Publications by authors named "Serge Hercberg"

551 Publications

Key Findings of the French BioNutriNet Project on Organic Food-Based Diets: Description, Determinants, and Relationships to Health and the Environment.

Adv Nutr 2021 Oct 18. Epub 2021 Oct 18.

Sorbonne Paris Nord University, National Institute of Health and Medical Research (INSERM), National Research Institute for Agriculture, Food, and the Environment (INRAE), National Conservatory of Arts and Crafts (CNAM), Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center-University of Paris (CRESS), Bobigny, France.

Few studies have investigated the relationships between organic food consumption, dietary patterns, monetary diet cost, health, and the environment. To address these issues, a consortium of French epidemiologists, nutritionists, economists, and toxicologists launched the BioNutriNet project in 2013. In 2014, an FFQ documented the usual organic and nonorganic (conventional) food consumption of approximately 35,000 NutriNet-Santé participants. Then, individual organic and conventional food intakes were merged with price, environmental, and pesticide residue data sets, which distinguished between conventional and organic farming methods. Many studies were conducted to characterize organic consumers and their environmental impacts (i.e., greenhouse gas emissions, energy demand, and land use) and organic food consumption impacts on health. We observed that organic consumers had diets that were healthier and richer in plant-based food than nonorganic consumers. Their diets were associated with higher monetary costs, lower environmental impacts, and reduced exposure to certain pesticide residues. Regular consumption of organic food was associated with reduced risks of obesity, type 2 diabetes, postmenopausal breast cancer, and lymphoma. Although several observations have been confirmed by several studies conducted in other countries, our results should be replicated in other cultural settings and coupled with experimental studies to be able to draw causal conclusions. Finally, the main finding of the BioNutriNet project is that while organic food consumption could be associated with positive externalities on human health and the environment, organic-based diets should be accompanied by dietary shifts toward plant-based diets to allow for better planetary and human health.
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http://dx.doi.org/10.1093/advances/nmab105DOI Listing
October 2021

Exposure to food additive mixtures in 106,000 French adults from the NutriNet-Santé cohort.

Sci Rep 2021 Oct 4;11(1):19680. Epub 2021 Oct 4.

Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University of Paris (CRESS), SMBH, Paris 13, 74 rue Marcel Cachin, 93017, Bobigny, Cedex, France.

Food additives (e.g. artificial sweeteners, emulsifiers, dyes, etc.) are ingested by billions of individuals daily. Some concerning results, mainly derived from animal and/or cell-based experimental studies, have recently emerged suggesting potential detrimental effects of several widely consumed additives. Profiles of additive exposure as well as the potential long-term impact of multiple exposure on human health are poorly documented. This work aimed to estimate the usual intake of food additives among participants of the French NutriNet-Santé cohort and to identify and describe profiles of exposure (single substances and mixtures). Overall, 106,489 adults from the French NutriNet-Santé cohort study (2009-ongoing) were included. Consumption of 90 main food additives was evaluated using repeated 24 h dietary records including information on brands of commercial products. Qualitative information (as presence/absence) of each additive in food products was determined using 3 large-scale composition databases (OQALI, Open Food Facts, GNPD), accounting for the date of consumption of the product. Quantitative ingested doses were estimated using a combination of laboratory assays on food matrixes (n = 2677) and data from EFSA and JECFA. Exposure was estimated in mg per kg of body weight per day. Profiles of exposure to food additive mixtures were extracted using Non-negative Matrix Factorization (NMF) followed by k-means clustering as well as Graphical Lasso. Sociodemographic and dietary comparison of clusters of participants was performed by Chi-square tests or linear regressions. Data were weighted according to the national census. Forty-eight additives were consumed by more than 10% of the participants, with modified starches and citric acid consumed by more than 90%. The top 50 also included several food additives for which potential adverse health effects have been suggested by recent experimental studies: lecithins (86.6% consumers), mono- and diglycerides of fatty acids (78.1%), carrageenan (77.5%), sodium nitrite (73.9%), di-, tri- and polyphosphates (70.1%), potassium sorbate (65.8%), potassium metabisulphite (44.8%), acesulfame K (34.0%), cochineal (33.9%), potassium nitrate (31.6%), sulfite ammonia caramel (28.8%), bixin (19.5%), monosodium glutamate (15.1%) and sucralose (13.5%). We identified and described five clusters of participants more specifically exposed to five distinct additive mixtures and one additional cluster gathering participants with overall low additive exposure. Food additives, including several for which health concerns are currently debated, were widely consumed in this population-based study. Furthermore, main mixtures of additives were identified. Their health impact and potential cocktail effects should be explored in future epidemiological and experimental studies.
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http://dx.doi.org/10.1038/s41598-021-98496-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8490357PMC
October 2021

Is FOP Nutrition Label Nutri-Score Well Understood by Consumers When Comparing the Nutritional Quality of Added Fats, and Does It Negatively Impact the Image of Olive Oil?

Foods 2021 Sep 17;10(9). Epub 2021 Sep 17.

Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center-University of Paris (CRESS), 93017 Bobigny, France.

It has been suggested that the current ranking of olive oil by Nutri-Score (C) is not in line with its nutritional quality and could have a negative impact on the sales and consumption of olive oil, especially compared to other added fats with lower nutritional qualities One of the objectives of this study is to investigate consumers' understanding of Nutri-Score when comparing the nutritional quality of added fats, and to test whether or not Nutri-Score has a negative impact on the image and the choice of olive oil in a sample of Spanish consumers. A cross-sectional study of 486 Spanish adults (mean age ± SD: 45.8 ± 14.0 years; 48.6% women) was conducted. Subjects were recruited through a web panel provider to participate in an online questionnaire. Almost 80% of participants declared that Nutri-Score was useful for recognizing the differences in nutritional quality between the eight added fats presented in the study; 89.1% rightly identified that olive oil was among the added fats with the best nutritional quality (vs. 4.1% for rapeseed oil (Nutri-Score C), and less than 3% for other added fats (Nutri-Score D or E)). When asked about which added fat they would buy more frequently, 86.2% of participants selected olive oil. Then, after being reminded that among added fats, the Nutri-Score C given to olive oil was the best grade, a majority of participants declared that they would keep consuming olive oil as much as before (71.4%). Finally, almost 78% of participants thought that Nutri-Score should be displayed on olive oil. In conclusion, the results of our study suggest that displaying Nutri-Score on olive oil was well accepted and understood by a large majority of participants who appeared to accept the current ranking of the Nutri-Score for olive oil (Nutri-Score C).
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http://dx.doi.org/10.3390/foods10092209DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8467858PMC
September 2021

Dietary macronutrient intake according to sex and trait anxiety level among non-diabetic adults: a cross-sectional study.

Nutr J 2021 09 8;20(1):78. Epub 2021 Sep 8.

Nutritional Epidemiology Research Group (EREN), Sorbonne Paris Nord University, INSERM U1153/INRAE U1125/CNAM, Epidemiology and Statistics Research Center (CRESS) - University of Paris, 74 Rue Marcel Cachin, 93017, Bobigny, France.

Background: Studies suggest that anxiety is correlated with eating behavior, however, little is known about the association between anxiety status as predictor of dietary macronutrient intake. The aim of the present study was to investigate the sex-stratified cross-sectional associations of trait anxiety with intake of various macronutrients in a large population-based sample of non-diabetic adults.

Methods: N = 20,231 participants (mean age = 53.7 ± 13.6 years) of the NutriNet-Santé web-cohort, who had completed the trait anxiety subscale of the Spielberger State-Trait Anxiety Inventory (T-STAI; 2013-2016) were included in the analyses. Dietary intake was calculated from at least 3 self-administered 24-h dietary records. The associations of interest were assessed by multiple linear regression stratified by sex, owing to significant interaction tests.

