Citizen science in environmental health research: A comparison with conventional approaches and creation of a guidance tool issued from the LILAS initiative.

CONTEXT: Public interest for citizen science (CS) in environmental health is growing. The goals of environmental health research projects are diverse, as are the methods used to reach these goals. Opportunities for greater implication of the civil society and related challenges differ at each step of such projects. These methodological aspects need to be widely shared and understood by all stakeholders. The LILAS initiative (acronym for "application of citizen science approaches such as LIving LAbS to research on environmental exposures and chronic risks") aimed to 1) favor a mutual understanding of the main issues and research methods in environmental health, of their stakes for different actors, but also of the requirements, strengths and limitations of these methods and to 2) identify expected benefits and points of attention related to stronger degrees of participation as part of environmental health research projects. METHODS: The LILAS initiative gathered institutional researchers, academics and civil society representatives interested in environmental exposures. Five meetings allowed to collectively identify different types of environmental health research studies and reflect about the benefits, limitations, and methodological issues related to the introduction of growing citizen participation as part of such studies. An analytic table matrix summarizing these aspects was co-created and filled by participants, as a tool devoted to help stakeholders with the definition of future CS research projects in environmental health. RESULTS: For different fields of research (e.g.: studies for assessment of environmental exposures, interventions on these exposures, quantitative risk assessment, epidemiological studies), the matrix lists expected benefits for various stakeholders, the fundamental principles of research methods and related practical constraints, but also advantages and limitations related to the use of CS or conventional research approaches. CONCLUSION: The LILAS initiative allowed to develop a tool which provides consolidated grounds for the co-creation of research projects on environmental exposures involving CS.

French Recommendations for Sugar Intake in Adults: A Novel Approach Chosen by ANSES.

This article presents a systematic review of the scientific evidence linking sugar consumption and health in the adult population performed by a group of experts, mandated by the French Agence nationale de sécurité sanitaire de l'alimentation, de l'environnement, et du travail (ANSES). A literature search was performed by crossing search terms for overweight/obesity, diabetes/insulin resistance, dyslipidemia/cardiovascular diseases, non-alcoholic fatty liver diseases (NAFLD), and uric acid concentrations on one hand and for intake of sugars on the other. Controlled mechanistic studies, prospective cohort studies, and randomized clinical trials were extracted and assessed. A literature analysis supported links between sugar intake and both total energy intake and body weight gain, and between sugar intake and blood triglycerides independently of total energy intake. The effects of sugar on blood triglycerides were shown to be mediated by the fructose component of sucrose and were observed with an intake of fructose >50 g/day. In addition, prospective cohort studies showed associations between sugar intake and the risk of diabetes/insulin resistance, cardiovascular diseases, NAFLD, and hyperuricemia. Based on these observations, ANSES proposed to set a maximum limit to the intake of total sugars containing fructose (sucrose, glucose⁻fructose syrups, honey or other syrups, and natural concentrates, etc.) of 100 g/day.

Food Processing and the Mediterranean Diet.

The benefits of the Mediterranean diet (MD) for protecting against chronic disorders such as cardiovascular disease are usually attributed to high consumption of certain food groups such as vegetables, and low consumption of other food groups such as meat. The influence of food processing techniques such as food preparation and cooking on the nutrient composition and nutritional value of these foods is not generally taken into consideration. In this narrative review, we consider the mechanistic and epidemiological evidence that food processing influences phytochemicals in selected food groups in the MD (olives, olive oil, vegetables and nuts), and that this influences the protective effects of these foods against chronic diseases associated with inflammation. We also examine how the pro-inflammatory properties of meat consumption can be modified by Mediterranean cuisine. We conclude by discussing whether food processing should be given greater consideration, both when recommending a MD to the consumer and when evaluating its health properties.

The Mediterranean diet: health, science and society.

