Adopting policies that promote health for the entire biosphere (One Health) requires human societies to transition towards a more sustainable food supply as well as to deepen the understanding of the metabolic and health effects of evolving food habits. At the same time, life sciences are experiencing rapid and groundbreaking technological developments, in particular in laboratory analytics and biocomputing, placing nutrition research in an unprecedented position to produce knowledge that can be translated into practice in line with One Health policies. In this dynamic context, nutrition research needs to be strategically organised to respond to these societal expectations. One key element of this strategy is to integrate precision nutrition into epidemiological research. This position article therefore reviews the recent developments in nutrition research and proposes how they could be integrated into cohort studies, with a focus on the Swiss research landscape specifically.

Population monitoring of lifestyle behaviours that are crucial as risk and protective factors for major chronic diseases is vital for the identification of priority areas for public health. In this study, we aimed to investigate the prevalence of adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) cancer prevention recommendations in Switzerland, overall and by selected sociodemographic and lifestyle characteristics. Data from the population-based, cross-sectional survey menuCH were used. We constructed a score reflecting adherence to the 2018 WCRF/AICR cancer prevention recommendations. Multinomial logistic regression models were fitted to investigate the association of sociodemographic and lifestyle characteristics with the level of adherence to the WCRF/AICR cancer prevention recommendations. The least frequently met cancer prevention recommendations were the ones on fibre intake (met by 13·7 %), red and processed meat (25·4 %), and ultra-processed food (33·3 %) consumption, while the recommendation on physical activity was met by almost 80 %. Women and individuals with tertiary education were more likely to have a score of ≥ 5 (as a reflection of adherence to the cancer prevention recommendations), compared with men or those who completed secondary education, respectively. Current smokers were less likely to have a score of ≥ 5, compared with never smokers. A high proportion of the population in Switzerland was found to not adhere closely to the WCRF/AICR cancer prevention recommendations. Differences were detected based on sociodemographic characteristics. Education and policy actions are needed to facilitate the adoption of a cancer-protective lifestyle.

We investigated the associations between dietary patterns and chronic disease mortality in Switzerland using an ecological design and explored their spatial dependence, i.e. the tendency of near locations to present more similar and distant locations to present more different values than randomly expected. Data of the National Nutrition Survey menuCH (n 2057) were used to compute hypothesis- (Alternate Healthy Eating Index (AHEI)) and data-driven dietary patterns. District-level standardised mortality ratios (SMR) were calculated using the Swiss Federal Statistical Office mortality data and linked to dietary data geographically. Quasipoisson regression models were fitted to investigate the associations between dietary patterns and chronic disease mortality; Moran’s I statistics were used to explore spatial dependence. Compared with the first, the fifth AHEI quintile (highest diet quality) was associated with district-level SMR of 0·95 (95 % CI 0·93, 0·97) for CVD, 0·91 (95 % CI 0·88, 0·95) for ischaemic heart disease (IHD), 0·97 (95 % CI 0·95, 0·99) for stroke, 0·99 (95 % CI 0·98, 1·00) for all-cancer, 0·98 (95 % CI 0·96, 0·99) for colorectal cancer and 0·93 (95 % CI 0·89, 0·96) for diabetes. The Swiss traditional and Western-like patterns were associated with significantly higher district-level SMR for CVD, IHD, stroke and diabetes (ranging from 1·02 to 1·08) compared with the Prudent pattern. Significant global and local spatial dependence was identified, with similar results across hypothesis- and data-driven dietary patterns. Our study suggests that dietary patterns partly contribute to the explanation of geographic disparities in chronic disease mortality in Switzerland. Further analyses including spatial components in regression models would allow identifying regions where nutritional interventions are particularly needed.

Processed meat (PM) has an important role in diet of the Swiss population, but increasingly regarded as a food group of concern due to epidemiological evidence for its association with colorectal cancer (CRC) and other chronic diseases. Data on CRC incidence for men and women and by region is available in Switzerland, but cannot be linked with PM intake.

This secondary analysis aimed to describe PM consumption in Switzerland, using data from the National Nutritional Survey menuCH, to investigate associations between PM intake and sociodemographic and lifestyle factors, and to examine CRC incidence in Switzerland for any similar regional patterns to PM consumption.

