Respective roles of social deprivation, health literacy, and clinical factors for COVID-19: a case-control study in hospitalized patients.

Introduction: To investigate the association between social deprivation and COVID-19 among hospitalized patients in an underprivileged department of the greater Paris area. Methods: Individuals hospitalized for COVID-19 between March 1st and October 31, 2020, were included, matched on age and sex, and compared with patients hospitalized for any other reason with negative RT-PCR for SARS-CoV-2, through a case-control study. Clinical, socio-demographic characteristics, health literacy, and social deprivation, assessed by the EPICES score, were collected. Factors associated with COVID-19 in hospitalized patients were assessed using univariate and multivariate logistic regression models. Results: 69 cases and 180 controls were included. Participants were mostly men (N = 148: 59.4%) aged 65 or older (N = 109: 44.1%). Median EPICES score was 43.2 (IQR 29.4-62.9). EPICES score > 30.17 (precariousness threshold) was not significantly associated with COVID-19 in hospitalized patients (adjusted odds ratio (aOR) = 0.46; 95% Confidence Interval (CI) [0.21-1.01]). Advanced age, higher BMI, professional activity, home area of less than 25 m2 per person, and low health literacy, were significantly associated with COVID-19 in hospitalized patients. Discussion: This study highlights probable risk factors for specific exposition in disadvantaged area: maintenance of professional activity, smaller home area, and low health literacy.

Public perception of the tax on sweetened beverages in France.

OBJECTIVE: To assess in 2021 the acceptance and perception of the French tax on sweetened beverages, following its revision in 2018, and factors associated with a higher level of acceptance. DESIGN: A cross-sectional survey within the NutriNet-Santé cohort study. Participants were invited to complete a self-reported questionnaire in March 2021. Weighting was applied to the sample to allow inferences on the French population. Individual characteristics associated with support for the tax were investigated using logistic regression modelling. SETTINGS: NutriNet-Santé prospective cohort study. PARTICIPANTS: Adults engaged in the NutriNet-Santé cohort, aged 18 years or older (n 28 344), living in mainland France. RESULTS: Almost two-thirds (63·4 %) of the participants were aware of the existence of a tax on sweetened beverages, although less than a quarter had specific knowledge regarding its design and the 2018 revision. In turn, 64·7 % of participants expressed a favourable opinion towards the taxation scheme. This proportion was higher if tax revenues were used to finance health-related measures (respectively 68·8 % of favourable opinion if used to finance a reduction in prices of healthy products and 76·4 % if used to finance the healthcare system). Multivariable analyses showed that support towards the tax varied among subgroups of the population. Groups who tended to be less financially affected by the measure and those who perceived sugar-sweetened beverages as having detrimental effects were more likely to support the tax. CONCLUSION: The revised French sugar-sweetened beverage tax appeared to be favourably received and perceived by the public.

Public health lessons from the French 2012 soda tax and insights on the modifications enacted in 2018.

In 2016, the World Health Organization officially recommended sugar-sweetened beverage (SSB) taxation as a strategy to reduce purchases, stimulate product reformulation and generate revenues for health-related programmes. Four years before, France had been one of the first countries to tax SSBs. However, the design of this tax was not considered optimal: its rate was flat, low, identical for SSBs and artificially-sweetened drinks containing no added sugars, and its initial public health justification was set aside in favour of budgetary concerns. In 2018, a new taxation scheme was enacted. Integrated in the Social Security Finance Bill, the tax on SSBs is now linearly indexed to the quantity of added sugars in the drink. In this article, we summarize the lessons learnt from the 2012 soda tax and offer insights on the potential public health benefits of the new tax enacted in 2018. A multidimensional framework aimed at gathering evidence about SSB taxation for public health drove our rational so that we address: (1) the soda tax policy-change process; (2) its impact on price and purchases; (3) the consumer receptiveness to the tax and; (4) its legal framework. We also discuss the potential application of the tax to other foods/nutrients.

Consumption of Ultra-Processed Food and Its Association with Sociodemographic Characteristics and Diet Quality in a Representative Sample of French Adults.

