title: The cumulative effect of small dietary changes may significantly improve nutritional intakes in free-living children and adults.
abstract: OBJECTIVE
  The ELPAS (Etude Longitudinale Prospective Alimentation et Santé) study was an 8-month randomized controlled dietary modification trial designed to test the hypothesis that family dietary coaching would improve nutritional intakes and weight control in 2026 free-living children and parents. It resulted in significant nutritional changes, with beneficial effects on body mass index in adults. In these ancillary analyses, we investigated dietary changes throughout the intervention.
  
  
  METHODS
  Before the study, modeling analyses were carried out on the French Association Sucre Produits Sucrés Consommation et Communication (ASPCC) food-consumption database to identify the most efficient dietary intervention strategy. During the study, all participants performed monthly three nonconsecutive 24-h dietary recalls: this allowed for measuring changes in the number of servings per day and serving size for each targeted food category throughout the intervention.
  
  
  RESULTS
  Modeling analyses showed that targeting only the 10 main foods contributing to fat and carbohydrate intakes did not allow for reaching the ELPAS nutritional goals. As a result, it was decided to target more foods and to propose several types of dietary advice (such as change in serving size, change in cooking method, food substitution). This strategy led to many appropriate dietary changes during the intervention, but only a few of them reached significance. The mean number of servings per day was indeed significantly modified for only 7% of the targeted food categories in children and 17% in parents. The mean serving size was modified for only 12% of targeted food categories in children and 9% in parents.
  
  
  CONCLUSIONS
  The cumulative effect of small dietary changes may induce significant nutritional improvements, with limited burden for populations.
authors.affiliation: Nutri-Health, Rueil-Malmaison, France.
authors.forename: D
authors.initials: D
authors.lastname: Paineau
authors.forename: F
authors.initials: F
authors.lastname: Beaufils
authors.forename: A
authors.initials: A
authors.lastname: Boulier
authors.forename: D-A
authors.initials: DA
authors.lastname: Cassuto
authors.forename: J
authors.initials: J
authors.lastname: Chwalow
authors.forename: P
authors.initials: P
authors.lastname: Combris
authors.forename: C
authors.initials: C
authors.lastname: Couet
authors.forename: B
authors.initials: B
authors.lastname: Jouret
authors.forename: L
authors.initials: L
authors.lastname: Lafay
authors.forename: M
authors.initials: M
authors.lastname: Laville
authors.forename: S
authors.initials: S
authors.lastname: Mahe
authors.forename: C
authors.initials: C
authors.lastname: Ricour
authors.forename: M
authors.initials: M
authors.lastname: Romon
authors.forename: C
authors.initials: C
authors.lastname: Simon
authors.forename: M
authors.initials: M
authors.lastname: Tauber
authors.forename: P
authors.initials: P
authors.lastname: Valensi
authors.forename: V
authors.initials: V
authors.lastname: Chapalain
authors.forename: O
authors.initials: O
authors.lastname: Zourabichvili
authors.forename: F R J
authors.initials: FR
authors.lastname: Bornet
mesh_terms: D000328:Adult; D002648:Child; D004032:Diet / Q000592:standards*; D015930:Diet Records; D002149:Energy Intake; D005247:Feeding Behavior; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical