Article pp.415-433 du Vol.21 n°4 (2001)

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CHAPTER 3

From nutrients to foods

1 - EVOLUTION OF FOOD CONSUMPTION IN FRANCE

1.1 Evolution of consumption and present consumption

1.1.1 Sources of data

Several sources of information can be used to try to describe the present state of food consumption and its modifications with changing life conditions. In this document, the following sources have been used:

• Per capita consumption based on agriculture production statistics have been compiled for many countries by several international organizations (FAO, OECD, EUROSTAT) for about forty years. These largely overestimate individual food consumption, since waste at different stages between production and ingestion are not taken into account. However, since these bias are estimated in a similar manner for most countries, studies can be made on geographical variations in food consumption as well as on their evolution with time.

• In France, a modified national per capita consumption survey is published annually by INSEE (National institute of statistics and economical studies) (INSEE, 1962 to 1998). These mean consumptions take into account commer- cial statistics, household budget statistics, consumption in institutions and out of the home are taken into account, as well as self-production. In spite of these adjustments, which give more precision to the per capita consumption, this type of statistics only give the apparent national mean consumption, which is, in general, still overestimated. However, as this kind of statistics has existed for a fairly long time, it can be used to study time trend of national food consumption.

Details of the changes in intakes of different food groups since 1950, according to this particular source, are given in table 1 and figure 1.

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• National household budget studies, based on weekly registration of food purchases, give a better approximation of individual consumption, on the basis of the family consumption, as well as geographical, socio-economic and generation influences (COMBRISet al., 1996; BABAYOUand VOLATIER, 1997). However, these statistics do not take into account the consumption of all individuals, of all kinds of food, or of quantities consumed out of the home.

• Investigations of individual food consumption, preferentially on representative population samples, give more precise information on current individual food consumption, although many possible biases, depending on the methods used, may introduce a distortion of the results. However, even if investigations on individual food consumption have been carried out for a fairly long time on specific samples of the population (HERCBERGet al., 1991a, b, 1998), up to now only a few investigations have been based on supposedly representative samples of the whole population (ASPCC: RIGAUDet al., 1997; Baromètre santé:

BAUDIERet al., 1997; INCA: VOLATIERet al., 2000). These surveys give the possi- bility to dispose of not only mean consumption but also individual, sex and age dependent variations, as well as geographical socio-economic influences, so as to define risk groups for under- or over-consumption of specific nutrients, for example.

The study of data from these different sources thus allows conclusions on several facets of food consumption, such as evolution of the consumption of specific food groups, general time trend, geographic and individual (age, sex…) variability, evolution in eating habits… (COLLET-RIBBINGand DECLOÎTRE, 1996).

1.1.2 Brief summary of the main characteristics of the consumption of different groups of foods (table 1 and figure 1)

• Bread, cereal products and potatoes

The consumption of this group has decreased strongly since 1950, except for some newer cereal products. Regional variation persists, with potato consumption dominant in northern France, pasta and rice consumption in the Mediterranean region. Consumption varies very strongly with age and sex, but also between individuals of the same age.

• Fruits and vegetables

The consumption of this group increases as the preceding group decreases, partially taking its place, especially concerning potato consumption. It is in the regions and age classes with low consumption of starchy food that the fruit and vegetable consumption is highest and vice versa. Nonetheless, the consumption of fruits and vegetables in age groups under 30 remains low.

• Meat and fish

Important consumption differences persist between European countries, between the French regions, between generations and individuals… and also in the relative proportion of food items in this group. Some male consumers have a very high intake of meat, sausages, pâtés, ham and/or offals.

• Milk products

Milk consumption is decreasing, but this decrease is partially compensated by an increase in the consumption of cheese and other milk products.

416 Sci. Aliments 21(4), 2001 Nutritional Recommendations for the French Population

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• Butter and vegetable oils

After a significant increase, fat consumption seems to be stabilized or even slightly decreasing in France, but the percentage of each kind of fat continues to change, with an increasing proportion of vegetable oils and a lower proportion of butter consumption. Rather strong differences persist as to the kinds of fats consumed in different parts of Europe and France. Older generations have a tendency to eat more fat. In fact, consumption out of the home seems not to contribute to fat consumption at a higher level than the overall consumption.

