The CoLaus study: a population-based study to investigate the epidemiology and genetic determinants of cardiovascular risk factors and metabolic syndrome

Prevalence and clinical significance of comorbid insomnia and sleep apnea (COMISA) in three population-based cohorts from Benin, Switzerland and India

INTRODUCTION

COMISA is defined as a comorbid condition comprising insomnia and obstructive sleep apnea (OSA). This study aims to assess the prevalence of COMISA and its association with cardiovascular risk factors within three population-based cohorts from Benin (BeSAS, n = 1733), Switzerland (HypnoLaus, n = 1999), and India (BLESS, n = 958).

METHODS

OSA was assessed by nocturnal recordings, while the presence of insomnia symptoms was assessed by questionnaires in the three cohorts. Adjusted logistic regression models were employed to assess the associations of COMISA with hypertension, diabetes and metabolic syndrome. These associations were also examined using different COMISA definitions based on insomnia subtypes (initiation difficulties and early morning awakenings/maintenance difficulties).

RESULTS

The crude prevalence of COMISA was 11.4 % in HypnoLaus, 9.1 % in BLESS and 1.7 % in BeSAS. In HypnoLaus, COMISA showed a trend towards an association with hypertension (OR: 1.34, p = 0.09) and metabolic syndrome (OR: 1.37, p = 0.09), which was statistically significant when insomnia was defined by sleep initiation difficulties. In BLESS, COMISA was significantly associated with both hypertension (OR: 3.30, p < 0.001) and metabolic syndrome (OR: 1.1.71, p = 0.008). No significant associations were observed in BeSAS.

CONCLUSION

COMISA has a high prevalence worldwide and may be associated with hypertension and metabolic syndrome.

First episode depression during the perinatal period is associated with atopic diseases and persistently increased eosinophil and basophil levels

PURPOSE

A previous diagnosis of depression is a strong predictor for perinatal depression, apart from other mental disorders, stress, and atopies. It is less clear which factors interfere if perinatal depression occurs as a first depression episode (fePND).

METHODS

We examined the associations with atopies and related blood parameters using data of CoLaus|PsyCoLaus.

RESULTS

Newly occurring depression during the perinatal period but not recurrent depression was associated with a lifetime diagnosis of allergies and asthma together with persistently increased levels of basophils and eosinophils.

CONCLUSION

The results imply that immune function may play a relevant role in the risk of a fePND. If confirmed and detailed, these findings could serve as the basis for designing preliminary prevention strategies by observing eosinophil and basophil levels as well as symptoms of atopic diseases before/during pregnancy.

Prediction of 10-Year Fragility Fractures Using Muscle Health Indicators in Postmenopausal Women: The OsteoLaus Cohort

BACKGROUND

Muscle strength, mass and function have been associated with falls, fractures and mortality, but the results vary between previous studies. We aimed to investigate the predictive ability of muscle strength and mass with 10-year incident fragility fractures.

METHODS

This study included 1475 postmenopausal women aged 50-80 years (OsteoLaus cohort, Lausanne, Switzerland). Handgrip strength (HGS) was assessed. With a Jamar dynamometer and lean mass (LM) with dual x-ray absorptiometers (DXA) every 2.5 years for 10 years. LM, appendicular lean mass (ALM) and their indexes were assessed following the International Society for Clinical Densitometry (ISCD) guidelines. Main outcomes included hip, humerus and forearm low-trauma fractures from in-person interviews and vertebral fracture (VF) from lateral DXA screening. Secondary outcomes included falls and death. Baseline values were compared using two-sided t-test or Wilcoxon test (p < 0.0029 based on Bonferroni). Multivariate analysis included time to fracture with accelerated failure time (AFT) model and odds ratio (OR) with logistic regression, 95% confidence interval (CI) and C-Index or AUC.

RESULTS

After 10.2 ± 0.4 years of follow-up, 944 women remained enrolled (age 73.0 ± 6.9 years, BMI 25.7 ± 4.8 kg/m2, ALM 16.8 ± 2.5 kg, HGS 21.2 ± 5.5 kg), of whom 260 fractured (174 VF, 107 non-VF), 863 fell and 74 died. Participants with an incident fragility fracture had a 1.5-kg lower HGS at baseline but no significant difference in their ALM, ALM/height2 and ALM/BMI compared to nonfractured participants. In the multivariable models, one SD increase in ALM (+2.58 kg) was associated with a 0.72 (CI:0.61-0.85) and 0.67 (CI:0.55-0.82) shorter time to major osteoporotic fractures (MOF) and VF. While ALM/BMI was associated with a 1.26 (CI:1.01-1.59) and 1.98 (CI:1.21-3.25) longer time to MOF and non-VF. One SD increase in HGS was associated with a 1.37 (CI:1.03-1.81) longer time to non-VF only. A careful consideration of body weight and fat mass is needed in the association of lean mass with fractures. Baseline muscle parameters were not different for participant with or without incident fall or death.

CONCLUSIONS

Lean mass and grip strength appear as independent risk factors for incident MOF, but with limited additional prediction performance. The prediction of fragility fractures differs between the fracture sites. Further studies with larger sample size, other muscle assessment modalities considering weight or fat mass as covariate, and broader ethnicities are needed.

Vitamin-mineral supplements and cognition among adults aged 65 and older: multiple cross-sectional population-based studies

PURPOSE

Many people consume vitamin-mineral supplements (VMS), to prevent cognitive decline or enhance cognition. We assessed the association between VMS intake and cognition.

METHODS

Data from three follow-ups of the population-based CoLaus|PsyColaus cohort. Participants aged ≥ 65 years were included and categorized as VMS consumers or non-consumers. Cognitive tests included the Mini-Mental State Examination (MMSE), Stroop colour test, the CERAD praxis items, lexical and semantic fluency tasks, and the Grober and Buschke episodic memory test.

RESULTS

There were 925 (64.5% women), 836 (41.1%), and 516 (29.4%) participants from the first (2009-2013), second (2014-2018) and third (2019-2021) follow-ups, respectively. After multivariable adjustment, no significant differences were found between VMS non-consumers and consumers regarding almost all cognitive tests. The multivariable-adjusted mean ± SEM of MMSE for VMS non-consumers vs. consumers were 29.27 ± 0.06 vs. 29.28 ± 0.09, 29.21 ± 0.06 vs. 29.28 ± 0.07 and 29.32 ± 0.08 vs. 29.21 ± 0.09 for the first, second, and third follow-ups, all p > 0.05. The exceptions were Stroop C, where non-consumers had a statistically better but clinically irrelevant performance than consumers at the third follow-up: effect size 0.30 (0.01; 0.58) p = 0.042 and the Grober and Buschke test in the first follow-up, where VMS consumers scored better than non-consumers in free recall: 9.11 ± 0.15 vs. 8.55 ± 0.10 (p = 0.003), with opposite findings in cued recall: 5.99 ± 0.14 vs. 6.48 ± 0.09 (p = 0.004).

CONCLUSION

We found no clinically significant association between VMS use and cognitive performance.

White coat and masked effects depend on blood pressure level and time of blood pressure measurement

Background

A total of 24 h ambulatory blood pressure monitoring (ABPM) offers enhanced accuracy for evaluating true blood pressure and associated risks compared to office blood pressure (OBP). However, conflicting results have been reported in studies comparing the two settings, largely due to the statistical bias introduced by the mean difference calculation using the Bland and Altman method, especially if the inherent circadian variation of blood pressure is not considered. This study aimed to assess the difference between OBP and ABPM using a refined statistical approach while accounting for circadian variations at different blood pressure levels.

Methods

Multilevel/mixed-effects harmonic regression models were employed to estimate mean 24 h systolic and diastolic blood pressure profiles. The bias plot method, with ABPM as the reference, was used to calculate the OBP- daytime ABPM difference.

Results

A total of 647 participants were included with a median of 63 measurements per individual, with most OBP measurements conducted between 8 a.m. and 10 a.m. Analysis showed individual average systolic OBP-ABPM differences ranging from +10 to -30 mmHg and diastolic differences ranging from +20 to -60 mmHg. As ABPM values increase, the patients tend to exhibit a masked effect. Normotensive individuals on ABPM exhibited a white coat effect phenotype, with systolic OBP-ABPM differences ranging from +6 to +9 mmHg. Conversely, hypertensive patients displayed a modest white coat effect for those at the lower hypertension limit and a pronounced masked effect for those at higher hypertension levels. The reduced circadian blood pressure variation observed in hypertensive patients, characterized by a nadir shift to later in the day, contributed to this divergence.

Conclusion

Differences between OBP and ABPM depend on mean ABPM blood pressure levels. OBP tends to overestimate in normotensive and underestimate in hypertensive patients. Differences in circadian variation between these groups contribute to the variance.

The relationship between obesity and obstructive sleep apnea in four community-based cohorts: an individual participant data meta-analysis of 12,860 adults

Background

Obesity is a well-established risk factor for obstructive sleep apnea (OSA). We assessed the reciprocal prevalence of obesity and OSA and how it varies by age and sex.

Methods

Following a systematic review through March 27, 2025, the final sample included four community-based cohort studies in the US and Switzerland. OSA severity was quantified using the apnea-hypopnea index (AHI, all apneas plus hypopneas with ≥4% oxygen desaturation/hour). Random effects individual participant data (IPD) meta-analyses estimated prevalences. Logistic regression compared odds of OSA across weight groups.

Findings

Among 12,860 adults (mean ± SD age: 66.6 ± 7.3 years), 7222 (56.2%) had OSA (AHI ≥5 events/h) and 3309 (25.7%) had obesity (BMI ≥30 kg/m2). IPD meta-analysis showed 31.5% [95% CI: 16.8-48.5] of individuals with OSA had obesity and 44.4% [36.5-52.5] had overweight status (25 ≤ BMI < 30). Among subgroups of individuals with obesity and overweight, 74.3% [63.8-83.5] and 59.8% [46.5-75.7] had any OSA, respectively. Obesity was higher in females than males with OSA, and in younger (<65 years) vs. older individuals. Odds ratios for OSA in subgroups of individuals with overweight and obesity compared to BMI <25 kg/m2 were 2.18 [1.73-2.76] and 4.84 [3.09-6.00], respectively.

Interpretation

Our analyses show that most adults with OSA do not have obesity, with 44.4% having overweight and 23.5% having normal weight or underweight. Obesity was more prevalent among females compared to males and in younger individuals (<65 years) compared to older individuals with OSA. Recognizing OSA is not exclusive to obesity highlights the need for personalized treatment plans.

