Diet profiles in a population sample from Mediterranean southern France

Design and Validation of MEDOC, a Tool to Assess the Combined Adherence to Mediterranean and Western Dietary Patterns

The Mediterranean diet (MD) and Western diet (WD) are poles apart as dietary patterns. Despite the availability of epidemiological tools to estimate the adherence to MD, to date, there is a lack of combined scores. We developed MEDOC, a food frequency questionnaire (FFQ) designed to calculate a combined adherence score for both diets and validated it on 213 subjects. The test-retest reliability revealed all frequency questions falling within the acceptable range of 0.5 to 0.7 (Pearson correlation coefficient) in younger (<30 years old) subjects, while 1 question out of 39 fell below the range in older (>30 years old) participants. The reproducibility for portion size was less satisfying, with, respectively, 38.2% and 70.5% of questions falling below 0.5 (Cohen's Kappa index) for younger and older subjects. The good correlation (R = 0.63, p < 0.0001 for subjects younger than 30 years and R = 0.54, p < 0.0001 for subjects older than 30 years, Pearson's correlation coefficient) between the MEDOC score and the MediDietScore (MDS) confirmed the validity of the MEDOC score in identifying patients who adhere to the MD. Harnessing the capabilities of this innovative tool, we aim to broaden the existing perspective to study complex dietary patterns in nutritional epidemiology studies.

Adherence to the Mediterranean Diet: Impact of Geographical Location of the Observations

The Mediterranean diet has emerged as a comprehensive lifestyle, including specific foods and meal composition and a set of behavioural and social features. Adherence to the Mediterranean diet has been shown to promote health and reduce the prevalence of chronic diseases. The actual implementation of the Mediterranean diet is affected by several sociocultural factors as well as geographical components. Indeed, the geographical location, such as a specific country or different areas in a country and specific latitude and climate, appears to be an important factor that may strongly affect the implementation of the Mediterranean diet or some of its principles as well as the adherence to it. Another dynamic component affecting personal nutritional choices, also regarding adherence to the Mediterranean diet and its principles, is the individual life-long trajectory of food preference and nutrition habits and awareness. In this review, we discuss the current evidence on the impact of geographical location on adherence to the Mediterranean diet.

Mediterranean diet adherence is associated with better cognitive status and less depressive symptoms in a Greek elderly population

PURPOSE

To evaluate the Mediterranean diet (MD) adherence of an elderly Greek population, and its association with the grade of cognitive decline and psychological status.

METHODS

Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS), and Mediterranean diet score (MedDietScore) questionnaires were used to assess the impact of MD adherence on cognitive abilities and psychological state of a Greek elderly population.

PARTICIPANTS

2092 men and women over 65 years old (mean age 74.97 ± 8.41 years) from seven different Greek cities RESULTS: 34.4% of the study population showed cognitive impairment, while 32.3% of the participants had depressive symptoms. More than half of the participants (52.1%) showed very low or low MD adherence. Higher MD adherence was significantly associated with better MMSE and GDS scores. Moreover, higher MD adherence was significantly associated with younger age, female gender, higher educational level, and better anthropometric parameters. MD adherence was independently associated with cognitive and psychological status, and gender after adjustment for potential confounders.

CONCLUSION

Higher MD adherence is strongly associated with better cognitive status and less depressive symptomatology. Public health policies are recommended to focus on the promotion of the MD, as a crucial strategy to reduce the risk of cognitive impairment and depression.

[Diet quality in a population aged over 65 and related socioeconomic factors]

INTRODUCTION

The consumption of certain foods and healthy eating habits are related to preventing and suffering from a number of chronic diseases. These foods tend to be included in food pyramids, such as that proposed by the Spanish Society for Community Nutrition. One method of analysing diet quality is the use of indices that assess the frequency of consumption of different food groups.

AIM

To analyse diet quality in a Spanish population of persons aged over 65years using the Healthy Eating Index and to determine how sociodemographic factors affect scores on the index.

DESIGN

A cross-sectional, descriptive study was conducted on the diet followed at home by Spanish population aged over 65years, using the Healthy Eating Index and taking information from the 2014 European Health Interview Survey in Spain. Multiple linear regression analysis was used to determine the socioeconomic factors associated with diet quality.

RESULTS

Of the study population, 89.6% need to make changes in their diet, while only 8.2% follow a healthy diet. Suffering from chronic diseases, overweight and occasional physical exercise were associated with higher scores on the Healthy Eating Index.

CONCLUSION

Most of the population aged 65years or over need to make changes in their dietary patterns. Those with potential health risks are more careful about their diet. These findings confirm the need to promote guidelines for healthy eating in the non-clinical population.

Socio-Demographic Characteristics, Dietary, and Nutritional Intakes of French Elderly Community Dwellers According to Their Dairy Product Consumption: Data from the Three-City Cohort

Few data are available regarding dietary habits of the elderly, especially about dairy products (DPs) (total DP and milk, fresh DP, and cheese), whereas these are part of healthy habits. The aim was to describe the socio-demographic characteristics, food, and nutritional intakes of elderly DP consumers. The sample consisted of 1584 participants from the Three-City-Bordeaux cohort (France), who answered a food frequency questionnaire and a 24-h dietary recall. Socio-demographic characteristics, practice of physical activity, Body Mass Index, and polymedication were registered. The sample was 76.2 years (SD 5.0 years) on average, 35% were in line with the French dietary guidelines for DP (3 or 4 servings of DP/day), while 49% were below, and 16% above. Women were significantly more likely to declare the highest total DP (≥4 times/day), milk (>1 time/day), and fresh DP (>1.5 times/day) frequency consumption. The highest cheese frequency consumers (>1.5 times/day) were more likely men, married, and ex-smokers. The highest frequency of fresh DP intake was significantly associated with the lowest energy and lipid intakes, and that of cheese with the highest consumption of charcuteries, meat, and alcohol. This cross-sectional analysis confirmed that the socio-demographics and dietary characteristics varied across DP sub-types consumed, which encourages individual consideration of these confounders in further analyses.