• Sugar and sugar products

The consumption of these products varies strongly from one country to ano- ther but has a tendency to increase with economic development. In France, total consumption increased considerably over a long period, but is now stabilized. However, the consumption of manufactured sweet products continues to rise, some of which are preferred by seniors, but chocolate products and sweet drinks are particularly favored by younger generation.

• Alcoholic beverages

Consumption of alcoholic beverages has decreased in all regions in France, especially concerning ordinary wine. Nonetheless, regional variations are still important, with higher levels of consumption in northern France, especially of beer and strong alcoholic drinks, while wine consumption remains highest in the south-west and Mediterranean regions. Older adults (but not elderly) have more drinks, especially of wine, but men consume much more than women. The younger generations often prefer beer, but teenagers also frequently choose strong drinks, and this consumption is increasing in this age class.

1.1.3 Time trends

Concomitantly with the elevation of the life standard in France, the consumption of energy in the form of bread and potatoes decreased (about 50%) from 1950 to 1997, but this decrease is partially compensated by a steep increase in the consumption of vegetables (100%) and fruit, although fruit consumption, culminating in 1985-1990, now seems to be falling.

The consumption of all kinds of milk products, especially elaborated ones, has increased (+ 350% for cheese consumption), as has fish consumption. On the other hand, meat consumption, which doubled from 1950 to 1990, is now decreasing, just as total sugar consumption, after a long period of continuous increase. However, there is a steep increase in the consumption of soft drinks.

The consumption of fat doubled from 1950 to 1980, but is now approxima- tely stable. Nevertheless, the structure of consumption continues to change:

butter consumption is decreasing while vegetable oil consumption is increasing in France, as in most other countries.

As for alcoholic beverages, consumption of ordinary wine, beer and cider is decreasing, while consumption of brandy remains stable and that of superior quality wine is rising.

On an individual level, the evolution between household studies in 1993 and 1997, as well as between ASPCC (1994) and INCA (1999), concerns in particular an important increase in the consumption of pastries, sweet rolls, pizzas,

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Table 1 Evolution of food consumption in France (1950-1997) Per capita consumption in kg or 1997 liters per year (adjusted values)1950195519601965197019751980198519901995base 1995 Bread01)121.7107.8100.087.480.376.870.666.363.459.659.6 Cereal products02)13.314.115.918.019.821.623.824.927.327.928.6 Potatoes152.7152.8126.5128.6125.6118.089.080.562.464.169.3 Pulses3.13.53.52.62.32.11.91.41.61.61.4 Vegetables03)59.568.082.299.1103.6108.4107.9114.2117.2118.8119.5 Fruits04)37.750.355.566.466.968.867.071.671.767.857.4 Meat05)44.453.460.565.971.274.886.088.890.985.386.2 Fish06)10.512.713.815.815.416.118.119.723.425.4– Milk, yogurt07)77.676.476.878.383.979.190.099.7104.599.1101.4 Cheese08)5.06.08.59.511.512.915.316.017.118.418.2 Butter, lard09)5.86.68.410.010.410.59.48.58.18.07.8 Vegetable oils10)5.26.37.68.68.18.310.811.311.412.913.1 Margarines11)0.91.21.61.91.92.02.32.42.32.12.3 Total fats12)11.814.117.620.520.420.722.622.321.822.923.1 Sugar13)13.215.117.022.023.220.219.616.914.714.413.9 Ice cream, frozen desserts*14)0.00.01.11.42.24.86.68.812.414.113.9 Soft drinks*8.310.39.713.419.024.523.727.735.837.538.8 Fruit juice, including nectar*0.10.40.91.92.41.92.63.76.810.811.4 Soft drinks and fruit juice*15)8.410.710.515.321.426.526.331.442.748.350.1 Beer, cider*50.451.550.847.648.851.251.747.046.144.341.6

