Publications by authors named "Pascal Bovet"

250 Publications

The associations between alcohol intake and cardiometabolic risk in African-origin adults spanning the epidemiologic transition.

BMC Public Health 2021 Dec 4;21(1):2210. Epub 2021 Dec 4.

Parkinson School of Health Sciences & Public Health, Loyola University Chicago, 2160 S. 1st Ave, Maywood, IL, 60153, USA.

Background: Cardiometabolic (CM) risk affects approximately 25% of adults globally, and is diagnosed by meeting 3 out of 5 of the following CM risk factors: elevated blood pressure, high triglycerides, elevated blood sugar, low high-density lipoprotein (HDL) level, and abdominal obesity. Adults with CM risk are approximately 22% more likely to have higher mortality rates, and alcohol consumption may be associated with higher CM risk. While previous studies have investigated this potential connection, the majority of them did not include African-origin adults. Therefore, the study aimed to explore the association between alcohol intake and CM risk in 5 African-origin cohorts, spanning the epidemiologic transition in Ghana, South Africa, Jamaica, Seychelles and the United States of America.

Methods: Measurements included clinical measures for CM risk and self-reported alcohol consumption. Each participant was categorized into one of three drinking categories: non-drinker, light drinker (1-3 drinks daily for men and 1-2 drinks daily for women) and heavy drinker (4 or more drinks every day for men and 3 or more drinks per day for women). Using non-drinker status as the reference, the association between alcohol consumption status and prevalence of each of the five CM risk factors and overall elevated CM risk (having 3 out of 5 risk factors) was explored, adjusting for site, age and sex. Associations were explored using logistic regression and significance was determined using odds ratios (OR) and 95% confidence intervals.

Results: Neither light nor heavy drinking was associated with increased odds for having higher CM risk compared to nondrinkers (OR = 1.05, p = 0.792 and OR = 1.11, p = 0.489, respectively). However, light drinking was associated with lower odds for having low high density lipoproteins (HDL) cholesterol (OR = 0.69, p = 0.002) and increased risk for high triglycerides (OR = 1.48, p = 0.030). Heavy drinking was associated with elevated blood pressure (OR = 1.59, p = 0.002), high triglycerides (OR = 1.73, p = 0.006) and decreased risk of low HDL-cholesterol (OR = 0.621, p < 0.0005). Finally, country-specific analyses indicated that the relationship between heavy drinking and elevated CM risk varied widely across sites.

Conclusion: While several CM risk factors were associated with alcohol consumption, the associations were inconsistent and varied widely across five international cohorts of African-origin. Future studies should focus on understanding the individual site-related effects.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12889-021-12128-2DOI Listing
December 2021

Tri-Ponderal Mass Index as a Screening Tool for Identifying Body Fat and Cardiovascular Risk Factors in Children and Adolescents: A Systematic Review.

Front Endocrinol (Lausanne) 2021 21;12:694681. Epub 2021 Oct 21.

Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.

Because of the limitation of body mass index (BMI) in distinguishing adipose mass from muscle, the tri-ponderal mass index (TMI) has been proposed as a new indicator for better assessing adiposity in children and adolescents. However, it remains unclear whether TMI performs better than BMI or other adiposity indices in predicting obesity status in childhood and obesity-related cardiovascular risk factors (CVRFs) in childhood or adulthood. We searched PubMed, Cochrane Library, and Web of Science for eligible publications until June 15, 2021. A total of 32 eligible studies were included in this systematic review. We found that TMI had a similar or better ability to predict body fat among children and adolescents than BMI. However, most of the included studies suggested that TMI was similar to BMI in identifying metabolic syndrome although TMI was suggested to be a useful tool when used in combination with other indicators (e.g., BMI and waist circumference). In addition, limited evidence showed that TMI did not perform better than BMI for identifying specific CVRFs, including insulin resistance, high blood pressure, dyslipidemia, and inflammation in children and adolescents, as well as CVRFs in adults.

Systematic Review Registration: https://www.crd.york.ac.uk/prospero, CRD42021260356.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fendo.2021.694681DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8566753PMC
October 2021

Unmet need for hypercholesterolemia care in 35 low- and middle-income countries: A cross-sectional study of nationally representative surveys.

PLoS Med 2021 Oct 25;18(10):e1003841. Epub 2021 Oct 25.

Department of Economics & Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany.

Background: As the prevalence of hypercholesterolemia is increasing in low- and middle-income countries (LMICs), detailed evidence is urgently needed to guide the response of health systems to this epidemic. This study sought to quantify unmet need for hypercholesterolemia care among adults in 35 LMICs.

