Determinants of energy drink consumption in adolescents: identification of sex-specific patterns.

OBJECTIVES: To investigate sex differences in sociodemographic and lifestyle correlates of frequent energy drink (ED) consumption in adolescents. STUDY DESIGN: This study was based on data collected among French-speaking Belgian adolescents aged 11-20 years (n = 8137) within the 2018 Health Behaviour in School-aged Children study. METHODS: Multiple logistic analyses stratified by sex were performed to estimate the associations between consuming EDs more than once a week, and various sociodemographic and lifestyle characteristics. RESULTS: Overall, 14.0% of boys and 7.6% of girls consumed ED more than once a week. For both genders, the likelihood of consuming ED more than once a week was higher among adolescents consuming soft drinks daily (vs. < daily), alcohol weekly (vs. < weekly), spending at least 5 h/day in front of screens (vs. < 5 h/day), and going to bed later than 11:30 PM (vs. ≤ 10:00 PM). Among boys, adolescents reporting at least 1 h of moderate-to-vigorous physical activity (MVPA) daily (vs. < 1 h/day MVPA) were more likely to consume ED more than once a week (adjusted odd ratio (aOR) = 1.49 (95% confidence interval [CI] 1.11-2.01)). Among girls, adolescents from low affluence families (vs. high affluence) (aOR = 2.03 (95% CI 1.19-3.48)) and immigrants (vs. natives) (2nd generation: aOR = 1.75 (95% CI 1.31-2.32); 1st generation: aOR = 1.90 (95% CI 1.20-3.03)) were more likely to consume ED more than once a week. CONCLUSIONS: We identified different patterns of ED consumption in boys and girls. These results suggest that sex-tailored interventions could be relevant to reduce ED consumption in adolescents.

Immigration and adolescent health: the case of a multicultural population.

OBJECTIVES: Previous research indicates that the impact of immigration on health tends to be specific as it is influenced by many factors such as life stage and host country. The aim of this study was to examine the relationship between immigration and adolescent health within the multicultural context of the Brussels-Capital Region in Belgium. STUDY DESIGN: The study was based on the 2014 Health Behaviour in School-aged Children survey. The sample consisted of 2962 adolescents from the fifth grade of primary to the last grade of secondary schools in Brussels. METHODS: Associations between health indicators and immigration status were analysed using multivariable logistic regression models adjusted for sociodemographic characteristics. RESULTS: Natives, first-generation immigrants, second-generation immigrants with both parents born abroad and second-generation immigrants with one parent born abroad represented 19%, 23%, 36% and 22% of the respondents, respectively. Sociodemographic characteristics and health behaviours varied according to immigrant status. Young immigrants were more likely to present overweight (odds ratio [OR] first-generation immigrants vs. natives = 1.76 [95% confidence interval {CI} = 1.16-2.65]; OR second-generation immigrants with both parents born abroad vs. natives = 2.06 [95% CI = 1.41-3.02]; OR second-generation immigrants with one parent born abroad vs. natives = 1.69 [95% CI = 1.12-2.56]). This effect turned out to be partially explained by sociodemographic status and health-related behaviours. No association was detected between immigration and self-rated health and multiple recurrent symptoms. CONCLUSIONS: Discrepancies in health behaviours and weight status were identified between adolescents of different immigration background, whereas this was not the case for well-being. Socio-economic status, cultural characteristics and specific behaviours partly explained these findings. Future research is needed to better understand immigration-related risk and protective factors, at individual and school levels.

Consumer acceptability and understanding of front-of-pack nutrition labels.

BACKGROUND: Front-of-pack (FOP) nutrition labelling has been proposed as a tool for helping consumers make healthy choices. Before determining its effects on consumer behaviour, factors involved in its use must be elucidated, i.e. understanding and acceptability on the part of the consumer. Among five FOP labels, we sought to determine which formats were most easily understood and accepted by a large sample of adults. METHODS: Among 39 370 adults who participated in the French Nutrinet-Santé cohort study, understanding and indicators of acceptability (attitude, liking, visual attractiveness and perceived cognitive workload) were measured for five FOP labels: The currently used 'multiple traffic lights' (MTL) and 'simple traffic lights' (STL), and the 'colour range' logo (CR), the 'green tick' and the PNNS logo. We investigated the contribution of the different elements to consumer perception of FOP labels using multiple correspondence analyses. RESULTS: Over half of the sample population showed a high level of understanding and perceived no discomfort in terms of the different logos. Label formats were positioned along an acceptability gradient ranging from acceptance to rejection, consisting of 'liking', 'attractiveness' and indicators of perceived cognitive workload. MTL was significantly more often liked and was viewed as reliable and informative. MTL, STL and the green tick performed better than the CR and PNNS logos in terms of ease of identification and comprehension. CR was clearly the least appreciated and it had the most complex format. CONCLUSIONS: Consumers prefer FOP labels which give complete, reliable and simplified information on the nutrient quality of foods.

