Determinants of energy drink consumption in adolescents: identification of sex-specific patterns.

OBJECTIVES: To investigate sex differences in sociodemographic and lifestyle correlates of frequent energy drink (ED) consumption in adolescents. STUDY DESIGN: This study was based on data collected among French-speaking Belgian adolescents aged 11-20 years (n = 8137) within the 2018 Health Behaviour in School-aged Children study. METHODS: Multiple logistic analyses stratified by sex were performed to estimate the associations between consuming EDs more than once a week, and various sociodemographic and lifestyle characteristics. RESULTS: Overall, 14.0% of boys and 7.6% of girls consumed ED more than once a week. For both genders, the likelihood of consuming ED more than once a week was higher among adolescents consuming soft drinks daily (vs. < daily), alcohol weekly (vs. < weekly), spending at least 5 h/day in front of screens (vs. < 5 h/day), and going to bed later than 11:30 PM (vs. ≤ 10:00 PM). Among boys, adolescents reporting at least 1 h of moderate-to-vigorous physical activity (MVPA) daily (vs. < 1 h/day MVPA) were more likely to consume ED more than once a week (adjusted odd ratio (aOR) = 1.49 (95% confidence interval [CI] 1.11-2.01)). Among girls, adolescents from low affluence families (vs. high affluence) (aOR = 2.03 (95% CI 1.19-3.48)) and immigrants (vs. natives) (2nd generation: aOR = 1.75 (95% CI 1.31-2.32); 1st generation: aOR = 1.90 (95% CI 1.20-3.03)) were more likely to consume ED more than once a week. CONCLUSIONS: We identified different patterns of ED consumption in boys and girls. These results suggest that sex-tailored interventions could be relevant to reduce ED consumption in adolescents.

Immigration and adolescent health: the case of a multicultural population.

OBJECTIVES: Previous research indicates that the impact of immigration on health tends to be specific as it is influenced by many factors such as life stage and host country. The aim of this study was to examine the relationship between immigration and adolescent health within the multicultural context of the Brussels-Capital Region in Belgium. STUDY DESIGN: The study was based on the 2014 Health Behaviour in School-aged Children survey. The sample consisted of 2962 adolescents from the fifth grade of primary to the last grade of secondary schools in Brussels. METHODS: Associations between health indicators and immigration status were analysed using multivariable logistic regression models adjusted for sociodemographic characteristics. RESULTS: Natives, first-generation immigrants, second-generation immigrants with both parents born abroad and second-generation immigrants with one parent born abroad represented 19%, 23%, 36% and 22% of the respondents, respectively. Sociodemographic characteristics and health behaviours varied according to immigrant status. Young immigrants were more likely to present overweight (odds ratio [OR] first-generation immigrants vs. natives = 1.76 [95% confidence interval {CI} = 1.16-2.65]; OR second-generation immigrants with both parents born abroad vs. natives = 2.06 [95% CI = 1.41-3.02]; OR second-generation immigrants with one parent born abroad vs. natives = 1.69 [95% CI = 1.12-2.56]). This effect turned out to be partially explained by sociodemographic status and health-related behaviours. No association was detected between immigration and self-rated health and multiple recurrent symptoms. CONCLUSIONS: Discrepancies in health behaviours and weight status were identified between adolescents of different immigration background, whereas this was not the case for well-being. Socio-economic status, cultural characteristics and specific behaviours partly explained these findings. Future research is needed to better understand immigration-related risk and protective factors, at individual and school levels.

Television viewing duration and blood pressure among 18-74-year-old adults. The French nutrition and health survey (ENNS, 2006-2007).

OBJECTIVES: To describe Blood Pressure (BP) according to the time spent viewing television and examine whether the associations between television viewing and systolic and diastolic BP differed depending on sex, age and BMI. DESIGN: The French health and nutrition survey (ENNS) was conducted in 2006-2007 on a multistage stratified random sample of 18-74-year-old adults. METHODS: Systolic (SBP) and diastolic BP (DBP) were assessed using three measurements. Among subjects without BP-lowering drugs and lifestyle measures, adjusted means of SBP and DBP were estimated for each television viewing category (<3h and ≥3h). RESULTS: Among 2050 ENNS participants, 81.2% declared neither drug medication nor lifestyle change to lower BP. In women without BP-lowering measure, viewing television 3h/day or more increased significantly SBP and DBP adjusted means (+2mmHg) compared to women who spent less than 3h/day in front of the television. These associations were stronger in obese or 35-54-year-old women. In men, no relationship between DBP and television-viewing has been observed. Though, SBP was positively associated with television-viewing in non-overweight, 18-29 or 55-74 year-old men. CONCLUSIONS: These results show that the association between television viewing duration and BP must be evaluated differently between gender, age group and BMI category.

