Exposure of the general French population to metals and metalloids in 2014-2016: Results from the Esteban study.

BACKGROUND: The purpose of the Esteban study was to describe levels of various biomarkers of exposure to several environmental pollutants, including metals and metalloids, among the French population. This paper describes the distribution of concentrations of 28 metals and metalloids in two different populations, and estimates the main determinants of exposure to total arsenic, the sum of inorganic arsenic (iAs) and its two metabolites monomethylarsonic acid (MMA) and dimethylarsinic acid (DMA), cadmium, chromium, copper, mercury and nickel. METHODS: Esteban is a cross-sectional study conducted between 2014 and 2016 on a random sample of 2503 adults (18-74 years old) and 1104 children (6-17 years old) from the general population. The data collected included biological samples (blood, hair, and urines), socio-demographic characteristics, environmental and occupational exposure, and information on dietary factors and lifestyle. The geometric mean and percentiles of the distribution were estimated for each metal. Multivariate analyses were performed to identify the determinants of exposure using a generalized linear model. RESULTS: Only four metals had a quantification rate below 90% in adults (beryllium, iridium, palladium, and platinum), and three metals in children (beryllium, iridium, and platinum). The concentrations of total arsenic, cadmium, chromium and mercury were higher than those found in most international studies. The determinants significantly associated with exposure were mainly diet and smoking. CONCLUSIONS: Esteban provided a nationwide description of 28 metal and metalloid exposure levels for adults (some never measured before) and for the first time in children. The study results highlighted widespread exposure to several metals and metalloids. These results could be used to advocate public health decisions for continued efforts to reduce harmful exposure to toxic metals. The Reference values (RV95) built from Esteban could also be used to support future government strategies.

Exposure of the general French population to herbicides, pyrethroids, organophosphates, organochlorines, and carbamate pesticides in 2014-2016: Results from the Esteban study.

Esteban is a nationwide cross-sectional study conducted in France in 2014-2016, including 2503 adults aged 18-74 years old and 1104 children aged 6-17 years old, as part of the French Human Biomonitoring programme. The present paper describes the biological levels of five families of pesticides analysed on random sub-samples of 900 adults and 500 children for urine concentrations, and 759 adults and 255 children for serum concentrations, and the determinants of exposure. Organophosphates, carbamates and herbicides were measured in urine by UPLC-MS/MS; chlorophenols and pyrethroids were measured in urine by GC-MS/MS; specific organochlorines were measured in serum by GC-HRMS. Multivariate analyses were performed to identify the determinants of exposure using a generalized linear model. Pyrethroid metabolites were quantified in 99% of adults and children, with the exeption of F-PBA, which was quantified in 31% of adults and 27% of children, respectively. Carbamates and some specific organophosphates were barely or not quantified. DMTP was quantified in 82% of adults and 93% of children, and γ-HCH (lindane) was quantified in almost 50% of adults and children. Concentration levels of pesticide biomarkers were consistent with comparable international studies, except for ß-HCH, DMTP, and the deltamethrin metabolite Br2CA, whose levels were sometimes higher in France. Household insecticide use and smoking were also associated with higher levels of pyrethroids. All pyrethroids concentration levels were below existing health-based HBM guidance values, HBM-GVsGenPop, except for 3-PBA, for which approximately 1% and 10% of children were above the lower and upper urine threshold values of 22 µg/L and 6.4 µg/L, respectively. Esteban provides a French nationwide description of 70 pesticide biomarkers for the first time in children. It also describes some pesticide biomarkers for the first time in adults, including glyphosate and AMPA. For the latter, urine concentration levels were overall higher in children than in adults. Our results highlight a possible beneficial impact of existing regulations on adult exposure to organochlorine and organophosphate pesticides between 2006 and 2016, as concentration levels decreased over this period.

Assessment of multi-chemical exposure using human biomonitoring data from the French Esteban study using exposure load method.

