By Emily Roberts

The United States is able to utilize government assistance to support various programs to help improve the nutritional status of our nation. There is a safety net of several programs to improve public health via nutrition. Prolonged consequences of an unhealthy lifestyle including obesity, heart disease and type II diabetes are being seen in other countries as well. As I am currently residing in the south of France for seven months to teach English, I have the opportunity to discover how another country is tackling the public health problems associated with nutrition.

Chronic Diseases in France

Worldwide we are seeing an increase rate of health disparities. Cardiovascular disease, obesity and type II diabetes are three main common ailments and are often preventable. Cardiovascular disease is the leading cause of death worldwide (1). Now in the 21st century over 30% of the world’s population suffers from heart disease. Interestingly enough in France, heart disease mortality isn’t as high as other 1st world countries (2). Despite a diet rich in saturated fats and cholesterol, the incidence of heart disease remains low (3). While heart disease may not been the main concern, circulatory disease remains an issue, being the second leading cause of death in 2012 after cancer (2). In 2014 25.7% of the French adult population was obese (4). Comparing this to the United States at 35% they aren’t too far behind (5). Type II diabetes is drawing attention as well as a health issue. In 2009 7.0%- 7.5% of the French population had type II diabetes in comparison to about 10.41% of the United States Population (6,7). France is addressing currently addressing these problems and taking on tactics similar to the United States by promoting preventative methods.

Le Programme National Nutrition SantÉ (PNNS)

Manger Bouger translates to Eat and Move. It is supported by Programme National Nutrition SantÉ (PNNS) meaning a national nutrition and health program (8). PNNS began in 2001 with the objective to improve public health and reduce the incidence of chronic diseases by improving nutritional practices. The goals of PNNS assess different social, cultural, cognitive and economic disparities when trying to improve the nutritional status and the level of physical activity of France. Under the umbrella of PNNS there are a few specific programs. In 2010, the French government has implemented un plan obÉsitÉ (PO) (an obesity plan) and also un programme national pour l’alimentation (PNA) (a national food program).

Manger Bouger

Similar to the US’s ChooseMyPlate, the Manger Bouger site offers a plethora of helpful nutritional information to the public (9,10). It stresses to regularly eat a diet mixed in fruits, vegetables, grains and fish; limit salts, sugars and fats and to participate in regular physical activity (10). It explains to the public how these healthy lifestyle choices can reduce your risk for many chronic ailments. The site also briefly mentions to read nutrition facts labels, but there is little assistance on how to understand this information. Furthermore, the format for Nutrition Facts in France is very different and hard to interpret given the main point that there are often no serving size portions and only 100g portion sizes. While, there is no software on the site similar to SuperTracker or any type of diet assessment tool, there is La Fabrique à Menus, which helps to plan out a daily menu of various healthy dishes. Manger Bouger also includes a blog titled “Le Mag” which includes tips on how to enjoy the many rich flavors of France or eating on a budget, while still eating healthy.

My experience

Living in France, I have witnessed how important cuisine is to the French population. A prime example is how each region has traditional dishes tied closely to their culture. In Nice a popular dish is socca, a chickpea pancake, and in SÈte you cannot walk a block without finding tielle, a savory fish tart. Manger Bouger embraces this by providing general nutritional practices like consuming smaller portions, while keeping the tradition of French cuisine alive. Manger Bouger only offers specific meal advice for lunch and dinner (11). This is most likely because a typical French breakfast or petit dÉjeuner is only a slice of bread or a croissant and a coffee. Snacking in France is also less common. While in America five small meals a day can be seen as a healthy eating habit, this would not be ideal for the French as they value their meal time as a time to relax and experience their food. Unfortunately, the French do not seem to draw much attention to the specific nutritional content of their food. Consequently the general public does not seem as well educated on their daily caloric intake and the nutritional makeup. This could be due to the fact that they seem to focus more on reducing portion sizes and over eating rather than changing the composition of their diet.

