Is body weight dissatisfaction a predictor of depression independent of body mass index, sex and age? Results of a cross-sectional study.

BACKGROUND: Little is known about the association of dissatisfaction with body weight - a component of body image - with depression in individuals of different sex, age, and with different body mass index (BMI). Hence, the aim of our study was to evaluate the association of body weight dissatisfaction (BWD) with depression in different sub-groups. METHODS: We analyzed data of 15,975 individuals from the cross-sectional 2012 Swiss Health Survey. Participants were asked about their body weight satisfaction. The validated Patient Health Questionnaire (PHQ-9) was used to ascertain depression. Age was stratified into three groups (18-29, 30-59, and ≥60 years). The body mass index (BMI) was calculated from self-reported body height and weight and categorized into underweight (BMI <18.5 kg/m(2)), normal weight (BMI 18.5-24.9 kg/m(2)), overweight (BMI 25.0-29.9 kg/m(2)), and obesity (BMI ≥30 kg/m(2)). The association between body weight dissatisfaction (BWD) and depression was assessed with logistic regression analyses and odds ratios (OR) with 95 % confidence intervals (CI) were computed. RESULTS: BWD was associated with depression in the overall group (OR 2.04, 95 % CI 1.66-2.50) as well as in men (OR 1.85, 95 % CI 1.34-2.56) and women (OR 2.25, 95 % CI 1.71-2.96) independent of BMI. The stratification by age groups showed significant associations of BWD with depression in young (OR 1.78, 95 % CI 1.16-2.74), middle-aged (OR 2.10, 95 % CI 1.61-2.74) and old individuals (OR 2.34, 95 % CI 1.30-4.23) independent of BMI. Stratification by BMI categories resulted in statistically significant positive associations of BWD and depression in underweight, normal weight, overweight and obese individuals. CONCLUSION: BWD was associated with depression independent of BMI, sex and age.

Breast cancer screening attendance in two Swiss regions dominated by opportunistic or organized screening.

BACKGROUND: In Switzerland, the French-speaking region has an organized breast cancer (BC) screening program; in the German-speaking region, only opportunistic screening until recently had been offered. We evaluated factors associated with attendance to breast cancer screening in these two regions. METHODS: We analyzed the data of 50-69 year-old women (n = 2769) from the Swiss Health Survey 2012. Factors of interest included education level, place of residence, nationality, marital status, smoking history, alcohol consumption, physical activity, diet, self-perceived health, history of chronic diseases and mental distress, visits to medical doctors and cervical and colorectal cancer screening. Outcome measures were dichotomized into ≤2 years since most recent mammography versus >2 years or never. RESULTS: In the German- and French-speaking regions, mammography attendance within the last two years was 34.9 % and 77.8 %, respectively. In the French region, moderate alcohol consumption (adjusted OR 2.01, 95 % CI 1.28-3.15) increased screening attendance. Compared to those with no visit to a physician during the recent year, women in both regions with such visits attended statistically significantly more often BC screening (1-5 times vs. no visit: German (adjusted OR 3.96, 95 % CI 2.58-6.09); French: OR 7.25, 95 % CI 4.04-13.01). Non-attendance to cervical screening had a negative effect in both the German (adjusted OR 0.44, 95 % CI 0.25-0.79) and the French region (adjusted OR 0.57, 95 % CI 0.35-0.91). The same was true for colorectal cancer screening (German (adjusted OR 0.66, 95 % CI 0.52-0.84); French: OR 0.52, 95 % CI 0.33-0.83). No other factor was associated with BC screening and none of the tests of interaction comparing the two regions revealed statistically significant results. CONCLUSION: The effect of socio-demographic characteristics, lifestyle, health factors and screening behavior other than mammography on non-attendance to BC screening did not differ between the two regions with mainly opportunistic and organized screening, respectively, and did not explain the large differences in attendance between regions. Other potential explanations such as public promotion of attendance for BC screening, physicians' recommendations regarding mammography participation or women's beliefs should be further investigated.

