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Context It is widely recognised that the Covid-19 pandemic has negatively impacted individuals’ mental health. However, little emphasis has been put on the possible influence of socio-economic factors in the relationship. In the context of the COVID-19 pandemic, our objectives were (i) to assess the relationship between education level and mental health in French adults, and (ii) to study the influence of the economic, social, health and the COVID-19-related factors in men and women respectively. Method Data are from 32,581 individuals representative of the French population who responded to the weekly survey “Baromètre COVID-19” between April 7th and May 31st 2020. Education level was self-reported (university degree, high school qualification, vocational certificate/qualification, no diploma). Anxiety-depressive state was derived from four items related to the frequency of occurrence of depressive and anxiety symptoms, and summarized in an overall validated anxiety-depressive score. Multivariate linear regression analyses were carried out with nested adjustments of variables related to economic, social, health and Covid-19 contexts to assess the relationship between education and anxiety-depressive state. Results In total, 45% of individuals reported symptoms of anxiety-depressive state (53% in women versus 36% in men). Among men, those with a vocational certificate/qualification and those with no diploma had a greater risk of having a higher anxiety-depressive state compared to those with a university degree (βVocational certificate/qualification=0.16 [0.04; 0.27]; βNo diploma=0.75 [0.43; 1.07]) while among women, the risk of anxiety-depressive state increased as education level decreased (βBaccalaureate=0.37 [0.25; 0.49]; βVocational certificate/qualification=0.41 [0.28; 0.54]; βNo diploma=0.8 [0.49; 1.12]).. For both men and women, economic, health, and Covid-19 factors partly attenuate these associations while social factors marginally modified the relationship. After accounting for confounders and intermediate variables, the absence of a diploma remained associated with anxiety-depressive state among men, while the whole educational gradient of anxiety-depressive state persisted among women. Conclusion In France, at the end of the first wave of COVID-19, individuals with a lower level of education had a higher risk of anxiety-depressive state. This association was more pronounced for women, highlighting a process of social inequality in health possibly related to gender. This should be considered in future prevention and public health interventions.

Data on health inequalities related to the dynamic of SARS-CoV-2 infection in France are scarce. The aim of this study was to analyse the association between an area-based deprivation indicator and SARS-CoV-2 incidence, positivity, and testing rates between May 2020 and April 2021.We analysed data reported to the Système d'Information de Dépistage Populationnel surveillance system between May 14, 2020 and April 29, 2021, which records the results of all SARS-CoV-2 tests in France. Residential addresses of tested individuals were geocoded to retrieve the associated aggregated units for the statistical information (IRIS) scale, corresponding to an area comprising 2000 inhabitants relatively homogenous in terms of socioeconomic characteristics. A social deprivation score was assigned to each area using the European Deprivation Index (EDI). We fitted negative binomial generalised additive models to model the age-standardised and sex-standardised ratios for SARS-CoV-2 incidence, positivity rates, and testing rates, and to estimate incidence rate ratios (IRRs) and 95% CIs of their association with EDI quintiles, using the first quintile (least deprived) as the reference category, adjusted for week, population density, and region.Analyses were based on 70 990 478 SARS-CoV-2 tests, of which 5 000 972 were positive. SARS-CoV-2 incidence was higher in the most deprived areas than the least deprived areas (IRR 1·148 [95% CI 1·138-1·158]) and positivity rates were also higher (IRR 1·283 [1·273-1·294]), whereas testing rates were lower in the most deprived areas than the least deprived areas (IRR 0·905 [0·904-0·907]). SARS-CoV-2 incidence and positivity rates remained higher in the most deprived areas than the least deprived areas during the second and third national lockdowns, and variation in testing rate was observed according to population density.Our results highlight a positive social gradient between deprivation and the risk of testing positive for SARS-CoV-2, with the highest risk among individuals living in the most deprived areas and a negative social gradient for testing rate. These findings might reflect structural barriers to health-care access in France and lower capacity of deprived populations to benefit from protective measures.None.

