Associations between liver enzymes or De Ritis ratio (DRR; aspartate aminotransferase (AST)/alanine aminotransferase (ALT)) and mortality stratified by non-alcoholic fatty liver disease (NAFLD), which have rarely been analyzed in previous studies, were investigated using the National Health and Nutrition Examination Survey (NHANES) III (1988–1994). Participants without risk factors for liver diseases other than NAFLD were linked with National Death Index records through 2019 (n = 11,385) and divided into two cohorts with or without NAFLD, based on ultrasound examination. Liver enzyme concentrations were categorized into sex-specific deciles and subsequently grouped (AST and ALT: 1–3, 4–9, 10; gamma glutamyltransferase (GGT): 1–8, 9–10). DRR was categorized into tertiles. Cox proportional hazards regression models adjusted for confounders were fitted to estimate associations with mortality. Compared with low levels, high GGT and DRR in participants with and without NAFLD had significantly higher hazard ratios for all-cause mortality. Compared with intermediate concentrations, low ALT showed higher all-cause mortality in participants with and without NAFLD, whereas low AST had higher HR in participants without NAFLD and high AST in those with NAFLD. Mortality was associated with liver enzymes or DRR in participants both with and without NAFLD, indicating that the relationship is not mediated solely by hepatocellular damage.

Among people infected with SARS-CoV-2, the determination of clinical features associated with poor outcome is essential to identify those at high risk of deterioration. Here, we aimed to investigate clinical phenotypes of patients hospitalized due to COVID-19 and to examine the predictive value of the neutrophil-to-lymphocyte ratio (NLR) in a representative patient collective of the Swiss population. We conducted a retrospective monocentriccohort study with patients hospitalized due to COVID-19 between 27 February and 31 December 2020. Data were analyzed descriptively, using the binary logistic regression model, proportional odds logistic regression model, competing risk analysis, and summary measure analysis. A total of 454 patients were included in our study. Dyspnea, elevated respiratory rate, low oxygen saturation at baseline, age, and presence of multiple comorbidities were associated with a more severe course of the disease. A high NLR at baseline was significantly associated with disease severity, unfavorable outcome, and mortality. In non-survivors, NLR further increased during hospital stay, whereas in survivors, NLR decreased. In conclusion, our data emphasize the importance of accurate history taking and clinical examination upon admission and confirm the role of baseline NLR as a surrogate marker for increased disease severity, unfavorable outcome, and mortality in patients hospitalized due to infection with SARS-CoV-2.

Background/Objectives: This study aims to investigate differences in cancer diagnosis based on absolute case numbers and age-standardized incidence rate ratios (IRRs) in the pre-Coronavirus disease 2019 (COVID-19) years (2018/19) and the first two years of the COVID-19 pandemic (2020, 2021) in two Swiss cantons. Methods: Data of the Swiss cantonal cancer registry of the cantons of Zurich (ZH) and Zug (ZG) were used to descriptively investigate differences in annual and monthly absolute numbers regarding all-cancer and the five most common cancer types. Directly age-standardized monthly incidence rates (IRs) were calculated. Multivariate Quasipoisson regression models were fitted to determine the IRRs with 95% confidence intervals (95% CI). Results: Annual absolute numbers of all investigated cancers were similar in 2018/19, 2020, and 2021, except for prostate cancer (increase of 20.8% in 2021 compared to 2018/19). In 2020, there were generally more cancer diagnoses in January and February followed by a decrease in April and May. Compared to the pre-COVID-19 period, lower IRs were observed in 2020 for all-cancer (IRR = 0.96 [95% CI 0.96, 0.97]) and female breast cancer (0.92 [0.89, 0.96]), whereas higher IRs were observed in 2021 for all-cancer (1.02 [1.02, 1.02]) and prostate cancer (1.23 [1.18, 1.28]). Conclusions: Cancer detection and diagnoses decreased during the first year of the pandemic, especially during the most stringent lockdown phase in April. The findings of this study may inform the decisions of policymakers and public health system during future pandemics.

BACKGROUND: The COVID-19 pandemic disrupted healthcare systems worldwide. This raised concerns about delays in cancer diagnosis and treatment, with potentially worse patient outcomes. The aim of this nationwide, population-based cohort study was to investigate the impact of the COVID-19 pandemic on cancer incidence, stage distribution and one-year survival in Switzerland. METHODS: We used national cancer registry data for the period 2017–2021 from the National Agency for Cancer Registration in Switzerland, covering all except three cantons. We estimated national cancer incidence counts and calculated age-standardised incidence rates for all cancers and separately for female breast cancer, colorectal cancer, lung cancer, melanoma and prostate cancer. We calculated proportional stage distributions for cancer types and estimated observed and relative one-year survival for all cancers and cancer types based on Swiss population life tables. Results were analysed descriptively. RESULTS: We included 218,736 cancer cases diagnosed between 2017 and 2021. Annual incidence counts of all cancer cases increased in 2020 (2.1%) and 2021 (7.3%) compared to the mean of 2017–2019. When evaluating monthly incidence counts, we observed a substantial decrease during the COVID-19 lockdown period, which was largest in April 2020 (−19.9% for all cancers). This decrease was most pronounced for female breast cancer (−39.9%), followed by prostate cancer (−29.0%), colorectal cancer (−28.7%) and melanoma (−26.9%). An increase in incidence counts for all cancers was observed in March 2021 (18.8%). We observed no clear shift in stage distributions across 2017–2021. The observed and relative one-year survival for all cancers and individual cancer types was similar in 2020 and slightly higher in 2021 compared to 2017–2019. CONCLUSIONS: This nationwide study suggests that the pandemic had no major effect on short-term cancer patient outcomes. These findings are of importance for policymakers and the public health system regarding future pandemics.

Purpose: Swiss healthcare institutions conducted only urgent procedures during the COVID-19 lockdown, potentially leading to a lack of care for other severe diseases, such as cancer. We examined the effects of the pandemic on cancer stage distribution and time between cancer diagnosis and treatment initiation using population-based cancer registry data. Methods: The study was based on data of the cancer registry of the cantons of Zurich and Zug from 2018 to 2021. Cancer stage distribution was analysed descriptively and with a Pearson’s Chi-squared test. Time between cancer diagnosis and treatment initiation was determined in days and analysed descriptively and by fitting Quasipoisson regression models. Results: For all-cancer and colorectal, lung, and prostate cancer statistically significant evidence for a difference in cancer stages distribution among the incidence years was observed. Based on the all-cancer regression models, longer time to treatment initiation (TTI) was observed for patients diagnosed in 2021 and receiving surgery (Rate Ratio = 1.08 [95% confidence interval 1.03, 1.14]) or hormone therapy (1.20 [1.03, 1.40]) compared to those diagnosed in 2018/19 receiving those therapies. We observed no difference in TTI between cancer patients diagnosed in 2020 compared to 2018/19 for any of the therapies investigated, except for chemotherapy with shorter TTI (0.92 [0.86, 0.98]). Conclusion: The observed effects on cancer outcomes in 2020 and 2021 compared to 2018/19 coincided with the beginning of the COVID-19 pandemic in Switzerland in 2020 onwards. Short- and long-term effects of the pandemic on cancer outcomes and the public healthcare system were observed. However, we cannot exclude that the implementation of the new Swiss law on cancer registration in 2020 explains part of our observations.

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