Dietary patterns of French adults: associations with demographic, socio-economic and behavioural factors.

BACKGROUND: Although the French eating model may differ from those of other countries, no studies to date have investigated dietary patterns in a wide age range of adults and at the national level. We aimed to identify dietary patterns (DP) of French adults and assess their associations with demographic, socio-economic and behavioural factors. METHODS: The present study included 2624 adults (1087 men, 1537 women) aged 18-79 years from the cross-sectional national French INCA2 dietary survey. Dietary data were collected using a 7-day estimated food record. Clusters of DP were derived using principal component analysis and clustering, conjointly. Age-adjusted logistic regression analyses were used to investigate the association between DP and correlates. RESULTS: Five DP were identified, namely 'traditional', 'prudent', 'diversified', 'processed' and 'sandwiches'. Men were more likely to follow a traditional diet and women the 'prudent' pattern. Members of the 'processed' and 'sandwiches' patterns were younger compared to non-members. Healthier dietary patterns were overall positively associated with a higher socio-economic position, healthier behaviours (in terms of sedentary behaviours and smoking status) and lower body mass index. Under-reporting of energy intake, restrictive diet to lose weight and dietary supplement consumption were also related to specific DP, although differentially in men and women. Associations with contextual factors (i.e. household composition, agglomeration size and region) were also observed. CONCLUSIONS: The identification of adults' dietary patterns and associated behaviours (all modifiable) is important for the conceptualisation of multi-behavioural programs. The additional information on social and environmental correlates is also essential for targeting the most vulnerable population groups in the context of such public health interventions.

The French OQALI survey on dairy products: comparison of nutrient contents and other nutrition information on labels among types of brands.

BACKGROUND: Depending on their spending power, consumers may choose foodstuffs from more or less expensive types of brands (national, retailer, economy-line retailer or discount brands). The present study, on dairy products, assesses the nutritional composition and the frequencies of labelled nutrition parameters, according to types of brands. METHODS: The 1646 most consumed dairy products were collected. Nutrient contents and other labelled nutrition parameters provided on the packaging (i.e. nutrition and health claims, nutrition guidelines such as guideline daily amounts, consumption advice and information on added vitamins and minerals) were captured in the French branded product composition database (OQALI). RESULTS: Significant differences between brands were found for energy, protein, fat, saturates, carbohydrate, sugars, dietary fibre, calcium and sodium, in four of six dairy groups studied, but not systematically. National brands and retailer brands provided more detailed nutrition labelling and more frequent nutrition claims than cheaper brands. More retailer brand products provided nutrition guidelines and consumption advice than the other branded products. National brand products more frequently contained added vitamins and minerals and more frequently bore health claims. CONCLUSIONS: Nutrient contents of the cheaper brands of dairy products did not vary systematically from more expensive ones. However, national brands and retailer brands products provided more nutrition information on labels than the cheaper ones. There should be more detailed studies comparing different types of brands regarding labelling practices for nutrient contents and other nutrition information about foodstuffs to help prepare public health recommendations, adapted to all consumers, regardless of their income.

Accounting for the multidimensional nature of the relationship between adult obesity and socio-economic status: the French second National Individual Survey on Food Consumption (INCA 2) dietary survey (2006-07).

The objective was to study the multidimensional nature of the relationship between adult obesity (OB) and socio-economic status (SES), using comprehensive indices of SES taken separately or synthesised in an overall index. A nationally representative sample of adults aged 18-79 years was taken from the French second National Individual Survey on Food Consumption (INCA 2) dietary survey (2006-07). Weight and height were measured and OB defined as BMI ≥ 30 kg/m2. SES variables were reported in questionnaires and included occupation, education and characteristics of household wealth. Composite indices of SES (household wealth and overall SES indices) were computed by correspondence analysis, and relationships with OB were investigated with logistic regression analysis. In total, 11·8 (95 % CI 10·1, 13·4) % of French adults were obese, without significant difference by sex. While no significant relationship was observed in men, all SES indicators were inversely correlated to OB in women. Both education and the household wealth index were retained in the stepwise multivariate model, confirming that different socio-economic variables are not necessarily proxies of each other regarding the OB issue. On the other hand, 'controlling for SES' while including several measures of SES in multivariate models may lead to collinearity, and thus over-adjustment. A more integrative approach may be to derive a synthetic index by including the SES factors available in a given study. Beyond this methodological perspective, understanding how OB is related to the different dimensions of SES should help to target the more vulnerable groups and increase the effectiveness of prevention.

