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Serum Vitamin C (mg/dl) by Salad Intake

Compliance with French Nutrition and Health Program recommendations is strongly associated with socioeconomic characteristics in the general adult population. Serum Vitamin C (mg/dl) by Salad Intake. Aurelie Malon, Pharm.D: Unité de Surveillance et d’Epidémiologie Nutritionnelle (USEN)

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Serum Vitamin C (mg/dl) by Salad Intake

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  1. Compliance with French Nutrition and Health Program recommendations is strongly associated with socioeconomic characteristics in the general adult population Serum Vitamin C (mg/dl) by Salad Intake Aurelie Malon, Pharm.D: Unité de Surveillance et d’Epidémiologie Nutritionnelle (USEN) Valerie Deschamps, Ph.D: USEN Benoit Salanave, M.Sc: USEN Michel Vernay, Ph.D: USEN Emmanuelle Szego, M.Sc: USEN Carla Estaquio, M.Sc: Unité de Recherche en Epidémiologie Nutritionnelle (UREN) Emmanuelle Kesse-Guyot, Ph.D: UREN Serge Hercberg, M.D, Ph.D: UREN, USEN Katia Castetbon, Ph.D.: USEN USEN: Institut de veille sanitaire, Université Paris 13, Bobigny, France UREN: Inserm U.557/Inra U.1125/Paris 13/Cnam, Bobigny, France JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Malon A, et al. J Am Diet Assoc; 2010; Volume 110 (June).

  2. Serum Vitamin C (mg/dl) by Salad Intake Compliance with French Nutrition and Health Program recommendations is strongly associated with socioeconomic characteristics in the general adult population Background • Dietary behavior is related to demographic & socioeconomic factors • Healthier dietary habits appear in groups with higher socioeconomic status and education level • Nutritional policies to prevent and reduce the risk of chronic diseases related to nutrition, implemented in various countries • In France: ‘Programme National Nutrition Santé’ (PNNS) • Certain subgroups living in poor conditions may encounter greater difficulty in adhering to PNNS recommendations. • Their identification is useful to improve PNNS actions JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Malon A, et al. J Am Diet Assoc; 2010; Volume 110 (June).

  3. Serum Vitamin C (mg/dl) by Salad Intake Compliance with French Nutrition and Health Program recommendations is strongly associated with socioeconomic characteristics in the general adult population Objectives • To describe compliance with PNNS recommendations in the general population in France • To investigate the relationship between social, economic and educational characteristics and poor compliance with French nutritional recommendations JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Malon A, et al. J Am Diet Assoc; 2010; Volume 110 (June).

  4. Serum Vitamin C (mg/dl) by Salad Intake Compliance with French Nutrition and Health Program recommendations is strongly associated with socioeconomic characteristics in the general adult population Methods The French Nutrition and Health Survey (ENNS) • National cross-sectional study with multistage stratified sampling scheme • Recruitment conducted in mainland France from February 2006 to March 2007 to account for seasonality of diet 3,115 adults (18-74 years of age) participated in the survey JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Malon A, et al. J Am Diet Assoc; 2010; Volume 110 (June).

  5. Serum Vitamin C (mg/dl) by Salad Intake Compliance with French Nutrition and Health Program recommendations is strongly associated with socioeconomic characteristics in the general adult population Methods: Data collection • Socioeconomic and demographic data: face to face interviews Date and country of birth, sex, marital status, household composition, occupation, educational level, holiday trip in the past 12 months • Dietary behavior: 3 x 24h dietary telephone recalls collected by dietitians Assessed food and beverage consumption during the previous day, from midnight to midnight; composition & quantities using pictures of portions • Physical activity: face to face interviews Short form of the International Physical Activity Questionnaire (IPAQ) • Body weight and height: at home or at a health examination center, standardized measuresby physicians, nurses or dietitians JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Malon A, et al. J Am Diet Assoc; 2010; Volume 110 (June).

  6. Serum Vitamin C (mg/dl) by Salad Intake Compliance with French Nutrition and Health Program recommendations is strongly associated with socioeconomic characteristics in the general adult population Methods The PNNS Guideline Score (PNNS-GS) • 13 components: • Cut-offs from PNNS recommendations or external sources • Raw scores range from -1 to 15 • Penalties applied to participants with Estimated Intakes (EI) 5% higher than their needs (estimated using basal metabolic rate and physical activity level) • Salt (1) • Physical activity (1) • Foods (9) • Beverages (2) JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Malon A, et al. J Am Diet Assoc; 2010; Volume 110 (June).