Benefits of the Mediterranean diet: Epidemiological and molecular aspects

More than 50 years after the Seven Countries Study, a large number of epidemiological studies have explored the relationship between the Mediterranean diet (MD) and health, through observational, case-control, some longitudinal and a few experimental studies. The overall results show strong evidence suggesting a protective effect of the MD mainly on the risk of cardiovascular disease (CVD) and certain types of cancer. The beneficial effects have been attributed to the types of food consumed, total dietary pattern, components in the food, cooking techniques, eating behaviors and lifestyle behaviors, among others. The aim of this article is to review and summarize the knowledge derived from the literature focusing on the benefits of the MD on health, including those that have been extensively investigated (CVD, cancer) along with more recent issues such as mental health, immunity, quality of life, etc. The review begins with a brief description of the MD and its components. Then we present a review of studies evaluating metabolic biomarkers and genotypes in relation to the MD. Other sections are dedicated to observation and intervention studies for various pathologies. Finally, some insights into the relationship between the MD and sustainability are explored. In conclusion, the research undertaken on metabolomics approaches has identified potential markers for certain MD components and patterns, but more investigation is needed to obtain valid measures. Further evaluation of gene-MD interactions are also required to better understand the mechanisms by which the MD diet exerts its beneficial effects on health. Observation and intervention studies, particularly PREDIMED, have provided invaluable data on the benefits of the MD for a wide range of chronic diseases. However further research is needed to explore the effects of other lifestyle components associated with Mediterranean populations, its environmental impact, as well as the MD extrapolation to non-Mediterranean contexts.

Mediterranean food pattern vs. Mediterranean diet: a necessary approach?

"Food pattern" and "diet" sometimes are referred with the same meaning. "Food pattern" can be defined by a priori and a posteriori approaches and refers to the characterisation of foods and frequency of consumption within a population combining with various characteristics. "Diet" may be represented as an individual way of life and considers the food consumption and others like culture, history, society, economy, sustainability, culinary activities, conviviality, physical activity and rest. Mediterranean diet fits on these two concepts. The question is if we are measuring Mediterranean diet as a whole, or whether we are only measuring one of its parts, neglecting the rest of components. Can this compromise the way we monitor its adherence and evolution, with the possibility of losing the perception of certain aspects? How can we preserve and promote the concept if we do not monitor all the pieces of the puzzle?

Mortality patterns in Southern Adriatic islands of Croatia: a registry-based study

Aim

To investigate the mortality patterns on the Southern Adriatic islands of Croatia and compare them with those in two, mainly coastal, mainland counties.

Methods

In this registry-based study we used the official mortality register data to analyze the mortality patterns on seven Croatian islands (Brač, Hvar, Korčula, Lastovo, Mljet, Šolta, and Vis) and Pelješac peninsula in the 1998-2013 period and calculated the average lifespan, life expectancy, and standardized mortality ratios (SMR). We compared the leading causes of death with those in the mainland population of two southernmost Croatian counties.

Results

The average lifespan of the island population was 3-10 years longer for men and 2-7 years longer for women than that on the mainland. All-cause SMRs were significantly lower for both men and women on Korčula, Brač, Mljet, and Pelješac but significantly higher for women on Šolta (1.22; 95% confidence intervals 1.07-1.38). The leading causes of death on the islands were cardiovascular diseases, with higher percentages in men and lower in women in comparison with those on the mainland. There were no substantial differences in the life expectancy at birth.

Conclusions

Despite longer lifespan, lack of differences in life expectancy at birth suggests that the recent generations of islanders no longer show beneficial mortality patterns, possibly due to diminishing adherence to the Mediterranean diet and lifestyle. Restoring the traditional lifestyles is a public health priority, with the ultimate aim of reducing inequalities and improving the health of island inhabitants.

Evaluation of Mediterranean diet adherence scores: a systematic review

OBJECTIVE

The aim of this review was to evaluate the conceptual suitability, applicability and psychometric properties of scores used internationally to measure adherence to the Mediterranean diet (MD).

DESIGN

This was a systematic review to identify original articles that examined some aspects of the conceptual suitability, applicability or psychometric properties of the MD adherence score. Electronic searches were carried out on the international databases MEDLINE, Scopus, Web of Science and EMBASE (from January 1980 to 31 December 2015).

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

The study included original articles that examined some aspects of the conceptual suitability, applicability or psychometric properties of the MD adherence score. The studies where MD adherence scores were administered but did not bring forward any evidence about their performance related to conceptual suitability, applicability or psychometric properties were excluded.

DATA EXTRACTION

Information relating to the scales was extracted in accordance with the quality criteria defined by the Scientific Advisory Committee of the Medical Outcomes Trust for measurement of health results and the quality criteria recommended by Terwee: (1) conceptual, (2) applicability and (3) psychometric properties. Three authors independently extracted information from eligible studies.

RESULTS

Twenty-seven studies were identified as meeting the inclusion criteria, yielding 28 MD adherence scores. The results showed that evidence is scarce and that very few scores fulfilled the applicability parameters and psychometric quality. The scores developed by Panagiotakos et al, Buckland et al and Sotos-Prieto et al showed the highest levels of evidence.

CONCLUSIONS

Scores measuring adherence to MD are useful tools for identifying the dietary patterns of a given population. However, further information is required regarding existing scores. In addition, new instruments with greater conceptual and methodological rigour should be developed and evaluated for their psychometric properties.

Choosing a healthy and sustainable diet: A three-level approach for understanding the drivers of the Italians' dietary regime over time

Dietary patterns play key roles in health promotion and in preserving the environment. A growing number of studies show the importance of individual factors on food consumption choices, such as socio-economic status, lifestyle variables and contextual and social factors that characterize the geographical area in which individuals reside. The Mediterranean Diet is a sustainable diet that respects the environment, thus reducing per capita emissions from food production in respect to less sustainable diet. The aim of this paper is to determine the Italians' prevailing food patterns using a composite indicator and to identify which factors determine a higher adherence to the Mediterranean Diet in Italy. By using 15 waves of the ISTAT "Aspect of Daily Life" survey, we constructed an original data set and referred to the multilevel approach which enabled us to distinguish between temporal and cross-sectional effects thus providing valuable insights to policy makers and stakeholders in order to promote the Mediterranean Diet and reap environmental and public health. The results show that education plays an important role in determining food consumption behavior while the tendency to practice sports on a regular basis and to have breakfast and lunch at home positively influence people's adherence to this diet.

