Environmental trade-offs of meeting nutritional requirements with a lower share of animal protein for adult subpopulations.

Decreasing the share of protein contributed by animal-based foods is recommended to move towards more sustainable and healthier diets. This study aimed to assess the potential environmental impacts of diets with a lower share of animal protein. The diets were modeled to include the minimum share of animal protein in total protein that met nutrient requirements and did not increase costs. The new diets also minimized the difference in the quantity of food from those of observed (OBS) diets. They were modeled for five adult subpopulations (defined by sex and age) using mathematical optimization. The model was created by combining the INCA2 database (to model OBS diets in the French population) and a database of 207 food items to adjust nutritional and price parameters. All modeled diets satisfied nutritional and cost constraints. A low-animal-protein (LAP) diet was identified for each subpopulation by progressively decreasing the share of animal protein by steps of 5% until the recommended quantity of protein and/or consumption constraints were no longer satisfied. Potential environmental impacts of the LAP diets in eight impact categories were calculated using life cycle assessment and life cycle inventories from Agribalyse® 3.0. A LAP diet for the entire population was calculated as a weighted mean of the subpopulations' LAP diets. The share of animal protein decreased from 70% in the OBS diet to 50% in the LAP diet. Compared to the OBS diet, the LAP diet decreased five environmental impacts: climate change (greenhouse gas emissions), acidification (emissions of acidifying compounds) and land occupation (all by more than 30%), cumulative energy demand (by 23%) and marine eutrophication (by 13%). Conversely, it increased three environmental impacts: freshwater eutrophication and water use (both by ca. 40%) and biodiversity damage potential (potential loss of species associated with land use) (by 66%). These results suggest that decreasing the share of animal protein to 50% is compatible with nutritional requirements, affordability and consumption constraints, but would have mixed effects on the environment.

Measuring the food and built environments in urban centres: reliability and validity of the EURO-PREVOB Community Questionnaire.

OBJECTIVES: The authors designed an instrument to measure objectively aspects of the built and food environments in urban areas, the EURO-PREVOB Community Questionnaire, within the EU-funded project 'Tackling the social and economic determinants of nutrition and physical activity for the prevention of obesity across Europe' (EURO-PREVOB). This paper describes its development, reliability, validity, feasibility and relevance to public health and obesity research. STUDY DESIGN: The Community Questionnaire is designed to measure key aspects of the food and built environments in urban areas of varying levels of affluence or deprivation, within different countries. The questionnaire assesses (1) the food environment and (2) the built environment. METHODS: Pilot tests of the EURO-PREVOB Community Questionnaire were conducted in five to 10 purposively sampled urban areas of different socio-economic status in each of Ankara, Brno, Marseille, Riga, and Sarajevo. Inter-rater reliability was compared between two pairs of fieldworkers in each city centre using three methods: inter-observer agreement (IOA), kappa statistics, and intraclass correlation coefficients (ICCs). RESULTS: Data were collected successfully in all five cities. Overall reliability of the EURO-PREVOB Community Questionnaire was excellent (inter-observer agreement (IOA) > 0.87; intraclass correlation coefficients (ICC)s > 0.91 and kappa statistics > 0.7. However, assessment of certain aspects of the quality of the built environment yielded slightly lower IOA coefficients than the quantitative aspects. CONCLUSIONS: The EURO-PREVOB Community Questionnaire was found to be a reliable and practical observational tool for measuring differences in community-level data on environmental factors that can impact on dietary intake and physical activity. The next step is to evaluate its predictive power by collecting behavioural and anthropometric data relevant to obesity and its determinants.

A Mediterranean diet pattern with low consumption of liquid sweets and refined cereals is negatively associated with adiposity in adults from rural Lebanon.