Associations between fruit and vegetable consumption and psychological distress: results from a population-based study.

BACKGROUND: Several studies observed associations of various aspects of diet with mental health, but little is known about the relationship between following the 5-a-day recommendation for fruit and vegetables consumption and mental health. Thus, we examined the associations of the Swiss daily recommended fruit and vegetable intake with psychological distress. METHODS: Data from 20,220 individuals aged 15+ years from the 2012 Swiss Health Survey were analyzed. The recommended portions of fruit and vegetables per day were defined as 5-a-day (at least 2 portions of fruit and 3 of vegetables). The outcome was perceived psychological distress over the previous 4 weeks (measured by the 5-item mental health index [MHI-5]). High distress (MHI-5 score ≤ 52), moderate distress (MHI-5 > 52 and ≤ 72) and low distress (MHI-5 > 72 and ≤ 100) were differentiated and multinomial logistic regression analyses adjusted for known confounding factors were performed. RESULTS: The 5-a-day recommendation was met by 11.6 % of the participants with low distress, 9.3 % of those with moderate distress, and 6.2 % of those with high distress. Consumers fulfilling the 5-a-day recommendation had lower odds of being highly or moderately distressed than individuals consuming less fruit and vegetables (moderate vs. low distress: OR = 0.82, 95 % confidence interval [CI] 0.69-0.97; high vs. low distress: OR = 0.55, 95 % CI 0.41-0.75). CONCLUSIONS: Daily intake of 5 servings of fruit and vegetable was associated with lower psychological distress. Longitudinal studies are needed to further determine the causal nature of this relationship.

Urinary lignans and inflammatory markers in the US National Health and Nutrition Examination Survey (NHANES) 1999-2004 and 2005-2008.

PURPOSE: Chronic inflammation has been implicated in the etiology of various chronic diseases. We previously found that certain urinary isoflavones are associated with markers of inflammation. In the present study, we examined the associations of serum C-reactive protein (CRP) and white blood cell (WBC) count with lignans, which are more frequent in the Western diet than isoflavones. METHODS: Our analysis included 2,028 participants of NHANES 2005-2008 and 2,628 participants of NHANES 1999-2004 aged 18 years and older. The exposures of interest were urinary mammalian lignans (enterodiol and enterolactone). Outcome variables were two inflammatory markers (CRP [≤10 mg/L] and WBC [≥3.0 and ≤11.7 (1,000 cells/µL)]). Log-transformed CRP concentration and WBC count by log-transformed creatinine-standardized concentrations of mammalian lignans were used for linear regression. RESULTS: Statistically significant inverse associations of urinary lignan, enterodiol, and enterolactone concentrations with circulating CRP and WBC counts were observed in the multivariate-adjusted models: In NHANES 2005-2008, per one-percent increase in lignan concentrations in the urine, CRP concentrations and WBC counts decreased by 8.1 % (95 % CI -11.5, -4.5) and 1.9 % (95 % CI -2.7; -1.2), respectively. Per one-percent increase in enterodiol and enterolactone, WBC counts decreased by 2.1 % (95 % CI -2.8, -1.3) and 1.3 % (95 % CI -1.9, -0.6), respectively. In NHANES 1999-2004, analogous results were 3.0 % (95 % CI -5.6, -0.3), 1.2 % (95 % CI -2.0; -0.4), 1.0 % (95 % CI -1.8, -0.2), and 0.8 % (95 % CI -1.4, 0.2). CONCLUSIONS: Mammalian lignans were inversely associated with markers of chronic inflammation. Due to the cross-sectional design, our findings require confirmation in prospective studies.

The association between urinary phytoestrogen excretion and components of the metabolic syndrome in NHANES.