Changing Diet Quality in China during 2004-2011

Currently, under- and over-nutrition problems co-exist in China. However, systematic studies on the diet quality of Chinese residents have been scant. This study described the trend in diet quality of Chinese residents over a recent eight-year period and investigated the relevant influential factors. The data of Chinese adults aged 20–59 years was extracted from 2004, 2006, 2009, and 2011 China Health and Nutrition Survey. The China diet quality index (DQI) was employed to assess the diet quality of Chinese adults. The dietary consumption data of each individual was collected using a 24-h dietary recall and weighed food records implemented for three consecutive days. A mixed ordinary least squares regression model was applied to analyze the factors influencing the DQI scores of Chinese residents. Results showed that the diet quality of Chinese residents increased from 2004 to 2006, followed by a decrease in 2009 and 2011. The income, urbanicity index, and southern dummy were positively associated with DQI scores, whereas the size of household and labor intensity were negative predictors of DQI scores. The DQI scores also varied over BMI values. With an increase of the average income level in the future, the diet quality of Chinese residents is estimated to further improve. Moreover, urbanization could also contribute to reaching a more balanced diet.

Dietary indexes, food patterns and incidence of metabolic syndrome in a Mediterranean cohort: The SUN project

BACKGROUND & AIMS

We prospectively assessed the association between adherence to several a priori defined healthy food patterns and risk of metabolic syndrome (MetS).

METHODS

We assessed 6851 participants of a Spanish dynamic prospective cohort of university graduates, initially free of any MetS-specific definition criteria, and followed-up for a median of 8.3 years. We calculated the adherence to thirteen different a priori defined food patterns or dietary indexes. MetS was classified according to the updated harmonizing criteria. We estimated multivariable-adjusted Incidence Rate Ratios (IRR) of metabolic syndrome and their 95% Confidence Intervals (95% CI), using Poisson regression models.

RESULTS

The cumulative incidence of MetS was 5.0%. Moderate adherence to the Pro-Vegetarian Diet (PVEG) was significantly associated with a lower risk for developing MetS (IRR = 0.75, 95% CI = 0.59-0.97). Among women, an inverse association with the PVEG was significant not only for a moderate adherence (IRR = 0.54, 95% CI = 0.36-0.82), but also for higher adherence (IRR = 0.63, 95% CI = 0.43-0.93). A higher adherence to the Dietary Approaches to Stop Hypertension (DASH) diet showed an inverse association with the MetS among participants, but only if they had low alcohol intake (RR = 0.41, 95% CI = 0.20-0.85).

CONCLUSIONS

Our findings support the adoption of a PVEG dietary pattern for the reduction of MetS risk. The same statement can be applied in relation to the DASH diet, insofar a limited consumption of alcoholic beverages is also maintained.

Evaluating and adapting the Mediterranean diet for non-Mediterranean populations: a critical appraisal

This review outlines the limitations of current techniques for evaluating the Mediterranean diet in Mediterranean versus non-Mediterranean populations. Differences between the two populations with regard to the foods that are available, food processing and preparation techniques, and eating and lifestyle habits may influence the implementation and effects of a Mediterranean diet in non-Mediterranean regions. For example, the composition of food groups may vary significantly, due to differences in the specific foods within a food group and to differences in aspects of food production and preparation. Notable differences between the diets of Mediterranean versus non-Mediterranean populations include the source of monounsaturated fatty acids (olive oil versus meat), the amount of vegetables consumed and their manner of preparation, the source of alcohol (wine versus other) and the pattern of intake, and the types of meat and dairy products consumed. Lifestyle factors such as meal patterns and exposure to sunlight may also act as confounding factors when the overall benefits of a Mediterranean diet are assessed. Improving the calculation of Mediterranean diet scores and measuring plasma nutrient levels may help mitigate the effects of confounders. These considerations could have important health implications when a Mediterranean diet is implemented by non-Mediterranean populations.

Does the Mediterranean dietary pattern or the Healthy Diet Index influence the risk of breast cancer in a large British cohort of women?

BACKGROUND/OBJECTIVE

To assess the risk of developing breast cancer associated with consumption of two common dietary patterns: a Mediterranean dietary pattern and a dietary pattern, which conforms to the World Health Organization Healthy Diet Index (WHO HDI).

SUBJECTS/METHODS

Dietary data from a 217-item food frequency questionnaire were used to generate two dietary patterns according to pre-defined criteria in women from the UK Women's Cohort Study. Survival analysis using Cox regression was used to estimate hazards ratios for risk of breast cancer adjusted for known confounders.

RESULTS

This analysis included 828 incident cases of breast cancer in 33,731 women with a mean follow-up of 9 years. There were no statistically significant associations between either the Mediterranean dietary pattern or the WHO HDI and risk of breast cancer. In premenopausal women, there was a nonsignificant trend suggesting that increasing compliance with the Mediterranean diet was associated with lower risk of breast cancer. Maximal adherence to the Mediterranean diet was associated with hazards ratio=0.65 (95% confidence interval: 0.42-1.02, P trend=0.09) compared with minimal adherence. In postmenopausal women, no clear trends were observed.

CONCLUSIONS

In this study, no strong association between the risk of breast cancer and the consumption of either a Mediterranean-type diet or one characterized by adherence to the WHO HDI was observed. In premenopausal, but not postmenopausal women, there was a nonsignificant inverse association with increasing adherence to the Mediterranean diet pattern.

Adherence to the Mediterranean diet, long-term weight change, and incident overweight or obesity: the Seguimiento Universidad de Navarra (SUN) cohort

BACKGROUND

The Mediterranean dietary pattern might be a potential tool for the prevention of obesity.

OBJECTIVES

We studied the association between adherence to 6 previously published scores used to assess the adherence to the Mediterranean diet and weight change. We also assessed the risk of relevant weight gain (≥ 5 kg) or the risk of developing overweight or obesity.

DESIGN

The study population included 10,376 Spanish men and women who were university graduates (mean age = 38 y) and were followed up for a mean (± SD) of 5.7 ± 2.2 y. Diet was assessed at baseline with a 136-item, previously validated food-frequency questionnaire. Weight was assessed at baseline and biennially during follow-up.

RESULTS

Participants with the lowest adherence (≤ 3 points) to the Mediterranean dietary score (MDS) proposed by Trichopoulou et al (range: 0-9; N Engl J Med 2003;348:2599-608) exhibited the highest average yearly weight gain, whereas participants with the highest (≥ 6 points) adherence exhibited the lowest weight gain (adjusted difference: -0.059 kg/y; 95% CI: -0.111, -0.008 kg/y; P for trend = 0.02). This inverse association was extended to other a priori-defined MDSs. The group with the highest adherence to the MDS also showed the lowest risk of relevant weight gain (≥ 5 kg) during the first 4 y of follow-up (odds ratio: 0.76; 95% CI: 0.64, 0.90).

