), the inter-wave period (May-June) and the second epidemic wave (November-December). A compliance score was constructed to measure systematic compliance with the five main measures. The association between systematic compliance and different variables (sociodemographic, mental health, level of health literacy, perceived severity of COVID-19, confidence in government, perceived effectiveness of the measures) was described using bivariate and multivariate logistic regression models, using the statistical software R. RESULTS: Systematic compliance with the preventive measures changed over time. Regardless of the period, being a woman, being over 50, perceiving COVID-19 as severe, having a high level of health literacy or anxiety were positively associated with compliance. Having a child under 16 years of age and perceiving the measures as effective were positively associated with compliance with the protective measures during the epidemic waves; conversely, having a high level of depression, living alone, not working were negatively associated in the first epidemic wave. Finally, during the inter-wave period, living in an area heavily affected during the first wave and having a high level of education were positively and negatively associated with systematic compliance with the preventive measures, respectively. CONCLUSION: The factors associated with compliance with the protective measures and social distancing evolved during the epidemic. Monitoring this evolution, in order to adapt communication and awareness strategies, is essential in the context of pandemic response.

Participant profiles according to recruitment source in a large Web-based prospective study: experience from the Nutrinet-Santé study.

BACKGROUND: Interest in Internet-based epidemiologic research is growing given the logistic and cost advantages. Cohort recruitment to maximally diversify the sociodemographic profiles of participants, however, remains a contentious issue. OBJECTIVE: The aim of the study was to characterize the sociodemographic profiles according to the recruitment mode of adult volunteers enrolled in a Web-based cohort. METHODS: The French NutriNet-Santé Web-based cohort was launched in 2009. Recruitment is ongoing and largely relies on recurrent multimedia campaigns. One month after enrollment, participants are asked how they learned about the study (eg, general newscast or a health program on television, radio newscast, newspaper articles, Internet, personal advice, leaflet/flyers) The sociodemographic profiles of participants recruited through operative communication channels (radio, print media, Internet, advice) were compared with the profiles of those informed through television by using polytomous logistic regression. RESULTS: Among the 88,238 participants enrolled through the end of 2011, 30,401 (34.45%), 16,751 (18.98%), and 14,309 (16.22%) learned about the study from television, Internet, and radio newscasts, respectively. Sociodemographic profiles were various, with 14,541 (16.5%) aged ≥60 years, 20,166 (22.9%) aged <30 years, 27,766 (32.1%) without postsecondary education, 15,397 (19.7%) with household income <€1200/month, and 8258 (10.6%) with household income €3700/month. Compared to employed individuals, unemployed and retired participants were less likely to be informed about the study through other sources than through television (adjusted ORs 0.56-0.83, P<.001). Participants reporting up to secondary education were also less likely to have learned about the study through radio newscasts, newspaper articles, Internet, and advice than through television (adjusted ORs 0.60-0.77, P<.001). CONCLUSIONS: Television broadcasts appear to permit the recruitment of e-cohort participants with diverse sociodemographic backgrounds, including socioeconomically disadvantaged individuals who are usually difficult to reach and retain in long-term epidemiologic studies. These findings could inform future Web-based studies regarding the development of promising targeted or general population recruitment strategies.

Physical activity patterns in the French 18-74-year-old population: French Nutrition and Health Survey (Etude Nationale Nutrition Santé, ENNS) 2006-2007.

OBJECTIVE: To describe detailed physical activity and sedentary behaviour in French adults across physical activity categories. DESIGN: The French Nutrition and Health Survey (Etude Nationale Nutrition Santé, ENNS), conducted in 2006-2007, was a national cross-sectional survey based on three-stage random sampling. The International Physical Activity Questionnaire (IPAQ) was used to classify participants into three physical activity categories. Time spent in a sitting position and time spent in front of a screen were used as markers of sedentary behaviour. SETTING: France. SUBJECTS: Adults (n 2971) aged 18 to 74 years were included. RESULTS: Overall, 29·5 % of men and 23·6 % of women were classified into the high-IPAQ category, while 36·1 % of men and 37·5 % of women were in the low-IPAQ category. For each intensity level of physical activity (vigorous intensity, moderate intensity or walking), the number of active days per week decreased from the high- to the low-IPAQ category and daily duration of physical activity was longer in the high-IPAQ category than in the other two categories; 6 % of adults declared neither vigorous nor moderate nor walking activities. CONCLUSIONS: For most adults in the low-IPAQ category, an increasing number of active days per week would be sufficient to attain the moderate-IPAQ category. This should be taken into account in public health initiatives aimed at promoting physical activity.