Associations between weight status and liking scores for sweet, salt and fat according to the gender in adults (The Nutrinet-Santé study).

BACKGROUND/OBJECTIVES: As taste preferences may be associated with obesity, the present study investigated whether obese subjects presented heightened liking for the sensations of sweet, salt and fat. SUBJECTS/METHODS: Liking scores were determined by a questionnaire including 83 items on liking for sweet or fatty foods, and the preferred extent of seasoning with salt, sweet or fat. Data from 46909 adults included in the French web-based observational cohort of the Nutrinet-Santé study were collected and weighted according to the national population census. Relationships between liking scores and body mass index (BMI) as categorical or linear explanatory variable were assessed separately by gender using covariance and linear regression analyses, adjusted for age, education level, living area, smoking and alcohol. RESULTS: Overall liking scores for salt and fat were linearly positively linked to BMI in men and women (P≤0.001) and were higher in obese than in normal-weight individuals. The score difference between BMI categories was greater in women for fat liking only. For sweet liking, results differed between gender and compounding factors. Liking for added sugar and sweet foods was positively linked to BMI in women unlike in men; liking for natural sweetness was negatively linked to BMI in both genders. CONCLUSIONS: This study demonstrates that the relationship between liking and BMI differs according to the gender in its magnitude for fat and in its nature for sweet, unlike that for salt. Liking for sweet and fat may be linked to overconsumption of the corresponding foods, especially in women. This warrants further investigation.

[Recent prevalence of child and adolescent overweight and obesity in France and abroad]. / L'évolution récente des prévalences de surpoids et d'obésité chez l'enfant et l'adolescent en France et au niveau international.

During the 2000s, surveillance of child overweight and obesity experienced a large expansion and provided an opportunity to document such a public health issue using standardized procedures in France and abroad. Nowadays, in France, it has been estimated that just less than one child out of five is overweight and among them, 3 to 4 % are obese. Like in other developed countries, these frequencies have reached a plateau during the 2000s and set France belonging to a group of countries in which the situation looks as fairly favorable. Nevertheless, they also hide huge disparities across social groups and the number of concerned children remains too high, while care possibilities are rather inconclusive. Therefore, prevention actions are still needed.

Body-weight perception and related preoccupations in a large national sample of adolescents.

OBJECTIVES: This study aimed to investigate the association between body-weight (BW) perception, weight preoccupation and behaviour, including weight control practices and compulsive over-eating episodes, across gender and actual BW classes. DESIGN: This study used a cross-sectional observational study. PARTICIPANTS: A large, nationally representative sample of 6404 ninth-grade French adolescents was randomly selected from schools throughout France. METHODS: Weight and height were measured, and BW preoccupation, BW control practices and compulsive over-eating were self-reported using standardized questionnaires. RESULTS: Nearly one-third of adolescents misperceived their BW. Misperception was more frequent among girls than boys (42.2% vs. 27.3%, P < 0.01). Underestimation of BW among overweight adolescents, like BW overestimation among underweight adolescents, was associated with less preoccupation with weight and fewer weight control practices than accurate perception of BW. Normal weight adolescents who overestimated their BW were more likely to declare weight preoccupations (ORa = 8.66 [6.67-11.25]), dieting (ORa = 4.81 [3.68-6.27]) and recurrent compulsive over-eating episodes (ORa = 2.36 [1.72-3.23]) compared with their counterparts who correctly estimated their BW. CONCLUSION: Our study underlines the role of these associations in each category of actual BW (underweight, normal weight and overweight) in a large national sample.

Metabolic syndrome and socioeconomic status in France: The French Nutrition and Health Survey (ENNS, 2006-2007).