CONCLUSIONS

Adherence to the Mediterranean dietary pattern is significantly associated with reduced weight gain. This dietary pattern can be recommended to slow down age-related weight gain.

Dietary total antioxidant capacity: a novel indicator of diet quality in healthy young adults

BACKGROUND

Overall diet quality measurements have been suggested as a useful tool to assess diet-disease relationships. Oxidative stress has been related to the development of obesity and other chronic diseases. Furthermore, antioxidant intake is being considered as protective against cell oxidative damage and related metabolic complications.

OBJECTIVE

To evaluate potential associations between the dietary total antioxidant capacity of foods (TAC), the energy density of the diet, and other relevant nutritional quality indexes in healthy young adults.

METHODS

Several anthropometric variables from 153 healthy participants (20.8 +/- 2.7 years) included in this study were measured. Dietary intake was assessed by a validated food-frequency questionnaire, which was also used to calculate the dietary TAC and for daily energy intake adjustment.

RESULTS

Positive significant associations were found between dietary TAC and Mediterranean energy density hypothesis-oriented dietary scores (Mediterranean Diet Score, Alternate Mediterranean Diet Score, Modified Mediterranean Diet Score), non-Mediterranean hypothesis-oriented dietary scores (Healthy Eating Index, Alternate Healthy Eating Index, Diet Quality Index-International, Diet Quality Index-Revised), and diversity of food intake indicators (Recommended Food Score, Quantitative Index for Dietary Diversity in terms of total energy intake). The Mediterranean Diet Quality Index and Diet Quality Index scores (a Mediterranean and a non-Mediterranean hypothesis-oriented dietary score, respectively), whose lower values refer to a higher diet quality, decreased with higher values of dietary TAC. Energy density was also inversely associated with dietary TAC.

CONCLUSION

These data suggest that dietary TAC, as a measure of antioxidant intake, may also be a potential marker of diet quality in healthy subjects, providing a novel approach to assess the role of antioxidant intake on health promotion and diet-based therapies.

Dietary pattern, a modifiable risk factor that can be easily assessed for atherosclerosis vascular disease prevention in clinical practice

OBJECTIVES

Nutrition is one of the modifiable risk factors of atherosclerosis vascular diseases (VD). We aimed to (i) evaluate the dietary patterns associated with VD in clinical practice using a validated FFQ; and (ii) determine potential independent sociodemographic and behavioural factors that are involved in such dietary patterns. The FFQ determined the vascular dietary score (VDS; ranges from -17 to 19) for each subject.

DESIGN

Cross-sectional study.

SETTING

A general practitioner's (GP) office in 2009.

SUBJECTS

A total of 250 French subjects (18-84 years old).

RESULTS

A total of 21 % had a favourable vascular diet (VDS ≥ 8), 79 % needed to improve their diet (VDS < 8) and 21 % had a risky vascular diet (VDS ≤ -1). A step-by-step multivariate linear regression analysis with stepwise selection was performed using the VDS as a dependent variable. Significant variables were: age (β = 0·495, P < 0·0001), men (β = -0·282, P < 0·0001), 'sport ≥ 1 h/week' (β = 0·253, P = 0·001), 'walking 20 min/d' (β = 0·161, P = 0·012), 'former smoker' (β = 0·118, P = 0·029), previous nutritional advice (β = 0·105, P = 0·049), 'alcohol ≥ 20 g/d' (β = -0·216, P < 0·0001) and 'primary school' (β = -0·156, P = 0·010). The R2 coefficient of this model was 0·347 (P < 0·0001). In all, 88·7 % of the subjects found the evaluation very interesting and 89·6 % believed that the GP should perform it.

CONCLUSIONS

Simple dietary assessment for VD prevention can be easily performed in clinical practice to allow physicians to give objective and rapid advice for each patient. Age, educational status, alcohol consumption, gender and physical activity are associated with the VDS. Compliance with such evaluation was found to be very high, which should encourage larger dietary screening in the population in order to reduce the impact of VD.

Socio-economic status, place of residence and dietary habits among the elderly: the Mediterranean islands study

OBJECTIVE

To investigate whether the socio-economic status (SES) of elderly eastern Mediterranean islanders is associated with their dietary habits, particularly with adherence to the traditional Mediterranean diet.

DESIGN

Cross-sectional.

SETTING

Adherence to the Mediterranean diet was measured by the MedDietScore (range: 0-55), whereas SES was estimated using education and financial status.

SUBJECTS

During 2005-2007, 300 men and women from Cyprus, 100 from Samothraki, 142 from Mitilini, 114 from Kefalonia, 131 from Crete, 150 from Lemnos, 150 from Corfu and 103 from Zakynthos (aged 65-100 years), free of known chronic diseases, participated in the survey.

RESULTS

Multiple linear regression analysis revealed that belonging to the highest SES was associated with a higher MedDietScore (P < 0.01), after adjusting for potential sociodemographic, lifestyle, dietary and clinical confounders. A significant positive association was also found between MedDietScore and years of school (P = 0.004), as well as financial status (P = 0.001).

CONCLUSIONS

Older Greek people of higher SES seem to follow a relatively healthier diet. Both education and income seem to play a role in this issue. Thus, public health policy makers should focus on people with low SES in order to improve their quality of diet and, consequently, their health status.

Hypothesis-oriented food patterns and incidence of hypertension: 6-year follow-up of the SUN (Seguimiento Universidad de Navarra) prospective cohort

OBJECTIVE

To study the association between adherence to several a priori-defined healthy food patterns and the risk of hypertension.

DESIGN

Prospective, multipurpose, dynamic cohort study (recruitment permanently open). We followed up 10 800 men and women (all of them university graduates), who were initially free of hypertension, for a variable period (range 2-6 years, median 4.6 years). During follow-up, 640 participants reported a new medical diagnosis of hypertension. Baseline diet was assessed using a validated 136-item FFQ. Validated information about non-dietary potential confounders was also gathered. We calculated adherence to fifteen different hypothesis-oriented food patterns and assessed the association between each of them and incident hypertension using multivariable Cox models.

SETTING

The SUN (Seguimiento Universidad de Navarra - University of Navarra Follow-up) Project, Spain.

