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Comment on Muzzioli et al. Are Front-of-Pack Labels a Health Policy Tool? Nutrients 2022, 14, 771.
Aguenaou, H, Babio, N, Deschasaux-Tanguy, M, Galan, P, Hercberg, S, Julia, C, Jones, A, Karpetas, G, Kelly, B, Kesse-Guyot, E, et al
Nutrients. 2022;(10)
Abstract
As scientists working and publishing in the field of front-of-pack nutrition labelling (FOPNL) for many years, we have read with interest and concern the narrative review regarding their effectiveness by Muzzioli et al. [...].
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International evidence for the effectiveness of the front-of-package nutrition label called Nutri-Score.
Andreeva, VA, Egnell, M, Touvier, M, Galan, P, Julia, C, Hercberg, S
Central European journal of public health. 2021;(1):76-79
Abstract
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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3.
Cholesterol and breast cancer risk: a systematic review and meta-analysis of prospective studies.
Touvier, M, Fassier, P, His, M, Norat, T, Chan, DS, Blacher, J, Hercberg, S, Galan, P, Druesne-Pecollo, N, Latino-Martel, P
The British journal of nutrition. 2015;(3):347-57
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Abstract
The objective of the present study was to conduct the first systematic review and meta-analysis of prospective studies investigating the associations between total cholesterol (TC), HDL-cholesterol (HDL-C) and LDL-cholesterol (LDL-C) levels and the risk of breast cancer. Relevant studies were identified in PubMed (up to January 2014). Inclusion criteria were original peer-reviewed publications with a prospective design. Random-effects models were used to estimate summary hazard ratios (HR) and 95% CI. Distinction was made between studies that did or did not exclude cancer cases diagnosed during the first years of follow-up, thereby eliminating potential preclinical bias. Overall, the summary HR for the association between TC and breast cancer risk was 0.97 (95% CI 0.94, 1.00; dose-response per 1 mmol/l increment, thirteen studies), and that between HDL-C and breast cancer risk was 0.86 (95% CI 0.69, 1.09; dose-response per 1 mmol/l increment, six studies), with high heterogeneity (I2= 67 and 47%, respectively). For studies that eliminated preclinical bias, an inverse association was observed between the risk of breast cancer and TC (dose-response HR 0.94 (95% CI 0.89, 0.99), seven studies, I2= 78%; highest v. lowest HR 0.82 (95% CI 0.66, 1.02), nine studies, I2= 81%) and HDL-C (dose-response HR 0.81 (95% CI 0.65, 1.02), five studies, I2= 30 %; highest v. lowest HR 0.82 (95% CI 0.69, 0.98), five studies, I2= 0%). There was no association observed between LDL-C and the risk of breast cancer (four studies). The present meta-analysis confirms the evidence of a modest but statistically significant inverse association between TC and more specifically HDL-C and the risk of breast cancer, supported by mechanistic plausibility from experimental studies. Further large prospective studies that adequately control for preclinical bias are needed to confirm the results on the role of cholesterol level and its fractions in the aetiology of breast cancer.
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Alcohol drinking and second primary cancer risk in patients with upper aerodigestive tract cancers: a systematic review and meta-analysis of observational studies.
Druesne-Pecollo, N, Keita, Y, Touvier, M, Chan, DS, Norat, T, Hercberg, S, Latino-Martel, P
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2014;(2):324-31
Abstract
BACKGROUND We conducted a systematic review and meta-analysis of existing data from observational studies to assess the strength of the association of alcohol drinking with second primary cancer risk in patients with upper aerodigestive tract (UADT; oral cavity, pharynx, larynx, and esophagus) cancer. METHODS PubMed and Embase were searched up to July 2012 and the reference lists of studies included in the analysis were examined. Random-effects models were used to estimate summary relative risks (RR) and 95% confidence interval (CI). RESULTS Nineteen studies, 8 cohort and 11 case-control studies, were included. In highest versus lowest meta-analyses, alcohol drinking was associated with significantly increased risk of UADT second primary cancers (RR, 2.97; 95% CI, 1.96-4.50). Significantly increased risks were also observed for UADT and lung combined (RR, 1.90; 95% CI, 1.16-3.11) and all sites (RR, 1.60; 95% CI, 1.22-2.10) second primary cancers. For an increase in the alcohol intake of 10 grams per day, dose-response meta-analysis resulted in a significantly increased RR of 1.09 (95% CI, 1.04-1.14) for UADT second primary cancers. CONCLUSIONS Alcohol drinking in patients with UADT cancer is associated with an increased risk of second primary cancers. Studies conducted in alcohol drinking patients with UADT cancer and evaluating the effect of alcohol cessation on second primary cancer and other outcomes are needed. IMPACT Our results emphasize the importance of prevention policies aiming to reduce alcohol drinking. Health-care professionals should encourage alcohol drinking patients with UADT cancer to reduce their consumption and reinforce the surveillance of this at-risk subpopulation.
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Eating behaviour in obese patients with melanocortin-4 receptor mutations: a literature review.
