Benjamin Allès

Potential benefits of adherence to the Mediterranean diet on cognitive health

The purpose of this review was to update available knowledge on the relationship between adherence to the Mediterranean diet (MeDi) and cognitive decline, risk of dementia or Alzheimers Disease (AD), and to analyse the reasons for some inconsistent results across studies. The traditional MeDi has been recognised by the United Nations Educational Scientific and Cultural Organisation as an Intangible Cultural Heritage of Humanity. This dietary pattern is characterised by a high consumption of plant foods (i.e. vegetables, fruits, legumes and cereals), a high intake of olive oil as the main source of fat, a moderate intake of fish, low-to-moderate intake of dairy products and low consumption of meat and poultry, with wine consumed in low-to-moderate amounts during meals. Beyond the well-known association between higher adherence to the MeDi and lower risk of mortality, in particular from CVD and cancer, new data from large epidemiological studies suggest a relationship between MeDi adherence and cognitive decline or risk of dementia. However, some inconsistent results have been found as well, even in Mediterranean countries. In this review, we analyse the reasons likely to explain these discrepancies, and propose that most of these differences are due to variations in the methodology used to assess MeDi adherence. We also discuss the possibility of residual confounding by lifestyle, that is, greater adherents to the MeDi also have a healthier lifestyle in general, which can favourably affect cognition. In conclusion, large-scale studies in various populations with common methodology are required before considering the MeDi as an optimal dietary strategy to prevent cognitive decline or dementia.

Contribution of Organic Food to the Diet in a Large Sample of French Adults (the NutriNet-Santé Cohort Study)

In developed countries, the demand for organic products continues to substantially increase each year. However, little information is available regarding the level of consumption of organic food and its relative share of the whole diet. Our aim was to provide, using individual consumption data, a detailed description of organic food consumption among French adults. Conventional and organic intakes were assessed using an organic food frequency questionnaire administered to 28,245 French adults participating in the NutriNet-Santé study. P values of Student t-test or Chi-square for the difference between genders were reported. Less than 12% of the respondents reported never consuming organic food in the past year. Women consumed on average 20% organic food in their whole diet per day while men consumed an average of 18%. The proportion of vegetables consumed that came from organic sources was 31% among women and 28% among men. Overall, the estimate of the contribution of organic food from products of plant origin was higher than that from products of animal origin. Our study provides a framework for the exploration of organic consumption and its correlates and can serve as a basis for future studies investigating relationships between the level of organic food consumption and health outcomes.

Impact of the front-of-pack 5-colour nutrition label (5-CNL) on the nutritional quality of purchases: an experimental study

BackgroundFront-of-pack (FOP) nutrition labelling has received growing attention from public health authorities, as a tool to promote healthier diets in the population. Recently, the French Health law introduced the principle of implementing a FOP nutrition labelling system. A scientific proposal has put forward the 5-Colour Nutrition Label (5-CNL), a five-category colour-coded summary system supported by research suggesting that it is well perceived and understood in the population. Our objective was to investigate the impact of the 5-CNL on the nutritional quality of purchases in experimental supermarkets.MethodsParticipants (n = 901) were recruited using quota sampling between September and December 2015 and evenly distributed in three experimental conditions: 1) control situation; 2) Application of the 5-CNL on all food products in three specific sections: breakfast cereals, sweet biscuits and appetizers; 3) introduction of the 5-CNL accompanied by consumer information on use and understanding of the label. Main outcome was the nutritional quality of the shopping cart in the three sections combined, measured using the United Kingdom Food Standards Agency nutrient profiling system (FSA score).ResultsSignificantly higher mean nutritional quality of the purchased items per section were observed for the sweet biscuits category in the intervention combining the label + communication (overall FSA score 21.01 vs. 20.23, P = 0.02). No significant effects were observed for the general mean over the three sections combined or other food categories. The results observed on purchase may be related to the high level of recall, self-reported and objective understanding of the label that were observed in the intervention groups as they are pre-requisites for use of a label in purchasing situations.ConclusionThese results suggest that the 5-CNL FOP nutrition label may have a limited impact on purchases, leading to healthier food choices in some food categories such as sweet biscuits.Trial registrationThe trial was registered on Clinicaltrials.gov under the number NCT02546505.