OBJECTIVES: The main objective was to estimate, in France, the prevalence of metabolic syndrome (MetS) and to investigate the association between socioeconomic position and MetS. METHODS: The French National Nutrition and Health Survey (ENNS) cross-sectional national multistage sampling was carried out in 2006-2007. Data collection included waist circumference and blood pressure measurements, blood sample and sociodemographic and medication information. The prevalence of MetS was assessed using several definitions, including Joint Interim Statement (JIS). Association with sociodemographic covariates was assessed using logistic regression models. RESULTS: Among the 1,856 participants 18-74 years of age, MetS prevalence was found to vary from 14.6 % (National Cholesterol Education Program definition) to 21.1 % (JIS), with no difference between genders. After adjustment, risk of MetS increased with age in both men and women. In women, MetS risk was inversely associated with education level. Risk of MetS was higher in men born outside France than in French-born males. CONCLUSIONS: MetS prevalence appeared to be lower in France than in most industrialised countries. The promoting of public health measures to reduce MetS, for example, lifestyle changes, is of utmost importance, particularly among less favourable socioeconomic categories and among migrants.

Consumer acceptability and understanding of front-of-pack nutrition labels.

BACKGROUND: Front-of-pack (FOP) nutrition labelling has been proposed as a tool for helping consumers make healthy choices. Before determining its effects on consumer behaviour, factors involved in its use must be elucidated, i.e. understanding and acceptability on the part of the consumer. Among five FOP labels, we sought to determine which formats were most easily understood and accepted by a large sample of adults. METHODS: Among 39 370 adults who participated in the French Nutrinet-Santé cohort study, understanding and indicators of acceptability (attitude, liking, visual attractiveness and perceived cognitive workload) were measured for five FOP labels: The currently used 'multiple traffic lights' (MTL) and 'simple traffic lights' (STL), and the 'colour range' logo (CR), the 'green tick' and the PNNS logo. We investigated the contribution of the different elements to consumer perception of FOP labels using multiple correspondence analyses. RESULTS: Over half of the sample population showed a high level of understanding and perceived no discomfort in terms of the different logos. Label formats were positioned along an acceptability gradient ranging from acceptance to rejection, consisting of 'liking', 'attractiveness' and indicators of perceived cognitive workload. MTL was significantly more often liked and was viewed as reliable and informative. MTL, STL and the green tick performed better than the CR and PNNS logos in terms of ease of identification and comprehension. CR was clearly the least appreciated and it had the most complex format. CONCLUSIONS: Consumers prefer FOP labels which give complete, reliable and simplified information on the nutrient quality of foods.

Impact of fruit and vegetable vouchers and dietary advice on fruit and vegetable intake in a low-income population.

BACKGROUND/OBJECTIVES: Lower-income subgroups consume fewer servings of fruit and vegetables (FVs) compared with their more advantaged counterparts. To overcome financial barriers, FV voucher delivery has been proposed. SUBJECTS/METHODS: In a 12-month trial, 302 low-income adults 18-60 years old (defined by evaluation of deprivation and inequalities in health examination centers, a specific deprivation score) were randomized into two groups: dietary advice alone ('advice'), or dietary advice plus FV vouchers ('FV vouchers') (10-40 euros/month) exchangeable for fresh fruits and vegetables. Self-reported data were collected on FV consumption and socioeconomic status at baseline, 3, 9 and 12 months. Anthropometric and blood pressure measurements were conducted at these periods, as well as blood samples obtained for determination of vitamins. Descriptive analyses, multiple linear regression and logistic regression were performed to evaluate the impact of FV. RESULTS: Between baseline and 3-month follow-up, mean FV consumption increased significantly in both the 'advice' (0.62±1.29 times/day, P=0.0004) and 'FV vouchers' groups (0.74±1.90, P=0.002), with no difference between groups. Subjects in the FV vouchers group had significantly decreased risk of low FV consumption (<1 time/day) compared with those in the advice group (P=0.008). No change was noted in vitamin levels (vitamin C and ß-carotene). The high number of lost-to-follow-up cases did not permit analysis at 9 or 12 months. CONCLUSION: In the low-income population, FV voucher delivery decreased the proportion of low FV consumers at 3 months. Longer-term studies are needed to assess their impact on nutritional status.

Correlates of sedentary behavior in 7 to 9-year-old French children are dependent on maternal weight status.