1.http://www.who.int/mediacentre/factsheets/fs317/en/

2.http://ec.europa.eu/eurostat/statistics-explained/index.php/File:Causes_of_death_%E2%80%94_standardised_death_rate,_2012_%28per_100_000_inhabitants%29_YB15.png

3.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1768013/

4.https://www.cia.gov/library/publications/the-world-factbook/geos/fr.html

5.https://www.cia.gov/library/publications/the-world-factbook/geos/us.html

6.http://www.changingdiabetesbarometer.com/diabetes-data/countries/France/fact-sheet.aspx

7.http://www.changingdiabetesbarometer.com/diabetes-data/countries/usa.aspx

8.http://www.mangerbouger.fr/pnns/le-pnns-c-est-quoi.html

9.http://www.choosemyplate.gov/about

10.http://www.mangerbouger.fr

11.http://www.mangerbouger.fr/bien-manger/la-fabrique-a-menus.html#menu

12.http://ec.europa.eu/eurostat/statistics-explained/index.php/Causes_of_death_statistics#Further_Eurostat_information

13.http://www.euro.who.int/__data/assets/pdf_file/0004/185215/Leading-causes-of-death-in-Europe-Fact-Sheet.pdf

By Allison Dostal, PhD, RD

The relationship between nutrition and health is fully entrenched in the mainstream media – everyone from career scientists to our next door neighbor seems to be an expert on the topic. Trained health professionals and researchers do our best to deliver credible information, but it’s all too easy for clear messages to get lost in the constant stream of 30-second sound bites.

Dr. Andrew Brown, a Scientist with the University of Alabama-Birmingham’s Nutrition Obesity Research Center (NORC) & Office of Energetics, is focusing his current work on illuminating common misconceptions in the field of nutrition and increasing awareness of media perspectives and biases. I recently had the opportunity to ask him a few questions related to research integrity, science communication, and being a part of the next generation of nutrition researchers and educators working to effectively deliver nutrition information in the Digital Age.

Tell us about your work with NORC and the Office of Energetics.

The majority of my work is in the field of meta-research, which can involve investigating what was studied, why it was studied, and how it was studied. In addition to the more common forms of meta-research, like systematic reviews and meta-analyses, I look at the way that research is conducted, the quality of reporting, analytical choices during statistical analysis, and from where nutritional zeitgeist comes despite little strong empirical evidence.

How did you become interested in calling attention to myths, presumptions, and reporting accuracy of nutrition research?

As a student studying lipid chemistry, I noted that most lipid biochemists (as well as many others) recognized that dietary cholesterol had little impact on blood cholesterol, and yet cholesterol-containing foods were demonized. During my doctoral degree, I attended the Office of Dietary Supplements’ Research Practicum, where I anticipated learning what was and was not known about the health impacts of dietary supplements. Instead, and to my benefit, much of the talk was about limitations of current research, regulatory limitations, and differences in philosophies about how diet – and particularly supplements – could be studied. Claims about dietary cholesterol and supplements are just some of the dietary beliefs that are either completely refuted by our best science or at best weakly supported; yet, many people within and beyond the nutrition science community believe them. Thus my interest is at least two fold. The first is trying to determine which beliefs I hold that are not supported by the evidence, such as the relationship between eating/skipping breakfast and obesity. The other is to help communicate the state of science to hopefully decrease confusion.

With the attention that your research group is calling to this movement, how do you see publication and the media’s attention to nutrition changing in the next 5-10 years?

I am optimistic that nutrition science will continue to improve, including more discussions of the nuances of nutrition science rather than speaking in absolutes. If we ‘know’ that sugar is bad, or polyunsaturated fats are good, or that breakfast prevents obesity, then there is nothing left to study. Because of human heterogeneity within ever-changing local and global environments, it is unlikely that there is one diet or one set of recommendations that is appropriate for everyone and every situation, even for essential nutrients. Population-level recommendations are great place-holders until we develop more refined recommendations for individuals, subgroups, food-types, food-compositions, and other aspects of diet.

In a recent ASN blogger interview with Paul Coates, the Director of the NIH Office of Dietary Supplements, he stated with regard to the aging of the nutrition researcher population, “A fairly urgent challenge is identifying people who can come up behind us and continue to identify opportunities for research—particularly those that have public health implications— and be committed to help tackle them.” What are your thoughts on strategies for engaging young nutrition researchers in scientific discourse? How can young researchers take part in a dialogue with fellow scientists, the media, and the public to improve communication and perception of nutrition research?