Methods And Findings: We pooled individual-level data from 129,040 respondents aged 15 years and older from 35 nationally representative surveys conducted between 2009 and 2018. Hypercholesterolemia care was quantified using cascade of care analyses in the pooled sample and by region, country income group, and country. Hypercholesterolemia was defined as (i) total cholesterol (TC) ≥240 mg/dL or self-reported lipid-lowering medication use and, alternatively, as (ii) low-density lipoprotein cholesterol (LDL-C) ≥160 mg/dL or self-reported lipid-lowering medication use. Stages of the care cascade for hypercholesterolemia were defined as follows: screened (prior to the survey), aware of diagnosis, treated (lifestyle advice and/or medication), and controlled (TC <200 mg/dL or LDL-C <130 mg/dL). We further estimated how age, sex, education, body mass index (BMI), current smoking, having diabetes, and having hypertension are associated with cascade progression using modified Poisson regression models with survey fixed effects. High TC prevalence was 7.1% (95% CI: 6.8% to 7.4%), and high LDL-C prevalence was 7.5% (95% CI: 7.1% to 7.9%). The cascade analysis showed that 43% (95% CI: 40% to 45%) of study participants with high TC and 47% (95% CI: 44% to 50%) with high LDL-C ever had their cholesterol measured prior to the survey. About 31% (95% CI: 29% to 33%) and 36% (95% CI: 33% to 38%) were aware of their diagnosis; 29% (95% CI: 28% to 31%) and 33% (95% CI: 31% to 36%) were treated; 7% (95% CI: 6% to 9%) and 19% (95% CI: 18% to 21%) were controlled. We found substantial heterogeneity in cascade performance across countries and higher performances in upper-middle-income countries and the Eastern Mediterranean, Europe, and Americas. Lipid screening was significantly associated with older age, female sex, higher education, higher BMI, comorbid diagnosis of diabetes, and comorbid diagnosis of hypertension. Awareness of diagnosis was significantly associated with older age, higher BMI, comorbid diagnosis of diabetes, and comorbid diagnosis of hypertension. Lastly, treatment of hypercholesterolemia was significantly associated with comorbid hypertension and diabetes, and control of lipid measures with comorbid diabetes. The main limitations of this study are a potential recall bias in self-reported information on received health services as well as diminished comparability due to varying survey years and varying lipid guideline application across country and clinical settings.

Conclusions: Cascade performance was poor across all stages, indicating large unmet need for hypercholesterolemia care in this sample of LMICs-calling for greater policy and research attention toward this cardiovascular disease (CVD) risk factor and highlighting opportunities for improved prevention of CVD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1371/journal.pmed.1003841DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8575312PMC
October 2021

Estimated effect of increased diagnosis, treatment, and control of diabetes and its associated cardiovascular risk factors among low-income and middle-income countries: a microsimulation model.

Lancet Glob Health 2021 11 22;9(11):e1539-e1552. Epub 2021 Sep 22.

Institute for Applied Health Research, University of Birmingham, Birmingham, UK; Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa; Medical Research Council-Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.

Background: Given the increasing prevalence of diabetes in low-income and middle-income countries (LMICs), we aimed to estimate the health and cost implications of achieving different targets for diagnosis, treatment, and control of diabetes and its associated cardiovascular risk factors among LMICs.

Methods: We constructed a microsimulation model to estimate disability-adjusted life-years (DALYs) lost and health-care costs of diagnosis, treatment, and control of blood pressure, dyslipidaemia, and glycaemia among people with diabetes in LMICs. We used individual participant data-specifically from the subset of people who were defined as having any type of diabetes by WHO standards-from nationally representative, cross-sectional surveys (2006-18) spanning 15 world regions to estimate the baseline 10-year risk of atherosclerotic cardiovascular disease (defined as fatal and non-fatal myocardial infarction and stroke), heart failure (ejection fraction of <40%, with New York Heart Association class III or IV functional limitations), end-stage renal disease (defined as an estimated glomerular filtration rate <15 mL/min per 1·73 m or needing dialysis or transplant), retinopathy with severe vision loss (<20/200 visual acuity as measured by the Snellen chart), and neuropathy with pressure sensation loss (assessed by the Semmes-Weinstein 5·07/10 g monofilament exam). We then used data from meta-analyses of randomised controlled trials to estimate the reduction in risk and the WHO OneHealth tool to estimate costs in reaching either 60% or 80% of diagnosis, treatment initiation, and control targets for blood pressure, dyslipidaemia, and glycaemia recommended by WHO guidelines. Costs were updated to 2020 International Dollars, and both costs and DALYs were computed over a 10-year policy planning time horizon at a 3% annual discount rate.

Findings: We obtained data from 23 678 people with diabetes from 67 countries. The median estimated 10-year risk was 10·0% (IQR 4·0-18·0) for cardiovascular events, 7·8% (5·1-11·8) for neuropathy with pressure sensation loss, 7·2% (5·6-9·4) for end-stage renal disease, 6·0% (4·2-8·6) for retinopathy with severe vision loss, and 2·6% (1·2-5·3) for congestive heart failure. A target of 80% diagnosis, 80% treatment, and 80% control would be expected to reduce DALYs lost from diabetes complications from a median population-weighted loss to 1097 DALYs per 1000 population over 10 years (IQR 1051-1155), relative to a baseline of 1161 DALYs, primarily from reduced cardiovascular events (down from a median of 143 to 117 DALYs per 1000 population) due to blood pressure and statin treatment, with comparatively little effect from glycaemic control. The target of 80% diagnosis, 80% treatment, and 80% control would be expected to produce an overall incremental cost-effectiveness ratio of US$1362 per DALY averted (IQR 1304-1409), with the majority of decreased costs from reduced cardiovascular event management, counterbalanced by increased costs for blood pressure and statin treatment, producing an overall incremental cost-effectiveness ratio of $1362 per DALY averted (IQR 1304-1409).

Interpretation: Reducing complications from diabetes in LMICs is likely to require a focus on scaling up blood pressure and statin medication treatment initiation and blood pressure medication titration rather than focusing on increasing screening to increase diabetes diagnosis, or a glycaemic treatment and control among people with diabetes.

Funding: None.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/S2214-109X(21)00340-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8526364PMC
November 2021

Changes in Mortality Related to Traumatic Brain Injuries in the Seychelles from 1989 to 2018.

Front Neurol 2021 27;12:720434. Epub 2021 Aug 27.

Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany.

