[show abstract][hide abstract] ABSTRACT: Lower-income subgroups consume fewer servings of fruit and vegetables (FVs) compared with their more advantaged counterparts. To overcome financial barriers, FV voucher delivery has been proposed.
In a 12-month trial, 302 low-income adults 18-60 years old (defined by evaluation of deprivation and inequalities in health examination centers, a specific deprivation score) were randomized into two groups: dietary advice alone ('advice'), or dietary advice plus FV vouchers ('FV vouchers') (10-40 euros/month) exchangeable for fresh fruits and vegetables. Self-reported data were collected on FV consumption and socioeconomic status at baseline, 3, 9 and 12 months. Anthropometric and blood pressure measurements were conducted at these periods, as well as blood samples obtained for determination of vitamins. Descriptive analyses, multiple linear regression and logistic regression were performed to evaluate the impact of FV.
Between baseline and 3-month follow-up, mean FV consumption increased significantly in both the 'advice' (0.62±1.29 times/day, P=0.0004) and 'FV vouchers' groups (0.74±1.90, P=0.002), with no difference between groups. Subjects in the FV vouchers group had significantly decreased risk of low FV consumption (<1 time/day) compared with those in the advice group (P=0.008). No change was noted in vitamin levels (vitamin C and β-carotene). The high number of lost-to-follow-up cases did not permit analysis at 9 or 12 months.
In the low-income population, FV voucher delivery decreased the proportion of low FV consumers at 3 months. Longer-term studies are needed to assess their impact on nutritional status.
European journal of clinical nutrition 03/2012; 66(3):369-75. · 3.07 Impact Factor
[show abstract][hide abstract] ABSTRACT: Some individuals have a preference for the present rather than for the future. We investigated the impact of this impatient relationship to temporality on adherence to medication and HbA(1c) level in type 2 diabetic patients.
An observational, cross-sectional monocenter study in 90 patients consulting for a health check-up at a Center for Preventive Medicine. We used questionnaires assessing adherence to medication, impatience in a fictive monetary choice (preferring a smaller amount now to a higher amount later) and in daily life situations, foresight, locus of control, and social deprivation.
Impatience in the monetary choice was associated with non-adherence to medication (P=0.005). In a multivariate logistic regression model, the risk of observing HbA(1c)≥7% was associated with a long duration of diabetes (OR 5.2, CI 1.7-15.7, P=0.003), monetary impatience (OR=5.1, CI 1.7-15.4, P=0.004), a high "chance and other people" score of the locus of control (OR=5.1, CI 1.7-15.7, P=0.004), a suboptimal foresight (OR 3.9, CI 1.2-12.0, P=0.02). A decision-tree analysis (CHAID algorithm) showed that in this cohort of 90 patients, the 11 people who were adherent to medication, patient in the monetary scenario, had optimal foresight, and gave importance neither to chance nor to other people, had all HbA(1c) below 7%.
An impatient relationship to temporality was found associated with non-adherence to medication and uncontrolled HbA(1c) in type 2 diabetic patients. Treatment strategies for chronic diseases should be tailored according to this novel dimension of psychology.
[show abstract][hide abstract] ABSTRACT: Determinants of fruit and vegetable consumption, including affordability and attitudes, have been poorly investigated, especially in European deprived populations. Our objective was to analyze various determinants of low consumption of fruits and vegetables in disadvantaged participants. Our participants were randomized into 2 groups, 1 which received nutritional advice alone and 1 that also received vouchers that were exchangeable for fruits and vegetables during a 12-mo period. Socioeconomic characteristics, food insufficiency, affordability, and motivation for eating fruits and vegetables were assessed. A short FFQ was administered. Determinants of consumption of <1 fruit or vegetable/d were analyzed using multivariate logistic regression. A total of 295 participants were included (mean age 44.8 y; 133 men, 162 women). At baseline, mean daily consumption of fruits and vegetables was 2.13 +/- 1.57 times/d. Nearly 30% of the sample did not eat fruits and vegetables every day. Determinants of low fruit and vegetable consumption were: age younger than 55 y, education level lower than tertiary, and absence of financial means for buying fruits and vegetables daily. Other determinants were affordability (whether fruits and vegetables are affordable, lack of money in preventing healthy diet) and attitudes (whether one's own diet is healthy, whether or not fruits and vegetables improve health, whether eating fruits and vegetables is a pleasure). Thus, determinants of inadequate consumption of fruits and vegetables in this deprived French population are numerous. The impact of financial difficulties is crucial, as is the perception of affordability of fruits and vegetables.