I think we need to keep our eyes open for promising individuals that we can trust to think scientifically and ethically, and help them grow in a tailored way. The increased use of Individual Development Plans seems to be a great step in this direction, as is putting a maximum number of years on post-doctoral training, with the idea that a post-doctoral position is for additional training, not for an indefinite job. I have been extremely fortunate to have had mentors that gave me opportunities to speak, develop ideas, and truly contribute to teams and discussions throughout my formal education, as early as my freshman year. I was encouraged to write grants, publish, and complete other essential activities in the business of science, but my mentors focused very much on teaching me how to ask scientific questions; read the existing literature; develop critical scientific thinking skills; communicate with precision; and conduct good science.

On the side of mentees and students, I think it is important to be inquisitive while being willing to admit if you don’t know something. Stating confidently something that is false is a great way to lose trust and be excluded from the discussion. Instead, ask for clarification; add information to the conversation that might be useful; and, most importantly, don’t force yourself into discussions just to be noticed.

I also think it is important to move away from research focusing so heavily on public health (with the full disclosure that I work in a School of Public Health). Improvements in the public’s health is a noble and lofty goal, but to come into a study with the assumption that the outcome will result in an improvement in public health (particularly the entire population’s health) encourages overstating of results, misinterpretation of data, and doubling-down on dietary preconceptions. In science, the focus needs to be on determining some form of objective truth or lawful relationship. If we can identify these truths and relationships, then ways to improve public health will become self-evident, with the understanding that policy decisions are based on value structures beyond scientific evidence.

What advice do you have for graduate students and early career investigators?

Make sure you are doing something you love, that you do it to the best of your ability, and that you do it with the highest integrity. Be sure anything you put your name to is something that you are willing to take credit for, but also understand that this means you will be responsible for shortcomings of the work if problems are discovered later. And always be willing to entertain and evaluate an idea, especially one you disagree with or find unpalatable; these could be the very ideas that lead you to new lines of work, may help you better communicate your ideas to those who disagree with you, or might even overturn your entire view on a subject. As Aristotle said, “It is the mark of an educated mind to be able to entertain a thought without accepting it.”

By Christopher Radlicz

Currently, only one-quarter of pregnant women in the United States are eating the amount of fish recommended for optimal maternal and child health (1). On the other end of the spectrum, about 10% of women of childbearing age have higher than recommended blood mercury concentrations (2).

A qualitative study done in 2010 has helped explain why women may be consuming less than the recommended two-servings of fish per week (1). Pregnant women in the Boston area, who under-consumed fish according to these guidelines, were broken into focus groups and discussed what was keeping them from eating more fish. These groups revealed that many women knew that fish might contain mercury, but were naïve of the fact that fish contained beneficial fatty acids, such as docosahexaenoic acid (DHA), which is essential for optimal fetal brain development (3). The women admitted that they hadn’t received advice to eat more fish or more specifically to eat fish that contain lower amounts of mercury and higher amounts of beneficial fatty acids. Instead, the women confessed that they were advised to limit fish intake due to possible mercury exposures.

Are these women misguided in keeping their fish consumption below the recommended two-servings per/week during pregnancy?

This past February, The 2015 Dietary Guidelines Advisory Committee reiterated that women who are pregnant, nursing, or are planning to become pregnant should still consume fish because neither the risk of mercury nor other organic pollutants outweigh the benefits (4). In a recent New York Times article on the issue, Dr. Steve Abrams, medical director of the Neonatal Nutrition Program at Baylor College of Medicine and panel member on the advisory committee commented on tuna consumption, explained, “The benefit of having (omega-3 fatty acids) in your diet really exceeds the likely risk of contamination. The point is that you should have a variety of types of seafood and not limit yourself to one type, and variety includes canned tuna.”(5).

The intake of fish during pregnancy is certainly more nuanced than simple elimination from the diet due to potential mercury exposure. Fish contains essential nutrients proven to have beneficial effects on brain neurodevelopment and may prevent cardiovascular disease (6). These benefits have been attributed in part to the long chain polyunsaturated fatty acids (LCPUFAs), DHA and eicosapentaenoic acid (EPA), but in addition seafood is a good source of protein, selenium, iron, iodine, choline, and vitamins E and D (4,7). These LCPUFAs are essential throughout pregnancy but are critical from the beginning of the third trimester until about 18 months after birth when the human brain is growing the fastest. Neglecting to supply LCPUFA among other nutrients during this period may result in deficits in brain development (9).