The present study aims to describe ultra-processed food (UPF) consumption in a representative sample of French adults and to evaluate the association between UPF consumption and socioeconomic characteristics and nutritional profile of the diet. This is a cross-sectional study using food consumption data from the Étude Nationale Nutrition Santé (ENNS), conducted with 2642 participants (18-74 years old), between February 2006 and March 2007 in France. Dietary data were collected through three 24-h dietary recalls. All food and beverages were classified according to the NOVA classification. The energy contribution of NOVA food groups to total energy intake was presented by categories of sociodemographic characteristics. Linear and logistic regression models were used to estimate the association between the percentage of UPF in the diet with nutritional indicators. The mean daily energy consumption of the adult French population was 2111 kcal, of which 31.1% came from UPF. This percentage was higher among younger individuals, and in the urban area, and lower among individuals with incomplete high school and individuals who were retired. The consumption of UPF was positively associated with the dietary energy density and the dietary contents of total carbohydrates, free sugar, and total and saturated fat, as well as with inadequate dietary energy density, saturated fat, free sugar, and fiber intakes.

Online Consumer Survey Comparing Different Front-of-Pack Labels in Greece.

According to the WHO, front-of-pack nutrition labeling provides simplified nutrition information in the form of symbols, colors or words that can help consumers understand the nutritional quality of food, thus leading them to healthier food choices. It is considered of the utmost importance to explore the knowledge and understanding of consumers about this form of nutrition labeling. The aim of this study was to investigate the understanding and perceptions of Greek consumers in response to five different front-of-pack nutrition labels (FoPLs): the Multiple Traffic Lights, Health Star Rating System, Guideline Daily Amounts, Warning Symbols and Nutri-Score. From April 2021 to June 2021, 1278 participants from Greece took part in an online survey where they were asked to rank three products according to their nutritional quality. The classification process was performed first without FoPLs and then with FoPLs. The ability to classify products according to their nutritional quality was evaluated with multinomial logistic regression models, and the Nutri-Score label presented greater improvements when compared to the GDA label for Greek consumers. The Nutri-Score seemed to better help the Greek consumers rank foods according to their nutritional value.

[Impact of different front-of-pack nutrition labels on foods according to their nutritional quality: a comparative study in Mexico]. / Impacto de diferentes etiquetados frontales de alimentos según su calidad nutricional: estudio comparativo en México.

OBJECTIVE: This study aimed to compare consumers' objec- tive understanding of five FoPLs [Health Star Rating system (HSR), Multiple Traffic Lights (MTL), Nutri-Score, Reference Intakes (RIs), Warning Symbol] in Mexico. MATERIALS AND METHODS: 1 001 Mexican consumers were recruited and asked to rank three sets of label-free products according to their nutritional quality, via a survey. Upon completion of this task, participants were randomized to one of five FoPL condi- tions and were again asked to rank the same sets of products, this time with a FoPL displayed on pack. Change in ability to correctly rank products across the two tasks was assessed by FoPL using ordinal logistic regression. RESULTS: Nutri-Score and MTL performed best, followed Warning Symbol, HSR and RIs. CONCLUSIONS: Nutri-Score and MTL appear as efficient schemes to inform consumers on the nutritional quality of foods, in particular in Mexico, where it would be a helpful tool for consumers in purchasing situations.

OBJETIVO: Evaluar la comprensión objetiva de cinco tipos de etiquetados frontales de paquetes (EFP) (Sistema de Clasifi- cación de Estrellas de Salud, Semáforo Múltiple, Nutri-Score, Ingestas de Referencia y Símbolo de Advertencia) en México. MATERIAL Y MÉTODOS: Se reclutaron 1 001 consumidores mexicanos para clasificar tres productos de tres categorías de alimentos sin EFP, según su calidad nutricional. Se les asignó al azar uno de los cinco EFP para clasificar los mismos productos, esta vez con un EFP en el empaque. El cambio en la capacidad para clasificar correctamente los productos en las dos tareas fue evaluado por EFP, utilizando un modelo de regresión logística ordinal. RESULTADOS: Nutri-Score y Semáforo Múltiple obtuvieron un mejor desempeño, seguidos del Símbolo de Advertencia, Sistema de Clasificación de Estrellas de Salud e Ingestas de Referencia. CONCLUSIONES: Nutri-Score y el Semáforo Múltiple surgen como esquemas eficientes para informar a los consumidores sobre la calidad nutricional de los alimentos en México, donde podrían ser una herramienta útil para los consumidores en situación de compra.