The Mediterranean diet (MD) emerged as a healthy food regimen long before it could be recognised which nutrients or foods were responsible for its observed benefits, and it was only in the middle of the last century that the first scientific approach 'The Seven Countries Study' appeared. Epidemiological and anthropological studies of the MD converged, first by investigating at single nutrients or foods, then by adopting the more holistic approach of dietary patterns (DP), and now with a molecular approach. These studies resulted in convincing evidence that a MD decreases the risk of all-cause mortality and cardiovascular mortality and incidence. A risk reduction of developing type 2 diabetes is probable. Evidence is less stringent for other metabolic diseases and all cancers but from possible to probable for some cancer sites. Although DP showed that the MD has to be considered in its totality, olive oil could have a specific role. Lifestyle factors such as physical activity for energy balance, outdoor life for vitamin D synthesis and conviviality are also probably partly responsible for the health benefits. The MD is a lifestyle well suited for coping not only with personal health but also with wider societal concerns in relation to environment, public health and economy.

Can rapeseed oil replace olive oil as part of a Mediterranean-style diet?

The present narrative review compares evidence from experimental, epidemiological and clinical studies of the health benefits of rapeseed oil (RO) (known as canola oil) and olive oil (OO) in order to assess whether rapeseed oil is suitable as a sustainable alternative to OO as part of a Mediterranean-style diet in countries where olive trees do not grow. From epidemiological studies, the evidence for cardiovascular protection afforded by extra-virgin OO is 'convincing', and for cancers 'limited-suggestive', especially oestrogen receptor-negative breast cancer, but more studies are required in relation to cognitive impairment. Evidence for RO is limited to short-term studies on the biomarkers of risk factors for CVD. Any benefits of RO are likely to be due to α-linolenic acid; however, it is prone to oxidation during frying. We conclude that due to a lack of evidence from observational or intervention studies indicating that RO has comparable health benefits to extra-virgin OO, RO cannot currently be recommended as a suitable substitute for extra-virgin OO as part of a Mediterranean-style diet.

Evaluating and adapting the Mediterranean diet for non-Mediterranean populations: a critical appraisal.

This review outlines the limitations of current techniques for evaluating the Mediterranean diet in Mediterranean versus non-Mediterranean populations. Differences between the two populations with regard to the foods that are available, food processing and preparation techniques, and eating and lifestyle habits may influence the implementation and effects of a Mediterranean diet in non-Mediterranean regions. For example, the composition of food groups may vary significantly, due to differences in the specific foods within a food group and to differences in aspects of food production and preparation. Notable differences between the diets of Mediterranean versus non-Mediterranean populations include the source of monounsaturated fatty acids (olive oil versus meat), the amount of vegetables consumed and their manner of preparation, the source of alcohol (wine versus other) and the pattern of intake, and the types of meat and dairy products consumed. Lifestyle factors such as meal patterns and exposure to sunlight may also act as confounding factors when the overall benefits of a Mediterranean diet are assessed. Improving the calculation of Mediterranean diet scores and measuring plasma nutrient levels may help mitigate the effects of confounders. These considerations could have important health implications when a Mediterranean diet is implemented by non-Mediterranean populations.

Identification of dietary patterns using two statistical approaches and their association with breast cancer risk: a case-control study in Southern France.

PURPOSE: The aim of this case-control study was to compare two different statistical methods in the identification of dietary patterns by use of principal component analysis (PCA) and variable clustering (VC) and to examine their association with the risk of breast cancer (BC). METHODS: A dose-response association was then performed by the use of an adaptation of free knot spline function in logistic models. RESULTS: A "Western" pattern was revealed by PCA and VC and was then shown to be associated with a nonsignificant increase of BC risk. Only PCA identified a "meat/alcohol" pattern. Above the spline threshold, BC risk increased significantly (OR ≥ s vs. < s = 2.56, 95% CI 1.54-4.27). When we used PCA, a "Mediterranean" pattern was identified, but no association between BC risk and this pattern was shown. VC split the "Mediterranean" dietary pattern in two: "raw vegetables and olive oil" and "fish." Above the spline threshold, the "fish" pattern tended to protect against BC risk (OR ≥ s vs. < s = 0.77, 95% CI 0.58-1.01), whereas an excess of raw vegetables and olive oil increased BC risk (OR 1 se = 1.22, 95% CI = 1.06-1.32). CONCLUSIONS: Some results from the PCA and the VC methods were similar, whereas others were different but gave complementary results.

Omega-3 fatty acids and cancers: a systematic update review of epidemiological studies.