Funding

American Academy of Sleep Medicine, National Heart, Lung, and Blood Institute, and Apnimed.

Circulating Levels of Branched-Chain Amino Acids Are Associated with Diet: A Cross-Sectional Analysis

Background: Higher circulating branched-chain amino acids (BCAAs) are linked to cardiometabolic and neurological diseases. While diet is the primary BCAA source, its impact on circulating levels remains unclear. This study examined the association between dietary intake and circulating BCAA concentrations in a large population-based sample. Methods: Data from 2159 participants (58.2% women, mean age 53.4 ± 8.6 years) were analyzed. Dietary intake was assessed using a questionnaire covering 91 individual food items, 9 nutrient categories, and 3 dietary patterns. BCAA concentrations were measured via LC-MS. All analyses were stratified by gender. Results: Circulating BCAA levels were higher in men than in women. BCAA levels were negatively associated with vegetables (standardized β = -0.029, p = 0.088; -0.051, p = 0.003; -0.038, p = 0.043 for leucine, isoleucine, and valine, respectively), dairy (-0.037, p = 0.029; -0.063, p < 0.001; -0.041, p = 0.028), and fruit (-0.031, p = 0.084; -0.039, p = 0.030; -0.041, p = 0.034), and a positive trend was observed for meat and meat-derived products, but the associations did not reach statistical significance. Vegetal protein, total carbohydrates, and monosaccharides showed a significant negative association with circulating BCAAs levels. Participants who complied with "dairy ≥ 3/day", "meat ≤ 5/week", or "at least three guidelines" had lower circulating BCAA levels. Conclusions: Circulating BCAA levels were negatively associated with dairy, vegetables, fruits, plant protein, carbohydrates, non-digestible fiber, calcium, and iron. While circulating BCAA levels were linked to meat consumption and adherence to dietary guidelines, the association was not linear. Differences were observed between men and women, which may be attributed to variations in dietary intake and preferences.

Urinary Copper Is Associated with Dyslipidemia, and This Association Is Mediated by Inflammation

Dyslipidemia is an important public health issue. Copper may influence lipid metabolism, possibly via inflammation, but the mechanisms remain unclear. This study aimed to assess the association between urinary copper concentrations and blood lipids (total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG)), and the possible mediating role of inflammation, assessed via high-sensitivity C-reactive protein (hs-CRP). We conducted a cross-sectional, population-based study using baseline data from Switzerland's CoLaus|PsyCoLaus cohort. Urinary copper was measured from spot urine using inductively coupled plasma mass spectrometry and adjusted for creatinine. Lipid markers and hs-CRP were measured using standardized biochemical assays. Multiple linear regression assessed associations, and mediation effects were evaluated using the SGmediation2 package. A total of 6284 adults (mean age 52.6 years, 53.4% female) were included. Urinary copper was positively associated with TG (beta=0.08, 95%CI 0.04, 0.12) and negatively associated with HDL-C (- 0.04, 95%CI - 0.07, - 0.003). Additionally, urinary copper was positively associated with hs-CRP (0.51, 95%CI 0.42, 0.60), which in turn was positively associated with TG (0.05, 95%CI 0.04, 0.06) and negatively associated with HDL-C (- 0.04, 95%CI - 0.05, - 0.03). Mediation analysis revealed that urinary copper exerts partial indirect effects on TG (mediation effect 31.4%) and HDL-C (56.9%) through hs-CRP. hs-CRP partially mediated the associations between urinary copper and HDL-C and TG, with a robust effect for TG but statistical uncertainty for HDL-C. No mediation was observed for TC or LDL-C. These findings suggest hs-CRP's role in lipid metabolism, especially in TG regulation.

Cortisol and 10-Year Cognitive Decline in Older People From the General Population

OBJECTIVE

The present study examined bidirectional effects between salivary cortisol and cognitive functioning over time. Furthermore, the role of the APOE-ɛ4 allele as a moderator of the associations was investigated.

METHODS

Using a prospective population-based study, we analyzed data from 752 older adults followed up over 10 years. A random-intercept Cross-Lagged Panel Model was applied to each combination of one cortisol measure (at waking time, 30 min after waking, 11 am, 8 pm, cortisol awakening response, total daily output, and diurnal slope) and one cognitive measure (primary outcome: Clinical Dementia Rating Scale sum of boxes score, CDR-SB; secondary outcome: Mini-Mental State Examination) resulting in 14 (7 × 2) models.

RESULTS

Between-person effects pointed out that a higher cortisol level at 11 am was associated with increased CDR-SB scores, and a higher cortisol awakening response was associated with decreased CDR-SB scores. Within-person effects indicated that cortisol levels at 11 am and 8 pm, and total daily cortisol output were associated with subsequent lower CDR-SB scores. The APOE-ɛ4 allele did not moderate the relationship between cortisol and cognitive functioning.

CONCLUSIONS

Our findings revealed within-person associations between higher cortisol levels and better cognitive functioning at the subsequent follow-up, suggesting cortisol protective effects for cognitive decline.

Longitudinal association of exposure to work-related stress with major depressive disorder and the role of occupational burnout in this association in the general population

PURPOSE

To prospectively assess (1) the associations of Effort-Reward Imbalance (ERI), its individual components, and over-commitment with (a) the onset of a Major Depressive Episode (MDE) during a 3.6-year follow-up in a population-based cohort in participants with no current Major Depressive Disorder (MDD) in the beginning of the follow-up (n = 959), (b) incidence of MDD in the subsample of participants exempt from lifetime MDD (n = 490), and (c) the onset of a new MDE (i.e. recurrence) in the subsample of participants with remitted but no current MDD (n = 485), and (2) potential effect modification of burnout on these associations.

METHODS

DSM-IV Axis-I disorders were elicited using the semi-structured Diagnostic Instrument for Genetic Studies at each investigation. The ERI Questionnaire was used to measure ERI and overcommitment. Burnout was measured with the Maslach Burnout Inventory General Survey. Serially adjusted logistic regression models were used. The effect of burnout dimensions on these associations was assessed by testing interactions between the ERI and burnout dimensions.

RESULTS

(1) ERI was prospectively associated with the onset of MDE, even after adjustment for burnout [OR (95CI) = 1.22 (1.003-1.49)]. (2) The association between ERI and MDD incidence became non-significant after adjusting for burnout. (3) ERI was not associated with recurrence of pre-existing MDD. (4) burnout did not interact with ERI.

CONCLUSIONS

Our results support a longitudinal association between ERI and the risk of onset of MDE in the community. Burnout did not modify this effect, but it may partially account for the association between ERI and MDD incidence.

Vitamin and mineral supplements and fatigue: a prospective study

PURPOSE

The consumption of vitamin/mineral supplements (VMS) and vitamin/mineral and/or dietary supplements (VMDS) is popular among the general population. However, the association of VMS/VMDS with fatigue remains sparse and conclusions are mixed. We aimed to understand the association between VMS/VMDS and fatigue.

METHODS

Prospective study in the city of Lausanne, Switzerland, including 1361 participants (50.3% female, mean age 61.0 ± 9.4 years). Participants were divided into VMS/VMDS users and non-users. Fatigue levels were assessed using the Fatigue Severity Scale (FSS) and the 14-item version of the Chalder Fatigue Scale (CFS). Statistical analyses included multivariable logistic regression for categorical outcomes and analysis of variance for continuous outcomes, adjusting for relevant covariates.

RESULTS

No association was found between VMS consumption and changes in FSS (mean ± standard error 0.05 ± 0.03 vs. -0.06 ± 0.14 for non-consumers and consumers, respectively, p = 0.440) and CFS (-0.05 ± 0.06 vs. 0.22 ± 0.28, p = 0.388). Similarly, no effect of VMS consumption was found on incidence odds ratio and 95% confidence interval: 1.75 (0.82-3.74), p = 0.149 or remission 1.36 (0.49-3.74), p = 0.550 of clinical fatigue. Similar findings were obtained for VMDS: FSS 0.06 ± 0.04 vs. 0 ± 0.08, p = 0.577; CFS - 0.07 ± 0.08 vs. 0.04 ± 0.15, p = 0.545 for non-consumers and consumers, respectively. OR 1.96 (1.20-3.20), p = 0.008 and 1.14 (0.57-2.31), p = 0.712 for incidence and remission of fatigue. Alternate or persistent VMS/ VMDS consumers had a higher incidence of clinical fatigue and a higher increase in FSS compared with never consumers.

CONCLUSION

In this population-based sample, we found no consistent association between VMS or VMDS consumption and remission of fatigue. Conversely, VMDS users tended to develop greater fatigue.

Large-scale georeferenced neuroimaging and psychometry data link the urban environmental exposome with brain health

In face of cumulating evidence about the impact of human-induced environmental changes on mental health and behavior, our understanding of the main effects and interactions between environmental factors - i.e., the exposome and the brain - is still limited. We seek to fill this knowledge gap by leveraging georeferenced large-scale brain imaging and psychometry data from the adult community-dwelling population (n = 2672; mean age 63 ± 10 years). For monitoring brain anatomy, we extract morphometry features from a nested subset of the cohort (n = 944) with magnetic resonance imaging. Using an iterative analytical strategy testing the moderator role of geospatially encoded exposome factors on the association between brain anatomy and psychometry, we demonstrate that individuals' anxiety state and psychosocial functioning are among the mental health characteristics showing associations with the urban exposome. The clusters of higher anxiety state and lower current psychosocial functioning coincide spatially with a lower vegetation density and higher air pollution. The univariate multiscale geographically weighted regression identifies the spatial scale of associations between individuals' levels of anxiety state, psychosocial functioning, and overall cognition with vegetation density, air pollution and structures of the limbic network. Moreover, the multiscale geographically weighted regression interaction model reveals spatially confined exposome features with moderating effect on the brain-psychometry/cognitive performance relationships. Our original findings testing the role of exposome factors on brain and behavior at the individual level, underscore the role of environmental and spatial context in moderating brain-behavior dynamics across the adult lifespan.

Fifteen-year trends in diabetes drug management and control in French-speaking Switzerland

OBJECTIVE

Drug management of type 2 diabetes (T2D) should comply with established guidelines. Still, little is known about how drug management of T2D in Switzerland has evolved over time. We aimed at assessing 15-year trends in antidiabetic drug prescription and its effectiveness in reducing fasting plasma glucose (FPG) levels.