Traumatic Brain Injuries (TBIs) are a significant source of disability and mortality, which disproportionately affect low- and middle-income countries. The Republic of Seychelles is a country in the African region that has experienced rapid socio-economic development and one in which all deaths and the age distribution of the population have been enumerated for the past few decades. The aim of this study was to investigate TBI-related mortality changes in the Republic of Seychelles during 1989-2018. All TBI-related deaths were ascertained using the national Civil Registration and Vital Statistics System. Age- and sex-standardised mortality rates (per 100,000 person-years) were standardised to the age distribution of the World Health Organisation standard population. The 30-year age-standardised TBI-related mortality rates were 22.6 (95% CI 19.9, 25.2) in males and 4.0 (95% CI 2.9, 5.1) in females. Road traffic collisions were the leading contributor to TBI-related mortality [10.0 (95% CI 8.2, 11.8) in males and 2.7 (95% CI 1.8, 3.6) in females, > 0.05]. TBI-related mortality was most frequent at age 20-39 years in males (8.0) and at age 0-19 in females (1.4). Comparing 2004-2018 vs. 1989-2003, the age-standardised mortality rates changed in males/females by -20%/-11% (all cause mortality), -24%/+39.4% (TBIs) and +1%/+34.8% (road traffic injury-related TBI). TBI-related mortality rates were much higher in males but decreased over time. Road traffic collisions were the single greatest contributor to TBI mortality, emphasising the importance of road safety measures.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fneur.2021.720434DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8430237PMC
August 2021

Gut microbiota alterations in response to sleep length among African-origin adults.

PLoS One 2021 8;16(9):e0255323. Epub 2021 Sep 8.

Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, United States of America.

Sleep disorders are increasingly being characterized in modern society as contributing to a host of serious medical problems, including obesity and metabolic syndrome. Changes to the microbial community in the human gut have been reportedly associated with many of these cardiometabolic outcomes. In this study, we investigated the impact of sleep length on the gut microbiota in a large cohort of 655 participants of African descent, aged 25-45, from Ghana, South Africa (SA), Jamaica, and the United States (US). The sleep duration was self-reported via a questionnaire. Participants were classified into 3 sleep groups: short (<7hrs), normal (7-<9hrs), and long (≥9hrs). Forty-seven percent of US participants were classified as short sleepers and 88% of SA participants as long sleepers. Gut microbial composition analysis (16S rRNA gene sequencing) revealed that bacterial alpha diversity negatively correlated with sleep length (p<0.05). Furthermore, sleep length significantly contributed to the inter-individual beta diversity dissimilarity in gut microbial composition (p<0.01). Participants with both short and long-sleep durations exhibited significantly higher abundances of several taxonomic features, compared to normal sleep duration participants. The predicted relative proportion of two genes involved in the butyrate synthesis via lysine pathway were enriched in short sleep duration participants. Finally, co-occurrence relationships revealed by network analysis showed unique interactions among the short, normal and long duration sleepers. These results suggest that sleep length in humans may alter gut microbiota by driving population shifts of the whole microbiota and also specific changes in Exact Sequence Variants abundance, which may have implications for chronic inflammation associated diseases. The current findings suggest a possible relationship between disrupted sleep patterns and the composition of the gut microbiota. Prospective investigations in larger and more prolonged sleep researches and causally experimental studies are needed to confirm these findings, investigate the underlying mechanism and determine whether improving microbial homeostasis may buffer against sleep-related health decline in humans.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0255323PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8425534PMC
September 2021

Physical activity and fat-free mass during growth and in later life.

Am J Clin Nutr 2021 11;114(5):1583-1589

Unité Mixte de Recherche en Nutrition et Alimentation, CNESTEN-Université Ibn Tofail URAC39, Regional Designated Center of Nutrition Associated with African Regional Agreement for Research/International Atomic Energy Agency, Rabat, Morocco.

Background: Physical activity may be a way to increase and maintain fat-free mass (FFM) in later life, similar to the prevention of fractures by increasing peak bone mass.

Objectives: A study is presented of the association between FFM and physical activity in relation to age.

Methods: In a cross-sectional study, FFM was analyzed in relation to physical activity in a large participant group as compiled in the International Atomic Energy Agency Doubly Labeled Water database. The database included 2000 participants, age 3-96 y, with measurements of total energy expenditure (TEE) and resting energy expenditure (REE) to allow calculation of physical activity level (PAL = TEE/REE), and calculation of FFM from isotope dilution.

Results: PAL was a main determinant of body composition at all ages. Models with age, fat mass (FM), and PAL explained 76% and 85% of the variation in FFM in females and males < 18 y old, and 32% and 47% of the variation in FFM in females and males ≥ 18 y old, respectively. In participants < 18 y old, mean FM-adjusted FFM was 1.7 kg (95% CI: 0.1, 3.2 kg) and 3.4 kg (95% CI: 1.0, 5.6 kg) higher in a very active participant with PAL = 2.0 than in a sedentary participant with PAL = 1.5, for females and males, respectively. At age 18 y, height and FM-adjusted FFM was 3.6 kg (95% CI: 2.8, 4.4 kg) and 4.4 kg (95% CI: 3.2, 5.7 kg) higher, and at age 80 y 0.7 kg (95% CI: -0.2, 1.7 kg) and 1.0 kg (95% CI: -0.1, 2.1 kg) higher, in a participant with PAL = 2.0 than in a participant with PAL = 1.5, for females and males, respectively.

Conclusions: If these associations are causal, they suggest physical activity is a major determinant of body composition as reflected in peak FFM, and that a physically active lifestyle can only partly protect against loss of FFM in aging adults.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ajcn/nqab260DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8574623PMC
November 2021

Daily energy expenditure through the human life course.

Science 2021 08;373(6556):808-812

Unité Mixte de Recherche en Nutrition et Alimentation, CNESTEN-Université Ibn Tofail URAC39, Regional Designated Center of Nutrition Associated with AFRA/IAEA, Rabat, Morocco.