BackgroundIn the context of the Covid-19 pandemic, several factors such as age, chronic disease or obesity have been associated with adverse outcomes and mortality from Covid-19. However, the social distribution of Covid-19 infection among men and women was largely neglected in France, mainly due to a lack of data. The aim of this study is to describe and analyse the risk of Covid-19 infection in relation to sex, and the influence of other social factors, specifically occupation, in this association.MethodsWe used data from the citizen science initiative ‘Barometre Covid-19’. Each week, an internet survey was administered to a sample of 5,000 people representative of the French mainland population aged 18 and over, using the quota method. A total of 25,001 participants were interviewed between 7 April and 11 May 2020. We used multivariable nested logistic regression modelling to study the relationship between sex, occupation and Covid-19 infection. Confounders included age, region of residence, population density, whether you worked outside of home during the lockdown, house overcrowding, comorbidities and body mass index.ResultsWomen reported a medical diagnosis of Covid-19 infection more often than men (4% vs. 3.2%). In a model adjusted for confounders, women were 23% more likely to report a medical diagnosis of Covid-19 infection than men (OR=1.23 [95%-CI=1.06–1.42]). Controlling for sex and socioeconomic variables (occupation), the risk of infection for women was reversed (OR=0.84 [95%-CI=0.59–1.19]). While most men, other than executives, were less likely to report the infection, this association was not observed amongst women.ConclusionOccupation was found to influence the relationship between sex and Covid-19 infection suggesting a gender effect. The differences in the risk of infection between men and women require exploration with regard to socioeconomic factors. The social roles of women and men are associated with a non-random distribution of the virus, potentially reflecting structural societal inequalities.

Background Reducing hypertension represents a critical point of intervention to lower the burden of cardiovascular disease worldwide. Although the relationship between lower socioeconomic status and higher rates of hypertension is well documented, most of the evidence comes from prevalence studies involving young adult population. Aim To investigate the independent association of wealth, education and income with incident hypertension among older adults living in the United States. Methods This cohort study included 16 587 individuals aged 50 years and older, free of hypertension and cardiovascular disease at baseline from the Health and Retirement Study over the period 1992-2014. We used Cox proportional hazards models to examine longitudinal associations between wealth, education, and income at baseline and self-reported diagnosis of incident hypertension. Results During a median follow-up of 7.8 years, 6817 participants declared an occurrence of hypertension (incidence rate: 45.3 [95% confidence interval (CI) = 44.2-46.4] per 1000 person-years). Overall, those in low as compared with high socioeconomic status groups had a higher risk of developing hypertension in late life. In particular, adjusted hazard ratios [95% CI] across decreasing wealth quartiles were 1.0 (reference), 0.97 [0.88-1.08], 1.17 [1.05-1.30], and 1.20 [1.07-1.35] in men, and 1.0 (reference), 1.28 [1.17-1.41], 1.21 [1.09-1.33], and 1.28 [1.16-1.42] in women. In multivariate analyses, wealth remained strongly associated with incident hypertension among women after accounting for other socioeconomic, behavioral and anthropometric risk factors. Conclusions Socioeconomic status, especially wealth, is a strong independent predictor of incident hypertension in older adults. Our findings support population-based interventions tailored to those in disadvantaged socioeconomic groups to reduce the risk of hypertension.

International audience

IntroductionGlucose intolerance and type 2 diabetes are increasing worldwide. Current scientific evidence tends to demonstrate that people with an Asian phenotype have a lower glucose tolerance compared to Caucasian phenotype. In addition, in Caucasian population, consumption of products with a high content of Slowly Digestible Starch (SDS) significantly decreases postprandial glycemic and insulinemic responses compared to products with a low-SDS content. The aim of this study was to evaluate the effect of consuming products with varying levels of SDS on postprandial glycemic and insulinemic responses, both in Asian and Caucasian populations.Materials and methodsFive products with varying starch digestibility profiles (determined by the SDS method developed by Englyst) and one glucose solution were tested. A randomized cross-over controlled study was set up in the University of Sydney to study the products’ Glycemic and Insulinemic Indexes (GI and II) and postprandial responses over 2 hours. 12 Caucasian and 12 Asian participants were recruited and consumed 50 g of available carbohydrates from each product (norm ISO-26642(2010)).ResultsAsian participants were 28.0 ± 2.6 yo with a body mass index (BMI) of 21.4 ± 0.3 kg/m2 and Caucasians were 26.0 ± 1.1 yo with a BMI of 22.4 ± 0.5 kg/m2 (no difference between groups). Among the products tested, 3 had a high-SDS content (26 to 28 g SDS / 100g) and 2 had a low-SDS content (0 to 2 g SDS / 100g). GI values for Asian participants ranged between 44 and 54 for high-SDS products (low GI) and were medium (64) or high (90) for low-SDS products. GI values for Caucasian participants ranged between 40 and 48 for high-SDS products (low GI) and between 60 and 79 for low-SDS products. In a statistical model including product effect, ethnicity effect, session effect, and the interaction term product*ethnicity, the product effect was the only significant parameter and products were split according to their SDS content. Furthermore, products with a high-SDS content decrease the glycemic peak value by about 1 mM, both in Asian and Caucasian participants. Consumption of high-SDS products also decreases the insulin demand by 29% and 32% in Asians and Caucasians respectively compared to low-SDS products.DiscussionOur study demonstrates that consumption of products with a high-SDS content similarly decreases the glycemic and insulinemic responses in both Asian and Caucasian participants. This decrease may be beneficial in the long term to prevent metabolic diseases.

