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Objective: Monitoring population salt intake is operationally and economically challenging. We explored whether a questionnaire assessment and a prediction of Na intake from spot-urine could replace or complement the recommended measurement of Na in 24-h urine (24-h U)., Design: Compare the agreement of a Na-specific food record checklist (FRCL) and a late-afternoon spot-urine measurement (PM-spot) with 24-h U measurement in estimating Na intake at group level. Each participant's use of these methods extended over 3 d. Agreement was assessed using mean (95 % CI) differences, linear regression models and Bland-Altman plots., Setting: The validation study was part of a 1-year workplace intervention trial to lower salt intake in Switzerland., Participants: Seventy women and 71 men, aged 21-61 years, completed three FRCL, and acceptable PM-spot and 24-h U samples at baseline (April-October 2015)., Results: Mean Na intake estimates varied slightly across methods (3·5-3·9 g/d). Mean Na intake differences from 24-h U were 0·2 (95 % CI (0, 0·5)) g/d for FRCL and 0·4 (95 % CI (0·2, 0·6)) g/d for PM-spot. Linear regression models and Bland-Altmann plots more clearly depicted differences by sex and discretionary salt use., Conclusions: Although 24-h U remains the best reference method for monitoring Na intake at the population level, PM-spot and FRCL might be more practical instruments for frequent, periodic Na intake assessments. Population-specific prediction models to estimate 24-h U could be developed and evaluated.

Reducing excessive dietary sodium may reduce cardiovascular disease risk. Environmental and behavioral interventions in workplaces may reduce salt consumption, but information on the effectiveness of workplace nutrition interventions is sparse. We used the RE-AIM framework to evaluate a one-year trial in 2015-2016 of an educational and environmental intervention to lower salt intake of employees in organizations with catering facilities in Switzerland. Five educational workshops for employees and assessments that included 24-hour urine collection were combined with five coaching sessions and food analyses in catering operations. We studied the adoption, reach, implementation, effectiveness, and maintenance of the intervention. Eight of 389 candidate organizations participated in the trial in which 145 (50% men) out of 5794 potentially eligible employees consented to participate, and 138 completed the trial with 13 in the control group. The overall mean change of daily salt intake was -0.6 g from 8.7 g to 8.1 g (6.9%). Though the mean daily salt intake of women was unaltered from 7 g, the mean intake of men declined by -1.2 g from 10.4 g to 9.2 g. Baseline salt intake, sex, and waist-to-height ratio were significant predictors of salt reduction. The analysis also highlighted pivotal determinants of low adoption and reach, and program implementation in catering operations. We conclude that a workplace program of nutrition intervention for employees and catering staff is feasible. The acceptance, effectiveness, and maintenance of nutrition interventions in the workplace require strong employer support. In a supportive food environment, interventions tailored to sex, age, and CVD risk inter alia could be successful., Competing Interests: The authors declare that they have no competing interests. PS states that he is an unpaid member of WASH (World Action on Salt and Health) and coordinator of the Interdisciplinary Working Group for Reduction of Salt Intake in Italy (GIRCSI).

Nutrition literacy and food literacy have become increasingly important concepts in health promotion. Researchers use one or the other term to describe the competencies needed to maintain a healthy diet. This systematic review examines whether these terms are synonymous or if their meanings are substantially different.We searched major bibliographic databases (Web of Science, PubMed, ScienceDirect, CINAHL, SocIndex and ERIC) for publications that provided an original definition of nutrition or food literacy. Then we used Nutbeam's tripartite health literacy model as an analytical grid. The definitions we found included specific competencies, which we mapped to the domains of functional, interactive, or critical literacy.In the 173 full-text publications we screened, we found six original definitions of nutrition literacy, and 13 original definitions of food literacy. Seven food literacy definitions were integrated into a conceptual framework. Analysing their structure revealed that nutrition literacy and food literacy are seen as specific forms of health literacy, and represent distinct but complementary concepts. Definitions of nutrition literacy mainly described the abilities necessary to obtain and understand nutrition information. Definitions of food literacy incorporated a broader spectrum of theoretical and practical knowledge and skills. To be food literate also means to apply information on food choices and critically reflect on the effect of food choice on personal health and on society. Since food literacy is based on a more comprehensive understanding of health behaviours, it is the more viable term to use in health promotion interventions. For the practical implication, a harmonization of the different definitions is desirable.

