Adherence to the French Programme National Nutrition Santé Guideline Score Is Associated with Better Nutrient Intake and Nutritional Status

doi:10.1016/j.jada.2009.03.012

Journal of the American Dietetic Association

Volume 109, Issue 6, June 2009, Pages 1031-1041

https://doi.org/10.1016/j.jada.2009.03.012 Get rights and content

Abstract

Background

The Nutrition and Health Program (Programme National Nutrition Santé), which has been carried out in France since 2001, includes diet and physical activity recommendations that are being widely disseminated to the general population.

Objectives

To develop a score based on adherence to these recommendations and retrospectively estimated its association with demographic and behavior factors, nutrient intake, and serum biomarkers. The Programme National Nutrition Santé Guideline Score (PNNS-GS) includes 13 components. Scoring and cut-off values were determined using information provided by national guidelines. At least one point was attributed when the behavior reported was in accordance with the recommendation.

Design/subjects

Adults participating in the SU.VI.MAX study with a minimum of three 24-hour dietary records were included in our analysis (n=5,500).

Statistical analysis

Data were analyzed by sex, and sex-specific quartiles of scores were estimated. Multiple logistic regression models adjusted for social and demographic variables were used to estimate the odds ratios for having a relatively high score (quartile 4 vs others). Multivariate linear regression models were used to examine associations of nutrient intake or biomarkers with PNNS-GS quartiles. When applicable, we included a linear contrast to test for trend.

Results

The authors found statistical associations between the top PNNS-GS quartile and older age, higher occupational categories, nonsmoking status, and normal body mass (P≤0.05). Higher PNNS-GS was also associated with lower intake of energy, cholesterol, and added simple sugars, and higher intake of various protective micronutrients. In addition, higher levels of serum beta-carotene and vitamin C were positively associated with increasing quartiles of PNNS-GS.

Conclusions

This score is a useful tool for monitoring compliance with the French recommendations.

Section snippets

PNNS Guideline Score (PNNS-GS) Components and Scoring Criteria

The PNNS-GS is based on quantitative and qualitative recommendations published in PNNS guides (Table 1). Three PNNS recommendations comprise minimum and maximum consumption frequencies: bread, cereals, potatoes and legumes; milk and dairy products; and meat and poultry, seafood, and eggs. Two recommendations (fruits and vegetables, and physical activity) give a definition of minimal expected frequency, whereas water is recommended at will and three recommendations refer to intake moderation

Results

Among participants who completed at least three dietary records during the first 2 years of follow-up (n=7,322), 1,296 subjects were not measured for height or weight at year 1, and 526 subjects had incomplete covariables. Final analyses included 5,500 individuals (2,380 men and 3,120 women). The mean age was 52.1±4.6 years in men and 46.9±6.5 years in women. The mean PNNS-GS was 7.54±1.91 (range 0.52 to 13.0) and 7.87±1.86 (range 0.81 to 13.5), respectively. The PNNS-GS was normally

Discussion

On the basis of data from men and women participating in the SU.VI.MAX study, the PNNS-GS is related to healthier nutritional status, assessed by both dietary and biochemical markers. In particular, subjects with the highest scores had more satisfactory intakes of several macronutrients and micronutrients. Beta-carotene and vitamin C, which are mainly found in fruits and vegetables, were highly associated with the probability of being in the highest quartile of the PNNS-GS in both men and

C. Estaquio is an epidemiologist, Department of Nutritional Epidemiology, French Institute of Health and Medical Research, Bobigny, France

References (50)

