Nutrition Transition in French West Indies : Interactions between food supply and dietary behaviors – NuTWInd

Regarding nutrition, we accurately characterize the diet and the nutritional status of adults and children, their evolution and the associated socio-demographic and economic factors, based on representative epidemiological studies conducted in Martinique and Guadeloupe. We also study how diet contributes to social inequalities in health using mediation models. Concurrently with food consumption, we are building a database to study dynamics of food supply over 20 years (food products’ importations and local production) in terms of nutritional quality. To study individual determinants of food choices, we evaluate how consumers balance different motives (price, sensory preference, product characteristics, local production) using experimental economics. Among individual determinants, we specifically focus on sensory preferences for fat, salt and sweet in adults by developing sensory tests (n=200) and a questionnaire on self-reported preferences (n=1500), adapted to the French West Indies population. Then, we will qualitatively explore how food environment influence consumers’ food practices. Regarding determinants of food supply, to determine the extent to which a healthy diet is accessible to consumers, we evaluate the variability of nutritional characteristics and food prices of foods that highly contribute to intakes of salt, sugar or fat, according to sale places and local or imported brands. This will allow to assess rooms for manoeuvre for local firms, in terms of nutritional improvement of foods. We also study the determinants of food importations by econometric analysis in panel data. Based on the whole results, we will then explore the most relevant strategies at consumer and food supply levels to improve nutrition security, using modeling and participatory research with stakeholders.

Macronutrient intakes of adults and children are in compliance with the recommendations, while intakes of fruits, vegetables and dairy products and therefore intakes of fiber and calcium were much lower. However, the overall diet quality scores are equivalent to those found in mainland France and are slightly associated with socioeconomic factors. As expected, adults of French West Indies have a worrisome health status: the prevalence of folate deficiency and anemia are 22% and 16%, respectively. Concurrently, 21% are obese, 11% are diabetic, 40% are hypertensive and 23% have a metabolic syndrome. We have shown that the diet quality little contributes to explain the socioeconomic inequalities associated with the prevalence of the metabolic syndrome. Regarding sensory determinants, the preference questionnaire is being administered in Martinique since December 2018 via a dedicated website (https://etudenutriparm.fr). The subjects are then invited to participate in the Nutrinet-Santé study to evaluate their individual food intake and their health status (www.etude-nutrinet-sante). Regarding the current food supply, we have created a database of nutritional compositions, prices, sale places and brands for several thousands of references for processed meat, sweet beverages, dairy products and biscuits and cakes. The first results showed a very high dispersion of sodium contents for processed meat, suggesting a room of manoeuvre to improve the nutritional quality of these products. Our results on dynamics of food supply showed a decrease of importations’ volume of 3% in Guadeloupe between 1995-2016, while in Martinique, they increased by 14%. Importations increased in value by 15%, taking into account the evolution of the price index. Since 1995, fresh or unprocessed products represented the largest share of importations in volume and value, followed by ultra-processed products.

The characterization of the diet goes on by studying the relationships between the part of ultra-processed foods in diet and diet quality and health status and their evolution over 10 years. We will also explore more behavioral dimensions of food consumption (meal patterns, snacking behaviors, food supply practices). Regarding the individual determinants of diet, a choice experiment will be conduct to understand whether consumers of French West Indies are willing to accept a nutritional improvement taking into account the price, the taste and the brand. In 2019, the collection and the analysis of self-reported sensory preferences will extend to Guadeloupean population. The sensory tests will be validated and then administered to 200 consumers and will be analyzed in 2020. The sociological study on the perceptions of the evolution of the food environment will be carried out in 2020. For the food supply, data collection goes on, in order to cover the diversity of distribution channels and territories and to understand how the access to healthy foods and their prices vary according to the area and in comparison with mainland France. Using data on food supply variability, we will evaluate to what extent change in consumption towards healthier foods within the group of food products affect the dietary intake of the populations and their food expenses. Regarding dynamics of food supply, we will match nutritional value for each food in our database to analyze changes in the nutritional quality of importations and local production and their determinants. To identify the most relevant actions, we will assess, by modeling, the dietary changes required to meet a whole set of nutritional recommendations from the available food supply in the French West Indies and from modification of the food supply. Then, we will evaluate the most relevant actions using method of participative research with the stakeholders.

