Dietary patterns in the French adult population: a study from the second French national cross-sectional dietary survey (INCA2) (2006-2007).

Identification and characterisation of dietary patterns are needed to define public health policies to promote better food behaviours. The aim of this study was to identify the major dietary patterns in the French adult population and to determine their main demographic, socio-economic, nutritional and environmental characteristics. Dietary patterns were defined from food consumption data collected in the second French national cross-sectional dietary survey (2006-2007). Non-negative-matrix factorisation method, followed by a cluster analysis, was implemented to derive the dietary patterns. Logistic regressions were then used to determine their main demographic and socio-economic characteristics. Finally, nutritional profiles and contaminant exposure levels of dietary patterns were compared using ANOVA. Seven dietary patterns, with specific food consumption behaviours, were identified: 'Small eater', 'Health conscious', 'Mediterranean', 'Sweet and processed', 'Traditional', 'Snacker' and 'Basic consumer'. For instance, the Health-conscious pattern was characterised by a high consumption of low-fat and light products. Individuals belonging to this pattern were likely to be older and to have a better nutritional profile than the overall population, but were more exposed to many contaminants. Conversely, individuals of Snacker pattern were likely to be younger, consumed more highly processed foods, had a nutrient-poor profile but were exposed to a limited number of food contaminants. The study identified main dietary patterns in the French adult population with distinct food behaviours and specific demographic, socio-economic, nutritional and environmental features. Paradoxically, for better dietary patterns, potential health risks cannot be ruled out. Therefore, this study demonstrated the need to conduct a risk-benefit analysis to define efficient public health policies regarding diet.

Dietary acrylamide intake during pregnancy and anthropometry at birth in the French EDEN mother-child cohort study.

BACKGROUND AND AIM: Acrylamide is a contaminant formed in a wide variety of carbohydrate-containing foods during frying or baking at high temperatures. Recent studies have suggested reduced foetal growth after exposure to high levels of acrylamide during pregnancy. OBJECTIVE: To study the relationship between maternal dietary acrylamide intake during pregnancy and their offspring's anthropometry at birth. DESIGN: In our population of 1471 mother-child pairs from two French cities, Nancy and Poitiers, dietary acrylamide intake during pregnancy was assessed by combining maternal food frequency questionnaires with data on food contamination at the national level, provided by the second "French Total Diet Study". Newborns weighing less than the 10th percentile, according to a customised definition, were defined as small for gestational age (SGA). Linear and logistic regression models were used to study continuous and binary outcomes respectively, adjusting for the study centre, maternal age at delivery, height, education, parity, smoking during pregnancy, the newborn's gestational age at birth and sex. RESULTS: The median and interquartile range of dietary acrylamide intake were 19.2µg/day (IQR, 11.8;30.3). Each 10µg/day increase in acrylamide intake was associated with an odds-ratio for SGA of 1.11 (95% Confidence Interval: 1.03,1.21), birth length change of -0.05cm (95% CI: -0.11,0.00) and birth weight change of -9.8g (95% CI: -21.3,1.7). CONCLUSIONS: Our results, consistent with both experimental and epidemiological studies, add to the evidence of an effect of acrylamide exposure on the risk of SGA and suggest an effect on foetal growth, for both weight and length.

A restricted cubic spline approach to assess the association between high fat fish intake and red blood cell EPA + DHA content.

BACKGROUND AND AIMS: Fish, especially fatty fish, are the main contributor to eicosapentaenoic (EPA) and docosahexaenoic (DHA) intake. EPA and DHA concentrations in red blood cells (RBC) has been proposed as a cardiovascular risk factor, with <4% and >8% associated with the lowest and greatest protection, respectively. The relationship between high fat fish (HFF) intake and RBC EPA + DHA content has been little investigated on a wide range of fish intake, and may be non-linear. We aimed to study the shape of this relationship among high seafood consumers. METHODS AND RESULTS: Seafood consumption records and blood were collected from 384 French heavy seafood consumers and EPA and DHA were measured in RBC. A multivariate linear regression was performed using restricted cubic splines to consider potential non-linear associations. Thirty-six percent of subjects had an RBC EPA + DHA content lower than 4% and only 5% exceeded 8%. HFF consumption was significantly associated with RBC EPA + DHA content (P [overall association] = 0.021) adjusted for sex, tobacco status, study area, socioeconomic status, age, alcohol, other seafood, meat, and meat product intakes. This relationship was non-linear: for intakes higher than 200 g/wk, EPA + DHA content tended to stagnate. Tobacco status and fish contaminants were negatively associated with RBC EPA + DHA content. CONCLUSION: Because of the saturation for high intakes, and accounting for the concern with exposure to trace element contaminants, intake not exceeding 200 g should be considered.