Exposure to chemical substances is common and comes from several sources (environmental, food, and occupational). It is often studied using a substance-by-substance approach. Although this method helps identify the determinants of exposure to a single chemical, it cannot accurately reflect exposure to multiple chemicals. In this study, we used the concept of exposure load (EL) to evaluate multi-chemical exposure in a representative sample of the general French population. EL corresponds to the number of substances (or metabolites) measured in body fluids above a defined concentration threshold. EL was calculated for adults and children separately for two groups of substances: those currently found in domestic environments (Group A) and pesticides (Group B). Although the EL does not assess the health impact linked to multi-chemical exposure, it does aid in the identification of particularly vulnerable populations. Accordingly, preventive actions specifically aimed at these subgroups could be useful. In Group A, we found that multi-chemical exposure was generalized since all the adults and children had an EL greater than or equal to 13 (out of 22 substances studied) when the LOQ (limit of quantification) was considered as the discretization threshold. In adults, men, smokers and people of working age (i.e., people under 60 years old) had a higher EL. In Group B, multi-chemical exposure was also generalized, since all the adults (15 substances studied) and children (13 substances studied) had a mean EL almost equal to 6 when the LOQ was considered as the discretization threshold. In adults, persons with occupational exposure to pesticide dust had a higher EL when the P90 was considered as the discretization threshold. This study highlights widespread multi-chemical exposure in adults and children in France, and the major impact of occupational exposure (Group B) and tobacco smoking (Group A) on EL.

Estimation of blood lead levels in the French population using two complementary approaches: Esteban (2014-2016) as part of the human biomonitoring program and the national surveillance system for childhood lead poisoning (2015-2018).

BACKGROUND: Used widely for centuries, lead is a common environmental pollutant. As a cumulative toxic, its presence in the body is always evidence of exposure, and health effects occur without threshold. Though regulated by European directives, lead requires close monitoring due to its environmental persistence and toxicity. METHODS: The first data source was the French surveillance system for monitoring childhood lead poisoning, which records the screening results of children (-18 years), providing data on their temporal and geographical distribution, characteristics, and risk factors. The second data source was Esteban, a cross-sectional study conducted in 2014-2016 on a random sample of the French population as part of the human biomonitoring program. The Esteban lead study concerns 904 children (6-17 years) and 999 adults (18-74 years), providing data on biological samples, sociodemographic characteristics, occupational exposure, environmental and dietary factors. RESULTS: The surveillance system highlighted that lead poisoning affected 10% of children screened between 2015 and 2018. The main risk factor remains housing. Esteban confirmed this observation, finding a general mean of blood lead level (BLL) at 9.9 and 18.5 µg/L for children and adults, respectively. In children, parents' occupation increased BLLs. In adults, the greatest exposure factors were smoking, age, place of residence, alcohol, bread-based products, and homegrown livestock products. In both, drinking tap water and year of housing construction increased BLLs. CONCLUSIONS: The surveillance system showed a high number of children with lead poisoning despite the implementation of prevention measures, which mainly concern lead paints in old and degraded homes. To help identify children at risk, healthcare providers need to know about exposure from housing and the emerging sources identified in the Esteban survey. Despite lower BLLs, the well-known risk factors of lead exposure persist, meaning prevention efforts must continue in order to limit their impact on the population.

Identification of pesticides exposure biomarkers for residents living close to vineyards in France.

