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BACKGROUND Renal sodium handling could be a potential mediator linking adipokines to hypertension. The aim of the study was to assess the relationship of leptin with urinary sodium excretion and proximal sodium reabsorption in humans. METHODS This cross-sectional study was conducted on participants of hypertensive families from the Seychelles Island. A split urine (daytime and nighttime) collection and plasma leptin were measured. Endogenous lithium clearance was used to assess proximal sodium reabsorption. Mixed multiple linear regression tests adjusted for confounding factors were used. RESULTS Three hundred and sixty-five participants (57% women) were included in this analysis. Leptin and adiponectin were higher in women (P < 0.001). Leptin was associated positively with daytime (coefficient [c]: 0.16, standard deviation (SD): 0.03, P < 0.001), nighttime urinary sodium excretion (c: 0.17, SD: 0.04), P < 0.01), daytime lithium clearance (c: 0.40, SD: 0.08, P < 0.001), and nighttime lithium clearance (c: 0.39, SD: 0.10, P < 0.001) after adjusting for sex. The association was lost or mitigated only when BMI was introduced in the model. When BMI was categorized in normal vs. overweight participant, leptin was associated with daytime and nighttime sodium excretion rates (c: 0.14, SD: 0.05, P = 0.011 and c: 0.22, SD: 0.07, P = 0.002, respectively) only in overweight participants. CONCLUSION Leptin is associated positively with daytime and nighttime sodium excretion and lithium clearance suggesting a natriuretic rather than a sodium retaining effect of leptin. Sex and body mass index (BMI) are major confounders in this association. These results highlight the importance of sex and obesity in our understanding of the relationships between leptin, blood pressure, and renal sodium handling.

Aim of the study Important regional differences in uranium exposure exist because of varying uranium concentrations in soil, water and food. Comprehensive data on the exposure of the general population to uranium is, however, scarce. Based on the 24-hour urinary excretion, the uranium exposure of the adult Swiss population was assessed in relation to age, sex, place of residence, body mass index (BMI), smoking habit and type of drinking water, as well as risk factors in relation to kidney impairment and indicators of a possible renal dysfunction. Methods Uranium was quantified in 24-hour urine from a nationwide population-based sample (n = 1393). The ratio 238U/233U was measured for isotope dilution calibration with a sector field inductively coupled plasma mass spectrometer (HR-ICP-MS). Results Overall median and 95th percentile were 15 and 67 ng/24 h, respectively. The place of residence significantly influenced urinary uranium excretion. However, most of the highest urinary uranium excretion levels could not be associated to areas known for their elevated uranium concentrations in the drinking water. Sources other than the local drinking water (e.g., bottled water) might be important, too. Gender as well as albumin excretion also had a significant effect on uranium excretion. The latter was, however, strongly dependent on the presence of diabetes mellitus. No association was found for age, BMI, smoking habit or the other examined kidney related variables. Conclusions On the basis of uranium exposure, assessed via 24-hour urinary uranium excretion, and current knowledge of the toxicity of naturally occurring uranium, a substantial corresponding health risk for the general adult population is unlikely. However, as long as no specific sensitive biomarker for the biological impact of low-dose chronic uranium exposure has been identified and validated, assessing subtle health impact of such exposure will remain difficult.

Limited data are available in the African region on trends in blood pressure (BP) and awareness, treatment and control rates. We examined trends in these indicators for a 25-year period in the Seychelles, a rapidly developing small island state in the African region. Population-based surveys of adults aged 25-64 years were performed in 1989, 1994, 2004 and 2013 using nearly identical methods for all surveys. BP was based on the average of the second and third readings. Data were age-standardized. Between 1989 and 2013, mean SBP decreased in older adults (but increased in younger adults) and mean DBP decreased in all age categories, despite a marked secular increase in mean BMI. At age 25-64 years, the proportions with BP at least 140/90 mmHg decreased from 44%/33% (men/women) in 1989 to 37%/22% in 2013. The proportions of persons aware of having high BP (among those with BP ≥ 140/90 or treatment) increased from 40%/63% (men/women) in 1989 to 65%/80% in 2013; the proportions under treatment (among aware) increased from 37%/49% to 64%/78%; and the proportions with controlled BP (among treated) increased from 10%/16% to 34%/61%. Awareness was associated with female sex, age, obesity and diabetes; treatment with age, obesity, low alcohol consumption and diabetes; and control with female sex, age and high socio-economic status. In 2013, the main classes of antihypertensive medications were used in similar proportions, and 64.5% received at least two medications. The prevalence of high BP (≥140/90 mmHg) decreased over time, which paralleled improved detection and control of hypertension. The identified associated factors should be considered when strengthening BP control programs.

Glomerular hyperfiltration has been suggested as a possible mechanism linking obesity and chronic kidney disease (CKD), independently of classical risk factors. We explored the association of overweight and obesity with glomerular hyperfiltration in a large sample of the Swiss adult population, accounting for several confounders including dietary factors. Data from a 2010 to 2012 cross-sectional population-based survey in Switzerland were used. Creatinine clearance (CrCl) was determined from 24-h urine collection; CrCl > 140 ml/min was used to define glomerular hyperfiltration. Participants were categorized into lean (

Background and objectives Molecular evidence suggests that levels of vitamin D are associated with kidney function loss. Still, population-based studies are limited and few have considered the potential confounding effect of baseline kidney function. This study evaluated the association of serum 25-hydroxyvitamin D with change in eGFR, rapid eGFR decline, and incidence of CKD and albuminuria. Design, setting, participants, & measurements Baseline (2003–2006) and 5.5-year follow-up data from a Swiss adult general population were used to evaluate the association of serum 25-hydroxyvitamin D with change in eGFR, rapid eGFR decline (annual loss >3 ml/min per 1.73 m2), and incidence of CKD and albuminuria. Serum 25-hydroxyvitamin D was measured at baseline using liquid chromatography–tandem mass spectrometry. eGFR and albuminuria were collected at baseline and follow-up. Multivariate linear and logistic regression models were used considering potential confounding factors. Results Among the 4280 people included in the analysis, the mean±SD annual eGFR change was −0.57±1.78 ml/min per 1.73 m2, and 287 (6.7%) participants presented rapid eGFR decline. Before adjustment for baseline eGFR, baseline 25-hydroxyvitamin D level was associated with both mean annual eGFR change and risk of rapid eGFR decline, independently of baseline albuminuria. Once adjusted for baseline eGFR, associations were no longer significant. For every 10 ng/ml higher baseline 25-hydroxyvitamin D, the adjusted mean annual eGFR change was −0.005 ml/min per 1.73 m2 (95% confidence interval, −0.063 to 0.053; P=0.87) and the risk of rapid eGFR decline was null (odds ratio, 0.93; 95% confidence interval, 0.79 to 1.08; P=0.33). Baseline 25-hydroxyvitamin D level was not associated with incidence of CKD or albuminuria. Conclusions The association of 25-hydroxyvitamin D with eGFR decline is confounded by baseline eGFR. Sufficient 25-hydroxyvitamin D levels do not seem to protect from eGFR decline independently from baseline eGFR.