Correlates of sedentary behavior in 7 to 9-year-old French children are dependent on maternal weight status.

OBJECTIVE: Sedentary behavior accounts for overweight and obesity, independently of physical activity. Correlates of sedentary behavior have not been extensively reported in the literature. Our objective was to determine factors associated with such behavior in 7 to 9-year-old French children in 2007, and to assess interactions between the identified correlates. DESIGN: A nationally representative sample of 2525 children participated in the study. Television viewing, video/computer duration and characteristics of the children and their parents were assessed using a questionnaire completed by the parents. Correlates of television viewing (<2 h per day versus ≥ 2 h per day) as a proxy for sedentary behavior were estimated using multivariate logistic regression. RESULTS: On an average, children spent more than 2 h per day in front of a screen (television: 1 h 32 min (s.e.m.: ± 0 h 02 min); video/computer: 0 h 40 min (± 0 h 02 min)). Television viewing duration was associated with sociodemographic (child's age, weight status, socio-economic characteristics of the family) and behavioral factors (physical and lifestyle activities). In children of non-overweight mothers, risk of spending ≥ 2 h per day in front of a television was significantly higher in those over 9 (versus 7 years: odds ratio (OR): 2.07; 95% confidence intervals (CI): 1.04-4.11), living in an educational priority zone (OR: 1.62; 95% CI: 1.08-2.44), who were not members of a sports team (OR: 2.24; 95% CI: 1.47-3.41), nor declared active by parents (OR: 1.92; 95% CI: 1.13-3.25), and whose parents' education level was lower than high school (OR: 1.84; 95% CI: 1.24-2.72). In contrast, in children of overweight mothers, only the criteria of ≥ 4 children in the family (versus 2-3 children: OR: 1.87; 95% CI: 1.05-3.35) and no reported parental occupation (versus manager or white collar: OR: 0.29; 95% CI: 0.11-0.76) were associated with watching television ≥ 2 h per day. CONCLUSIONS: Correlates of sedentary behavior in 7 to 9-year-old children vary according to maternal overweight. Maternal body mass index must therefore be taken into account when developing strategies to prevent a sedentary lifestyle in children.

A first national prevalence estimate of diagnosed and undiagnosed diabetes in France in 18- to 74-year-old individuals: the French Nutrition and Health Survey 2006/2007.

AIMS: To estimate the nationwide prevalence of diagnosed and undiagnosed diabetes and pre-diabetes in adults residing in France. METHODS: A probability sample of a non-institutionalized civilian population residing throughout the whole of continental France was recruited from February 2006 to March 2007 for the French Nutrition and Health Survey. All individuals aged between 18 and 74 years who agreed to participate in the survey were included; thus there were 3115 participants, 2102 of whom were undergoing biochemical assessments. The prevalence of diagnosed diabetes was estimated using self-reported diabetes history and the prevalence of undiagnosed diabetes was estimated using fasting plasma glucose ≥ 7.0 mmol/l or HbA(1c) ≥ 6.5% (≥ 48 mmol/mol). RESULTS: The prevalence of diagnosed diabetes was 4.6%, 95% CI 3.6-5.7. The prevalence of undiagnosed diabetes according to standard fasting plasma glucose criteria was 1% (95% CI 0.6-1.7) and contributed to less than 20% of all cases of diabetes. This proportion decreased with age from 30% in 30- to 54-year-olds to 12% in 55- to 74-year-olds. Based on HbA(1c) criteria, the prevalence of undiagnosed diabetes was 0.8% (95% CI 0.4-1.6). CONCLUSIONS: The prevalence of diagnosed diabetes in adults in France is comparable with recent estimates from Northern Europe. The percentage of total diabetes that is undiagnosed is low in France, which may be explained by a widely practised strategy of opportunist screening. During the past years, improvements in diabetes care and increased awareness may have contributed towards decreasing the prevalence of undiagnosed diabetes more widely in Europe, and studies should further monitor such improvements.

