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Understanding of different front-of-package labels by the Spanish population: Results of a comparative study.
Galan, P, Egnell, M, Salas-Salvadó, J, Babio, N, Pettigrew, S, Hercberg, S, Julia, C
Endocrinologia, diabetes y nutricion. 2020;(2):122-129
Abstract
BACKGROUND AND OBJECTIVES Increased prevalence of obesity and its comorbidities has shown the need to implement social policies to help curb this trend. Nutritional risk factors are recognized as key drivers of obesity and other chronic diseases in Spain and in other Western countries. Front-of-package labels (FoPLs) are efficient tools to help consumers make healthier choices. To be useful in purchasing situations, consumers need to understand the information provided by FoPLs. The study objective was to assess objective understanding by consumers of five types of FoPLs, i.e. Health Star Rating system (HSR), Multiple Traffic Lights (MTL), Nutri-Score, Reference Intakes (RIs), and Warning symbol in Spain. METHODS In 2018, 1,000 Spanish participants were recruited and requested to rank three sets of label-free products (one set of three pizzas, one set of three cakes, and one set of three breakfast cereals) according to their nutritional quality in an on-line survey. Participants were then randomized to one of the five types of FoPLs, and were requested to rank the same sets of products again, this time with a given FoPL displayed on the package. Changes in ability to correctly rank products according to FoPLs were compared between both tasks using ordinal logistic regression. RESULTS For all three food categories, Nutri-Score performed significantly better, followed by MTL, the Warning symbol, HSR and RIs. CONCLUSIONS Nutri-Score emerged as the most efficient FoPL in conveying information on the nutritional quality of foods among Spanish consumers.
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Impact of Front-of-Pack Nutrition Labels on Portion Size Selection: An Experimental Study in a French Cohort.
Egnell, M, Kesse-Guyot, E, Galan, P, Touvier, M, Rayner, M, Jewell, J, Breda, J, Hercberg, S, Julia, C
Nutrients. 2018;(9)
Abstract
In the European Union (EU) three coloured graded Front-of-Pack labels (FoPLs), two endorsed by governments (Nutri-Score and Multiple Traffic Lights (MTL)) and one designed by industry (Evolved Nutrition Label (ENL)) are currently being discussed. This study aimed to investigate the impact of these FoPLs on portion size selection, specifically for less healthy products. In 2018, participants from the French NutriNet-Santé cohort study (N = 25,772) were exposed through a web-based self-administered questionnaire to products from three food categories (sweet biscuits, cheeses, and sweet spreads), with or without FoPLs, and were invited to select the portion they would consume (in size and number). Kruskall-Wallis tests, and mixed ordinal logistic regression models, were used to investigate the effects of FoPLs on portion size selection. Compared to no label, Nutri-Score consistently lowered portion sizes (OR = 0.76 (0.74⁻0.76)), followed by MTL (OR = 0.83 (0.82⁻0.84)). For ENL, the effects differed depending on the food group: It lowered portion size selection for cheeses (OR = 0.84 (0.83⁻0.87)), and increased it for spreads (OR = 1.19 (1.15⁻1.22)). Nutri-Score followed by MTL appear efficient tools to encourage consumers to decrease their portion size for less healthy products, while ENL appears to have inconsistent effects depending on the food category.
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Overweight and obesity prevention for adolescents: a cluster randomized controlled trial in a school setting.
Bonsergent, E, Agrinier, N, Thilly, N, Tessier, S, Legrand, K, Lecomte, E, Aptel, E, Hercberg, S, Collin, JF, Briançon, S, et al
American journal of preventive medicine. 2013;(1):30-9
Abstract
BACKGROUND Given the increasing prevalence of obesity among youth over the past decade, prevention has become an international public health priority. PURPOSE To evaluate the 2-year effectiveness of three strategies aimed at preventing overweight and obesity among adolescents in a high school setting. DESIGN PRomotion de l'ALIMentation et de l'Activité Physique (PRALIMAP) is a school-based RCT. Each study high school was assigned to receive or not, over a 2-year period (Grades 10 and 11), each of three prevention strategies according to a 2 × 2 × 2 factorial school randomization. Data were collected in 2006-2009 and analyzed in 2009-2011. SETTING/PARTICIPANTS A total of 3538 adolescents (aged 15.6±0.7 years at baseline) in 24 public high schools in Lorraine (northeastern France) completed the PRALIMAP trial. INTERVENTIONS The prevention strategies were education (development of nutritional knowledge and skills); environment (creation of a favorable environment by improving availability of "healthy" dietary items and physical activity); and screening and care (detection of overweight/obesity and, if necessary, adapted care management). MAIN OUTCOMES MEASURES The main outcome of interest was BMI; BMI z-score and prevalence of overweight/obesity were considered as secondary outcomes. RESULTS Adolescents who completed the PRALIMAP trial were younger, less often suspected of having eating disorders and depression, and came from a higher socioeconomic class than those who did not. The 2-year change of outcomes was more favorable in the 12 screening and care high schools compared to the no-screening ones: a 0.11 lower increase in BMI (p=0.0303); a 0.04 greater decrease in BMI z-score (p=0.0173); and a 1.71% greater decrease in overweight/obesity prevalence (p=0.0386). Education and environment strategies were not more effective than no strategy intervention. CONCLUSIONS Although the screening and care strategy is an effective way to prevent, at 2 years, overweight and obesity among adolescents in a high school setting, its effects over and above no strategy intervention were small. TRIAL REGISTRATION This study is registered at www.clinicaltrials.govNCT00814554.
