Influence of socio-economic and lifestyle factors on overweight and nutrition-related diseases among Tunisian migrants versus non-migrant Tunisians and French

<p>Abstract</p> <p>Background</p> <p>Migrant studies in France revealed that Mediterranean migrant men have lower mortality and morbidity than local-born populations for non-communicable diseases (NCDs). We studied overweight and NCDs among Tunisian migrants compared to the population of the host country and to the population of their country of origin. We also studied the potential influence of socio-economic and lifestyle factors on differential health status.</p> <p>Methods</p> <p>A retrospective cohort study was conducted to compare Tunisian migrant men with two non-migrant male groups: local-born French and Tunisians living in Tunisia, using frequency matching. We performed quota sampling (n = 147) based on age and place of residence. We used embedded logistic regression models to test socio-economic and lifestyle factors as potential mediators for the effect of migration on overweight, hypertension and reported morbidity (hypercholesterolemia, type-2 diabetes, cardiovascular diseases (CVD)).</p> <p>Results</p> <p>Migrants were less overweight than French (OR = 0.53 [0.33–0.84]) and had less diabetes and CVD than Tunisians (0.18 [0.06–0.54] and 0.25 [0.07–0.88]). Prevalence of hypertension (grade-1 and -2) and prevalence of hypercholesterolemia were significantly lower among migrants than among French (respectively 0.06 [0.03–0.14]; 0.04 [0.01–0.15]; 0.11 [0.04–0.34]) and Tunisians (respectively OR = 0.07 [0.03–0.18]; OR = 0.06 [0.02–0.20]; OR = 0.23 [0.08–0.63]).</p> <p>The effect of migration on overweight was mediated by alcohol consumption. Healthcare utilisation, smoking and physical activity were mediators for the effect of migration on diabetes. The effect of migration on CVD was mediated by healthcare utilisation and energy intake. No obvious mediating effect was found for hypertension and hypercholesterolemia.</p> <p>Conclusion</p> <p>Our study clearly shows that lifestyle (smoking) and cultural background (alcohol) are involved in the observed protective effect of migration.</p

Influence des facteurs socio-économiques, de l'alimentation et des modes de vie sur les maladies non transmissibles liées à l'alimentation chez les immigrés tunisiens vivant en Languedoc-Roussillon

The available studies in France showed a paradox among Mediterranean migrant men: migration could have a protective effect on mortality and morbidity linked to nutrition-related non-communicable diseases (NR-NCD) compared with the population of the host country. This study focuses on the origin of this paradox, particularly on the influence of lifestyle on NR-NCD among Tunisian migrants.A retrospective cohort study was conducted to compare Tunisian migrant men living in Languedoc-Roussillon with two non-migrant male groups: local-born French and Tunisians living in Tunisia. Different risk factors (socio-economic level, lifestyles, diet quality) were tested as potential mediators for the effect of migration on overweight and morbidity. Moreover, the effects of acculturation and exposure to Tunisian socio-cultural norms on diet and physical activity were assessed.Tunisian migrant men residing in France enjoy better health with respect to overweight and NR-NCD than local-born French and non-migrant Tunisians. Thus, our study confirms the existence of a Mediterranean migrant paradox in France. On the one hand, cultural factors (lower alcohol consumption, better diet adequacy, higher fruit consumption) seem to be involved in the origin of the migrant paradox. On the other hand, environmental factors (more active lifestyle, less prevalent smoking) may partly explain the health advantages of migrants, compared with non-migrant Tunisians. Even if acculturation led to a convergence of some lifestyles to those of the host population, past and current exposure to socio-cultural norms of the home country helped maintain some positive aspects of the healthy traditional Tunisian diet.Les hommes immigrés d’origine méditerranéenne vivant en France ont des taux de mortalité et de morbidité pour les maladies non transmissibles liées à l’alimentation (MNTA) plus faibles que la population née en France. Cette étude s’intéresse à l’origine de ce ‘paradoxe méditerranéen des migrants’ et notamment à l’aspect ‘modes de vie’ dans l’apparition des MNTA chez les immigrés tunisiens.Une étude de cohorte rétrospective a été réalisée chez des hommes migrants tunisiens vivant en Languedoc Roussillon comparés aux Français nés en France et aux Tunisiens vivant en Tunisie. Différents facteurs de risque (niveau socio-économique, modes de vie, alimentation) ont été testés comme facteurs médiateurs de l’effet de la migration sur le surpoids et la morbidité. L’influence de l’acculturation et de l’exposition à la culture tunisienne sur l’alimentation et l’activité physique a aussi été évaluée.Les immigrés tunisiens ont un meilleur état de santé que les Français et Tunisiens non migrants. Notre étude confirme donc l’existence d’un paradoxe méditerranéen des migrants en France. D’une part, des facteurs culturels (faible consommation d’alcool, meilleure adéquation du régime, consommation de fruits élevée) semblent être à l’origine du paradoxe. D’autre part, des facteurs environnementaux (mode de vie plus actif, tabagisme moins prévalent) peuvent en partie expliquer le meilleur état de santé des migrants, comparés aux Tunisiens non migrants. Même si l’acculturation conduit à une convergence des modes de vie vers ceux de la population hôte, l’exposition à la culture tunisienne permet la conservation d'aspects positifs du régime traditionnel tunisien plus favorable à la santé

