Food additive emulsifiers and cancer risk: Results from the French prospective NutriNet-Santé cohort.

BACKGROUND: Emulsifiers are widely used food additives in industrially processed foods to improve texture and enhance shelf-life. Experimental research suggests deleterious effects of emulsifiers on the intestinal microbiota and the metabolome, leading to chronic inflammation and increasing susceptibility to carcinogenesis. However, human epidemiological evidence investigating their association with cancer is nonexistent. This study aimed to assess associations between food additive emulsifiers and cancer risk in a large population-based prospective cohort. METHODS AND FINDINGS: This study included 92,000 adults of the French NutriNet-Santé cohort without prevalent cancer at enrolment (44.5 y [SD: 14.5], 78.8% female, 2009 to 2021). They were followed for an average of 6.7 years [SD: 2.2]. Food additive emulsifier intakes were estimated for participants who provided at least 3 repeated 24-h dietary records linked to comprehensive, brand-specific food composition databases on food additives. Multivariable Cox regressions were conducted to estimate associations between emulsifiers and cancer incidence. Overall, 2,604 incident cancer cases were diagnosed during follow-up (including 750 breast, 322 prostate, and 207 colorectal cancers). Higher intakes of mono- and diglycerides of fatty acids (FAs) (E471) were associated with higher risks of overall cancer (HR high vs. low category = 1.15; 95% CI [1.04, 1.27], p-trend = 0.01), breast cancer (HR = 1.24; 95% CI [1.03, 1.51], p-trend = 0.04), and prostate cancer (HR = 1.46; 95% CI [1.09, 1.97], p-trend = 0.02). In addition, associations with breast cancer risk were observed for higher intakes of total carrageenans (E407 and E407a) (HR = 1.32; 95% CI [1.09, 1.60], p-trend = 0.009) and carrageenan (E407) (HR = 1.28; 95% CI [1.06, 1.56], p-trend = 0.01). No association was detected between any of the emulsifiers and colorectal cancer risk. Several associations with other emulsifiers were observed but were not robust throughout sensitivity analyses. Main limitations include possible exposure measurement errors in emulsifiers intake and potential residual confounding linked to the observational design. CONCLUSIONS: In this large prospective cohort, we observed associations between higher intakes of carrageenans and mono- and diglycerides of fatty acids with overall, breast and prostate cancer risk. These results need replication in other populations. They provide new epidemiological evidence on the role of emulsifiers in cancer risk. TRIAL REGISTRATION: ClinicalTrials.gov NCT03335644.

The association between consideration of future consequences and food intake is mediated by food choice motives in a French adult population.

OBJECTIVES: Consideration of future consequences (CFC) distinguishes individuals who adopt behaviours based on immediate needs and concerns from individuals who consider the future consequences of their behaviours. We aimed to assess the association between CFC and diet, and testing the mediating role of food choice motives on this relationship. DESIGN: Individuals (aged ≥ 18 years) completed the CFC-12 questionnaire in 2014, at least three 24-h dietary records, and a food choice motive questionnaire. A multiple mediator analysis allowed to assess the mediating effect of food choice motives on the cross-sectional association between CFC and diet, adjusted for socio-demographic factors. SETTING: Data from the NutriNet-Santé cohort study. PARTICIPANTS: 27 330 participants. RESULTS: CFC was associated with all food choice motives (P < 0·001), with the strongest positive associations for avoidance for environmental reasons, absence of contaminants and health motives and the strongest negative associations for innovation and convenience. Positive total effects were found between CFC and the consumption of healthy food groups (fruits and vegetables, whole-grain foods, legumes), and negative total effects for alcohol, meat and poultry and processed meat (P < 0·001). CFC was positively associated with diet quality (P < 0·001). Across food groups, major mediators of these relationships were higher health (8·4-32·6%), higher environmental (13·7-22·1 %) and lower innovation (7·3-25·1 %) concerns. CONCLUSIONS: CFC was associated with healthier dietary intake, essentially mediated by a greater motivation of future-oriented participants for self-centred and altruistic outcomes, including health and environment. Focusing on the awareness of future benefits in public health interventions might lead to healthier dietary behaviours.

Cross-sectional and longitudinal associations between self-esteem and BMI depends on baseline BMI category in a population-based study.