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Supplementation with B vitamins or n-3 fatty acids and depressive symptoms in cardiovascular disease survivors: ancillary findings from the SUpplementation with FOLate, vitamins B-6 and B-12 and/or OMega-3 fatty acids (SU.FOL.OM3) randomized trial.
Andreeva, VA, Galan, P, Torrès, M, Julia, C, Hercberg, S, Kesse-Guyot, E
The American journal of clinical nutrition. 2012;96(1):208-14
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Depression is associated with poorer outcomes in people with heart disease. Substantial evidence suggests a link between dietary factors and mental health. The objective of this study was to examine the effects of supplementation with B vitamins or omega-3 (n-3) fatty acids on depressive symptoms in people with heart disease. Adults aged 45-80 years with cardiovascular disease were randomly assigned to receive 0.56mg folate (as 5-methyl-tetrahydrofolate), 3mg vitamin B6 and 0.02mg vitamin B12 ; 600mg EPA and DHA (in a 2:1 ratio); B vitamins plus n-3 fatty acids; or a placebo. Depressive symptoms were measured at years 3 and 5 using the Geriatric Depression Scale. There was no association between supplementation with B vitamins and depressive symptoms. However, men who took n-3 fatty acid supplements had a 28% higher risk of experiencing symptoms of depression. There was no such association observed in women. The authors concluded that the results of the study do not support the use of B vitamin or n-3 supplements for the prevention of depression in CVD survivors.
Abstract
BACKGROUND Dietary factors might affect depressive symptoms. OBJECTIVE In secondary data analyses, we examined effects of supplementation with B vitamins or n-3 (omega-3) fatty acids on depressive symptoms in cardiovascular disease survivors. DESIGN The SUpplementation with FOLate, vitamins B-6 and B-12 and/or OMega-3 fatty acids (SU.FOL.OM3) trial was a secondary prevention trial (2003-2009; n = 2501) in which individuals aged 45-80 y were randomly assigned, by using a 2 × 2 factorial design, to receive 0.56 mg 5-methyl-tetrahydrofolate and vitamins B-6 (3 mg) and B-12 (0.02 mg); EPA and DHA (600 mg) in a 2:1 ratio; B vitamins and n-3 fatty acids; or a placebo. Depressive symptoms were evaluated at years 3 and 5 with the 30-item Geriatric Depression Scale (GDS). Overall and sex-specific ORs and 95% CIs were estimated in 2000 participants by using factorial logistic regression. RESULTS After a median of 4.7 y of supplementation, there was no association between allocation to receive B vitamins and depressive symptoms. However, the allocation to receive n-3 fatty acids was positively associated with depressive symptoms (GDS >10) in men (adjusted OR: 1.28; 95% CI: 1.03, 1.61) but not in women. CONCLUSIONS We showed no beneficial effects of a long-term, low-dose supplementation with B vitamins or n-3 fatty acids on depressive symptoms in cardiovascular disease survivors. The adverse effects of n-3 fatty acids in men merit confirmation.
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Effect of B-vitamins and n-3 PUFA supplementation for 5 years on blood pressure in patients with CVD.
