Cancer cases attributable to modifiable lifestyle risk factors in Switzerland between 2015 and 2019.

Several modifiable lifestyle risk factors have been linked to higher cancer risk in the literature. Determining the proportion and number of cancer cases attributable to these risk factors is pivotal in informing effective cancer prevention and control plans that have the greatest effect on reducing cancer incidence. We aimed to estimate the proportion and number of incident cancer cases that were attributable to modifiable lifestyle risk factors (ie, tobacco smoking, high alcohol consumption, excess body weight, physical inactivity and unhealthy diet) in Switzerland between 2015 and 2019. The exposure prevalence of selected risk factors was estimated based on the representative national nutrition survey menuCH, the associated relative risks were obtained from systematic literature reviews and the numbers of incident cancer cases were provided by the National Institute for Cancer Epidemiology and Registration. The fractions and numbers of attributable cases were calculated overall, by sex and by the three major language regions of Switzerland. The investigated modifiable risk factors combined were linked to 25.2% of potentially preventable incident cancer cases in Switzerland between 2015 and 2019. The proportion and numbers were slightly larger in males (28.4%, 6945 cases per year) than in females (21.9%, 4493 cases per year), and variations were observed between language regions. Tobacco smoking, excess body weight and high alcohol consumption were the leading contributors to lifestyle-attributable cancer cases. The observed differences in the leading risk factors both within Switzerland and compared to other countries underline the need for regionally and nationally tailored cancer prevention and education strategies.

The future backbone of nutritional science: integrating public health priorities with system-oriented precision nutrition.

Adopting policies that promote health for the entire biosphere (One Health) requires human societies to transition towards a more sustainable food supply as well as to deepen the understanding of the metabolic and health effects of evolving food habits. At the same time, life sciences are experiencing rapid and groundbreaking technological developments, in particular in laboratory analytics and biocomputing, placing nutrition research in an unprecedented position to produce knowledge that can be translated into practice in line with One Health policies. In this dynamic context, nutrition research needs to be strategically organised to respond to these societal expectations. One key element of this strategy is to integrate precision nutrition into epidemiological research. This position article therefore reviews the recent developments in nutrition research and proposes how they could be integrated into cohort studies, with a focus on the Swiss research landscape specifically.

How prevalent is a cancer-protective lifestyle? Adherence to the 2018 World Cancer Research Fund/American Institute for Cancer Research cancer prevention recommendations in Switzerland.

Population monitoring of lifestyle behaviours that are crucial as risk and protective factors for major chronic diseases is vital for the identification of priority areas for public health. In this study, we aimed to investigate the prevalence of adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) cancer prevention recommendations in Switzerland, overall and by selected sociodemographic and lifestyle characteristics. Data from the population-based, cross-sectional survey menuCH were used. We constructed a score reflecting adherence to the 2018 WCRF/AICR cancer prevention recommendations. Multinomial logistic regression models were fitted to investigate the association of sociodemographic and lifestyle characteristics with the level of adherence to the WCRF/AICR cancer prevention recommendations. The least frequently met cancer prevention recommendations were the ones on fibre intake (met by 13·7 %), red and processed meat (25·4 %), and ultra-processed food (33·3 %) consumption, while the recommendation on physical activity was met by almost 80 %. Women and individuals with tertiary education were more likely to have a score of ≥ 5 (as a reflection of adherence to the cancer prevention recommendations), compared with men or those who completed secondary education, respectively. Current smokers were less likely to have a score of ≥ 5, compared with never smokers. A high proportion of the population in Switzerland was found to not adhere closely to the WCRF/AICR cancer prevention recommendations. Differences were detected based on sociodemographic characteristics. Education and policy actions are needed to facilitate the adoption of a cancer-protective lifestyle.

Alcohol consumption: context and association with mortality in Switzerland.

