Sandrine Péneau

Evidence that the prevalence of childhood overweight is plateauing: data from nine countries

Until quite recently, there has been a widespread belief in the popular media and scientific literature that the prevalence of childhood obesity is rapidly increasing. However, high quality evidence has emerged from several countries suggesting that the rise in the prevalence has slowed appreciably, or even plateaued. This review brings together such data from nine countries (Australia, China, England, France, Netherlands, New Zealand, Sweden, Switzerland and USA), with data from 467,294 children aged 2-19 years. The mean unweighted rate of change in prevalence of overweight and obesity was +0.00 (0.49)% per year across all age ×sex groups and all countries between 1995 and 2008. For overweight alone, the figure was +0.01 (0.56)%, and for obesity alone -0.01 (0.24)%. Rates of change differed by sex, age, socioeconomic status and ethnicity. While the prevalence of overweight and obesity appears to be stabilizing at different levels in different countries, it remains high, and a significant public health issue. Possible reasons for the apparent flattening are hypothesised.

Prevalence of overweight in 6- to 15-year-old children in central/western France from 1996 to 2006: Trends toward stabilization

Objective:The prevalence of overweight in children has markedly increased over the past few decades in France, as in all Western countries. We sought to describe the yearly prevalence of childhood overweight from 1996 to 2006 and to assess whether a shift in trends could be observed dating from the time the Nutrition and Health National Program (PNNS) was set up in France in 2001, in particular according to gender, age and family economic status.Design:We used annual overweight prevalence of standardized 6- to 15-year-old populations (total=26 600) with weight and height measured at health examination centers in the central/western part of France between 1996 and 2006. Regression slopes of overweight prevalence were evaluated between 1996 and 2006, and specifically between 1996 and 2001, and 2001 and 2006. The annual prevalence and estimated slopes were compared in subgroups, taking into account gender, age and economic status of the family.Results:The prevalence increased between 1996 (11.5%) and 1998 (14.8%) and was stable between 1998 and 2006 (15.2%). According to linear regression, the overall trend in prevalence of overweight children between 1996 and 2006 was stable (slope=0.19, P=0.08). Similarly, the prevalence of overweight increased between 1996 and 1998 in boys and girls, in 6–10 year olds, in 11–15 year olds and in non-disadvantaged children, and remained stable thereafter. The prevalence of overweight in the disadvantaged group increased between 1996 (12.8%) and 2001 (18.9%) (slope=1.16, P=0.004) and was stable between 2001 and 2006 (18.2%) (slope=0.09, P=0.78).Conclusion:The results of this study reveal a stable prevalence of overweight since 1998 in most groups studied, and since 2001 in the disadvantaged group.

Validity of Web-Based Self-Reported Weight and Height: Results of the Nutrinet-Santé Study

Background With the growing scientific appeal of e-epidemiology, concerns arise regarding validity and reliability of Web-based self-reported data. Objective The objectives of the present study were to assess the validity of Web-based self-reported weight, height, and resulting body mass index (BMI) compared with standardized clinical measurements and to evaluate the concordance between Web-based self-reported anthropometrics and face-to-face declarations. Methods A total of 2513 participants of the NutriNet-Santé study in France completed a Web-based anthropometric questionnaire 3 days before a clinical examination (validation sample) of whom 815 participants also responded to a face-to-face anthropometric interview (concordance sample). Several indicators were computed to compare data: paired t test of the difference, intraclass correlation coefficient (ICC), and Bland–Altman limits of agreement for weight, height, and BMI as continuous variables; and kappa statistics and percent agreement for validity, sensitivity, and specificity of BMI categories (normal, overweight, obese). Results Compared with clinical data, validity was high with ICC ranging from 0.94 for height to 0.99 for weight. BMI classification was correct in 93% of cases; kappa was 0.89. Of 2513 participants, 23.5% were classified overweight (BMI≥25) with Web-based self-report vs 25.7% with measured data, leading to a sensitivity of 88% and a specificity of 99%. For obesity, 9.1% vs 10.7% were classified obese (BMI≥30), respectively, leading to sensitivity and specificity of 83% and 100%. However, the Web-based self-report exhibited slight underreporting of weight and overreporting of height leading to significant underreporting of BMI (P<.05) for both men and women: –0.32 kg/m2 (SD 0.66) and –0.34 kg/m2 (SD 1.67), respectively. Mean BMI underreporting was –0.16, –0.36, and –0.63 kg/m2 in the normal, overweight, and obese categories, respectively. Almost perfect agreement (ie, concordance) was observed between Web-based and face-to-face report (ICC ranged from 0.96 to 1.00, classification agreement was 98.5%, and kappa 0.97). Conclusions Web-based self-reported weight and height data from the NutriNet-Santé study can be considered as valid enough to be used when studying associations of nutritional factors with anthropometrics and health outcomes. Although self-reported anthropometrics are inherently prone to biases, the magnitude of such biases can be considered comparable to face-to-face interview. Web-based self-reported data appear to be an accurate and useful tool to assess anthropometric data.