BACKGROUND: Metabolic syndrome is a major risk factor for cardiovascular diseases, which are still the major cause of death in developed countries. METHODS: We cross-sectionally studied the association between urinary phytoestrogen excretion and metabolic cardiovascular risk factors. Hence, we used data from the National Health and Nutrition Examination Survey from 1999 to 2004 with 1,748 participants, who had urine levels of isoflavones and lignans measured. Geometric means of waist circumference, blood pressure, fasting glucose, HDL cholesterol, and triglyceride levels were computed by quartiles of isoflavone or lignan urinary excretion. Outcome was assessed as the presence of metabolic syndrome according to NCEP-ATP III criteria. The association between phytoestrogen concentration and the metabolic syndrome was calculated using logistic regression analyses. RESULTS: Plasma triglyceride and HDL cholesterol levels were lower in participants in the highest quartile of lignan excretion compared with the lowest (both P < 0.01). However, blood pressure, waist circumference, and plasma glucose levels did not differ significantly between extreme quartiles. The presence of metabolic syndrome was lower with increasing levels of urinary lignans (OR 0.48, 95% CI 0.28; 0.80 top vs. bottom quartile), especially when separately computed for the excretion of enterolactone (OR 0.47, 95% CI 0.28; 0.78). There was no significant association between isoflavone excretion and any component of the metabolic syndrome. CONCLUSIONS: Our study shows that an increasing excretion of lignans, especially enterolactone, might be associated with a decreased presence of the metabolic syndrome.

Racial variation in vitamin D cord blood concentration in white and black male neonates.

AIM: The aim of this study is to evaluate racial variation in umbilical cord blood concentration of vitamin D and to explore its correlation with markers of the insulin-like growth factor axis (IGFs) and sex steroid hormones in white and black male neonates. METHODS: In 2004-2005, venous umbilical cord blood samples were collected from 75 black and 38 white male neonates, along with maternal and birth characteristics from two hospitals in Maryland, United States. 25-Hydroxyvitamin D [25(OH)D] and 1,25-dihydroxyvitamin D [1,25(OH)(2)D] were measured by radioimmunoassay and testosterone, estradiol, and sex hormone-binding globulin (SHBG) by immunoassay and IGF-1, IGF-2, and IGF-binding protein-3 by ELISA. Crude and multivariable-adjusted geometric mean concentrations were computed. RESULTS: Mean 25(OH)D levels were lower in black than in white neonates (11.44; 95 % CI 10.10-12.95 ng/mL vs. 18.24; 95 % CI 15.32-21.72 ng/mL; p < 0.0001). Black neonates were at higher risk of suboptimal vitamin D levels [25(OH)D < 20 ng/mL] than whites (84 vs. 63 %). 25(OH)D concentrations varied by season in whites but not in blacks and were significantly inversely correlated with mother's parity (number of live births) in blacks but not in whites. Mean concentration of 1,25(OH)(2)D did not differ by race. 25(OH)D and 1,25(OH)(2)D did not correlate with IGFs, sex steroid hormones, and SHBG. CONCLUSIONS: Suboptimal vitamin D levels were prevalent especially in blacks and influenced by mother's parity and by season. The observed vitamin D differences between black and white neonates warrant further evaluation of the etiology of the disparity in chronic diseases in adulthood.

Association of urinary phytoestrogen concentrations with serum concentrations of prostate-specific antigen in the National Health and Nutrition Examination Survey.

Some clinical trials have shown that high phytoestrogen intake may decrease serum concentrations of prostate-specific antigen (PSA), and phytoestrogens may also lower prostate cancer risk. It was the aim of this study to examine the relationship between the serum PSA level and urine phytoestrogen concentration in generally healthy U.S. men. Eight hundred twenty-four men, 40+ yr old without prostate cancer, who participated in the 2001-2004 NHANES surveys, were included in the analysis. The association of total PSA, free PSA, and PSA ratio [free PSA/total PSA * 100] with concentrations of isoflavones and lignans (standardized for urinary creatinine concentration) was examined using multivariable-adjusted linear and logistic regression models. The linear regression analyses showed no clear association between creatinine-standardized urinary phytoestrogen concentrations and serum total or free PSA levels or PSA ratio. However, the odds of having a PSA ratio <15% rose from Quartile 1 to Quartile 4 of isoflavone excretion (odds ratio = 2.82, 95% confidence interval 1.28-6.22 for top vs. bottom quartile), but there were no associations with having a PSA ratio <25%. In generally healthy U.S. men, 40+ yr old without a diagnosis of prostate cancer, urinary isoflavone, and lignan concentrations were not associated with serum PSA level.