Results: In total, 74.3% (n = 15,033) of the sample were females who had a significantly higher mean T-STAI score than did males (39.0 versus 34.8; p < 0.01). Among females, the fully-adjusted analyses showed significant positive associations of T-STAI with total carbohydrate intake (β = 0.04; p < 0.04), complex carbohydrate intake (β = 0.05; p < 0.02), and percentage energy from carbohydrates (β = 0.01; p < 0.03), as well as a significant inverse association of T-STAI with percentage energy from fat (β = -0.01; p < 0.05). As regards males, the only significant finding was an inverse association between T-STAI and percent of the mean daily energy from protein (fully-adjusted model: β = -0.01; p = 0.05).

Conclusion: This cross-sectional study found modest sex-specific associations between anxiety status and macronutrient intake among French non-diabetic adults. Prospective studies are needed to further elucidate the observed associations.
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http://dx.doi.org/10.1186/s12937-021-00733-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8424616PMC
September 2021

Glycaemic index, glycaemic load and cancer risk: results from the prospective NutriNet-Santé cohort.

Int J Epidemiol 2021 Sep 7. Epub 2021 Sep 7.

Sorbonne Paris Nord University, Inserm U1153, INRAE U1125, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center-University of Paris (CRESS), Bobigny, France.

Background: Evidence is accumulating that high dietary glycaemic index (GI) and glycaemic load (GL) are potential risk factors for several metabolic disorders (e.g. type-2 diabetes, cardiovascular diseases), but remains limited concerning cancer risk. Although, mechanistic data suggest that consuming high-GI foods may contribute to carcinogenesis through elevated blood glucose levels, insulin resistance or obesity-related mechanisms. Our objective was to study the associations between dietary GI/GL and cancer.

Methods: In total, 103 020 French adults (median age = 40.2 years) from the NutriNet-Santé cohort (2009-2020) with no cancer or diabetes at baseline were included (705 137 person-years, median follow-up time = 7.7 years). Repeated 24-h dietary records linked with a detailed food-composition table (>3500 food/beverage items). We computed the average dietary GI and GL at the individual level. Associations between GI, GL, contribution of low- and medium/high-GI foods to energy and carbohydrate intake and cancer risk (overall, breast, prostate and colorectal) were assessed using multivariable Cox proportional-hazard models.

Results: Higher dietary GL was associated with higher overall cancer risk [n = 3131 cases, hazard ratios (HRs) for sex-specific quintile 5 vs 1 = 1.25, 95% confidence interval (CI) = 1.03-1.52; Ptrend = 0.008] and specifically postmenopausal breast cancer (n = 924, HRQ5vs.Q1 = 1.64, 95% CI = 1.06-2.55; Ptrend = 0.03). A higher contribution of low-GI food/beverages to energy intake was associated with lower cancer risk whereas a higher contribution of medium/high-GI items to energy intake was positively associated with higher risk of overall, breast and postmenopausal breast cancers (Ptrend ≤ 0.02).

Conclusions: These results support a possible impact of GI/GL on cancer risk. If confirmed in other populations and settings, dietary GI/GL could be considered as modifiable risk factors for primary cancer prevention.

Trial Registration: https://clinicaltrials.gov/ct2/show/NCT03335644.
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http://dx.doi.org/10.1093/ije/dyab169DOI Listing
September 2021

The Nutri-Score nutrition label.

Int J Vitam Nutr Res 2021 Jul 27. Epub 2021 Jul 27.

Complete list of authors are presented in the Electronic Supplementary Material (ESM) 1.

Nutri-Score is a front-of-pack nutrition label with summary graded colour-coding, which aims to inform consumers, in a simple and understandable way, of the overall nutritional value of foods, in order to help them to make healthier choices at the point of purchase and to encourage manufacturers to improve the nutritional quality of their products. It is based on a five-colour scale (from dark green to dark orange) associated with letters, from A to E, to optimize logo accessibility and understanding by the consumer. Nutri-Score does not merely characterize foods as "healthy" or "unhealthy". Rather, the graded logo provides semi-quantitative information, depending on the colour/ letter, of the relative overall nutritional composition of a food product compared to other similar products as to whether it is more or less favourable to health. Nutri-Score is the only proposed labelling scheme that adheres entirely to the concepts and processes that were published by the World Health Organisation (WHO) Europe concerning the validation studies that are required to select and evaluate a front-of-pack nutrition label. The aim of the present paper is to present the scientific basis for the design of the Nutri-Score and to summarize the various studies to validate its calculation method and its graphic format. We explore its effectiveness and superiority compared to other labelling schemes that have been implemented in other countries or supported by pressure groups. The necessity for objective, impartial consideration of how best to use Nutri-Score and avoid misunderstandings is highlighted.
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http://dx.doi.org/10.1024/0300-9831/a000722DOI Listing
July 2021

Self-reported periodontal health and incident hypertension: longitudinal evidence from the NutriNet-Santé e-cohort.

J Hypertens 2021 Jul 13. Epub 2021 Jul 13.

Department of Periodontology, U.F.R. d'Odontologie-Garanciere, Université de Paris, Paris and Rothschild Hospital (AP-HP), Paris Inserm, Population-based Epidemiologic Cohorts Unit, UMS 011, Villejuif INSERM U970, Pharmacology Department, Georges Pompidou European Hospital, Paris Sorbonne Paris Nord University/Inserm/Inrae/Cnam, Nutritional Epidemiology Research Group (EREN), Epidemiology and Statistics Research Center - University of Paris (CRESS) Public Health Department, Paris Seine-Saint-Denis Hospitals (AP-HP), Bobigny EA 2496, U.F.R. d'Odontologie-Montrouge, Université de Paris, Paris, France.

Objective: An association between periodontitis and arterial hypertension has been suggested recently. This study aimed at investigating the hypothesis that periodontal health is linked to incident arterial hypertension.

Methods: We analyzed data from the French population-based e-cohort NutriNet-Santé, selecting participants who had completed two oral health questionnaires in 2011-2012. Pregnant women, participants with diabetes, cancer, arterial hypertension and cardiovascular diseases at inclusion were excluded. Incident cases of arterial hypertension were self-reported and/or based on the use of antihypertensive therapy. Periodontal health was evaluated by estimating the modified and validated PEriodontal Screening Score (mPESS), with mPESS at least 5 corresponding to a high probability of severe periodontitis. Descriptive statistics and Cox proportional hazards regression models, taking into account sociodemographic and lifestyle confounders, were used.

Results: The study population consisted of 32 285 participants (mean age: 45.79 ± 13.87 years); 78.5% were women. Two thousand one hundred and sixteen incident cases of arterial hypertension were identified during a median follow-up of 8 years (April 2012--December 2019). In the fully adjusted model, an mPESS at least 5 [hazard ratio: 1.84; 95% confidence interval (CI): 1.66-2.03] and the presence of nonreplaced missing teeth (hazard ratio: 1.13; 95% CI: 1.03-1.23) were significantly associated with a greater risk of incident arterial hypertension, whereas a regular annual visit to the dentist was associated with a lower risk (hazard ratio: 0.88; 95% CI: 0.80-0.97).

Conclusion: Self-reported assessed periodontitis was associated with incident arterial hypertension over an 8-year period. The present results highlight the importance of considering periodontal health when assessing an individual's risk of arterial hypertension.

Trial Registration: # NCT03335644.
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http://dx.doi.org/10.1097/HJH.0000000000002941DOI Listing
July 2021

Are recent dietary changes observed in the NutriNet-Santé participants healthier and more sustainable?

