1. French Nutrition and Health Survey 2006 - 2007 (Etude Nationale Nutrition Santé ENNS 2006 – 2007) French Institute for Public Health Surveillance

2. Background National Nutrition and Health Program – PNNS – (2001) –General goal : improve the state of health of the population by intervening through nutrition. –Nine priority objectives : Increase consumption of fruits and vegetables … Reduce overweight, obesity, mean LDL-c, mean SBP … Increase physical activity. Public health law (2004) –100 quantitative objectives (some of them relative to nutrition). Need for a national monitoring system –Diet and nutrient intakes data collection –Nutritional status description (including blood and urinary samples) –Physical activity and sedentary lifestyle measurements –Conducted by the French National Institute for Public Health Surveillance (InVS)

3. French Nutrition and Health Survey Etude Nationale Nutrition Santé (ENNS) Principal objective –To describe dietary intakes, nutritional status and physical activity in a national sample of adults (18-74 years) and children (3-17 years) living in France, 2006 - 2007. Secondary objectives –To describe the frequencies of diabetes, metabolic syndrome, hypertension, dyslipidemia, their nutritional risk factors and their nutritional and drug care in adults. –To describe the exposure to diet toxins (heavy metals and pesticides) and their determinants.

4. ENNS: sampling methods Complex multistage sampling (three degrees) –Geographical zones stratified on population density: N= 190 –Households sampling: phone lists including exclusive mobiles –One person in each household: birthday method Geographical location of the 190 sampling areas

5. ENNS: data collection (1) One subjects participation in the study ( 2 months) Phone contact (physician) Presentation visit (dietician at home) Three 24-hour recalls (dietician by phone or at home – children < 15 y – ) Final visit - questionnaires (dietician at home) Measurements and biochemical samples (Health examination centres or at home) Information letter Consent for health examination (physician by phone) Physician Dietician Health examination centres or nurses

6. Diet and nutrient intakes –Data collection –Three 24-hour recalls randomly distributed within 2 weeks (2 days of week and 1 day of week-end): specific software with more than 3,000 foods and photographs of typical serving sizes –Questionnaire about salt intakes and added fats –Mini-PNNS food frequency questionnaire Physical activity and sedentary lifestyle – 15 years old: International Physical Activity Questionnaire (IPAQ) –11-14 years old: YRBS (adapted in French) –3-10 years old: specific questionnaire (validation study vs. accelerometry) ENNS: data collection (2)

7. ENNS: data collection (3) Health and biochemical measurements (at home or at a health examination center) –Anthropometry (according to WHO recommendations): weight, height (children and adults), waist and hip circumferences (adults) –Blood pressure: one run of 3 measures after 5 min. of rest (repeated once if the difference between 2nd and 3rd measures > 10 mm of Hg) –Biochemical analysis (blood, urine and hair samples): Performed at health examination center labs: cholesterol (total, HDL, LDL), triglycerides, glucose, hemoglobin, ferritin, creatinine Performed at central laboratories: HbA1c, vitamins B9 / B12, vitamin D, transferrin, albumin, carotenoids, retinol, alpha-tocopherol, pesticides, heavy metals (As, Ca, Pb, Hg,…) Biobank (storage at -80°C)

8. ENNS: data collection (4) Other questionnaires (face to face and self-report questionnaire) –Social and demographic characteristics, smoking habits, alcohol consumption –Drugs, previous cardiovascular diseases and diabetes –Environmental exposure (at work, leisure time…)

9. ENNS: methods (5) Staff involved in the data collection –Management: 4 epidemiologists, 1 project leader, 3 data monitors, 1 assistant –Data collection in addition to the health examination First contact & consents 6 physicians Diet recall by phone 8 dieticians Visits at home 32 dieticians –Health examination Social Security Health Examination centersN = 73 LaboratoriesN = 45 Nurses (health examination at home) N = 30 –Data monitoring and collection Specific web-based software to monitor appointments (dietician, consents, health examination center, …) Computer Assisted Personal Interview

10. ENNS: methods (6) View of the web-based monitoring software

11. ENNS: time frame & inclusion Two pilot studies conducted in 2002 and 2004 National survey –2005: Preparation / calibration of financial means –02/2006-03/2007: Dietary data collection –02/2006-07/2007 : Health examination survey –12/2007: Dissemination of the first results regarding PNNS indicators Inclusions –About 3,115 adults (response rate: 61%) and 1,675 children (68%) –Health examination in adults Anthropometry and BP:N ~ 2,400 Blood and urine samples:N ~ 2,100 (67% of the adults included or 40 % of all adults)

12. ENNS: conclusion 1 rst national survey including a food consumption survey and a health examination survey in France. Interest in surveillance and monitoring of public health programs. Participation in the health examination expanded by home visits from a nurse (but home visit strategy is costly). Initial contact, organized home visits, individual and global result return, and staff quality may have an effect upon the participation rate.