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Association Between Ultraprocessed Food Consumption and Risk of Mortality Among Middle-aged Adults in France.
Schnabel, L, Kesse-Guyot, E, Allès, B, Touvier, M, Srour, B, Hercberg, S, Buscail, C, Julia, C
JAMA internal medicine. 2019;(4):490-498
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Abstract
IMPORTANCE Growing evidence indicates that higher intake of ultraprocessed foods is associated with higher incidence of noncommunicable diseases. However, to date, the association between ultraprocessed foods consumption and mortality risk has never been investigated. OBJECTIVE To assess the association between ultraprocessed foods consumption and all-cause mortality risk. DESIGN, SETTING, AND PARTICIPANTS This observational prospective cohort study selected adults, 45 years or older, from the French NutriNet-Santé Study, an ongoing cohort study that launched on May 11, 2009, and performed a follow-up through December 15, 2017 (a median of 7.1 years). Participants were selected if they completed at least 1 set of 3 web-based 24-hour dietary records during their first 2 years of follow-up. Self-reported data were collected at baseline, including sociodemographic, lifestyle, physical activity, weight and height, and anthropometrics. EXPOSURES The ultraprocessed foods group (from the NOVA food classification system), characterized as ready-to-eat or -heat formulations made mostly from ingredients usually combined with additives. Proportion (in weight) of ultraprocessed foods in the diet was computed for each participant. MAIN OUTCOMES AND MEASURES The association between proportion of ultraprocessed foods and overall mortality was the main outcome. Mean dietary intakes from all of the 24-hour dietary records available during the first 2 years of follow-up were calculated and considered as the baseline usual food-and-drink intakes. Mortality was assessed using CépiDC, the French national registry of specific mortality causes. Hazard ratios (HRs) and 95% CIs were determined for all-cause mortality, using multivariable Cox proportional hazards regression models, with age as the underlying time metric. RESULTS A total of 44 551 participants were included, of whom 32 549 (73.1%) were women, with a mean (SD) age at baseline of 56.7 (7.5) years. Ultraprocessed foods accounted for a mean (SD) proportion of 14.4% (7.6%) of the weight of total food consumed, corresponding to a mean (SD) proportion of 29.1% (10.9%) of total energy intake. Ultraprocessed foods consumption was associated with younger age (45-64 years, mean [SE] proportion of food in weight, 14.50% [0.04%]; P < .001), lower income (<€1200/mo, 15.58% [0.11%]; P < .001), lower educational level (no diploma or primary school, 15.50% [0.16%]; P < .001), living alone (15.02% [0.07%]; P < .001), higher body mass index (calculated as weight in kilograms divided by height in meters squared; ≥30, 15.98% [0.11%]; P < .001), and lower physical activity level (15.56% [0.08%]; P < .001). A total of 602 deaths (1.4%) occurred during follow-up. After adjustment for a range of confounding factors, an increase in the proportion of ultraprocessed foods consumed was associated with a higher risk of all-cause mortality (HR per 10% increment, 1.14; 95% CI, 1.04-1.27; P = .008). CONCLUSIONS AND RELEVANCE An increase in ultraprocessed foods consumption appears to be associated with an overall higher mortality risk among this adult population; further prospective studies are needed to confirm these findings and to disentangle the various mechanisms by which ultraprocessed foods may affect health.
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Eating Patterns in Patients with Compensated Cirrhosis: A Case-Control Study.
