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See detailStability-based validation of dietary patterns obtained by cluster analysis
Sauvageot, Nicolas ULg; Schritz, Anna; Alkerwi, Ala'a et al

in Nutrition Journal (2017), 16(3),

Abstract Background Cluster analysis is a data-driven method used to create clusters of individuals sharing similar dietary habits. However, this method requires specific choices from the user which have ... [more ▼]

Abstract Background Cluster analysis is a data-driven method used to create clusters of individuals sharing similar dietary habits. However, this method requires specific choices from the user which have an influence on the results. Therefore, there is a need of an objective methodology helping researchers in their decisions during cluster analysis. The objective of this study was to use such a methodology based on stability of clustering solutions to select the most appropriate clustering method and number of clusters for describing dietary patterns in the NESCAV study (Nutrition, Environment and Cardiovascular Health), a large population-based cross-sectional study in the Greater Region (N = 2298). Methods Clustering solutions were obtained with K-means, K-medians and Ward’s method and a number of clusters varying from 2 to 6. Their stability was assessed with three indices: adjusted Rand index, Cramer’s V and misclassification rate. Results The most stable solution was obtained with K-means method and a number of clusters equal to 3. The “Convenient” cluster characterized by the consumption of convenient foods was the most prevalent with 46% of the population having this dietary behaviour. In addition, a “Prudent” and a “Non-Prudent” patterns associated respectively with healthy and non-healthy dietary habits were adopted by 25% and 29% of the population. The “Convenient” and “Non-Prudent” clusters were associated with higher cardiovascular risk whereas the “Prudent” pattern was associated with a decreased cardiovascular risk. Associations with others factors showed that the choice of a specific dietary pattern is part of a wider lifestyle profile. Conclusion This study is of interest for both researchers and public health professionals. From a methodological standpoint, we showed that using stability of clustering solutions could help researchers in their choices. From a public health perspective, this study showed the need of targeted health promotion campaigns describing the benefits of healthy dietary patterns. [less ▲]

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See detailUse of finite mixture models in dietary patterns analysis.
Sauvageot, Nicolas ULg; Schritz, Anna; Leite, Sonia et al

Scientific conference (2016, September 29)

Background In recent years, the dietary pattern approach has been used extensively to describe overall eating profiles in populations. In the literature, dietary patterns are often computed by cluster ... [more ▼]

Background In recent years, the dietary pattern approach has been used extensively to describe overall eating profiles in populations. In the literature, dietary patterns are often computed by cluster analysis and principal component analysis (PCA). However, PCA does not create distinct groups of individuals with different dietary habits; moreover the choice of the clustering method and of the number of clusters in cluster analysis remains difficult. On the other hand, finite mixture models (FMM) do not have those limitations and have many other advantages. However, they have been rarely used in dietary pattern analysis. Objective The objective of this study was to use FMM to compute dietary patterns based on data from the NESCaV survey (Nutrition, Environment and Cardiovascular Health), a large population-based study carried out between 2007 and 2011among the Greater Region population (N=2298 subjects). Methods A 134-food frequency questionnaire was used to assess dietary intakes. The most appropriate parameterization of the covariance matrix and number of clusters was chosen on the basis of the Bayesian information criterion (BIC). Results Four dietary patterns were determined. A ”non-prudent” and a “prudent” patterns were characterized respectively by non-healthy and healthy food choices. A “breakfast/low alcohol” pattern was characterized by high intakes of food items usually consumed at breakfast. Finally, a “vegetables/dairy products/low carbohydrate” pattern was characterized by low intakes of carbohydrates but high intakes of vegetables, pulses, fruits, animal protein and fat mostly from dairy products. The “non-prudent” pattern was the most prevalent with 34% of the population assigned to this cluster. The “prudent”, “breakfast/low alcohol” and “vegetables/dairy products/low carbohydrate” patterns accounted respectively for 25%, 29% and 19% of the population, respectively. Women, older people and non-smokers followed the “prudent” and “breakfast/low alcohol”, whereas the “non-prudent” and “vegetables/dairy products/low carbohydrate” were more adopted by men and smokers. In addition, the “non-prudent” pattern was associated with higher cardiovascular risk. Conclusion FMM should be considered more often as they do not have limitations encountered with other methods and are not restrictive on cluster geometry. Moreover, this study highlights the need for targeted health promotion campaigns focussing on the benefits of healthy dietary patterns. [less ▲]

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See detailComparaison de deux méthodes statistiques explorant la relation entre régimes alimentaires et risques cardiovasculaires.
Sauvageot, Nicolas ULg; Leite, Sonia; Donneau, Anne-Françoise ULg et al

Poster (2016, September)