OBJECTIVE: Sedentary behavior accounts for overweight and obesity, independently of physical activity. Correlates of sedentary behavior have not been extensively reported in the literature. Our objective was to determine factors associated with such behavior in 7 to 9-year-old French children in 2007, and to assess interactions between the identified correlates. DESIGN: A nationally representative sample of 2525 children participated in the study. Television viewing, video/computer duration and characteristics of the children and their parents were assessed using a questionnaire completed by the parents. Correlates of television viewing (<2 h per day versus ≥ 2 h per day) as a proxy for sedentary behavior were estimated using multivariate logistic regression. RESULTS: On an average, children spent more than 2 h per day in front of a screen (television: 1 h 32 min (s.e.m.: ± 0 h 02 min); video/computer: 0 h 40 min (± 0 h 02 min)). Television viewing duration was associated with sociodemographic (child's age, weight status, socio-economic characteristics of the family) and behavioral factors (physical and lifestyle activities). In children of non-overweight mothers, risk of spending ≥ 2 h per day in front of a television was significantly higher in those over 9 (versus 7 years: odds ratio (OR): 2.07; 95% confidence intervals (CI): 1.04-4.11), living in an educational priority zone (OR: 1.62; 95% CI: 1.08-2.44), who were not members of a sports team (OR: 2.24; 95% CI: 1.47-3.41), nor declared active by parents (OR: 1.92; 95% CI: 1.13-3.25), and whose parents' education level was lower than high school (OR: 1.84; 95% CI: 1.24-2.72). In contrast, in children of overweight mothers, only the criteria of ≥ 4 children in the family (versus 2-3 children: OR: 1.87; 95% CI: 1.05-3.35) and no reported parental occupation (versus manager or white collar: OR: 0.29; 95% CI: 0.11-0.76) were associated with watching television ≥ 2 h per day. CONCLUSIONS: Correlates of sedentary behavior in 7 to 9-year-old children vary according to maternal overweight. Maternal body mass index must therefore be taken into account when developing strategies to prevent a sedentary lifestyle in children.

Higher adherence to French dietary guidelines and chronic diseases in the prospective SU.VI.MAX cohort.

BACKGROUND/OBJECTIVES: Nutritional recommendations are widely disseminated, but assessment of their predictive value for risk of chronic diseases and mortality is essential for ensuring their validity. We evaluated, in a large population-based study, the association between the French Programme National Nutrition Santé (PNNS) Guideline Score (GS) (maximum score of 15 points), an a priori-based score, and the incidences of cancer, cardiovascular disease (CVD) and overall mortality. SUBJECTS/METHODS: Subjects included in this analysis (n=5823) were participants in the Supplémentation en Vitamines et Minéraux AntioXydants study, with available data for estimating the PNNS-GS. Hazards ratios (HRs) and 95% confidence intervals (95% CIs) for outcomes (cancer, CVD and death) were estimated across quartiles of PNNS-GS using Cox proportional hazards models. RESULTS: A total of 734 major events were recorded during an average 11.6-year follow-up (maximum 13 years): 423 cancers, 193 ischemic diseases and 118 deaths. In the fully adjusted model, a significant reduction in CVD risk between the first and fourth PNNS-GS quartiles (HR=0.65, 95% CI=0.41, 1.00, P for trend=0.04) was observed. No significant overall association with risk of cancer or death was detected. CONCLUSIONS: These observations support the role of nutritional guidelines in prevention of CVD.

Dietary behaviour and nutritional status in underprivileged people using food aid (ABENA study, 2004-2005).

BACKGROUND: Although initiatives are setting up to improve the nutritional status of deprived people, few studies have described the food aid user profile and evaluated their nutritional needs. The contributions of food aid to the food supply, dietary behaviour and nutritional status of food aid users were evaluated in the ABENA study. METHODS: A cross-sectional study was conducted among food aid users in four urban French zones (n = 1664, age ≥18 years). Sociodemographic and economic characteristics, food insufficiency, food supply and diet behaviours were assessed using standardised questionnaires. A subsample of participants underwent clinical and biochemical examinations. Descriptive and comparative analyses were performed taking into account sample weights. RESULTS: Over 70% of participants used food aid as the only source of supply among numerous food groups, and one-quarter of them (27.2%) were using food aid for 3 years or more. The mean food budget was €70.0 per person per month, and 46.0% of subjects were classified as 'food-insufficient'. Half of the subjects fulfilled the French recommendations for starchy foods (48.7%) and 'meat, fish and eggs' (49.4%); 27.3% met the requirements for seafood. Only a very small proportion of participants met the recommendations for fruits and vegetables (1.2%) and dairy products (9.2%). In addition, 16.7% of subjects were obese, 29.4% had high blood pressure, 14.8% were anaemic, 67.9% were at risk of folate deficiency and 85.6% had vitamin D deficiency. CONCLUSIONS: These results provide evidence of an unhealthy diet and poor health profiles in severely disadvantaged persons and highlight the importance of food aid in this population. Thus, this study points to the necessity of improving the nutritional quality of currently distributed food aid.