Experimental models showed consistently a modulation of carcinogenesis by omega 3 polyunsaturated fatty acids (ω3 PUFA). Fish intake is often described as part of a beneficial dietary pattern. However, observational epidemiological studies on the relationship between ω3 PUFA reported conflicting results. The objective of this systematic review is to determine whether there exists any progress in the evaluation of the causal relationship between dietary ω3 PUFA and cancers since the previous FAO/OMS expert consultation and whether it is possible to propose preventive and/or adjuvant therapeutic recommendations. Prospective and case-control observational studies published since 2007 and meeting validity criteria were considered together with RCT. Experimental studies are mentioned to provide for biological plausibility. When evaluating the level of evidence, a portfolio approach was used, weighted by a hierarchy giving higher importance to prospective studies followed by RCT if any. There is a probable level of evidence that ALA per se is neither a risk factor nor a beneficial factor with regards to cancers. Observational studies on colorectal, prostate and breast cancers only provided limited evidence suggesting a possible role of LC-ω3PUFA in cancer prevention because insufficient homogeneity of the observations. Explanation for heterogeneity might be the inherent difficulties associated with epidemiology (confounding and dietary pattern context, measurement error, level of intake, genetic polymorphism). The role of LC-ω3PUFA as adjuvant, might be considered of possible use, in view of the latest RCT on lung cancers even if RCT on other cancers still need to be undertaken.

Alcohol and genetic polymorphisms: effect on risk of alcohol-related cancer.

Public health guidelines aim to limit the consumption of alcoholic beverages worldwide and the subsequent health burden. In particular, alcohol consumption is an avoidable risk factor for cancer. In human beings, ethanol in alcoholic drinks is mainly oxidised in the liver by alcohol dehydrogenases to acetaldehyde, and is further detoxified to acetate by aldehyde dehydrogenases. Functional variants in genes involved in alcohol metabolism result in differences between individuals in exposure to carcinogenic acetaldehyde, suggesting a possible interaction of genetic susceptibility and alcohol exposure in cancer. We reviewed available studies of the combined effects of alcohol drinking and genetic polymorphisms on alcohol-related cancer risk. Most available data were for polymorphisms in alcohol and folate metabolism. We give an overview of published studies on the combined effects of alcohol drinking and polymorphisms in genes for alcohol dehydrogenase (ADH), aldehyde dehydrogenase (ALDH), cytochrome P450 2E1, and methylene-tetrahydrofolate reductase on the risk of alcohol-related cancer. Current data lend support to a role of polymorphisms ADH1B and ALDH2 combined with alcohol consumption in cancer. Other available data are insufficient or inconclusive, highlighting the need for additional studies.

Dietary intakes of omega-6 and omega-3 polyunsaturated fatty acids and the risk of breast cancer.

Experimental studies suggest detrimental effects of omega-6 polyunsaturated fatty acids (PUFA), and beneficial effects of omega-3 PUFAs on mammary carcinogenesis, possibly in interaction with antioxidants. However, PUFA food sources are diverse in human diets and few epidemiologic studies have examined whether associations between dietary PUFAs and breast cancer risk vary according to food sources or antioxidant intakes. The relationship between individual PUFA intakes estimated from diet history questionnaires and breast cancer risk was examined among 56,007 French women. During 8 years of follow-up, 1,650 women developed invasive breast cancer. Breast cancer risk was not related to any dietary PUFA overall; however, opposite associations were seen according to food sources, suggesting other potential effects than PUFA per se. Breast cancer risk was inversely associated with alpha-linolenic acid (ALA) intake from fruit and vegetables [highest vs. lowest quintile, hazard ratio (HR) 0.74; 95% confidence interval (CI) 0.63, 0.88; p trend < 0.0001], and from vegetable oils (HR 0.83; 95% CI 0.71, 0.97; p trend 0.017). Conversely, breast cancer risk was positively related to ALA intake from nut mixes (p trend 0.004) and processed foods (p trend 0.068), as was total ALA intake among women in the highest quintile of dietary vitamin E (p trend 0.036). A significant interaction was also found between omega-6 and long-chain omega-3 PUFAs, with breast cancer risk inversely related to long-chain omega-3 PUFAs in women belonging to the highest quintile of omega-6 PUFAs (p interaction 0.042). These results emphasize the need to consider food sources, as well as interactions between fatty acids and with antioxidants, when evaluating associations between PUFA intakes and breast cancer risk.