BACKGROUND: Some studies have reported associations between self-esteem and weight status, but longitudinal data on adults remain scarce. The aim of this population-based study was to analyze the cross-sectional and longitudinal association between self-esteem and body mass index (BMI) and to investigate whether baseline BMI has an impact on this association. METHODS: In 2016, 29,735 participants aged ≥ 18 years in the NutriNet-Santé cohort completed the Rosenberg Self-Esteem Scale. BMI was self-reported yearly over a 4-year period. Association between self-esteem and BMI was assessed using mixed models and logistic regressions. Analyses were stratified by BMI (categorical) at baseline and adjusted on sociodemographic and lifestyle characteristics. RESULTS: At baseline, higher self-esteem was associated with higher BMI in normal weight individuals(p = 0.32), and with lower BMI in obese class II and III individuals (p = 0.13). In addition, higher baseline self-esteem was associated with BMI increase over time in normal weight individuals (p = 0.15). Among normal weight individuals, those with higher self-esteem were less likely to show a decrease in their BMI (p = 0.005), while no association was observed with BMI increase (p = 0.81). DISCUSSION: Our findings suggest that the association between self-esteem and BMI depends on the initial category of BMI, with a negligible effect of self-esteem.

Dietary exposure to nitrites and nitrates in association with type 2 diabetes risk: Results from the NutriNet-Santé population-based cohort study.

BACKGROUND: Nitrites and nitrates occur naturally in water and soil and are commonly ingested from drinking water and dietary sources. They are also used as food additives, mainly in processed meats, to increase shelf life and to avoid bacterial growth. Experimental studies suggested both benefits and harmful effects of nitrites and nitrates exposure on type 2 diabetes (T2D) onset, but epidemiological and clinical data are lacking. We aimed to study these associations in a large population-based prospective cohort study, distinguishing foods and water-originated nitrites/nitrates from those from food additives. METHODS AND FINDINGS: Overall, 104,168 adults from the French NutriNet-Santé cohort study (2009 to 2021, 79.1% female, mean age [SD] = 42.7 [14.5]) were included. Associations between self-reported exposure to nitrites and nitrates (evaluated using repeated 24-h dietary records, linked to a comprehensive food composition database and accounting for commercial names/brands details of industrial products) and risk of T2D were assessed using cause-specific multivariable Cox proportional hazard models adjusted for known risk factors (sociodemographic, anthropometric, lifestyle, medical history, and nutritional factors). During a median follow-up duration of 7.3 years (interquartile range: [3.2; 10.1] years), 969 incident T2D cases were ascertained. Total nitrites and foods and water-originated nitrites were both positively associated with a higher T2D risk (HRtertile 3 vs.1 = 1.27 (95% CI 1.04 to 1.54), Ptrend = 0.009 and 1.26 (95% CI 1.03 to 1.54), Ptrend = 0.02, respectively). Participants with higher exposure to additives-originated nitrites (i.e., above the sex-specific median) and specifically those having higher exposure to sodium nitrite (e250) had a higher T2D risk compared with those who were not exposed to additives-originated nitrites (HR higher consumers vs. non-consumers = 1.53 (95% CI 1.24 to 1.88), Ptrend < 0.001 and 1.54 (95% CI 1.26 to 1.90), Ptrend < 0.001, respectively). There was no evidence for an association between total, foods and water-originated, or additives-originated nitrates and T2D risk (all Ptrend = 0.7). No causal link can be established from this observational study. Main limitations include possible exposure measurement errors and the lack of validation versus specific nitrites/nitrates biomarkers; potential selection bias linked to the healthier behaviors of the cohort's participants compared to the general population; potential residual confounding linked to the observational design, as well as a self-reported, yet cross-checked, case ascertainment. CONCLUSIONS: The findings of this large prospective cohort did not support any potential benefits for dietary nitrites and nitrates. They suggested that a higher exposure to both foods and water-originated and additives-originated nitrites was associated with higher T2D risk in the NutriNet-Santé cohort. This study provides a new piece of evidence in the context of current debates about updating regulations to limit the use of nitrites as food additives. The results need to be replicated in other populations. TRIAL REGISTRATION: ClinicalTrials.gov NCT03335644 (https://clinicaltrials.gov/ct2/show/NCT03335644).

Stages of Change toward Meat Reduction: Associations with Motives and Longitudinal Dietary Data on Animal-Based and Plant-Based Food Intakes in French Adults.

BACKGROUND: Reducing meat consumption is advocated for healthier and more sustainable diets. However, behavioral studies are needed to better understand the mechanisms underlying meat-reducing dietary changes. OBJECTIVES: The main aim of this study was to compare the motives associated with stages of change toward meat reduction in French adults, using the transtheoretical model (TTM). A second aim was to investigate the associations between stages of change and adherence to dietary patterns favoring a better balance of animal and plant food consumption over time. METHODS: This longitudinal study included 25,143 non-vegetarian participants of the web-based NutriNet-Santé cohort with a mean follow-up of 6.2 (SD = 2.6) y. Dietary data were obtained from 24-h dietary records over the period 2009-2019. The contribution of meat to total energy intake and scores measuring the contribution of healthy and unhealthy plant-based foods to the diet were computed. A questionnaire completed in 2018 allowed us to identify the TTM stages of change related to meat reduction (precontemplation, contemplation, preparation, action, and maintenance), and recorded motives related to meat consumption. We used multivariate linear mixed models for repeated data to assess associations between food intake changes and stages, and logistic regression for motives, presented as adjusted frequencies. RESULTS: Participants in later stages were characterized by a significantly higher decrease in meat intake over time, compared with the earliest stage (for example, ßmaintenance ∗ time = -0.08, P < 0.0001), and a higher increase in the healthy plant-based food consumption score over time (for example, ßmaintenance∗time = 0.11, P < 0.0001). Concerns about health, nutrition, and the environment were the most frequently cited motives for reducing meat consumption at all stages. CONCLUSIONS: Individuals who had already initiated meat reduction adhered to healthier and more sustainable diets than meat continuers. Characterizing motives according to readiness to reduce meat consumption could support tailored public health campaigns. TRIAL REGISTRATION NUMBER: The study protocol is registered at clinicaltrials.gov with Clinical Trial Registry number NCT03335644 available at https://clinicaltrials.gov/ct2/show/NCT03335644.