Intakes of total PM and of categories ham, bacon, sausage and other PM types were described by means and standard errors (SEM). Multiple regression analysis was used to investigate associations between meat intake (total meat and PM, assessed separately, g/1000 kcal) and the following sociodemographic and lifestyle factors: sex, language-speaking region, age-category, nationality, education, gross household income, household status, smoking status, overall health status (self-reported), and currently following a weight-loss diet. Data were weighted for age, sex, marital status, major areas of Switzerland, nationality and household size, and for consumption data, also season and weekday.

Results show PM was consumed by approximately 70% of the population with mean total intake of 42.7 (SEM 1.2 g/d). Sausage intake was highest with 16.8 g/day, followed by ham, other PM and bacon, 12.4, 10.6, and 2.0 g/day, respectively. Sex was significantly associated with total meat and PM intake; women consumed 10.1 g/1000 kcal less total meat [95% CI: -13.60; -6.64], and 4.70 g /1000 kcal less PM [95% CI: -6.73; -2.68] than men. For both variables, total meat and PM intake, positive associations were observed for overweight, obesity and current smoking; and negative associations observed for tertiary education and following a diet. The later was significant only for PM intake. The ecological data for CRC incidence revealed much higher rates for men than women, over 24 years; but the data shown by language region did not reveal any particular pattern.

This study is the first to describe intakes of total and different PM types, based on national representative data. Positive associations between PM intake and smoking and obesity merit careful monitoring. More regular data collection by methods enabling separate quantification of meat and PM, as well as relevant health biomarkers are needed in future studies.

Today's high interest for no- or low-meat diets is driven by evidence-based associations between high meat consumption and unhealthy lifestyle factors as well as increased risk of various chronic diseases. This study aims to characterize no-, low- and high-meat consumers and describe their protein intake using data from the Swiss nutrition survey menuCH.This first national survey assessed descriptive factors by a questionnaire and dietary intake by 24-hour dietary recall (24 HDR) across all three linguistic regions, German, French and Italian of Switzerland (N = 2057). Data from the questionnaire (food avoidance) and two 24 HDRs were used to categorize total participants (N) into four subgroups: no meat (4.4%); low (15%), medium (65.6%), or high-meat eaters (15%), based on meat-energy contributions of 0; 0–2.4; 2.4–18.7; 18.7–48.4, respectively. Contributions of overall macronutrients and protein from the different food groups were described for each subgroup to identify quantitative and qualitative differences. Multinomial logistic regression analysis was applied to predict the probability of belonging to one of the four subgroups according to the following sociodemographic and behavioral variables: sex, language region, age, nationality, marital status, education, gross household income, BMI, physical activity, smoking, dietary supplements and overall health status. The subgroups differed in protein intake with 11.5%, 12.8%, 15.4% and 19.1% of total energy intake for no-, low-,medium- and high-meat diets, respectively, weighted for sampling design, non-response, weekdays and season. In general, no- and low-meat consumers included a greater variety of foods contributing to protein intake than meat consumers, including more dairy products and meat-alternatives. None of the subgroups met the Swiss Food-based Dietary Guidelines of three portions of dairy products per day. The regression analysis showed that sex, taking dietary supplements or not and BMI were important determinants of the subgroups: women had a higher predicted probability than men to be no- and low-meat eaters and for these same subgroups, individuals showed higher probabilities for taking dietary supplements. Overweight and obese participants showed higher probabilities to be high-meat eaters.

These findings show considerable differences in protein intake and in variety of protein-food selections, between extremes of meat intake (no- to high meat consumption). Future surveys should include frequency methods to allow conclusions about habitual meat intake or avoidance and health status screening to analyse individuals health data.

