Dietary index based on the Food Standards Agency nutrient profiling system and risk of Crohn's disease and ulcerative colitis

Background: Nutri-score is now widely available in food packages in Europe. Aim: To study the overall nutritional quality of the diet in relation to risks of Crohn's disease (CD) and ulcerative colitis (UC), in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Methods: We collected dietary data at baseline from validated food frequency questionnaires. We used a dietary index based on the UK Food Standards Agency modified nutrient profiling system (FSAm-NPS-DI) underlying the Nutri-Score label, to measure the nutritional quality of the diet. We estimated the association between FSAm-NPS-DI score, and CD and UC risks using Cox models stratified by centre, sex and age; and adjusted for smoking status, BMI, physical activity, energy intake, educational level and alcohol intake. Results: We included 394,255 participants (68.1% women; mean age at recruitment 52.1 years). After a mean follow-up of 13.6 years, there were 184 incident cases of CD and 459 incident cases of UC. Risk of CD was higher in those with a lower nutritional quality, that is higher FSAm-NPS-DI Score (fourth vs. first quartile: aHR: 2.04, 95% CI: 1.24–3.36; p-trend: <0.01). Among items of the FSAm-NPS-DI Score, low intakes of dietary fibre and fruits/vegetables/legumes/nuts were associated with higher risk of CD. Nutritional quality was not associated with risk of UC (fourth vs. first quartile of the FSAm-NPS-DI Score: aHR: 0.91, 95% CI: 0.69–1.21; p-trend: 0.76). Conclusions: A diet with low nutritional quality as measured by the FSAm-NPS-DI Score is associated with a higher risk of CD but not UC

Dietary index based on the Food Standards Agency nutrient profiling system and risk of Crohn's disease and ulcerative colitis

Background: Nutri-score is now widely available in food packages in Europe. Aim: To study the overall nutritional quality of the diet in relation to risks of Crohn's disease (CD) and ulcerative colitis (UC), in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Methods: We collected dietary data at baseline from validated food frequency questionnaires. We used a dietary index based on the UK Food Standards Agency modified nutrient profiling system (FSAm-NPS-DI) underlying the Nutri-Score label, to measure the nutritional quality of the diet. We estimated the association between FSAm-NPS-DI score, and CD and UC risks using Cox models stratified by centre, sex and age; and adjusted for smoking status, BMI, physical activity, energy intake, educational level and alcohol intake. Results: We included 394,255 participants (68.1% women; mean age at recruitment 52.1 years). After a mean follow-up of 13.6 years, there were 184 incident cases of CD and 459 incident cases of UC. Risk of CD was higher in those with a lower nutritional quality, that is higher FSAm-NPS-DI Score (fourth vs. first quartile: aHR: 2.04, 95% CI: 1.24–3.36; p-trend: <0.01). Among items of the FSAm-NPS-DI Score, low intakes of dietary fibre and fruits/vegetables/legumes/nuts were associated with higher risk of CD. Nutritional quality was not associated with risk of UC (fourth vs. first quartile of the FSAm-NPS-DI Score: aHR: 0.91, 95% CI: 0.69–1.21; p-trend: 0.76). Conclusions: A diet with low nutritional quality as measured by the FSAm-NPS-DI Score is associated with a higher risk of CD but not UC

Prise de position de la société française de gériatrie et gérontologie sur le concept d'intégration

International audienceThe concept of integrated services delivery, although dating from the 1990s, has only recently appeared in French public health policy. This concept must now be linked with “coordination” which is the base of the majority of public policies applied to the field of geriatrics since the 1960s in France. To clarify the concept and its adaptation to the reality of the French systems of healthcare and social services, the French Society of Geriatrics and Gerontology established an interdisciplinary working group. This article reports that group’s findings.Le concept d’intégration des soins et des services, bien que datant des années 90, n’est que récemment apparu dans les politiques publiques en France. Ce concept doit s’articuler avec celui de « coordination » qui a prévalu dans la conduite de la majorité des politiques publiques touchant le champ gérontologique depuis les années 60 en France. Afin de clarifier le concept et son adaptation à la réalité du système de soins et de services français, la Société française de gériatrie et de gérontologie a mandaté un groupe de travail interdisciplinaire. Les travaux de ce groupe sont synthétisés dans cet article

The French Society of Geriatrics and Gerontology position paper on the concept of integration