Urinary phytoestrogen levels and frailty in older American women of the National Health and Nutrition Examination Survey (NHANES) 1999-2002: a cross-sectional study.

BACKGROUND/AIMS: A deficit of various hormones during the process of aging and/or a heightened inflammatory state may be causally linked to the development of frailty. Phytoestrogens as weak estrogens, antioxidants, and anti-inflammatory agents may counteract this process. METHODS: In a cross-sectional study including two cycles of the National Health and Nutrition Examination Survey (NHANES, i.e. 1999-2002), logistic regression was used to analyze the association between urinary concentrations of isoflavones and lignans and frailty in 600 females aged 50 years or older (median age 66.5 years). Participants were classified as 'frail' (meeting 3 or more of the 5 frailty criteria), 'prefrail' (meeting 1 or 2 of the criteria), or 'robust' (meeting none of the criteria). Four percent were frail. RESULTS: For all of the phytoestrogens considered, the unadjusted OR were lower than 1 but generally not statistically significant aside from the association with O-desmethylangolensin (O-DMA) (OR = 0.76; 95% CI 0.61-0.92). Multivariate analysis did not attenuate this finding (OR = 0.74; 95% CI 0.61-0.90). CONCLUSIONS: This first analysis of the relationship between phytoestrogens and frailty revealed an inverse association between urinary O-DMA levels and frailty in women. However, the number of frail women was low. Although this finding may be confounded or biased, it seems worthwhile to intensify research on the potential preventive effects of O-DMA.

Effects of phenotypes in heterocyclic aromatic amine (HCA) metabolism-related genes on the association of HCA intake with the risk of colorectal adenomas.

BACKGROUND: Heterocyclic aromatic amines (HCA), formed by high-temperature cooking of meat, are well-known risk factors for colorectal cancer (CRC). Enzymes metabolizing HCAs may influence the risk of CRC depending on the enzyme activity level. We aimed to assess effect modification by polymorphisms in the HCA-metabolizing genes on the association of HCA intake with colorectal adenoma (CRA) risk, which are precursors of CRC. METHODS: A case-control study nested in the EPIC-Heidelberg cohort was conducted. Between 1994 and 2005, 413 adenoma cases were identified and 796 controls were matched to cases. Genotypes were determined and used to predict phenotypes (i.e., enzyme activities). Odds ratios (OR) and corresponding 95 % confidence intervals (CI) were calculated by logistic regression analysis. RESULTS: CRA risk was positively associated with PhIP, MeIQx, and DiMeIQx (p trend = 0.006, 0.022, and 0.045, respectively) intake. SULT1A1 phenotypes modified the effect of MeIQx on CRA risk (p (Interaction) > 0.01) such that the association of MeIQx intake with CRA was stronger for slow than for normal phenotypes. Other modifying effects by phenotypes did not reach statistical significance. CONCLUSIONS: HCA intake is positively associated with CRA risk, regardless of phenotypes involved in the metabolizing process. Due to the number of comparisons made in the analysis, the modifying effect of SULT1A1 on the association of HCA intake with CRA risk may be due to chance.

Effects of selenium status, dietary glucosinolate intake and serum glutathione S-transferase α activity on the risk of benign prostatic hyperplasia.