Background Individual socioeconomic characteristics and in particular education have been shown to be strongly associated with hypertension (HTN). Few studies have examined the mechanisms involved in such associations and understanding them would help to reduce the burden of social inequalities. We aimed to investigate whether specific risk factors of HTN intervene as mediators in the association between individual education and HTN in a large sample of French adults. Methods In this cross-sectional analysis, participants are adults aged between 18 and 69 years old recruited to the CONSTANCES cohort over the period 2012-2015. We included behavioral (poor diet, physical inactivity, alcohol consumption), anthropometric (body mass index) and socioeconomic risk factors (income and longest occupation) as potential mediators. Analyses were stratified by sex. Natural direct and indirect effects of education on HTN were estimated using weighted Poisson regression models with inverse odds weighting. Results A total of 62,247 individuals (53% women, mean age 48±13 years) were included. Prevalence of HTN was 37.3% [95%-Confidence Interval (95%-CI) =36.6-38.0] in men and 23.2% [95%-CI=22.7-23.8] in women. We found a steep educational gradient of HTN in both sexes, larger among young adults in relative terms. Low education was strongly associated with HTN: RRTotal Effect=1.16 [95%-CI=1.12-1.21] in men and 1.26 [95%-CI=1.21-1.32] in women. Behavioral, anthropometric and socioeconomic risk factors accounted for 49% and 32% of the total effect in men and women respectively. Conclusions This study underlines the importance of education in inequalities in HTN and suggests that behavioral, anthropometric and socioeconomic risk factors substantially mediate the association between education and HTN. Future research using longitudinal data should be done to help understand the causal pathway linking education and HTN. Key messages A strong gradient of decreased prevalence of hypertension with higher individual education is observed in both sexes and in early adulthood, suggesting that prevention should start early. Behavioral, anthropometric and socioeconomic characteristics at adulthood substantially mediate the association between education and hypertension.

Background There is ample evidence that hypertension prevalence increases when socioeconomic status (SES) decreases. However, sex differences in this relationship has been less studied. Investigating potential sex differences could help understand the mechanisms of social health disparities. The aim of this work was to explore the pattern of associations between several indicators of SES and hypertension across sexes in a large sample of French adults. Methods In this cross-sectional analysis, participants are adults aged between 18 and 69 years old recruited to the CONSTANCES cohort over the period 2012–2015 in 16 recruitment centers. SES was estimated using education (individual level), income (household level) and an indicator of residential socioeconomic deprivation, FDep (municipal level). Log-binomial and Poisson regressions with robust variance estimations were used to estimate the Risk Ratios (RR) comparing the extreme levels of SES and to test for interaction of sex in the associations between SES and hypertension prevalence. Results A total of 62,247 individuals (53% women, mean age 48±13 years) were included. Age-standardized prevalence of hypertension was 30.1% [95%CI=29.7–30.6], higher in men (37.3% [95%CI=36.6–38.0]) than in women (23.2% [95%CI=22.7–23.8]). Globally, we found steep socioeconomic gradients of hypertension in both genders. Education showed the strongest association with hypertension prevalence, especially among women (p for interaction between sex and education Discussion In this sample, individual education displayed different patterns of association with hypertension across sexes, but not household income nor neighborhood deprivation. This result underlines that systematic stratification by sex may not be appropriate in all analyses focusing on hypertension as outcome of interest. Besides, these results suggest that education attainment has a greater impact on women in preventing hypertension and therefore prevention should start early. More work is needed to understand sex differences in the causal pathway linking SES and hypertension.