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Table 1 Evolution of food consumption in France (1950-1997) Per capita consumption in kg or 1997 liters per year (adjusted values)1950195519601965197019751980198519901995base 1995 Wine, sparkling wine, sweet wine*16)123.4142.7132.8123.3111.1106.493.780.572.067.465.3 Aperitif drinks, fortified wine*17)5.54.23.74.84.35.15.94.84.9–– Brandy, liqueur*3.93.32.72.93.13.53.13.13.2–– Coffee18)3.13.43.73.93.94.54.74.34.44.34.6 *in liters 01) Prepacked bread not included from 1980. 02) Includes all kinds of flour, rice and cereal products other than bread. 03) Includes fresh and canned vegetables as well as frozen vegetables since 1970. 04) Includes citrus fruits, bananas, other fresh and frozen fruits, but not nuts, dried, stewed or canned fruits, jam, marmalade or fruit jelly. 05) Includes all kinds of fresh meat (including fowl, rabbit and game), ham and other cooked, canned or frozen meat, giblet or offal products. The weight indicated concerns products exempt of waste, as bought in retail shops. 06) Includes fresh, frozen and canned fish and shellfish. 07) Until 1960 only fresh milk. Since 1960 yogurt is included. Since 1980 milk-based desserts and cottage cheese are also included. 08) Other cheeses. 09) Butter, lard and other animal fats until 1975, since then only butter. 10) All vegetable oils 11) Margarines and other vegetable fats, oils excluded. 12) Total of the consumption of lines 9), 10) and 11). 13) Includes sugar bought as such, honey and sweets. Sugar as ingredient of purchased foods is not included. 14) Ice cream, water ice, frozen desserts, bulk or prepacked. 15) Soft carbonated drinks, fruit juice and nectars, but not mineral water. 16) Ordinary and vintage wine; champagne. Sweet wines included before 1980.

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Figure 1

Time trends in the consumption of some food categories: Food consumption in France since 1950

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quiches and sandwiches, fruit juice and soft drinks, pasta and dairy desserts.

(VOLATIERet al., 2000).

1.1.4 Geographic variability

In Europe, there is an important variability in the consumption of different foodstuffs, with a north-south gradient for several of them, such as cereal products, potatoes, vegetables, diary products, butter, margarine, sugar and wine.

For other kinds of foodstuffs, this consumption gradient is not apparent, for example for fruit, meat, fish and vegetable oil.

In France, there has been a steep decrease in the regional variability of food consumption over the last 45 years, but it persists, particularly for potatoes, fruit, vegetables, vegetable oil, butter, and alcoholic beverages.

1.1.5 Individual variability

There is a clear difference in the consumption structure between men and women and according to age. For example, men eat more bread, potatoes, meat, poultry, cheese, fat and wine than women, who drink more tea, milk and water. Juniors eat more dairy products, sweet drinks and other sweet products as well as pastry and pizza than seniors, who prefer soup, bread, cheese, fish, fruit and vegetables (INCA, VOLATIERet al., 2000).

1.1.6 Evolution in eating habits

The study of these different, aggregated categories of foodstuffs does not reveal the important changes related to the obligations of current lifestyles, which direct purchase habits toward more elaborated industrial products in order to reduce preparation time. This effect is more pronounced in younger generations (LAHLOU, 1989). As a consequence, consumption of pizza, quiche, pies, hot dogs etc. is clearly higher before the age of forty (ASPCC, RIGAUDet al., 1997) as well as for food intake out of home. On the contrary, the destructu- ration of meals and the decrease in the variety of food intake, perceived in young people, seems to concern only a small fraction of children and teenagers, cumulating risk behaviors (MICHAUD, 1998). The sequence of 3 to 4 meals a day, of varied composition is still applied by a majority of our contemporaries (LOUIS- SYLVESTRE, 1998; BELLISLE, 1995). Moreover, conviviality during mealtime is still appreciated by a great majority of juniors (ARÈNESet al., 1998).

As a whole, the evolution and the structure of the food consumption actually seems rather satisfying in the majority of the French population, but risk groups, justifying a preventive nutritional intervention, should be defined. The detailed analyses of individual food consumption studies presented in the following part of the chapter could help in this definition.

1.2 Dietary diversity and consumer typology

The power of statistics and computer science applied to existent individual dietary studies gives an opportunity to analyze in detail the diversity of food intake and to establish groups of consumers according to the typology of their dietary diversity. A method has been elaborated by OCA/CREDOC, the French food consumption observatory, and applied to a dietary study on a representa-

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tive sample of the population (ASPCC 1994: RIGAUD et al., 1997), associated with the French food composition database (FAVIER et al., 1995). At this time, only results from the ASPCC study can be presented, but the method has also been applied to a more recent study, INCA 1999, and might be applied to coming studies (INCA 2), thus giving an instant cross sectional food intake pat- tern in order to identify risk groups.