Mass balance approach to assess the impact of cadmium decrease in mineral phosphate fertilizers on health risk: The case-study of French agricultural soils.

Cadmium is a ubiquitous and highly toxic contaminant that can cause serious adverse effects. The European Food Safety Authority (EFSA) and the French Agency for Food, Environmental and Occupational Health & Safety (ANSES) have shown that the risk related to food contamination by cadmium cannot be ruled out in Europe and France. Fertilizing material is one of the main sources of cadmium contamination in the food chain on which regulators can play to reduce cadmium exposure in the population. The aim of this work was to develop a mass-balance approach integrating the various environmental sources of cadmium to estimate the effects of a decrease in cadmium concentrations in crop fertilizers on dietary exposure and on the health risk. This approach led to a predictive model that can be used as a decision-making tool. Representative and protective fertilization scenarios associated with controlled cadmium levels in mineral phosphate fertilizers were simulated and converted into cadmium fluxes. Cadmium inputs from industrial mineral phosphate fertilizers were then compared with cadmium brought by the application of manure, sewage sludge and farm anaerobic digest, at the levels typical of French agricultural practices. Regardless of the fertilizer and scenario used, a flux lower than 2 g Cd.ha-1.year-1 reduces both the accumulation in soils and the transfer of cadmium in the food chain. It corresponds to a cadmium content of 20 mg.kg P2O5-1 or less in mineral phosphate fertilizers. Modelling the transfer of cadmium from the soil to consumed food made it possible to propose cadmium limits in fertilizers applied in France. In a global context of ecological transition to promote human health, this research will help risk managers and public authorities in the regulatory decision-making process for the reduction of environmental cadmium contamination and human exposure.

Dietary exposure and biomarkers of arsenic in consumers of fish and shellfish from France.

Seafood, especially fish, is considered as a major dietary source of arsenic (As). Seafood consumption is recommended for nutritional properties but contaminant exposure should be considered. The objectives were to assess As intake of frequent French seafood consumers and exposure via biomarkers. Consumptions of 996 high consumers (18 and over) of 4 coastal areas were assessed using a validated food frequency questionnaire. Seafood samples were collected according to a total diet study (TDS) sampling method and analyzed for total As, arsenite (AsIII), arsenate (AsV), arsenobetaïne (AsB), monomethylarsonic acid (MMA) and dimethylarsinic acid (DMA). The average As dietary exposure is 94.7+/-67.5 microg/kg bw/week in females and 77.3+/-54.6 microg/kg bw/week in males (p<0.001) and the inorganic As dietary exposure is respectively 3.34+/-2.06 microg/kg bw/week and 3.04+/-1.86 microg/kg bw/week (p<0.05). Urine samples were collected from 382 of the subjects. The average urinary As concentration is 94.8+/-250 microg/g creatinine for females and 59.7+/-81.8 microg/g for males (p<0.001). Samples having an As concentration above 75 microg/g creatinine (n=101) were analyzed for inorganic As (As(III), As(V), MMA(V) and DMA(V)) which was 24.6+/-27.9 microg/g creatinine for males and 27.1+/-20.6 microg/g for females. Analyses do not show any correlation between dietary exposure and urinary As. These results show that biological results should be interpreted cautiously. Diet recording seems to be the best way to assess dietary As exposure. Seafood is a high source of As exposure but even among high consumers it is not the main source of toxic As. From a public health point of view these results should be interpreted carefully in the absence of international consensus on the health-based guidance value.

To which mixtures are French pregnant women mainly exposed? A combination of the second French total diet study with the EDEN and ELFE cohort studies.