Introduction L’analyse en composantes principales (ACP) et la régression à rangs réduits (RRR) sont deux méthodes de réduction de dimension permettant de construire des variables reflétant des régimes ... [more ▼]

Introduction L’analyse en composantes principales (ACP) et la régression à rangs réduits (RRR) sont deux méthodes de réduction de dimension permettant de construire des variables reflétant des régimes alimentaires. Les régimes alimentaires obtenus par ACP sont associés aux habitudes alimentaires de la population étudiée tandis que ceux obtenus par RRR sont associés à des indicateurs d’intérêt. L’objectif de cette étude est de comparer les deux approches quant aux régimes alimentaires obtenus et à leurs associations avec les facteurs de risques cardiovasculaires (FRCV). Méthodologie Les données proviennent de l’étude interrégionale et transversale nutrition, environnement et santé cardiovasculaire (NESCAV) ayant pour but de décrire la santé cardiovasculaire de la grande région (Luxembourg, Lorraine et Wallonie). Les apports alimentaires ont été mesurés à l’aide d’un questionnaire de fréquence alimentaire et 2298 individus ont été retenus pour cette analyse. Les indicateurs d’intérêt retenus pour l’approche RRR sont les FRCV usuels (obésité, hypertension, diabète, dyslipidémie). Résultats Nous avons trouvé que les régimes alimentaires consommés par la population et ceux associés au FRCV étaient similaires. Les régimes riches en fruits, fruits secs et oléagineux, légumes, huile d’olive, graisse riche en oméga 6, thé, et ceux pauvres en aliments frits, viandes, charcuteries, soda, plats préparés, bières étaient associés à une diminution des FRCV. Les autres régimes caractérisés par des apports élevés en aliments frits, viandes, abats, bières, vins, apéritifs et liqueurs et de faibles apports en céréales, sucres et soda étaient associés à une augmentation des FRCV. Conclusions L’utilisation des deux méthodes est utile pour obtenir des informations permettant d’élaborer de nouvelles recommandations alimentaires. Les régimes alimentaires identifiés dans cette étude sont à la fois associés aux habitudes alimentaires de la population et aux FRCV. [less ▲]

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See detailAssociation of Empirically Derived Dietary Patterns with Cardiovascular Risk Factors: A Comparison of PCA and RRR Methods
Sauvageot, Nicolas ULg; Leite, sonia; Alkerwi, Ala'a et al

in PLoS ONE (2016), 11(8),

Abstract Introduction Principal component analysis is used to determine dietary behaviors of a population whereas reduced rank regression is used to construct disease-related dietary patterns. This study ... [more ▼]

Abstract Introduction Principal component analysis is used to determine dietary behaviors of a population whereas reduced rank regression is used to construct disease-related dietary patterns. This study aimed to compare both types of DP and theirs associations with cardiovascular risk factors (CVRF). Materiel and Methods Data were derived from the cross sectional NESCAV (Nutrition, Environment and Cardiovascular Health) study, aiming to describe the cardiovascular health of the Greater region’s population (Grand duchy of Luxembourg, Wallonia (Belgium), Lorraine (France)). 2298 individuals were included for this study and dietary intake was assessed using a 134-item food frequency questionnaire. Results We found that CVRF-related patterns also reflect eating behaviours of the population. Comparing concordant food groups between both dietary pattern methods, a diet high in fruits, oleaginous and dried fruits, vegetables, olive oil, fats rich in omega 6 and tea and low in fried foods, lean and fatty meat, processed meat, ready meal, soft drink and beer was associated with lower prevalence of CVRF. In the opposite, a pattern characterized by high intakes of fried foods, meat, offal, beer, wine and aperitifs and spirits, and low intakes of cereals, sugar and sweets and soft drinks was associated with higher prevalence of CVRF. Conclusion In sum, we found that a “Prudent” and “Animal protein and alcohol” patterns were both associated with CVRF and behaviourally meaningful. Moreover, the relationships of those dietary patterns with lifestyle characteristics support the theory that food choices are part of a larger pattern of healthy lifestyle. [less ▲]

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See detailAssessment of cardiovascular risk of new drugs for the treatment of diabetes mellitus: risk assessment vs. risk aversion.
Zannad, Faiez; Stough, Wendy Gattis; Lipicky, Raymond J. et al

in European heart journal. Cardiovascular pharmacotherapy (2016), 2(3), 200-205

The Food and Drug Administration issued guidance for evaluating the cardiovascular risk of new diabetes mellitus drugs in 2008. Accumulating evidence from several completed trials conducted within this ... [more ▼]

