Carine Dubuisson

Trends in child overweight rates and energy intake in France from 1999 to 2007: relationships with socioeconomic status.

Our objectives were (i) to assess the current prevalence of childhood overweight (including obesity) (OWOB) in France and its relationship with comprehensive socioeconomic status (SES) indicators and (ii) to examine trends in OWOB prevalence and changes in energy intake (EI) and sedentary behavior (SED) based on the previous INCA 1 (Individuelle Nationale des Consommations Alimentaires) data (1998–1999). A representative sample of children aged 3–14 (n = 1,030) was taken from the 2006–2007 cross‐sectional INCA 2 food consumption survey. Weight and height were measured. The prevalence of OWOB was estimated according to the IOTF (International Obesity Task Force) definition. Average daily EI was evaluated using a 7‐day food record. SED (screen time) and SES were reported by answering questionnaires. SES indicators included the occupation and level of education of the head of the household (HH), and variables describing household wealth. Composite indices of SES were computed by correspondence analysis, and relationships with OWOB were explored by logistic regression analysis. In total, 14.5% (95% CI: 12.1–17.0) of the children were OWOB. All SES indicators were inversely correlated to OWOB. Average EI was equal to 1,739 kcal/day. Daily, children spent 113.5 min watching television, and 38.5 min playing video games or using a computer. Compared to the INCA 1 study, OWOB prevalence was not significantly different, EI was lower, and SED was higher. These trends were the same across all occupational categories of heads of household. Although overall rates of childhood OWOB are currently stabilizing, no change was observed in the strong inverse socioeconomic gradient of OWOB between the two studies.

Trends in food intake in French children from 1999 to 2007 : results from the INCA (étude Individuelle Nationale des Consommations Alimentaires) dietary surveys

The objectives of the present study were to assess the intake of different food groups in French children aged 3-17 years (n 1455), and to analyse trends since a dietary survey undertaken 8 years ago. Dietary intake was evaluated using data from the 2006-7 cross-sectional INCA2 national dietary survey (étude Individuelle Nationale sur les Consommations Alimentaires), based on a 7 d food record. Dietary intake (percentage of subjects consuming the food group and amount eaten) was assessed for thirty-nine food categories. We observed variations in food consumption by age, sex, North-South regional gradient, seasonal period and educational level of the responding parent. Trends in dietary intake between 1999 and 2007 were determined by comparing the INCA1 (n 1126) and the INCA2 surveys. Both surveys had been carried out using the same methodology. The findings showed a decrease in energy intake in children aged 3-14 years, due to a reduction in the consumption of foods of animal origin and sweetened products. In adolescents aged 15-17 years, energy intake remained rather stable; during this 8-year period, the consumption of meat decreased, whereas the consumption of savoury snacks such as sandwiches and hamburgers significantly increased. These trends occurred during a time of growing concern about overweight and the associated co-morbidities in France. A number of public health measures were implemented over this period to improve dietary habits and physical activity patterns in children and adults. The periodic monitoring of dietary patterns through the INCA surveys is an essential part of the surveillance network in France.

Characteristics of energy under-reporting in children and adolescents

Under-reporting (UR) of food intake is an issue of concern, as it may distort the relationships studied between diet and health. This topic has been scarcely addressed in children. The objective of the study was to assess the extent of UR in French children and investigate associated covariates. A total of 1455 children aged 3-17 years were taken from the nationally representative cross-sectional French étude Individuelle Nationale des Consommations Alimentaires (INCA2) dietary survey (2006-7). Food intake was reported in a 7 d diet record. Socio-economic status, sedentary behaviour, weight perception variables and food habits were collected by questionnaires. Weight and height were measured. Under-reporters were identified according to the Goldberg criterion adapted to children. Multivariate logistic regressions investigated the associations between UR and covariates. Rates of under-reporters were 4·9 and 26·0 % in children aged 3-10 and 11-17 years, respectively (P < 0·0001), without significant differences between boys and girls. Overall, UR was positively associated with a lower socio-economic status, overweight, skipping breakfast and dinner, a higher contribution of proteins to energy intake (EI), and a lower contribution of simple carbohydrates to EI. Under-reporters aged 3-10 years also had a higher sedentary behaviour and a lower snack-eating frequency. In adolescents, UR was also associated with a less-frequent school canteen attendance, a perception of being overweight, a wish to weigh less, and current and past restrictive diets. In conclusion, under-reporters differ from plausible reporters in several characteristics related to diet, lifestyle, weight status and socio-economic status. Therefore, it is important to consider this differential UR bias when investigating diet-disease associations in children.

