Facteurs associés aux consommations alimentaires des bénéficiaires de l’aide alimentaire : étude abena

The majority of data available on the nutritional situation of low socioeconomic populations in industrialized countries describe a diet that is less favorable for health. The objective of this article is to describe the demographic and economic factors associated with low food intakes as defined by the National Nutrition and Health Program (Programme National Nutrition Santé, PNNS) dietary guidelines in a food aid dependent population.Subjects from the Abena (Food and nutritional status of food aid recipients) study were recruited in four urban zones (Marseille, Dijon, Paris, Seine-Saint-Denis). Questionnaires were principally about food intake frequencies, food supplies and food insecurity.Among the 1,164 included subjects, low consumption frequencies of fruits and vegetables (94.5% consuming <3.5/day), meat, fish and eggs group (42.6% <1/day), and dairy products (81.9% <3/day) were found. Men, young and aged people, and individuals with dependent children seem to be more often at risk for inadequate intakes with regard to the PNNS dietary guidelines. The food insecurity (49.2% declared not having enough to eat “sometimes” or “often”) was associated with an insufficient intake of fruits and vegetables, and meat, fish, and eggs.The described factors associated with lower food intakes observed in this precarious population confirms the notion that fruit and vegetable, and meat, fish and egg consumptions are markers of the socioeconomic status. This has been already observed in studies on more various socioeconomic statuses. The nutritional situation of food aid recipients described here underlines the need for food aid improvement, eventually focused on specific groups which have been identified.     

Un colis de référence pour une aide alimentaire équilibrée

Practical and specific guidelines are needed to design nutritionally adequate food baskets for food aid. Since the weight of foods is the only information on food easily available and understandable by non nutritionist field-workers, weight-based guidelines were presently developed. They are compatible with the French food-based dietary guidelines and take into account that food-insecure individuals have limited access to some foods, such as meat, fish, fruit and vegetables, while refined cereals are the main component of their diets. These guidelines can also be used to evaluate the dietary quality of existing food aid. factual food baskets delivered by food aid agencies in France were compared to the recommended food basket. The results show that fruit and vegetables are severely lacking (only 10% of total food basket weight instead of 33% recommended) while staples, mainly refined cereals, are given in excess (40% instead of 15%), as well as sugar- or salt-containing food products (9% instead of 2%). This results show that it is necessary to improve the dietary quality of food aid in France and suggest that simple weight-based recommendations can be helpful.     

Lieu de contrôle chez les obèses : traduction et première étude de validation de l’échelle du lieu de contrôle du poids de saltzer

The objectives of this study are to enable the use of the concept of locus of control in the treatment of obese subjects and to verify if the presence of an alimentary disorder influences the belief in the weight’s control. The translation and validation in French is also part of the objective. We translated into French Saltzer’s specific scale of Weight Locus of Control (WLOC: weight locus of control) and then examined it’s validity. Then we compared it on general scales of the place of control (IPC of Levenson and SOC-3 of Paulhus). The subjects were both classified according to the presence of eating disorders (ED). A sample of 46 obese women (IMC>30) was tested, 20 of them without ED, and 26 with, associated to the presence ED, according to the criteria of the DSM-IV.The internal validity of WLOC is rather satisfactory. It correlates negatively with internality (IPC), personal control and interpersonal control (SOC-3). ED at the obese subjects are related on the externality of weight control and the externality of personal control. Obese subjects without ED believe more in weight control by themselves and personal control that the obese subjects with ED (Eating Disorders). Finally the scale of weight locus of control (WLOC) remains the most adapted in the treatment and the study of the obese subject.     