Pregnant women and their unborn child are exposed to a large number of substances during pregnancy. Some of these substances may cross the placenta, resulting in exposure of the foetus. There is growing evidence that certain substances could interact to produce a mixture effect. It is therefore essential to identify the main mixtures mothers are exposed to. This study aimed to identify the major mixtures French pregnant women included in EDEN and ELFE cohorts were exposed to, on the basis of the 441 substances analysed in the second French total diet study. Exposure systems and the composition of substances were identified from co-exposures using sparse non-negative matrix under-approximation to generate the main mixtures. Individuals were clustered to define clusters with similar co-exposure profiles. Six clusters associated with eight mixtures were identified. For example in ELFE, cluster 2 comprising 10% of the population was characterised by mixtures "Pest-1" mainly contains pesticides and "TE-F-PAH″ contains trace elements, furans and polycyclic aromatic hydrocarbons. Five other clusters were also described with their associated mixtures. Similar results were observed for EDEN. This study helps to prioritise mixtures for which it is crucial to investigate possible toxicological effects and to recommend epidemiological studies concerning health effects.

Organotin levels in seafood and its implications for health risk in high-seafood consumers.

Fish and fishery products are considered as the main source of organotin compounds (OTC). Unfortunately, little national contamination data is available to assess food exposure of organotins from French consumers. To provide a more accurate estimate of risks to human health, the butyltin, phenyltin and octyltin compounds sampling in four French coastal areas were measured in 159 composite samples (96 fresh and frozen fish, 28 mollusks, 14 crustaceans, 1 echinoderm, 11 canned foods, 4 smoked fish, 5 prepared seafood-based dishes) by capillary gas chromatography coupled with a microwave induced plasma atomic-emission spectrometer (CGC-MIP-AES). In these samples, butyltins were usually predominant and the range of the contamination levels was generally below those of earlier studies (fish: mean 5.6; min-max 1.1-23 microg/kg; fishery products: mean 6; min-max 0.8-14 microg/kg). Fish, especially tuna, salmon, mackerel, saithe/coalfish and cod were largely the main contributors (38%) to the total organotin exposure. With the supplementary contribution of great scallop, surimi, squid and oysters, the exposure exceeded 50% in all. However, the utmost OTC exposure was lesser than 47% of the provisional tolerable weekly intake [EFSA (European Food Safety Agency). Opinion of the Scientific Panel on Contaminants in the food chain on a request from the Commission to assess the health risks to consumers associated with exposure to organotins in foodstuffs. (Question N EFSA-Q-2003-110). The EFSA Journal, 102, 1-119, 2004. http://www.efsa.eu.int]. Nobody would exceed this limit. Finally, as this study has some limitations and since some other sources and health effects have not been clearly evaluated, it appears rational from public health and environmental viewpoints to continue to reduce the OTC levels in the environment.

To which chemical mixtures is the French population exposed? Mixture identification from the second French Total Diet Study.

Through their diet, humans are exposed to a wide range of substances with possible adverse effects. Total diet studies (TDS) assess exposure and risk for many single substances or mixtures from the same chemical family. This research aims to identify from 440 substances in the second French TDS, the major mixtures to which the French population is exposed and their associated diet. Firstly, substances with a contamination value over the detection limit were selected. Secondly, consumption systems comprising major consumed foods were identified using non-negative matrix factorisation and combined with concentration levels to form the main mixture. Thirdly, individuals were clustered to identify "diet clusters" with similar consumption patterns and co-exposure profiles. Six main consumption systems and their associated mixtures were identified. For example, a mixture of ten pesticides, six trace elements and bisphenol A was identified. Exposure to this mixture is related to fruit and vegetables consumed by a diet cluster comprising 62% of women with a mean age of 51 years. Six other clusters are described with their associated diets and mixtures. Cluster co-exposures were compared to the whole population. This work helps prioritise mixtures for which it is crucial to investigate possible toxicological effects.

Establishing a food list for a Total Diet Study: how does food consumption of specific subpopulations need to be considered?