L.B. Dixon et al.
Let the pyramid guide your food choices: Capturing the total diet concept
J Nutr
(2001)
P.S. Haines et al.
The Diet Quality Index revised: A measurement instrument for populations
J Am Diet Assoc
(1999)
E.T. Kennedy et al.
The Healthy Eating Index: Design and applications
J Am Diet Assoc
(1995)
M.L. McCullough et al.
Diet quality and major chronic disease risk in men and women: Moving toward improved dietary guidance
Am J Clin Nutr
(2002)
J.J. Fogli-Cawley et al.
The 2005 Dietary Guidelines for Americans Adherence Index: Development and application
J Nutr
(2006)
S.A. McNaughton et al.
An index of diet and eating patterns is a valid measure of diet quality in an Australian population
J Nutr
(2008)
L. Harnack et al.
An evaluation of the Dietary Guidelines for Americans in relation to cancer occurrence
Am J Clin Nutr
(2002)
S. Hercberg et al.
A primary prevention trial using nutritional doses of antioxidant vitamins and minerals in cardiovascular diseases and cancers in a general population: the SU. VI.MAX study—Design, methods, and participant characteristics. SUpplementation en VItamines et Mineraux AntioXydants
Control Clin Trials
(1998)
S. Czernichow et al.
Indicators of abdominal adiposity in middle-aged participants of the SU.VI. MAX study: Relationships with educational level, smoking status and physical inactivity
Diabetes Metab
(2004)
C. Estaquio et al.
The French National Nutrition and Health Program score is associated with nutritional status and risk of major chronic diseases
J Nutr
(2008)

S.M. Moeller et al.

Dietary patterns: Challenges and opportunities in dietary patterns research an Experimental Biology workshop, April 1, 2006

J Am Diet Assoc

(2007)

R.E. Patterson et al.

Diet quality index: Capturing a multidimensional behavior

J Am Diet Assoc

(1994)

J. Dallongeville et al.

Cigarette smoking is associated with unhealthy patterns of nutrient intake: A meta-analysis

J Nutr

(1998)

P. Martikainen et al.

Socioeconomic differences in dietary patterns among middle-aged men and women

Soc Sci Med

(2003)

N. Darmon et al.

Does social class predict diet quality?

Am J Clin Nutr

(2008)

A. Drewnowski et al.

Serum beta-carotene and vitamin C as biomarkers of vegetable and fruit intakes in a community-based sample of French adults

Am J Clin Nutr

(1997)

C.S. Hann et al.

Validation of the Healthy Eating Index with use of plasma biomarkers in a clinical sample of women

Am J Clin Nutr

(2001)

M.J. Gerber et al.

Profiles of a healthful diet and its relationship to biomarkers in a population sample from Mediterranean southern France

J Am Diet Assoc

(2000)

Diet, Nutrition and the Prevention of Chronic Diseases

(2003)

Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective

(2007)

C. Lachat et al.

A concise overview of national nutrition action plans in the European Union Member States

Public Health Nutr

(2005)

S. Hercberg et al.

The French National Nutrition and Health Program: 2001–2006–2010

Int J Public Health

(2008)

T. Costacou et al.

Tracing the Mediterranean diet through principal components and cluster analyses in the Greek population

Eur J Clin Nutr

(2003)

M.B. Schulze et al.

Dietary patterns and their association with food and nutrient intake in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam study

Br J Nutr

(2001)

P.M. Waijers et al.

A critical review of predefined diet quality scores

Br J Nutr

(2007)

Cited by (150)