Dietary behaviour and nutritional status in underprivileged people using food aid (ABENA study, 2004-2005).

BACKGROUND: Although initiatives are setting up to improve the nutritional status of deprived people, few studies have described the food aid user profile and evaluated their nutritional needs. The contributions of food aid to the food supply, dietary behaviour and nutritional status of food aid users were evaluated in the ABENA study. METHODS: A cross-sectional study was conducted among food aid users in four urban French zones (n = 1664, age ≥18 years). Sociodemographic and economic characteristics, food insufficiency, food supply and diet behaviours were assessed using standardised questionnaires. A subsample of participants underwent clinical and biochemical examinations. Descriptive and comparative analyses were performed taking into account sample weights. RESULTS: Over 70% of participants used food aid as the only source of supply among numerous food groups, and one-quarter of them (27.2%) were using food aid for 3 years or more. The mean food budget was €70.0 per person per month, and 46.0% of subjects were classified as 'food-insufficient'. Half of the subjects fulfilled the French recommendations for starchy foods (48.7%) and 'meat, fish and eggs' (49.4%); 27.3% met the requirements for seafood. Only a very small proportion of participants met the recommendations for fruits and vegetables (1.2%) and dairy products (9.2%). In addition, 16.7% of subjects were obese, 29.4% had high blood pressure, 14.8% were anaemic, 67.9% were at risk of folate deficiency and 85.6% had vitamin D deficiency. CONCLUSIONS: These results provide evidence of an unhealthy diet and poor health profiles in severely disadvantaged persons and highlight the importance of food aid in this population. Thus, this study points to the necessity of improving the nutritional quality of currently distributed food aid.

Sociodemographic and economic characteristics associated with dairy intake vary across genders.

BACKGROUND: Recommendations promote a diversified and optimal but not excessive consumption of dairy products. Their efficiency may depend on sociodemographic and economic factors, for which little information is available. Links between these factors and dairy intake were investigated in a large sample of French adults. METHODS: Dietary intakes were assessed using at least six 24-h dietary records collected during a 2-year period from 4574 adults aged 45-60 years. The cost of each food item was estimated from national data. Sociodemographic and economic characteristics were assessed by self-administered questionnaires. Compliance with the current dairy recommendation, distribution of the dairy budget and calcium inadequacy were compared by logistic regression and covariance analyses. RESULTS: Thirty-five percent of subjects complied with the three-per-day dairy recommendation, with more men than women exceeding this (36.2% versus 26.5%, P < 0.0001). The proportion of the dairy budget spent on milk increased with age in men (P = 0.002); in women, it was inversely associated with occupational category (P = 0.009) and residence in an urban area (P = 0.0001). The proportion of this budget spent on cheese increased with education level in women (P = 0.04) and decreased with age in men (P = 0.03). In men, the consumption of cream desserts decreased with age (P = 0.006) and education level (P = 0.002). Dietary calcium inadequacy was more prevalent in women than in men (32.7% versus 14.2%, P < 0.0001). Among women, this prevalence was higher in older subjects (P < 0.0001) and those who lived alone (P = 0.005). CONCLUSIONS: Although compliance with dairy recommendation needs to be improved, sociodemographic and economic factors should be taken into account to improve the efficiency of targeted public health messages.

Prevalence of overweight in 6- to 15-year-old children in central/western France from 1996 to 2006: trends toward stabilization.

