serum vitamin c (mg/dl) by salad intake

Serum Vitamin C (mg/dl) by Salad Intake

JOURNAL OFTHE AMERICAN DIETETICASSOCIATION

Malon A, et al. J Am Diet Assoc; 2010; Volume 110 (June).

Compliance with French Nutrition and Health Program recommendations is

strongly associated with socioeconomic characteristics in the

general adult populationAurelie Malon, Pharm.D: Unité de Surveillance et d’Epidémiologie Nutritionnelle (USEN)

Valerie Deschamps, Ph.D: USENBenoit Salanave, M.Sc: USENMichel Vernay, Ph.D: USEN

Emmanuelle Szego, M.Sc: USENCarla Estaquio, M.Sc: Unité de Recherche en Epidémiologie Nutritionnelle (UREN)

Emmanuelle Kesse-Guyot, Ph.D: URENSerge Hercberg, M.D, Ph.D: UREN, USEN

Katia Castetbon, Ph.D.: USENUSEN: Institut de veille sanitaire, Université Paris 13, Bobigny, France

UREN: Inserm U.557/Inra U.1125/Paris 13/Cnam, Bobigny, France


Compliance with French Nutrition and Health Program recommendations is strongly associated withsocioeconomic characteristics in the general adult population



Background

- Dietary behavior is related to demographic & socioeconomic factors

Healthier dietary habits appear in groups with higher socioeconomic status and education level

- Nutritional policies to prevent and reduce the risk of chronic diseases related to nutrition, implemented in various countries

In France: ‘Programme National Nutrition Santé’ (PNNS)

- Certain subgroups living in poor conditions may encounter greater difficulty in adhering to PNNS recommendations.

Their identification is useful to improve PNNS actions





Objectives

• To describe compliance with PNNS recommendations in the general population in France

• To investigate the relationship between social, economic and educational characteristics and poor compliance with French nutritional recommendations





MethodsThe French Nutrition and Health Survey (ENNS)

• National cross-sectional study with multistage stratified sampling scheme

• Recruitment conducted in mainland France from February 2006 to March 2007 to account for seasonality of diet

3,115 adults (18-74 years of age) participated in the survey





Methods: Data collection

• Socioeconomic and demographic data: face to face interviewsDate and country of birth, sex, marital status, household composition, occupation, educational level, holiday trip in the past 12 months

• Dietary behavior: 3 x 24h dietary telephone recalls collected by dietitiansAssessed food and beverage consumption during the previous day, from midnight to midnight; composition & quantities using pictures of portions

• Physical activity: face to face interviewsShort form of the International Physical Activity Questionnaire (IPAQ)

• Body weight and height: at home or at a health examination center, standardized measures by physicians, nurses or dietitians





MethodsThe PNNS Guideline Score (PNNS-GS)

• 13 components:

• Cut-offs from PNNS recommendations or external sources

• Raw scores range from -1 to 15

• Penalties applied to participants with Estimated Intakes (EI) 5% higher than their needs (estimated using basal metabolic rate and physical activity level)

• Foods (9)• Beverages (2)

• Salt (1)• Physical activity (1)





Programme National Nutrition Santé-Guideline Score (PNNS-GS): Components and scores according to French recommendations

Nutrient Recommendation Scoring criteriaa Score

Fruits and vegetables At least 5/d ≥0–3.5>≥3.5–5>≥5–7.5>≥7.5

00.512

Bread, cereals, potatoes and legumes

At each meal, according to appetite

≥0–1>≥1–3>≥3–6>≥6

00.510.5

- Whole grain food Choose whole grains and whole-grain breads products more often

≥0–1/3>≥1/3–2/3>≥2/3

00.51

Milk and dairy products (e.g., yogurt, cheese)

3/d(≥55 y: 3 to 4/d)

≥0–1>≥1–2.5>≥2.5–3.5≥ (≥55 y: ≥2.5–4.5≥)>3.5 (>55 y: >4.5)

00.510.5

Meat, poultry, seafood and eggs

1 to 2/d 0>0–1>≥1–2≥> 2

00.510

- Seafood At least twice/wk <2 servings/wk≥2 servings/wk

01

a Servings per day unless otherwise noted.b Established according to French recommended dietary allowances.c EI: energy intake without alcohol.d Pregnant women are advised to abstain from all alcohol consumption during the entire duration of their pregnancy.