PURPOSE: Non-communicable diseases generate the largest number of avoidable deaths often caused by risk factors such as alcohol, smoking, and unhealthy diets. Our study investigates the association between amount and context of alcohol consumption and mortality from major non-communicable diseases in Switzerland. METHODS: Generalized linear regression models were fitted on data of the cross-sectional population-based National Nutrition Survey menuCH (2014-2015, n = 2057). Mortality rates based on the Swiss mortality data (2015-2018) were modeled by the alcohol consumption group considering the amount and context (i.e., during or outside mealtime) of alcohol consumption and potential confounders. The models were checked for spatial autocorrelation using Moran's I statistic. Integrated nested Laplace approximation (INLA) models were fitted when evidence for missing spatial information was found. RESULTS: Higher mortality rates were detected among drinkers compared to non-drinkers for all-cancer (rate ratio (RR) ranging from 1.01 to 1.07) and upper aero-digestive tract cancer (RR ranging from 1.15 to 1.20) mortality. Global Moran's I statistic revealed spatial autocorrelation at the Swiss district level for all-cancer mortality. An INLA model led to the identification of three districts with a significant decrease and four districts with a significant increase in all-cancer mortality. CONCLUSION: Significant associations of alcohol consumption with all-cancer and upper aero-digestive tract cancer mortality were detected. Our study results indicate the need for further studies to improve the next alcohol-prevention scheme and to lower the number of avoidable deaths in Switzerland.

Adherence to cancer prevention recommendations and risk of breast cancer in situ in the United Kingdom Biobank.

A health-conscious lifestyle may protect against breast cancer in situ. However, breast cancer in situ is mainly detected by screening, and many studies lack information on screening participation. Thus, we evaluated the association between prediagnostic lifestyle and risk of breast cancer in situ, accounting for screening participation at recruitment. A score reflecting the adherence to the World Cancer Research Fund/American Institute for Cancer Research cancer prevention recommendations was constructed, using the recommendations on healthy body weight, physical activity, consumption of plant-based foods, red and processed meat, alcohol and avoidance of sugar. Cox proportional hazards regression models were used to investigate the association between the lifestyle score and breast cancer in situ risk, while accounting for important confounders. The lifestyle score was not significantly associated with breast cancer in situ risk (HRcontinuous  = 0.96, 95% CI = 0.91-1.03) in the overall cohort. In participants not reporting dietary changes in the past 5 years, the lifestyle score was inversely associated with breast cancer in situ risk (HRcontinuous  = 0.92, 95% CI = 0.85-0.99). In those reporting dietary changes in the past 5 years due to illness or other reasons, the lifestyle score was not associated with breast cancer in situ risk (HRcontinuous  = 1.04, 95% CI = 0.94-1.15). Lifestyle was inversely associated with breast cancer in situ risk in women not reporting recent changes in their dietary habits. This inverse association is consistent with inverse associations reported in previous studies. Our findings suggest that breast cancer in situ and invasive breast cancer share a similar risk factor profile.

Does diet map with mortality? Ecological association of dietary patterns with chronic disease mortality and its spatial dependence in Switzerland.

We investigated the associations between dietary patterns and chronic disease mortality in Switzerland using an ecological design and explored their spatial dependence, i.e. the tendency of near locations to present more similar and distant locations to present more different values than randomly expected. Data of the National Nutrition Survey menuCH (n 2057) were used to compute hypothesis- (Alternate Healthy Eating Index (AHEI)) and data-driven dietary patterns. District-level standardised mortality ratios (SMR) were calculated using the Swiss Federal Statistical Office mortality data and linked to dietary data geographically. Quasipoisson regression models were fitted to investigate the associations between dietary patterns and chronic disease mortality; Moran's I statistics were used to explore spatial dependence. Compared with the first, the fifth AHEI quintile (highest diet quality) was associated with district-level SMR of 0·95 (95 % CI 0·93, 0·97) for CVD, 0·91 (95 % CI 0·88, 0·95) for ischaemic heart disease (IHD), 0·97 (95 % CI 0·95, 0·99) for stroke, 0·99 (95 % CI 0·98, 1·00) for all-cancer, 0·98 (95 % CI 0·96, 0·99) for colorectal cancer and 0·93 (95 % CI 0·89, 0·96) for diabetes. The Swiss traditional and Western-like patterns were associated with significantly higher district-level SMR for CVD, IHD, stroke and diabetes (ranging from 1·02 to 1·08) compared with the Prudent pattern. Significant global and local spatial dependence was identified, with similar results across hypothesis- and data-driven dietary patterns. Our study suggests that dietary patterns partly contribute to the explanation of geographic disparities in chronic disease mortality in Switzerland. Further analyses including spatial components in regression models would allow identifying regions where nutritional interventions are particularly needed.

