Depression and anxiety before and at the beginning of the COVID-19 pandemic and incident persistent symptoms: a prospective population-based cohort study.

Many patients affected by COVID-19 suffer from debilitating persistent symptoms whose risk factors remained poorly understood. This prospective study examined the association of depression and anxiety symptoms measured before and at the beginning of the COVID-19 pandemic with the incidence of persistent symptoms. Among 25,114 participants [mean (SD) age, 48.72 years (12.82); 51.1% women] from the SAPRIS and SAPRIS-Sérologie surveys nested in the French CONSTANCES population-based cohort, depression and anxiety symptoms were measured with the Center for Epidemiologic Studies-Depression scale and the 12-item General Health Questionnaire before the pandemic, and with the 9-item Patient Health Questionnaire and the 7-Item Generalized Anxiety Disorder scale at the beginning of the pandemic (i.e., between April 6, 2020 and May 4, 2020). Incident persistent symptoms were self-reported between December 2020 and January 2021. The following variables were also considered: gender, age, educational level, household income, smoking status, BMI, hypertension, diabetes, self-rated health, and SARS-CoV-2 infection according to serology/PCR test results. After a follow-up of seven to ten months, 2329 participants (9.3%) had been infected with SARS-CoV-2 and 4262 (17.0%) reported at least one incident persistent symptom that emerged from March 2020, regardless of SARS-CoV-2 infection. In multi-adjusted logistic regression models, participants in the highest (versus the lowest) quartile of depressive or anxiety symptom levels before or at the beginning of the pandemic were more likely to have at least one incident persistent symptom (versus none) at follow-up [OR (95%CI) ranging from 2.10 (1.89-2.32) to 3.01 (2.68-3.37)], with dose-response relationships (p for linear trend <0.001). Overall, these associations were significantly stronger in non-infected versus infected participants, except for depressive symptoms at the beginning of the pandemic. Depressive symptoms at the beginning of the pandemic were the strongest predictor of incident persistent symptoms in both infected and non-infected participants [OR (95%CI): 2.88 (2.01-4.14) and 3.03 (2.69-3.42), respectively]. In exploratory analyses, similar associations were found for each symptom taken separately in different models. Depression and anxiety symptoms should be tested as a potential target for preventive interventions against persistent symptoms after an infection with SARS-CoV-2.

Prevalence, treatment and determinants of obstructive sleep apnoea and its symptoms in a population-based French cohort.

Background: Obstructive sleep apnoea (OSA) is associated with increased morbidity and mortality. Although the disorder has been well studied in selected high-risk populations, few data exist on its prevalence in the general population. We aimed to assess the prevalence and determinants of OSA in France. Methods: Data from participants of the French population-based CONSTANCES cohort aged 18-69 years at inclusion and being treated for sleep apnoea or screened for OSA in 2017 using the Berlin Questionnaire were analysed. Weighted analyses were performed to provide recent and representative results in the general population. Results: Among 20 151 participants, the prevalence of treated sleep apnoea was 3.5% (95% CI 3.0-3.9%). The prevalence of untreated subjects with a positive Berlin Questionnaire was 18.1% (95% CI 17.3-19.2%) for a total weighted prevalence of treated sleep apnoea or high risk of OSA of 20.9% (95% CI 20.0-21.9%). Regarding prevalence of OSA symptoms, it was 37.2% (95% CI 36.1-38.3%) for severe snoring and 14.6% (95% CI 13.8-15.5%) for hypersomnolence. In multivariable logistic regression analysis, male sex, age, previous cardiovascular events, smoking, low educational level, low physical activity and depressive symptoms were associated with having either treated sleep apnoea or a positive Berlin Questionnaire. Conclusion: In this large French population-based cohort, one in five participants had a high likelihood of OSA, whereas only 3.5% were treated for the disorder, suggesting major underdiagnosis in the general population. OSA diagnosis should be considered more often in people with risk factors such as depressive symptoms as well as unhealthy behaviours and socioeconomic conditions.

