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.

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.

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.

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.

Reproducibility and relative validity of a food-frequency questionnaire among French adults and adolescents.

OBJECTIVE: Our aim was to evaluate the reproducibility of a food-frequency questionnaire (FFQ) developed in a French population, and its validity against four 24-h dietary recalls (24-HRs). METHODS: A total of 57 adults (aged 18-63), 17 adolescents (aged 14-18) and 20 children (aged 10-14) completed four 24-HRs (one per season) and two FFQs over a 1-year interval. Reproducibility of the FFQ was estimated by intraclass correlation coefficients (ICCs). The validity of FFQ was assessed by comparison with the four 24-HRs. RESULTS: For most nutrients, the first FFQ measurements gave higher mean values than the second FFQ. The ICCs for nutrients ranged from 0.39 for total protein to 0.83 for alcohol. The ICCs were higher for food items consumed daily such as milk (0.80) or sugars and confectionery (0.65), and lower for rarely eaten food such as inner organs (0.11). Nutrient intakes as assessed by FFQs were higher than those from the 24-HRs, except for alcohol. The de-attenuated Pearson's correlation coefficient for nutrients varied from 0.25 (dietary fiber) to 0.90 (alcohol), but the adjustment for energy did not improve these coefficients. When nutrient intakes were categorized into quintiles, FFQ and 24-HRs produced agreement rates (same or adjacent quintile) between 55% (for PUFA) and 95% (for alcohol), while misclassification to an extreme quintile was rare (<5%). CONCLUSION: The FFQ developed for the FLVS II Study can be used to classify adults or adolescents according to their nutrients and food intakes over a 1-year period.

Characteristics and survival of 26 patients with paraneoplastic arthritis.

OBJECTIVE: To date, only a few series of patients with paraneoplastic arthritis have been published. The charts of patients with cancer-associated arthritis were collected in order to describe characteristics of this rheumatism. METHODS: A questionnaire was created for this study and validated by experts based on specific criteria of inclusion and exclusion. Histology of neoplasia was included. RESULTS: In all, 16 males and 10 females with a mean (range) age of 57.5 years (28-85) were recruited from 17 nationwide centres in France. Patients presented with symmetric polyarthritis involving wrists and hands (85%) and extra-articular symptoms were frequent (84%). There was no specific biologic or radiographic feature. The mean (range) delay between the diagnosis of rheumatism and neoplasia was 3.6 months (0-21.2). Tumours were usually diagnosed after articular symptoms occurred (88.5%). Twenty patients had a solid cancer, and six a haematological malignancy. Adenocarcinoma of the lungs was the most frequent type of solid cancer (60%). Tumours were diagnosed at an early stage, which may explain the good median survival of 1.21 years (range 0.64-present) with a mean follow-up of 1.9 years (range 0.16-10). The percentage of articular symptoms resolution was significantly higher in patients with solid tumours, as compared to patients with haemopathy (p = 0.007). In cases of tumour relapse, rheumatic symptoms did not recur for 75% of patients. CONCLUSIONS: Underlying neoplasia should be considered in male patients with new onset polyarthritis, smokers, and particularly in patients chronically ill. Additional investigations should then be performed to diagnose cancer at an early stage.

Changes in physical activity explain paradoxical relationship between baseline physical activity and adiposity changes in adolescent girls: the FLVS II study.

OBJECTIVE: To investigate in adolescents relationships between habitual physical activity (PA) and changes in several indicators of adiposity. DESIGN: Longitudinal population-based study. The Fleurbaix-Laventie Ville Sante II (FLVS II) study in Northern France. SUBJECTS: A total of 222 boys and 214 girls aged 8-18 y, not obese at inclusion. MEASUREMENTS: PA (Modifiable Activity Questionnaire) and adiposity (body mass index (kg/m2), percent body fat by bioimpedance analysis, sum of four skinfolds, waist circumference) were assessed in 1999 and 2001. Adiposity indicators adjusted for age and pubertal stage were compared between groups of baseline PA and between groups of PA changes, separately by sex. RESULTS: At baseline, PA was not associated with adiposity indicators in both sexes. In girls only, being in the group with the highest age-relative level of moderate PA at baseline predicted the highest adiposity gain from baseline to follow-up, for all indicators. After adjustment for baseline values, all adiposity indicators were higher at follow-up in girls who had decreased their relative level of moderate PA during follow-up. In boys, changes in adiposity during follow-up were not significantly different across groups of PA changes. However, the sum of skinfolds at follow-up, adjusted for baseline value, tended to be higher in those who decreased their vigorous PA level and lower in those who increased it. CONCLUSION: In adolescent girls, a decrease in PA rather than inactivity per se may result in increased adiposity over time.