Impacto de diferentes etiquetados frontales de alimentos según su calidad nutricional: estudio comparativo en México / Impact of different front-of-pack nutrition labels on foods according to their nutritional quality: a comparative study in Mexico

Resumen: Objetivo: Evaluar la comprensión objetiva de cinco tipos de etiquetados frontales de paquetes (EFP) (Sistema de Clasificación de Estrellas de Salud, Semáforo Múltiple, Nutri-Score, Ingestas de Referencia y Símbolo de Advertencia) en México. Material y métodos: Se reclutaron 1 001 consumidores mexicanos para clasificar tres productos de tres categorías de alimentos sin EFP, según su calidad nutricional. Se les asignó al azar uno de los cinco EFP para clasificar los mismos productos, esta vez con un EFP en el empaque. El cambio en la capacidad para clasificar correctamente los productos en las dos tareas fue evaluado por EFP, utilizando un modelo de regresión logística ordinal. Resultados: Nutri-Score y Semáforo Múltiple obtuvieron un mejor desempeño, seguidos del Símbolo de Advertencia, Sistema de Clasificación de Estrellas de Salud e Ingestas de Referencia. Conclusión: Nutri-Score y el Semáforo Múltiple surgen como esquemas eficientes para informar a los consumidores sobre la calidad nutricional de los alimentos en México, donde podrían ser una herramienta útil para los consumidores en situación de compra.

Abstract: Objective: This study aimed to compare consumers' objective understanding of five FoPLs [Health Star Rating system (HSR), Multiple Traffic Lights (MTL), Nutri-Score, Reference Intakes (RIs), Warning Symbol] in Mexico. Materials and methods: 1 001 Mexican consumers were recruited and asked to rank three sets of label-free products according to their nutritional quality, via a survey. Upon completion of this task, participants were randomized to one of five FoPL conditions and were again asked to rank the same sets of products, this time with a FoPL displayed on pack. Change in ability to correctly rank products across the two tasks was assessed by FoPL using ordinal logistic regression. Results: Nutri-Score and MTL performed best, followed Warning Symbol, HSR and RIs. Conclusion: Nutri-Score and MTL appear as efficient schemes to inform consumers on the nutritional quality of foods, in particular in Mexico, where it would be a helpful tool for consumers in purchasing situations.

Objective understanding of Nutri-Score Front-Of-Package nutrition label according to individual characteristics of subjects: Comparisons with other format labels.

BACKGROUND: To improve nutritional status and prevent chronic nutrition-related diseases, international organizations have recommended the use of multiple strategies, including front-of-package nutrition labelling (FOPL). In France, the Nutri-Score has been selected by health authorities in March 2017. However, to be effective in purchasing situations, the label needs to be well understood, which may be influenced by label format and sociodemographic characteristics. This study aimed at investigating the objective understanding of the Nutri-Score compared to other label formats, and more particularly among specific at-risk populations. METHODS: The objective understanding of four FOPLs-namely Nutri-Score, Multiple Traffic Lights (MTL), the simplified nutrition labelling system (SENS), and modified Reference Intakes (mRIs)-was investigated in a sample from the NutriNet-Santé French cohort (n = 3,751). Logistic regression mixed models were computed to assess the association of the four FOPLs, compared to a "no label" situation, on the consumers' ability to rank products according to their overall nutritional quality. Objective understanding was also investigated according to sociodemographic and lifestyle characteristics. RESULTS: Compared to a "no label" situation, all FOPLs were significantly associated to an increase in consumers' ability to classify the products correctly, with wide disparities in results according to formats. The best performance was observed for the Nutri-Score (OR = 20.33(17.68-23.37)), followed by SENS (OR = 9.57(8.50-10.77)), MTL (OR = 3.55(3.20-3.93)) and mRIs (OR = 1.53(1.39-1.69)). This ranking was similar among all sub-populations and the ORs associated to the Nutri-Score were over 10, whichever the sub-group considered. Women, younger people, non-smokers, individuals with higher educational level and those with children had a higher capacity to identify healthier products (all P≤0.05). CONCLUSION: Nutri-Score, with a summarized graded and color-coded format, using semantic colours, is associated to a higher objective understanding than monochrome and nutrient-specific labels. Furthermore, though objective understanding may differ according to individual characteristics of subjects, the magnitude of effect of the Nutri-Score largely outweighed this effect, even in the at-risk populations.