Aims While international variations in the prevalence of hypertension are well described, less is known about intra-national disparities and their determinants. We wanted to describe the variations in hypertension prevalence within France and to determine how much lifestyle and socioeconomic factors contributed to explain these regional variations. Methods Participants (62,247 French adults aged 18 to 69 years) were recruited in the 16 centres of the CONSTANCES study between 2012 and 2015. Hypertension was defined as blood pressure higher than 140/90 mmHg and/or taking antihypertensive medications. The contribution of lifestyle and socioeconomic factors to hypertension prevalence variations among centres was examined using sequential hierarchical logistic models. Results Hypertension prevalence was 37.3% (95% confidence interval (CI) = 36.6–38.0) in men and 23.2% (95% CI = 22.7–23.8) in women. Hypertension prevalence rates varied by almost two-fold among centres (1.9 in men, 1.6 in women) with the highest prevalence in the north and the east of France. Body mass index was strongly associated with hypertension in women (odds ratio (OR)1-unit increase = 1.11 (95% CI = 1.11–1.12)) and was the highest contributor to between-centre variations (27% in women), followed by socioeconomic characteristics (e.g. ORhigh versus low education = 0.85 (95% CI = 0.83–0.87), contributing to 14% of variations in women). Together, family history of hypertension, body mass index, education, occupation and residential area socioeconomic level explained about 30% and 40% of between-centre variations in men and women, respectively. Conclusion Hypertension prevalence greatly varies among French regions and this is partly explained by known lifestyle and socioeconomic factors. Nevertheless, these variations and all the hypertension determinants have not been fully deciphered yet.

International audience; Inflammation is a ubiquitous underlying mechanism of the links between diet and cognitive functioning. No study has yet evaluated the overall inflammatory potential of the diet, using the dietary inflammatory index (DII), in relation to cognitive functioning. In a French cohort of middle-aged adults, we evaluated the association between the DII, assessed in midlife, and cognitive performance evaluated 13 years later. The DII is a literature-derived dietary index developed to determine the inflammatory potential of diet. The DII was estimated at baseline (1994-1996) among 3080 subjects of the SU.VI.MAX (supplementation with antioxidant vitamins and minerals) cohort. Cognitive performance was assessed in 2007-2009 via a battery of standardized neuropsychological tests. Principal component analysis was performed to extract a summary score of cognitive performance. Multivariable-adjusted linear regression analyses were performed to provide regression coefficients and 95 % confidence intervals (95 % CI). In a multivariate model, a strong inverse association was observed between a higher DII (reflecting a more inflammatory diet) and overall cognitive functioning (mean difference Q4 vs. Q1 = -1.76; 95 % CI = -2.81, -0.72, P for trend =0.002). With regard to specific cognitive domains, similar associations were observed with scores reflecting verbal memory, but not executive functioning. This study suggests that a pro-inflammatory diet at midlife might be associated with subsequent lower cognitive functioning. A diet exhibiting anti-inflammatory properties may help to maintain cognitive health during aging. Clinicaltrials.gov (number NCT00272428).

International audience

International audience; Despite the availability of efficient therapies to reduce the risk of cardiovascular complications, poor adherence to antihypertensive (anti-HTN) drugs is frequent, especially during the first year of treatment and among uncontrolled/resistant hypertensive patients. The aim of the study was to identify factors associated with adherence to anti-HTN treatment and to examine whether they differ across sex. A total of 2743 treated hypertensive participants to the cross-sectional Metascope survey (France, 2015) aged 55 years or more were included. The authors measured adherence to anti-HTN treatment using the 6-item Girerd compliance test. Variations in adherence were examined using the Rao-Scott statistics and Poisson regression. Overall, 63.6% of participants were adherent to anti-HTN treatment. Adherence was more frequent among women than men (69% vs 58%, P < 10(-4)). For both sexes, level of adherence was positively associated with age (P < 10(-4)), but inversely associated with number of anti-HTN tablets, number of tablets taken for metabolic diseases, history of cardiovascular diseases, number of other chronic diseases (all P < 10(-4)). The inverse relationship between adherence and the number of anti-HTN tablets significantly differed between sexes (P < 10(-4)) Adherence decreased sharply when taking two or more anti-HTN tablets in men, whereas the decrease in women was only observed when taking three or more anti-HTN tablets. This study suggests that adherence to anti-HTN treatment is higher among women, decreases with the number of tablets prescribed, and differentially so across sex. Reducing the number of tablets for anti-HTN treatment may improve adherence, especially among men and patients with multiple comorbidities.