Total daily energy expenditure ("total expenditure") reflects daily energy needs and is a critical variable in human health and physiology, but its trajectory over the life course is poorly studied. We analyzed a large, diverse database of total expenditure measured by the doubly labeled water method for males and females aged 8 days to 95 years. Total expenditure increased with fat-free mass in a power-law manner, with four distinct life stages. Fat-free mass-adjusted expenditure accelerates rapidly in neonates to ~50% above adult values at ~1 year; declines slowly to adult levels by ~20 years; remains stable in adulthood (20 to 60 years), even during pregnancy; then declines in older adults. These changes shed light on human development and aging and should help shape nutrition and health strategies across the life span.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1126/science.abe5017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8370708PMC
August 2021

Consumption of Monounsaturated Fatty Acids Is Associated with Improved Cardiometabolic Outcomes in Four African-Origin Populations Spanning the Epidemiologic Transition.

Nutrients 2021 Jul 16;13(7). Epub 2021 Jul 16.

Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL 60153, USA.

Long-chain omega-3 PUFAs, specifically eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are of increasing interest because of their favorable effect on cardiometabolic risk. This study explores the association between omega 6 and 3 fatty acids intake and cardiometabolic risk in four African-origin populations spanning the epidemiological transition. Data are obtained from a cohort of 2500 adults aged 25-45 enrolled in the Modeling the Epidemiologic Transition Study (METS), from the US, Ghana, Jamaica, and the Seychelles. Dietary intake was measured using two 24 h recalls from the Nutrient Data System for Research (NDSR). The prevalence of cardiometabolic risk was analyzed by comparing the lowest and highest quartile of omega-3 (EPA+ DHA) consumption and by comparing participants who consumed a ratio of arachidonic acid (AA)/EPA + DHA ≤4:1 and >4:1. Data were analyzed using multiple variable logistic regression adjusted for age, gender, activity, calorie intake, alcohol intake, and smoking status. The lowest quartile of EPA + DHA intake is associated with cardiometabolic risk 2.16 (1.45, 3.2), inflammation 1.59 (1.17, 2.16), and obesity 2.06 (1.50, 2.82). Additionally, consuming an AA/EPA + DHA ratio of >4:1 is also associated with cardiometabolic risk 1.80 (1.24, 2.60), inflammation 1.47 (1.06, 2.03), and obesity 1.72 (1.25, 2.39). Our findings corroborate previous research supporting a beneficial role for monounsaturated fatty acids in reducing cardiometabolic risk.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/nu13072442DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8308507PMC
July 2021

Body-mass index and diabetes risk in 57 low-income and middle-income countries: a cross-sectional study of nationally representative, individual-level data in 685 616 adults.

Lancet 2021 07;398(10296):238-248

Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: The prevalence of overweight, obesity, and diabetes is rising rapidly in low-income and middle-income countries (LMICs), but there are scant empirical data on the association between body-mass index (BMI) and diabetes in these settings.

Methods: In this cross-sectional study, we pooled individual-level data from nationally representative surveys across 57 LMICs. We identified all countries in which a WHO Stepwise Approach to Surveillance (STEPS) survey had been done during a year in which the country fell into an eligible World Bank income group category. For LMICs that did not have a STEPS survey, did not have valid contact information, or declined our request for data, we did a systematic search for survey datasets. Eligible surveys were done during or after 2008; had individual-level data; were done in a low-income, lower-middle-income, or upper-middle-income country; were nationally representative; had a response rate of 50% or higher; contained a diabetes biomarker (either a blood glucose measurement or glycated haemoglobin [HbA]); and contained data on height and weight. Diabetes was defined biologically as a fasting plasma glucose concentration of 7·0 mmol/L (126·0 mg/dL) or higher; a random plasma glucose concentration of 11·1 mmol/L (200·0 mg/dL) or higher; or a HbA of 6·5% (48·0 mmol/mol) or higher, or by self-reported use of diabetes medication. We included individuals aged 25 years or older with complete data on diabetes status, BMI (defined as normal [18·5-22·9 kg/m], upper-normal [23·0-24·9 kg/m], overweight [25·0-29·9 kg/m], or obese [≥30·0 kg/m]), sex, and age. Countries were categorised into six geographical regions: Latin America and the Caribbean, Europe and central Asia, east, south, and southeast Asia, sub-Saharan Africa, Middle East and north Africa, and Oceania. We estimated the association between BMI and diabetes risk by multivariable Poisson regression and receiver operating curve analyses, stratified by sex and geographical region.

Findings: Our pooled dataset from 58 nationally representative surveys in 57 LMICs included 685 616 individuals. The overall prevalence of overweight was 27·2% (95% CI 26·6-27·8), of obesity was 21·0% (19·6-22·5), and of diabetes was 9·3% (8·4-10·2). In the pooled analysis, a higher risk of diabetes was observed at a BMI of 23 kg/m or higher, with a 43% greater risk of diabetes for men and a 41% greater risk for women compared with a BMI of 18·5-22·9 kg/m. Diabetes risk also increased steeply in individuals aged 35-44 years and in men aged 25-34 years in sub-Saharan Africa. In the stratified analyses, there was considerable regional variability in this association. Optimal BMI thresholds for diabetes screening ranged from 23·8 kg/m among men in east, south, and southeast Asia to 28·3 kg/m among women in the Middle East and north Africa and in Latin America and the Caribbean.

Interpretation: The association between BMI and diabetes risk in LMICs is subject to substantial regional variability. Diabetes risk is greater at lower BMI thresholds and at younger ages than reflected in currently used BMI cutoffs for assessing diabetes risk. These findings offer an important insight to inform context-specific diabetes screening guidelines.

Funding: Harvard T H Chan School of Public Health McLennan Fund: Dean's Challenge Grant Program.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/S0140-6736(21)00844-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8336025PMC
July 2021

Waist circumference change and risk of high carotid intima-media thickness in a cohort of Chinese children.