Fruits and vegetables at home (FLAM): a randomized controlled trial of the impact of fruits and vegetables vouchers in children from low-income families in an urban district of France.

BACKGROUND: Fruits and Vegetables (FV) consumption is considered a marker of social inequalities in health since it is considerably decreased in disadvantaged populations. The main objective of this trial was to evaluate the impact of vouchers for FV purchase on the consumption of FV among children living in disadvantaged families in a French urban district. METHODS: The FLAM study was a controlled randomized intervention trial, performed in Saint-Denis (North suburbs of Paris). The study group (intervention or control) was randomly attributed to parent-child pairs at inclusion. The intervention group received vouchers exchangeable for FV over a 1 year period. Nutritional education through workshops was available for both groups. FV consumption was assessed through face-to-face food frequency questionnaires. Participants who reported eating less than 3.5 FV per day were considered low FV consumers. RESULTS: A total of 92 parent-child pairs were included, in which 45 were allocated to the intervention group and 47 to the control group. Amongst them, 64 completed the final follow-up questionnaire (30% lost to follow-up). After one year, the proportion of low FV consumers in children was significantly lower in the intervention group (29.4%) compared to the control group (66.7%, p = 0.005). Overall, 82% of the vouchers were used by the families. CONCLUSIONS: This study found a decreased proportion of small consumers in children after 1 year of distribution of FV vouchers compared to the control group. FV vouchers could be an effective lever to increase FV consumption among children from disadvantaged households. TRIAL REGISTRATION: ClinicalTrials.gov identifier no. NCT02461238 .

Perception of different formats of front-of-pack nutrition labels according to sociodemographic, lifestyle and dietary factors in a French population: cross-sectional study among the NutriNet-Santé cohort participants.

OBJECTIVE: Four formats for a front-of-pack (FOP) nutrition label are currently considered in France: the Nutriscore (or 5-Colour Nutrition Label, developed by a public research team), the SENS (supported by retailers), Multiple Traffic Lights (MTL, currently used in UK) and a modified version of the Reference Intakes (mRIs, supported by industry). Our objective was to investigate the perception of these FOP labels, according to sociodemographic, lifestyle and dietary factors. DESIGN: Cross-sectional study. SETTING: Web-based French cohort. MAIN OUTCOME MEASURE: FOP labels perception. PARTICIPANTS: Participants in the NutriNet-Santé cohort received a specific questionnaire on the perceptions of the four label formats identified. Sociodemographic, lifestyle and dietary data (three 24-hours dietary records) were collected through self-administered questionnaires. Mutually exclusive clusters of FOP labels perception were identified through a multiple correspondence analysis followed by a hierarchical clustering procedure. Sociodemographic, lifestyle and dietary factors associated with the clusters were explored using multivariable multinomial logistic regression. All analyses were weighted according to 2009 French census data. RESULTS: Among the 21,702 participants in the study, the Nutriscore received the most important number of favourable responses on positive perception dimensions by participants, followed by MTL and SENS. The five identified clusters were characterised by marked preferences for Nutriscore (cluster 1, 43.2% of participants, crude n=9,399), MTL (cluster 2, 27.3%, crude n=6,163), SENS (cluster 3, 17.05%, crude n=3,546), mRIs (cluster 4, 7.31%, crude n=1,632) and none of the presented formats (cluster 5, 5.10%, crude n=965). The cluster 1 (Nutriscore) was associated with lower adherence to nutritional recommendations, while cluster 2 (MTL) was associated with younger age and higher level of education. CONCLUSION: The Nutriscore appears to have a wide reach in the population and to appeal to subjects with lower adherence to nutritional recommendations.

Long-term association between the dietary inflammatory index and cognitive functioning: findings from the SU.VI.MAX study.