The association between substance use and subsequent employment among students: prospective findings from the CONSTANCES cohort.

PURPOSE: To examine prospectively associations between substance use and subsequent employment among young students. METHODS: From the French population-based CONSTANCES cohort, 1427 students who never worked were included between 2012 and 2018 and followed up for 2.1 years on average. Generalized estimating equations computed the odds of being unemployed versus employed according to substance use at baseline controlling for sociodemographic factors and depressive state. Tobacco use (smoking status and number of cigarettes), cannabis use frequency, and at-risk alcohol use according to the Alcohol Use Disorder Identification Test (total score > 7) were introduced separately in the models. RESULTS: Tobacco use was not significantly associated with employment. Cannabis use at least weekly was associated with increased odds of being unemployed OR 1.73 (1.16-2.57). At-risk alcohol use was no longer significantly associated with employment after adjustment for depressive state, while analyses on sub-scores of alcohol use suggested that alcohol dependence was associated with increased odds of being unemployed OR 1.65 (1.16-2.34). CONCLUSION: Public health campaigns targeting youth should include lower chances of getting employed among the detrimental roles of regular cannabis use and at-risk alcohol use.

Atypical working hours are associated with tobacco, cannabis and alcohol use: longitudinal analyses from the CONSTANCES cohort.

BACKGROUND: This study examined prospective associations between atypical working hours with subsequent tobacco, cannabis and alcohol use as well as sugar and fat consumption. METHODS: In the French population-based CONSTANCES cohort, 47,288 men and 53,324 women currently employed included between 2012 and 2017 were annually followed for tobacco and cannabis use. Among them, 35,647 men and 39,767 women included between 2012 and 2016 were also followed for alcohol and sugar and fat consumption. Three indicators of atypical working hours were self-reported at baseline: working at night, weekend work and non-fixed working hours. Generalized linear models computed odds of substance use and sugar and fat consumption at follow-up according to atypical working hours at baseline while adjusting for sociodemographic factors, depression and baseline substance use when appropriate. RESULTS: Working at night was associated with decreased smoking cessation and increased relapse in women [odds ratios (ORs) of 0.81 and 1.25], increased cannabis use in men [ORs from 1.46 to 1.54] and increased alcohol use [ORs from 1.12 to 1.14] in both men and women. Weekend work was associated with decreased smoking cessation in women [ORs from 0.89 to 0.90] and increased alcohol use in both men and women [ORs from 1.09 to 1.14]. Non-fixed hours were associated with decreased smoking cessation in women and increased relapse in men [ORs of 0.89 and 1.13] and increased alcohol use in both men and women [ORs from 1.12 to 1.19]. Overall, atypical working hours were associated with decreased sugar and fat consumption. CONCLUSIONS: The potential role of atypical working hours on substance use should be considered by public health policy makers and clinicians in information and prevention strategies.

The association of substance use with attaining employment among unemployed job seeking adults: Prospective findings from the French CONSTANCES cohort.

This study aimed to examine the prospective association between tobacco, alcohol and cannabis use with attaining employment among unemployed job seekers. Data from the French population-based CONSTANCES cohort on 5114 unemployed job seeking adults enrolled from 2012 to 2018 were analyzed. Binary logistic regressions were computed. Odds ratio (OR) and 95%CI of remaining unemployed at one-year of follow-up (versus attaining employment) according to substance use at baseline were obtained. The following independent variables were introduced into separate models: tobacco use (non-smoker, former smoker, light (<10cig/day), moderate (10-19cig/day) and heavy smoker (>19cig/day)), alcohol use according to the Alcohol Use Disorder Identification Test (non-users (0), low (<7), moderate (7-15) and high or very high-risk (>15)) and cannabis use (never used, no use in the previous 12 months, less than once a month, at least once a month but less than once per week, once per week or more). Analyses were adjusted for age, gender and education. At follow-up, 2490 participants (49.7%) were still unemployed. Compared to non-smokers, moderate and heavy smokers were more likely to remain unemployed, with ORs (95%CI) of 1.33 (1.08-1.64) and 1.42 (1.04-1.93), respectively. Compared to low-risk alcohol users, no alcohol users and high or very high-risk alcohol users were more likely to remain unemployed, with ORs (95% CI) of 1.40 (1.03-1.83) and 2.10 (1.53-2.87), respectively. Compared to participants who never used cannabis, participants who use cannabis once a week or more were more likely to remain unemployed, OR (95%CI) of 1.63 (1.33-2.01). Substance use may play an important role in difficulty attaining employment.