The Food and Drug Administration issued guidance for evaluating the cardiovascular risk of new diabetes mellitus drugs in 2008. Accumulating evidence from several completed trials conducted within this framework raises questions as to whether requiring safety outcome studies for all new diabetes mellitus therapies remains justified. Given the burden of cardiovascular disease in patients with diabetes, the focus should shift towards cardiovascular outcome studies designed to evaluate efficacy (i.e. to determine the efficacy of a drug over placebo or standard care) rather than demonstrating that risk is not increased by a pre-specified safety margin. All stakeholders are responsible for ensuring that new drug approvals occur under conditions of appropriate safety and effectiveness. It is also a shared responsibility to avoid unnecessary hurdles that may compromise access to useful drugs and threaten the sustainability of health systems. It is critical to renew this debate so that stakeholders can collectively determine the optimal approach for developing new drugs to treat type 2 diabetes mellitus. [less ▲]

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See detailAdherence to physical activity recommendations and its associated factors: an interregional population-based study
Alkerwi, Ala'a; Schuh, Barbara; Sauvageot, Nicolas et al

in Journal of Public Health Research (2015), 4(1),

Background. Though the influence of physical activity in preventing cardiovascular diseases is well documented, only a few comparative studies have determined the degree of adherence to physical activity ... [more ▼]

Background. Though the influence of physical activity in preventing cardiovascular diseases is well documented, only a few comparative studies have determined the degree of adherence to physical activity recommendations among populations and identified the demographic, socioeconomic, behavioural and health-related factors associated with good compliance. Design and methods. Cross-sectional interregional NESCaV survey of 3133 subjects compared three populations, Luxembourg, Lorraine (France) and Wallonia (Belgium), by using the International Physical Activity Questionnaire. Age and gender prevalence rates of physical activity were standardized to the European population. Results. The likelihood to meet the recommendations was higher in Luxembourg, after adjustment for age, gender, education, employment, weight status, morbidity score, health perception and level of importance attributed to the practice of physical activity (P<0.0001). The odds for meeting the recommendations were significantly higher among those with secondary than tertiary education. Compared to good self-health perception, subjects with poor or fair self-perceived health were less likely to meet the recommendations; this also applied to those attributing little or enough importance to physical activity compared with great importance. Conclusions. Region, education, self-perceived health and perception of importance of physical activity were emerged as independent determinants of meeting the recommendations. Awareness of the positive health effects of physical activity might thus be crucial for motivating the people to become more active. Further research is needed to explore potential region-specific factors which might explain the difference in population behaviours with respect to physical activity. [less ▲]

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See detailON THE RELATIONSHIP BETWEEN DIETARY PATTERNS AND CARDIOVASCULAR RISK FACTORS IN THE GREATER REGION POPULATION
Sauvageot, Nicolas ULg; Alkerwi, Alaa; Zannad, Faiez et al

Conference (2013, October 25)

Abstract Background: The prevalence of chronic pathologies such as cardio-vascular diseases is increasing, in part due to dietary habits. Some dietary patterns may influence health more than individual ... [more ▼]

Abstract Background: The prevalence of chronic pathologies such as cardio-vascular diseases is increasing, in part due to dietary habits. Some dietary patterns may influence health more than individual foods, nutrients or food groups. The objective of this research was to identify dietary patterns associated with common cardiovascular risk factors (CVRF) in a sample of adult individuals living in the Greater Region. Methods: Data were taken from the cross-sectional NESCAV (Nutrition, Environment and Cardiovascular Health) study, aiming to describe the cardiovascular health of the Greater Region’s population (1). Dietary intake was assessed using a 132-item food frequency questionnaire (FFQ), from which 44 food groups were formed. Food group consumptions were adjusted for energy intake using the residuals method of Willet and Stampfer (2). Participants under a special diet to manage their CVRF were excluded. Likewise, those who had a history of cardiovascular disease or with confirmed diabetes, hypertension, and/or dyslipidemia were also discarded as they may have changed their diet. Thus, a total of 1691 individuals were included in the study (865 from Luxembourg, 527 from Wallonia and 299 from Lorraine). We applied the reduced rank regression method to identify specific dietary patterns strongly associated with common CVRF (3). The CVRF-specific dietary patterns were constructed by choosing intake data as predictors and CVRF as outcomes. Nine CVRF (BMI, waist to hip ratio, total cholesterol, triglycerides, HDL cholesterol, LDL cholesterol, blood glucose, diastolic and systolic blood pressure) were used in the statistical analysis. Associations between dietary patterns and CVRF were adjusted according to gender, age, smoking status and level of physical activity. Results: Two main dietary patterns were identified. A pattern characterized by high intakes of alcohol, potatoes and high-fat food such as pastries, fried foods, offal, processed and smoked meat, margarine, but low intakes of cereals, soups, soft drink and olive oil, was significantly associated with an increase of all CVRF. On the other hand, a healthy pattern characterized by high consumption of brown bread, nuts, soups, vegetables, smoked and canned fish, olive oil and oil rich in omega 6 and 3, high-fat dairy products, butter and margarine, but a low consumption of fried foods, rice/pasta, meat, ready meal, soft drink and beer, was associated with a decrease of all CVRF except LDL. Conclusions: Our results suggest that dietary patterns of the Greater Region population are related to CVRF. Diet rich in alcohol and high-fat food is associated with a higher cardiovascular risk whereas a healthy diet is associated with a lower cardiovascular risk. These results emphasize the need for cross-border preventive nutritional strategies. [less ▲]