SUBJECTS

Participants recruited to the SUN cohort before October 2005 were eligible for inclusion; after excluding those with self-reported hypertension or CVD at baseline, or with extreme total energy intake, data of 10 800 were analysed.

RESULTS

Higher adherence to the DASH (Dietary Approaches to Stop Hypertension) diet (range of the score: 0 to 5) was significantly associated with a lower risk for developing hypertension (P for trend = 0.02). The other food patterns showed no significant association with incident hypertension.

CONCLUSIONS

Our results support a long-term protection of the DASH diet against the incidence of hypertension, but we found no evidence of a similar inverse association with hypertension for any other a priori-defined healthy food pattern.

Food patterns and Mediterranean diet in western and eastern Mediterranean islands

Objective

To assess current Mediterranean dietary patterns (MDP) in the western and eastern Mediterranean, i.e. in Balearic islanders (BI) and Greek islanders (GI).

Subjects and methods

Dietary patterns were assessed using FFQ on a representative sample (n1200) of the BI and GI (n1324) adult population. A Mediterranean Diet Score (MDS) was calculated according to the consumption of nine MDP components: (i) with a beneficial effect on health, i.e. vegetables, fruits and nuts, cereals, legumes, fish and shellfish, MUFA:SFA ratio, and moderate alcohol consumption; and (ii) with a detrimental effect on health, i.e. meat and meat products, and milk and dairy products. Persons with consumption of beneficial components below the median (GI plus BI) received a value of 0 and those with consumption above the median a value of 1. Persons with below-median consumption of detrimental components received a value of 1 and above-median consumption a value of 0. For alcohol, a value of 1 was given to consumptions of 10–50 g/d (men) and 5–25 g/d (women). The range of the MDS was 0–9, with higher scores indicating greater adherence to the MDP.

Results

GI showed higher adherence (mean MDS 5·12 (sd1·42)) to the MDP than BI (mean MDS 3·32 (sd1·23)). BI diet was characterized by a high intake of legumes, nuts, seed oils, sugar and confectionery, and non-alcoholic beverages compared with GI, whereas GI diet was richer in fruit, vegetables, potatoes, olive oil, animal products and alcoholic beverages.

Conclusions

The GI diet seems closer to the traditional MDP than the BI diet.

Evaluation of diet quality with the mediterranean dietary quality index in university students

Data on diet quality in Croatian university students have been missing for more than 15?years. A food approach rather than a nutrient approach appears more appropriate to present knowledge on diet and health. The aim of the present study was to evaluate diet quality in Croatian university students (n = 663) with the Mediterranean Dietary Quality Index (M-DQI) in continental and Mediterranean regions. The M-DQI was determined with a Quantified Food Frequency Questionnaire. The minimum score for the M-DQI is 0 and the maximum score is 14. A higher score indicates a less healthy diet. The score for the M-DQI was the same in both regions (9.6) and did not differ significantly. In the category for scores 8-14 were 84.0% and 84.6% of students in the continental and Mediterranean regions, respectively. Higher correlation for the M-DQI was observed with macronutrient intakes than with micronutrient intakes. The M-DQI did not correlate with trans-fatty acid intake. A significant correlation (negative) with lycopene was observed in the Mediterranean region only. The body mass index did not correlate with the M-DQI. Students from both regions, continental and Mediterranean, had a lower diet quality evaluated with the M-DQI, with no significant difference according to region.

Diet quality of a population sample from coastal north-east Spain evaluated by a Mediterranean adaptation of the diet quality index (DQI)

OBJECTIVE

To assess the adherence to the Mediterranean dietary pattern in the population from a coastal region from north-east Spain and its relationship to diseases, applying the Mediterranean Diet Quality Index (M-DQI) validated by the use of several biomarkers.

DESIGN

Cross-sectional nutrition survey.

SETTING

Population-based random sample derived from the Catalan Nutrition Survey.

SUBJECTS

A total of 621 healthy adults.

RESULTS

The Catalan representative sample presented a mean M-DQI score of 6.6 (sd 2.3, median 7, range 0-14). The percentage of adherence to the Mediterranean diet was 53 %; 10 % of subjects showed high adherence to the Mediterranean diet, while only 2 % were categorized as poorest adherence. The plasma fatty acid profile of the Catalan sample progressed with perfect regularity throughout the index ranges. Both EPA and DHA presented a significant correlation to the M-DQI (r = -0.410 for EPA and -0.360 for DHA). A significant increase in palmitic, oleic and alpha-linolenic acids and a significant decrease in stearic, linoleic and arachidonic acids content were also observed. The mean values for the M-DQI according to the clinical characteristics of the Catalan sample were also calculated.

CONCLUSIONS

The M-DQI has been demonstrated a suitable tool for assessment of an individual's nutritional status according to the Mediterranean dietary pattern and for clinical purposes. Although the current diet followed in Catalonia seems to agree with the main characteristics of the Mediterranean diet, the promotion of the Mediterranean pattern should be reinforced in the Catalan population, especially among young people.

Mediterranean diet and plasma concentration of inflammatory markers in old and very old subjects in the ZINCAGE population study

BACKGROUND

Aging is associated with low-grade elevation of circulating inflammatory markers, leading to increased risk of morbidity and mortality. The Mediterranean diet has been suggested as a determinant of longevity. In the current study, we investigated the impact of the Mediterranean diet on inflammatory status in old subjects.

METHODS

Within the ZINCAGE study, 957 healthy old subjects (>or=60 years old) from five European countries were recruited. Plasma interleukin (IL)-6, IL-8, monocyte chemoattractant protein, tumor necrosis factor-alpha, high-density lipoprotein cholesterol (HDL-C) and erythrocyte sedimentation rate (ESR) were measured. Dietary data were collected applying a food frequency questionnaire and were used to estimate adherence to the Mediterranean diet.

RESULTS

The Italians presented the greatest adherence to the Mediterranean diet, while the Polish the poorest. In females, higher diet score was significantly associated with lower body mass index and ESR and higher HDL-C levels (beta=-0.127, p=0.003; beta=-0.144, p=0.001; beta=0.144, p=0.029, respectively). In males, diet score was negatively associated with IL-8 levels (beta=-0.101, p=0.044). The Mediterranean diet was associated with reduced IL-8 concentrations in Greeks (beta=-0.213, p=0.007).

CONCLUSIONS

There were significant effects of the components of the Mediterranean diet on inflammation markers. The Mediterranean diet score is useful in assessing nutritional influence on immune status.

