Giulia Pestoni

Purpose Diets low in quality represent a large risk for global mortality, morbidity, and environmental deterioration. In 2019, the EAT-Lancet commission published a universal reference diet, the ‘planetary health diet’ (PHD), focusing on human health and sustainability. We aimed to compare the average Swiss diet, four Swiss dietary patterns, and the sex- and language-specific dietary habits with the PHD with respect to adherence and sustainability. Methods Data of the cross-sectional population-based National Nutrition Survey menuCH (2014–2015, n = 2057) were used. Food consumption was assessed with 24-hours dietary recalls. Using the multiple source method, the usual dietary intake was determined. Sustainability impacts were examined by determining Greenhouse Gas emissions, total land and grassland use, the Social Hotspots Index, and diet’s costs. Adherence and sustainability of the Swiss diet were analyzed descriptively. Results Participants consumed on average more red meat, dairy products, and added sugar and less whole grains, vegetables, legumes, nuts, and unsaturated fats than recommended by the PHD. None or few of the participants adhered to the whole grains (0.0%), legumes (0.0%), and nuts (5.1%) recommendations, whereas nearly all adhered to the tubers and starchy vegetables (97.7%) and saturated fats (99.9%) recommendations. Overall, diets low in animal-source products tended to have reduced Greenhouse Gas emissions and land use, whereas diets high in fruits and vegetables tended to have higher costs and risks of adverse social impacts. In the subgroup analyses, closer adherence to the PHD was seen among females and among participants following the Prudent dietary pattern, while the differences in sustainability impacts were generally small among subgroups. Conclusion A dietary shift decreasing consumption of animal-based protein sources and increasing consumption of plant-based foods would be beneficial for Swiss residents’ health and lower the environmental footprint of the average Swiss diet. Policy measures should incentivize this dietary shift towards a healthier and more sustainable diet, especially among males and individuals following a traditional or Western dietary pattern, as they have the highest potential for improvement.

Background/Objectives: More than half of Swiss adults exceed the World Health Organization’s recommended limit for free sugar intake, with sugar-sweetened beverage (SSB) as a major contributor. SSB intake may be associated with other dietary risk factors, but little is known about diet quality excluding SSB intake. Therefore, the objective of this study was to investigate the association of SSB intake with the non-SSB diet quality in Swiss adults. Methods: Data from the cross-sectional, national nutrition survey menuCH (2014–2015, n = 2057, 18–75 years) were analyzed. Dietary intake was assessed via two 24 h dietary recalls. Participants were categorized as non-, low-, or high-SSB consumers based on the Swiss dietary guideline for free sugar intake. Diet quality excluding SSB was evaluated using the Alternative Healthy Eating Index (AHEI) scoring system (non-SSB AHEI). Results: Non-SSB consumers had higher non-SSB AHEI scores compared to low-SSB consumers, indicating healthier food choices beyond SSB intake, while high-SSB consumers had substantially poorer non-SSB diet quality. Despite these differences, non-SSB AHEI scores were only moderate across all SSB consumer types, suggesting that reducing SSB alone may not suffice to achieve optimal diet quality. Conclusions: In addition to population-based strategies to reduce SSB intake, future policies should aim to improve overall diet quality, including higher consumption of vegetables, fruits, whole grains and unsaturated fats. Prospective studies are needed to clarify which alternative food choices individuals make when reducing SSB intake.

Introduction: While a balanced diet is crucial for human health, the food system is also a key driver of climate change. The EAT-Lancet Commission developed the Planetary Health Diet (PHD), providing guidelines for a healthy and sustainable diet. Objectives: The aim of this study was to examine the association of PHD adherence with mortality in Switzerland. Methods: In this analysis, data from the cross-sectional national nutrition survey menuCH (2014–2015, n=2057) were linked with Swiss mortality and census data (2015–2019). By applying the multiple source method, habitual food intake was calculated based on the reported dietary intakes of two 24- hour dietary recalls and information on food avoidance obtained through a self-administered questionnaire. PHD adherence was quantified using a score that was used to categorise participants (G1, 0–5 points; G2, 6 points; G3, 7 points; G4, 8–14 points). Regression models were fitted to assess the association of the PHD score with all-cause and cause-specific mortality. Spatial autocorrelation of residuals was evaluated using Moran’s I statistic. Results: A higher PHD score was associated with lower mortality from diseases of the circulatory system (per 1-point increment: rate ratio=0.98 (95% CI 0.97 to 1.00); G4 vs G1, 0.94 (0.88 to 1.00)). In female participants, a higher PHD score was associated with a lower risk of mortality from diseases of the circulatory system (per 1-point increment: 0.97 (0.94 to 0.99)). In male participants, a higher PHD score was associated with lower all-cancer mortality risk (per 1-point increment: 0.98 (0.96 to 1.00); G4 vs G1, 0.92 (0.86 to 0.99)). Conclusions: This study generally indicates an inverse association between PHD adherence and mortality risk, especially for diseases of the circulatory system, although the associations varied among subgroups. This study provides further evidence on the potential beneficial effects of sustainable and balanced diets on human health.