Sustainability analysis of the Mediterranean diet: results from the French NutriNet-Santé study.

The Mediterranean diet is often proposed as a sustainable diet model. This study aimed to evaluate the associations between adherence to the Mediterranean diet and sustainability domains in a cohort of French adults, using multiple criteria including nutritional quality, environmental pressures, monetary cost and dietary pesticide exposure. Food intakes of 29 210 NutriNet-Santé volunteers were assessed in 2014 using a semi-quantitative FFQ. Adherence to the Mediterranean diet was evaluated using the validated literature-based adherence score (MEDI-LITE). The associations between the MEDI-LITE and various sustainability indicators were examined using ANCOVA models, adjusted for sex, age and energy intake. Higher adherence to the MEDI-LITE was associated with higher nutritional quality scores, better overall nutrient profile as well as reduced environmental impact (land occupation: Q5 v. Q1: -35 %, greenhouse gas emissions: -40 % and cumulative energy demand: -17 %). In turn, monetary cost increased with increasing adherence to the Mediterranean diet (Q5 v. Q1: +15 %), while higher adherents to the Mediterranean diet had overall higher pesticide exposure due to their high plant-based food consumption. In this large cohort of French adults, greater adherence to the Mediterranean diet was associated with nutritional and environmental benefits, but also with higher monetary cost and greater exposure to pesticides, illustrating the necessity to develop large-scale strategies for healthy, safe (pesticide- and contaminant-free) and environmentally sustainable diets for all.

Associations between measures of socio-economic position and sustainable dietary patterns in the NutriNet-Santé study.

OBJECTIVE: We aimed to explore the relationship between socio-economic characteristics and sustainable dietary patterns. DESIGN: Dietary data were derived from a web-based FFQ. Diet sustainability was evaluated using a modified Sustainable Diet Index, comprising nutritional, environmental and cultural components (higher scores expressing higher sustainability). The socio-economic position markers were education, household income and occupation status. Multi-adjusted linear and Poisson regression models were used to assess the cross-sectional association of the markers of socio-economic status with a sustainable diet and sustainability subcomponents, respectively. SETTING: France. PARTICIPANTS: 29 119 NutriNet-Santé participants. RESULTS: Individuals with a more sustainable diet had slightly higher diet monetary cost, lower total energy intake and consumed less animal-based foods than their counterparts. Lower education level was associated with lower overall diet sustainability (ßprimary v. postgraduate = -0·62, 95 % CI (-0·72, -0·51)) and nutrition, socio-cultural and environmental subscores. Manual workers and employees had a lower modified Sustainable Diet Index than intermediate professionals (ßmanual workers v. intermediate professionals = -0·43, 95 % CI (-0·52, -0·33) and ßemployees v. intermediate professionals = -0·56, 95 % CI (-0·64, -0·48)). Participants with the lowest v. highest incomes had a higher environmental subscore but a lower socio-cultural subscore, whereas the results were less marked for occupational status. CONCLUSIONS: Overall, our results documented associations between socio-economic status and the level of diet sustainability, arguing for the implementation of appropriate food policies to promote sustainable diets at lower cost.

Artificial sweeteners and cancer risk: Results from the NutriNet-Santé population-based cohort study.

