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This study aimed to examine the association between drinking water intake and diet quality, and to analyse the adherence of French men and women to the European Food Safety Authority 2010 Adequate Intake (EFSA AI). A representative sample of French adults (>= 18) from the Individual and National Survey on Food Consumption (INCA2) was classified, by sex, into small, medium, and large drinking water consumers. Diet quality was assessed with several nutritional indices (mean adequacy ratio (MAR), mean excess ratio (MER), probability of adequate intakes (PANDiet), and solid energy density (SED)). Of the total sample, 72% of men and 46% of women were below the EFSA AI. This percentage of non-adherence decreased from the small to the large drinking water consumers (from 95% to 34% in men and from 81% to 9% in women). For both sexes, drinking water intake was associated with higher diet quality (greater MAR and PANDiet). This association remained significant independently of socio-economic status for women only. Low drinking water consumers did not compensate with other sources (beverages and food moisture) and a high drinking water intake was not a guarantee for reaching the EFSA AI, meaning that increasing consumption of water should be encouraged in France.

La lutte contre l'insécurité alimentaire et nutritionnelle a connu des succès relatifs au cours des décennies passées en Afrique subsaharienne, grâce à certaines innovations techniques et à la mobilisation de nouveaux acteurs. Mais, avec la pérennisation des situations " à risque ", la complexification des contextes " de crise ", les interactions imprévues et les changements " d'échelle ", les effets de telles actions s'avèrent de plus en plus limités. Les enjeux globalisés et renouvelés de la sécurité alimentaire (convergence entre droits, capacités, inégalités, vulnérabilités,...) en appellent non seulement à la mise au point de nouveaux instruments techniques et politiques mais plus encore à un changement de paradigme., The struggle against food and nutrition insecurity has achieved relative successes during the past few decades: the widespread use of technical innovations (in risks prediction, in agricultural intensification or in ready-to-use therapeutic foods) has been combined with the reshaping of the political and humanitarian environment. But, as risky situations and food crises are going on, these sectorial actions are no longer functional and effective. These "new or variant food crisis" are more difficult to anticipate and more complex to resolve because of multi-dimensional and multi-level scales, because of unpredictable interactions between risks, perceptions and actions, and also because of competition between actors. The challenges concerning food securitization are so important that revising our way of thinking has now become a must. This led us to reverse the perspective and to no longer consider the fight against food insecurity in terms of quantified targets and standards but rather as a process made of uncertainties, trials and errors, and of various arrangements owing to existing power relations. Using the concept of "food securitization" seems more appropriate to give a full account of the diverse achievements as well as of the remaining challenges in this broadened field of inquiries, which encompasses the agro-environmental issue (related to future effects of climate change), the nutritional sphere, as well as problems of rights, inequality, vulnerability and resilience.

ObjectiveTo compare the responsiveness of different anthropometric indicators for measuring nutritional stress among children in developing countries.DesignGrowth was studied within 6-month intervals in a rural Senegalese community during one dry and two rainy (hungry) seasons. Responsiveness was defined as the change divided by the standard deviation of each anthropometric indicator. Contrast was defined as the difference in responsiveness between dry and rainy seasons.SettingThe study was conducted in Niakhar, a rural area of Senegal under demographic surveillance, with contrasted food and morbidity situations between rainy and dry seasons.SubjectsSome 5000 children under 5 years of age were monitored at 6-month intervals in 1983–1984. The present analysis was carried out on a sub-sample of children aged 6–23 months with complete measures, totalling 2803 children-intervals.ResultsIn both univariate and multivariate analysis, mid-upper arm circumference was found to be more responsive to nutritional stress than the commonly used weight-for-height Z-score (contrast = −0·64 for mid-upper arm circumference v. −0·53 for weight-for-height Z-score). Other discriminant indicators were: muscle circumference, weight-for-height, BMI and triceps skinfold. Height, head circumference and subscapular skinfold had no discriminating power for measuring the net effect of nutritional stress during the rainy season.ConclusionsThe use of mid-upper arm circumference for assessing nutritional stress in community surveys should be considered and preferred to other nutritional indicators. Strict standardization procedures for measuring mid-upper arm circumference are required for optimal use.