Sociodemographic Factors and Attitudes toward Food Affordability and Health Are Associated with Fruit and Vegetable Consumption in a Low-Income French Population

Determinants of fruit and vegetable consumption, including affordability and attitudes, have been poorly investigated, especially in European deprived populations. Our objective was to analyze various determinants of low consumption of fruits and vegetables in disadvantaged participants. Our participants were randomized into 2 groups, 1 which received nutritional advice alone and 1 that also received vouchers that were exchangeable for fruits and vegetables during a 12-mo period. Socioeconomic characteristics, food insufficiency, affordability, and motivation for eating fruits and vegetables were assessed. A short FFQ was administered. Determinants of consumption of <1 fruit or vegetable/d were analyzed using multivariate logistic regression. A total of 295 participants were included (mean age 44.8 y; 133 men, 162 women). At baseline, mean daily consumption of fruits and vegetables was 2.13 +/- 1.57 times/d. Nearly 30% of the sample did not eat fruits and vegetables every day. Determinants of low fruit and vegetable consumption were: age younger than 55 y, education level lower than tertiary, and absence of financial means for buying fruits and vegetables daily. Other determinants were affordability (whether fruits and vegetables are affordable, lack of money in preventing healthy diet) and attitudes (whether ones own diet is healthy, whether or not fruits and vegetables improve health, whether eating fruits and vegetables is a pleasure). Thus, determinants of inadequate consumption of fruits and vegetables in this deprived French population are numerous. The impact of financial difficulties is crucial, as is the perception of affordability of fruits and vegetables.

Dietary patterns and their sociodemographic and behavioural correlates in French middle-aged adults from the SU.VI.MAX cohort.

Background/Objectives:Few studies have investigated dietary patterns among French adults. We aimed to identify dietary patterns and their relation with nutrient intakes, sociodemographic, lifestyle and other health indicators in a large population of middle-aged subjects living in France.Subjects/Methods:Dietary patterns were identified using factor analysis in 5194 women and men aged 45–60 years enrolled in the SU.VI.MAX (Supplémentation en Vitamines et Minéraux Antioxydants) study. Dietary data were based on repeated 24-h dietary records (at least six records during 2 years).Results:Four patterns were identified: (1) ‘alcohol and meat products’; (2) ‘prudent diet’; (3) ‘convenience foods’; and (4) ‘starch, sauces, and vegetables’. The first pattern was positively associated with low education, smoking and overweight in both genders, as well as with abdominal obesity in women and treated hyperlipidaemia and/or hypertension in men. The second pattern was positively correlated with high education and being older than 55 years and negatively correlated with current smoking. This pattern was also associated with overweight and low waist circumference in women and with hyperlipidaemia treatment in men. The third pattern was inversely related to age and positively related to higher education in both genders. In men, higher scores were related to living alone and an urban residence. The fourth pattern was associated with high education and an urban residence in men only.Conclusions:Our study identified four dietary patterns in this population of French middle-aged adults. Associations with sociodemographic, behavioural and health-related factors were found to differ according to dietary patterns. Sex-specific relationships were also found.

Profiles of organic food consumers in a large sample of French adults: results from the Nutrinet-Santé cohort study.

Background Lifestyle, dietary patterns and nutritional status of organic food consumers have rarely been described, while interest for a sustainable diet is markedly increasing. Methods Consumer attitude and frequency of use of 18 organic products were assessed in 54,311 adult participants in the Nutrinet-Santé cohort. Cluster analysis was performed to identify behaviors associated with organic product consumption. Socio-demographic characteristics, food consumption and nutrient intake across clusters are provided. Cross-sectional association with overweight/obesity was estimated using polytomous logistic regression. Results Five clusters were identified: 3 clusters of non-consumers whose reasons differed, occasional (OCOP, 51%) and regular (RCOP, 14%) organic product consumers. RCOP were more highly educated and physically active than other clusters. They also exhibited dietary patterns that included more plant foods and less sweet and alcoholic beverages, processed meat or milk. Their nutrient intake profiles (fatty acids, most minerals and vitamins, fibers) were healthier and they more closely adhered to dietary guidelines. In multivariate models (after accounting for confounders, including level of adherence to nutritional guidelines), compared to those not interested in organic products, RCOP participants showed a markedly lower probability of overweight (excluding obesity) (25≤body mass index<30) and obesity (body mass index ≥30): −36% and −62% in men and −42% and −48% in women, respectively (P<0.0001). OCOP participants (%) generally showed intermediate figures. Conclusions Regular consumers of organic products, a sizeable group in our sample, exhibit specific socio-demographic characteristics, and an overall healthy profile which should be accounted for in further studies analyzing organic food intake and health markers.