Dietary Patterns and Health: Insights From NESR Systematic Reviews to Inform the Dietary Guidelines for Americans
2024, Journal of Nutrition Education and Behavior
This perspective article shares unique insights from the extensive experience of the US Department of Agriculture Nutrition Evidence Systematic Review branch in conducting systematic reviews on dietary patterns and health outcomes to inform the Dietary Guidelines for Americans. Methodological approaches for reviewing dietary patterns research are described, including approaches to operationalizing definitions and analyzing labeled dietary patterns. The review also describes techniques for synthesizing dietary patterns research across life stages in systematic reviews that inform food-based, federal dietary guidance. Current research activities and recommendations for how to improve or address gaps in dietary patterns research in the future are also discussed.
Body Composition, Physical Function, and Dietary Patterns in People from 20 to Over 80 Years Old
2023, Journal of Nutrition, Health and Aging
Diet may influence biochemical pathways involved in age-related changes in body composition and physical function. This study aimed to describe dietary patterns and their relationships with body composition, physical performance, and grip strength according to age and sex.
Cross-sectional study.
Data were collected in the Clinical Research Center (CRC) of the Gérontopôle of the Centre Hospitalier Universitaire (CHU) of Toulouse or at participants' homes when unable to attend the research facilities.
470 (63% female) people with a median age of 56 (38–70) years.
The “Mediterranean-like” (i.e., plant-based foods, dairy), “Animal products” (i.e., meat, processed meat, butter, refined starch), and “Sugar and fast food” (i.e., ultra-processed and sugary foods) dietary patterns were extracted by principal component analysis. Total and trunk fat mass indexes (kg/m²), and total and appendicular lean mass indexes (kg/m²) were assessed by DXA. The physical tests comprised gait speed (m/sec), chair rise (sec), the Short Physical Performance Battery test (/12 points), and handgrip strength (kg). The associations were explored through multivariate linear regressions by sex and age groups: ≥20 to <50, ≥50 to <65, and ≥65 years.
Men and women had higher adherence to the “Sugar and fast food” diet in the youngest group. Middle-aged and older women adhered more to a “Mediterranean-like” diet. Men kept a “Sugar and fast food” diet when middle-aged and changed to the “Animal products” diet when ≥65 years. Higher adherence to the “Mediterranean-like” diet was associated with lower BMI, body fat, and lean mass in middle-aged men. Higher adherence to the “Animal products” diet was associated with higher lean mass in middle-aged women, more trunk fat in young men, lower strength in middle-aged men, and higher strength in older men. Higher adherence to the “Sugar and fast food” diet was associated with higher body fat in middle-aged men but lower body fat in older men.
Diets composed of sugary foods, fast foods, and processed meat were associated with higher fat mass and lower strength. Men were more prone to have less healthy food intake in all age groups.
Maternal diet during pregnancy and child neurodevelopment up to age 3.5 years: the nationwide Étude Longitudinale Française depuis l'Enfance (ELFE) birth cohort
2022, American Journal of Clinical Nutrition
Dietary guidelines available to pregnant women are made to improve maternal health and fetal development. But their adequacy to sustain offspring neurodevelopment has remained understudied.
We assessed the association between compliance with nutritional guidelines during pregnancy and neurodevelopment in preschool children.
The analyses were based on data for 6780 to 11,278 children from the Étude Longitudinale Française depuis l’Enfance (ELFE) study, a nationwide birth cohort. Maternal diet during the last 3 mo of pregnancy was evaluated at delivery by using a validated 125-item FFQ. From this FFQ, food group consumption, a diet quality score (adapted National Health and Nutrition Program Guideline Score), and a nutrient intake score (Probability of Adequate Nutrient intake based Diet quality index) were calculated and dietary patterns were derived by principal component analysis. Child neurodevelopment was reported by parents at 1 and 3.5 y with the Child Development Inventory (CDI-1, CDI-3.5) and at 2 y with the MacArthur–Bates Communicative Development Inventories (MB-2), and assessed by a trained investigator at 3.5 y with the Picture Similarities test (British Ability Scales, PS-3.5). Associations between maternal diet and child neurodevelopment were assessed by multivariable linear regression models on standardized variables.
Higher nutrient intake score was associated with higher neurodevelopmental scores from 1 to 3.5 y (β = 0.04; 95% CI: 0.02, 0.06 for CDI-1; β = 0.03; 95% CI: 0.01, 0.05 for MB-2; and β = 0.03; 95% CI: 0.01, 0.05 for CDI-3.5). Higher fruit and vegetables or fish intake and lower pork-meat products intake were related to higher CDI-3.5 scores (β = 0.03; 95% CI: 0.01, 0.05 for fruit and vegetables; β = 0.03; 95% CI: 0.01, 0.05 for fish; and β = −0.02; 95% CI: −0.04, 0.00 for pork-meat products). A higher score on the processed food pattern was associated with poorer neurodevelopmental score at 1 y (β = −0.05; 95% CI: −0.06, −0.03).
Higher diet quality during pregnancy was associated with higher parent-reported neurodevelopmental scores in early childhood. The negative association of pork-meat products consumption with early neurodevelopmental scores needs to be further confirmed.
Key Findings of the French BioNutriNet Project on Organic Food-Based Diets: Description, Determinants, and Relationships to Health and the Environment
2022, Advances in Nutrition