Vitamin D deficiency during pregnancy is associated with negative health consequences for mothers and their infants. Data on the vitamin D status of pregnant women in Switzerland are scarce. A three-centre study was conducted in the obstetric departments of Zurich, Bellinzona and Samedan (Switzerland) to investigate the prevalence and determinants of vitamin D deficiency (serum 25-hydroxyvitamin D (25(OH)D)<50 nmol/l) in 3rd-trimester pregnant women living in Switzerland (n 305), and the correlation between 25(OH)D in pregnant women and their offspring at birth (n 278). Demographic and questionnaire data were used to explore the determinants of vitamin D deficiency. Median concentration of serum 25(OH)D in the third trimester of pregnancy was 46·0 nmol/l (1st–3rd quartiles: 30·5–68·5), representing a 53·4 % prevalence of vitamin D deficiency. 25(OH)D levels in the umbilcal cord blood (median: 50·0 nmol/l; 1st–3rd quartiles: 31·0–76·6) strongly correlated with mothers’ serum 25(OH)D (Spearman’s correlation ρ=0·79, P<0·001). Multivariable logistic regression analysis showed that significant determinants of vitamin D deficiency in pregnant women were centre of study, country of origin, season of delivery and vitamin D supplement intake. Near-term BMI, skin colour, use of sunscreen and mothers’ education, although each not individually significant, collectively improved the ability of the model to explain vitamin D status. Low vitamin D levels were common in this sample of pregnant women and their newborns’ cord blood. Vitamin D supplement intake was the most actionable determinant of vitamin D status, suggesting that vitamin D supplementation during pregnancy should receive more attention in clinical practice.

Dietary intervention may alter the insulin-like growth factor (IGF) system and thereby cancer risk. In a qualitative review, eleven of twenty studies showed a link between one or more carotenoids, vegetable or fruit intake and the IGF system, however, with partly contrary findings, such that no firm conclusion can be drawn. Therefore, we evaluated associations between serum carotenoid concentrations or the intake of fruits and vegetables with IGF-1, IGF binding protein (BP)-3 and their molar ratio (IGF-1:IGFBP-3) within the Third National Health and Nutrition Examination Survey (NHANES III, 1988–1994). In our analysis, we included 6061 NHANES III participants and used multivariable-adjusted linear regression models. IGF-1 concentrations were significantly positively associated with serum concentrations of lycopene, β-carotene, α-carotene, β-cryptoxanthin and lutein/zeaxanthin in men and women. Statistically significant positive associations were observed for serum concentrations of α-carotene and lutein/zeaxanthin and intake of fruits with serum IGFBP-3 concentrations in women, but not in men. The IGF-1:IGFBP-3 molar ratio was significantly positively associated with serum concentrations of lycopene, β-carotene and α-carotene in men and with β-carotene in women. In conclusion, dietary interventions with carotenoids, fruits and vegetables may affect the IGF system, although the direction of these effects is currently unclear.

Meat is a food rich in protein, minerals such as iron and zinc as well as a variety of vitamins, in particular B vitamins. However, the content of cholesterol and saturated fat is higher than in some other food groups. Processed meat is defined as products usually made of red meat that are cured, salted or smoked (e.g. ham or bacon) in order to improve the durability of the food and/or to improve colour and taste, and often contain a high amount of minced fatty tissue (e.g. sausages). Hence, high consumption of processed foods may lead to an increased intake of saturated fats, cholesterol, salt, nitrite, haem iron, polycyclic aromatic hydrocarbons, and, depending upon the chosen food preparation method, also heterocyclic amines. Several large cohort studies have shown that a high consumption of processed (red) meat is related to increased overall and cause-specific mortality. A meta-analysis of nine cohort studies observed a higher mortality among high consumers of processed red meat (relative risk (RR) = 1·23; 95 % CI 1·17, 1·28, top v. bottom consumption category), but not unprocessed red meat (RR = 1·10; 95 % CI 0·98, 1·22). Similar associations were reported in a second meta-analysis. All studies argue that plausible mechanisms are available linking processed meat consumption and risk of chronic diseases such as CVD, diabetes mellitus or some types of cancer. However, the results of meta-analyses do show some degree of heterogeneity between studies, and it has to be taken into account that individuals with low red or processed meat consumption tend to have a healthier lifestyle in general. Hence, substantial residual confounding cannot be excluded. Information from other types of studies in man is needed to support a causal role of processed meat in the aetiology of chronic diseases, e.g. studies using the Mendelian randomisation approach.