Buscail, C, Bourcier, V, Fezeu, LK, Roulot, D, Brulé, S, Ben-Abdesselam, Z, Cagnot, C, Hercberg, S, Nahon, P, Ganne-Carrié, N, et al
Nutrients. 2018;(1)
Abstract
BACKGROUND There is growing evidence suggesting that maintaining an adequate nutritional status for patients with liver cirrhosis (LC) is relevant to prevent complications. The present study aimed to describe dietary behaviours of patients with compensated and non-complicated LC and comparing them with those of subjects from the general population. METHODS In this case-control study, patients were volunteers enrolled in the ALICIR (ALImentation et CIRrhose) study, an observational survey nested in two French prospective cohorts of patients with biopsy-proven compensated cirrhosis related either to excessive alcohol consumption (CIRRAL) or to hepatitis B or C virus infection (CirVir). Controls were selected from the NutriNet-Santé cohort. Dietary data were collected through a semi quantitative food frequency questionnaire. Dietary and nutritional data were compared using multi-adjusted paired Student's tests. RESULTS Between June 2014 and February 2016, 174 patients of CirVir (N = 97) or CIRRAL (N = 77) were matched with 348 controls from the NutriNet-Santé cohort, according to gender, age, BMI and educational level. Compared to controls, patients (mean ± SD) consumed more sodas (236.0 ± 29.8 mL vs. 83.0 ± 33.0 mL) and water (1787.6 ± 80.6 mL vs. 933.6 ± 85.3 mL), and lower amounts of salty snacks (4.2 ± 1.42 g vs. 9.0 ± 1.6 g) and alcoholic beverages (71.8 ± 23.4 g vs. 151.2 ± 25.9 g), with all p values < 0.0001. Dietary behaviours differed according to LC aetiology. CONCLUSIONS Dietary behaviour of patients significantly differed from subjects from the general population.
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MTHFR 677C → T genotype modulates the effect of a 5-year supplementation with B-vitamins on homocysteine concentration: The SU.FOL.OM3 randomized controlled trial.
Fezeu, LK, Ducros, V, Guéant, JL, Guilland, JC, Andreeva, VA, Hercberg, S, Galan, P
PloS one. 2018;(5):e0193352
Abstract
AIMS: To study how MTHFR 677C→T genotype modulates the effect of supplementation with B-vitamins on total homocysteine (tHcy) and B-vitamin concentrations. METHODS 2381 patients with a personal history of cardiovascular disease were randomly assigned to one of four groups: 1) B-vitamins alone (560 μg of 5-methyl-THF, 3 mg of vitamin B6 and 20 μg of vitamin B12), 2) n-3 fatty acids alone (600 mg of EPA and DHA in a 2:1 ratio), 3) B-vitamins and n-3 fatty acids, and 4) placebo. Participants were followed up for 4.7 years. At baseline and annually thereafter, biological parameters were assessed. Multivariate and linear mixed models were fit to study the interaction between B-vitamins and MTHFR genotype. RESULTS Among supplemented participants, concentrations of all three B-vitamins increased during the first year (all p<0.0001) across MTHFR genotype categories. tHcy decreased by 26.3% during the first year (p<0.0001), then steadily increased throughout the 5 years (ptrend<0.001). However, at the end of follow-up, that increase was smaller among TT than among CT or CC subjects (pinteraction<0.02). At baseline, the difference in tHcy concentrations between TT homozygous and CC homozygous subjects was 2.33 μmol/l (p<0.001). After 5 years, that difference was reduced to 1.06 μmol/l and remained statistically significant (p<0.001). CONCLUSION Participants with the TT genotype exhibited a lower 5-year decrease in tHcy concentrations following a B-vitamin supplementation than did participants with the CC or CT genotype. CLINICAL TRIAL REGISTRATION Current Controlled Trials # ISRCTN41926726.
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Prospective association between a dietary quality index based on a nutrient profiling system and cardiovascular disease risk.
Adriouch, S, Julia, C, Kesse-Guyot, E, Méjean, C, Ducrot, P, Péneau, S, Donnenfeld, M, Deschasaux, M, Menai, M, Hercberg, S, et al
European journal of preventive cardiology. 2016;(15):1669-76
Abstract
BACKGROUND Public health strategies are essential to guide consumers' choices and produce a substantial population impact on cardiovascular disease risk prevention through nutrition. Our aim was to investigate the prospective association between the Food Standards Agency nutrient profiling system dietary index (FSA-NPS DI) and cardiovascular disease risk. The FSA-NPS has been proposed to serve as a basis for a five-colour nutrition label suggested in France to be put on the front of pack of food products. METHODS AND RESULTS A total of 6515 participants to the SU.VI.MAX cohort (1994-2007), who completed at least six 24-hour dietary records during the first two years of the study, were followed for a median of 12.4 years (25th-75th percentiles: 11.0-12.6). Multivariable Cox proportional hazards models were used to characterise the associations between FSA-NPS DI (continuous and sex-specific quartiles) and the incidence of cardiovascular diseases. Interactions with individual characteristics were tested; 181 major cardiovascular events were reported (59 myocardial infarctions, 43 strokes, 79 anginas). A higher FSA-NPS DI, characterising poorer food choices, was associated with an overall increase in cardiovascular disease risk (HRfor a 1-point increment = 1.14 (1.03-1.27); HRQ4vs.Q1 = 1.61 (1.05-2.47), Ptrend Q4-Q1 = 0.03). This association tended to be stronger in smokers (HRfor a 1-point increment = 1.39 (1.11-1.73); Pinteraction = 0.01) and those less physically active (HRfor a 1-point increment = 1.26 (1.08-1.46); Pinteraction = 0.04). CONCLUSIONS Our results suggest that poorer food choices, as reflected by a higher FSA-NPS DI, may be associated with a significant increase in cardiovascular risk, especially in at-risk individuals (smokers and physically inactive persons). This score could be a useful tool for public health prevention strategies. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00272428.