UNLABELLED: Study Type--Prognosis (case control) Level of Evidence 2. What's known on the subject? and What does the study add? Geographical and ethnic differences in the distribution of BPH and the results of migrant studies indicate that not only age, androgens and genetics, but also modifiable factors may play a role in the aetiology of BPH. Oxidative stress induced by chronic inflammation could be a cause and antioxidants, including selenoproteins, may reduce the risk. The published data related to this topic are scarce and are mainly based on cross-sectional and case-control studies. In a nested case-control study, we observed a significant inverse association between serum selenium concentrations and the risk of BPH. These results need to be confirmed in larger, prospective epidemiological studies. Prostate enlargement is an increasing health problem as a result of an ageing population in many countries. Modifiable factors may also play a role. In the present study, before this antioxidant can be recommended as a preventive measure. OBJECTIVE: • To determine whether geographical differences in the distribution of benign prostatic hyperplasia (BPH) and migrant studies indicate that modifiable factors play a role in the aetiology of BPH. Oxidative stress produced by chronic inflammation could represent one of the causes, and antioxidants, including selenoproteins, may reduce the risk. SUBJECTS AND METHODS: • Conditional logistic regression was used to examine the associations of serum selenium and selenoprotein P concentrations and glutathione peroxidase activity with respect to the risk of BPH in a case-control study nested in the European Prospective Investigation into Cancer and Nutrition-Heidelberg cohort, including 111 cases and 214 matched controls. • In addition, dietary glucosinolate intake and the serum glutathione S-transferase α concentration was investigated. RESULTS: • The risk of BPH significantly decreased with an increasing serum selenium concentration; the risk estimate was 0.83 (35% CI 0.69-0.99) per 10 µg/L increase in serum selenium concentration. • However, no significant association was present for serum selenoprotein P concentration or glutathione peroxidase activity. Risk estimates for BPH decreased with a higher intake of glucosinolates, although the results were not statistically significant. CONCLUSION: • A low serum selenium concentration may increase the risk of BPH, although the findings reported in the present study need to be confirmed in larger, well-designed epidemiological studies.

Serum sex steroid hormones and frailty in older American men of the Third National Health and Nutrition Examination Survey (NHANES III).

OBJECTIVE: To determine whether frailty is associated with circulating total and free testosterone, total and free estradiol, and sex hormone-binding globulin (SHBG) in older men. METHODS: With NHANES III data of 461 men aged 60 years and older, we used logistic regression to analyze the associations between serum concentrations of sex steroid hormones, SHBG and frailty. Participants meeting any three or more of the five frailty criteria were classified as "frail", all others were considered as non-frail. RESULTS: 2.5% of men were frail. Men with SHBG ≥66 nmol/L had three times the odds of frailty (OR = 2.97; 95% CI 1.28-6.86) compared to men with SHBG <66 nmol/L. Men with free testosterone levels below 243 pmol/L had an increased odds of frailty (OR = 3.92; 95% CI 1.29-11.89). None of these associations was statistically significant after additionally adjusting for body mass index, smoking and history of cardiovascular diseases (CVD). Total testosterone, and total and free estradiol serum levels were not statistically significantly associated with frailty. CONCLUSIONS: In this US nationally representative study of older men, low free testosterone and high SHBG serum levels were associated with a significantly increased odds of frailty after adjustment for age and race/ethnicity. These associations may, however, be explained by confounding due to obesity, smoking, and the higher prevalence of CVD in frail men or by low hormones or high SHBG mediating the association between obesity, smoking, CVD and frailty.

Ability of a biomarker-based score to predict death from circulatory disease and cancer in NHANES III.

BACKGROUND: A score based on serum concentrations of C-reactive protein (CRP), albumin, gamma-glutamyl transferase (GGT), and HDL cholesterol was positively associated with death from cancer, circulatory disease, and all-cause mortality. We replicated this in the third National Health and Nutrition Examination Survey (NHANES III), a US nationally representative survey conducted between 1988-1994. METHODS: Baseline measurements of CRP, albumin, GGT, and HDL were available for participants with mortality follow-up (n=13,056). A biomarker score, ranging 0-4, was created by adding number of markers with abnormal values (cut-off: CRP>10mg/L, albumin<35mg/L, GGT>36U/L, HDL<1.04mmol/L). Its association with mortality was analyzed with multivariate Cox proportional hazards models. RESULTS: The score was positively associated with death from all causes, cancer and circulatory disease [e.g. HR all-cause mortality: 1.21 (95% CI: 1.09, 1.35), 1.92 (1.67, 2.20), 3.38 (2.62, 4.36), and 7.93 (5.77, 10.89), for score 1, 2, 3, 4 vs.0]. These patterns were found across the Charlson Comorbidity Index (CCI). Where CCI =3, risk of cancer death was 1.09 (0.93, 1.28), 1.81 (1.43, 2.29), 4.67 (3.05, 7.14), and 6.97 (5.32, 9.14) for score 1, 2, 3, 4 vs. 0. No effect-modification by sex or race/ethnicity was observed. CONCLUSIONS: These findings correlate with results from a Swedish study. This biomarker-based score could help clinicians make decisions in prevention and disease management.

