References of "Alkerwi, Ala'a"
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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 detailValidation of the Food Frequency Questionnaire Used to Assess the Association between Dietary Habits and Cardiovascular Risk Factors in the NESCAV Study
Sauvageot, Nicolas ULg; Guillaume, Michèle ULg; Albert, Adelin ULg et al

in Journal of Food Science (2013), 3(3),

Abstract Background: In epidemiological studies, the validation of dietary assessment instruments is important to avoid biased associations with outcome measures. Objective: Our objective was to assess ... [more ▼]

Abstract Background: In epidemiological studies, the validation of dietary assessment instruments is important to avoid biased associations with outcome measures. Objective: Our objective was to assess the validity of the 134-item food frequency questionnaire (FFQ) used in the Nutrition Environment and Cardiovascular Health (NESCAV) study. Methods: The FFQ was validated against a 3-day dietary record (DR) on a sample of 29 women. The intra- class correlation coefficient (ICC) and Bland and Altman plots were used to assess absolute agreement, whereas relative agreement was appraised by Spearman’s correlation coefficient and Cohen kappa coefficient based on cross classification of 3-category nutrient intake. Results: The two methods differed significantly for the majority of micronutrients with FFQ yielding higher intakes than the DR. The bias between the two methods was nonetheless acceptable with an average overestimation by the FFQ of 11% for macronutrients and 29% for micronutrients. Regarding precision, results differed by 48% for micronutrients and 50% for macronutrients. Correlations on energy-adjusted data by the two methods were satisfactory with an average correlation of 0.47 and 16/25 coefficients above 0.40. Only vitamin A and cholesterol showed poor correlations of 0.02 and 0.05, respectively. On average, the correct classification rate in 3 categories was 50.3% and 19/25 kappa coefficients were above 0.20. Poor agreement was found for protein, cholesterol, starch, vitamins A, B12 and E with weighted kappa coefficient less than 0.20. Conclusion: Although absolute values of dietary intakes were not always accurate, the relationship and agreement between FFQ and DR may be considered as satisfactory. In particular, the FFQ was able to categorize subjects into 3 broad categories of intakes for most nutrients. Results for proteins, cholesterol, starch, vitamins A, E and B12 however ought to be interpreted with caution [less ▲]

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See detailUse of food frequency questionnaire to assess relationships between dietary habits and cardiovascular risk factors in NESCAV study: validation with biomarkers
Sauvageot, Nicolas ULg; alkerwi, alaa; Albert, Adelin ULg et al

in Nutrition Journal (2013), 12(143),

Abstract Background: Validation of Food frequency questionnaire (FFQ) is particularly important element, as incorrect information may lead to false associations between dietary factors and diseases. The ... [more ▼]

Abstract Background: Validation of Food frequency questionnaire (FFQ) is particularly important element, as incorrect information may lead to false associations between dietary factors and diseases. The aim of the study was to evaluate the validity of the FFQ used in NESCAV (Nutrition, Environment and Cardiovascular Health) study, by comparing the estimated intakes of fruits and vegetables and of several micro-nutrients with corresponding nutritional biomarkers. Methods: Relative validity was assessed in a sample of 922 subjects (452 men and 470 women). Comparisons between FFQ-estimates and their corresponding biomarkers were performed through correlation and cross classification into quintiles by using both crude and energy-adjusted FFQ-estimates. Correlations adjusted for confounders were also computed. All analyses were performed separately for men and women. Results: Concerning micro-nutrients, significant correlations were found for vitamin B9, D, E, B12 β -carotene and iodine in both men and women. Energy-adjustment led to an increase of all correlations cited previously. However, after excluding supplement users, correlations for vitamin D were not significant anymore. Concerning fruits and vegetables, all correlations were significant. Vegetables alone and fruits and vegetables correlated better in men (r around 0.2) than in women (r around 0.1). In men, correlation was also better for vegetables alone and fruits and vegetables than fruits alone. Conclusion: These data demonstrate that this FFQ is a reasonable tool to assess intakes of fruits and vegetables and of several micro-nutrients. We conclude that our FFQ is suitable to be used in NESCAV study, although protein and vitamin D estimates should be interpreted with caution [less ▲]

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See detailValidation par biomarqueurs d’un FFQ permettant d’étudier le lien entre alimentation et risques cardiovasculaires
Sauvageot, Nicolas ULg; Alkerwi, Alaa; Donneau, Anne-Françoise ULg et al

Poster (2012, September)