Colombet Z, Perignon M, Salanave B, Landais E, Martin-Prevel Y, Allès B, Drogue S, Amiot MJ, Méjean C. Does diet quality mediate socioeconomic differences in metabolic syndrome in the French West Indies? Submitted to JAHA 21/12/2018
Colombet Z, Perignon M, Salanave B, Landais E, Martin-Prevel Y, Allès B, Amiot MJ, Darmon N, Méjean C. Socioeconomic disparities in diet quality in the French West Indies. EGEA VIII conference, 7-9 Nov 2018, Lyon (communication affichée)
Colombet Z, Perignon M, Salanave B, Landais E, Martin-Prevel Y, Allès B, Drogue S, Amiot MJ, Méjean C. Does diet quality explain socioeconomic difference in metabolic syndrome in French West Indies?. EGEA VIII conference, 7-9 Nov 2018, Lyon (communication affichée)
Colombet Z, Perignon M, Salanave B, Landais E, Martin-Prevel Y, Allès B, Drogue S, Amiot MJ, Méjean C. Does diet quality explain socioeconomic difference in metabolic syndrome in French West Indies?. 12th Annual Social Science Conference (JRSS), 13-14 Dec 2018, Nantes (communication orale)
Colombet Z, Perignon M, Salanave B, Landais E, Martin-Prevel Y, Allès B, Amiot MJ, Darmon N, Méjean C. Identification des caractéristiques individuelles associées à la sous-déclaration dans les Antilles françaises. Journées Francophones de Nutrition (JFN), 28-30 Nov. 2018, Nice (communication affichée)
Colombet Z, Perignon M, Salanave B, Landais E, Martin-Prevel Y, Allès B, Amiot MJ, Darmon N, Méjean C. Influence des disparités socioéconomiques sur la qualité de l’alimentation dans les Antilles françaises. Journées Francophones de Nutrition (JFN), 28-30 Nov. 2018, Nice (communication affichée)
Colombet Z, Perignon M, Salanave B, Landais E, Martin-Prevel Y, Allès B, Drogue S, Amiot MJ, Darmon N, Méjean C. La qualité de l’alimentation contribue-t-elle à expliquer les différences socioéconomiques de la prévalence du syndrome métabolique dans les Antilles Françaises ?. 35th journées scientifiques de l'AFERO, 31/01/2019, Marseille (communication affichée)

The few available studies in the Caribbean, including the French West Indies, highlight urgent public health issues: a shift in the dietary structure and increasing rates of obesity and chronic diseases have been observed over recent decades, revealing an advanced phase of the nutrition transition, which may affect nutrition security. Among the striking characteristics of nutrition transition are changes in food supply and population diet over short periods related to international trade and increased dependence on foods’ importation. An in-depth knowledge of individual and environmental determinants of dietary behaviours in French West Indies is urgently needed to better understand how they impact population health and to guide public health measures.
Our multidisciplinary project, involving nutritionists, epidemiologists, economists, sociologists, sensory scientists, a food technical institute, food industries and the French Ministry of Agriculture, aims to elucidate the relationships between characteristics of local food supply and dietary behaviours of populations and to propose strategies to improve nutrition security in the French West Indies. Specifically, our project aims at:
-characterizing individual food and nutrient intakes, nutritional status and household food supply practices (WP1). Based on epidemiological representative studies conducted in 2004 among 1113 Martinican adults and in 2014 among 1273 Martinican and Guadeloupean adults and 153 children, we will characterize dietary patterns, in relation with the prevalence of obesity, folate and iron deficiencies as well as their social determinants and their evolution over 11 years.
-understanding determinants of consumers’ food choices (WP2). We will assess sensory preferences for sweet, fat and salt in Martinican adults, by developing sensory tests and preference questionnaire adapted to the population. We will study their relationships with dietary intake, through 24h dietary records. We will also evaluate how consumers balance different motives (price, sensory preference, product characteristics, local production) using experimental economics. Then, we will qualitatively explore how food environment influence consumers’ food practices.
-characterizing the evolution of food supply and the rooms for manoeuvre for local firms to improve the nutritional quality of foods (WP3). Using interviews, we will characterize supply chain and strategies of different stakeholders in the French West Indies. We will study dynamics of food products’ importations and local production in terms of price, amounts, nutritional quality and types of foods, over two decades in Martinique and Guadeloupe, using existing data from custom duties and local production. Rooms for manoeuvre for local firms, in terms of nutritional improvement of foods (reformulation, redeployment and innovation) will be estimated.
-exploring strategies, at consumer and food supply levels, able to improve nutrition security. Based on findings on firms’ rooms of manœuvre, we will simulate the impact of reformulations on the nutritional quality of individual observed diets, i.e. when no changes occur at consumer level. Based on findings on consumers’ behaviours, and when no changes occur at food supply level, we will model the dietary changes allowing meeting nutritional recommendations with lowest departure from observed food patterns and at no additional cost. Then, the potential impact on nutrition security of combining improvements of food supply and food choices will be explored through quantitative and qualitative approaches, in order to suggest guidelines for public and private decision makers.
By proposing ways to improve nutrition security through more favorable dietary behaviors and local food supply accessible and conducive to well-being and health, our project will contribute to identify and to promote strategies to meet the nutritional and hedonic needs of consumers under their budget constraints.