The focus on personal responsibility is naive, foolishly ignoring far more powerful population-wide policy measures.5 Likewise the blatant failures to tackle climate sustainability,4 equity, and ...child health.1 Crucially, this policy paper also ducks the sugar and salt reformulation levy, a powerful public health measure that has long been recommended by the wider scientific community. Fiscal policies targeting salt, fats, and sugar have been proved to be particularly effective, decreasing consumption of unhealthful foods6 and thus saving thousands of lives.467 A 20% sugary drinks duty in England, for example, could gain over 40 000 quality adjusted life years (QALYs) every year.7 Fiscal policies might be feasible and acceptable in a UK policy context to increase the affordability and accessibility of healthy food and disincentivise unhealthy food consumption.8 Revenues from duties on sugar, salt, and junk foods can then be used to subsidise buying fruit and vegetables. Guardian 2022 Jun 13. https://www.theguardian.com/politics/2022/jun/13/governments-food-plan-unlikely-to-beat-obesity-crisis-uk-health-expert-warns 6 Afshin A Peñalvo JL Del Gobbo L. The prospective impact of food pricing on improving dietary consumption: A systematic review and meta-analysis.
Purpose
As the French West Indies are facing an ongoing nutrition transition with increasing type-2 diabetes mellitus (T2DM) prevalence, our study aimed to evaluate the effect of potential shifts in ...dietary patterns on T2DM risk in French West Indian adults according to several scenarios.
Methods
We used a cross-sectional multistage sampling survey on dietary intake conducted in 2013 on a representative sample of Guadeloupeans and Martinicans adults (
n
= 1063). From previously identified current dietary patterns, we used PRIME-Diabetes, a comparative risk assessment model, to estimate the effect of potential shifts from the “transitioning” pattern to the “convenient,” the “prudent,” and the “traditional” ones on T2DM risks.
Results
Potential shift in dietary intakes from the “transitioning” pattern to the “traditional” one reduced the T2DM risk in women (− 16% − 22; − 10) and in men − 14% − 21; − 7), as the shift in dietary intakes toward the “prudent” pattern (− 23% − 29; − 17 and − 19% − 23; − 14, respectively). These risk reductions were mostly driven by increased whole grains, fruits, green leafy vegetable intakes, and decreases in potatoes, red meats, processed meats, and sugar-sweetened beverages. The shift in dietary intakes toward the “convenient” pattern did not affect the T2DM risks.
Conclusion
To curb the increase in T2DM prevalence and reduce this burden, one public health action could be to target transitioning adults and help them to shift towards a diet associated with a reduced risk of T2DM as a prudent or a traditional diet.
There are well documented socioeconomic disparities in diet quality and obesity. Menu energy labelling is a public health policy designed to improve diet and reduce obesity. However, it is unclear ...whether the impact energy labelling has on consumer behaviour is socially equitable or differs based on socioeconomic position (SEP).
Systematic review and meta-analysis of experimental (between-subjects) and pre-post implementation field studies examining the impact of menu energy labelling on energy content of food and/or drink selections in higher vs. lower SEP groups.
Seventeen studies were eligible for inclusion. Meta-analyses of 13 experimental studies that predominantly examined hypothetical food and drink choices showed that energy labelling tended to be associated with a small reduction in energy content of selections that did not differ based on participant SEP (X
(1) = 0.26, p = .610). Effect estimates for higher SEP SMD = 0.067 95% CI: -0.092 to 0.226 and lower SEP SMD = 0.115 95% CI: -0.006 to 0.237 were similar. A meta-analysis of 3 pre-post implementation studies of energy labelling in the real world showed that the effect energy labelling had on consumer behaviour did not significantly differ based on SEP (X
(1) = 0.22, p = .636). In higher SEP the effect was SMD = 0.032 95% CI: -0.053 to 0.117 and in lower SEP the effect was SMD = -0.005 95% CI: -0.051 to 0.041.
Overall there was no convincing evidence that the effect energy labelling has on consumer behaviour significantly differs based on SEP. Further research examining multiple indicators of SEP and quantifying the long-term effects of energy labelling on consumer behaviour in real-world settings is now required.
Registered on PROSPERO (CRD42022312532) and OSF ( https://doi.org/10.17605/OSF.IO/W7RDB ).
The hypothesis that increasing protein and energy intakes may confer protection against frailty has been suggested, although few studies have examined these associations, especially regarding current ...protein energy recommendations in the older population.
To assess the association between frailty and higher protein and energy intakes.
The present study is a secondary, cross-sectional analysis of the French Three-City cohort. Participants were community-dwelling older adults aged 65 and over. Frailty was defined as a score of 3/5 among the 5 Fried criteria: weight loss, exhaustion, muscle weakness, slowness, and physical activity. Protein intake was set at a daily intake ≥1 g/kg body weight and optimal energy intake defined as a daily intake ≥30 kcal/kg. Logistic regressions were performed while adjusting for several sociodemographic and clinical variables.