Few studies have investigated the relationships between organic food consumption, dietary patterns, monetary diet cost, health, and the environment. To address these issues, a consortium of French epidemiologists, nutritionists, economists, and toxicologists launched the BioNutriNet project in 2013. In 2014, an FFQ documented the usual organic and nonorganic (conventional) food consumption of approximately 35,000 NutriNet-Santé participants. Then, individual organic and conventional food intakes were merged with price, environmental, and pesticide residue data sets, which distinguished between conventional and organic farming methods. Many studies were conducted to characterize organic consumers and their environmental impacts (i.e., greenhouse gas emissions, energy demand, and land use) and organic food consumption impacts on health. We observed that organic consumers had diets that were healthier and richer in plant-based food than nonorganic consumers. Their diets were associated with higher monetary costs, lower environmental impacts, and reduced exposure to certain pesticide residues. Regular consumption of organic food was associated with reduced risks of obesity, type 2 diabetes, postmenopausal breast cancer, and lymphoma. Although several observations have been confirmed by several studies conducted in other countries, our results should be replicated in other cultural settings and coupled with experimental studies to be able to draw causal conclusions. Finally, the main finding of the BioNutriNet project is that while organic food consumption could be associated with positive externalities on human health and the environment, organic-based diets should be accompanied by dietary shifts toward plant-based diets to allow for better planetary and human health.
Association between adherence to the French dietary guidelines and the risk of type 2 diabetes
2021, Nutrition
French food-based dietary guidelines (FBDG) were updated in 2017. The objective of this prospective study was to estimate the associations between the Programme National Nutrition Santé–guidelines score 2 (PNNS-GS2), reflecting the level of adherence to the 2017 FBDG, and the risk of type 2 diabetes (T2D).
A total of 79 205 French adult participants (mean age: 41.5 y [SD = 14.5]; 78.5% were women; 65% were postgraduate) from the NutriNet-Santé cohort (2009–2019) were included. Dietary intakes were collected using repeated 24-h dietary records. The PNNS-GS2 (theorical range: -∞ to 14.25), including six adequacy components and seven moderation components as well as a penalization on energy intake, was computed.
The association between the PNNS-GS2 (as quintiles [Q]) and T2D risk was estimated using multivariable Cox proportional hazard models accounting for sociodemographic, anthropometric, and lifestyle and health-related factors.
During an average follow-up of 6.7 y (536 679 person-years), 676 T2D cases occurred. In the multiadjusted model, participants with the highest PNNS-GS2 (higher adherence to the 2017 FBDG), compared with those with the lowest (lower adherence to FBDG), exhibited a 49% reduction in risk of T2D (HR_{Q5 versus Q1}: 0.51, 95% CI: 0.37, 0.69). Body mass index accounted for up to 27% of the main association. The healthy profiles of the cohort's participants may have reduced statistical power.
In this large, prospective cohort study, a higher adherence to the French 2017 FBDG was strongly and inversely associated with the risk of developing T2D. Such analysis should be confirmed in other settings, but in terms of public health and nutritional policy, this study supports the relevance of the 2017 French FBDG.
Dietary practices, their determinants and their association with oral health: epidemiological findings among seniors enrolled in the NutriNet-Santé cohort
2021, Cahiers de Nutrition et de Dietetique
Très peu d’études se sont intéressées aux typologies de consommation alimentaire au cours de vieillissement. Nous synthétisons ici 3 analyses transversales réalisées chez les seniors inscrits à la cohorte NutriNet-Santé. Ces analyses confirment la diversité des habitudes alimentaires chez les seniors en France. L’analyse du comportement alimentaire a montré que la typologie « alimentation saine » a expliqué le plus de variabilité au niveau de l’apport alimentaire chez les seniors. Des associations modestes et dépendantes de l’âge ont été observées entre la santé orale et l’adéquation aux recommandations du PNNS. Enfin, certains résultats reflètent une évolution avec l’âge des consommations alimentaires en faveur d’un meilleur respect des règles nutritionnelles. Ces études fournissent des connaissances actualisées sur les caractéristiques et déterminants du comportement alimentaire des seniors français. Des recherches longitudinales avec des échantillons représentatifs seraient nécessaires afin de compléter ces travaux et orienter le développement des stratégies de santé publique.
Very few studies have explored dietary patterns in the course of aging. Here we summarize 3 cross-sectional analyses carried out among seniors enrolled in the French NutriNet-Santé cohort. The results confirm the diversity of eating habits among the elderly in France. The analysis of dietary patterns showed that the “healthy” pattern explained most of the variance in food intake among seniors. Modest and age-dependent associations were observed between oral health and adherence to the PNNS dietary guidelines. Finally, it is possible that certain results reflect an evolution in food consumption in favor of better compliance with nutritional guidelines in the course of aging. These epidemiological results provide updated information about the characteristics and determinants of the eating behaviors of French seniors. In the future, longitudinal research with representative samples would be necessary in order to extend this work and guide the development of public health strategies.