Journal of Nutrition 02/2010; 140(4):823-30. · 4.20 Impact Factor
[show abstract][hide abstract] ABSTRACT: As the constantly progressing metabolic syndrome is accompanied by an increased risk of type 2 diabetes and cardiovascular complications, it is essential to take appropriate, non-pharmacological, cost-effective measures immediately after the diagnosis has been made. The purpose of our prospective, non-controlled, 6-month study was to determine the impact of lifestyle interventions involving patients' behaviour in collaboration with their general practitioners (GPs).
We recruited 95 patients (46 men and 49 women, aged 45 to 60 years) who presented with the metabolic syndrome. Each patient received a copy of the national French recommendations (PNNS) leaflet, containing guidelines aimed to balance dietary intake and increase daily physical activity. Socioeconomic status was estimated using the EPICES score. Following a less than 1 hour face-to-face interventional session with each patient to present the lifestyle-modification goals, we contacted each patient's GP by phone to advise on measures to reinforce these lifestyle modifications.
The percentage of patients presenting with the metabolic syndrome decreased by 52.4% after 6 months. Hypertension, triglycerides and waist circumference decreased by 30.5, 29.3 and 22.0%, respectively, in the study patients. Rates of compliance to PNNS goals at the last follow-up versus baseline were: for drinks, 63.0% versus 22.2%; for sweet products, 91.4% versus 49.4%; for fat, 91.4% versus 80.3%; and for increased exercise, 26.9% versus 6.4%.
Short-term, single lifestyle modifications targeting the metabolic syndrome in collaboration with GPs was effective in decreasing most of the parameters of the syndrome. However, no factors predictive of success were identified.
[show abstract][hide abstract] ABSTRACT: The association between the metabolic syndrome (MetS) and socioeconomic deprivation has already been recognized. The aim of this study was to examine the relationship between MetS and psychosocial deprivation, and to determine whether or not this relationship is independent of gender, age and obesity.
The sample included 17074 subjects, aged 16-91 years, who attended the Health Examination Centre of the National Health Insurance Service at Bobigny (a northern suburb of Paris). Exclusion criteria were known diabetes and current lipid-lowering treatment. MetS was defined according to NCEP-ATP III criteria. Psychosocial deprivation was analyzed using the Evaluation of Deprivation and Inequalities by Health Examination Centres (EPICES) score, which includes 11 validated questions and ranges from zero to 100. Psychosocial deprivation was defined as a score greater than or equal to 40.
The sample included slightly more women (52.5%) than men, and 52.5% were considered to be deprived. These subjects were slightly older (41 vs 40.2 years, P<0.0001). Around half of the study population benefited from social help. MetS prevalence was higher in the deprived group (11.5% vs 9.4%; P<0.0001), and this was confirmed for every age group. Similarly, the prevalence of all MetS components, except for blood glucose, was significantly higher. The deprivation rate increased with the number of MetS criteria in the non-obese. In a multiple logistic regression, female gender (OR=1.50), age (OR>14 for those over 50 compared with those aged 16-19 years) and deprivation (OR=1.22) were independent predictors of MetS. Taking obese and non-obese populations separately, deprivation remained an independent predictor of MetS only in the non-obese (OR=1.30).
Psychosocial deprivation is an independent determinant of MetS in non-obese people, and elderly psychosocially deprived women, even if not obese, are at a particularly high risk of MetS. Educational efforts need to be developed to prevent MetS and its consequences in this population.
[show abstract][hide abstract] ABSTRACT: Microalbuminuria is considered as a marker of endothelial dysfunction and is associated with an increase in cardiovascular risk. The aim of this study was to evaluate this parameter as a potential marker of artery rigidity and left ventricle (LV) function.
