[Cancers: incidence and survival in metropolitan France]. / Cancers : incidence et survie en France métropolitaine.

CANCERS: INCIDENCE AND SURVIVAL IN METROPOLITAN France. Incidence and survival rates are key indicators for cancer surveillance. They also help to drive cancer control programs and public health policies. Focusing on the main cancer localisations, this paper describes the latest incidence (2023) and survival (2018) rates, as well as their evolutions since 1990 in metropolitan France. In 2023, the number of new cases of cancer was estimated to be 433 136, of which 57% occurring in men. Both gender considered, the most frequent cancers are: breast cancer (61 214 new cases), prostate cancer (59 885 new cases) and lung cancer (52 777 new cases). Although the « all cancer ¼ incidence rate as remained quite stable for 33 years in men, it has been raising by almost 1% per year in women. Regarding survival, the standardized net survival (SNS) at 5 years shows great disparities among tumor sites, and it is overall higher in women. Cancers with the best prognosis are thyroid cancer (SNS at 5 years: 96%), prostate cancer (93%), skin melanoma (93%) and uterine cancer (74%). On the contrary, a few tumor locations, including the pancreas (SNS at 5 years of 11%), the liver (18%) and the lung (20%) are still associated with a poor prognosis, even if survival rates have increased in most of cancer locations since 1990.

CANCERS: INCIDENCE ET SURVIE EN FRANCE MÉTROPOLITAINE. Les données d'incidence et de survie constituent des indicateurs essentiels à la surveillance des cancers et à l'orientation des politiques publiques en matière de lutte contre le cancer. Cet article résume les données les plus récentes d'incidence (2023) et de survie (2018) des principaux cancers, ainsi que leur évolution depuis 1990. En 2023, en France, le nombre total de nouveaux cas de cancers est estimé à 433 136 cas, dont 57 % chez l'homme. Tous sexes confondus, les cancers les plus fréquents sont le cancer du sein (61 214 nouveaux cas), le cancer de la prostate (59 885 nouveaux cas) et le cancer du poumon (52 777 nouveaux cas). Si le taux d'incidence « tous cancers ¼ est plutôt stable chez l'homme depuis 1990 (+0,3 % par an), il a augmenté de presque 1 % par an chez la femme. La survie nette standardisée (SNS) à cinq ans varie, quant à elle, considérablement selon les localisations, meilleure chez les femmes pour les cancers qui concernent les deux sexes. Les cancers de meilleur pronostic sont notamment ceux de la thyroïde (96 %), de la prostate (93 %), le mélanome de la peau (93 %) et le cancer du corps de l'utérus (74 %). À l'inverse, certains cancers fréquents, dont celui du pancréas (SNS à cinq ans de 11 %), du foie (18 %) ou encore du poumon (20 %), ont une survie qui reste défavorable, malgré une évolution encourageante de la survie dans la plupart des localisations depuis 1990.

[Insurability and history of cancer]. / Assurabilité et antécédents de cancer.

At the instigation of the Aeras convention -Insuring and borrowing with an aggravated health risk - and the 2014- 2019 Cancer Plan, the Law of 26 January 2016 introduces the « right to be forgotten ¼ for people with cancer. Thus, people wishing to take out an insurance policy for a mortgage or consumer credit do not have to declare their cancer 10 years after the end of the therapeutic protocol, in the absence of relapse. This period is reduced to 5 years for cancers occurring before the age of 18 years. Associated with this right, the « reference grid ¼ identifies situations for which insurance will be granted without surcharge or exclusion of guarantee, or under conditions that are close to standard conditions. This concerns both cancer -breast, thyroid, prostate cancers ...- and noncancer diseases -HIV, hepatitis C, cystic fibrosis ...-. Through his relationship with his patient, the doctor plays a key role in providing the best insight and helping him in his efforts.