Biomonitoring can be relevant for assessing pesticides exposure of residents living close to vineyards (LCTV). However, because xenobiotics are generally present at low levels in human biological matrices and the sources of pesticide exposure are multiple, several challenges need to be overcome to reliably assess exposure in residents LCTV. This includes particularly identifying the most appropriate exposure biomarkers, the biological matrices in which they should be measured, and analytical methods that are sufficiently sensitive and specific to quantify them. The aim of the present study was to develop a tiered approach to identify relevant biomarkers and matrices for assessing pesticide exposure in residents LCTV. We used samples from a biobank for 121 adults and children included in a national prevalence study conducted between 2014 and 2016 who lived near or far from vineyards. We analyzed five priority pesticides (folpet, mancozeb, tebuconazole, glyphosate, and copper) and their metabolites in urine and hair samples. We identified relevant biomarkers according to three criteria related to: i) the detection frequency of those pesticides and metabolites in urine and hair, ii) the difference in concentrations depending on residence proximity to vineyards and, iii) the influence of other environmental and occupational exposure sources on pesticide levels. This tiered approach helped us to identify three relevant metabolites (two metabolites of folpet and one of tebuconazole) that were quantified in urine, tended to be higher in residents LCTV than in controls, and were not significantly influenced by occupational, dietary, or household sources of pesticide exposure. Our approach also helped us to identify the most appropriate measurement strategies (biological matrices, analytical methods) to assess pesticide exposure in residents LCTV. The approach developed here was a prerequisite step for guiding a large-scale epidemiological study aimed at comprehensively measuring pesticides exposures in French residents LCTV with a view to developing appropriate prevention strategies.

Hair versus urine for the biomonitoring of pesticide exposure: Results from a pilot cohort study on pregnant women.

BACKGROUND/AIM: The quantitative assessment of human exposure to contaminants such as pesticides is a crucial step in the characterization of exposure-associated risk. For this purpose, biomonitoring is often privileged as it presents the advantage of integrating all the possible sources and routes of exposure and of being representative of the internal dose resulting from exposure. Although biological fluids such as urine and blood have been used to date for this purpose, increasing interest has also been observed over the past decade for hair analysis. The present work aimed at comparing the information obtained from the analysis of urine versus hair regarding exposure to pesticides in a pilot cohort of pregnant women. METHODS: In ninety-three pregnant women included in the pilot of the French cohort ELFE, one urine and one hair sample were collected simultaneously from each subject at the maternity. Samples were analyzed using GC-MS/MS analytical methods allowing for the detection of both parent pesticides and metabolites, and designed to be as similar as possible between urine and hair for reliable inter-matrix comparison. Fifty-two biomarkers of exposure were targeted, including parents and metabolites of organochlorines, organophosphates, pyrethroids, carbamates, phenylpyrazoles and other pesticides. RESULTS: The number of different compounds detected ranged from 16 to 27 (median = 22) in hair, and from 3 to 22 (median = 12) in urine. In hair, 24 compounds were found in > 40% of the individuals, whereas only 12 compounds presented the same frequency of detection in urine. Among the chemicals detected in > 80% of both hair and urine samples, only one (pentachlorophenol) showed a signification correlation between hair and urine concentrations. CONCLUSIONS: The present results highlight the multiple exposure of the pregnant women included in this cohort and suggest that hair provides more comprehensive information on pesticide exposure than urine analysis. This study thus supports the relevance of hair analysis in future epidemiological studies investigating association between exposure and adverse health effects.

Exposure of the French population to bisphenols, phthalates, parabens, glycol ethers, brominated flame retardants, and perfluorinated compounds in 2014-2016: Results from the Esteban study.