Impact of overweight and obesity on postmenopausal breast cancer: analysis of 20-year data from Switzerland.

PURPOSE: Greater body fatness has been identified as a risk factor for postmenopausal breast cancer. For countries with low overweight/obesity rates, data on prevalence and time course of overweight/obesity in women with breast cancer in comparison to women in the general population is limited. The Swiss female population is distinctive for two reasons: (a) low rates of overweight/obesity compared with other western countries, and (b) no obesity epidemic, i.e. stable rates of overweight/obesity for more than 10 years. METHODS: Overweight and obesity were analyzed in 51 to 80-year-old breast cancer patients initially diagnosed between 1990 and 2009. Patient data was derived from the Basel Breast Cancer Database (BBCD). This data was compared with the data of women of the same age from the four Swiss Health Surveys (SHS) conducted between 1992 and 2007. Differences between measured (BBCD) and self-reported (SHS) data were corrected using equations approved for the Swiss population. RESULTS: Of 958 postmenopausal BBCD patients, 32% were overweight and 20% were obese. Of the 14,476 women of the SHS, 38% were overweight and 17% were obese. In the BBCD, there was no change in the prevalence of overweight/obesity over the last 20 years. The four SHS show a convex curvature for obesity, i.e. a transient increase. No significant differences were observed between BBCD and corrected SHS data for overweight and obesity during this period. CONCLUSIONS: In this Swiss study group with a comparably low prevalence of overweight and obesity, no association between body fatness and postmenopausal breast cancer was observed.

The impact of depression on adherence to organized and opportunistic breast cancer screening.

One in five women will experience depression over her lifetime, and one out of eight will develop breast cancer. We evaluated the effect of depression on adherence to mammography in Switzerland, where opportunistic and organized screening programs coexist. We analyzed data from 3206 women aged 50-69 who participated in the Swiss Health Survey 2012. We compared mammographic rates among women with no to mild versus moderate to severe depressive symptoms. The effect of the type of screening on the odds of undertaking a mammography was calculated using multivariable logistic regression analysis. Women with moderate to severe major depressive symptoms were more likely to have had a mammography in the previous 2 years than their nondepressed or less-depressed counterparts (51 vs. 39.2%, respectively, P = 0.005). In the multivariable analysis, women with no to mild major depression living in cantons with an organized screening program had an adjusted odds ratio of 2.7 (95% confidence interval: 2.30-3.17, P < 0.001) of having had a mammography within the past 24 months compared with those living in the regions with an opportunistic screening. The adjusted odds ratio for women with moderate to severe major depression was 4.21 (95% confidence interval: 2.13-8.33, P < 0.001). In Switzerland. adherence to mammographic screening among women with moderate to severe major depression is higher than among women with no or minimal major depressive symptoms. This increased adherence is even more pronounced in regions with organized screening.

Folic acid: a public-health challenge.

Despite worldwide public-health campaigns recommending periconceptional daily supplementation of synthetic folic acid to reduce the risk of neural tube defects, many women are not following these recommendations. At the same time, in most European countries no decline in defects has been recorded in recent years. Vulnerable groups are those with a low standard of education, young people, and women with unplanned pregnancies. Furthermore, in most countries without mandatory fortification, the general population is not consuming the recommended 0.4 mg of food folate per day. Voluntary fortification improves the situation, but does not reach all parts of the population. In the USA, Canada, and Chile, mandatory fortification of flour substantially improved folate and homocysteine status, and neural tube defects rates fell by between 31% and 78%. Nevertheless, many countries do not choose mandatory folic acid fortification, in part because expected additional health benefits are not yet scientifically proven in clinical trials, in part because of feared health risks, and because of the issue of freedom of choice. Thus, additional creative public-health approaches need to be developed to prevent neural tube defects and improve the folate status of the general population.

