Diet Quality and Dietary Diversity in France: Implications for the French Paradox

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Abstract

Objectives Assessing the quality of the total diet is a relatively new focus of studies in nutritional epidemiology. New indexes of healthful eating patterns have been largely limited to US populations. This study used evaluative criteria developed in the United States to assess diet quality and dietary diversity of French adults.

Methods Habitual dietary intakes of a representative sample of 837 adults (361 men and 476 women) in the Val-de-Marne Departement were evaluated. Evaluative measures of diet quality included a modified diet quality index (DQI), a dietary diversity (DD) score, and a dietary variety score (DVS). The 5-point DQI assessed compliance with the key guidelines of the US Department of Agriculture (USDA) for healthy people. The DD score counted the number of major food groups consumed whereas the DVS counted the total number of foods consumed on a regular basis.

Results Few French adults consumed diets consistent with the USDA dietary recommendations. Only 14% of respondents derived less than 30% of energy from fat and only 4% derived less than 10% of energy from saturated fat. As a result, 63% of the sample had DQI scores of either 0 or 1. In contrast, close to 90% of respondents scored a maximum of 5 in DD. Persons whose diets met US dietary recommendations also had the lowest DVSs.

Conclusions Methodologic factors and cultural biases may account for some of the observed differences between French and US data. Nevertheless, studies of diet quality and diversity are a promising new approach to the study of the total diet and associated health outcomes and may provide new insight into the French paradox. J Am Diet Assoc. 1996; 96:663–669.

Section snippets

The Val-de-Marne Study

The dietary survey was conducted in 1988 to 1989 by members of the Institut Scientifique et Technique de l’Alimentation in Paris (22), (23), (24). The subject sample was selected using a two-stage cluster-design sampling procedure. First, 12 of the 47 districts in the Val-de-Marne Dèpartement (population=1,192,692) were selected by probability sampling, where the probability of selection was proportional to district size. In the second stage, 75 families per district were selected, again at

Results

Mean age of the subject sample was 42.5 years for men and 42.8 years for women. The mean body mass index (kg/m2) was 24.4 for men and 22.6 for women. Subject distribution by age, sex, and occupation and by use of alcohol and tobacco is shown in Table 1.

Discussion

Assessments of diet quality and dietary diversity represent relatively new tools in nutritional epidemiology. Past studies of dietary quality conducted with NHANES and Nationwide Food Consumption Survey data sets were, of necessity, limited to data obtained with 24-hour recalls and 3- or 4-day food records (10), (11), (12). At the same time, the dietary history method is generally recognized as providing a more accurate picture of the habitual food consumption of individuals (25). This

Conclusions

One limitation to research on diet and chronic disease has been the lack of appropriate methods to evaluate overall diet quality. The complex and multidimensional nature of the human diet poses a challenge to the investigator, especially when it comes to comparisons between countries. In this study, some existing methodologies were adapted to evaluate diet quality of a sample of French adults. Although the French diet failed to meet some of the USDA dietary guidelines, it was diverse and varied

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