Background: Blood pressure is a primary cardiovascular disease risk factor. Population-wide governmental strategies aim to reduce lifestyle and dietary risk factors for hypertension, one of which is an unbalanced diet with high sodium and low potassium intakes. Nutrition interventions in the workplace are considered a promising approach in encouraging health-promoting behaviors. We developed and conducted the health promoting sodium reduction trial "Healthful & Tasty: Sure!" in worksites in the German-speaking part of Switzerland from May 2015 to Nov 2016, for which we present the study protocol and baseline characteristics., Methods: Healthful & Tasty, a cluster nonrandomized single-arm trial with calibration arm, aimed to demonstrate the effectiveness of a combined educational and environmental intervention in the workplace in reducing employees' average daily sodium/salt intake by 15%. To this end, health and food literacy of employees and guideline compliance among the catering facility team needed to be improved. The primary outcome measure was sodium/salt intake estimated from sodium excretion in a 24-h urine sample. Secondary outcome measures included changes in the overall qualitative diet composition, blood pressure, anthropometric indices, and health and food literacy. Of eight organizations with catering facilities, seven organizations took part in the nutrition education and catering salt reduction interventions, and one organization participated as a control. Overall, 145 consenting employees were included in the staggered, one-year four-phase trial, of which 132 participated in the intervention group. In addition to catering surveys and food sampling, the trial included five follow-up health assessments including questionnaires, blood pressure measurements, anthropometrics, and sodium, potassium, and iodine intake measurements obtained from 24-h and spot urine samples, and a food record checklist. Exploratory and hypothesis generating baseline statistical analysis included 141 participants with adequate 24-h urine samples., Discussion: Despite practice-driven limitations to the study design and small cluster and participant numbers, this trial has methodological strength and will provide important insights into the effectiveness of a combined educational and environmental intervention to reduce salt intake among female and male Swiss employees., Trial Registration: German Clinical Trials Register, DRKS00006790 . Registered 23 September 2014.

The short food literacy questionnaire (SFLQ) was developed to measure a broad range of skills including functional, interactive, and critical elements of FL. This study evaluated SFLQ measurement properties. We used a workplace intervention trial to reduce salt intake in Switzerland to explore the underlying structure of the questionnaire with 350 respondents and identify the ideal number of SFLQ items to capture the different elements of FL. Exploratory factor analysis showed a unidimensional structure of the final 12-item questionnaire. A sum score based on all 12 items (Cronbach's α = 0.82) showed expected positive associations with health literacy and knowledge of recommended salt intake. The findings indicate the SFLQ is a feasible and reliable tool to assess FL among adults that can be helpful in public health practices focusing on FL., (Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Switzerland is a multilingual country located between Germany, France and Italy, which differ by dietary habits and related outcomes. We explored differences in food consumption as well as compliance to the Swiss food-based dietary guidelines (FBDG) across the German-, French-, and Italian-speaking regions. The 2014-2015 nationwide cross-sectional survey was conducted among a stratified random sample of 2057 adults aged 18 to 75 years. Trained dietitians assessed food consumption via two non-consecutive 24-h dietary recalls using the international validated software GloboDiet ® . Recorded foods and beverages were classified into six groups and 31 subgroups relevant for assessing compliance to the FBDG (Swiss Food Pyramid). Usual daily intake distributions were modelled and weighted for sampling design, non-response, weekdays and season. Participation rate was 38%. Significant differences across regions were observed in 18 of 31 food subgroups ( p ≤ 0.01). Weighted mean daily intakes in the German-, French- and Italian-speaking regions were, respectively, 245 g, 155 g, 140 g for soft drinks, 273 g, 214 g, 135 g for coffee, 127 g, 72 g, 109 g for milk, 32 g, 45 g, 43 g for red meat, 18 g, 29 g, 34 g for fish/seafood, 8.1 g, 6.4 g, 3.7 g for butter, and 206 g, 214 g, 168 g for vegetables. The seven FBDGs were followed by <1% of the population. Four in 10 participants met ≥3 FBDG. Eighteen percent of participants ate ≥5 portions of fruit and vegetables a day, without regional differences. Food consumption substantially differed across the three linguistic regions of Switzerland. Adherence to FBDG was uniformly low. This highlights the potential influence of culture on diet. Nutritional education along with public health interventions are needed and may be most efficient if regionally targeted., Competing Interests: The authors declare no conflict of interest. The survey funders were involved in the study design, the writing of the manuscript, and the decision to publish the results. They had no direct role in the collection, analyses, or interpretation of data. The survey funders developed the Swiss version of GloboDiet in collaboration with IARC. In addition, they linked the consumption data with the Swiss Food Composition Database.

