The cost of diets according to nutritional quality and sociodemographic characteristics in Belgium

Introduction

Prices of foods may influence purchases and therefore, the overall quality of diets. Our objective was to estimate cost variations according to the nutritional quality of diets and to identify sociodemographic characteristics associated with the cost differences in adults' diets.

Methods

Data from adults (N = 1,158; 18-64 years) included in the 2014-2015 Belgian National Food Consumption Survey were used. Dietary assessment was based on two 24-h dietary recalls and a food frequency questionnaire. The “Mediterranean Diet Score” (MDS) and the “Healthy Diet Indicator” (HDI) were used to assess diet quality. Daily diet cost was estimated after linking the consumed foods with the 2014 GfK ConsumerScan panel food price data. Associations were estimated using linear regressions.

Results

The mean diet cost was 5.79€/day (SEM: 0.07). Adjusted for covariates and energy intake, it was significantly higher in the highest (T3) tercile of both scores than in the lowest tercile (T1) (MDS: T1=5.60€/d (0.09) vs. T3=6.03€/d (0.10); HDI: T1=5.42€/d (0.09) vs. T3=6.34€/d (0.10)). Higher intake of fruits, vegetables, fish, dairy products, vegetable oil, fibre and potassium and lower intake of free sugars were associated with higher diet cost. Both diet quality and cost were higher in 35-64-year-old (vs. 18-34 years), active (vs. students) and post-secondary education (vs. secondary education or lower) respondents. The association between quality and cost of diets was weaker in males and among individuals with higher education levels.

Conclusions

Healthier diets are more expensive than less healthy diets in Belgium. These findings contribute to a better understanding of social inequalities in diet in order to support public health policies and actions.

Key messages

Strategies need to be developed to improve the affordability to a healthy diet. In particular, messages promoting healthy diet targeted to the vulnerable populations should better consider the food cost.

Determinants of energy drink consumption in adolescents: identification of sex-specific patterns

OBJECTIVES

To investigate sex differences in sociodemographic and lifestyle correlates of frequent energy drink (ED) consumption in adolescents.

STUDY DESIGN

This study was based on data collected among French-speaking Belgian adolescents aged 11-20 years (n = 8137) within the 2018 Health Behaviour in School-aged Children study.

METHODS

Multiple logistic analyses stratified by sex were performed to estimate the associations between consuming EDs more than once a week, and various sociodemographic and lifestyle characteristics.

RESULTS

Overall, 14.0% of boys and 7.6% of girls consumed ED more than once a week. For both genders, the likelihood of consuming ED more than once a week was higher among adolescents consuming soft drinks daily (vs. < daily), alcohol weekly (vs. < weekly), spending at least 5 h/day in front of screens (vs. < 5 h/day), and going to bed later than 11:30 PM (vs. ≤ 10:00 PM). Among boys, adolescents reporting at least 1 h of moderate-to-vigorous physical activity (MVPA) daily (vs. < 1 h/day MVPA) were more likely to consume ED more than once a week (adjusted odd ratio (aOR) = 1.49 (95% confidence interval [CI] 1.11-2.01)). Among girls, adolescents from low affluence families (vs. high affluence) (aOR = 2.03 (95% CI 1.19-3.48)) and immigrants (vs. natives) (2nd generation: aOR = 1.75 (95% CI 1.31-2.32); 1st generation: aOR = 1.90 (95% CI 1.20-3.03)) were more likely to consume ED more than once a week.

CONCLUSIONS

We identified different patterns of ED consumption in boys and girls. These results suggest that sex-tailored interventions could be relevant to reduce ED consumption in adolescents.

Sequence of cigarette and e-cigarette initiations and daily smoking in adolescents (HBSC 2018)

Background

Electronic cigarette may help adults quit smoking. For adolescents, the concern is whether e-cigarette initiation is a gateway to subsequent smoking. Our objectives were to describe the sequence of conventional cigarette and e-cigarette initiations among adolescents who had already used both products, and to analyse the current smoking behaviour according to the first experienced product.

