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The Mediterranean diet is often proposed as a sustainable diet model. This study aimed to evaluate the associations between adherence to the Mediterranean diet and sustainability domains in a cohort of French adults, using multiple criteria including nutritional quality, environmental pressures, monetary cost and dietary pesticide exposure. Food intakes of 29 210 NutriNet-Santé volunteers were assessed in 2014 using a semi-quantitative FFQ. Adherence to the Mediterranean diet was evaluated using the validated literature-based adherence score (MEDI-LITE). The associations between the MEDI-LITE and various sustainability indicators were examined using ANCOVA models, adjusted for sex, age and energy intake. Higher adherence to the MEDI-LITE was associated with higher nutritional quality scores, better overall nutrient profile as well as reduced environmental impact (land occupation: Q5 v. Q1: −35 %, greenhouse gas emissions: −40 % and cumulative energy demand: −17 %). In turn, monetary cost increased with increasing adherence to the Mediterranean diet (Q5 v. Q1: +15 %), while higher adherents to the Mediterranean diet had overall higher pesticide exposure due to their high plant-based food consumption. In this large cohort of French adults, greater adherence to the Mediterranean diet was associated with nutritional and environmental benefits, but also with higher monetary cost and greater exposure to pesticides, illustrating the necessity to develop large-scale strategies for healthy, safe (pesticide- and contaminant-free) and environmentally sustainable diets for all.
We aimed to explore the relationship between socio-economic characteristics and sustainable dietary patterns.
Dietary data were derived from a web-based FFQ. Diet sustainability was evaluated using a modified Sustainable Diet Index, comprising nutritional, environmental and cultural components (higher scores expressing higher sustainability). The socio-economic position markers were education, household income and occupation status. Multi-adjusted linear and Poisson regression models were used to assess the cross-sectional association of the markers of socio-economic status with a sustainable diet and sustainability subcomponents, respectively.
29 119 NutriNet-Santé participants.
Individuals with a more sustainable diet had slightly higher diet monetary cost, lower total energy intake and consumed less animal-based foods than their counterparts. Lower education level was associated with lower overall diet sustainability (βprimary v. postgraduate = -0·62, 95 % CI (-0·72, −0·51)) and nutrition, socio-cultural and environmental subscores. Manual workers and employees had a lower modified Sustainable Diet Index than intermediate professionals (βmanual workers v. intermediate professionals = -0·43, 95 % CI (−0·52, −0·33) and βemployees v. intermediate professionals = -0·56, 95 % CI (−0·64, −0·48)). Participants with the lowest v. highest incomes had a higher environmental subscore but a lower socio-cultural subscore, whereas the results were less marked for occupational status.
Overall, our results documented associations between socio-economic status and the level of diet sustainability, arguing for the implementation of appropriate food policies to promote sustainable diets at lower cost.
To assess in 2021 the acceptance and perception of the French tax on sweetened beverages, following its revision in 2018, and factors associated with a higher level of acceptance.
A cross-sectional survey within the NutriNet-Santé cohort study. Participants were invited to complete a self-reported questionnaire in March 2021. Weighting was applied to the sample to allow inferences on the French population. Individual characteristics associated with support for the tax were investigated using logistic regression modelling.
NutriNet-Santé prospective cohort study.
Adults engaged in the NutriNet-Santé cohort, aged 18 years or older (n 28 344), living in mainland France.
Almost two-thirds (63·4 %) of the participants were aware of the existence of a tax on sweetened beverages, although less than a quarter had specific knowledge regarding its design and the 2018 revision. In turn, 64·7 % of participants expressed a favourable opinion towards the taxation scheme. This proportion was higher if tax revenues were used to finance health-related measures (respectively 68·8 % of favourable opinion if used to finance a reduction in prices of healthy products and 76·4 % if used to finance the healthcare system). Multivariable analyses showed that support towards the tax varied among subgroups of the population. Groups who tended to be less financially affected by the measure and those who perceived sugar-sweetened beverages as having detrimental effects were more likely to support the tax.