  7. Serum Vitamin C (mg/dl) by Salad Intake Compliance with French Nutrition and Health Program recommendations is strongly associated with socioeconomic characteristics in the general adult population Programme National Nutrition Santé-Guideline Score (PNNS-GS): Components and scores according to French recommendations a Servings per day unless otherwise noted. b Established according to French recommended dietary allowances. c EI: energy intake without alcohol. d Pregnant women are advised to abstain from all alcohol consumption during the entire duration of their pregnancy. JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Malon A, et al. J Am Diet Assoc; 2010; Volume 110 (June).

  8. Compliance with French Nutrition and Health Program recommendations is strongly associated with socioeconomic characteristics in the general adult population Serum Vitamin C (mg/dl) by Salad Intake Programme National Nutrition Santé-Guideline Score (PNNS-GS): Components and scores according to French recommendations (cont’d) a Servings per day unless otherwise noted. b Established according to French recommended dietary allowances. c EI: energy intake without alcohol. d Pregnant women are advised to abstain from all alcohol consumption during the entire duration of their pregnancy. Malon A, et al. J Am Diet Assoc; 2010; Volume 110 (June). JOURNAL OFTHE AMERICAN DIETETICASSOCIATION

  9. Serum Vitamin C (mg/dl) by Salad Intake Compliance with French Nutrition and Health Program recommendations is strongly associated with socioeconomic characteristics in the general adult population Methods: Statistical analyses • Analyses comprised not-diet-underreporting participants with at least 2 x 24h dietary recalls • Calibration of data in terms of gender, age, educational level, presence of at least one child at home and season of data collection • Social and demographic description (weighted data) • Calculation of gender-stratified quartiles of scores • Assessment of the independent associations between social, economic and educational variables and the probability of a low PNNS-GS (1st quartile vs others), using logistic regression JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Malon A, et al. J Am Diet Assoc; 2010; Volume 110 (June).

  10. Serum Vitamin C (mg/dl) by Salad Intake Compliance with French Nutrition and Health Program recommendations is strongly associated with socioeconomic characteristics in the general adult population Results: Inclusion in the analyses ≥ Two 24-h recalls and social and demographic data n = 3,115 (Men: n = 1,126; Women: n = 1,989) (97% with three 24h recalls) Not diet underreporting n = 2,734 Inclusion in analysis (covariates available) n = 2,577 (Men: n= 952 ; Women: n=1,625) JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Malon A, et al. J Am Diet Assoc; 2010; Volume 110 (June).

  11. Serum Vitamin C (mg/dl) by Salad Intake Compliance with French Nutrition and Health Program recommendations is strongly associated with socioeconomic characteristics in the general adult population Social and demographic characteristics (weighted dataa) of 18-74-year-old adults, French Nutrition and Health Survey (ENNSb 2006-2007) a Variables used to weight data were age, education level and at least one child at home. b ENNS: Etude Nationale Nutrition Santé. c Non-weighted sample size. Malon A, et al. J Am Diet Assoc; 2010; Volume 110 (June). JOURNAL OFTHE AMERICAN DIETETICASSOCIATION

  12. Serum Vitamin C (mg/dl) by Salad Intake Compliance with French Nutrition and Health Program recommendations is strongly associated with socioeconomic characteristics in the general adult population Social and demographic characteristics (weighted dataa) of 18-74-year-old adults, French Nutrition and Health Survey (ENNSb 2006-2007) (cont’d) a Variables used to weight data were age, education level and at least one child at home. b ENNS: Etude Nationale Nutrition Santé. c Non-weighted sample size. JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Malon A, et al. J Am Diet Assoc; 2010; Volume 110 (June).

  13. Serum Vitamin C (mg/dl) by Salad Intake Compliance with French Nutrition and Health Program recommendations is strongly associated with socioeconomic characteristics in the general adult population Results: Compliance with PNNS recommandations • Mean PNNS-GS: • 7.67 ±0.17 (range: 1.2 to 15.0) in men • 8.55 ±0.12 (range: -2.2 to 14.0) in women • Mean number of attained recommendations: • 6.7 ±0.15 in men • 7.2 ±0.12 in women • A difference of ~ 4 attained recommendations was observed between the lowest and highest quartiles (in both genders) • “Healthy” thresholds were attained by less than 40% of adults of both genders for whole grain food, seafood and dairy products, for salt in men and for “bread, cereals, potatoes and legumes” in women JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Malon A, et al. J Am Diet Assoc; 2010; Volume 110 (June).