Associations between anxiety disorders and diet quality in a Swiss cohort study.

OBJECTIVES: Anxiety disorders are common in the general population and can have a major impact on a person's behavior. These disorders may also affect shopping and cooking habits, which may lead to a less healthy diet. Thus, we aimed to assess whether any current anxiety disorder or current specific anxiety disorders were associated with diet quality. METHODS: Data of 6392 observations of 3993 participants were retrieved from 2 data waves of a population-based prospective cohort study conducted in an urban area in Switzerland. To assess the associations of anxiety status with diet quality measured by the Alternate Healthy Eating Index (AHEI), we performed cross-sectional multilevel random-effects linear regression analyses, which accounted for potential repeated participation and a series of potential confounders. RESULTS: We observed an association between the presence of any current anxiety disorder and lower diet quality. For the most conclusive model, the AHEI was 1.2 points lower among those with current anxiety disorders compared to those participants with no anxiety disorder (p = 0.016). When specific anxiety disorders were included separately into the model, panic disorder was associated with lower diet quality in the fully adjusted model (p = 0.037). CONCLUSIONS: Our findings of reduced diet quality in people with any current anxiety disorder suggest that practical support is needed when it comes to buying and processing food. This might be systematically addressed in psychotherapy and external interdisciplinary support (e.g. occupational therapy and dietary counselling) should be involved. However, further data is needed to strengthen the findings of the present study.

Different dietary assessment methods, similar conclusions? Comparison of a country's adherence to food-based dietary guidelines as depicted in two population-based surveys using different dietary assessment methods.

OBJECTIVE: Different methods of dietary intake assessment are frequently used to assess a population's diet. In this study, we aimed to compare the adherence to Swiss food-based dietary guidelines as depicted in two Swiss population-based surveys using different methods of dietary assessment. DESIGN: Two population-based, cross-sectional surveys were compared. In the Swiss Health Survey (SHS), diet was assessed via a short set of questions on specific food groups, while in menuCH by two non-consecutive 24-h dietary recall interviews. SETTING: To compare the diet depicted in these surveys, we used the Swiss food-based dietary guidelines on vegetable, fruit, dairy product, meat and meat product, fish and alcohol. The weighted proportion of responders meeting these guidelines was calculated for both surveys and was compared overall and by selected characteristics. PARTICIPANTS: Residents of Switzerland, selected from a stratified random sample of the non-institutionalised residents, who agreed to participate in the respective survey. To ensure comparability between the surveys, the age of the study populations was restricted to 18-75 years. RESULTS: In menuCH, approximately 2 % of responders met ≥4 of the selected Swiss food-based dietary guidelines. In the SHS, using a cruder dietary assessment, the corresponding percentage was 20 %. In both surveys, more women and never smokers were meeting ≥4 food-based dietary guidelines compared to men and current or former smokers, respectively. CONCLUSIONS: Our study comparing the diet in two population-based, representative surveys detected large variations in guideline adherence depending on the dietary assessment method used.

Daily and meal-based assessment of dairy and corresponding protein intake in Switzerland: results from the National Nutrition Survey menuCH.

PURPOSE: Dairy contributes to daily protein and provides important minerals and vitamins. Using data of the National Nutrition Survey in Switzerland (menuCH), we aimed to describe intakes of dairy and its subcategories, to compare daily and per-meal dairy protein with total protein intake, and to investigate associations between energy-standardized dairy intake and sociodemographic, lifestyle and anthropometric factors. METHODS: From two 24-h dietary recalls, anthropometric measurements, and a lifestyle questionnaire from a representative sample (n = 2057, 18-75 years), we calculated daily and energy-standardized means and standard error of the means for dairy, its subcategories (milk, yoghurt and cheese), and compared daily and per-meal dairy protein with total protein intake. Associations were investigated between dairy intake (g/1000 kcal) and sociodemographic, lifestyle and anthropometric factors by multivariable linear regression. RESULTS: Dairy intake provided 16.3 g/day protein with cheese contributing highest amounts (9.9 g/day). Dairy protein intake was highest at dinner (6.3 g/day) followed by breakfast, lunch and snacks (4.3, 3.3 and 2.4 g/day, respectively). Per meal, total protein reached the amounts suggested for improving protein synthesis only at dinner and lunch (33.1 and 28.3 g/day, respectively). Energy-standardized dairy intake was 20.7 g/1000 kcal higher for women than men (95% CI 13.2; 28.1), 24.3 g/1000 kcal lower in the French than German-speaking region (95% CI - 32.4; - 16.1), and also significantly associated with nationality, household type and smoking status. CONCLUSION: This first description of dairy consumption is an important basis for developing meal-specific recommendations, aimed to optimize dairy and protein intake especially for older adults.