A first national prevalence estimate of diagnosed and undiagnosed diabetes in France in 18- to 74-year-old individuals: the French Nutrition and Health Survey 2006/2007.

AIMS: To estimate the nationwide prevalence of diagnosed and undiagnosed diabetes and pre-diabetes in adults residing in France. METHODS: A probability sample of a non-institutionalized civilian population residing throughout the whole of continental France was recruited from February 2006 to March 2007 for the French Nutrition and Health Survey. All individuals aged between 18 and 74 years who agreed to participate in the survey were included; thus there were 3115 participants, 2102 of whom were undergoing biochemical assessments. The prevalence of diagnosed diabetes was estimated using self-reported diabetes history and the prevalence of undiagnosed diabetes was estimated using fasting plasma glucose ≥ 7.0 mmol/l or HbA(1c) ≥ 6.5% (≥ 48 mmol/mol). RESULTS: The prevalence of diagnosed diabetes was 4.6%, 95% CI 3.6-5.7. The prevalence of undiagnosed diabetes according to standard fasting plasma glucose criteria was 1% (95% CI 0.6-1.7) and contributed to less than 20% of all cases of diabetes. This proportion decreased with age from 30% in 30- to 54-year-olds to 12% in 55- to 74-year-olds. Based on HbA(1c) criteria, the prevalence of undiagnosed diabetes was 0.8% (95% CI 0.4-1.6). CONCLUSIONS: The prevalence of diagnosed diabetes in adults in France is comparable with recent estimates from Northern Europe. The percentage of total diabetes that is undiagnosed is low in France, which may be explained by a widely practised strategy of opportunist screening. During the past years, improvements in diabetes care and increased awareness may have contributed towards decreasing the prevalence of undiagnosed diabetes more widely in Europe, and studies should further monitor such improvements.

Sociodemographic and economic characteristics associated with dairy intake vary across genders.

BACKGROUND: Recommendations promote a diversified and optimal but not excessive consumption of dairy products. Their efficiency may depend on sociodemographic and economic factors, for which little information is available. Links between these factors and dairy intake were investigated in a large sample of French adults. METHODS: Dietary intakes were assessed using at least six 24-h dietary records collected during a 2-year period from 4574 adults aged 45-60 years. The cost of each food item was estimated from national data. Sociodemographic and economic characteristics were assessed by self-administered questionnaires. Compliance with the current dairy recommendation, distribution of the dairy budget and calcium inadequacy were compared by logistic regression and covariance analyses. RESULTS: Thirty-five percent of subjects complied with the three-per-day dairy recommendation, with more men than women exceeding this (36.2% versus 26.5%, P < 0.0001). The proportion of the dairy budget spent on milk increased with age in men (P = 0.002); in women, it was inversely associated with occupational category (P = 0.009) and residence in an urban area (P = 0.0001). The proportion of this budget spent on cheese increased with education level in women (P = 0.04) and decreased with age in men (P = 0.03). In men, the consumption of cream desserts decreased with age (P = 0.006) and education level (P = 0.002). Dietary calcium inadequacy was more prevalent in women than in men (32.7% versus 14.2%, P < 0.0001). Among women, this prevalence was higher in older subjects (P < 0.0001) and those who lived alone (P = 0.005). CONCLUSIONS: Although compliance with dairy recommendation needs to be improved, sociodemographic and economic factors should be taken into account to improve the efficiency of targeted public health messages.

[Why and how to use the new body mass index curves for children]. / Pourquoi et comment utiliser les nouvelles courbes de corpulence pour les enfants ?