PURPOSE: Inflammation is a ubiquitous underlying mechanism of the links between diet and cognitive functioning. No study has yet evaluated the overall inflammatory potential of the diet, using the dietary inflammatory index (DII), in relation to cognitive functioning. In a French cohort of middle-aged adults, we evaluated the association between the DII, assessed in midlife, and cognitive performance evaluated 13 years later. METHODS: The DII is a literature-derived dietary index developed to determine the inflammatory potential of diet. The DII was estimated at baseline (1994-1996) among 3080 subjects of the SU.VI.MAX (supplementation with antioxidant vitamins and minerals) cohort. Cognitive performance was assessed in 2007-2009 via a battery of standardized neuropsychological tests. Principal component analysis was performed to extract a summary score of cognitive performance. Multivariable-adjusted linear regression analyses were performed to provide regression coefficients and 95 % confidence intervals (95 % CI). RESULTS: In a multivariate model, a strong inverse association was observed between a higher DII (reflecting a more inflammatory diet) and overall cognitive functioning (mean difference Q4 vs. Q1 = -1.76; 95 % CI = -2.81, -0.72, P for trend =0.002). With regard to specific cognitive domains, similar associations were observed with scores reflecting verbal memory, but not executive functioning. CONCLUSION: This study suggests that a pro-inflammatory diet at midlife might be associated with subsequent lower cognitive functioning. A diet exhibiting anti-inflammatory properties may help to maintain cognitive health during aging. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov (number NCT00272428).

Promoting physical activity in a low-income neighborhood of the Paris suburb of Saint-Denis: effects of a community-based intervention to increase physical activity.

BACKGROUND: Physical activity (PA) is a key factor for facing the increasing prevalence of obesity and overweight, and should be part of every public health programs. In this context, a community-based public health program promoting PA was developed in a low-income neighborhood of the city of Saint-Denis (France). METHODS: This work aimed at assessing the effectiveness of a 2-year PA promotion program. A quasi-experimental study was carried out using a pre/post design, with an assessment before (2013) and after (2015) the program. The interviewees were selected using a stratified random cluster sampling. The primary outcome was the proportion of participants practicing sufficient PA (WHO guidelines), and was measured using the RPAQ questionnaire. External interventions (on both neighborhood environment and inhabitants) were listed. RESULTS: We collected 199 questionnaires at baseline and 217 in 2015. There was a majority of women in both samples: 64.3 % in 2013 and 58.2 % in 2015. The average age of participants was 38.1 years (+/-1.1) and 40.6 (+/-1.1) respectively. The proportion of people practicing sufficient PA was modified from 48.1 % in 2013 to 63.5 % in 2015 (p = 0.001). This was mainly driven by women whose level of PA, increased from 40.3 % to 60.3 % (p = 0.002), reaching the average national French estimation of PA level among adults (63.5 %). CONCLUSIONS: This work showed a significant increase of the proportion of people practicing PA in a disadvantaged neighborhood where a community-based program promoting PA was developed. Simultaneous external interventions contributed to the results, showing the necessity of synergic interventions to reach efficiency.

Validation of the FSA nutrient profiling system dietary index in French adults-findings from SUVIMAX study.

PURPOSE: Population-wide nutritional recommendations give guidance on food groups' consumption, though a wide variability in nutritional quality within groups may subsist. Nutrient profiling systems may help capturing such variability. We aimed to apply and validate a dietary index based on the British Food Standards Agency nutrient profiling system (FSA-NPS DI) in French middle-aged adults. METHODS: Dietary data were collected through repeated 24-h dietary records in participants of the Supplémentation en Vitamines et Minéraux Antioxydants study (N = 5882). An aggregated dietary index at the individual level was computed using the FSA-NPS for each food consumed as well as compliance to the French nutritional guidelines using the Programme National Nutrition Santé-Guideline Score (PNNS-GS). Cross-sectional associations between FSA-NPS DI and nutrient intake, PNNS-GS, socio-demographic factors, lifestyle and nutritional biomarkers were computed using ANOVAs. RESULTS: The FSA-NPS DI was able to characterize the quality of the diets at the individual level in terms of nutrient intake and of adherence to nutritional recommendations: +37.6 % in beta-carotene intakes between subjects with a healthier diet versus subjects with a poorer diet, +42.8 % in vitamin C intakes; +17 % in PNNS-GS, all P < 0.001. FSA-NPS-DI was also associated with nutritional status at the biological level: +21.4 % in beta-carotene levels between subjects with a healthier diet versus subjects with a poorer diet, +12.8 % in vitamin C levels, all P < 0.001. CONCLUSIONS: The FSA-NPS DI is a useful and validated tool to discriminate individuals according to the quality of the diet, accounting for nutritional quality within food groups. Taking into account nutritional quality of individual foods allows monitoring change in dietary patterns beyond food groups.

