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Regional factors interact with educational and income tax levels to influence food intake in France



The goal of the present study was to assess whether geographic factors affect the relationship between socioeconomic indicators and adherence to the French National Nutritional Health Programme (Programme National Nutrition Santé (PNNS)) guidelines.


The MONA LISA-NUT study (2005–2007) is a cross-sectional survey of a representative sample from northern, northeastern and southwestern France. Educational level and household income tax were recorded by trained interviewers. Food intake was assessed with a 3-day food diary in 3188 subjects aged from 35–64 years. Adherence to the PNNS guidelines was assessed with a validated score (the French score of indicators of the PNNS objective (FSIPO)). Multivariate analyses were adjusted for gender, age, marital status, body mass index, energy intake and medically prescribed diets.


The FSIPO score was higher in southwestern France than in the two other regions (P<0.0001). The FSIPO score was correlated with the educational level in northern and northeastern France (P<0.0001) but not in southwestern France (region–education interaction: P<0.001). This interaction was accounted for by fruit and vegetable (P<0.0001), calcium (P=0.03), saturated fatty acid (P<0.0001), and fibre (P=0.0001) components of the FSIPO score. In contrast, the income tax level and the FSIPO score were positively correlated (P<0.0001) to a similar extent in all three regions (region × income tax interaction: P=0.09).


The relationship between educational level and adherence to the national nutritional health guidelines differs from one region of France to another, suggesting that nutrition education programmes should perhaps be adapted on a regional basis. In contrast, guideline adherence is correlated with income tax level independently of geographical factors, suggesting that financial constraints on food choices are uniform across France.

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We thank the nurses, physicians, dieticians, computer scientists and secretaries in Lille, Strasbourg and Toulouse, and the Centre de Médecine Préventive de Lille, the Laboratoire d′Analyses Génomiques and the Service de Biologie Spécialisée de l′Institut Pasteur de Lille, the Centre de Santé de la MGEN de Strasbourg, the Unité de Coordination de la Biologie des Essais Cliniques des Hôpitaux Universitaires de Strasbourg, the Departments of Cardiology of the Toulouse University Hospital and the city halls, which participated in the three regions. The third MONA LISA survey was made possible by an unrestricted grant from Pfizer and a grant from the French National Research Agency (ANR-05-PNRA-018).

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Wyndels, K., Dallongeville, J., Simon, C. et al. Regional factors interact with educational and income tax levels to influence food intake in France. Eur J Clin Nutr 65, 1067–1075 (2011).

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  • food score
  • dietary patterns
  • Mediterranean diet
  • geographical determinants
  • educational level
  • fruit

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