Eur J Nutr 2021 Jul 6. Epub 2021 Jul 6.

Nutritional Epidemiology Research Team (EREN), Sorbonne Paris Nord University, INSERM, INRAE, CNAM, Epidemiology and Statistics Research Center, University of Paris (CRESS), 93017, Bobigny, France.

Purpose: While intensive modern food systems have significant unfavourable impacts on health and the environment, new sustainable food consumption trends have been emerging in recent years. This study identified recent dietary trends over a 4-year period in terms of overall dietary patterns and organic foods consumption and associated socio-demographic determinants.

Methods: Food intakes were assessed among 18,108 participants of the NutriNet-Santé cohort in 2014 and 2018. A food frequency questionnaire was used to estimate organic and conventional food consumption. Change in food consumption, quality of the diet (assessed by the adherence to the French national guidelines), plant-based diet using published scores, organic food intake were evaluated in regard with various socio-demographic factors. The paired student t test to compare dietary intake and the Kruskal-Walllis test to consider socio-demographic characteristics were used.

Results: Consumption of meat and processed meat decreased respectively by 5.09 g/day (SD 51.15) and 1.12 g/day (SD 26.05). The average total consumption of organic products increased by 12% (+ 93 g/day) while consumption of organic fish and seafood (- 1.4 g/day), poultry (- 1 g/day), processed meat (- 0.3 g/day) and meat (- 3.3 g/day) decreased. The dietary towards healthier diets was more pronounced in certain population subgroups. For example, females, young individuals and postgraduate participants were more likely to increase their consumption of healthful plant and animal-based foods, organic foods and to improve the overall nutritional quality of their diets during the follow-up period than their counterparts.

Conclusion: Our results indicate a slight inflexion towards healthier and plant-based diets over a 4-year period at least in some segments of the population. A decrease in the consumption of animal products and an increase in the consumption of healthful plant-based foods and organic foods suggests a potential trend towards more sustainable diets among certain subgroups. The environmental impacts of these changes need to be assessed in further works as well as the way to sustain and improve them, in particular those who do not initiate sustainable transition.
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http://dx.doi.org/10.1007/s00394-021-02631-yDOI Listing
July 2021

FODMAP Consumption by Adults from the French Population-Based NutriNet-Santé Cohort.

J Nutr 2021 Oct;151(10):3180-3186

Equipe de recherche en épidémiologie nutritionnelle (EREN), Université Sorbonne Paris Nord, INSERM U1153, INRAE U1125, CRESS, Bobigny, France.

Background: Fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) are increasingly studied because they are suspected unfavorably to impact health (irritable bowel syndrome in particular). However, little is known about FODMAP intake in the general population, or which groups are more likely to consume them, because their intakes are usually assessed in inpatient settings.

Objectives: This study aimed to describe FODMAP consumption in a large French cohort and its association with sociodemographic and lifestyle characteristics.

Methods: This cross-sectional study described FODMAP intakes in 109,362 volunteers (78.0% female, mean age 43.8 ± 14.7 y) from the French NutriNet-Santé cohort, using an ad hoc FODMAP composition table. Associations between FODMAP intakes and sociodemographic characteristics were investigated using χ2 tests or Kruskal-Wallis tests according to the qualitative or quantitative status of the variable, and multinomial logistic regressions were performed after adjusting for energy intake in sensitivity analyses. Eligible participants had completed ≥3 detailed 24-h food records.

Results: We observed a mean intake of 18.9 ± 9.5 g/d FODMAPs in this French cohort, and 11.7% of participants had intakes <9 g/d (i.e., low-FODMAP diets). Participants with FODMAP intakes <9 g/d were more likely to have lower caloric intakes (Δ = 383 kcal/d compared with participants with FODMAP intakes ≥16 g/d), to be smokers, to have lower incomes, and to have lower levels of physical activity. Total FODMAPs accounted for a mean intake of 18.9 ± 9.5 g/d, which was 3.7 ± 2.0% of total energy intake. The highest intake of FODMAPs was represented by lactose followed by excess fructose, fructans, polyols, and galacto-oligo-saccharides.

Conclusions: FODMAP consumption by a large sample of adults from the general population is ∼19 g/d, with half of the population having a FODMAP intake >16 g/d.This trial was registered at www.clinicaltrials.gov as NCT03335644.
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http://dx.doi.org/10.1093/jn/nxab207DOI Listing
October 2021

Trends in breastfeeding practices and mothers' experience in the French NutriNet-Santé cohort.

Int Breastfeed J 2021 07 2;16(1):50. Epub 2021 Jul 2.

Sorbonne Paris Nord University, Inserm, Inrae, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center - University of Paris (CRESS), SMBH-74 rue Marcel Cachin, 93017, Bobigny, France.

Background: France has one of the lowest rates in the world regarding breastfeeding initiation and duration. Few studies have explored breastfeeding practices in France since the middle of the twentieth century, or following from initiation to cessation. The purpose of our study was to determine trends in breastfeeding over the past decades regarding public health recommendations, and to examine mothers' perceptions about factors known to have an impact on breastfeeding support and cessation.

Methods: From the NutriNet-Santé cohort, 29,953 parous women (launched in 2009 to study relation between nutrition and health), were included in the present study. Using web-questionnaires, they were asked retrospectively if they had breastfed their youngest child or not, and if so, the duration of exclusive and total breastfeeding. For those who had breastfed, we investigated their perceptions about support at initiation and during the entire breastfeeding period and reasons for breastfeeding cessation. We also asked those who did not breastfeed about their perceptions and reasons for infant formula feeding their youngest child. Analyses were weighted according to the French census data.

Results: In the NutriNet-Santé cohort, 67.3% of mothers breastfed their youngest child. The proportion of breastfed children increased over the past few decades, from 55.0% (95% CI 54.3, 55.6) in the 1970s to 82.9% (82.4, 83.4) in the 2010s. Total and exclusive breastfeeding duration went from 3.3 months and 2.4 months respectively in the 1970s to 5.9 months and 3.2 months respectively in the 2010s. Most mothers felt supported at initiation and during the breastfeeding period. A reported desire to have breastfed longer than two months was 59.5%. Mothers who did not breastfeed did it by choice (64.3%). They did not feel guilty (78.2%) and did not perceive a problem not to breastfeed (58.8%), but almost half of them would have liked to have breastfed (45.9%).

Conclusion: Breastfeeding duration has increased in the past decades but did not reach the public health recommendations threshold. Targets other than mothers have to be considered for breastfeeding education, like the partner and her environment, to increase breastfeeding practices.

Trial Registration: The study was registered at ClinicalTrials.gov ( NCT03335644 ).
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http://dx.doi.org/10.1186/s13006-021-00397-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8254215PMC
July 2021

Public health potential of guidelines-based dietary scores for non-communicable diseases mortality prevention: simulation study using the Preventable Risk Integrated ModEl (PRIME) model.

Public Health Nutr 2021 Jul 2:1-11. Epub 2021 Jul 2.

Sorbonne Paris Nord (Paris 13) University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University of Paris (CRESS), SMBH Paris 13, 74 Rue Marcel Cachin, F-93017 Bobigny, France.

Objective: Dietary indexes measure the adherence of individuals to a set of nutritional recommendations. However, the health gains associated with adherence to various dietary indexes may vary. Our objective was to compare the magnitude of estimated avoided deaths by chronic diseases obtained by improving diet quality in the French population, measured by a variety of dietary indexes.

Design: Simulation study based on observational data.

Setting: Weighted data from a French population-based cohort study.