OBJECTIVE: The prevalence of overweight in children has markedly increased over the past few decades in France, as in all Western countries. We sought to describe the yearly prevalence of childhood overweight from 1996 to 2006 and to assess whether a shift in trends could be observed dating from the time the Nutrition and Health National Program (PNNS) was set up in France in 2001, in particular according to gender, age and family economic status. DESIGN: We used annual overweight prevalence of standardized 6- to 15-year-old populations (total=26 600) with weight and height measured at health examination centers in the central/western part of France between 1996 and 2006. Regression slopes of overweight prevalence were evaluated between 1996 and 2006, and specifically between 1996 and 2001, and 2001 and 2006. The annual prevalence and estimated slopes were compared in subgroups, taking into account gender, age and economic status of the family. RESULTS: The prevalence increased between 1996 (11.5%) and 1998 (14.8%) and was stable between 1998 and 2006 (15.2%). According to linear regression, the overall trend in prevalence of overweight children between 1996 and 2006 was stable (slope=0.19, P=0.08). Similarly, the prevalence of overweight increased between 1996 and 1998 in boys and girls, in 6-10 year olds, in 11-15 year olds and in non-disadvantaged children, and remained stable thereafter. The prevalence of overweight in the disadvantaged group increased between 1996 (12.8%) and 2001 (18.9%) (slope=1.16, P=0.004) and was stable between 2001 and 2006 (18.2%) (slope=0.09, P=0.78). CONCLUSION: The results of this study reveal a stable prevalence of overweight since 1998 in most groups studied, and since 2001 in the disadvantaged group.

[Factors associated to breastfeeding up to 6 months in the maternity of Antoine-Béclère Hospital, Clamart]. / Facteurs associés à l'allaitement maternel du nourrisson jusqu'à 6 mois à la maternité de l'hôpital Antoine-Béclère, Clamart.

OBJECTIVES: In order to improve the frequency and duration of breastfeeding, various public health initiatives have been established at local and national levels in France. In 2002, we conducted a study in the maternity center of the Antoine Beclere Hospital with the aim to describe breastfeeding practices and to identify factors associated with its duration. METHODS: This prospective study was conducted among newborns of immediate postpartum women admitted to the maternity center of the Antoine Beclere Hospital (Clamart, France). Extremely premature newborns were excluded (<31 weeks of amenorrhea). Mothers were interviewed at delivery, at one month and 6 months postpartum. Data were collected on maternal medical history, pregnancy and delivery, the newborn's health status, feeding practices, and the reasons for their choice in feeding practices. RESULTS: Between January 7 and April 7, 2002, 562 newborns were included in the study. At birth, 73% were breastfed, whereas 68% were breastfed at discharge from the maternity center. Among the latter, 89% of infants were still being breastfed at one month, and 37% at 6 months of age. Factors associated with breastfeeding at one month were as follows: a secondary level of education (OR(a): 2.4 [1.0-5.7] compared to primary level), multiparity (OR(a): 3.0 [1.2-8.0] compared to primiparity), full-term birth (OR(a): 6.6 [2.4-18.4] compared to premature birth), treatment during pregnancy (OR(a): 0.2 [0.04-0.6]), and medical history (OR(a): 0.4 [0.2-1.0]). Among women who were breastfeeding at one month, the continuation of breastfeeding at 6 months was associated with a secondary education level (OR(a): 2.2 [1.0-5.0]), the choice of feeding practice during pregnancy (OR(a): 2.5 [1.1-5.0] compared to those who did not choose), and to medically assisted reproduction (OR(a): 5.0 [1.2-14.3] compared to spontaneous procreation). DISCUSSION: The prevalence of breastfeeding observed in this study is higher than it was observed at the national level. Factors associated with continuation of breastfeeding at 6 months allow identifying women who should be encouraged to breastfeed by the maternity team involved during pregnancy. Interventions should therefore involve maternity healthcare professionals as a first step in breastfeeding promotion.

Television viewing duration and blood pressure among 18-74-year-old adults. The French nutrition and health survey (ENNS, 2006-2007).

OBJECTIVES: To describe Blood Pressure (BP) according to the time spent viewing television and examine whether the associations between television viewing and systolic and diastolic BP differed depending on sex, age and BMI. DESIGN: The French health and nutrition survey (ENNS) was conducted in 2006-2007 on a multistage stratified random sample of 18-74-year-old adults. METHODS: Systolic (SBP) and diastolic BP (DBP) were assessed using three measurements. Among subjects without BP-lowering drugs and lifestyle measures, adjusted means of SBP and DBP were estimated for each television viewing category (<3h and ≥3h). RESULTS: Among 2050 ENNS participants, 81.2% declared neither drug medication nor lifestyle change to lower BP. In women without BP-lowering measure, viewing television 3h/day or more increased significantly SBP and DBP adjusted means (+2mmHg) compared to women who spent less than 3h/day in front of the television. These associations were stronger in obese or 35-54-year-old women. In men, no relationship between DBP and television-viewing has been observed. Though, SBP was positively associated with television-viewing in non-overweight, 18-29 or 55-74 year-old men. CONCLUSIONS: These results show that the association between television viewing duration and BP must be evaluated differently between gender, age group and BMI category.