International audience; Background and aims: The prevention of the metabolic syndrome (MetS) is of major concern and nutrition has been shown to modulate at least partly MetS risk. Our objective was to investigate whether a pro-inflammatory diet was associated with a higher risk of MetS and its components in a large cohort of French adults. Methods and results: A total of 3726 participants from the Supplementation en Vitamines et Mineraux AntioXydants (SU.VI.MAX) cohort were included in this study. The MetS status was identified at baseline and after 13 years of follow-up using self-reported medication, data from clinical investigations and biological measurements. The dietary inflammatory index (DII) was computed using repeated 24 h-dietary records (n = 10.1 +/- 3.1). Logistic and linear regression analyses were conducted to assess the prospective association of the DII (as Q, quartiles) with the incidence of MetS and with the traits contributing to the MetS-definition (blood pressure, glycaemia, triglycerides, HDL-cholesterol, waist circumference). A diet with pro-inflammatory properties, as expressed by higher DII scores, was significantly associated with a higher risk of developing the MetS (OR comparing Q4 to Q1: 1.39, 95% confidence interval 1.01-1.92, P = 0.047). Moreover, higher DII scores were associated with higher systolic and diastolic blood pressure (P-trend across quartiles = 0.03 and 0.05, respectively) and triglycerides (P-trend = 0.01), and with lower HDL-cholesterol (P-trend = 0.03). Conclusion: A higher DII score was prospectively associated with a higher risk of MetS, with associations with blood pressure, triglycerides and HDL-cholesterol. Promotion of a healthy diet exhibiting anti-inflammatory properties may contribute to prevent cardio-metabolic disorders.

Background Cardiovascular diseases (CVD) are the leading cause of death in the world, and diet plays a major role in CVD incidence, especially through lipid oxidation mechanisms. This, in turn, leads to tissue inflammation and formation of atheromatous plaques. Methods and Results Our objective was to evaluate the association between the inflammatory potential of the diet and the incidence of overall CVD or its subclasses. We included 7743 participants from the Supplémentation en Vitamines et Minéraux AntioXydants (SU.VI.MAX) cohort. All cardiovascular events were recorded using self‐reported information or clinical visits, and were validated. The dietary inflammatory index (DII) was computed using repeated 24‐hour dietary records (mean=9.5±3.4 records/subject). Hazard ratio and 95% CI for outcomes (CVD and subclasses) were estimated across sex‐specific quartiles of the DII using Cox proportional hazard models. A total of 292 cardiovascular events were recorded and validated during an average of 11.4 years of follow‐up: 93 myocardial infarctions, 58 strokes, 128 angina pectoris and revascularization interventions, and 13 sudden deaths. When considering CVD subclasses, a diet with pro‐inflammatory properties, as expressed by higher DII scores, was significantly associated with a higher risk of myocardial infarction (hazard ratio Quartile 4 versus Quartile 1 =2.24, 95% CI: 1.08–4.67). No significant association was observed between the DII score and stroke or both angina pectoris and revascularization intervention. Conclusions A pro‐inflammatory diet, as measured by a higher DII score, was prospectively associated with a higher risk of myocardial infarction. Promotion of a diet exhibiting anti‐inflammatory properties may help prevent myocardial infarctions.

International audience; Background: Chronic inflammation is one of the mechanisms involved in carcinogenesis. Diet is a major source of pro- and anti-inflammatory compounds. The Dietary Inflammatory Index (DII) was designed to estimate its overall inflammatory potential.Objective: Our objective was to investigate the associations between the DII and overall, breast, and prostate cancer risks.Methods: This prospective study included 6542 participants [3771 women and 2771 men with a mean ± SD age of 49.2 ± 6.4 y and a BMI (in kg/m2) of 24.0 ± 3.6 at baseline] from the Supplémentation en VItamines et Minéraux AntioXydants (SU.VI.MAX) cohort who completed at least six 24-h dietary records during the first 2 y of follow-up. The DII was based on 36 food variables. Higher scores corresponded to more proinflammatory diets. A total of 559 incident cancers were diagnosed (median follow-up, 12.6 y), including 158 female breast and 123 prostate cancers (the 2 main cancer sites in this cohort). Associations were characterized by multivariable Cox proportional hazards models. Stratified analyses were performed according to the median of usual daily alcohol intake.Results: Sex-specific quartiles of the DII were positively associated with prostate cancer risk [quartile (Q) 4 compared with Q1, HR: 2.08; 95% CI: 1.06, 4.09] but not with overall or breast cancer risks. There was an interaction between the DII and alcohol intake (grams per day) on overall cancer risk (P-interaction = 0.02): the DII was positively associated with overall cancer risk in low-to-moderate alcohol drinkers (Q4 compared with Q1 HR: 1.75; 95% CI: 1.15, 2.68; P-trend = 0.02), whereas no association was detected in higher consumers of alcohol (P-trend = 0.8). This interaction was also observed for breast cancer (P-interaction = 0.001).Conclusion: Consistent with mechanistic data, findings from this study indicated that proinflammatory diets are associated with increased prostate cancer risk and, in low-to-moderate alcohol drinkers, with increased overall and breast cancer risk. The SU.VI.MAX trial was registered at clinicaltrials.gov as NCT00272428.