RESEARCH DESIGN AND METHODS

Data from the baseline (2003-2006) and three follow-ups (2009-2012, 2014-2017 and 2018-2021) of a population-based study conducted in Lausanne, Switzerland. Participants treated for T2D were included. At baseline and the follow-ups, participants had their antidiabetic drugs collected, together with their FPG and glycated haemoglobin (HbA1c) levels.

RESULTS

There were 274, 280, 268 and 195 participants treated for T2D at the baseline, first, second and third follow-ups, respectively, of whom 101 (36.9%), 103 (36.8%), 138 (51.5%) and 84 (43.1%) were controlled (FPG < 7 mmol/L). During the study period, the percentage of biguanides remained stable, the percentage of sulfonylureas and thiazolidinediones decreased, and the percentage of SGLT2 and DPP4 inhibitors increased, but no consistent association with T2D control was found. On bivariate and multivariable analysis, participants with newly diagnosed T2D had a higher likelihood of being controlled than participants with established T2D: odds ratio (95% CI) 3.39 (1.89-6.07), 5.41 (2.25-13.0) and 3.47 (1.45-8.31) for the first, second and third follow-ups on multivariable analysis, respectively.

CONCLUSIONS

Despite the prescription of novel antidiabetic drugs, half of participants treated for diabetes do not achieve adequate control in Switzerland. Participants with newly diagnosed diabetes achieve much better control than participants with established diabetes.

Diabetes and the risk of cardiovascular events and all-cause mortality among older adults: an individual participant data analysis of five prospective studies

BACKGROUND

Guidelines and studies provide conflicting information on whether type 2 diabetes (T2D) should be considered a coronary heart disease risk (CHD) equivalent in older adults.

METHODS

We synthesized participant-level data on 82,723 individuals aged ≥65 years from five prospective studies in two-stage meta-analyses. We estimated multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of T2D (presence versus absence) on a primary composite outcome defined as cardiovascular events or all-cause mortality. Secondary outcomes were the components of the composite. We evaluated CHD risk equivalence by comparing outcomes between individuals with T2D but no CHD versus CHD but no T2D.

RESULTS

The median age of participants was 71 years, 20% had T2D and 17% had CHD at baseline. A total of 29,474 participants (36%) experienced the composite outcome. Baseline T2D was associated with higher risk of cardiovascular events or all-cause mortality versus no T2D (HR 1.44, 95% CI [1.40-1.49]). The association was weaker in individuals aged ≥75 years versus 65-74 years (HR 1.32 [1.19-1.46] vs. 1.56 [1.50-1.62]; p-value for interaction = .032). Compared to individuals with CHD but no T2D, individuals with T2D but no CHD had a similar risk of the composite outcome (HR 0.95 [0.85-1.07]), but a lower risk of cardiovascular events (HR 0.76 [0.59-0.98]).

CONCLUSIONS

T2D was associated with increased risk of cardiovascular events and all-cause mortality in older adults, but T2D without CHD conferred lower risk of cardiovascular events compared to CHD without T2D. Our results suggest that T2D should not be considered a CHD risk equivalent in older adults.

Correlates of chronic pain onset and recovery in the CoLaus cohort

BACKGROUND

Only few previous cohort studies examined simultaneously predictors of chronic pain (CP) onset and recovery. Furthermore, these studies used various sociodemographic and pain-related characteristics, without standardized measures of sleep and depression. The present study aimed at expanding and strengthening these findings in a large Swiss population.

METHODS

We analysed data from a longitudinal cohort (n = 4602) collected at two time points separated by 5 years in Lausanne, Switzerland. We studied through two independent multivariable logistic regression models, the predictors of CP onset and recovery, including socio-demographic data as well as standardized measures of sleep and mood.

RESULTS

Chronic pain was reported by 43.1% and 44.4% of participants, with 11.6% at the second follow-up reporting moderate or intense pain. Neuropathic pain, regardless of intensity, had a more negative impact on quality of life. An inferential model (n = 1331) identified the male sex as predictive for recovering from CP. Older age, being overweight or obese (compared to normal weight), higher depression scores and pain medication intake were predictive for sustained pain at the second follow-up. A second model (n = 1886) identified being overweight or obese (compared to normal weight), low quality of sleep and being a former smoker (compared to a non-smoker) as predictive for developing CP, while the male sex was lowering the risk.

CONCLUSIONS

While sex and weight are associated with both recovery and new CP onset, separate variables also need to be considered in these processes, underlining specific factors to be addressed, depending on the context, whether preventive or therapeutic.

SIGNIFICANCE STATEMENT

Multivariable models in a Swiss cohort (N = 4602) associate male sex, not taking pain medication, normal weight, lower depression scores and younger age with recovery from chronic pain, while females, obese or overweight, having worse sleep and former smokers are associated with onset of new chronic pain. These common and separate factors need to be considered in treatment and prevention efforts.

Impact of Different CKD Definitions on Long-Term Renal Function and Mortality in a Population-Based Cohort Study

Introduction

The adoption of age or individualized body surface area (i-BSA) estimated glomerular filtration rate (eGFR) thresholds could influence the prevalence and prognosis of chronic kidney disease (CKD). This longitudinal study with up to 15 years of follow-up in the general population, compares different eGFR thresholds for CKD definition: standard, corrected to i-BSA, and age-stratified. For each, we assessed the prevalence of CKD and the combined impact on rapid renal function decline (RRFD) and mortality.

Methods

Patients were classified as CKD according to the presence of significant albuminuria and/or different eGFR thresholds as follows: (i) < 60ml/min per 1.73 m2; (ii) < 60ml/min corrected to i-BSA; (iii) stratified by age, that is, < 75, < 60 and < 45 ml/min per 1.73 m2 if aged < 40 years, 40 to 65 years, and > 65 years, respectively. We performed adjusted Cox regression analyses to predict RRFD and global mortality.

Results

We analyzed 4952 participants (54% women; mean age: 52 years). Age-stratified definition resulted in 24 of 677 participants aged < 40 years reclassified as CKD, with no adverse outcomes; whereas 55 of 713 participants aged > 65 years were reclassified as non-CKD, with 12 deaths and 1 RRFD. After multivariate adjustment, the CKD group had a poorer prognosis compared with the non-CKD group independently of the definition used; hazard ratio (HR) and 95% confidence interval (CI) were 2.23 (1.59-3.12), 2.06 (1.46-2.90), and 1.64 (1.13-2.38) for the standard, corrected to i-BSA, and age-stratified definitions, respectively.

Conclusion

In our study, classification of CKD by age or i-BSA does not appear to improve prediction of RRFD and mortality.

Vitamin and dietary supplements are not associated with total or cardiovascular mortality in Switzerland: the CoLaus|PsyCoLaus prospective study

PURPOSE

Vitamin-mineral and dietary supplements (VMDS) are taken by a large fraction of the population. Whether their long-term consumption impacts mortality and cardiovascular disease (CVD) has seldom been studied.

METHODS

Prospective study from a population-based cohort from Lausanne, Switzerland. Participants were categorized as non-users (no consumption at baseline and first follow-up), persistent users (consumption at baseline and follow-up), and occasional users (consumption either at baseline or follow-up). Incidence of CVD and of total mortality was assessed after the first follow-up.

RESULTS

Data from 4261 participants (57.4 ± 10.4 years, 55% females) was used. Median follow-up was 9 years (interquartile range 7.0-9.2) After multivariable analysis, no association was found between VMDS use and total mortality: hazard ratio and (95% confidence interval) 0.95 (0.71-1.28) and 0.83 (0.55-1.26) for occasional and persistent consumers, respectively, CVD mortality: 1.00 (0.47-2.11) and 1.30 (0.53-3.18), or CVD events: 0.96 (0.72-1.27) and 0.95 (0.64-1.42). Similar findings were obtained after inverse probability weighting, using only vitamin-mineral supplement users, or considering only participants at baseline. When CVD events were split into coronary heart disease (CHD) or stroke, persistent use of VMDS was associated with a higher risk of CHD in females: 3.12 (1.52-6.41), p = 0.002, but not in males, 0.25 (0.03-1.82), p = 0.171, p for interaction < 0.05. No association was found between VMDS use and incidence of stroke in both sexes.

CONCLUSION

We found no association between vitamin and dietary supplement use and total or CVD mortality, or CVD events. The higher risk of CHD for persistent use in females should be further explored.

Association between urinary heavy metal/trace element concentrations and kidney function: a prospective study

Background

Chronic kidney disease (CKD) is an important public health problem. Although cross-sectional studies have identified many heavy metals/trace elements associated with reduced kidney function, prospective studies are needed to determine the pathogenic role of these elements in the development and progression of CKD.

Methods

To explore the association between baseline urinary heavy metal/trace element concentrations and long-term impaired kidney function (IKF)/CKD, as well as the incidence of rapid decline in kidney function in a population-based exploratory prospective study, with mean age 51.9 years at baseline whose urinary trace elements concentrations have been determined by inductively coupled plasma mass spectrometry. IKF was defined by a reduced estimated glomerular filtration rate (eGFR) between 60 and 90 mL/min/1.73 m2, and CKD was defined as an eGFR <60 mL/min/1.73 m2. Rapid eGFR decline was defined as a decrease ≥3 mL/min/1.73 m2/year.

Results

Over a mean follow-up of 12.5 years, 123 participants (2.6%) experienced rapid decline in kidney function, and 1455 (31.7%) developed IKF or CKD. After adjusting for covariates including baseline eGFR, we found that urinary vanadium [hazard ratio (HR) = 1.07, 1.03-1.12], cobalt (HR = 1.69, 1.21-2.37), nickel (HR = 1.19, 1.08-1.3), copper (HR = 1.03, 1.01-1.06), selenium (HR = 1.33, 1.02-1.73), molybdenum (HR = 1.48, 1.2-1.82) and iodine (HR = 1.1, 1.02-1.2) were associated with an increased risk of new incident IKF or CKD cases during the follow-up. Also, urinary copper [odds ratio (OR) = 1.12, 1.04-1.21], silver (OR = 1.83, 1-3.35), molybdenum (OR = 1.02, 1.01-1.04) and cadmium (OR = 1.05, 1.01-1.09) were associated with an increased risk of rapid eGFR decline.

Conclusion

In the general population, several urinary heavy metals/trace elements are associated with a rapid decline in kidney function or new cases of IKF/CKD.

