Consommation de fruits et légumes et risque d’accident vasculaire cérébral et cardiaque : méta-analyse des études épidémiologiques prospectives

Background

Fruit and vegetable consumption is recommended for prevention of cardiovascular disease.

Objective

To summarize evidence from prospective studies on fruit and vegetable intake and risk of strokes or coronary heart disease (CAD) DESIGN: Results from cohort studies were collected by a MEDLINE search and pooled in a meta-analysis.

Results

The RR of stroke is 0.95 [0.92-0.97] and the RR of CAD is 0.98 [0.96-0.99] for one additional portion per day of “fruits and vegetables”. The RR of stroke is 0.90 [0.86-0.95] and the RR of CAD is 0.92 [0.89-0.96] one additional portion per day of fruit. Finally, the RR of stroke is 0.97 [0.92-1.02] and the RR of CAD is 0.94 [0.91-0.97] one additional portion per day of vegetables.

Conclusions

These results show an inverse association between “fruits and vegetables” intake and stroke or CAD. However the lack of any nutritional trial preclude any conclusion on the putative mechanisms of the relationship.     

Homéostasie énergétique et métabolisme glucido-lipidique : pourquoi deux substrats différents ?

Two nutrient families mainly ensure covering human energy needs: carbohydrates and lipids, even if proteins are also involved, while in a particular way. Paradoxically, energy storage is mainly based on lipid deposition in adipose tissue. Carbohydrate oxidation represents a substantial part of energy metabolism, while human beings cannot synthesize glucose from lipids. In fact, the respective properties of these two families of substrates are very complementary, in term of metabolism and energy supply, according to metabolic status, either physiological or pathological. Each of these substrates could represent an advantage or a disadvantage depending on rate and/or efficiency of ATP synthesis. The comparison between these two pathways with their respective characteristics is particularly interesting when considering the today's diseases related to excess of nutrient supply of either carbohydrates and or lipids.     

Consommation de produits laitiers et facteurs de risque cardiovasculaire dans l′étude MONICA

The aim of this study was to assess the associations between dairy products and cardiovascular risk factors in a representative sample of the French population. A sample of 912 men aged 45-64 years was randomly selected from the general population in Northern (Lille), Eastern (Strasbourg) and South-Western (Toulouse) regions of France. Risk factors were evaluated in each participant who completed a three-consecutive-day food record. In statistical analysis, subjects were separated according to quintiles of daily dairy product consumption. From the lowest quintile to the highest quintile of dairy product consumption and after adjustment for center, age, energy intake, alcohol, sodium, magnesium, and antihypertensive and antidiabetic treatments, systolic blood pressure significantly decreased. The prevalence of the metabolic syndrome decreased significantly from 32.6% to 25.0%, 21.8%, 18.3% and 19.9% (p=0.02 after adjustment for center, age, energy intake, alcohol, sodium, magnesium, and antihypertensive and antidiabetic treatments). In conclusion, high consumption of dairy products is associated with lower levels of blood pressure and a lower prevalence of the metabolic syndrome.     

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.     

L’ail au banc d’essai dans la prévention cardiovasculaire et les maladies métaboliques

May garlic have beneficial effects on cardiovascular and metabolic diseases?Some data support that garlic may have benefical medicinal functions on dyslipidemia, hypertension and diabetes mellitus. However the results of clinical trials are controversial. Several metaanalysis and a systematic review didn’t confirm that garlic or its compounds had significant effects on plasma lipids or on blood pressure. The hypoglycaemic effect was supported by any randomised clinical study. Contrary to the assertion of many physicians and patients, consumption of garlic can’t be considered as an alternative treatment for dyslipidemia or hypertension.     

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.     

Conception et évaluation d’une intervention brève « alimentation et prévention cardiovasculaire » en médecine de premier recours

The goal of our project was to assess acceptability and feasibility of a 5-step brief intervention (BI) on diet and coronary heart disease (CHD) prevention by general practitioners in a primary care setting. The intervention process and its acceptability by patients and physicians were assessed by standardised interviews and questionnaires, measuring the proportion of patients included, BI duration, perceived obstacles, usefulness and relevance of BI, patients’ knowledge and planned behavior change. Of 99 eligible patients, 76 (77 %) participated and 48 received the BI, which took 5–10 minutes in the consultation. Three of the five steps were usually (38 %) performed. The five physicians were interested and motivated but mentioned lack of time. Most patients (77 %) said they had learned something new about their diet in relation to CHD, and 64 % were able to express at least one dietary habit they planned to change. Ninety-eight percent considered it was their physician's role to discuss their diet to prevent CHD. However, BI's implementation proves difficult in physicians’ routine.     