BACKGROUND: The beneficial impact of the traditional Mediterranean diet pattern on adiposity is still under debate, and this has never been assessed in a developing Mediterranean country. OBJECTIVES: To assess the relationships between adherence to a traditional Mediterranean diet and adiposity indexes, that is, body mass index (BMI) and waist circumference (WC), in a sample from rural Lebanon. DESIGN: A sample of 798 adults, aged 40-60 years, was selected in continental rural areas of Lebanon for a cross-sectional study. The questionnaire included socio-demographic, anthropometric and dietary sections. The daily consumption frequencies of selected food groups, categorized as positive or negative components, were calculated based on a food frequency questionnaire. Adherence to the Mediterranean diet was assessed using six a priori scores; including the widely used Mediterranean diet score (MDS). Associations between diet scores and BMI and WC were assessed. RESULTS: Overall, the diet of the study sample only partially matched the traditional Mediterranean diet. A total of 17.0% of men and 33.7% women were obese. The MDS was negatively associated (P<0.05) with WC, but not BMI, in men and women. The constructed composite Mediterranean score combining positive components of the diet (whole cereals, vegetables, legumes and fruit, olive oil and fish) and negative components adapted to this sample (refined cereals and pastries, and liquid sweets) was consistently and negatively associated with both BMI and WC for men and women in multivariate models. A 2-point increase in that score was associated with a decrease in BMI of 0.51 and 0.78 kg m(-2) and a decrease in WC of 2.77 and 4.76 cm in men and women, respectively. CONCLUSION: The results demonstrate that a Mediterranean diet is negatively associated with obesity and visceral adiposity in a rural population of a developing Mediterranean country.

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.

Low-cost diets: more energy, fewer nutrients.

Energy-dense diets offer a low-cost dietary option to the consumer. However, they are more likely to be nutrient-poor. In this study, based on the French national food consumption survey, the diet costs were estimated using retail food prices in France. Adult participants were stratified by quartiles of energy cost (in euro/10 MJ). Dietary energy density, energy and nutrient intakes were then compared across groups. Participants in the lowest quartile of energy cost had the highest energy intakes, the most energy-dense diets and the lowest daily intakes of key vitamins and micronutrients. Participants in the highest quartile of energy cost had lower energy intakes, and diets that were higher in nutrients and lower in energy density. However, their daily diet costs were 165% higher. In this observational study, the more nutrient-dense diets were associated with higher diet costs.

Relearning of Activities of Daily Living: A Comparison of the Effectiveness of Three Learning Methods in Patients with Dementia of the Alzheimer Type.

This study examined the effectiveness of three different learning methods: trial and error learning (TE), errorless learning (EL) and learning by modeling with spaced retrieval (MR) on the relearning process of IADL in mild-to-moderately severe Alzheimer's Dementia (AD) patients (n=52), using a 6-weeks randomized controlled trial design. The participants had to relearn three IADLs. Repeated-measure analyses during pre-intervention, post-intervention and 1-month delayed sessions were performed. All three learning methods were found to have similar efficiency. However, the intervention produced greater improvements in the actual performance of the IADL tasks than on their explicit knowledge. This study confirms that the relearning of IADL is possible with AD patients through individualized interventions, and that the improvements can be maintained even after the intervention.

Metabolic and biochemical abnormalities of articular cartilage induced by implantation of a sterile sheet of polyethylene in the rabbit patellofemoral joint.

A polyethylene sheet was implanted in the patellofemoral joint of the right knee of the rabbit and the biochemical and metabolic changes in the articular cartilage from femoral trochleas (in contact with the implant) and femoral condyles (free of direct contact) were compared with those in their sham-operated counterparts 7, 15, and 30 days after joint implantation. The results showed that there was an increase in the water content; the extraction yields of uronic acid--, 35SO4-, and [3H]glycine-containing compounds; and the incorporation of [3H]thymidine, [3H]glycine, and 35SO4. Concomitantly, the contents of uronic acid--, hexosamine-, neutral sugars-, and hydroxyproline-containing substances decreased in the femoral trochlear cartilage and, to a much lesser extent, in the femoral condylar cartilage from implanted joints. The increased capacity of viable chondrocytes to incorporate metabolic radiolabeled precursors into newly synthesized macromolecules may represent a reparative cell response to the tissue injury induced by the implant. This is therefore a useful model for studying the response of chondrocytes to mechanical injury and tissue tolerance to intraarticularly implanted prosthetic materials.

Effects of protein deficiency on lipid peroxidation in the small intestine and liver of rats.

This study investigated the influence of protein restriction on lipid peroxide content (thiobarbituric acid-reactive substances) and the intracellular antioxidant defence system in the small intestine and the liver. Weanling male Sprague-Dawley rats were divided into two groups: a low-protein group fed ad lib. a diet containing 6% casein for 4 wk, and a control group fed a diet containing 22% casein but restricted to the same dietary intake as that of the low-protein group. Compared with pair-fed controls, the protein-deficient rats exhibited a decrease in glutathione content in the small intestine and the liver. Thiobarbituric acid-reactive substances were increased in the intestine only. Data on the enzymatic antioxidant defence system in the protein-deficient animals showed an increase in catalase activity in the intestine but a decrease of this activity in the liver. The activity of selenium-dependent glutathione peroxidase was decreased in the liver and remained unchanged in the intestine. Superoxide dismutase was not modified by protein deficiency in either tissue. In control rats, enzyme activities were 6-43 times higher in the liver than in the intestine. The deleterious effects of protein deficiency appeared more marked in the intestine.

