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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.
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.
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.
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.
Pesticides are used in large quantities in current agriculture all over Europe. Some pesticides are suspected of having negative effects on human health. While the risk associated with occupational exposure is getting well-documented, evidence of dietary exposure to these molecules in the general population is lacking. The aim of this study is to describe dietary exposure to pesticides among NutriNet-Santé cohort participants’.
NutriNet-Santé is a web-based cohort of French middle-aged adults launched in 2009. BioNutriNet is an ancillary study launched in 2014, aiming to measure organic and conventional food consumption and evaluate different dimensions of diet sustainability. Dietary intake of organic and conventional foods was assessed using a 264 items self-administered semi-quantitative food frequency questionnaire. Exposure to 25 commonly used pesticides was evaluated using contamination data from CVUA Stuttgart accounting for farming system. Dietary pesticide exposure profiles were identified using Non-Negative Matrix factorization (NMF), specially adapted for non-negative data with excess zeros. The NMF scores were then introduced in a hierarchical clustering process. Identified clusters were described in terms of sociodemographics, dietary patterns and exposure to pesticides.
A total of 34,442 participants were selected. Four clusters were identified. All clusters seemed to be exposed to the same molecules, with gradual intensity. The first cluster was characterized by the lowest energy-intake, highest organic food consumption (26.9%) and lowest dietary pesticide exposure; participants had highest consumption levels of organic food groups, including fruits and vegetables. Proportion of male participants and of rural residents was higher than in other groups. Clusters 2 and 3 were characterized by intermediate energy intake, and low organic food consumption. High conventional fruits and vegetables intake and moderate pesticide exposure were observed in cluster 2, composed of a lower smokers’ proportion. Cluster 3 individuals were less exposed to pesticides than clusters 2 and 4, except for Spinosad and Pyrethrins. Cluster 4 was characterized by the highest energy intake, lowest organic food consumption (12.2%), and highest pesticide exposure ; high consumption levels of conventional fruits, vegetables and a higher proportion of vegetarians were observed. This cluster was composed of 85.6% female participants, mainly retired (47.5%), mostly living in cities of 200 000 inhabitants and more (48.2%), and physically active.
Dietary pesticide exposures seem to vary across the clusters and depending on the proportion of organic food in the diet. High consumers of conventional fruits and vegetables consumers seem to be more exposed to our selection of pesticides.
Recently, Food-Based Dietary Guidelines (FBDG) have introduced the sustainability concept relying on health and environmental issues related diet. In 2017, the French FBDG were updated including, beyond healthy diet for human, environmental protection and the promotion of organic food.
The aim of the present analysis was to describe sustainable indicators (nutrition, environment, economic, sanitary exposure and long-term) according to adherence to the 2017 FBDG.
Material and Methods
The sample included a total of 28,240 from the NutriNet-Santé cohort having completed an, in the framework of the BioNutriNet project, an organic food frequency questionnaire allowing to estimate organic and conventional food consumption for 264 items. After matching, several databases were compiled to evaluate environmental impacts (greenhouse gas emissions, cumulative energy demand and land occupation and the pReCiPe score aggregating the three individual indicators), purchase costs of the diet and dietary exposure to pesticides, all data accounting for farming systems. A recently validated adherence score estimating compliance with the 2017 FBDG (programme national nutrition santé guidelines-score, PNNS-GS 2) was used and the quintiles were computed for comparison purpose of multiple sustainable. Numbers of averted or avoided deaths by adhering to the FBDG were also estimated using the PRIME.
A higher PNNS-GS2 scores is positively correlated to a high plant-based diet, a lower energy intake and a higher cost (+ 0.91€/d). It was associated with lower environmental impacts (ΔQ5vsQ1pReCiPe: -50% for PNNS-GS2). Higher PNNS-GS2 was associated with lower exposure to all pesticides except those used in organic farming and led to a reduction of about 20,000 averted or delayed deaths.
Our results suggest that 2017 FBDG are in line with the sustainable despite a slight higher cost. Such dietary guidelines, if largely adopted, may help in health promotion and reducing environmental protection in a context of an alarming climatic change.
Organic food consumption has risen in many countries during the past decades, but individual behaviors leading to these choices remain unclear.. The aim of this study was to evaluate the associations between cognitive restraint, weight loss diet history and organic food intake, in French adults. This cross-sectional analysis included 21,516 participants from the NutriNet-Santé cohort (26.4% male, mean age 55.3 years; SD = 13.8). Cognitive restraint was evaluated by the Three-Factor Eating Questionnaire and practice of weight-loss diet in the past years was assessed by an ad hoc questionnaire. Organic food intake of 17 food groups was assessed by the Organic-Food Frequency Questionnaire. Adjusted means of proportions of organic food intakes out of total food intakes were compared across quartiles of the cognitive restraint score and weight loss diet history. Analyses were adjusted for sociodemographic and lifestyle factors. Women with higher levels of cognitive restraint had in average a lower contribution of organic foods in their diet (26.5% in Q4 vs. 30.9% in Q1; p < 0.0001). In addition, women with a history of weight loss diet had in average a lower contribution of organic foods in their diet (27.1% in current/past vs. 28.5% in never dieters; p = 0.0012). Associations were observed in men for specific food groups. Overall, individuals, and in particular women, with higher cognitive restraint scores or with a history of weight loss diet consumed less organic food. Results suggest that it can be too complex to follow both weight control and organic food choice strategies at the same time.