Participants: In participants from the NutriNet-Santé cohort, we computed dietary scores reflecting the adherence to various recommendations (Medi-Lite, Healthy Diet Indicator (HDI), Programme National Nutrition Santé/National Nutrition and Health Program - Guidelines Score, Diet Quality Index (DQI), Alternative Healthy Eating Index (AHEI) and the modified Food Standards Agency nutrient profiling system dietary index (FSAm-NPS DI)). Quintiles of the food groups' consumption and dietary intakes were used as input in a simulation model (Preventable Risk Integrated ModEl (PRIME)), yielding the number of delayed or avoided deaths in nutrition-related non-communicable diseases, comparing between very high or very low nutritional quality of the diet and medium nutritional quality.

Results: A modification of dietary intakes from medium quality to very low quality (i.e. from the middle quintile to the quintile with the lowest nutritional quality) was associated with an increased number of deaths ranging from 3485 (95 % uncertainty interval (CI) 4002, 2987) for HDI and 3379 (95 % CI 3881, 2894) for FSAm-NPS DI to 838 (95 % CI 1163, 523) for Medi-Lite. Conversely, a modification of dietary intakes from medium quality to very high quality was associated with a decrease in the number of deaths ranging from 1995 (95 % CI 1676, 2299) for Probability of Adequate Nutrient intake diet, 1986 (95 % CI 1565, 2361) for DQI-International, 1931 (95 % CI 1499, 2316) for FSAm-NPS DI and 858 (95 % CI 499, 1205) for HDI.

Conclusions: Our results provide some insights as the potential impact of following various dietary guidelines to reduce mortality from nutrition-related diseases.
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http://dx.doi.org/10.1017/S1368980021002871DOI Listing
July 2021

Plasma Metabolomics for Discovery of Early Metabolic Markers of Prostate Cancer Based on Ultra-High-Performance Liquid Chromatography-High Resolution Mass Spectrometry.

Cancers (Basel) 2021 Jun 23;13(13). Epub 2021 Jun 23.

Sorbonne Paris Nord University, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center Inserm U1153, Inrae U1125, Cnam, University of Paris (CRESS), 74 Rue Marcel Cachin, CEDEX, 93017 Bobigny, France.

Background: The prevention and early screening of PCa is highly dependent on the identification of new biomarkers. In this study, we investigated whether plasma metabolic profiles from healthy males provide novel early biomarkers associated with future risk of PCa.

Methods: Using the (SU.VI.MAX) cohort, we identified plasma samples collected from 146 PCa cases up to 13 years prior to diagnosis and 272 matched controls. Plasma metabolic profiles were characterized using ultra-high-performance liquid chromatography-high resolution mass spectrometry (UHPLC-HRMS).

Results: Orthogonal partial least squares discriminant analysis (OPLS-DA) discriminated PCa cases from controls, with a median area under the receiver operating characteristic curve (AU-ROC) of 0.92 using a 1000-time repeated random sub-sampling validation. Sparse Partial Least Squares Discriminant Analysis (sPLS-DA) identified the top 10 most important metabolites ( < 0.001) discriminating PCa cases from controls. Among them, phosphate, ethyl oleate, eicosadienoic acid were higher in individuals that developed PCa than in the controls during the follow-up. In contrast, 2-hydroxyadenine, sphinganine, L-glutamic acid, serotonin, 7-keto cholesterol, tiglyl carnitine, and sphingosine were lower.

Conclusion: Our results support the dysregulation of amino acids and sphingolipid metabolism during the development of PCa. After validation in an independent cohort, these signatures may promote the development of new prevention and screening strategies to identify males at future risk of PCa.
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http://dx.doi.org/10.3390/cancers13133140DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8268247PMC
June 2021

[Nutri-Score: the results 3 years after its official adoption In France].

Rev Prat 2021 Feb;71(2):151-154

Université Sorbonne Paris-Nord. Équipe de recherche en épidémiologie nutritionnelle U1153 (Institut national de la santé et de la recherche médicale/Institut national de la recherche en agriculture, alimentation et environnement/Cnam/université Sorbonne Paris-Nord), Bobigny, France. Unité de nutrition et santé publique, département de santé publique, hôpital Avicenne, Bobigny, France.

"Nutri-score : results 3 years after its official adoption in franc Since its adoption 3 years ago, we have witnessed a strong dynamic of Nutri-Score both in France and in several European countries. Scientific work demonstrating its effectiveness has accumulated. More and more manufacturers and retailers are committed to displaying the Nutri-Score on their products, which is the subject of strong consumer support. A battle against powerful lobbies is underway at the level of the European Commission for it to be chosen in 2022 as the harmonised and mandatory nutritional logo for Europe. But right now, healthcare professionals, especially medical doctors, can use this tool as part of the nutritional care of their patients to help them improve the nutritional quality of their food choices at the point of purchase."
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February 2021

Halving food-related greenhouse gas emissions can be achieved by redistributing meat consumption: Progressive optimization results of the NutriNet-Santé cohort.

Sci Total Environ 2021 Oct 24;789:147901. Epub 2021 May 24.

Solagro, 75, Voie TOEC, CS 27608, F-31076 Toulouse Cedex 3, France.

Background: Diet-related greenhouse gas emissions (GHGe) mainly comes from animal-sourced foods. As progressive changes are more acceptable for a sustainable food transition, we aimed to identify nutritionally adequate and culturally acceptable optimized diets ensuring a gradual reduction in GHGe, using observed diet from a large sample of French adults, while considering the mode of food production (organic vs conventional farming) and the co-production link between milk and beef.

Material And Method: Based on the consumption of 257 organic and conventional foods among 29,413 participants (75% women, age: 53.5 ± 14.0y) of the NutriNet-Santé study, we modelled optimal diets according to GHGe reduction scenarios in 5% steps, from 0 to 50% with nutritional, acceptability, and coproduct constraints, for men, premenopausal and menopausal women separately.

Results: Gradual GHGe decrease under these constraints led to optimal diets with an overall decrease in animal foods, with marked reductions in dairy products (up to -83%), together with a stable but largely redistributed meat consumption in favor of poultry (up to +182%) and pork (up to +46%) and at the expense of ruminant meat (down to -92%). Amounts of legumes increases dramatically (up to +238%). The greater the reduction in diet-related GHGe, the lower the cumulative energy demand (about -25%) and land use (about -43%). The proportion of organic food increased from ~30% in the observed diets to ~70% in the optimized diets.

Conclusion: Our results suggest that meeting both nutrient reference value and environmental objectives of up to 50% GHGe reduction requires the reduction of animal foods together with important substitutions between animal food groups, which result in drastic reductions in beef and dairy products. Further research is required to explore alignment with long-term health value and conflict with acceptability, in particular for even greater GHGe reductions.
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http://dx.doi.org/10.1016/j.scitotenv.2021.147901DOI Listing
October 2021

Prospective association between adherence to the 2017 French dietary guidelines and risk of death, CVD and cancer in the NutriNet-Santé cohort.

Br J Nutr 2021 May 21:1-11. Epub 2021 May 21.

Sorbonne Paris Nord University, Inserm, INRAE, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University of Paris (CRESS), Bobigny93017, France.