Key Messages: A fundamental failure of high-risk prevention strategies is their inability to prevent disease in the large part of the population at a relatively small average risk and from which most cases of diseases originate. The development of individual predictive medicine and the widening of high-risk categories for numerous (chronic) conditions lead to the application of pseudo-high-risk prevention strategies. Widening the criteria justifying individual preventive interventions and the related pseudo-high-risk strategies lead to treating, individually, ever healthier and larger strata of the population. The pseudo-high-risk prevention strategies raise similar problems compared with high-risk strategies, however on a larger scale and without any of the benefit of population-based strategies. Some 30 years ago, the strengths and weaknesses of population-based and high-risk prevention strategies were brilliantly delineated by Geoffrey Rose in several seminal publications (Table 1).1,2 His work had major implications not only for epidemiology and public health but also for clinical medicine. In particular, Rose demonstrated the fundamental failure of high-risk prevention strategies, that is, by missing a large number of preventable cases.

OBJECTIVES Several guidelines recommend universal screening for hypertension in childhood and adolescence. Targeted screening to children with parental history of hypertension could be a more efficient strategy than universal screening. Therefore, we assessed the association between parental history of hypertension and hypertension in children, and estimated the sensitivity, specificity, negative, and positive predictive values of parental history of hypertension for hypertension in children. METHODS The present study was a school-based cross-sectional study including 5207 children aged 10-14 years from all public 6th grade classes in the Canton of Vaud, Switzerland. Children had hypertension if they had sustained elevated blood pressure over three separate visits. RESULTS In children, the prevalence of hypertension was 2.2%. Some 8.5% of mothers and 12.9% of fathers reported to be hypertensive. Maternal history of hypertension (odds ratio 2.0, 95% confidence interval 1.2-3.3) and paternal history of hypertension (odds ratio 2.2, 95% confidence interval 1.4-3.6) were independent risk factors for hypertension in children. Nevertheless, the sensitivity of parental history of hypertension for the identification of hypertension in children was low (from 4% for both parents' positive history up to 41% for at least one parent's positive history). Positive predictive values were also low (between 4 and 5%). CONCLUSION Children with hypertensive parents were at higher risk of hypertension. Nevertheless, parental history of hypertension helped only marginally to identify hypertension in offspring. Targeting screening only toward children with a parental history of hypertension may not be a substantially better strategy to identify hypertension in children compared with universal screening.

BACKGROUND: In humans, low socioeconomic status (SES) across the life course is associated with greater diurnal cortisol production, increased inflammatory activity and higher circulating antibodies for several pathogens, all suggesting a dampened immune response. Recent evidence suggests that DNA methylation of pro-inflammatory genes may be implicated in the biological embedding of the social environment. METHODS: The present study examines the association between life-course SES and DNA methylation of candidate genes, selected on the basis of their involvement in SES-related inflammation, in the context of a genome-wide methylation study. Participants were 857 healthy individuals sampled from the EPIC Italy prospective cohort study. RESULTS: Indicators of SES were associated with DNA methylation of genes involved in inflammation. NFATC1, in particular, was consistently found to be less methylated in individuals with low vs high SES, in a dose-dependent manner. IL1A, GPR132 and genes belonging to the MAPK family were also less methylated among individuals with low SES. In addition, associations were found between SES and CXCL2 and PTGS2, but these genes were consistently more methylated among low SES individuals. CONCLUSIONS: Our findings support the hypothesis that the social environment leaves an epigenetic signature in cells. Although the functional significance of SES-related DNA methylation is still unclear, we hypothesize that it may link SES to chronic disease risk.

Background: In high-income countries, high socioeconomic status (SES) is generally associated with a healthier diet, but whether social differences in dietary intake are also present in low- and middle-income countries (LMICs) remains to be established. Objective: We performed a systematic review of studies that assessed the relation between SES and dietary intake in LMICs. Design: We carried out a systematic review of cohort and crosssectional studies in adults in LMICs and published between 1996 and 2013. We assessed associations between markers of SES or urban and rural settings and dietary intake. Results: A total of 33 studies from 17 LMICs were included (5 lowincome countries and 12 middle-income countries; 31 cross-sectional and 2 longitudinal studies). A majority of studies were conducted in Brazil (8), China (6), and Iran (4). High SES or living in urban areas was associated with higher intakes of calories; protein; total fat; cholesterol; polyunsaturated, saturated, and monounsaturated fatty acids; iron; and vitamins A and C and with lower intakes of carbohydrates and fiber. High SES was also associated with higher fruit and/or vegetable consumption, diet quality, and diversity. Although very few studies were performed in low-income countries, similar patterns were generally observed in both LMICs except for fruit intake, which was lower in urban than in rural areas in low-income countries. Conclusions: In LMICs, high SES or living in urban areas is associated with overall healthier dietary patterns. However, it is also related to higher energy, cholesterol, and saturated fat intakes. Social inequalities in dietary intake should be considered in the prevention and control of noncommunicable diseases in LMICs. Am J Clin Nutr 2014;100:1520‐31.

Primary care is recognized worldwide as a key component for improving health outcomes in the population. At the same time, healthcare systems are rapidly changing with increasing expectations from technological advances. Genomics is a major driver in changing how medicine is being practiced; however, the importance for primary care has been under-appreciated. Strategically implementing genomics in a way that accounts for the unique characteristics of the primary care context is essential. In this perspective, we present important areas that we believe are critical in consideration of both the future of genomic medicine and primary healthcare delivery.

Resume Introduction La frequence des tests du prostate-specific antigen (PSA) est elevee en France. Cette etude a permis d’estimer leur frequence et celles de biopsies et de cancer de la prostate (CPr) nouvellement diagnostiques selon l’existence d’une hypertrophie benigne (HBP) traitee. Patients et methodes Cette etude observationnelle a concerne les hommes de 40 ans et plus couverts par le regime general (73 % de la population de cet âge). Les informations provenaient du systeme national d’information inter-regimes de l’Assurance maladie (SNIIRAM) qui rassemble de facon individuelle des informations sur les prescriptions et prestations remboursees aux assures des differents regimes et, a l’aide d’un chainage, celles de leurs eventuelles hospitalisations fournies par le programme de medicalisation du systeme d’information (PMSI). Resultats La frequence des hommes sans CPr diagnostique (10,9 millions) avec au moins un dosage du PSA etait tres elevee en 2011 (40 ans et plus : 30 %, 70–74 ans : 56 %, 85 ans et plus : 33 % et hors HBP : 25 %, 41 % et 19 %). Les hommes avec une HBP totalisaient 9 % des hommes de l’etude en 2011, 18 % de ceux avec au moins un test du PSA, 44 % pour la biopsie et 40 % pour un CPr nouvellement diagnostique. En trois ans et hors CPr, 88 % des hommes avec une HBP avaient eu au moins un dosage du PSA et 52 % trois ou plus et, pour ceux sans HBP, 52 % et 15 %. Un an apres un test du PSA, ceux de 55–69 ans avec une HBP avaient plus frequemment une biopsie de la prostate que ceux sans HBP (5,4 % vs 1,8 %) et aussi un CPr nouvellement diagnostique (1,9 % vs 0,9 %). Conclusion En France, les frequences de dosages du PSA sont elevees meme apres exclusion des hommes avec une HBP. Ces derniers avec des frequences plus elevees de dosages du PSA et de biopsies sont plus susceptibles d’avoir un CPr pris en charge. Niveau de preuve 4.