Methods

Analyses were based on a two-stage random sample of 9,937 12-20-year-old adolescents included in the French-speaking Belgian 2018 Health Behaviour in School-aged Children cross-sectional survey. Cigarette and e-cigarette initiations and its sequence, current daily smoking and other characteristics were collected through a self-administered questionnaire. Associations, adjusted for demographic data, were estimated using logistic regression and weighted. Sampling design was considered in analyses.

Results

In 2018, 66.0% of adolescents reported never having tried a cigarette and e-cigarette, 8.1% having experimented cigarettes only, 9.2% e-cigarette only and 16.6% having experimented both. Among adolescents who tried both products, eight out of ten smoked cigarettes before trying the e-cigarette (78.2%). In the whole sample, 6.8% of adolescents were smoking every day. Daily smoking was observed in 19.8% of adolescents who initiated e-cigarette and cigarettes and in 6.4% of those who initiated cigarettes only. Adolescents who first smoked cigarettes were more likely to further smoke daily (aOR: 2.48 [1.69-3.64]) than those who first used e-cigarette. The risk of daily smoking was not different between adolescents who first used e-cigarette compared with those who tried cigarettes only (aOR: 1.23 [0.76-2.00]).

Conclusions

In French-speaking Belgium, conventional cigarette was the first step in the initiation and continuation of tobacco smoking. These findings help understand smoking patterns among adolescents and will support the development of smoking prevention strategies.

Key messages

Our findings suggest that health promotion interventions should remain focused on conventional cigarette. Based on a cross-sectional study, they should however be confirmed by prospective studies.

Sexual maturation in girls: association with physical activity and sedentary behaviour

Introduction

During adolescence, physical activity tends to decline, especially among girls. Adolescent inactivity is due in part to biological factors, among which pubertal development may play a role. Our aim was to study in girls, the relationship of sexual maturation based on menarche with physical activity and sedentary behaviour.

Methods

Analyses were based on a two-stage random sample of 3,911 10-15-year-old girls included in the 2018 cross-sectional Health Behaviour in School-aged Children survey carried out in French-speaking schools. Menarche, sufficient levels of physical activity (PA) (global PA: at least 60 min. of moderate- to vigorous-intensity PA daily, and vigorous PA: at least 3 times/week), sedentary week time based on all-screen use duration (SWT; categories based on tertiles), and sociodemographic characteristics were self-reported. Multilevel multiple binary (for PA) and multinomial (for SWT) logistic regressions were performed, stratified by age group (≤12.5 years vs. &gt;12.5 years).

Results

Twenty percent of girls aged ≤ 12.5 years and 85.0% of girls aged &gt; 12.5 years have had their first period. Within the group aged ≤12.5, post-menarcheal girls were more likely to spend long SWT (≥8h/day) than pre-menarcheal girls (vs. short SWT (&lt;4h/day): aRRR= 1.74 [1.27-2.37]; NS for moderate SWT (4-7h/day)). Within those aged &gt;12.5, post-menarcheal girls were less likely to engage in sufficient vigorous PA (aOR=0.76 [0.59-0.98]) than pre-menarcheal girls. Moreover, they were more likely to spend moderate (aRRR=1.70 [1.19-2.42]) and long SWT (aRRR=2.74 [1.94-3.88]) than pre-menarcheal girls of same ages. Additional adjustments for age modified the strength of associations.

Conclusions

Our results suggest that during adolescence, the physiological changes induced by sexual maturation may contribute to the decline in physical activity (in &gt; 12.5 years), and in the increase in sedentary behaviour in girls. Potential confounding by age will be explored further.

Key messages

Development of strategies aimed at improving physical activity among adolescent girls should take into account, among other aspects, pubertal development. Specific interventions, targeting pubescent girls, should also be developed to reduce screen time in order to prevent its potential negative consequences.

