Eating patterns and prevalence of obesity. Lessons learned from the Malaysian Food Barometer.

The Malaysian society is experiencing and coping with a fast modernization process, which is characterized by a rapid urbanization and rural exodus, an important reduction of the size of households, and the emergence of a new middle class. The Malaysian Food Barometer launched in 2013 has provided better understanding how these macro issues have affected the lifestyles and especially the food habits of the Malaysians. The country has indeed undergone a transition period from under-nutrition to over-nutrition in a few decades, with the prevalence of overweight and obesity having markedly and rapidly increased. A quantitative survey (n = 2000), elaborated from a qualitative preliminary phase, was carried out with the aim of analyzing the transformation of food habits at the national level. The present article focuses on the BMI issue in Malaysia, and investigates its relationships with the socio-demographic variables of the population, as well as their eating patterns. The mean BMI is 23.64 kg/m2, with 9.5% of the sample being obese, and 22% overweight. Strong statistical associations have been identified between BMI and independent variables such as size of the living area, ethnicity, level of education, gender, and age. Contrary to general believe, overweight and obesity were neither associated with the number of food intakes taken per day (including snacks) nor with the frequency of eating out. Nonetheless, obesity is over-represented in people who have dissonant eating behaviors, i.e. who declare having fewer food intakes a day (food norms) than they do actually (food practices). This process testifies that the Malaysians are experiencing a "food transition", which is linked with socio-economic development.

Representations and practices of prevention in elderly populations: investigating acceptance to participate in and adhesion to an intervention study for the prevention of Alzheimer's disease (ACCEPT study)--the need for a multidisciplinary approach.

BACKGROUND: In the domain of Alzheimer's disease (AD) prevention, various potentially protective factors have been identified in epidemiological studies. Although the results of these observational studies have been relatively consistent, the results of intervention studies remain disappointing. Methodological problems could explain these negative results, like the selection of the population; a plausible assumption is that the older people who agree to take part in these intervention studies differ from those who refuse, and are those that are least likely to benefit from such programs. The aim of this study was (i) to study the determinants of participation in and adhesion to a prevention trial in a population of older individuals via a quantitative approach using a questionnaire, (ii) to study the representations and practices of prevention in this population using a qualitative approach using semi-structured interviews and focus groups. METHOD: The study population for the ACCEPT study was recruited at the time of inclusion of subjects in a prevention trial. The population was made up of persons aged 70 years or older, living at home and demonstrating some form of frailty, defined as a spontaneous memory complaint to their general practitioner or difficulties in carrying out instrumental activities of daily living. We used a quantitative approach based on the administration of a self-completed questionnaire sent to 1680 subjects having accepted to take part in the prevention trial, and to the sample of subjects meeting the inclusion criteria but having refused to take part. The qualitative approach, carried out at the moment of inclusion, involved subjects that having accepted to take part and subjects that having refused. Semi-structured interviews were carried out in order to understand the logic leading to refusal or acceptance. CONCLUSION: The analysis of the results will combine the viewpoints of the different disciplines. It will allow us to better understand the logic at work, to characterise the populations at risk of refusal, and perhaps to remove some of the barriers to participation in prevention programs. The identification of such barriers will provide feedback in terms of the conception and management of prevention measures.

The THEMA study: a sociodemographic survey of hypercholesterolaemic individuals.

BACKGROUND: Hypercholesterolaemia is estimated to affect 20% of the population, although little sociodemographic information is available on affected individuals. The present study aimed to gather relevant information and investigate social determinants of dietary compliance. METHODS: A telephone survey was carried out on a representative population sample. Quotas were applied for gender, geography and degree of urbanisation. Individuals were eligible if they were hypercholesterolaemic, and were being followed by a doctor. Sociodemographic, socioeconomic and health data were collected, as well as information about the individuals' perception of the disease, their relationship and beliefs surrounding food, and their food behaviour (shopping, cooking, eating-out, deviation from prescribed diet). The association between compliance with diet and medication was investigated. RESULTS: Overall, 802 individuals were included, representing 8% of those contacted, as opposed to the expected 20%. Mean (SD) age was 60 (14.2) years, with 51% of individuals living as a couple; 48% had a good level of physical activity; 44% considered that the hypercholesterolaemia was inherited; 31% felt that the disease was normal beyond the age of 45 years. The functional and convivial aspects of eating were of more importance than that of health maintenance. Cheese was particularly likely to be eaten in dietary lapses. Of a subgroup of 729 individuals, 476 (65%) took medication; of these 476 individuals, 51% complied with dietary recommendations (P < 0.05). CONCLUSIONS: The key factors associated with dietary compliance in hypercholesterolaemic individuals were identified: age, sex, the perceptions of hypercholesterolaemia, and the sociocultural aspects of food. By contrast to general assumptions, both dietary and medicinal measures are practised fairly well by a large proportion of these individuals.

