The "SUpplementation en VItamines et Minéraux AntioXidants" (SU.VI.MAX) study is a randomized double-blind, placebo controlled, primary-prevention trial designed to test the efficacy of a daily supplementation with antioxidant vitamins (vitamin C, 120 mg; vitamin E, 30 mg; and beta-carotene, 6 mg) and minerals (selenium, 100 microg; and zinc, 20 mg) at nutritional doses (one to three times the daily recommended dietary allowances), in reducing the frequency of cancers and cardiovascular diseases. The study involves 12,735 eligible subjects (women aged 35-60 years, men aged 45-60 years) included in 1994 in France. They will be followed up for 8 years. The targeted population is the general population. The aim of this specific analysis is to assess the effect of 2 years of supplementation on biochemical indicators of vitamin and trace element on a subsample of 1000 subjects. The mean (+/- standard deviation) concentrations of plasma beta-carotene, alpha-tocopherol, vitamin C, selenium and zinc among participants who were randomly assigned to receive a daily supplementation with beta-carotene, vitamin E, vitamin C, selenium and zinc for 2 years were significantly higher than those who were assigned to receive placebo. Specifically, the mean concentrations among men in the intervention group were 0.86 +/- 0.70 micromol/L for beta-carotene, 35.3 +/- 9.3 micromol/L for alpha-tocopherol, 11.5 +/- 4.7 microg/ mL for vitamin C, 1.65 +/- 0.33 micromol/L for selenium, and 16.2 +/- 3.9 micromol/L for zinc. The mean concentrations among women in the intervention were 1.25 +/- 0.90 micromol/L for beta-carotene, 34.9 +/- 8.4 micromol/L for alpha-tocopherol, 12.6 +/- 4.0 microg/mL for vitamin C, 1.68 +/- 0.37 micromol/L for selenium, and 15.3 +/- 3.9 micromol/L for zinc. The values observed for beta-carotene and vitamin E in the supplementation group after 2 years of intervention are those that have been associated with the lowest risk of cancer in observational studies. They are definitely lower than concentrations reported in intervention studies showing an apparent negative effect of high levels of beta-carotene supplementation on the lung cancer incidence rate in high-risk subjects (initial level multiplied by 12-18). Data from the follow-up will ascertain if any plausible reduction in the incidence rate of cancers may be associated with such amounts of antioxidant agents.

Cardiovascular diseases continue to constitute a major public health problem in all industrialized countries, where they are the main causes of premature mortality. There is a large body of evidence suggesting that free radical production directly or indirectly plays a major role in cellular processes implicated in atherosclerosis. Here we present mechanistic data and results of epidemiologic studies on the relationship between antioxidant vitamin intake or biochemical status and the risk of cardiovascular diseases. Most epidemiologic data obtained on this topic have been based on observational approaches, i.e. ecological studies, case-control or prospective studies. All these studies indicate that a high dietary intake or high blood concentrations of antioxidant vitamins are associated with a reduced risk of cardiovascular diseases. Although the results of these studies are convergent, they merely suggest a relationship at the population and individual level, but do not affirm a causality link. Only intervention studies (randomized trials), by specifically changing antioxidant vitamin intake, can provide conclusive answers. The apparent discrepancies between the results of recently published trials may be explained by the type of population (general or high-risk subjects), the differing doses of supplementation (nutritional levels or higher), the number of antioxidants tested (one, two or more) and the type of administration (alone or in balanced association). It thus appears that low risk of pathologies may be related to multiple nutrients consumed, at nutritional doses, and in combination. Optimal effects may be expected with a combination of nutrients at levels similar to those found in a healthy diet. A single antioxidant vitamin given at high doses in subjects with high risk of pathologies may not have substantial benefits and could even have negative consequences.

The aim was to estimate the association between dairy products (total and their subgroups), calcium intake and the risk of breast cancer. As few studies have considered menopausal status, we also investigated stratified analyses. This analysis included 3,627 women from the French SU.VI.MAX study, among whom 92 developed breast cancer during the follow-up period. Food consumption was assessed based on five 24-hour records completed during the previous 18 months to follow-up. Calcium intake was calculated using an ad-hoc food composition database. Cox proportional hazards models were used to estimate relative risk (RR), comparing 4th quartile vs. 1st quartile, and 95% confidence intervals (95% CI). A lower risk of breast cancer was observed with high total dairy product consumption in the whole population (RR = 0.55, 95% CI = 0.29-1.03, p(trend) = 0.03) and among premenopausal women with a RR of 0.35 (95% CI = 0.12-0.95, p(trend) = 0.01). None of these associations remained after control for calcium intake. Increasing calcium intake was inversely associated with breast cancer risk considering the whole population (RR = 0.50, 95% CI = 0.27-0.91, p(trend) = 0.04) and among the subgroup of premenopausal women (RR = 0.26, 95% CI = 0.10-0.71, p(trend) = 0.01) respectively. Our data support the hypothesis that dairy products, through calcium content or a correlated component, might have a negative association with the risk of breast cancer, particularly among premenopausal women.

Whereas indoor tanning should be discouraged, it seems that indoor tanners are also regular sunbathers unconcerned about the risk of photoageing and skin cancer occurrence. Moreover, indoor tanners seem to have more behavioural risk factors for cancer, such as smoking.

La denutrition est un probleme majeur de Sante publique qui touche 100 millions d'enfants dans le monde (pays en developpement) ou elle est le plus souvent la consequence de la malnutrition. Elle n'epargne pas les pays favorises. La maladie favorise son developpement endemique a l'hopital. L'aspect clinique n'est pas uniforme et se situe en general entre les extremes d'une physiopathologie qui va du kwashiorkor (denutrition proteique) au marasme (denutrition adaptative par insuffisance d'apports proteino-energetiques globaux equilibres). L'installation insidieuse de la denutrition fait qu'il est souvent difficile d'en faire le diagnostic au debut et surtout de differencier les consequences sur la morbidite et la mortalite de la denutrition propre et de la maladie souvent causale. En regle generale, une perte de poids involontaire de 5 a 10 % doit etre consideree comme un signe possible de denutrition. Un index de masse corporelle (IMC, BMI) inferieur a 18 est le plus souvent, en dehors des maigreurs constitutionnelles, un signe de denutrition patente. L'ideal serait de pouvoir apprecier les variations des reserves proteiques (en pratique masse cellulaire) que seule l'impedance bioelectrique peut apprecier au lit du malade. Un deficit de 10 kg de la masse cellulaire par rapport aux valeurs limites inferieures de la normale pour la taille et l'âge est le signe que la denutrition per se met en danger la vie du malade. Pour lutter contre la denutrition endemique hospitaliere, 2 outils sont necessaires. Le premier est d'utiliser des index d'evaluation simples, tels que l'index de Busby prenant en consideration l'albuminemie plasmatique et les variations de poids ou l'evaluation subjective de Desky. De tels index permettent non seulement de depister la denutrition hospitaliere mais aussi d'aider a la decision d'une intervention therapeutique specifique (nutrition artificielle). Le 2 e point est qu'il est necessaire de creer des structures transversales permettant d'integrer la reconnaissance de la denutrition a l'hopital comme une des priorites de la prise en charge medicale des malades. Ceci peut etre fait par la creation de comites de liaison alimentation-nutrition.

An increasing dose-response relationship was found between alcohol intake levels and ORs for thyroid enlargement in both males and females. Alcohol consumption was strongly associated with a higher risk in females.

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