Core food of the French food supply: second Total Diet Study

As first described in the 1980s, the core food intake model allows a precise assessment of dietary nutrient intake and dietary exposure to contaminants insofar as it reflects the eating habits of a target population and covers the most important foods in terms of consumption, selected nutrient and contaminant contribution. This model has been used to set up the sampling strategy of the second French Total Diet Study (TDS) with the aim of obtaining a realistic panorama of nutrient intakes and contaminant exposure for the whole population, useful for quantitative risk assessment. Data on consumption trends and eating habits from the second French individual food consumption survey (INCA2) as well as data from a 2004 purchase panel of French households (SECODIP) were used to identify the core foods to be sampled. A total of 116 core foods on a national scale and 70 core foods on a regional scale were selected according to (1) the consumption data for adults and children, (2) their consumer rates, and (3) their high contribution to exposure to one or more contaminants of interest. Foods were collected in eight French regions (36 cities) and prepared ‘as consumed’ to be analysed for their nutritional composition and contamination levels. A total of 20 280 different food products were purchased to make up the 1352 composite samples of core foods to be analysed for additives, environmental contaminants, pesticide residues, trace elements and minerals, mycotoxins and acrylamide. The establishment of such a sampling plan is essential for effective, high-quality monitoring of dietary exposure from a public health point of view.

Socio-economic characteristics, living conditions and diet quality are associated with food insecurity in France.

OBJECTIVE To assess the prevalence of household food insecurity (FI) in France and to describe its associations with socio-economic factors, health behaviours, diet quality and cost (estimated using mean food prices). DESIGN Cross-sectional nationally representative survey. FI was assessed using an adapted version of the US Department of Agricultures Food Insufficiency Indicator; dietary intake was assessed using a 7 d open-ended food record; and individual demographic, socio-economic and behavioural variables were assessed using self-administered questionnaires and interviews. Individuals experiencing FI were compared with food-secure individuals, the latter being divided into four categories according to quartiles of their income per consumption unit (FS1 to FS4). Differences among categories were analysed using χ² tests, ANOVA and tests for trend. SETTING Individual and National Dietary Survey (INCA2), 2006-2007. SUBJECTS Adults aged 18-79 years (n 2624). RESULTS Individuals experiencing FI represented 12·2% of the population. They were on average younger, more frequently women and single parents with children compared with those in the other four categories. Their mean income per consumption unit was higher than that in the FS1 category, but they reported poorer material and housing conditions. The prevalence of smoking and the mean daily time spent watching television were also higher in the FI category. No significant difference among categories was found for energy intake, but mean intakes of fruits, vegetables and fish were lower, and diet quality was slightly but significantly poorer in the FI category. Daily diet cost was also lower in the FI category. CONCLUSIONS France is not spared by FI. FI should be routinely monitored at the national level and research should be promoted to identify effective strategies to reduce nutrition inequalities in France.

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 (β = 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 (β = 0.07 and β = 0.08, respectively; P < 0.01) and an inverse association in men (β = -0.07 and β = -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.

Dietary intake and food sources of choline in European populations

Choline is an important nutrient for humans. Choline intake of the European population was assessed considering the European Food Safety Authority European Comprehensive Food Consumption Database and the United States Department of Agriculture Nutrient Database. Average choline intake ranges were 151-210 mg/d among toddlers (1 to ≤3 years old), 177-304 mg/d among other children (3 to ≤10 years old), 244-373 mg/d among adolescents (10 to ≤18 years old), 291-468 mg/d among adults (18 to ≤65 years old), 284-450 mg/d among elderly people (65 to ≤75 years old) and 269-444 mg/d among very elderly people (≥75 years old). The intakes were higher among males compared with females, mainly due to larger quantities of food consumed per day. In most of the population groups considered, the average choline intake was below the adequate intake (AI) set by the Institute of Medicine in the USA. The main food groups contributing to choline intake were meat, milk, grain, egg and their derived products, composite dishes and fish. The main limitations of this study are related to the absence of choline composition data of foods consumed by the European population and the subsequent assumption made to assess their intake levels. Given the definition of AI, no conclusion on the adequacy of choline intake can be drawn for most European population groups. Such results improve the knowledge on choline intake in Europe that could be further refined by the collection of choline composition data for foods as consumed in Europe.

