Martina Zandonà

Background/Objectives: Urinary urea excretion is a marker of protein catabolism and follows circadian biological rhythms. Although small-scale studies have suggested a diurnal pattern, its population-level characterisation and determinants remain poorly defined. Methods: This cross-sectional study was conducted within the Ticino Epidemiological Stiffness Study (TEST-study), a population-based cross-sectional analysis of 1202 adults (≥18 years) recruited in the Italian-speaking region of Switzerland in 2017–2018. A final analytical sample of 859 participants provided 24 h urine collections divided into diurnal and nocturnal fractions, from which a day-to-night (Day/Night) urea excretion ratio was calculated as the primary outcome. Multivariable linear regression was used to identify independent determinants. Results: Across the cohort, a predominant nocturnal pattern of urinary urea excretion was observed, with a mean Day/Night ratio below 1. In younger women (65 years) displayed a significantly more pronounced nocturnal predominance. No comparable age-related trend was observed in men. In multivariable analysis, advancing age, greater nocturnal blood pressure dipping, and higher sodium excretion were independently associated with the Day/Night urea ratio. Conclusions: Urinary urea excretion, a surrogate marker of protein catabolism, exhibits a measurable Day/Night variation, associated with age, sex, and hemodynamic factors. These findings provide insights for chrononutritional strategies aimed at preserving muscle health across lifespan.

Healthcare overuse is a widespread issue, accounting for approximately 10–30% of total healthcare costs. This study examines the impact of a computer

Background: Cardiovascular diseases are the leading cause of death globally, with hypertension and high sodium intake being major contributors. Accurate estimation of sodium intake is essential, but 24 h urine collection, the gold standard, is cumbersome and impractical for routine clinical use. Existing spot urine-based prediction formulae lack accuracy at the individual and population level. Objective: To develop and validate population-specific formulas for estimating 24 h urinary sodium excretion from spot urine samples using data from a representative Swiss adult population. Methods: Models with and without urea and potassium were developed incorporating age, sex, and anthropometry-based, population-specific, estimated urinary creatinine excretion values. Data quality was rigorously controlled, and model performance was compared to the INTERSALT, Kawasaki, and Tanaka formulae and to a nocturnal timed urine collection used to calculate hourly creatinine excretion. Results: Models based on first morning urine demonstrated improved accuracy (AUCs: Swiss anthropometric model 0.85 (95% CI: 0.80–0.90), Swiss anthropometric model with urea 0.86 (95% CI: 0.81–0.91)) and lower bias (−5.5 mmol/24 h for the Swiss anthropometric model and −2.86 mmol/24 h for the Swiss anthropometric model with urea) compared to existing equations. Performance was consistent across clinically relevant sodium intake thresholds and the models were therefore suitable for use in clinical settings. A timed nocturnal urine collection further improves accuracy. Conclusions: These new simple and reliable formulae provide a promising and practical tool for estimating sodium intake from first morning urine spot in adult European populations, and are potentially applicable in clinical settings.

Background: Air pollution is a well-established risk factor for cardiovascular and metabolic diseases. Although Southern Switzerland is considered a relatively low-pollution area, levels of nitrogen dioxide (NO₂) and particulate matter (PM₁₀) still exceed the latest WHO air quality guidelines. This study aimed to assess the association between long-term exposure to air pollutants, vascular aging, and body composition in a Swiss population sample. Methods: A cross-sectional analysis was conducted on 1202 participants from the Ticino Epidemiological Stiffness Study (2017–2018). Vascular health was assessed via pulse wave velocity (PWV), used to estimate vascular age. Body composition was evaluated through bioimpedance analysis, yielding fat mass index (FMI), body cellular mass (BCM), and body cellular mass index (BCMI). Individual exposure to NO₂ and PM₁₀ was estimated, using geocoded residential data and environmental monitoring records from 2002 to 2017. Statistical models were adjusted for major cardiovascular risk factors. Results: Higher exposure to NO₂ was significantly associated with increased vascular age (mean delta age: +0.53 years in the high exposure group) and adverse body composition markers, including higher FMI and lower BCM/BCMI. These associations remained significant after adjusting for confounders. PM₁₀ showed weaker associations, significant only in unadjusted models. Conclusions: Even in a relatively clean environment, exposure to NO₂ is linked to early vascular aging and unfavorable body composition. These findings reinforce the need for stricter air quality standards and underline the importance of continuous environmental health surveillance, even in regions considered low risk.