The influence of the typology and diversity of food consumption in terms of nutrient intake will be detailed in the next chapter.

1.2.1 Dietary diversity

USDA has elaborated an index for dietary diversity based on daily intakes, over one or several consecutive days, from five food groups: meat-fish-egg, milk products (excluding butter or cream), cereal products (including potatoes, but not pastry, cakes and cookies), fruits (including fruit juice and dried fruits) and vegetables (KANTet al., 1991).

When this method is applied to the results from the ASPCC dietary study, 55.8% of the individuals of the sample attain a maximal diversity index on only one day, 81.3% on two days. An asymptotic threshold, of more than 96%, is obtained after six to seven days of observation (VOLATIERet al., 1997). The analysis of these results identifies fruit and vegetable consumption as the cause of individual differences of diversity, particularly for one day of consumption.

Women have more frequently a maximal diversity on one day, and the percentage increases with age, from teenagers to the age of 64 years.

A regional variation is also observed, the diversity being higher in the western parts of France, and lower in the north and eastern parts (CHAMBOLLEet al., 1999).

On this basis, dietary diversity is higher in France than in the United States, where only 33.7% of consumers attain 5, the highest index, on a one day survey (NAHNES study). Still more important differences in dietary diversity between these two countries were identified using the Val-de-Marne study (1988-1994) (DREWNOWSKIet al., 1996).

1.2.2 Typology of consumers

The method elaborated by OCA/CREDOC on the basis of the ASPCC study allows to establish a typology of consumers over 18 years old based on all food intake during seven days. Instead of the very reducing 5 categories in the preceding analysis, the foods are grouped in 44 categories. Automatic statistical processing (analysis of principal components and ascendant hierarchic classification) individualizes 6 groups of consumers, on maximizing differences between groups and minimizing differences in consumption profiles inside the groups. On the basis on their “USDA dietary diversity” (five classes of foods) on day one, the six groups are attributed a number from 1 to 6, with the highest diversity in group 1 (69.3% of the subjects at index 5 on day one of the study) and the lowest diversity in the group 6 (only 41.7%). These variations of diversity are essentially due to the consumption of vegetables and fruit, for which the mean consumption is res- pectively 2 and 3 times higher in the group 1 than in the group 6. It is clear that other foods also contribute to the distinction between the six groups. The most important food intakes in the groups 1 and 6 are presented in table 2.

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The principal characteristics of the six groups are detailed as follows:

• Group 1, named “small and diversified female eaters”, constitutes 15% of the population sample studied, and is characterized by a low total energy intake, high fruit and vegetable consumption and frequent soup consumption. 80% are women, two thirds are over 45 years old, but in spite of the age, obesity is virtually absent — only 0.7% have a BMI > 30 kg·m^–2.

• Group 2, named “big and diversified male eaters”, 14% of the sample, with 35% of the group living in the Parisian area, is composed of 85% men in the ages of 25 to 54 years. Their diet is diversified (63% at index 5) but rich in energy, due to a high consumption of bread, butter, meat, sauces and sweetened products. Overweight and obesity are consequently frequent, with 45% of BMI > 25 and 10% of BMI > 30 kg·m^–2.

• Group 3, the “standard eaters”, 27% of the sample, has as principal characteristics consumption of most foods close to the total sample mean consumption and the absence of specific over-eating, with the exception of shellfish and mollusks (25% of the persons of this group come from the western parts of France, near the seaside). 38% of the retired people of the sample and 30% of the employees are attributed to this group. With 60% women, the sex distribution is, as in group 4, fairly equal, in contrast with the other groups. Age distribution is equivalent to group 1, but 38%

have a BMI > 25 kg·m^–2. This group might represent the traditional French diet.

• Group 4, the “young eaters”, represent 14% of the sample. They love sweet biscuits, rice, spaghetti, sodas and chocolate. 60% are males, 75% between 18 and 34 years old, 38% from the Parisian area. The prevalence of obesity is very low because of the age structure, but the major worry for this group is toward which typology they will evolve while growing older.

