Benoît Salanave

Obstetric patients treated in intensive care units and maternal mortality

OBJECTIVE To ascertain the frequency of serious diseases in pregnant women. STUDY DESIGN A population based survey was performed in France. The cases were all the women admitted for treatment in intensive care unit (ICU). The severity of the cases was measured with the simplified acute physiology score (SAPS) the lethality and the rate of still birth. RESULTS 435 obstetric patients were included. The estimated frequency of severe diseases was 310 S.D.36 per 100,000 live births. The most frequent diagnose that motived admission in ICU was hypertensive diseases. The lethality rates differed greatly between specific disorders. The lethality rate was lower when scheduled maternity was located in a teaching hospital. CONCLUSION Regarding these results it appears that the majority of obstetric patients with severe diseases are referred to suitable care, but a small proportion of women who had to change their type of care registered a significant higher lethality.

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

BackgroundIdentification 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.MethodsAnalyses 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 ≥ 25) and central obesity (WC above gender-specific references) were identified using multiple logistic regression.ResultsAlmost 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).ConclusionThe 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.

Comparison of the sociodemographic characteristics of the large NutriNet-Santé e-cohort with French Census data: the issue of volunteer bias revisited

Background A recurring concern in traditional and in Web-based studies pertains to non-representativeness due to volunteer bias. We investigated this issue in an ongoing, large population-based e-cohort. Methods The sample included 122 912 individuals enrolled in the Internet-based, nutrition-focused NutriNet-Santé study between May 2009 and March 2014, with complete baseline data. Participants were recruited via recurrent multimedia campaigns and other traditional and online strategies. Individuals aged 18+ years, residing in France and having Internet access, were eligible for enrolment. Their sociodemographic characteristics were compared with the corresponding 2009 Census data via χ2 goodness-of-fit tests. The effectiveness of statistical weighting of the e-cohort data was also explored. Results The sample exhibited marked geographical and sociodemographic diversity, including volunteers belonging to typically under-represented subgroups in traditional surveys (unemployed, immigrants, the elderly). Nonetheless, the proportions of women, relatively well-educated individuals and those who are married or cohabiting, were notably larger compared with the corresponding national figures (women: 78.0% vs 52.4%; postsecondary education: 61.5% vs 24.9%; married or cohabiting: 70.8% vs 62.0%, respectively; all p<0.0001). Conclusions There were notable sociodemographic differences between the general French population and this general population-based e-cohort, some of which were corrected by statistical weighting. The findings bear on the potential generalisability of future investigations in the context of e-epidemiology.

A first national prevalence estimate of diagnosed and undiagnosed diabetes in France in 18‐ to 74‐year‐old individuals: the French Nutrition and Health Survey 2006/2007

Diabet. Med. 28, 583–589 (2011)

Compliance with French Nutrition and Health Program Recommendations Is Strongly Associated with Socioeconomic Characteristics in the General Adult Population

BACKGROUND In many countries, nutrition policies such as the Programme National Nutrition Santé (PNNS), implemented in France since 2001, have been developed to prevent and reduce the risk of chronic disease. However, the way in which such programs might benefit persons having different socioeconomic characteristics is unknown. The French nutrition and health survey (Etude Nationale Nutrition Santé [ENNS]) represented an opportunity to address this issue. OBJECTIVE To describe compliance with PNNS recommendations in the general population and to investigate the relationship between social, economic, and educational characteristics and poor compliance with French nutrition recommendations. DESIGN A national cross-sectional multistage sampling survey. Food intake was estimated through three 24-hour recalls. Adherence to French nutrition recommendations was estimated using the PNNS guideline score (15 possible points). PARTICIPANTS Two thousand five hundred seventy-seven adults aged 18 to 74 years living in France in 2006-2007 were included in these analyses. STATISTICAL ANALYSIS All analyses were carried out in men and women separately. Sex-specific quartiles of score were estimated. Multiple logistic models were used to identify socioeconomic characteristics (ie, age, marital status, occupational status, education level, and holiday trip in the past 12 months) associated with poor compliance with recommendations (first PNNS guideline score quartile vs three other quartiles), estimating odds ratios (ORs), and their 95% confidence intervals (CIs). RESULTS The mean PNNS guideline score was 7.67+/-0.17 in men and 8.55+/-0.12 in women. In both sex groups, a difference of approximately four attained recommendations (out of 13 maximum) was observed between the lowest and highest quartiles. In multivariate models, being in the first PNNS guideline score quartile was significantly associated with lower age and lower occupational status for both sexes. Moreover, women living without a partner were at higher risk of poor compliance with recommendations (adjusted OR 1.43; 95% CI 1.01 to 2.04, vs women living with a partner), as were men not having taken a holiday trip during the past 12 months (adjusted OR 1.78, 95% CI 1.05 to 3.02, vs at least one holiday trip). CONCLUSIONS Compliance with nutrition recommendations can be improved despite several years of public health interventions carried out by the PNNS. Identification of characteristics associated with poor compliance should help to target future public health measures.