J Hypertens 2021 09;39(9):1901-1907

Department of Epidemiology, School of Public Health, Cheeloo College of Medicine.

Objective: Previous cross-sectional studies showed a positive association between waist circumference (WC) and carotid intima-media thickness (cIMT) among children and adolescents. We examined the association between change in WC and cIMT in a cohort study of Chinese children with 2-year follow-up.

Methods: A school-based cohort study named 'Huantai Childhood Cardiovascular Health Cohort Study' was conducted in Zibo City, Shandong Province, China. WC and cIMT were measured in 2017 and 2019. Change in WC was categorized into four groups: persistently low WC, WC loss, WC gain and persistently high WC. We examined the association between WC change and cIMT during a 2-year follow-up.

Results: A total of 1183 children aged 6-11 years at baseline were included in this study. After adjustment for potential covariates, WC change was associated positively with cIMT change (linear regression coefficient = 5.92 μm/cm per 2 years, 95% confidence interval [CI]: 4.55-7.30). Among the 1072 children (out of 1183 children) with normal cIMT at baseline, compared with persistently low WC, WC gain (odds ratio [OR] = 3.23, 95% CI: 1.14-9.17) and persistently high WC (OR = 7.94, 95% CI: 3.81-16.51) were associated with high cIMT at the end of the follow-up period. In contrast, WC loss during follow-up was not associated with high cIMT (OR = 1.33, 95% CI:0.35-5.11).

Conclusion: In this cohort of children, WC gain and persistently high WC were associated with increased cIMT whereas WC loss was not. These findings emphasize the importance of maintaining a normal WC in childhood to promote vascular health.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/HJH.0000000000002881DOI Listing
September 2021

Increasing prevalence of overweight among Seychelles children, 1998-2002.

Neurotoxicology 2020 12 12;81:259-265. Epub 2020 Oct 12.

Health Education and Promotion Division, Ministry of Health, Republic of Seychelles.

To examine the prevalence and trends in excess weight among children in the Seychelles. Serial surveys of weight and height were conducted each year between 1998-2002 in all students attending four school grades (crèche, 4, 7 and 10 years of compulsory school). Overweight and obesity were defined using age-specific body mass index (BMI) criteria of the International Obesity Task Force. Two questions explored physical activity at leisure time and daily walking time. From an eligible total of 32 077 observations between 1998-2002, data were available in 22 694 (71%), which corresponded to 17 627 separate children. Median age in the four grades was respectively 5.5, 9.2, 12.6, and 15.8 years. The overall prevalence of excess weight ('overweight' and 'obese' categories combined) was 10.5% in boys and 16.4% in girls. From 1998 to 2002, the prevalence of excess weight increased from 8.4% to 11.8% in boys and from 11.9% to 18.4% in girls. The increase of excess weight over calendar years was particularly marked among the younger children. Only a quarter of children reported walking at least 30minutes per day. Leisure physical activity was inversely associated with excess body weight. The prevalence of excess body weight was high among school children of Seychelles and increased substantially over a five-year period. This calls for prompt and energetic policies and programs to promote physical activity and healthy nutrition among children.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.neuro.2020.09.014DOI Listing
December 2020

Evolution of water conservation in humans.

Curr Biol 2021 04 5;31(8):1804-1810.e5. Epub 2021 Mar 5.

Lester E. Fisher Center for the Study and Conservation of Apes, Lincoln Park Zoo. Chicago, IL 60614, USA.

To sustain life, humans and other terrestrial animals must maintain a tight balance of water gain and water loss each day. However, the evolution of human water balance physiology is poorly understood due to the absence of comparative measures from other hominoids. While humans drink daily to maintain water balance, rainforest-living great apes typically obtain adequate water from their food and can go days or weeks without drinking. Here, we compare isotope-depletion measures of water turnover (L/d) in zoo- and rainforest-sanctuary-housed apes (chimpanzees, bonobos, gorillas, and orangutans) with 5 diverse human populations, including a hunter-gatherer community in a semi-arid savannah. Across the entire sample, water turnover was strongly related to total energy expenditure (TEE, kcal/d), physical activity, climate (ambient temperature and humidity), and fat free mass. In analyses controlling for those factors, water turnover was 30% to 50% lower in humans than in other apes despite humans' greater sweating capacity. Water turnover in zoo and sanctuary apes was similar to estimated turnover in wild populations, as was the ratio of water intake to dietary energy intake (∼2.8 mL/kcal). However, zoo and sanctuary apes ingested a greater ratio of water to dry matter of food, which might contribute to digestive problems in captivity. Compared to apes, humans appear to target a lower ratio of water/energy intake (∼1.5 mL/kcal). Water stress due to changes in climate, diet, and behavior apparently led to previously unknown water conservation adaptations in hominin physiology.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.cub.2021.02.045DOI Listing
April 2021

A standard calculation methodology for human doubly labeled water studies.

Cell Rep Med 2021 Feb 16;2(2):100203. Epub 2021 Feb 16.

Maastricht University, Maastricht, the Netherlands.

The doubly labeled water (DLW) method measures total energy expenditure (TEE) in free-living subjects. Several equations are used to convert isotopic data into TEE. Using the International Atomic Energy Agency (IAEA) DLW database (5,756 measurements of adults and children), we show considerable variability is introduced by different equations. The estimated rCO is sensitive to the dilution space ratio (DSR) of the two isotopes. Based on performance in validation studies, we propose a new equation based on a new estimate of the mean DSR. The DSR is lower at low body masses (<10 kg). Using data for 1,021 babies and infants, we show that the DSR varies non-linearly with body mass between 0 and 10 kg. Using this relationship to predict DSR from weight provides an equation for rCO over this size range that agrees well with indirect calorimetry (average difference 0.64%; SD = 12.2%). We propose adoption of these equations in future studies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.xcrm.2021.100203DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7897799PMC
February 2021

Variation in the Proportion of Adults in Need of Blood Pressure-Lowering Medications by Hypertension Care Guideline in Low- and Middle-Income Countries: A Cross-Sectional Study of 1 037 215 Individuals From 50 Nationally Representative Surveys.