[Recent prevalence of child and adolescent overweight and obesity in France and abroad]. / L'évolution récente des prévalences de surpoids et d'obésité chez l'enfant et l'adolescent en France et au niveau international.

During the 2000s, surveillance of child overweight and obesity experienced a large expansion and provided an opportunity to document such a public health issue using standardized procedures in France and abroad. Nowadays, in France, it has been estimated that just less than one child out of five is overweight and among them, 3 to 4 % are obese. Like in other developed countries, these frequencies have reached a plateau during the 2000s and set France belonging to a group of countries in which the situation looks as fairly favorable. Nevertheless, they also hide huge disparities across social groups and the number of concerned children remains too high, while care possibilities are rather inconclusive. Therefore, prevention actions are still needed.

Body-weight perception and related preoccupations in a large national sample of adolescents.

OBJECTIVES: This study aimed to investigate the association between body-weight (BW) perception, weight preoccupation and behaviour, including weight control practices and compulsive over-eating episodes, across gender and actual BW classes. DESIGN: This study used a cross-sectional observational study. PARTICIPANTS: A large, nationally representative sample of 6404 ninth-grade French adolescents was randomly selected from schools throughout France. METHODS: Weight and height were measured, and BW preoccupation, BW control practices and compulsive over-eating were self-reported using standardized questionnaires. RESULTS: Nearly one-third of adolescents misperceived their BW. Misperception was more frequent among girls than boys (42.2% vs. 27.3%, P < 0.01). Underestimation of BW among overweight adolescents, like BW overestimation among underweight adolescents, was associated with less preoccupation with weight and fewer weight control practices than accurate perception of BW. Normal weight adolescents who overestimated their BW were more likely to declare weight preoccupations (ORa = 8.66 [6.67-11.25]), dieting (ORa = 4.81 [3.68-6.27]) and recurrent compulsive over-eating episodes (ORa = 2.36 [1.72-3.23]) compared with their counterparts who correctly estimated their BW. CONCLUSION: Our study underlines the role of these associations in each category of actual BW (underweight, normal weight and overweight) in a large national sample.

Associations between weight status and liking scores for sweet, salt and fat according to the gender in adults (The Nutrinet-Santé study).

BACKGROUND/OBJECTIVES: As taste preferences may be associated with obesity, the present study investigated whether obese subjects presented heightened liking for the sensations of sweet, salt and fat. SUBJECTS/METHODS: Liking scores were determined by a questionnaire including 83 items on liking for sweet or fatty foods, and the preferred extent of seasoning with salt, sweet or fat. Data from 46909 adults included in the French web-based observational cohort of the Nutrinet-Santé study were collected and weighted according to the national population census. Relationships between liking scores and body mass index (BMI) as categorical or linear explanatory variable were assessed separately by gender using covariance and linear regression analyses, adjusted for age, education level, living area, smoking and alcohol. RESULTS: Overall liking scores for salt and fat were linearly positively linked to BMI in men and women (P≤0.001) and were higher in obese than in normal-weight individuals. The score difference between BMI categories was greater in women for fat liking only. For sweet liking, results differed between gender and compounding factors. Liking for added sugar and sweet foods was positively linked to BMI in women unlike in men; liking for natural sweetness was negatively linked to BMI in both genders. CONCLUSIONS: This study demonstrates that the relationship between liking and BMI differs according to the gender in its magnitude for fat and in its nature for sweet, unlike that for salt. Liking for sweet and fat may be linked to overconsumption of the corresponding foods, especially in women. This warrants further investigation.

Preventing mother-to-child transmission of HIV-1 in Africa in the year 2000.