Dietary factors and breast cancer risk: a case control study among a population in Southern France.

This case-control study examined different food groups in relation to breast cancer. Between 2002 and 2004, 437 cases and 922 controls matched according to age and area of residence were interviewed. Diet was measured by a validated food frequency questionnaire. Adjusted odds ratios (Ors) were computed across levels of various dietary intakes identified by two methods: the "classical" and the "spline" methods. Neither of the 2 methods found an association between total fruit and vegetable consumption and breast cancer. Results of the 2 methods showed a nonsignificant decreased association with cooked vegetables intake as well as legumes and fish consumption. Whereas the spline method showed no association, the classical method showed significant associations related to the lowest consumption of raw vegetables or dairy products and breast cancer risk: Adjusted OR for raw vegetable consumption between (67.4 and 101.3 g/day) vs. (< 67.4 g/day) was 0.63 [95% confidence interval (CI) = 0.43-0.93]. Adjusted OR for dairy consumption between (134.3 and 271.2 g/day) vs. (< 134.3 g/day) was 1.57 (95% CI = 1.06-2.32). However, the overall results were not consistent. Compared to the classical method, the use of the spline method showed a significant association for cereal, meat, and olive oil. Cereal and olive oil were inversely associated with breast cancer risk. Breast cancer risk increased by 56% for each additional 100 g/day of meat consumption. Studies using novel methodological techniques are needed to confirm the dietary threshold responsible for changes in breast cancer risk. New approaches that consist in analyzing dietary patterns rather than dietary food are necessary.

'All under one roof?' differences in food availability and shopping patterns in Southern France and Central England.

BACKGROUND: This study investigates patterns of food shopping and availability of fruit and vegetables and snack foods in a northern European (Central England) and southern European region (Southern France). METHODS: Two studies were conducted in England (Nottingham) and France (Montpellier): (i) Cross-sectional population surveys using self-administered postal questionnaires to assess type of outlets used for food shopping in random population samples (England: n = 826; Montpellier: n = 766). (ii) Food availability studies to determine: the number of food outlets in defined comparable geographical areas; the number stocking fruit and vegetables, their quality and energy dense snacks. RESULTS: The English respondents used supermarkets most regularly (P < 0.001), whereas the French preferred to use smaller local shops, such as bakers (P < 0.001), butchers (P < 0.001) and markets (P < 0.001). Overall a larger proportion of outlets in Montpellier than Nottingham sold fresh fruit and vegetables and a wider variety of fresh fruit. However, a range of vegetables and all other types of fruit were as widely available in English shops. Although the quality of fresh fruit and vegetables tended to be better in Montpellier, the difference was not significant. Crisps (P < 0.05) and confectionary items (P < 0.05) were more widely available in England. CONCLUSIONS: Food shopping was done 'under one roof' more often in England, whereas in France, shopping was done in smaller specialist shops, which was reflected in their presence within the locality. Even though availability of fruit and vegetables was good in both countries, snack foods were more abundant in England. This clearly impacts on the food environment and could explain the higher prevalence of obesity in England, factors which are also influenced by culture, habits and convenience.

Nutrient intake in an elderly population in southern France (POLANUT): deficiency in some vitamins, minerals and omega-3 PUFA.

OBJECTIVE: Evaluation of the nutritional status of an elderly cohort from a French Mediterranean area. DESIGN: Cross-sectional nutritional assessment in the framework of the population-based POLA cohort. SUBJECTS AND METHODS: 832 subjects aged 70 years or older answered a 165-item, semi-quantitative food frequency questionnaire. Mean Nutritional Need (MNN) was defined as 77% of the French Recommended Daily Allowance (RDA). The risk for clinical deficiency (CD) was defined as intakes lower than the Limit Threshold Intake (70% of the MNN). RESULTS: Consumption was characterized by an excess of saturated fatty acids (SFA) (95.4% of subjects above the RDA) and a deficit of omega-3 polyunsaturated fatty acids (PUFA) (60.1% and 46.9% of subjects at risk for CD for alpha-linolenic (ALA) and long-chain omega-3 PUFA, respectively). Median intakes of fiber, vitamins B6, B9, and D, calcium, and magnesium were below the RDA. Dairy products were the first providers of SFA, nuts of ALA, and fish of long-chain omega-3 PUFA and vitamin D. CONCLUSION: The study identified an unbalanced food intake, with an excess of mammal animal products, mainly of dairy products, and a deficit of fish and vegetal foods. This resulted in a deficiency in some vitamins, minerals, and omega-3 PUFA.