Neoadjuvant Chemotherapy with Continuous Infusion of Cisplatin and Fluorouracil in Stage II-IV, M0 Squamous Cell Carcinoma of the Head and Neck

Aims and Background

The aim of the study was to assess the activity and the toxicity of cisplatin (DDP) and fluorouracil (FU) administered by continuous infusion as neoadjuvant chemotherapy for patients with stage II-IV, MO squamous cell carcinoma of the head and neck.

Methods

Thirty previously untreated patients were submitted to chemotherapy with DDP (20 mg/m2) and FU (1000 mg/m2), both in continuous infusion for 5 days, repeated every 21 days, for a maximum of 5 cycles. Following completion of chemotherapy, the patients underwent radiotherapy; in some patients surgery was performed immediately after chemotherapy. All patients were monitored for response, time to failure, survival, treatment-related events and toxicity.

Results

All patients were evaluated for response; after chemotherapy the complete response rate was 27% and the partial response rate 33%. Twenty-four patients underwent radiotherapy: the overall response rate was 83% (complete response 79%). After a median follow-up of 34 months, the median survival time was 22 months with a median time to failure of 15 months. Acute vascular accidents were the main and unexpected adverse events, with 2 deaths for pulmonary embolism and 1 for stroke. The response rate to the regimen does not seem to be better than that obtained with the standard combination of cisplatin bolus and fluorouracil continuous infusion. The disadvantage of the regimen is that it causes more discomfort for the patient in that it requires hospitalization.

Conclusions

For this reason, we believe that there are no elements for recommending the schedule as neoadjuvant treatment of patients with squamous cell carcinoma of the head and neck or as an experimental arm in a randomized trial.

Is a five-category reporting scheme for thyroid fine needle aspiration cytology accurate? Experience of over 18,000 FNAs reported at the same institution during 1998-2007

OBJECTIVE

Fine needle aspiration (FNA) has long been recognized as an essential technique for the evaluation of thyroid nodules. Although specific cytological patterns have been recognized, a wide variety of reporting schemes for thyroid FNA results have been adopted. This study reports our experience with a five-category reporting scheme developed in-house based on a numeric score and applied to a large series of consecutive thyroid FNAs. It focuses mainly on the accuracy of thyroid FNA as a preoperative test in a large subset of histologically distinct thyroid lesions.

METHODS

During the 1998-2007 period, 18,359 thyroid ultrasound-guided FNAs were performed on 15,269 patients; FNA reports were classified according to a C1-C5 reporting scheme: non-diagnostic (C1), benign (C2), indeterminate (C3), suspicious (C4), and malignant (C5).

RESULTS

Non-diagnostic (C1) and indeterminate (C3) FNA results totalled 2,230 (12.1%) and 1,461 (7.9%), respectively, while suspicious (C4) and malignant (C5) results totalled 238 (1.3%) and 531 (2.9%), respectively. Histological results were available in 2,047 patients, with thyroid malignancy detected in 840. Positive predictive value of FNA was 98.1% with a 49.0 likelihood ratio (LR) of malignancy in patients with a C4/C5 FNA report.

CONCLUSIONS

This five-category scheme for thyroid FNA is accurate in discriminating between the virtual certainty of malignancy associated with C5, a high rate (92%) of malignancy associated with C4, and a 98% probability of a histological benign diagnosis associated with C2. Further sub-classifications of C3 may improve the accuracy of the diagnostic scheme and may help in recognizing patients eligible for a 'wait and see' management.

Different expression of protein kinase A (PKA) regulatory subunits in cortisol-secreting adrenocortical tumors: relationship with cell proliferation

