The Third French Individual and National Food Consumption (INCA3) Survey 2014-2015: method, design and participation rate in the framework of a European harmonization process

Cumulative dietary risk assessment for French consumers exposed to succinate dehydrogenase inhibitor pesticides

Consumers are exposed to succinate dehydrogenase inhibitor (SDHI) pesticides through their diet. A cumulative dietary risk assessment for the French population has been performed with French monitoring data (2017-2021) and consumption data from INCA3. The calculation followed a two-tiered approach, using deterministic then probabilistic methods. It was carried out, using European health based guidance values (HBGV) derived for each active substance to characterise their toxicity. In Tier I, the calculated hazard index of 0.12 was below the threshold of 1 and in Tier II, the total margin of exposure at percentile 99.9 remains above the trigger value of 100 (1798 [1631-2311]). In Tier II, the three main risk drivers identified at the upper tail of the distribution were strawberries-fluopyram (19.1%), peaches-fluopyram (14.1%) and table grapes-boscalid (10.5%). Finally, the impact of the major sources of uncertainties was qualitatively evaluated. All together, they were considered of low impact on the outcomes. This work demonstrates the absence of unacceptable chronic risk related to the cumulative exposure of SDHI for French consumers during the 2017-2021 period.

In Healthy Pathways of Dietary Changes, a Very Rapid Reduction of Red Meat Is Possible, but Specific Diet Changes Are Required for Full Reduction-A Graph-Based Analysis

BACKGROUND

Although reducing meat consumption is becoming increasingly popular in Western countries, such a transition to a sustainable diet may pose some nutritional risks.

OBJECTIVES

We aim to analyze the pathways for reaching a low-meat healthy diet and the changes in other food categories needed to rapidly decrease total red meat consumption.

METHODS

We used a recently developed method based on graph theory to represent all possible pathways of stepwise changes that avoid nutritional deficiencies toward a target healthy diet. Initial and target diets were defined as the daily consumption of 33 food groups. For each sex, 3 initial diets were taken from the French representative survey third individual and national study on food consumption survey as the mean observed diet and low (first quintile) and high (fifth quintile) meat consumption. Target diets were identified using multicriteria optimization to minimize the long-term health risk (HR) of chronic diseases while ensuring nutritional adequacy. The Dijkstra algorithm was used to identify the optimal pathways between the initial and target diets, with the aim of reducing meat consumption as quickly as possible and thus minimizing long-term HRs.

RESULTS

Unprocessed red meat was easily minimized in the first steps of the pathways regardless of sex and initial level of meat consumption. However, processed meat could only be decreased later and required prior changes such as increases in fruit, vegetables, and oily fish. During total red meat minimization in females, securing adequate intakes of bioavailable iron had the most substantial impact on the other dietary changes needed.

CONCLUSIONS

Immediate reduction of red meat consumption is possible on the pathway to a healthy diet that avoids any nutrient deficiency. However, early increases in fruit, vegetables, and fish are required before minimizing total red meat early in the diet.

New insights into dairy management and the prevention and treatment of osteoporosis: The shift from single nutrient to dairy matrix effects-A review

Dairy is recognized as a good source of calcium, which is important for preventing osteoporosis. However, the relationship between milk and bone health is more complex than just calcium supplementation. It is unwise to focus solely on observing the effects of a single nutrient. Lactose, proteins, and vitamins in milk, as well as fatty acids, oligosaccharides, and exosomes, all work together with calcium to enhance its bioavailability and utilization efficiency through various mechanisms. We evaluate the roles of dairy nutrients and active ingredients in maintaining bone homeostasis from the perspective of the dairy matrix effects. Special attention is given to threshold effects, synergistic effects, and associations with the gut-bone axis. We also summarize the associations between probiotic/prebiotic milk, low-fat/high-fat milk, lactose-free milk, and fortified milk with a reduced risk of osteoporosis and discuss the potential benefits and controversies of these dairy products. Moreover, we examine the role of dairy products in increasing peak bone mass during adolescence and reducing bone loss in old age. It provides a theoretical reference for the use of dairy products in the accurate prevention and management of osteoporosis and related chronic diseases and offers personalized dietary recommendations for bone health in different populations.

Relationship between children's eating behavior (1-6 years) and body mass index: a cross-sectional study in French maternal-infant protection centers within the Parisian region

BACKGROUND

Early detection of obesity-promoting dietary behavior patterns improves the identification of at-risk families and the implementation of interventions. This is accomplished through the use of the Child Eating Behavior Questionnaire (CEBQ). No study has been conducted using the CEBQ in children followed in Essonne's Maternal-Infant Protection (PMI) centers. We investigated, in a cross-sectional design, the differences in children's eating behavior with PMI follow-up according to their weight status.

METHODS

A questionnaire addressed to parents was collected in PMI centers. Multiple hierarchical regression analysis was used to investigate the predictability of the child's CEBQ on body mass index (BMI).

RESULTS

From January to April 2022, 850 children were selected, from which 500 (aged 1-6 years) were included, and of whom 10.6% were obese. There was a significant positive association between 'Food Responsiveness', 'Enjoyment of Food' and BMI. In contrast, there was a significant negative association between 'Satiety Responsiveness', 'Slowness in Eating' and BMI. Besides, 'Food approach' and 'food avoidance' behaviors were positively and negatively related to BMI z-scores, respectively.

CONCLUSION

Due to significant differences in children's eating behavior according to their weight, it is needed to raise awareness among parents about their impact on them.