Non-communicable diseases, such as cancers and CVD, represent a major public health concern, and diet is an important factor in their development. French dietary recommendations were updated in 2017, and an adherence score, the Programme National Nutrition Santé Guidelines Score (PNNS-GS2), has been developed and validated using a standardised procedure. The present study aimed to analyse the prospective association between PNNS-GS2 and the risk of death, cancer and CVD. Our sample consisted of French adults included in the prospective NutriNet-Santé cohort (n 67 748, 75 634 and 80 269 for the risk of death, cancer and CVD, respectively). PNNS-GS2 (range: -∞ to 14·25) was calculated from the 24-h dietary records of the first 2 years of monitoring. Association between PNNS-GS2 (in quintiles, Q) and the risk of death, cancer and CVD was studied using Cox models adjusted for the main confounding factors. The sample included 78 % of women, aged on average 44·4 years (sd 14·6) with on average 6·6 (sd 2·3) dietary records. Average PNNS-GS2 was 1·5 (sd 3·4) and median follow-up was 6·6 years for cancers and 6·2 years for CVD and deaths. PNNS-GS2 was significantly associated with the risk of death (hazard ratio (HR)Q5vsQ1: 0·77 (95 % CI 0·60, 1·00), 828 cases), cancer (HRQ5vsQ1 = 0·80 (95 % CI 0·69, 0·92), 2577 cases) and CVD (HRQ5vsQ1 0·64 (95 % CI 0·51, 0·81), 964 cases). More specifically, PNNS-GS2 was significantly associated with colorectal and breast cancer risks but not prostate cancer risk. Our results suggest that strong adherence to the 2017 French dietary recommendations is associated with a lower risk of death, cancer or CVD. This reinforces the validity of these new recommendations and will help to promote their dissemination.
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http://dx.doi.org/10.1017/S0007114521001367DOI Listing
May 2021

Are foods 'healthy' or 'healthier'? Front-of-pack labelling and the concept of healthiness applied to foods.

Br J Nutr 2021 May 5:1-5. Epub 2021 May 5.

Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University of Paris (CRESS), Bobigny, France.

While food-based dietary guidelines have been widely disseminated for decades to improve nutritional knowledge in the population about healthy diets, more recent interventions such as front-of-pack labelling have made the differences between the two approaches apparent. While food-based dietary guidelines provide the overarching framework and benchmarks for a healthy diet, based on the current knowledge of the associations between various dietary components and health outcomes, front-of-pack labelling provides guidance to select a specific food, either within a food group or among similar foods belonging to various brands. Labelling foods as 'healthy' or 'unhealthy' raises multiple questions on the criteria used to define the terms and the implications of assigning an absolute healthiness value to an individual food in the context of complex diets. Gradual systems may provide more relative assessments and avoid dichotomisation. The present article presents the inherent differences and the complementarity of food-based dietary guidelines and food choice guidance in the context of food labelling.
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http://dx.doi.org/10.1017/S0007114521001458DOI Listing
May 2021

A Comparison of Sugar Intake between Individuals with High and Low Trait Anxiety: Results from the NutriNet-Santé Study.

Nutrients 2021 Apr 30;13(5). Epub 2021 Apr 30.

Nutritional Epidemiology Research Group (EREN), Sorbonne Paris Nord University, INSERM U1153/INRAE U1125/CNAM, Epidemiology and Statistics Research Centre (CRESS)-University of Paris, 93017 Bobigny, France.

(1) Background: Dietary carbohydrates are likely correlated with mental health in general, and with anxiety in particular. Our aim was to investigate the cross-sectional relationship between trait anxiety and carbohydrate (especially sugar) intake in a large sample derived from the general French population. (2) Methods: The analyses included 20231 non-diabetic adults enrolled in the NutriNet-Santé e-cohort, who had completed the trait anxiety subscale of the Spielberger State-Trait Anxiety Inventory (T-STAI, 2013-2016) and who were subsequently divided into high and low trait anxiety groups (T-STAI cut-off of 40 points). Sugar-rich food and macronutrient intake was calculated from ≥3 self-administered 24-h dietary records. The association between trait anxiety and carbohydrate intake was evaluated by ANCOVA according to age category (<45 and ≥45 years). (3) Results: In the full sample, 7942 (39,3%) individuals fell into the high trait anxiety category. They were more likely to be women (82,2% versus 69,2%; < 0,0001) and younger (mean age 51,6 versus 55,1 years; < 0,0001) compared to the low trait anxiety group. In fully-adjusted models, high-anxiety individuals aged under 45 years had significantly higher mean consumption of added simple sugars (43,9 versus 42,3 g/d; < 0,0007), whereas those aged over 45 years with high trait anxiety had significantly lower mean consumption of fruit (214,0 versus 219,5 g/d; < 0,02) compared to their low-anxiety counterparts. (4) Conclusion: This cross-sectional study revealed modest age-specific associations between anxiety status and sugar intake among adults. Prospective studies with representative samples are needed to explore potential bi-directionality of the observed associations.
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http://dx.doi.org/10.3390/nu13051526DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8147234PMC
April 2021

Consumption of dairy products and CVD risk: results from the French prospective cohort NutriNet-Santé.

Br J Nutr 2021 Apr 29:1-11. Epub 2021 Apr 29.

Sorbonne Paris Nord University, Inserm, INRAE, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center, University of Paris (CRESS), 93017 Bobigny, Bobigny, France.

In France, dairy products contribute to dietary saturated fat intake, of which reduced consumption is often recommended for CVD prevention. Epidemiological evidence on the association between dairy consumption and CVD risk remains unclear, suggesting either null or inverse associations. This study aimed to investigate the associations between dairy consumption (overall and specific foods) and CVD risk in a large cohort of French adults. This prospective analysis included participants aged ≥18 years from the NutriNet-Santé cohort (2009-2019). Daily dietary intakes were collected using 24-h dietary records. Total dairy, milk, cheese, yogurts, fermented and reduced-fat dairy intakes were investigated. CVD cases (n 1952) included cerebrovascular disease (n 878 cases) and CHD (n 1219 cases). Multivariable Cox models were performed to investigate associations. This analysis included 104 805 French adults (mean age at baseline 42·8 (sd 14·6) years, mean follow-up 5·5 (sd 3·0) years, i.e. 579 155 person-years). There were no significant associations between dairy intakes and total CVD or CHD risks. However, the consumption of at least 160 g/d of fermented dairy (e.g. cheese and yogurts) was associated with a reduced risk of cerebrovascular diseases compared with intakes below 57 g/d (hazard ratio = 0·81 (95 % CI 0·66, 0·98), Ptrend = 0·01). Despite being a major dietary source of saturated fats, dairy consumption was not associated with CVD or CHD risks in this study. However, fermented dairy was associated with a lower cerebrovascular disease risk. Robust randomised controlled trials are needed to further assess the impact of consuming different dairy foods on CVD risk and potential underlying mechanisms.
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http://dx.doi.org/10.1017/S0007114521001422DOI Listing
April 2021

Estimated dietary exposure to pesticide residues based on organic and conventional data in omnivores, pesco-vegetarians, vegetarians and vegans.

Food Chem Toxicol 2021 Jul 20;153:112179. Epub 2021 May 20.

Sorbonne Paris North University, Inserm, Inrae, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre, University of Paris (CRESS), Bobigny, France.

Purpose: To examine dietary exposure to 25 pesticide residues in several diet groups including omnivores, pesco-vegetarians, vegetarians and vegans while accounting for the farming system (organic or conventional) of plant-based foods consumed.

Methods: Organic and conventional consumption data in combination with data on pesticide residues in plant-based foods were used to derive estimated dietary exposure to pesticide residues. Pesticide residue exposure was estimated based on observed data, and using two scenarios simulated for 100%-conventional and 100%-organic diets in 33,018 omnivores, 555 pesco-vegetarians, 501 vegetarians and 368 vegans from the NutriNet-Santé study. Pesticide residue exposure across groups was compared using Kruskal-Wallis tests.

Results: Exposure levels varied across diet groups depending on the pesticide studied. The highest exposure was observed for imazalil in all groups. Vegetarians appeared to be less exposed to the studied pesticides overall. Compared to omnivores - apart from pesticides authorised in organic farming - vegetarians had lowest exposure. The 100%-conventional scenario led to a sharp increase in exposure to pesticide residues, except for pesticides allowed in organic farming and conversely for the 100%-organic scenario.

