Hélène Lelong

Relationship Between Nutrition and Blood Pressure: A Cross-Sectional Analysis from the NutriNet-Santé Study, a French Web-based Cohort Study

BACKGROUND Hypertension is the most prevalent chronic disease worldwide. Lifestyle behaviors for its prevention and control are recommended within worldwide guidelines. Nevertheless, their combined relationship with blood pressure (BP) level, particularly in the general population, would need more investigations. Our aim in this study was to evaluate the relative impact of lifestyle and nutritional factors on BP level. METHODS Cross-sectional analyses were performed using data from 8,670 volunteers from the NutriNet-Santé Study, an ongoing French web-based cohort study. Dietary intakes were assessed using three 24-hour records. Information on lifestyle factors was collected using questionnaires and 3 BP measurements following a standardized protocol. Age-adjusted associations and then multivariate associations between systolic BP (SBP) and lifestyle behaviors were estimated using multiple linear regressions. RESULTS SBP was higher in participants with elevated body mass indices (BMIs). Salt intake was positively associated with SBP in men but not in women. The negative relationship between consumption of fruits and vegetables and SBP was significant in both sexes. Alcohol intake was positively associated with SBP in both sexes; physical activity was not. The 5 parameters representing the well-accepted modifiable factors for hypertension reduction plus age and education level, accounted for 19.7% of the SBP variance in women and 12.8% in men. Considering their squared partial correlation coefficient, age and BMI were the most important parameters relating to SBP level. Salt intake was not associated with SBP in either sex after multiple adjustments. CONCLUSIONS BMI was the main contributory modifiable factor of BP level after multiple adjustments.

Individual and Combined Effects of Dietary Factors on Risk of Incident HypertensionNovelty and Significance: Prospective Analysis From the NutriNet-Santé Cohort

Dietary intake is pointed as one of the major determinants in hypertension development. Data in the area are mostly obtained from cross-sectional studies. We aimed to investigate the prospective association between (1) individual nutritional factors and (2) adherence to the Dietary Approach to Stop Hypertension and the risk of incident hypertension in a large cohort study. We prospectively examined the incidence of hypertension among 80 426 French adults participating in the NutriNet-Santé cohort study. Self-reported sociodemographic, lifestyle health questionnaires and dietary consumption assessed by three 24-hour records were completed at baseline and yearly thereafter. Associations between quartiles (Q) of nutrients and food groups and adherence to Dietary Approach to Stop Hypertension diet and hypertension risk were assessed by multivariable Cox proportional hazards models. During a mean follow-up of 3.4±2.1 years, 2413 cases of incident hypertension were documented. Dietary intakes of sodium (Q4 versus Q1): hazard ratio (HR)=1.17 (95% confidence interval [CI], 1.02–1.35), potassium: HR=0.82 (95% CI, 0.72–0.94), animal protein: HR=1.26 (95% CI, 1.11–1.43), vegetable protein: HR=0.85 (95% CI, 0.75–0.95), fiber: HR =0.81 (95% CI, 0.71–0.93), magnesium: HR=0.77 (95% CI, 0.67–0.89), fruit and vegetables: HR=0.85 (95% CI, 0.74–0.97), whole grain: HR=0.84(95% CI, 0.76–0.93), nuts: HR=0.72 (95% CI, 0.63–0.83), and red and processed meat: HR=1.25 (95% CI, 1.11–0.42) were associated with risk of hypertension. Besides, adherence to the Dietary Approach to Stop Hypertension was strongly inversely associated with incident hypertension: (Q4 versus Q1) HR=0.66 (95% CI, 0.58–0.75). Our results confirmed the association of several nutritional factors intake and incident hypertension and highlighted that adopting a global healthy diet could strongly contribute to the prevention of hypertension.

Association Between Blood Pressure and Adherence to French Dietary Guidelines

BACKGROUND Adopting a healthy diet like the Dietary Approach to Stop Hypertension (DASH) or Mediterranean diet (MD) represents a major lifestyle for blood pressure (BP) control in general population. Nutritional policies, such as the French Nutrition and Health Program (Programme National Nutrition Santé or PNNS), have been implemented in several countries with the aims of preventing chronic diseases. The objective of our study was to investigate association between BP and adherence to PNNS guidelines compared with adherence to DASH or MD. METHODS We conducted a cross-sectional study in 11,302 untreated participants from the NutriNet-Santé study, a French web-based cohort study. Three validated scores reflecting adherence to PNNS guidelines, DASH diet, and MD were calculated from repeated 24-hour records. Three BP measurements using a standardized protocol were collected. Multivariate linear models were used to assess the associations between the dietary scores and BP. RESULTS In women, independent of age, socioeconomic status, body mass index, tobacco use, alcohol consumption, and physical activity, adherence to PNNS guidelines was inversely significantly associated with systolic BP (β = -0.63, P < 0.0001). This association was of similar amplitude that between BP and adherence to DASH-style diet (β = -0.66, P < 0.0001) or MD (β = -0.63, P = 0.0002). No significant association was found in men. CONCLUSION Adherence to French nutritional recommendations was found negatively associated with BP at the same magnitude as adherence to well-known dietary pattern in the prevention and treatment of hypertension.