BACKGROUND: The food industry uses artificial sweeteners in a wide range of foods and beverages as alternatives to added sugars, for which deleterious effects on several chronic diseases are now well established. The safety of these food additives is debated, with conflicting findings regarding their role in the aetiology of various diseases. In particular, their carcinogenicity has been suggested by several experimental studies, but robust epidemiological evidence is lacking. Thus, our objective was to investigate the associations between artificial sweetener intakes (total from all dietary sources, and most frequently consumed ones: aspartame [E951], acesulfame-K [E950], and sucralose [E955]) and cancer risk (overall and by site). METHODS AND FINDINGS: Overall, 102,865 adults from the French population-based cohort NutriNet-Santé (2009-2021) were included (median follow-up time = 7.8 years). Dietary intakes and consumption of sweeteners were obtained by repeated 24-hour dietary records including brand names of industrial products. Associations between sweeteners and cancer incidence were assessed by Cox proportional hazards models, adjusted for age, sex, education, physical activity, smoking, body mass index, height, weight gain during follow-up, diabetes, family history of cancer, number of 24-hour dietary records, and baseline intakes of energy, alcohol, sodium, saturated fatty acids, fibre, sugar, fruit and vegetables, whole-grain foods, and dairy products. Compared to non-consumers, higher consumers of total artificial sweeteners (i.e., above the median exposure in consumers) had higher risk of overall cancer (n = 3,358 cases, hazard ratio [HR] = 1.13 [95% CI 1.03 to 1.25], P-trend = 0.002). In particular, aspartame (HR = 1.15 [95% CI 1.03 to 1.28], P = 0.002) and acesulfame-K (HR = 1.13 [95% CI 1.01 to 1.26], P = 0.007) were associated with increased cancer risk. Higher risks were also observed for breast cancer (n = 979 cases, HR = 1.22 [95% CI 1.01 to 1.48], P = 0.036, for aspartame) and obesity-related cancers (n = 2,023 cases, HR = 1.13 [95% CI 1.00 to 1.28], P = 0.036, for total artificial sweeteners, and HR = 1.15 [95% CI 1.01 to 1.32], P = 0.026, for aspartame). Limitations of this study include potential selection bias, residual confounding, and reverse causality, though sensitivity analyses were performed to address these concerns. CONCLUSIONS: In this large cohort study, artificial sweeteners (especially aspartame and acesulfame-K), which are used in many food and beverage brands worldwide, were associated with increased cancer risk. These findings provide important and novel insights for the ongoing re-evaluation of food additive sweeteners by the European Food Safety Authority and other health agencies globally. TRIAL REGISTRATION: ClinicalTrials.gov NCT03335644.

Serum ω-3 Fatty Acids and Cognitive Domains in Community-Dwelling Older Adults from the NuAge Study: Exploring the Associations with Other Fatty Acids and Sex.

BACKGROUND: Omega-3 (n-3) PUFAs are suggested to play a role in the prevention of cognitive decline. The evidence may be inconsistent due to methodologic issues, including interrelations with other long-chain (14 or more carbons) fatty acids (LCFAs) and use of sex as a confounding factor rather than an effect modifier. OBJECTIVES: This study evaluated the association between serum n-3 PUFAs and performance across 4 cognitive domains, overall and by sex, while controlling for other LCFAs. METHODS: In total, 386 healthy older adults (aged 77.4 ± 3.8 y; 53% females) from the Quebec Longitudinal Study on Nutrition and Successful Aging underwent a cognitive evaluation and blood sampling. Verbal and nonverbal episodic memory, executive functioning, and processing speed were evaluated. Serum LCFA concentrations were measured by gas chromatography. LCFAs were grouped according to standard fatty acid classes and factor analysis using principal component analysis (FA-PCA). Multivariate linear regression models were performed, including unadjusted and adjusted models for other LCFAs. RESULTS: Higher n-3 PUFA concentrations were associated with better nonverbal memory and processing speed in fully adjusted models not including other LCFAs (ßs of 0.21 and 0.19, respectively). The magnitude of these associations varied when other LCFAs were entered in the model (ßs of 0.27 and 0.32, respectively) or when FA-PCA factors were considered (ßs of 0.27 and 0.21, respectively). Associations with verbal episodic memory were limited to higher concentrations of EPA, whereas there was no association between n-3 PUFAs and executive functioning. Higher n-3 PUFAs were associated with better verbal and nonverbal episodic memory in females and with better executive functioning and processing speed in males. CONCLUSIONS: These results suggest that other LCFAs should be considered when evaluating the association between n-3 PUFAs and cognitive performance in healthy older adults. Sex differences across cognitive domains warrant further investigation.

Rebalancing meat and legume consumption: change-inducing food choice motives and associated individual characteristics in non-vegetarian adults.