Body mass index (BMI) curves are very useful tools to supervise corpulence during growth and to detect children at risk of overweight and obesity early. In 2009, the French National Nutrition Health Program decided to update the BMI curves used in France. A working group was then created, coordinated by the committee on nutrition of the société française de pédiatrie and by the association pour la prevention de l'obésité en pédiatrie. This article discusses the criteria adopted in elaborating the new curves among the existing references and curves (French references, the International Obesity Task Force [IOTF], the World Health Organization [WHO] standards). It presents recommendations for using the new curves and the BMI values used to define weight insufficiency, overweight, and obesity according to the references utilized.

[Early screening criteria for children at risk of overweight]. / Critères de repérage précoce des enfants à risque de développer un surpoids.

BACKGROUND: Health professionals who monitor the growth of children are also involved in the early detection of overweight. Appropriate tools are required for this purpose. OBJECTIVE: The study sought to identify predictive markers of the development of subsequent overweight using a simple set of criteria. METHODS: A consecutive cohort was composed of 1424 grade 4 children in Aquitaine, France, aged 8-9 years. Body mass index (BMI) was calculated during school health assessments at 8-9 years of age. Data from previous assessments at 3-4 and 5-6 years of age were also collected. RESULTS: Of the 189/1424 children (13.9 %) who were overweight according to the French national cut off for children aged 8-9 years, 67 (33.8 %) were already overweight at 3-4 years and 107 (54.1 %) at 5-6 years. Of the 134 (9.4 %) who were overweight at 5-6 years, 43.3 % were already overweight at 3-4 years and 79.9 % were overweight at 8-9 years. On the other hand, 76 of these 134 children (56.7 %) were not overweight at 3-4 years, so they had become overweight between the two assessments. The combination of the criterion "overweight at 3-4 years or 5-6 years" and "increase in BMI>1kg/m(2) between 3-4 years and 5-6 years" appears to be the best predictor of the risk of overweight at 8-9 years, with good sensitivity (75.3 %) and specificity (87.9 %). CONCLUSION: A predictive tool based on BMI changes between ages 3-4 years and 5-6 years could be used for the early detection of the risk of developing overweight and obesity. The tool is easy to use, especially for health care in schools. Furthermore, the present findings confirm the value of following up and managing children who are already overweight between the ages of 3 and 6 years.

Associations of socioeconomic factors with inadequate dietary intake in food aid users in France (The ABENA study 2004-2005).

BACKGROUND/OBJECTIVES: Few studies in Europe have examined the relationship of sociodemographic and economic factors with diet in deprived populations. We analysed the association between socioeconomic characteristics and consumption of different food groups in food aid users. SUBJECTS/METHODS: A cross-sectional study was conducted among food aid users in four urban French zones (n=1664). Associations of sociodemographic and economic factors and food aid use with frequency of consumption of the main food groups were tested using multivariate logistic regression models accounting for sampling weights. RESULTS: Both migrant status and consumption of fewer than three daily meals were associated with risk of low frequency of starchy food consumption (<3 times per day). Migrant status was also associated with low frequency of consumption of fruits and vegetables (<3.5 times per day) and dairy products (<2 times per day). Subjects with severe food insufficiency were more likely to be low consumers of fruits and vegetables, meat, seafood and eggs (<1 time per day), and dairy products. A low monthly food budget, temporary housing in a shelter and no source of household income were all associated with risk of low frequency of seafood consumption (<2 times per week). Finally, duration of food aid use, type of food aid distribution and perception of poor health status were associated with low consumption of meat, seafood and eggs. CONCLUSIONS: Economic level and other social characteristics were associated with an unhealthy diet within this deprived French population.

Overweight and obesity in infants and pre-school children in the European Union: a review of existing data.

The objective of this study was to synthesize available information on prevalence and time trends of overweight and obesity in pre-school children in the European Union. Retrieval and analysis or re-analysis of existing data were carried out. Data sources include WHO databases, Medline and Google, contact with authors of published and unpublished documents. Data were analysed using the International Obesity Task Force reference and cut-offs, and the WHO standard. Data were available from 18/27 countries. Comparisons were problematic because of different definitions and methods of data collection and analysis. The reported prevalence of overweight plus obesity at 4 years ranges from 11.8% in Romania (2004) to 32.3% in Spain (1998-2000). Countries in the Mediterranean region and the British islands report higher rates than those in middle, northern and eastern Europe. Rates are generally higher in girls than in boys. With the possible exception of England, there was no obvious trend towards increasing prevalence in the past 20-30 years in the five countries with data. The use of the WHO standard with cut-offs at 1, 2 and 3 standard deviations yields lower rates and removes gender differences. Data on overweight and obesity in pre-school children are scarce; their interpretation is difficult. Standard methods of surveillance, and research and policies on prevention and treatment, are urgently needed.