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See detailRapport d'activités final - « Nutrition, Environnement, et Santé Cardio-Vasculaire (NESCaV)»
Lair, Marie-Lise; Alkerwi, Ala'a; Zannad, Faiez et al

Report (2012)

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See detailNutrition, environment and cardiovascular health (NESCAV): protocol of an inter-regional cross-sectional study.
Alkerwi, Ala'a; Guillaume, Michèle ULg; Zannad, Faiez et al

in BMC Public Health (2010), 10(1), 698

BACKGROUND: Despite the remarkable technological progress in health care and treatment, cardiovascular disease remains the leading cause of premature death, prolonged hospitalization and disability in ... [more ▼]

BACKGROUND: Despite the remarkable technological progress in health care and treatment, cardiovascular disease remains the leading cause of premature death, prolonged hospitalization and disability in most European countries. In the population of the Greater Region (Grand-Duchy of Luxembourg, Wallonia in Belgium, and Lorraine in France), the prevalence of cardiovascular risk factors and disease is among the highest in Europe, warranting the need for a better understanding of factors contributing to this pattern. In this context, the cross-border "Nutrition, Environment and Cardiovascular Health-NESCAV" project is initiated by an inter-regional multi-disciplinary consortium and supported by the INTERREG IV A program "Greater Region", 2007-2013, to fight synergically and harmoniously against this major public health problem. METHODS/DESIGN: The objectives of the three-year planned project are to assess, in a representative sample of 3000 randomly selected individuals living at the Greater Region, 1) the cardiovascular health and risk profile, 2) the association between the dietary habits and the cardiovascular risk, 3) the association of occupational and environmental pollution markers with the cardiovascular risk, 4) the knowledge, awareness and level of control of cardiovascular risk factors, 5) the potential gaps in the current primary prevention, and finally, to address evidence-based recommendations enabling the development of inter-regional guidance to help policy-makers and health care workers for the prevention of cardiovascular disease. DISCUSSION: The findings will provide tools that may enable the Greater Region's decision-makers and health professionals to implement targeted and cost-effective prevention strategies. [less ▲]

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See detailRosuvastatin and cardiovascular events in patients undergoing hemodialysis
Fellström, Bengt C.; Jardine, Alan G.; Schmieder, Roland E. et al

in New England Journal of Medicine [=NEJM] (2009), 360

Background Statins reduce the incidence of cardiovascular events in patients at high cardiovascular risk. However, a benefit of statins in such patients who are undergoing hemodialysis has not been proved ... [more ▼]

Background Statins reduce the incidence of cardiovascular events in patients at high cardiovascular risk. However, a benefit of statins in such patients who are undergoing hemodialysis has not been proved. Methods We conducted an international, multicenter, randomized, double-blind, prospective trial involving 2776 patients, 50 to 80 years of age, who were undergoing maintenance hemodialysis. We randomly assigned patients to receive rosuvastatin, 10 mg daily, or placebo. The combined primary end point was death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. Secondary end points included death from all causes and individual cardiac and vascular events. Results After 3 months, the mean reduction in low-density lipoprotein (LDL) cholesterol levels was 43% in patients receiving rosuvastatin, from a mean baseline level of 100 mg per deciliter (2.6 mmol per liter). During a median follow-up period of 3.8 years, 396 patients in the rosuvastatin group and 408 patients in the placebo group reached the primary end point (9.2 and 9.5 events per 100 patient-years, respectively; hazard ratio for the combined end point in the rosuvastatin group vs. the placebo group, 0.96; 95% confidence interval [CI], 0.84 to 1.11; P = 0.59). Rosuvastatin had no effect on individual components of the primary end point. There was also no significant effect on all-cause mortality (13.5 vs. 14.0 events per 100 patient-years; hazard ratio, 0.96; 95% CI, 0.86 to 1.07; P = 0.51). Conclusions In patients undergoing hemodialysis, the initiation of treatment with rosuvastatin lowered the LDL cholesterol level but had no significant effect on the composite primary end point of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. (ClinicalTrials.gov number, NCT00240331.) [less ▲]

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