The revised French sugar-sweetened beverage tax appeared to be favourably received and perceived by the public.
To investigate clustering of risk behaviours in adolescents with excess weight.
Cross-sectional analysis of baseline data from the PRALIMAP-INÈS trial. Information on food frequency consumption (fruit, vegetables, sugary products and beverages), physical activity, sedentary behaviour (week and weekend days), smoking and alcohol consumption (current frequency and intoxication episodes) and socio-demographic data was collected using self-reported questionnaires. Behavioural risk factors were entered as categorical variables in a two-step clustering procedure: multiple correspondence analysis followed by hierarchical clustering. Associations between cluster membership and socio-demographic variables were investigated using multivariable multinomial logistic regression.
French PRALIMAP-INÈS trial.
Adolescents with excess weight.
A total of 1391 participants (13–18 years old, 58·2 % female) were included in the analysis, which resulted in the identification of four groups of participants, including, respectively, 543 (39·0 %), 373 (26·8 %), 246 (17·7 %) and 229 (16·5 %) participants. Clusters 1 and 4 showed associations of rather healthy behaviours (high physical activity and low consumption of sugary products; high consumption of fruit and vegetables, respectively), while clusters 2 and 3 showed associations of rather unhealthy behaviours (high sedentary behaviour and low consumption of fruit and vegetables; smoking and alcohol consumption, respectively). Both social status and family structure were associated with cluster membership.
Risk behaviour patterns in adolescents with excess weight were clustered in both healthier and less healthy ways, with a complex interplay with socio-demographic factors.
Dietary indexes measure the adherence of individuals to a set of nutritional recommendations. However, the health gains associated with adherence to various dietary indexes may vary. Our objective was to compare the magnitude of estimated avoided deaths by chronic diseases obtained by improving diet quality in the French population, measured by a variety of dietary indexes.
Simulation study based on observational data.
Weighted data from a French population-based cohort study.
In participants from the NutriNet-Santé cohort, we computed dietary scores reflecting the adherence to various recommendations (Medi-Lite, Healthy Diet Indicator (HDI), Programme National Nutrition Santé/National Nutrition and Health Program – Guidelines Score, Diet Quality Index (DQI), Alternative Healthy Eating Index (AHEI) and the modified Food Standards Agency nutrient profiling system dietary index (FSAm-NPS DI)). Quintiles of the food groups’ consumption and dietary intakes were used as input in a simulation model (Preventable Risk Integrated ModEl (PRIME)), yielding the number of delayed or avoided deaths in nutrition-related non-communicable diseases, comparing between very high or very low nutritional quality of the diet and medium nutritional quality.
A modification of dietary intakes from medium quality to very low quality (i.e. from the middle quintile to the quintile with the lowest nutritional quality) was associated with an increased number of deaths ranging from 3485 (95 % uncertainty interval (CI) 4002, 2987) for HDI and 3379 (95 % CI 3881, 2894) for FSAm-NPS DI to 838 (95 % CI 1163, 523) for Medi-Lite. Conversely, a modification of dietary intakes from medium quality to very high quality was associated with a decrease in the number of deaths ranging from 1995 (95 % CI 1676, 2299) for Probability of Adequate Nutrient intake diet, 1986 (95 % CI 1565, 2361) for DQI-International, 1931 (95 % CI 1499, 2316) for FSAm-NPS DI and 858 (95 % CI 499, 1205) for HDI.
Our results provide some insights as the potential impact of following various dietary guidelines to reduce mortality from nutrition-related diseases.