View all citing articles on Scopus

C. Estaquio is an epidemiologist, Department of Nutritional Epidemiology, French Institute of Health and Medical Research, Bobigny, France

S. Bertrais is an epidemiologist, Department of Nutritional Epidemiology, French Institute of Health and Medical Research, Bobigny, France

E. Kesse Guyot is a researcher, Department of Nutritional Epidemiology, French Institute of Health and Medical Research, Bobigny, France

P. Galan is a researcher, Department of Nutritional Epidemiology, French Institute of Health and Medical Research, Bobigny, France

V. Deschamps is an epidemiologist, Bobigny, France

K. Castetbon is an epidemiologist and head of the Nutritional Surveillance and Epidemiology Unit, Bobigny, France

L. Dauchet is an assistant professor of epidemiology and public health, University Hospital of Lille, Lille, France

S. Hercberg is a nutritionist, full professor, head of the Department of Nutritional Epidemiology, French Institute of Health and Medical Research, Bobigny, France

View full text

ResearchCurrent ResearchAdherence to the French Programme National Nutrition Santé Guideline Score Is Associated with Better Nutrient Intake and Nutritional Status

Abstract

Background

Objectives

Design/subjects

Statistical analysis

Results

Conclusions

Section snippets

PNNS Guideline Score (PNNS-GS) Components and Scoring Criteria

Results

Discussion

J Nutr

J Am Diet Assoc

J Am Diet Assoc

Am J Clin Nutr

J Nutr

J Nutr

Am J Clin Nutr

Control Clin Trials

Diabetes Metab

J Nutr

J Am Diet Assoc

J Am Diet Assoc

J Nutr

Soc Sci Med

Am J Clin Nutr

Am J Clin Nutr

Am J Clin Nutr

J Am Diet Assoc

Diet, Nutrition and the Prevention of Chronic Diseases

Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective

A concise overview of national nutrition action plans in the European Union Member States

Public Health Nutr

The French National Nutrition and Health Program: 2001–2006–2010

Int J Public Health

Tracing the Mediterranean diet through principal components and cluster analyses in the Greek population

Eur J Clin Nutr

Dietary patterns and their association with food and nutrient intake in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam study

Br J Nutr

A critical review of predefined diet quality scores

Br J Nutr

Research
Current Research
Adherence to the French Programme National Nutrition Santé Guideline Score Is Associated with Better Nutrient Intake and Nutritional Status