Circulation 2021 03 8;143(10):991-1001. Epub 2021 Feb 8.

Division of Primary Care and Population Health, Department of Medicine, Stanford University, CA (P.G.).

Background: Current hypertension guidelines vary substantially in their definition of who should be offered blood pressure-lowering medications. Understanding the effect of guideline choice on the proportion of adults who require treatment is crucial for planning and scaling up hypertension care in low- and middle-income countries.

Methods: We extracted cross-sectional data on age, sex, blood pressure, hypertension treatment and diagnosis status, smoking, and body mass index for adults 30 to 70 years of age from nationally representative surveys in 50 low- and middle-income countries (N = 1 037 215). We aimed to determine the effect of hypertension guideline choice on the proportion of adults in need of blood pressure-lowering medications. We considered 4 hypertension guidelines: the 2017 American College of Cardiology/American Heart Association guideline, the commonly used 140/90 mm Hg threshold, the 2016 World Health Organization HEARTS guideline, and the 2019 UK National Institute for Health and Care Excellence guideline.

Results: The proportion of adults in need of blood pressure-lowering medications was highest under the American College of Cardiology/American Heart Association, followed by the 140/90 mm Hg, National Institute for Health and Care Excellence, and World Health Organization guidelines (American College of Cardiology/American Heart Association: women, 27.7% [95% CI, 27.2-28.2], men, 35.0% [95% CI, 34.4-35.7]; 140/90 mm Hg: women, 26.1% [95% CI, 25.5-26.6], men, 31.2% [95% CI, 30.6-31.9]; National Institute for Health and Care Excellence: women, 11.8% [95% CI, 11.4-12.1], men, 15.7% [95% CI, 15.3-16.2]; World Health Organization: women, 9.2% [95% CI, 8.9-9.5], men, 11.0% [95% CI, 10.6-11.4]). Individuals who were unaware that they have hypertension were the primary contributor to differences in the proportion needing treatment under different guideline criteria. Differences in the proportion needing blood pressure-lowering medications were largest in the oldest (65-69 years) age group (American College of Cardiology/American Heart Association: women, 60.2% [95% CI, 58.8-61.6], men, 70.1% [95% CI, 68.8-71.3]; World Health Organization: women, 20.1% [95% CI, 18.8-21.3], men, 24.1.0% [95% CI, 22.3-25.9]). For both women and men and across all guidelines, countries in the European and Eastern Mediterranean regions had the highest proportion of adults in need of blood pressure-lowering medicines, whereas the South and Central Americas had the lowest.

Conclusions: There was substantial variation in the proportion of adults in need of blood pressure-lowering medications depending on which hypertension guideline was used. Given the great implications of this choice for health system capacity, policy makers will need to carefully consider which guideline they should adopt when scaling up hypertension care in their country.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/CIRCULATIONAHA.120.051620DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7940589PMC
March 2021

Prevalence and trends in tobacco use among adolescents aged 13-15 years in 143 countries, 1999-2018: findings from the Global Youth Tobacco Surveys.

Lancet Child Adolesc Health 2021 04 2;5(4):245-255. Epub 2021 Feb 2.

Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.

Background: Tobacco use is a leading preventable cause of morbidity and mortality worldwide. Little is known about recent prevalence and trends in tobacco use among adolescents globally. We aimed to assess the recent global prevalence of tobacco use in young adolescents and the secular trends in prevalence between 1999 and 2018.

Methods: We used the most recent Global Youth Tobacco Surveys data on adolescents aged 13-15 years from 143 countries or territories that had done at least one survey between Jan 1, 2010, and Dec 31, 2018, to assess the recent prevalence of tobacco use; and data from 140 countries that had done two or more surveys between Jan 1, 1999, and Dec 31, 2018, to assess the trends in the prevalence of tobacco use.

Findings: 530 234 adolescents were included from the 143 countries that had done at least one survey between 2010 and 2018. 1 192 312 adolescents were included from the 140 countries that had done two or more surveys between 1999 and 2018. The most recent global prevalence of cigarette smoking was 11·3% (95% CI 10·3-12·3) in boys and 6·1% (5·6-6·6) in girls, based on cigarette smoking on at least 1 day during the past 30 days, 6·0% (5·5-6·6) and 2·6% (2·4-2·9) based on smoking on at least 3 days, and 4·2% (3·8-4·6) and 1·6% (1·4-1·8) based on smoking on at least 6 days. The most recent prevalence of the use of tobacco products other than cigarettes (eg, chewing tobacco, snuff, dip, cigars, cigarillos, pipe, electronic cigarettes) on at least 1 day during the past 30 days was 11·2% (9·9-12·6) in boys and 7·0% (6·4-7·7) in girls. The most recent prevalence of any tobacco use on at least 1 day during the past 30 days was 17·9% (16·1-19·6) in boys and 11·5% (10·5-12·4) in girls. The prevalence of cigarette smoking on at least 1 day during the past 30 days decreased between the first and last surveys in 80 (57·1%) of 140 countries, was unchanged in 39 countries (27·9%), and increased in 21 countries (15·0%). However, the prevalence of the use of tobacco products other than cigarettes was unchanged or increased in 81 (59·1%) of 137 countries.

