Occupational quantitative exposure to crystalline silica, solvents, pesticides, and risk of clinical forms of systemic sclerosis.

OBJECTIVES: To estimate the association between SSc clinical phenotypes and quantitative occupational exposure to crystalline silica, chlorinated solvents, trichloroethylene, and pesticides using job-exposure matrices. METHODS: In the VISS-EXPOSITION transversal study, data on declarative occupational exposure to crystalline silica, solvents, and pesticides were retrieved. In parallel, the Lifetime Occupational History was evaluated using a questionnaire and cursus laboris for SSc patients followed at Bordeaux University Hospital (France). Using job-exposure matrices, we assessed patients' occupational exposure in relation to relevant clinical phenotypic forms of the disease. RESULTS: Toxic exposure to crystalline silica and pesticides is underestimated by patients. Non-biased job-exposure matrices retrieved more exposed patients than the declarative assessment (10.1% of patients by job-exposure matrices versus 6.3% by declaration for crystalline silica and 25.9% versus 12.2% for pesticides). Patients overestimate their solvent exposure (7.9% for chlorinated solvents and 4.8% for trichlorethylene assessed by job-exposure matrices and 24.4% declarative exposure to solvents at large). Clinical form evaluation revealed a nonsignificant trend toward an increased risk of crystalline silica occupational exposure in the pulmonary fibrotic group of SSc patients (OR 3.12 CI 95% [0.80-12.15]). We also observed a nonsignificant trend toward elevated OR (OR 2.89 CI 95% [0.93-8.95]) for chlorinated solvent occupational exposure and the vascular phenotype of SSc. Of note, pesticide occupational exposure evaluation represents one of the largest to date in SSc patients. CONCLUSION: This study emphasizes that many exposed SSc patients are unaware of their occupational exposure. Job-exposure matrices allow better exposure screening for SSc secondary prevention and occupational exposure compensation. CLINICAL TRIAL REGISTRATION: clinicaltrials.gov, https://www.clinicaltrials.gov, NCT03543956.

Environmental pressures and pesticide exposure associated with an increase in the share of plant-based foods in the diet.

Diets rich in plant-based foods are encouraged for human health and to preserve resources and the environment but the nutritional quality and safety of such diets is debated. This study aimed to model nutritionally adequate diets with increasing plant food content and to characterise the derived diets using a multicriteria approach including, nutrients intake, environmental pressures and exposure to pesticides. Using data of the NutriNet-Santé cohort (N = 29,413), we implemented stepwise optimization models to identified maximum plant-food content under nutritional constraints. Environmental indicators at the production level were derived from the DIALECTE database, and exposure to pesticide residues from plant food consumption was estimated using a contamination database. Plant-based foods contributed to 64.3% (SD = 10.6%) of energy intake in observed diets and may reach up to 95% in modelled diets without jeopardizing nutritional status. Compared to the observed situation, an increase in plant-based foods in the diets led to increases in soy-based products (+ 480%), dried fruits (+ 370%), legumes (+ 317%), whole grains (+ 251%), oils (+ 144%) and vegetables (+ 93%). Animal products decreased progressively until total eviction, except for beef (- 98%). Dietary quality (estimated using the Diet Quality Index Based on the Probability of Adequate Nutrient Intake) was improved (up to 17%) as well as GHGe (up to - 65%), energy demand (up to - 48%), and land occupation (- 56%) for production. Exposures to pesticides from plant-based foods were increased by 100% conventional production and to a much lesser extent by 100% organic production. This study shows that shifting to nutritionally-adequate plant-based diets requires an in-depth rearrangement of food groups' consumption but allows a drastic reduction environmental impact. Increase exposure to pesticide residues and related risks can be mitigated by consuming foods produced with low pesticide input.

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

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

Higher adherence to the EAT-Lancet reference diet is associated with higher nutrient adequacy in the NutriNet-Santé cohort: a cross-sectional study.

BACKGROUND: In 2019, the EAT-Lancet Commission proposed a planetary and healthy reference diet; however, its nutritional quality has been rarely evaluated. OBJECTIVE: Across different adherence levels to the EAT-Lancet reference diet, the following were our objectives:1) describe the food and nutritional intakes of the French population, 2) evaluate the nutrient quality, and 3) investigate the consistency between the French national recommendations and the EAT-Lancet reference diet. METHODS: This cross-sectional study was conducted among participants of the NutriNet-Santé cohort, and the sample was weighted on the characteristics of the general French population. Adherence to the EAT-Lancet reference diet was estimated using the EAT-Lancet Diet Index (ELD-I). Usual nutrient intakes were obtained using the variance reduction method. We used the estimated average requirements cut-point method to estimate the proportion of participants who meet their respective nutritional requirements. Furthermore, the adequacy of the French food-based dietary recommendations [Programme National Nutrition Santé (PNNS)] according to adherence to the EAT-Lancet reference diet was studied. RESULTS: The weighted sample was composed of 98,465 participants. Except for bioavailable zinc and vitamin B12, we observed a decrease in the nutrient inadequacy prevalence when the adherence to the EAT-Lancet reference diet increased, particularly for vitamin B9 (Q1 = 37.8% compared with Q5 = 5.5%, P < 0.0001) and vitamin C (Q1 = 59.0% compared with Q5 = 10.8 %, P < 0.0001). However, inadequacy prevalence remained high in all ELD-I quintiles, particularly for fiber (95.9%), vitamin B1 (70.8%), iodine (48.4%), and magnesium (76.8%). Higher ELD-I score was associated with higher adherence for most components of the PNNS, except for food groups that are not specifically included in the EAT-Lancet reference diet and are typical of the French diet, including alcohol, processed meat, and salt. CONCLUSION: In the French context, although issues with the intake of certain nutrients may occur, a diet that remains within the planetary limits as the EAT-Lancet reference diet allows a favorable nutritional quality. This trial was registered at clinicaltrials.gov as NCT03335644.

