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.     

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.     

Développement du tissu adipeux : importance des lipides alimentaires

A well-balanced development of white adipose tissue (WAT) is physiologically important. Longitudinal studies indicate that excess of adipose tissue at early age is predictive of subsequent overweight and obesity, emphasizing infancy as a critical period for WAT development. In this respect, in response to a positive energy balance, its expansion takes place from adipocyte precursor cells which remain present throughout life. Moreover, lipoatrophy and lipodystrophy on one hand, overweight and obesity on the other hand, lead to the metabolic syndrome. In obese patients, the earlier is the obesity onset, the higher is adipocyte size and even more so adipocyte number. As adipocytes do not divide, this observation indicates that excessive proliferation of adipocyte precursor cells is a critical issue, hampered by the lack of specific markers of these cells which represent the true potential of WAT development.In animals and humans, both cross-sectional and longitudinal studies have shown that a caloric excess, i.e. fat-enriched foods in most cases, is associated to enhanced fat mass. The role of dietary fat as a major player in adult human obesity remains controversial because the prevalence of overweight and obesity has increased dramatically over the last decades despite no recent major change in the amount of ingested fats. However the importance of qualitative changes in the fatty acid composition of fats has been largely disregarded despite a dramatic alteration over decades of the balance of essential polyunsaturated fatty acids (PUFAs). There is evidence from animal and human studies that changes in the balance of ω6 and ω3 PUFAs may alter the early stages of adipose tissue development. Under isonenergetic conditions, pups from wild-type mother mice fed a linoleic acid (LA)-enriched diet were 40% heavier 1 week after weaning than those from mothers fed a LA/α-linolinenic acid (LA/LNA) diet, and the weight difference is maintained at the adult age. The LA-induced enhancement of fat mass is abolished in mice invalidated for the cell surface prostacyclin receptor (ip ^-/- mice), demonstrating the critical role of arachidonic acid and prostacyclin in excessive adipose tissue development. Changes observed in the past decades in the fatty acid composition of dietary fats observed in breast milk and formula milk, i.e. an increase in LA with slight or no change in LNA content, acting in concert with a positive energy balance, may be responsible at least in part for the dramatic rise in the prevalence of childhood overweight and obesity. The significant change in the composition of PUFAs in most consumed foods can be traced to changes in human food habits but, quite importantly, also in the feeding pattern of breeding stock. Since prevention of obesity appears critical to avoid difficult if not insurmountable health problems in the future, and in addition to a better control of energy balance, the composition of dietary lipids should be reconsidered from the very beginning of the food chain.     

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.     

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.     

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).     

Fréquence et gravité des troubles du comportement alimentaire chez les jeunes diabétiques de type 1 : revue de la littérature

Eating disorders (ED) of young diabetics have been the subject of many publications for the last twenty years. They have been especially studied in the case of young girls in the pre-adolescent period or during adolescence. These eating disorders are part of DSM-IV classification: anorexia nervosa, bulimia nervosa or non other specified disorders (NOSD) where a clinical sign in the above mentioned diseases is lacking. An example of NOSD is “binge eating disorder”. Other more moderate ED, not classified in the DSM-IV have also been described. Ten case-control studies showed that anorexia nervosa does not appear frequently with diabetes, but when it does appear, mortality is very frequent. All the other ED are statistically more frequent with diabetes, especially binge eating disorder and the moderate ED which are not included in the DSM-IV. Purging behaviour, including insulin omission is equally frequent with young diabetics when weight must be controlled. This, will result in an increase of the HbA₁C and more of chronic complications, especially retinopathy. Two principal factors seem to enter into the appearance of the ED. First, weight, often higher than in control cases, where regulation can contribute to the apparition of ED to compensate for insulin omission. Then, bad familial environment, without really knowing if this is found more often with diabetes, or with ED control subjects. Several studies have shown that a follow up of ED is possible and efficient, but also, that ED are not always necessary in a certain number of cases, when more care is taken with young diabetics when the metabolic control is and continues to be mediocre.     