Fate of nitrogen in French human excreta: Current waste and agronomic opportunities for the future

Nitrogen (N) is essential for plant growth and protein synthesis but global reactive N losses, mainly from food systems, induce strong environmental impacts. N losses after human excretion are often overlooked because, in Western societies, they partly occur as inert N2, following denitrification in wastewater treatment plants (WWTP), and losses in waters are often small compared to diffuse agricultural emissions. Yet N from human excretions could be used for crop fertilization, potentially with very high recycling rates via source separation. In this study we use unique operational data from the ∼20,000 French WWTPs to produce a N mass-balance of excretions in the French sanitation system. Even though 75 % of WWTPs' sludge is spread on crops, only 10 % of the excreted N is recycled and 50 % of N is lost to the atmosphere, mainly through WWTP nitrification-denitrification. The remaining 40 % ends up in water or in diffuse losses in the ground, of which about half is lost outside of the WWTPs' discharge system, through sewers storm water and individual autonomous systems. While WWTPs removal efficiency increased in the 2000s, it has been followed by a decade of stagnation, reaching 70 % at the national level. This national average hides regional discrepancies, from 60 to 85 % in the 6 French water agencies basins. These differences closely correlate with the classification as "N sensitive areas" and is mainly due to large WWTPs which handle most of the N load. Recycling all N in excretions could supply 10 % of domestic protein consumption in the current French food system, and up to 30 % if it is prioritized towards crop production for human consumption. Redesigning the food system (decrease of nutrient losses, more plant-based diets) could further increase this contribution.

How to use an in vitro approach to characterize the toxicity of airborne compounds

As part of the development of new approach methodologies (NAMs), numerous in vitro methods are being developed to characterize the potential toxicity of inhalable xenobiotics (gases, volatile organic compounds, polycyclic aromatic hydrocarbons, particulate matter, nanoparticles). However, the materials and methods employed are extremely diverse, and no single method is currently in use. Method standardization and validation would raise trust in the results and enable them to be compared. This four-part review lists and compares biological models and exposure methodologies before describing measurable biomarkers of exposure or effect. The first section emphasizes the importance of developing alternative methods to reduce, if not replace, animal testing (3R principle). The biological models presented are mostly to cultures of epithelial cells from the respiratory system, as the lungs are the first organ to come into contact with air pollutants. Monocultures or cocultures of primary cells or cell lines, as well as 3D organotypic cultures such as organoids, spheroids and reconstituted tissues, but also the organ(s) model on a chip are examples. The exposure methods for these biological models applicable to airborne compounds are submerged, intermittent, continuous either static or dynamic. Finally, within the restrictions of these models (i.e. relative tiny quantities, adhering cells), the mechanisms of toxicity and the phenotypic markers most commonly examined in models exposed at the air-liquid interface (ALI) are outlined.

Identification of three dietary groups in French university students and their associations with nutritional quality and environmental impact

Introduction

The student period is associated with changes in eating habits, usually leading to diets of lower nutritional quality. However, some variability may exist in students' dietary patterns. We aimed to describe French students' diets and identify dietary groups that may vary in nutritional quality and environmental impact.

Methods

A representative sample of French students (N = 582) for age, sex and scholarship status completed an online 125-item food frequency questionnaire. The nutritional quality of diets was assessed by a score of adherence to the French nutritional guidelines (sPNNS-GS2 score, ranging from-17 to 11.5) and its environmental impact by greenhouse gas emissions for an isocaloric diet (GHGE). An ascending hierarchical classification analysis on food and beverage intakes led to three dietary groups. Between-group differences in food consumption, dietary indicators and sociodemographic characteristics were investigated using ANOVA models.

Results

The average sPNNS-GS2 score of students' diets was -0.8 ± 2.8, representing a 57% coverage of French nutritional recommendations, and GHGE were 5.4 ± 1.7 kg eCO2/2000 kcal. The three dietary groups were: a healthy diet group (20% of the sample) with the highest nutritional quality and high GHGE, which included older students with a higher level of physical activity; a Western diet group (40%) with the worst nutritional quality and high GHGE, which included more students who lived with their parents; and a frugal diet group (40%) with the lowest energy intake, intermediate nutritional quality, and low GHGE, which included more students who lived alone.

Conclusion

None of the dietary groups optimized both nutritional quality and environmental impact simultaneously, which suggests an apparent incompatibility in the student population between these two sustainability dimensions. These findings emphasize the need for tailored public health policies that acknowledge the diversity of student eating patterns and address specific individual barriers to healthy and sustainable diets.

Advances in diagnosis and management of distal sensory polyneuropathies

Distal sensory polyneuropathy (DSP) is characterised by length-dependent, sensory-predominant symptoms and signs, including potentially disabling symmetric chronic pain, tingling and poor balance. Some patients also have or develop dysautonomia or motor involvement depending on whether large myelinated or small fibres are predominantly affected. Although highly prevalent, diagnosis and management can be challenging. While classic diabetes and toxic causes are well-recognised, there are increasingly diverse associations, including with dysimmune, rheumatological and neurodegenerative conditions. Approximately half of cases are initially considered idiopathic despite thorough evaluation, but often, the causes emerge later as new symptoms develop or testing advances, for instance with genetic approaches. Improving and standardising DSP metrics, as already accomplished for motor neuropathies, would permit in-clinic longitudinal tracking of natural history and treatment responses. Standardising phenotyping could advance research and facilitate trials of potential therapies, which lag so far. This review updates on recent advances and summarises current evidence for specific treatments.