ASSURABILITÉ ET ANTÉCÉDENTS DE CANCER Sous l'impulsion de la convention AERAS -S'assurer et emprunter avec un risque aggravé de santé- et du Plan cancer 2014-2019, la loi de 26 janvier 2016 introduit le « droit à l'oubli ¼ pour les personnes atteintes d'un cancer. Ainsi, les personnes souhaitant souscrire une assurance pour un prêt immobilier ou un crédit à la consommation n'ont plus à déclarer leur cancer 10 ans après la fin du protocole thérapeutique, en absence de rechute. Ce délai est ramené à 5 ans pour les cancers survenant avant l'âge de 18 ans. Associé à ce droit, la grille de référence identifie des situations pour lesquelles l'assurance sera accordée sans surprime ni exclusion de garantie, ou dans des conditions se rapprochant des conditions standard. Cela concerne à la fois des pathologies cancéreuses -cancer du sein, de la thyroïde, de la prostate…- et non cancéreuses -infection par le virus de l'immunodéficience humaine, hépatite C, mucoviscidose…-. Du fait de sa relation avec son patient, le médecin joue un rôle clé en l'éclairant au mieux et en l'aidant dans ses démarches.

[Incidence, mortality and prevalence of cancers in metropolitan France]. / Incidence, mortalité et prévalence des cancers en France métropolitaine.

Incidence, mortality and prevalence of cancers in metropolitan France. About 400,000 new people are diagnosed with cancer every year in metropolitan France, including 53.5% men and 46.5% women. Cancer is also the cause of almost 150,000 annual deaths of which 56% occur in men and 44% in women. Nearly 3.8 million people (1.8 million men and 2.0 million women) aged 15 and over have had cancer during their lifetime and are alive in 2017, or 7.0 % of the population aged 15 and over.

Incidence, mortalité et prévalence des cancers en France métropolitaine. Près de 400 000 nouvelles personnes sont diagnostiquées avec un cancer chaque année en France métropolitaine dont 53,5 % d'hommes et 46,5 % de femmes. Le cancer est également la cause d'environ 150 000 décès annuels parmi lesquels 56 % surviennent chez l'homme et 44 % chez la femme. On estime que près de 3,8 millions de personnes (1,8 million d'hommes et 2,0 millions de femmes) de 15 ans et plus ont eu un cancer au cours de leur vie et sont en vie en 2017, soit 7,0 % de la population de 15 ans et plus.

The relationship between school lunch attendance and the food intakes of French schoolchildren aged 3-17 years.

OBJECTIVE: Recently, school meal composition regulations have been implemented in France in order to improve the nutritional status of children. The present study investigated the link between school lunch attendance and the food intakes of schoolchildren aged 3-17 years. DESIGN: Second French cross-sectional dietary survey (2006-2007). Eating frequencies were assessed for twenty-four food groups with a 7 d food record. Eating locations were recorded for main meals. Food group intakes at weekday lunches were compared for the school canteen and for other locations. The children's overall dietary intake was compared based on school lunch attendance. SETTING: Mainland France. SUBJECTS: Schoolchildren aged 3-17 years (n 1068). RESULTS: Lunchtime food intake differed between the school canteen and other locations. Some intakes at school canteens were more in accordance with the regulations (more fruit and vegetables, fish and dairy products, and less sandwiches, soft drinks, chocolate and confectionery), whereas others highlighted needs for improvement (more sweet biscuits and pastries, ice cream and dairy desserts, pizzas and salty pastries). Many of these differences were also observed in the children's overall diet: children regularly attending school lunches ate more mashed fruit, fish and sweet biscuits or pastries, and less sandwiches and soft drinks. The link between school lunch attendance and overall diet was less pronounced in secondary-school children. CONCLUSIONS: School canteen attendance is associated with both potentially beneficial and deleterious differences in the lunchtime and overall diets of French children. These findings are important to consider when setting national regulations for school meal composition.

[Mapping of the key oncology indicators available in France]. / Cartographie des principaux indicateurs disponibles en France dans le domaine du cancer.

BACKGROUND: Available data in the field of oncology in France are scattered due to the large number of available indicators and their sources. In order to facilitate identification and analysis of these indicators, the French National Cancer Institute (INCa) has mapped the main indicators available in oncology. METHODS: Mapping was based on the needs of various categories of potential users. Standardized interviews were conducted face-to-face or by email among representatives to determine their needs and expectations. The underlying data sources were also identified: databases, national surveys, websites. A first selection of indicators was proposed in the report entitled "La situation du cancer en France en 2009" ("The state of cancer in France in 2009") and was expanded. Data collection concerning indicators was performed among INCa correspondents for each theme. RESULTS: Several themes were defined: epidemiology, prevention and risk factors, screening, medical demography, health care offer, living conditions, costs and expenses, research. Data were classified according to: geographical coverage, age, gender, type of cancer, occupational categories. This information was collected for each indicator selected and was made available via the cancer data website (http://lesdonnees.e-cancer.fr). CONCLUSIONS: The available oncology indicators are numerous and scattered. Mapping can be a useful tool to facilitate access to these indicators. It should be regularly updated to reflect the most recent data.