Towards quantifying the reciprocal associations between frequency of cannabis use and alcohol consumption: a cross-lagged analysis from the CONSTANCES cohort.

OBJECTIVE: Disentangle the temporal relationships between frequency of cannabis use and alcohol consumption. METHODS: A cross-lagged model providing standardised coefficients (SCs)±their standard errors in 13 255 men and 13 696 women enrolled in 2015 or 2016 in the French population-based 'CONSulTANts des Centres d'Examens de Santé' (CONSTANCES) cohort. Cannabis use was categorised as follows: 'No use during the past 12 months', 'Use during the past 12 months but not in the past month' and 'Use in the past month' for cannabis use at baseline, and No use during the past 12 months, 'Use less than once per month' and 'Use once per month or more' for cannabis use at 1 year of follow-up. Alcohol consumption was measured at baseline and at 1 year of follow-up and three categories were determined: low risk (<28 drinks per week in men; <14 drinks per week in women), moderate risk (≥28 and<42 in men; ≥14 and<28 in women) and high risk (≥42 in men; ≥28 in women). Analyses were adjusted for age, sex, education, income, tobacco consumption, self-rated health status and depressive symptoms. RESULTS: Both associations from alcohol to cannabis and from cannabis to alcohol were significant (SC=0.02±0.01 with p=0.003 and SC=0.06±0.01 with p<0.001, respectively). However, the SC of the association from cannabis to alcohol was three times higher than the opposite association (p<0.001). After stratification for sex, SCs of the association from cannabis to alcohol were more than two times higher than for the opposite association in men, and more than four times higher in women (both p<0.001). CONCLUSIONS: The association between frequency of cannabis use and subsequent alcohol consumption was stronger than the opposite association. This finding encourages considering the risk of increased alcohol consumption among cannabis users.

Physical exertion at work and addictive behaviors: tobacco, cannabis, alcohol, sugar and fat consumption: longitudinal analyses in the CONSTANCES cohort.

We examined the prospective association of physical exertion at work with subsequent tobacco, cannabis, alcohol use, and sugar and fat consumption. Volunteers of the French population-based CONSTANCES cohort currently employed were included from 2012 to 2017 for tobacco and cannabis outcomes (n = 100,612), and from 2012 to 2016 for alcohol and sugar and fat outcomes (n = 75,414). High level of physical exertion at work was defined as a score ≥ 12 at the Rating Perceived Exertion Borg scale. Substance use was self-reported and diet rich in sugar and fat was obtained from principal component analysis and analyzed as quartiles. Generalized linear models computed odds of substance use and sugar and fat consumption at follow-up according to baseline physical exertion at work, while adjusting for sociodemographic factors, depressive symptoms and baseline level of consumption. High physical exertion was associated with tobacco use with dose-dependent relationships. It was also associated with increased odds of cannabis use at least once per month compared to no use in the past and with increased odds of diet rich in sugar and fat. Hence, the role of physical exertion at work on tobacco and cannabis use and diet rich in sugar and fat should be tackled for information and prevention strategies.

Sociodemographic and Clinical Characteristics of Vapers Using E-Cigarettes Exclusively: The French Vapoquid Study.