Association between the EAT-Lancet Diet, Incidence of Cardiovascular Events, and All-Cause Mortality: Results from a Swiss Cohort

BACKGROUND

An unhealthy diet is a major contributor to several noncommunicable diseases, including cardiovascular diseases, the leading cause of death worldwide. Additionally, our food system has significant impacts on the environment. The EAT-Lancet Commission has recommended a healthy diet that preserves global environmental resources.

OBJECTIVES

This prospective study aimed to evaluate the associations between adherence to the EAT-Lancet diet and the incidence of cardiovascular events and all-cause mortality in a Swiss cohort.

METHODS

We analyzed data from the CoLaus/PsyCoLaus cohort study (N = 3866). Dietary intake was assessed using a semiquantitative food frequency questionnaire. The EAT-Lancet adherence score was calculated based on the recommended intake and reference intervals of 12 food components, ranging from 0 to 39 points. Participants were categorized into low-, medium-, and high-adherence groups according to score tertiles. We used Cox Proportional Hazards regressions to assess the association among diet adherence, incident cardiovascular events, and all-cause mortality.

RESULTS

During a mean follow-up of 7.9 y (SD: ±2.0 y), 294 individuals (7.6%) from our initial sample experienced a first cardiovascular event, and 264 (6.8%) died. Compared with the low-adherence group, the adjusted hazard ratios for all-cause mortality were 0.88 (95% CI: 0.66, 1.17) and 0.70 (95% CI: 0.49, 0.98) for the medium-adherence and high-adherence groups, respectively (P-trend = 0.04). We observed no association between adherence groups and cardiovascular events.

CONCLUSIONS

In a Swiss cohort, high adherence to the EAT-Lancet diet is associated with a potential 30% lower risk of overall mortality. However, it is not associated with cardiovascular events.

Trends in diabetes mellitus and related costs among hospital admissions in Switzerland, 2012-2020

BACKGROUND

In Switzerland, the prevalence of diabetes mellitus (DM) has increased in the general population, but little is known regarding DM-related hospitalizations and their impact on mortality and health costs. Hence, our objectives were to assess (1) the evolution of hospitalizations for DM as first diagnosis and as comorbidity; (2) the association of DM with ICU admission, length of stay (LOS), in-hospital mortality and costs.

METHODS

Swiss hospital discharge data for period 2012-2020. Type 1 (T1DM), type 2 (T2DM) and other types (OTDM) of DM were considered.

RESULTS

Between 2012 and 2020, the number of hospitalizations (% total) increased from 4204 (0.27) to 4980 (0.45) for T2DM, 539 (0.05) to 854 (0.08) for T1DM and 221 (0.02) to 381 (0.03) or OTDM. Hospitalizations with DM as comorbidity increased from 89,752 (8.6) to 128,700 (11.7) for T2DM, 2934 (0.29) to 3536 (0.32) or T1DM and 5774 (0.58) to 9143 (0.83) for OTDM. Compared to non-DM hospitalizations, all types of DM had a higher likelihood of lower limb amputation; hospitalizations for T1DM had a higher likelihood of ICU admission: odds ratio and 95% CI: 3.38 (3.19-3.59), while T2DM had higher LOS: 5.5 ± 1.0 vs. 5.1 ± 1.0 days, and all DM types had a lower odds of in-hospital mortality. Patients with any type of DM as comorbidity had a longer LOS than patients without. Total cost of DM rose from CHF 42 million in 2012 to almost 100 million in 2019 and decreased afterwards.

CONCLUSION

DM represents an increasing health and economic burden in Switzerland.

Prevalence and incidence of sarcopenia in Swiss postmenopausal women: findings from the OsteoLaus Cohort

STUDY AIMS

Sarcopenia is a progressive, age-related loss of muscle mass, strength and function. Given the ageing population and the adverse outcomes associated with sarcopenia, monitoring its epidemiology is particularly important. This study aimed to describe sarcopenia prevalence, 5-year incidence and agreement between definitions using the latest operational criteria in Swiss postmenopausal women.

METHODS

Postmenopausal women from the last 5 years of the CoLaus/OsteoLaus prospective population-based cohort were included based on complete case analysis (April 2015 to October 2022; Lausanne, Switzerland). We assessed appendicular lean mass via Dual X-ray Absorptiometry (GE Lunar iDXA), handgrip strength using a Jamar Dynamometer and 6-metre gait speed at multiple visits. Sarcopenia was defined based on handgrip strength and/or appendicular lean mass and/or gait speed using 11 definitions, including that from the European Working Group on Sarcopenia in Older People (EWGSOPII, 2019). Prevalence was measured as the number and rate of sarcopenic cases at the last visit, while incidence was measured as the number and rate of new sarcopenic cases over 2.5 or 5 years.

RESULTS

A total of 930 women were included, with a mean (standard deviation) age of 72.9 (6.9) years, BMI of 25.7 (4.8) kg/m2, appendicular lean mass 16.8 (2.5) kg, handgrip strength 21.2 (5.5) kg, gait speed 1.1 (0.2) m/s. Sarcopenia prevalence based on EWGSOPII definitions ranged from 2.2% to 5.7%, while other definitions varied from 0.5% to 13.4%. The 5-year incidence rates based on EWGSOPII were 1.9% to 4.7%. Prevalence and incidence increased significantly between the lowest and highest age tertiles (Fisher's exact test, p <0.05) for most definitions. Agreement between definitions was predominantly "none" or "minimal" according to the Cohen Kappa score.

CONCLUSION

This population-based cohort of postmenopausal women highlights an increase in sarcopenia prevalence and incidence beginning in the seventh decade of life, underscoring the accelerated decline in muscle health with age. The minimal agreement between the definitions highlights the need for a consensus, which would improve future research and clinical implementations.

Relationship Between ABO Blood Groups and Mental Disorders

Previous research has unveiled an intriguing positive association between the AB blood group and mental disorders in general. In this study, we compared ABO blood groups with five major groups of mental disorders to attain a higher level of specificity. The analyses were conducted using data from the CoLaus|PsyCoLaus study (N=5111). They revealed that the AB blood group exhibited a positive association with both neurodevelopmental disorders (RR 2.29, CI 1.38-3.82) and substance use disorders (RR 2.25, CI 1.38-3.65) after adjusting for sex and childhood adversities. These associations could be replicated with respect to the familial aggregation of neurodevelopmental and substance use disorders. Large databases are needed to achieve more detailed results related to specific disorders.

Factor associated with and risk of cardiovascular disease in people with uncontrolled hypertension

We aimed to identify and validate factors related to uncontrolled hypertension. Participants treated with at least one antihypertensive drug from the prospective contemporaneous CoLaus|PsyCoLaus study were enrolled. We investigated the association between hypertension status (uncontrolled, defined as systolic blood pressure [SBP] ≥ 140 mm Hg and/or diastolic blood pressure [DBP] ≥ 90 mm Hg, versus controlled hypertension [SBP/DBP < 140/90 mm Hg]) and potential risk factors. Additionally, the prospective association of uncontrolled hypertension with cardiovascular disease and all-cause mortality was evaluated. 1040 participants recruited between 2003 and 2006 with a mean follow-up of 12.3 years (SD ± 3.4) were included in the analyses. Heavy alcohol consumption, increased BMI, increased ferritin and albuminuria were positively associated with uncontrolled hypertension. Factors inversely associated with uncontrolled hypertension were university degree, current smoker, and high potassium urinary excretion. Uncontrolled hypertension status was not associated with incident ASCVD nor all-cause mortality in our study. In conclusion, uncontrolled hypertension was associated with modifiable factors, such as heavy drinking, obesity and level of education. Further studies should investigate whether including biological markers in clinical practice, such as potassium excretion, ferritin levels, or albuminuria, would help identify individuals who may develop uncontrolled hypertension.

Development and External Validation of a Home-based Risk Prediction Model of Natural Onset of Menopause-Teuta

OBJECTIVE

To develop and externally validate a 10-year risk prediction model of natural onset of menopause using ready-to-use predictors.

DESIGN

Population-based prospective cohort study.

PARTICIPANTS

Community-dwelling, premenopausal women aged 28 years and older enrolled in the Swiss (CoLaus) and Dutch (PREVEND) study.

MAIN OUTCOME MEASURE

Incidence of self-reported natural menopause.

MODEL DEVELOPMENT

Based on existing literature, 11 predictors were tested in this study. The CoLaus cohort was used to develop the model by applying the backward-elimination approach and Bayesian Model Averaging. Internal validation was performed by bootstrapping. External validation was performed using data from the PREVEND cohort and recalibrating the baseline survival estimate. C-statistics, calibration slopes, and expected/observed probabilities were calculated as measures of model internal and/or external performances.

RESULTS

The final analysis included 750 and 1032 premenopausal women from the CoLaus and the PREVEND cohorts, respectively. Among them, 445 (59%) from CoLaus and 387 (38%) from PREVEND experienced menopause over a median follow-up of 10.7 and 9 years, respectively. The final model included age, alcohol consumption, smoking status, education level, and systolic blood pressure. Upon external calibration in the PREVEND cohort, the model exhibited good discrimination, with a C-statistic of 0.888 and an expected/observed probability of 0.82.

CONCLUSION

We present the first internally and externally validated prediction model of natural menopause onset using readily available predictors. Validation of our model to other populations is needed.

Investigation of the impact of exposure to trace elements on health and disease from the ToxiLaus study

The ToxiLaus study aims at evaluating the impact of environmental toxic species on health and diseases' onset and development. Specifically, the ubiquitous presence of trace elements (TEs) in the environment urges for a better characterization of their influence on human organism. In its primary phase, the ToxiLaus study focused on measuring the urinary concentrations of 23 TEs in the baseline samples from the CoLaus|PsyCoLaus population-based cohort, using inductively coupled plasma mass spectrometry (ICP-MS). Statistical analyses were carried out on 5866 participants, investigating links between TEs concentrations and smoking status, metabolic syndrome and body mass index (BMI). Smoking status was associated with Cd, Zn, Pb, Mo and Hg (respectively OR = 3.64, 1.42, 1.20, 0.69 and 0.58) while metabolic syndrome was associated with Zn and Cd (OR = 1.81 and 1.24 respectively). Concentrations of Zn, Hg, Co, Ni, Cu, Mo, As, Sn, Tl, Fe where significantly different (p < 0.0001) between BMI groups (Normal, Overweight, Obese). Finally, this study provides an overview of the distribution of trace elements in a cohort large sample of the general population, as well as their main associations with cardiovascular risk factors. Theses relations will be further analysed in subsequent phases of the study.