Modalités de l’offre alimentaire (hors restauration scolaire) dans les collèges et lycées d’aquitaine: Évolution entre 2004 et 2005 en application de la loi de santé publique du 9 août 2004

Within the framework of the French National Programme on Nutrition and Health, a survey was conducted in middle and high schools of the French Aquitaine region with the aim of describing the food supply within middle and high schools in 2004-2005, before and after the application of regulation of snack machins in September 2005 of the recent French law of public health.The results show that:

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20 % of schools offered free snacks, specially bread (67 %) and fruit (39,3 %).

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63 % of the answering schools had food or drink sales, concerning pastries (74,6 %), chocolate bars (30 %) and soft drinks (25,4 %).

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In 2004-2005, 44 % of the high schools had snack machins. In Septembre 2005, each school (99 %) had removed on snack machines.

These results highlight the importance of the actions implemented in the programme of “Nutrition, prevention and health of children and teenagers in Aquitaine”, especially actions focussing on food supply within schools.     

Le blues du mangeur: Comment manger sans pécher ?

For human consumers, eating means more than simply obtaining nutrients. Following millenaries of food shortages, the present-day plethora associated with industrialized and globalized production has changed the food situation and exposed human consumers to dangers for which they are not prepared, among which obesity is the most obvious. Food behavior and weight “norms” recommended by experts might have done more harm than good. A consequence of the restrictive diets proposed by medical dietetics for over half a century is “cognitive restraint”, which favors eating disorders as well as weight gain, and compromises the quality of life of obese individuals confronted by social stigma. Nutrition specialists who have remained aware of human heterogeneity and complexity, denied by the orthodox dogma supported by international medical dietetics, have proposed promising options for both treatment and prevention.     

Pauvreté, monoparentalité et alimentation: Une étude de cas dans le nord de la France

The survey was carried out in the North of France. Its purpose was to examine the link between poverty and food. The results underline that the marital and social situations of the interviewed persons were more important to understand their meal patterns, than their low level of resources. When the spouse is left, there is no more familial interest to have meal together, and then we observed that women spend less time to cook. On the opposite, food can, in other cases, play a positive role in dealing with poverty. Thus, provisioning and cooking appear as social activities which allow isolated people to keep a social life. In both cases, the meal is maintained, and the difference sets at the level of preparation. In conclusion, the article invites to reconsider the ways of cooking in poverty situations. It suggests that we should change the representations of an elaborate meal which doesn’t necessarily needs fresh products, but also appertized and frozen products. In this way, we should partly solve the constraint of cost and time of preparation.     

Intérêts et limites du Programme National Nutrition Santé (PNNS) en faveur de l’éducation nutritionnelle: Enquête d’opinion auprès de patients diabétiques de type 2 et de type 1

A survey among 104 type 2 and 81 type 1 diabetic patients has explored their opinions on two major national educationnal programs on nutrition launched by the french health authorities: the “Program National Nutrition Santé” (PNNS1) (2001-2005) and the PNNS2 (2006-2010). The majority of the patients has acquired knowledge on the PNNS through the media and at the care setting level. The messages they have the best recorded concern the daily consumption of fruits and vegetables and the obesity. On the other hand, they know nothing on the printed educationnal guides distributed by the PNNS, nor on the local PNNS initiatives. If the half of the type 2 diabetic patients considers that the PNNS helps them to carry out food choices, a little number of patients estimates that PNNS plays an important role in preventing nutritionnal problems among the young people. Few patients considers also that the food industries may have a possible “perverse” influence on the food consumption and eating behaviors. The half of the type 2 diabetics is in favor of alternatives ways to the hospital-based therapeutic patient education programs, for example programs organized by the Health Social Insurance or by Mutual insurance companies, while respecting criteria of quality. Lastly, the majority of the patients estimates that, due to their own experience, they have a role to play in the nutritional education.     