Should the WHO Growth Charts Be Used in France

Background Growth charts are an essential clinical tool for evaluating a childs health and development. The current French reference curves, published in 1979, have recently been challenged by the 2006 World Health Organization (WHO) growth charts. Objective To evaluate and compare the growth of French children who were born between 1981 and 2007, with the WHO growth charts and the French reference curves currently used. Design Anthropometric measurements from French children, who participated in 12 studies, were analyzed: 82,151 measurements were available for 27,257 children in different age groups, from birth to 18 years. We calculated and graphically compared mean z-scores based on the WHO and French curves, for height, weight and Body Mass Index (BMI) according to age and sex. The prevalence of overweight using the WHO, the French and International Obesity Task Force definitions were compared. Results Our population of children was on average 0.5 standard deviations taller than the French reference population, from the first month of life until puberty age. Mean z-scores for height, weight and BMI were closer to zero based on the WHO growth charts than on the French references from infancy until late adolescence, except during the first six months. These differences not related to breastfeeding rates. As expected, the prevalence of overweight depended on the reference used, and differences varied according to age. Conclusion The WHO growth charts may be appropriate for monitoring growth of French children, as the growth patterns in our large population of French children were closer to the WHO growth charts than to the French reference curves, from 6 months onwards. However, there were some limitations in the use of these WHO growth charts, and further investigation is needed.

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 < 10−3) 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.

Determinants of blood pressure treatment and control in obese people: evidence from the general population

Objective: We assessed hypertension prevalence, blood pressure (BP)-lowering treatment and control in obese adults compared with lean/normal-weight individuals in France. Methods: Multistage stratified random sample of 2075 adults from the French Nutrition and Health Survey (ENNS), a cross-sectional national survey carried out in 2006–2007. BP was measured three times on the left arm using an automatic device. Weight and height were assessed using standardized methods to compute body mass index (BMI, kg/m2). BP-lowering drugs were self-reported. BP control was defined as SBP/DBP less than 140/90 among hypertensive individuals. Results: As anticipated, mean SBP and DBP increased significantly across BMI categories (P for trend <0.0001). The age-adjusted and sex-adjusted prevalence of hypertension also increased across the same categories (15.7, 24.7 and 56.9%, respectively, P < 0.001). Among hypertensive individuals, obese participants were more likely to receive BP-lowering drugs compared with their lean/normal weight counterparts (P = 0.02). However, independently of age, smoking status and alcohol intake, obesity was associated with a 62% lower risk of BP control (OR: 0.38, 95% CI: 0.19–0.75) compared with the lean/normal-weight status. Conclusion: Although hypertension was much more prevalent in the obese compared with overweight and lean/normal-weight individuals, uncontrolled hypertension was also more frequent despite a higher rate of treatment. To some extent, this observation may probably be the consequence of obesity and its complex pathophysiology, more than to an inadequate therapeutic decision by clinicians.

Body-weight perception and related preoccupations in a large national sample of adolescents.

This study aimed to investigate the association between body‐weight (BW) perception, weight preoccupation and behaviour, including weight control practices and compulsive over‐eating episodes, across gender and actual BW classes.

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.