Szabo de Edelenyi, F, Vergnaud, AC, Ahluwalia, N, Julia, C, Hercberg, S, Blacher, J, Galan, P
The British journal of nutrition. 2012;(6):921-7
Abstract
Certain epidemiological and experimental studies suggest that n-3 fatty acids and folate can reduce blood pressure (BP). We investigated the effect of a daily supplementation with dietary doses of B-vitamins or n-3 fatty acids for 5 years on BP in patients with a history of CVD who participated in the Supplémentation en Folates et Omega-3 trial. The patients (n 2501; 1987 men and 514 women) were randomly assigned in a 2 × 2 factorial design to one of four groups: B-vitamins (5-methyl-THF (560 μg); vitamin B₆ (3 mg) and vitamin B₁₂ (20 μg)) and a placebo capsule for n-3 fatty acids; n-3 fatty acids (600 mg of EPA and DHA at a ratio of 2:1) and a placebo capsule for B-vitamins; both B-vitamins and n-3 fatty acids; or placebo capsules for both treatments. The patients took two capsules daily in a double-blind manner for a median duration of 4·7 years. At baseline and annual examination for 5 years, the patients underwent a clinical examination where BP and clinical and biological parameters were assessed. No effect of supplementation with either n-3 PUFA or B-vitamins on BP was observed in crude and adjusted multivariate models. Change in BP was not associated with change in homocysteine. In conclusion, the present results do not support the routine use of dietary supplements containing B-vitamins, or of n-3 fatty acids, to reduce BP in people with prior CVD.
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Incidence of cancers, ischemic cardiovascular diseases and mortality during 5-year follow-up after stopping antioxidant vitamins and minerals supplements: a postintervention follow-up in the SU.VI.MAX Study.
Hercberg, S, Kesse-Guyot, E, Druesne-Pecollo, N, Touvier, M, Favier, A, Latino-Martel, P, Briançon, S, Galan, P
International journal of cancer. 2010;(8):1875-81
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Abstract
The Supplementation in Vitamins and Mineral Antioxidants Study was a double-blind, placebo-controlled, randomized trial, in which 12,741 French adults (7,713 women aged 35-60 years and 5,028 men aged 45-60 years) received a combination of ascorbic acid (120 mg), vitamin E (30 mg), beta-carotene (6 mg), selenium (100 microg) and zinc (20 mg), or placebo daily for a median follow-up time of 7.5 years [October 1994 to September 2002]. Antioxidant supplementation decreased total cancer incidence and total mortality in men. Postintervention follow-up assessment of total cancer incidence, ischemic cardiovascular disease incidence and total mortality was carried out for 5 years [September 1, 2002, to September 1, 2007]. No late effect of antioxidant supplementation was revealed 5 years after ending the intervention neither on ischemic cardiovascular disease incidence and mortality in both genders nor on cancer incidence in women. Regarding duration of intervention effects in men, the reduced risk of total cancer incidence and total mortality was no longer evident after the 5-year postintervention follow-up. During the postsupplementation period, the relative risk (RR) for total cancer incidence (n = 126) was 0.98 (95% confidence interval [CI], 0.75-1.27) among antioxidant recipients compared to nonrecipients. For total mortality (n = 90), the RR was 0.98 (95% CI, 0.75-1.26) for men receiving antioxidants compared to nonrecipients. In conclusion, beneficial effects of antioxidant supplementation in men disappeared during postintervention follow-up.
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Control of baseline cardiovascular risk factors in the SU-FOL-OM3 study cohort: does the localization of the arterial event matter?
Vesin, C, Galan, P, Gautier, B, Czernichow, S, Hercberg, S, Blacher, J
European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology. 2010;(5):541-8
Abstract
AIM AND METHOD No data are currently available on the prevalence and control of cardiovascular (CV) risk factors in secondary prevention depending on the cardiac or cerebral localization of the ischemic disease. We investigated the prevalence and control of modifiable CV risk factors, as well as the determinants of CV risk factors' control and adequate treatment in a secondary prevention cohort, the SU-FOL-OM3 study cohort, to determine the role of the localization of the ischemic disease including events. RESULTS A total of 2491 patients were included in the study. The prevalence of all modifiable risk factors was high in both coronary heart disease and cerebrovascular disease (CVD) groups. Control of all risk factors and the presence of antiplatelet medication were noted in 29.6% of patients with coronary heart disease and 11% of patients with CVD. The cardiac localization of the including event was independently associated with the control of each of the risk factors studied (hypertension, low-density lipoprotein-cholesterol, smoking) and to the control of all risk factors present and prescription of antiplatelet therapy with an odds ratio (95% confidence interval) of 2.72 (1.97-3.75). CONCLUSION There is a need to improve the control of CV risk factors in secondary prevention patients. This is particularly crucial for patients with CVD.
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Effect of supplementation with antioxidants upon long-term risk of hypertension in the SU.VI.MAX study: association with plasma antioxidant levels.