Consumption of Bivalve Shellfish in French Coastal Populations: Data for Acute and Chronic Exposure Assessment

Shellfish are a source of nutrients but are also a matter of concern in terms of food safety due to natural contaminants such as phycotoxins or anthropogenic contaminants including microbial agents and heavy metals. However, data related to consumption for each mollusk species are scarce and missing for appropriate exposure calculation. The objective of the study was to generate shellfish consumption data in the adult coastal population in France to assess exposure to health risks, the effects of determinants on the frequency of consumption and usual intake, and shellfish food risk perception. Our study, named the CONSOMER study, was carried out using an online survey in 2016 and 2017 and included a food frequency questionnaire. After validation, 2,479 individual questionnaires were available for statistical analysis. Our findings provide estimates of shellfish consumption frequency, portion sizes, weekly intake in g/week, and g/week/body weight that can be used for acute and chronic exposure calculations. For the acute risk, the 97.5th percentile of the portion size was found to be around 290 g for the adult coastal population. For chronic exposure, recreational shellfish harvesting activities were associated with higher weekly intakes. A non-negligible part of this subpopulation is not aware of food safety recommendations concerning harvesting areas. Results for shellfish harvester consumption in particular are consistent with other available data. Exposure calculations and safety recommendations should target shellfish harvesters.

Identifying the most Efficient Detailed Trajectories toward Healthy Diets-A Graph-Based Analysis

BACKGROUND

Much effort has been devoted to defining healthy diets, which could lower the burden of disease and provide targets for populations. However, these target diets are far removed from current diets, so at best, the population is expected to move slowly along a trajectory.

OBJECTIVE

Our aim was to characterize the different possible trajectories toward a target diet and identify the most efficient one for health to point out the first dietary changes being the most urgent to implement.

METHODS

Using graph theory, we have developed a new method to represent in a graph all stepwise change trajectories toward a target healthy diet, with trajectories all avoiding risk of nutrient deficiency. Then, we have identified and characterized the trajectory with the highest value for long-term health. Observed male and female average diets are from the French representative survey INCA3, and target diets were set using multicriteria optimization. The best trajectories were found using the Dijkstra algorithm with the Health risk criteria based on epidemiological data.

RESULTS

Within ∼2.6M diets in the graphs, we found optimal trajectories that were rather similar for males and females regarding the most efficient changes in the first phase of the pathways. In particular, we found that a 1-step increase in the consumption of whole/semirefined bread (60 g) was the first step in all healthiest trajectories. In males, the subsequent decrease in red meat was immediately preceded by increases in legumes.

CONCLUSIONS

We show simple practical dietary changes that can be prioritized along an integral pathway that is the most efficient overall for health when transiting toward a distant healthy diet. We put forward a new method to analyze dietary strategy for public health transition and highlight the first critical steps to prioritize.

Ranking food products based on estimating and combining their microbiological, chemical and nutritional risks: Method and application to Ready-To-Eat dishes sold in France

Microbiological (M), chemical (C), and nutritional (N) risks associated with food products are usually assessed and managed independently by experts in public services or food companies. This can render difficult the comparison of food products in term of overall risk for the consumer. The objective of this study was to suggest a relatively simple method to (i) classify food products based on their M, C and N risks, and (ii) aggregate these risks and rank the food products accordingly. The method was developed and applied to 17 ready-to-eat (RTE) dishes available on the French market. With regard to food safety, the individual M and C risks were characterized considering likelihood and severity as recommended by the Codex Alimentarius. With regard to nutrition/health, the N risk was estimated based on the tendency of the dish to contribute to nutrient adequacy and to a healthy eating pattern. Finally, the outranking method PROMETHEE was applied to aggregate the three M, C, N risks and rank the food dishes. Food products were ranked relatively to each other, not in absolute terms. When we attributed the same weight to M, C and N risks, the RTE dish "Duck Parmentier" had the highest risk score while "Papillote of chicken, potatoes and small vegetables" and "Vegetarian plate vegetables and quinoa" had the lowest. However, this overall ranking changed according to the weight assigned to individual M, C and N risks, at least for food products whose scores varied according to risk types, such as"sushi discovery" (high M and C risks, low N risk). Since the risk ranking method developed here was built with assumptions and hypotheses related to the specific case study, more applications are needed to assess whether it can be generic. Nevertheless, this method is well grounded, objective, transparent, relatively fast and easy to set up. It might lead to further development of decision tools, particularly for consumers. This study paves the way towards food product multi-risk ranking.

Plant to animal protein ratio in the diet: nutrient adequacy, long-term health and environmental pressure

Background

Animal and plant protein sources have contrasting relationships with nutrient adequacy and long-term health, and their adequate ratio is highly debated.

Objective

We aimed to explore how the percentage of plant protein in the diet (%PP) relates to nutrient adequacy and long-term health but also to environmental pressures, to determine the adequate and potentially optimal %PP values.

Methods

Observed diets were extracted from the dietary intakes of French adults (INCA3, n = 1,125). Using reference values for nutrients and disease burden risks for foods, we modeled diets with graded %PP values that simultaneously ensure nutrient adequacy, minimize long-term health risks and preserve at best dietary habits. This multi-criteria diet optimization was conducted in a hierarchical manner, giving priority to long-term health over diet proximity, under the constraints of ensuring nutrient adequacy and food cultural acceptability. We explored the tensions between objectives and identified the most critical nutrients and influential constraints by sensitivity analysis. Finally, environmental pressures related to the modeled diets were estimated using the AGRIBALYSE database.

Results

We find that nutrient-adequate diets must fall within the ~15-80% %PP range, a slightly wider range being nevertheless identifiable by waiving the food acceptability constraints. Fully healthy diets, also achieving the minimum-risk exposure levels for both unhealthy and healthy foods, must fall within the 25-70% %PP range. All of these healthy diets were very distant from current typical diet. Those with higher %PP had lower environmental impacts, notably on climate change and land use, while being as far from current diet.