Epidemiology and pathophysiology of obesity as cause of cancer.

According to World Health Organisation estimates 1.1 billion people were overweight or obese worldwide in the year 2000 with the prevalence rapidly increasing. Compelling evidence suggests that excess body weight is a risk factor for several cancer types including cancer of the colon, breast, endometrium, kidney, oesophagus, as well as possibly additional sites. According to previous meta-analyses and systematic literature reviews, an important proportion of cancer has been estimated to be attributable to excess body weight. The extrapolation of a European meta-analysis [1] to the Swiss situation broadly estimates that around 700 cancers could be prevented in the absence of overweight and obesity in this country. The data presented highlights the public health relevance of preventing excess body weight. Several interacting metabolic and hormonal pathways seem to underlie the association between being overweight and cancer with insulin-resistance playing a central role. Since evidence is mounting that excess body weight can also adversely affect cancer prognosis, obesity is a primary target for cancer control programs.

Loneliness is adversely associated with physical and mental health and lifestyle factors: Results from a Swiss national survey.

INTRODUCTION: Loneliness is a common, emotionally distressing experience and is associated with adverse physical and mental health and an unhealthy lifestyle. Nevertheless, little is known about the prevalence of loneliness in different age groups in Switzerland. Furthermore, the existing evidence about age and gender as potential effect modifiers of the associations between loneliness, physical and mental health and lifestyle characteristics warrants further investigation. Thus, the aim of the study was to examine the prevalence of loneliness among adults in Switzerland and to assess the associations of loneliness with several physical and mental health and behavioral factors, as well as to assess the modifying effect of sex and age. METHODS: Data from 20,007 participants of the cross-sectional population-based Swiss Health Survey 2012 (SHS) were analyzed. Logistic regression analyses were used to assess associations of loneliness with physical and mental health or lifestyle characteristics (e.g. diabetes, depression, physical activity). Wald tests were used to test for interactions. RESULTS: Loneliness was distributed in a slight U-shaped form from 15 to 75+ year olds, with 64.1% of participants who had never felt lonely. Lonely individuals were more often affected by physical and mental health problems, such as self-reported chronic diseases (Odds ratio [OR] 1.41, 95% confidence interval [CI] 1.30-1.54), high cholesterol levels (OR 1.31, 95% CI 1.18-1.45), diabetes (OR 1.40, 95% CI 1.16-1.67), moderate and high psychological distress (OR 3.74, 95% CI 3.37-4.16), depression (OR 2.78, 95% CI 2.22-3.48) and impaired self-perceived health (OR 1.94, 95% CI 1.74-2.16). Loneliness was significantly associated with most lifestyle factors (e.g. smoking; OR 1.13, 95% 1.05-1.23). Age, but not sex, moderated loneliness' association with several variables. CONCLUSION: Loneliness is associated with poorer physical and mental health and unhealthy lifestyle, modified by age, but not by sex. Our findings illustrate the importance of considering loneliness for physical and mental health and lifestyle factors, not only in older and younger, but also in middle-aged adults. Longitudinal studies are needed in Switzerland to elucidate the causal relationships of these associations.

Adherence to dietary recommendations is not associated with depression in two Swiss population-based samples.