OBJECTIVES: Various approaches to preventing mother-to-child transmission (MTCT) of HIV have recently been, or are being, evaluated in developing countries, especially in Africa. New findings from these trials are now becoming available, the implications of which, for population-based intervention programmes, need urgent consideration. METHOD: A critical review of 18 randomized trials and other relevant studies from developing and industrialized countries. RESULTS: Most African results relate to trials of antiretroviral agents (ARV). They demonstrate efficacy in reducing transmission in the first 6 months of life with short regimens of zidovudine (ZDV), with or without lamivudine (3TC), and nevirapine (NVP) alone. Preliminary results suggest the long-term efficacy of zidovudine. Antiseptic and nutritional interventions have been shown to reduce maternal and infant mortality and morbidity but not MTCT of HIV. HIV confidential voluntary counselling and testing for pregnant women, a short regimen of peripartum ARV with alternatives to breastfeeding such as early weaning or breast milk substitutes from birth currently represent the best option to reduce MTCTof HIV in Africa. However, the prevention of postnatal transmission requires further research, particularly in view of the consequences of different feeding options and the possibility of post-perinatal exposure prophylaxis of newborns with ARV. Issues relating to the implementation of currently validated strategies are discussed.

Effect of early chemoprophylaxis with co-trimoxazole on nutritional status evolution in HIV-1-infected adults in Abidjan, Côte d'Ivoire.

BACKGROUND: In sub-Saharan Africa, malnutrition is a major complication of HIV disease. Measuring accurately the nutritional benefits of a therapeutic intervention could be an easy-to-monitor secondary outcome. METHODS: Anthropometric data were analysed from patients participating in a placebo-controlled trial of co-trimoxazole prophylaxis in adults recruited at early stages of HIV-1 infection in Côte d'Ivoire (COTRIMO-CI ANRS 059 trial). Body mass index (BMI), arm muscle circumference (AMC) and percentage of fat mass (FM) were measured at baseline and quarterly during the follow up. Percentage of variation from the baseline value was compared between treatment groups and within the groups using Student t-test. RESULTS: An improvement of all anthropometric indicators was observed in the first 3 months of follow up in both treatment groups, significant in the co-trimoxazole group (P < or = 0.0006) but not in the placebo group (P > or = 0.06). In the co-trimoxazole group, this improvement was maintained for up to 24 months for BMI (P = 0.007), 21 months for AMC (P = 0.02) and only up to 12 months for FM (P = 0.04). The placebo group had a stable anthropometric status up to the end of the trial. Differences between treatment groups were significant for up to 15 months for BMI and AMC and 12 months for FM. CONCLUSION: As co-trimoxazole prophylaxis is now recommended in Africa as part of a minimum package of care for HIV-infected symptomatic subjects, the short-term improvement of these anthropometric indicators in adults who start co-trimoxazole prophylaxis should be considered as an effective clinical outcome.

Care of human immunodeficiency virus-infected children in developing countries. International Working Group on Mother-to-Child Transmission of HIV.

CONTEXT: There is urgent need to strengthen the area of pediatric HIV/AIDS care in developing countries. Clinical research in this area is also scarce. METHODOLOGY: A literature review and a postal survey were used to obtain updated information on mortality, morbidity and current standards of care of children born to HIV-infected mothers in developing countries. A 2-day workshop was organized to review the available data and to identify the key areas where clinical research should be conducted. MAIN FINDINGS: Rates of mortality and morbidity were very different from one study to another but generally higher than in industrialized countries. Prognostic studies for HIV-1-infected children in developing countries were not available. Based on the report of 14 teams from 11 countries, specific protocols for HIV-infected children with persistent diarrhea or severe malnutrition were documented in fewer than one-half of the cases. Secondary antimicrobial prophylaxis after interstitial pneumonia or recurrent infections was still infrequent, as primary prophylaxis of opportunistic infections. The following list of clinical research priorities was identified by the workshop participants: primary prophylaxis of opportunistic and bacterial infections; case management of persistent diarrhea; reassessment of the performance of p24 antigen for diagnostic and prognosis use; studies on the etiology of pulmonary infections; long term observational pediatric cohorts; current weaning practices and duration of breast-feeding; counseling and HIV testing of children and families; prevention of HIV sexual transmission in children and adolescents.

Pregnancy, body weight and human immunodeficiency virus infection in African women: a prospective cohort study in Kigali (Rwanda), 1992-1994. Pregnancy and HIV Study Group (EGE).