BACKGROUND: Electronic cigarettes are increasingly being used as smoking cessation aids. Most studies assess the dual use of e-cigarettes and traditional cigarettes, but there remains a paucity of literature concerning individuals who use e-cigarettes exclusively. Objective: The aim of this study is to examine the sociodemographic and clinical characteristics of exclusive e-cigarette users, and consider their willingness to quit e-cigarette use. Methods: A French online survey was conducted from March to December 2017. We assessed the following factors: sociodemographic factors; the clinical characteristics of e-cigarette use and its social acceptability; and the self-perceived effectiveness of nicotine replacement therapy (NRT). Associations between the listed factors and a willingness to quit e-cigarette use were examined. Results: A total of 386 exclusive e-cigarette users (70% men) participated in the study and were included in the analysis. Most respondents were not planning to quit e-cigarette use (75%). Compared to those who did not want to quit, a desire to quit was associated with using smoking cessation services (OR [95%CI]: 3.45 [1.82-6.56]), e-cigarette craving (OR [95%CI]: 2.63 [1.44-4.80]) and NRT past-use (1.78 [1.12-2.87]). Users who planned to quit expressed more concerns about smoking initiation among youths using e-cigarettes (OR [95%CI]: 3.62 [1.90-6.93]). In multivariate analysis, these associations remained significant for the use of smoking cessation services, e-cigarette cravings, and concerns about youth tobacco initiation. Conclusion: Most exclusive e-cigarette users were not likely to quit. Planned cessation was associated with using smoking cessation services, experiencing e-cigarette dependence symptoms, and being concerned about smoking initiation among teenager e-cigarette users.

Evolution of the prevalence of obesity in the adult population in France, 2013-2016: the Constances study.

This study provides trends in obesity prevalence in adults from 2013 to 2016 in France. 63,582 men and women from independent samples upon inclusion from the Constances cohort were included. Anthropometrics were measured at Health Screening Centers and obesity defined as a Body mass index (BMI) ≥ 30 kg/m2; obesity classes according to BMI are as follows: class 1 [30-34.9]; class 2 [35-39.9]; class 3 [≥ 40 kg/m2]. Linear trends across obesity classes by sex and age groups were examined in regression models and percentage point change from 2013 to 2016 for each age category calculated. All analyses accounted for sample weights for non-response, age and sex-calibrated to the French population. Prevalence of obesity ranged from 14.2 to 15.2% and from 14 to 15.3% in women and men respectively from 2013 to 2016. Class 1 obesity category prevalence was the only one to increase significantly across survey years in both men and women (p for linear trend = 0.04 and 0.01 in women and men respectively). The only significant increase for obesity was observed in the age group 18-29 y in both women and men (+ 2.71% and + 3.26% point increase respectively, equivalent to an approximate rise of 50% in women and 93% in men, p = 0.03 and 0.02 respectively). After adjustment for survey non-response and for age and sex distribution, the results show that class 1 obesity prevalence has significantly increased in both women and men from 2013 to 2016, and only in young adults in a representative sample of the French population aged 18-69 years old.

Evaluation of Eating Habits and Quality of Life in Postbariatric Surgery Patients and Their Family Members: A Case-Control Study.

BACKGROUND: Obesity is a major health problem worldwide. Today, bariatric surgery is considered as the last option and most effective treatment for severe obesity (BMI ≥40 kg/m2 or BMI ≥35 kg/m2 with metabolic conditions). AIMS: We aimed to evaluate the medium-term effect (>36 months) of bariatric surgery and assess postbariatric nutritional and lifestyle management among Lebanese patients who underwent bariatric surgeries in Jbeil and Keserwan hospitals. METHODS: This study is a quantitative case-control study. The case group includes a couple of patients who have undergone sleeve or bypass surgery 6 months ago and above, along with the main family caregivers. The control group constitutes a couple of obese patients with BMI ≥30 kg/m2 who did not proceed to any surgical intervention with their main caregivers. The final samples consisted of 53 cases and caregivers and 50 controls and caregivers. The assessment was made by an online questionnaire. RESULTS: Compared to obese patients, bariatric patients were less likely to have high energy intake (54% versus 34%, P value 0.012). Moreover, 35.8% of the caregivers of bariatric patients had a low physical activity level compared to those of the control group who had a lower level (70%). In addition, cases' main caregivers (75.5%) had much higher quality of life compared to the cases (56.6%), and also, higher quality of life was seen among the case's main caregivers (75%) compared to the controls (72%). CONCLUSION: In Jbeil and Keserwan regions of Lebanon, there is a lack of postbariatric nutritional and lifestyle management leading to less desirable outcomes in the medium to long term. A set of recommendations are developed based on this study.

