A dynamic public health context

Implemented in France in 2001, the French National Program on Nutrition and Health (PNNS) aims at reducing the burden of nutrition-related chronic diseases in the general population by acting on nutrition. Various public health initiatives have been conducted, including media campaigns and the dissemination of guidelines covering the importance of nutrition and physical activity. Such initiatives necessitate monitoring activities such as process evaluation as well as epidemiological assessments.

ENNS: A tool for nutritional surveillance

The objective of the French nutrition and health survey (“Etude Nationale Nutrition Santé”, ENNS) was to describe dietary intake, physical activity and nutritional status in a national sample of adults and children, taking into account current French recommendations. This study was based on a cross-sectional population-based survey using a multistage sampling design. Between February 2006 and March 2007, 3,115 adults aged 18-74 years (participation rate: 59.7%) and 1,675 children aged 3-17 years (67.9%) were included.

Energy, macronutrient and food consumption was estimated through three randomly distributed 24 hour recalls, and compared to PNNS recommendations. Physical activity was described using “International Physical Activity Questionnaire” (IPAQ) guidelines in 15-74 year-old individuals and age-adapted questionnaires in 3-14 year-old children. Anthropometry in adults and children, and blood pressure and biochemical measurements in adults were assessed according to national and international references.

Diet behaviors to improve in adults and children along with frequent cardiovascular risks in adults

In adults, when compared to current recommendations, intake of carbohydrates (>50% EI: 26.4%), saturated fatty acids (<35% total lipids: 18.5%) and total fiber (>25g/d: 13.7%) was frequently unsatisfactory. While overall consumption of “meat, seafood and eggs” was satisfactory, that of Fruits and Vegetables (F&V) (≥400 g/d: 43.8%) and seafood (≥2 servings /week: 29.9%) was frequently too low. The physical activity level was satisfactory (moderate and high IPAQ-categories) at 63.2%.

Overweight (BMI ≥25) was observed in 49.3% of adults (among them, 16.9% were obese, BMI ≥30), while 30.9% were hypertensive (elevated blood pressure and / or anti-hypertensive intake) and 44.1% had dyslipidemia (abnormal values of triacylglycerol, LDL- and HDL-cholesterol, and / or lipid-lowering medication). Vitamin and iron poor status was found to affect less than 10% of the adult population. Diet behaviors and nutritional status varied between men and women, and across age categories. Briefly, diet quality was higher in women than in men, as well as in the 55-74 year-old-category compared to the 18-29 year-olds. Besides, while men were generally at higher-risk of cardiovascular abnormalities, these later also increased with age categories. In children, the figure regarding diet was little different but it includes more frequent behaviors unsatisfactory compared to PNNS recommendations. In particular, only 19.7% of children ate ≥400g/d of F&V. In addition, half of 3-17-year-old children consumed <3 dairy products daily, with 28.2% consuming seafood ≥2 servings /week.

While a few variations were observed between boys and girls, diet behaviors varied across age categories, in particular regarding saturated fat (too much elevated in 3-10-year-olds), low consumption of dairy products and calcium (in 15-17-year-old girls) and salt (too much elevated in 15-17-year-old boys). Sedentary lifestyle, estimated using time spent in front of a television or a computer, was generally high (3 hours per day on the average). Finally, 17% of children were overweight, including 3.4% of them being obese.

Based on the ENNS survey, overall nutrition remains a problem in France. Comparison of data with that of other countries could contribute to a better understanding of observed variations in nutrition-related diseases. The intermediate situation of France consisting between a Mediterranean and Western diet, previously documented, may no be true longer for the young French generations.