The number of urban poor is increasing quickly in West Africa, yet food security early warning systems still do not include urban areas. One reason is the lack of appropriate and internationally agreed-upon indicators to measure urban household food insecurity. Our objective was to assess the performance of the household food insecurity access scale (HFIAS) and an index-member's dietary diversity score (IDDS) to approximate the adequacy of urban households' diets. A survey was performed on a random cluster sample of 1056 households in Ouagadougou, Burkina Faso. Data on HFIAS and IDDS and 2 nonconsecutive household quantitative 24-h recalls were collected twice, in June-July and in November-December 2007. Diet adequacy was assessed through the household's mean adequacy ratio (MAR) using energy and 11 micronutrients. Structural equation modeling was used to quantify the association of each candidate indicator with the MAR and receiver-operating characteristic (ROC) analyses were performed to assess their targeting performance in predicting low or high MAR. HFIAS was negatively associated with the MAR [path coefficient (P) = -7.95 × 10(-3) ± 1.45 × 10(-3); P < 0.001], whereas IDDS was positively associated with it (P = 5.19 × 10(-2) ± 1.27 × 10(-2); P < 0.001). Areas under the ROC curves ranged from 0.585 to 0.661 for HFIAS and from 0.536 to 0.629 for IDDS. In conclusion, HFIAS and IDDS performed well in approximating adequacy of urban households' diets. They are informative indicators about urban food insecurity, promising for evaluation and monitoring but not for household targeting given their insufficient predictive power.

A partir des modèles causaux élaborés pour le retard de croissance des enfants, l'anémie et l'obésité en Tunisie, une sélection de déterminants probables a d'abord été faite sur la base de leur importance dans les chaînes causales et de leur évolutivité. Pour chacun des déterminants des indicateurs ont ensuite été identifiés, quantitatifs ou qualitatifs, souhaitables à rassembler pour suivre l'évolution des pathologies concernées et de leurs causes. Ces indicateurs ont enfin été caractérisés du point de vue de leur disponibilité, de leur fréquence et de leur niveau d'agrégation spatiale. La liste d'indicateurs présentée dans cet article est encore provisoire. Si de nombreux indicateurs sont disponibles en Tunisie mais n'ont pas encore été mis en relation, d'autres sont en revanche inexistants et leur mise à disposition demande un travail d'enquêtes spécifiques. L'importance de certains déterminants est encore hypothétique et leurs indicateurs ont été sélectionnés dans une perspective de recherche. Les indicateurs sélectionnés ont peu été discutés jusqu'ici avec des utilisateurs potentiels. La mise en place d'une base de données sur Internet et d'une surveillance pilote à l'échelle d'un ou deux gouvernorats leur fournira de premières informations qui leurs permettront de réagir et de réajuster le dispositif de surveillance en fonction de leurs besoins.

The objective of this study was to evaluate the ability of the body mass index (BMI, kg/m2) to reflect low percent body fat (%BF) in a population with a rather mild but widespread prevalence of low BMI. A sample of 586 women was studied in the Plateau Koukouya, a rural area of the Republic of Congo, Central Africa. Percent BF was estimated from bio-electrical impedance (BIA). BIA parameters were assumed to reflect lean body mass. The correlation between %BF and BMI was high (r = 0.84; P is less than 0.001). Low %BF or low BIA parameters were defined as the first quartile of value of BMI is less than 18.5, an accepted international cutoff for thinness, in relation to %BF was 58.5%, 93.6%, 75.4%, and 87.1%, respectively. A continuous sensitivity/specificity analysis (receiver operator characteristic (ROC) curves) for characterizing low %BF or low BIA parameters was done for a large range of BMI values. ROC curve analysis for %BF suggested that an acceptable trade-off between sensitivity (89.8%) and specificity (77.9%) occurred at a BMI of 19.7 kg/m2. However, the positive predictive value was low (57.6%). For the prediction of low BIA parameters, results were similar, showing moderate sensitivity and high specificity for BMI is less than 18.5, a cutoff point of BMI = 19.6, and low positive predictive values (less than 48%). The data suggest that BMI was not a good predictor of low %BF. This is consistent with the assumption of a decrease in both fat and fat free body mass in cases of low BMI. (Résumé d'auteur)