Contribution of ultra-processed foods in the diet of adults from the French NutriNet-Santé study

OBJECTIVE Concerns have been raised about the potential health impact of ultra-processed foods (UPF) in the diet. Our objective was to investigate the contribution of UPF in the diet in a large French population and its association with sociodemographic factors and dietary patterns. DESIGN Cross-sectional analysis of dietary data from 74 470 participants in the web-based NutriNet-Santé cohort. UPF were identified in repeated 24 h records and the proportion (in weight) of UPF in the total diet (UPFp) was computed for each participant. Associations of sociodemographic characteristics and UPFp in quartiles were assessed using multivariate multinomial logistic regression. Food group consumption and nutrient intakes across quartiles of UPFp were estimated using linear regression adjusted for sociodemographic factors and energy intake. SETTING France. RESULTS UPF contributed 18·4 % of the foods consumed in weight and 35·9 % of total energy intake. Higher UPFp consumption was independently associated with male gender, younger age, lower education, smoking, and overweight and obesity (all P<0·0001). Participants in the highest UPFp quartile consumed lower amounts of fruit and vegetables (difference between quartile 4 and quartile 1 of UPFp, Δ=-180·3 g/d) and higher amounts of sweet products (Δ=68·5 g/d) and soft drinks (Δ=98·6 g/d; all P<0·0001). They had higher intakes of energy (Δ=610 kJ/d (145·7 kcal/d)) and added sugar (Δ=17·1 g/d), and lower intakes of fibre (Δ=-4·04 g/d), β-carotene (Δ=-1019·6 μg/d) and Ca (Δ=-87·8 mg/d; all P<0·0001). CONCLUSIONS UPF represent an important part of the diet in adults from the French general population and are associated with unbalanced nutritional intakes.

Typology of eaters based on conventional and organic food consumption: results from the NutriNet-Sante cohort study

Limited information is available on large-scale populations regarding the socio-demographic and nutrient profiles and eating behaviour of consumers, taking into account both organic and conventional foods. The aims of this study were to draw up a typology of consumers according to their eating habits, based both on their dietary patterns and the mode of food production, and to outline their socio-demographic, behavioural and nutritional characteristics. Data were collected from 28 245 participants of the NutriNet-Santé study. Dietary information was obtained using a 264-item, semi-quantitative, organic FFQ. To identify clusters of consumers, principal component analysis was applied on sixteen conventional and sixteen organic food groups followed by a clustering procedure. The following five clusters of consumers were identified: (1) a cluster characterised by low energy intake, low consumption of organic food and high prevalence of inadequate nutrient intakes; (2) a cluster of big eaters of conventional foods with high intakes of SFA and cholesterol; (3) a cluster with high consumption of organic food and relatively adequate nutritional diet quality; (4) a group with a high percentage of organic food consumers, 14 % of which were either vegetarians or vegans, who exhibited a high nutritional diet quality and a low prevalence of inadequate intakes of most vitamins except B12; and (5) a group of moderate organic food consumers with a particularly high intake of proteins and alcohol and a poor nutritional diet quality. These findings may have implications for future aetiological studies investigating the potential impact of organic food consumption.

Dietary intakes and diet quality according to levels of organic food consumption by French adults: cross-sectional findings from the NutriNet-Santé Cohort Study.