Bias in protein and potassium intake collected with 24-h recalls (EPIC-Soft) is rather comparable across European populations.

PURPOSE: We investigated whether group-level bias of a 24-h recall estimate of protein and potassium intake, as compared to biomarkers, varied across European centers and whether this was influenced by characteristics of individuals or centers. METHODS: The combined data from EFCOVAL and EPIC studies included 14 centers from 9 countries (n = 1,841). Dietary data were collected using a computerized 24-h recall (EPIC-Soft). Nitrogen and potassium in 24-h urine collections were used as reference method. Multilevel linear regression analysis was performed, including individual-level (e.g., BMI) and center-level (e.g., food pattern index) variables. RESULTS: For protein intake, no between-center variation in bias was observed in men while it was 5.7% in women. For potassium intake, the between-center variation in bias was 8.9% in men and null in women. BMI was an important factor influencing the biases across centers (p < 0.01 in all analyses). In addition, mode of administration (p = 0.06 in women) and day of the week (p = 0.03 in men and p = 0.06 in women) may have influenced the bias in protein intake across centers. After inclusion of these individual variables, between-center variation in bias in protein intake disappeared for women, whereas for potassium, it increased slightly in men (to 9.5%). Center-level variables did not influence the results. CONCLUSION: The results suggest that group-level bias in protein and potassium (for women) collected with 24-h recalls does not vary across centers and to a certain extent varies for potassium in men. BMI and study design aspects, rather than center-level characteristics, affected the biases across centers.

School meals in French secondary state schools: Do national recommendations lead to healthier nutrition on offer?

To improve the dietary offering in schools, the French authorities published recommendations on nutrition in 1999, which were then revised in 2007. The aim of the present study was to assess the nutritional offering in secondary school meals and the extent to which the recommendations promote balanced nutritional offerings. In 2005, a national survey was conducted on a representative sample of secondary schools, either administrated by the Ministry of Education (ES) or the Ministry of Agriculture (AS). Information on school-catering organisation and twenty consecutive meals was collected from each of the 707 secondary schools surveyed. Nutritional composition was estimated according to the French food composition database. Univariate and multivariate analyses were used to investigate the impact of food-group frequency guidelines (FFG) on nutritional offering. It was found that 15 and 26 % of ES and AS schools, respectively, had high compliance with the FFG, at lunch. Macronutrient content was unbalanced in ES school lunches in which 42·8 % lipids, 21·5 % proteins and 35·7 % carbohydrates contributed to the energy. Nevertheless, proper offerings in Fe, Ca and vitamin C content were observed. In addition, a lower offering in lipids and a higher offering in proteins, Ca, vitamin C and Fe were found when the FFG were applied (P < 0·001). Similar results were found for AS schools. This paper confirms the effectiveness of FFG in providing nutritionally balanced school meals. However, others measures such as nutrition promotion and actions to improve children's food habits have to be introduced to make the recommendations more effective and easier to understand.

Characteristics of energy under-reporting in children and adolescents.