BACKGROUND: As part of the French Human Biomonitoring (HBM) programme, the Esteban study described, among other things, biomarkers levels of various chemicals in adults (18-74 years old) and children (6-17 years old). This paper describes the design of the study and provides, for the first time, data on the biological exposure of the general French population to a wide range of contaminants posing a threat to human health which are currently found in domestic environments. METHODS: Esteban is a cross-sectional study conducted on a nationwide sample of the French general population. Exposure biomarkers of six families of contaminants deemed detrimental to adults' and children's health were measured in biological samples collected either at participants' homes by a nurse, or brought to a National Health Insurance examination centre. All participants were randomly selected (2503 adults and 1104 children). The geometric mean and percentiles of the distribution of levels were estimated for each biomarker. Most of the descriptive statistical analyses were performed taking into account the sampling design. RESULTS: Results provided a nationwide description of biomarker levels. Bisphenols (A, S and F), and some metabolites of phthalates and perfluorinated compounds (PFCs) (specifically, PFOS and PFOA) were quantified in almost all the biological samples analysed. Higher levels were observed in children (except for PFCs). Levels were coherent with international studies, except for bisphenols S and F, brominated flame retardants (BFRs) and parabens (with higher levels reported in the USA than in France). CONCLUSION AND PERSPECTIVES: This study is the first to provide a representative assessment of biological exposure to domestic contaminants at the French population level. Our results show that the French general population was exposed to a wide variety of pollutants in 2014-2016, and identify the determinants of exposure. These findings will be useful to stakeholders who wish to advocate an overall reduction in the French population's exposure to harmful substances. Similar future studies in France will help to measure temporal trends, and enable public policies focused on the reduction of those chemicals in the environment to be evaluated.

Prevalence of prediabetes and undiagnosed type 2 diabetes in France: Results from the national survey ESTEBAN, 2014-2016.

AIM: To assess the prevalence of prediabetes, undiagnosed diabetes and diagnosed diabetes in France, among adults between 2014 and 2016 using data from the nationwide Esteban survey. METHODS: National cross-sectional study conducted between 2014 and 2016 in metropolitan France. Individuals aged 18 to 74 were recruited with a 3-stage geographic sampling. They completed two face-to-face interviews, filled in a self-administered questionnaire and underwent a medical examination with the collection of biological samples. Their data were linked to the National Health Data System to identify anti-diabetic drugs reimbursement. Prediabetes and undiagnosed diabetes were defined as no diagnosis of diabetes and 6.1 mmol/l ≤ Fasting Plasma Glucose (FPG) < 7.0 mmol/l for prediabetes and FPG ≥ 7.0 mmol/l for undiagnosed diabetes. Non-pharmacologically treated diabetes and pharmacologically treated diabetes were defined as self-reported diabetes without or with self-reported or reimbursed antidiabetic medication, respectively. Estimated prevalence were weighted to take into account survey design and non-response. RESULTS: The ESTEBAN survey recruited 3476 adults, 2270 were included in this analysis. The weighted prevalence was 1.7% [1.1 - 2.4] for undiagnosed diabetes (men: 2.7%, women; 0.9%), 9.9% [8.3 - 11.5] for prediabetes (men: 13.2%, women: 7.0%), 5.7% [4.3 - 7.1] for diagnosed diabetes. Among the diagnosed cases, 79% were pharmacologically treated. Among all diabetes cases, 23% were undiagnosed. CONCLUSION: The prevalence of undiagnosed diabetes and prediabetes is increasing in France. Our results highlight the need to increase primary prevention and reinforce secondary prevention of diabetes.

Occurrence of perfluorinated alkylated substances in breast milk of French women and relation with socio-demographical and clinical parameters: results of the ELFE pilot study.

A previously developed and validated methodology based on liquid chromatography coupled to high resolution mass spectrometry was used for determine the concentration levels of 14 perfluoroalkylated substances (PFASs) in a set of 48 breast milk samples collected from French women in the frame of the ELFE pilot study. In accordance with other similar studies conducted at european and international levels, PFOS, PFOA, and PFHxS were detected and quantified in most of the analyzed samples (90%, 98% and 100%, respectively), and appeared as major contributors to the total PFAS exposure (38%, 37%, 25%, respectively), whereas the other targeted PFAS were very rarely, if not, found at the limits of detection of the method. Also in agreement with other published data, the concentration levels measured for the detected substances varied from <0.05 to 0.33µg/L for PFOS (median=0.079), from <0.05 to 0.22µg/L for PFOA (median=0.075), and from 0.04 to 0.07µg/L for PFHxS (median=0.050). On the basis of this relatively limited data set, no statistically significant relation was observed between these exposure levels and developmental outcomes, in particular the weight at birth. Similarly, no relation was observed between the measured PFAS levels and various socio-demographical parameters including the consumption of seafood, alcohol, smoking, or socio-economical level. These results suggest a need for further research and better knowledge regarding the sources, pharmacokinetics, and factors of exposure for other substances belonging to this class of emerging contaminants.