That being said, mercury exposure is a real possibility. Methylmercury is the organic form of mercury that we are exposed to when consuming fish in our diet. This form of mercury is relatively stable, mobile within the body, and exhibits a high potential to damage the brain (8). Mercury poisoning outbreaks in Japan are a testament to the wide spread damage that can occur from exposure to methylmercury, resulting in infants born with serious neurological damage, even when mothers were seemingly unaffected (10).

Extreme exposure to mercury in the food chain as in the case of Japan is a rather isolated instance though. But what is the balance? Do the beneficial effects of fish counteract the adverse effects of toxicants?

In the literature, detection of methylmercury exposure in infants is typically done by measuring levels in maternal hair, maternal toenails, cord blood, and maternal blood. These methods are variable in measuring biomarkers and on certain occasion, can be imprecise (5,7). Additionally, many observational studies do not statically control for negative confounders. This means that majority of the cohort studies done in this field have focused on either the risk of methylmercury or on nutrient benefits but not both (7).

All of the complications in study design and analysis show the complexity of establishing recommendations from these studies. Even with good study designs, clear-cut recommendations as to how much fish pregnant women should eat may still not be feasible, due to the variability of toxicants in seafood species. Empowering pregnant women by informing them of seafood that is lower in mercury levels and higher in LCPUFAs is a practical solution. A pertinent rule to apply when making seafood choices is that small sea creatures, which live shorter lives and are lower on the food chain, tend to be the lowest in methylmercury levels and exponentially higher in LCPUFAs. Larger seafood, on the other hand, tends to have higher levels of methylmercury due to a longer lifespan and their higher settlement on the food chain allowing for an accumulation of more methylmercury. The Dietary Guidelines Advisory Committee is in consensuses with the FDA and EPA in advising pregnant women to avoid eating these larger fish, such as swordfish, tilefish, shark, and king mackerel due to their high levels of methylmercury (4,7).

References:

1.Bloomingdale A, Guthrie LB, Price S, Wright RO, Platek D, Haines J, Oken E. A qualitative study of fish consumption during pregnancy. Am J Clin Nutr 2010; 92: 1234-40. doi:10.3945/ajcn.2010.30070

2.Mahaffey KR, Clickner RP, Bodurow CC. Blood organic mercury and

dietary mercury intake: National Health and Nutrition Examination

Survey, 1999 and 2000. Environ Health Perspect 2004 ;112:562–70.

3.Koletzko B, Cetin I, Thomas Brenna J. Dietary fat intakes for pregnant

and lactating women. Br J Nutr 2007;98:873–7.

4.United States Department of Agriculture. Scientific Report of the 2015 Dietary guidelines Advisory Committee. Washington, DC. 2015.

5.Parker-Pope T. (2015, March 2). Should Pregnant Women Eat More Tuna. The New York Times. Retrieved from http://www.nytimes.com. http://well.blogs.nytimes.com/2015/03/02/should-pregnant-women-eat-more-tuna/?r=0

6.Anon. The Madison Declaration on Mercury Pollution. Ambio 2007;36:62–65. [PubMed: 17408191]

7.Choi AL, Cordier S, Weihe P, Grandjean G. Negative Confounding in the Evaluation of Toxicity: The Case of Methylmercury in Fish and Seafood. Crit Rev Roxicol. 2008; 38: 877-893. doi:10.1080/10408440802273164.

8.Clarkson CW, Vyas JB, Ballatori N. Mechanisms of Mercury Disposition in the Body. American Journal of Industrial Medicine 2007;50:757-764.

9.Innis SM. Essential fatty acids in growth and development. Prog Lip Res 1991; 30: 39.

10.Harada M. Minamata Disease: Methylmercury Poisoning in Japan Caused by Environmental Pollution. Crit Rev Toxicol 1995;25:1–24.

11.Hibbeln JR, Davis JM, Steer C, Emmett P, Rogers I, Williams C, Golding J. Maternal seafood consumption in pregnancy and neurodevelopmental outcomes in childhood (ALSPAC study): an observational cohort study. Lancet 2007;369:578–585.