Nutrition patterns and metabolic syndrome: a need for action in young adults (French Nutrition and Health Survey - ENNS, 2006-2007).

OBJECTIVE: The objective of this study was to investigate the relationship between adherence to French diet and physical activity recommendations and metabolic syndrome (MetS) risk. METHODS: 18-74-year-old subjects who underwent dietary assessment and health examination in the 2006-2007 French Nutrition and Health Survey (Etude Nationale Nutrition Santé, ENNS 2006-2007) were included in the analyses (n=1608). Quintiles of PNNS-GS, the score measuring adherence to French recommendations, were generated. The prevalence of overall MetS risk and separate components across quintiles of PNNS-GS was estimated by adjusted logistic regressions. Interactions were searched for between PNNS-GS and sex, age and currently used medication. RESULTS: The PNNS-GS was inversely associated with overall MetS risk in subjects not taking antidiabetic, antihypertensive or lipid-lowering medication (12.8% in the lowest quintile vs. 4.6% in the highest PNNS-GS quintile; P<0.01). This was true in 18-49-year-old subjects (10.0% vs. 1.7%, P<0.01), but not in 50-74-year-olds (23.8% vs. 11.2%; P=0.15). In 18-49-year-old adults, including those taking such medication, the HDL component was associated with PNNS-GS (22.1% vs. 7.9%; P<0.01). CONCLUSION: Improvement in diet and physical activity in line with recommendations could be effective in young adults for MetS prevention so as to decrease the risk of cardiovascular disease in France.

Innovative use of data sources: a cross-sectional study of data linkage and artificial intelligence practices across European countries.

BACKGROUND: The availability of data generated from different sources is increasing with the possibility to link these data sources with each other. However, linked administrative data can be complex to use and may require advanced expertise and skills in statistical analysis. The main objectives of this study were to describe the current use of data linkage at the individual level and artificial intelligence (AI) in routine public health activities, to identify the related estimated health indicators (i.e., outcome and intervention indicators) and health determinants of non-communicable diseases and the obstacles to linking different data sources. METHOD: We performed a survey across European countries to explore the current practices applied by national institutes of public health, health information and statistics for innovative use of data sources (i.e., the use of data linkage and/or AI). RESULTS: The use of data linkage and AI at national institutes of public health, health information and statistics in Europe varies. The majority of European countries use data linkage in routine by applying a deterministic method or a combination of two types of linkages (i.e., deterministic & probabilistic) for public health surveillance and research purposes. The use of AI to estimate health indicators is not frequent at national institutes of public health, health information and statistics. Using linked data, 46 health outcome indicators, 34 health determinants and 23 health intervention indicators were estimated in routine. The complex data regulation laws, lack of human resources, skills and problems with data governance, were reported by European countries as obstacles to routine data linkage for public health surveillance and research. CONCLUSIONS: Our results highlight that the majority of European countries have integrated data linkage in their routine public health activities but only a few use AI. A sustainable national health information system and a robust data governance framework allowing to link different data sources are essential to support evidence-informed health policy development. Building analytical capacity and raising awareness of the added value of data linkage in national institutes is necessary for improving the use of linked data in order to improve the quality of public health surveillance and monitoring activities.

Dietary intake, physical activity and nutritional status in adults: the French nutrition and health survey (ENNS, 2006-2007).

The French National Programme on Nutrition and Health (Programme national nutrition santé (PNNS)), the aim of which is to reduce nutrition-related chronic diseases, necessitates monitoring of nutritional characteristics. Our objective was to describe dietary intake, physical activity and nutritional status in a national sample of adults, especially according to current French recommendations. The study is based on a cross-sectional population-based survey using a multistage sampling design (Etude nationale nutrition santé (ENNS)). Between February 2006 and March 2007, 3115 18-74-year-old adults were included (participation rate 59.7 %). Energy, macronutrient and food consumption were estimated through three randomly distributed 24 h recalls, and compared to PNNS recommendations; physical activity was described using International Physical Activity Questionnaire guidelines; anthropometry, blood pressure and biochemical measurements were assessed according to national and international references. When compared to current recommendations, intake of carbohydrates (>50 % energy intake without alcohol: 26.4 %), SFA ( < 35 % total lipids: 18.5 %) and total fibre (>25 g/d: 13.7 %) was frequently unsatisfactory. While overall consumption of 'meat, seafood and eggs' was satisfactory, that of fruits and vegetables ( > or = 400 g/d: 43.8 %) and seafood (two or more servings per week: 29.9 %) was frequently too low. The physical activity level was satisfactory at 63.2 %. Overweight was observed in 49.3 % of adults, while 30.9 % were hypertensive and 44.1 % had dyslipidaemia. Vitamin and iron-poor status was found to affect less than 10 % of the population. Based on the ENNS survey, overall nutrition remains a problem in France. Comparison of these data with those of other countries could contribute to a better understanding of variations in nutrition-related diseases.