Background: The diagnosis of hypertension in children is difficult because of the multiple sex-, age-, and height-specific thresholds to define elevated blood pressure (BP). Blood pressure to height ratio (BPHR) has been proposed to facilitate the identification of elevated BP in children. Objective: We assessed the performance of BPHR at a single screening visit to identify children with hypertension, that is, sustained elevated BP. Method: In a school-based study conducted in Switzerland, BP was measured at up to three visits in 5207 children. Children had hypertension if BP was elevated at the three visits. Sensitivity, specificity, negative and positive predictive values (PV) for the identification of hypertension were assessed for different thresholds of BPHR. The ability of BPHR at a single screening visit to discriminate children with and without hypertension was evaluated with receiver operating characteristic (ROC) curve analyses. Results: The prevalence of systolic/diastolic hypertension was 2.2%. Systolic BPHR had a better performance to identify hypertension compared to diastolic BPHR (area under the ROC curve: 0.95 vs. 0.84). The highest performance was obtained with a systolic BPHR threshold set at 0.80 [mmHg/cm] (sensitivity: 98%; specificity: 85%; positive PV: 12%; negative PV: 100%) and a diastolic BPHR threshold set at 0.45 [mmHg/cm] (sensitivity: 79%; specificity: 70%; positive PV: 5%; negative PV: 99%). The positive PV was higher among tall or overweight children. Conclusion: BPHR at a single screening visit had a high performance to identify hypertension in children, although the low prevalence of hypertension led to a low positive PV.

Objectif : decrire les buts et les methodes de la surveillance sanitaire contemporaine et presenter les activites de l’Observatoire valaisan de la sante (OVS), un outil unique en Suisse de surveillance sanitaire pour la population d’un canton.Methodes : revue narrative et presentation des activites de l’OVS.Resultats : la surveillance sanitaire est la recolte, l’analyse, l’interpretation et la dissemination continues et systematiques de donnees sanitaires essentielles a la planification en sante publique. Elle s’organise en tenant compte des enjeux contemporains de sante publique. La Suisse est dans une ere de preponderance des affections chroniques a cause du vieillissement de la population. Cette ere de la « nouvelle sante publique » est aussi caracterisee par l’importance grandissante des technologies medicales, de la gestion rationnelle des risques, de la medecine preventive et de la promotion de la sante et du role central du citoyen/patient. Les technologies de l’information donnent acces a de nouvelles donnees sanitaires mais necessitent d’adapter les methodes de surveillance. En Suisse, la surveillance sanitaire est morcelee car elle est conduite par des acteurs federaux, cantonaux, publics et prives. Le canton du Valais dispose de l’OVS, un outil de surveillance integratif, regional et reactif.Conclusion : la surveillance sanitaire produit de l’information permettant la decision et l’action dans le domaine de la sante. C’est un element-cle de la planification sanitaire.

Background. Allostatic load reflects cumulative exposure to stressors throughout lifetime and has been associated with several adverse health outcomes. It is hypothesized that people with low socioeconomic status (SES) are exposed to higher chronic stress and have therefore greater levels of allostatic load. Objective. To assess the association of receiving social transfers and low education with allostatic load. Methods. We included 3'589 participants (1'812 women) aged over 35 years and under retirement age from the population-based CoLaus study (Lausanne, Switzerland, 2003-2006). We computed an allostatic load index aggregating cardiovascular, metabolic, dyslipidemic and inflammatory markers. A novel index additionally including markers of oxidative stress was also examined. Results. Men with low vs high SES were more likely to have higher levels of allostatic load (Odds ratio (OR)=1.93/2.34 for social transfers/education,95%CI from 1.45 to 4.17). The same patterns were observed among women. Associations persisted after controlling for health behaviors and marital status. Conclusions. Low education and receiving social transfers independently and cumulatively predict high allostatic load and dysregulation of several homeostatic systems in a Swiss population-based study. Participants with low SES are at higher risk of oxidative stress, which may justify its inclusion as a separate component of allostatic load.

The purpose of this study is to explore the periodical patterns of events and deaths related to cardiovascular disease (CVD), acute myocardial infarction (AMI) and stroke in Swiss adults (≥ 18 years).Mortality data for period 1969-2007 (N=869,863 CVD events) and hospitalization data for period 1997-2008 (N=959,990 CVD events) were used. The annual, weekly and circadian distribution of CVD-related deaths and events were assessed. Multivariate analysis was conducted using multinomial logistic regression adjusting for age, gender and calendar year and considering deaths from respiratory diseases, accidents or other causes as competitive events.CVD deaths and hospitalizations occurred less frequently in the summer months. Similar patterns were found for AMI and stroke. No significant weekly variation for CVD deaths was found. Stratification by age and gender showed subjects aged65 years to present a higher probability of dying on Mondays and Saturday, only for men. This finding was confirmed after multivariate adjustment. Finally, a circadian variation in CVD mortality was observed, with a first peak in the morning (8-12 am) and a smaller second peak in the late afternoon (2-6 pm). This pattern persisted after multivariate adjustment and was more pronounced for AMI than for stroke.There is a periodicity of hospitalizations and deaths related to CVD, AMI and stroke in Switzerland. This pattern changes slightly according to the age and sex of the subjects. Although the underlying mechanisms are not fully identified, preventive measures should take into account these aspects to develop better strategies of prevention and management of CVD.