Background: Our study aimed to gain from a comprehensive understanding of organic food consumption in Switzerland. Methods: Data from the Swiss National Nutrition Survey menuCH (2014–2015, n = 2057, 18 to 75 years old)and a cross-sectional, population-based survey were used. Dietary information was collected using two non-consecutive 24-hour dietary recalls (24HDRs). Organic foods were classified using information about food descriptors and labels. Participants were classified as organic food consumers if they had consumed organic foods in at least one 24HDR. Binomial logistic regression models were used to identify factors associated with organic food consumption. Results: This study determined that 27.8% of the Swiss population consumed organic food. However, only 3.6% of all food consumed within this group of organic food consumers was organic. Food products of plant origin tended to be consumed more frequently as organic than were those of animal origin, except for eggs and dairy products. Organic food consumption was positively associated with female sex (odds ratio (OR) = 2.18, 95% confidence interval (CI) 1.69, 2.80), high educational degree (OR = 1.28, 95% CI 1.02, 1.61), and high alternate healthy eating index (OR = 5.45, 95% CI 3.70, 8.02), and negatively associated with young age (OR = 0.56, 95% CI 0.40, 0.78), French-speaking living area (OR = 0.73, 95% CI 0.56, 0.93), non-Swiss nationality (OR = 0.74, 95% CI 0.56, 0.98), large household size (OR = 0.59 95% CI 0.38, 0.89), and obesity (OR = 0.53, 95% CI 0.36, 0.77). Conclusion: The present study provides a better understanding of the distribution of organic food consumption within the Swiss population and which subgroups consume particularly little organically produced food. Clinical Trial Registration: Clinical Trial Registration: ISRCTN 16778734; https://www.isrctn.com/search?q=menuch.

Recommended dietary fibre consumption is rarely met in high-income countries. Detailed analysis of fibre consumption patterns is essential to identify strategies for increasing intake. This study investigated the timing and sources of fibre intake in Switzerland, using data from the Swiss Nutrition Survey, menuCH (n = 2057, 18–75 years). Dietary characteristics were summarised for the adult population and for subgroups stratified by absolute (< 15 g/day, 15-=30 g/day) and relative (< 10 g/1000 kcal/day, 10-=14 g/1000 kcal/day) fibre intake. Mean fibre intake of both 24 HDRs for each individual and contribution of food groups and timing (before breakfast, breakfast, during the morning, lunch, during the afternoon, dinner, after dinner/at night) was calculated. Fibre was mainly consumed at breakfast (4.1 g/day), lunch (6.0 g/day), and dinner (6.4 g/day). Intake at breakfast differed between the lowest and highest fibre intake groups by 6.4 g/day (absolute) and 4.3 g/day (relative). Breakfast skipping was more frequent among low-fibre intake groups (29% for absolute intake, 19% for relative intake) than in the overall population (15%). The main sources of dietary fibre were grain products (35.6%), followed by vegetables (18.3%) and fruits (18.2%), with whole grains accounting for 17.5% of grain intake. Legumes contributed only to 1% of total fibre intake. Public health efforts encouraging regular breakfast consumption, and intake of whole grains and legumes are recommended to improve fibre intake.

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.

Background and Objectives: Advancements in treatment and care, as well as early detection, have contributed to an increase in cancer survival rates. However, limited evidence exists on the optimal diet that should be followed by people after receiving a cancer diagnosis and how it may affect their survival outcomes. Recently, the EAT-Lancet Commission on Food, Planet, Health proposed the “planetary health diet” as a diet within the planetary boundaries. We aimed to investigate, for the first time, the association between adherence to the EAT-Lancet reference diet and mortality in cancer survivors. Methods: Using data from the UK Biobank cohort, we created a sub-population of cancer survivors, based on cancer-registry diagnoses. Data from the UK Biobank’s Touchscreen questionnaire were used to develop a score reflecting adherence to the EAT-Lancet reference diet. Cox proportional hazards regression models were fitted to assess the association of the EAT-Lancet reference diet score with all-cause, cancer, and cardiovascular mortality in cancer survivors. Results: Better adherence to the EAT-Lancet reference diet was inversely associated with all-cause and cancer mortality, while mostly null associations were seen for cardiovascular mortality. Stratified analyses using potential effect modifiers led to largely similar results. Discussion: Our findings support the notion that the adoption of the EAT-Lancet reference diet has the potential to be beneficial for cancer survivors. Additional studies are needed in this specific population to further assess their post-diagnostic needs as well as the perceived barriers to the adoption of healthy lifestyle habits.

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 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.

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-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/ 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.