Prevalence and survival implications of malnutrition and sarcopenia in metastatic breast cancer: A longitudinal analysis.

BACKGROUND: Malnutrition and sarcopenia are challenges for patients with metastatic breast cancer and have been proposed as independent prognostic factors. Very few studies have addressed the temporal evolution of these parameters and, notably, the separate and combined analysis of sarcopenia and malnutrition. This study aimed to i) determine the prevalence of malnutrition and sarcopenia, individually and combined, and their evolution over time, ii) identify risk factors for each condition, and iii) explore their impact on overall survival (OS). METHODS: This retrospective study was conducted on 111 patients treated for at least a third-line metastatic breast cancer at the Institut Curie between January 1st and March 31st, 2018. Solitary malnutrition was defined from weight loss and body mass index values while solitary sarcopenia was defined solely based on low muscle mass. We analyzed solitary malnutrition, solitary sarcopenia, and then malnutrition with or without sarcopenia, at three key stages (T1: diagnosis of metastasis, T2: initiation of third-line treatment, and T3: 3-month re-evaluation). Univariate and multivariate logistic regression analyses were conducted to investigate the risk factors. We performed Cox proportional hazards analyses for each variable. RESULTS: At T1, the prevalence of solitary malnutrition, solitary sarcopenia and malnutrition with or without sarcopenia was 18.6%, 36.1% and 48.9% respectively, increasing to 27.7%, 45.5% and 56.6% at T2. At T2, in multivariate logistic regression analyses, patients aged over 60 years were at an elevated risk of experiencing solitary malnutrition as well as malnutrition with or without sarcopenia, but not solitary sarcopenia. In multivariate analyses, solitary malnutrition was significantly associated with poorer OS (HR 2.2 [95% CI 1.1-4.1], p = 0.02), while solitary sarcopenia and malnutrition with or without sarcopenia showed no association. CONCLUSION: Solitary malnutrition and sarcopenia were highly prevalent in patients with metastatic breast cancer, affecting around a quarter and half of patients respectively at third-line treatment initiation. Notably, solitary malnutrition emerged as a prognostic factor for overall survival, whereas no significant association was observed for solitary sarcopenia or malnutrition with or without sarcopenia. This highlights the critical need for early identification of patients at risk of malnutrition and the importance of timely intervention.

Clinical utility of comprehensive liquid molecular profiling in patients with advanced endometrial cancer.

BACKGROUND: Molecular characterization has significantly improved the management of advanced endometrial cancer (EC). It distinguishes four molecular subclasses associated with prognosis and personalized therapeutic strategies. This study assesses the clinical utility of cell-free DNA (cfDNA) profiling in EC to identify targetable alterations. METHODS: Women with metastatic or recurrent EC were prospectively recruited within the framework of the STING trial (NCT04932525), during which cfDNA was analyzed. Genomic alterations were identified with the FoundationOne CDx assay. Each molecular report underwent review by a molecular tumor board. Alterations were categorized via the European Society of Medical Oncology Scale for Clinical Actionability of Molecular Targets (ESCAT). RESULTS: A total of 61 patients were enrolled. The median age was 66.9 years, with 43% presenting frontline metastatic disease. All histologic subgroups were represented. Notably, 89% of patients yielded informative cfDNA analysis. Six tumors were classified with deficient mismatch repair/microsatellite instability (11%) and 37 as TP53 gene mutant (67%), and 12 had nonspecific molecular profiles (22%). Molecular classification based on liquid biopsy showed 87.5% accuracy in correlating with tissue results. Moreover, 65% of cases exhibited ≥1 actionable alteration, including 25% ESCAT I alterations and 13% ESCAT II alterations. Consequently, 16% of patients received a molecularly matched therapy, and presented with a 56% response rate and median progression-free survival of 7.7 months. CONCLUSIONS: cfDNA sequencing in EC is a feasible approach that produces informative results in 89% of cases and accurately categorizes patients into the main molecular subclasses. It also reveals multiple actionable alterations, which offers the potential for personalized therapeutic strategies.