Body mass index and incidence of dementia: the PAQUID study.

To study the relationship between body mass index (BMI) and risk of dementia, a cohort of 3,646 individuals aged > or =65 years living at home and without cognitive disorders at baseline were followed up for 8 years (the PAQUID [Personnes Agées Quid] Study). Subjects with a BMI < 21 had an increased risk of developing dementia as compared with subjects whose BMI was between 23 and 26 (odds ratio = 1.48, 95% CI = 1.08 to 2.04). However, when individuals who developed dementia early during the follow-up were excluded from the analysis, this relationship was no longer significant. A low BMI does not in itself seem to be a risk factor for dementia.

Nutritional status of healthy elderly persons living in Dordogne, France, and relation with mortality and cognitive or functional decline.

OBJECTIVE: Description of the nutritional status of healthy elderly people and investigation of its longitudinal relationship with mortality and cognitive or functional decline. DESIGN: Longitudinal study. SETTING: In Dordogne, France. SUBJECTS: A total of 169 French elderly community dwellers aged 68 y and older from in the PAQUID (Personnes Agées QUID) study were included. Dietary intake was assessed by a 3 day food record and a dietary history. Self-reported weight and height were used to calculate the body mass index (BMI, kg/m(2)). Mortality, activities of daily living (ADL), instrumental activities of daily living (IADL) and the Mini Mental State Examination (MMSE) were measured at 5 y follow-up. RESULTS: Nutritional intake and BMI vary according to age and sex. Men generally have a higher nutritional intake than women. Intake decreases with age especially in men. Among the 169 subjects, 22 died. When analyzed by logistic regression, there was no relation between markers of risk of poor nutrition and mortality but a BMI greater or equal 27 at baseline was associated with a increased risk of 5 y mortality (OR=6.27, 95% CI 1.29-30.37) adjusted for sex and age. With regard to cognitive decline, subjects with a BMI greater or equal than 23 kg/m(2) had 3.6 times lower chance of presenting a decline in the subsequent 5 y adjusted by age and sex (OR=0.28, 95%, CI 0.09-0.90). BMI ranging between 23 and 27 was associated with a significantly decreased risk of IADL disability (OR=0.31, 95% CI 0.10-0.93) in multivariate analyses. CONCLUSION: In apparently healthy elderly people a BMI ranging between 23 and 27 is associated with lower risks of functional and cognitive declines in the subsequent 5 y.

Nutritional factors in cerebral aging and dementia: epidemiological arguments for a role of oxidative stress.

There is increasing evidence that oxidative stress is involved in cerebral aging and dementia. The objective of this review is to give a progress report on the more recent results of the various epidemiologic cohorts studied for the association between nutrition of older people, the evolution of cognitive performances and the risk of later occurrence of dementia or stroke. The oxidative theory of pathological brain ageing is supported by animal laboratory experiments. Furthermore, experimental research has consistently suggested that diet-related factors play an important role in cognitive functions in ageing. In humans, a number of epidemiological case-control and prospective studies analyzed the association between nutrition, particularly fatty acids and antioxidant molecules (vitamins A, E, C, beta-carotene and polyphenols) and cognition. In the context of evidence already available, further studies are needed to identify the specific role of various nutrients, their interactions and the influence of genetic factors and living habits on cerebral aging and dementia. Vascular dementia and Alzheimer's disease, that share several risk factors, might be targets for primary prevention through nutritional recommendations and/or supplementation.

Relationships between cholesterol, apolipoprotein E polymorphism and dementia: a cross-sectional analysis from the PAQUID study.