Levels of polychlorinated dibenzo-p-dioxins, polychlorinated dibenzofurans and polychlorinated biphenyls in human milk from different regions of France.

We report on the pilot study carried out before the start of the Elfe project (French longitudinal study from childhood). A total of 44 samples of mature human milk were collected at home 8 weeks after delivery. A total of 7 polychlorinated dibenzo-p-dioxins (PCDDs), 10 polychlorinated dibenzofurans (PCDFs), 12 dioxin-like (DL) polychlorinated biphenyls (PCBs), and 6 non dioxin-like (NDL)-PCBs were measured. For total TEQ (PCDD/Fs and DL-PCBs), the geometric mean concentration was 17.81 pg TEQ(WHO05)/g lipids. Relative PCDD, PCDF, and DL-PCB contributions to the arithmetic mean TEQ(WHO05) were 38%, 18%, and 44%, respectively. The use of TEF(WHO05) instead of TEF(WHO98) resulted in a 27% reduction of the total TEQ value. Although PCDD levels did not significantly change (less than 0.5% increase), PCDF and DL-PCB levels both decreased by 35% and 38%, respectively. Levels have been compared to data obtained during a previous non-reported national study conducted in 1998 (TEF(WHO98)) in French lactaria (n=244). The mean of PCDD/Fs has decreased about 39.4% (18.8 pg TEQ(WHO98)/g lipids in 1998 vs 11.4 pg TEQ(WHO98)/g lipids in pilot study), respectively 41.5% for PCDDs (10.6 pg TEQ(WHO98)/g lipids in 1998 vs 6.2 pg TEQ(WHO98)/g lipids in pilot study) and 36.7% for PCDFs (7.9 pg TEQ(WHO98)/g lipids in 1998 vs 5.0 pg TEQ(WHO98)/g lipids in pilot study). For the sum of the 6 NDL-PCBs, the 2007 geometric mean concentration in milk was 176.3 ng/g lipids. The arithmetic mean lipid concentration in 2007 breast milk was 26.4 g/l (range from 6.0 to 46.7 g/l). A PCDD/F and DL-PCB daily intake was estimated to be 62.3 pg TEQ(WHO05)/kg body weight per day (85.0 pg TEQ(WHO98)/kg body weight per day) for a baby of 5 kg of body weight fed daily with 700 ml of maternal milk containing 25 g/l of lipids.

Diet and blood pressure in 18-74-year-old adults: the French Nutrition and Health Survey (ENNS, 2006-2007).

OBJECTIVE: Dietary recommendations to reduce blood pressure (BP) have been widely disseminated. We investigated associations between dietary intake and BP in a national sample of adults living in France. METHODS: The survey included 1968 18-74-year-old participants in the French Nutrition and Health Survey (Etude Nationale Nutrition Santé), a cross-sectional national multistage sampling study. Dietary intake and SBP and DBP were assessed using three 24-h recalls and three measurements, respectively. Mean dietary intake was compared across BP categories: previously diagnosed hypertensive and among undiagnosed optimal (SBP <120  mmHg and DBP <80  mmHg), intermediate and high (SBP ≥140  mmHg and/or DBP ≥90  mmHg) BP participants. After exclusion of previously diagnosed hypertensive participants, linear regressions were also carried out between dietary intake and SBP and DBP. RESULTS: Eating habits of previously diagnosed hypertensive participants were not different from those of undiagnosed high BP participants, except higher milk consumption (P = 0.03) and lower seafood and alcohol intake (P < 0.03 and P = 0.002, respectively) in previously diagnosed hypertensive. After exclusion of them, dairy products (milk especially), fruit and vegetables, fiber and whole-grain food consumption were inversely and linearly associated with SBP (P < 0.04), whereas alcohol intake was positively associated with SBP (P < 10) and DBP (P = 0.005). Modification effect of sex was observed for saturated fatty acids intake (positive association with DPB in women) and calcium (negative association with SBP in men). CONCLUSION: Adherence to nutritional recommendations still needs to be improved in hypertensive adults even if they are aware of their condition. In the rest of the population, proper habits regarding milk, fruit and vegetables, fiber and alcohol should decrease the risk of hypertension onset.