Vitamin and mineral supplements: Are they associated with fatigue?

BACKGROUND AND AIMS

Vitamin/mineral supplements (VMS) and vitamin/mineral and/or dietary supplements (VMDS) are commonly consumed, based on the belief of their invigorating properties. Still, the association of VMS/VMDS with fatigue in the general population remains sparse and conclusions are mixed. This study aimed to understand the association between VMS/VMDS and fatigue.

METHODS

Two cross-sectional studies (2014-2017 and 2018-2021) conducted on a population-based cohort. Participants were divided into VMS/VMDS users and non-users. Fatigue levels were assessed using the Fatigue Severity Scale (FSS) and the 14-item version of the Chalder Fatigue Scale (CFS).

RESULTS

Overall, 2084 (50.8 % female, 61.7 ± 9.8 years) and 1728 (51.0 % female, 64.1 ± 9.3 years) were included in the first and second surveys, respectively. In the first survey, after multivariable analysis, no association was found between VMS use and FSS: adjusted mean ± sem 3.04 ± 0.13 vs. 2.82 ± 0.03 for users and non-users, respectively, p = 0.083, while users scored higher in the CFS: 6.17 ± 0.22 vs. 5.72 ± 0.06 for users and non-users, respectively, p = 0.048. In the second survey, no association was found between VMS use and FSS (2.83 ± 0.19 vs. 2.84 ± 0.03, p = 0.952) and CFS (5.38 ± 0.33 vs. 5.61 ± 0.06, p = 0.504). In the first survey, VMDS users scored higher in both FSS (3.03 ± 0.06 vs. 2.76 ± 0.04, p < 0.001) and CFS (6.19 ± 0.11 vs. 5.58 ± 0.06, p < 0.001) while no differences were found in the second survey in both FSS (2.93 ± 0.07 vs. 2.81 ± 0.04, p = 0.161) and CFS (5.78 ± 0.12 vs. 5.54 ± 0.07, p = 0.088).

CONCLUSION

In this population-based cross-sectional study, the authors found no consistent association between VMS consumption and fatigue. Participants taking VMDS tended to present with higher fatigue scores.

Association between physical activity and diabetes control: multiple cross-sectional studies and a prospective study in a population-based, Swiss cohort

INTRODUCTION

Physical activity (PA) is recommended in patients with type 2 diabetes mellitus (T2DM) to improve their glycaemic control. We aimed to assess PA levels among participants with controlled and uncontrolled T2DM.

RESEARCH DESIGN AND METHODS

Three cross-sectional analyses of a prospective cohort conducted in Lausanne, Switzerland. PA levels (sedentary, light, moderate and vigorous) were either self-reported via questionnaire (first and second survey) or objectively assessed using accelerometry (second and third survey). T2DM control was defined as glycaemia <7.0 mmol/L or glycated haemoglobin <6.5% (48 mmol/mol).

RESULTS

Data from 195 (30.3% women), 199 (30.1% women) and 151 (44.4% women) participants with T2DM were analysed in the first (2009-2012), second (2014-2017) and third (2018-2021) surveys. Approximately half of the participants did not have controlled glycaemia. Using subjective data, over 90% (first survey) and 75% (second survey) of participants reported moderate and vigorous PA >150 min/week. After multivariable adjustment, no differences were found regarding all types of self-reported PA levels between controlled and uncontrolled participants. Objective assessment of PA led to considerable differences according to the software used: 90% and 20% of participants with moderate and vigorous PA >150 min/week, respectively. After multivariable adjustment, no differences were found for all PA levels between controlled and uncontrolled participants, irrespective of the analytical procedure used. Using glycated haemoglobin, almost two-thirds of participants were considered as uncontrolled, and no differences were found for objectively assessed PA between controlled and uncontrolled participants.

CONCLUSIONS

No differences in PA levels were found between participants with controlled and uncontrolled T2DM.

Early-life adversity predicting the incidence of multisite chronic pain in the general population

INTRODUCTION

Adverse childhood events (ACEs) have been linked to widespread chronic pain (CP) in various cross-sectional studies, mainly in clinical populations. However, the independent role of different ACEs on the development of different types of CP remains elusive. Accordingly, we aimed to prospectively assess the associations between specific types of ACEs with the development of multisite CP in a large population-based cohort.

METHODS

Data stemmed from the three first follow-up evaluations of CoLaus|PsyCoLaus, a prospective population-based cohort study of initially 6734 participants (age range: 35-75 years). The present sample included 1537 participants with 2161 analyzable intervals (49.7% men, mean age 57.3 years). Diagnostic criteria for ACEs were elicited using semi-structured interviews and CP was assessed by self-rating questionnaires. Multinomial logistic regressions with generalized estimating equations method analyzed the relationship between the different ACEs measured in the beginning of the interval and the risk of developing multisite CP during the follow-up. Sensitivity analyses were performed to assess the predictive value of ACEs on multisite CP with neuropathic features.

RESULTS

Participants with a history of parental divorce or separation had an increased risk of developing multisite CP at during follow-up in comparison to those without (RR1.98; 95% CI 1.13-3.47). A strong association was highlighted between parental divorce or separation and the risk of subsequent CP with neuropathic characteristics (RR 4.21, 95% CI 1.45-12.18).

CONCLUSION

These results highlight the importance of psychotherapeutic management of people experiencing parental separation to prevent CP in the future.

Dairy products and hypertension: Cross-sectional and prospective associations

BACKGROUND

The association between dairy intake and prevalence or incidence of hypertension remains controversial. We aimed to investigate the association between intake of different dairy products and prevalence and incidence of hypertension in a community-dwelling sample.

METHODS

Three cross-sectional studies (2009-12, 2014-17 and 2018-21) and one prospective study (2009-12 to 2018-21) were conducted in Lausanne, Switzerland. Dietary intake was assessed via a validated food frequency questionnaire. Dairy consumption was compared between participants with and without prevalent or incident hypertension.

RESULTS

For the cross-sectional analyses, data from 4437 (2009-12, 54.0% women, 57.7 ± 10.5 years), 2925 (2014-17, 53.4% women, 62.5 ± 10.0 years), and 2144 (2018-21; 53.3% women, 65.5 ± 9.6 years) participants were used. No consistent differences between participants with and without hypertension were found for all dairy products (total dairy, milk, yogurt, cheese, low-fat dairy, and full-fat dairy) although participants with hypertension tended to consume less cheese (51 ± 1 vs. 55 ± 1, p = 0.014, 52 ± 1 vs. 56 ± 1, p = 0.053, and 54 ± 1 vs. 56 ± 1 g/day for 2009-12, 2014-17 and 2018-21, respectively). For the prospective study, data from 2303 participants (60.8% women, 53.9 ± 9.0 years) were used. Irrespective of the dairy product considered, no association was found between quartiles of dairy consumption and development of hypertension. Similar findings were obtained after stratifying on dietary quality.

CONCLUSION

In this population-based study, no association was found between the consumption of different dairy products and the prevalence or incidence of hypertension.

The future backbone of nutritional science: integrating public health priorities with system-oriented precision nutrition

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.

Prevalence of actionable pharmacogenetic variants and high-risk drug prescriptions: A Swiss hospital-based cohort study

Drug type and dosing recommendation have been designed and optimized based on average response in the general population. Yet, there is significant inter-individual variability in drug response, which results in treatment inefficacy or adverse drug reactions in a subset of patients. This is partly due to genetic factors that typically affect drug metabolism or clearance. To verify the relevance and applicability of international pharmacogenetic guidelines in the Swiss population, we genotyped 1533 patients from a hospital-based biobank who received at least 30 different drugs, as documented in their electronic health record. We then assessed the prevalence of clinically actionable variants in 13 high-risk pharmacogenes. We compared the allele frequencies obtained in the hospital-based cohort with those of a Swiss population-based cohort of 4791 individuals. The prevalence of clinically actionable variants was comparable between the two cohorts, with most study participants (97.3%) carrying at least one actionable pharmacogenetic variant. We then assessed the frequency of high-risk prescriptions due to actionable gene-drug interactions and observed that 31% of patients in the hospital-based cohort were prescribed at least one drug for which they carried a high-risk variant, and for which international guidelines recommend a change of drug or dosage. Our analysis confirms the high prevalence of actionable pharmacogenetic variants in the Swiss population. It also shows that a substantial minority of patients are exposed to drugs for which they carry potentially problematic variants. Implementing a genetically informed approach to drug prescribing could have a positive impact on the quality of healthcare delivery.

Standardization of body composition parameters between GE Lunar iDXA and Hologic Horizon A and their clinical impact

Body composition (BC) measured by DXA differs between devices. We aimed to compare regional and total BC measurements assessed by the Hologic Horizon A and the GE Lunar iDXA devices; to determine device-specific calibration equations for each BC parameter; and to assess the impact of this standardization procedure on the assessment of sarcopenia, lipedema, obesity, and cardiovascular risk with DXA. A total of 926 postmenopausal women (aged 72.9 ± 6.9 yr, height 160.3 ± 6.6 cm, weight 66.1 ± 12.7 kg) underwent BC assessment on each device within 1 h, following the ISCD guidelines. The included sample was split into 80% train and 20% test datasets stratified by age, height, and weight. Inter-device differences in BC parameters were assessed with Bland-Altman analysis, Pearson or Spearman correlation coefficients, and t-tests or Wilcoxon tests. The equations were developed in the train dataset using backward stepwise multiple linear regressions and were evaluated in the test dataset with the R-squared and mean absolute error. We compared the abovementioned BC-derived health conditions before and after standardization in the test set with respect to relative risk, accuracy, Kappa score, and McNemar tests. Total and regional body masses were similar (p>.05) between devices. BMC was greater for all regions in the Lunar device (p<.05), while fat and lean masses differed among regions. Regression equations showed high performance metrics in both datasets. The BC assessment from Hologic classified 2.13 times more sarcopenic cases (McNemar: p<.001), 1.39 times more lipedema (p<.001), 0.40 times less high cardiovascular risk (p<.001), and similarly classified obesity (p>.05), compared to Lunar. After standardization, the differences disappeared (p>.05), and the classification metrics improved. This study discusses how hardware and software differences impact BC assessments. The provided standardization equations address these issues and improve the agreement between devices. Future studies and disease definitions should consider these differences.

