Intergenerational differences in cardiovascular risk factor levels in Switzerland

Background: There is little information regarding cardiovascular risk factor (CV RF) trends in Switzerland. We aimed at assessing generation differences in CV RFs by comparing CV RFs levels within selected age groups separated by a 20 year time lag. Design: Two population-based surveys. Methods: Data from the Monica (1984-1986) and Colaus (2004-2006) surveys were used. Analyses were stratified by sex and age groups (35-44, 45-54, 55-64 and 65-75 years). Results: No changes were found for BMI levels and status between surveys: in men, 26}3, 26}3, 27}4 and 27}4 kg/m2 for age groups 35-44, 45-54, 55-64 and 65-74, respectively, in MONICA, vs. 26}4, 26}4, 27}4 and 28}4 kg/m2 in COLAUS, p=NS, in women: 24}4, 26}4, 26}4 and 26}5 kg/m2 in MONICA, vs. 24}5, 25}5, 26}5 and 26}5 kg/m2 in COLAUS, p=NS. Similar results were found after adjusting for education. Smoking prevalence increased in men: 28, 30, 22 and 15% for age groups 35-44, 45-54, 55-64 and 65-74, respectively, in MONICA, vs. 35, 29, 28 and 21% in COLAUS. In women, changes differed according to age: 39, 26, 16 and 18%, in MONICA vs. 28, 30, 22 and 15% in COLAUS. Blood pressure decreased in the younger age groups and remained constant in the older ones: in men, systolic blood pressure was 129}15, 133}16, 138}18 and 143}21 mm Hg in MONICA, vs. 125}12, 129}15, 137}16 and 144}19 mm Hg in COLAUS, p<0.01. Similar findings were obtained after adjusting for education. Prevalence of hypertension increased, due to an increase in the prevalence of treated subjects, in men : 4, 8, 16 and 19% for age groups 35-44, 45-54, 55-64 and 65-74, respectively, in MONICA, vs. 5, 14, 31 and 46% in COLAUS, p<0.05; in women: 2, 10, 16, and 24% in MONICA, vs. 4, 12, 24, and 34% in COLAUS, p<0.05. This increase was stronger in men: 14, 17, 23 and 31% for age groups 35-44, 45-54, 55-64 and 65-74, respectively, in MONICA vs. 10, 21, 41 and 55% in COLAUS, p<0.01 and smaller in women: 6, 15, 24 and 44% in MONICA vs. 6, 16, 30 and 42% in COLAUS, p=NS. Similar findings were obtained after adjusting for education. Conclusion: With the exception of BMI, the newer Swiss generations appear to have a worse CV profile than the older generations. This is especially true regarding smoking and hypertension

Prevalence and determinants of weight misperception in an urban Swiss population.

Weight misperception precludes effective management of pre-obesity and obesity, but little is known regarding its status in the Swiss population. Our study aimed to assess the prevalence and determinants of weight over- and underestimation in an adult urban Swiss population. Cross-sectional study conducted between 2009 and 2012 in the city of Lausanne. Height and weight were measured using standardised procedures. Weight perception and other socio-demographic variables were collected through questionnaires. Data from 4284 participants (2261 women, 57.5 ± 10.4 years) were analysed. Overall, almost one-fifth (18%) of participants underestimated their weight, while only 7% overestimated it. One quarter of women and half of men with overweight underestimated their weight; the corresponding values for obese subjects were 7% and 10%. Multivariate analysis showed male gender (odds ratio [OR] 3.09, 95% confidence interval [CI] 2.54-3.76), increasing age or body mass index (p-value for trend <0.001), being born in Portugal (OR 2.10, 95% CI 1.42-3.10), low education (OR 1.90, 95% CI 1.47-2.47), and absence of diagnosis of pre-obesity or obesity by the doctor (OR 5.61, 95% CI 4.51-7.00) to be associated with weight underestimation. Overestimation was significantly higher in women (19.6%) than in men (8.5%). Weight overestimation was negatively associated with male gender (OR 0.29, 95% CI 0.22-0.39), increasing age (p-value for trend <0.001), being born in Portugal (OR 0.37, 95% CI 0.16-0.87) and positively associated with absence of diagnosis (OR 3.11, 95% CI 2.23-4.34). Almost one quarter of the Swiss population aged 40 to 80 has weight misperception, underestimation being over twice as frequent as overestimation. Adequate diagnosis of overweight or obesity might be the best deterrent against weight misperception

Factors Associated with Readmission of Patients with Congenital Heart Disease in a Swiss University Hospital.

