Food and health: prevention could prove effective at a population level

Nutritional interventions offering simple and performed in the general population dietary advice actually exert an action on markers of overweight and obesity, suggest the results of Elpas project (longitudinal prospective study nutrition and health), announced at a conference press briefing in Paris.
A new nutritional survey
Away to everyone in the plan or prohibit certain foods, this project aimed to promote a change in eating habits in children and adults, through comparable to simple dietary advice conveyed by the National Health and Nutrition Program (NFHP) suggesting to reduce the consumption of lipids (fats) and promote the complex carbohydrates (bread and starches).

Described by its promoters as the "first nutritional intervention study of a long term, ensuring individual attention to the scale of a large population including both children and adults," Elpas was assessed During the 2005-2006 school year, with 1000 parent-child pairs. Young students and schoolgirls aged eight years on average, CE1 or CE2 in one of 55 schools Parisian partners have been included in this project, along with one of their parents, "especially moms [82% of women among adult participants], aged forty years on average, "said Dr. Francis Bornet, scientific coordinator for the company Elpas Nutri-Health.

At the launch of the study, "Elpassiens" were randomized into three groups according to the type of nutritional intervention that was offered to them. The 400 pairs of "control group" received a general nutritional information without being then offer "nutritional coaching."

All other participants were instructed to reduce their fat intake and try to increase those complex carbohydrates (group A), 300 of these families saw further advice to reduce their intake of simple carbohydrates, that is ie sugar (group B).

Participants in both intervention groups were regularly received by electronic mail or document information related to their goals were set, were able to participate in various activities, but have mostly been followed throughout the year by dieticians offering personalized advice in view of their eating habits (obtained through a comprehensive monthly food collection for three days made via the website). The program for these monthly contacts: simple messages and practical advice, "without prohibiting, but rather playing on the frequency of consumption of foods such as meats or sweets, for example," stressed Dr. Francis Bornet.

Better eating habits
In terms of power, the target for the reduction of fat intake was achieved in both intervention groups, both in children and adults, not only in quantitative terms (reduced amount of fat consumed daily 12 g in adults and 8 g in children), but also in qualitative terms. Indeed, at the launch of the study, 37% of daily energy intake of adults and 35% of those children came from fat, while after the nutritional recommendations, fat should account for 35% of the contribution energy. These values are increased to 33% and 32% at the end of the school year in the intervention group, whereas they were not significantly changed in the control group.

Regarding the instructions to promote the consumption of complex carbohydrates in the two intervention groups and also to limit the simple carbs in group B, the results were comparable in pediatric and adult population. The researchers found, compared to the control group, a significant increase in the consumption of carbohydrates in one group A (about 10g/day) and a significant decrease in consumption of sugars in one group B (about 10g/day ).

This could indicate "a challenge to achieve several objectives simultaneously in terms of nutrition," said Dr. Francis Bornet, welcoming, however, that this approach was successful in inducing a "favorable" distribution of fat and carbohydrate intake, without affecting the importance of protein in the daily energy intake. It is also accompanied by a reduction in total energy intake, "not initially sighting" in the three groups of adults in both groups of children who received the intervention, he said.

The impact of this strategy was also considered in the light of changing values of different clinical, biological and behavioral parameters including collected during comprehensive health assessments made at the beginning and end of the study, comparing changes occurred among participants in the control group and those in the other two groups of participants.

The body mass index (BMI, weight ratio of the square of height) showed a "normal, reflecting the dynamics of normal and harmonious growth" progression and comparable children of the three groups. In adults, the analysis showed a stabilization in mean BMI and a significant reduction in fat mass compared to the control group in group B, while in group A, the proposed intervention had the effect of slow increase in mean BMI and body fat compared to the increase observed in the control group.

Moreover, none of the interventions did not exercise effect on biological data (blood glucose, insulin, lipid), "but this was probably predictable in a general population of young adults." Further analyzes are underway to determine the changes in different sub-groups (depending on the value of BMI at baseline, the degree of compliance with nutritional advice or level of physical activity ... ).

Overall, given the very significant resources mobilized to achieve these results, such a procedure can not be applied in the general population. The cost of the first phase of this operation is high at 3,000 euros per household (funding phase including design) because the funds being provided by public and private partners (Ministry of Research, the Centre studies and documentation sugar or Cedus, trade organization of the industrial sector and the Louis Bonduelle Foundation).

Next planned step: see if these changes in eating habits persist permanently and if they have an impact on long-term parameters evaluated, but this phase requires to gather funding of 500,000 euros, said Dr. Francis Bornet to APM health.

In addition to these results on the impact of nutrition intervention programs, the program has Elpas develop tools for evaluation of fat children, who previously lacked. The study also led to the validation of the analysis of the body composition of children by impedance methods and development of a system for calculating this parameter from equations involving the values of various parameters to thrive, weight (waist, chest, hip, knee ...). A publication has been submitted to the "International Journal of Obesity" on this calculation method.