Cette étude est le résultat d'une collaboration intensive de quatre années entre démographes et nutritionnistes de l'IRD (ex-ORSTOM) et de l'ORANA (Dakar) dans le cadre d'un grand programme de recherche sur les déterminants de la santé dans les pays du Sud. L'étude porte sur la relation statistique entre l'état nutritionnel des enfants d'âge préscolaire, mesuré par les indices anthropométriques, et la survie de l'enfant au cours des 6 mois suivant la mesure, dans une zone rurale d'Afrique de l'Ouest (Niakhar, Sénégal). Divers indices anthropométriques sont utilisés, et tous apparaissent fortement corrélés avec la survie de l'enfant. L'étude a permis de quantifier le rôle que la malnutrition joue dans la mortalité des jeunes enfants : environ 60 % des décès d'enfants de 1 à 60 mois sont attribuables au mauvais état nutritionnel. Cette étude voulait aussi fournir un outil pratique de dépistage de la malnutrition sur le terrain. C'est le tour de bras, mesuré simplement à l'aide d'une bandelette graduée, qui semble le plus simple à mesurer en pratique. L'étude présente aussi de nombreux résultats sur la démographie de la zone d'étude, sur l'alimentation du jeune enfant, et des résultats détaillés sur l'évaluation de l'état nutritionnel. (Résumé d'auteur)

L'Afrique est le continent qui a actuellement le plus fort taux d'accroissement urbain dans le monde. Ce bouleversement démographique, parfois présenté comme une chance car porteur de modernisation, avait dès les années quatre-vingt attiré l'attention sur les implications potentielles en matière de nutrition. Au cours des dernières décennies, les difficultés économiques et les programmes d'ajustement structurel ont lourdement frappé les populations urbaines. Aujourd'hui l'aggravation de la pauvreté et les effets incertains de la mondialisation réactualisent les questions de nutrition urbaine. Les prévalences de retard de croissance et de maigreur restent moins importantes qu'en milieu rural, mais la disparité entre ménages riches et pauvres y est beaucoup plus forte. De plus, au cours des années quatre-vingt-dix la maigreur y a parfois davantage progressé, atteignant même dans certains pays le niveau du milieu rural. Chez les adultes le niveau d'obésité des femmes en milieu urbain est caractéristique d'un début de transition nutritionnelle mais on a pu également noter des augmentations de la maigreur. Malgré la grande diversité des situations urbaines, l'analyse de ces facteurs sous-jacents permet de dégager un certain nombre d'invariants : importance du revenu monétaire, de l'emploi du temps des femmes, des modifications du régime alimentaire, de l'hygiène de l'environnement, de l'accès aux services de santé. Pour la plupart de ces facteurs, la marque du milieu urbain est l'accroissement d'inégalités déjà fortes. (Résumé d'auteur)

In 1986, 1991 and 1996, three anthropometric cross-sectional surveys were carried out in Brazzaville, the capital city of the Congo, on the representative samples of children less than 6 y. old (n = 2,265, 2,345 and 2,000, respectively) and their mothers. In addition all other members of the households were also investigated in 1991 and 1996. Comparisons between years were adjusted for age, district and, when necessary, sex. Prevalence of wasting (weight-for-height is less than -2 z-scores) among children showed a significant increase over the three surveys (2.9%, 3.9%, 4.6% - OR 96 vs 86 = 1.72, p = 0.001). The prevalence of low Body Mass Index (BMI is less than 18.5 Kg/m2) among mothers also significantly increased (8.4%, 10.5%, 14.2% - OR 96 vs 86 = 1.89, p is less than 0.001). Paradoxically the proportion of stunted children (height-for-age is less than -2 z-scores) first decreased from 1986 to 1991 (13.4% to 10.7% - OR 91 vs 86 = 0.73, p is less than 0.001). These results reflect a global deterioration of the nutritional situation. Moreover, similar trends among the other household members were observed from 1991 to 1996 ; increase of low BMI prevalence among adults (women, OR = 1.42, p is less than 0.001 ; men, OR = 1,49, p = 0.001) ; increase of low BMI for age among adolescents, especially males (OR = 1.75, p is less than 0.001), increase of stunting in school children (9.6% to 14.5% - OR = 1.54, p. is less than 0.01). (Résumé d'auteur)