Assessment of iron and zinc intake and related biochemical parameters in an adult Mediterranean population from southern Spain: influence of lifestyle factors

This study assessed factors influencing iron and zinc intake and associated biochemical parameters in an adult population from southern Spain to identify patterns of intake and groups at risk for deficiency. A cross-sectional survey was done in Andalusia (southern Spain) to study nutrient intakes in a random sample of 3421 subjects (1747 men, 1674 women, age between 25 and 60 years). Blood samples were obtained for biochemical assays in a random subsample of 354 subjects (170 men, 184 women). Food consumption was assessed by 48-h recall. In blood samples, we measured red blood cells, haemoglobin (Hb), haematocrit, total iron binding capacity (TIBC) and plasma concentration of Fe and Zn. Information about educational level, smoking habit, alcohol consumption and physical exercise was collected with a structured questionnaire. Intakes were below two thirds of the recommended dietary allowances (RDA) in 22.45% of the sample for Fe and in 56.45% for Zn. Iron deficiency [two or more abnormal values for plasma Fe, TIBC, transferrin saturation and mean cell volume (MCV)] was found in 12.7% of the sample, and iron-deficient anaemia (low values for Hb, MCV, mean cell Hb and mean corpuscular Hb concentration) was found in 2.1%. In smokers, plasma levels of Fe were higher, and MCV was lower than in nonsmokers. Plasma Zn concentrations were below the reference value in 17.8% of the persons. Age and body mass index correlated inversely with plasma Zn (P<.01). Gender, age, obesity, smoking, alcohol consumption and physical activity were associated with differences in nutrient intakes. Logistic regression analysis showed that female gender and older age were associated with the risk of low intakes of Fe and Zn.

Does social class predict diet quality?

A large body of epidemiologic data show that diet quality follows a socioeconomic gradient. Whereas higher-quality diets are associated with greater affluence, energy-dense diets that are nutrient-poor are preferentially consumed by persons of lower socioeconomic status (SES) and of more limited economic means. As this review demonstrates, whole grains, lean meats, fish, low-fat dairy products, and fresh vegetables and fruit are more likely to be consumed by groups of higher SES. In contrast, the consumption of refined grains and added fats has been associated with lower SES. Although micronutrient intake and, hence, diet quality are affected by SES, little evidence indicates that SES affects either total energy intakes or the macronutrient composition of the diet. The observed associations between SES variables and diet-quality measures can be explained by a variety of potentially causal mechanisms. The disparity in energy costs ($/MJ) between energy-dense and nutrient-dense foods is one such mechanism; easy physical access to low-cost energy-dense foods is another. If higher SES is a causal determinant of diet quality, then the reported associations between diet quality and better health, found in so many epidemiologic studies, may have been confounded by unobserved indexes of social class. Conversely, if limited economic resources are causally linked to low-quality diets, some current strategies for health promotion, based on recommending high-cost foods to low-income people, may prove to be wholly ineffective. Exploring the possible causal relations between SES and diet quality is the purpose of this review.

Patterns of alcohol (especially wine) consumption and breast cancer risk: a case-control study among a population in Southern France

PURPOSE

The association between alcohol consumption and breast cancer has been largely investigated, but few studies have investigated the effects of average intake when the pattern of drinking is taken into account. We sought to examine the association between drinking pattern of alcoholic beverages, particularly wine, and breast cancer using different statistical approaches.

METHODS

Our study included 437 cases of breast cancer, newly diagnosed in the period 2002-2004, and 922 residence- and age-matched controls.

RESULTS

Women who had an average consumption of less than 1.5 drinks per day had a lower risk (odds ratio [OR] = 0.58, 95% confidence interval [CI] = 0.34-0.97) when compared with nondrinkers. This protective effect was due substantially to wine consumption since the proportion of regular wine drinkers is predominant in our study population. Furthermore, women who consumed between 10 and 12 g/d of wine had a lower risk (OR = 0.51; 95% CI = 0.30-0.91) when compared with non-wine drinkers. Above 12 g per day of wine consumption, the risk of breast cancer increased, but the association was nonsignificant.

CONCLUSIONS

Although no association between the pattern of total alcohol consumption and breast cancer was found, the type of alcoholic beverage seemed to play an important role in this association. Our results support the hypothesis that there is a threshold effect that risk decreased or was not modified for consumption under a certain threshold. Above that threshold, risk increased, however. The drinking pattern of each type of specific beverage, especially wine, seems important in terms of alcohol-breast cancer association. Low and regular wine consumption does not increase breast cancer risk.

Intervention studies on Mediterranean diet and cardiovascular risk

The traditional Mediterranean diet, as studied in the 1950s to 1960s in the South of Europe, is characterized by moderate energy intake, low animal fat, high olive oil, high cereals, high legumes, nuts and vegetables, and regular and moderate wine. A Mediterranean-type diet is being developed to mimic the traditional one and fit with present life style. While numerous epidemiological studies have supported the concept that adherence to the traditional Mediterranean diet is beneficial for health and particularly protects against cardiovascular disease, the limited number of intervention studies in this field have not yet provided major support. Nevertheless, the dietary interventions performed until now have demonstrated that adoption of a Mediterranean-type diet reduces several cardiovascular risk factors in subjects at risk (primary prevention) and/or cardiovascular events or mortality in patients after a first cardiac event (secondary prevention). Among numerous foodstuffs characterizing the Mediterranean diet, virgin olive oil has been shown to display beneficial effects on a wide range of risk factors.

Effectiveness of the Mediterranean diet in the elderly

The Mediterranean diet is known to be one of the healthiest dietary patterns in the world due to its relation with a low morbidity and mortality for some chronic diseases. The purpose of this study was to review literature regarding the relationship between Mediterranean diet and healthy aging. A MEDLINE search was conducted looking for literature regarding the relationship between Mediterranean diet and cardiovascular disease (or risk factors for cardiovascular disease), cancer, mental health and longevity and quality of life in the elderly population (65 years or older). A selection of 36 articles met the criteria of selection. Twenty of the studies were about Mediterranean diets and cardiovascular disease, 2 about Mediterranean diets and cancer, 3 about Mediterranean diets and mental health and 11 about longevity (overall survival) or mental health. The results showed that Mediterranean diets had benefits on risks factors for cardiovascular disease such as lipoprotein levels, endothelium vasodilatation, insulin resistance, the prevalence of the metabolic syndrome, antioxidant capacity, the incidence of acute myocardial infarction, and cardiovascular mortality. Some positive associations with quality of life and inverse associations with the risk of certain cancers and with overall mortality were also reported.