Éducation et prévention de l’obésité de l’enfant. bilan des études en population

The prevalences of overweight and obesity are increasing in France as well as in many countries around the world. Results of randomised controlled primary prevention studies in schools are summarized. They show the feasibility of improving school meals and energy expenditure during PE classes. However, the effect on overweight and obesity prevention are often modest. It is clear that the out-of-school life can totally compensate the effect of an intervention at school. Studies that have been able to modify the children's sedentary and active behaviours out of school have shown the most promising results. The National Nutrition and Health Plan in France comprises a set of actions targeting the whole population, from young children to the elderly, for several years. In that context, we may hope that the different actions undertaken in France including those at school will end with more favourable results.     

Place du diététicien dans l’équipe de soutien nutritionnel : évolution d’une profession

Recognised 30 years ago, hospital nutritional depletion remains a major problem of public health which concerns from 30% to 50% of all patients at admission. The circular DHOS/E 1 n? 2002-186 of the 29 March 2002, recommending the implementation of both the committee for food-nutrition (CLAN: Comité de Liaison Alimentation Nutrition) and the nutrition support team within the hospital, is the result of 10 years effort in regard to food-nutrition and the accreditation process in health care. The dietician, previously accountable for the quality of food and dietary services, has now the opportunity to play a leading role within the nutritional care team for the screening and treatment of nutritional depletion. However, the initial training and the present status of the dietician don’t allow him to follow this evolution effectively. Updating of his training and the redefinition of his missions seem indispensable to respond to today's health care needs. This will help to ensure that above legal recommendation can be applied.     

Quelques aspects de la motivation à manger en fonction de l’index de masse corporelle (de la maigreur à l’obésité massive) dans un groupe de 2 509 adultes

This study examines how chronic dietary restraint, disinhibition, and hunger, as assessed by the Eating Inventory (also called the “Three Factor Eating Questionnaire”), vary over a broad range of Body Mass Index (BMI) values from leanness to massive obesity, in subjects with family obesity. EI factors were also studied as a function of personal weight history. Subjects were 2509 participants in a genetic study of obesity. BMIs ranged from 15 to 87kg/m². Multivariate analyses showed that restraint and disinhibition were significantly associated with the BMI in men, while only disinhibition was in women. Further analyses were performed after subdividing the population in 6 BMI groups. Disinhibition scores correlated strongly with hunger scores in both genders in all BMI categories; dietary restraint tended to correlate with the other two factors positively in leaner subjects, and negatively in highest BMI categories. The highest restraint scores were observed in nonobese adult women with previous obesity in childhood and/or adolescence, suggesting a beneficial influence of restraint on body weight loss. The role of behaviors associated with disinhibition in the development of body adiposity deserves further investigation.     

Le poids des contraintes économiques dans les choix alimentaires

Long term trends in food consumption highlight the impact of economic factors on food choices. In France, as in other industrialized countries, consumption has evolved first through a quantitative increase in the consumption of the cheapest foods, and then through a qualitative change in the structure of the diet, reflecting a shift from cheap vegetable products to animal products, fat and sugar. This nutritional transition is now followed by a steady stage during which the macronutrient structure of the diet remains stable. The changes in food prices, in particular those of staple foods, played a prominent role in this evolution. These changes have had large positive effects, however they had as well less desirable consequences, among which nutritional inequalities, obesity and nutrition-related degenerative diseases are the most visible.     

Rôles physiologiques des endocannabinoïdes dans le contrôle de l’homéostasie énergétique

Endocannabinoids are endogenous lipids which modulate the release of neurotransmitters and activate different signaling pathways, through the binding to cannabinoïd receptors, CB1 and CB2. Endocannabinoids are involved in the control of a variety of behavioural and neuroendocrine functions, including feeding behaviour. In the central nervous system, they essentially modulate the expression of orexigen or anorexigen neuropeptides thus resulting in the stimulation of food intake. Their peripheral targets are mainly the liver and the white adipose tissue where they stimulate lipogenesis, through the modulation of several enzymes and proteins expressions. Cannabinoïd receptor agonists are nowadays prescribed to improve appetite of people suffering from cancer or AIDS. In the same way, CB1 antagonist, such as Rimonabant, could provide efficient treatment of obesity.     