IANA task force on nutrition and cognitive decline with aging.

Cognitive impairment can be influenced by a number of factors. The potential effect of nutrition has become a topic of increasing scientific and public interest. In particular, there are arguments that nutrients (food and/or supplements) such as vitamins, trace minerals, lipids, can affect the risk of cognitive decline and dementia, especially in frail elderly people at risk of deficiencies. Our objective in this paper is to review data relating diet to risk of cognitive decline and dementia, especially Alzheimer's disease (AD). We chose to focus our statements on homocysteine-related vitamins (B-vitamins), antioxidant nutrients (vitamins E and C, carotenoids, flavonoids, enzymatic cofactors) and dietary lipids. Results of epidemiological studies may sometimes appeared conflicting; however, certain associations are frequently found. High intake of saturated and trans-unsaturated (hydrogenated) fats were positively associated with increased risk of AD, whereas intake of polyunsaturated and monounsaturated fats were protective against cognitive decline in the elderly in prospective studies. Fish consumption has been associated with lower risk of AD in longitudinal cohort studies. Moreover, epidemiologic data suggest a protective role of the B-vitamins, especially vitamins B9 and B12, on cognitive decline and dementia. Finally, the results on antioxidant nutrients may suggest the importance of having a balanced combination of several antioxidant nutrients to exert a significant effect on the prevention of cognitive decline and dementia, while taking into account the potential adverse effects of these nutrients. There is no lack of attractive hypotheses to support research on the relationships between nutrition and cognitive decline. It is important to stress the need to develop further prospective studies of sufficiently long duration, including subjects whose diet is monitored at a sufficiently early stage or at least before disease or cognitive decline exist. Meta analyses should be developed, and on the basis of their results the most appropriate interventional studies can be planned. These studies must control for the greatest number of known confounding factors and take into account the impact of the standard social determinants of food habits, such as the regional cultures, social status, and educational level.

[Should the prevention of obesity be demedicalised?]. / Faut-il démédicaliser la prévention de l'obésité?

Obesity prevalence is rapidly growing, particularly in children and young adolescents. It is proved to be important to prevent it within a public health strategy. Primary prevention of obesity should not be focused on obesity itself, but should be part of a global public health national policy, targeted to improve the nutritional status of the community, to reduce the risk for chronic diseases, to improve the health status and the quality of life of the general population. This overall prevention programme should be conducted on a large scale, at all level of the country infrastructure and sectors of society, and should acquired a strong local and regional support from communities, consumers and government, but it has also to be particularly focused on young subjects (and their family and school workers), especially in groups with low socio-economic status. Secondary prevention should be particularly focused on children with a high-risk for obesity and/or those with potential associated risk factors. Medical involvement is of a particular importance in this secondary prevention, to identify and to manage these at-risk children and young adolescents. The various approaches from a paediatrician, a physician specialised in human nutrition, a sociologist and a consumer representative are presented in this review.

The contemporary diet in France: "de-structuration" or from commensalism to "vagabond feeding".

Data collected from a sample of working individuals lunching at staff cafeterias were analysed to characterise contemporary food habits in terms of meal structure, eating outside meals, and other aspects of the organization of the daily food intake. Discrepancies were found between individuals' ideas of a proper meal and their actual practices. This brings to light some contradictions between conceptions underlying the contemporary diet and the more traditional idea of a structured meal. Analysis of the eater's search for a balanced diet from a cultural and historical viewpoint opens avenues of research common to both the social sciences and food science.