[Schools meals in French secondary state schools: compliance to national recommendations and schools catering patterns]. / La restauration scolaire dans les établissements publics français du second degré : respect des recommandations nationales et profils d'établissements.

BACKGROUND: Recent reports on the lack of nutritional quality of meals served in schools have led public authorities to draft, in 1999, recommendations for restoring a balanced food supply. Following the survey carried out by the French food safety Agency in 2005-2006, which highlighted gaps in the implementation of these recommendations, a law passed in July 2010 plans to make these recommendations mandatory, as their 2007 revised version. Thus, the objective of this study was to assess initial school compliance with regard to this last revised version of the recommendations and to identify school patterns through their catering management and implication in a dietary project. METHODS: Seven hundred and seven secondary state schools were questioned (570 were administrated by the Ministry of Education and 137 by the Ministry of Agriculture) on their catering practices. Twenty consecutive menus from each school were also analyzed with a specific coding system to establish its nutritional composition for comparison with the 2007 recommendations. RESULTS: On average, schools complied with half of the recommendations. Good compliance was observed with the 2007 recommendations concerning fried products, starchy foods, fruits, and dairy products whereas very few schools were in compliance with recommendations concerning fish, cheeses and sweetened desserts containing less than 15 % fat and more than 20 g of sugar per portion. Furthermore, compliance with recommendations was significantly better for lunch meals, and even better for agricultural establishments. A 5-component meal was also associated with greater compliance with the recommendations. In addition, four school patterns were identified based on catering management practices. The first two categories of establishments had knowledge of the recommendations but exhibited different levels of application. The last two types of establishments had no knowledge of the recommendations and differed in their catering management practices. CONCLUSION: Compliance with recommendations was contrasted, with high adequacy for some guidelines and low for others. Nevertheless, application of the current guidelines and real implication of the school in a dietary project did improve the dietary offer in such schools.

Trends in child overweight rates and energy intake in France from 1999 to 2007: relationships with socioeconomic status.

Our objectives were (i) to assess the current prevalence of childhood overweight (including obesity) (OWOB) in France and its relationship with comprehensive socioeconomic status (SES) indicators and (ii) to examine trends in OWOB prevalence and changes in energy intake (EI) and sedentary behavior (SED) based on the previous INCA 1 (Individuelle Nationale des Consommations Alimentaires) data (1998-1999). A representative sample of children aged 3-14 (n = 1,030) was taken from the 2006-2007 cross-sectional INCA 2 food consumption survey. Weight and height were measured. The prevalence of OWOB was estimated according to the IOTF (International Obesity Task Force) definition. Average daily EI was evaluated using a 7-day food record. SED (screen time) and SES were reported by answering questionnaires. SES indicators included the occupation and level of education of the head of the household (HH), and variables describing household wealth. Composite indices of SES were computed by correspondence analysis, and relationships with OWOB were explored by logistic regression analysis. In total, 14.5% (95% CI: 12.1-17.0) of the children were OWOB. All SES indicators were inversely correlated to OWOB. Average EI was equal to 1,739 kcal/day. Daily, children spent 113.5 min watching television, and 38.5 min playing video games or using a computer. Compared to the INCA 1 study, OWOB prevalence was not significantly different, EI was lower, and SED was higher. These trends were the same across all occupational categories of heads of household. Although overall rates of childhood OWOB are currently stabilizing, no change was observed in the strong inverse socioeconomic gradient of OWOB between the two studies.

Is food portion size a risk factor of childhood overweight?