Conclusion

There is no single optimal %PP value when considering only nutrition and health, but high %PP diets are more sustainable. For %PP > 80%, nutrient fortification/supplementation and/or new foods are required.

Effectiveness of multilevel interventions based on socio-ecological model to decrease sedentary time in children: a systematic review of controlled studies

Objectives

Preventive actions of sedentary behavior (SB) based on the socio-ecological model are needed among children and young adolescents. The aim of this systematic review is to ascertain the effectiveness of multilevel interventions (i.e., involving consideration of at least two interventional levels) in reducing sedentary time (ST) in children aged 5-12 years.

Methods

Adhering to PRISMA guidelines, a systematic literature search was conducted in three databases (PsyInfo, PubMed and ERIC) until July 2021.

Results

30 trials met the eligibility criteria and were included. They showed acceptable (< 8, n = 18) and high (≥ 8, n = 12) methodological quality. Among studies targeting 2 (n = 2), 3 (n = 19) and 4 levels (n = 9), 1 (50%), 9 (47%) and 7 (78%) were effective and reported significant reduction of ST, respectively.

Conclusion

Interventions tend to be more effective when they involve 4 levels, using both agentic and structural strategies (targeting intrinsic determinants, in the organizational environment of the child). Findings underline the relevance of multilevel strategies to reduce ST in children, but also raise issues about operationalization of the socio-ecological perspective.

Systematic review registration

PROSPERO, identifier: CRD42020209653.

Soft Drink Intake in Europe—A Review of Data from Nationally Representative Food Consumption Surveys

Public health interest in reducing the intake of sugar-sweetened soft drinks has resulted in various guidelines and initiatives related to their consumption, together with an increase in availability and sales of low and no-sugars versions. The aim of this review was to gain insight regarding individual-level amounts and types of soft drinks consumed across the lifecycle as reported in nationally representative surveys in Europe. The review highlighted significant gaps and challenges regarding the availability of recent country-specific soft drink consumption data including heterogeneity in categorisations used in reporting soft drinks. Nonetheless, crude estimates of mean intake (across countries) indicated that total soft drinks and soft drinks with sugars was highest in adolescents and lowest in infants/toddlers and older adults. For infants/toddlers, crude mean intakes of soft drinks with reduced/no sugars were higher than soft drinks with sugars. The review also found that consumption of total soft drinks is decreasing with a shift to consumption of soft drinks with reduced/no sugars in replacement of sugars-containing soft drinks. This review provides valuable insight into what data are currently available on soft drink consumption in Europe with heterogeneity in categorisations, terminology, and definitions of soft drinks observed.

Plant-based meat substitutes are useful for healthier dietary patterns when adequately formulated - an optimization study in French adults (INCA3)

PURPOSE

We studied to what extent plant-based meat substitutes could improve the nutritional adequacy and healthiness of dietary patterns, depending on their nutrient composition.

METHODS

From diets observed in French adults (INCA3, n = 1125), modeled diets were identified by allowing various dietary changes, between and within food categories, when two plant-based meat substitutes were made available: an average substitute (from 43 market substitutes) and a theoretical nutritionally designed substitute, fortified or not with zinc and iron at 30% or 50% of Nutrient Reference Values. Under each scenario, healthier but acceptable modeled diets were identified using multi-criteria optimization, by maximizing a health criteria related to Dietary Guidelines while minimizing deviation from the observed diets, under constraints for nutrient adequacy.

RESULTS

Without fortification, the average substitute was hardly introduced into modeled diets, whereas the optimized substitute was preferentially introduced, in large amounts, yet together with a moderate reduction of red meat (- 20%). The comparative advantages of the optimized substitute were its higher contribution to vitamins B6 and C, fiber and α-linolenic acid (ALA) intakes, and its lower contribution to sodium intake. When fortified with iron and zinc, substitutes were introduced in larger amounts into modeled diets, with much higher red meat reductions (down to - 90%). The optimized substitute continued to be preferred, leading to healthier modeled diets that deviated less from the observed.

CONCLUSION

Plant-based meat substitutes can be levers for healthy diets only when well nutritionally designed with enough zinc and iron for a substantial red meat reduction.

Principles and Validations of an Artificial Intelligence-Based Recommender System Suggesting Acceptable Food Changes

BACKGROUND

Along with the popularity of smartphones, artificial intelligence-based personalized suggestions can be seen as promising ways to change eating habits toward more desirable diets.

OBJECTIVES

Two issues raised by such technologies were addressed in this study. The first hypothesis tested is a recommender system based on automatically learning simple association rules between dishes of the same meal that would make it possible to identify plausible substitutions for the consumer. The second hypothesis tested is that for an identical set of dietary-swaps suggestions, the more the user is-or thinks to be-involved in the process of identifying the suggestion, the higher is their probability of accepting the suggestion.

METHODS

Three studies are presented in this article, first, we present the principles of an algorithm to mine plausible substitutions from a large food consumption database. Second, we evaluate the plausibility of these automatically mined suggestions through the results of online tests conducted for a group of 255 adult participants. Afterward, we investigated the persuasiveness of 3 suggestion methods of such recommendations in a population of 27 healthy adult volunteers through a custom designed smartphone application.

RESULTS

The results firstly indicated that a method based on automatic learning of substitution rules between foods performed relatively well identifying plausible swaps suggestions. Regarding the form that should be used to suggest, we found that when users are involved in selecting the most appropriate recommendation for them, the resulting suggestions were more accepted (OR = 3.168; P < 0.0004).

CONCLUSIONS

This work indicates that food recommendation algorithms can gain efficiency by taking into account the consumption context and user engagement in the recommendation process. Further research is warranted to identify nutritionally relevant suggestions.