Do the associations between the use of electronic cigarettes and smoking reduction or cessation attempt persist after several years of use? Longitudinal analyses in smokers of the CONSTANCES cohort.

INTRODUCTION: We examined whether duration of electronic cigarette (e-cigarette) use could be associated with smoking reduction or cessation attempt. METHODS: 5,409 current smokers at baseline enrolled in the French CONSTANCES cohort in 2015 or 2016 were included. Duration of e-cigarette use was categorized as follows: never; former user for more than one year; former user for less than one year; new user for less than one year; return to use for less than one year; regular use for one to two years; regular use for more than two years. Two outcomes were considered at one-year of follow-up: change in the number of cigarettes per day and cessation attempt. RESULTS: Compared to never users, former users had an increase in the number of cigarettes per day at follow-up (B = 0.95[95%CI:0.57-1.33] and B = 1.03[95%CI:0.47-1.59] for former users of more than one year and less than one year, respectively). Compared to never users, all categories of current users had a decrease in the number of cigarettes per day (B = -3.31[95%CI:-4.07;-2.54] and B = -4.18[95%CI:-5.06;-3.29] for new users of less than one year and users of more than two years, respectively). Compared to never users, former users had a decreased likelihood of cessation attempt (OR = 0.80[95%CI:0.67-0.95] and OR = 0.77[95%CI:0.60-0.99] for former users of more than one year and less than one year, respectively). Compared to never users, all categories of current users had an increased likelihood of cessation attempt (OR = 3.12[95%CI:2.32;4.19] and OR = 3.36[95%CI:2.39;4.72] for new users of less than one year and users of more than two years, respectively). CONCLUSIONS: E-cigarette use was associated with smoking reduction and cessation attempt for individuals who have used it for less than one year and additional benefits are expected to occur with a longer duration of use. Former users of e-cigarettes had poorer outcomes than those who have never used them.

Dietary Restrictions and Depressive Symptoms: Longitudinal Results from the Constances Cohort.

Cross-sectional results have suggested a linear association between the number of dietary exclusions and depressive symptoms. This longitudinal study aimed to examine the direction of this association. Methods: In the population-based Constances cohort, depressive symptoms were defined by a score ≥19 on the Centre of Epidemiologic Studies-Depression (CES-D) scale. Diet was measured with a 24-item qualitative food frequency questionnaire (FFQ). Both variables were available at inclusion (from 2012 to 2014) and on follow-up (2015 for the CES-D and 2017 for diet). Food exclusion was categorized into five different groups: No exclusion, exclusion of one, two, three, or ≥4 food groups according to the self-reported number of food groups rarely or never consumed. Logistic regressions were conducted, either taking depressive symptoms as the outcome on follow-up with dietary exclusions at baseline as predictor or with the opposite, adjusting for age, sex, education, income, alcohol intake, smoking, physical activity, and anemia. The path analysis included outcomes and covariates in one model. Results: The median follow-up was three years. A total of 29,337 participants (53.4% women, 48.15 ± 12.9 y.o.) had complete CES-D data and 25,356 (53.56% women, 49.05 ± 12.8 y.o.) FFQ data. Dietary exclusion at inclusion predicted depressive symptoms at follow-up (odds ratio [95% confidence interval]: 2.35 [1.62-3.40] for ≥4 excluded items compared to no exclusions). Depressive symptoms at inclusion predicted dietary exclusions at follow-up (3.45 [1.93-6.16] for ≥4 excluded items). In the path analysis, the standardized estimate of the association between dietary exclusions at inclusion and depressive symptoms at follow-up was by far higher than the opposite (0.1863 and 0.00189, respectively, both p < 0.05). Conclusions: The association of dietary exclusion with subsequent depression is stronger than the opposite association.