Non-communicable diseases, such as cancers and CVD, represent a major public health concern, and diet is an important factor in their development. French dietary recommendations were updated in 2017, and an adherence score, the Programme National Nutrition Santé Guidelines Score (PNNS-GS2), has been developed and validated using a standardised procedure. The present study aimed to analyse the prospective association between PNNS-GS2 and the risk of death, cancer and CVD. Our sample consisted of French adults included in the prospective NutriNet-Santé cohort (n 67 748, 75 634 and 80 269 for the risk of death, cancer and CVD, respectively). PNNS-GS2 (range: –∞ to 14·25) was calculated from the 24-h dietary records of the first 2 years of monitoring. Association between PNNS-GS2 (in quintiles, Q) and the risk of death, cancer and CVD was studied using Cox models adjusted for the main confounding factors. The sample included 78 % of women, aged on average 44·4 years (sd 14·6) with on average 6·6 (sd 2·3) dietary records. Average PNNS-GS2 was 1·5 (sd 3·4) and median follow-up was 6·6 years for cancers and 6·2 years for CVD and deaths. PNNS-GS2 was significantly associated with the risk of death (hazard ratio (HR)Q5vsQ1: 0·77 (95 % CI 0·60, 1·00), 828 cases), cancer (HRQ5vsQ1 = 0·80 (95 % CI 0·69, 0·92), 2577 cases) and CVD (HRQ5vsQ1 0·64 (95 % CI 0·51, 0·81), 964 cases). More specifically, PNNS-GS2 was significantly associated with colorectal and breast cancer risks but not prostate cancer risk. Our results suggest that strong adherence to the 2017 French dietary recommendations is associated with a lower risk of death, cancer or CVD. This reinforces the validity of these new recommendations and will help to promote their dissemination.
While food-based dietary guidelines have been widely disseminated for decades to improve nutritional knowledge in the population about healthy diets, more recent interventions such as front-of-pack labelling have made the differences between the two approaches apparent. While food-based dietary guidelines provide the overarching framework and benchmarks for a healthy diet, based on the current knowledge of the associations between various dietary components and health outcomes, front-of-pack labelling provides guidance to select a specific food, either within a food group or among similar foods belonging to various brands. Labelling foods as ‘healthy’ or ‘unhealthy’ raises multiple questions on the criteria used to define the terms and the implications of assigning an absolute healthiness value to an individual food in the context of complex diets. Gradual systems may provide more relative assessments and avoid dichotomisation. The present article presents the inherent differences and the complementarity of food-based dietary guidelines and food choice guidance in the context of food labelling.
In France, dairy products contribute to dietary saturated fat intake, of which reduced consumption is often recommended for CVD prevention. Epidemiological evidence on the association between dairy consumption and CVD risk remains unclear, suggesting either null or inverse associations. This study aimed to investigate the associations between dairy consumption (overall and specific foods) and CVD risk in a large cohort of French adults. This prospective analysis included participants aged ≥18 years from the NutriNet-Santé cohort (2009–2019). Daily dietary intakes were collected using 24-h dietary records. Total dairy, milk, cheese, yogurts, fermented and reduced-fat dairy intakes were investigated. CVD cases (n 1952) included cerebrovascular disease (n 878 cases) and CHD (n 1219 cases). Multivariable Cox models were performed to investigate associations. This analysis included 104 805 French adults (mean age at baseline 42·8 (sd 14·6) years, mean follow-up 5·5 (sd 3·0) years, i.e. 579 155 person-years). There were no significant associations between dairy intakes and total CVD or CHD risks. However, the consumption of at least 160 g/d of fermented dairy (e.g. cheese and yogurts) was associated with a reduced risk of cerebrovascular diseases compared with intakes below 57 g/d (hazard ratio = 0·81 (95 % CI 0·66, 0·98), Ptrend = 0·01). Despite being a major dietary source of saturated fats, dairy consumption was not associated with CVD or CHD risks in this study. However, fermented dairy was associated with a lower cerebrovascular disease risk. Robust randomised controlled trials are needed to further assess the impact of consuming different dairy foods on CVD risk and potential underlying mechanisms.