Assessing the construct validity of five nutrient profiling systems using diet modeling with linear programming.

Nutrient profiling classifies individual food products according to their nutrient content. According to the WHO (World Health Organization), validation is a key step in the development of a nutrient profiling system. The aim was to assess the construct validity of five European nutrient profiling systems (Choices, Keyhole, (AFSSA), European Commission (EC) system and FoodProfiler). Construct validity was assessed for each of the five-selected nutrient profiling systems by testing whether healthy foods (that is, identified as eligible by the system) make healthy diets, and unhealthy foods (that is, non-eligible) make unhealthy diets, using diet modeling. The AFSSA, EC and FoodProfiler systems were identified as valid, but differences in their levels of permissiveness suggested some misclassified food products. The two other systems failed the construct validity assessment. Among these three systems, the EC system is the less demanding in terms of nutritional information, it would, therefore, be the easiest to implement for regulating nutrition and health claims in Europe.

Associations of socioeconomic factors with inadequate dietary intake in food aid users in France (The ABENA study 2004-2005).

BACKGROUND/OBJECTIVES: Few studies in Europe have examined the relationship of sociodemographic and economic factors with diet in deprived populations. We analysed the association between socioeconomic characteristics and consumption of different food groups in food aid users. SUBJECTS/METHODS: A cross-sectional study was conducted among food aid users in four urban French zones (n=1664). Associations of sociodemographic and economic factors and food aid use with frequency of consumption of the main food groups were tested using multivariate logistic regression models accounting for sampling weights. RESULTS: Both migrant status and consumption of fewer than three daily meals were associated with risk of low frequency of starchy food consumption (<3 times per day). Migrant status was also associated with low frequency of consumption of fruits and vegetables (<3.5 times per day) and dairy products (<2 times per day). Subjects with severe food insufficiency were more likely to be low consumers of fruits and vegetables, meat, seafood and eggs (<1 time per day), and dairy products. A low monthly food budget, temporary housing in a shelter and no source of household income were all associated with risk of low frequency of seafood consumption (<2 times per week). Finally, duration of food aid use, type of food aid distribution and perception of poor health status were associated with low consumption of meat, seafood and eggs. CONCLUSIONS: Economic level and other social characteristics were associated with an unhealthy diet within this deprived French population.

Should nutrient profiles be based on 100 g, 100 kcal or serving size?

BACKGROUND/OBJECTIVES: Nutrient profiling of foods is defined as the science of ranking or classifying foods based on their nutrient content. Nutrient profiles can be calculated based on 100 g or 100 kcal of food or on standard serving sizes. The objective of this study was to compare the performance of nutrient profiles based on 100 g, 100 kcal and government-mandated serving sizes, and to identify the optimal base of calculation. SUBJECTS/METHODS: Nutrient profiles tested were composed of positive subscores based on nutrients to encourage and negative subscores based on nutrients to limit. Alternative profiles, computed using different bases of calculation, were used to rank order 378 commonly consumed foods from a food frequency instrument. Profile performance was tested with respect to the foods' energy density. RESULTS: Serving sizes, defined by the US Food and Drug Administration as reference amounts customarily consumed (RACC), were inversely linked to energy density of foods. Positive subscores based on 100 kcal were equivalent to those calculated using RACC values. Negative subscores performed better when based on 100 g as opposed to 100 kcal. CONCLUSIONS: Models based on serving sizes and on 100 kcal were preferable for positive subscores and models based on 100 g of food were preferable for negative subscores. RACC-based profiles may represent an attractive option for the US consumer.

Testing nutrient profile models in relation to energy density and energy cost.

BACKGROUND: Nutrient profiling of foods is defined as the science of classifying foods based on their nutrient content. Food rankings generated by nutrient profile models need to be tested against objective reality as opposed to public opinion. OBJECTIVE: To test the performance of selected nutrient profile models in relation to the foods' energy density (kcal g(-1)) and energy cost (Dollar per 1000 kcal). SUBJECTS/METHODS: Analyses were based on 378 component foods of a food frequency instrument. The models tested were the French nutrient adequacy models NAS23 and NAS16 and nutrient density models NDS23 and NDS16; and a family of nutrient-rich models (NR(n), where n=5-7; 10-12, and 15). Also tested were LIM scores and a modified British Food Standards Agency model WXYfm. Profiles were calculated based on 100 g, 100 kcal and on Reference Amounts Customarily Consumed. Food rankings generated by different models were correlated with each other and with the foods' energy density and energy cost. RESULTS: Nutrient profile models based on protein, fiber, vitamins and minerals showed an inverse correlation with energy density that diminished as more micronutrients were introduced into the model. Models based on fat, sugar and sodium were highly correlated with energy density. Foods classified as healthier were generally associated with higher energy costs. CONCLUSIONS: Not all models accurately reflected the foods' content of nutrients known to be beneficial to health. High correlations with energy density meant that some models classified foods based on their energy density as opposed to nutrient content.