OBJECTIVE We aimed to assess dietary profiles of adults from the NutriNet-Santé cohort according to different levels of organic food consumption using detailed self-reported data on organic food intakes. DESIGN Food intakes were obtained using an organic food frequency questionnaire (Org-FFQ). The participants were ranked into five groups (quintiles, Q) according to the proportion of organic foods in their diet. To determine diet quality, two scores were computed reflecting adherence to food-based recommendations (mPNNS-GS) and the probability of adequate nutrient intake (PANDiet). Relationships between levels of organic food consumption and dietary characteristics were assessed using multivariable-adjusted ANCOVA models. SETTING The NutriNet-Santé Study. SUBJECTS French adults from the NutriNet-Santé Study (n 28 245). RESULTS Intakes of foods of plant origin increased along with the contribution of organic foods to the diet while a reverse trend was identified for dairy products, cookies and soda (P-trend<0·0001). The diet quality scores increased from Q1 (mPNNS-GS, 7·89 (se 0·02); PANDiet: 63·04 (se 0·11)) to Q5 (mPNNS-GS, 8·78 (se 0·02); PANDiet, 69·37 (se 0·10)). Overall, high organic food consumers exhibited better diet quality, although intermediate organic food consumers showed better adherence to specific nutritional recommendations related to animal products. CONCLUSIONS The study provides new insights into the understanding of organic food consumption as a part of a healthy diet and sheds some light on the dietary profiles of different categories of organic food consumers. These results underline strong dietary behaviour correlates associated with organic food consumption that should be controlled for in future aetiological studies on organic foods and health.

The 5-CNL Front-of-Pack Nutrition Label Appears an Effective Tool to Achieve Food Substitutions towards Healthier Diets across Dietary Profiles.

Background Front-of-pack (FOP) nutrition labels are considered helpful tools to help consumers making healthier food choices, thus improving their diet. In France, the implementation of a FOP nutrition label–the 5-Colour Nutrition Label (5-CNL)–is currently under consideration. Our objective was to investigate dietary profiles in a French adult population using the 5-CNL, and to assess its potential impact in improving the diet through substitution of foods. Methods and Findings Subjects included in the NutriNet-Santé cohort, who had completed three 24-h dietary records were included in this cross-sectional analysis. Mutually exclusive clusters of individuals were identified using the percentage of energy derived from foods of each of the 5-CNL colours as input variables. Three scenarios of substitution of foods for healthier alternative using the 5-CNL were tested. Food group and dietary intakes, socio-demographic and lifestyle data were compared across clusters using ANOVAs or Chi-square tests, as appropriate. We identified three mutually exclusive dietary profiles: ‘Healthy’ (N = 28 095, 29.3% of the sample), with high consumption of fruit, vegetables, whole cereals and fish; ‘Western’ (N = 33 386, 34.8%); with high consumption of sweetened beverages, breakfast cereal, cheese, fatty and sugary foods; ‘Traditional’ (N = 34 461, 35.1%), with high consumption of potatoes, bread, meat and dairy desserts. Overall, substitutions strategies led to an increase in the number of subjects reaching the recommended intakes in energy, macro and micronutrients. Increases were particularly high in the ‘Western’ pattern for lipids and saturates intakes: from 16.2% reaching the recommended amount for lipids (13.5% for saturates) to 60.6% and 85.7% respectively. Conclusion The use of the 5-CNL as an indicator of food choice meaningfully characterizes clusters of dietary habits and appears as an effective tool to help improving the nutritional quality of the diet.

Nutrient Patterns and Their Food Sources in Older Persons from France and Quebec: Dietary and Lifestyle Characteristics

Background: Dietary and nutrient patterns have been linked to health outcomes related to aging. Food intake is influenced by environmental and genetic factors. The aim of the present study was to compare nutrient patterns across two elderly populations sharing a common ancestral cultural background, but living in different environments. Methods: The diet quality, lifestyle and socioeconomic characteristics of participants from the Three-City Study (3C, France, n = 1712) and the Québec Longitudinal Study on Nutrition and Successful Aging (NuAge, Quebec, Canada, n = 1596) were analyzed. Nutrient patterns and their food sources were identified in the two samples using principal component analysis. Diet quality was compared across sample-specific patterns by describing weekly food intake and associations with the Canadian Healthy Eating Index (C-HEI). Results: Three nutrient patterns were retained in each study: a healthy, a Western and a more traditional pattern. These patterns accounted for 50.1% and 53.5% of the total variance in 3C and NuAge, respectively. Higher education and non-physical occupations over lifetime were associated with healthy patterns in both studies. Other characteristics such as living alone, having a body mass index lower than 25 and being an ex-smoker were associated with the healthy pattern in NuAge. No association between these characteristics and the nutrient patterns was noted in 3C. The healthy and Western patterns from each sample also showed an inverse association with C-HEI. Conclusion: The two healthy patterns showed important similarities: adequate food variety, consumption of healthy foods and associations with common sociodemographic factors. This work highlights that nutrient patterns derived using a posteriori methods may be useful to compare the nutritional quality of the diet of distinct populations.