Although micronutrient deficiencies affect 2 billion people worldwide, no index focuses on measuring the risk of overt nutrient deficiency. We aimed to develop an index that could capture the nutrient dimension of nutritional security, a nutrient security index (named SecDiet), and evaluate its apparent validity. The SecDiet (range: 0–1) is based on the square-weighted average of the probabilities that the intake of twelve critical nutrients exceeds the threshold value associated with a risk of overt deficiency. Using adult populations from a French representative survey (INCA3, n 1774) and a large cohort (NutriNet-Santé, n 104 382), the content and construct validity of the SecDiet was evaluated by estimating associations of the SecDiet with its components and with relevant socio-demographic characteristics. The SecDiet was high in the overall population (0·93 (SD 0·09) in INCA3) and markedly skewed towards 1 (i.e. lower risk of insufficient intake). It correlated positively with its twelve components (r 0·17–0·78, all P < 0·001). The SecDiet was associated with monthly income (P = 0·002), perception of financial situation, professional situation, food insufficiency and security statuses (all P < 0·001) in the INCA3 population and with monthly income, professional situation and level of education (all P < 0·001) in the NutriNet-Santé population. Unlike a broader nutrient-based quality index taken as comparison, the SecDiet mean decreased and the tail of its distribution notably extended downwards in at-risk sub-populations, thus revealing its specific sensitivity. The SecDiet could be used to screen sub-groups or study the determinants of nutrient insecurity in large population surveys.
Host–microbial co-metabolism products are being increasingly recognised to play important roles in physiological processes. However, studies undertaking a comprehensive approach to consider host–microbial metabolic relationships remain scarce. Metabolomic analysis yielding detailed information regarding metabolites found in a given biological compartment holds promise for such an approach. This work aimed to explore the associations between host plasma metabolomic signatures and gut microbiota composition in healthy adults of the Milieu Intérieur study. For 846 subjects, gut microbiota composition was profiled through sequencing of the 16S rRNA gene in stools. Metabolomic signatures were generated through proton NMR analysis of plasma. The associations between metabolomic variables and α- and β-diversity indexes and relative taxa abundances were tested using multi-adjusted partial Spearman correlations, permutational ANOVA and multivariate associations with linear models, respectively. A multiple testing correction was applied (Benjamini–Hochberg, 10 % false discovery rate). Microbial richness was negatively associated with lipid-related signals and positively associated with amino acids, choline, creatinine, glucose and citrate (−0·133 ≤ Spearman’s ρ ≤ 0·126). Specific associations between metabolomic signals and abundances of taxa were detected (twenty-five at the genus level and nineteen at the species level): notably, numerous associations were observed for creatinine (positively associated with eleven species and negatively associated with Faecalibacterium prausnitzii). This large-scale population-based study highlights metabolites associated with gut microbial features and provides new insights into the understanding of complex host–gut microbiota metabolic relationships. In particular, our results support the implication of a ‘gut–kidney axis’. More studies providing a detailed exploration of these complex interactions and their implications for host health are needed.
The rising popular belief that gluten is unhealthy has led to growth in gluten avoidance in people without coeliac disease. Little information is available on their dietary profiles and their dietary behaviours. Our aim was to compare the consumption of organic foods between gluten avoiders and non-avoiders, and their places of food purchase. We described their sociodemographic and dietary profiles. The study population included participants of the NutriNet-Santé cohort who completed both a food exclusion questionnaire and an organic semi-quantitative FFQ (n 23 468). Food intake and organic food consumption ratios were compared using multivariable adjusted ANCOVA models. Associations between gluten avoidance and organic food consumption as well as places of food purchase were investigated with multivariable logistic regression. Participants avoiding gluten were more likely to be women and had a healthier dietary profile. Organic food consumption was higher among gluten avoiders (48·50 % of total diet for total avoiders, 17·38 % for non-avoiders). After adjustments for confounders, organic food consumption and purchase in organic stores were positively associated with gluten avoidance: adjusted OR (aOR)Q5 v.Q1 organic food = 4·95; 95 % CI 3·70, 6·63 and aORorganic stores v.supermarkets = 1·82; 95 % CI 1·42, 2·33 for total avoiders. Our study highlights that individuals avoiding gluten are high organic consumers and frequently purchase their foods in organic stores which propose an extended offer of gluten-free food. Further research is needed to determine the underlying common motivations and the temporality of the dietary behaviours of healthy people avoiding gluten.
