What we have learned from the world’s largest nutrition study

The NutriNet-Santé examine is an ongoing investigation into the connection between diet and well being. On this Particular Characteristic, we have a look at a few of the mission’s findings and communicate with Principal Investigator Dr. Mathilde Touvier, who has been concerned within the examine since its inception.

A variety of things influences well being, together with genetics, life-style, environmental components, and eating regimen. Unraveling the complicated relationships between these components is a problem.

For a lot of causes, it’s extremely tough to research the function of diet in well being and illness. For example, no two individuals eat the very same eating regimen, and only a few individuals eat the very same meals 2 days in a row.

As it’s neither possible nor moral to ask hundreds of individuals to observe a strict eating regimen for 10 years to see what occurs, researchers have to seek out different methods of unpicking the hyperlinks between eating regimen and illness.

One of the simplest ways to sort out any tough health-related query is to generate as a lot good high quality knowledge as doable, and that is the NutriNet-Santé examine’s raison d’etre.

Starting in 2009, the NutriNet-Santé examine was the primary internet-based examine of its type. By the beginning of 2021, the group was repeatedly gathering knowledge from 171,000 individuals aged 15 years and older, making it the most important ongoing diet examine on the earth.

Now operating in France and Belgium, the group can also be seeding related initiatives in Canada, Mexico, and Brazil.

Particularly, the researchers set out with the next goals:

  1. Examine the connection between diet, well being, life-style components, and mortality.
  2. Look at the components that affect dietary patterns, equivalent to financial and cultural components.

The researchers maintain a biobank of serum, plasma, and urine from about 20,000 individuals. In addition they acquire stool to watch and analyze intestine micro organism.

Alongside questions on meals consumption, the NutriNet-Santé group collects details about meals packaging, cooking practices, mode of manufacturing, bodily exercise, tobacco, medication, environmental components, and home {and professional} exposures.

Importantly, knowledge from the NutriNet-Santé examine are linked with medical and insurance coverage information to enhance accuracy concerning medicines, diagnoses, and long-term sick depart. The examine is financed completely by public establishments.

Article highlights:

Lately, ultra-processed meals have turn out to be a dietary pariah, and the NutriNet-Santé examine has performed no small half on this.

Over current years, knowledge from the NutriNet-Santé examine have revealed associations between diets excessive in ultra-processed meals and an elevated danger of most cancers, heart problems, mortality, depressive signs, kind 2 diabetes, weight problems, and gastrointestinal problems.

For instance, one paper primarily based on knowledge from the NutriNet-Santé cohort, which appeared within the BMJ in 2018, concluded:

“On this giant potential examine, a ten% improve within the proportion of ultra-processed meals within the eating regimen was related to a big improve of larger than 10% in dangers of total and breast most cancers.”

One other examine utilizing their knowledge, which additionally appeared in BMJ, concludes:

“[H]igher consumption of ultra-processed meals was related to greater dangers of cardiovascular, coronary coronary heart, and cerebrovascular ailments.”

But extra analysis, which appeared in BMC Medication in 2019, investigated ultra-processed meals and their hyperlinks with melancholy. The authors write:

“Total, [ultra-processed food] consumption was positively related to the chance of incident depressive signs, suggesting that accounting for this non-nutritional facet of the eating regimen could possibly be essential for psychological well being promotion.”

Subsequent, the NutriNet-Santé researchers plan to research the causative features of this relationship. They are going to drill down into the particular compounds that is perhaps accountable.

In response to Dr. Touvier, because of the researchers’ wealth of diet knowledge, they’ll now “estimate the additive publicity for greater than 330 components licensed in Europe and likewise detect the mixtures of components which can be consumed by the inhabitants.”

They’ve already recognized these cocktails of components and at the moment are looking for relationships between specific mixtures of compounds and particular illness states.

Understanding which meals are related to which well being situations is essential, however the subsequent step — altering habits — might be much more difficult.

To handle this, the NutriNet-Santé examine centered on meals labeling. Though product labels already present details about ranges of fats, sugar, and different components, as Dr. Touvier identified, rapidly gauging whether or not a product is healthful as you rush round a grocery retailer shouldn’t be simple.

With this in thoughts, the NutriNet-Santé group designed Nutri-Rating. This straightforward label provides every product a rating from A to E, with A being probably the most healthful and E the least healthful.

The scoring system takes under consideration the quantity of sugar, saturated fat, sodium, protein, fiber, fruits, greens, nuts, and legumes to supply a rating.

“The rating has been validated towards many well being outcomes, utilizing the NutriNet-Santé cohort [and other cohorts]. So we confirmed that individuals who ate meals with a greater rating had much less danger of cancers, heart problems, weight problems, and so forth. We additionally validated it in different unbiased cohorts,” defined Dr. Touvier.

“We additionally used the NutriNet-Santé cohort to validate how the rating is known and utilized by contributors to fee dietary high quality.”

And, much more importantly, the analysis has proven that in a grocery setting, individuals with entry to this sort of labeling select extra healthful meals. Because the authors of 1 paper clarify:

“The Nutri-Rating was related to a better dietary high quality of purchases in experimental and huge scale trials.”

In France, some corporations are already making use of this label on a voluntary foundation. To this point, 520 corporations, together with a complete of 690 manufacturers, have registered to make use of the scoring system.

Dr. Touvier and the group are presently making an attempt to persuade the European Union to roll out the scoring system all through the E.U. in 2022. Nonetheless, they’re dealing with stiff resistance from sure giant meals companies and their lobbying teams.