Identification of nutritionally adequate mixtures of vegetable oils by linear programming.

OBJECTIVE: To determine the types and proportions of vegetable oils to recommend for a healthy diet. METHODS: Optimal vegetable oil combinations were designed, using linear programming and, as decision variables, nine single oils and 29 basic food items. 'Oil models' were run to determine whether reasonable amounts of individuals oils or oil mixtures satisfied a set of constraints on essential fatty acids and vitamin E. 'Meal models' were run to test whether selected mixtures could be used as the sole source of added fat in a meal that met micronutrient and macronutrient recommendations. RESULTS: The cheapest mixture (0.97 euro L(-1)) that solved the oil models contained 81% rapeseed and 19% sunflower oils. About 10-15 g of this mixture, alone or with olive, soya bean, wheat germ or walnut oils, also solved the meal models. Mixtures that contained a high proportion (>or=50%) of the tasty olive and walnut oils also solved the models but were more expensive (4.9 euro L(-1) and 8.5 euro L(-1), respectively). CONCLUSIONS: The consumption of a mixture composed of rapeseed and sunflower oils in a 4 : 1 proportion is an inexpensive and simple way to meet current dietary recommendations for essential fatty acids and vitamin E, favouring overall dietary nutrient adequacy.

An overview of the health status of migrants in France, in relation to their dietary practices.

OBJECTIVE: To review studies on the morbidity, mortality and nutrition of migrant populations in France. DESIGN: A systematic search of the bibliographic database Medline, and direct contact with associations and institutions concerned with migrants' health. RESULTS: In France, as in other host countries, migrants belong to the lowest socio-economic strata. They have on average better health and lower mortality than the local-born population. Health benefits are particularly noticeable in Mediterranean men, especially for affluence-related diseases such as cancer and cardiovascular diseases. North African men smoke as heavily as the local-born of the same occupational categories, and yet their mortality rates from lung cancer are notably lower. Such a paradox may be the result of a synergy between different phenomena such as the selection of the fittest applicants for immigration and the maintenance of healthy lifestyles from the countries of origin. In contrast, migrant women do not enjoy the same health advantages, possibly because they are less likely to be selected on the basis of their health and because they are often non-working. Adult migrants from southern Europe and North Africa report dietary practices consistent with the typical Mediterranean diet, which is renowned for its positive effects on health. CONCLUSIONS: The diet of Mediterranean adults living in France may partly explain the low rates of chronic diseases and high adult life expectancy observed in migrant men from northern Africa. Information about their diets might provide clues for the design of nutritional education campaigns aimed at low-income people.

Structural and biochemical abnormalities of articular cartilage in rheumatoid arthritis.

Compared with normal cartilage, the water content, extraction yields, and capacity of 34SO4 incorporation, were found to be increased in articular cartilage from rheumatoid joints, which also synthesizes an increased proportion of low and middle density small size proteoglycans (PGs), enriched in dermatan sulfate. These small [35S]-PGs also possess longer glycosaminoglycan side chains and lack the ability to interact with hyaluronan. An altered pattern of PG synthesis of rheumatoid chondrocytes may contribute to cartilage damage in this condition.

Characterization of proteoglycans synthesized by different layers of adult human femoral head cartilage.