Introduction La recherche sur l'alimentation et son lien avec les maladies nécessite une collecte rigoureuse des données nutritionnelles permettant d'estimer avec précision l'apport nutritionnel. Le « ... [more ▼]

Introduction La recherche sur l'alimentation et son lien avec les maladies nécessite une collecte rigoureuse des données nutritionnelles permettant d'estimer avec précision l'apport nutritionnel. Le « Food Frequency Questionnaire (FFQ) » a été choisie pour étudier le lien entre alimentation et risques cardiovasculaires dans un échantillon représentatif de la Grande région recruté pour l’étude NESCAV (Nutrition, environnement et santé cardio-vasculaire). Objectif Valider le FFQ utilisé à l’aide de biomarqueurs afin d’évaluer son habilité à estimer correctement les habitudes alimentaires. Méthodes Afin de prendre en compte les spécificités de la Grande région et le volet cardio-vasculaire, la liste d’items d’un FFQ existant a été modifiée et élargie. Tous les nutriments calculés à partir du FFQ ont été ajustés par rapport à l’énergie par la méthode des résidus. La comparaison des nutriments calculés par le FFQ et les bio-marqueurs correspondants a été faite par le calcul des coefficients de corrélation avec ajustement sur plusieurs facteurs confondants. L’accord entre les deux méthodes a été estimé par le calcul des pourcentages de concordance et du coefficient Kappa. Résultats La validation s’est effectuée sur un échantillon de 466 sujets (236 hommes et 241 femmes). Des corrélations significatives ont été observées pour les folates, le β-carotène dans les deux sexes et pour la vitamine B12 et l’iode chez les femmes. Discussion Ces résultats sont comparables à ceux d’études précédentes. Les corrélations sont souvent expliquées par le fait que les nutriments du FFQ représentent la quantité ingérée alors que les biomarqueurs représentent la quantité absorbée par le corps. [less ▲]

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See detailDietary, behavioural and socio-economic determinants of the metabolic syndrome among adults in Luxembourg: findings from the ORISCAV-LUX study.
Alkerwi, Ala'a; Donneau, Anne-Françoise ULg; Sauvageot, Nicolas et al

in Public Health Nutrition (2012), 15(5), 849-59

OBJECTIVE: The purpose of the present research was to investigate the epidemiological profile of the metabolic syndrome (MetS) and to explore its potential dietary, behavioural and socio-economic ... [more ▼]

OBJECTIVE: The purpose of the present research was to investigate the epidemiological profile of the metabolic syndrome (MetS) and to explore its potential dietary, behavioural and socio-economic determinants among European adults residing in Luxembourg. DESIGN: Cross-sectional, population-based ORISCAV-LUX survey. SETTING: European adults aged 18-69 years residing in Luxembourg. SUBJECTS: A total of 1349 Europid adults, who participated in the ORISCAV-LUX survey, were included in the study. The prevalence of MetS was estimated according to the Revised-Adult Treatment Panel (R-ATPIII) criteria. Multivariate logistic regression was used to identify the dietary, behavioural and socio-economic factors independently associated with MetS. RESULTS: The overall prevalence of MetS was 24.7 % with significant gender difference (18.5 % for women v. 30.8 % for men, P < 0.0001). Age, male gender, primary level of education, physical inactivity, family history of diabetes and hypertension and inadequate protein intake were identified as significant determinants of MetS, after adjusting for other socio-economic, family medical history and lifestyle factors. CONCLUSIONS: MetS is a common condition among Europid adults in Luxembourg and increases dramatically with age, in both genders. Several dietary, socio-economic and behavioural factors explain the disparity observed. These findings highlight the importance of a comprehensive approach to MetS encompassing dietary, lifestyle and socio-economic aspects, both in clinical and community settings. [less ▲]

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See detailPrevalence of the metabolic syndrome in Luxembourg according to the Joint Interim Statement definition estimated from the ORISCAV-LUX study.
Alkerwi, Ala'a; Donneau, Anne-Françoise ULg; Sauvageot, Nicolas et al

in BMC Public Health (2011), 11(1), 4

ABSTRACT: BACKGROUND: The prevalence of the metabolic syndrome (MS) has been determined in many countries worldwide but never in Luxembourg. This research aimed to 1) establish the gender- and age ... [more ▼]