  14. Compliance with French Nutrition and Health Program recommendations is strongly associated with socioeconomic characteristics in the general adult population Serum Vitamin C (mg/dl) by Salad Intake Social and economic factors associated with low Programme National Nutrition Santé Guideline-Score (PNNS-GS) adherence (1st quartile compared to the other three quartiles). French Nutrition and Health Survey (ENNSa2006-2007) a ENNS: Etude Nationale Nutrition Santé. b Non-weighted sample size. c Models 1 estimate the OR of each social and economic variable with the probability of being in the lowest PNNS-GS quartile and adjusted for energy intake (continuous variable) and age (in three classes). d Model 2 includes variables with P < 20% in models 1, adjusted for energy intake (continuous variable). e ORa: adjusted odds ratio f CI: confidence intervals g P < 20% Malon A, et al. J Am Diet Assoc; 2010; Volume 110 (June). JOURNAL OFTHE AMERICAN DIETETICASSOCIATION

  15. Compliance with French Nutrition and Health Program recommendations is strongly associated with socioeconomic characteristics in the general adult population Serum Vitamin C (mg/dl) by Salad Intake Social and economic factors associated with low Programme National Nutrition Santé Guideline-Score (PNNS-GS) adherence (1st quartile compared to the other three quartiles). French Nutrition and Health Survey (ENNSa 2006-2007)(cont’d) a ENNS: Etude Nationale Nutrition Santé. b Non-weighted sample size. c Models 1 estimate the OR of each social and economic variable with the probability of being in the lowest PNNS-GS quartile and adjusted for energy intake (continuous variable) and age (in three classes). d Model 2 includes variables with P < 20% in models 1, adjusted for energy intake (continuous variable). e ORa: adjusted odds ratio f CI: confidence intervals g P < 20% Malon A, et al. J Am Diet Assoc; 2010; Volume 110 (June). JOURNAL OFTHE AMERICAN DIETETICASSOCIATION

  16. Serum Vitamin C (mg/dl) by Salad Intake Compliance with French Nutrition and Health Program recommendations is strongly associated with socioeconomic characteristics in the general adult population Social and economic factors associated with low Programme National Nutrition Santé Guideline-Score (PNNS-GS) adherence (1st quartile compared to the other three quartiles). French Nutrition and Health Survey (ENNSa 2006-2007)(cont’d) a ENNS: Etude Nationale Nutrition Santé. b Non-weighted sample size. c Models 1 estimate the OR of each social and economic variable with the probability of being in the lowest PNNS-GS quartile and adjusted for energy intake (continuous variable) and age (in three classes). d Model 2 includes variables with P < 20% in models 1, adjusted for energy intake (continuous variable). e ORa: adjusted odds ratio f CI: confidence intervals g P < 20% JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Malon A, et al. J Am Diet Assoc; 2010; Volume 110 (June).

  17. Serum Vitamin C (mg/dl) by Salad Intake Compliance with French Nutrition and Health Program recommendations is strongly associated with socioeconomic characteristics in the general adult population Social and economic factors associated with low Programme National Nutrition Santé Guideline-Score (PNNS-GS) adherence (1st quartile compared to the other three quartiles). French Nutrition and Health Survey (ENNSa 2006-2007)(cont’d) a ENNS: Etude Nationale Nutrition Santé. b Non-weighted sample size. c Models 1 estimate the OR of each social and economic variable with the probability of being in the lowest PNNS-GS quartile and adjusted for energy intake (continuous variable) and age (in three classes). d Model 2 includes variables with P < 20% in models 1, adjusted for energy intake (continuous variable). e ORa: adjusted odds ratio f CI: confidence intervals g P < 20% JURNAL OFTHE AMERICAN DIETETICASSOCIATION Malon A, et al. J Am Diet Assoc; 2010; Volume 110 (June).

  18. Serum Vitamin C (mg/dl) by Salad Intake Compliance with French Nutrition and Health Program recommendations is strongly associated with socioeconomic characteristics in the general adult population Discussion & Conclusion • In France, adherence to PNNS recommendations could still be improved, especially in the economically disadvantaged. • These results were globally consistent with previous literature on the relationship between socioeconomic characteristics and adherence to a healthy diet. • Low adherence to PNNS recommendations was associated with poor living conditions rather than with low education level. • Strengths & limitations • Biased recruitment compensated by weighting procedure • Diet data collection methods; PNNS-GS calculation JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Malon A, et al. J Am Diet Assoc; 2010; Volume 110 (June).

  19. Serum Vitamin C (mg/dl) by Salad Intake Compliance with French Nutrition and Health Program recommendations is strongly associated with socioeconomic characteristics in the general adult population Discussion & Conclusion • Compliance with nutritional recommendations should help to define future public health policies in France • Special attention should be given to: • young and middle-aged people, • women living without partners • and, in general, the economically disadvantaged • Adherence to nutritional recommendations also depends on the availability and cost of certain foods, especially for the economically disadvantaged JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Malon A, et al. J Am Diet Assoc; 2010; Volume 110 (June).

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