Active and passive biomonitoring of trace elements, polycyclic aromatic hydrocarbons, and polychlorinated biphenyls in small Mediterranean harbours

Pollution particularly affects coastal ecosystems due to their proximity to anthropic sources. Among those environments, harbours are subjected to marine traffic but also to accidental and chronic pollution. These areas are thus exposed to complex mixtures of contaminants such as trace elements and organic contaminants which can impact marine species, habitats, and ecosystem services. The monitoring of these compounds is thus a crucial issue for assessment of environmental health. In this context, the aim of the present work was to evaluate the chemical contamination of harbours in Corsica (NW Mediterranean) by measuring the bioaccumulation of trace elements, polycyclic aromatic hydrocarbons, and polychlorinated biphenyls in mussels, limpets, and sea cucumbers. The human health risks associated with seafood consumption were also assessed. Results reveal a relatively low contamination in the Corsican harbours studied compared to larger Mediterranean ports and suggest that the potential health risk for consumers eating seafood is low.

Dietary protein consumption profiles show contrasting impacts on environmental and health indicators

Patterns of protein intake are strong characteristics of diets, and protein sources have been linked to the environmental and nutrition/health impacts of diets. However, few studies have worked on protein profiles, and most of them have focused on specific diets like vegetarian or vegan diets. Furthermore, the description of the environmental impact of diets has often been limited to greenhouse gas emissions (GHGe) and land use. This paper analyzes the alignment of environmental pressures and nutritional impacts in a diversity of representative protein profiles of a western population. Using data from a representative survey in France (INCA3, n = 1125), we identified protein profiles using hierarchical ascendant classification on protein intake (g) from main protein sources (refined grains, whole grains, dairy, eggs, ruminant meat, poultry, pork, processed meat, fish, fruits & vegetables, pulses). We assessed their diet quality using 6 dietary scores, including assessment of long-term risk for health, and associated 14 environmental pressure indicators using the Agribalyse database completed by the SHARP database for GHGe. Five protein profiles were identified according to the high contributions of ruminant meat, pork, poultry, fish, or, conversely, as low contribution from meat. The profile including the lowest protein from meat had the lowest impact on almost all environmental indicators and had the lowest long-term risk. Conversely, the profile with high protein from ruminant-based foods had the highest pressures on most environmental indicators, including GHGe. We found that the protein profile with low contribution from meat has great potential for human health and environment preservation. Shifting a large part of the population toward this profile could be an easy first step toward building a more sustainable diet.

Nutritional issues and dietary levers during gradual meat reduction - A sequential diet optimization study to achieve progressively healthier diets

BACKGROUND & AIMS

Reducing meat consumption is a current trend and a strong prospect for the future in Western countries, but its dietary modalities and nutrient challenges remain poorly documented. Using diet optimization under a broad set of constraints, we tried to identify a sequential meat reduction transition and analyze its nutrient issues and dietary levers.

METHODS

Based on the consumption of French adults (INCA3, n = 1 125, 18-64 years old), we modeled a transition towards a nutritionally adequate healthy dietary pattern under the constraint of a gradual reduction in meat consumption in successive 10% steps. Using a multi-criteria optimization procedure, the diet modeled at each meat reduction step was to be healthier but close to the previous diet.

RESULTS

The most significant changes occurred early in the modeled transition process, with drastic reductions in processed and red meats in favor of poultry, which rapidly became the predominant meat before gradually decreasing from 50% to 100% meat reduction. At the same time, whole grain products, fruits and vegetables consumption increased rapidly to reach a plateau from 50% meat reduction onwards. Some nutrients were limiting, in particular bioavailable iron and zinc, and vitamin A, but sufficient intakes were achieved by restructuring diets based on food groups other than meat. Other nutrients mainly supplied by meat such as vitamin B6 and B12, protein and indispensable amino acids, were never limiting.

CONCLUSION

Healthy and nutritionally adequate food patterns can be identified throughout a transition to complete meat reduction. After a 50% reduction in meat consumption, poultry is almost the only meat remaining and its further reduction makes the diet only marginally healthier.

Possible Measures to Improve Both Participation and Response Quality in Japan’s National Health and Nutrition Survey: Results from a Workshop by Local Government Personnel in Charge of the Survey

Increasing participation rates are crucial to ensure the representativeness of national survey results of the population. This study aimed to identify measures that could be taken by local government personnel in charge of the National Health and Nutrition Survey (NHNS), Japan, to improve participation rates. The subjects were twenty-one health personnel who worked in 19 local governments and participated in the training course at the National Institute of Public Health. Qualitative data were collected through a workshop. They discussed the problems that seem to affect participation rates and identified possible solutions. The contents were coded and grouped to create categories, using the Jiro Kawakita (KJ) method. For data analysis, researchers combined and reviewed all codes and categories. The measures that could improve participation rates were divided into the following 12 categories: 1. standardization of survey methods, 2. investigator skills, 3. survey organization, 4. venue setting, 5. accessing target households, 6. time of survey, 7. responses during the investigation, 8. confirming meal contents reported in the nutritional intake status survey, 9. rewards/incentives, 10. possible rewards, 11. feedback on survey results, and 12. survey practices during the COVID-19 pandemic. These findings represent viable initiatives for local health personnel to increase participation rates for the NHNS.