Interpretation: The global prevalence of tobacco use among adolescents aged 13-15 years was substantial. Although the prevalence of cigarette smoking decreased over time in the majority of countries, the prevalence of the use of other tobacco products increased or did not change in the majority of countries during the past two decades. These findings re-emphasise the need to strengthen tobacco control efforts among young adolescents globally.

Funding: Shandong University.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/S2352-4642(20)30390-4DOI Listing
April 2021

Association of abdominal obesity and high blood pressure with left ventricular hypertrophy and geometric remodeling in Chinese children.

Nutr Metab Cardiovasc Dis 2021 01 11;31(1):306-313. Epub 2020 Sep 11.

Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China. Electronic address:

Background And Aims: Many studies have examined the association between overweight or obesity assessed by body mass index and left ventricular hypertrophy (LVH) in children or adolescents, but only few studies have assessed the relation with abdominal obesity in children. This study aimed to assess the association of abdominal obesity assessed by waist circumference (WC), high blood pressure (BP) and their joint effect on LVH and left ventricular (LV) geometric remodeling in Chinese children.

Methods And Results: Data were from a cross-sectional survey of 1319 Chinese children aged 6-11 years who had undergone cardiac ultrasound. Compared with normal WC, the adjusted odds ratios (ORs) for abdominal obesity were 6.78 (95% confidence interval [CI] 3.77-12.16) for LVH, 2.80 (1.55-5.05) for CR, 5.43 (2.84-10.39) for EH, and 20.05 (4.46-90.08) for CH, respectively. Compared with children with both normal WC and normal BP, the adjusted ORs for those with abdominal obesity and normal BP were 6.98 (3.71-13.10) for LVH, 2.87 (1.47-5.60) for CR, 5.52 (2.70-11.26) for EH, and 15.20 (4.51-78.13) for CH. The adjusted ORs for those with abdominal obesity and high BP were 7.12 (3.27-15.50) for LVH, 4.71 (2.04-10.85) for CR, 7.49 (3.23-17.40) for EH, and 8.65 (1.32-56.89) for CH. The ORs for those with high BP and normal WC were not significant for these cardiac outcomes (P > 0.05).

Conclusions: LVH and LV geometric remodeling were associated more strongly with abdominal obesity than with high BP in Chinese children, stressing the need to prevent childhood abdominal obesity for reducing cardiac risk.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.numecd.2020.09.007DOI Listing
January 2021

Trends in mortality from external causes in the Republic of Seychelles between 1989 and 2018.

Sci Rep 2020 12 17;10(1):22186. Epub 2020 Dec 17.

Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany.

Data on injury-related mortality are scarce in the African region. Mortality from external causes in the Seychelles was assessed, where all deaths are medically certified and the population is regularly enumerated. The four fields for underlying causes of death recorded were reviewed in the national vital statistics register. The age-standardised mortality rates were estimated (per 100,000 person-years) from external causes in 1989-1998, 1999-2008, and 2009-2018. Mortality rates per 100,000 person-years from external causes were 4-5 times higher among males than females, and decreased among males over the three 10-year periods (127.5, 101.4, 97.1) but not among females (26.9, 23.1, 26.9). The contribution of external causes to total mortality did not change markedly over time (males 11.6%, females 4.3% in 1989-2018). Apart from external deaths from undetermined causes (males 14.6, females 2.4) and "other unintentional injuries" (males 14.1, females 8.0), the leading external causes of death in 2009-2018 were drowning (25.9), road traffic injuries (18.0) and suicide (10.4) among males; and road traffic injuries (4.6), drowning (3.4) and poisoning (2.6) among females. Mortality from broad categories of external causes did not change consistently over time but rates of road traffic injuries increased among males. External causes contributed approximately 1 in 10 deaths among males and 1 in 20 among females, with no marked change in cause-specific rates over time, except for road traffic injuries. These findings emphasise the need for programs and policies in various sectors to address this large, but mostly avoidable health burden.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-020-79228-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7746745PMC
December 2020

Hypertension Prevalence Based on Blood Pressure Measurements on Two vs. One Visits: A Community-Based Screening Programme and a Narrative Review.

Int J Environ Res Public Health 2020 12 15;17(24). Epub 2020 Dec 15.

Department of Health Services and Epidemiology, University Center for Primary Care and Public Health (Unisanté), 1010 Lausanne, Switzerland.

We assessed the difference in the prevalence of hypertension in community surveys when blood pressure (BP) was measured on two vs. one visits and its impact on hypertension awareness, treatment and control proportions. A community-based BP screening programme was conducted in public places in the Seychelles (619 adults) and BP was rechecked a few days later among untreated participants with high BP (≥140/90 mmHg). A narrative review of the literature on this question was also conducted. Only 64% of untreated participants with high BP still had high BP at the second visit. The prevalence of hypertension in the whole sample decreased by 13% (from 33.8% to 29.5%) when BP was measured on two vs. one visits. These results concurred with our findings in our narrative review based on 10 surveys. In conclusion, the prevalence of hypertension can be markedly overestimated in community surveys when BP is measured on two vs. one visits. The overestimation could be addressed by measuring BP on a second visit among untreated individuals with high BP or, possibly, by taking more readings at the first visit. These findings have relevance for clinical practice, policy and surveillance.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/ijerph17249395DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7765379PMC
December 2020

Association between country preparedness indicators and quality clinical care for cardiovascular disease risk factors in 44 lower- and middle-income countries: A multicountry analysis of survey data.

PLoS Med 2020 11 10;17(11):e1003268. Epub 2020 Nov 10.

Institut Africain de Santé publique (IASP), Ouagadougou, Burkina Faso.