Conclusions: Despite their high plant-based product consumption, vegetarians were less exposed to synthetic pesticides than omnivores, due to their greater propensity to consume organic.
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http://dx.doi.org/10.1016/j.fct.2021.112179DOI Listing
July 2021

Clinical Prediction of Iron Deficiency at Age 2 Years: A National Cross-sectional Study in France.

J Pediatr 2021 Aug 6;235:212-219. Epub 2021 Apr 6.

Center of Research in Epidemiology and Statistics, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, INSERM UMR 1153, Université de Paris, Paris, France; Department of General Pediatrics and Pediatric Infectious Diseases, Necker Sick Children Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France.

Objective: To assess the diagnostic accuracy of existing clinical criteria and to develop prediction tools for iron deficiency in 2-year-old children.

Study Design: In a national cross-sectional study conducted in primary care pediatricians' practices throughout France, 2-year-old children were consecutively included (2016-2017). Multivariable logistic regression modeling and bootstrapping were used to develop several clinical models to predict iron deficiency (serum ferritin <12 μg/L). These models used the best criteria and combinations among the American Academy of Pediatrics' (AAP) criteria adapted to the European context (n = 10), then all potential predictors (n = 19). One model was then simplified into a simple prediction tool.

Results: Among 568 included infants, 38 had iron deficiency (6.7%). In univariable analyses, no significant association with iron deficiency was observed for 8 of the 10 adapted AAP criteria. Three criteria (both parents born outside the European Union, low weight at 1 year old, and weaning to cow's milk without supplemental iron) were retained in the AAP model, which area under the receiver operating characteristic curve, sensitivity, and specificity were 0.62 (95% CI, 0.58-0.67), 30% (95% CI, 22%-39%), and 95% (95% CI, 92%-97%), respectively. Four criteria were retained in a newly derived simple prediction tool (≥1 criterion among the 3 previous plus duration of iron-rich formula consumption <12 months), which area under the receiver operating characteristic curve, sensitivity, and specificity were 0.72 (95% CI, 0.65-0.79), 63% (95% CI, 47%-80%), and 81% (95% CI, 70%-91%), respectively.

Conclusions: All prediction tools achieved acceptable diagnostic accuracy. The newly derived simple prediction tool offered potential ease of use.

Trial Registration: ClinicalTrials.gov NCT02484274.
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http://dx.doi.org/10.1016/j.jpeds.2021.03.072DOI Listing
August 2021

International evidence for the effectiveness of the front-of-package nutrition label called Nutri-Score.

Cent Eur J Public Health 2021 Mar;29(1):76-79

Nutritional Epidemiology Research Group, Sorbonne Paris Nord University, Bobigny, France.

Objectives: Front-of-package nutrition labels are intended to easily convey to consumers comprehensible information about the nutritional composition of pre-packaged food and are thus a tool in the combat against the growing prevalence of nutrition-related disorders, such as obesity, type 2 diabetes, cardiovascular disease, and some types of cancer. The objective of the present narrative review was first to describe Nutri-Score and then to synthesize some of the international scientific evidence for its effectiveness. Guided by scientific data and collective expertise, France formally adopted labelling of pre-packaged food with the 5-colour Nutri-Score label in October 2017 and that move was later followed by Belgium, Spain, Germany, Switzerland, the Netherlands, and Luxembourg.

Methods: This article synthesizes evidence from several countries regarding the effectiveness of Nutri-Score and the associated individual-level diet quality index in terms of attitude/behaviour- and health-related outcomes. It also addresses criticism levied at the label.

Results: The effectiveness of Nutri-Score has been demonstrated in terms of consumer ability to correctly classify food according to its nutritional quality, the nutritional quality of actual and intended food purchases, and portion size choices. In addition, consumption of foods that are less favourably rated on the Nutri-Score scale has been prospectively associated with chronic disease risk (cancer, cardiovascular disease, metabolic syndrome, etc.).

Conclusion: The adoption and implementation of a uniform front-of-package label such as the scientifically validated Nutri-Score on pre-packaged foods/beverages across Europe could be beneficial to consumers at the point of purchase and could help reduce the incidence of diet-related chronic diseases by means of improvement in diet quality.
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http://dx.doi.org/10.21101/cejph.a6239DOI Listing
March 2021

Relation between Mood and the Host-Microbiome Co-Metabolite 3-Indoxylsulfate: Results from the Observational Prospective NutriNet-Santé Study.

Microorganisms 2021 Mar 31;9(4). Epub 2021 Mar 31.

Micalis Institute, INRAE, AgroParisTech, Université Paris-Saclay, 78350 Jouy-en-Josas, France.

Gut microbiota metabolizes tryptophan into indole, which can influence brain and behavior. Indeed, some oxidized derivatives of indole, formed in the liver, have neuroactive properties, and indole overproduction by the gut microbiota induces an anxio-depressive phenotype in rodents. The aim of this study was to investigate in humans whether there was a relationship between recurrent depressive symptoms and indole production by the gut microbiota. A case-control study was conducted in 45-65-year-old women, who were participants in the observational prospective NutriNet-Santé Study. Cases were defined as having two Center for Epidemiological Studies-Depression Scales (CES-D) scores ≥ 23 at a two-year interval (recurrent depressive symptoms, = 87). Each case was matched with two controls (two CES-D <23; = 174). Urinary excretion of 3-indoxylsulfate, the major final metabolite of indole, was used as a biomarker of indole production by the gut microbiota. Conditional logistic regression models for paired data showed a positive association between urinary 3-indoxylsulfate concentrations, grouped in tertiles, and recurrent depressive symptoms (odds ratio = 2.46, for trend = 0.0264 in the final model adjusted for confounding factors). This association suggested that indole production by the gut microbiota may play a role in the onset of mood disorders in humans.
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http://dx.doi.org/10.3390/microorganisms9040716DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8065611PMC
March 2021

The inflammatory potential of the diet is prospectively associated with subjective hearing loss.

Eur J Nutr 2021 Oct 18;60(7):3669-3678. Epub 2021 Mar 18.

Sorbonne Paris Nord University/INSERM/INRAE/CNAM, Nutritional Epidemiology Research Group (EREN), Epidemiology and Statistics Research Center, University of Paris, 74 rue Marcel Cachin, 93017, Bobigny, France.

Purpose: We investigated the association between the inflammatory potential of the diet and hearing loss in the context of aging.

Methods: We studied 3435 French adults enrolled in the SU.VI.MAX 2 (2007-2009) cohort. The inflammatory potential of the diet was estimated by the Dietary Inflammatory Index (DII) using ≥ 3 baseline 24-h dietary records. Subjective hearing loss was assessed after a mean of 12.5 ± 0.7 years by 3 individual items (ability to carry a conversation in a noisy setting, frequently asking for repetition, and need to increase the television/radio volume) and by a composite score, dichotomized for analyses. We fit sex-specific multivariable logistic regression models.

Results: Compared with males, females had higher DII scores (i.e., more pro-inflammatory diet) and less subjective hearing loss. Among males, a significant positive association between DII (continuous scale) and inability to carry a conversation in a noisy setting was found (OR = 1.10; 95% CI 1.02, 1.18), while the opposite was seen among females (OR = 0.92; 95% CI 0.87, 0.98). Regarding the need to turn up the television/radio volume, a significant positive association with DII (continuous scale) was found only among males (OR = 1.09; 95% CI 1.01, 1.18). A significant association with the subjective hearing loss composite score was found among females (OR = 0.74; 95% CI 0.57, 0.97).