Congenital heart defects (CHD) lead to extensive use of healthcare resources. Still, there is little information available regarding readmission rates or associated factors. We sought to evaluate readmission rates and their determinants among patients with CHD hospitalized in a Swiss university hospital. We conducted a retrospective study using data from all non-adult (<18 years) patients hospitalized between 2002 and 2014 at the University Hospital of Lausanne with an International Classification of Diseases version 10 code Q20-Q25. Overall, 996 patients (460 girls, 332 undergoing surgery, mean age 2.7 years) were assessed, 96 of whom (9.6%) were readmitted within 30 days after discharge. Among the 96 readmissions, 83 (86.5%) were related to the CHD. Median time to readmission was 10 days (interquartile range 6-20) and median length of readmission was 12 days (interquartile range 6-20). After multivariate adjustment, foreign nationality, greater distance to hospital and length of index hospitalization <14 days predisposed to readmission. Patients who underwent surgery were less likely to be readmitted (8.7%). We conclude that readmissions were frequent, almost 1 in 10 patients, and associated with several socio-clinical factors. Providing patients who live far from hospital with specialized care closer to home may help reduce the rate of readmission

Trends in food availability in Portugal in 1966-2003: Comparison with other Mediterranean countries

Background: Dietary intake has changed considerably in South European countries, but whether those changes were similar between countries is currently unknown. Aim of the study: To assess the trends in food availability in Portugal and four other Mediterranean countries from 1966 to 2003. Methods: Food and Agricultural Organization food balance sheets from Portugal, France, Italy, Greece and Spain. Trends were assessed by linear regression. Results: The per capita availability of calories has increased in Portugal, France, Greece, Italy and Spain in the past 40 years. Portugal presented the most rapid growth with an annual increase of 28.5 ± 2.2 kcal (slope ± standard error), or +1000 kcal overall. In animal products, Portugal had an annual increase of 20.7 ± 0.9 kcal, much higher than the other four countries. Conversely, the availabilities of vegetable and fruit only showed a slight growth of 1.0 ± 0.1 kcal/year and 2.5 ± 0.4 kcal/year, respectively, thus increasing the ration of animal to vegetable products. Olive oil availability increased in all countries with the notable exception of Portugal, where a significant decrease was noted. Wine supply decreased in all five countries; in contrast, beer supply started to take up more alcohol share. Percentage of total calories from fat increased from nearly 25% to almost 35% in Portugal during the study period, mainly at the expenses of calories from carbohydrates, whereas the share of protein showed just a slight increase. Furthermore, fat and protein were increasingly provided by animal products. Conclusions: Portugal is gradually moving away from the traditional Mediterranean diet to a more Westernized diet as well as France, Greece, Italy and Spain. Noticeably, the trends of diet transition were observed relatively faster in Portugal than in the other four Mediterranean countrie

Retirement is associated with a decrease in dietary quality.

Retirement has been associated with changes in dietary intake. We evaluated dietary intake and compliance to dietary guidelines after retirement in a population-based survey. Data from a prospective study conducted in Lausanne, Switzerland. Dietary intake was assessed using a validated food frequency questionnaire in 2009-2012 (first survey) and 2014-2017 (second survey). Total energy intake (TEI), macro and micronutrients, foods, dietary scores and compliance to dietary guidelines were assessed. Three approaches were used comparing changes in dietary intake: 1) before and after retiring (paired analysis); 2) in participants who retired with gender- and age-matched participants who did not retire (two-group comparison), and 3) in participants who retired, who did not retire or who were retired at both surveys (analysis of variance). Using the first approach, newly retired participants (n = 215) increased their intake of total (median and [interquartile range]: 15.2 [13.7-17.5] vs. 14.9 [13.3-17.1] % of TEI) and animal (11.1 [9.1-13.0] vs. 10.0 [8.5-12.6] %TEI) protein; total (35.8 [32.1-40.7] vs. 34.6 [30.0-39.1] %TEI), saturated and monounsaturated fat; alcohol; cholesterol; vitamin D and fish, and decreased their intake of vegetable protein; total carbohydrates and monosaccharides, and of the Mediterranean diet score. Those findings were confirmed for total and saturated fat, alcohol, total carbohydrates and monosaccharides; vitamin D and fish intake, and of the Mediterranean diet score in the other two approaches. Retirement was associated with an unhealthier dietary intake

Impact of COVID-19 pandemic on cardiovascular diseases hospitalisation, management and mortality in Switzerland.