Hypertension is a major public health concern worldwide, significantly contributing to cardiovascular morbidity and mortality. This study investigates the prevalence, management, and treatment outcomes of hypertension in the Italian- speaking region of Switzerland. A total of 1,202 individuals participated in the study, undergoing office blood pressure measurements and 24-hour ambulatory blood pressure monitoring. Results indicate that over 40% of the examined population exhibited hypertensive blood pressure levels according to the 2024 ESC and 2023 ESH guidelines. A key finding is that one in four individuals with office hypertension experienced stress-induced hypertension, highlighting the importance of ambulatory blood pressure monitoring in distinguishing context related elevations from sustained hypertension. Additionally, three-quarters of those diagnosed with office hypertension presented with Grade 1 hypertension, underscoring the need for early intervention through lifestyle modifications and pharmacological treatment when necessary. Alarmingly, a significant proportion of hypertensive individuals did not receive adequate treatment. Among hypertensive patients, 74% were untreated, and among those undergoing treatment, 80% failed to reach target blood pressure levels. The study found that 85% of patients on monotherapy remained hypertensive, indicating the potential need for combination therapy and treatment optimization. These findings emphasize the essential role of primary care physicians in diagnosing and managing hypertension effectively. Physicians must ensure accurate blood pressure assessment, promote lifestyle changes, and tailor pharmacological interventions to individual needs. A comprehensive, multifaceted approach incorporating patient education, regular monitoring, and evidencebased treatment strategies is crucial to improving hypertension control and reducing the associated cardiovascular risks. This study highlights the urgent need for enhanced public health strategies to address hypertension and its long-term consequences effectively.

Background/Objectives: Phosphorus plays a fundamental role in cellular and extracellular metabolism, contributing to nucleic acid synthesis, enzymatic activity, neurologic function, and skeletal mineralization. Despite its significance, non-severe hypophosphatemia (HP) remains largely asymptomatic and underdiagnosed, with limited data on its prevalence in the general population. Most studies focus on specific subgroups, such as critically ill or dialysis patients, while the impact of mild HP in older adults, a potentially vulnerable demographic, is not well understood. The objective of this systematic review is to investigate the prevalence and clinical implications of non-severe HP in older adults. Methods: The study followed PRISMA guidelines to assess HP in patients aged ≥ 65 years without critical illnesses or genetic disorders. A systematic search was conducted in PubMed, Web of Science, and Scopus (March 2024). Eligible studies included RCTs and prospective/retrospective studies, excluding cancer-related studies or insufficient phosphate data. Results: We identified 1350 articles, with 26 meeting eligibility criteria. Ultimately, eight studies involving 26,548 patients were included, with an HP prevalence of 12.5%. Studies reveal a higher prevalence of HP in frail individuals, particularly those with increased frailty scores, and an association between HP and cognitive decline, depressed mood, falls, and chronic comorbidities. HP was also prevalent in infectious diseases, especially bacterial pneumonia, with longer hospital stays and increased mortality rates. Malnutrition was significantly more common in HP patients, characterized by weight loss and poor nutritional status. Furthermore, HP increased fall risk during hospitalization and worsened outcomes after coronary artery bypass graft surgery, including higher mortality and graft failure rates, underscoring its clinical importance. Discussion: This review identified that non-severe hypophosphatemia (HP) is associated with conditions such as frailty, cognitive decline, and an increased risk of falls. The evidence suggests that low phosphate levels may negatively impact health, increasing mortality and the risk of adverse clinical outcomes. Despite limitations in diagnostic criteria and sample variability, the findings indicate that HP can be a useful marker for identifying patients at risk of health deterioration. Further research is needed to clearly define the management and treatment of HP in this vulnerable population.

AIMS OF THE STUDY: Physicians frequently prescribe antipsychotics off-label to treat, among others, insomnia and anxiety. The Swiss “smarter medicine – Choosing Wisely” campaign has tried to raise awareness about the risks and to limit benzodiazepine and Z-drug prescriptions. In the Italian-speaking part of Switzerland, our network of public hospitals joined the campaign with the aim of avoiding unnecessary benzodiazepine and Z-drug treatments, with prescription monitoring, benchmarking and educational contributions. Considering the risks of a possible shift towards the prescription of antipsychotics, and aware of the potential role of the COVID-19 pandemic, we decided to analyse the prescription trends of antipsychotics and benzodiazepines/Z-drugs before, during (2016–2017) and after the intervention. METHODS: For this longitudinal study, we reactivated a continuous monitoring of inpatient benzodiazepine/Z-drug and antipsychotics prescriptions/deprescriptions, paused in 2018 after the end of the internal Choosing Wisely campaign, based on routinely collected observational health data. We screened all demographic, administrative and prescription data of patients admitted to the internal medicine department of the four teaching hospitals (H1-H4) belonging to the EOC (Ente Ospedaliero Cantonale) network, from the fourth quarter of 2014 to the second quarter of 2023. RESULTS: We analysed 74,659 hospital stays (14,645 / 16,083 / 24,285 / 19,646 at hospitals H1 / H2 / H3 / H4 respectively). The mean (± SD) case mix (a metric that reflects the diversity, complexity and severity of the treated patients) and patient age were 1.08 ± 0.14 and 73 ± 2 years. 10.6% and 12.1% of patients received antipsychotics prior to admission and at discharge respectively (new prescriptions 3.3 ± 0.7%; deprescriptions 13.3 ± 5.2%). New prescriptions showed an upward trend, with +0.20% per year (p <0.001). Patients admitted with ongoing antipsychotics therapy increased 0.36% per year (p <0.001). New benzodiazepine/Z-drug prescriptions showed a 0.20% per year decrease (p = 0.01). Patients admitted with ongoing benzodiazepine/Z-drug therapy decreased 0.32% per year (p <0.001). New antipsychotics prescriptions showed differences between hospitals, with H3 above and H2 below the average. CONCLUSIONS: The increase in antipsychotics quantitatively matched the decrease in benzodiazepine/Z-drug prescribing, suggesting a shift from one to the other sedative therapy. The same trend was visible in the ongoing prescriptions at admission revealing a similar out-of-hospital approach. This suggests a change in sedative prescribing strategy rather than the choice of alternative, non-pharmacological approaches. Furthermore, the variation between similar services of different hospitals points out the consequences of local prescribing cultures and the importance of continuously monitoring and benchmarking medication prescriptions.