Association between dietary patterns and prediabetes, undetected diabetes or clinically diagnosed diabetes: results from the KORA FF4 study.

PURPOSE: Diet is one of the most important modifiable risk factors for the development of type 2 diabetes. Here, we aim to identify dietary patterns and to investigate their association with prediabetes, undetected diabetes and prevalent diabetes. METHODS: The present study included 1305 participants of the cross-sectional population-based KORA FF4 study. Oral glucose tolerance test (OGTT) measurements together with a physician-confirmed diagnosis allowed for an accurate categorization of the participants according to their glucose tolerance status into normal glucose tolerance (n = 698), prediabetes (n = 459), undetected diabetes (n = 49), and prevalent diabetes (n = 99). Dietary patterns were identified through principal component analysis followed by hierarchical clustering. The association between dietary patterns and glucose tolerance status was investigated using multinomial logistic regression models. RESULTS: A Prudent pattern, characterized by high consumption of vegetables, fruits, wholegrains and dairy products, and a Western pattern, characterized by high consumption of red and processed meat, alcoholic beverages, refined grains and sugar-sweetened beverages, were identified. Participants following the Western pattern had significantly higher chances of having prediabetes (odds ratio [OR] 1.92; 95% confidence interval [CI] 1.35, 2.73), undetected diabetes (OR 10.12; 95% CI 4.19, 24.43) or prevalent diabetes (OR 3.51; 95% CI 1.85, 6.67), compared to participants following the Prudent pattern. CONCLUSION: To our knowledge, the present study is one of the few investigating the association between dietary patterns and prediabetes or undetected diabetes. The use of a reference group exclusively including participants with normal glucose tolerance might explain the strong associations observed in our study. These results suggest a very important role of dietary habits in the prevention of prediabetes and type 2 diabetes.

No-meat eaters are less likely to be overweight or obese, but take dietary supplements more often: results from the Swiss National Nutrition survey menuCH.

OBJECTIVE: To describe and analyse the sociodemographic, anthropometric, behavioural and dietary characteristics of different types of Swiss (no-)meat eaters. DESIGN: No-, low-, medium- and high-meat eaters were compared with respect to energy and total protein intake and sociodemographic, anthropometric and behavioural characteristics. SETTING: National Nutrition Survey menuCH, the first representative survey in Switzerland. PARTICIPANTS: 2057 participants, aged 18-75 years old, who completed two 24-h dietary recalls (24-HDR) and a questionnaire on dietary habits, sociodemographic and lifestyle factors. Body weight and height were measured by trained interviewers. No-meat eaters were participants who reported meat avoidance in the questionnaire and did not report any meat consumption in the 24-HDR. Remaining study participants were assigned to the group of low-, medium- or high-meat eaters based on energy contributions of total meat intake to total energy intake (meat:energy ratio). Fifteen percentage of the participants were assigned to the low- and high-meat eating groups, and the remaining to the medium-meat eating group. RESULTS: Overall, 4·4 % of the study participants did not consume meat. Compared with medium-meat eaters, no-meat eaters were more likely to be single and users of dietary supplements. Women and high-educated individuals were less likely to be high-meat eaters, whereas overweight and obese individuals were more likely to be high-meat eaters. Total energy intake was similar between the four different meat consumption groups, but no-meat eaters had lowest total protein intake. CONCLUSIONS: This study identified important differences in sociodemographic, anthropometric, behavioural and dietary factors between menuCH participants with different meat-eating habits.

Dietary fibre intake and its association with ultraprocessed food consumption in the general population of Switzerland: analysis of a population-based, cross-sectional national nutrition survey.