• Group 5, in the group of “small and hurried female eaters”, 70% are women and two thirds are in their procreative years. Their mean energy intake is identical with group 1, and in spite of a high consumption of sweet rolls, pizzas and quiches, the prevalence of overweight and obesity is weak. This group represents 18% of the sample and is characterized by a very low dietary diversity, (44% at index 5), especially alarming in this fertile period group.

• Group 6, the “big and monotonous male eaters”, represents 11% of the sample, with 90% males, in majority between 25 and 54 years old. This group is also characterized by a very low dietary diversity as well as by an over-consumption of alcoholic beverages (these represent in mean 20% of their total energy intake). Their favorite foods are cheese, ham, sausages, pâtés (generally very fat), offals, potatoes and coffee, resulting in a tendency to overweight and obesity (45% have a BMI > 25 kg·m^–2, 8.8% a BMI > 30 kg·m^–2), as in group 2. These dietary errors might in part be explained by the low mean level of education and incomes, since 44% of this group are workers and employees.

The impact of these typologies on nutrient intake and public health will be discussed in next paragraphs, as well as the possibilities to define specific risk groups, needing adapted preventive measures.

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Table 2

Average consumption of selected food categories in the two “extreme”

groups of consumers

g·d^–1, mean of 7 days

Small and Big and

diversified female monotonous male

eaters eaters

(group 1) (group 6)

Bread 71.1 142.5

Cereal products 14.1 6.8

Diary products 138.2 42.9

Milk 103.1 57

Cheese 30.7 53.8

Butter 12.9 24.4

Meat products 49.6 96.4

Ham 15.6 26.7

Pâtés, sausages 13.9 41.1

Fish 36.1 18.5

Fresh vegetables 199.4 95.1

Potatoes 33.8 81.5

Fruits 209.3 70.7

Beer and cider 11.2 206

Wine 49.2 391.3

Alcoholic beverages 2 31.8

Water 595.1 442.5

Coffee 144.3 385

Hot drinks 236.6 28.1

Composite dishes 17.8 39

Soups 81.7 41

This table only takes into account the foods for which the differences are the most important between these two groups.

2 - WELL-BALANCED DIET AND SATISFACTION OF REQUIREMENTS

Man eats foods and not nutrients; thus, it is important to assess whether dietary habits, in conformity with recommendations of dietitians, can satisfy present requirements in the current food context. Original research works have been carried out, using data from a nationwide representative dietary survey (ASPCC survey: RIGAUDet al., 1997). The survey has been done over the year 1994 on a representative sample of 1,500 individuals, using 7-d weighed dietary records. Some of the results have been verified (especially for food patterns) using data of the recent INCA survey (VOLATIERet al., 2000), performed over the year 1998, which used 7-d dietary records and a food photograph booklet on 2,000 individuals over age 15.

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Children 6-10 y Adolescents

14-18 y Adults

> 62-65 y Adults 18-65 y

Table 3

Nutritional status of different groups of the French population according to recent surveys

Risk of deficiency or excess in different groups of the French population

Age Sex Risk of deficiency Requirement

Risk of excess satisfaction

Men B₆ B₁, B₂, PP, B₉, B₁₂, C B₁₂

(β-carotene) A, E A, retinol, (β-carotene) (Zn), (Cu), iodine Ca, Fe Ca∞∞, (Zn)∞, iodine***

Mg (?)

Women B₆ B₁, B₂, PP, B₉, B₁₂, C B₁₂ (Zn), (Cu), iodine A, (β-carotene), E A, retinol

Ca, Mg (?) Fe (1) Ca∞∞, (Zn)∞∞,

iodine***

Men B₁, C B₂, PP, B₉, B₁₂ B₁₂

(β-carotene) A, E Retinol

Ca, Mg, (Zn), (Cu) Fe (Zn)∞

Women B₁, B₆, C PP, B₉, B₁₂ B₁₂

Ca, Mg, (Zn), (Cu) (β-carotene), E (β-carotene)

Fe (Zn)∞

Boys (β-carotene), E B₁, B₂, PP, B₉, B₁₂, C B₁₂

A A, retinol

Fe (Zn)∞

Girls B₆ B₁, B₂, PP, B₉, B₁₂, C B₁₂

E A, (β-carotene) Retinol

Ca, Fe, (Cu) (Zn)∞

Boys B₁, B₂, B₆, PP, B₉, B₁₂

B₁₂, C, A, E A, retinol (β-carotene) Ca∞∞, (Zn)∞ Ca, Fe, Mg, (Cu)

Girls B₁, B₂, PP, B₆, B₉ B₁₂

B₁₂, C, A, E Retinol (β-carotene) Ca∞∞, (Zn)∞∞

Ca, Fe, Mg

Risk of insufficient intake: median intakes < 0.9 ANC and more than 10% of the population below the biological threshold of deficiency.