We included 375 subjects referred to a health assessment center. They were 228 men and 147 women aged in means of 52.7 and 53.1 years, respectively. Among this population, 57 had type 2 diabetes, 28 of them with hypertension, 65 were hypertensive but free of diabetes, and 39 were free of diabetes but exhibited a metabolic syndrome (NCEP-ATP III). Urinary albumin excretion rate (UAER) was determined. Artery rigidity was evaluated by pulse pressure of the brachial artery (plethysmographic method), pulse pressure of the radial artery and aorta and pulse wave velocity (PWV) measured by aplanation tonometry (SphygmoCor). LV afterload was appreciated by LV telesystolic pressure and coronary perfusion by the diastolic area/systolic area ratio for aortic pressure curve (Buckberg index).
UAER correlated with PWV in the overall population (p<0.0001) and in the diabetic sub-group (p<0.001). In the overall population UAER correlated with LV telesystolic pressure (p=0.006) but not with Buckberg index. In the overall population and the diabetic subgroup, the artery rigidity indexes correlated strongly with LV telesystolic pressure, and radial and aortic pulse pressure correlated negatively with Buckberg index.
These data suggest that 1) microalbuminuria may be considered as a marker of artery rigidity, in line with experimental data which indicate the deleterious role of endothelial dysfunction on artery compliance; 2) artery rigidity is a potent determinant of LV afterload and coronary perfusion, in particular in diabetic patients.
Archives des maladies du coeur et des vaisseaux 08/2007; 100(8):673-6. · 0.40 Impact Factor
[show abstract][hide abstract] ABSTRACT: Previous studies have related poor glycemic control and/or some diabetes complications to low socioeconomic status. Some aspects of socioeconomic status have not been assessed in these studies. In the present study, we used an individual index of deprivation, the Evaluation de la Précarité et des Inégalités de santé dans les Centres d'Examens de Santé (Evaluation of Precarity and Inequalities in Health Examination Centers [EPICES]) score, to determine the relationship among glycemic control, diabetes complications, and individual conditions of deprivation.
We conducted a cross-sectional prevalence study in 135 consecutive diabetic patients (age 59.41 +/- 13.2 years [mean +/- SD]) admitted in the hospitalization unit of a French endocrine department. Individual deprivation was assessed by the EPICES score, calculated from 11 socioeconomic questions. Glycemic control, lipid levels, blood pressure, retinopathy, neuropathy, and nephropathy were assessed.
HbA(1c) level was significantly correlated with the EPICES score (r = 0.366, P < 0.001). The more deprived patients were more likely than the less deprived patients to have poor glycemic control (beta = 1.984 [SE 0.477], P < 0.001), neuropathy (odds ratio 2.39 [95% CI 1.05-5.43], P = 0.037), retinopathy (3.66 [1.39-9.64], P = 0.009), and being less often admitted for 1-day hospitalization (0.32 [0.14-0.74], P = 0.008). No significant relationship was observed with either nephropathy or cardiovascular risk factors.
Deprivation status is associated with poor metabolic control and more frequent microvascular complications, i.e., retinopathy and neuropathy. The medical and economic burden of deprived patients is high.
Diabetes Care 12/2005; 28(11):2680-5. · 7.74 Impact Factor
[show abstract][hide abstract] ABSTRACT: The relationship between smoking and various socio-demographic or socio-economic factors, as well as the interactions between depressive mood and smoking are already known. However, the respective contribution of psychological factors and stressful life antecedents during childhood and adolescence warrants further specification.
2315 consecutive subjects, aged 16 to 59, consulting for a free work-up in a preventive health centre, supported by the National French Health insurance system, were invited to fill out a series of questionnaires: the GHQ-28 and the LOT, respectively measuring psychosocial distress and dispositional optimism, as well as a questionnaire on socio-demographic, socio-economic and biographical data.