To compare the effectiveness of treating malnourished children in different centers, the authors believe there is a need to have a simple method of adjusting mortality rates so that differences in the nutritional status of the children are taken into account. The authors compared different anthropometric indices based on weight and height to predict the risk of death among severely malnourished children. Anthropometric data from 1,047 children who survived were compared with those of 147 children who died during treatment in therapeutic feeding centers set up in African countries in 1993. The optimal ratio of weight to height determined by logistic regression was weight (kg)/height (m)1.74 (95% confidence interval of beta estimate 1.65-1.84). The receiver operating curves (sensitivity vs. specificity) showed that the body mass index (weight (kg)/height (m)2), optimal ratio of weight to height, and weight/height index expressed as the percentage of the median of the National Center for Health Statistics' standard were equivalent and superior to the weight/height index expressed as the z score of the National Center for Health Statistics' standard to predict death. As the optimal ratio of weight to height is easier to calculate than the weight/height index expressed as the percentage of the median or z score and does not depend upon either standards or tables, the optimal ratio of weight to height could be conveniently used to adjust mortality rates for nutritional status in therapeutic feeding centers.The development of a simple anthropometric index closely related to child survival prognosis could enhance the treatment of severely malnourished children at therapeutic feeding centers in Africa. This study examined whether simple ratios of weight to powers of height could be used to adjust the observed mortality rates for differences in the anthropometric state of 1194 children 6-59 months of age admitted to 9 feeding centers in Sierra Leone, Rwanda, and Madagascar. 147 of these children died during treatment. The optimal ratio of weight to height determined by logistic regression was weight (kg)/height (m). The receiver operating curves showed that the body mass index (weight (kg)/height (m)2), optimal ratio of weight to height, and weight/height index expressed as the percentage of the median of the US National Center for Health Statistics (NCHS) standard were equivalent and superior to the weight/height index expressed as the z score of the NCHS standard to predict death. Edema was a significant risk factor for death (odds ratio, 3.8; 95% confidence interval, 2.2-6.6). The optimal ratio of weight to height can be computed on a pocket calculator and does not require reference to standards or tables, making it appropriate for conditions in the feeding centers.

Cette étude à pour but de déterminer le risque de décès associé à différents états nutritionnels chez l'enfant d'âge préscolaire (0-5 ans), au Sénégal, plus précisemment dans la région de Niakhar. Les principales données de l'étude, ainsi que les détails de la méthodologie du travail sur le terrain, sont ainsi rendus disponibles pour l'usage des chercheurs et des responsables de santé publique. (VRL)

The usefulness of nutritional indices and classifications in predicting the death of children under 5 years old was evaluated by comparing measurements of 34 children with diarrhoea who died in a Dhaka hospital with those of 318 patients who were discharged in a satisfactory condition. In a logistic regression analysis mid-upper arm circumference was found to be as effective as other nutritional indices in predicting death. Combinations of different indices did not improve the prediction. Arm circumference might be preferable to more complex criteria for predicting the death of malnourished children.

Les recherches menées en milieu rural sahélien (Burkina Faso) ont permis d'identifier certains indicateurs de crise alimentaire afin d'anticiper l'apparition de la soudure alimentaire et hiérarchiser les réponses familiales mises ne place pour y faire face. Toute la difficulté consiste à saisir dans le temps et dans l'espace, les décisions prises et leurs conséquences dont dépend aussi la vulnérabilité alimentaire. Sont considérés comme des indicateurs tous les repères de déséquilibre, dans le temps et dans le paysage, à l'échelle de la concession. Ce texte part d'une réflexion théorique sur la vulnérabilité rurale et revient sur la méthodologique d'enquêtes adoptée.