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The cumulative effect of small dietary changes may significantly improve nutritional intakes in free-living children and adults

Abstract

Background/Objectives:

The ELPAS (Etude Longitudinale Prospective Alimentation et Santé) study was an 8-month randomized controlled dietary modification trial designed to test the hypothesis that family dietary coaching would improve nutritional intakes and weight control in 2026 free-living children and parents. It resulted in significant nutritional changes, with beneficial effects on body mass index in adults. In these ancillary analyses, we investigated dietary changes throughout the intervention.

Subjects/Methods:

Before the study, modeling analyses were carried out on the French Association Sucre Produits Sucrés Consommation et Communication (ASPCC) food-consumption database to identify the most efficient dietary intervention strategy. During the study, all participants performed monthly three nonconsecutive 24-h dietary recalls: this allowed for measuring changes in the number of servings per day and serving size for each targeted food category throughout the intervention.

Results:

Modeling analyses showed that targeting only the 10 main foods contributing to fat and carbohydrate intakes did not allow for reaching the ELPAS nutritional goals. As a result, it was decided to target more foods and to propose several types of dietary advice (such as change in serving size, change in cooking method, food substitution). This strategy led to many appropriate dietary changes during the intervention, but only a few of them reached significance. The mean number of servings per day was indeed significantly modified for only 7% of the targeted food categories in children and 17% in parents. The mean serving size was modified for only 12% of targeted food categories in children and 9% in parents.

Conclusions:

The cumulative effect of small dietary changes may induce significant nutritional improvements, with limited burden for populations.

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References

  • Adamson AJ, Mathers JC (2004). Effecting dietary change. Proc Nutr Soc 63, 537–547.

    Article  Google Scholar 

  • Anderson AS, Porteous LE, Foster E, Higgins C, Stead M, Hetherington M et al. (2005). The impact of a school-based nutrition education intervention on dietary intake and cognitive and attitudinal variables relating to fruits and vegetables. Public Health Nutr 8, 650–656.

    Article  CAS  Google Scholar 

  • Ash S, Reeves M, Bauer J, Dover T, Vivanti A, Leong C et al. (2006). A randomised control trial comparing lifestyle groups, individual counselling and written information in the management of weight and health outcomes over 12 months. Int J Obes (Lond) 30, 1557–1564.

    Article  CAS  Google Scholar 

  • Boushey CJ, Edmonds JW, Welshimer KJ (2001). Estimates of the effects of folic-acid fortification and folic-acid bioavailability for women. Nutrition 17, 873–879.

    Article  CAS  Google Scholar 

  • Britten P, Lyon J, Weaver CM, Kris-Etherton PM, Nicklas TA, Weber JA et al. (2006). MyPyramid food intake pattern modeling for the Dietary Guidelines Advisory Committee. J Nutr Educ Behav 38 (6 Suppl), S143–S152.

    Article  Google Scholar 

  • Couet C, Rigaud D, Volatier JL, Borys JM, Giachetti I, Cassuto DA et al. (2000). Enquête française de consommation alimentaire (II). La consommation des glucides: aspects quantitatifs et qualitatifs. Cah Nutr Diét 35, 257–268.

    Google Scholar 

  • De Bourdeaudhuij I, Stevens V, Vandelanotte C, Brug J (2007). Evaluation of an interactive computer-tailored nutrition intervention in a real-life setting. Ann Behav Med 33, 39–48.

    Article  Google Scholar 

  • De Jong N, Pijpers L, Bleeker JK, Ocke MC (2004). Potential intake of phytosterols/-stanols: results of a simulation study. Eur J Clin Nutr 58, 907–919.

    Article  CAS  Google Scholar 

  • Department of Health and Human Services and Department of Agriculture (2005). Dietary Guidelines for Americans. Internet: http://www.health.gov/dietaryguidelines/dga2005/document/default.htm (accessed 5 August 2009).

  • Dixon LB, McKenzie J, Shannon BM, Mitchell DC, Smiciklas-Wright H, Tershakovec AM (1997). The effect of changes in dietary fat on the food group and nutrient intake of 4- to 10-year-old children. Pediatrics 100, 863–872.

    Article  CAS  Google Scholar 

  • Drummond S (2007). Obesity: a diet that is acceptable is more likely to succeed. J Fam Health Care 17, 219–222.

    PubMed  Google Scholar 

  • Estaquio C, Castetbon K, Kesse-Guyot E, Bertrais S, Deschamps V, Dauchet L et al. (2008). The French National Nutrition and Health Program score is associated with nutritional status and risk of major chronic diseases. J Nutr 138, 946–953.

    Article  CAS  Google Scholar 

  • Eurodiet (2001). Nutrition & diet for healthy lifestyles in Europe, science and policy implications. Internet: http://ec.europa.eu/health/ph_determinants/life_style/nutrition/report01_en.pdf (accessed 5 August 2009).