Meal patterns and cooking practices in Southern France and Central England.

OBJECTIVE: To evaluate whether meal patterns and cooking practices in Central England and Mediterranean France conform to popular stereotypes, eating together as a household, preparation of meals, food purchasing patterns, cooking practices and eating out were investigated. DESIGN: Cross-sectional studies conducted simultaneously in April 2001 using self-administered postal questionnaires. SETTING: England (Nottingham, East Midlands) and France (Montpellier, Languedoc-Roussillon). SUBJECTS: A stratified random sample of 1000 males and 1000 females aged 18-65 years was generated from the electoral roll in each country. The final sample comprised 826 subjects in England (58% males, 42% females; mean age 44 years) and 766 subjects in France (42% males, 58% females; mean age 42 years). Analyses were conducted on samples standardised for sociodemographic differences. RESULTS: The French cooked from raw ingredients most often (P<0.001), ate together as a household more regularly (P<0.001) and were most likely to follow a regular meal pattern of three meals a day. On the other hand, the English relied more on ready-prepared (P<0.001) and take-away (P<0.001) meals, as well as on energy-dense snack foods such as crisps (P<0.001). Females in both countries reported having most responsibility for preparing meals. CONCLUSIONS: Some of the study's findings confirm popular stereotypes of French and English food cultures, as the importance of the convivial aspects of eating, as well as more traditional practices such as cooking meals from basic ingredients, structured mealtimes and less between-meal snacking, remain more prominent within the French population. This may contribute to the differences in prevalence of obesity seen between the two countries.

Qualitative methods to evaluate Mediterranean diet in adults.

OBJECTIVE: To fulfil a comprehensive approach to consumption, which is necessary to characterise food habits and their relationship to diseases, using a diet quality index (DQI) developed for a Mediterranean region (Med-DQI). SETTING: A cross-sectional nutritional survey provided the data for the construction of the DQI. SUBJECTS: A representative sample made up of 964 subjects from a French Mediterranean area, Hérault département. METHODS: Foods such as olive oil, fish and cereals were used instead of nutrients to build up scores which constructed the Med-DQI. Biochemical analysis identified biomarkers used to validate the Med-DQI. Correspondence factorial analysis illustrated the characteristics of subjects with different scores given by the Med-DQI. RESULTS: The subjects could be satisfactorily classified by the Med-DQI. The oldest age, less educated, overweight, manual workers, living in a rural area and male classes showed a better Med-DQI. For women, they were also from the oldest age class, but some of them were from the upper social class, with an ideal BMI and lived by the Mediterranean shore. A composite biomarker index, based on plasma carotene and vitamin E levels and the percentage of EPA and DHA in erythrocytes membranes, can identify subjects with good and poor Med-DQI. CONCLUSION: Med-DQI G is a good instrument to identify groups at risk with regard to nutritional quality. SUBJECTS with alpha + beta-carotene levels >1 mg/l, vitamin E > 30 mg/l, EPA > 0.65% and DHA > 4% of fatty acids in erythrocytes are likely to have a good diet.

Factors determining the nutrition transition in two Mediterranean islands: Sardinia and Malta.