BACKGROUND: A shift toward more plant-based foods in diets is required to improve health and to reduce environmental impact. Little is known about food choice motives and associated characteristics of those individuals who have actually reduced their consumption of animal-based foods. The aim of this cross-sectional study was to identify change-inducing motives related to meat and legume consumptions among non-vegetarians. The association between change-inducing motives and individual characteristics was also studied. METHODS: This study included 25,393 non-vegetarian participants in the French NutriNet-Santé cohort (77.4% women, mean age 55.4 ± 13.9 y.). The motives related to the declared change in meat and legume consumptions (e.g., taste, environment, social pressure) were assessed by an online questionnaire in 2018. For each motive, respondents could be classified into three groups: no motive; motive, not change-inducing; change-inducing motive. Associations between change-inducing motives and individual characteristics were evaluated using multivariable polytomic logistic regressions. Characteristics of participants who rebalanced their meat and legume consumptions were also compared to those who reduced their meat but did not increase their legume consumption. RESULTS: Motives most strongly declared as having induced a change in meat or legume consumptions were health and nutrition (respectively 90.7 and 81.0% declared these motives as change-inducing for the meat reduction), physical environment (82.0% for meat reduction only) and taste preferences (77.7% for legume increase only). Other motives related to social influences, meat avoidance and meat dislike were reported by fewer individuals, but were declared as having induced changes in food consumption. Most motives that induced a meat reduction and a legume increase were more likely to be associated with specific individual characteristics, for example being a woman or highly educated for health motives. CONCLUSIONS: Besides the motives reported as important, some motives less frequently felt important were declared as having induced changes in meat or legume consumptions. Change-inducing motives were reported by specific subpopulations. Public campaigns on health and sustainability could usefully develop new tools to reach populations less willing to change. TRIAL REGISTRATIONS: The study was registered at ClinicalTrials.gov (NCT03335644).

Are recent dietary changes observed in the NutriNet-Santé participants healthier and more sustainable?

PURPOSE: While intensive modern food systems have significant unfavourable impacts on health and the environment, new sustainable food consumption trends have been emerging in recent years. This study identified recent dietary trends over a 4-year period in terms of overall dietary patterns and organic foods consumption and associated socio-demographic determinants. METHODS: Food intakes were assessed among 18,108 participants of the NutriNet-Santé cohort in 2014 and 2018. A food frequency questionnaire was used to estimate organic and conventional food consumption. Change in food consumption, quality of the diet (assessed by the adherence to the French national guidelines), plant-based diet using published scores, organic food intake were evaluated in regard with various socio-demographic factors. The paired student t test to compare dietary intake and the Kruskal-Walllis test to consider socio-demographic characteristics were used. RESULTS: Consumption of meat and processed meat decreased respectively by 5.09 g/day (SD 51.15) and 1.12 g/day (SD 26.05). The average total consumption of organic products increased by 12% (+ 93 g/day) while consumption of organic fish and seafood (- 1.4 g/day), poultry (- 1 g/day), processed meat (- 0.3 g/day) and meat (- 3.3 g/day) decreased. The dietary towards healthier diets was more pronounced in certain population subgroups. For example, females, young individuals and postgraduate participants were more likely to increase their consumption of healthful plant and animal-based foods, organic foods and to improve the overall nutritional quality of their diets during the follow-up period than their counterparts. CONCLUSION: Our results indicate a slight inflexion towards healthier and plant-based diets over a 4-year period at least in some segments of the population. A decrease in the consumption of animal products and an increase in the consumption of healthful plant-based foods and organic foods suggests a potential trend towards more sustainable diets among certain subgroups. The environmental impacts of these changes need to be assessed in further works as well as the way to sustain and improve them, in particular those who do not initiate sustainable transition.

Nutritional risk factors for SARS-CoV-2 infection: a prospective study within the NutriNet-Santé cohort.

BACKGROUND: Nutritional factors are essential for the functioning of the immune system and could therefore play a role in COVID-19 but evidence is needed. Our objective was to study the associations between diet and the risk of SARS-CoV-2 infection in a large population-based sample. METHODS: Our analyses were conducted in the French prospective NutriNet-Santé cohort study (2009-2020). Seroprevalence of anti-SARS-CoV-2 antibodies was assessed by ELISA on dried blood spots. Dietary intakes were derived from repeated 24 h dietary records (at least 6) in the two years preceding the start of the COVID-19 pandemic in France (February 2020). Multi-adjusted logistic regression models were computed. RESULTS: A total of 7766 adults (70.3% women, mean age: 60.3 years) were included, among which 311 were positive for anti-SARS-CoV-2 antibodies. Dietary intakes of vitamin C (OR for 1 SD=0.86 (0.75-0.98), P=0.02), vitamin B9 (OR=0.84 (0.72-0.98), P=0.02), vitamin K (OR=0.86 (0.74-0.99), P=0.04), fibers (OR=0.84 (0.72-0.98), P=0.02), and fruit and vegetables (OR=0.85 (0.74-0.97), P=0.02) were associated to a decreased probability of SARS-CoV-2 infection while dietary intakes of calcium (OR=1.16 (1.01-1.35), P=0.04) and dairy products (OR=1.19 (1.06-1.33), P=0.002) associated to increased odds. No association was detected with other food groups or nutrients or with the overall diet quality. CONCLUSIONS: Higher dietary intakes of fruit and vegetables and, consistently, of vitamin C, folate, vitamin K and fibers were associated with a lower susceptibility to SARS-CoV-2 infection. Beyond its established role in the prevention of non-communicable diseases, diet could therefore also contribute to prevent some infectious diseases such as COVID-19.