Nutritionally adequate and environmentally respectful diets are possible for different diet groups: an optimized study from the NutriNet-Santé cohort.

BACKGROUND: Research has shown that vegetarian diets have a low environmental impact, but few studies have examined the environmental impacts and nutritional adequacy of these diets together, even though vegetarian diets can lead to nutritional issues. OBJECTIVES: Our objective was to optimize and compare 6 types of diets with varying degrees of plant foods (lacto-, ovolacto-, and pescovegetarian diets and diets with low, medium, and high meat content) under nutritional constraints. METHODS: Consumption data in 30,000 participants were derived from the French NutriNet-Santé cohort using an FFQ. Diets were optimized by a nonlinear algorithm minimizing the diet deviation while meeting multiple constraints at both the individual and population levels: nonincrease of the cost and environmental impacts (as partial ReCiPe accounting for greenhouse gas emissions, cumulative energy demand, and land occupation, distinguishing production methods: organic and conventional), under epidemiologic, nutritional (based on nutrient reference values), and acceptability (according to the diet type) constraints. RESULTS: Optimized diets were successfully identified for each diet type, except that it was impossible to meet the EPA (20:5n-3) + DHA (22:6n-3) requirements in lacto- and ovolactovegetarians. In all cases, meat consumption was redistributed or reduced and the consumption of legumes (including soy-based products), whole grains, and vegetables were increased, whereas some food groups, such as potatoes, fruit juices, and alcoholic beverages, were entirely removed from the diets. The lower environmental impacts (as well as individual indicators) observed for vegetarians could be attained even when nutritional references were reached except for long-chain n-3 (omega-3) fatty acids. CONCLUSIONS: A low-meat diet could be considered as a target for the general population in the context of sustainable transitions, although all diets tested can be overall nutritionally adequate (except for n-3 fatty acids) when planned appropriately.This trial was registered at clinicaltrials.gov as NCT03335644.

Association between adherence to the EAT-Lancet diet and risk of cancer and cardiovascular outcomes in the prospective NutriNet-Santé cohort.

BACKGROUND: The EAT-Lancet commission proposed, in 2019, a planetary, healthy, and universal dietary pattern. However, this diet has rarely been studied in relation to various health outcomes. OBJECTIVES: We aimed to prospectively estimate the association between the EAT-Lancet diet and cancer and cardiovascular disease (CVD) risk. METHODS: The study was conducted in participants of the NutriNet-Santé cohort (2009-2021). The endpoints were the incident outcomes (cancer and CVDs and mortality from these diseases), combined and separately. Adherence to the EAT-Lancet diet was estimated using the EAT-Lancet Diet Index (ELD-I) modeled as quintiles (Qs). Multivariable Cox proportional hazard models were used to estimate HRs and 95% CIs, adjusted for potential confounders and moderators. RESULTS: A total of 62,382 subjects were included; 2475 cases of cancer and 786 cases of cardiovascular events occurred during a median follow-up of 8.1 y. The sample was 76% female, the mean ± SD age at inclusion was 51.0 ± 10.2 y. The ELD-I ranged from -162 to 332 points with a mean ± SD score of 45.4 ± 25.6 points. In multivariable models, no significant association between the EAT-Lancet diet and the risk of cancer and CVD combined, and separately, was observed. Alcohol consumption was an effect modifier of the association. A significant association was observed among low drinkers (HRQ5vs.Q1: 0.86; 95% CI: 0.73, 1.02; P-trend = 0.02). A higher ELD-I was significantly associated with a lower risk of overall cancer only among females (HRQ5vs.Q1: 0.89; 95% CI: 0.75, 1.05; P-trend = 0.03). Both associations were largely attenuated by BMI. CONCLUSIONS: Contrary to our hypothesis, our results documented significant associations between adherence to the EAT-Lancet diet and incidence of cancer only in some subgroups, and no association with CVD.This trial was registered at clinicaltrials.gov as NCT03335644.