Association of socioeconomic status with overall overweight and central obesity in men and women: the French Nutrition and Health Survey 2006.

BACKGROUND: Identification of subpopulations at high risk of overweight and obesity is crucial for prevention and management of obesity in different socioeconomic status (SES) categories. The objective of the study was to describe disparities in the prevalence of overweight and obesity across socioeconomic status (SES) groups in 18-74 year-old French adults. METHODS: Analyses were based on a multistage stratified random sample of non-institutionalized adults aged 18-74-years-old from the French Nutrition and Health Survey (ENNS), a cross-sectional national survey carried out in 2006/2007. Collected data included measured anthropometry (weight, height and waist circumference (WC)), demographic and SES data (occupation, education and frequency of holiday trips as a marker of family income). SES factors associated with overweight (BMI > or = 25) and central obesity (WC above gender-specific references) were identified using multiple logistic regression. RESULTS: Almost half (49.3%) of French adults were overweight or obese and 16.9% were obese. In men, the risk of overall overweight or obesity was associated with occupation (p < 0.05), whereas the risk of central obesity was independently associated with occupation (p < 0.05) and frequency of holiday trips (p < 0.01). In women, both overall and central overweight and obesity were independently associated with educational level (respectively p < 10(-3) and p < 10(-3)) and frequency of holiday trips (respectively p < 0.05 and p < 10-3). CONCLUSION: The prevalence of overweight and obesity was found to be similar to that of several neighbouring western European countries, and lower than the UK and eastern Europe. Risk of being overweight or obese varied across SES groups both in men and women, but associations were different between men and women, indicating differing determinants.

Correlations between Fruit, Vegetables, Fish, Vitamins, and Fatty Acids Estimated by Web-Based Nonconsecutive Dietary Records and Respective Biomarkers of Nutritional Status.

BACKGROUND: It is of major importance to measure the validity of self-reported dietary intake using web-based instruments before applying them in large-scale studies. OBJECTIVE: This study aimed to validate self-reported intake of fish, fruit and vegetables, and selected micronutrient intakes assessed by a web-based self-administered dietary record tool used in the NutriNet-Santé prospective cohort study, against the following concentration biomarkers: plasma beta carotene, vitamin C, and n-3 polyunsaturated fatty acids. PARTICIPANTS/SETTING: One hundred ninety-eight adult volunteers (103 men and 95 women, mean age=50.5 years) were included in the protocol: they completed 3 nonconsecutive-day dietary records and two blood samples were drawn 3 weeks apart. The study was conducted in the area of Paris, France, between October 2012 and May 2013. MAIN OUTCOME MEASURES: Reported fish, fruit and vegetables, and selected micronutrient intakes and plasma beta carotene, vitamin C, and n-3 polyunsaturated fatty acid levels were compared. STATISTICAL ANALYSES: Simple and adjusted Spearman's rank correlation coefficients were estimated after de-attenuation for intra-individual variation. RESULTS: Regarding food groups in men, adjusted correlations ranged from 0.20 for vegetables and plasma vitamin C to 0.49 for fruits and plasma vitamin C, and from 0.40 for fish and plasma c20:5 n-3 (eicosapentaenoic acid [EPA]) to 0.55 for fish and plasma c22:6 n-3 (docosahexaenoic acid). In women, correlations ranged from 0.13 (nonsignificant) for vegetables and plasma vitamin C to 0.41 for fruits and vegetables and plasma beta carotene, and from 0.27 for fatty fish and EPA to 0.54 for fish and EPA+docosahexaenoic acid. Regarding micronutrients, adjusted correlations ranged from 0.36 (EPA) to 0.58 (vitamin C) in men and from 0.32 (vitamin C) to 0.38 (EPA) in women. CONCLUSIONS: The findings suggest that three nonconsecutive web-based dietary records provide reasonable estimates of true intake of fruits, vegetables, fish, beta carotene, vitamin C, and n-3 fatty acids. Along with other validation studies, this study shows acceptable validity of using such diet-assessment methods in large epidemiologic surveys and broadens new perspectives for epidemiology.

The prevalence of ESRD treated with renal dialysis in France in 2003.