Association between Impulsivity and Weight Status in a General Population.

The objective of this study is to examine the association between impulsivity and weight status in a large sample of the adult general population in France, and the influence of gender on this relationship. A total of 11,929 men and 39,114 women participating in the NutriNet-Santé cohort were selected in this cross-sectional analysis. The Barratt Impulsiveness Scale (BIS-11) was used to assess impulsivity. Weight and height were self-reported. The association between impulsivity and BMI was estimated using logistic regressions adjusted for socio-demographic and lifestyle factors. Individuals with high impulsivity levels (BIS-11 total score >71) were more likely to be obese (Odds Ratio (OR) = 1.80, 95% Confidence Interval (CI): 1.39, 2.33 in men; OR = 1.30, 95% CI: 1.15, 1.48 in women) compared to individuals in the average range of impulsivity. The strongest associations between impulsivity and obesity were observed in men, where highly impulsive participants were more likely to be class III obese (BMI > 40 kg/m²) (OR = 3.57, 95% CI: 1.86, 6.85). This large sample analysis supports the existence of a relationship between impulsivity and weight status and the importance of psychological factors in the prevention of obesity.

Intuitive Eating Dimensions Were Differently Associated with Food Intake in the General Population-Based NutriNet-Santé Study.

BACKGROUND: Intuitive eating (IE) is characterized by eating in response to physiological hunger and satiety cues rather than emotional cues and not considering certain foods to be forbidden. Evidence supports an inverse association of IE with body mass index (BMI), but little is known about its association with food intake. OBJECTIVE: We aimed to examine the relation between IE and food intake in a large sample from the general adult population. METHODS: A total of 9581 men and 31,955 women aged ≥18 y participating in the NutriNet-Santé cohort were included in this cross-sectional analysis. IE was assessed by using the validated French version of the Intuitive Eating Scale-2 (modeled in quartiles). Food intake was assessed by using ≥6 self-reported 24-h dietary records (2009-2015). The associations between IE subscales (Eating for Physical rather than Emotional Reasons, referred to as Physical Reasons; Reliance on Hunger and Satiety Cues, referred to as Cues; and Unconditional Permission to Eat, referred to as Permission) and food intake were assessed by using multiple linear and logistic regression models. RESULTS: In women, higher Physical Reasons and Cues scores were associated with lower energy intake (P < 0.0001). Also, a higher Physical Reasons score was associated with lower sweet- and fatty-food intake in both women (143 g/d in quartile 1 compared with 124 g/d in quartile 4) and men (153 compared with 138 g/d) and lower intakes of dairy products and meat, fish, and eggs in women (all P < 0.0001). A higher Cues score was associated with a lower intake of dairy products and meat, fish, and eggs in both sexes and a higher whole-grain intake in women (all P < 0.0001). In contrast, higher Permission scores were associated with a higher energy intake and unhealthier intake, including lower fruit, vegetable, and whole-grain intake (all P < 0.0001). CONCLUSIONS: IE dimensions such as Physical Reasons and Cues subscales were associated with healthier dietary intakes overall, whereas the Permission dimension was associated with unhealthier dietary intakes. From a public health perspective, these findings suggest the importance of developing strategies to promote eating in response to hunger and satiety signals. This study was registered at eudract.ema.europa.eu as 2013-000929-31.

Dietary scores at midlife and healthy ageing in a French prospective cohort.