Development, validity, and reproducibility of a semiquantitative food frequency questionnaire for the assessment of antioxidant vitamins intake in Lebanon.

OBJECTIVES: The growing interest in the possible role of antioxidant vitamins in many pathologies makes the methods of evaluating the intakes of these vitamins necessary. The food frequency questionnaire is the most widely used tool in epidemiologic studies and large-scale surveys to assess long-term nutritional exposure and to determine the usual intake of specific foods or nutrients. The aims of this study were to develop and investigate the validity and reproducibility of a semiquantitative food frequency questionnaire (SQFFQ) to evaluate the antioxidant vitamins intake in the Lebanese population and for use in clinical trials. METHODS: An SQFFQ draft was built with the major sources of vitamins with antioxidant properties initially selected from food that have the higher percentages of the daily value of vitamins A, C, and E; listed in the US Department of Agriculture tables. We used food intake data that were available through a 24-h dietary recall (3 weekdays and 1 weekend day) among a subsample of 50 participants to complete the SQFFQ. We sought the major sources of the most frequently reported antioxidant vitamins, portion sizes, and percentages of the daily value of the major sources of these vitamins (developed by the US Department of Agriculture) to build a 34-item SQFFQ. The consumption frequency was coded as daily, weekly, monthly, or occasionally and one to three times or more. Five hundred Lebanese participants (the previous 50 who provided the 24 h dietary recall, along with 450 new participants) completed the questionnaire, whereas only 50 and 42 were accepted to be enrolled in the validity and reproducibility studies, respectively. To assess validity, the questionnaire was compared with the 24-h dietary recall performed on a subsample of 50 participants who already completed the SQFFQ. The reproducibility was assessed by comparing baseline SQFFQ with a second administration of the SQFFQ 3 to 5 wk later at the same dietetic clinic. RESULTS: The means of daily consumption of vitamins A, C, and E based on the SQFFQ and the 24 h data were as follows: Vitamin A: 252.5 ± SD 958.9 versus 242.6 ± SD 580.5 mcg of retinol activity equivalents (µg RAE), Vitamin C: 86.5 ± SD 59.9 versus 85.5 ± SD 56.2 µg, and Vitamin E: 17 ± SD 7.2 versus 17.1 ± SD 7.9 µg. The Pearson correlation coefficients of the three vitamins between dietary intake estimates derived from the SQFFQ and 24-h data were, respectively, r = 0.83, 0.98, and 0.9; they were highly significant at P < 0.001. One sample t tests and Bland-Altman plots confirmed this validity. The reproducibility of the SQFFQ was assessed using the Cronbach α index that measures reliability between different components (for vitamin A: 0.994, vitamin C: 0.998, and vitamin E: 0.975). The correlation matrix (interitem correlation) showed that all elements were highly correlated (r > 0.4) and even close to 1 (for vitamin A = 0.989, vitamin C = 0.995, and vitamin E = 0.95). CONCLUSIONS: In this study, we described the development of an SQFFQ. Based on the results, we found the SQFFQ to be valid and reproducible to assess intake of antioxidant vitamins in Lebanese adults..

Diet and physical activity in the association between depression and metabolic syndrome: Constances study.

BACKGROUND: The association between depression and the metabolic syndrome remains poorly understood. Diet and physical activity may partly explain this association. METHODS: Baseline data on 64,861 subjects from the French population-based Constances cohort was analyzed. Depressive symptoms were determined with the Center of Epidemiologic Studies Depression (CES-D) scale. A CES-D score ≥ 19 combined with self-reported limitations related to depressive symptoms was used to define depression. The metabolic syndrome was defined according to the International Diabetes Federation criteria. Dietary patterns were determined with a food frequency questionnaire and a principal component analysis. Physical activity was measured with 3 questions resulting in a composite 6-point scale. Associations between depression and the metabolic syndrome were estimated through logistic regression and path analysis. RESULTS: The odds-ratios (95% confidence interval) for the association between depression and the metabolic syndrome, adjusting for age, sex, education and income, was 1.75 (1.57-1.96). The path analysis showed that 23% of this association was explained by diet and physical activity, 67% being attributed to physical activity. LIMITATIONS: The cross-sectional nature of the analyses warrants the results to be confirmed by longitudinal analyses. CONCLUSION: Diet and physical activity might partially explain the association between depressive symptoms and metabolic syndrome but other factors (e.g. inflammatory factors) are involved.