Under-reporting (UR) of food intake is an issue of concern, as it may distort the relationships studied between diet and health. This topic has been scarcely addressed in children. The objective of the study was to assess the extent of UR in French children and investigate associated covariates. A total of 1455 children aged 3-17 years were taken from the nationally representative cross-sectional French étude Individuelle Nationale des Consommations Alimentaires (INCA2) dietary survey (2006-7). Food intake was reported in a 7 d diet record. Socio-economic status, sedentary behaviour, weight perception variables and food habits were collected by questionnaires. Weight and height were measured. Under-reporters were identified according to the Goldberg criterion adapted to children. Multivariate logistic regressions investigated the associations between UR and covariates. Rates of under-reporters were 4·9 and 26·0 % in children aged 3-10 and 11-17 years, respectively (P < 0·0001), without significant differences between boys and girls. Overall, UR was positively associated with a lower socio-economic status, overweight, skipping breakfast and dinner, a higher contribution of proteins to energy intake (EI), and a lower contribution of simple carbohydrates to EI. Under-reporters aged 3-10 years also had a higher sedentary behaviour and a lower snack-eating frequency. In adolescents, UR was also associated with a less-frequent school canteen attendance, a perception of being overweight, a wish to weigh less, and current and past restrictive diets. In conclusion, under-reporters differ from plausible reporters in several characteristics related to diet, lifestyle, weight status and socio-economic status. Therefore, it is important to consider this differential UR bias when investigating diet-disease associations in children.

Two non-consecutive 24 h recalls using EPIC-Soft software are sufficiently valid for comparing protein and potassium intake between five European centres--results from the European Food Consumption Validation (EFCOVAL) study.

The use of two non-consecutive 24 h recalls using EPIC-Soft for standardised dietary monitoring in European countries has previously been proposed in the European Food Consumption Survey Method consortium. Whether this methodology is sufficiently valid to assess nutrient intake in a comparable way, among populations with different food patterns in Europe, is the subject of study in the European Food Consumption Validation consortium. The objective of the study was to compare the validity of usual protein and K intake estimated from two non-consecutive standardised 24 h recalls using EPIC-Soft between five selected centres in Europe. A total of 600 adults, aged 45-65 years, were recruited in Belgium, the Czech Republic, France, The Netherlands and Norway. From each participant, two 24 h recalls and two 24 h urines were collected. The mean and distribution of usual protein and K intake, as well as the ranking of intake, were compared with protein and K excretions within and between centres. Underestimation of protein (range 2-13%) and K (range 4-17%) intake was seen in all centres, except in the Czech Republic. We found a fair agreement between prevalences estimated based on the intake and excretion data at the lower end of the usual intake distribution (< 10% difference), but larger differences at other points. Protein and K intake was moderately correlated with excretion within the centres (ranges = 0·39-0·67 and 0·37-0·69, respectively). These were comparable across centres. In conclusion, two standardised 24 h recalls (EPIC-Soft) appear to be sufficiently valid for assessing and comparing the mean and distribution of protein and K intake across five centres in Europe as well as for ranking individuals.

Socio-economic and demographic variations in school lunch participation of French children aged 3-17 years.

OBJECTIVE: To assess school canteen attendance in a French nationally representative sample of children and to analyse its association with the socio-economic and demographic characteristics of the children and their families. DESIGN: Data from the second French national cross-sectional food consumption survey (INCA2), performed in 2006-2007, were used. Information on usual weekly school canteen attendance was collected through a self-reported questionnaire, and demographic and socio-economic variables through a face-to-face questionnaire. The associations between school canteen attendance and the socio-economic and demographic variables were investigated by multivariate logistic regression analyses. SETTING: The INCA2 sample was representative of the children aged 3-17 years in France. SUBJECT: Analysis was performed on 1413 schoolchildren who completed the school canteen attendance questions. RESULTS: Some 65·6 % of schoolchildren aged 3-17 years had school lunch at least once weekly. This rate of attendance was positively correlated with age. Whatever the school level, school canteen attendance was positively associated with the educational level of the caregiver/parent. In pre- and elementary-school children, enrolment at the school canteen was also higher when the caregiver/parent worked, or in single-parent families. In secondary-school children, school lunch participation decreased with children living in more densely populated areas and increased with the level of the household's living standards. CONCLUSIONS: School canteen attendance was positively associated with children's socio-economic background. This could reduce the effectiveness of the forthcoming school meal composition regulations designed to improve the diet of children from deprived backgrounds, who are more likely to have unhealthy food habits.

Dietary exposure assessments for children in europe (the EXPOCHI project): rationale, methods and design.