BACKGROUND/OBJECTIVES: Food portion sizes have been increasing in industrialized countries and this is thought to be one of the risk factors of overweight. France is also facing the development of adiposity, particularly in its child population, where overweight rates are rising faster than in adults. Given this background, the objectives of the present study were, for each food category, to describe dietary intake in French children aged 3-11 years, and to assess the relationship between childhood overweight and portion size, adjusting for dietary energy density, physical activity and sedentary behaviour. SUBJECTS/METHODS: A representative sample of 748 French children aged 3-11 years was taken from the 1998-1999 cross-sectional French INCA1 (Enquête Individuelle et Nationale sur les Consommations Alimentaires) food consumption survey. Dietary intake was assessed using a 7-day food record. Portion sizes were estimated for 23 food categories. Weight and height, physical activity and sedentary behaviour were reported by parents or children in questionnaires. RESULTS: In multivariate logistic regression adjusted models, overweight in children aged 3-6 years was positively correlated to portion sizes of croissant-like pastries and other sweetened pastries. Conversely, portion sizes of liquid dairy products were inversely associated with overweight in children aged 7-11 years. CONCLUSIONS: At very young ages, the increase in overweight may be driven in part by a shift in eating patterns towards larger portion size of energy-dense and nutrient-poor foods.

Dietary patterns associated with vitamin/mineral supplement use and smoking among women of the E3N-EPIC cohort.

BACKGROUND/OBJECTIVES: An understanding of the relationships between dietary habits and supplement use or smoking is useful for aetiological studies and surveillance purposes. The objective of this study is to describe dietary patterns associated with vitamin/mineral supplement use and smoking habits in French women. METHODS: Scores for dietary patterns were obtained by factor analysis in 64,252 women from the French E3N-EPIC cohort. The association with supplement and tobacco use was investigated by logistic regression analysis. RESULTS: We identified three dietary patterns: 'processed meat/starchy foods' (fast foods, processed meat, rice/pasta/semolina and cakes and few vegetables); 'fruit/vegetables' (fruits, vegetables, seafood, vegetable oils and yoghurt); and 'alcohol/meat products' (alcohol, meat and meat products, and coffee, and few fruits and soup). Supplement use was positively associated with the fruit/vegetables pattern (multivariate OR for quartile 4 versus 1 (OR(4))=1.55, 95% confidence interval: 1.47-1.63), and inversely associated with the processed meat/starchy foods (OR(4)=0.84; 0.80-0.89) and alcohol/meat products (OR(4)=0.69; 0.66-0.73) patterns (P trend for all associations <0.0001). As compared with never smoking, current smoking was inversely associated with the fruit/vegetables pattern (OR(4)=0.85; 0.78-0.92), while former smoking was positively associated with the fruit/vegetables pattern (OR(4)=1.32; 1.25-1.40); both current and former smoking were inversely associated with the processed meat/starchy foods pattern (OR(4)=0.57; 0.53-0.62 and 0.64; 0.60-0.67, respectively); whereas current and former smoking were both strongly positively associated with the alcohol/meat products pattern (OR(4)=5.78; 5.26-6.36 and 2.03; 1.91-2.15, respectively); P trend for all associations was <0.001. CONCLUSIONS: Supplement use and smoking are strongly associated with dietary patterns.

Dietary exposure and biomarkers of arsenic in consumers of fish and shellfish from France.

Seafood, especially fish, is considered as a major dietary source of arsenic (As). Seafood consumption is recommended for nutritional properties but contaminant exposure should be considered. The objectives were to assess As intake of frequent French seafood consumers and exposure via biomarkers. Consumptions of 996 high consumers (18 and over) of 4 coastal areas were assessed using a validated food frequency questionnaire. Seafood samples were collected according to a total diet study (TDS) sampling method and analyzed for total As, arsenite (AsIII), arsenate (AsV), arsenobetaïne (AsB), monomethylarsonic acid (MMA) and dimethylarsinic acid (DMA). The average As dietary exposure is 94.7+/-67.5 microg/kg bw/week in females and 77.3+/-54.6 microg/kg bw/week in males (p<0.001) and the inorganic As dietary exposure is respectively 3.34+/-2.06 microg/kg bw/week and 3.04+/-1.86 microg/kg bw/week (p<0.05). Urine samples were collected from 382 of the subjects. The average urinary As concentration is 94.8+/-250 microg/g creatinine for females and 59.7+/-81.8 microg/g for males (p<0.001). Samples having an As concentration above 75 microg/g creatinine (n=101) were analyzed for inorganic As (As(III), As(V), MMA(V) and DMA(V)) which was 24.6+/-27.9 microg/g creatinine for males and 27.1+/-20.6 microg/g for females. Analyses do not show any correlation between dietary exposure and urinary As. These results show that biological results should be interpreted cautiously. Diet recording seems to be the best way to assess dietary As exposure. Seafood is a high source of As exposure but even among high consumers it is not the main source of toxic As. From a public health point of view these results should be interpreted carefully in the absence of international consensus on the health-based guidance value.