Nutrient profiling systems (NPS) are used to classify foods according to their nutritional composition. However, investigating their prospective associations with health is key to their validation. The study investigated the associations of the original Food Standards Agency (FSA)-NPS and three variants (Food Standards Australia New Zealand Nutrient Profiling Scoring Criterion (NPSC), Health Star Rating NPS and the French High Council of Public Health NPS (HCSP-NPS)), with weight status. Individual dietary indices based on each NPS at the food level were computed to characterise the dietary quality of 71 403 French individuals from the NutriNet-Santé cohort. Associations of these indices with weight gain were assessed using mixed models and with overweight and obesity risks using Cox models. Participants with a higher dietary index (reflecting lower diet nutritional quality) were more likely to have a significant increase in BMI over time (β-coefficients positive) and an increased risk of overweight (hazard ratio (HR) T3 v. T1 = 1·27 (95 % CI 1·17, 1·37)) for the HCSP-Dietary Index, followed by the original FSA-Dietary Index (HR T3 v. T1 = 1·18 (95 % CI 1·09, 1·28)), the NPSC-Dietary Index (HR T3 v. T1 = 1·14 (95 % CI 1·06, 1·24)) and the Health Star Rating-Dietary Index (HR T3 v. T1 = 1·12 (95 % CI 1·04, 1·21)). Whilst differences were small, the HCSP-Dietary Index appeared to show significantly greater association with overweight risk. Overall, these results show the validity of NPS derived from the FSA-NPS, supporting their use in public policies for chronic disease prevention.
Dispositional optimism is a psychological trait that has been associated with health issues such as cardiovascular disease. However, there is little knowledge on the relationship between optimism and dietary intake in the general population. The objective of this cross-sectional study was to assess whether optimism was associated with diet quality, food group consumption and snacking. In 2016, 32,806 adult participants from the NutriNet-Santé study completed the Life-Orientation Test Revised (LOT-R) which assesses dispositional optimism. Diet quality (N = 17,849) and food group consumption (N = 19,335) were evaluated using at least three self-reported 24-h dietary records, while snacking behavior was evaluated by an ad-hoc question (N = 28,948). Logistic and linear regressions were used to analyze the associations between optimism and diet quality, food group consumption, and snacking behavior taking into account socio-demographic, lifestyle and depressive symptomatology characteristics. Optimism was positively associated with diet quality (b (95% CI) = 0.07 (0.004–0.11), P < 0.0001), while no association with energy was observed. Optimism was positively associated with consumption of fruit and vegetables, seafood, whole-grain food, fats, dairy product and meat substitutes, legumes, appetizers, non-salted oleaginous fruits and alcoholic beverages, and negatively associated with consumption of meat and poultry, dairy products, milk-based desserts and sugars and confectionery. In addition, optimism was negatively associated with snacking (OR (95% CI) = 0.89 (0.84, 0.95). Optimism was associated with a better diet quality overall and less snacking. It was also associated with consumption of healthy food groups as well as unhealthy food groups typically consumed at social eating occasions. These findings suggest that optimism could be taken into account in the promotion of a healthy eating behavior.