Socioeconomic Indicators Are Independently Associated with Nutrient Intake in French Adults: A DEDIPAC Study

Studies have suggested differential associations of specific indicators of socioeconomic position (SEP) with nutrient intake and a cumulative effect of these indicators on diet. We investigated the independent association of SEP indicators (education, income, occupation) with nutrient intake and their effect modification. This cross-sectional analysis included 91,900 French adults from the NutriNet-Santé cohort. Nutrient intake was estimated using three 24-h records. We investigated associations between the three SEP factors and nutrient intake using sex-stratified analysis of covariance, adjusted for age and energy intake, and associations between income and nutrient intake stratified by education and occupation. Low educated participants had higher protein and cholesterol intakes and lower fibre, vitamin C and beta-carotene intakes. Low income individuals had higher complex carbohydrate intakes, and lower magnesium, potassium, folate and vitamin C intakes. Intakes of vitamin D and alcohol were lower in low occupation individuals. Higher income was associated with higher intakes of fibre, protein, magnesium, potassium, beta-carotene, and folate among low educated persons only, highlighting effect modification. Lower SEP, particularly low education, was associated with lower intakes of nutrients required for a healthy diet. Each SEP indicator was associated with specific differences in nutrient intake suggesting that they underpin different social processes

Social disparities in food preparation behaviours: a DEDIPAC study

BACKGROUND: The specific role of major socio-economic indicators in influencing food preparation behaviours could reveal distinct socio-economic patterns, thus enabling mechanisms to be understood that contribute to social inequalities in health. This study investigated whether there was an independent association of each socio-economic indicator (education, occupation, income) with food preparation behaviours. METHODS: A total of 62,373 adults participating in the web-based NutriNet-Santé cohort study were included in our cross-sectional analyses. Cooking skills, preparation from scratch and kitchen equipment were assessed using a 0-10-point score; frequency of meal preparation, enjoyment of cooking and willingness to cook better/more frequently were categorical variables. Independent associations between socio-economic factors (education, income and occupation) and food preparation behaviours were assessed using analysis of covariance and logistic regression models stratified by sex. The models simultaneously included the three socio-economic indicators, adjusting for age, household composition and whether or not they were the main cook in the household. RESULTS: Participants with the lowest education, the lowest income group and female manual and office workers spent more time preparing food daily than participants with the highest education, those with the highest income and managerial staff (P < 0.0001). The lowest educated individuals were more likely to be non-cooks than those with the highest education level (Women: OR = 3.36 (1.69;6.69); Men: OR = 1.83 (1.07;3.16)) while female manual and office workers and the never-employed were less likely to be non-cooks (OR = 0.52 (0.28;0.97); OR = 0.30 (0.11;0.77)). Female manual and office workers had lower scores of preparation from scratch and were less likely to want to cook more frequently than managerial staff (P < 0.001 and P < 0.001). Women belonging to the lowest income group had a lower score of kitchen equipment (P < 0.0001) and were less likely to enjoy cooking meal daily (OR = 0.68 (0.45;0.86)) than those with the highest income. CONCLUSION: Lowest socio-economic groups, particularly women, spend more time preparing food than high socioeconomic groups. However, female manual and office workers used less raw or fresh ingredients to prepare meals than managerial staff. In the unfavourable context in France with reduced time spent preparing meals over last decades, our findings showed socioeconomic disparities in food preparation behaviours in women, whereas few differences were observed in men