BACKGROUND/PURPOSE: The number of dietary exposure assessment studies focussing on children is very limited. Children are however a vulnerable group due to their higher food consumption level per kg body weight. Therefore, the EXPOCHI project aims 1 to create a relational network of individual food consumption databases in children, covering different geographical areas within Europe, and 2 to use these data to assess the usual intake of lead, chromium, selenium and food colours. METHODS: EXPOCHI includes 14 food consumption databases focussed on children (1-14 y old). The data are considered representative at national/regional level: 14 regions covering 13 countries. Since the aim of the study is to perform long-term exposure assessments, only data derived from 24 hr dietary recalls and dietary records recorded on at least two non-consecutive days per individual were included in the dietary exposure assessments. To link consumption data and concentration data of lead, chromium and selenium in a standardised way, categorisation of the food consumption data was based on the food categorisation system described within the SCOOP Task report 3.2.11. For food colours, the food categorisation system specified in the Council Directive 94/36/EC was used. CONCLUSION: The EXPOCHI project includes a pan-European long-term exposure assessment of lead, chromium, selenium and food colours among children living in 13 different EU countries. However, the different study methods and designs used to collect the data in the different countries necessitate an in-depth description of these different methods and a discussion about the resulting limitations.

Comparison of different maximum safe levels in fortified foods and supplements using a probabilistic risk assessment approach.

Different European institutions have developed mathematical models to propose maximum safe levels either for fortified foods or for dietary supplements. The objective of the present study was to compare and check the safety of these different maximum safe levels (MSL) by using a probabilistic risk assessment approach. The potential maximum nutritional intakes were estimated by taking into account all sources of intakes (base diet, fortified foods and dietary supplements) and compared with the tolerable upper intake levels for vitamins and minerals. This approach simulated the consequences of both food fortification and supplementation in terms of food safety. Different scenarios were tested. They are the result of the combination of several MSL obtained using the previous models. The study was based on the second French Individual and National Study on Food Consumption performed in 2006-7, matched with the French food nutritional composition database. The analyses were based on a sample of 1918 adults aged 18-79 years. Some MSL in fortified foods and dietary supplements obtained independently were protective enough, although some others could lead to nutritional intakes above the tolerable upper intake levels. The simulation showed that it is crucial to consider the inter-individual variability of fortified food intakes when setting MSL for foods and supplements. The risk assessment approach developed here by integrating the MSL for fortified foods and dietary supplements is useful for ensuring consumer protection. It may be subsequently used to test any other MSL for vitamins and minerals proposed in the future.

Trends in food and nutritional intakes of French adults from 1999 to 2007: results from the INCA surveys.

Two independent cross-sectional dietary surveys (the Individual and National Food Consumption Surveys, INCA), performed in 1998-99 (INCA1) and in 2006-07 (INCA2) on nationally representative samples of French people, were used to analyse trends in the dietary habits and nutritional intake of French adults. Food consumption was recorded through 7-d dietary records, and nutritional intakes were assessed using the French food composition database. After exclusion of under-reporters, analyses were performed on 3267 adults, aged 18-79 years: 1345 from INCA1 and 1922 from INCA2. The trends highlighted over the 8-year period showed a decrease in consumption of dairy products, meat, bread, potatoes, pastries/croissant-like pastries/cakes/biscuits and sugar/confectionery. In contrast, the consumption of fruits and vegetables, rice, ice cream and chocolate increased. Other food groups, like fish and snacking foods, remained stable. Food choices were mostly age specific. These age differences remained consistent over the years and underlined two opposite dietary trends: a 'traditional' one mainly followed by the elderly, and a 'snacking and convenience' one mainly adopted by young adults. The overall trends in food consumption did not influence the mean energy intake, but did slightly modify the contribution of each macronutrient to energy intake. These repeated surveys highlighted the fact that trends in French food habits have moved towards an average European diet at the crossroads between Mediterranean and Northern diets, and that food consumption changes impacted, to a lesser extent, nutritional intake.

Trends in food intake in French children from 1999 to 2007: results from the INCA (étude Individuelle Nationale des Consommations Alimentaires) dietary surveys.