Greater than 40 printed research again the advantages of the Nutri-Rating. Dr. Touvier hopes that “will probably be adopted as a result of, for the patron, we actually confirmed it is going to have an incredible influence.”

Over time, there was a good quantity of controversy round the advantages of consuming natural produce. As Dr. Touvier defined, till just lately, there have been merely not sufficient knowledge to make connections between these merchandise and well being outcomes.

As soon as once more, the NutriNet-Santé examine has begun to fill these gaps. In response to Dr. Touvier, the group discovered “an affiliation between greater concentrations of natural meals and a decrease danger of breast most cancers and lymphoma.” Equally, the info “confirmed a decrease danger of weight problems, chubby, and metabolic syndrome.”

The researchers have additionally demonstrated that individuals who eat extra natural meals have “decrease ranges of pesticides of their urine.” Subsequent, they plan to quantify exposures to the assorted forms of pesticides and determine “cocktails” of pesticide exposures. They’re within the technique of assessing whether or not sure pesticidal cocktails is perhaps related to particular well being outcomes.

In response to Dr. Touvier, one such examine, which has simply been accepted for publication within the Worldwide Journal of Epidemiology, discovered that:

“Individuals uncovered to those cocktails of pesticides had a better danger of postmenopausal breast most cancers.”

Because the COVID-19 pandemic continues, so does NutriNet-Santé’s knowledge assortment. The scientists are monitoring how diets have shifted throughout these uncommon instances.

One examine, for example, confirmed that the pandemic has affected individuals in another way, with some consuming much less healthfully and others enhancing their eating regimen considerably.

“We noticed a really various profile of contributors. A few of them began to eat extra sugary meals and to eat between meals as a result of they have been bored or harassed. Additionally, they lowered the extent of bodily exercise. […] For these contributors, we noticed a rise in physique weight,” defined Dr. Touvier. However the pandemic has had totally different results on different individuals, she famous:

“Different contributors started to prepare dinner extra at dwelling, so much less processed meals and extra home made meals, they usually elevated their stage of bodily exercise […] These contributors misplaced weight.”

The NutriNet-Santé scientists additionally discovered that there have been individuals who had made no change to their eating regimen or stage of exercise.

Because the researchers have additionally collected dried blood spots from greater than 20,000 contributors, they’re able to detect anti-SARS-CoV-2 antibodies.

They’re presently engaged on a strategy to hyperlink an infection to eating regimen. This analysis might reveal whether or not any dietary patterns are related to an elevated danger of SARS-CoV-2 an infection or, conversely, whether or not any dietary profiles are related to a protecting impact.

Investigating diet is difficult. Each particular person eats a whole lot or hundreds of components every week, and no two diets are the identical. Additionally, when scientists depend on self-reported dietary info, they’re more likely to get imprecise solutions.

The NutriNet-Santé examine was the primary to make use of on-line questionnaires to gather knowledge. As trailblazers for this system, the researchers spent quite a lot of power ensuring that the info they have been gathering have been correct and significant.

Medical Information Right this moment requested Dr. Touvier how the NutriNet-Santé examine group went about this. She defined that early on within the examine, the investigators ran a sequence of validation research during which they checked contributors’ self-reported meals consumption towards their “blood and urinary biomarkers” and their cellphone interviews with skilled dietitians.

They discovered a “excessive correlation” between the data coming from contributors, blood markers, and interview knowledge.

In some instances, the info they collected have been extra dependable than the cellphone interviews. Dr. Touvier defined that some contributors have been extra more likely to enter unhealthful meals within the nameless on-line type than they have been to say it when talking with a dietitian. She mentioned:

“It’s not excellent. It’s nonetheless an observational examine, however now we have validated all of those strategies, so they’re dependable.”

One other frequent problem that diet scientists face is that one model of frozen pizza shouldn’t be the identical as one other, and one bag of chips can harbor completely totally different components than one other.

To assist reduce this problem, the researchers designed a barcode reader that enables contributors to scan their meals objects immediately into the system. On this approach, the scientists have direct entry to the exact dietary content material of the meals merchandise.

One other vital problem with diet analysis is the function of business bias. Research that obtain funding from events usually tend to report the advantages of their produce. The NutriNet-Santé examine, nevertheless, is publicly funded, and the info usually are not open entry.

As Dr. Touvier defined, “now we have an ethical settlement with the contributors to not present the info to the meals business.” Nonetheless, the group does “share their knowledge with different public researchers.”

Correlation versus causation is the thorn in any observational examine’s heel. Discovering an affiliation is one factor, however proving that one issue immediately causes one other is a distinct problem altogether. To make sure that the researchers chop away as many confounding components as doable, they monitor a large number of variables.

For example, they maintain anthropometric knowledge, equivalent to peak and weight; socioeconomic knowledge; details about contributors’ occupations in order that they’ll monitor potential environmental exposures to chemical substances, for example; medical historical past; present and previous medicines; exercise ranges; and extra.

The NutriNet-Santé scientists are starting to dive even deeper into the complexities of diet and well being. Past the dietary make-up of meals, they’re starting to research how the packaging may work together with meals objects and affect well being. Their revolutionary barcode system helps them collate this info.

These knowledge may even assist with investigating sustainability, which is one other space on which the group is starting to focus.

The wealth of information that the NutriNet-Santé group has collected and continues to gather will slowly permit scientists to reply more and more complicated questions.

Because the variety of contributors within the examine steadily grows, Dr. Touvier hopes that the NutriNet-Santé group can “proceed indefinitely.” Undoubtedly, the insights that this group generates may have a helpful impact on the well being of future generations.

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