Introduction et but de l’etude L’inflammation chronique est un mecanisme central implique dans quatre causes majeures de deces : les maladies cardiovasculaires, les cancers, le diabete et les maladies respiratoires chroniques. L’alimentation est une source majeure de composes bioactifs pro- et anti-inflammatoires. Le Dietary Inflammatory Index (DII) a ete concu pour estimer le potentiel inflammatoire de l’alimentation. Notre objectif etait, pour la premiere fois, d’etudier les associations entre le DII et la mortalite et d’investiguer si une supplementation en antioxydants etait susceptible de moduler cette relation. Materiel et methodes L’etude SU.VI.MAX est un essai randomise en double-aveugle durant lequel les participants ont recu des antioxydants a dose nutritionnelle ou un placebo entre 1994 et 2002. Cette etude prospective observationnelle incluait 7 997 participants suivis entre 1994 et 2007 (suivi median de 12,4 ans). Le DII a ete calcule a partir d’enregistrements alimentaires de 24 h repetes ; un score plus eleve correspondant a un regime alimentaire plus pro-inflammatoire. Au cours du suivi, 184 deces ont ete enregistres dont 102 dus a un cancer et 41 a une maladie cardiovasculaire. Les associations ont ete caracterisees par des modeles multivaries de Cox a risques proportionnels. Resultats et analyse statistique Les tertiles de DII sexe-specifiques etaient positivement associes a la mortalite par cancers et maladies cardiovasculaires (RR T3 vs T1 = 1,53 [1,01–2,33], p = 0,04) et par cancer uniquement (RR T3 vs T1 = 1,84 [1,12–3,00], p = 0,01). La p -value correspondante pour toutes causes de mortalite etait de 0,07. Le DII etait significativement associe a une augmentation de la mortalite dans le groupe placebo de l’essai SU.VI.MAX (RR T3 vs T1 = 2,11 [1,15–3,85], p = 0,02), mais pas dans le groupe supplemente en antioxydants ( p = 0,8 ; P-interaction = 0,1). Conclusion Ces resultats suggerent qu’une alimentation pro-inflammatoire pourrait etre associee a une augmentation de la mortalite et que les antioxydants pourraient contrecarrer certains des effets pro-inflammatoires de l’alimentation.