Czernichow, S, Bertrais, S, Blacher, J, Galan, P, Briançon, S, Favier, A, Safar, M, Hercberg, S
Journal of hypertension. 2005;(11):2013-8
Abstract
OBJECTIVE To assess the effects of supplementation with a combination of antioxidant vitamins and trace elements, at nutritional doses, upon the 6.5-year risk of hypertension in the SU.VI.MAX trial. To describe the association between baseline plasma antioxidant levels and the same long-term risk using observational data from the study. SETTING A total of 5086 adults from the SU.VI.MAX trial, a randomized primary prevention trial. RESULTS Compared with the placebo group, no effect of supplementation upon the 6.5-year risk of hypertension could be detected (odds ratio, 1.04 and 95% confidence interval, 0.87-1.23 in men; and odds ratio, 1.10 and 95% confidence interval, 0.95-1.29 in women). Furthermore, compared with men in the first tertile, those in the second and third tertiles of serum baseline levels of beta-carotene presented a lower risk of hypertension in both the placebo and supplementation groups. Multivariate-adjusted odds ratios (95% confidence interval) were 0.70 (0.44-1.12) and 0.53 (0.33-0.86) in the placebo group, and were 0.59 (0.37-0.94) and 0.67 (0.42-1.07) in the supplementation group. In women, a decreasing trend was observed with vitamin C levels and risk of hypertension in the intervention group. No association could be shown between vitamin E and trace element plasma levels and the risk of hypertension. CONCLUSIONS Despite an inverse association between baseline plasma levels of beta-carotene in men and the risk of developing hypertension, we could not demonstrate any beneficial effect of low-dose antioxidant supplementation upon the 6.5-year risk of hypertension in the randomized analysis.
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Blood lipid and lipoprotein levels: relationships with educational level and region of residence in the French SU.VI.MAX study.
Bruckert, E, Czernichow, S, Bertrais, S, Paillard, F, Tichet, J, Galan, P, Castetbon, K, Hercberg, S
Preventive medicine. 2005;(6):803-11
Abstract
BACKGROUND Blood lipid profile of French men and women obtained from the general population is not well known. Furthermore, the association between these lipids, as a function of other potential risk factors for cardiovascular disease, and sociodemographic factors such as age, educational level, and region of residence is not well studied in large samples in Europe. METHODS Data on French healthy volunteers, aged between 40 and 65 years for men (n = 5141) and 35 and 65 years for women (n = 7876) were obtained from the "Supplementation en Vitamines et Mineraux Antioxydants" (SU.VI.MAX) study, a primary prevention trial. Baseline blood samples were collected in 1994-1995 and analyzed for cholesterol, triglyceride, apolipoproteins (apo)-B and -A1. The results were analyzed separately for men and women as a function of age, educational level, and area of residence. RESULTS Overall, blood lipid levels for men and women did not differ significantly from those reported in other Western industrialized countries. Except for triglyceride in men, all blood lipids were statistically different among ages. In women, cholesterol, apo-A1, and apo-B showed a significant decrease with educational level. Statistical differences were found in both genders between blood lipids and lipoproteins among regions of residence. CONCLUSIONS Even if differences between region of residence were found in blood lipid levels, this cannot explain the North-East to South gradient in the prevalence of cardiovascular disease in France nor differences between France and other industrialized Western countries.
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Consumption of foods rich in flavonoids is related to a decreased cardiovascular risk in apparently healthy French women.
Mennen, LI, Sapinho, D, de Bree, A, Arnault, N, Bertrais, S, Galan, P, Hercberg, S
The Journal of nutrition. 2004;(4):923-6
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A high consumption of flavonoids may lower cardiovascular risk through their antioxidant capacity. This study evaluated the relation between consumption of foods rich in flavonoids and estimated cardiovascular risk. A cross-sectional analysis was performed in 1286 women and 1005 men of the SU.VI.MAX Study (an 8-y trial evaluating the effect of antioxidant supplementation on the incidence of major chronic diseases). Dietary intakes were estimated using six 24-h dietary records collected during the year between the clinical measurement of blood pressure, weight and height and the biological measurement of total serum cholesterol and fasting plasma glucose. The relation between flavonoid rich food consumption and cardiovascular risk factors was evaluated with analyses of covariance and the effect on cardiovascular risk with logistic regression analyses. In women, flavonoid-rich food consumption was inversely related to systolic blood pressure (P = 0.005). No relation between risk factors and flavonoid-rich food consumption was seen in men. Women in the highest tertile of flavonoid-rich food consumption were at lower risk for cardiovascular disease [odds ratio (OR): 0.31; 95%CI: 0.14, 0.68], whereas a positive tendency was seen in men (OR: 1.38; 95%CI: 0.96, 2.00). These results indicate that in women, a high consumption of flavonoid-rich foods may prevent cardiovascular disease.