ABSTRACT: BACKGROUND: The prevalence of the metabolic syndrome (MS) has been determined in many countries worldwide but never in Luxembourg. This research aimed to 1) establish the gender- and age-specific prevalence of MS and its components in the general adult population of Luxembourg, according to the most recent Joint Interim Statement (JIS) definition, by using both the high and low cut-off points to define abdominal obesity, and 2) compare and assess the degree of agreement with the Revised National Cholesterol Education Programme-Adult Treatment Panel III (R-ATPIII) and the International Diabetes Federation (IDF) definitions. METHODS: A representative stratified random sample of 1349 European subjects, aged 18-69 years, participated to ORISCAV-LUX survey. Logistic regression and odds ratios (OR) were used to study MS prevalence with respect to gender and age. The Framingham risk score (FRS) to predict the 10-year coronary heart disease (CHD) risk was calculated to compare the proportion of MS cases below or above 20%, according to both high and low waist circumference (WC) thresholds. Cohen's kappa coefficient (kappa) was utilized to measure the degree of agreement between MS definitions. RESULTS: The prevalence of the MS defined by the JIS was 28.0% and 24.7% when using the low (94/80) and the high (102/88) WC cut-off points, respectively. The prevalence was significantly higher in men than in women (OR = 2.6 and 2.3 for the low and high WC thresholds), as were all components of the MS except abdominal obesity measured by both thresholds. It also increased with age (OR values in age categories ranging from 2.7 to 28 when compared to the younger subjects for low WC and from 3.3 to 31 for the high WC cut-offs). The 10-year predicted risk of CHD by FRS did not depend on the threshold used. Globally, excellent agreement was observed between the three definitions of MS (kappa= 0.89), in particular between JIS and IDF (kappa = 0.93). Agreement was significantly higher in women than in men, and differed between age groups. CONCLUSION: Regardless of the definition used, the adult population of Luxembourg reveals a high MS prevalence. Our findings contribute to build evidence regarding the definitive construct of the MS, to help selecting the waist circumference thresholds for Europid populations, and to support the need to revise the guidelines for abdominal obesity levels. [less ▲]

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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 detailFirst nationwide survey on cardiovascular risk factors in Grand-Duchy of Luxembourg (ORISCAV-LUX).
Alkerwi, Ala'a; Sauvageot, Nicolas; Donneau, Anne-Françoise ULg et al

in BMC Public Health (2010), 10

BACKGROUND: The ORISCAV-LUX study is the first baseline survey of an on-going cardiovascular health monitoring programme in Grand-Duchy of Luxembourg. The main objectives of the present manuscript were 1 ... [more ▼]

BACKGROUND: The ORISCAV-LUX study is the first baseline survey of an on-going cardiovascular health monitoring programme in Grand-Duchy of Luxembourg. The main objectives of the present manuscript were 1) to describe the study design and conduct, and 2) to present the salient outcomes of the study, in particular the prevalence of the potentially modifiable and treatable cardiovascular disease risk factors in the adult population residing in Luxembourg. METHOD: ORISCAV-LUX is a cross-sectional study based on a random sample of 4496 subjects, stratified by gender, age categories and district, drawn from the national insurance registry of 18-69 years aged Luxembourg residents, assuming a response rate of 30% and a proportion of 5% of institutionalized subjects in each stratum. The cardiovascular health status was assessed by means of a self-administered questionnaire, clinical and anthropometric measures, as well as by blood, urine and hair examinations. The potentially modifiable and treatable risk factors studied included smoking, hypertension, dyslipidemia, diabetes mellitus, and obesity. Both univariate and multivariate statistical analyses used weighted methods to account for the stratified sampling scheme. RESULTS: A total of 1432 subjects took part in the survey, yielding a participation rate of 32.2%. This figure is higher than the minimal sample size of 1285 subjects as estimated by power calculation. The most predominant cardiovascular risk factors were dyslipidemia (69.9%), hypertension (34.5%), smoking (22.3%), and obesity (20.9%), while diabetes amounted 4.4%. All prevalence rates increased with age (except smoking) with marked gender differences (except diabetes). There was a significant difference in the prevalence of hypertension and of lipid disorders by geographic region of birth. The proportion of subjects cumulating two or more cardiovascular risk factors increased remarkably with age and was more predominant in men than in women (P<0.0001). Only 14.7% of men and 23.1% of women were free of any cardiovascular risk factor. High prevalence of non-treated CVRF, notably for hypertension and dyslipidemia, were observed in the study population. CONCLUSION: The population-based ORISCAV-LUX survey revealed a high prevalence of potentially modifiable and treatable cardiovascular risk factors among apparently healthy subjects; significant gender and age-specific differences were seen not only for single but also for combined risk factors. From a public health perspective, these preliminary findings stress the urgent need for early routine health examinations, preventive interventions and lifestyle behavioural changes, even in young asymptomatic adults, to decrease cardiovascular morbidity and mortality in Luxembourg. [less ▲]