In Western countries, the growing availability of animal products alternatives such as plant-based drinks or vegetarian patties for vegetarians and vegans, suggest that there could be an increase of their consumption of ultra-processed foods (UPFs). However, very little is known about the share of UPFs, and inversely unprocessed foods (UnPFs), in their diet. Thus, the aim of this study was to describe the proportion of UPFs and UnPFs, in adults from the NutriNet-Santé cohort, according to three types of vegetarian diets compared to meat-eaters. The relationship between diet characteristics such as duration and commencing age of the diet, and the share of UPFs, and UnPFs, were also studied among individuals following vegetarian diets.
Materials and Methods
The study population (n = 21,212) was divided into 4 groups: 19,812 meat eaters, 646 fish-eaters, 500 vegetarians and 254 vegans. Daily food intakes, adjusted for sex, age and total energy intake, were collected using repeated 24-h dietary records. Vegetarian diets were described according to indicators of UPFs and UnPFs, and the Healthy and Unhealthy plant-based Diet Indices (hPDI/uPDI). In a sub-sample without meat eaters (n = 1,400), multivariable linear regression models were performed to assess the association between UPF consumptions and diet characteristics.
UPFs accounted for 33.0%, 32.5%, 37.0% and 39.5% respectively for meat-eaters, fish-eaters, vegetarians and vegans. On the contrary, UnPFs accounted for 29%, 29%, 27% and 31%. The means of uPDI and hPDI indices were respectively equal to 54.0, 53.2, 56.9 and 59.9, and 53.5, 60.6, 61.4 and 67.9 for meat-eaters, fish-eaters, vegetarians and vegans. Concerning diet characteristics, a shorter duration of being vegetarian, or a younger age at commencing of the diet was significantly associated with increased consumptions of UPFs (respectively p = 0.0010 and p < 0.0001).
We showed that vegetarians can be distinguished according to the share of both UPFs and UnPFs in their diet, but also concerning the diet quality according to hPDI and uPDI. Thus, the share of UPFs in the diet and associated characteristics such duration and commencing age of the diet, should be considered in future studies about the link between vegetarianisms and health.
In the current context of unsustainable food systems, we aimed to develop and validate an index, the sustainable diet index (SDI), assessing the sustainability of dietary patterns, including multidimensional individual indicators of sustainability. Based on the FAO’s definition of sustainable diets, the SDI includes seven indicators categorised into four standardised sub-indexes, respectively, environmental, nutritional, economic and sociocultural. The index (range: 4–20) was obtained by summing the sub-indexes. We computed the SDI for 29 388 participants in the NutriNet-Santé cohort study, estimated its validity and identified potential socio-demographic or lifestyle differences across the SDI quintile. In our sample, the SDI (mean=12·10/20; 95 % CI 12·07, 12·13) was highly correlated to all the sub-indexes that exerted substantial influence on the participants’ ranking. The environmental and economical sub-indexes were the most and less correlated with the SDI (Pearson R2 0·66 and 0·52, respectively). Dietary patterns of participants with a high SDI (considered as more sustainable) were concordant with the already published sustainable diets. Participants with high SDI scores were more often women (24 %), post-secondary graduates (22 %) and vegetarians or vegans (7 %), without obesity (16 %). Finally, the SDI could be a useful tool to easily assess the sustainability-related changes in dietary patterns, estimate the association with long-term health outcomes and help guide future public health policies.
A lower BMI has been reported among consumers of organic foods, but this relationship has never been examined in a prospective design study. Our aim was to prospectively investigate the association between frequency of organic food consumption and weight change. We analysed data from 62 224 participants of the NutriNet-Santé cohort (78 % women, mean age=45 years) with information on consumption frequency of organic foods, dietary intake and repeated anthropometric data. For sixteen products, participants reported their consumption frequency of labelled organic foods (never, occasionally, most of the time). An organic score (OS) with a maximum of thirty-two points was computed. The associations of the OS (modeled as quartiles (Q)) with change in BMI during follow-up (on average 3·1 years) and with the risk of overweight and obesity were estimated by ANCOVA and multivariable logistic regression. A lower BMI increase was observed across quartiles of the OS (mean difference Q4 v. Q1=−0·16 (95 % CI −0·32, −0·01). An increase in the OS was associated with a lower risk of overweight and obesity (among non-overweight and non-obese participants at inclusion): OR for Q4 v. Q1 were 0·77 (95 % CI 0·68, 0·86) and 0·69 (95 % CI 0·58, 0·82), respectively. Concerning obesity risk, the association was stronger among participants with higher adherence to nutritional guidelines. This study supports a strong protective role of consumption frequency of organic foods with regard to the risk of overweight and obesity that depends on overall dietary quality. Upon confirmation, these results may contribute to fine-tune nutritional guidelines by accounting for farming practices in food production.