Programme National Nutrition Santé-Guideline Score (PNNS-GS): Components and scores according to French recommendations (cont’d)

Nutrient Recommendation Scoring criteriaa Score

Added fatsb Limit consumption Lipids from added fats ≥16% EIc/dLipids from added fats <16% EI/d

01

- Type of added fats Favor vegetable-origin added fats No use of vegetable fats or ratio vegetable added fats / total added fats ≤0.5No use of added fats or ratio vegetable added fats / total added fats >0.5

01

Sweetened foodsb Limit consumption Simple sugars from sweetened foods ≥17.5% EI/dSimple sugars from sweetened foods ≥12.5–17.5> % EI/dSimple sugars from sweetened foods <12.5% EI/d

-0.501

Beverages- Non-alcoholic beveragesb

Drink water as desiredLimit sweetened beverages: no more than one glass/d

<1 L water and >250 mL soda≥1 L water and >250 mL soda<1 L water and ≤250 mL soda≥1 L water and ≤250 mL soda

00.50.751

- Alcohol Do not exceed 2 glasses of wine/d for womend and 3 glasses of wine/d for men

Alcohol >20g/d for women, >30g/d for menAlcohol ≤20g/d for women, ≤30g/d for menAbstainers

00.81

Saltb Limit consumption >12g/d>10-12≥ g/d>8–10≥ g/d>6–8≥ g/d≤6g/d

-0.500.511.5

Physical activity At least 30 min of brisk walking or equivalent/d ≥0–30> minutes/d≥30–60> minutes/d≥ 60 minutes/d

011.5

a Servings per day unless otherwise noted.b Established according to French recommended dietary allowances.c EI: energy intake without alcohol.d Pregnant women are advised to abstain from all alcohol consumption during the entire duration of their pregnancy.





Methods: Statistical analyses

• Analyses comprised not-diet-underreporting participants with at least 2 x 24h dietary recalls

• Calibration of data in terms of gender, age, educational level, presence of at least one child at home and season of data collection

• Social and demographic description (weighted data)

• Calculation of gender-stratified quartiles of scores

• Assessment of the independent associations between social, economic and educational variables and the probability of a low PNNS-GS (1st quartile vs others), using logistic regression





Results: Inclusion in the analyses≥ Two 24-h recalls and social and demographic data

n = 3,115 (Men: n = 1,126; Women: n = 1,989)

(97% with three 24h recalls)

Not diet underreportingn = 2,734

Inclusion in analysis(covariates available)

n = 2,577 (Men: n= 952 ; Women: n=1,625)





Social and demographic characteristics (weighted dataa) of 18-74-year-old adults, French Nutrition and Health Survey (ENNSb 2006-2007)

a Variables used to weight data were age, education level and at least one child at home.b ENNS: Etude Nationale Nutrition Santé.c Non-weighted sample size.

Men(nc=952)

Women(n=1,625)

All(n=2,577)

Age (%)

55-74-years old 28.2 29.9 29.1

30-54-years-old 49.0 49.3 49.1

18-29-years-old 22.8 20.8 21.8

Birthplace (%)

France (including overseas territories) 92.4 92.4 92.4

Europe 1.7 2.5 2.1

Africa 5.4 4.1 4.7

Other 0.5 1.0 0.8

Marital status (%)

Married / cohabiting 71.4 71.6 71.5

Single / separated / divorced / widowed 28.6 28.4 28.5

At least one child at home (%)

Yes 35.4 34.4 34.9

No 64.6 65.6 65.1





Social and demographic characteristics (weighted dataa) of 18-74-year-old adults, French Nutrition and Health Survey (ENNSb 2006-2007) (cont’d)

a Variables used to weight data were age, education level and at least one child at home.b ENNS: Etude Nationale Nutrition Santé.c Non-weighted sample size.

Men(nc=952)

Women(n=1,625)

All(n=2,577)

Occupation (%)

Management / intermediate profession 20.8 16.9 18.8

Self-employed / agricultural worker 5.1 2.3 3.6

Manual worker / employee 40.9 41.0 41.0

Retired 22.2 18.6 20.4

Homemaker, disabled person, other 11.0 21.2 16.2

Education level (%)

University 20.3 19.7 20.0

High school 18.0 18.4 18.2

Secondary school 43.3 39.0 41.1

Primary school 18.4 22.9 20.7

Holiday trip in the past 12 months (%)

Yes 69.7 68.4 69.1

No 30.3 31.6 30.9





Results: Compliance with PNNS recommandations

• Mean PNNS-GS:7.67 ±0.17 (range: 1.2 to 15.0) in men

8.55 ±0.12 (range: -2.2 to 14.0) in women

• Mean number of attained recommendations: 6.7 ±0.15 in men

7.2 ±0.12 in women

• A difference of ~ 4 attained recommendations was observed between the lowest and highest quartiles (in both genders)

• “Healthy” thresholds were attained by less than 40% of adults of both genders for whole grain food, seafood and dairy products, for salt in men and for “bread, cereals, potatoes and legumes” in women





Social and economic factors associated with low Programme National Nutrition Santé Guideline-Score (PNNS-GS) adherence (1st quartile compared to the other three quartiles).