A Total Diet Study (TDS) consists of selecting, collecting and analysing commonly consumed foods to obtain concentration data of different chemical compounds in foods as eaten. A TDS food list summarises the most consumed foods and represents the dietary habits of the general population of the country under study. The work reported here investigated whether TDS food lists that were initially designed for the whole population of the country under study also sufficiently cover the dietary pattern of specific subpopulations that are extra vulnerable for certain contaminants. The work was performed using data of three European countries: the Czech Republic, France and the UK. Each national food consumption database was combined with the corresponding national TDS food list (containing 336, 212 and 119 food items for the Czech Republic, France and the UK, respectively). The data were aggregated on the highest level of hierarchy of FoodEx-1, a pan-European food classification system, including 20 main FoodEx-1 groups. For the group 'milk and dairy products', the coverage of the consumption by the food list was investigated for more refined subgroups. For each food group or subgroup and country, the average percentage of coverage of the diet by the national TDS food list was calculated for different subpopulations, including children versus adults, women versus men, vegetarians versus non-vegetarians, and women of child-bearing age versus older women. The average diet of the different subpopulations was sufficiently covered by the food list of the Czech Republic and France. For the UK the average coverage was low due to a different food-coding approach and because food lists were not derived directly from national food consumption data. At the level of the 20 main food groups, differences between the subpopulations with respect to the average coverage of consumption by the TDS food list were minimal. The differences were more pronounced when looking in detail at the coverage of the dairy consumption. TDS food lists based on the mean consumption of the general population are also applicable to study the chemical exposure of different subpopulations, e.g. children, women of child-bearing age and vegetarians. This lowers the effort when performing a TDS.

Exposure assessment within a Total Diet Study: a comparison of the use of the pan-European classification system FoodEx-1 with national food classification systems.

A Total Diet Study (TDS) consists of selecting, collecting and preparing commonly consumed foods purchased at retail level and analysing them for harmful and/or beneficial chemical substances. A food classification system is needed to link food consumption data with the contaminant concentration data obtained in the TDS for the exposure assessment. In this study a comparison was made between the use of a national food classification systems and the use of FoodEx-1, developed and recommended by the European Food Safety Authority (EFSA). The work was performed using data of six European countries: Belgium, Czech Republic, France, The Netherlands, Spain and the UK. For each population, exposure to contaminant A (organic compounds) and/or contaminant B (inorganic compound) was assessed by the Monte Carlo Risk Assessment (MCRA) software using the national classification system and FoodEx-1 for food consumption data and for TDS laboratory results. Minimal differences between both approaches were observed. This observation applied for both contaminant A and contaminant B. In general risk assessment will be similar for both approaches; however, this is not guaranteed. FoodEx-1 proved to be a valuable hierarchic classification system in order to harmonise exposure assessment based on existing TDS results throughout Europe.

TDS exposure project: application of the analytic hierarchy process for the prioritization of substances to be analyzed in a total diet study.

The objective of this article is to develop a general method based on the analytic hierarchy process (AHP) methodology to rank the substances to be studied in a Total Diet Studies (TDS). This method was tested for different substances and groups of substances (N = 113), for which the TDS approach has been considered relevant. This work was performed by a group of 7 experts from different European countries representing their institutes, which are involved in the TDS EXPOSURE project. The AHP methodology is based on a score system taking into account experts' judgments quantified assigning comparative scores to the different identified issues. Hence, the 10 substances of highest interest in the framework of a TDS are trace elements (methylmercury, cadmium, inorganic arsenic, lead, aluminum, inorganic mercury), dioxins, furans and polychlorinated biphenyls (PCBs), and some additives (sulfites and nitrites). The priority list depends on both the national situation (geographical variations, consumer concern, etc.) and the availability of data. Thus, the list depends on the objectives of the TDS and on reachable analytical performances. Moreover, such a list is highly variable with time and new data (e.g. social context, vulnerable population groups, emerging substances, new toxicological data or health-based guidance values).

Assessment of infant exposure to food chemicals: the French Total Diet Study design.