Plant and Animal Protein Intakes Largely Explain the Nutritional Quality and Health Value of Diets Higher in Plants: A Path Analysis in French Adults

Diets higher in plants are associated with lower risks of chronic diseases. However, animal foods, which are rich in protein, are also rich in some important minerals and vitamins. Using data from a representative survey in France (INCA3, n = 1,125), we used path analyses as a mediation-like approach to decipher the importance of plant and animal proteins in the relationship between the plant-based diet index (PDI) and diet quality. We used three types of diet quality scores, namely, nutrient security, positive nutrient adequacy, and long-term mortality risk of four diet-related diseases (i.e., coronary heart disease, stroke, type 2 diabetes, and colorectal cancer). We identified positive and negative mediations, i.e., changes in plant/animal protein intake that are associated with changes in PDI, and favor or limit the association with the diet quality score. The PDI was positively associated with the risk of long-term mortality but not significantly with nutrient adequacy or nutrient security. A positive mediation by plant protein was found for all diet quality scores (specific indirect effects (SIEs) ranging from 0.04 to 0.10 SD). Conversely, the association between PDI and nutrient adequacy (but not nutrient security) was negatively mediated by animal protein intake (SIE: −0.06 SD). In further detailed models, the association between PDI and diet quality was mainly positively mediated by protein foods from the fruit-vegetables-legumes group (0.01 SD for the nutrient security and 0.02 SD for the nutrient adequacy) and whole grains (0.02 SD for the nutrient adequacy). Our data suggest that the positive impact of plant-based diets on diet quality is largely driven by higher intakes of plant protein foods, especially from fruits-vegetables-legumes and whole grains. Conversely, lower animal protein intake tends to limit the positive impact of plant-based diets on overall positive nutrient adequacy but not security. Protein sources appear critical to healthy plant-based diets.

Development and evaluation of a new dietary index assessing nutrient security by aggregating probabilistic estimates of the risk of nutrient deficiency in two French adult populations

Although micronutrient deficiencies affect 2 billion people worldwide, no index focuses on measuring the risk of overt nutrient deficiency. We aimed to develop an index that could capture the nutrient dimension of nutritional security, a nutrient security index (named SecDiet), and evaluate its apparent validity. The SecDiet (range: 0-1) is based on the square-weighted average of the probabilities that the intake of twelve critical nutrients exceeds the threshold value associated with a risk of overt deficiency. Using adult populations from a French representative survey (INCA3, n 1774) and a large cohort (NutriNet-Santé, n 104 382), the content and construct validity of the SecDiet was evaluated by estimating associations of the SecDiet with its components and with relevant socio-demographic characteristics. The SecDiet was high in the overall population (0·93 (SD 0·09) in INCA3) and markedly skewed towards 1 (i.e. lower risk of insufficient intake). It correlated positively with its twelve components (r 0·17-0·78, all P < 0·001). The SecDiet was associated with monthly income (P = 0·002), perception of financial situation, professional situation, food insufficiency and security statuses (all P < 0·001) in the INCA3 population and with monthly income, professional situation and level of education (all P < 0·001) in the NutriNet-Santé population. Unlike a broader nutrient-based quality index taken as comparison, the SecDiet mean decreased and the tail of its distribution notably extended downwards in at-risk sub-populations, thus revealing its specific sensitivity. The SecDiet could be used to screen sub-groups or study the determinants of nutrient insecurity in large population surveys.

Potential of existing online 24-h dietary recall tools for national dietary surveys

OBJECTIVE

To describe existing online, 24-h dietary recall (24-h DR) tools in terms of functionalities and ability to tackle challenges encountered during national dietary surveys, such as maximising response rates and collecting high-quality data from a representative sample of the population, while minimising the cost and response burden.

DESIGN

A search (from 2000 to 2019) was conducted in peer-reviewed and grey literature. For each tool, information on functionalities, validation and user usability studies, and potential adaptability for integration into a new context was collected.

SETTING

Not country-specific.

PARTICIPANTS

General population.

RESULTS

Eighteen online 24-h DR tools were identified. Most were developed in Europe, for children ≥10 years old and/or for adults. Eight followed the five multiple-pass steps but used various methodologies and features. Almost all tools (except three) validated their nutrient intake estimates, but with high heterogeneity in methodologies. User usability was not always assessed, and rarely by applying real-time methods. For researchers, eight tools developed a web platform to manage the survey and five appeared to be easily adaptable to a new context.

CONCLUSIONS

Among the eighteen online 24-h DR tools identified, the best candidates to be used in national dietary surveys should be those that were validated for their intake estimates, had confirmed user and researcher usability, and seemed sufficiently flexible to be adapted to new contexts. Regardless of the tool, adaptation to another context will still require time and funding, and this is probably the most challenging step.

Substituting Meat or Dairy Products with Plant-Based Substitutes Has Small and Heterogeneous Effects on Diet Quality and Nutrient Security: A Simulation Study in French Adults (INCA3)

BACKGROUND

Plant-based substitutes are designed to have the same use as animal-based foods in the diet and could therefore assist the transition toward more plant-based diets. However, their nutritional impact has not been characterized.

OBJECTIVES

We assessed and compared the effects of plant-based substitutes on the nutritional quality of the diet.

METHODS

We simulated separately the substitution of meat, milk, and dairy desserts with 96 plant-based substitutes in the diets of 2121 adults (18-79 y old) from the cross-sectional French Third Individual and National Study on Food Consumption Survey (INCA3; 2014-2015). The quality of initial individual diets and the 203,616 substituted diets was evaluated using the Probability of Adequate Nutrient Intake (PANDiet) scoring system, which assesses the probability of adequate (sufficient and not excessive) nutrient intake; also, nutrient security was evaluated using the SecDiet scoring system, which assesses the risk of overt deficiency.