Objective Understanding of Front-of-Package Nutrition Labels among Nutritionally At-Risk Individuals.

In the ongoing debate about front-of-package (FOP) nutrition labels, little data exist regarding nutritionally at-risk populations, although they are critical targets of prevention programs. This study aimed to compare the impact of FOP labels on the ability to rank products according to their nutritional quality among French adults potentially at risk of poor dietary quality (N = 14,230). Four labels were evaluated: Guideline Daily Amounts (GDA), Multiple Traffic Lights (MTL), 5-Color Nutrition Label (5-CNL), Green Tick (Tick), along with a reference without label. Mixed models were used to assess how individual characteristics and FOP labels were associated with the ability to rank products. Older participants and those with a lower educational level, income, nutritional knowledge, and likelihood of reading nutrition facts were less skilled at ranking food products according to nutritional quality. Compared with individual characteristics, nutrition labels had an increased impact on food product ranking ability. Overall, 5-CNL corresponded to the highest rate of correct responses, followed by MTL, GDA, and Tick (p < 0.0001). The strongest impact of 5-CNL was observed among individuals with no nutritional knowledge (odds ratio (OR): 20.24; 95% confidence interval (CI): 13.19-31.06). Therefore, 5-CNL appeared to be effective at informing consumers, including those who are nutritionally at-risk, about the nutritional quality of food products.

Public perception and characteristics related to acceptance of the sugar-sweetened beverage taxation launched in France in 2012.

OBJECTIVE: In France, an excise tax on sugar-sweetened beverages was introduced on 1 January 2012. Our objective was to assess perception of this tax as well as the sociodemographic characteristics of its supporters and opponents. DESIGN: Cross-sectional study within the Nutrinet-Santé cohort. A sub-sample of 1996 individuals was selected among participants in the Nutrinet-Santé cohort study. Perceptions of the sugar-sweetened beverage tax were assessed via self-administered questionnaires. The sociodemographic and dietary profiles of supporters and opponents of this tax were explored by multinomial logistic regression. Setting Nationally representative French sample, 2012. SUBJECTS: Adults aged >18 years (largest sample n 1996). RESULTS: Half of the study sample was generally supportive of the tax and 57·7 % perceived it as helpful in improving population health. Participants were more likely to support the tax model if the revenue it generated would be used for health-care system improvement (72·7 %) and if such taxing was associated with a corresponding decrease in the prices of other foodstuffs (71·5 %). Older participants were more likely to support the tax than were their younger counterparts (OR=2·37; 95 % CI 1·60, 3·49 for >65 years v. 26-45 years; P<0·001). Participants with lower educational levels were less likely to support the tax than were those with more formal education (OR=0·31; 95 % CI 0·19, 0·52 for low educational level v. high education level; P<0·001). In our models, sugar-sweetened beverage consumption was not associated with tax perception. CONCLUSIONS: The French sugar-sweetened beverage tax appeared to be favourably perceived by the public. Sociodemographic factors modulated such perceptions and should thus be taken into consideration when drafting future public health measures.

Development and validation of an individual dietary index based on the British Food Standard Agency nutrient profiling system in a French context.