As part of the previous French Total Diet Studies (TDS) focusing on exposure to food chemicals in the population aged 3 years and older, the French Agency for Food, Environmental and Occupational Health & Safety (ANSES) launched a specific TDS on infants to complete its overall chemical food safety programme for the general population. More than 500 chemical substances were analysed in food products consumed by children under 3 years old, including nutrients, several endocrine disruptors resulting from human activities (polychlorinated biphenyls, dioxins and furans, brominated flame retardants, perfluoroalkyl acids, pesticide residues, etc.) or migrating from food contact materials such as bisphenol A or phthalates, but also natural substances such as mycotoxins, phytoestrogens and steroids. To obtain a representative and general view of infant food consumption, food items were selected based on results of a national consumption survey conducted specifically on this population. Moreover, a specific study on food was conducted on 429 households to determine which home-cooking practices are employed to prepare food consumed by infants. Overall, the targeted chemical substances were analysed in more than 450 food samples, representing the purchase and home-cooking practices of over 5500 food products. Foods included common foods such as vegetables, fruit or cakes as well as specific infant foods such as infant formula or jarred baby food. The sampling plan covered over 80% of the total diet. Specificities in infant food consumption and habits were therefore considered to define this first infant TDS. This study, conducted on a large scale and focusing on a particularly sensitive population, will provide accurate information on the dietary exposure of children under 3 years to food chemicals, especially endocrine disruptors, and will be particularly useful for risk assessment analysis under the remit of ANSES' expert committees.

Food risk assessment for perfluoroalkyl acids and brominated flame retardants in the French population: results from the second French total diet study.

To determine the exposure of the French population to toxic compounds contaminating the food chain, a total diet study was performed in France between 2007 and 2009. This study was designed to reflect the consumption habits of the French population and covered the most important foods in terms of consumption, selected nutrients and contribution to contamination. Based on French consumption data, the present study reports the dietary exposure to perfluoroalkyl acids (16 congeners) and brominated flame retardants (polybrominated diphenyl ethers, hexabromocyclododecane and polybrominated biphenyls). Comparison of the calculated dietary exposures with the generally accepted health-based guidance values revealed that most compounds do not pose any risk. There are however knowledge gaps for some congeners in these large chemical classes.

Dietary exposure to perfluoroalkyl acids of specific French adult sub-populations: high seafood consumers, high freshwater fish consumers and pregnant women.

Perfluoroalkyl acids (PFAAs) are globally found in various media, including food and especially fishery products. In the present study, the dietary exposure to 15 perfluoroalkyl acids was assessed for 3 French adult populations, namely high seafood consumers, high freshwater fish consumers, and pregnant women. Purified food extracts were analysed by LC-MS/MS and PFBA, PFPA, PFHxA, PFHpA, PFOA, PFNA, PFDA, PFUnA, PFTrDA, PFTeDA, PFBS, PFHxS, PFHpS, PFOS and PFDS were monitored and quantified according to the isotope dilution principle. Under lower bound (LB) hypothesis (i.e. contamination values

Assessment of dietary exposure to annatto (E160b), nitrites (E249-250), sulphites (E220-228) and tartaric acid (E334) in the French population: the second French total diet study.

The results of the assessment of the dietary exposure to annatto, nitrites, tartaric acid and sulphites within the framework of the second French total diet study (TDS) are reported. These 4 additives were selected from the Bemrah et al. study [Bemrah N, Leblanc JC, Volatier JL. 2008. Assessment of dietary exposure in the French population to 13 selected food colours, preservatives, antioxidants, stabilizers, emulsifiers and sweeteners. Food Addit Contam B. 1(1):2-14] on 13 food additives which identified a possible health risk for annatto, sulphites and nitrites and a lack of data for tartaric acid. Among the composite samples selected for the whole TDS, 524 were analysed for additives (a sample was analysed for a given additive when it was identified as a major contributor for this additive only): 130 for tartaric acid, 135 for nitrites, 59 for annatto and 200 for sulphites. Estimated concentrations (minimum lower bound to maximum upper bound) vary nationally from 0 to 9 mg/kg for annatto, 0 to 420 mg/kg for tartaric acid, 0 to 108 mg/kg for sulphites and 0 to 3.4 mg/kg for nitrites. Based on the analytical results, the dietary exposure was calculated for adults and children, separately, using lower bound and upper bound assumptions. The European ADIs for these 4 additives were not exceeded except for the dietary exposure for sulphites among 2.9% of the adult population, where the major contributors were alcoholic drinks and especially wine under both hypotheses (lower and upper bound).

Core food of the French food supply: second Total Diet Study.

