Étude du comportement et des contextes associés à la consommation d’aliments sucrés dans une communauté montréalaise originaire du Moyen-Orient

The World Health Organization recommends that individuals reduce their consumption of sweet foods and drinks to prevent chronic diseases. Research in public health has not generally sought to elucidate the environmental and individual factors that may jointly influence sweet food consumption. Such knowledge would be relevant, however, in supporting interventions on sweet food consumption. The aim of this thesis was to examine contextual and individual factors associated with daily consumption of sweet foods in adults living in a western urban setting. An established Middle Eastern community in Montreal was the setting for this study. Sweet food was defined as refined carbohydrates that contain more than 20% of total energy from total sugars. In a preliminary step (N = 42), 24-hour recalls enabled the identification of sweet food sources and the measurement of daily intake of total sugars from total energy intake. The context of sweet food consumption was studied through a qualitative descriptive study. An ecological conceptual framework was used to frame the context of sweet food consumption and thus to guide the collection of semi-structured interviews (N=42). Content analysis using open and focused coding techniques was used to inform the development of a quantitative measure to investigate the context of sweet food consumption. This measure was pilot-tested on 20 individuals and administered to the main sample (N = 192). Contextual domains were clarified using exploratory factor analysis. Individual factors measured included depressive symptoms, mastery, sociodemographic factors, perception, daytime sleepiness and HbA1C. A food frequency questionnaire was used to measure daily intake of sweet food (N = 192). Sweet food consumption followed a gamma distribution. Multivariate regression analysis using the generalised linear model (gamma distribution and log-link function) was used to estimate the associations between contextual and individual factors and consumption of sweet food, accounting for covariates (gender and age).  Total sugar consumption was 20,3 % of total energy, similar to the average intake of the population of Quebec and Canada. Daily consumption of total sugars averaged 76 g/day. Qualitative analyses and factor analysis led to the identification and refinement of a 42-item contextual measure with items grouped into seven domains (emotional needs, snacking, energy demands, socialisation, visual stimuli, indulgence and constraints). Consumption of total sugars was higher amongst males (B = 0,204, SE = 0,094, p = 0,03). Domains positively associated with total sugar consumption included eating dessert (B = 0,105, SE = 0,036, p = 0,001), snacking (B = 0,225, SE = 0,091, p = 0,01) and depressive symptoms (B = 0,017, SE = 0,094, p = 0,03). Indulgence (B = -0,103, SE = 0,052, p = 0,05), self-moderation (B = -0,121, SE = 0,042, p = 0,001), and age (B = -0,01, SE = 0,004, p = 0,02) were negatively associated with sugar consumption.  This mixed-methods study developed a novel measure to study the factors associated with sugar consumption. Individual and contextual factors were jointly associated with consumption of sweet foods. Contextual as well as individual factors should be jointly targeted by public health efforts to support individuals in limiting their consumption of sweet foods, as necessary.

Keyphrases: sugar, total sugars, refined carbohydrates, food behavior, context of consumption, obesogenic environment, health promotion, mixed methods