Consumption of Ultra-Processed Foods by Pesco-Vegetarians, Vegetarians, and Vegans: Associations with Duration and Age at Diet Initiation.

BACKGROUND: There is a growing availability of industrial plant-based meat and dairy substitutes that can be classified as ultra-processed foods (UPFs). Very little is known about the consumption of UPFs by vegetarians. OBJECTIVE: The aim of this cross-sectional study, from the NutriNet-Santé cohort, was to describe the contribution of UPFs to different vegetarian diets, in relation to the nutritional quality of their diet, and determinants of UPF consumption, including duration and age at vegetarian diet initiation. METHODS: The study population (n = 21,212) was divided into 4 groups: 19,812 meat eaters, 646 pesco-vegetarians, 500 vegetarians, and 254 vegans. Daily food intakes were collected using repeated 24-h dietary records. Vegetarian diets were described by the proportion of energy from UPFs and the nutritional quality of the diet using healthy and unhealthy plant-based diet indices (PDIs). In a subsample without meat eaters (n = 1,400), a multivariable linear regression model was performed to study the association between UPF consumption and its determinants. RESULTS: Higher avoidance of animal-based foods was associated with a higher consumption of UPFs (P < 0.001), with UPFs supplying 33.0%, 32.5%, 37.0%, and 39.5% of energy intakes for meat eaters, pesco-vegetarians, vegetarians, and vegans. The nutritional quality of diets was also associated with the level of animal-based foods avoidance (P < 0.001), with healthy PDIs at 53.5, 60.6, 61.3 and 67.9 for meat-eaters, pesco-vegetarians, vegetarians, and vegans. Short duration and young age at diet initiation were associated with an increased consumption of UPFs (ßage at initiation = -0.003, P = 0.001; ßduration = -0.002, P < 0.001). CONCLUSIONS: Not all vegetarian diets necessarily have health benefits, because of potential adverse effects of UPFs on nutritional quality and healthiness of diet. UPF consumption by vegetarians and their diet characteristics should be considered in future studies on the links between vegetarianism and health. This trial was registered at clinicaltrials.gov as NCT03335644.

Organic food consumption and gluten-free diet, is there a link? Results in French adults without coeliac disease.

The rising popular belief that gluten is unhealthy has led to growth in gluten avoidance in people without coeliac disease. Little information is available on their dietary profiles and their dietary behaviours. Our aim was to compare the consumption of organic foods between gluten avoiders and non-avoiders, and their places of food purchase. We described their sociodemographic and dietary profiles. The study population included participants of the NutriNet-Santé cohort who completed both a food exclusion questionnaire and an organic semi-quantitative FFQ (n 23 468). Food intake and organic food consumption ratios were compared using multivariable adjusted ANCOVA models. Associations between gluten avoidance and organic food consumption as well as places of food purchase were investigated with multivariable logistic regression. Participants avoiding gluten were more likely to be women and had a healthier dietary profile. Organic food consumption was higher among gluten avoiders (48·50 % of total diet for total avoiders, 17·38 % for non-avoiders). After adjustments for confounders, organic food consumption and purchase in organic stores were positively associated with gluten avoidance: adjusted OR (aOR)Q5 v.Q1 organic food = 4·95; 95 % CI 3·70, 6·63 and aORorganic stores v.supermarkets = 1·82; 95 % CI 1·42, 2·33 for total avoiders. Our study highlights that individuals avoiding gluten are high organic consumers and frequently purchase their foods in organic stores which propose an extended offer of gluten-free food. Further research is needed to determine the underlying common motivations and the temporality of the dietary behaviours of healthy people avoiding gluten.

Caribbean nutrition transition: what can we learn from dietary patterns in the French West Indies?

PURPOSE: Despite the urgency regarding increasing rates of obesity and chronic diseases in the Caribbean, few studies described the nutrition transition. We aimed to provide such information by identifying dietary patterns in the French West Indies and their characteristics. METHODS: This cross-sectional analysis included 1144 Guadeloupeans and Martinicans from a multistage sampling survey conducted on a representative sample. Dietary patterns were identified using principal component analysis followed by a clustering procedure, and described using multivariable regression models. RESULTS: Four patterns were identified: (i) a "prudent" pattern characterized by high intakes of fruits, vegetables, legumes, seafood and yogurts, low intakes of fatty and sweet products, and a high Diet Quality Index-International (DQI-I); (ii) a "traditional" pattern characterized by high intakes of fruits, vegetables, tubers and fish, low intakes of red and processed meat, snacks, fast foods, and sweetened beverages, with a high DQI-I, mostly shaped by women and older persons; (iii) a "convenient" pattern characterized by high intakes of sweetened beverages, snacks, and fast foods, with the lowest DQI-I, principally shaped by young participants; (iv) a "transitioning" pattern characterized by high consumptions of bread, processed meat, sauces, alcoholic and sweetened beverages, but also high intakes of tubers, legumes, and fish, mainly shaped by men, middle aged, of whom 35% had metabolic syndrome. CONCLUSION: The co-existing dietary patterns in the French West Indies, marked by a generational contrast, seem to reflect different steps in dietary change as described in the literature, suggesting an ongoing nutrition transition.