Structural and Functional Arterial Parameters, Immunovirological Control and Vitamin D in HIV-Infected Patients

Objective: HIV-infected patients still experience higher Cardiovascular (CV) mortality rates, even if an adequate viral suppression is achieved. In addition, vitamin D insufficiency, a common condition in HIV-infected patients, is increasingly associated with CV risk. We therefore aim to investigate relationships between immunological parameters, antiretroviral therapy, plasma vitamin D and arterial parameters, including aortic stiffness and wave reflections, in HIV-infected patients who achieved viral suppression but possibly remain at increased CV risk. Methods: We conducted a cross-sectional study including 178 middle-aged HIV-infected patients. HIV infection was controlled in a large number of participants, representative of a real-world setting. In addition to carotid Intima Media Thickness (IMT), central hemodynamic parameters involved aortic Pulse Wave Velocity (PWV), carotid Augmentation index (AIx) and Pulse Pressure Amplification (PPA) measured noninvasively using applanation tonometry. Results: Aortic PWV was slightly but unsignificantly higher than the theoretical values obtained in general population according to age and blood pressure, and was independent of HIV-related parameters. In univariate and multivariate analyses, carotid AIx was positively correlated with current CD4 T-cell count and PPA was positively correlated with vitamin D, independently of other confounders. No HIV-related parameters or vitamin D entered the multivariate analysis of carotid IMT / plaque. Conclusion: In our chronically treated population, HIV infection was not associated with increased aortic stiffness but with a positive correlation between current CD4 T-cell count and degree of AIx, suggesting that patients with higher CD4 T-cell count may have higher wave reflections. The positive correlation between vitamin D and PPA suggests that vitamin D deficiency may be independently associated with altered central hemodynamics in well controlled HIV-infected patients. These findings should be confirmed in prospective studies.

Cross-Sectional and longitudinal associations of objectively-measured physical activity on blood pressure: evaluation in 37 countries

Background: We examined the cross-sectional and longitudinal associations of objectively-measured physical activity (step counts) and blood pressure (BP) among adults spanning 37 countries. Methods: Across 37 countries, we used data from a pool of 9238 adult owners of Withings’ Pulse activity trackers, which measures steps taken each day, and Wireless Blood Pressure Monitor, which measures BP. Analyses were adjusted on age, sex, number of days where the tracker was worn, and number of BP measurements. Data was collected from 2009 to 2013. Results: Subjects had a mean ± standard deviation (SD) age of 51.6 ± 11.3 years and a body mass index (BMI) of 28.7±5.5 kg/m2. A 1-month increase of more than 3000 steps per day was associated with a decrease of systolic BP (SBP) and diastolic BP (DBP) among the obese (1.57mm Hg and 1.29 mm Hg respectively, both P<0.001) and the overweight population (0.79 mm Hg and 0.84 mm Hg respectively, both P≤0.001), but not in the normal weight population (P=0.60 and P=0.36 respectively). Conclusion: One-month increases in daily step counts was associated with a decrease of SBP and DBP in a large obese and overweight free living population.

Compliance with Nutritional and Lifestyle Recommendations in 13,000 Patients with a Cardiometabolic Disease from the Nutrinet-Santé Study

Background: A healthy diet has been shown to prevent cardiovascular diseases complications. The objective of this study was to assess dietary intakes and compliance with nutritional and lifestyle recommendations in French adults diagnosed with hypertension, diabetes, dyslipidaemia or cardiovascular disease compared with healthy individuals. Methods: Data was collected from 26,570 subjects aged 35 to 70 years (13,285 patients and 13,285 controls matched by sex and age) of the French cohort NutriNet-Santé. Dietary intakes were assessed using three 24-h records. Mean food and nutrient intakes of patients were compared to those of healthy subjects using multivariable mixed logistic and linear regressions. Results: Compared to healthy controls, adults reporting cardiometabolic diseases had lower intakes of sweetened products, higher intakes of fish and seafood and a better compliance with dairy products. However, overall, they reported unhealthier lifestyles and dietary habits. Indeed, they were less often physically active and had similar habits regarding alcohol and tobacco consumption. They also had lower intakes of fruit, higher intakes of meat, processed meat and added fats. It is noteworthy that diabetic subjects tended to show the highest compliance with certain dietary recommendations (vegetables, pulses and whole grain products). Conclusion: Our study brings into focus the fact that some nutritional aspects still need to be improved among individuals with a cardiometabolic disease. We should encourage higher intakes of fruits and vegetables, whole grain products, and lower intakes of meat and sodium, as well as healthy lifestyle (physical activity, no-smoking and limited intake of alcohol) in order to encourage a healthier management after being diagnosed.