RESULTS

Impacts on PANDiet depended on both the food substituted and the types of substitutes. Soy-based substitutes provided a slight improvement in diet quality (0.8% increase of the PANDiet score when substituting meat), whereas cereal-based substitutes resulted in a 1.1% decrease. Globally, substitutions led to better adequacies for fiber, linoleic acid, α-linolenic acid, vitamin E, folate, and SFAs, but lower adequacies regarding vitamin B-12 and riboflavin, as well as bioavailable zinc and iron when substituting meat, and calcium and iodine when substituting milk/dairy desserts. When they substituted dairy products, calcium-fortified substitutes allowed maintenance of calcium adequacy but there was a higher risk of iodine deficiency when substituting dairy, which may warrant iodine fortification. Substitutions modified the energy share of ultra-processed foods from 29% to 27%-40%, depending on the food substituted and the substitute used.

CONCLUSIONS

Plant-based substitutes had a small effect on overall diet quality and heterogeneous impacts on nutrient adequacy and security. Plant-based substitutes that include legumes appear more nutritionally adequate to substitute animal products than do other substitutes.

Identification of psychological correlates of dietary misreporting under laboratory and free-living environments

Errors inherent in self-reported measures of energy intake (EI) are substantial and well documented, but correlates of misreporting remain unclear. Therefore, potential predictors of misreporting were examined. In Study One, fifty-nine individuals (BMI = 26·1 (sd 3·8) kg/m2, age = 42·7 (sd 13·6) years, females = 29) completed a 14-d stay in a residential feeding behaviour suite where eating behaviour was continuously monitored. In Study Two, 182 individuals (BMI = 25·7 (sd 3·9) kg/m2, age = 42·4 (sd 12·2) years, females = 96) completed two consecutive days in a residential feeding suite and five consecutive days at home. Misreporting was directly quantified by comparing covertly measured laboratory weighed intakes (LWI) with self-reported EI (weighed dietary record (WDR), 24-h recall, 7-d diet history, FFQ). Personal (age, sex and %body fat) and psychological traits (personality, social desirability, body image, intelligence quotient and eating behaviour) were used as predictors of misreporting. In Study One, those with lower psychoticism (P = 0·009), openness to experience (P = 0·006) and higher agreeableness (P = 0·038) reduced EI on days participants knew EI was being measured to a greater extent than on covert days. Isolated associations existed between personality traits (psychoticism and openness to experience), eating behaviour (emotional eating) and differences between the LWI and self-reported EI, but these were inconsistent between dietary assessment techniques and typically became non-significant after accounting for multiplicity of comparisons. In Study Two, sex was associated with differences between LWI and the WDR (P = 0·009), 24-h recall (P = 0·002) and diet history (P = 0·050) in the laboratory, but not home environment. Personal and psychological correlates of misreporting identified displayed no clear pattern across studies or dietary assessment techniques and had little utility in predicting misreporting.

A Sustainable and Global Health Perspective of the Dietary Pattern of French Population during the 1998–2015 Period from INCA Surveys

In France, the evolution of dietary pattern relative to sustainability and global health remains insufficiently studied. The objective of this study was to assess dietary changes during 1998–2015 through three generic metrics potentially related to sustainability. Food consumption data were collected from three French National Individual Study of Food Consumption surveys (INCA) for children (0–17 years) and adults (18–79 years) representative of the French population. The consumed foods were converted into plant (metric 1) and non-ultra-processed (UPF, metric 2) calories, and analyzed in meeting dietary recommended intakes (metric 3). French children and adults consumed high levels of animal and UPF calories, and nutrient deficiencies were observed in adults from the 2015 survey, e.g., fiber, EPA, DHA, magnesium, retinol, and vitamin C. In children, UPF daily calories increased from 42.8 to 45.5% and decreased in adults from 39.2 to 35.0%. In children and adults, diet revegetation was observed. While the level of physical activity decreased, overweight, obesity and type 2 diabetes prevalence increased in French adults. The French dietary pattern is not sustainable for global health unless public health policy is reinforced, with at least a twofold decrease in animal and UPF calories and improved food diversity.

Contrary to ultra-processed foods, the consumption of unprocessed or minimally processed foods is associated with favorable patterns of protein intake, diet quality and lower cardiometabolic risk in French adults (INCA3)

PURPOSE

While the consumption of ultra-processed foods is steadily increasing, there is a growing interest in more sustainable diets that would include more plant protein. We aimed to study associations between the degree of food processing, patterns of protein intake, diet quality and cardiometabolic risk.

METHODS

Using the NOVA classification, we assessed the proportion of energy from unprocessed/minimally processed foods (MPFp), processed foods (PFp) and ultra-processed foods (UPFp) in the diets of 1774 adults (18-79 years) from the latest cross-sectional French national survey (INCA3, 2014-2015). We studied the associations between MPFp, PFp and UPFp with protein intakes, diet quality (using the PANDiet scoring system, the global (PDI), healthful (hPDI) and unhealthful (uPDI) plant-based diet indices) and risk of cardiometabolic death (using the EpiDiet model).

RESULTS

MPFp was positively associated with animal protein intake and plant protein diversity, whereas PFp was positively associated with plant protein intake and negatively with plant protein diversity. The PANDiet was positively associated with MPFp (β = 0.14, P < 0.0001) but negatively with UPFp (β = - 0.05, P < 0.0001). These associations were modified by adjustment for protein intakes and plant protein diversity. As estimated with comparative risk assessment modeling between extreme tertiles of intake, mortality from cardiometabolic diseases would be decreased with higher MPFp (e.g. by 31% for ischemic heart diseases) and increased with higher UPFp (by 42%) and PFp (by 11%).

CONCLUSIONS

In the French population, in contrast with UPFp, higher MPFp was associated with higher animal protein intake, better plant protein diversity, higher diet quality and markedly lower cardiometabolic risk.