The objectives of the present study were to assess the intake of different food groups in French children aged 3-17 years (n 1455), and to analyse trends since a dietary survey undertaken 8 years ago. Dietary intake was evaluated using data from the 2006-7 cross-sectional INCA2 national dietary survey (étude Individuelle Nationale sur les Consommations Alimentaires), based on a 7 d food record. Dietary intake (percentage of subjects consuming the food group and amount eaten) was assessed for thirty-nine food categories. We observed variations in food consumption by age, sex, North-South regional gradient, seasonal period and educational level of the responding parent. Trends in dietary intake between 1999 and 2007 were determined by comparing the INCA1 (n 1126) and the INCA2 surveys. Both surveys had been carried out using the same methodology. The findings showed a decrease in energy intake in children aged 3-14 years, due to a reduction in the consumption of foods of animal origin and sweetened products. In adolescents aged 15-17 years, energy intake remained rather stable; during this 8-year period, the consumption of meat decreased, whereas the consumption of savoury snacks such as sandwiches and hamburgers significantly increased. These trends occurred during a time of growing concern about overweight and the associated co-morbidities in France. A number of public health measures were implemented over this period to improve dietary habits and physical activity patterns in children and adults. The periodic monitoring of dietary patterns through the INCA surveys is an essential part of the surveillance network in France.

Postmenopausal breast cancer risk and dietary patterns in the E3N-EPIC prospective cohort study.

Since evidence relating diet to breast cancer risk is not sufficiently consistent to elaborate preventive proposals, the authors examined the association between dietary patterns and breast cancer risk in a large French cohort study. The analyses included 2,381 postmenopausal invasive breast cancer cases diagnosed during a median 9.7-year follow-up period (1993-2005) among 65,374 women from the E3N-EPIC cohort. Scores for dietary patterns were obtained by factor analysis, and breast cancer hazard ratios were estimated by Cox proportional hazards regression for the highest quartile of dietary pattern score versus the lowest. Two dietary patterns were identified: "alcohol/Western" (essentially meat products, French fries, appetizers, rice/pasta, potatoes, pulses, pizza/pies, canned fish, eggs, alcoholic beverages, cakes, mayonnaise, and butter/cream) and "healthy/Mediterranean" (essentially vegetables, fruits, seafood, olive oil, and sunflower oil). The first pattern was positively associated with breast cancer risk (hazard ratio = 1.20, 95% confidence interval (CI): 1.03, 1.38; P = 0.007 for linear trend), especially when tumors were estrogen receptor-positive/progesterone receptor-positive. The "healthy/Mediterranean" pattern was negatively associated with breast cancer risk (hazard ratio = 0.85, 95% CI: 0.75, 0.95; P = 0.003 for linear trend), especially when tumors were estrogen receptor-positive/progesterone receptor-negative. Adherence to a diet comprising mostly fruits, vegetables, fish, and olive/sunflower oil, along with avoidance of Western-type foods, may contribute to a substantial reduction in postmenopausal breast cancer risk.

School meals in French secondary state schools with regard to the national recommendations.

In 2001, a circular addressing both the composition of school meals and food safety issues was introduced in France to improve the nutrient composition of school meals and provided food-frequency guidelines to guarantee dietary balanced meals. The present study assesses the extent to which secondary state schools are familiar with and implement this circular. In 2005, a nationally representative sample of 1440 secondary state schools received a questionnaire on their catering service and the implementation of the circular's recommendations, and were requested to enclose all menus (lunches and dinners) served over 1 month. Menu analysis shows that progress is still required to achieve a meal composition in accordance with the food-group frequency guidelines appended to the circular. Some recommendations are followed by most of the schools, such as limiting high-fat products and providing plenty of raw fruits and vegetables, cooked vegetables and starchy foods. Other guidelines should be implemented further, especially with regard to the nutritional quality of main courses and dairy products, which are met by less than a third and a half of schools, respectively. Specific efforts are necessary for evening meals to ensure that the nutritional requirements of boarders are covered. Some recommendations, such as the food purchasing manager being trained in nutrition (38 % of schools) and the involvement of dietetic expertise when designing meals (6 %), seem to be linked to better dietary balance of meals. Implementation of the circular must therefore be promoted in schools and may require stronger regulatory nutrition standards and better cooperation between schools.

Are eating occasions and their energy content related to child overweight and socioeconomic status?