Little is known about adherence to dietary recommendations and depression. Furthermore, dietary habits may differ among depression subtypes, which has not been evaluated previously. Two population-based Swiss studies, including 3620 individuals from PsyCoLaus and 11,032 individuals from the Swiss Health Survey 2012 (SHS), were used to examine the associations between adherence to common dietary guidelines and odds of depressive disorders. In both studies, depression was assessed by validated instruments. Adherence to dietary recommendations were assessed by a semi-quantitative food frequency questionnaire (PsyCoLaus) and by single item questions (SHS). Logistic regression analyses were used to assess the association of adhering to dietary recommendations with depression. For the analyses of diet with depression subtypes maximum-likelihood multinomial (polytomous) logistic regression analyses were conducted. No association of adherence to dietary recommendations with current major depressive disorder (MDD) was observed in any of the two study populations except for adherence to fish consumption, which was positively associated with MDD in the SHS. For depression subtypes, statistically significantly positive associations of vegetable consumption and adherence to the 5-a-day recommendation with current unspecified and current melancholic MDD were found. In conclusion, we don't see consistent associations between adherence to dietary recommendations and MDD or subtypes of depression.

Overweight, obesity, and breast cancer screening: results from the 2012 Swiss Health Survey.

Obesity is associated with poor breast cancer (BC) prognosis. Larger tumor size and more advanced disease stage at diagnosis could partly explain this outcome and nonadherence of obese women to BC screening may play a role. We examined the relationship between BMI (kg/m) and the use of mammography in Switzerland as well as separately in the German-speaking part with mainly opportunistic screening and in the French-speaking part with organized programs. We analyzed the data of 50-69-year-old women (n=3121) of the Swiss Health Survey 2012. Study participants were classified as underweight (BMI<18.5), normal weight (BMI 18.5-24.9), overweight (BMI 25-29), or obese (BMI≥30). Outcome measures were dichotomized into 2 years or less since most recent mammography versus more than 2 years or never. We carried out multivariable logistic regression analyses, adjusting for sociodemographics, lifestyle, and self-perceived health. In Switzerland, 47% of women aged 50-69 years had had BC screening within the last 2 years, 35% of women in the German-speaking and 78% of women in the French-speaking part. In the total group, mammography use was higher in overweight than in normal-weight women (adjusted odds ratio 1.21, 95% confidence interval 0.98-1.49). Stratified by region, this effect was only maintained in women of the German-speaking part (adjusted odds ratio 1.41, 95% confidence interval 1.08-1.85; P-interaction<0.001). There were no differences in mammography attendance between normal-weight and obese and underweight women. In the 2012 Swiss Health Survey, overweight, obesity, and underweight were no barriers to mammography. In the German-speaking part, overweight women even attended mammography screening more often than normal-weight women.

Body mass index and the risk of male cancer mortality of various sites: 17-year follow-up of the Basel cohort study.

QUESTIONS UNDER STUDY: There is growing evidence for a link between body weight and cancer risk, but there is not a clear consensus yet. METHODS: We studied the association between body mass index (BMI) and overall, lung, prostate and colon cancer mortality. In 1971/73, weight and height were measured in 2974 men working in Basel, Switzerland. In 1990, the vital status of all participants was assessed. RESULTS: 290 men had died from cancer, 87 from lung, 30 from prostate, and 22 from colon cancer. In the predefined Cox Proportional Hazards Regression Models for survival analysis, a baseline hazard was modified multiplicatively by covariates, i.e. the untransformed continuous variable "BMI" was chosen as covariate. In addition it was assumed that the baseline hazard may be different for smokers, non-smokers and different age groups (age at entry into study). Thus, multiple strata, i.e. combinations of smoking status and age groups were allowed. With increasing BMI overall cancer mortality did not change. Accordingly, the relative risk (RR) per 1-unit increase of BMI (unit = 1 kg/m2) was 1.03 (95% CI: 0.99-1.07). In relation to lung cancer, mortality did neither increase nor decrease with increasing BMI (RR = 1.0; 95% CI 0.93- 1.07). The results for prostate cancer mortality were similar, i.e. no correlation with BMI was observed (RR = 0.95; 95% CI: 0.93-1.18). The same was true for colon cancer mortality (RR = 1.09; 95% CI: 0.92-1.24). CONCLUSIONS: This investigation provides little evidence of an association between BMI and mortality of all cancers combined, cancer of the lung, the prostate and the colon.