Les acides gras : molécules informatives du contrôle nerveux de l’homéostasie énergétique

Free fatty acids (FFA) are not fuel for neurons and do not cross “easily” blood brain barrier. However, it is know well established that FFA could act as informative molecules and any change in plasma FFA concentration are detected at the level of central nervous system (CNS) structure such as hypothalamus and brainstem, where FFA sensitive neurons are located. These neurons control in turn energy homeostasis including food behaviour, hepatic glucose production or insulin secretion. Sub-populations of FFA sensitive neurons (either excited or inhibited) are now described in hypothalamus. Regarding, cell signaling, both acyl-CoA and malonyl-CoA could be major factor to mediate FFA effect. Indeed, increased intracellular concentration of malonyl-CoA in hypothalamus induce food intake inhibition. Such effects are partly related to decrease in NPY gene expression, as well as increase in alpha-MSH expression. Finally, dysregulation of FFA sensing in CNS could lead to development of metabolic diseases such as obesity or type 2 diabetes, in predisposed subject.     

Une typologie des consommateurs à partir de l’enquête Baromètre santé nutrition 2002

The purpose of this article is to define various consumers’ profiles based on the Health Barometer survey data about the consumption of different foods within the previous 15 days. This typology is based on factorial analysis and classification methods. Seven profiles were identified: “hedonist”, “not concerned”, “concerned”, “practical”, “traditional”, “aware”, “small eater”. These seven groups are described according to social and demographic variables as well as the behavioral and life style variables associated with eating habits. This study contributes to an improved knowledge of different eating behaviours in the French population and provides elements for defining specific groups towards whom prevention strategies should be implemented.     

La publicité, quel impact sur l’alimentation de l’enfant ?

Advertisements who target children pose a real problem in health and ethical terms given the current context of the rise of obesity levels. The solutions open to legislators are, however, far from clear as highlighted by the results of research undertaken in various countries. The options tested range from a total ban of the messages to a stiffer monitoring of their contents. This article tries to shed light on the current debate and emphasizes the role that food culture can play in this context.     

Consommation et habitudes alimentaires chez des femmes de l’ouest algérien atteintes de lithiase cholestérolique

Dietary consumption and food habits have been determined in normal or overweight west Algerian women with cholesterol gallstone disease compared to normal-weight control women. None of the lithiasic patients did any sporting activity, which represented a risk factor in gallstones formation. In patients, in particular overweight ones dietary intake was higher in energy, proteins and cholesterol (p<0.01), than that of controls, as a consequence of increased fish consumption, chicken and eggs and important simple sugar intakes. Low fresh vegetables but more important dried vegetables intakes were noted in all patients. These nutritional factors might play an important role in of cholesterol gallstones formation. The reduced intake of coffee (2 cups/day) noted in all patients could be suggest that coffee will have a protecting role. Moreover, a bad to day meal distribution could contribute to cholesterol lithogenesis.     

Rôle du préavis psychiatrique dans l’évaluation préopératoire des patients candidats à la chirurgie de l’obésité

The increase of obesity prevalence and severity, the failure of conservative treatment and the request for a long term efficient solution have given to surgery a rising role in the treatment of obesity. The psychiatric evaluation for bariatric surgery, the preparation and follow up of the patients are essential aims to reduce surgical risks and complications and improve the eating tolerance imposed by bariatric surgery.In this context the multidisciplinary team is very important, each complementary advice allowing the setting of strategies to better anticipate and manage post operative changes.The psychiatric evaluation includes the detection of formal contra-indications, the appreciation of relative indications and the assessment of eating disorders.     

