Ultra-processed foods (UPFs) are associated with lower diet quality and several non-communicable diseases. Their consumption varies between countries/regions of the world. We aimed to describe the consumption of UPFs in adults aged 18–75 years living in Switzerland. We analysed data from the national food consumption survey conducted among 2085 participants aged 18 to 75 years. Foods and beverages resulting from two 24-h recalls were classified as UPFs or non-UPFs according to the NOVA classification, categorized into 18 food groups, and linked to the Swiss Food Composition Database. Overall, the median energy intake [P25–P75] from UPFs was 587 kcal/day [364–885] or 28.7% [19.9–38.9] of the total energy intake (TEI). The median intake of UPFs relative to TEI was higher among young participants (<30 years, p = 0.001) and those living in the German-speaking part of Switzerland (p = 0.002). The food groups providing the most ultra-processed calories were confectionary, cakes & biscuits (39.5% of total UPF kcal); meat, fish & eggs (14.9%); cereal products, legumes & potatoes (12.5%), and juices & soft drinks (8.0%). UPFs provided a large proportion of sugars (39.3% of total sugar intake), saturated fatty acids (32.8%), and total fats (31.8%) while providing less than 20% of dietary fibre. Consumption of UPFs accounted for nearly a third of the total calories consumed in Switzerland. Public health strategies to reduce UPF consumption should target sugary foods/beverages and processed meat.

The optimal protein intake for critically ill children remains uncertain. This systematic review aimed to evaluate the effectiveness of high versus lower enteral protein intake, accounting for energy intake, on clinical and nutritional outcomes in children hospitalized in pediatric intensive care units (PICU). Following the JBI methodology, a comprehensive search was conducted across Medline, CINAHL Ultimate, Embase, and Cochrane Library from inception to March 18, 2024. Randomized controlled trials (RCTs) involving critically ill children admitted to PICU for ≥48 h and receiving enteral nutrition were eligible. Studies comparing protein intake of 2 g/kg/day to internationally recommended intakes were included. Two independent reviewers screened, selected, extracted the data, and assessed the risk of bias using the JBI critical appraisal checklist for RCTs; a third reviewer resolved any disagreements. Meta-analyses were performed for nitrogen balance, PICU length of stay, prealbumin and blood urea levels using a random-effects model to account for between-study heterogeneity. Eight RCTs were included, assessing high (n = 6) and low (n = 2) enteral protein intake versus the recommended intake, mostly in infants aged 2-4 months, with bronchiolitis or after cardiac surgery. Four studies presented an unclear risk of bias and four a high risk. High protein intake (∼3 g/kg/day) was associated with significantly higher nitrogen balance values (effect size: 0.59; 95 % CI: 0.18-1.01; p = 0.0055) compared to the recommended intake (∼1.6 g/kg/day) but had no impact on PICU length of stay and was associated with increased blood urea levels. Among four RCTs assessing gastrointestinal tolerance, two reported increased diarrhea or gastric retention. Data on low versus recommended intake were limited to two studies. High enteral protein intake may increase nitrogen balance in this PICU population, but potential adverse effects and the lack of evidence for clinical benefit raise concerns about its safety. Further well-powered RCTs are needed to evaluate the effects of protein doses within the 1-2.2 g/kg/day ranges in more diverse PICU populations. This study protocol was registered in PROSPERO (number: CRD42022315325) and subsequently published in JBI Evidence Synthesis (DOI: 10.11124/JBIES-22-00133).

This cross-sectional study examined the barriers and facilitators that influence vegetarian menu choices in a university cafeteria in Geneva, Switzerland. As a first step, an online survey developed by the authors based on the Capability, Opportunity, and Motivation Behaviour (COM-B) model was e-mailed to all university students and staff. In the second step, focus groups (FG) were held to complete the survey responses and identify what needed to be changed to promote the choice of the vegetarian menu in the cafeteria. Data from 304 participants collected through the survey was analysed. The main mentioned barriers were lack of vegetarian options, tastelessness and insufficient satiation. The facilitators that emerged from the survey were the price of the vegetarian menu for students and health and environmental benefits. Thirteen people participated in four FG sessions, which were analysed using thematic analysis. Five themes were identified: spontaneous menu selection, predefined menu selection, influence of opportunity on menu selection, influence of environmental sensitivity on menu selection, and threat to identity in menu selection. The choice of a vegetarian menu in a university cafeteria was mainly influenced by the attractiveness and taste of the plate. Future strategies to reduce food-related greenhouse gas emissions should (a) ensure the quality and attractiveness of the vegetarian menu, especially to appeal to the more resistant, such as men and omnivores, and (b) inform consumers about the guarantee of balanced nutrient intake of the vegetarian menu offered in the cafeteria, and about health and environmental benefits.