L’évolution des achats alimentaires: 30 ans d’enquêtes auprès des ménages en France

We describe the evolution of the French food consumption in the last thirty years from representative household data. Such microeconomic data can be found in the French food survey (Insee) and in SECODIP panel data. On 1969-2001, the analysis of these data sources allows to have a picture of French food consumption before the implementation of any nutritional prevention program. We observe decreasing purchases in the majority of food groups. Within this trend, we note decreasing purchases of traditional products and at the same time the development of manufactured products. An increasing share of industrial products can be observed for every food group through substitutions between products. The transformation of the structure of food purchases is discussed along with the evolution of the economic environment, changes in lifestyles and in cultural habits in France.     

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.     

Développement et validation d’une échelle de qualité de vie axée sur l’alimentation pour la population française

Dietary modifications are hard to achieve and maintain over time. They may affect the subject's quality of life. Very few scales have been developed and validated in French to measure the quality of life of healthy subjects. None of them are designed to specifically analyze quality of life as it relates to diet. Within the framework of the ELPAS study, an original scale (QV-AF) was developed to measure the effects of dietary coaching on food-related quality of life in healthy subjects. This scale underwent linguistic and psychometric validation. It may be freely used; scoring parameters are available upon request.     

Connaissance et application des recommandations vaccinales concernant la coqueluche par la médecine du travail des établissements de santé de Paris

Objective

A questionnaire was used on 44 public and private hospital physicians in Paris to evaluate their knowledge of and adherence to Vaccination Guidelines, three years after their introduction.

Results

Eighty per cent of the physicians answered and 92.5% were aware of the vaccination guidelines but only 2 out of 4 respected the targeted vaccination in young adults even when the vaccine was available. A policy of pertussis vaccination was applied only in 12 institutions, but even in these, the rate of vaccinated healthcare workers remained low or was not documented.

Conclusion

Pertussis is a potential risk to newborns not or partially vaccinated in France. Even if the vaccine is available, adherence to pertussis vaccination guidelines must be improved. Efforts should be made to better publicize and apply pertussis vaccination guidelines.     

Évaluation des apports alimentaires d’adolescents obèses et post-obèses : comparaison de la méthode iconographique SU.VI.MAX à la méthode de pesée des aliments

The objectives of this study were 1) to validate the SU.VI.MAX iconographic method against the weighed diet record method to assess food and nutrient intakes in obese and post-obese adolescents, and ; 2) to determine the effects of dietetic education on the precision of this method. Energy and nutrient intakes were determined by both methods in 26 institutionalised obese adolescents over 7-day-periods before the beginning and at the end of a weight-reduction programme, and 4 months later. The mean food, energy, carbohydrate, protein, and lipid intakes as assessed by the two methods were not significantly different, but the limits of agreement between the two methods were high. Obese and post-obese adolescents underestimated intake of their favourite meals (pasta, fried potatoes…) but often overvalued intake of vegetables, milk and hard cheese. The SU.VI.MAX iconographic method is, therefore, a reliable method to assess energy and nutrient intakes of obese and post-obese adolescents in epidemiologic studies, but it is unappropriate for assessment in individuals. In addition, dietetic education resulted in 50% decreases in the mean difference, and in the inter-individual differences in energy intake between the two methods.     

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.     

De l’épizootie à l’épidémie : perception et gestion d’un risque dans l’ancien régime

Recent events, from mad cow disease to bird flu, suggest that modern societies are exposed to novel food-associated risks. This impression of novelty is illusory. History has been marked by several alimentary crises, among which critical situations associated with meat intake during times of epizooties. The first of such crises that was well documented, thanks to physicians’ reports, was the cattle plague that spread over Europe in the years 1711-1714. In France and Italy, it thus becomes possible to analyze reactions to animal disease, in particular among consumers and public authorities. In all cases, a hyper-responsiveness is noted to potential dangers associated with meat, in line with the intellectual context of the time: limited scientific knowledge, and also popular representations of nutrition. While concerns are shared, prevention policies vary in different places. Individual behaviors as well as public policies are rational, aiming to establish a favorable risk to benefit ratio, given that a “no risk” situation cannot be obtained.