This paper informs about the implementation of the first trilingual Swiss nutrition pilot survey and lessons learnt in terms of recruitment, participation, data collection feasibility, and data management. The population-based cross-sectional nutrition pilot survey took place between June and November 2013. Six trained dietitians interviewed 276 adults aged 18-75 years residing in the cantons of Bern (German), Vaud (French) or Ticino (Italian). Food consumption was assessed with two non-consecutive computer-assisted 24-Hour Dietary Recalls (24HDR), applying a trilingual version of GloboDiet® adapted to specific requirements of Switzerland. The first interview was face-to-face and included anthropometric measurements while the second was by phone. Quality controls consisted mainly in the descriptive analysis of data at food level, and the observation and rating of 21 interviews (4%) by coordinators. Net participation rate was 29%. Participants and non-participants were similar: mean [±SD] age was 49±16 and 47±16 years, and women proportion 49.6% and 49.8%, respectively. Training and data collection proved feasible and deliverable in the six months using the newly developed survey instruments. Dietitians followed the standard operating procedures. Quality controls on food consumption data showed comparable results between face-to-face and phone 24HDR, and across dietitians (median number of reported food items per 24HDR: 27). Procedures to transfer and clean food consumption data were developed. The implementation concept proved applicable in the trilingual Swiss context. Additional resources were planned for increasing participation rate and facilitating data cleaning.

Various studies have linked different genetic single nucleotide polymorphisms (SNPs) to different blood lipids (BL), but whether these "connections" were identified using cross-sectional or longitudinal (i.e., changes over time) designs has received little attention. Cross-sectional and longitudinal assessments of BL [total, high-, low-density lipoprotein cholesterol (TC, HDL, LDL), triglycerides (TG)] and non-genetic factors (body mass index, smoking, alcohol intake) were measured for 2,002 Geneva, Switzerland, adults during 1999-2008 (two measurements, median 6 years apart), and 20 SNPs in 13 BL metabolism-related genes. Fixed and mixed effects repeated measures linear regression models, respectively, were employed to identify cross-sectional and longitudinal SNP:BL associations among the 1,516 (76%) study participants who reported not being treated for hypercholesterolemia at either measurement time. One-third more (12 vs. 9) longitudinal than cross-sectional associations were found [Bonferroni-adjusted two-tailed p < 0.00125 (=0.05/2)/20) for each of the four ensembles of 20 SNP:individual BL associations tested under the two study designs]. There was moderate consistency between the cross-sectional and longitudinal findings, with eight SNP:BL associations consistently identified across both study designs: [APOE.2 and APOE.4 (rs7412 and rs429358)]:TC; HL/LIPC (rs2070895):HDL; [APOB (rs1367117), APOE.2 and APOE.4 (rs7412 and rs429358)]:LDL; [APOA5 (rs2072560) and APOC III (rs5128)]:TG. The results suggest that cross-sectional studies, which include most genome-wide association studies (GWAS), can assess the large majority of SNP:BL associations. In the present analysis, which was much less powered than a GWAS, the cross-sectional study was around 2/3 (67%) as efficient as the longitudinal study.