OBJECTIVE: To study the relationship between human immunodeficiency virus (HIV) infection and body weight in African women during and after pregnancy. METHODS: A prospective cohort study was initiated at the Centre Hospitalier de Kigali in July 1992. Every woman seen at the antenatal clinic and with a gestational age of <28 weeks was offered HIV-1 antibody testing. Comparable numbers of HIV-infected (HIV+) and uninfected (HIV-) women were recruited. At inclusion, socio-demographic characteristics and self-reported pre-pregnancy weight were recorded; height and weight were measured. Each woman enrolled had a monthly follow-up until 9 months after delivery, with a clinical examination including weighing. Three anthropometric indices were used to answer the study objectives: weight, body mass index (BMI), and pregnancy balance. RESULTS: As of April 1994, 101 HIV+ and 106 HIV- women were followed until 5 months after delivery. Weight and BMI during pregnancy were lower in HIV+ women than in HIV- women. After delivery, weight and BMI gains were significantly lower in HIV+ women. Until 5 months after delivery, the mean weight variation was -2.2 kg (standard deviation [SD] = 5.9 kg) in HIV+ women and +0.2 kg (SD = 6.6 kg) in HIV- women (P = 0.007) in comparison to pre-pregnancy weight. Comparisons of the slopes of the weight curves did not show statistical differences throughout the pregnancy, but it did during the post-partum period (P = 0.02). CONCLUSIONS: Our study suggests that HIV infection could impair nutritional status in pregnant women, especially during the post-partum period. Family planning and maternal and child health services including HIV testing and counselling, should consider a nutritional assessment and intervention programme targeted to HIV+ pregnant women.

Nutritional status and dietary intakes in human immunodeficiency virus (HIV)-infected outpatients in Abidjan, Côte D'Ivoire, 1995.

OBJECTIVE: To evaluate nutritional status and dietary intakes in HIV-outpatients in Abidjan, Côte d'Ivoire. DESIGN: Cross-sectional study. SETTING: In the Outpatients and Counselling Unit in the University Hospital in Treichville, and in the follow-up Unit of Blood Donors. SUBJECTS: 100 HIV-infected patients at different stages of the infection recruited consecutively in the two consultation services. MAIN OUTCOME MEASURES: Clinical, biological and anthropometric data were collected: weight, baseline weight, height, triceps skinfold (TS), arm circumference (AC), body mass index (BMI), muscular circumference (MC) and weight loss (WL). Dietary intake was estimated by the 24 h recall method. RESULTS: The M:F sex ratio was 1.1:1. Mean age was 32.5 y (30.7-34.4); 64% of the patients were symptomatic (S+). Mean weight was 58.7 kg (56.8-60.6) and mean BMI, 20.9 k/m2 (20.7-21.1); 67% of the patients had a BMI < 21.5 kg/m2. S+ patients had mean weight, BMI, AC and MC significantly lower than asymptomatic patients (P < 0.0001 = 0.001, 0.0003 and 0.004 respectively) and had suffered a more important WL (P < 0.0001). Immunodepressed patients had mean weight, AC and MC significantly lower than patients with a CD4 count > or = 200/mm3 (P = 0.04, 0.005 and 0.04 respectively). WL was independent of CD4 count. Protein, carbohydrate and fat intakes were respectively 59 g/24 h (52-66), 266 g/24 h (240-292) and 59 g/24 h (51-66). Energy mean intake was 7.6 MJ/24 h (6.9-8.4) and lower than WHO recommended intakes. CONCLUSIONS: In Abidjan, anthropometric parameters and dietary intakes of HIV-infected patients are worsened by clinical events. Nutritional intakes are generally lower than recommendations. Further studies are needed to determine if, in the African context, a causal relationship could exist between dietary intakes and nutritional status in HIV-infected patients.

Background and rationale of the SU.FOL.OM3 study: double-blind randomized placebo-controlled secondary prevention trial to test the impact of supplementation with folate, vitamin B6 and B12 and/or omega-3 fatty acids on the prevention of recurrent ischemic events in subjects with atherosclerosis in the coronary or cerebral arteries.