The study sample consisted of 1345 participants mean age (SD) 74.0 (4.9) years, of whom 55 (4.1%) were identified as frail. After adjusting for sociodemographic and clinical variables, higher protein intake was significantly associated with a lower frailty prevalence odds ratio (OR) = 0.41, 95% confidence interval (CI) = 0.19-0.89; P = .024 whereas no significant association was observed between an optimal energy intake and the presence of frailty (OR = 0.70, 95% CI = 0.32-1.55, P = .38).
A 1 g/kg protein intake was associated with a lower prevalence of frailty in French community-dwelling older subjects. This observation adds to the literature, suggesting increasing the daily protein intake to at least 1 g/kg for older adults aged 65 and more.
Obesity and metabolic diseases represent a major health burden in the Caribbean, particularly since a large part of the population is disadvantaged. However, socioeconomic inequalities in chronic ...diseases are poorly explored in this region. We investigated the association between socioeconomic position and metabolic syndrome (MetS) prevalence and explored the contribution of diet quality to explain this association, among adults in the French West Indies.
This cross-sectional analysis included 1144 subjects (≥16 y) from a multistage sampling survey conducted in 2013-2014 on a representative sample of the Guadeloupean and Martinican population. MetS prevalence was assessed using the Joint Interim Statement. Dietary intakes were estimated from 24 h-dietary recalls, and diet quality was assessed through the Diet Quality Index-International (DQI-I). Associations between socioeconomic indicators (education, employment, social assistance benefits) and MetS prevalence, and the potential contribution of diet quality in this association were assessed using multivariable logistic regression models, adjusted for sociodemographic characteristics.
MetS prevalence adjusted for age and sex was 21 and 30% among Guadeloupean and Martinican, respectively. Compared to high-educated participants, low-educated subjects were more likely to be at risk of MetS (OR = 2.4; 95%CI = 1.3-4.4, respectively), as were recipients of social assistance benefits compared to non-recipients (OR = 2.0; 95%CI = 1.0-4.0). The DQI-I explained 10.5% of the overall variation in MetS due to education.
Socioeconomic inequalities in MetS prevalence, reflected by education and social assistance benefits, were found. However, diet quality contributed only to socioeconomic inequalities due to education underlining that education may impact health through the ability to generate overall dietary behavior, long-term beneficial. Our work identified subgroups with higher risk of MetS, which is needed when implementing public health measures, particularly in this Caribbean population with of high poverty rates. Further prospective studies are needed to improve our understanding of the mechanisms of social inequalities in MetS in a high poverty rates context.
Purpose
Despite the urgency regarding increasing rates of obesity and chronic diseases in the Caribbean, few studies described the nutrition transition. We aimed to provide such information by ...identifying dietary patterns in the French West Indies and their characteristics.
Methods
This cross-sectional analysis included 1144 Guadeloupeans and Martinicans from a multistage sampling survey conducted on a representative sample. Dietary patterns were identified using principal component analysis followed by a clustering procedure, and described using multivariable regression models.
Results
Four patterns were identified: (i) a “prudent” pattern characterized by high intakes of fruits, vegetables, legumes, seafood and yogurts, low intakes of fatty and sweet products, and a high Diet Quality Index-International (DQI-I); (ii) a “traditional” pattern characterized by high intakes of fruits, vegetables, tubers and fish, low intakes of red and processed meat, snacks, fast foods, and sweetened beverages, with a high DQI-I, mostly shaped by women and older persons; (iii) a “convenient” pattern characterized by high intakes of sweetened beverages, snacks, and fast foods, with the lowest DQI-I, principally shaped by young participants; (iv) a “transitioning” pattern characterized by high consumptions of bread, processed meat, sauces, alcoholic and sweetened beverages, but also high intakes of tubers, legumes, and fish, mainly shaped by men, middle aged, of whom 35% had metabolic syndrome.
Conclusion
The co-existing dietary patterns in the French West Indies, marked by a generational contrast, seem to reflect different steps in dietary change as described in the literature, suggesting an ongoing nutrition transition.
Poor dietary habits are common and lead to significant morbidity and mortality. However, addressing and improving nutrition in various cardiovascular settings remain sub-optimal. This paper discusses ...practical approaches to how nutritional counselling and promotion could be undertaken in primary care, cardiac rehabilitation, sports medicine, paediatric cardiology, and public health.
Nutrition assessment in primary care could improve dietary patterns and use of e-technology is likely to revolutionize this. However, despite technological improvements, the use of smartphone apps to assist with healthier nutrition remains to be thoroughly evaluated. Cardiac rehabilitation programmes should provide individual nutritional plans adapted to the clinical characteristics of the patients and include their families in the dietary management. Nutrition for athletes depends on the sport and the individual and preference should be given to healthy foods, rather than nutritional supplements. Nutritional counselling is also very important in the management of children with familial hypercholesterolaemia and congenital heart disease. Finally, policies taxing unhealthy foods and promoting healthy eating at the population or workplace level could be effective for prevention of cardiovascular diseases. Within each setting, gaps in knowledge are provided.
This clinical consensus statement contextualizes the clinician's role in nutrition management in primary care, cardiac rehabilitation, sports medicine, and public health, providing practical examples of how this could be achieved.