Corrigendum: Environmental Impacts of Plant-Based Diets: How Does Organic Food Consumption Contribute to Environmental Sustainability?

Background Studies investigating diet-related environmental impacts have rarely considered the production method of the foods consumed. The objective of the present study, based on the NutriNet-Santé cohort, was to investigate the relationship between a provegetarian score and diet-related environmental impacts. We also evaluated potential effect modifications on the association between a provegetarian score and the environmental impacts of organic food consumption. Methods Food intake and organic food consumption ratios were obtained from 34,442 French adults using a food frequency questionnaire, which included information on organic food consumption for each group. To characterize the overall structure of the diets, a provegetarian score was used to identify preferences for plant-based products as opposed to animal-based products. Moreover, three environmental indicators were used to assess diet-related environmental impacts: greenhouse gas (GHG) emissions, cumulative energy demand (CED), and land occupation. Environmental impacts were assessed using production life cycle assessment (LCA) at the farm level. Associations between provegetarian score quintiles, the level of organic food consumption, and environmental indicators were analyzed using ANCOVAs adjusted for energy, sex, and age. Results Participants with diets rich in plant-based foods (fifth quintile) were more likely to be older urban dwellers, to hold a higher degree in education, and to be characterized by an overall healthier lifestyle and diet. A higher provegetarian score was associated with lower environmental impacts (GHG emissionsQ5vsQ1 = 838/1,664 kg CO2eq/year, −49.6%, P < 0.0001; CEDQ5vsQ1 = 4,853/6,775 MJ/year, −26.9%, P < 0.0001; land occupationQ5vsQ1 = 2,420/4,138 m2/year, −41.5%, P < 0.0001). Organic food consumption was also an important modulator of the relationship between provegetarian dietary patterns and environmental impacts but only among participants with diets rich in plant-based products. Conclusion Future field studies should endeavor to integrate all the components of a sustainable diet, i.e., both diet composition and production methods.

Food Choice Motives When Purchasing in Organic and Conventional Consumer Clusters: Focus on Sustainable Concerns (The NutriNet-Santé Cohort Study)

The purpose of this study was to examine food choice motives associated with various organic and conventional dietary patterns among 22,366 participants of the NutriNet-Santé study. Dietary intakes were estimated using a food frequency questionnaire. Food choice motives were assessed using a validated 63-item-questionnaire gathered into nine food choice motive dimension scores: “absence of contaminants”, “avoidance for environmental reasons”, “ethics and environment”, “taste”, “innovation”, “local and traditional production”, “price”, “health” and “convenience”. Five consumers’ clusters were identified: “standard conventional food small eaters”, “unhealthy conventional food big eaters”, “standard organic food small eaters”, “green organic food eaters” and “hedonist moderate organic food eaters”. Relationships between food choice motive dimension scores and consumers’ clusters were assessed using analysis of covariance (ANCOVA) models adjusted for sociodemographic factors. “Green organic food eaters” had the highest mean score for the “health” dimension, while “unhealthy conventional food big eaters” obtained the lowest mean score for the “absence of contaminants” dimension. “Standard organic food small eaters”, “green organic food eaters” and “hedonist moderate organic food eaters” had comparable scores for the “taste” dimension. “Unhealthy conventional food big eaters” had the highest mean score for the “price” dimension while “green organic food eaters” had the lowest mean scores for the “innovation” and “convenience” dimensions. These results provide new insights into the food choice motives of diverse consumers’ profiles including “green” and “hedonist” eaters.