Aims: To determine the prevalence of atrial fibrillation (AF) in a population-based sample of adults., Methods and Results: Between January 2005 and December 2007 individuals aged > or =50 years, residents of the city of Geneva, who had participated in a previous random survey were invited for follow-up examination. AF was assessed on a single resting 6-lead ECG. Reported prevalences were standardized for the age distribution of Canton Geneva. Overall participation was 72.8%. Twenty-nine cases of AF (22 men) were diagnosed among 3285 subjects (1696 men). The crude prevalence of AF (95% CI) was 0.88% (0.86, 0.90) overall, but higher in men [1.30% (1.26, 1.34)] than in women [0.44% (0.41, 0.47)]. The age-standardized AF prevalence was slightly higher [overall: 0.94% (0.91, 0.97), men: 1.23% (1.19, 1.27), women: 0.54% (0.47, 0.61)]. AF prevalence increased with age in both sexes. A 'history of suspected arterial embolism' (brain or legs) was higher in the AF cases (10.3 vs. 3.3%; P = 0.03)., Conclusion: This population-based survey of a general Swiss population indicates that the prevalence of AF remains below 1%. These results are less alarming than those from previous studies based on patients seeking medical care.

Objective: To develop and integrate the assessment of functional foods (FuF; manufactured foods with altered composition carrying a health claim) consumption into an existing risk factor surveillance system., Design: FuF market research followed by an experimental FuF intake study incorporated into an ongoing community-based survey. Concurrent completion of a self-administered semi-quantitative FFQ and a self-administered, qualitative FuF frequency questionnaire (FuFFQ) followed by a face-to-face control step using FuF photographs and combined food group-based data analyses., Setting: 'Bus Santé' risk factor surveillance programme, Geneva/Switzerland., Subjects: Population-based random sample of 639 residents (52 % women, aged 35-74 years) surveyed from September 2003 to April 2004., Results: Local Geneva/French neighbourhood market research identified 148 FuF in five major FuF food groups which were compiled into a functional ingredient database. Prior to the face-to-face verification, 210 (33 %) individuals categorized themselves as FuF consumers, 429 (67 %) as non-consumers. The control step revealed that 70 % of the 639 participants were already familiar with the FuF concept, and thus were correctly self-categorized as FuF consumers or non-consumers. For the remaining 30 % of participants the true FuF consumption status was established, resulting in a final number of 285 FuF consumers (45 %; 12 % net increase) and 354 (55 %) non-consumers., Conclusions: The developed self-administered, brief, qualitative food group-based FuF frequency check list in combination with an FFQ and a photo-assisted control step provides a flexible assessment tool for measuring FuF consumption in the context of a specific fluctuating FuF market and may be applicable to other population settings and times.