Prevalence of overweight in 6- to 15-year-old children in central/western France from 1996 to 2006: trends toward stabilization.

OBJECTIVE: The prevalence of overweight in children has markedly increased over the past few decades in France, as in all Western countries. We sought to describe the yearly prevalence of childhood overweight from 1996 to 2006 and to assess whether a shift in trends could be observed dating from the time the Nutrition and Health National Program (PNNS) was set up in France in 2001, in particular according to gender, age and family economic status. DESIGN: We used annual overweight prevalence of standardized 6- to 15-year-old populations (total=26 600) with weight and height measured at health examination centers in the central/western part of France between 1996 and 2006. Regression slopes of overweight prevalence were evaluated between 1996 and 2006, and specifically between 1996 and 2001, and 2001 and 2006. The annual prevalence and estimated slopes were compared in subgroups, taking into account gender, age and economic status of the family. RESULTS: The prevalence increased between 1996 (11.5%) and 1998 (14.8%) and was stable between 1998 and 2006 (15.2%). According to linear regression, the overall trend in prevalence of overweight children between 1996 and 2006 was stable (slope=0.19, P=0.08). Similarly, the prevalence of overweight increased between 1996 and 1998 in boys and girls, in 6-10 year olds, in 11-15 year olds and in non-disadvantaged children, and remained stable thereafter. The prevalence of overweight in the disadvantaged group increased between 1996 (12.8%) and 2001 (18.9%) (slope=1.16, P=0.004) and was stable between 2001 and 2006 (18.2%) (slope=0.09, P=0.78). CONCLUSION: The results of this study reveal a stable prevalence of overweight since 1998 in most groups studied, and since 2001 in the disadvantaged group.

[Factors associated to breastfeeding up to 6 months in the maternity of Antoine-Béclère Hospital, Clamart]. / Facteurs associés à l'allaitement maternel du nourrisson jusqu'à 6 mois à la maternité de l'hôpital Antoine-Béclère, Clamart.

OBJECTIVES: In order to improve the frequency and duration of breastfeeding, various public health initiatives have been established at local and national levels in France. In 2002, we conducted a study in the maternity center of the Antoine Beclere Hospital with the aim to describe breastfeeding practices and to identify factors associated with its duration. METHODS: This prospective study was conducted among newborns of immediate postpartum women admitted to the maternity center of the Antoine Beclere Hospital (Clamart, France). Extremely premature newborns were excluded (<31 weeks of amenorrhea). Mothers were interviewed at delivery, at one month and 6 months postpartum. Data were collected on maternal medical history, pregnancy and delivery, the newborn's health status, feeding practices, and the reasons for their choice in feeding practices. RESULTS: Between January 7 and April 7, 2002, 562 newborns were included in the study. At birth, 73% were breastfed, whereas 68% were breastfed at discharge from the maternity center. Among the latter, 89% of infants were still being breastfed at one month, and 37% at 6 months of age. Factors associated with breastfeeding at one month were as follows: a secondary level of education (OR(a): 2.4 [1.0-5.7] compared to primary level), multiparity (OR(a): 3.0 [1.2-8.0] compared to primiparity), full-term birth (OR(a): 6.6 [2.4-18.4] compared to premature birth), treatment during pregnancy (OR(a): 0.2 [0.04-0.6]), and medical history (OR(a): 0.4 [0.2-1.0]). Among women who were breastfeeding at one month, the continuation of breastfeeding at 6 months was associated with a secondary education level (OR(a): 2.2 [1.0-5.0]), the choice of feeding practice during pregnancy (OR(a): 2.5 [1.1-5.0] compared to those who did not choose), and to medically assisted reproduction (OR(a): 5.0 [1.2-14.3] compared to spontaneous procreation). DISCUSSION: The prevalence of breastfeeding observed in this study is higher than it was observed at the national level. Factors associated with continuation of breastfeeding at 6 months allow identifying women who should be encouraged to breastfeed by the maternity team involved during pregnancy. Interventions should therefore involve maternity healthcare professionals as a first step in breastfeeding promotion.