Although nutrition has been advocated as a major determinant of healthy ageing (HA), studies investigating the link between dietary quality and HA are scarce. We investigated the association between adherence to French food-based and nutrient-based guidelines at midlife, as assessed by three dietary scores, and HA. HA was assessed in 2007-2009, among 2329 participants of the SUpplémentation en Vitamines et Minéraux AntioXydants study aged 45-60 years at baseline (1994-1995) and initially free of diabetes, CVD and cancer. HA was defined as not developing any major chronic disease, good physical and cognitive functioning, no limitations in instrumental activities of daily living, no depressive symptoms, no health-related limitations in social life, good overall self-perceived health and no function-limiting pain. Data from repeated 24-h dietary records provided at baseline permitted the computation of the modified French Programme National Nutrition Santé-Guideline Score (mPNNS-GS), the Probability of Adequate Nutrient Intake Dietary Score (PANDiet) and the Diet Quality Index-International (DQI-I). Associations of these scores with HA were assessed by logistic regression. In 2007-2009, 42 % of men and 36 % of women met our criteria of HA. After adjustment for potential confounders, higher scores of the mPNNS-GS (ORquartile 4 v. quartile 1 1·44; 95 % CI 1·10, 1·87; P trend=0·006) and the PANDiet (1·28; 95 % CI 1·00, 1·64; P trend=0·03) were associated with higher odds of HA. We observed no association between DQI-I and HA. In conclusion, this study suggests a beneficial long-term role of high adherence to both food-based and nutrient-based French dietary guidelines for a HA process.

Intuitive eating is inversely associated with body weight status in the general population-based NutriNet-Santé study.

OBJECTIVE: To examine the relationship between intuitive eating (IE), which includes eating in response to hunger and satiety cues rather than emotional cues and without having forbidden foods, and weight status in a large sample of adults. METHODS: A total of 11,774 men and 40,389 women aged ≥18 years participating in the NutriNet-Santé cohort were included in this cross-sectional analysis. Self-reported weight and height were collected as well as IE levels using the validated French version of the Intuitive Eating Scale-2. The association between IE and weight status was assessed using multinomial logistic regression models. RESULTS: A higher IE score was strongly associated with lower odds of overweight or obesity in both men and women. The strongest associations were observed in women for both overweight [quartile 4 vs. 1 of IE: odds ratio, 95% confidence interval: (0.19, 0.17-0.20)] and obesity (0.09, 0.08-0.10). Associations in men were as follows: for overweight (0.43, 0.38-0.48) and obesity (0.14, 0.11-0.18). CONCLUSIONS: IE is inversely associated with overweight and obesity which supports its importance. Although no causality can be inferred from the reported associations, these data suggest that IE might be relevant for obesity prevention and treatment.

Correlations between Fruit, Vegetables, Fish, Vitamins, and Fatty Acids Estimated by Web-Based Nonconsecutive Dietary Records and Respective Biomarkers of Nutritional Status.

BACKGROUND: It is of major importance to measure the validity of self-reported dietary intake using web-based instruments before applying them in large-scale studies. OBJECTIVE: This study aimed to validate self-reported intake of fish, fruit and vegetables, and selected micronutrient intakes assessed by a web-based self-administered dietary record tool used in the NutriNet-Santé prospective cohort study, against the following concentration biomarkers: plasma beta carotene, vitamin C, and n-3 polyunsaturated fatty acids. PARTICIPANTS/SETTING: One hundred ninety-eight adult volunteers (103 men and 95 women, mean age=50.5 years) were included in the protocol: they completed 3 nonconsecutive-day dietary records and two blood samples were drawn 3 weeks apart. The study was conducted in the area of Paris, France, between October 2012 and May 2013. MAIN OUTCOME MEASURES: Reported fish, fruit and vegetables, and selected micronutrient intakes and plasma beta carotene, vitamin C, and n-3 polyunsaturated fatty acid levels were compared. STATISTICAL ANALYSES: Simple and adjusted Spearman's rank correlation coefficients were estimated after de-attenuation for intra-individual variation. RESULTS: Regarding food groups in men, adjusted correlations ranged from 0.20 for vegetables and plasma vitamin C to 0.49 for fruits and plasma vitamin C, and from 0.40 for fish and plasma c20:5 n-3 (eicosapentaenoic acid [EPA]) to 0.55 for fish and plasma c22:6 n-3 (docosahexaenoic acid). In women, correlations ranged from 0.13 (nonsignificant) for vegetables and plasma vitamin C to 0.41 for fruits and vegetables and plasma beta carotene, and from 0.27 for fatty fish and EPA to 0.54 for fish and EPA+docosahexaenoic acid. Regarding micronutrients, adjusted correlations ranged from 0.36 (EPA) to 0.58 (vitamin C) in men and from 0.32 (vitamin C) to 0.38 (EPA) in women. CONCLUSIONS: The findings suggest that three nonconsecutive web-based dietary records provide reasonable estimates of true intake of fruits, vegetables, fish, beta carotene, vitamin C, and n-3 fatty acids. Along with other validation studies, this study shows acceptable validity of using such diet-assessment methods in large epidemiologic surveys and broadens new perspectives for epidemiology.