Dietary patterns associated with vitamin/mineral supplement use and smoking among women of the E3N-EPIC cohort

BACKGROUND/OBJECTIVES

An understanding of the relationships between dietary habits and supplement use or smoking is useful for aetiological studies and surveillance purposes. The objective of this study is to describe dietary patterns associated with vitamin/mineral supplement use and smoking habits in French women.

METHODS

Scores for dietary patterns were obtained by factor analysis in 64,252 women from the French E3N-EPIC cohort. The association with supplement and tobacco use was investigated by logistic regression analysis.

RESULTS

We identified three dietary patterns: 'processed meat/starchy foods' (fast foods, processed meat, rice/pasta/semolina and cakes and few vegetables); 'fruit/vegetables' (fruits, vegetables, seafood, vegetable oils and yoghurt); and 'alcohol/meat products' (alcohol, meat and meat products, and coffee, and few fruits and soup). Supplement use was positively associated with the fruit/vegetables pattern (multivariate OR for quartile 4 versus 1 (OR(4))=1.55, 95% confidence interval: 1.47-1.63), and inversely associated with the processed meat/starchy foods (OR(4)=0.84; 0.80-0.89) and alcohol/meat products (OR(4)=0.69; 0.66-0.73) patterns (P trend for all associations <0.0001). As compared with never smoking, current smoking was inversely associated with the fruit/vegetables pattern (OR(4)=0.85; 0.78-0.92), while former smoking was positively associated with the fruit/vegetables pattern (OR(4)=1.32; 1.25-1.40); both current and former smoking were inversely associated with the processed meat/starchy foods pattern (OR(4)=0.57; 0.53-0.62 and 0.64; 0.60-0.67, respectively); whereas current and former smoking were both strongly positively associated with the alcohol/meat products pattern (OR(4)=5.78; 5.26-6.36 and 2.03; 1.91-2.15, respectively); P trend for all associations was <0.001.

CONCLUSIONS

Supplement use and smoking are strongly associated with dietary patterns.

A critical review of predefined diet quality scores

The literature on predefined indexes of overall diet quality is reviewed. Their association with nutrient adequacy and health outcome is considered, but our primary interest is in the make-up of the scores. In total, twenty different indexes have been reviewed, four of which have gained most attention, and many others were based on those four. The various scores differ in many respects, such as the items included, the cut-off values used, and the exact method of scoring, indicating that many arbitrary choices have been made. Correlations in intake between dietary components may not be adequately addressed. In general, diet quality scores show an association with mortality or disease risk, but these relations are generally modest. Existing indexes do not predict morbidity or mortality significantly better than individual dietary factors. Although conclusions from the review may provide guidance in the construction of a diet quality score, it is questionable whether a dietary score can be obtained that is a much better predictor of health outcome.

Meal patterns and cooking practices in Southern France and Central England

OBJECTIVE

To evaluate whether meal patterns and cooking practices in Central England and Mediterranean France conform to popular stereotypes, eating together as a household, preparation of meals, food purchasing patterns, cooking practices and eating out were investigated.

DESIGN

Cross-sectional studies conducted simultaneously in April 2001 using self-administered postal questionnaires.

SETTING

England (Nottingham, East Midlands) and France (Montpellier, Languedoc-Roussillon).

SUBJECTS

A stratified random sample of 1000 males and 1000 females aged 18-65 years was generated from the electoral roll in each country. The final sample comprised 826 subjects in England (58% males, 42% females; mean age 44 years) and 766 subjects in France (42% males, 58% females; mean age 42 years). Analyses were conducted on samples standardised for sociodemographic differences.

RESULTS

The French cooked from raw ingredients most often (P<0.001), ate together as a household more regularly (P<0.001) and were most likely to follow a regular meal pattern of three meals a day. On the other hand, the English relied more on ready-prepared (P<0.001) and take-away (P<0.001) meals, as well as on energy-dense snack foods such as crisps (P<0.001). Females in both countries reported having most responsibility for preparing meals.

CONCLUSIONS

Some of the study's findings confirm popular stereotypes of French and English food cultures, as the importance of the convivial aspects of eating, as well as more traditional practices such as cooking meals from basic ingredients, structured mealtimes and less between-meal snacking, remain more prominent within the French population. This may contribute to the differences in prevalence of obesity seen between the two countries.

Correlates of diet quality in the Quebec population

Objective:

To determine the correlates of a high-fat diet in urban, suburban and rural areas of Quebec, Canada.

Design:

A secondary analysis of data collected as part of a 5-year multi-factorial, multi-setting, community-intervention project.

Setting:

Urban, suburban and rural settings of the province of Quebec, 1997.

Subjects:

Data were analysed from a sample of 5214 participants (2227 males, 2987 females). A food-frequency questionnaire was completed and a global index of food quality was calculated. Logistic regression was used to identify correlates of a diet high in total fats, saturated fat and cholesterol.

Results:

In both genders, lower level of education, smoking status, French and English languages compared with other languages spoken at home, and a rural environment were associated with poor diet quality. Having no intention to eat low-fat dairy products more often was associated with a high-fat diet. In men, obesity (body mass index >30 kg m−2) and absence of reported health problems were correlates of a high-fat diet, while, in women, lower physical activity was a correlate.

Conclusions:

Future health interventions in Quebec should target people with low education, smokers and those living in a rural environment. Obese men and sedentary women should have access to specific dietetic resources.

Meal patterns and cooking practices in Southern France and Central England

Objective

To evaluate whether meal patterns and cooking practices in Central England and Mediterranean France conform to popular stereotypes, eating together as a household, preparation of meals, food purchasing patterns, cooking practices and eating out were investigated.

Design

Cross-sectional studies conducted simultaneously in April 2001 using self-administered postal questionnaires.

Setting

England (Nottingham, East Midlands) and France (Montpellier, Languedoc-Roussillon).

Subjects

A stratified random sample of 1000 males and 1000 females aged 18–65 years was generated from the electoral roll in each country. The final sample comprised 826 subjects in England (58% males, 42% females; mean age 44 years) and 766 subjects in France (42% males, 58% females; mean age 42 years). Analyses were conducted on samples standardised for sociodemographic differences.