  • European Commission (1997). Commission Recommendation of 29 July 1997 concerning the scientific aspects and the presentation of information necessary to support applications for the placing on the market of novel foods and novel food ingredients and the preparation of initial assessment reports under Regulation (EC) No 258/97 of the European Parliament and of the Council (97/618/EC). Off J Eur communities L 253, 1–36.

    Google Scholar 

  • European Communities (1997). Regulation (EC) No 258/97 of the European Parliament and of the Council of 27 January 1997 concerning novel foods and novel food ingredients. Off J Eur communities L 043, 1–6.

    Google Scholar 

  • European Food Safety Authority (2008). Scientific opinion of the Panel on Dietetic Products, Nutrition and Allergies on a request from the EC on food-based dietary guidelines. EFSA J 644, 1–44.

    Google Scholar 

  • Favier JC, Ireland-Ripert J, Toque C, Feinberg M (1995). Répertoire Général des Aliments. Table de composition (Composition tables). 2nd edn. INRA, CIQUAL-REGAL, Tec & Doc Lavoisier: Paris.

    Google Scholar 

  • Gehling RK, Magarey AM, Daniels LA (2005). Food-based recommendations to reduce fat intake: an evidence-based approach to the development of a family-focused child weight management programme. J Paediatr Child Health 41, 112–118.

    Article  CAS  Google Scholar 

  • Goldberg GR, Black AE, Jebb SA, Cole TJ, Murgatroyd PR, Coward WA et al. (1991). Critical evaluation of energy intake data using fundamental principles of energy physiology: 1. Derivation of cut-off limits to identify under-recording. Eur J Clin Nutr 45, 569–581.

    CAS  PubMed  Google Scholar 

  • Institute of Medicine (2005). Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids (macronutrients). Internet: http://books.nap.edu/catalog.php?record_id=10490 (accessed 5 August 2009).

  • Johnson-Down L, L’Abbe MR, Lee NS, Gray-Donald K (2003). Appropriate calcium fortification of the food supply presents a challenge. J Nutr 133, 2232–2238.

    Article  CAS  Google Scholar 

  • Keller I, Lang T (2008). Food-based dietary guidelines and implementation: lessons from four countries—Chile, Germany, New Zealand and South Africa. Public Health Nutr 11, 867–874.

    Article  Google Scholar 

  • King JC, Dietary Guidelines Advisory Committee (2007). An evidence-based approach for establishing dietary guidelines. J Nutr 137, 480–483.

    Article  CAS  Google Scholar 

  • Kroeze W, Oenema A, Campbell M, Brug J (2008). The efficacy of web-based and print-delivered computer-tailored interventions to reduce fat intake: results of a randomized, controlled trial. J Nutr Educ Behav 40, 226–236.

    Article  Google Scholar 

  • Lanza E, Schatzkin A, Daston C, Corle D, Freedman L, Ballard-Barbash R et al. (2001). Implementation of a 4-y, high-fiber, high-fruit-and-vegetable, low-fat dietary intervention: results of dietary changes in the Polyp Prevention Trial. Am J Clin Nutr 74, 387–401.

    Article  CAS  Google Scholar 

  • Maillot M, Ferguson EL, Drewnowski A, Darmon N (2008a). Nutrient profiling can help identify foods of good nutritional quality for their price: a validation study with linear programming. J Nutr 138, 1107–1113.

    Article  CAS  Google Scholar 

  • Maillot M, Vieux F, Ferguson E, Amiot-Carlin MJ, Volatier JL, Darmon N (2008b). Modelling the feasibility of nutritional recommendations at the individual level. Proc Nutr Soc 67 (OCE5), E168.

    Article  Google Scholar 

  • McCallum Z, Wake M, Gerner B, Baur LA, Gibbons K, Gold L et al. (2007). Outcome data from the LEAP (Live, Eat and Play) trial: a randomized controlled trial of a primary care intervention for childhood overweight/mild obesity. Int J Obes (Lond) 31, 630–636.

    Article  CAS  Google Scholar 

  • Nicklas TA, Hayes D, American Dietetic Association (2008). Position of the American Dietetic Association: nutrition guidance for healthy children ages 2 to 11 years. J Am Diet Assoc 108, 1038–1044, 1046–7.

    Article  Google Scholar 

  • Paineau DL, Beaufils F, Boulier A, Cassuto DA, Chwalow J, Combris P et al. (2008). Family dietary coaching to improve nutritional intakes and body weight control: a randomized controlled trial. Arch Pediatr Adolesc Med 162, 34–43.

    Article  Google Scholar 

  • Papadaki A, Scott JA (2005). The Mediterranean eating in Scotland experience project: evaluation of an internet-based intervention promoting the Mediterranean diet. Br J Nutr 94, 290–298.

    Article  CAS  Google Scholar 

  • Patterson RE, Kristal A, Rodabough R, Caan B, Lillington L, Mossavar-Rahmani Y et al. (2003). Changes in food sources of dietary fat in response to an intensive low-fat dietary intervention: early results from the Women's Health Initiative. J Am Diet Assoc 103, 454–460.