Ultra-processed food intake in association with BMI change and risk of overweight and obesity: A prospective analysis of the French NutriNet-Santé cohort.

BACKGROUND: Ultra-processed food (UPF) consumption has increased drastically worldwide and already represents 50%-60% of total daily energy intake in several high-income countries. In the meantime, the prevalence of overweight and obesity has risen continuously during the last century. The objective of this study was to investigate the associations between UPF consumption and the risk of overweight and obesity, as well as change in body mass index (BMI), in a large French cohort. METHODS AND FINDINGS: A total of 110,260 adult participants (≥18 years old, mean baseline age = 43.1 [SD 14.6] years; 78.2% women) from the French prospective population-based NutriNet-Santé cohort (2009-2019) were included. Dietary intakes were collected at baseline using repeated and validated 24-hour dietary records linked to a food composition database that included >3,500 different food items, each categorized according to their degree of processing by the NOVA classification. Associations between the proportion of UPF in the diet and BMI change during follow-up were assessed using linear mixed models. Associations with risk of overweight and obesity were assessed using Cox proportional hazard models. After adjusting for age, sex, educational level, marital status, physical activity, smoking status, alcohol intake, number of 24-hour dietary records, and energy intake, we observed a positive association between UPF intake and gain in BMI (ß Time × UPF = 0.02 for an absolute increment of 10 in the percentage of UPF in the diet, P < 0.001). UPF intake was associated with a higher risk of overweight (n = 7,063 overweight participants; hazard ratio (HR) for an absolute increase of 10% of UPFs in the diet = 1.11, 95% CI: 1.08-1.14; P < 0.001) and obesity (n = 3,066 incident obese participants; HR10% = 1.09 (1.05-1.13); P < 0.001). These results remained statistically significant after adjustment for the nutritional quality of the diet and energy intake. Study limitations include possible selection bias, potential residual confounding due to the observational design, and a possible item misclassification according to the level of processing. Nonetheless, robustness was tested and verified using a large panel of sensitivity analyses. CONCLUSIONS: In this large observational prospective study, higher consumption of UPF was associated with gain in BMI and higher risks of overweight and obesity. Public health authorities in several countries recently started to recommend privileging unprocessed/minimally processed foods and limiting UPF consumption. TRIAL REGISTRATION: ClinicalTrials.gov NCT03335644 (https://clinicaltrials.gov/ct2/show/NCT03335644).

Prospective association between organic food consumption and the risk of type 2 diabetes: findings from the NutriNet-Santé cohort study.

BACKGROUND: Organic food (OF) consumption has substantially increased in high income countries, mostly driven by environmental concerns and health beliefs. Lower exposure to synthetic pesticides has been systematically documented among consumers of organic products compared to non-consumers. While experimental studies suggest that pesticides currently used in food production may be associated with type 2 diabetes (T2D), no well-conducted prospective studies have investigated the potential association between consumption of organic products and the risk of T2D, controlling for potential confounding factors. The objective of this prospective study was to estimate the association between OF consumption and the risk of T2D. METHODS: A total of 33,256 participants (76% women, mean (SD) age: 53 years (14)) of the French NutriNet-Santé prospective cohort study who completed the organic food frequency questionnaire were included (2014-2019). The proportion of OF in the diet (as weight without drinking water) was computed. The associations between the proportion of OF in the diet (as 5% increment and as quintiles) and the risk of T2D were estimated using multivariable Hazard Ratio (HR) and 95% confidence interval (95% CI) derived from proportional hazards models adjusted for confounders (sociodemographic, anthropometric, lifestyle, medical and nutritional factors). RESULTS: During follow-up (mean = 4.05 y, SD = 1.03 y, 134,990 person-years), 293 incident cases of T2D were identified. After adjustment for confounders including lifestyle (physical activity, smoking status, alcohol consumption) and nutritional quality of the diet assessed by the adherence to the French food-based dietary guidelines, OF consumption was associated with a lower risk of T2D. Participants with the highest quintile of OF consumption, compared with those with the lowest quintile, had 35% lower risk of T2D (95% CI = 0.43-0.97). Each increment of 5% in the proportion of OF in the diet was associated with 3% lower risk of T2D (HR 0.97, 95% CI = 0.95-0.99). CONCLUSIONS: In this large prospective cohort study, OF consumption was inversely associated with the risk of T2D. Further experimental and prospective studies should be conducted to confirm these observations. CLINICAL TRIAL REGISTRY: The study was registered at ClinicalTrials.gov ( NCT03335644 ).