BACKGROUND: Nutrient profiling systems could be useful public health tools as a basis for front-of-package nutrition labeling, advertising regulations, or food taxes. However, their ability beyond characterization of foods to adequately characterize individual diets necessitates further investigation. OBJECTIVES: The objectives of this study were 1) to calculate a score at the individual level based on the British Food Standard Agency (FSA) food-level nutrient profiling system of each food consumed, and 2) to evaluate the validity of the resulting diet-quality score against food group consumption, nutrient intake, and sociodemographic and lifestyle variables. METHODS: A representative sample of the French population was selected from the NutriNet-Santé Study (n = 4225). Dietary data were collected through repeated 24-h dietary records. Sociodemographic and lifestyle data were self-reported. All foods consumed were characterized by their FSA nutrient profile, and the energy intake from each food consumed was used to compute FSA-derived aggregated scores at the individual level. A score of adherence to French nutritional recommendations [Programme National Nutrition Santé guideline score (PNNS-GS)] was computed as a comparison diet-quality score. Associations between food consumption, nutritional indicators, lifestyle and sociodemographic variables, and quartiles of aggregated scores were investigated using ANOVAs and linear regression models. RESULTS: Participants with more favorable scores consumed higher amounts of fruits [difference Δ = 156 g/d between quartile 1 (less favorable) and quartile 4 (most favorable), P < 0.001], vegetables (Δ = 85 g/d, P < 0.001), and fish, and lower amounts of snack foods (Δ = -72 g/d, P < 0.001 for sugary snacks); they also had higher vitamin and mineral intakes and lower intakes of saturated fat. Participants with more favorable scores also had a higher adherence to nutritional recommendations measured with the PNNS-GS (Δ = 2.13 points, P < 0.001). Women, older subjects, and higher-income subjects were more likely to have more favorable scores. CONCLUSION: Our results show adequate validity of the FSA nutrient profiling system to characterize individual diets in a French context. The NutriNet-Santé Study was registered in the European Clinical Trials Database (EudraCT) as 2013-000929-31.

Motives for participating in a web-based nutrition cohort according to sociodemographic, lifestyle, and health characteristics: the NutriNet-Santé cohort study.

BACKGROUND: In traditional epidemiological studies, participants are likely motivated by perceived benefits, feelings of accomplishment, and belonging. No study has explored motives for participation in a Web-based cohort and the associated participant characteristics, although such information is useful for enhancing recruitment and improving cohort retention. OBJECTIVE: We aimed to evaluate the relationships between motives for participation and sociodemographic, health, and lifestyle characteristics of participants in the NutriNet-Santé Web-based cohort, designed to identify nutritional risk or protective factors for chronic diseases. METHODS: The motives for participation were assessed using a specifically developed questionnaire administered approximately 2 years after baseline. A total of 6352 completed the motives questionnaire (43.34%, 6352/15,000 randomly invited cohort participants). We studied the associations between motives (dependent variables) and individual characteristics with multivariate multinomial logistic regression models providing odds ratios and 95% confidence intervals. RESULTS: In total, 46.45% (2951/6352) of participants reported that they would not have enrolled if the study had not been conducted on the Internet, whereas 28.75% (1826/6352) were not sure. Men (OR 1.21, 95% CI 1.04-1.42), individuals aged 26-35 years (OR 1.51, 95% CI 1.20-1.91), and obese participants (OR 1.30, 95% CI 1.02-1.65) were more inclined to be motivated by the Internet aspect. Compared with younger adults and managerial staff, individuals >55 years (OR 0.60, 95% CI 0.48-0.45) and employees/manual workers were less likely motivated by the Internet aspect (OR 0.77, 95% CI 0.63-0.92). Regarding reasons for participation, 61.37% (3898/6352) reported participating to help advance public health research on chronic disease prevention; 22.24% (1413/6352) to help advance nutrition-focused research; 6.89% (438/6352) in response to the call from the media, after being encouraged by a close friend/associate, or a medical provider. Individuals >45 years (vs younger participants) were more likely (OR 1.62, 95% CI 1.07-2.47), whereas overweight and obese participants (vs nonobese participants) were less likely to participate in the study for reasons related to helping public health research on chronic disease prevention (OR 0.72, 95% CI 0.58-0.89; OR 0.62, 95% CI 0.46-0.84; respectively). Exclusive public funding of the study was important for 67.02% (4257/6352) of the participants. Men (OR 1.37, 95% CI 1.17-1.61) and persons >55 years (OR 1.97, 95% CI 1.57-2.47) were more likely to consider the exclusive public funding as very important. CONCLUSIONS: The use of the Internet, the willingness to help advance public health research, and the study being publicly funded were key motives for participating in the Web-based NutriNet-Santé cohort. These motives differed by sociodemographic profile and obesity, yet were not associated with lifestyle or health status. These findings can help improve the retention strategies in Web-based cohorts, particularly during decisive study periods when principal exposure information is collected.