Integrative Modeling of Accelerometry-Derived Sleep, Physical Activity, and Circadian Rhythm Domains With Current or Remitted Major Depression

Importance

Accelerometry has been increasingly used as an objective index of sleep, physical activity, and circadian rhythms in people with mood disorders. However, most prior research has focused on sleep or physical activity alone without consideration of the strong within- and cross-domain intercorrelations; and few studies have distinguished between trait and state profiles of accelerometry domains in major depressive disorder (MDD).

Objectives

To identify joint and individual components of the domains derived from accelerometry, including sleep, physical activity, and circadian rhythmicity using the Joint and Individual Variation Explained method (JIVE), a novel multimodal integrative dimension-reduction technique; and to examine associations between joint and individual components with current and remitted MDD.

Design, Setting, and Participants

This cross-sectional study examined data from the second wave of a population cohort study from Lausanne, Switzerland. Participants included 2317 adults (1164 without MDD, 185 with current MDD, and 968 with remitted MDD) with accelerometry for at least 7 days. Statistical analysis was conducted from January 2021 to June 2023.

Main Outcomes and Measures

Features derived from accelerometry for 14 days; current and remitted MDD. Logistic regression adjusted for age, sex, body mass index, and anxiety and substance use disorders.

Results

Among 2317 adults included in the study, 1261 (54.42%) were female, and mean (SD) age was 61.79 (9.97) years. JIVE reduced 28 accelerometry features to 3 joint and 6 individual components (1 sleep, 2 physical activity, 3 circadian rhythms). Joint components explained 58.5%, 79.5%, 54.5% of the total variation in sleep, physical activity, and circadian rhythm domains, respectively. Both current and remitted depression were associated with the first 2 joint components that were distinguished by the salience of high-intensity physical activity and amplitude of circadian rhythm and timing of both sleep and physical activity, respectively. MDD had significantly weaker circadian rhythmicity.

Conclusions and Relevance

Application of a novel multimodal dimension-reduction technique demonstrates the importance of joint influences of physical activity, circadian rhythms, and timing of both sleep and physical activity with MDD; dampened circadian rhythmicity may constitute a trait marker for MDD. This work illustrates the value of accelerometry as a potential biomarker for subtypes of depression and highlights the importance of consideration of the full 24-hour sleep-wake cycle in future studies.

Biopsychosocial risk factors for subjective cognitive decline among older adults during the COVID-19 pandemic: a population-based study

OBJECTIVES

There have been concerns that the COVID-19 pandemic and the measures used to contain it impacted the cognitive health of older adults. We therefore examined the prevalence of subjective cognitive decline, and its associated risk factors and health consequencs, among dementia-free older adults 2 years into the pandemic in Switzerland.

STUDY DESIGN

Population-based cohort study.

METHODS

Prevalence of SCD was estimated using the cognitive complaint questionnaire administered to adults aged ≥65 years in June-September 2022 (Specchio-COVID19 cohort, N = 1414), and compared to prepandemic values from 2014 to 2018 (CoLaus|PsyCoLaus cohort, N = 1181). Associated risk factors and health consequences were assessed using logistic and/or linear regression.

RESULTS

Prevalence of SCD in 2022 (18.9% [95% CI, 16.2-21.9]) was comparable to prepandemic levels in 2014-2018 (19.5% [17.2-22.1]). Risk factors included established risks for dementia-namely health issues, health behaviours, and depressive symptoms. Self-reported post-COVID, perceived worsening of mental health since the start of the pandemic, less frequent social club attendance, and increased loneliness were also risk factors for SCD. In turn, SCD was associated with poorer objective cognitive performance, difficulty performing instrumental activities of daily living, greater risk of falls, and lower well-being at one-year follow-up.

CONCLUSIONS

While the overall prevalence of SCD in 2022 was comparable to prepandemic levels, we identified several pandemic-related risk factors for SCD, including perceived worsening of mental health and increased isolation since the start of the pandemic. These findings highlight the importance of mental health promotion strategies in reducing cognitive complaints and preventing cognitive decline.

Long-term changes in adiposity markers during and after antidepressant therapy in a community cohort

Research on antidepressant-related weight changes over more than 12 months is scarce and adjustment for the effects of depressive episodes has rarely been applied. Accordingly, our aim was to assess the associations of the use of any antidepressants, subclasses of antidepressant and specific compounds prior to baseline and during a 5.5-year follow-up with changes in adiposity markers, and the effect of sex on these associations, with adjustment for multiple confounders including the effects of depressive episodes and their severity. Data stemmed from a prospective cohort study including 2479 randomly selected 35-66 year-old residents of an urban area (mean age 49.9 years, 53.3% women) who underwent physical and psychiatric evaluations at baseline and follow-up. Weight, height, waist circumference, and body fat were measured by trained nurses and information on diagnosis and antidepressant use prior to baseline and during follow-up was collected through standardized interviews. In the fully adjusted models, the number of antidepressants, mainly SSRIs and TCAs, used prior to baseline, was associated with a lower increase of body-mass index (BMI, β (95%CI) = -0.12 (-0.19, -0.05)) and waist circumference (β = -0.28 (-0.56, -0.01)), whereas participants treated with antidepressants during the follow-up had a steeper increase in BMI (β = 0.32 (0.13, 0.50)) and waist circumference (β = 1.23 (0.44, 2.01)). Within the class of SSRIs, the use of fluoxetine, sertraline or escitalopram during follow-up was associated with a steeper increase in adiposity markers. The associations of SSRIs with BMI and waist circumference were only observed when the SSRIs were used during the second period of the follow-up. Sex did not moderate these associations. Our findings suggest an increase of adiposity markers during sustained treatment with TCAs and SSRIs, which however return to normal levels after cessation of treatment. Hence, the benefit of long-term administration of these antidepressants should be carefully weighed against the potential risk of weight gain.

Willingness to participate in a personalized health cohort - insights from the swiss health study pilot phase

BACKGROUND

This paper explores the feasibility of establishing a large-scale population-based cohort and biobank in Switzerland by assessing potential participants' needs, expectations, and concerns about such an infrastructure providing information on health, lifestyle, and exposure trajectories, the development of disease, and risk factors over time.

METHODS

We utilized a scenario-based questionnaire in the Swiss Health Study pilot phase (2020-2021), involving 1349 adults aged 20-69 from the cantons Vaud and Bern. We conducted descriptive statistics supported by R and qualitative content analysis of n = 374 open responses related to attitudes towards research.

RESULTS

We highlight the benefits and challenges of the scenario-based approach, discuss the sample represented in the pilot phase, and present implications for building a full cohort. We also report on participants' attitudes towards and previous experience with health research. We analyze references regarding informed consent and feedback, attitudes towards the Swiss Health Study, and recommendations on improving its scope, design, and instruments. Results indicate a high interest (90%) in participating in a national health study, with 85% of a random population sample willing to join a long-term cohort. Only 43% were familiar with biobanks, and 44% preferred general consent. Trust was high for Swiss-based public research but lower for researchers from other countries or private sector. Over 95% expressed willingness to complete online questionnaires, undergo physical examination, and donate biosamples. Almost all participants wanted to know the outcomes of the medical tests (99.5%) and the exposure to environmental stressors (95%) from their study center visit. Preferred tools for monitoring sleep, physical activity, and diet were known smartphone apps with automatic data management.

CONCLUSION

Overall, the study reveals a positive attitude towards personalized health research, with a strong willingness to share data and samples. Key insights focus the meaning of informed consent for participation, the relevance of sampling and representativeness, as well as the significance and challenges of personalized feedback, especially regarding environmental health concerns. Findings emphasize participants' supportive yet reflexive stances, underscoring the importance of aligning research values with individual values in personalized health research. These insights contribute valuable considerations for refining the scope, design, and instruments of future cohort studies.

Sleep disturbances and incident risk of major depressive disorder in a population-based cohort

Sleep disturbances are well-known symptoms of major depressive disorder (MDD). However, the prospective risk of MDD in the presence of sleep disturbances in a general population-based cohort is not well known. This study investigated associations between both polysomnography (PSG)-based or subjective sleep features and incident MDD. Participants representative of the general population who had never had MDD completed sleep questionnaires (n = 2000) and/or underwent PSG (n = 717). Over 8 years' follow-up, participants completed psychiatric interviews enabling the diagnosis of MDD. Survival Cox models were used to analyze associations between sleep features and MDD incidence. A higher Epworth Sleepiness Scale and presence of insomnia symptoms were significantly associated with a higher incidence of MDD (hazard ratio [HR] [95 % confidence interval (CI)]: 1.062 [1.022-1.103], p = 0.002 and 1.437 [1.064-1.940], p = 0.018, respectively). Higher density of rapid eye movements in rapid eye movement (REM) sleep was associated with a higher incidence of MDD in men (HR 1.270 [95 % CI 1.064-1.516], p = 0.008). In women, higher delta power spectral density was associated with a lower MDD incidence (HR 0.674 [95 % CI 0.463-0.981], p = 0.039). This study confirmed the associations between subjective and objective sleep features and the incidence of MDD in a large community dwelling cohort.

Self-reported caffeine consumption miss-matched consumption measured by plasma levels of caffeine and its metabolites: results from two population-based studies

IMPORTANCE AND OBJECTIVE

Self-reported caffeine consumption has been widely used in research while it may be subject to bias. We sought to investigate the associations between self-reported caffeine consumption and plasma levels of caffeine and its two main metabolites (paraxanthine and theophylline) in the community.

METHODS

Data from two population-based studies (SKIPOGH1 and 2 (N = 1246) and CoLaus|PsyCoLaus (N = 4461)) conducted in Switzerland were used. Self-reported caffeine consumption was assessed using questionnaires. Plasma levels of caffeine and its metabolites were quantified by ultra-high performance liquid chromatography coupled to a tandem quadrupole mass spectrometer.

RESULTS

In both studies, mean log plasma levels of caffeine and its two metabolites were over 6.48 (plasma levels = 652 ng/ml) when no caffeine consumption was reported. Subsequently, nonlinear associations between log plasma levels and self-reported caffeine consumption were observed in SKIPOGH, with a change of the slope at 3-5 cups of espresso per day in SKIPOGH1 but not SKIPOGH2. In CoLaus|PsyCoLaus, increased daily consumption of caffeinated beverages was associated with increased log plasma levels with a change of the slope at 3 cups. In both studies, declared caffeine consumption higher than 3-5 cups per day was not associated with higher plasma levels of caffeine and its metabolites.