Objective: To evaluate the reliability of anthropometric measurements (weight, height, Body Mass Index (BMI), waist and hip circumferences (WC; HC) and waist-to-hip ratio (WHR)) performed by doctors to assess obesity., Method: Repeated anthropometric measurements were performed by 12 primary care physicians on 24 adult volunteers in Geneva, Switzerland, 2006. Volunteers (54% women, mean age 41) had a mean BMI of 28.1 (respective mean values for WC, HC and WHR: 91.4, 108.3, 0.84). Inter-observer reliability coefficient (R) and percent disagreement in categorisation of volunteers (normal weight, overweight, obesity, abdominal obesity) were computed according to these measurements., Results: The inter-observer reliability for weight, height, and derived BMI were excellent (R>0.99), but unsatisfactory for WC (R=0.92), HC (R=0.76) and WHR (R=0.51). Based on the BMI, only 1% of the volunteers were misclassified as overweight or obese, whereas the use of WC and WHR lead to misclassification in 6% and 23% respectively. Reliability for the measurements improved after a one-hour training in anthropometric measurements (R=0.97 for WC, 0.92 for HC and 0.89 for WHR), but the proportion who were misclassified remained high despite the training session for WC (5%) and WHR (9%)., Conclusions: BMI remains the most reliable measure to detect obesity in medical practice, whereas WC, HC and WHR are less reliable. These results challenge current recommendations on obesity-related cardio-vascular risk management based on WC and WHR and underline the need for further research to improve the reliability of anthropometric measurements by doctors.

Objectives: We estimated the amount of physical activity required for individuals to expend an additional 418.4 kJ (100 kcal) per day with the goal of achieving energy balance at the population level., Methods: Data on total daily energy expenditures were derived from a random sample of adults residing in Geneva, Switzerland, who completed a self-administered physical activity frequency questionnaire. These data were used to simulate the effects of typical physical activity pyramid recommendations on average population energy expenditures for various activity intensities and rates of population compliance with pyramid recommendations., Results: If an average 418.4 kJ (100 kcal) per day increase in energy expenditures is to be achieved, assuming 100% compliance with physical activity pyramid recommendations, the bottom tier of the pyramid must correspond to everyday activities performed at moderate to high intensity levels (e.g., moderate walking or biking). Expected population gains in energy expenditures would be only 167.4 to 251.0 kJ (40 to 60 kcal) per day at a 50% compliance rate., Conclusions: Achieving population-level energy balance through increasing energy expenditures with physical activity increases alone would require profound structural and environmental changes promoting more active lifestyles.

Objective: To assess whether the rapid increase in obesity prevalence among persons with higher education levels observed in one U.S. study is also observed in a European adult population., Research Methods and Procedures: This study involved continuous surveillance of the adult population of Geneva, Switzerland (1993 to 2004), with annual random, independent, cross-sectional, representative samples (6635 men and 6558 women, ages 35 to 74 years) and analysis of 12-year trends in obesity prevalence across educational level subgroups., Results: Obesity prevalence in men had an upward trend in the medium education subgroup (p < 0.02), a borderline upward trend in the high education subgroup (p < 0.08), but no trend in the low education subgroup. There was a borderline trend interaction between the male low and medium education subgroups (p < 0.09). Obesity prevalence in women had a borderline increase in the low education subgroup (p < 0.08), an almost borderline increase in the high education subgroup (p = 0.11), but no significant trend in the medium education subgroup. There was no evidence of trend interaction between the female education groups., Discussion: In Geneva, as in the United States, the inverse association between education level and obesity rates has weakened over time among men, but, inconsistent with the U.S. findings, has persisted for women. Explanations may include more physically demanding occupations for men with low education levels and different attitudes toward body image between the sexes.

Food consumption (divided into 10 food groups) as well as energy and main nutrient intake of a Swiss collective (n = 3653) aged 7 years and older was studied. The caloric density was much improved for all five age groups considered as compared with findings in former studies. Carbohydrates gained and alcohol lost significance as main energy suppliers. These results indicate a positive trend in the dietary habits of the collective and suggest an improvement in the dietary habits of the Swiss population as a whole.

From May to November 1991, a dietary survey in form of a 24-h-recall questionnaire was carried out in Zurich. For the first time, food data from a large, voluntary, undefined, selected collective was acquired (n = 3653). The mean dietary fiber intake of the women was 30 g/day and of the men 33 g/day, which is comparable with various literature data. These values show a positive trend in the eating habits of the population. The dietary fiber intake was also considered in relation to the origin of the fibers.