Conclusion: The findings among males supported the hypothesis that a pro-inflammatory diet could increase risk of hearing loss, whereas the findings among females were unexpected. This study could provide impetus for future research in sensory disability and aging.

Trial Registration: www.clinicaltrials.gov # NCT00272428.
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http://dx.doi.org/10.1007/s00394-021-02531-1DOI Listing
October 2021

The impact of the Nutri-Score front-of-pack nutrition label on purchasing intentions of unprocessed and processed foods: post-hoc analyses from three randomized controlled trials.

Int J Behav Nutr Phys Act 2021 03 17;18(1):38. Epub 2021 Mar 17.

Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center - University of Paris (CRESS), SMBH Paris 13, 74 rue Marcel Cachin, F-93017, Bobigny Cedex, France.

Background: The Nutri-Score summary graded front-of-pack nutrition label has been identified as an efficient tool to increase the nutritional quality of pre-packed food purchases. However, no study has been conducted to investigate the effect of the Nutri-Score on the shopping cart composition, considering the type of foods. The present paper aims to investigate the effect of the Nutri-Score on the type of food purchases, in terms of the relative contribution of unpacked and pre-packed foods, or the processing degree of foods.

Methods: Between September 2016 and April 2017, three consecutive randomized controlled trials were conducted in three specific populations - students (N = 1866), low-income individuals (N = 336) and subjects suffering from cardiometabolic diseases (N = 1180) - to investigate the effect of the Nutri-Score on purchasing intentions compared to the Reference Intakes and no label. Using these combined data, the proportion of unpacked products in the shopping carts, as well as the distribution of products across food categories taking into account the degree of processing (NOVA classification) were assessed by trials arm.

Results: The shopping carts of participants simulating purchases with the Nutri-Score affixed on pre-packed foods contained higher proportion of unpacked products - especially raw fruits and meats, i.e. with no FoPL -, compared to participants purchasing with no label (difference of 5.93 percentage points [3.88-7.99], p-value< 0.0001) or with the Reference Intakes (difference of 5.27[3.25-7.29], p-value< 0.0001). This higher proportion was partly explained by fewer purchases of pre-packed processed and ultra-processed products overall in the Nutri-Score group.

Conclusions: These findings provide new insights on the positive effect of the Nutri-Score, which appears to decrease purchases in processed products resulting in higher proportions of unprocessed and unpacked foods, in line with public health recommendations.
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http://dx.doi.org/10.1186/s12966-021-01108-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7968175PMC
March 2021

Prospective association between dietary pesticide exposure profiles and postmenopausal breast-cancer risk in the NutriNet-Santé cohort.

Int J Epidemiol 2021 08;50(4):1184-1198

Sorbonne Paris Nord University, INSERM, INRAE, CNAM, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center-University of Paris (CRESS), 93017, Bobigny, France.

Background: Some pesticides, used in large quantities in current agricultural practices all over Europe, are suspected of adverse effects on human reproductive health (breast and prostate cancers), through mechanisms of endocrine disruption and possible carcinogenic properties, as observed in agricultural settings. However, evidence on dietary pesticide exposure and breast cancer (BC) is lacking for the general population. We aimed to assess the associations between dietary exposure to pesticides and BC risk among postmenopausal women of the NutriNet-Santé cohort.

Methods: In 2014, participants completed a self-administered semi-quantitative food-frequency questionnaire distinguishing conventional and organic foods. Exposures to 25 active substances used in EU plant-protection products were estimated using a pesticide-residue database accounting for farming practices, from Chemisches und Veterinäruntersuchungsamt Stuttgart, Germany. Non-negative matrix factorization (NMF), adapted for data with excess zeros, was used to establish exposure profiles. The four extracted NMF components' quintiles were introduced into Cox models estimating hazard ratio (HR) and 95% confidence interval (95% CI), adjusted for known confounding factors.

Results: A total of 13 149 postmenopausal women were included in the analysis (169 BC cases, median follow-up = 4.83 years). Negative associations between Component 3, reflecting low exposure to synthetic pesticides, and postmenopausal BC risk were found [HRQ5 = 0.57; 95% CI (0.34; 0.93), p-trend = 0.006]. Positive association between Component 1 score (highly correlated to chlorpyrifos, imazalil, malathion, thiabendazole) and postmenopausal BC risk was found specifically among overweight and obese women [HRQ5 = 4.13; 95% CI (1.50; 11.44), p-trend = 0.006]. No associations were detected for the other components.

Conclusion: These associations suggest a potential role of dietary pesticide exposure on BC risk. Further research is needed to investigate the mechanisms and confirm these results in other populations.
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http://dx.doi.org/10.1093/ije/dyab015DOI Listing
August 2021

NMR metabolomic profiles associated with long-term risk of prostate cancer.

Metabolomics 2021 03 11;17(3):32. Epub 2021 Mar 11.

Inserm U1153, Inrae U1125, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center - University of Paris (CRESS), Sorbonne Paris Nord University, SMBH Paris 13, 74 rue Marcel Cachin, 93017, Bobigny Cedex, France.

Introduction: Prostate cancer is a multifactorial disease whose aetiology is still not fully understood. Metabolomics, by measuring several hundred metabolites simultaneously, could enhance knowledge on the metabolic changes involved and the potential impact of external factors.

Objectives: The aim of the present study was to investigate whether pre-diagnostic plasma metabolomic profiles were associated with the risk of developing a prostate cancer within the following decade.

Methods: A prospective nested case-control study was set up among the 5141 men participant of the SU.VI.MAX cohort, including 171 prostate cancer cases, diagnosed between 1994 and 2007, and 171 matched controls. Nuclear magnetic resonance (NMR) metabolomic profiles were established from baseline plasma samples using NOESY1D and CPMG sequences. Multivariable conditional logistic regression models were computed for each individual NMR signal and for metabolomic patterns derived using principal component analysis.

Results: Men with higher fasting plasma levels of valine (odds ratio (OR) = 1.37 [1.07-1.76], p = .01), glutamine (OR = 1.30 [1.00-1.70], p = .047), creatine (OR = 1.37 [1.04-1.80], p = .02), albumin lysyl (OR = 1.48 [1.12-1.95], p = .006 and OR = 1.51 [1.13-2.02], p = .005), tyrosine (OR = 1.40 [1.06-1.85], p = .02), phenylalanine (OR = 1.39 [1.08-1.79], p = .01), histidine (OR = 1.46 [1.12-1.88], p = .004), 3-methylhistidine (OR = 1.37 [1.05-1.80], p = .02) and lower plasma level of urea (OR = .70 [.54-.92], p = .009) had a higher risk of developing a prostate cancer during the 13 years of follow-up.

Conclusions: This exploratory study highlighted associations between baseline plasma metabolomic profiles and long-term risk of developing prostate cancer. If replicated in independent cohort studies, such signatures may improve the identification of men at risk for prostate cancer well before diagnosis and the understanding of this disease.
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http://dx.doi.org/10.1007/s11306-021-01780-9DOI Listing
March 2021

Diet and physical activity during the coronavirus disease 2019 (COVID-19) lockdown (March-May 2020): results from the French NutriNet-Santé cohort study.

Am J Clin Nutr 2021 04;113(4):924-938

Sorbonne Paris Nord University, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement (INRAE), Conservatoire National des Arts et Métiers (CNAM), Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center-University of Paris (CRESS), Bobigny, France.

Background: Since December 2019, coronavirus disease 2019 (COVID-19) has been spreading steadily, resulting in overwhelmed health-care systems and numerous deaths worldwide. To counter these outcomes, many countries, including France, put in place strict lockdown measures, requiring the temporary closure of all but essential places and causing an unprecedented disruption of daily life.