International audience; Introduction et but de l’étude: L’inflammation est l’un des mécanismes majeurs impliqués dans la carcinogénèse.L’alimentation est une source importante de composés bioactifs pro- et anti- inflammatoires. Le Dietary InflammatoryIndex (DII) a été conçu pour estimer le potentiel inflammatoire global des régimes alimentaires. Notre objectif étaitd’étudier les associations entre le DII et le risque de cancers au global, de cancer du sein et de cancer de la prostate, cequi jusqu’à présent n’avait jamais été réalisé avec un design prospectif.Matériel et méthodes: Cette étude portait sur 6542 participants de la cohorte SU.VI.MAX (1994-2007) ayant complété aumoins six enregistrements alimentaires de 24h pendant les deux premières années de suivi. Le DII a été calculé pourchaque sujet à partir de 36 paramètres alimentaires. Les scores les plus élevés correspondaient à des régimesalimentaires plus pro-inflammatoires. Après un suivi médian de 12,6 ans, 559 cancers incidents ont été diagnostiqués,dont 158 cancers du sein et 123 cancers de la prostate. Les associations ont été caractérisées par des modèlesmultivariés de Cox à risques proportionnels.Résultats et Analyse statistique: Les quartiles de DII sexe-spécifiques étaient positivement associés au risque decancer de la prostate (RRQ4vsQ1=2,08 [1,06-4,09], P=0,005). Les résultats n’étaient pas significatifs pour les risques decancer au global et du sein. Néanmoins, une interaction significative était observée entre le DII et la consommationd’alcool (facteur de risque majeur de plusieurs cancers) sur le risque de cancer au global (P-interaction=0,02). Le DIIétait associé avec une augmentation de risque de cancer chez les consommateurs modérés d’alcool (RRQ4vsQ1=1,75[1,15-2,68], P=0,02), alors qu’aucune association n’était observée chez les sujets ayant une consommation d’alcoolsupérieure à la médiane sexe-spécifique (P=0,8).Conclusion: En accord avec les données expérimentales, les résultats de cette étude prospective ont montré qu’unealimentation pro-inflammatoire pourrait augmenter le risque de cancer de la prostate. Les régimes alimentaires proinflammatoiresétaient également associés à une augmentation de risque de cancer au global chez les faiblesconsommateurs d’alcool. La promotion d’une alimentation anti-inflammatoire pourrait contribuer à la prévention primairedes cancers.

International audience; ABSTRACTBackground: Chronic inflammation is a central mechanism involved in cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases, 4 leading causes of mortality. Diet is a major source of pro- and anti-inflammatory bioactive compounds. The Dietary Inflammatory Index (DII) was designed to estimate the overall inflammatory potential of the diet.Objective: Our aim was to study the prospective association between the DII and mortality, as well as assess whether antioxidant supplementation could modulate this association.Design: The Supplémentation en Vitamines et Minéraux Antioxydants study was a randomized, double-blind, placebo-controlled trial in which participants received low-dose antioxidants or a placebo from 1994 to 2002. In this observational prospective analysis, 8089 participants (mean ± SD age at baseline: 49.0 ± 6.3 y) were followed between 1994 and 2007 (median: 12.4 y). The DII was calculated from repeated 24-h dietary records; higher scores correspond to more proinflammatory diets. A total of 207 deaths occurred during follow-up, including 123 due to cancer and 41 due to cardiovascular events. Multivariate Cox proportional hazards models were computed.Results: Sex-specific tertiles of the DII were positively associated with cardiovascular + cancer mortality (HR for tertile 3 compared with tertile 1 = 1.53; 95% CI: 1.01, 2.32; P-trend = 0.05) and specific cancer mortality (HR for tertile 3 compared with tertile 1 = 1.83; 95% CI: 1.12, 2.99; P-trend = 0.02). The corresponding P value was 0.07 for all-cause mortality. The DII was statistically significantly associated with increased all-cause mortality in the placebo group (HR for tertile 3 compared with tertile 1 = 2.10; 95% CI: 1.15, 3.84; P-trend = 0.02) but not in the antioxidant-supplemented group (P-trend = 0.8; P-interaction = 0.098).Conclusion: These results suggest that a proinflammatory diet is associated with increased all-cause and cancer mortality and antioxidants may counteract some of the proinflammatory effects of the diet. This trial was registered at clinicaltrials.gov as NCT00272428.