Association of organic food consumption with obesity in a nationally representative sample

The increased prevalence and adverse health consequences of obesity have made it one of the leading public health issues in recent years. Importantly, several epidemiological studies have revealed significant associations between BMI and organic food consumption. However, although these studies have suggested that this factor holds promise to prevent obesity, they all suffer from methodological limitations, including self-reporting methods to assess BMI, not controlling for potential confounding factors or using a non-representative sample. Moreover, all were restricted to an adult sample. We present the results of a cross-sectional epidemiological study assessing the association of organic food consumption with BMI and obesity in a representative lifespan French sample (INCA3 study). Objective methods were used to measure BMI, and several potentially confounding variables were controlled for. In total, 1775 children and adolescents and 2121 adults underwent anthropometric measurements and completed questionnaires concerning their dietary habits and lifestyle. Unadjusted models systematically revealed negative associations between organic food consumption and both BMI and obesity across all age groups. These associations tended to remain statistically significant even after controlling for several confounding variables concerning socio-economic status, quality of the diet and physical activity. The effect sizes were, however, small. These data confirm the association between organic food consumption and obesity during both childhood and adulthood. Evidence from randomised controlled trials is required to investigate causality between organic food consumption and lower BMI or obesity rate.

May omega-3 fatty acid dietary supplementation help reduce severe complications in Covid-19 patients?

In around 10% of SARS-CoV-2 infected patients, coronavirus disease-2019 (Covid-19) symptoms are complicated with a severe lung damage called Acute Respiratory Distress Syndrome (ARDS), which is often lethal. ARDS is mainly associated with an uncontrolled overproduction of immune cells and cytokines, called "cytokine storm syndrome"; it appears 7-15 days following the onset of symptoms, leading to systemic inflammation and multiple organ failure. Because they are well-known metabolic precursors of specialized pro-resolving lipid mediators (SPMs), omega-3 long-chain polyunsaturated fatty acids (omega-3 LC-PUFAs) could help improve the resolution of the inflammatory balance, limiting therefore the level and duration of the critical inflammatory period. Omega-3 LC-PUFAs may also interact at different stages of the viral infection, notably on the virus entry and replication. In the absence of demonstrated treatment and while waiting for vaccine possibility, the use of omega-3 LC-PUFAs deserve therefore to be considered, based on previous clinical studies suggesting that omega-3 supplementation could improve clinical outcomes of critically ill patients at the acute phase of ARDS. In this context, it is crucial to remind that the omega-3 PUFA dietary intake levels in Western countries remains largely below the current recommendations, considering both the omega-3 precursor α-linolenic acid (ALA) and long chain derivatives such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). An optimized omega-3 PUFAs status could be helpful to prevent infectious diseases, including Covid-19.

Outbreak of Salmonella Newport associated with internationally distributed raw goats' milk cheese, France, 2018

Raw milk cheeses are commonly consumed in France and are also a common source of foodborne outbreaks (FBOs). Both an FBO surveillance system and a laboratory-based surveillance system aim to detect Salmonella outbreaks. In early August 2018, five familial FBOs due to Salmonella spp. were reported to a regional health authority. Investigation identified common exposure to a raw goats' milk cheese, from which Salmonella spp. were also isolated, leading to an international product recall. Three weeks later, on 22 August, a national increase in Salmonella Newport ST118 was detected through laboratory surveillance. Concomitantly isolates from the earlier familial clusters were confirmed as S. Newport ST118. Interviews with a selection of the laboratory-identified cases revealed exposure to the same cheese, including exposure to batches not included in the previous recall, leading to an expansion of the recall. The outbreak affected 153 cases, including six cases in Scotland. S. Newport was detected in the cheese and in the milk of one of the producer's goats. The difference in the two alerts generated by this outbreak highlight the timeliness of the FBO system and the precision of the laboratory-based surveillance system. It is also a reminder of the risks associated with raw milk cheeses.

Plant-Protein Diversity Is Critical to Ensuring the Nutritional Adequacy of Diets When Replacing Animal With Plant Protein: Observed and Modeled Diets of French Adults (INCA3)

BACKGROUND

There is a current trend in Western countries toward increasing the intake of plant protein. A higher plant-protein intake has been associated with nutritional and health benefits, but these may depend on the pattern of plant-protein sources.

OBJECTIVE

We hypothesized that the diversity of plant foods could be important to nutrient adequacy when increasing plant-protein intake in the diet.

METHODS

Using data on 1341 adults (aged 18-64 y) from a representative French national dietary survey conducted in 2014-2015 (the third Individual and National Study on Food Consumption Survey-INCA3), we studied the links between plant-protein intake, dietary diversity (using various dimensions), and nutrient adequacy [assessed using the PANDiet (Probability of Adequate Nutrient Intake) scoring system, comprising adequacy (AS) and moderation (MS) subscores]. We simulated substituting plant-protein foods for animal-protein foods using different models of plant-protein diversity.

RESULTS

We found that overall diet quality was weakly associated with total and protein diversity and more strongly with plant-protein diversity. Plant-protein intake was inversely associated with animal-protein intake, and positively with the PANDiet and MS, but not with the AS. Plant-protein intake displayed little diversity, mostly taking the form of grains (61% of plant-protein intake), and this diversity was even less marked under a higher plant-protein intake. Finally, modeled substitutions showed that reducing animal-protein intake increased the MS (by 32%) in a similar manner whichever plant protein was used for substitution, whereas it decreased the AS (by 20%) unless using a highly diversified plant-protein mix. These simulated improvements in overall adequacy included marked decreases in adequacy regarding certain nutrients that are typically of animal origin.

CONCLUSIONS

We conclude that in French adults the current pattern of plant-protein intake is hindering the nutritional benefits of a transition toward more plant protein, indicating that the consumption of plant-protein-based foods other than refined grains should be encouraged.