Full thickness human femoral head cartilage fragments were labeled in vitro with 35S-SO4 and 3H-proline and cut tangentially to the surface in a cryostat. Sixteen-micrometer thick sections were pooled from four zones: I (0-160 microns); II (160-480 microns); III (480-960 microns); and IV (> 960 microns). The pooled sections were extracted with 4 M guanidinium chloride solvent and the extracts and 35S-labeled proteoglycans (35S-PGs) were characterized. The superficial layer gave lowest extraction yields and the deep layers gave the highest yields. The highest specific activity (dpm/mg of dry weight) of 35S-SO4 labeling was in zones II and III and that of [3H] proline in zone I. The superficial layer I also contained: (1) the highest proportions of 35S-PG monomers of small hydrodynamic size and low buoyant density; (2) an increased proportion of hydrodynamically small 35S-PG monomers; (3) the smallest proportion of endogenously reassociated 35S-PG aggregates, although similar proportions of 35S-PG monomers extracted from all layers interacted with exogenous hyaluronan (HA); and (4) the more heterogeneous population of 35S-glycosaminoglycan (GAG) side chains with respect to their size, although their chemical compositions were similar in all layers. In addition, extracted 35S-PGs had shorter GAG chains than the residual nonextracted molecules and were enriched in chondroitin-6 sulfate whereas residual/non-extracted 35S-PGs were enriched in chondroitin-4 sulfate. The extraction yields of keratan sulfate (KS)-enriched 35S-PGs also decreased with the depth of tissue, though the overall 35S-KS chain content varied little with depth of tissue, being slightly higher in the deepest zone IV.

Superoxide anion scavenging capacity measured by a polarographic method. Comparison with a colourimetric method.

A polarographic method to assess the scavenging capacity of a molecule for O2-. is proposed. This method is based on the fact that O2-. is not detected by the Clark electrode and that a scavenger competes with spontaneous dismutation of O2-. So, the reduction of O2 into O2-. and the decomposition of H2O2 by catalase, releasing O2, show a biphasic kinetic. Various kinetic parameters can be used to calculate the nmol of O2-. scavenged and also supply data on the reaction mechanisms (oxidation or reduction of O2-.) involved in scavenging. This method presents several other advantages: scavenging capacity can be assayed without added indicators which themselves behave as scavengers (as demonstrated for NBT), the presence of scavengers which interfere with the O2-. generating system (xanthine-xanthine oxidase) does not invalidate the measurements made.

Dietary inadequacies observed in homeless men visiting an emergency night shelter in Paris.

OBJECTIVE: To assess the dietary intake and the nutritional status of homeless men. SETTING: A night emergency shelter in Paris, France. DESIGN: Dietary survey (48-h) including alcohol intake and a questionnaire on age, duration of homelessness, smoking habits. Subjects were also weighed and measured. SUBJECTS: Ninety-seven men aged 18-72 years (mean 43.3), of whom 54% were homeless for more than 18 months, 82% were smokers and 53% were regular and/or excessive drinkers. RESULTS: The BMI distribution was shifted towards low values, the percentage of wasted persons being four times higher than in the reference population. The mean total energy intake was 2376 kcal and included a high and highly variable percentage of energy derived from alcohol (12.0% Among drinkers, the mean ethanol intake was 90 g and there was a significant negative correlation between ethanol and non-alcoholic energy intakes. The median intakes of potassium, calcium, zinc, vitamins B1, B2, and niacin were lower than European Population Reference Intakes but only the mean intake of vitamin B1 was significantly lower. Eighty percent of non-alcoholic energy was provided by charitable organisations. For most nutrients, the nutritional density of the shelter ration was not significantly different from the density of the foods purchased by the homeless. CONCLUSIONS: These data suggest that the content of some nutrients should be increased in existing food assistance programs for homeless people in France.

Oxidative stress may contribute to the intestinal dysfunction of weanling rats fed a low protein diet.

Intestinal function is impaired in malnutrition. Because oxidative stress is a component of gastrointestinal injury, and malnutrition may reduce antioxidant defenses, we investigated the involvement of oxidative stress in the intestinal dysfunction due to malnutrition. Weanling rats were fed either a normal protein (22% casein) or a low protein (6% casein) diet for 4 wk. In intestinal homogenates, we assessed free radical damage and enzymatic antioxidant defenses. In jejunal fragments mounted in Ussing chambers, we measured ionic transport by short-circuit current (Isc) and protein permeability by transepithelial fluxes of beta-lactoglobulin. Catalase activity and the thiobarbituric acid-reacting substances concentration were greater in intestinal mucosa of the low protein group, whereas the glutathione concentration and the activities of superoxide dismutase and Se-dependent glutathione peroxidase were the same as in the normal protein group intestinal mucosa. Both basal Isc and the delta Isc induced by glucose and forskolin, as well as beta-lactoglobulin fluxes, were higher in the low protein group. Exogenous H2O2 stress increased Isc significantly more in the low protein than the normal protein group but did not alter protein permeability. These results show that malnutrition induces both intestinal free radical damage and altered epithelial transport, suggesting that oxidative stress may contribute to the intestinal dysfunction associated with malnutrition.