Results

The French cooked from raw ingredients most often (P < 0.001), ate together as a household more regularly (P < 0.001) and were most likely to follow a regular meal pattern of three meals a day. On the other hand, the English relied more on ready-prepared (P < 0.001) and take-away (P < 0.001) meals, as well as on energy-dense snack foods such as crisps (P < 0.001). Females in both countries reported having most responsibility for preparing meals.

Conclusions

Some of the study's findings confirm popular stereotypes of French and English food cultures, as the importance of the convivial aspects of eating, as well as more traditional practices such as cooking meals from basic ingredients, structured mealtimes and less between-meal snacking, remain more prominent within the French population. This may contribute to the differences in prevalence of obesity seen between the two countries.

Adherence to a Mediterranean diet is associated with reduced 3-year incidence of obesity

Few studies have prospectively examined dietary patterns and adult weight change, and results to date are inconsistent. This study examines whether a Mediterranean diet (MD) pattern is associated with reduced 3-y incidence of obesity using data from the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Spain). The sample included 17,238 women and 10,589 men not obese and aged 29-65 y at baseline (1992-96). Height and weight were measured at baseline; weight was self-reported in a follow-up survey a mean of 3.3 y later. Detailed dietary history data, collected using a validated method, were used to construct a MD score. Logistic regression models were used to estimate odds of becoming overweight or obese. Among initially overweight subjects, 7.9% of women and 6.9% of men became obese, whereas 13.8% of normal weight men and 23.0% women became overweight. High MD adherence was associated with significantly lower likelihood of becoming obese among overweight subjects, with stronger associations after adjusting for underreporting of dietary data. Associations (odds ratios with 95% CI) were similar in women (0.69, 0.54-0.89) and men (0.68, 0.53-0.89). Adjusting for the plausibility of reported dietary intakes increased the magnitude of these associations, which were approximately 0.8 without this adjustment. MD adherence was not associated with incidence of overweight in initially normal-weight subjects. Nonetheless, results suggest that promoting eating habits consistent with MD patterns may be a useful part of efforts to combat obesity.

Dietary Habits in a Greek Sample of Men and Women: The ATTICA Study

OBJECTIVE

Although there are several dietary guidelines accepted at the international and national level, there are indications that dietary habits in Greece have been changing, moving away from the traditional Mediterranean diet pattern. The aim of this work was to evaluate the dietary habits of a randomly selected sample from the general adult population, in Greece.

SUBJECTS

The "ATTICA" study is a prospective health and nutrition survey. For the purpose of this study, 3,042 adults, from whom 1514 were men (48%) and 1,528 were women (52%), were selected from the greater Athens area during 2001 and 2002. The assessment of the dietary habits was carried out using a validated food frequency questionnaire.

RESULTS

Dietary intakes of red meat and sweets were higher (p<0.005), and dietary intakes of fish, poultry, dairy products, vegetables, and cereals were lower (p<0.05) than the ones recommended by the Hellenic Ministry of Health.

CONCLUSION

The results from the present study indicate a change in the dietary habits towards an unhealthier type of diet.

Dietary and other lifestyle correlates of serum folate concentrations in a healthy adult population in Crete, Greece: a cross-sectional study

Background

Folate has emerged as a key nutrient for optimising health. Impaired folate status has been identified as a risk factor for cardiovascular disease, various types of cancers, and neurocognitive disorders. The study aimed at examining the distribution and determinants of serum folate concentrations in a healthy adult population in Crete, Greece.

Methods

A cross-sectional sample of 486 healthy adults (250 men, 236 women) aged 39 ± 14 years, personnel of the Medical School and the University Hospital of Crete in Greece, was examined. Serum folate and vitamin B₁₂ concentrations were measured by microbiological assay, and total homocysteine was determined fluorometrically and by high-pressure liquid chromatography. Lifestyle questionnaires were completed, and nutrient intakes and food consumption were assessed by 24-h dietary recalls. Multivariate analyses were performed using SPSS v10.1.

Results

The geometric mean (95% confidence interval) concentrations of serum folate were 15.6 μmol/l (14.6–16.8) in men and 19.2 μmol/l (17.9–20.7) in women (p < 0.001). Inadequate folate levels (≤7 nmol/l) were present in 6.8% of men and 2.1% of women (p < 0.001). Approximately 76% of men and 87% of women did not meet the reference dietary intake for folate (400 μg/day). Serum folate was inversely related to total homocysteine levels (p < 0.001). Increased tobacco and coffee consumption were associated with lower folate concentrations (p < 0.05 for both) but these associations disappeared after controlling for nutrient intakes. In multivariate analysis, intakes of MUFA, fibre, calcium, magnesium, folate, and vitamins A, E, C, B₁, and B₆ were positively associated with serum folate. Consumption of potatoes, legumes, fruits, and vegetables were favourably related to the serum folate status.

Conclusion

Serum folate concentrations were associated with various demographic, lifestyle and dietary factors in healthy Cretan adults. Large-scale epidemiological studies should be conducted within the general Greek adult population to assess the prevalence of impaired folate status and further examine associations with dietary patterns and chronic disease risk. Considering the importance of folate in health maintenance, it is important to increase the public's awareness of modifiable lifestyle patterns and diet and tobacco use in particular, which may be associated with improved folate status.

Intake of added oils and fats among middle-aged French adults: relationships with educational level and region of residence

OBJECTIVE

To describe the relative contribution of 10 created food groups to total fat intake in middle-aged subjects. The relationship of added oil and fat intake with region of residence and educational level was also assessed.

DESIGN

Cross-sectional study.

SUBJECTS/SETTING

Participants of the French Supplémentation en Vitamines et Minéraux Antioxydants study who completed at least six 24-hour dietary records after inclusion into the study (N=6,572).

RESULTS

Added oils and fats were the main source of total fat intake. Animal fat and margarine intakes showed a significant inverse association with educational level, whereas oils with monounsaturated fatty acids (MUFA) were positively associated with education level. Animal fat intake was significantly higher in the western and northern parts of France (54.2% and 50.4%) and lower in the Mediterranean Coast (39.0%). A significant inverse gradient was found with oils with polyunsaturated fatty acids or MUFA in the southwest and the Mediterranean Coast compared with the northern part of France.

CONCLUSIONS

We showed a north to south gradient for animal fat intake and the opposite for oils with MUFA and polyunsaturated fatty acid in France. This gradient parallels the known disparities for cardiovascular mortality in this country. This should contribute to adapting dietary guidelines for dietary change in a public health perspective.