Background Caffeine intake is generally estimated by self-reported consumption, but it remains unclear how well self-report associates with metabolite urinary excretion. We investigated the associations of self-reported consumption of caffeinated drinks with urinary excretion of caffeine and its major metabolites in an adult population. Methods We used data from the population-based Swiss Kidney Project on Genes in Hypertension (SKIPOGH) study. Consumption of caffeinated coffee, decaffeinated coffee and other caffeinated beverages was assessed by self-administered questionnaire. Quantification of caffeine, paraxanthine, theobromine and theophylline was performed by ultra-high performance liquid chromatography tandem mass spectrometry in 24-h urine. Association of reported consumption of caffeinated drinks with urinary caffeine derived metabolites was determined by quantile regression. We then explored the association between urinary metabolite excretion and dichotomized weekly consumption frequency of caffeinated coffee, with Receiver Operator Characteristic (ROC) analysis. Results In the present analysis, we included 598 individuals (52% women, mean age =46 ± 17 years). Self-reported caffeinated coffee intake was positively associated with 24-h urinary excretions of paraxanthine, theophylline and caffeine (p

Targeted screening of hypertension in childhood might be more efficient than universal screening. We estimated the sensitivity, specificity, negative and positive predictive values of combined parental history of hypertension and overweight/obesity for the diagnosis of hypertension in 5207 children aged 10–14 years. Children had hypertension if they had sustained elevated blood pressure over three separate visits. The prevalence of hypertension was 2.2%. 14% of children were overweight or obese, 20% had a positive history of hypertension in at least one parent and 30% had either or both conditions. Targeted screening of hypertension to children with either overweight/obesity or with hypertensive parents limits the proportion of children (30%) to screen and identifies up to 65% of all hypertensive cases.

Introduction Diet is a major risk factor for non-communicable diseases (NCDs) and is also strongly patterned by socioeconomic factors. Whether interventions promoting healthy eating reduce social inequalities in diet in low- and middle-income countries (LMICs) remains uncertain. This paper aims to summarize current evidence on interventions promoting healthy eating in LMICs, and to establish whether they reduce social inequalities in diet. Methods Systematic review of cross-sectional or quasi-experimental studies (pre- and post-assessment of interventions) in Pubmed, Scielo and Google Scholar databases, including adults in LMICs, assessing at least one outcome of healthy eating and showing results stratified by socioeconomic status. Results Seven intervention studies including healthy eating promotion, conducted in seven LMICs (Brazil, Chile, Colombia, Iran, Panama, Trinidad and Tobago, and Tunisia), met our inclusion criteria. To promote healthy eating, all interventions used nutrition education and three of them combined nutrition education with improved acces to foods or social support. Interventions targeted mostly women and varied widely regarding communication tools and duration of the nutrition education sessions. Most interventions used printed material, media use or face-to-face training and lasted from 6 weeks to 5 years. Four interventions targeted disadvantaged populations, and three targeted the entire population. In three out of four interventions targeting disadvantaged populations, healthy eating outcomes were improved suggesting they were likely to reduce social inequalities in diet. All interventions directed to the entire population showed improved healthy eating outcomes in all social strata, and were considered as having no impact on social inequalities in diet. Conclusion In LMICs, agentic interventions promoting healthy eating reduced social inequalities in diet when specifically targeting disadvantaged populations. Further research should assess the impact on social inequalities in diet of a combination of agentic and structural approaches in interventions promoting healthy eating. Electronic supplementary material The online version of this article (doi:10.1186/s12939-016-0489-3) contains supplementary material, which is available to authorized users.

We aimed to assess the associations of socioeconomic factors with dietary patterns in a Guatemalan population. Cross-sectional data of 1076 participants (42 % men, mean age 32.6 ± 4.2 years) collected between 2002 and 2004 in four rural villages in Guatemala. Dietary patterns were derived using principal component analysis. Chi-square and Poisson regression models were used to assess associations between socioeconomic factors and dietary patterns. Three dietary patterns were identified: “Western” (high in processed foods), “traditional” (high in traditional foods) and “coffee and sugar”, explaining 11, 7 and 6 % of the variance, respectively. Annual expenditures were associated with a higher adherence to the “Western” pattern: prevalence ratios [(PR) (95 % confidence interval)] 1.92 (1.17–3.15) for the highest vs. lowest expenditure group in men and 8.99 (3.57–22.64) in women. A borderline significant (p = 0.06) negative association was found between the “traditional” pattern and higher household expenditures [0.71 (0.49–1.02) in men] and with schooling [0.23 (0.05–1.02)] in women (p = 0.05). Dietary patterns in Guatemala are predicted by socioeconomic factors. In particular, high annual expenditures are associated with a more westernized, less traditional diet.

Several studies have reported high levels of inflammatory biomarkers in hypertension, but data coming from the general population are sparse, and sex differences have been little explored. The CoLaus Study is a cross-sectional examination survey in a random sample of 6067 Caucasians aged 35–75 years in Lausanne, Switzerland. Blood pressure (BP) was assessed using a validated oscillometric device. Anthropometric parameters were also measured, including body composition, using electrical bioimpedance. Crude serum levels of interleukin-6 (IL-6), tumor necrosis factor α (TNF-α) and ultrasensitive C-reactive protein (hsCRP) were positively and IL-1β (IL-1β) negatively (P

Background: Several studies have reported increased levels of inflammatory biomarkers in chronic kidney disease (CKD), but data from the general population are sparse. In this study, we assessed levels of the inflammatory markers C-reactive protein (hsCRP), tumor necrosis factor α (TNF-α), interleukin (IL)-1β and IL-6 across all ranges of renal function. Methods: We conducted a cross-sectional study in a random sample of 6,184 Caucasian subjects aged 35–75 years in Lausanne, Switzerland. Serum levels of hsCRP, TNF-α, IL-6, and IL-1β were measured in 6,067 participants (98.1%); serum creatinine-based estimated glomerular filtration rate (eGFRcreat, CKD-EPI formula) was used to assess renal function, and albumin/creatinine ratio on spot morning urine to assess microalbuminuria (MAU). Results: Higher serum levels of IL-6, TNF-α and hsCRP and lower levels of IL-1β were associated with a lower renal function, CKD (eGFRcreat 2; n = 283), and MAU (n = 583). In multivariate linear regression analysis adjusted for age, sex, hypertension, smoking, diabetes, body mass index, lipids, antihypertensive and hypolipemic therapy, only log-transformed TNF-α remained independently associated with lower renal function (β –0.54 ±0.19). In multivariate logistic regression analysis, higher TNF-α levels were associated with CKD (OR 1.17; 95% CI 1.01–1.35), whereas higher levels of IL-6 (OR 1.09; 95% CI 1.02–1.16) and hsCRP (OR 1.21; 95% CI 1.10–1.32) were associated with MAU. Conclusion: We did not confirm a significant association between renal function and IL-6, IL-1β and hsCRP in the general population. However, our results demonstrate a significant association between TNF-α and renal function, suggesting a potential link between inflammation and the development of CKD. These data also confirm the association between MAU and inflammation.