CONCLUSION

Self-reports of no or low caffeine consumption and consumption of more than 3-5 cups of coffee should be interpreted with caution, with possible under- or over-estimation. Quantifying plasma levels of caffeine and its metabolites may contribute to a better estimation of caffeine intake.

Biobanks in chronic disease management: A comprehensive review of strategies, challenges, and future directions

Biobanks, through the collection and storage of patient blood, tissue, genomic, and other biological samples, provide unique and rich resources for the research and management of chronic diseases such as cardiovascular diseases, diabetes, and cancer. These samples contain valuable cellular and molecular level information that can be utilized to decipher the pathogenesis of diseases, guide the development of novel diagnostic technologies, treatment methods, and personalized medical strategies. This article first outlines the historical evolution of biobanks, their classification, and the impact of technological advancements. Subsequently, it elaborates on the significant role of biobanks in revealing molecular biomarkers of chronic diseases, promoting the translation of basic research to clinical applications, and achieving individualized treatment and management. Additionally, challenges such as standardization of sample processing, information privacy, and security are discussed. Finally, from the perspectives of policy support, regulatory improvement, and public participation, this article provides a forecast on the future development directions of biobanks and strategies to address challenges, aiming to safeguard and enhance their unique advantages in supporting chronic disease prevention and treatment.

Exploring the gender difference in type 2 diabetes incidence in a Swiss cohort using latent class analysis: an intersectional approach

Introduction

Type 2 diabetes is multifactorial and influenced by the intersection of gender-related variables and other determinants of health. The aim of this study was to highlight the intersectional social position of the participants and disentangle its role from administrative sex in predicting the development of type 2 diabetes.

Methods

Using CoLaus|PsyCoLaus study, a Swiss single-centre prospective cohort initiated in 2003 and including 6733 participants (age 35-75 years; 54% women) at baseline, we conducted latent class analyses using gender-related variables (eg, risk-taking behaviours, gender roles represented by employment status, etc) and socioeconomic determinants at baseline (2003-2006) to construct intersectional classes and we tested their association with the development of type 2 diabetes at follow-up (2018-2021).

Results

Of the 6733 participants enrolled at baseline, 3409 were included in our analyses (50.6%). Over a median follow-up time of 14.5 years, 255 (7.5%) participants developed type 2 diabetes, of which 158 men (62.0%). We identified seven latent classes highlighting different intersectional social position groups (ie, young, fit, educated men (N=413), non-White physically inactive men and women (N=170), highly qualified men, former or current smokers (N=557), working women living alone (N=914), low qualified working men with overweight (N=445), women with obesity, low education and low qualified job or housewives (N=329), low educated retired participants (N=581)). Using the class labelled as 'young, fit, educated men' as reference, the risk of incident type 2 diabetes was higher in all other classes (adjusted OR values between 4.22 and 13.47). Classes mostly feminine had a more unfavourable intersectional social position than that of the predominantly masculine classes. The corresponding OR increased in sex-adjusted regressions analyses.

Conclusions

We observe cumulative intersectional effects across behavioural and socioeconomic profiles with different risks of developing type 2 diabetes emphasising the deleterious effect of a feminine gender profile. These patterns are only partly captured by traditional sex-stratified analyses.

Adherence to 2020 ESC recommendations on physical activity in a population with different cardiovascular risk levels: A prospective population-based study from the CoLaus/PsyCoLaus study

Introduction

In 2020, the European Society of Cardiology (ESC) recommends 150 min of moderate or 75 min of vigorous-intensity PA per week. While general population PA adherence is suboptimal, its status among those with previous ASCVD or high ASCVD risk remains unknown. We aimed to assess objective adherence to ESC PA recommendations using accelerometer-based measurement among these populations.

Methodology

We used data from the Swiss CoLaus|PsyCoLaus cohort study (2014-2016). PA was measured using a 14-day wrist accelerometer. Adherence was defined as > 80 % of recommended PA achievement. Adherence was investigated separately among participants with previous ASCVD and among cardiovascular risk groups (based on the Systematic Coronary Risk Evaluation SCORE-1 and more recent SCORE2) with simple and multivariable logistic regressions. Participants' characteristics were also evaluated as independent factors after adjustment.

Results

We studied 1867 participants (median age: 61.2 years, 51.3 % female). ESC PA Adherence reached 55.5 % overall, and 37 % in those with previous ASCVD. Multivariable analysis showed no significant association between previous ASCVD or high cardiovascular risk and PA adherence (Odds ratio adjusted [ORa] 0.9, 95 % Confidence Interval [CI] 0.6-1.4 and ORa 0.7, 95 % CI 0.4-1.2, respectively). Age (≥60 years old), obesity, smoking, chronic renal disease, hypertension, diabetes and benzodiazepine use were significantly associated with lower likelihood of PA adherence in multivariable logistic regression.

Conclusion

Adherence to ESC PA guidelines, particularly in participants with higher cardiovascular risk, was poor. Since PA adherence was associated with modifiable risk factors (e.g., obesity, smoking, and benzodiazepine use), maintained efforts to implement the ESC recommendations are advised.

Cross-sectional and longitudinal associations of Iron biomarkers and cardiovascular risk factors in pre- and postmenopausal women: leveraging repeated measurements to address natural variability

BACKGROUND

The association between iron biomarkers and cardiovascular disease risk factors (CVD-RFs) remains unclear. We aimed to (1) evaluate the cross-sectional and longitudinal associations between iron biomarkers (serum ferritin, transferrin saturation (TSAT), transferrin) and CVD-RFs among women, and (2) explore if these associations were modified by menopausal status.

METHOD

Cross-sectional and longitudinal analyses including 2542 and 1482 women from CoLaus cohort, respectively. Multiple linear regression and multilevel mixed models were used to analyse the associations between Iron biomarkers and CVD-RFs. Variability of outcomes and iron markers between surveys was accessed using intraclass correlation (ICC).

RESULTS

After multivariable adjustment, elevated serum ferritin levels were associated with increased insulin and glucose levels, while higher transferrin levels were linked to elevated glucose, insulin and total cholesterol, and systolic and diastolic blood pressure (p < 0.05). No association was observed between CVD-RFs and TSAT (p > 0.05). Iron biomarkers demonstrated low reliability across reproductive stages but exhibited stronger associations in the perimenopausal group. In longitudinal analysis, we found association only for transferrin with lower glucose levels [β = - 0.59, 95% CI (- 1.10, - 0.08), p = 0.02] and lower diastolic blood pressure [β = - 7.81, 95% CI (- 15.9, - 0.56), p = 0.04].

CONCLUSION

In cross-sectional analysis, transferrin was associated with several CVD-RFs, and the associations did not change according to menopausal status. Conversely, in the longitudinal analyses, changes in transferrin were associated only with lower glucose and diastolic blood pressure levels. These differences might stem from the substantial longitudinal variation of iron biomarkers, underscoring the need for multiple iron measurements in longitudinal analyses.

The Neurobiology of Life Course Socioeconomic Conditions and Associated Cognitive Performance in Middle to Late Adulthood

Despite major advances, our understanding of the neurobiology of life course socioeconomic conditions is still scarce. This study aimed to provide insight into the pathways linking socioeconomic exposures-household income, last known occupational position, and life course socioeconomic trajectories-with brain microstructure and cognitive performance in middle to late adulthood. We assessed socioeconomic conditions alongside quantitative relaxometry and diffusion-weighted magnetic resonance imaging indicators of brain tissue microstructure and cognitive performance in a sample of community-dwelling men and women (N = 751, aged 50-91 years). We adjusted the applied regression analyses and structural equation models for the linear and nonlinear effects of age, sex, education, cardiovascular risk factors, and the presence of depression, anxiety, and substance use disorders. Individuals from lower-income households showed signs of advanced brain white matter (WM) aging with greater mean diffusivity (MD), lower neurite density, lower myelination, and lower iron content. The association between household income and MD was mediated by neurite density (B = 0.084, p = 0.003) and myelination (B = 0.019, p = 0.009); MD partially mediated the association between household income and cognitive performance (B = 0.017, p < 0.05). Household income moderated the relation between WM microstructure and cognitive performance, such that greater MD, lower myelination, or lower neurite density was only associated with poorer cognitive performance among individuals from lower-income households. Individuals from higher-income households showed preserved cognitive performance even with greater MD, lower myelination, or lower neurite density. These findings provide novel mechanistic insights into the associations between socioeconomic conditions, brain anatomy, and cognitive performance in middle to late adulthood.

Physical activity and lung function association in a healthy community-dwelling European population

BACKGROUND

The association of physical activity (PA) and lung function (LF) varies from no measurable effect to delayed LF decline. We assessed the association between accelerometery-assessed PA and LF in a sample of apparently healthy, community-dwelling subjects.

METHODS

We included two cross-sectional studies using data from the PneumoLaus study (2014-17 and 2018-21), conducted in Lausanne, Switzerland. PA was assessed by accelerometry and categorised as inactivity, light, moderate or vigorous. Forced expiratory volume in 1 second (FEV1), forced volume capacity (FVC) and maximal mid-expiratory flow (MMEF) were measured by spirometry and expressed in percentage of predicted value (PV).

RESULTS

Overall, 1'910 (54.7% women, 62.0 ± 9.7 years) and 1'174 (53.4% women, 65.8 ± 9.5 years) participants were included in the first and the second surveys, respectively. In both surveys, moderate and vigorous PA showed a weak but significant correlation with FEV1 in percentage (PV) (R = 0.106 and 0.132 for the first and 0.111 and 0.125 for the second surveys, p < 0.001). Similar correlations with FVC (p < 0.001) were found. Associations held irrespective of smoking status and remained after multivariable adjustment. Fewer associations were detected between LF and light PA or between MMEF and PA.

CONCLUSION

Moderate and vigorous intensity PA are associated with increased LF regardless of smoking status in apparently healthy community-dwelling European population. These associations are statistically but not clinically significant due to the small correlation coefficients (R < 0.30), corresponding to a weak association.

Vitamin supplements: Are they associated with immune status?

BACKGROUND & AIMS

Vitamins are essential nutrients, taken in very small amounts (0.01-100 mg a day). Associations between vitamin supplement intake or status and the immune system are far from consensual. Our aim was to understand the association between vitamin supplements and the immune system, namely regarding lymphocyte count and immunoglobulin levels against infectious pathogens.