Évolution de la consommation alimentaire dans l’étude SU.VI.MAX (1995-2002)

Nutrition is involved in an essential way in the development and clinical expression of many chronic diseases. In this context, the National Nutrition and Health Program (PNNS, 2001), has as a general objective the improvement of the health of the whole of the population, by acting on one of its major determinants, the nutrition. This paper presents the evolution of the food consumption in the participants of the SU.VI.MAX study, between 1995 and 2002. Data are presented by category of food, such as they are defined in the recommendations of the PNNS. The analyses, performed before the development of the nutritional policy, showed that this population was in general far away from the reference marks of consumption PNNS. Only the frequencies of fruits and vegetables consumption and the average consumption of added fat trend to improved since 1995. These observations stress the importance of such an initiative of public health in France.     

Pensées et ressenti face à l’alimentation de 3 732 personnes de l’agglomération de dijon

Purpose: it was to know the cognitive and emotional thoughts concerning foods and eating in the general and student population of the region of Dijon.Methods: a questionnaire concerning the cognitive and emotional thoughts was beforehand established, validated and handed or sent to 10 000 students and persons of the population of Dijon drawn lots and paired according to district and family. The analysis concerned 3 732 persons, i.e. the 882 students and the 2 850 people of both genders from the general population who restored a more than 95% completed and coherent questionnaire.Results: in this population, negative thoughts and fear in front of the food were noted in a not exceptional way:

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to eat disgusts me: 1.6%;

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to eat frightens me: 3.3%;

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the glance of the other one when I eat frightens me: 13%;

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this food which we propose me make me bad, sink, sad or tightened in 9 at 18% of the cases.

Also, a important percentage of eating disorders or abnormalities was found:

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binge eating: 8%;

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bulimia nervosa: 4.3%;

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anorexia nervosa: 2.2%;

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low weight (IMC<19 kg/(m)²) and frightens in front of glance of the other one: 13%.

These abnormalities were more frequent in young people than in older one’s and in women than in men, but were not so rare in older women (>35 years old) and in men. The questionnaire allowed us to show that a subgroup of people really exists, who are very attentive to the “dietically correct” and anxious about foods. This so-called subgroup “orthorexia” concerned around 1.9% of our total population and 6.1% of thin people (IMC<19 kg/(m)²).Conclusion: the health aspect of the food and the fear of getting fat are important preoccupations of certain number of persons, both in the student population and the general one. This raises the problem of the irrational meaning of the food for a certain number of people, in front of media messages and of the food availability.     

Rôle de l’alimentation dans la prévention des caries

Over the last three decades the condition of the teeth of children has improved tremendously. This has generally been attributed to the increased use of fluoride toothpaste. During this period the total amount of sugars disappearing into the population per capita has hardly changed. This suggests that the relationship between diet and caries has to be reassessed, which provokes different opinions among dental experts.Some suggest a maximum threshold level for the daily amount of sugars to prevent caries. Others propose that in general the amount of sugars eaten is not an important determinant of caries experience. The scientific evidence for the various opinions on the role of diet in caries development will be discussed. It is concluded that the role of diet is not so much related to the diet itself, but to the individual behaviour of people. Where oral hygiene and fluoride supplementation are adequate, the diet has become a lesser factor in caries prevention. However, those diets may cause caries when there is too little fluoride. It is a mistake to classify a diet as cariogenic it may be potentially cariogenic. When one wants to decrease this potency, one should modify those factors that are actually controlling it, which is, in most cases, the topical presence of fluoride and not the composition of the diet.     

Apports alimentaires et dépenses énergétiques d’adolescents footballeurs de haut niveau: comparaison de deux méthodes d′évaluation des apports