As first described in the 1980s, the core food intake model allows a precise assessment of dietary nutrient intake and dietary exposure to contaminants insofar as it reflects the eating habits of a target population and covers the most important foods in terms of consumption, selected nutrient and contaminant contribution. This model has been used to set up the sampling strategy of the second French Total Diet Study (TDS) with the aim of obtaining a realistic panorama of nutrient intakes and contaminant exposure for the whole population, useful for quantitative risk assessment. Data on consumption trends and eating habits from the second French individual food consumption survey (INCA2) as well as data from a 2004 purchase panel of French households (SECODIP) were used to identify the core foods to be sampled. A total of 116 core foods on a national scale and 70 core foods on a regional scale were selected according to (1) the consumption data for adults and children, (2) their consumer rates, and (3) their high contribution to exposure to one or more contaminants of interest. Foods were collected in eight French regions (36 cities) and prepared 'as consumed' to be analysed for their nutritional composition and contamination levels. A total of 20 280 different food products were purchased to make up the 1352 composite samples of core foods to be analysed for additives, environmental contaminants, pesticide residues, trace elements and minerals, mycotoxins and acrylamide. The establishment of such a sampling plan is essential for effective, high-quality monitoring of dietary exposure from a public health point of view.

Low-carbohydrate diets affect energy balance and fuel homeostasis differentially in lean and obese rats.

In parallel with increased prevalence of overweight people in affluent societies are individuals trying to lose weight, often using low-carbohydrate diets. Nevertheless, long-term metabolic consequences of those diets, usually high in (saturated) fat, remain unclear. Therefore, we investigated long-term effects of high-fat diets with different carbohydrate/protein ratios on energy balance and fuel homeostasis in obese (fa/fa) Zucker and lean Wistar rats. Animals were fed high-carbohydrate (HC), high-fat (HsF), or low-carbohydrate, high-fat, high-protein (LC-HsF-HP) diets for 60 days. Both lines fed the LC-HsF-HP diet displayed reduced energy intake compared with those fed the HsF diet (Zucker, -3.7%) or the HC diet (Wistar rats, -12.4%). This was not associated with lower weight gain relative to HC fed rats, because of increased food efficiencies in each line fed HsF and particularly LC-HsF-HP food. Zucker rats were less glucose tolerant than Wistar rats. Lowest glucose tolerances were found in HsF and particularly in LC-HsF-HP-fed animals irrespective of line, but this paralleled reduced plasma adiponectin levels, elevated plasma resistin levels, higher retroperitoneal fat masses, and reduced insulin sensitivity (indexed by insulin-induced hypoglycemia) only in Wistar rats. In Zucker rats, however, improved insulin responses during glucose tolerance testing and tendency toward increased insulin sensitivities were observed with HsF or LC-HsF-HP feeding relative to HC feeding. Thus, despite adverse consequences of LC-HsF diets on blood glucose homeostasis, principal differences exist in the underlying hormonal regulatory mechanisms, which could have benefits for B-cell functioning and insulin action in the obese state but not in the lean state.

Natural antioxidant L-carnosine inhibits LPO intensification in structures of the auditory analyzer under conditions of chronic exposure to aminoglycoside antibiotics.

Intragastric administration of L-carnosine suspension to Wistar-Kyoto rats 3 days before and after 7-day course of intraperitoneal injections of ototoxic aminoglycoside antibiotic kanamycin compensated expenditures of tissue antioxidant systems and significantly eliminated kanamycin-induced intensification of MDA production in tissues of the membrane part of the cochlea and in the auditory cortex of the temporal lobe. L-NAME (competitive NO synthase inhibitor) also inhibited LPO, increased total antioxidant activity, and decreased ototoxicity of kanamycin, which confirms the contribution of NO into LPO intensification under conditions of aminoglycoside treatment. Inhibition of pathological intensification of LPO processes and increase in total antioxidant activity under conditions of induced acute aminoglycoside ototoxicity characterizes L-carnosine as a highly effective otoprotector.

Protective effect of carnosine on excitable structures of the auditory apparatus in albino rats with acute acoustic trauma.

We studied the effect of natural antioxidant carnosine on Wistar rats with experimental acoustic trauma of the auditory apparatus. Repeated intraperitoneal injection of carnosine in a dose of 200 mg/kg 12 and 0.5 h before modeling of acute acoustic trauma decreased the severity of degenerative and atrophic changes in the nuclei of hair cells in the cochleae. Carnosine compensated the deficiency of tissue antioxidant systems and suppressed generation of lipid peroxidation products in tissues of the membranous cochlea and auditory cortex of the temporal lobes. Carnosine holds much promise as a nonspecific otoprotector.