We aimed to assess dietary profiles of adults from the NutriNet-Santé cohort according to different levels of organic food consumption using detailed self-reported data on organic food intakes.
Food intakes were obtained using an organic food frequency questionnaire (Org-FFQ). The participants were ranked into five groups (quintiles, Q) according to the proportion of organic foods in their diet. To determine diet quality, two scores were computed reflecting adherence to food-based recommendations (mPNNS-GS) and the probability of adequate nutrient intake (PANDiet). Relationships between levels of organic food consumption and dietary characteristics were assessed using multivariable-adjusted ANCOVA models.
The NutriNet-Santé Study.
French adults from the NutriNet-Santé Study (n 28 245).
Intakes of foods of plant origin increased along with the contribution of organic foods to the diet while a reverse trend was identified for dairy products, cookies and soda (P-trend<0·0001). The diet quality scores increased from Q1 (mPNNS-GS, 7·89 (se 0·02); PANDiet: 63·04 (se 0·11)) to Q5 (mPNNS-GS, 8·78 (se 0·02); PANDiet, 69·37 (se 0·10)). Overall, high organic food consumers exhibited better diet quality, although intermediate organic food consumers showed better adherence to specific nutritional recommendations related to animal products.
The study provides new insights into the understanding of organic food consumption as a part of a healthy diet and sheds some light on the dietary profiles of different categories of organic food consumers. These results underline strong dietary behaviour correlates associated with organic food consumption that should be controlled for in future aetiological studies on organic foods and health.
Limited information is available on large-scale populations regarding the socio-demographic and nutrient profiles and eating behaviour of consumers, taking into account both organic and conventional foods. The aims of this study were to draw up a typology of consumers according to their eating habits, based both on their dietary patterns and the mode of food production, and to outline their socio-demographic, behavioural and nutritional characteristics. Data were collected from 28 245 participants of the NutriNet-Santé study. Dietary information was obtained using a 264-item, semi-quantitative, organic FFQ. To identify clusters of consumers, principal component analysis was applied on sixteen conventional and sixteen organic food groups followed by a clustering procedure. The following five clusters of consumers were identified: (1) a cluster characterised by low energy intake, low consumption of organic food and high prevalence of inadequate nutrient intakes; (2) a cluster of big eaters of conventional foods with high intakes of SFA and cholesterol; (3) a cluster with high consumption of organic food and relatively adequate nutritional diet quality; (4) a group with a high percentage of organic food consumers, 14 % of which were either vegetarians or vegans, who exhibited a high nutritional diet quality and a low prevalence of inadequate intakes of most vitamins except B12; and (5) a group of moderate organic food consumers with a particularly high intake of proteins and alcohol and a poor nutritional diet quality. These findings may have implications for future aetiological studies investigating the potential impact of organic food consumption.
The dietary and health traits of organic food (OF) consumers have not been comprehensively described. The aim of this study was to identify factors associated with OF consumption. Data were collected from 54 283 participants from the NutriNet-Santé cohort using self-administered web-based questionnaires. Occasional organic food consumers and regular organic food consumers (ROFC) were compared with non-organic food consumers (NOFC) using logistical regression providing an OR and 95 % CI. Adherence to the French food-based guidelines and interactions between nutritional knowledge and OF consumption in adherence to dietary guidelines were investigated. Medical history was also assessed in relation to OF consumption. Compared with NOFC, ROFC were more likely to be vegetarian (OR 9·93; 95 % CI 7·42, 13·29 in women; OR 13·07; CI 7·00, 24·41 in men) and were less likely to be aware of nutritional guidelines regarding meat consumption (OR 0·37; CI 0·34, 0·40 in women; OR 0·41; CI 0·36, 0·47 in men). Compared with NOFC, ROFC had a lower risk of type II diabetes, hypertension and CVD; however, this effect was only significant for men. In contrast, organic consumers were more likely to report food allergies. Consuming OF appeared to affect the relationship between nutritional knowledge and adequate intake of meat/poultry/seafood/eggs and starchy food among both sexes. Our study provides new insights into the diet- and health-related behaviours of OF consumers in a large sample of participants residing in France. This should be taken into account in future studies investigating relationships between health and OF consumption.
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