The 2017 implementation in France of the front-of-package nutrition label known as Nutri-Score is a major public health strategy to help individuals make healthier food choices at the point of purchase and thus help reduce chronic disease risk on the population level. The algorithm behind the Nutri-Score is intended to reflect the overall nutritional quality of food and is based on the one developed by the British Food Standards Agency Nutrient Profiling System, following a slight modification (FSAm-NPS) in accordance with French dietary guidelines. Prior research has focused on its association with various physical health outcomes (weight gain, metabolic syndrome, cancer incidence, etc.), yet no studies have explored the link with oral health indicators. We analyzed the cross-sectional association of the FSAm-NPS with oral health in a population-based sample of 33,231 men and women enrolled in the NutriNet-Santé cohort. Oral health (main dependent variable) was assessed in 2016 with the General Oral Health Assessment Index (GOHAI). It consists of 12 items scored on a 5-point Likert scale (maximum score = 60) with lower scores corresponding to poorer oral health with a detrimental impact on quality of life. FSAm-NPS (main independent variable) was calculated on the basis of 3 non-consecutive 24-h dietary records, following established methodology (score range: -15 to + 40, with lower scores corresponding to higher nutritional quality). Age-specific associations (cutoff = 60 y) were explored via multivariable linear regression models. Mean GOHAI score in the sample was 53.8 ± 5.5 (range: 19 to 60) and mean FSAm-NPS was 6.0 ± 2.2 (range: -6.7 to + 15.5). The unadjusted and the age- and sex-adjusted models were significant only in the younger age group (18–59 y). The fully-adjusted model showed modest yet significant associations between overall nutritional quality and oral health in younger and older participants, with the strength of the model being more pronounced in the former compared with the latter age group (F value: 28.5 vs. 6.3, both p < 0.0001). Overall, consuming food with a higher FSAm-NPS score (corresponding to lower nutritional quality) was associated with higher risk of oral health problems. Future longitudinal studies are needed to confirm the observed associations. On the public health policy level, the findings support implementation of the Nutri-Score on pre-packaged food in order to steer consumer choice toward nutritional profiles that are favorable not only for chronic disease prevention but also for oral health.
The new score of adherence to the 2017 French food-based dietary guidelines (PNNS-GS2) has previously been validated. Overweight and obesity being major risk factors for morbidity and mortality and highly related to diet, this study therefore aimed to study their prospective association with PNNS-GS2. A secondary objective was to compare these results to those obtained with PNNS-GS, reflecting 2001 recommendations.
Material and methods
The sample included French adults recruited in the prospective NutriNet-Santé cohort (N = 31,804 and 42,471 for overweight and obesity analyses respectively). The PNNS-GS and the PNNS-GS2 were calculated from repeated 24-hour dietary records collected during the first 2 years of follow-up, and weights were recorded after them in various questionnaires (N = 7.7 weight values on average, SD = 2.3). The association between the scores (as continuous and in quintiles, Q) and the risk of overweight or obesity was modelled by a Cox regression. Events were defined as having a BMI higher than 25 or 30, for overweight and obesity respectively. Comparison to the association with the PNNS-GS was performed using the mPNNS-GS, a modified PNNS-GS without the “physical activity” component. Models were adjusted for age (time scale), gender, size, energy intake, physical activity, socio-professional category, smoking, cohabitation, monthly income and alcohol consumption
Results and Statistical Analysis
Mean scores were 2.2 (SD = 3.2) for PNNS-GS2 and 8.2 (SD = 1.6) for the mPNNS-GS in the “overweight” sample, and 1.9 (SD = 3.3) for the PNNS-GS2 and 8.2 (SD = 1.6) for mPNNS-GS in the “obesity” sample. In our cohort, PNNS-GS2 was significantly associated with the risk obesity, both in quintiles (HRQ5vsQ1 [95%IC] = 0.43 [0.36–0.51]), with a very linear pattern across quintiles (p for trend < 0.0001), and continuously (HR1 point ofPNNS-GS2 [95%IC] = 0.90 [0.88–0.92]). Results were very similar for overweight. On the other hand, mPNNS-GS associations were not significant, whatever the outcome.
The strong association of PNNS-GS2 with the risk of overweight and obesity reinforces its construct validity. Its apparent superiority over the mPNNS-GS contributes to the relevance of the 2017 dietary guidelines.
Dietary supplements (DS) containing nutrients found mainly in animal products might be useful for individuals following specific type of vegetarian diet. However, the nutritional quality of the overall diet has been reported better in vegetarians compared to meat eaters, nuancing this potential interest. Little information is available about DS use according to the different types of vegetarian diets. This cross-sectional study aimed to describe DS use among fish eaters, vegetarians, vegans and meat eaters and to investigate its impact on nutritional inadequacy and its association with sociodemographic characteristics. Potentially at-risk DS use which include DS-drugs contraindicated associations; use of DS pointed out by safety authorities; and excess of tolerable upper intake levels were also described.
