Demographic and socio-economic shifts partly explain the Martinican nutrition transition: an analysis of 10-year health and dietary changes (2003-2013) using decomposition models

OBJECTIVE

The Caribbean has seen a dramatic shift in the obesity and chronic disease prevalence over the past decades, suggesting a nutrition transition. Simultaneously, Martinique has faced a demographic transition marked by significant population ageing. We aimed to differentiate the contribution of changes in health status and dietary intakes due to shifts in demographic and socio-economic characteristics (DSEC) from that due to unobserved factors.

DESIGN

Two cross-sectional surveys conducted in 2003 (n 743) and 2013 (n 573) on representative samples were used. Dietary intakes were estimated by 24-h recalls. The contribution of changes in health status and dietary intakes due to shifts in observed DSEC was differentiated from that due to unobserved factors over a 10-year interval, using Oaxaca-Blinder decomposition models.

SETTING

Martinique, French region in the Caribbean.

PARTICIPANTS

Martinican adults (≥16 years).

RESULTS

Over the study period, health status deteriorated, partly owing to shifts in DSEC, explaining 62 % of the change in the prevalence of hypertension (+13 percentage points (pp)) and 48 % of waist circumference change (+3 cm). Diet quality decreased (mean adequacy ratio -2pp and mean excess ratio + 2 pp) and energy supplied by ultra-processed food increased (+4 pp). Shifts in DSEC marginally explained some changes in dietary intakes (e.g. increased diet quality), while the changes that remained unexplained were of opposite sign, with decreased diet quality, lower fruits, tubers and fish intakes and higher energy provided by ultra-processed foods.

CONCLUSION

Explained dietary changes were of opposite sign to nutrition transition conceptual framework, probably because unobserved drivers are in play, such as food price trends or supermarkets spread.

The Influence of Household Refrigerator Ownership on Diets in Vietnam

Refrigerator ownership accompanies socio-economic development, with the potential to change human diets. Household refrigerator ownership in Vietnam has increased from 13% to 59% between 2004-2014. This study estimates changes in food consumption and diet linkages with household refrigerator ownership in Vietnam, while controlling for socioeconomic variables. We use a two-step instrumental variable regression model on two panels of the Vietnam Household Living Standards Survey covering 2004-2014. Our study finds refrigerator ownership to be significantly associated with decreases in per-capita calorie intake over both periods. Refrigerator ownership may be connected with households substituting lower-nutrient foods with higher ones, with substantial decreases in starchy staple food consumption connected with refrigerator ownership in both panels. For both periods, refrigerator ownership is significantly connected with increased dairy consumption, potentially reflecting the refrigerator increasing a household's ability to store dairy products.

Interpretation of Explanatory Variables Impacts in Compositional Regression Models

We are interested in modeling the impact of media investments on automobile manufacturer's market shares. Regression models have been developed for the case where the dependent variable is a vector of shares. Some of them, from the marketing literature, are easy to interpret but quite simple (Model A). Alternative models, from the compositional data analysis literature, allow a large complexity but their interpretation is not straightforward (Model B).  This paper combines both approaches in order to obtain a performing market share model and develop relevant interpretations for practical use.We prove that Model A is a particular case of Model B, and that an intermediate specification is possible (Model AB). A model selection procedure is proposed. Several impact measures are presented and we show that elasticities are particularly useful: they can be computed from the transformed or from the original model, and they are linked to the simplicial derivatives.

Decomposition of changes in the consumption of macronutrients in Vietnam between 2004 and 2014

Vietnam is undergoing a nutritional transition like many middle-income countries. This transition is characterized by an increase in per capita total calorie intake resulting from an increase in the consumption of fat and protein while the carbohydrate consumption decreases. This paper proposes to highlight the sociodemographic drivers of this transition over the period 2004-2014, using Vietnam Household Living Standard Survey data. We implement a method of decomposition of between-year differences in economic outcomes recently proposed in the literature. This method decomposes the between-year change in various indicators related to the outcome distribution (mean, median, quantiles, etc.) into (1) the effect due to between-year change in the conditional distribution of the outcome given sociodemographic characteristics, or "structure effect", and (2) the effect due to the differences in sociodemographic characteristics across years, or "composition effect". In turn, this last effect is decomposed into direct contributions of each sociodemographic characteristics and effects of their interactions. The composition effect, always positive, generally outweighs the structure effect when considering the between-year changes in distributions of per capita calorie intake or calorie intake coming from protein or fat. The effects of changes in the composition of the Vietnamese population thus overcome the effects of changes in preferences of the same population. This finding is reversed in the case of carbohydrates. Food expenditure and household size appear to be the main contributors to the composition effect. The positive effects of these two variables explain well most of the between-year shifts observed in the calorie intake distributions. Urbanization and level of education contribute negatively to the composition effect, with the noticeable exception of fat where the effect of urbanization is positive. But these two variables effects are negligible compared to those of food expenditure and household size.

Relations between socio-economic factors and nutritional diet in Vietnam from 2004 to 2014: New insights using compositional data analysis

This paper contributes to the analysis of the impact of socioeconomic factors, like food expenditure level and urbanization, on diet patterns in Vietnam, from 2004 to 2014. Contrary to the existing literature, we focus on the diet balance in terms of macronutrients consumption (protein, fat and carbohydrate) and we take into account the fact that the volumes of macronutrients are not independent. In other words, we are interested in the shares of each macronutrient in the total calorie intake. We use compositional data analysis (CODA), adapted to deal with the relative information contained in shares, to describe the evolution of diet patterns over time, and to model the impact of household characteristics on the macronutrient shares vector. We compute food expenditure elasticities of macronutrient shares, and we compare them to classical elasticities for macronutrient volumes and total calorie intake. The compositional model highlights the important role of many factors in the determination of diet choices and we will focus mainly on the role of food expenditure. Our results are consistent with the rest of the literature, but they have the advantage to highlight the substitution effects between macronutrients in the context of nutrition transition.