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Association between Mindfulness and Weight Status in a General Population from the NutriNet-Santé Study.
Camilleri, GM, Méjean, C, Bellisle, F, Hercberg, S, Péneau, S
PloS one. 2015;(6):e0127447
Abstract
BACKGROUND Mindfulness is defined as non-judgmental awareness of the present moment. There is some evidence of the efficacy of mindfulness-based interventions in weight loss. However, this psychological concept has only been rarely explored in observational studies, and no study to date has examined the association between dispositional mindfulness and weight status in a large population-based sample. OBJECTIVE We aimed to examine the relationship between mindfulness scores and weight status in a large sample of the adult general population in France. DESIGN AND METHODS A total of 14,400 men and 49,228 women aged ≥18 y participating in the NutriNet-Santé study were included in this cross-sectional analysis. We collected mindfulness data using the Five Facet Mindfulness Questionnaire as well as self-reported weight and height. The association between weight status and dispositional mindfulness, as well as its subscales (observing, describing, acting with awareness, non-judging and non-reactivity), was assessed using multinomial logistic regression models adjusted for socio-demographic and lifestyle factors. RESULTS Women with higher dispositional mindfulness scores were less likely to be overweight (excluding obesity) (OR quartile 4 vs. 1 = 0.84, 95% CI: 0.79-0.90) and obese (OR quartile 4 vs. 1 = 0.71, 95% CI: 0.65-0.78). In addition, overall, in this group, all subscales were inversely associated with weight status, with the strongest association found for the "observing" subscale. In men, higher mindfulness was associated only with lower odds of obesity (OR quartile 4 vs. 1 = 0.81 (0.69, 0.96)), and only the "observing" and "non-reactivity" subscales were significantly inversely associated with weight status. CONCLUSION Results support the interest of a shift in perspective that takes into account positive psychological and cognitive factors such as dispositional mindfulness in the investigation of obesity and its associated factors.
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Evidence of a cumulative effect of cardiometabolic disorders at midlife and subsequent cognitive function.
Kesse-Guyot, E, Julia, C, Andreeva, V, Fezeu, L, Hercberg, S, Galan, P
Age and ageing. 2015;(4):648-54
Abstract
BACKGROUND longitudinal data as regards the link between the cumulative effect of cardiometabolic disorders and cognition are relatively scant and heterogeneous. OBJECTIVE we examined the cross-time associations of MetS status with cognitive performance in ageing adults. DESIGN AND METHODS using data from the French SU.VI.MAX cohort, we studied 2,788 adults. The presence of abdominal obesity, hyperglycaemia, dyslipidaemia and elevated blood pressure was clinically evaluated in 1994-96. Cognitive performance was assessed after a mean of 13 years via a battery of six validated instruments. The standardised individual test scores were summed up to provide a composite cognitive performance measure; principal component analysis was performed to define performance scores on verbal memory and executive functioning. Associations between MetS and subsequent cognitive performance were examined via ANCOVA, providing estimates of mean difference and corresponding 95% confidence intervals (CI). RESULTS MetS status at midlife was not associated with subsequent cognitive function. However, a 1-unit increase in the number of cardiometabolic disorders present was associated with a decrease in the composite cognitive score (mean difference = -0.36; 95% CI: -0.68, -0.05). Significant associations were also found with several cardiometabolic disorders (hyperglycaemia, central obesity and dyslipidaemia) and specific cognitive domains. CONCLUSION this study supports the existence of a cross-time, cumulative effect of cardiometabolic disorders present at midlife and subsequent cognitive performance. Given the worldwide population ageing and the increase in MetS prevalence, there is an urgent need for recommendations as regards cognitive ageing.