This study assesses the cross-sectional relationship between serum cholesterol level and dementia, controlling for apolipoprotein E (apoE) genotype, in a nested case-control study of 334 elderly French subjects aged 73 and over who participated in the PAQUID study (37 demented subjects and 297 nondemented controls). A diagnosis of dementia was established by two-step screening: (1) psychometric testing and DSM-III-R criteria and (2) neurologist's confirmation. Cholesterol, its fractions and apoE genotype were determined from a blood sample. Elevated high-density lipoprotein cholesterol was associated with a significantly decreased risk of dementia, independent of apoE status and other potential confounding variables, suggesting that cholesterol fractions could be involved in both Alzheimer's disease and vascular dementia.

Laparoscopic adjustable gastric banding.

We introduced open adjustable silicone gastric banding (ASGB) for treatment of morbid obesity in our institution in 1991. It was done in a prospective study comparing ASGB with vertical banded gastroplasty (VBG) with regard to weight loss. After 200 cases of open ASGB and 210 VBG procedures and the encouraging weight loss results, we started laparoscopic placement of the adjustable silicone band. The initial work was done in an animal laboratory program where a new surgical protocol has been established. Details of the laparoscopic dissection around the stomach in a deep operative field and fatty atmosphere have been developed, and a laparoscopically implantable version of the adjustable silicone band (LAGB) has been devised. The first human laparoscopic ASGB procedure was performed in our institution on September 1, 1993. Altogether 350 patients had undergone adjustable silicone gastric banding (LASGB) procedures by May 1997 (277 women, 73 men). All the patients were morbidly obese, with an average preoperative weight of 118 kg (92-200 kg). The mean BMI was 43 kg/m2 (36-65 kg/m2). The conversion rate to laparotomy has been low (1.4%). Early complications have been rare, and pouch dilatation and stomach slippage have been the only significant late complications. The rate of these complications has been considerably improved by reducing the pouch volume and using more gastrogastric sutures. Evaluation of postoperative weight loss of LASGB patients compared with our VBG and ASGB (open) patients showed a similar curve.

[Serous otitis and necrotizing angiitis]. / Otites séreuses et angéites nécrosantes.

Three cases are reported of necrotizing angiitis of otologic origin (one polyarteritis nodosa and two wegener's disease). Data in the published literature are reviewed and necrotizing angiitis classified. Two features resulting from this review are emphasized. Firstly, form the pathogenic point of view the fact that specific lesions were detected in the ear in one of these patients means that this localization may be a possible visceral manifestation, as are rhinologic and pulmonary lesions. Otologic sites may be an isolated, or in association, further type of pathogenic mechanism. From the practical point of view, any unexpected serous otitis in adults should suggest the need for an erythrocyte sedimentation test, very high values requiring investigation of etiology. This will avoid unnecessary medical and surgical treatments and the institution of immunosuppressant therapy active against all visceral lesions and the only effective means of treating the otitis. Early treatment could avoid the catastrophic prognosis observed short-term in the 3 cases reported.

[Mandibular reconstruction by composite musculocutaneous flap in glossopelvimandibular excisions]. / La reconstruction mandibulaire par lambeau musculo-cutané composé dans les exérèses glosso-pelvi-mandibulaires.

Results of 14 mandibular reconstruction by a composite muscular flap of the pectoralis major and trapezium muscles during widespread glossopelvimandibular excisions are described. The technique employed is outlined, emphasis being placed on the need to observe strict precautions during removal and application of the bone component, to avoid accidental avulsion during reconstruction which could compromise the musculoperiosteal vascularization of the graft. Results are sufficiently encouraging for this type of reconstructive surgery to be proposed in all cases where mandibular repair is necessary after interruption of continuity.

[Recovery total glossectomy with immediate reconstruction by means of a musculocutaneous flap : functional results and perspectives (author's transl)]. / Glossectomies totales de rattrapage avec reconstruction d'emblée par lambeaux musculo-cutanés. Résultats fonctionnels, perspectives.

A surgical procedure is proposed for treating recurrent or non-sterile cancer of the tongue whenever satisfactory excision of the tumor can be accomplished. The technique involves a recovery total glossectomy associated, as shown to be necessary following its application in 3 cases, with a transmaxillary buccopharyngectomy. This operation has become valid following the use of musculocutaneous flaps, which enable reconstruction of the tongue with good quality functional results.