Mind-Body Practice and Body Weight Status in a Large Population-Based Sample of Adults.

INTRODUCTION: In industrialized countries characterized by a high prevalence of obesity and chronic stress, mind-body practices such as yoga or meditation may facilitate body weight control. However, virtually no data are available to ascertain whether practicing mind-body techniques is associated with weight status. The purpose of this study is to examine the relationship between the practice of mind-body techniques and weight status in a large population-based sample of adults. METHODS: A total of 61,704 individuals aged ≥18 years participating in the NutriNet-Santé study (2009-2014) were included in this cross-sectional analysis conducted in 2014. Data on mind-body practices were collected, as well as self-reported weight and height. The association between the practice of mind-body techniques and weight status was assessed using multiple linear and multinomial logistic regression models adjusted for sociodemographic, lifestyle, and dietary factors. RESULTS: After adjusting for sociodemographic and lifestyle factors, regular users of mind-body techniques were less likely to be overweight (OR=0.68, 95% CI=0.63, 0.74) or obese (OR=0.55, 95% CI=0.50, 0.61) than never users. In addition, regular users had a lower BMI than never users (-3.19%, 95% CI=-3.71, -2.68). CONCLUSIONS: These data provide novel information about an inverse relationship between mind-body practice and weight status. If causal links were demonstrated in further prospective studies, such practice could be fostered in obesity prevention and treatment.

Association between Mindfulness and Weight Status in a General Population from the NutriNet-Santé Study.

BACKGROUND: Mindfulness is defined as non-judgmental awareness of the present moment. There is some evidence of the efficacy of mindfulness-based interventions in weight loss. However, this psychological concept has only been rarely explored in observational studies, and no study to date has examined the association between dispositional mindfulness and weight status in a large population-based sample. OBJECTIVE: We aimed to examine the relationship between mindfulness scores and weight status in a large sample of the adult general population in France. DESIGN AND METHODS: A total of 14,400 men and 49,228 women aged ≥18 y participating in the NutriNet-Santé study were included in this cross-sectional analysis. We collected mindfulness data using the Five Facet Mindfulness Questionnaire as well as self-reported weight and height. The association between weight status and dispositional mindfulness, as well as its subscales (observing, describing, acting with awareness, non-judging and non-reactivity), was assessed using multinomial logistic regression models adjusted for socio-demographic and lifestyle factors. RESULTS: Women with higher dispositional mindfulness scores were less likely to be overweight (excluding obesity) (OR quartile 4 vs. 1 = 0.84, 95% CI: 0.79-0.90) and obese (OR quartile 4 vs. 1 = 0.71, 95% CI: 0.65-0.78). In addition, overall, in this group, all subscales were inversely associated with weight status, with the strongest association found for the "observing" subscale. In men, higher mindfulness was associated only with lower odds of obesity (OR quartile 4 vs. 1 = 0.81 (0.69, 0.96)), and only the "observing" and "non-reactivity" subscales were significantly inversely associated with weight status. CONCLUSION: Results support the interest of a shift in perspective that takes into account positive psychological and cognitive factors such as dispositional mindfulness in the investigation of obesity and its associated factors.

Validation of a Web-based, self-administered, non-consecutive-day dietary record tool against urinary biomarkers.