Satisfactory intakes and status: median intakes above or equal to 1 ANC and/or less than 10% of the population below the biological threshold of deficiency.

Risk of excessive intake: median intake above 1.5 ANCs and 95^thpercentile above 5 ANCs and/or the highest intakes above 10 ANCs or:

∞above the upper safety limit defined by CSHPF (notice of September 12, 1995).

∞∞intakes above 2 ANCs at the 95^thpercentile and/or above 4 ANCs at the highest intake.

*** for iodine, above the biological threshold of 350-500µg·L^–1defining the risk of toxicity.

() In brackets: nutrients for which food content is still not precise (zinc or copper) and/or requirements not well known (copper) or for which ANCs have been estimated (β-carotene = 60% as retinol equivalent in the ANCs of total vitamin A).

(1) Except between the ages 18 and 30.

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According to the Barometer on Health and Nutrition (BAUDIER et al., 1996), 72% of French people think they have a well-balanced diet (including 7% with a

“very well-balanced” diet!); in all, 76% think that they are well or very well infor- med about nutrition. However, when macronutrient intakes are compared to current worldwide recommendations, only 14% obtain less than 35% energy as fat and, moreover, only 5% also obtain more than 50% energy from carbohydrates. In a pan-European survey (IEFS, 1996), French people were the worst pupils of Europe: only 17% (vs. 41% in the remaining European countries) declared that fruits and vegetables were constitutive of a healthy diet and 29%

(vs. 48% in other European countries) also mentioned “decrease in fat intake”.

An analysis of recent French nutritional surveys concludes that, on average, requirement satisfaction is achieved at the population level, though there is a persisting deficiency risk for some nutrients in some groups, not precluding risk of excessive intakes for some (or the same) nutrients in the same groups (POTIER de COURCY et al., 1999; table 3). Analyses performed with data of nationwide representatives surveys or computer simulations are useful tools to unravel complex issues dealing with links between food intakes and nutrient requirements.

2.1 Study of diet diversity

According to the diversity index set forth by USDA (KANTet al., 1991), a diet is diversified (index 5) when foods from 5 groups are consumed every day (meat-fish-eggs, milk and milk products, fruits, vegetables, cereals and cereal products). The comparison of nutrient intakes in 670 individuals having the maximal diversity on the first day of the survey to that of 466 people having

Carotene Retinol Vit. A Vit. B2 Vit. B6 Vit. B9 Vit. C Vit. D Vit. E Ca Iron Mg Fibres

Figure 2

Influence of food diversity on requirement satisfaction

Micronutrient intakes are compared either to present ANCs or to regulatory dietary reference values (AJR: apports journaliers recommandésfor vitamins B2, B6, D, E, Ca, Mg), to limit the extent of ordi- nate scale.

120 100 80 60 40 20 0

low diversity high diversity

% AJR/ANCs

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One dairy product(varying fresh dairy products and cheeses) (1,2,3) Meator ham(4), fish or seafood(3,4)

and/or from time to timeegg (1,3), warm processed meats, liver paste (1,4) or liver (at most once a week) (1,4)

Vegetables** (1) cooked: green beans, peas, spinach, Belgian endives, courgettes, cauliflower, tomatoes, carrots, mushrooms… (fresh, frozen, or even canned)

or

potatoes, rice, pasta, legumes (1,4), chestnuts, corn, chickpeas (1) with green salad or raw vegetables (including avocado and melon) or vegetable soup (1,5)

1 fruit in season (apple, pear, berries, grapes, apricots, peaches…) (1,5) + 1 citrus fruit(1,5), + possible dry fruit (1,4)

Sweet dessert or sweet roll

Bread: vary types of bread, preferably with cereals Fats (varied vegetable oils, butter, cream, margarine…) Water(if mineral or spring water, vary the sources) Use iodine enriched salt (3)

* Vitamin C facilitates iron absorption; it is thus recommended to consume foods containing these two nutrients at the same meal.