Cross-sectional studies suggest that dietary supplement use is associated with favourable demographic and lifestyle factors and certain health conditions. However, factors that affect the consistency of supplement use have not been investigated in prospective cohort studies. The aim of the present study was to seek baseline demographic, lifestyle and health-status predictors of subsequent consistent vitamin and/or mineral supplement use. A total of 8968 men and 10 672 women of the European Prospective Investigation into Cancer and Nutrition (EPIC)-Heidelberg cohort, who answered the supplement-use questions in the baseline survey and two follow-up surveys, were categorised into three groups: consistent, inconsistent and never users. At baseline, 28·5 % of men and 38·6 % of women reported vitamin and/or mineral supplement use. After a median follow-up of 8·5 years, 14·6 % of men and 22·9 % of women were consistent users. During follow-up, 36·0 % of male and 26·6 % of female initial users stopped supplement use, whereas 27·8 % of male and 39·4 % of female initial non-users started supplement use. Women were more likely to be consistent users than men. Older age ( ≥ 50 years), lower BMI ( < 25 kg/m2) and self-reported hyperlipidaemia were common predictors of consistent use for both sexes. Additional predictors included higher educational level for men, and being more physically active and higher lifetime alcohol consumption for women. Consistent users had the highest intake of dairy products, fish, fruits and vegetables, and wine but the lowest intake of total meat. We concluded that supplement use is a fairly unstable behaviour in free-living individuals. Individuals with a favourable lifestyle and healthier diet are more likely to show consistent supplementation.

It was the aim of the present study to estimate the intake of heterocyclic aromatic amines (HCA) from meat, which have been associated with cancer risk in several epidemiological studies, of 21 462 subjects who participated in the European Prospective Investigation into Cancer and Nutrition (EPIC) in Heidelberg. This was accomplished by using a detailed dietary questionnaire that assessed meat consumption, cooking methods, and degree of browning of the respective food items. Median total HCA intake from meat was 31 ng/d (mean 69 ng/d), which was lower than results observed in previous studies. 2-Amino-1-methyl-6-phenylimidazo[4,5b]pyridine was the most common HCA in this cohort (median 17; mean 48 ng/d). The present study offers the opportunity of a detailed examination of the associations between meat cooking as well as HCA intake from meat and cancer risk in a prospective way.

Within a prospective cohort study, we explored the long-term reproducibility of the food-frequency questionnaire (FFQ) and dietary changes in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Heidelberg cohort. After a mean follow-up time of 68·8 (sd 4·1) months the dietary assessment by means of a validated FFQ was repeated in 21 462 participants in the EPIC-Heidelberg cohort. The correlation and test–retest reproducibility of both dietary intake measurements was explored. The long-term correlation coefficients ranged from 0·41 (vegetables in men) to 0·77 (alcoholic beverage consumption in women). The median intake of potatoes, added fat, sugar/confectionary, cakes and alcoholic beverages was lower in the second than in the first FFQ, whereas the median intake of fruits, vegetables, cereals/cereal products and non-alcoholic beverages were higher. Consistently for food groups, 60–70 % of the participants in both genders were re-classified to the same or adjacent quintile of intake. The results of fairly high correlation coefficients indicate good agreement between both measurements. It is acknowledged that this result reflects to a substantial extent the measurement error of the FFQ and conclusions on real changes in the diet should be drawn very carefully. For some nutrients the dietary changes were consistent with results from independent national surveys. The performance of the FFQ gives confidence in the dietary data to be used as long-term exposure variables.

Tree nuts, peanuts and seeds are nutrient dense foods whose intake has been shown to be associated with reduced risk of some chronic diseases. They are regularly consumed in European diets either as whole, in spreads or from hidden sources (e.g. commercial products). However, little is known about their intake profiles or differences in consumption between European countries or geographic regions. The objective of this study was to analyse the population mean intake and average portion sizes in subjects reporting intake of nuts and seeds consumed as whole, derived from hidden sources or from spreads. Data was obtained from standardised 24-hour dietary recalls collected from 36 994 subjects in 10 different countries that are part of the European Prospective Investigation into Cancer and Nutrition (EPIC). Overall, for nuts and seeds consumed as whole, the percentage of subjects reporting intake on the day of the recall was: tree nuts = 4·4%, peanuts = 2·3% and seeds = 1·3%. The data show a clear northern (Sweden: mean intake = 0·15 g/d, average portion size = 15·1 g/d) to southern (Spain: mean intake = 2·99 g/d, average portion size = 34·7 g/d) European gradient of whole tree nut intake. The three most popular tree nuts were walnuts, almonds and hazelnuts, respectively. In general, tree nuts were more widely consumed than peanuts or seeds. In subjects reporting intake, men consumed a significantly higher average portion size of tree nuts (28·5 v. 23·1 g/d, P<0·01) and peanuts (46·1 v. 35·1 g/d, P<0·01) per day than women. These data may be useful in devising research initiatives and health policy strategies based on the intake of this food group.