Objectives: The objective of this study was to describe the compliance to dietary fibre recommendations of the Swiss population and to investigate the association between dietary fibre intake and ultraprocessed food (UPF) consumption. Methods: Data were obtained from the cross-sectional Swiss National Nutrition Survey menuCH. We summarised the sociodemographic, lifestyle and anthropometric parameters as well as dietary data collected with two 24-hour dietary recalls for the whole population and subgroups according to absolute and relative dietary fibre intake. We analysed the associations between dietary fibre intake and UPF consumption by fitting multinomial logistic regression models. Data were weighted according to the menuCH weighting strategy to achieve a representation of the Swiss population. Results: Data obtained from 2057 adults were included in the analysis, of which 87% had a dietary fibre intake of <30 g/day. Participants with high UPF consumption had lower odds of being in the medium or high dietary fibre intake groups than participants with low UPF consumption. The odds of being in the medium or high dietary fibre intake groups decreased linearly across quartiles of UPF consumption (p for trend ≤0.004). Conclusions: Dietary fibre intake is insufficient in all population groups in Switzerland. UPF consumption is inversely and dose dependently associated with dietary fibre intake. To increase dietary fibre intake, public health measures should discourage UPF consumption and increase dietary fibre intake via unprocessed or minimally processed foods.

Determinants and changes in adherence to the World Cancer Research Fund/American Institute for Cancer Research cancer-prevention recommendations over the past 25†years in Switzerland.

OBJECTIVES: The World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) established 10 lifestyle recommendations for cancer prevention. The current study examines the proportion and changes over 25 years of adherence to these recommendations and their determinants in Switzerland. METHODS: On the basis of six Swiss Health Surveys (1992-2017, N = 110 478), an index reflecting adherence to the 2018 WCRF/AICR cancer-prevention recommendations was created. Multinomial logistic regression models were fitted to investigate changes over time and determinants of a cancer-protective lifestyle. RESULTS: Adherence to cancer-prevention recommendations was moderate and higher in the years 1997-2017 compared to 1992. Higher adherence was observed among women (odds ratio [OR]high vs. low adherence ranging from 3.31 to 3.74) and participants with a tertiary education level (ORhigh vs. low adherence ranging from 1.71 to 2.18), and lower adherence among participants of the oldest age group (ORhigh vs. low adherence ranging from 0.28 to 0.44) and participants of the Switzerland (lat.: Confoederatio helvetica)-French language regions (ORhigh vs. low adherence ranging from 0.53 to 0.73). CONCLUSION: Our results showed that cancer-prevention recommendations are not well followed by the general Swiss population, as the adherence to a cancer-protective lifestyle was generally moderate; however, adherence to cancer-prevention recommendations improved over the past 25 years. Sex, age group, education level, and language regions were significant determinants of adherence to a cancer-protective lifestyle. Further actions at the governmental and individual levels promoting the adoption of a cancer-protective lifestyle are needed.

Is Following a Cancer-Protective Lifestyle Linked to Reduced Cancer Mortality Risk?

Objectives: This study investigates the association between a cancer protective lifestyle (defined based on the revised World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) cancer prevention recommendations) and mortality in Switzerland. Methods: Based on the cross-sectional, population-based National Nutrition Survey, menuCH (n = 2057), adherence to the WCRF/AICR recommendations was assessed via a score. Quasipoisson regression models were fitted to examine the association of adherence to the WCRF/AICR recommendations with mortality at the Swiss district-level. Spatial autocorrelation was tested with global Moran's I. Integrated nested Laplace approximation models were fitted when significant spatial autocorrelation was detected. Results: Participants with higher cancer prevention scores had a significant decrease in all-cause (relative risk 0.95; 95% confidence interval 0.92, 0.99), all-cancer (0.93; 0.89, 0.97), upper aero-digestive tract cancer (0.87; 0.78, 0.97), and prostate cancer (0.81; 0.68, 0.94) mortality, compared to those with lower scores. Conclusion: The inverse association between adherence to the WCRF/AICR recommendations and mortality points out the potential of the lifestyle recommendations to decrease mortality and especially the burden of cancer in Switzerland.

Adherence to the EAT-Lancet reference diet is associated with a reduced risk of incident cancer and all-cause mortality in UK adults.