A Pilot Study of the ELFE Longitudinal Cohort: Feasibility and Preliminary Evaluation of Biological Collection.

Etude Longitudinale Française depuis l'Enfance (ELFE) will be a national French cohort of 20,000 children followed from birth to adulthood. Biological samples will be taken at birth to evaluate the fetal exposition to several substances. A pilot study was carried out in October 2007 to test the preanalytical factors that affected sample quality. A variety of fractions were collected by the midwife after delivery from different blood collection tubes. Options in the collection process were 2 daily transports of samples, centralized and standardized processing methodology, and storage of multiple aliquots in liquid nitrogen or at -80°C. We analyzed preanalytical factors that could have affected coagulation and then soluble CD40 Ligand (sCD40L) as a quality control tool for serum quality. Cord blood and urine were collected from 82% and 84% of women, respectively, who agreed to be followed up in the ELFE project. The use of syringe was the main factor correlated with coagulation (relative risk: 2.79 [1.47; 5.31], P<0.01). Maternity unit status was also associated with coagulation (RR: 1.48 [1.03; 2.13] in a private maternity unit vs. a public maternity) as well as time between collection and centrifugation (RR 1.03 [1; 1.07] when time between collection and centrifugation increases from 1 h). There were no extremely low sCD40L values indicating extreme exposures to room temperatures. This first evaluation study allowed us to stress the importance of carefully recording all potentially critical preanalytical variables that might be used at a large-scale level.

Bisphenol-A and phthalates contamination of urine samples by catheters in the Elfe pilot study: implications for large-scale biomonitoring studies.

Exposure to phthalates and Bisphenol A could cause developmental and reproductive toxicity. This study provides a first assessment of these exposures for more than 250 French pregnant women. The median concentrations of total and free Bisphenol A in urine were similar to those in other studies except the highest concentrations (5% of women had total and free Bisphenol A >50µg/L). Our study highlights high levels of Di-(2-ethylhexyl)-phthalate metabolites in pregnant women, suggesting recent exposure, probably in hospital. Differences between types of delivery (caesarean vs. natural) support this hypothesis. This is a significant implication for large-scale biomonitoring studies among this population.

Nutrition patterns and metabolic syndrome: a need for action in young adults (French Nutrition and Health Survey - ENNS, 2006-2007).

OBJECTIVE: The objective of this study was to investigate the relationship between adherence to French diet and physical activity recommendations and metabolic syndrome (MetS) risk. METHODS: 18-74-year-old subjects who underwent dietary assessment and health examination in the 2006-2007 French Nutrition and Health Survey (Etude Nationale Nutrition Santé, ENNS 2006-2007) were included in the analyses (n=1608). Quintiles of PNNS-GS, the score measuring adherence to French recommendations, were generated. The prevalence of overall MetS risk and separate components across quintiles of PNNS-GS was estimated by adjusted logistic regressions. Interactions were searched for between PNNS-GS and sex, age and currently used medication. RESULTS: The PNNS-GS was inversely associated with overall MetS risk in subjects not taking antidiabetic, antihypertensive or lipid-lowering medication (12.8% in the lowest quintile vs. 4.6% in the highest PNNS-GS quintile; P<0.01). This was true in 18-49-year-old subjects (10.0% vs. 1.7%, P<0.01), but not in 50-74-year-olds (23.8% vs. 11.2%; P=0.15). In 18-49-year-old adults, including those taking such medication, the HDL component was associated with PNNS-GS (22.1% vs. 7.9%; P<0.01). CONCLUSION: Improvement in diet and physical activity in line with recommendations could be effective in young adults for MetS prevention so as to decrease the risk of cardiovascular disease in France.