Huiles végétales et margarines : évolution de la qualité : Les solutions technologiques à la réduction des acides gras trans

Industrial trans fatty acids (TFA) originate from partial hydrogenation and deodorisation (last step of oils & fats refining).Concerning refining, technological improvements and optimized conditions applied during the deodorisation step, lead to reduced amounts of trans isomers in vegetable oils (less than 1% or 2%), a trend encouraged since 2003 by FEDIOL.The production of margarines, spreads and shortenings with adapted properties (namely, in terms of solid fat crystals), requires the modification of “natural” oils & fats: fractionation, interesterification and hydrogenation (full or partial), among which partial hydrogenation is the only trans-producing process. Appropriate combinations of the available trans-free modification techniques together with a proper choice of the feedstock, allow to produce trans-free or low-trans fats for these applications. Thanks to these different options, the vast majority of retail margarines/fat spreads are currently below 1% TFA. Industrial margarines, according to the IMACE good manufacturing practice code, go on reducing their TFA content (target<5%). Nevertheless, some improvements should be made for certain products (puff pastry, viennoiserie…) still contributing to TFA intakes.     

Enzymes de l’extrême et alimentation: Application des propriétés enzymatiques spécifiques aux procédés alimentaires

The catalytic activities of the enzymes are widely used in industrial processes of feed and food industry. The applications of these natural substances in this industry are very diversified since they can be used during manufacturing process of food, for example to improve their digestibility, and also to accelerate the physicochemical transformations giving particular organoleptic properties. Many natural food complements are already manufactured using enzymes and proteins are enzymatically hydrolyzed in order to increase their emulsifying property, develop flavors or give a particular savor to food.Until recently, industrial processes developed were limited to those possible using the enzymes available. Today, state-of-the-art technologies in microbiology and in molecular biology enable the development of enzymes perfectly suited to the targeted application. Selected enzymes must be able to catalyze the reactions under specific pH and temperature conditions. They should resist to the conditions of formulation and have a very high specificity. The use of extremophilic micro-organisms has given access to a broad diversity of enzymes with new properties. Protéus has a unique collection of micro-organisms, and has developed a unique know-how and proprietary technologies to use these micro-organisms for screening and selecting the enzymes of interest. Additionally, technologies of directed evolution have made possible to refine the properties of the enzymes so that they perfectly fit with the targeted applications. The L-Shuffling™ technology, developed and patented by Protéus, is a dramatically efficient tool for adjusting both the physico-chemical characteristics of the enzymes (e.g. optimal pH or temperature, thermostability, etc.) and their catalytic properties (e.g. specific activities, substrate specificity, sensitivity to inhibitors, etc.). L-Shuffling™ therefore allows to quickly design new enzymes with improved characteristics and performances in the targeted process.     

Réduction de la teneur en acides gras trans dans la technologie biscuitière : La démarche Recherche et Développement de la société LU

The reduction of the trans fatty acid content (TFA) has long been integrated in LU's will to always improve the nutritional quality of its products, particularly the lipids quantity and quality. The fat content is essential to the manufacture of cereals products, thanks to its technological and nutritional roles, and its impact on taste and texture.Our Research and Development project to reduce TFA has progressed since 1997. After having checking that the processing conditions in our factories (temperature, pressure, duration) do not generate TFA, we concentrated our work on the quality of the fat used. An internal standard was established in order not to exceed 2% of the total energy contribution in our finished products. This standard had important implications for each of our raw material specification. These stricter requirements for raw materials implied a selection of new suppliers qualified with the contribution of the Purchasing and Quality departments.The use of margarines and shortenings, the principal sources of TFA in cereal products, was reduced drastically as of 1997 (less 70% between 1994 and 2006). Reformulations were carried out with fats & oils alone or in mixture, with specific adaptations to the various processes. Danone's will to increase the use of nutritional oils like rapeseed oil confronted us with various problems, solved by our R&D. Today, LU has acquired the control of new vegetable oils, in particular rapeseed oil, which finds many applications in our product range such as Taillefine, Ourson, Lu Petit Déjeuner.To date, almost the totality of LU's products made in France conform with the internal standard (1 g of TFA for 100 g of finished product), based on public health recommendations. Optimization of the quality of the fat content is still on-going, with particular attention to the saturated fatty acids contents. (implication for example in NUTRISAT project).