Food systems have been identified as significant contributors to the global environmental emergency. However, there is no universally agreed-upon definition of what constitutes a planetary healthy, sustainable diet. In our study, we investigated the association between the EAT-Lancet reference diet, a diet within the planetary boundaries, and incident cancer, incident major cardiovascular events, and all-cause mortality. Higher adherence to the EAT-Lancet reference diet was associated with lower incident cancer risk (hazard ratio [HR]continuous: 0.99; 95% confidence interval [CI]: 0.98-0.99]) and lower all-cause mortality (HR continuous: 0.98; 95% CI: 0.98-0.99), while mostly null associations were detected for major cardiovascular event risk (HR continuous: 1.00; 95% CI: 0.98-1.01). Stratified analyses using potentially modifiable risk factors led to similar results. Our findings, in conjunction with the existing literature, support that adoption of the EAT-Lancet reference diet could have a benefit for the prevention of non-communicable diseases.

Investigation of Alcohol-Drinking Levels in the Swiss Population: Differences in Diet and Associations with Sociodemographic, Lifestyle and Anthropometric Factors.

Alcohol-drinking levels in Switzerland were investigated to identify dietary differences and explore the relationship between drinking levels and sociodemographic, lifestyle and anthropometric factors using the National Nutrition Survey menuCH (n = 2057, 18−75 years). After two 24 h dietary recalls (24HDRs), participants were categorized into four subgroups: abstainers (both self-declared alcohol avoidance and no alcohol reported); no alcohol reported; moderate drinkers (women/men < 12 g/<24 g mean daily alcohol, respectively); and heavy drinkers (women/men > 12 g/>24 g mean daily alcohol, respectively). Differences in diet between these groups were described by comparing daily total energy and non-alcohol energy intake, macronutrient energy contribution, food group intake, and diet quality (Alternate Healthy Eating Index excluding alcohol). The sociodemographic, anthropometric and lifestyle factors that determine alcohol-drinking levels were investigated using multinomial logistic regression. Abstainers reported the lowest daily energy intake (total and non-alcohol), heavy drinkers had the highest total energy intake and the lowest diet quality, and moderate drinkers had the highest non-alcohol energy intake. Sex, age, language region, body mass index, household size, smoking status, self-reported health status and following a diet were significantly associated with different alcohol-drinking subgroups. Results could facilitate interventions that target subgroups who exceed safe alcohol-drinking levels and lead unfavorable lifestyles.

The compatibility of circularity and national dietary recommendations for animal products in five European countries: a modelling analysis on nutritional feasibility, climate impact, and land use.

BACKGROUND: National food-based dietary guidelines (FBDGs) are generally designed from a human health perspective and often disregard sustainability aspects. Circular food production systems are a promising solution to achieve sustainable healthy diets. In such systems, closing nutrient cycles where possible and minimising external inputs contribute to reducing environmental impacts. This change could be made by limiting livestock feed to available low-opportunity-cost biomass (LOCB). We examined the compatibility of national dietary guidelines for animal products with livestock production on the basis of the feed supplied by available LOCB. METHODS: We investigated whether the national dietary recommendations for animal products for Bulgaria, Malta, the Netherlands, Sweden, and Switzerland could be met with domestically available LOCB. We used an optimisation model that allocates feed resources to different species of farm animals. Of the resulting scenarios, we assessed the nutritional feasibility, climate impact, and land use. FINDINGS: Our results showed the environmental benefits of reducing the recommended animal products in the FBDGs, and that animal products from LOCB could provide between 22% (Netherlands) and 47% (Switzerland) of total protein contributions of the FBDGs. This range covers a substantial part of the nutritional needs of the studied populations. To fully meet these needs, consumption of plant-based food could be increased. INTERPRETATION: Our results contribute to the discussion of what quantities of animal products in dietary guidelines are compatible with circular food systems. Thus, national dietary recommendations for animal products should be revised and recommended quantities lowered. This finding is consistent with recent efforts to include sustainability criteria in dietary guidelines. FUNDING: Swiss National Science Foundation and the Dutch Research Council.

Ultraprocessed Food Consumption is Strongly and Dose-Dependently Associated with Excess Body Weight in Swiss Women.