Objectives: Our objective was to explore potential changes in dietary intake, physical activity, body weight, and food supply during the COVID-19 lockdown and how these differed according to individual characteristics.

Methods: The analyses included 37,252 adults from the French web-based NutriNet-Santé cohort who completed lockdown-specific questionnaires in April-May 2020. Nutrition-related changes and their sociodemographic, lifestyle, and health-status correlates were investigated using multivariable logistic regression models. Clusters of participants were defined using an ascending hierarchical classification of change profiles derived from multiple correspondence analyses.

Results: During the lockdown, trends of unfavorable changes were observed: decreased physical activity (reported by 53% of the participants), increased sedentary time (reported by 63%), increased snacking, decreased consumption of fresh food (especially fruit and fish), and increased consumption of sweets, cookies, and cakes. Yet, the opposite trends were also observed: increased home cooking (reported by 40%) and increased physical activity (reported by 19%). Additionally, 35% of the participants gained weight (mean weight gain in these individuals, 1.8 kg ± SD 1.3 kg) and 23% lost weight (2 kg ± SD 1.4 kg weight loss). All of these trends displayed associations with various individual characteristics.

Conclusions: These results suggest that nutrition-related changes occurred during the lockdown in both unfavorable and favorable directions. The observed unfavorable changes should be considered in the event of a future lockdown, and should also be monitored to prevent an increase in the nutrition-related burden of disease, should these diet/physical activity changes be maintained in the long run. Understanding the favorable changes may help extend them on a broader scale. This trial was registered at clinicaltrials.gov as NCT03335644.
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http://dx.doi.org/10.1093/ajcn/nqaa336DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7989637PMC
April 2021

Consumption of Ultra-Processed Food and Its Association with Sociodemographic Characteristics and Diet Quality in a Representative Sample of French Adults.

Nutrients 2021 Feb 20;13(2). Epub 2021 Feb 20.

Department of Preventive Medicine, School of Medicine, University of São Paulo (FMUSP), São Paulo 01246-903, Brazil.

The present study aims to describe ultra-processed food (UPF) consumption in a representative sample of French adults and to evaluate the association between UPF consumption and socioeconomic characteristics and nutritional profile of the diet. This is a cross-sectional study using food consumption data from the Étude Nationale Nutrition Santé (ENNS), conducted with 2642 participants (18-74 years old), between February 2006 and March 2007 in France. Dietary data were collected through three 24-h dietary recalls. All food and beverages were classified according to the NOVA classification. The energy contribution of NOVA food groups to total energy intake was presented by categories of sociodemographic characteristics. Linear and logistic regression models were used to estimate the association between the percentage of UPF in the diet with nutritional indicators. The mean daily energy consumption of the adult French population was 2111 kcal, of which 31.1% came from UPF. This percentage was higher among younger individuals, and in the urban area, and lower among individuals with incomplete high school and individuals who were retired. The consumption of UPF was positively associated with the dietary energy density and the dietary contents of total carbohydrates, free sugar, and total and saturated fat, as well as with inadequate dietary energy density, saturated fat, free sugar, and fiber intakes.
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http://dx.doi.org/10.3390/nu13020682DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7924346PMC
February 2021

Modelling the number of avoidable new cancer cases in France attributable to alcohol consumption by following official recommendations: a simulation study.

Addiction 2021 09 18;116(9):2316-2325. Epub 2021 Feb 18.

Nutritional Epidemiology Research Team, University of Paris, Sorbonne Paris Nord University, Bobigny, France.

Aims: To predict the effects of perfect adherence to the French alcohol consumption guidelines, a maximum of 10 standard alcoholic drinks per week with no more than two standard alcoholic drinks per day, during a 36-year period (2014-50).

Design: This simulation study is an adaption of the Sheffield Alcohol Policy Model. The dose-response relationship between alcohol consumption and alcohol-attributable cancer risks was defined by cancer site-specific risk functions, each modelled as a continuous risk. These estimates were used to compute the potential impact fraction (PIF) associated with alcohol consumption by cancer site.

Setting: The French general adult population during a 36-year period (2014-50).

Participants: For the baseline scenario, the current distribution of consumption levels, the counterfactual scenario and perfect adherence to the French alcohol consumption guidelines, we generated for each gender and age group 1000 randomly distributed alcohol consumption values from calibrated group-specific gamma distribution.

Measurements: The predicted number of new cancer cases among men and women in France between 2015 and 2050 that could have been prevented by following the French government's alcohol consumption guidelines.

Findings: The simulation predicted that perfect adherence to the French government's alcohol consumption guidelines would prevent, on average, an estimated 15 952 cancer cases per year after the PIF reached its full effect, which would have represented 4.5% of new cancer cases in 2015. The number of averted cancer cases over the study period were highest for oral cavity, oropharynx and hypopharynx cancer (respectively, 118 462, 95% CI = 113 803-123 022 and 11 167, 95% CI = 10 149-12 229] for men and women; liver and intrahepatic bile ducts cancer (123 447, 95% CI = 112 581-133 404 and 2825, 95% CI = 2208,4095); colorectal cancer (89 859, 95% CI = 84 651-95 355 and 12 847, 95% CI = 11 545-14 245); and female breast cancer (61 649, 95% CI = 56 330-67 452).

Conclusion: This simulation study of the French general population predicted that perfect adherence to the French government's alcohol consumption guidelines (no more than 10 standard alcoholic drinks per week and two per day) would prevent almost 16 000 cancer cases per year.
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http://dx.doi.org/10.1111/add.15426DOI Listing
September 2021

Randomised controlled trial in an experimental online supermarket testing the effects of front-of-pack nutrition labelling on food purchasing intentions in a low-income population.

BMJ Open 2021 02 8;11(2):e041196. Epub 2021 Feb 8.

Sorbonne Paris Nord University, Inserm, Inrae, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Centre -University of Paris (CRESS), Bobigny, France.

Background: The Nutri-Score, a front-of-pack nutrition label, has been adopted in 2017 in France but its impact on low-income populations is unknown, and they are more at risk of having unhealthy diets. The present study assessed the effects of the Nutri-Score on the nutritional quality of purchasing intentions among low-income individuals, compared with the current French labelling situation: references intakes (RIs) and no label, using a three-arm parallel-group randomised controlled trial.

Methods: Low-income active adults from the NutriNet-Santé cohort (household income below €1200/month) were asked to perform a shopping task in an experimental online supermarket after being randomised in one of the three conditions (Nutri-Score, RIs or no labelling). The main outcome was the overall nutritional quality of the virtual shopping cart, assessed with the French-modified Food Standards Agency Nutrient Profiling System (FSAm-NPS), and secondary outcomes were the nutrient content of the shopping carts. 524 subjects were randomised, and 336 included in the analyses.

Results: The Nutri-Score resulted in the highest overall nutritional quality of the shopping cart, as reflected by a FSAm-NPS score (1.86 (SD 3.59) points) significantly lower (reflecting higher nutritional quality) than the RIs (3.21 (SD 4.14) points, p≤0.05) but not significantly lower than no label (2.60 (SD 3.09) points, p=0.3). The Nutri-Score also resulted into significantly lower contents in calories and saturated fatty acids in the shopping cart, compared with the RIs only (p≤0.05).

Conclusion: The implementation of the front of pack nutrition label Nutri-Score, adopted in France and in different European countries, appears to have the potential to encourage purchasing intentions of foods from higher nutritional quality among low-income individuals, compared with the RIs label promoted by food manufacturers. NCT02769455.
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http://dx.doi.org/10.1136/bmjopen-2020-041196DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7871692PMC
February 2021
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