Prospective associations between sustainable dietary pattern assessed with the Sustainable Diet Index (SDI) and risk of cancer and cardiovascular diseases in the French NutriNet-Santé cohort.

To ensure a sustainable development, it is essential to better characterize the relationships between diet sustainability and health. We investigated the associations between sustainable dietary patterns, assessed using the Sustainable Diet Index (SDI) and the risk of cancer and cardiovascular diseases in a large prospective cohort of French volunteers. We computed the SDI among 25,592 participants of the NutriNet-Santé cohort using a database developed within the BioNutriNet project comprising nutritional, behavioral, environmental and economic data. Health status of each participant was collected from 2014 to 2018 and validated by physicians. Associations between the SDI and risk of chronic diseases (cancer and cardiovascular diseases) were assessed using multivariable Cox models. 640 incident chronic diseases occurred during the 3.8-year follow-up (483 cancer cases and 158 cardiovascular disease cases). A higher SDI was associated with a lower risk of overall chronic diseases after adjustment for potential confounding factors. Participants in the fourth quartile, reflecting the highest sustainable dietary patterns, exhibited a significant decrease in risk of cancers or cardiovascular diseases (HRQ4 vs. Q1 = 0.61 (95% CI 0.47-0.80), P-trend = 0.0002). More specifically, this association was observed for cancers in the fully adjusted model but was not statistically significant for cardiovascular diseases. Although these results need to be confirmed by other observational studies, they support the fact that a wide adoption of sustainable dietary patterns may contribute to improving global health in France and argue for existing dietary patterns exhibiting cobenefits for human health and the environment.

Dispositional optimism is associated with weight status, eating behavior, and eating disorders in a general population-based study.

OBJECTIVE: The objective of this cross-sectional study was to assess whether optimism is associated with body mass index (BMI), eating behavior and eating disorders (EDs) in a population-based study. METHOD: In 2016, a total of 32,805 participants aged ≥18 years from the NutriNet-Santé cohort completed the Life Orientation Test-Revised, assessing dispositional optimism. Height and weight were self-reported. Eating behavior was assessed with the revised 21-item Three-Factor Eating Questionnaire. Risk of EDs was evaluated with the Sick-Control-One-Fat-Food Questionnaire. Linear and Logistic regression was used to analyze the association between optimism, BMI categories, eating behavior and ED risk, controlling for sociodemographic, lifestyle and depressive symptom characteristics. RESULTS: Our sample was composed of 73.5% women, and the mean age was 55.39 ± 13.70 years. More optimistic participants were less likely to be underweight (OR = 0.82; 95% CI: 0.75, 0.89), or obese, particularly class III obese (BMI ≥40 kg/m2 ) (OR = 0.69; 95% CI: 0.56, 0.84) compared with less optimistic individuals. Optimism was negatively associated with cognitive restraint (ß = -.07; 95%CI: -0.08; -0.06), emotional eating (ß = -.17; 95% CI: -0.19, -0.16) and uncontrolled eating (ß = -.10; 95% CI: -0.11, -0.09). In addition, more optimistic participants had a lower risk of EDs (OR = 0.60; 95% CI: 0.56, 0.64). DISCUSSION: Our findings showed that optimism was associated with weight status, eating behavior and risk of EDs in both women and men. The causal structure of the underlying observed association remains unclear and should be further investigated.

Prospective association between ultra-processed food consumption and incident depressive symptoms in the French NutriNet-Santé cohort.

BACKGROUND: Ultra-processed food (UPF) consumption has increased over the last decades in Westernized countries. Our objective was to investigate for the first time the association between the proportion of UPF (%UPF) in the diet and incident depressive symptoms in the NutriNet-Santé cohort. METHODS: The sample included 20,380 women and 6350 men (aged 18-86 years) without depressive symptoms at the first Center for Epidemiologic Studies Depression Scale (CES-D) measurement, using validated cut-offs (CES-D score ≥ 17 for men and ≥ 23 for women). The proportion of UPF in the diet was computed for each subject using the NOVA classification applied to dietary intakes collected by repeated 24-h records (mean = 8; SD = 2.3). The association between UPF and depressive symptoms was evaluated using multivariable Cox proportional hazards models. RESULTS: Over a mean follow-up of 5.4 years, 2221 incident cases of depressive symptoms were identified. After accounting for a wide range of potential confounders, an increased risk of depressive symptoms was observed with an increased %UPF in the diet. In the main model adjusted for sociodemographic characteristics, body mass index, and lifestyle factors, the estimated hazard ratio for a 10% increase in UPF was 1.21 (95% confidence interval = 1.15-1.27). Considering %UPF in food groups, the association was significant only for beverages and sauces or added fats. CONCLUSION: Overall, UPF consumption was positively associated with the risk of incident depressive symptoms, suggesting that accounting for this non-nutritional aspect of the diet could be important for mental health promotion.