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Baseline plasma fatty acids profile and incident cardiovascular events in the SU.FOL.OM3 trial: the evidence revisited.
Fezeu, LK, Laporte, F, Kesse-Guyot, E, Andreeva, VA, Blacher, J, Hercberg, S, Galan, P
PloS one. 2014;(4):e92548
Abstract
OBJECTIVE We aimed to investigate the association between baseline plasma fatty acids profile and the risk of future major cardiovascular events in patients with a history of ischaemic heart disease or ischemic stroke. METHODS Baseline plasma fatty acids as well as established cardiovascular risk factors were measured in 2,263 patients enrolled in the SUpplementation with FOLate, vitamins B-6 and B-12 and/or OMega-3 fatty acids randomized controlled trial. Incident major cardiovascular, cardiac and cerebrovascular events were ascertained during the 4.7 years of follow up. Hazard ratios were obtained from Cox proportional hazards models after adjustment for cardiovascular risk factors. RESULTS During the follow-up, 154, 379 and 84 patients had major cardiovascular, cardiac and cerebrovascular events respectively. Upon adjustment for gender, initial event, baseline age and BMI, the risk of developing a major cardiovascular event decreased significantly in successive quartiles of arachidonic acid (P trend<0.002), total omega 3 polyunsaturated fatty acids (P trend<0.03), docosapentaenoic acid (P trend<0.019), docosahexaenoic acid (P trend<0.004), eicosapentaenoic acid + docosahexaenoic acid (P trend<0.03) and eicosapentaenoic acid + docosapentaenoic acid + docosahexaenoic acid (P trend<0.02). This inverse association was borderline significant with increased quartiles of stearidonic acid (P trend<0.06). In the full model, only stearidonic acid remained inversely associated with the risk of developing a major cardiovascular event (P trend<0.035), a cardiac event (P trend<0.016) or a cerebrovascular event (P trend<0.014), while arachidonic acid was inversely associated with the risk a cerebrovascular event (P trend<0.033). CONCLUSION The inverse association of long chain omega 3 polyunsaturated fatty acids with recurrence of Cardiovascular diseases was mainly driven by well-known cardiovascular risk factors. TRIAL REGISTRATION Controlled-Trials.com ISRCTN41926726.
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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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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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Fruit and vegetable intake and cognitive function in the SU.VI.MAX 2 prospective study.
Péneau, S, Galan, P, Jeandel, C, Ferry, M, Andreeva, V, Hercberg, S, Kesse-Guyot, E, ,
The American journal of clinical nutrition. 2011;(5):1295-303
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Abstract
BACKGROUND Current hypotheses suggest that intake of fruit and vegetables (FVs) protects against age-related cognitive impairment. OBJECTIVE We examined the 13-y association between FV intake and cognitive performance in a sample of French adults. DESIGN A total of 2533 subjects aged 45-60 y at baseline, who were part of the Supplementation with Antioxidant Vitamins and Minerals 2 (SU.VI.MAX 2) cohort, were selected. FV intake was estimated at baseline in participants who had completed at least six 24-h dietary records. Cognitive performance was assessed 13 y after baseline and included an evaluation of verbal memory (RI-48 cued recall, semantic, and phonemic fluency tests) and executive function (trail-making and forward and backward digit span tests). Principal components analysis was performed to account for correlations in test scores. The relation between cognitive performance and quartiles of FV intake was assessed by multivariate linear regression analyses. RESULTS Intakes of FVs (P-trend = 0.02), fruit alone (P-trend = 0.04), vitamin C-rich FVs (P-trend = 0.03), vitamin C (P-trend = 0.005), and vitamin E (P-trend = 0.04) were positively associated with verbal memory scores. In contrast, intakes of FVs (P-trend = 0.006), vegetables alone (P-trend = 0.03), and β-carotene-rich FVs (P-trend = 0.02) were negatively associated with executive functioning scores. CONCLUSIONS FVs might have a differential effect on cognition according to groups of FVs and type of cognitive function. Further research using sensitive and reliable measures of various types of cognitive function is needed to clarify the effect of individual FV groups and nutrients. This trial is registered at clinicaltrials.gov as NCT00272428.