Phenotypic APC resistance in carriers of the A20210 prothrombin mutation is associated with an increased risk of venous thrombosis

We hypothesized that increased prothrombin levels associated with G20210A prothrombin gene mutation could affect the results of activated protein C (APC) resistance phenotype and increase the risk of venous thrombosis (VT). The increasing addition of purified prothrombin in plasma of 90 normal subjects resulted in a parallel significant increase of APC resistance. Significantly different mean n-APC-SR in 879 GG20210 subjects compared to 27 heterozygous carriers of isolated G20210A mutation was observed (1.0 +/- 0.12 vs. 0.95 +/- 0.11; P = 0.02) in a random sample of 906 normal population subjects. Twenty-seven families with VT and isolated G20210A mutation consecutively diagnosed during 1998-1999 were evaluated. Mean n-APC-SR was significantly lower in the 80 G20210A carriers compared to 58 GG 20210 relatives investigated, even after sex and age adjustment (0.92 +/- 0.08 vs. 1.05 +/- 0.13; P < 0.0001). A strong relationship between plasma prothrombin level and n-APC-SR was observed in the families. When n-APC-SR values were grouped in tertiles, the odds ratio for VTE, after exclusion of the index cases and adjustment for 20210 status, for subjects in the lowest tertile (n-APC-SR 0.73-0.90) was 4.58 (95% CI 0.78-26.88) compared to upper tertile (n-APC-SR 1.01-1.30). In conclusion, in subjects with G20210A mutation APC resistance is significantly increased, correlates with plasma prothrombin level and the carriers with the lowest APC resistance values have an increased risk of VTE.

Platelet activation and modulation of the induction of nitric oxide synthase in the conscious rat

Injection of lipopolysaccharide (LPS) (Salmonella W. Typhosa i.v. bolus) into conscious rats, induced a rapid drop of circulating platelets analogous to that induced by ADP. The animals showed a small fall in mean arterial blood pressure (MABP), an increase in heart rate and a significant increase in plasma nitrite and nitrate level. This result is consistent with the stimulation of an inducible NO synthase (i-NOS). The administration of the stable prostacyclin analogue, iloprost plus ADP or LPS, significantly protected against the decrease in free platelet number induced by ADP or LPS. The plasma nitrite and nitrate level stimulated by LPS was significantly reduced by iloprost and also by prostacyclin. These results are consistent with an inhibition of i-NOS by agents that increase the intracellular level of cAMP. The administration of the NO donor S-Nitroso-N-acyl-D-penicillamine (SNAP) plus ADP or LPS, significantly prevented thrombocytopenia induced by ADP and by LPS. SNAP did not decrease the plasma nitrite and nitrate level stimulated by LPS; furthermore it induced a significant increase of heart rate, without affecting MABP, suggesting a direct accelerating effect of NO on the sino-atrial node. The administration of S-nitroso-glutathione (GSNO), a stable nitrosothiol, plus ADP or LPS, significantly prevented thrombocytopenia induced by ADP but not by LPS. GSNO significantly reduced the plasma nitrite and nitrate level stimulated by LPS. These data demonstrate that the L-Arginine: NO pathway in vivo may be modulated by prostanoids and that compounds which increase cAMP, such as iloprost, are able to protect against LPS-induced early thrombocytopenia.

Serum IgA and gold toxicity in rheumatoid arthritis: lack of predicting value

The previously reported predictive value of serum IgA for gold toxicity was investigated by measuring such immunoglobulins in 114 patients affected with rheumatoid arthritis and treated with gold salts over a period of 36 months. Side effects were observed in 41 cases (35.9%) (toxic group), mostly within the first year of treatment. Basal levels of IgA were normal in all but 2 patients who maintained low levels throughout the follow-up but did not show any toxic effects. Before therapy and during gold salt administration no difference in serum IgA was noted between the toxic and the non-toxic group. After 6 months of therapy a significant decrease (p less than 0.05) in serum IgA (although never below normal limits) was detected in the toxic group as compared to both the basal values of the same group and the values of the non-toxic group at the same control. Moreover, we did not find any difference in serum IgA between toxic patients with and without mucocutaneous reactions. In our experience the monitoring of serum IgA is not useful in predicting gold toxicity.

[Proglumetacin for the treatment of inflammatory and degenerative arthropathies]

Twenty patients with inflammatory (15) or degenerative (5) joint disorders had been treated with 450 mg/day of proglumetacin during 35 +/- 18 days. Articular symptoms showed a definite and continued improvement, particularly evident during the initial 15 days of treatment on both painful and inflammatory components. The final physician's evaluation rated 75% of results as excellent or good, versus 15% of poor (3 patients, one of whom already refractory to diclofenac). The tolerance was defined as excellent to good in 90% of patients: one (5%) was dropped out upon the onset of sweating and palpitation, already observed with other drugs. Overall, only one case each of heartburn, anorexia and diarrhoea were considered as possibly related to the treatment. Laboratory tests did not show any variation that could be attributed to the drug. Proglumetacin therefore, by force of its efficacy and safety, appears to be particularly suited as a first-choice drug for the management of both inflammatory and degenerative joint disorders.