BACKGROUND: The prevalence of end-stage renal disease (ESRD) treated with renal dialysis is poorly known in France because there is no national registry of dialysis patients. The specific aims of this study are to determine the total number of patients treated with renal dialysis and their social, demographic, and clinical characteristics, as well as define the overall care they received. METHODS: We performed a cross-sectional descriptive study from June 2 to June 8, 2003, in all renal dialysis units (including pediatric units) by including all patients residing in France with ESRD who were dialyzed during that week, irrespective of age or the treatment they received. We gathered sociodemographic (age, sex, place of residence, and occupation) and clinical data (year they entered dialysis therapy, initial renal disease, comorbidities, and associated handicaps) and information concerning their overall treatment plan (waiting list for kidney transplant, therapeutic regimen, and dialysis technique used). RESULTS: A total of 30,882 patients residing in France were treated with renal dialysis. The unadjusted prevalence of dialysis was 513.1 patients per million population (pmp); 498.2 pmp in metropolitan France and 1,035.7 pmp in the overseas territories. Clinical and sociodemographic characteristics of patients and their therapeutic regimens were different in metropolitan France and the overseas territories. CONCLUSION: This study constitutes the first comprehensive inventory of dialysis therapy in France, where the prevalence of ESRD is among the highest in the world.

[Regional disparities in the management of dialysed patients in France in 2003]. / Les disparités régionales de prise en charge des patients dialysés en France en 2003.

Epidemiologic data on end-stage renal disease (ESRD) treated with renal dialysis remain sparse and incomplete in France because there is no national registry of dialysis patients. The aim of this study was to determine the characteristics (age, gender, comorbidities, associated handicap) of patients treated with renal dialysis and to compare the dialysis regional practices. We performed a cross-sectional descriptive study from June 2 to June 8, 2003 in all renal dialysis units by enrolling all the patients residing in France with ESRD who were dialysed during that week, irrespective of the treatment they received or where they were being treated. In 2003, the type of dialysis units available and the technique they employ were quite different from one region to another, varying from 41.1 to 70.2% for highly specialized unit, 9.4 to 48.4% for self-care hemodialysis, and 2.9 to 26.5% for peritoneal dialysis.

National trends in rate of patients hospitalized for heart failure and heart failure mortality in France, 2000-2012.

AIMS: The objectives of this study were to describe annual trends in patients hospitalized for heart failure (HF) and HF-associated mortality rates in France between 2000 and 2012. METHODS AND RESULTS: Hospital discharge data were extracted from the French National Hospitalization Database (PMSI). Mortality data were obtained from the French National Mortality Database. HF events constituting the underlying or associated cause of death were selected. Rates were age standardized using the 2010 European census population as the standard population. Time trends were tested using a Poisson regression model. In 2012, the overall age-standardized rate of patients hospitalized for HF was 246.2 per 100,000 inhabitants. The age-standardized rate of HF-associated mortality was 113.8 per 100,000 inhabitants in 2010. Hospitalized patient rates remained steady between 2002 and 2012, whereas mortality decreased by 3.3% annually from 2000 to 2010. Trends in hospitalized patients and mortality differed significantly between men and women, particularly among the 45- to 55- and 65- to 74-year-old age groups, with a smaller decrease observed in women. CONCLUSION: Among men, a slight decrease in patients hospitalized for HF and a substantial reduction in mortality were observed. Among women, only a large decrease in HF mortality was observed. HF remains one of the leading causes of death and hospitalization in France, particularly in the elderly.

Comparison of the sociodemographic characteristics of the large NutriNet-Santé e-cohort with French Census data: the issue of volunteer bias revisited.

BACKGROUND: A recurring concern in traditional and in Web-based studies pertains to non-representativeness due to volunteer bias. We investigated this issue in an ongoing, large population-based e-cohort. METHODS: The sample included 122 912 individuals enrolled in the Internet-based, nutrition-focused NutriNet-Santé study between May 2009 and March 2014, with complete baseline data. Participants were recruited via recurrent multimedia campaigns and other traditional and online strategies. Individuals aged 18+ years, residing in France and having Internet access, were eligible for enrolment. Their sociodemographic characteristics were compared with the corresponding 2009 Census data via χ(2) goodness-of-fit tests. The effectiveness of statistical weighting of the e-cohort data was also explored. RESULTS: The sample exhibited marked geographical and sociodemographic diversity, including volunteers belonging to typically under-represented subgroups in traditional surveys (unemployed, immigrants, the elderly). Nonetheless, the proportions of women, relatively well-educated individuals and those who are married or cohabiting, were notably larger compared with the corresponding national figures (women: 78.0% vs 52.4%; postsecondary education: 61.5% vs 24.9%; married or cohabiting: 70.8% vs 62.0%, respectively; all p<0.0001). CONCLUSIONS: There were notable sociodemographic differences between the general French population and this general population-based e-cohort, some of which were corrected by statistical weighting. The findings bear on the potential generalisability of future investigations in the context of e-epidemiology.