Valette, M, Bellisle, F, Carette, C, Poitou, C, Dubern, B, Paradis, G, Hercberg, S, Muzard, L, Clément, K, Czernichow, S
International journal of obesity (2005). 2013;(8):1027-35
Abstract
Melanocortin-4 receptor (MC4R) mutations are the most common known cause of monogenic obesity and an important contributor to polygenic obesity. MC4R mutations with partial or total loss of function, as well as the variant rs17782313 mapped near MC4R, are positively associated with obesity. MC4R is involved in the leptin-melanocortin signalling system, located in hypothalamic nuclei, that controls food intake via both anorexigenic or orexigenic signals. Impairment in this receptor might affect eating behaviours. Thus, in the case of MC4R mutation carriers, obesity could be related, at least partly, to inadequate control over eating behaviours. Many published studies address eating behaviours in MC4R mutation carriers. Most studies focus on binge eating disorder, whereas others examine various aspects of intake and motivation. Up to now, no evaluation of this literature has been performed. In this review, we examine the available literature on eating behaviours in carriers of MC4R mutations and variant rs17782313 near MC4R gene. We address binge eating disorder, bulimia nervosa, mealtime hyperphagia, snacking, psychological factors, satiety responsiveness and intake of energy and macro/micronutrient. In a small number of studies, MC4R mutations seem to impair eating behaviours or motivation, but no clear causal effects can be found in the balance of the evidence presented. Improvements in methodologies will be necessary to clarify the behavioural effects of MC4R mutations.
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Dietary patterns, inflammation and the metabolic syndrome.
Ahluwalia, N, Andreeva, VA, Kesse-Guyot, E, Hercberg, S
Diabetes & metabolism. 2013;(2):99-110
Abstract
AIM: The study of dietary patterns offers a comprehensive, real-life approach towards examining the complex diet and disease relationship. The simultaneous association of dietary patterns with inflammation and the metabolic syndrome (MetS) has not been extensively reviewed. This report reviews the association of dietary patterns with inflammation in the context of the MetS. METHODS Original English-language research studies with humans were identified via MEDLINE, using inflammation, MetS, whole diets and dietary patterns as keywords. The findings were carefully examined and synthesized along consistent axes. RESULTS Many observational and a few prospective studies, as well as some randomized controlled trials (RCTs), support an inverse association between a Mediterranean dietary pattern and markers of inflammation. The link is generally independent of traditional cardiovascular disease (CVD) risk factors and weight loss. The few studies that have examined the association between following a healthy dietary pattern, evaluated using various diet quality scores, and inflammation report an inverse association; however, this association was attenuated upon adjusting for CVD risk factors. A Mediterranean dietary pattern has also been associated with a reduced risk of the MetS in several cross-sectional studies and a few prospective studies conducted with healthy people. Few RCTs (lasting 1-2years) have confirmed the benefits of following a Mediterranean diet on MetS risk in obese individuals, in those with the MetS or in those at CVD risk. The evidence, albeit limited, for a link between healthy diets based on other diet quality scores and the MetS supports a similar inverse association for the primary and secondary prevention of the MetS. CONCLUSION Adhering to healthy diets such as the Mediterranean diet and/or national dietary guidelines can reduce inflammation and the MetS.
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Excess body weight and second primary cancer risk after breast cancer: a systematic review and meta-analysis of prospective studies.
Druesne-Pecollo, N, Touvier, M, Barrandon, E, Chan, DS, Norat, T, Zelek, L, Hercberg, S, Latino-Martel, P
Breast cancer research and treatment. 2012;(3):647-54
Abstract
Several observational studies have investigated the role of body mass index (BMI) in second primary cancer incidence in women with breast cancer. We conducted a systematic review and meta-analysis of the evidence to assess the strength of this association. PubMed and Embase were searched for observational studies up to May 2012, and the reference lists of studies included in the analysis were examined. Random effects models were used to estimate summary relative risks (RRs) and 95 % confidence intervals (CIs). Thirteen prospective studies, five cohort and eight nested case-control studies, were included. In categorical meta-analyses of BMI, obesity was associated to significantly increased risks of contralateral breast (RR = 1.37, 95 % CI: 1.20-1.57), breast (RR = 1.40, 95 % CI: 1.24-1.58), endometrial (RR = 1.96, 95 % CI: 1.43-2.70), and colorectal (RR = 1.89, 95 % CI: 1.28-2.79) second primary cancers. For a BMI increase of 5 kg/m(2), dose-response meta-analyses resulted in significantly increased RRs of 1.12 (95 % CI: 1.06-1.20) and 1.14 (95 % CI: 1.07-1.21) for contralateral breast and breast second primary cancers, respectively. The summary RR for endometrial second primary cancers was 1.46 (95 % CI: 1.17-1.83) for a 5-unit increment. This result emphasizes the importance of prevention policies aiming to reduce overweight and obesity prevalence. Clinical trials in breast cancer patients with excess body weight evaluating the effect of normal weight restoration on second primary cancer incidence are needed.