How Healthy Lifestyle Factors at Midlife Relate to Healthy Aging

With increasing life expectancies worldwide, it is an important public health issue to identify factors that influence the quality of aging. We aimed to investigate the individual and combined roles of lifestyle factors at midlife for healthy aging (HA). We analyzed data from 2203 participants of the French ”Supplémentation en Vitamines et Minéraux Antioxydants” (SU.VI.MAX) cohort aged 45–60 years at baseline (1994–1995), and assessed the combined impact of lifestyle factors (weight, smoking status, physical activity, alcohol consumption, and diet) on HA (absence of chronic diseases and function-limiting pain, good physical and cognitive functioning, functional independence, no depressive symptoms, and good social and self-perceived health) with a five-component healthy lifestyle index (HLI). Relative risks (RR) and 95% confidence intervals (CIs) were estimated using a robust-error-variance Poisson regression. Approximately 39% of our sample aged healthily. After adjustment for potential confounders, a one-point increase in HLI was related to an 11% higher probability of HA (95% CI = 6%, 16%; p < 0.001). The proportions of HA attributable to specific factors based on the “population attributable risk” concept were 7.6%, 6.0%, 7.8%, and 16.5% for body mass index (BMI), physical activity, diet quality, and smoking status, respectively. This study highlights the importance of healthy lifestyle habits at midlife for the promotion of good overall health during aging.

Reflections on the Medical Treatment of Socially Vulnerable Patients: The Paris Hotel-Dieu Experience

In 1998, through the law on combating exclusion of specific persons, the French government focused on socially vulnerable individuals. A section on medical treatment for them recommended that systems called Permanences d’Accès aux Soins de Santé (PASS–health care access service) be set up, which are designed to provide easier, sometimes even free access to health care, even while patients are awaiting permanent health insurance coverage. In 2003, a report ordered by the Hospital and Health Care Organization Directorate counted close to 370 such services. The PASS services are spread out over the entire country, and are to be largely found in mediumand large-sized urban areas (Fabre et al. 2003). In 2011, 70 new measures were created to focus on psychiatric and oral health issues in these centres. Since the beginning of the Paris Hôtel-Dieu, it has been committed to treating socially disadvantaged individuals. It was founded around 660 A.D. by St. Landry, under the reign of Dagobert’s son, Clovis II, and the bishop used his own funds to host the ailing, as well as beggars and simple pilgrims. Its motto, ‘‘Medicus et Hospes (doctor and hospice)’’, speaks well about this mission focused on medical care and hospitality.

Protéine C réactive, homocystéine et risque cardiovasculaire

La recente etude Interheart a apporte des informations scientifiques importantes en ce qui concerne les facteurs favorisants la survenue d’un infarctus du myocarde, notamment l’importance, en matiere de prediction, des facteurs socio-economiques et psycho-comportementaux [1]. Dans cette etude, la prise en consideration des facteurs de risque cardiovasculaire classiques et moins classiques explique plus de 90 % de la variance de survenue des infarctus du myocarde. Cette information est capitale puisque, jusqu’a present, on estimait que les facteurs de risque cardiovasculaire conventionnels (diabete, hypertension arterielle, tabagisme et hypercholesterolemie) expliquaient environ la moitie de la variance de la survenue des infarctus du myocarde. Ces resultats sont a verifier, l’etude Interheart etant une etude cas-temoins retrospective. En pratique clinique quotidienne, des patients ayant tous les facteurs de risque pour un evenement morbide restent cependant sains. D’autres presentent des evenements illegitimes, a savoir des evenements survenant chez des patients n’ayant pas les facteurs de risque traditionnels. D’autres facteurs de risque cardiovasculaire, notamment coronariens, tel l’hyperhomocysteinemie ou l’augmentation de la CRP, sont fortement associes a la survenue d’evenements cardiaques morbides et ne sont pas pris en compte par les echelles de risque traditionnelles (Framingham, SCORE) [2, 3].