Assessment of dietary exposure of nitrate and nitrite in France.

The aim of this study was to assess the dietary exposure of nitrate and nitrite in France. A total of 13, 657 concentration levels of nitrate and nitrite measured in food, representing 138 and 109 food items, respectively, and coming from French monitoring programmes between 2000 and 2006, were used. Depending on the non-detected and non-quantified analysis treatment, lower and upper concentration mean estimates were calculated for each food item. These were combined with consumption data derived from 1474 adults and 1018 children from the French national individual consumption survey (INCA1), conducted in 1999 and based on a 7-day food record diary. A total of 18% of spinaches, 6% of salads, 10% of cheeses, 8% of meat products and 6% of industrial meat products exceeded the European nitrate maximum level or maximum residual level. A total of 0.4% of industrial meat products and 0.2% of meat products exceeded their European nitrite maximum level or maximum residual level. Nitrate dietary exposure averaged 40% of the acceptable daily intake (ADI; 3.7 mg kg(-1) body weight day(-1)) for adults and 51 - 54% of the ADI for children with the major contributors being, for adults and children, respectively, vegetables (24 and 27% of ADI), potatoes (5 and 11% of ADI), and water (5 and 5% of ADI). The individual nitrate dietary intake of 1.4% (confidence interval (CI(95th)) [0.8; 2.0]) to 1.5% (CI(95th) [0.9; 2.1]) of adults and 7.9% (CI(95th) [6.2; 9.6]) to 8.4% (CI(95th) [6.7; 10.1]) of children were higher than the ADI. Nitrite dietary exposure averaged 33-67% of the ADI (0.06 mg kg(-1) body weight day(-1)) for adults and 67-133% of the ADI for children, with contributions of additive food vectors at 33% of ADI for adults and 50-67% of ADI for children. The individual nitrite dietary intake of 0.7% (CI(95th) [0.3; 1.1]) to 16.4% (CI(95th) [14.5; 18.3]) of adults and 10.5% (CI(95th) [8.6; 12.4]) to 66.2% (CI(95th) [63.3; 69.1]) of children were higher than the ADI.

Organotin levels in seafood and its implications for health risk in high-seafood consumers.

Fish and fishery products are considered as the main source of organotin compounds (OTC). Unfortunately, little national contamination data is available to assess food exposure of organotins from French consumers. To provide a more accurate estimate of risks to human health, the butyltin, phenyltin and octyltin compounds sampling in four French coastal areas were measured in 159 composite samples (96 fresh and frozen fish, 28 mollusks, 14 crustaceans, 1 echinoderm, 11 canned foods, 4 smoked fish, 5 prepared seafood-based dishes) by capillary gas chromatography coupled with a microwave induced plasma atomic-emission spectrometer (CGC-MIP-AES). In these samples, butyltins were usually predominant and the range of the contamination levels was generally below those of earlier studies (fish: mean 5.6; min-max 1.1-23 microg/kg; fishery products: mean 6; min-max 0.8-14 microg/kg). Fish, especially tuna, salmon, mackerel, saithe/coalfish and cod were largely the main contributors (38%) to the total organotin exposure. With the supplementary contribution of great scallop, surimi, squid and oysters, the exposure exceeded 50% in all. However, the utmost OTC exposure was lesser than 47% of the provisional tolerable weekly intake [EFSA (European Food Safety Agency). Opinion of the Scientific Panel on Contaminants in the food chain on a request from the Commission to assess the health risks to consumers associated with exposure to organotins in foodstuffs. (Question N EFSA-Q-2003-110). The EFSA Journal, 102, 1-119, 2004. http://www.efsa.eu.int]. Nobody would exceed this limit. Finally, as this study has some limitations and since some other sources and health effects have not been clearly evaluated, it appears rational from public health and environmental viewpoints to continue to reduce the OTC levels in the environment.