French Nutrition and Health Survey (ENNSa 2006-2007)

a ENNS: Etude Nationale Nutrition Santé.b Non-weighted sample size.c Models 1 estimate the OR of each social and economic variable with the probability of being in the lowest PNNS-GS quartile and adjusted for energy intake (continuous variable) and age (in three classes).d Model 2 includes variables with P < 20% in models 1, adjusted for energy intake (continuous variable).e ORa: adjusted odds ratiof CI: confidence intervalsg P < 20%

Men (nb=952) Women (n=1,625)

Models 1c Model 2d Models 1 Model 2

ORae 95% CIf ORa 95% CI ORa 95% CI ORa 95% CI

Age

55-74-years-old 1.00 1.00 1.00 1.00

30-54-years-old1.67 0.96 -2.92 2.26 1.16 - 4.42 1.95 1.34 - 2.83 1.79 1.04 -3.10

18-29-years-old3.73 1.80 -7.72 3.65 1.63 - 8.16 4.27 2.64 - 6.91 3.35 1.80 -6.24






French Nutrition and Health Survey (ENNSa 2006-2007) (cont’d)


Men (nb=952) Women (n=1,625)



OccupationManagement / intermediate profession

1.00 1.00 1.00 1.00

Self-employed / agricultural worker

1.05 0.45 - 2.44 0.91 0.38 - 2.15 2.65 1.18 - 5.93 2.37 1.05 - 5.34

Manual worker / employee

1.98 1.22 - 3.22 1.70 0.99 - 2.91 1.52 1.02 - 2.26 1.28 0.82 - 2.02

Retired 2.26 0.99 - 5.13 1.92 0.83 - 4.44 1.22 0.62 - 2.39 1.00 0.49 - 2.00

Homemaker, disabled person, other

3.43 151 - 7.83 3.07 1.36 - 6.91 1.90 1.17 - 3.07 1.56 0.95 - 2.58








Men (nb=952) Women (n=1,625)



Education level

University 1.00 1.00 1.00 1.00

High school1.55 0.82 - 2.94 1.19 0.62 - 2.26 1.75 1.11 -

2.731.49 0.93 - 2.39

Secondary school 1.51 0.95 - 2.39 1.06 0.63 - 1.76 1.61 1.08-2.40 1.39 0.89 - 2.19

Primary school 2.25 0.95 - 5.33 1.34 0.56 - 3.17 1.45 0.85-2.50 1.23 0.70 - 2.19



JURNAL OFTHE AMERICAN DIETETICASSOCIATION





Men (nb=952) Women (n=1,625)



Marital status

Married / cohabiting 1.00g 1.00 1.00

Single /separated / divorced/widowed

1.38 0.87 - 2.20 1.44 1.01 - 2.06 1.43 1.01 - 2.04

Holiday trip in the past 12 months

Yes 1.00 1.00 1.00g

No1.90 1.14 - 3.18 1.78 1.05 -3.02 1.26 0.89 - 1.78





Discussion & ConclusionIn France, adherence to PNNS recommendations could still be improved, especially in the economically disadvantaged.

These results were globally consistent with previous literature on the relationship between socioeconomic characteristics and adherence to a healthy diet.

Low adherence to PNNS recommendations was associated with poor living conditions rather than with low education level.

Strengths & limitations• Biased recruitment compensated by weighting procedure

• Diet data collection methods; PNNS-GS calculation





Discussion & ConclusionCompliance with nutritional recommendations should help to define future public health policies in France

Special attention should be given to:• young and middle-aged people,

• women living without partners

• and, in general, the economically disadvantaged

Adherence to nutritional recommendations also depends on the availability and cost of certain foods, especially for the economically disadvantaged

serum vitamin c (mg/dl) by salad intake

Documents

diet assoc

salad intakejournal

dietitiansserum vitamin

surveyserum vitamin

france serum vitamin

pnns recommendations

seasonality of diet

methodsthe french nutrition