Associations between dietary patterns and arterial stiffness, carotid artery intima-media thickness and atherosclerosis:

Background Few studies have examined the association between global diet, assessed through dietary patterns, and arterial structure and function. The aim of this study was to investigate the relationship between carotid-femoral pulsewave velocity (PWV), common carotid-arteries intima-media thickness (CCA-IMT) and plaques with dietary patterns measured 7.5 years earlier. Design A prospective cohort study between diet and markers of structure and function of large arteries. Methods Dietary patterns (linear combination of food consumption) were identified using principal component analysis among 1026 middle-aged participants in the SUpplémentation en VItamines et Minéraux AntioXydants (SU.VI.MAX) vascular substudy. Dietary data were based on repeated 24-h dietary records (at least three records during 2 years) obtained at inclusion. Carotid-femoral PWV was used to assess aortic stiffness. Carotid ultrasound examination included measurements of CCA-IMT and carotid plaques. Results Four dietary patterns were identified. In multivariate models, a significant positive association was observed between PWV and a dietary pattern positively correlated with meat and alcohol consumption and negatively correlated with fibers, vitamins B9 and C, β-carotene and calcium consumption. Adjusted PWV mean across tertiles of this pattern score was 11.15,11.26 and 11.58m/s in the first, second and third tertiles, respectively (P for trend = 0.03). Others dietary patterns were not associated with PWV and we detected no association between dietary patterns and IMT or plaques. Conclusion This study suggests that a nutritionally poor dietary pattern, characterized by a high meat and alcohol consumption and low micronutrients intake, is related to an increased stiffening of large arteries.

Fruit and vegetable intake and cognitive function in the SU.VI.MAX 2 prospective study

BACKGROUND Current hypotheses suggest that intake of fruit and vegetables (FVs) protects against age-related cognitive impairment. OBJECTIVE We examined the 13-y association between FV intake and cognitive performance in a sample of French adults. DESIGN A total of 2533 subjects aged 45-60 y at baseline, who were part of the Supplementation with Antioxidant Vitamins and Minerals 2 (SU.VI.MAX 2) cohort, were selected. FV intake was estimated at baseline in participants who had completed at least six 24-h dietary records. Cognitive performance was assessed 13 y after baseline and included an evaluation of verbal memory (RI-48 cued recall, semantic, and phonemic fluency tests) and executive function (trail-making and forward and backward digit span tests). Principal components analysis was performed to account for correlations in test scores. The relation between cognitive performance and quartiles of FV intake was assessed by multivariate linear regression analyses. RESULTS Intakes of FVs (P-trend = 0.02), fruit alone (P-trend = 0.04), vitamin C-rich FVs (P-trend = 0.03), vitamin C (P-trend = 0.005), and vitamin E (P-trend = 0.04) were positively associated with verbal memory scores. In contrast, intakes of FVs (P-trend = 0.006), vegetables alone (P-trend = 0.03), and β-carotene-rich FVs (P-trend = 0.02) were negatively associated with executive functioning scores. CONCLUSIONS FVs might have a differential effect on cognition according to groups of FVs and type of cognitive function. Further research using sensitive and reliable measures of various types of cognitive function is needed to clarify the effect of individual FV groups and nutrients. This trial is registered at clinicaltrials.gov as NCT00272428.

Association of nutrition in early life with body fat and serum leptin at adult age.

Background:There is overwhelming evidence that experiences during early life could have long-term health consequences. However, the role of early nutrition in programming obesity and leptin resistance is still poorly understood.Objective:We aimed at determining whether nutritional intakes in early life are associated with body composition and hormonal status at 20 years.Subjects:Healthy infants participating in the two-decade-long prospective ELANCE (Etude Longitudinale Alimentation Nutrition Croissance des Enfants) study were examined at 10 months and 2 years. At 20 years, weight, height, subscapular and triceps skinfold thicknesses, fat mass (FM) and fat-free mass (FFM) assessed via bioelectrical impedance analysis, and serum leptin concentration were recorded in 73 subjects still participating in the follow-up.Results:In adjusted linear regression models, an increase by 100 kcal in energy intake at 2 years was associated with higher subscapular skinfold thickness (β=6.4% SF, 95% confidence interval 2.53–10.30, P=0.002) and higher FFM (0.50 kg, 0.06–0.95, P=0.03) at 20 years. An increase by 1% energy from fat at 2 years was associated with lower subscapular skinfold thickness (−2.3% SF, −4.41 to −0.18, P=0.03), lower FM (−0.31 kg, −0.60 to −0.01, P=0.04) and lower serum leptin concentration (−0.21 μg l−1, −0.39 to −0.03, P=0.02) at 20 years.Conclusions:Low-fat intake in early life was negatively associated with body fat (particularly at the trunk site) and serum leptin concentration at 20 years, suggesting that early low-fat intake could increase the susceptibility to develop overweight and leptin resistance at later ages. These findings substantiate current recommendations against restricting fat intake in early life and open new directions for investigating the origin of obesity.

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.