Background/Objectives: Blood pressure (BP) is characterized by a circadian rhythm (Circr) with lower nighttime values, called dipping. Non-dipping is associated with higher CVD risk. The Circr of urinary sodium excretion (NaCle), peaking during the day, is linked to BP patterns. Physical activity (PA) is known to improve BP control and enhance the dipping phenomenon, but its possible effect on NaCle remains unclarified. This study aimed to investigate the correlation between PA and the Circr of NaCle and to determine if the relationship is independent of age, sex, BP values, dipping pattern, and salt intake. Methods: A pilot cross-sectional analysis was conducted using data from the Ticino Epidemiological Stiffness Study, involving 953 participants in Switzerland. Data collection included standardized questionnaires, blood samples, 24 h urine collections, and ambulatory BP monitoring. Participants were categorized into sedentary, partially active, and active. The effect of PA, NaCl intake, and dipping on the day/night NaCle ratio was assessed with multivariable linear regressions. Results: Participants’ median age was 49 years, with 78% having normal BP values and 47% exhibiting a dipping pattern; 51% were classified as sedentary and 22% as partially active. The median NaCl intake was 7.9 g/day. The youngest subjects had a higher hourly NaCle ratio compared to older subjects. Higher NaCl intake correlated with increased BP, a phenomenon more pronounced in men and younger subjects. The hourly day/night NaCle ratio positively correlates with dipping; however, PA did not show a significant correlation with the NaCle ratio. Conclusions: This study indicates that while the day/night NaCle ratio correlates with the dipping pattern, PA is unrelated to the circadian rhythm of renal sodium handling. The beneficial effects of PA on BP and cardiovascular health thus appear to be mediated through mechanisms other than NaCle. These are explorative findings only but relativize the need for further investigations on the topic.

Background: Blood pressure (BP) is characterized by a circadian rhythm (Circr), with lower nighttime values, called dipping. Non-dipping is associated with higher CVD risk. The Circr of urinary sodium excretion (NaCle), peaking during the day, is linked to BP patterns. Physical ac-tivity (PA) is known to improve BP control and enhance the dipping phenomenon, but its possi-ble effect on NaCle remains unclarified. Objectives: This study aimed to investigate the correla-tion between PA and the Circr of NaCle and to determine if the relationship is independent of age, sex, BP values, dipping pattern, and salt intake. Methods: A cross-sectional analysis was conducted using data from the Ticino Epidemiological Stiffness Study, involving 953 participants in Switzerland. Data collection included standardized questionnaires, blood samples, 24-hour urine collections, and ambulatory BP monitoring. Participants were categorized into sedentary, partially active, and active. The effect of PA, NaCl intake, and dipping on the day/night NaCle ratio, was assessed with multivariable linear regressions. Results: Participants median age 49 years, with 78% having normal BP values and 47% exhibiting a dipping pattern. 51% were classi-fied as sedentary and 22% as partially active. The median NaCl intake was 7.9 g/day. The youngest subjects had a higher hourly NaCle ratio compared to older subjects. Higher NaCl in-take correlated with increased BP, phenomenon more pronounced in men and younger subjects. The hourly day/night NaCle ratio positively correlates with dipping; however, PA did not show a significant correlation with the NaCle ratio. Conclusion: This study indicates that while the day/night NaCle ratio correlates with the dipping pattern, PA is unrelated to the circadian rhythm of renal sodium handling. The beneficial effects of PA on BP and cardiovascular health thus appear to be mediated through mechanisms other than NaCle. These are explorative find-ings only, but relativize the need for further investigations on the topic.