Alcohol consumption and insulin resistance syndrome parameters: associations and evolutions in a longitudinal analysis of the French DESIR cohort.

PURPOSE: To determine the effects of average alcohol consumption and changes in alcohol intake on the insulin resistance syndrome parameters in a 3-year follow-up study. METHODS: Longitudinal study of 1856 and 1529 alcohol drinking men and women in the French DESIR study (Data from an Epidemiological Study on the Insulin Resistance syndrome), aged 30 to 64 years. RESULTS: In men, fasting glucose, body mass index, waist circumference, systolic blood pressure, and HDL-cholesterol were positively associated with average alcohol consumption while there was no association with insulin or triglycerides concentrations. A change in alcohol intake was positively associated with HDL-cholesterol concentration and systolic blood pressure at follow-up. These effects of alcohol could not be attributed specifically to the intake of wine. In women, while the alcohol HDL-cholesterol relation was similar to that found in the men, the only significant effect of average alcohol intake was an increase in systolic blood pressure, with a spurious decrease in blood pressure related to a 3-year increase in alcohol intake. CONCLUSIONS: Alcohol only provided a beneficial effect on HDL-cholesterol. The beneficial effect seen by other authors of moderate alcohol drinking on diabetes and cardiovascular risk may be due to effects on parameters other than those included in the current definitions of the insulin resistance syndrome.

Diet in 45- to 74-year-old individuals with diagnosed diabetes: comparison to counterparts without diabetes in a nationally representative survey (Etude Nationale Nutrition Santé 2006-2007).

A healthy diet has been shown to prevent diabetes complications. However, the eating habits of individuals with diabetes who are aware of their glycemic condition have been poorly studied. This study's objective was to assess the dietary behavior overall and according to dietary recommendations in adults diagnosed with diabetes compared with those of a general population of the same age (45 to 74 years) in a nationally representative survey carried out in France in 2006-2007 (Etude Nationale Nutrition Santé) (n=1,476 including 101 patients with diabetes). Trained dietitians assessed diet using three 24-hour recalls and diabetes was self-declared. After weighting and using multiple adjustments, mean food and nutrient intakes were compared according to diabetes status. Interactions with age and sex were sought. Adults with diabetes had lower intakes of sweetened foods (40 g/day vs 125 g/day), alcohol (1.45 g/day vs 1.64 g/day), energy (1,790 kcal/day vs 1,986 kcal/day), and simple sugar (63.1 g/day vs 89.8 g/day) and higher intakes of meat (126 g/day vs 109 g/day), complex carbohydrates (26.3% energy intake vs 23.6% energy intake), and vitamins B and E (628 µg/day vs 541 µg/day). In addition, 45- to 59-year-old individuals with diabetes ate more fruits and vegetables, fiber, beta carotene, folate, vitamin C, and potassium than adults of the same age who did not have diabetes. Overall, 45- to 74-year-old adults with diabetes had a higher-quality diet than individuals without diabetes. However, compared with recommendations, a healthy diet continues to represent a public health challenge in terms of preventing diabetes complications.

Patterns of hypertension management in France (ENNS 2006-2007).

OBJECTIVES: The objectives of this study were to describe the hypertensive population and therapeutic management of hypertension in subjects between 18 and 74 years of age in continental France in 2006. METHODS: ENNS was a cross-sectional survey conducted in continental France in 2006-2007. Blood pressure (BP) was measured in a national sample of non-institutionalized adults aged 18-74 years and pharmacological treatment was collected by a self-questionnaire. Hypertension was defined by systolic blood pressure (SBP) ≥140 mmHg, diastolic blood pressure (DBP) ≥90 mmHg, or treatment with BP-lowering drugs. The therapeutic control of treated hypertensive patients was defined by SBP <140 mmHg and DBP <90 mmHg. RESULTS: The prevalence of hypertension was 31.0%. Half of hypertensive subjects reported taking an antihypertensive drug (50.3%) and nearly half of them were treated with a single antihypertensive pharmacological class (44.3%). Overall, among hypertensives, 25.6% had a satisfactory BP control. CONCLUSIONS: Our survey revealed a high prevalence of hypertension in continental France, with only half of the hypertensive subjects receiving pharmacological therapy and one treated out of two with BP at goal. More effective measures are needed to improve clinical management of hypertension.