** Frozen vegetables are as recommended as fresh vegetables for their folic acid content; in both cases, overcooking should be avoided.

Table 5

Results of the simulation of dietetic recommendations using representative consumption data for young women

Vitamin A 1,870 µg Vitamin B₂ 1.8 mg

Vitamin B₆ 1.5 mg Vitamin B₉ 297 µg

Vitamin C 99 mg Vitamin D 2.3 µg

Vitamin E 8.9 mg Calcium 1,049 mg

Iron 10.4 mg Magnesium 259 mg

Fibres 17 g β- carotene 3,052 µg

Theoretical average intakes of some nutrients obtained by following current nutritional recommendations concerning types and frequencies of various foods (results from computer simulation using representative consumption data for young women).

Table 4

Frequency of consumption of foods allowing an adequate supply especially for folic acid (1), calcium (2), iodine (3), iron (4) and vitamin C (5)

At each of the three principal meals Once a day

Twice a day

Once of each kind every day At most once a day At every meal Preferably raw As much as wanted

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index equal or less than 3 indicates that nutrient intakes are constantly higher for the former than for the latter, except for ubiquitous vitamins and iron. This is particularly clear for carotene, folic acid and vitamin C, since fruits and vege- tables are the most often missed foods in a low-diversity diet (figure 2). On the first day of the survey, 55.8% of the subjects were at index 5.

2.2 Simulation studies

Using representative data on dietary habits, it was possible to calculate the amounts at the population level of nutrients provided by following general recommendations made by dieticians on type and frequency of principal food categories. Taking into account consumption data for food repartition within each group listed in table 4 and usual portion sizes, virtual foods were built, from which nutrient intakes were estimated by applying recommended frequencies. For example, a dairy product is built from x g whole milk + y g skimmed milk + z g yogurt + … The results of this simulation for young women are displayed in table 5.

2.3 Linear programming studies

Linear programming consists in the automatic building of diets from a food database, with respect to fixed constraints, such as food diversity, portion sizes (for acceptability of the diet), respect of ANCs and cost (DARMON and BRIEND, 1999). The principal conclusions are the following:

– Satisfaction of ANCs is possible with an energy supply of 1,800 kcal·d^–1for women and 2,200 kcal·d^–1for men, assuming strict constraints on macro- nutrients (30-35% fat, > 50% carbohydrates, 10-15% proteins). It is necessary to use portion sizes at the 95^th percentile, since some foods that appear to be necessary at this level of energy consumption are not consumed by a large majority of the population (such as liver, some fishes or shellfishes).

– With lower constraints (fat 20-37%, carbohydrates 45-70%, proteins 10- 18%), diets satisfying ANCs can be built with 1,500 kcal·d^–1 (women) or 1,700 kcal·d^–1(men).

– In these last diets, minimal intake of proteins is 65 g·d^–1(women) and 75 g·d^–1 (men), which is less than current intakes, but above ANCs for proteins.

– Some recommendations are more difficult to satisfy: iron and vitamin D for women; copper for men; zinc, magnesium and vitamin E for both genders.

To satisfy these recommendations with the current food supply implies that intakes for some other nutrients are far above ANCs (3 times for carotene, vitamins A and PP, and up to ten times for vitamin B12). Satisfying recommendations for these nutrients implies that all other recommendations are equally satisfied.

– Compared to current dietary habits, the lowest energy diets satisfying recommendations contain less meat and animal fats, but more fish, fruits and vegetables, roots and dried vegetables.

– It costs 4.6 euros to satisfy ANCs, respecting dietary habits of the French population. This can be decreased to 2.7 euros with diets rich in dairy products, roots, dried vegetables, liver, and vegetable oils. This incompres-

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sible minimal price can be reached only with a sound knowledge of food nutritional quality and prices and, moreover, of cooking skills.

2.4 Study of food consumption patterns

Consumption patterns were described in paragraph 1.2.2 from data of the ASPCC survey. In the INCA study (VOLATIER et al., 2000), “young eaters” and

“small and hurried female eaters” cannot be distinguished and are combined in a single group of “young and hurried eaters”, representing 29% of the population.