Eighty percent of the global 17 million deaths due to cardiovascular disease (CVD) occur in low and middle income countries (LMICs). The burden of CVD and other noncommunicable diseases (NCDs) is expected to markedly increase because of the global aging of the population and increasing exposure to detrimental lifestyle-related risk in LMICs. Interventions to reduce four main risks related to modifiable behaviors (tobacco use, unhealthy diet, low physical activity and excess alcohol consumption) are key elements for effective primary prevention of the four main NCDs (CVD, cancer, diabetes and chronic pulmonary disease). These behaviors are best improved through structural interventions (e.g., clean air policy, taxes on cigarettes, new recipes for processed foods with reduced salt and fat, urban shaping to improve mobility, etc.). In addition, health systems in LMICs should be reoriented to deliver integrated cost-effective treatment to persons at high risk at the primary health care level. The full implementation of a small number of highly cost effective, affordable and scalable interventions ("best buys") is likely to be the necessary and sufficient ingredient for curbing NCDs in LMICs. NCDs are both a cause and a consequence of poverty. It is therefore important to frame NCD prevention and control within the broader context of social determinants and development agenda. The recent emphasis on NCDs at a number of health and economic forums (including the September 2011 High Level Meeting on NCDs at the United Nations) provides a new opportunity to move the NCD agenda forward in LMICs.

We present a narrative review of the literature linking dietary salt intake with cardiovascular health outcomes in humans and list the tools and strategies to reduce salt intake at the population level. There is a strong agreement among experts that dietary salt intake should be reduced, targeting average population levels less than 5 g per day. The main aim of this reduction is a decline in cardiovascular morbidity and mortality. Experimental data clearly show that reducing salt intake lowers blood pressure. Considering that high blood pressure is a major cardiovascular risk factor, this provides indirect evidence that salt reduction should improve cardiovascular health.1 There is also recent direct evidence that reducing salt intake reduces the incidence of cardiovascular disease. Direct evidence linking reduction in salt intake with decreased overall and cardiovascular mortality is more limited and disputed and the data for stroke are inconsistent. Thus, there is a debate on the quality and nature of the available evidence, particularly on the magnitude of the benefit provided by the achievable reduction in salt intake. Yet, there are no known deleterious consequences of the proposed reduction in salt intake. Several countries have adopted policies aiming at reducing salt intake in the general population. The relevant tools and strategies are directed to both the food industry and the consumers. At the industry level, the most efficient measure is legislation on the salt content of selected foods, an approach much more (cost) effective than voluntary reductions. None of the interventions aiming at reducing salt intake has been rigorously evaluated. In view of recurrent controversies, any intervention in this field should be accompanied by an appropriate monitoring and evaluation program.

We assessed the association between birth weight, weight change, and current blood pressure (BP) across the entire age-span of childhood and adolescence in large school-based cohorts in the Seychelles, an island state in the African region.Three cohorts were analyzed: 1004 children examined at age 5.5 and 9.1 years, 1886 children at 9.1 and 12.5, and 1575 children at 12.5 and 15.5, respectively. Birth and 1-year anthropometric data were gathered from medical files. The outcome was BP at age 5.5, 9.1, 12.5 or 15.5 years, respectively. Conditional linear regression analysis was used to estimate the relative contribution of changes in weight (expressed in z-score) during different age periods on BP. All analyses were adjusted for height.At all ages, current BP was strongly associated with current weight. Birth weight was not significantly associated with current BP. Upon adjustment for current weight, the association between birth weight and current BP tended to become negative. Conditional linear regression analyses indicated that changes in weight during successive age periods since birth contributed substantially to current BP at all ages. The strength of the association between weight change and current BP increased throughout successive age periods.Weight changes during any age period since birth have substantial impact on BP during childhood and adolescence, with BP being more responsive to recent than earlier weight changes.

The purpose of this article is to discuss some of the current challenges faced by European schools of public health. Perhaps most remarkable on the continent is the diversity, the magnitude, and the rapidity of the developments in public health education since the Second World War. This article discusses its evolution, its main characteristics and the underlying rationale with several examples. Further, it addresses specific aspects of the future development, namely the collaboration of academic schools with practice-oriented institutions, as well as the interactions between the constituent disciplines of public health. The Bologna process on post-graduate education in Europe has had an important impact on the overall design of most schools. There is a willingness to develop public health in each country of the European region and there is a need to develop common strategies to reach high standards in teaching, training and researching in all disciplines related to public health.

ObjectiveMigrants tend to present higher overweight and obesity levels, but whether this relationship applies to all nationalities has seldom been studied. The present study aimed to assess the prevalence of overweight and obesity according to nationality in adults.DesignCross-sectional population-based samples.SettingFive-year nationwide interview surveys (Swiss Health Surveys – SHS) from 1992 to 2007 (n 63 766) and a local examination survey (CoLaus Study in Lausanne 2004–2006, n 6743).SubjectsParticipants were separated into Swiss, French, German, Italian, Portuguese, Spanish nationals, those from the former Republic of Yugoslavia and from other European and other countries.ResultsCompared with Swiss nationals, German and French nationals presented a lower prevalence of overweight and obesity, whereas nationals from Italy, Spain, Portugal and the former Republic of Yugoslavia presented higher levels. Adjusting the SHS data for age, gender, education, smoking, leisure-time physical activity and survey year, a lower risk for overweight and obesity was found for German (OR = 0·80, 95 % CI 0·70, 0·92) and French (OR = 0·74, 95 % CI 0·61, 0·89) nationals, whereas higher risks were found for participants from Italy (OR = 1·45, 95 % CI 1·33, 1·58), Spain (OR = 1·36, 95 % CI 1·15, 1·61), Portugal (OR = 1·25, 95 % CI 1·06, 1·47) and the former Republic of Yugoslavia (OR = 1·98, 95 % CI 1·69, 2·32). Similar findings were observed in the CoLaus Study for Italian (OR = 1·63, 95 % CI 1·29, 2·06), Spanish (OR = 1·54, 95 % CI 1·17, 2·04) and Portuguese (OR = 1·49, 95 % CI 1·16, 1·91) participants and for those from the former Republic of Yugoslavia (OR = 5·34, 95 % CI 3·00, 9·50).ConclusionsOverweight and obesity are unevenly distributed among migrants in Switzerland. Migrants from Southern Europe and from the former Republic of Yugoslavia present higher prevalence rates. This suggests that preventive messages should be tailored to these specific populations.

OBJECTIVE To evaluate the public health impact of statin prescribing strategies based on the Justification for the Use of Statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin Study (JUPITER). METHODS We studied 2268 adults aged 35 75 without cardiovascular disease in a population based study in Switzerland in 2003 2006. We assessed the eligibility for statins according to the Adult Treatment Panel III (ATPIII) guidelines and by adding "strict" (hs CRP=2.0 mg/L and LDL cholesterol