The objectives of this study were: (i) to assess the relationships between childhood overweight (OW) and four eating behaviors: daily eating frequency, and the relative contribution of breakfast, main meals (lunch and dinner), and snacks to total daily energy intake (EI); (ii) to explore whether these eating behaviors are involved in the negative association between socioeconomic status (SES) and OW. A representative sample of French children aged 3-11 years (n = 748) was taken from the 1998-1999 cross-sectional French INCA1 (Enquête Individuelle et Nationale sur les Consommations Alimentaires) food consumption survey. Food intake was reported in a 7-day food record, and SES, physical activity, sedentary behavior (SED), weight, and height were reported by answering face-to-face questionnaires. After adjusting for EI, physical activity, and SED, OW was positively associated with the contribution of the main meals to EI (P = 0.03), not significantly associated with the contribution of breakfast to EI, and inversely correlated to the number of eating episodes (P = 0.009) and to the contribution of snacking episodes to EI (P = 0.007). Our data suggest that a combination of more frequent intake occasions and lower contribution of the main meals to total daily EI is associated with a smaller risk of OW in children. However, eating frequency was the only eating behavior that played a slight mediation role (contributing approximately 8%) in the inverse relationship between SES and OW.

Family dietary coaching to improve nutritional intakes and body weight control: a randomized controlled trial.

OBJECTIVE: To test the hypothesis that family dietary coaching would improve nutritional intakes and weight control in free-living (noninstitutionalized) children and parents. DESIGN: Randomized controlled trial. SETTING: Fifty-four elementary schools in Paris, France. PARTICIPANTS: One thousand thirteen children (mean age, 7.7 years) and 1013 parents (mean age, 40.5 years). INTERVENTION: Families were randomly assigned to group A (advised to reduce fat and to increase complex carbohydrate intake), group B (advised to reduce both fat and sugar and to increase complex carbohydrate intake), or a control group (given no advice). Groups A and B received monthly phone counseling and Internet-based monitoring for 8 months. OUTCOME MEASURES: Changes in nutritional intake, body mass index (calculated as weight in kilograms divided by height in meters squared), fat mass, physical activity, blood indicators, and quality of life. RESULTS: Compared with controls, participants in the intervention groups achieved their nutritional targets for fat intake and to a smaller extent for sugar and complex carbohydrate intake, leading to a decrease in energy intake (children, P < .001; parents, P = .02). Mean changes in body mass index were similar among children (group A, + 0.05, 95% confidence interval [CI], - 0.06 to 0.16; group B, + 0.10, 95% CI, - 0.03 to 0.23; control group, + 0.13, 95% CI, 0.04-0.22; P = .45), but differed in parents (group A, + 0.13, 95% CI, - 0.01 to 0.27; group B, - 0.02, 95% CI, - 0.14 to 0.11; control group, + 0.24, 95% CI, 0.13-0.34; P = .001), with a significant difference between group B and the control group (P = .01). CONCLUSIONS: Family dietary coaching improves nutritional intake in free-living children and parents, with beneficial effects on weight control in parents. Trial Registration clinicaltrials.gov Identifier: NCT00456911.

Dietary and physical activity patterns in French children are related to overweight and socioeconomic status.

Sedentary behavior (SED) has already been identified as a risk factor of childhood overweight (OW) but less is known about the dietary patterns related to adiposity. Our objective was to investigate if lifestyle patterns combining overall diet and physical activity were associated with childhood OW and if they were involved in the reverse association between socioeconomic status (SES) and OW. Dietary intake was assessed using a 7-d food record in 748 French children aged 3-11 y from the 1998-1999 cross-sectional French Enquête Individuelle et Nationale sur les Consommations Alimentaires national food consumption survey. Weight and height, leisure time physical activity, SED (television viewing), and SES were reported by parents or children by answering questionnaires. Scores for lifestyle patterns were assessed with factor analysis and their relationship with OW was explored by logistic regression analysis. Two similar lifestyle patterns were identified in children aged 3-6 y and 7-11 y: "snacking and sedentary" and "varied food and physically active." The snacking and sedentary pattern was positively associated with OW in the youngest children (P-trend = 0.0161) and partly mediated the negative association of SES to OW. The varied food and physically active pattern was inversely correlated with OW in the eldest children only (P-trend = 0.0401). A third pattern called "big eaters at main meals" was derived in children aged 7-11 y and was positively correlated with OW (P-trend = 0.0165). From a public health perspective, the combinations of identifiable dietary and physical activity behaviors may be useful as a basis for recommendations on preventing OW.