The four regulatory subunits (R1A, R1B, R2A, R2B) of protein kinase A (PKA) are differentially expressed in several cancer cell lines and exert distinct roles in growth control. Mutations of the R1A gene have been found in patients with Carney complex and in a minority of sporadic primary pigmented nodular adrenocortical disease (PPNAD). The aim of this study was to evaluate the expression of PKA regulatory subunits in non-PPNAD adrenocortical tumors causing ACTH-independent Cushing's syndrome and to test the impact of differential expression of these subunits on cell growth. Immunohistochemistry demonstrated a defective expression of R2B in all cortisol-secreting adenomas (n=16) compared with the normal counterpart, while both R1A and R2A were expressed at high levels in the same tissues. Conversely, carcinomas (n=5) showed high levels of all subunits. Sequencing of R1A and R2B genes revealed a wild type sequence in all tissues. The effect of R1/R2 ratio on proliferation was assessed in mouse adrenocortical Y-1 cells. The R2-selective cAMP analogue 8-Cl-cAMP dose-dependently inhibited Y-1 cell proliferation and induced apoptosis, while the R1-selective cAMP analogue 8-HA-cAMP stimulated cell proliferation. Finally, R2B gene silencing induced up-regulation of R1A protein, associated with an increase in cell proliferation. In conclusion, we propose that a high R1/R2 ratio favors the proliferation of well differentiated and hormone producing adrenocortical cells, while unbalanced expression of these subunits is not required for malignant transformation.

Mutational analysis of PRKAR1A and Gs(alpha) in sporadic adrenocortical tumors

Little is known about the pathogenesis of adrenocortical tumors. The cAMP-dependent pathway is physiologically activated by ACTH in adrenocortical cells and different components of this cascade may be altered in some functioning adrenocortical tumors. Recently, mutations of the gene encoding the PKA type 1 A regulatory subunit (R1 A), PRKAR1A, associated with loss of heterozygosity (LOH) at PRKAR1A locus, have been demonstrated in primary pigmented nodular adrenocortical disease (PPNAD), either isolated or associated with Carney complex. Moreover, activating mutations of the Gs(alpha) gene (the gsp oncogene) have also been found in a small number of adrenocortical cortisol-secreting adenomas. Aim of this study was to investigate the presence of such genetic alterations on a series of 10 ACTH-independent Cushing syndrome due to non-PPNAD adrenocortical adenomas. The coding sequence of PRKAR1A, evaluated by PCR and direct sequencing analysis, revealed the absence of mutations while heterozygosity for at least 1 polymorphism excluded LOH in most tumors. In one single adenoma gsp mutation was detected. In conclusion, we provide additional evidence that the only mutational changes able to activate the cAMP pathway so far identified, i.e. PRKAR1A mutations and gsp oncogene, are a rare event in adrenocortical tumors.

Postradiation sarcoma of head and neck: report of two cases

AIMS AND BACKGROUND

Post-irradiation sarcoma (PIS) a rare, late side effect of radiotherapy and, consequently, its natural history is not well known. For this reason, two cases treated between 1975 and 1990 are described.

CASE REPORTS

The Authors describe one case of malignant fibrous histiocytoma grown in the larynx 111 months after conservative surgery and postoperative radiotherapy, and one case of soft tissue sarcoma developed in the oral cavity 72 months after radical interstitial low dose rate brachytherapy. Both patients had chronic distress of the soft tissues after the primary treatment. The patients are alive and well respectively at 94 and 18 months from salvage surgery.

DISCUSSION

The PIS of the head and neck region is a rare event, usually with a bad prognosis. An improvement in results could be possible with early diagnosis, followed by a timely excision, when anatomically possible. As the chronic suffering of the irradiated tissues may increase the risk of PIS, a longer and more frequent follow-up is advisable in these cases.

Cobalt powdersintering industry (stone cutting diamond wheels): a study of environmental-biological monitoring, workplace improvement and health surveillance

This communication deals with an aspect of occupational hygiene in a factory producing granite cutting diamond wheels by sintering, in moulds, of fine cobalt powder. The factory has been studied between 1988 and 1991; the Department of Preventive and Occupational Medicine of the Local Sanitary Unit of Reggio Emilia has followed the evolution of the local exhaust ventilation equipment supplied by the employer in that period. At the same time, the following measurements and observations were carried out: (a) cobalt exposure by personal sampling, (b) airborne cobalt measurements by area sampling, (c) biological monitoring of cobalt in urine, (d) health surveillance.