OBJECTIVE: This study investigated the association between ultraprocessed food consumption and excess body weight in a Swiss nationally representative study. METHODS: Data stem from the cross-sectional Swiss National Nutrition Survey menuCH (n = 2,057). Dietary information was collected with 24-hour dietary recalls, and food items were categorized into non-ultraprocessed or ultraprocessed using the NOVA food classification system. The following three excess body weight indicators were considered: BMI, waist circumference (WC), and a BMI-WC composite outcome. Multinomial logistic regression models stratified by sex were fitted. RESULTS: Women in the highest quintile of ultraprocessed food weight proportion had significantly higher odds of having obesity (odds ratio [OR] 3.01, 95% CI: 1.48-6.11), having abdominal obesity (OR 2.69, 95% CI: 1.43-5.05), and being in the highest category of the BMI-WC composite outcome (OR 3.28, 95% CI: 1.59-6.77). No relevant associations were observed in men. CONCLUSIONS: Ultraprocessed food weight proportion was strongly and dose-dependently associated with excess body weight in women but not in men. Further studies are required to elucidate potential mechanisms behind this association. Increasing evidence of the detrimental effect of ultraprocessed food consumption on health stresses the need to consider these products in future public health strategies.

Risk for Invasive Cancers in Women With Breast Cancer In Situ: Results From a Population Not Covered by Organized Mammographic Screening.

BACKGROUND: Even though breast cancer in situ (BCIS) incidence has been increasing, the prognosis of BCIS patients has not been extensively investigated. According to the literature, women with BCIS have a higher risk of developing subsequent invasive breast cancer; conflicting information has been reported regarding their potential risk for a subsequent invasive non-breast cancer. METHODS: Data from 1,082 women, whose first-ever cancer diagnosis was primary BCIS between 2003 and 2015 and were living in the canton of Zurich, were used. Standardized incidence ratios (SIRs) were calculated to compare the risk of an invasive breast or non-breast cancer among women with a primary BCIS with the corresponding risk of the adult female population. SIRs were calculated overall and by patient and tumor characteristics. To investigate potential risk factors (e.g., age at diagnosis, treatment) for a subsequent invasive breast or non-breast cancer we used Cox proportional hazards regression models. RESULTS: BCIS patients had 6.85 times [95% confidence interval (CI): 5.52-8.41] higher risk of being diagnosed with invasive breast cancer compared to the general population. They additionally faced 1.57 times (95% CI: 1.12-2.12) higher risk of an invasive non-breast cancer. The SIRs were higher for women < 50-years old for both invasive breast and non-breast cancer at BCIS diagnosis. Age ≥ 70-years old at BCIS diagnosis was statistically significantly associated with a subsequent invasive non-breast cancer diagnosis. CONCLUSIONS: BCIS patients had a higher risk of being diagnosed with invasive breast and non-breast cancer compared to the general population. Age 70 years or older at BCIS diagnosis was the only risk factor statistically significantly associated with a subsequent invasive non-breast cancer. Our results support the increased risk for subsequent cancers in BCIS patients reported in the literature. Future studies should establish the risk factors for subsequent cancers, highlight the need for intensive monitoring in this population, and help distinguish BCIS patients who could benefit from systemic therapy to prevent distant cancers.

Are there sex differences among colorectal cancer patients in treatment and survival? A Swiss cohort study.

BACKGROUND: Colorectal cancer (CRC) is among the three most common incident cancers and causes of cancer death in Switzerland for both men and women. To promote aspects of gender medicine, we examined differences in treatment decision and survival by sex in CRC patients diagnosed 2000 and 2001 in the canton of Zurich, Switzerland. METHODS: Characteristics assessed of 1076 CRC patients were sex, tumor subsite, age at diagnosis, tumor stage, primary treatment option and comorbidity rated by the Charlson Comorbidity Index (CCI). Missing data for stage and comorbidities were completed using multivariate imputation by chained equations. We estimated the probability of receiving surgery versus another primary treatment using multivariable binomial logistic regression models. Univariable and multivariable Cox proportional hazards regression models were used for survival analysis. RESULTS: Females were older at diagnosis and had less comorbidities than men. There was no difference with respect to treatment decisions between men and women. The probability of receiving a primary treatment other than surgery was nearly twice as high in patients with the highest comorbidity index, CCI 2+, compared with patients without comorbidities. This effect was significantly stronger in women than in men (p-interaction = 0.010). Survival decreased with higher CCI, tumor stage and age in all CRC patients. Sex had no impact on survival. CONCLUSION: The probability of receiving any primary treatment and survival were independent of sex. However, female CRC patients with the highest CCI appeared more likely to receive other therapy than surgery compared to their male counterparts.