Influence des facteurs socio-économiques, de l'alimentation et des modes de vie sur les maladies non transmissibles liées à l'alimentation chez les immigrés tunisiens vivant en Languedoc-Roussillon

The available studies in France showed a paradox among Mediterranean migrant men: migration could have a protective effect on mortality and morbidity linked to nutrition-related non-communicable diseases (NR-NCD) compared with the population of the host country. This study focuses on the origin of this paradox, particularly on the influence of lifestyle on NR-NCD among Tunisian migrants.A retrospective cohort study was conducted to compare Tunisian migrant men living in Languedoc-Roussillon with two non-migrant male groups: local-born French and Tunisians living in Tunisia. Different risk factors (socio-economic level, lifestyles, diet quality) were tested as potential mediators for the effect of migration on overweight and morbidity. Moreover, the effects of acculturation and exposure to Tunisian socio-cultural norms on diet and physical activity were assessed.Tunisian migrant men residing in France enjoy better health with respect to overweight and NR-NCD than local-born French and non-migrant Tunisians. Thus, our study confirms the existence of a Mediterranean migrant paradox in France. On the one hand, cultural factors (lower alcohol consumption, better diet adequacy, higher fruit consumption) seem to be involved in the origin of the migrant paradox. On the other hand, environmental factors (more active lifestyle, less prevalent smoking) may partly explain the health advantages of migrants, compared with non-migrant Tunisians. Even if acculturation led to a convergence of some lifestyles to those of the host population, past and current exposure to socio-cultural norms of the home country helped maintain some positive aspects of the healthy traditional Tunisian diet.Les hommes immigrés d’origine méditerranéenne vivant en France ont des taux de mortalité et de morbidité pour les maladies non transmissibles liées à l’alimentation (MNTA) plus faibles que la population née en France. Cette étude s’intéresse à l’origine de ce ‘paradoxe méditerranéen des migrants’ et notamment à l’aspect ‘modes de vie’ dans l’apparition des MNTA chez les immigrés tunisiens.Une étude de cohorte rétrospective a été réalisée chez des hommes migrants tunisiens vivant en Languedoc Roussillon comparés aux Français nés en France et aux Tunisiens vivant en Tunisie. Différents facteurs de risque (niveau socio-économique, modes de vie, alimentation) ont été testés comme facteurs médiateurs de l’effet de la migration sur le surpoids et la morbidité. L’influence de l’acculturation et de l’exposition à la culture tunisienne sur l’alimentation et l’activité physique a aussi été évaluée.Les immigrés tunisiens ont un meilleur état de santé que les Français et Tunisiens non migrants. Notre étude confirme donc l’existence d’un paradoxe méditerranéen des migrants en France. D’une part, des facteurs culturels (faible consommation d’alcool, meilleure adéquation du régime, consommation de fruits élevée) semblent être à l’origine du paradoxe. D’autre part, des facteurs environnementaux (mode de vie plus actif, tabagisme moins prévalent) peuvent en partie expliquer le meilleur état de santé des migrants, comparés aux Tunisiens non migrants. Même si l’acculturation conduit à une convergence des modes de vie vers ceux de la population hôte, l’exposition à la culture tunisienne permet la conservation d'aspects positifs du régime traditionnel tunisien plus favorable à la santé