OBJECTIVE: To examine and analyse consumption changes over time of 24 food items between Sardinia and Malta. SETTING: The data were collected in 2001 in Sardinia and 2002 in Malta. DESIGN: A structured qualitative questionnaire, articulated around four main themes: food supply, transformation, preparation and consumption habits, was administered by face-to-face interviews with the help of a local person. It encompassed mainly open-ended questions, which allowed us to measure factors contributing to change. SUBJECTS: Thirty mother-daughter pairs were interviewed in each insular territory. RESULTS: Despite a common trend revealing a shift away from cereals, pulses and potatoes to the benefit of meat products, fats and sugar, our results showed contrasting evolutions in food consumption between both insular societies. Fruit and vegetables, olive oil and fish, which are part of the main features of the Mediterranean diet, were among the top foods for which consumption frequency has increased in Sardinia. In Malta, besides an increase in olive oil and vegetable consumption, cheeses and desserts showed the highest increase. Along with modernity and improved living conditions, enhanced commercial availability and increased diversity of food preparation were also identified as factors contributing to food consumption changes. CONCLUSIONS: Although the Sardo-Mediterranean model is evolving under the impact of modernisation, it is not disappearing. In Malta, however, modernity has led to a more sudden shift from a state of food shortage to one of affluence, but in a cultural context where the identity is no longer Mediterranean but Anglo-Saxon.

The Medi-RIVAGE study: reduction of cardiovascular disease risk factors after a 3-mo intervention with a Mediterranean-type diet or a low-fat diet.

BACKGROUND: Epidemiologic studies link Mediterranean-type diets to a low incidence of cardiovascular disease; however, few dietary intervention studies have been undertaken, especially in primary prevention. OBJECTIVES: In the Mediterranean Diet, Cardiovascular Risks and Gene Polymorphisms (Medi-RIVAGE) study, the effects of a Mediterranean-type diet (Med group) or a low-fat diet (low-fat group) on risk factors were evaluated in 212 volunteers (men and women) with moderate risk factors for cardiovascular disease. DESIGN: After the 3-mo dietary intervention, changes in many risk factors were evaluated. Dietary questionnaires and plasma nutritional markers were used to test compliance. RESULTS: Although the dietary goals were only partially reached, changes in dietary habits were observed in both groups (n = 169): protein, carbohydrate, and fiber intakes increased and fat quality (decreased saturated fat and increased monounsaturated or polyunsaturated fat) improved. BMI, total and triacylglycerol-rich lipoprotein (TRL) cholesterol, triacylglycerols, TRL triacylglycerols, apolipoproteins A-I and B, insulinemia, glycemia, and the homeostasis model assessment score were significantly lower after 3 mo. The reductions in total cholesterol, triacylglycerols, and insulinemia remained significant after adjustment for BMI. There was a trend for a diet-by-time interaction for LDL cholesterol (P = 0.09). Our data predicted a 9% reduction in cardiovascular disease risk with the low-fat diet and a 15% reduction with this particular Mediterranean diet. CONCLUSION: After a 3-mo intervention, both diets significantly reduced cardiovascular disease risk factors to an overall comparable extent.

[Dietary fat consumption of the French population and quality of the data on the composition of the major food groups]. / Consommation lipidique de la population française et qualité des données de composition des principaux groupes d'aliments vecteurs.

The validity of estimated association between dietary fat intake and cancer depends both on the methodology of dietary assessment used and on the quality of food composition data. The food composition database of Afssa/Ciqual shows that there is a deficiency in data on fatty acids. In order to identify the priorities for improving the quality of the database, we analysed the data quality of major dietary contributors of fatty acids in the French population. These food contributors, listed according to their contribution to fat intake, have been identified by French national consumption survey Inca. Consumption studies in France show a high dietary fat contribution (37-38% even 40% of total energy) with over-consumption of saturated fatty acids, under-consumption of monounsaturated fat and, to a lesser extent of polyunsaturated fatty acids. Major food contributors of total fat and saturated fatty acids are butter, cheese, meat products, meats, dishes, dressing, cakes and pastry and, only in children, biscuits. Among contributors of monounsaturated fatty acids, vegetable oils and sauces are listed after processed meats before meats, butter, cheese and dishes. Vegetable oils and sauces are the major contributors of polyunsaturated fatty acids before "fatty" potatoes (such as chips...) in adults whereas the opposite was observed in children. Composition tables do not presently allow the identification of contributors of specific fatty acids (omega 3, omega 6, conjugated linoleic acid). If nutritional data of milk products, fats, and oils are reliable because of existing specific tables for these products, there is a need for improving quality of composition data for other major contributors such as: meats, processed meats, fish and dishes such as pizzas, pasteries...