METHODS

Cross-sectional study using data from the first follow-up of the CoLaus|PsyCoLaus study (April 2009 to September 2012). Participants were categorized as vitamin users and non-users. Serostatus for 15 viruses, six bacteria, and one parasite was assessed. Data for inflammatory markers (hs-CRP, IL-1β, IL-6, and TNF-α) and blood elements were also collected.

RESULTS

Of the initial 5064 participants, 3769 (74.5 %, mean age 58.3 ± 10.5 years, 53.6 % women) were retained for serostatus. On bivariate analysis, participants taking vitamins presented with higher positivity levels in three markers and lower positivity levels in two, but those differences were no longer statistically significant after multivariable analysis. 4489 participants (88.6 %, mean age 57.7 ± 10.5 years, 53.2 % women) had data for inflammatory markers; no association was found between vitamin supplement use and inflammatory markers both on bivariate and multivariable analysis. Finally, 3349 participants (66.1 %, mean age 57.3 ± 10.3 years, 53.1 % women) had data for blood elements; on bivariate analysis, vitamin supplement users had lower levels of haemoglobin and lymphocytes, but those differences were no longer significant after multivariable adjustment.

CONCLUSION

In this cross-sectional, population-based study, we found no association between vitamin supplement use and markers of immune status.

Associations between antipsychotics-induced weight gain and brain networks of impulsivity

Given the unpredictable rapid onset and ubiquitous consequences of weight gain induced by antipsychotics, there is a pressing need to get insights into the underlying processes at the brain system level that will allow stratification of "at risk" patients. The pathophysiological hypothesis at hand is focused on brain networks governing impulsivity that are modulated by neuro-inflammatory processes. To this aim, we investigated brain anatomy and functional connectivity in patients with early psychosis (median age: 23 years, IQR = 21-27) using anthropometric data and magnetic resonance imaging acquired one month to one year after initiation of AP medication. Our analyses included 19 patients with high and rapid weight gain (i.e., ≥5% from baseline weight after one month) and 23 patients with low weight gain (i.e., <5% from baseline weight after one month). We replicated our analyses in young (26 years, IQR = 22-33, N = 102) and middle-aged (56 years, IQR = 51-62, N = 875) healthy individuals from the general population. In early psychosis patients, higher weight gain was associated with poor impulse control score (β = 1.35; P = 0.03). Here, the observed brain differences comprised nodes of impulsivity networks - reduced frontal lobe grey matter volume (Pcorrected = 0.007) and higher striatal volume (Pcorrected = 0.048) paralleled by disruption of fronto-striatal functional connectivity (R = -0.32; P = 0.04). Weight gain was associated with the inflammatory biomarker plasminogen activator inhibitor-1 (β = 4.9, P = 0.002). There was no significant association between increased BMI or weight gain and brain anatomy characteristics in both cohorts of young and middle-aged healthy individuals. Our findings support the notion of weight gain in treated psychotic patients associated with poor impulse control, impulsivity-related brain networks and chronic inflammation.

Evaluating the clinical utility of an easily applicable prediction model of suicide attempts, newly developed and validated with a general community sample of adults

BACKGROUND

A suicide attempt (SA) is a clinically serious action. Researchers have argued that reducing long-term SA risk may be possible, provided that at-risk individuals are identified and receive adequate treatment. Algorithms may accurately identify at-risk individuals. However, the clinical utility of algorithmically estimated long-term SA risk has never been the predominant focus of any study.

METHODS

The data of this report stem from CoLaus|PsyCoLaus, a prospective longitudinal study of general community adults from Lausanne, Switzerland. Participants (N = 4,097; Mage = 54 years, range: 36-86; 54% female) were assessed up to four times, starting in 2003, approximately every 4-5 years. Long-term individual SA risk was prospectively predicted, using logistic regression. This algorithm's clinical utility was assessed by net benefit (NB). Clinical utility expresses a tool's benefit after having taken this tool's potential harm into account. Net benefit is obtained, first, by weighing the false positives, e.g., 400 individuals, at the risk threshold, e.g., 1%, using its odds (odds of 1% yields 1/(100-1) = 1/99), then by subtracting the result (400*1/99 = 4.04) from the true positives, e.g., 5 individuals (5-4.04), and by dividing the result (0.96) by the sample size, e.g., 800 (0.96/800). All results are based on 100 internal cross-validations. The predictors used in this study were: lifetime SA, any lifetime mental disorder, sex, and age.

RESULTS

SA at any of the three follow-up study assessments was reported by 1.2%. For a range of seven a priori selected threshold probabilities, ranging between 0.5% and 2%, logistic regression showed highest overall NB in 97.4% of all 700 internal cross-validations (100 for each selected threshold probability).

CONCLUSION

Despite the strong class imbalance of the outcome (98.8% no, 1.2% yes) and only four predictors, clinical utility was observed. That is, using the logistic regression model for clinical decision making provided the most true positives, without an increase of false positives, compared to all competing decision strategies. Clinical utility is one among several important prerequisites of implementing an algorithm in routine practice, and may possibly guide a clinicians' treatment decision making to reduce long-term individual SA risk. The novel metric NB may become a standard performance measure, because the a priori invested clinical considerations enable clinicians to interpret the results directly.

Role of sex and gender-related variables in development of metabolic syndrome: A prospective cohort study

INTRODUCTION

The burden of metabolic syndrome (MetS) and its components has been increasing mainly amongst male individuals. Nevertheless, clinical outcomes related to MetS (i.e., cardiovascular diseases), are worse among female individuals. Whether these sex differences in the components and sequalae of MetS are influenced by gender (i.e., psycho-socio-cultural factors)) is a matter of debate.  Therefore, the purpose of this study was to determine the association between gender-related factors and the development of MetS, and to assess if the magnitude of the associations vary by sex.

METHOD

Data from the Colaus/PsyColaus study, a prospective population-based cohort of 6,734 middle-aged participants in Lausanne (Switzerland) (2003-2006) were used. The primary endpoint was the development of MetS as defined by the Adult Treatment Panel III of the National Cholesterol Education Program. Multivariable models were estimated using logistic regression to assess the association between gender-related factors and the development of MetS. Two-way interactions between sex,  age and gender-related factors were also tested.

RESULTS

Among 5,195 participants without MetS (mean age=51.3 ± 10.6, 56.1 % females), 27.9 % developed MetS during a mean follow-up of 10.9 years. Female sex (OR:0.48, 95 %CI:0.41-0.55) was associated with decreased risk of developing MetS. Conversely, older age, educational attainment less than university, and low income were associated with an increased risk of developing MetS. Statistically significant interaction between sex and strata of age, education, income, smoking, and employment were identified showing that the reduced risk of MetS in female individuals was attenuated in the lowest education, income, and advanced age strata. However, females who smoke and reported being employed demonstrated a decreased risk of MetS compared to males. Conversely smoking and unemployment were significant risk factors for MetS development among male adults.

CONCLUSIONS

Gender-related factors such as income level and educational attainment play a greater role in the development of MetS in female than individuals. These factors represent novel modifiable targets for implementation of sex- and gender-specific strategies to achieve health equity for all people.

Associations of Depressive and Anxiety Disorders with Pulmonary Disorders in the Community: The PneumoLaus and PsyCoLaus Studies

INTRODUCTION

Mental health disorders figure among the many comorbidities of obstructive respiratory diseases. The multisystemic characteristics of chronic respiratory disease and its impact on quality of life could affect depressive and/or anxiety disorders. We aimed to evaluate the association of spirometric indices, ventilatory disorders, and self-reported respiratory diseases with psychiatric disorders considering potential confounders.

METHODS

We analysed data from CoLaus|PsyCoLaus, a Swiss population-based cohort study, consisting of 2'774 participants (56% women; mean age: 62.3 (standard deviation = ±9.9) years) who performed spirometry and completed semi-structured psychiatric interviews. We defined ventilatory disorders using GLI-2012 references. Major depressive episode (MDE) and anxiety disorders were defined using the DSM-IV (Diagnostic and Statistical Manual).

RESULTS

630 subjects (22.7%) presented a recent MDE. Reversible obstructive ventilatory disorders were associated with recent MDE (OR = 1.94, 95% confidence interval (95% CI) 1.10-3.43) and recent anxiety disorders (2.21 [1.16-4.22]) only in unadjusted model. Self-reported chronic obstructive pulmonary (COPD) and asthma were associated with MDE with ORs of 2.49 (95% CI, 1.19-5.27) and 1.56 (95% CI, 1.04-2.35) after adjustment, respectively. Possible restrictive ventilatory impairment was positively associated with recent anxiety disorders (OR = 2.46, 1.10-5.51). Z-scores of FEV1, FVC, and maximal mid-expiratory flow were not associated with psychiatric disorders. There was no association between ventilatory disorders and MDE in adjusted models.

CONCLUSIONS

In this cross-sectional population-based study, the association between respiratory disorders and depressive disorders was observed for self-reported COPD and asthma, but not with objective diagnoses based on spirometry. Lung volumes are not associated with psychiatric disorders. Further prospective studies will be necessary to understand the significance of the association.

Spatial analysis of 10-year predicted risk and incident atherosclerotic cardiovascular disease: the CoLaus cohort

Whether cardiovascular risk scores geographically aggregate and inform on spatial development of atherosclerotic cardiovascular diseases (ASCVD) remains unknown. Our aim is to determine the spatial distribution of 10-year predicted cardiovascular risk and ASCVD, and to compare the overlap of the resulting spatial distributions. Using prospective data from the CoLaus|PsyCoLaus cohort study (2003-2021) we computed SCORE2 in participants free from ASCVD. Geographical distributions of predicted risk and events were determined using the Gi* Getis-Ord autocorrelation statistic. 6203 individuals (54% women, mean age 52.5 ± SD 10.7, ASCVD incidence rate 5.7%) were included. We identified clusters of high versus low predicted risk (4%, 6%, respectively) and ASCVD (5%, 5% respectively) at baseline. They persisted at follow-up. Overlap of SCORE2 and ASCVD clusters was marginal. Body-mass index and alcohol consumption explained most of the predicted risk distribution. For ASCVD, high clusters persisted or were reinforced after multivariate adjustment, while low incidence clusters were reduced, multifactorial determinants. Incidence rate of ASCVD was 2.5% higher (IC 95%, 1.4-3.7) in clusters of higher incidence of ASCVD. To develop up-to-date, geographically targeted prevention strategies, there is a need to study novel geographically risk factors affecting ASCVD and to update commonly used prediction models for a population approach.