New technologies are promising for the use of short-term instruments for dietary data collection; however, innovative tools should be validated against objective biomarkers. The aim of the present study was to investigate the validity of a Web-based, self-administered dietary record (DR) tool using protein, K and Na intakes against 24 h urinary biomarkers (24 h U). Of the total participants, 199 adult volunteers (104 men and 95 women, mean age 50·5 (23-83 years)) of the NutriNet-Santé Study were included in the protocol. They completed three non-consecutive-day DR and two 24 h U on the first and third DR days. Relative differences between reported (DR) and measured (24 h U) intakes were calculated from the log ratio (DR/24 h U) for protein, K and Na intakes: -14·4,+2·6 and -2·1 % for men; and -13·9, -3·7 and -8·3 % for women, respectively. The correlations between reported and true intakes were 0·61, 0·78 and 0·47 for men and 0·64, 0·42 and 0·37 for women for protein, K and Na, respectively. Attenuation factors, that represent attenuation of the true diet-disease relationship due to measurement error (a value closer to 1 indicating lower attenuation), ranged from 0·23 (Na, women) to 0·60 (K, men). We showed that the Web-based DR tool used in the NutriNet-Santé cohort study performs well in estimating protein and K intakes and fairly well in estimating Na intake. Furthermore, three non-consecutive-day DR appear to be valid for estimating usual intakes of protein and K, although caution is advised regarding the generalisability of these findings to other nutrients and general population.

Cross-cultural validity of the Intuitive Eating Scale-2. Psychometric evaluation in a sample of the general French population.

Intuitive eating is an adaptive dietary behavior that emphasizes eating in response to physiological hunger and satiety cues. The Intuitive Eating Scale-2 (IES-2) measures such attitudes and behaviors. The aim of the present study was to adapt the IES-2 to the French context and to test its psychometric properties in 335 women and 297 men participating in the NutriNet-Santé study. We evaluated the construct validity of the IES-2 by testing hypotheses with regard to its factor structure, relationships with scores of the revised 21-item Three Factor Eating Questionnaire and the Center for Epidemiologic Studies Depression scale, and differences between "a priori" relevant subgroups. First, the exploratory factor analysis revealed three main dimensions: Eating for Physical Rather than Emotional Reasons, Reliance on Hunger and Satiety Cues, and Unconditional Permission to Eat. Second-order confirmatory factor analysis upheld the 3-factor solution influenced by a broader intuitive eating dimension. IES-2 total score was negatively related to cognitive restraint (r = -0.31, P < 0.0001), emotional eating (r = -0.58, P < 0.0001), uncontrolled eating (r = -0.40, P < 0.0001), and depressive symptoms (r = -0.20, P < 0.0001). IES-2 subscales showed similar correlations. Women had lower scores than did men for the IES-2 total scale (3.3 in women vs. 3.5 in men, P < 0.0001), Eating for Physical Reasons, and Unconditional Permission to Eat subscales. Current or former dieters had lower scores on the IES-2 total scale and on all subscales than did those who had never dieted (all P < 0.01). Finally, results showed satisfactory reliability for the IES-2 total scores (internal consistency = 0.85 and test-retest reliability = 0.79 over a mean 8-week period) and for its subscales. Thus, the French IES-2 can be considered a useful instrument for assessing adult intuitive eating behaviors in empirical and epidemiological studies in the general population.

Validity of a questionnaire measuring motives for choosing foods including sustainable concerns.

Since the 1990s, sustainability of diet has become an increasingly important concern for consumers. However, there is no validated multidimensional measurement of motivation in the choice of foods including a concern for sustainability currently available. In the present study, we developed a questionnaire that measures food choice motives during purchasing, and we tested its psychometric properties. The questionnaire included 104 items divided into four predefined dimensions (environmental, health and well-being, economic and miscellaneous). It was administered to 1000 randomly selected subjects participating in the Nutrinet-Santé cohort study. Among 637 responders, one-third found the questionnaire complex or too long, while one-quarter found it difficult to fill in. Its underlying structure was determined by exploratory factor analysis and then internally validated by confirmatory factor analysis. Reliability was also assessed by internal consistency of selected dimensions and test-retest repeatability. After selecting the most relevant items, first-order analysis highlighted nine main dimensions: labeled ethics and environment, local and traditional production, taste, price, environmental limitations, health, convenience, innovation and absence of contaminants. The model demonstrated excellent internal validity (adjusted goodness of fit index = 0.97; standardized root mean square residuals = 0.07) and satisfactory reliability (internal consistency = 0.96, test-retest repeatability coefficient ranged between 0.31 and 0.68 over a mean 4-week period). This study enabled precise identification of the various dimensions in food choice motives and proposed an original, internally valid tool applicable to large populations for assessing consumer food motivation during purchasing, particularly in terms of sustainability.