Material and methods
76,925 participants to the NutriNet-Santé cohort who completed a quantitative DS questionnaire and three 24 h dietary records were classified into 4 diet groups: 74,558 meat eaters, 1,126 fish eaters, 793 strict vegetarians and 448 vegans. A composition database including > 8000 DS was used. The prevalence of nutritional inadequacy was determined based on usual dietary intakes corrected by variance reduction, and analyses were weighted according to the French census data. Multivariable logistic regression models were performed to estimate the associations between sociodemographic characteristics and DS use.
The proportion of DS users (at least one DS during the last 12 months) was 42.4% in meat eaters, 65.7% in fish eaters, 61.7% in strict vegetarians and 76.7% in vegans. As compared to food intake alone, DS use lead to low decrease in nutritional inadequacy (< 5%), except in vegan for whom substantial decrease in inadequacy was observed for zinc (-5%), riboflavin (-11%) and vitamin B12 (-28%). Compared to meat eaters, fish eaters and vegetarians DS users showed highest proportions of DS-drugs contraindicated associations, use of DS pointed out by safety authorities, and subjects exceeding tolerable upper intake. Vegan DS users showed the lowest proportions of DS-drugs contraindicated associations and use of DS pointed out by safety authorities. DS use was associated with higher education in fish eaters, higher education and being non-smoker in vegetarians, and higher income in vegans (all p < 0.001).
Our results suggest that DS contribute to reducing the risk of inadequate intake for specific animal product-related nutrients mostly in vegans. DS use was associated with different sociodemographic characteristics depending on the vegetarian diet type. Potential benefits or risks associated with DS use in vegetarians should be assessed in further longitudinal studies.
Current French National Health and Nutrition Plan (PNNS) recommends 2 servings of dairy products per day for adults. However, dairy contributes to dietary saturated fat intake, of which reduced consumption is often recommended for cardiovascular disease (CVD) prevention. Epidemiological evidence on the association between dairy product consumption and CVD risk remains unclear, with findings from recent prospective cohorts suggesting either null or inverse associations between dairy intake and CVD risk(1,2). This study aimed to investigate the associations between intakes of dairy products (overall and specific types) and CVD risk in a large cohort of French adults.
This prospective study included self-selected participants aged ≥ 18 years from the NutriNet-Santé cohort (2009–2019). Dietary data were collected every 6 months using 24 h-dietary records, averaged in daily intakes and coded as sex-specific quartiles. Dairy foods were classified according the PNNS dairy groups: milk, cheese, and yogurts (i.e. yogurts, curd cheese and petit-suisses). Total, fermented and low-fat dairy intakes were also investigated. CVD cases (n = 1,952) included cerebrovascular (i.e. stroke and transient ischemic attack, n = 878 cases) and coronary heart diseases (i.e. myocardial infarction, angina, acute coronary syndrome and angioplasty, n = 1,219 cases). Multivariable Cox models were performed to characterize associations and were adjusted for age, gender, without-alcohol energy intake, number of 24h-dietary records, smoking status, educational level, physical activity, BMI, alcohol intake and family history of CVD.
This analysis included n = 104,805 French adults with a mean age 42.8 (SD 14.6) years and the mean number of dietary records per subject was 5.7 (SD 3.1). There was no association between total or specific dairy intakes and total CVD or coronary heart disease risks. However, consumption of fermented dairy, such as cheese and yogurts, was associated with a 19% reduction in the risk of cerebrovascular disease (HRQ4 vs. Q1 = 0.81 [0.66–0.98], p trend = 0.01).
Despite being important dietary sources of saturated fat, dairy product consumption was not associated with total CVD or coronary heart disease risks in a large cohort of French adults. However, fermented dairy products may be associated with a lower risk of cerebrovascular diseases. Further observational and interventional studies may be needed to further assess the impact of dairy on CVD risk and to identify potential mechanisms underlying the beneficial effects of fermented dairy products on cerebrovascular disease risk.