INTRODUCTION Common variation in the CHRNA5-CHRNA3-CHRNB4 gene region is robustly associated with smoking quantity. Conversely, the association between one of the most significant single nucleotide polymorphisms (SNPs; rs1051730 within the CHRNA3 gene) with perceived difficulty or willingness to quit smoking among current smokers is unknown. METHODS Cross-sectional study including current smokers, 502 women, and 552 men. Heaviness of smoking index (HSI), difficulty, attempting, and intention to quit smoking were assessed by questionnaire. RESULTS The rs1051730 SNP was associated with increased HSI (age, gender, and education-adjusted mean ± SE: 2.6 ± 0.1, 2.2 ± 0.1, and 2.0 ± 0.1 for AA, AG, and GG genotypes, respectively, p < .01). Multivariate logistic regression adjusting for gender, age, education, leisure-time physical activity, and personal history of cardiovascular or lung disease showed rs1051730 to be associated with higher smoking dependence (odds ratio [OR] and 95% CI for each additional A-allele: 1.38 [1.11-1.72] for smoking more than 20 cigarette equivalents/day; 1.31 [1.00-1.71] for an HSI ≥5 and 1.32 [1.05-1.65] for smoking 5 min after waking up) and borderline associated with difficulty to quit (OR = 1.29 [0.98-1.70]), but this relationship was no longer significant after adjusting for nicotine dependence. Also, no relationship was found with willingness (OR = 1.03 [0.85-1.26]), attempt (OR = 1.00 [0.83-1.20]), or preparation (OR = 0.95 [0.38-2.38]) to quit. Similar findings were obtained for other SNPs, but their effect on nicotine dependence was no longer significant after adjusting for rs1051730. CONCLUSIONS These data confirm the effect of rs1051730 on nicotine dependence but failed to find any relationship with difficulty, willingness, and motivation to quit.

BACKGROUND Several studies have shown that treatment with HMG CoA reductase inhibitors (statins) can reduce coronary heart disease (CHD) rates. However the cost effectiveness of statin treatment in the primary prevention of CHD has not been fully established. OBJECTIVE To estimate the costs of CHD prevention using statins in Switzerland according to different guidelines over a 10 year period. METHODS The overall 10 year costs costs of one CHD death averted and of 1 year without CHD were computed for the European Society of Cardiology (ESC) the International Atherosclerosis Society (IAS) and the US Adult Treatment Panel III (ATP III) guidelines. Sensitivity analysis was performed by varying number of CHD events prevented and costs of treatment. RESULTS Using an inflation rate of medical costs of 3 a single yearly consultation a single total cholesterol measurement per year and a generic statin the overall 10 year costs of the ESC IAS and ATP III strategies were 2.2 3.4 and 4.1 billion Swiss francs (SwF [SwF1?=?US0.97]). In this scenario the average cost for 1 year of life gained was SwF352 SwF421 and SwF485 thousand respectively and it was always higher in women than in men. In men the average cost for 1 year of life without CHD was SwF30.7 SwF42.5 and SwF51.9 thousand for the ESC IAS and ATP III strategies respectively and decreased with age. Statin drug costs represented between 45 and 68 of the overall preventive cost. Changing the cost of statins inflation rates or number of fatal and non fatal cases of CHD averted showed ESC guidelines to be the most cost effective. CONCLUSION The cost of CHD prevention using statins depends on the guidelines used. The ESC guidelines appear to yield the lowest costs per year of life gained free of CHD.

Population ageing is the sought-for outcome of improved public health, education and medical care over the last century. Worldwide, life expectancy is increasing. The health with which people age, given longer lives, has become a critically important determinant of population health and of development agendas as well as the economic well-being of nations. This issue of Public Health Reviews is devoted to the description and the analysis of how increased life expectancy and ageing affect population needs and compel us to modify public health science and leadership. It lays out the transitions in population science and the multilevel public health and policy agenda for the future necessary to support longer lives that are healthy and engaged. The public health consequences of longevity and population ageing do not come as a surprise. The emergence of ageing as a public health issue dates back to the mid-20 century. The demographic transition (as originally expressed in the 1920’s by Warren Thompson) predicted an increase in the proportion of aged people in the post-transitional period, i.e., as a result of the combination of low mortality and low birth rate. The link between the demographic transition and population health was further characterized by Omran in the 1970’s. The so-called epidemiologic transition characterizes the secular change between two epidemiological stages, i.e., from high fertility and a high, unstable frequency of rapidly lethal infectious diseases to a new situation of low fertility and health issues dominated by slowly progressing chronic and degenerative diseases. Cardiometabolic disease, cancer, neuropsychiatric diseases and musculo-skeletal conditions are now predominant (or will be soon) in most parts of the world. Several current observations were, however, unexpected. One is the ever-increasing longevity in most high income countries. Mortality is low

BACKGROUND There is little information regarding the prevalence and management of dyslipidaemia in Switzerland. DESIGN Cross sectional population based study of 3238 women and 2846 men aged 35 75. METHODS Dyslipidaemia prevalence treatment and control were defined according to PROCAM guidelines adapted to Switzerland. RESULTS About 29 of the overall sample presented with dyslipidaemia of which 39 were treated and 58 of those treated were controlled. Among the 710 patients with personal history of cardiovascular disease (CVD) and/or diabetes 632 (89) presented with dyslipidaemia of which 278 (44) and 134 (21) patients were treated and adequately controlled respectively. On multivariate analysis hypolipidaemic drug treatment was positively related with age and body mass index (P for trend

Elevated levels of γ-glutamyltransferase (GGT) have been associated with elevated blood pressure (BP) and diabetes. However, the causality of these relations has not been addressed. The authors performed a cross-sectional analysis (2003-2006) among 4,360 participants from the population-based Cohorte Lausannoise (CoLaus) Study (Lausanne, Switzerland). The rs2017869 variant of the γ-glutamyltransferase 1 (GGT1) gene, which explained 1.6% of the variance in GGT levels, was used as an instrument for Mendelian randomization (MR). Sex-specific GGT quartiles were strongly associated with both systolic and diastolic BP (all P's < 0.0001). After multivariable adjustment, these relations were attenuated but remained significant. Using MR, the authors observed no positive association of GGT with BP (systolic: β -5.68, 95% confidence interval (CI): -11.51, 0.16 (P = 0.06); diastolic: β = -2.24, 95% CI: -5.98, 1.49 (P = 0.24)). The association of GGT with insulin was also attenuated after multivariable adjustment but persisted in the fully adjusted model (β = 0.07, 95% CI: 0.04, 0.09; P < 0.0001). Using MR, the authors also observed a positive association of GGT with insulin (β = 0.19, 95% CI: 0.01, 0.37; P = 0.04). In conclusion, the authors found evidence for a direct causal relation of GGT with fasting insulin but not with BP.

Background and aims Normal weight obesity (NWO) is defined as an excessive body fat associated with a normal body mass index (BMI) and has been associated with early inflammation, but its relationship with cardiovascular risk factors await investigation. Methods and results Cross-sectional study including 3213 women and 2912 men aged 35–75 years to assess the clinical characteristics of NWO in Lausanne, Switzerland. Body fat was assessed by bioimpedance. NWO was defined as a BMI 2 and a % body fat > = 66 th gender-specific percentiles. The prevalence of NWO was 5.4% in women and less than 3% in men, so the analysis was restricted to women. NWO women had a higher % of body fat than overweight women. After adjusting for age, smoking, educational level, physical activity and alcohol consumption, NWO women had higher blood pressure and lipid levels and a higher prevalence of dyslipidaemia (odds-ratio = 1.90 [1.34–2.68]) and fasting hyperglycaemia (odds-ratio = 1.63 [1.10–2.42]) than lean women, whereas no differences were found between NWO and overweight women. Conversely, no differences were found between NWO and lean women regarding levels of CRP, adiponectin and liver markers (alanine aminotransferase, aspartate aminotransferase and gamma glutamyl transferase). Using other definitions of NWO led to similar conclusions, albeit some differences were no longer significant. Conclusion NWO is almost nonexistent in men. Women with NWO present with higher cardiovascular risk factors than lean women, while no differences were found for liver or inflammatory markers. Specific screening of NWO might be necessary in order to implement cardiovascular prevention.