The associations between emotional eating and consumption of energy-dense snack foods are modified by sex and depressive symptomatology.

In recent years, emotional eating (EmE) has incited substantial research interest as an important psychologic determinant of food intake and overweight. However, little is known about factors that might modulate its relations with dietary habits. The objective of this study was to examine the association between EmE and consumption of energy-dense snack food and assess the 2-way interaction of EmE with sex and depressive symptoms. A total of 7378 men and 22,862 women from the NutriNet-Santé cohort (France, 2009-2013) who completed ≥6 self-reported 24-h food records were included in this cross-sectional analysis. EmE was evaluated via the revised 21-item Three-Factor Eating Questionnaire. Depressive symptoms were assessed by the Center for Epidemiologic Studies Depression Scale. The associations between EmE and energy-dense food consumption were assessed by multivariable logistic and linear regression models adjusted for sociodemographic and lifestyle factors. Higher EmE was associated with higher consumption of energy-dense snacks and, in particular, with consumption of sweet-and-fatty foods across most categories studied. However, these associations were stronger in women with depressive symptoms (e.g., high consumption of chocolate, OR: 1.77, 95% CI: 1.43, 2.20; cakes/biscuits/pastries, OR: 1.81, 95% CI: 1.45, 2.26) compared with those without depressive symptoms (e.g., high consumption of chocolate, OR: 1.52, 95% CI: 1.36, 1.69; cakes/biscuits/pastries, OR: 1.44, 95% CI: 1.29, 1.61). In contrast, the significant positive associations observed in men without depressive symptoms (e.g., high consumption of chocolate, OR: 1.33, 95% CI: 1.16, 1.52; cakes/biscuits/pastries, OR: 1.28, 95% CI: 1.11, 1.48) were not found in men with depressive symptoms. In conclusion, in women, EmE was positively associated with consumption of energy-dense snack food, particularly in those with depressive symptoms. For men, the relation between EmE and energy-dense snack foods was found only in those without depressive symptoms. These findings call for consideration of the psychologic state when targeting unhealthy dietary habits, especially in women. This trial was registered at eudract.ema.europa.eu as 2013-000929-31.

Plant and animal protein intakes are differently associated with nutrient adequacy of the diet of French adults.

The sustainability of dietary plant and animal protein consumption is an important issue, but few data are available to ascertain the health-related impact of animal and plant protein intake. The objective was to study the relationships between animal and plant protein intake and diet quality, as reflected by an integrated index of nutrient adequacy. Using data on 1912 adults from the French Individual and National Consumption Survey 2 (2006-2007), we assessed diet quality by using the PANDiet, a unique score combining 35 probabilities of having an adequate nutrient intake, and used multiple regression analysis to study the relationship with intakes of plant, animal, and related food source proteins. After adjustments for intakes of energy, alcohol, and protein from other sources and sociodemographic factors, plant protein intake was positively associated with the PANDiet, irrespective of sex (ß = 0.50, P < 0.0001). By contrast, total and animal protein intakes were differently associated with the PANDiet according to sex, with a positive association in women (ß = 0.07 and ß = 0.08, respectively; P < 0.01) and an inverse association in men (ß = -0.07 and ß = -0.05, respectively; P < 0.01). The relationships between the PANDiet and intakes of protein from animal food sources varied: for instance, associations were inverse for red meat and poultry in men but not in women, whereas irrespective of sex, they were positive for fish, milk, and yogurt and inverse for processed meat, cheese, and eggs. These findings show that plant protein is a robust marker of a healthy diet, whereas total animal protein includes different subtypes of animal protein that largely vary in their relationship with diet quality. These data could help refine protein recommendations from a qualitative and dietary standpoint.