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[Nutrition and miscarriages: a literature review].
Benammar, A, Sermondade, N, Faure, C, Dupont, C, Cedrin-Durnerin, I, Sifer, C, Hercberg, S, Levy, R
Gynecologie, obstetrique & fertilite. 2012;(3):162-9
Abstract
Miscarriage concerns approximately 15% of pregnancies and recurrent fetal loss (RFL) constitute a particular situation concerning approximately 1% of women. The etiologic inquiry is often disappointing. Nutritional factors represent a promising aspect, insufficiently investigated even if numerous studies underline their impact on fertility, gametogenesis, embryonic development and pregnancies outcome. Obesity is considered as an independent risk factor for miscarriage, involved in oocyte and embryo quality, but also in endometrial receptivity. The male part involved in miscarriage was for a long time underestimated, neglecting the role of sperm in embryo development. If conventional sperm analysis remains essential, new investigations have to be considered such as sperm DNA or oxidant stress evaluation. It is particularly important to take into account nutritional factors as favoring miscarriage because they represent a flexible factor on which intervention is possible to improve pregnancy outcome, with toxics eviction and recommendations for diversified and well-balanced food. At last, effects of nutritional complements for miscarriage prevention remain controversial.
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Obesity is associated with higher risk of intensive care unit admission and death in influenza A (H1N1) patients: a systematic review and meta-analysis.
Fezeu, L, Julia, C, Henegar, A, Bitu, J, Hu, FB, Grobbee, DE, Kengne, AP, Hercberg, S, Czernichow, S
Obesity reviews : an official journal of the International Association for the Study of Obesity. 2011;(8):653-9
Abstract
The aim of this study was to assess the association between obesity and the risk of intensive care unit (ICU) admission and death among patients hospitalized for influenza A (H1N1) viral infection. A systematic review of the Medline and Cochrane databases using 'obesity', 'hospitalization', 'influenza A viral infection', various synonyms, and reference lists of retrieved articles from January 2009 to January 2010. Studies comparing the prevalence of obesity among patients with confirmed infection for influenza A virus and who were either hospitalized or admitted to ICU/died were included. A total of 3059 subjects from six cross-sectional studies, who were hospitalized for influenza A (H1N1) viral infection, were included in this meta-analysis. Severely obese H1N1 patients (body mass index ≥ 40 kg m(-2), n = 804) were as twice as likely to be admitted to ICU or die (odds ration: 2.01, 95% confidence interval: 1.29-3.14, P < 0.002) compared with H1N1 patients who were not severely obese. Having a body mass index ≥ 30 kg m(-2) was similarly associated with a more than twofold increased risk of ICU admission or death although this did not reach statistical significance (2.14, 0.92-4.99, P < 0.07). This meta-analysis supports the view that obesity is associated with higher risks of ICU admission or death in patients with influenza A (H1N1) infection. Therefore, morbid obese patients should be monitored more intensively when hospitalized.
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Beta-carotene supplementation and cancer risk: a systematic review and metaanalysis of randomized controlled trials.
Druesne-Pecollo, N, Latino-Martel, P, Norat, T, Barrandon, E, Bertrais, S, Galan, P, Hercberg, S
International journal of cancer. 2010;(1):172-84
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Abstract
The effect of beta-carotene supplementation on cancer incidence has been investigated in several randomized controlled trials. The objective was to review the effect of beta-carotene supplementation on cancer incidence in randomized trials by cancer site, beta-carotene supplementation characteristics and study population. Relevant trials were retrieved by searching PubMed (up to April 2009). Authors involved in selected studies were contacted for additional information. Thirteen publications reporting results from 9 randomized controlled trials were included. Overall, no effect of beta-carotene supplementation was observed on the incidence of all cancers combined (RR, 1.01; 95% CI, 0.98-1.04), pancreatic cancer (RR, 0.99; 95% CI, 0.73-1.36), colorectal cancer (RR, 0.96; 95% CI, 0.85-1.09), prostate cancer (RR, 0.99; 95% CI, 0.91-1.07), breast cancer (RR, 0.96; 95% CI, 0.85-1.10), melanoma (RR, 0.98; 95% CI, 0.65-1.46) and non melanoma skin cancer (RR, 0.99; 95% CI, 0.93-1.05). The incidence of lung and stomach cancers were significantly increased in individuals supplemented with beta-carotene at 20-30 mg day(-1) (RR, 1.16; 95% CI, 1.06-1.27 and RR, 1.34; 95% CI, 1.06-1.70), in smokers and asbestos workers (RR, 1.20; 95% CI, 1.07-1.34 and RR, 1.54; 95% CI, 1.08-2.19) compared to the placebo group. Beta-carotene supplementation has not been shown to have any beneficial effect on cancer prevention. Conversely, it was associated with increased risk not only of lung cancer but also of gastric cancer at doses of 20-30 mg day(-1), in smokers and asbestos workers. This study adds to the evidence that nutritional prevention of cancer through beta-carotene supplementation should not be recommended.