Depressive Symptoms and Vegetarian Diets: Results from the Constances Cohort.

The association between depressive symptoms and vegetarian diets is controversial. This study examines the cross-sectional association between depressive symptoms and vegetarian diets while controlling for potential confounders. Among 90,380 subjects from the population-based Constances cohort, depressive symptoms were defined by a score ≥19 on the Centre of Epidemiologic Studies-Depression (CES-D) scale and diet types (omnivorous, pesco-vegetarian, lacto-ovo-vegetarian and vegan) were determined with a food frequency questionnaire. Associations between depressive symptoms and diet were estimated through logistic regressions adjusting for socio-demographics, other foods, alcohol and tobacco consumption, physical activity and health-related concerns; specificity analyses considered the exclusion of any other food group. Depressive symptoms were associated with pesco-vegetarian and lacto-ovo-vegetarian diets in multivariable analyses (Odds-Ratio [95% confidence interval]: 1.43 [1.19⁻1.72] and 1.36 [1.09⁻1.70], respectively), especially in case of low legumes intake (p for interaction < 0.0001), as well as with the exclusion of any food group (e.g., 1.37 [1.24⁻1.52], 1.40 [1.31⁻1.50], 1.71 [1.49⁻1.97] for meat, fish and vegetables exclusion, respectively). Regardless of food type, the Odds-Ratio of depressive symptoms gradually increased with the number of excluded food groups (p for trend < 0.0001). Depressive symptoms are associated with the exclusion of any food group from the diet, including but not restricted to animal products.

Interrelated factors favoring physical performance and activity in older adults from the NuAge cohort study.

OBJECTIVES: Contribute evidence towards the complex interrelationships of body composition, physical performance and physical activity (PA) in an older population to assist in decisions for maintaining functional capacity in older adults. DESIGN: This is a cross-sectional analysis of an existing dataset in which a literature-supported model linking together the variables of interest is tested using path analysis. A proposed model with age, sex, energy intake and chronic diseases as predictors associated with body composition components, while the latter associated with physical performance and with PA acting both as a predictor and as an outcome of physical performance. PARTICIPANTS: A sample of 847, community dwellers, non-diabetic older men and women from the Quebec Longitudinal Study on Nutrition and Successful Aging (NuAge Study). MEASUREMENTS: Physical performance tests were reduced to two indices: strength and mobility. Muscle mass index (MMI; kg/height(2)) and % body fat were derived from DXA and bioimpedance analysis (BIA). PA was assessed by the Physical Activity Scale for the Elderly (PASE) and energy intakes were calculated from 24-hour food recalls. Data from the NuAge dataset served to test the relationships. The proposed model was evaluated using indices of fit. RESULTS: Significant associations were found for MMI and % body fat with mobility (ß -0.11 and -0.02, respectively), and for MMI with strength (ß=0.60). PA was associated with MMI (ß=0.02) and negatively with % body fat (ß=-0.16), while mobility associated with PA (ß=0.65). Our hypothesized model, with some paths added, fit the data: chi-square=4.64, root mean square error of approximation (RMSEA)=0. CONCLUSIONS: PA has desirable associations with body composition in older adults and mobility is associated with PA. These results stress the importance of taking into account the prior level of mobility when recommending PA for this age group. This model could explain in part the complex interrelationships that occur with aging and the potential factors that could be targeted to assist older individuals in maintaining functional capacity.