Summary Objectives Little is known regarding the distribution and the determinants of leptin and adiponectin levels in the general population. Design Cross-sectional study. Patients Women (3004) and men (2552) aged 35–74 living in Lausanne, Switzerland. Measurements Plasma levels of leptin and adiponectin (ELISA measurement). Results Women had higher leptin and adiponectin levels than men. In both genders, leptin and adiponectin levels increased with age. After adjusting for fat mass, leptin levels were significantly and negatively associated with age in women: 18·1 ± 0·3, 17·1 ± 0·3, 16·7 ± 0·3 and 15·5 ± 0·4 ng/ml (adjusted mean ± SE) for age groups [35–44], [45–54], [55–64] and [65–75], respectively, P

Objective: Limited information is available on the quantitative relationship between family history and the corresponding underlying traits. We analyzed these associations for blood pressure, fasting blood glucose, and cholesterol levels. Methods: Data were obtained from 6,102 Caucasian participants (2,903 men and 3,199 women) aged 35–75 years using a population-based cross-sectional survey in Switzerland. Cardiovascular disease risk factors were measured, and the corresponding family history was self-reported using a structured questionnaire. Results: The prevalence of a positive family history (in first-degree relatives) was 39.6% for hypertension, 22.3% for diabetes, and 29.0% for hypercholesterolemia. Family history was not known for at least one family member in 41.8% of participants for hypertension, 14.4% for diabetes, and 50.2% for hypercholesterolemia. A positive family history was strongly associated with higher levels of the corresponding trait, but not with the other traits. Participants who reported not to know their family history of hypertension had a higher systolic blood pressure than participants with a negative history. Sibling histories had higher positive predictive values than parental histories. The ability to discriminate, calibrate, and reclassify was best for the family history of hypertension. Conclusions: Family history of hypertension, diabetes, and hypercholesterolemia was strongly associated with the corresponding dichotomized and continuous phenotypes.

OBJECTIVE: We evaluated whether subjects with long-lived parents show lower levels of cardiovascular risk factors, including the metabolic syndrome. METHODS: We analyzed data from a Swiss population-based sample (1163 men and 1398 women) aged 55-75 years from Lausanne. Participants were stratified by number of parents (0, 1, 2) who survived to 85 years or more. The associations of parental longevity with cardiovascular risk factors and related metabolic variables were analyzed using multiple linear regressions. RESULTS: Age-adjusted metabolic syndrome prevalence varied from 24.8%, 20.5% to 13.8% in women (P

Moderate alcohol consumption has been associated with lower coronary artery disease (CAD) risk. However, data on the CAD risk associated with high alcohol consumption are conflicting. The aim of this study was to examine the impact of heavier drinking on 10-year CAD risk in a population with high mean alcohol consumption. In a population-based study of 5,769 adults (aged 35 to 75 years) without cardiovascular disease in Switzerland, 1-week alcohol consumption was categorized as 0, 1 to 6, 7 to 13, 14 to 20, 21 to 27, 28 to 34, and > or =35 drinks/week or as nondrinkers (0 drinks/week), moderate (1 to 13 drinks/week), high (14 to 34 drinks/week), and very high (> or =35 drinks/week). Blood pressure and lipids were measured, and 10-year CAD risk was calculated according to the Framingham risk score. Seventy-three percent (n = 4,214) of the participants consumed alcohol; 16% (n = 909) were high drinkers and 2% (n = 119) very high drinkers. In multivariate analysis, increasing alcohol consumption was associated with higher high-density lipoprotein cholesterol (from a mean +/- SE of 1.57 +/- 0.01 mmol/L in nondrinkers to 1.88 +/- 0.03 mmol/L in very high drinkers); triglycerides (1.17 +/- 1.01 to 1.32 +/- 1.05 mmol/L), and systolic and diastolic blood pressure (127.4 +/- 0.4 to 132.2 +/- 1.4 mm Hg and 78.7 +/- 0.3 to 81.7 +/- 0.9 mm Hg, respectively) (all p values for trend

This study is aimed to assess the prevalence of awareness, treatment and control of high blood pressure (HBP) and associated factors in a Swiss city.Population-based cross-sectional study of 6182 participants (52.5% women) aged 35-75 years living in Lausanne, Switzerland.HBP was defined as blood pressure/=140/90 mmHg or current antihypertensive medication.The overall prevalence of HBP was 36% (95% confidence interval: 35-38%). Among participants with HBP, 63% were aware of it. Among participants aware of HBP, 78% were treated, and among those treated, 48% were controlled (BP140/90 mmHg). In multivariate analysis, HBP prevalence was associated with older age, male sex, low educational level, high alcohol intake, awareness of diabetes or dyslipidaemia, obesity and parental history of myocardial infarction. HBP awareness was associated with older age, female sex, awareness of diabetes or dyslipidaemia, obesity and parental history of myocardial infarction. HBP control was associated with younger age, higher educational level and no alcohol intake. Alone or in combination, sartans were the most often prescribed antihypertensive medication category (41%), followed by diuretics, beta-blockers, angiotensin converting enzyme inhibitors and calcium channel blockers. Only 31% of participants treated for HBP were taking/=2 antihypertensive medications.Although more than half of all participants with HBP were aware and more than three-quarters of them received a pharmacological treatment, less than half of those treated were adequately controlled.

Summary Background & aims Normal weight obesity (NWO) has been defined as an excessive body fat (BF) associated with a normal body mass index (BMI). Still, little is known regarding the effect of differing cut-offs for %BF on the prevalence of NWO. We thus conducted a study to assess the effect of modifying the cut-offs for excessive %BF on the prevalence of NWO. Methods We examined a convenience sample of 1523 Portuguese adults. BF was measured by validated hand-held bioimpedance. NWO was defined as a BMI 30% or according to sex- and age-specific %BF cut-offs. Results Prevalence of NWO was 10.1% in women and 3.2% in men. In women, prevalence of NWO increased considerably with age, and virtually all women aged over 55 with a BMI Conclusions In women, the prevalence of NWO varies considerably according to the cut-off used to define excess BF, whereas a much smaller variation is found in men. While further studies are needed to describe the risk associated with NWO using various %BF cut-offs, this study suggests that sex- and age-specific cut-offs may be preferred.