School meals in French secondary state schools with regard to the national recommendations.

In 2001, a circular addressing both the composition of school meals and food safety issues was introduced in France to improve the nutrient composition of school meals and provided food-frequency guidelines to guarantee dietary balanced meals. The present study assesses the extent to which secondary state schools are familiar with and implement this circular. In 2005, a nationally representative sample of 1440 secondary state schools received a questionnaire on their catering service and the implementation of the circulars recommendations, and were requested to enclose all menus (lunches and dinners) served over 1 month. Menu analysis shows that progress is still required to achieve a meal composition in accordance with the food-group frequency guidelines appended to the circular. Some recommendations are followed by most of the schools, such as limiting high-fat products and providing plenty of raw fruits and vegetables, cooked vegetables and starchy foods. Other guidelines should be implemented further, especially with regard to the nutritional quality of main courses and dairy products, which are met by less than a third and a half of schools, respectively. Specific efforts are necessary for evening meals to ensure that the nutritional requirements of boarders are covered. Some recommendations, such as the food purchasing manager being trained in nutrition (38 % of schools) and the involvement of dietetic expertise when designing meals (6 %), seem to be linked to better dietary balance of meals. Implementation of the circular must therefore be promoted in schools and may require stronger regulatory nutrition standards and better cooperation between schools.

Dietary patterns in the French adult population: a study from the second French national cross-sectional dietary survey (INCA2) (2006-2007).

Identification and characterisation of dietary patterns are needed to define public health policies to promote better food behaviours. The aim of this study was to identify the major dietary patterns in the French adult population and to determine their main demographic, socio-economic, nutritional and environmental characteristics. Dietary patterns were defined from food consumption data collected in the second French national cross-sectional dietary survey (2006–2007). Non-negative-matrix factorisation method, followed by a cluster analysis, was implemented to derive the dietary patterns. Logistic regressions were then used to determine their main demographic and socio-economic characteristics. Finally, nutritional profiles and contaminant exposure levels of dietary patterns were compared using ANOVA. Seven dietary patterns, with specific food consumption behaviours, were identified: ‘Small eater’, ‘Health conscious’, ‘Mediterranean’, ‘Sweet and processed’, ‘Traditional’, ‘Snacker’ and ‘Basic consumer’. For instance, the Health-conscious pattern was characterised by a high consumption of low-fat and light products. Individuals belonging to this pattern were likely to be older and to have a better nutritional profile than the overall population, but were more exposed to many contaminants. Conversely, individuals of Snacker pattern were likely to be younger, consumed more highly processed foods, had a nutrient-poor profile but were exposed to a limited number of food contaminants. The study identified main dietary patterns in the French adult population with distinct food behaviours and specific demographic, socio-economic, nutritional and environmental features. Paradoxically, for better dietary patterns, potential health risks cannot be ruled out. Therefore, this study demonstrated the need to conduct a risk–benefit analysis to define efficient public health policies regarding diet.

Comparison of different maximum safe levels in fortified foods and supplements using a probabilistic risk assessment approach

Different European institutions have developed mathematical models to propose maximum safe levels either for fortified foods or for dietary supplements. The objective of the present study was to compare and check the safety of these different maximum safe levels (MSL) by using a probabilistic risk assessment approach. The potential maximum nutritional intakes were estimated by taking into account all sources of intakes (base diet, fortified foods and dietary supplements) and compared with the tolerable upper intake levels for vitamins and minerals. This approach simulated the consequences of both food fortification and supplementation in terms of food safety. Different scenarios were tested. They are the result of the combination of several MSL obtained using the previous models. The study was based on the second French Individual and National Study on Food Consumption performed in 2006-7, matched with the French food nutritional composition database. The analyses were based on a sample of 1918 adults aged 18-79 years. Some MSL in fortified foods and dietary supplements obtained independently were protective enough, although some others could lead to nutritional intakes above the tolerable upper intake levels. The simulation showed that it is crucial to consider the inter-individual variability of fortified food intakes when setting MSL for foods and supplements. The risk assessment approach developed here by integrating the MSL for fortified foods and dietary supplements is useful for ensuring consumer protection. It may be subsequently used to test any other MSL for vitamins and minerals proposed in the future.