Food intake was assessed over 7 consecutive days in 14 adolescent soccer players (14.1 y; 1.65 ± 0.07 m; 55.4 ± 7.6 kg) housed in a training Centre equipped with a self-service restaurant, using the weighed diet record method and the SU.VI.MAX iconographic method. Nutrient intake was estimated using the software Prodiet^®. Daily energy expenditure (DEE) was assessed using a factorial method after a seven day activity record. Mean food and nutrient intakes were nearly adequate. However, intakes of starchy foods, fruit and vegetables were too low, whereas intake of sugar rich foods was too high. Mean saturated fatty acid intake was in excess, whereas PUFA intake was lower than RDA. Calcium, magnesium and iron intakes were close to RDA. Mean daily energy intake agreed with the mean estimated DEE. However, the high inter-individual variability in food choice, food and nutrient intakes, as well as food inadequacy during the weekend, must be underlined. The SU.VI.MAX iconographic method was adequate to assess energy and nutrient intakes in a group of adolescent athletes, but unappropriate for assessment in individuals. In addition, the adolescents underestimated intake of their favourite meals (starchy foods) and overvalued intake of fruit and vegetables.     

Modifications des pratiques d’élevage : conséquences pour la viande de porcs et autres monogastriques

The monogastric meat of today differs from that produced by the animals 50 years ago. The selection of animals according to growth performance has modified the sensorial and nutritional qualities of the meat. The carcass is less fat and the animals are slaughtered younger at the same weight. The lipid content of the meat is thus decreased. However, in the medical world, meat still has a negative image of being a fat meat whereas this is no longer the case. The rearing conditions influence the quality of monogastrics meat. The feeding level and the fat matter in the diet determine the rate and composition of growth (lipids/proteins) and influence the fatty acids composition. The lipid composition of tissues highly depends on the lipid composition of the diet. Therefore, the fatty acid profile of meat (n-3 fatty acid content for example) can be easily modified through feeding, thereby improving the meat quality for the consumer and meeting the nutritionist's requirements.     

Mise au point d’un questionnaire d’analyse des pensées et sentiments autour de l’alimentation

Purpose

It was to construct a questionnaire in French on the thoughts and the feelings in the respect of the food in the general population. We also wished to detect some eating disorders.

Methods

Eight experts selected nine major subjects concerning the thoughts and the feelings around the food and elaborated a questionnaire including 8 to 10 questions by subject. Having twice been revised by the experts, the questionnaire was criticized by a sample group of 20 persons of different circles, then by 42 medical students in Nutrition. The questionnaire was then handed in 88 medical students (4^th year). These various stages allowed to suppress, to modify and to add different questions. The questionnaire was then sent to 114 medical students and 112 subjects from the general population.

Results

The percentage of returned and totally informed questionnaires (from a sending of 202 questionnaires) was very satisfying (>85%). The concordance of the answers to the redundant questions was very high (>90%). In this population (74% of women), we noted that fear towards the food and eating disorder were frequent: binge eating: 11%, bulimia nervosa: 4,2%, anorexia nervosa: 5%, “the glance of the other one when I eat frightens me”: yes, absolutely: 15%.

Conclusion

This questionnaire concerning thoughts and feelings around the food was validated by the interest which was carried to it, its reproducibility, its understanding by the interrogated persons and the behavioral aspects which it brings. It will be send to 3 000 unselected people of Dijon to judge its interest in the general population. It will be accompanied with a validated inventory to detect eating disorders in order to test its sensitivity and its reproducibility.     

Stratégies d’approvisionnements et comportements alimentaires de familles recourant à l’aide alimentaire: le cas des multi-glaneurs

Various categories of poor people resort to food aid in France. We will focus on families who make a multiple and simultaneous use of several different food programs in a dense urban environment. Thus we’ll outline certain aspects of the food aid structure and of its nutritional consequences. We’ll shed light on how these families keep a not-so-close relationship with the various fields of social aid and on how they parrallely make tremendous psychosocial efforts, sometimes since childhood, to find strategies to cope by themselves even though these very strategies may set them apart from the rest of society. Through the recounting and the detailed analysis of a paradigmatic case of a Rmiste (whose household lives on 4 € per head a day), we’ll try to draw a clear picture of this social situation and of the practical strategies and arguments which turn food into a flexible budget item, liable to be reduced in order to pay other bills (such as the rent in particular).