Introduction: The concept of integration, although dating from the 1990s, has only recently appeared in French public health policy. It must be linked with “coordination”, which is the base of most French public policies applied to geriatrics since the 1960s. Herein, we report the French Society of Geriatrics and Gerontology working group’s findings according to three axes: definition of integration, objectives of this organisational approach and the means needed to achieve them. Discussion: Integration is a process that aims to overcome the fragmentation of services for vulnerable people. This process requires a multilevel approach, particularly concerning how to modify public policies and financing systems. Notably, all relevant levels need to develop shared processes, tools, resources, financing, interventions and action-reports on the latter. Integration must to be accompanied by a local dedicated professional (the “pilot”). Results of recent experiments showed that it is possible to implement integrative dynamics in France

Hormone Therapy and Venous Thromboembolism: Early Results from the E3N Prospective Study

Oral estrogen therapy increases the risk of venous thromboembolism (VTE) among postmenopausal women. Although recent data have shown that transdermal estrogen may be safe with respect to thrombotic risk, the impact of the route of estrogen administration is not fully established. In addition, data on the role of combined progestogens are scarce. We used the data from the E3N Study, a French prospective cohort of 85943 postmenopausal women born between 1925 and 1950 and followed by biannually questionnaires sent from 1990 (mean duration: 10.4 years). We identified 984 women with a first documented VTE (199 pulmonary embolisms and 785 deep vein thrombosis). The relative risks (RR) and 95% confidence intervals (CI) were estimated using a multivariate Cox proportional hazards models after adjustment for obesity, parity, education level and time-period. Compared with non-users, the RR for VTE in current users of oral and transdermal estrogen therapy was 1.6 (95% CI: 1.3–2.0) and 1.0 (95%CI: 0.8 –1.2), respectively. Among oral estrogens users, there was no significant difference in VTE risk across all progestogen subgroups. Transdermal estrogen alone or combined with either micronised progesterone or pregnane derivatives was not significantly associated with VTE risk (RR_0.9; 95%CI: 0.6 –1.3, RR_0.9; 95%CI: 0.7–1.1 and RR_1.0; 95% CI: 0.7–1.3, respectively) whereas transdermal estrogen combined with either norpregnane derivatives or nortestosterone derivatives significantly increased VTE risk (RR_1.4; 95%CI: 1.1–1.8 and RR_3.0; 95%CI: 1.3–7.3, respectively). In conclusion, these data confirm that the route of estrogen administration as well as the type of progestogen may be important determinants of the VTE risk among postmenopausal women who use hormone therapy. Transdermal estrogen alone or combined with either micronised progesterone or pregnane derivatives may be safe with respect to VTE risk

Postmenopausal hormone therapy and risk of idiopathic venous thromboembolism: results from the E3N cohort study.: Hormone therapy and venous thromboembolism

International audienceOral estrogen therapy increases venous thromboembolism risk among postmenopausal women. Although recent data showed transdermal estrogens may be safe with respect to thrombotic risk, the impact of the route of estrogen administration and concomitant progestogens is not fully established. We used data from the E3N French prospective cohort of women born between 1925 and 1950 and biennially followed by questionnaires from 1990. Study population consisted of 80 308 postmenopausal women (average follow-up: 10.1 years) including 549 documented idiopathic first venous thromboembolism. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using Cox proportional models. Compared to never-users, past-users of hormone therapy had no increased thrombotic risk (HR=1.1; 95% CI: 0.8 to 1.5). Oral not transdermal estrogens were associated with increased thrombotic risk (HR=1.7; 95% CI: 1.1 to 2.8 and HR=1.1; 95% CI: 0.8 to 1.8; homogeneity: P=0.01). The thrombotic risk significantly differed by concomitant progestogens type (homogeneity: P<0.01): there was no significant association with progesterone, pregnanes, and nortestosterones (HR=0.9; 95% CI: 0.6 to 1.5, HR=1.3; 95% CI: 0.9 to 2.0 and HR=1.4; 95% CI: 0.7 to 2.4). However, norpregnanes were associated with increased thrombotic risk (HR=1.8; 95% CI: 1.2 to 2.7). In this large study, we found that route of estrogen administration and concomitant progestogens type are 2 important determinants of thrombotic risk among postmenopausal women using hormone therapy. Transdermal estrogens alone or combined with progesterone might be safe with respect to thrombotic risk