[The determination of serum amino-terminal procollagen type-III propeptide (PIIINP) in occupational exposure to rock wool fiber]

Fifty-six males workers exposed to rock wool during production, and 20 referents were examined. Exposure, evaluated by personal sampling, ranged from 0.05 to 0.74 fibres/ml (median 0.15). The subjects underwent a medical examination, chest X-ray according to ILO recommendations and pulmonary function tests. In all subjects the serum levels of type III procollagen N-terminal propeptide (PIIINPs) were determined. No evidence of pulmonary fibrosis, nor work-related lung diseases were observed. PIIINPs mean values in the exposed (9.8 ng/ml; 2.8 S.D.) were slightly higher, but not significantly different when compared to referents (8.5 ng/ml; 2.5 S.D.). No significant correlation between PIIINPs and rock wool exposure (both airborne levels and exposure duration) was observed. Furthermore, peptide levels were not related to pulmonary function test results. Our results suggest that occupational exposure to rock wool fibres lower than 0.75 fibres/ml for less than 20 years does not induce definite cases of pulmonary fibrosis nor an increase of type III collagen synthesis in the lung.

Biological monitoring of occupational exposure to different chromium compounds at various valency states

Chromium concentrations in the air were measured in seven different workroom environments, where exposure to water soluble hexavalent or trivalent compounds was expected. Urinary excretion of chromium was measured before and after the same arbitrarily chosen working day. End-of-shift urinary chromium and its increase above pre-exposure levels were closely related to the concentration of water soluble chromium (VI) in the air. The values corresponding to 50 micrograms m-3 in the air, which is the current threshold limit value in most countries, were 29.8 and 12.2 micrograms g-1 of creatinine, respectively. Urinary chromium in workers exposed to water insoluble chromates or to water soluble chromic (III) sulphate was definitely higher than that observed in subjects not occupationally exposed to chromium compounds, but it cannot be recommended as short-term exposure test for evaluation of the job-related hazard.

Chromosomal aberrations and sister-chromatid exchanges in workers exposed to styrene

Few studies exist about chromosomal damage in workers occupationally exposed to styrene. In the present study, chromosomal aberrations and SCEs were analyzed from cultures of peripheral lymphocytes of workers employed in 6 different reinforced-plastics industries with styrene air exposure levels ranging from 30 to 400 mg/mc. A control group was selected on the base of sex, age and smoking habit. We examined 50-h cultures (for chromosomal-aberrations) and 72-h cultures (for SCEs) for each individual. All workers exposed to styrene, as compared with controls, showed significantly increased frequencies of chromosomal aberrations, while SCEs were significantly increased at 4 of the 6 plants. High SCE values appeared with styrene air concentrations higher than 200 mg/mc. Apart from the possible presence and role of other interfering chemicals in the various plants, chromosomal aberrations seem to be more sensitive than SCEs for the detection of chromosomal damage caused by exposure to low doses of styrene.

Absorption and alveolar excretion of cyclohexane in workers in a shoe factory

The lung uptake and excretion of cyclohexane were studied in five workers and three volunteers in a shoe factory. Air samples were collected from the breathing zones with personal samplers, and simultaneous samples of inhaled and alveolar air were collected with the aid of a Rhan-Otis valve. Cyclohexane was absorbed on activated NIOSH approved charcoal tubes. The uptake was calculated from the pulmonary ventilation, the retention coefficient and environmental concentration. Alveolar excretion was monitored during a 6 h post-exposure period. The amount of exhaled cyclohexane was calculated from the decay curve. According to experimental data, the alveolar retention of cyclohexane is about 34% of the inhaled dose. This corresponds to a lung uptake of 23%. The post-exposure alveolar excretion does not exceed 10% of the total uptake. The difference between respiratory uptake and excretion indicates that the amount metabolized may be very large. Nevertheless, the urinary excretion of the main metabolites, cyclohexanol and cyclohexanone, was only about 1% of the absorbed dose.