In groups 2, 3 and 6, having an average caloric intake above 2,200 kcal·d^–1, requirements are satisfied; however, for the group of “small and diversified female eaters”, requirement satisfaction is achieved despite a low caloric intake (1,800 kcal·d^–1), in contrast with the high risk of deficiency observed in the group of “small and hurried female eaters”. In the latter, with the same caloric intake (1,800 kcal·d^–1) as the former group, folic acid (mean 200 µg·d^–1) and calcium (mean 600 mg·d^–1) intakes are of particular concern, because there are many young women in this group, for whom pregnancy would eventually begin in conditions of low stores for very essential nutrients. Due to the fact that there is a clear difference between the two groups for the diversity index, the figures for ANCs satisfaction are very similar to those depicted in figure 2. Considering general nutritional data, the most striking differences between the six groups consist not in macronutrient repartition, but in energy density of the diet (table 6).

Table 6

Nutritional data for the six typologies from the ASPCC survey

Group 1 Group 2 Group 3 Group 4 Group 5 Group 6

Diversity index* 69.3 63.1 60.2 46.5 44.3 41.7

Total daily energy (kJ·j^–1) 7,882 11,928 8,178 9,545 7,522 11,711 Energy without alcohol (kJ·j^–1) 7,667 11,194 7,698 9,351 7,128 9,973

% provided by carbohydrates 41.9 41.2 40.2 45.0 42.7 41.5

including% by simple sugars 12.6 11.3 11.4 15.3 12.7 10.2

% by fat 39.5 42.1 41.4 38.6 39.8 40.9

% by proteins 18.6 16.7 18.4 16.4 17.5 17.6

Total food weight (g·j^–1)** 1,345 1,534 1,129 1,392 1,012 1,176

Energy density (kJ·g^–1) 5.7 7.3 6.8 6.7 7.04 8.5

(excluding alcohol)

% BMI > 30 kg·m^–2 0.4 9.7 5.6 0.9 1.3 8.7

* Percentage of individuals with and index = 5 on the first day of the survey.

** Including milk, fruit juices, sodas and soup, but excluding alcoholic beverages, tea and coffee.

2.5 A new representation of diet balance

Taken together, these studies are convergent and demonstrate that requirement satisfaction is possible at the population level with usual foods, by appli- cation of simple and traditional recommendations from nutritionists. The satisfactory global nutritional status of the French population (POTIER DE

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COURCYet al., 1999; table 3) must not mask, however, the obvious existence of groups at risk of insufficient intakes and insufficiency diseases. Typology analysis is an interesting tool to better characterize these groups and define tools for correction.

Figure 3 The dietary sailing ship Vegetables

V.

Dairy products D.P.

D.P.

Fish and meat F.M.

F.M.

Animal fats A.F.

A.F.

V.O.

Vegetables oils

Water Fruits

Fr.

Starchy foods St.F.

St.F.

Sweets S.s.

S.s.

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Since a well-balanced diet is necessary for satisfaction of nutrient requirement, any tool that could make significant deviation evident would be valuable.

Many representation of “ideal” diets are used throughout the world, among which different versions of a pyramid are the most popular (Mediterranean pyramid, pyramid from WHO or USDA… WILLETet al., 1995). We propose a new representation in the form of an alimentary sailing ship, as a dynamic, pedago- gic and ludic tool to illustrate individual diets, via its construction using an inter- active program available on the AFSSA website (www·afssa·fr/dossiers/ANCs) (figure 3). The importance of fruits, vegetables, and other products rich in com- plex carbohydrates are emphasized by the representation as sails pushing the ship forward; moreover, the necessity of water is clearly illustrated. The color code is the traditional code used in France for food categories by the French Committee for Health Education (CFES, Comité français d’éducation pour la santé).

3 - CONCLUSION

Many questions remained unanswered and, especially, future results of intervention studies could lead to modifications of ANCs. However, many more efforts than today should be devoted to research on global diets, including frac- tionation between meals and dietary rhythms, since focusing on only a few essential nutrients could divert attention from the necessary balance of the whole diet or lifestyle. This could be deleterious for public health and lead to the disappearance of the French cultural specificity, that is the pleasure of eating tasteful foods in a pleasant, human ambiance (ROZINet al., 1999), which seems also to be not so bad for health.

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