Obesity, defined by a body mass index (BMI) ≥ 30 kg/m², is associated with higher mortality in the general population but shows a complex relationship with chronic diseases and critically illness. The aim of this study was to determine whether BMI predicted 30-day mortality (primary outcome) and intensive care unit (ICU) and hospital lengths of stay (LOS) (secondary outcome) in critically ill patients. This retrospective monocentric study encompassed adult patients admitted to the ICU of the Geneva University Hospitals between January 2010 and December 2022. They were categorized according to their BMI as underweight (<18.5 kg/m²), normal weight (18.5-24.9 kg/m², reference category), overweight (25.0-29.9 kg/m²), obesity class I (30.0-34.9 kg/m²), class II (35.0-39.9) and class III (≥40.0 kg/m²). The association between BMI and outcomes was assessed by multivariate Cox Lasso (Least absolute shrinkage and selection operator) or linear Lasso regression models, adjusted for age, sex, Simplified Acute Physiology Score (SAPS) II, primary diagnosis (ICD-10 codes) and measurement time points. We included 5473 patients (34.2 % women), age 60 ± 17.6 years, SAPS II 49.6 ± 19.9, BMI 26.5 ± 6.0 kg/m², admitted to the ICU mainly for trauma, cardio-vascular and infectious diseases. The 30-day mortality rate was 21.4 % for women and 22.1 % for men. In multivariate analyses, mortality risk, expressed as hazard ratio (HR), was lower in patients with a BMI of 35.0-39.9 kg/m² (HR 0.72, p = 0.020) and higher in those with a BMI <18.5 kg/m² (HR 1.44, p = 0.006) compared to normal weight. BMI categories in the overweight, obesity class I and class II range were all associated with longer ICU and hospital LOS (all p < 0.05). Patients with higher BMI, particularly with class II obesity, show a lower 30-day mortality in ICU settings, but a longer ICU and hospital LOS. This is likely a reflection of the obesity paradox and the complex role of body composition in critical illness outcomes. clinicaltrials.gov, identifier: NCT05834894.

Current diets in Western countries are unsustainable. Reducing meat consumption can benefit both human health and the environment. This study aimed to design and evaluate an intervention to promote vegetarian menu choices in a Swiss university cafeteria, using the Behavior Change Wheel methodology. The intervention was designed based on barriers and facilitators to vegetarian menu choices, which were collected from students and staff in a previous study. Using the COM-B (Capability, Opportunity, Motivation–Behavior) model, we identified key determinants and designed the intervention. The impact of the intervention was evaluated quantitatively by comparing the percentage of vegetarian menus sold to all menus at four measurement points, using the Kruskal–Wallis nonparametric statistical test, and qualitatively with focus groups ( n = 7 participants), using thematic analysis. The intervention focused on enhancing capability and motivation through healthy eating and protein diversity activities in a 1-week stand to address limited knowledge about vegetarian foods while being considerate of those opposed to vegetarianism. Sales data indicated that the intervention was not sufficient to increase purchases, with no significant difference in the proportion of vegetarian menus sold. Focus groups revealed positive feedback on the educational stand, mixed opinions on how pricing affects menu attractiveness, and a preference for “flexitarian” labeling. Future efforts should focus on combining educational approaches with practical strategies, as well as making vegetarian menus more appealing. The use of a theoretical framework was crucial to help us avoid missteps when designing an intervention to promote vegetarian menus in a sensitive context.

Background & Aims: The 24-hour dietary recall is a widely recommended tool in nutrition research. The Automated Self-Administered 24-Hour Dietary Assessment Tool (ASA24) is a free, web-based tool, validated in North America and available in Canadian French. This observational study aimed to assess the acceptability, usability, and reported dietary intake patterns of a self-assessment 24h-recall tool, using ASA24, across different age groups in French-speaking Switzerland. Methods: French-speaking participants with internet access were recruited across different age groups. A preparatory phase included a pre-test of ASA24 and the development of a tutorial video and user guide. In the main study, participants completed ASA24 on two non-consecutive days, answered an online survey including the System Usability Scale (SUS); and a subsample took part in a semi-structured interview. Results: Of 129 interested individuals, 92 were included and 80 (62%) completed the main study. Most were women (n=55, 70%), Swiss nationals (n=64, 80%), and comfortable with technology (n=55, 70%). Mean (±SD) completion time was 35±18 minutes for the first recall and 28±15 for the second, with longer durations among older adults (52±26 and 42±20 minutes). SUS scores averaged 65±17 (acceptable score: 52-73), ranging from 58±24 in older adults to 71±17 in younger adults. Reported challenges included finding local foods, estimating portion sizes in ounces, and understanding the AM/PM time format. Conclusions: ASA24 was well accepted and usable among younger adults, with some limitations observed in the other age groups. With appropriate adaptations to the local context, ASA24 could become a valuable tool for dietary assessment in Switzerland.