The Caribbean has seen a dramatic shift in the obesity and chronic disease prevalence over the past decades, suggesting a nutrition transition. Simultaneously, Martinique has faced a demographic ...transition marked by significant population ageing. We aimed to differentiate the contribution of changes in health status and dietary intakes due to shifts in demographic and socio-economic characteristics (DSEC) from that due to unobserved factors.
Two cross-sectional surveys conducted in 2003 (n 743) and 2013 (n 573) on representative samples were used. Dietary intakes were estimated by 24-h recalls. The contribution of changes in health status and dietary intakes due to shifts in observed DSEC was differentiated from that due to unobserved factors over a 10-year interval, using Oaxaca-Blinder decomposition models.
Martinique, French region in the Caribbean.
Martinican adults (≥16 years).
Over the study period, health status deteriorated, partly owing to shifts in DSEC, explaining 62 % of the change in the prevalence of hypertension (+13 percentage points (pp)) and 48 % of waist circumference change (+3 cm). Diet quality decreased (mean adequacy ratio -2pp and mean excess ratio + 2 pp) and energy supplied by ultra-processed food increased (+4 pp). Shifts in DSEC marginally explained some changes in dietary intakes (e.g. increased diet quality), while the changes that remained unexplained were of opposite sign, with decreased diet quality, lower fruits, tubers and fish intakes and higher energy provided by ultra-processed foods.
Explained dietary changes were of opposite sign to nutrition transition conceptual framework, probably because unobserved drivers are in play, such as food price trends or supermarkets spread.
Purpose
Rebalancing the contribution of animal- and plant-based foods is needed to achieve sustainable diet. However, little is known concerning individual characteristics that may influence intake ...of plant-based foods and their changes over time. We aimed to assess changes in the contribution of plant-based foods to dietary intake over time and their association with individual characteristics.
Methods
The contribution of plant-based foods was assessed by percent energy intake provided by plant proteins in diet (PEIPP) and a score of adherence to a pro-vegetarian diet, using repeated 24-h records in 15,615 French adults participating in the NutriNet-Santé cohort study. Associations between baseline individual characteristics and changes in the two indicators over a 4–6-year follow-up were assessed using a linear mixed model.
Results
At baseline, PEIPP and pro-vegetarian score were positively associated with age
β
65+ = 0.80, 95% CI = (0.71, 0.88),
β
65+ = 3.30, 95% CI = (2.97, 3.64), respectively and education
β
postgraduate = 0.23, 95% CI = (0.12, 0.34),
β
postgraduate = 1.19, 95% CI = (0.75, 1.62), while they were inversely associated with BMI class
β
obesity = − 0.48, 95% CI = (0.56, 0.41),
β
obesity = − 2.31, 95% CI = (− 2.63, − 1.98). Men had higher PEIPP than women
β
= 0.06, 95% CI = (0.01, 0.11). Pro-vegetarian score significantly increased over time
β
= 0.23, 95% CI = (0.08, 0.37). The older the individual at baseline, the greater the decrease in the two indicators during follow-up. Pro-vegetarian score increased during follow-up for obese participants at baseline.
Conclusions
The contribution of plant-based foods was associated with several socio-demographic and economic characteristics at baseline, whereas change over time was related to age and weight status. Further analysis of individual obstacles and lever to consume plant-based foods is needed.
Abstract
Background
French West Indies, like the other Caribbean territories, are currently undergoing a nutrition transition. Little is known about how migration and subsequent changes in food ...habits could influence adherence to specific dietary patterns. Our study aimed to assess dietary intake among French West Indians who live in and/or were born in the French West Indies, compared with individuals born and living in mainland France.
Methods
1,094 participants from the NutriNet-Santé e-cohort, prospectively included between 2009-2019, were categorized into 4 subgroups: born and living in the French West Indies (West Indies/West Indies WW; n = 172); born in the West Indies and living in France Mainland (West Indies/mainland, WM n = 317); born in France Mainland and living in the French West Indies (mainland/West Indies, MW n = 288) and those born and living in Mainland France (mainland/mainland, MM n = 317). We compared the four subgroups on their nutritional quality of the diet using data provided by 24h records, and sociodemographic, lifestyle and anthropometric characteristics. The association between dietary patterns and migration status was estimated by polytomous logistic regression models.
Results
The WM group had consumptions reflecting an intermediate nutritional quality between the WW and the MM groups, with higher consumption of plant-based foods. The WM and WW groups were more likely to adhere both to a traditional dietary pattern from the West Indies (tubers grown in the West Indies, legumes, fish and offal) and, to a lesser extent, a convenient dietary pattern (high in ultra-processed foods), compared to MM, confirming the ongoing nutrition transition.
Conclusions
Migrants from French West Indies may have changed their traditional dietary habits, suggesting an influence of the environment. Migrants presented both potentially protective and detrimental dietary patterns compared to their peers born in mainland France due to the maintenance of cultural habits.
Key messages
• Migration may influence food habits for migrants between the French West Indies and Mainland France.
• The nutrition transition is on going in the French West Indies, representing a public health issue.
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