Dioxins, furans and dioxin-like PCBs: occurrence in food and dietary intake in France.

PCDD/Fs and DL-PCBs contamination data in food products consumed in France collected from national monitoring programmes (2001-04) and representing analytical results for almost 800 individual food samples were combined with food consumption data from the French national dietary survey to estimate PCDD/Fs and DL-PCBs dietary intakes, expressed as toxic equivalents (WHO-TEQs). The mean PCDD/Fs and DL-PCBs intakes were estimated as 1.8 and 2.8 pg WHO-TEQ kg(-1) b.w. day(-1), respectively, for adults (aged 15 years and over) and children (aged 3-14 years). The main contributors to total intake were fish and milk products for both children and adults (48 and 31% for adults and 34 and 43% for children, respectively). DL-PCBs constituted the largest contributor to contamination in most foodstuffs. A life-long intake estimate showed that a non-negligible part of the French population (between 20 and 28%) had an intake above the tolerable monthly intake for dioxins and dioxin-like PCBs of 70 pg WHO-TEQ kg(-1) b.w. month(-1).

Child overweight in France and its relationship with physical activity, sedentary behaviour and socioeconomic status.

OBJECTIVE: (1) To assess the prevalence of childhood overweight (OW) and obesity in France; (2) to examine how physical activity and sedentary behaviour are involved in the association between socioeconomic status (SES) and OW, while taking into account total energy intake. DESIGN AND SUBJECTS: Representative sample of French children aged 3-14 years (n=1016) taken from the 1998-1999 cross-sectional French INCA (Enquête Individuelle et Nationale sur les Consommations Alimentaires) food consumption survey. MEASUREMENTS: Weight and height, leisure-time physical activity (LTPA), sedentary behaviour (TV viewing and video-game use), and SES were reported by parents or children by answering questionnaires; total energy intake was assessed using a 7-day food record. RESULTS: In total, 15.2% (95% CI: 13.0-17.6) of the children are OW (including obese), according to the IOTF (International Obesity Task Force) definition. OW is inversely associated with SES in children over 6 years of age. LTPA is negatively correlated to OW among the 3 to 5-year-old children only, whereas sedentary behaviour is positively related to OW in childhood and adolescence. From 6 years old on, SES is inversely associated with sedentary behaviour, which consequently may partly mediate the relationship between SES and OW. CONCLUSION: This study confirms the association between SES, sedentary behaviour and childhood OW in France. It was performed before the launching of the French Program of Nutrition and Health (PNNS) in 2001 and will be repeated in 2006. This will contribute to monitoring both childhood OW and its main determinants at the population scale.

[Comparison of two national food surveys (INCA 1 1998-99 and Health Nutrition Barometer 2002) with regard to five food recommendations of the National Nutrition and Health Program]. / Comparaison de deux enquêtes nationales de consommations alimentaires (INCA 1 1998/99 et Baromètre santé nutrition 2002) au regard de cinq objectifs alimentaires du Programme national nutrition santé.

BACKGROUND: Monitoring the dietary intake of the French population requires the implementation and regular renewal of representative national survey. As these surveys can use different methodologies (food frequency questionnaire, 24 hour recall, 3 or 7-day dietary record...), it seems useful to check whether they supply similar results. The aim of this study is to determine whether two representative national surveys with different methodologies can be used alternately to monitor changes in food consumption of the French population. METHOD: Percentages of consumers aged 15-75 were compared between two national food surveys (Health Nutrition Barometer 2002 and INCA 1 1998-99) with respect to five food frequency recommendations of the French National Nutrition and Health Program. RESULTS: The same public health priorities were found in both surveys: the food groups were graded according to the same hierarchy of adequate food intake prevalences (ascending: fruits and vegetables, dairy products, fish, starchy foods and meat-fish-egg products). On the other hand, significant statistical different elements were pointed out in a few food groups which may be explained by methodological patterns. Definitions of portions and food groups, survey duration and seasons are indeed important parameters to be considered when comparing surveys. CONCLUSION: The results show the need to elaborate standardized methods for comparison of food consumption surveys, which can be useful for the evaluation of the national nutritional recommendations. The methodological limitations described in this study also indicate that the quantitative description of food intake trends should improve when established by the results of the same regularly repeated survey.