    PubMed  Google Scholar 

  • Rao G (2008). Childhood obesity: highlights of AMA Expert Committee recommendations. Am Fam Physician 78, 56–63.

    PubMed  Google Scholar 

  • Richards A, Kattelmann KK, Ren C (2006). Motivating 18- to 24-year-olds to increase their fruit and vegetable consumption. J Am Diet Assoc 106, 1405–1411.

    Article  Google Scholar 

  • Rigaud D, Giachetti I, Deheeger M, Borys JM, Volatier JL, Lemoine A et al. (1997). Enquête Française de Consommation Alimentaire (II). Énergie et macronutriments. Cah Nutr Diét 32, 379–389.

    Google Scholar 

  • Ritchie LD, Welk G, Styne D, Gerstein DE, Crawford PB (2005). Family environment and pediatric overweight: what is a parent to do? J Am Diet Assoc 105 (5 Suppl 1), S70–S79.

    Article  Google Scholar 

  • Roblin L (2007). Childhood obesity: food, nutrient, and eating-habit trends and influences. Appl Physiol Nutr Metab 32, 635–645.

    Article  Google Scholar 

  • Rodearmel SJ, Wyatt HR, Barry MJ, Dong F, Pan D, Israel RG et al. (2006). A family-based approach to preventing excessive weight gain. Obesity (Silver Spring) 14, 1392–1401.

    Article  Google Scholar 

  • Schofield WN (1985). Predicting basal metabolic rate, new standards and review of previous work. Hum Nutr Clin Nutr 39 (Suppl 1), 5–41.

    PubMed  Google Scholar 

  • Sharma M (2006). School-based interventions for childhood and adolescent obesity. Obes Rev 7, 261–269.

    Article  CAS  Google Scholar 

  • Suojanen A, Raulio S, Ovaskainen ML (2002). Liberal fortification of foods: the risks. A study relating to Finland. J Epidemiol Community Health 56, 259–264.

    Article  CAS  Google Scholar 

  • Van Horn L, Obarzanek E, Friedman LA, Gernhofer N, Barton B (2005). Children's adaptations to a fat-reduced diet: the dietary intervention study in children (DISC). Pediatrics 115, 1723–1733.

    Article  Google Scholar 

  • Vandevijvere S, De Vriese S, Huybrechts I, Moreau M, Temme E, De Henauw S et al. (2008). The gap between food-based dietary guidelines and usual food consumption in Belgium, 2004. Public Health Nutr 12, 423–431.

    PubMed  Google Scholar 

  • Women's Health Initiative Study Group (2004). Dietary adherence in the Women's Health Initiative Dietary Modification Trial. J Am Diet Assoc 104, 654–658.

    Article  Google Scholar 

  • World Health Organization and Food and Agriculture Organization of the United Nations (2003). Diet, Nutrition and the Prevention of Chronic Diseases. WHO Technical Report Series 916. Internet: http://whqlibdoc.who.int/trs/WHO_TRS_916.pdf (accessed 5 August 2009).

  • Zazpe I, Sanchez-Tainta A, Estruch R, Lamuela-Raventos RM, Schröder H, Salas-Salvado J et al. (2008). A large randomized individual and group intervention conducted by registered dietitians increased adherence to Mediterranean-type diets: the PREDIMED study. J Am Diet Assoc 108, 1134–1144; discussion 1145.

    Article  CAS  Google Scholar 

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Acknowledgements

We thank the families, schools and administrators (Rectorat de Paris) who participated in this project. Michel Vidailhet, MD, Brabois Hospital, Vandoeuvre les Nancy, France, helped with supervising the study and drafting the manuscript. Ambroise Martin, MD, PhD, Lyon Medical Faculty, Lyon, France, helped with drafting the paper. Mohamed Grairia, Socio Logiciels, Paris, France, contributed to statistical analyses. Funding was provided by the French Ministry of Research (2002 Réseau Alimentation Référence Europe), and by the ELPAS study's private partners (Avenance Enseignement, the Centre d’Etudes et de Documentation du Sucre, and the Louis Bonduelle Foundation). The private partners did not participate in conduct of the study; collection, management, analyses or interpretation of the data; or preparation, review or approval of the paper. The Centre d’Etudes et de Documentation du Sucre participated in the study design.

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Correspondence to F R J Bornet.

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Competing interests

Dr Cassuto served as an independent consultant for the Centre d’Etudes et de Documentation du Sucre. All other authors have no competing financial interests in relation to the work described.

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Paineau, D., Beaufils, F., Boulier, A. et al. The cumulative effect of small dietary changes may significantly improve nutritional intakes in free-living children and adults. Eur J Clin Nutr 64, 782–791 (2010). https://doi.org/10.1038/ejcn.2010.78

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