Summary Background & aims There is little information regarding the prevalence of thinness in European adolescents. This was assessed in a convenience sample of children and adolescents from the Lisbon area (Portugal). Methods Cross-sectional study including 2494 boys and 2519 girls aged 10–18 years. Body mass index (BMI), waist and hip were measured using standardized methods; thinness was defined using international criteria. Body fat was assessed by bioelectrical impedance. Results In girls, prevalence of thinness, overweight and obesity were 5.6%, 19.7% and 4.7%, respectively, whereas the corresponding numbers in boys were 3.9%, 17.4% and 5.3%. Prevalence of thinness increased whereas obesity decreased with age: from 1.5% to 7.6% for thinness and from 9.2% to 3.8% for obesity in girls aged 10 and 18, respectively. In boys, the corresponding trends were from 0% to 7.3% for thinness and from 10.6% to 3% for obesity. After adjusting for age, differences were found between BMI groups for weight, body fat percentage, fat mass, lean mass, waist and hip, while no differences regarding height were found between thin and normal weight participants. Conclusions The prevalence of thinness is more frequent than obesity after age 14 in girls and 16 years in boys. Thinness is associated with a decreased body weight and body fat, whereas no consistent effect on height was noted.

Our aim was to critically evaluate the relations among smoking, body weight, body fat distribution, and insulin resistance as reported in the literature. In the short term, nicotine increases energy expenditure and could reduce appetite, which may explain why smokers tend to have lower body weight than do nonsmokers and why smoking cessation is frequently followed by weight gain. In contrast, heavy smokers tend to have greater body weight than do light smokers or nonsmokers, which likely reflects a clustering of risky behaviors (eg, low degree of physical activity, poor diet, and smoking) that is conducive to weight gain. Other factors, such as weight cycling, could also be involved. In addition, smoking increases insulin resistance and is associated with central fat accumulation. As a result, smoking increases the risk of metabolic syndrome and diabetes, and these factors increase risk of cardiovascular disease. In the context of the worldwide obesity epidemic and a high prevalence of smoking, the greater risk of (central) obesity and insulin resistance among smokers is a matter of major concern.

BACKGROUND Normal weight obesity (NWO) is defined as an excessive body fat associated with a normal body mass index (BMI < 25 kg/m(2)) but its prevalence in the general population is unknown. AIM OF THE STUDY To assess the prevalence of NWO in Switzerland according to different cut points used to define excess body fat. METHODS Cross sectional study including 3213 women and 2912 men aged 35 75 years. Body fat was assessed by bioelectrical impedance analysis and prevalence of NWO was assessed using four previously published definitions for excess body fat. RESULTS Percent body fat increased with age: in men the values (mean +/ SD) were 20.2 +/ 5.4 23.0 +/ 5.4 26.3 +/ 5.2 and 28.2 +/ 4.6 for age groups 35 44 45 54 55 64 and 65 75 years respectively; the corresponding values for women were 29.9 +/ 7.8 33.1 +/ 7.4 36.7 +/ 7.5 and 39.6 +/ 6.9. In men prevalence of NWO was

This study assessed the impact of education on diet and compliance with the national recommendations. The study included 4338 adult participants of the Colaus study, a cross-sectional, population-based study conducted between 2009 and 2012 in Lausanne (Switzerland). Education was categorized as primary, apprenticeship, secondary, and tertiary. Men with primary vs. tertiary education had a lower intake of monounsaturated fatty acids (29.4 vs. 30.9 g/day), iron (11.4 vs. 11.8 mg/day), vitamin A (758.2 vs. 904.2 retinol equivalents/day), and vitamin D (2.3 vs. 3.0 μg/day). Women with primary vs. tertiary education had a lower intake of monounsaturated fatty acids (25.5 vs. 27.4 g/day), fiber (15.6 vs. 17.2 g/day) and iron (9.8 vs. 10.3 mg/day). Men with primary vs. tertiary education had a better compliance with protein recommendations [odds ratio (95 % CI): 2.31 (1.37; 3.90)], while women with primary vs. tertiary education had a better compliance with vitamin A recommendations [odds ratio 1.74 (1.15; 2.65)]. Overall, our results do not confirm a unidirectional association between education and diet, and question the approach of targeted interventions alone in selected educational groups to prevent chronic diseases.

Background: Our purpose was to assess blood pressure (BP) and its relationship with body mass index (BMI) over a 15-year interval in the Seychelles, a rapidly developing country in the African region. Methods: Two independent cross-sectional examination surveys were conducted in 1989 (n = 1081) and 2004 (n = 1255) using representative samples of the population age 25-64 years. Results: Between 1989 and 2004, mean BP (mm Hg) decreased slightly (from 133/87 to 131/86 in men and from 127/82 to 124/81 in women), with little change in the age-standardized prevalence of high BP (BP ≥140/90 or current treatment; from 45% to 44% in men and from 34% to 36% in women). During this same time period, there were marked increases in awareness (from 42% to 64%), treatment (22% to 59%), and control (3% to 20%) among participants with high BP. The prevalence of overweight (BMI ≥25 kg/m 2 ) increased from 39% to 60%. Furthermore, the linear relationship between BMI and BP was markedly weaker in 2004 than in 1989, irrespective of antihypertensive treatment and age, and among both lean and overweight participants. Among untreated persons, a BMI increment of 1 kg/m 2 was associated with an elevation of 2.0/1.5 mm Hg of systolic/diastolic BP in 1989 but only 1.3/1.0 mm Hg in 2004. Conclusions: The association between BMI and BP has decreased over time. Further study is needed to understand the reasons for the decline in this association, and what the implications are in the context of the obesity epidemic.

n-3 polyunsaturated fatty acids (n-3 PUFA) convey several health benefits, including a reduction of serum concentration of triglycerides (TG).To examine the effect on blood lipids, particularly TG, of a diet with n-3 PUFA enriched eggs in healthy volunteers in the Seychelles (Indian Ocean).Double-blind crossover trial with one group of volunteers fed with 5 normal eggs per week during 3 weeks followed by 5 enriched eggs per week during the next 3 weeks while the other group received eggs in the inverse sequence. Hen feed was supplemented at 5% with tuna oil. Enriched eggs contained nine times more n-3 PUFA than usual eggs (mainly docosahexaenoic acid).Twenty-five healthy volunteers participated in the study. Based on pooled results observed during the two 3-week periods, consumption of enriched eggs was associated with a significant 16-18% decrease in serum triglycerides (P0.01) but with no significant difference in serum LDL-cholesterol and HDL-cholesterol. Serum LDL-cholesterol increased during the first 3-week period and decreased during the second 3-week period with both normal and enriched eggs. Participants did not report a systematic preference for either type of eggs.Reasonable consumption of n-3 PUFA enriched eggs was associated with a significant decrease in serum triglycerides. These eggs could be a palatably acceptable source of n-3 PUFA.