Fitness-for-purpose of dietary survey duration: a case-study with the assessment of exposure to ochratoxin A.

The duration of food consumption survey may have a marked effect on estimates of usual nutrient intakes in individuals and groups. This arises from a high degree of within-person variability in food intakes, primarily on a day-to-day basis. Both the level of observation-populations versus individuals-and the desirable level of precision decide upon the 'fitness-for-purpose' of dietary survey duration. Though similar from a methodological standpoint, the question was rarely addressed in the case of non-nutrients. Our work aims at estimating the number of days of food records needed for the assessment of usual intakes of food chemicals as a function of research purpose. Focusing on the French population exposure to food mycotoxin ochratoxin A, we implement a range of well-established methods borrowed from the field of nutrient intakes assessment. Our results on OTA show that: (a) at the population level, as low as three days give satisfactory distributional estimates; yet, the implementation of variance reduction methods is of particular relevance when higher percentiles of exposure are at stake; (b) the estimation of individual usual intakes based on food records is behind practical possibilities, which calls for alternative options such as biomarkers of exposure.

Estimated dietary exposure to principal food mycotoxins from the first French Total Diet Study.

This study reports estimates on dietary exposure from the first French Total Diet Study (FTDS) and compares these estimates with both existing tolerable daily intakes for these toxins and the intakes calculated during previous French studies. To estimate the dietary exposure of the French population to the principal mycotoxins in the French diet (as consumed), 456 composite samples were prepared from 2280 individual samples and analysed for aflatoxins, ochratoxin A, trichothecenes, zearalenone, fumonisins and patulin. Average and high percentile intakes were calculated taking account of different eating patterns for adults, children and vegetarians. The results showed that contaminant levels observed in the foods examined 'as consumed' complied fully with current European legislation. However, particular attention needs to be paid to the exposure of specific population groups, such as children and vegans/macrobiotics, who could be exposed to certain mycotoxins in quantities that exceed the tolerable or weekly daily intake levels. This observation is particularly relevant with respect to ochratoxin A, deoxynivalenol and zearalenone. For these mycotoxins, cereals and cereal products were the main contributors to high exposure.

Handling of contamination variability in exposure assessment: a case study with ochratoxin A.

The contamination of foods dedicated to human consumption varies over space and time. In exposure assessment, this is usually addressed through probabilistic modelling. The present work explores how the variability and uncertainty of exposures estimated at the population level are affected by: (a) the (non-)parametric nature of input contamination distributions; (b) the time-window used to sample contamination values within those distributions. Focusing on exposure of the French population to food mycotoxin ochratoxin A, we implement a range of second-order Monte-Carlo simulations that allow distinguishing variability of exposures from uncertainty of distributional parameters estimates. A simulation runs 10,000 iterations. Overall estimates of parameters are given by the median across iterations and 95%CI by 2.5th and 97.5th percentiles. Our results show that: (a) parametric (log-normal) input distributions may lead to over-estimation of variability and greater uncertainty as compared to non-parametric ones (P97.5 [95%CI] of 7.1 [6.6;7.7] for Parametric-Occasion, 4.6 [4.3;5.0] for Non-Parametric-Occasion), and that (b) the 'Occasion' time-window combines better estimate of variability and lower uncertainty when exposure modelling is applied to populations living in developed countries with complex agri-food systems (P97.5 [95%CI]: 7.3 [6.2;8.9] for Non-Parametric-Week, 4.6 [4.3;5.0] for Non-Parametric-Occasion). A deterministic approach is nevertheless preferred to probabilistic modelling every time input data quality is questionable.

Por una política de nutrición en Europa en el siglo XXI: desarrollo de unas guías alimentarias basadas en el consumo de alimentos / Towards a nutrition policy in Europe for the XXI centruy: development of food-based dietary guidelines

No disponible