Association of socioeconomic status with overall overweight and central obesity in men and women: the French Nutrition and Health Survey 2006.

BACKGROUND: Identification of subpopulations at high risk of overweight and obesity is crucial for prevention and management of obesity in different socioeconomic status (SES) categories. The objective of the study was to describe disparities in the prevalence of overweight and obesity across socioeconomic status (SES) groups in 18-74 year-old French adults. METHODS: Analyses were based on a multistage stratified random sample of non-institutionalized adults aged 18-74-years-old from the French Nutrition and Health Survey (ENNS), a cross-sectional national survey carried out in 2006/2007. Collected data included measured anthropometry (weight, height and waist circumference (WC)), demographic and SES data (occupation, education and frequency of holiday trips as a marker of family income). SES factors associated with overweight (BMI > or = 25) and central obesity (WC above gender-specific references) were identified using multiple logistic regression. RESULTS: Almost half (49.3%) of French adults were overweight or obese and 16.9% were obese. In men, the risk of overall overweight or obesity was associated with occupation (p < 0.05), whereas the risk of central obesity was independently associated with occupation (p < 0.05) and frequency of holiday trips (p < 0.01). In women, both overall and central overweight and obesity were independently associated with educational level (respectively p < 10(-3) and p < 10(-3)) and frequency of holiday trips (respectively p < 0.05 and p < 10-3). CONCLUSION: The prevalence of overweight and obesity was found to be similar to that of several neighbouring western European countries, and lower than the UK and eastern Europe. Risk of being overweight or obese varied across SES groups both in men and women, but associations were different between men and women, indicating differing determinants.

Dietary intake, physical activity and nutritional status in adults: the French nutrition and health survey (ENNS, 2006-2007).

The French National Programme on Nutrition and Health (Programme national nutrition santé (PNNS)), the aim of which is to reduce nutrition-related chronic diseases, necessitates monitoring of nutritional characteristics. Our objective was to describe dietary intake, physical activity and nutritional status in a national sample of adults, especially according to current French recommendations. The study is based on a cross-sectional population-based survey using a multistage sampling design (Etude nationale nutrition santé (ENNS)). Between February 2006 and March 2007, 3115 18-74-year-old adults were included (participation rate 59.7 %). Energy, macronutrient and food consumption were estimated through three randomly distributed 24 h recalls, and compared to PNNS recommendations; physical activity was described using International Physical Activity Questionnaire guidelines; anthropometry, blood pressure and biochemical measurements were assessed according to national and international references. When compared to current recommendations, intake of carbohydrates (>50 % energy intake without alcohol: 26.4 %), SFA ( < 35 % total lipids: 18.5 %) and total fibre (>25 g/d: 13.7 %) was frequently unsatisfactory. While overall consumption of 'meat, seafood and eggs' was satisfactory, that of fruits and vegetables ( > or = 400 g/d: 43.8 %) and seafood (two or more servings per week: 29.9 %) was frequently too low. The physical activity level was satisfactory at 63.2 %. Overweight was observed in 49.3 % of adults, while 30.9 % were hypertensive and 44.1 % had dyslipidaemia. Vitamin and iron-poor status was found to affect less than 10 % of the population. Based on the ENNS survey, overall nutrition remains a problem in France. Comparison of these data with those of other countries could contribute to a better understanding of variations in nutrition-related diseases.