National audience

Introduction et but de l’etude Les maladies cardiovasculaires (MCV) sont la principale cause de deces dans le monde. Le regime alimentaire joue un role majeur dans l’apparition de ces MCV, en particulier a travers les mecanismes d’oxydation des lipides qui sont a l’origine de l’inflammation des tissus et de la formation des plaques d’atherome. Notre objectif a donc ete d’evaluer l’association entre le potentiel inflammatoire du regime alimentaire et l’incidence globale de MCV ou des types de MCV : infarctus du myocarde (IM) ; accident vasculaire cerebral (AVC) ; angor et interventions de revascularisation. Materiel et methodes Dans cette etude, 7743 participants issus de la cohorte supplementation en vitamines et mineraux antioxydants (SU.VI.MAX) ont ete inclus. Les MCV ont ete enregistrees au fur et a mesure de leur apparition via des auto-questionnaires mensuels, des visites medicales annuelles, ou des tests plus approfondis au besoin. Elles ont ensuite ete examinees et validees par un comite d’experts independant. L’indice alimentaire, le Dietary Inflammatory Index (DII), a ete calcule a partir de donnees issues d’enregistrements de 24 h (moyenne = 9,5 ± 3,4 enregistrements/sujet). Les hazard ratios (HR) et les intervalles de confiance a 95 % (IC 95 %) pour les variables d’interet (MCV et types de MCV) ont ete estimes entre les quartiles par sexe de score de DII avec des modeles a risque proportionnel de Cox. Resultats et analyse statistique Au cours du suivi, d’une duree moyenne de 11,4 ans, un total de 292 evenements cardiovasculaires ont ete enregistres puis valides : 93 IM, 58 AVC, 128 angor ou interventions de revascularisation et 13 morts subites. En separant les MCV par types, un regime alimentaire pro-inflammatoire, qui se traduit par des scores de DII eleves, etait significativement associe a une augmentation de risque d’IM (HRQ4vsQ1 = 2,24, IC 95 % 1,08–4,67, p = 0,03). Les associations entre le score de DII et toutes les MCV ou les autres types de MCV (AVC ; angor ou interventions de revascularisation) n’etaient pas significatives. Conclusion Un score de DII plus eleve etait associe de maniere prospective a une augmentation de risque d’IM. La promotion d’un regime alimentaire sain presentant des proprietes anti-inflammatoires pourrait contribuer a l’amelioration de la prevention des infarctus du myocarde.

Introduction – The social distribution of SARS-CoV-2 infection among men and women and the role of gender have been largely neglected in France, mainly due to a lack of data. The aim of this article is to describe and analyse the risk of SARS-CoV-2 infection with respect to sex, and the influence of other social factors, especially occupation, in this relationship. Methods – We used data from the “COVID-19 Barometer”. Each week, a cross-sectional survey was administered via Internet to a sample of 5,000 people representative of the French metropolitan population, aged 18 and over, established by the quota method. A total of 25,001 participants were questioned between 7 April and 11 May 2020. The relationship between sex, occupation and SARS-CoV-2 infection was studied using multi- variate nested logistic regression modelling. Results – During the first lockdown of spring 2020 in France, women reported a medical diagnosis of SARS-CoV-2 infection more often than men (4% vs 3.2%). However, when taking into account the relationship between sex and socioeconomic variables (occupation), the additional risk of infection for women was no longer observed. Specifically, while men in executive positions were more likely to report a diagnosis of infection compared to those in other occupations, this association was not observed amongst women. Conclusions – The relationship between gender and SARS-CoV-2 infection was modified by the inclusion of occupation, suggesting the distribution of occupations by sex is important to consider. The differences in the risk of infection between men and women therefore require further exploration with regard to socioeconomic factors., Introduction – La distribution sociale de l’infection au SARS-CoV-2 et le rôle du genre ont été largement négligés en France, principalement en raison du manque de données. L’objectif de cet article est d’analyser le risque d’infection au SARS-CoV-2 en fonction du sexe, en étudiant l’influence d’autres dimensions sociales dans cette relation, en particulier la profession.Méthodes – Nous avons utilisé les données du Baromètre Covid-19. Chaque semaine, une vague de sondage était administrée sur Internet auprès d’un échantillon de 5 000 personnes représentatif de la population française métropolitaine âgée de 18 ans et plus, établi par la méthode des quotas. Au total, 25 001 participants ont été interrogés entre le 7 avril et le 11 mai 2020. La relation entre le sexe, la profession et l’infection au SARS-CoV-2 a été étudiée par des modèles de régression logistique emboités.Résultats – Durant la période du premier confinement en 2020 en France, les femmes déclarent plus souvent que les hommes un diagnostic médical d’infection au SARS-CoV-2 (4% vs 3,2%). Cependant, lorsque l’on prend en compte la relation entre le sexe et les professions et catégories socioprofessionnelles, le sur-risque d’infection chez les femmes ne s’observe plus. Plus spécifiquement, les hommes cadres sont plus à risque de déclarer l’infection que ceux appartenant aux autres professions et catégories socioprofessionnelles, ce qui n’est pasobservé chez les femmes.Conclusions – Le lien entre sexe et infection au SARS-CoV-2 est modifié par la prise en compte de la profession, suggérant que la distribution des professions par sexe est une dimension importante à considérer. Les différences de risque d’infection entre hommes et femmes méritent donc d’être analysées au regard des facteurs socioéconomiques et des rôles sociaux qui leur sont dévolus.