COVID-19 pandemic led to a reduction in hospital admissions and intervention for other diseases in many countries. We aimed to assess the effect of COVID-19 pandemic on cardiovascular disease (CVD) hospitalisations, management and mortality in Switzerland. Swiss hospital discharge and mortality data for period 2017-2020. CVD hospitalisations, CVD interventions and CVD mortality were assessed before (2017-2019) and during (2020) the pandemic. Expected numbers of admissions, interventions and deaths for 2020 were computed using simple linear regression model. Compared with 2017-2019, 2020 was characterised by a reduction of CVD admissions in age groups 65-84 and ≥85 by approximately 3700 and 1700 cases, respectively, and by an increase in the percentage of admissions with a Charlson index >8. The total number of CVD-related deaths decreased from 21 042 in 2017 to 19 901 in 2019, and increased to 20 511 in 2020, with an estimated excess of 1139 deaths. This increase was due to out-of-hospital deaths (+1342), while the number of in-hospital deaths decreased from 5030 in 2019 to 4796 in 2020, which concerned mostly subjects aged ≥85 years. The total number of admissions with cardiovascular interventions increased from 55 181 in 2017 to 57 864 in 2019, and decreased in 2020, with an estimated reduction of 4414 admissions; percutaneous transluminal coronary angioplasty (PTCA) was the exception, as the number and percentage of emergency admissions with PTCA increased. The preventive measures applied against COVID-19 inverted the seasonal pattern of CVD admissions, the highest number of admissions being found in summer and the lowest in winter. The COVID-19 pandemic led to a reduction in CVD hospital admissions, planned CVD interventions, an increase in total and out-of-hospital CVD deaths and a change in seasonal patterns

Not as bad as you think: a comparison of the nutrient content of best price and brand name food products in Switzerland.

Several studies have shown that low-cost foods have an equivalent nutrient composition compared to high-cost foods, but such information is lacking in Switzerland. Thus, we compared the caloric and nutrient content of "best price" (BPF) and brand name foods (BNF) in Switzerland using the version 5.0 (April 2015) of the Swiss Food and Nutrient composition database. Over 4000 processed food items were included and 26 food categories were compared regarding total energy, protein, fat and carbohydrates, saturated fatty acids, sugar, fiber and sodium. BPF, namely core food categories like Bread, Red meat, White meat and Fish products, were 42%, 39%, 42% and 46% less expensive than their BNF equivalents, respectively. No differences were found between BPF and BNF regarding total energy and protein, fat and carbohydrates for most food categories. In the Cheese category, BPF had a lower caloric content than BNF [Median (interquartile range, IQR): 307 (249-355) vs. 365 (308-395) kcal/100 g, respectively, p < 0.001]; BPF also had lower fat and saturated fatty acid content but higher carbohydrate content than BNF (both p < 0.01). In the Creams and puddings group, BPF had lower fat 1.3 (0.9-1.7) vs. 6.0 (3.5-11.0) g/100 g and saturated fatty acid 0.6 (0.6-0.8) vs. 2.9 (2.3-6.0) g/100 g content than BNF (both p < 0.005). In the Tinned fruits and vegetables group, BPF had lower sodium content than BNF: 175 (0-330) vs. 370 (150-600) mg/100 g, p = 0.006. BPF might be a reasonable and eventually healthier alternative of BNF for economically deprived people in Switzerland

Impact of nutritional risk screening in hospitalized patients on management, outcome and costs: A retrospective study.

Hospitalized patients should be screened for nutritional risk and adequately managed. Being nutritionally 'at-risk' increases in-hospital mortality, length of stay (LOS) and costs, but the impact on actual costs has seldom been assessed. We aimed to determine nutritional risk screening and management in a Swiss university hospital. The impact of being nutritionally 'at-risk' on in-hospital mortality, LOS and costs was also assessed. Retrospective analysis of administrative data for years 2013 and 2014 from the department of internal medicine of the Lausanne university hospital (8541 hospitalizations, mean age 72.8 ± 16.5 years, 50.4% women). Being nutritionally 'at-risk' was defined as a Nutritional risk screening-2002 score ≥ 3 and nutritional managements were collected from medical records. Screening increased from 16.5% in 2013 to 41.9% in 2014 (p < 0.001), while prevalence of 'at-risk' patients remained stable (64.6% in 2013 and 62.7% in 2014, p = 0.37). Prevalence of 'at-risk' patients was highest in patients with cancer (85.3% in 2013 and 70.2% in 2014) and lowest in patients with disease of skin (42% in 2013 and 44.8% in 2014). Less than half of patients 'at-risk' received any nutritional management, and this value decreased between 2013 and 2014 (46.9% vs. 40.3%, p < 0.05). After multivariate adjustment, 'at-risk' patients had a 3.7-fold (95% confidence interval: 1.91; 7.03) higher in-hospital mortality and higher costs (excess 5642.25 ± 1479.80 CHF in 2013 and 5529.52 ± 847.02 CHF in 2014, p < 0.001) than 'not at-risk' patients, while no difference was found for LOS. Despite an improvement in screening, management of nutritionally 'at-risk' patients is not totally covered yet. Being nutritionally 'at-risk' affects three in every five patients and is associated with increased mortality and hospitalization costs