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See detailComparison of participants and non-participants to the ORISCAV-LUX population-based study on cardiovascular risk factors in Luxembourg.
Alkerwi, Ala'a; Sauvageot, Nicolas; Couffignal, Sophie et al

in BMC Medical Research Methodology (2010), 10

BACKGROUND: Poor response is a major concern in public health surveys. In a population-based ORISCAV-LUX study carried out in Grand-Duchy of Luxembourg to assess the cardiovascular risk factors, the non ... [more ▼]

BACKGROUND: Poor response is a major concern in public health surveys. In a population-based ORISCAV-LUX study carried out in Grand-Duchy of Luxembourg to assess the cardiovascular risk factors, the non-response rate was not negligible. The aims of the present work were: 1) to investigate the representativeness of study sample to the general population, and 2) to compare the known demographic and cardiovascular health-related profiles of participants and non-participants. METHODS: For sample representativeness, the participants were compared to the source population according to stratification criteria (age, sex and district of residence). Based on complementary information from the "medical administrative database", further analysis was carried out to assess whether the health status affected the response rate. Several demographic and morbidity indicators were used in the univariate comparison between participants and non-participants. RESULTS: Among the 4452 potentially eligible subjects contacted for the study, there were finally 1432 (32.2%) participants. Compared to the source population, no differences were found for gender and district distribution. By contrast, the youngest age group was under-represented while adults and elderly were over-represented in the sample, for both genders. Globally, the investigated clinical profile of the non-participants was similar to that of participants. Hospital admission and cardiovascular health-related medical measures were comparable in both groups even after controlling for age. The participation rate was lower in Portuguese residents as compared to Luxembourgish (OR = 0.58, 95% CI: 0.48-0.69). It was also significantly associated with the professional status (P < 0.0001). Subjects from the working class were less receptive to the study than those from other professional categories. CONCLUSION: The 32.2% participation rate obtained in the ORISCAV-LUX survey represents the realistic achievable rate for this type of multiple-stage, nationwide, population-based surveys. It corresponds to the expected rate upon which the sample size was calculated. Given the absence of discriminating health profiles between participants and non-participants, it can be concluded that the response rate does not invalidate the results and allows generalizing the findings for the population. [less ▲]

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See detailAlcohol consumption and the prevalence of metabolic syndrome: a meta-analysis of observational studies.
Alkerwi, Ala'a; Boutsen, Michel; Vaillant, Michel et al

in Atherosclerosis (2009), 204(2), 624-35

BACKGROUND: In the past two decades, the metabolic syndrome has given rise to much clinical and research interest. The broad overlap of alcohol consumption with different components of metabolic syndrome ... [more ▼]

BACKGROUND: In the past two decades, the metabolic syndrome has given rise to much clinical and research interest. The broad overlap of alcohol consumption with different components of metabolic syndrome makes alcohol-metabolic syndrome relationship a controversial topic. OBJECTIVES: To support the evidence available about the relationship between alcohol consumption and metabolic syndrome as a comprehensive clinical entity, as well as to identify the gender-specific dose-response, by performing a meta-analysis based on information from published data. METHODS: Manual and computer searches in different bibliographic databases were performed to identify the relevant scientific publications, on the relation between alcohol consumption and metabolic syndrome. Alcohol intake was converted into a same unit (g/day) and then categorized using standard classification in order to provide relevant comparisons. Fixed and random effects models were used to aggregate individual odds ratios and to derive pooled estimates and 95% confidence intervals. RESULTS: Fourteen relevant publications were identified on the relation between alcohol consumption and the prevalence of metabolic syndrome. 7 studies were included in the meta-analysis. The results showed that alcohol consumption of less than 40 g/day in men and 20 g/day in women significantly reduced the prevalence of metabolic syndrome. CONCLUSION: "Responsible alcohol intake" appears to be associated with a reduced prevalence of metabolic syndrome. Favorable metabolic effect seemed to be restricted to alcohol consumption of less than 20 g/day among women, and of less than 40 g/day among men. These findings support the actual recommendations regarding alcohol consumption among apparently healthy people. [less ▲]

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