Cardiovascular diseases are the primary cause of mortality in France. Many epidemiological studies have shown that the total homocysteine concentration is a risk indicator for cardiovascular disease. Furthermore, it has been shown that the homocysteine concentration can be effectively lowered by supplementation with folic acid, vitamin B6 and B12. However, it is not yet known whether a reduction of the homocysteine concentration by such a supplementation indeed leads to a decreased risk of cardiovascular disease. Another possible dietary factor that may lower the risk of cardiovascular disease is fish-oil, which is rich in omega-3 fatty acids. These fatty acids lower platelet aggregation and triglyceride rich lipoproteins and may have antiarrhythmic effects. Some trials have investigated the effect of fish or fish-oil on cardiovascular mortality, and the results, although not conclusive, suggest a protective effect of a higher intake. In the SU.FOL.OM3 study we will evaluate the effect of supplementation at nutritional doses of folate (in the natural 5-methyl-tetrahydrofolate form) in combination with vitamin B6 and B12 and/or omega-3 fatty acids and/or placebo on recurrent ischemic diseases in a factorial design. The supplements will be randomly allocated to the participants in a double-blind fashion. In total 3,000 patients aged between 45 and 80 years who had a past history of myocardial infarction or unstable angina pectoris or an ischemic stroke will be included. The participants will be supplemented and followed up for a period of five years.

[Thyroid hormone levels and thyroid dysfunction of French adults participating in the SU.VI.MAX study]. / Statut thyroïdien et fréquences des dysthyroïdies chez les adultes inclus dans l'étude SU.VI.MAX en 1994-1995.

Abnormal thyroid function has important public health consequences. However, the various degrees of thyroid dysfunction remain unsettled. The SU.VI.MAX cohort provided a unique opportunity to conduct a cross-sectional study of abnormal thyroid function in a large representative population of 11256 men and women representing the geographic distribution of the French continental adult population. Thyroid status was measured, in fasting blood samples, at baseline in 1994-1995. Serum thyrotropin (TSH) levels (abnormal < 0.4 mU/l or > or =4.0 mU/l) and free thyroxine (fT4) were both performed in duplicate on the same sample. Subjects with previous or present thyroid diseases or who were taking thyroid hormones or antithyroid drugs (n=920) were excluded (8.1%). Thus, the final study group consisted of 10346 subjects, 4121 men aged 45-60 years (mean +/-SD) (51.8+/-4.7 yrs), 2641 women aged 35-44 years (40.6+/-2.8 yrs), and 3584 women aged 45-60 years (51.4+/-4.4 yrs). Median (2.5th and 97.5th percentiles) for TSH (mU/l) were 1.52 (0.20-4.54) for men, 1.78 (0.22-5.54) for women aged 35-44 years, and 1.96 (0.22-6.80) for women aged 45-60 years. The TSH distribution of women was shifted to the right compared with men. Arithmetic mean fT4 (+/-SD) was 10.7+/-1.7 ng/l (13.8 +/-2.2 pmol/l) for men and 10.9+/-1.8 ng/l (14.0+/-2.3 pmol/l) for women. The prevalence of abnormal TSH values in men, and in women (35-44 yrs and 45-60 yrs) were TSH<0.4 mU/l 7.0%, 5.3% and 4.4%; TSH 4.0-9.9 mU/l 4.0%, 7.2% and 11.1% and TSH > or =10.0 mU/l 0.2%, 0.4% and 0.7%, respectively. Geometric mean serum TSH and arithmetic mean serum fT4 concentrations showed significant overall inter-regional differences for men and women (p<0.0001). There was also an inter-regional difference in the prevalence of thyroid dysfunction for men (p=0.003), and for the older group of women (i.e. > or =45 yrs) (p=0.04) exclusively. Over the age of 45 years, the women: men ratio for unrecognized elevated TSH levels (> or =4.0 mU/l) was 2.82, whereas it was 0.64 for low TSH levels (<0.4 mU/l). In summary, abnormal TSH values and thyroid dysfunction were more prevalent in women than men, increased with age and were significantly associated with environmental factors. A high prevalence of identified thyroid diseases in the French population was confirmed by the high number of subjects in this study with laboratory evidence of abnormal biochemical thyroid function. Further studies are needed to determine the geographical determinants of thyroid dysfunctions, especially regional differences in iodine intakes, and to assess the long-term adverse effects of biochemical thyroid dysfunction on all-cause morbidity.