78.1% complete records could be analysed: the "smokers" group (n = 870, 48.1%) declared a current tobacco consumption of at least one cigarette/day. This group was characterized by a predominance of male subjects, older age, modest educational level, low income level and responded to socio-economic criteria of precariousness more frequently (p < 0.001, except for age: p = 0.006). Smoking was also associated with higher levels of psychosocial distress, as assessed by GHQ-28, especially for the depressive mood and anxiety items of the questionnaire (p < 0.001), and with lower levels of dispositional optimism (p < 0.01). As regards biographical data, smokers were characterized by a way of life marked by financial problems, reduced social contacts, and a higher frequency, before the age of 18, of divorce or separation of the parents (p = 0.002), frequent parental quarrels (p < 0.001) or separation from the parents (p < 0.001). The presence of a depressive mood at GHQ-28 as well as frequent parental quarrels remained independent risk factors for smoking in multiple logistic regression (odds ratio respectively equal to 1.61 and 1.34), after adjustment on gender, educational level and the notion of socio-economic precariousness.
These results highlight the complementary role of socio-economic, psychological factors and certain stressful life antecedents among the determinants of smoking and should be taken into account for tailoring smoking cessation programs.
[show abstract][hide abstract] ABSTRACT: Obesity is a complex multi-factorial disease. The role of socioeconomic factors is known but few studies have attempted to analyse separately the impact of the various participating factors: oncome, level of education, cultural and social status.
These factors were analysed in 26,278 persons aging from 16 to 59 years, living in the district and having benefited from a medical check-up in the Seine-Saint-Denis health and social prevention centre, district particularly concerned by socio-economic insecurity. Among these persons, a representative sample of 1804 filled-in an additional questionnaire including questions on their income, level of education, marital status and the area or country of origin.
The prevalence of obesity (body mass index or BMI > or = 30 kg/m2) and overweight (MCI = 25 to 29.9 kg/m2) was respectively of 17.6 and 32.7%. Using univariate analysis, the prevalence of obesity was significantly associated with age, gender (higher in women), settled way of life, socio-professional category, low education, marital status and origin (higher in persons from Africa and North Africa). Using a logistic regression model, the risk of obesity was increased 1.45-fold in persons earning less than 838,47 euros and 1.67-fold in persons with low education. Moreover, it was 2.28-fold greater in the un-working population, 1.62-fold in the redundant and 1.5-fold in the working class, compared with the executive-freelance population.
The risk of obesity is therefore independently related to cultural, economic and social parameters.
La Presse Médicale 01/2003; 32(2):55-60. · 0.87 Impact Factor
[show abstract][hide abstract] ABSTRACT: A sympathetic hyperactivity is a common feature in hypertension, type 2 diabetes (T2D), ageing and obesity-induced hypertension. This increase in sympathetic activity may lead to an elevation of arterial rigidity. By contrast, cardiac parasympathetic impairment is observed in these pathologies. Recently we showed in a model of rats with massive obesity (ventromedial hypothalamic lesions) that an enhanced vagal activity may be protective against hypertension. The aim of the present study was to evaluate the influence of an increase in sympathetic activity and a change in vagal activity on arterial rigidity and hypertension in T2D patients. Fourteen hypertensive T2D patients aged 54 +/- 2 years were compared to 22 elderly normotensive subjects (75 +/- 1 years: 11 controls and 11 T2D) and 34 middle aged normotensive subjects (43 +/- 1 years; 17 controls and 17 T2D). Cardiovascular vagosympathetic activity was investigated by spectral analysis of heart rate (HR) and blood pressure (BP) (Finapres) during 6 min at a controlled breathing rate (12 cycles/min). BP and the low frequencies of systolic BP (LF-SBP) were significantly (p<0.01) higher in hypertensive T2D and elderly patients. Pulse pressure (PP) and the high frequencies of HR (HF-HR) were lower in hypertensive T2D patients. PP was positively correlated to LF-SBP (r=0.58; p=0.03) only in hypertensive T2D patients. Diastolic BP was negatively correlated to HF-HR in elderly control subjects (r=-0.63; p=0.03) but not in hypertensive T2D patients. The present results suggest that: sympathetic nervous system activity is enhanced in subjects over 70 years without any aggravating effect of T2D and in middle-aged hypertensive patients with type 2 diabetes; the increase in pulse pressure, an index of arterial rigidity, in elderly subjects may result from sympathetic override; the decrease in the cardiac sympathovagal balance, mainly due to a high vagal activity, may be protective against the occurrence of hypertension in patients with type 2 diabetes.
Archives des maladies du coeur et des vaisseaux 97(7-8):749-52. · 0.40 Impact Factor