Background: Cardiovascular diseases are leading causes of death, globally, and health systems that deliver quality clinical care are needed to manage an increasing number of people with risk factors for these diseases. Indicators of preparedness of countries to manage cardiovascular disease risk factors (CVDRFs) are regularly collected by ministries of health and global health agencies. We aimed to assess whether these indicators are associated with patient receipt of quality clinical care.

Methods And Findings: We did a secondary analysis of cross-sectional, nationally representative, individual-patient data from 187,552 people with hypertension (mean age 48.1 years, 53.5% female) living in 43 low- and middle-income countries (LMICs) and 40,795 people with diabetes (mean age 52.2 years, 57.7% female) living in 28 LMICs on progress through cascades of care (condition diagnosed, treated, or controlled) for diabetes or hypertension, to indicate outcomes of provision of quality clinical care. Data were extracted from national-level World Health Organization (WHO) Stepwise Approach to Surveillance (STEPS), or other similar household surveys, conducted between July 2005 and November 2016. We used mixed-effects logistic regression to estimate associations between each quality clinical care outcome and indicators of country development (gross domestic product [GDP] per capita or Human Development Index [HDI]); national capacity for the prevention and control of noncommunicable diseases ('NCD readiness indicators' from surveys done by WHO); health system finance (domestic government expenditure on health [as percentage of GDP], private, and out-of-pocket expenditure on health [both as percentage of current]); and health service readiness (number of physicians, nurses, or hospital beds per 1,000 people) and performance (neonatal mortality rate). All models were adjusted for individual-level predictors including age, sex, and education. In an exploratory analysis, we tested whether national-level data on facility preparedness for diabetes were positively associated with outcomes. Associations were inconsistent between indicators and quality clinical care outcomes. For hypertension, GDP and HDI were both positively associated with each outcome. Of the 33 relationships tested between NCD readiness indicators and outcomes, only two showed a significant positive association: presence of guidelines with being diagnosed (odds ratio [OR], 1.86 [95% CI 1.08-3.21], p = 0.03) and availability of funding with being controlled (OR, 2.26 [95% CI 1.09-4.69], p = 0.03). Hospital beds (OR, 1.14 [95% CI 1.02-1.27], p = 0.02), nurses/midwives (OR, 1.24 [95% CI 1.06-1.44], p = 0.006), and physicians (OR, 1.21 [95% CI 1.11-1.32], p < 0.001) per 1,000 people were positively associated with being diagnosed and, similarly, with being treated; and the number of physicians was additionally associated with being controlled (OR, 1.12 [95% CI 1.01-1.23], p = 0.03). For diabetes, no positive associations were seen between NCD readiness indicators and outcomes. There was no association between country development, health service finance, or health service performance and readiness indicators and any outcome, apart from GDP (OR, 1.70 [95% CI 1.12-2.59], p = 0.01), HDI (OR, 1.21 [95% CI 1.01-1.44], p = 0.04), and number of physicians per 1,000 people (OR, 1.28 [95% CI 1.09-1.51], p = 0.003), which were associated with being diagnosed. Six countries had data on cascades of care and nationwide-level data on facility preparedness. Of the 27 associations tested between facility preparedness indicators and outcomes, the only association that was significant was having metformin available, which was positively associated with treatment (OR, 1.35 [95% CI 1.01-1.81], p = 0.04). The main limitation was use of blood pressure measurement on a single occasion to diagnose hypertension and a single blood glucose measurement to diagnose diabetes.

Conclusion: In this study, we observed that indicators of country preparedness to deal with CVDRFs are poor proxies for quality clinical care received by patients for hypertension and diabetes. The major implication is that assessments of countries' preparedness to manage CVDRFs should not rely on proxies; rather, it should involve direct assessment of quality clinical care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1371/journal.pmed.1003268DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7654799PMC
November 2020

Physical Activity and Sedentary Behavior among Young Adolescents in 68 LMICs, and Their Relationships with National Economic Development.

Int J Environ Res Public Health 2020 10 23;17(21). Epub 2020 Oct 23.

Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China.

It is unclear whether physical activity and sedentary behavior are associated with economic development in low- and middle-income countries (LMICs). We aimed to assess the association between these two behaviors and country economic development among young adolescents in LMICs. Data came from the Global School-based Student Health Survey (GSHS) conducted between 2009 and 2016 in 68 LMICs. A total of 180,298 adolescents aged 12-15 years were included; 15.3% of young adolescents achieved the recommended level for sufficient physical activity (≥60 min/day of physical activity of any kind per week according to WHO) and 64.6% achieved a low sedentary behavior (≤2 h of sitting activities/day according to some guidelines, not accounting for sitting time at school or for doing homework). However, only 9.1% of young adolescents met the recommended levels of both behaviors. Comparing the lowest to the highest quintiles of a country's purchasing power parity per capita (PPP), mean values of both physical activity (boys: 2.55 to 2.96 days/week; girls: 2.10 to 2.31 days/week) and sedentary behavior(boys: 1.86 to 3.13 h/day; girls: 1.83 to 3.53 h/day) increased. The prevalence of having both recommended behaviors decreased among boys (12.0% to 10.0%) and girls (9.6% to 4.9%) ( < 0.001). Although there might be an ecological fallacy, the findings emphasize the need for interventions to increase physical activity and reduce sedentary behavior among children and young adolescents.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/ijerph17217752DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7660305PMC
October 2020

Trends in the prevalence of overweight, obesity, and abdominal obesity among Chinese adults between 1993 and 2015.

Int J Obes (Lond) 2021 02 10;45(2):427-437. Epub 2020 Oct 10.

Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.

Background: Most previous studies on trends in the prevalence of obesity or abdominal obesity in Chinese adults were based on regional data and/or short time intervals, and recent trends are not available. We aimed to examine the secular trends in the prevalence of overweight, obesity, and abdominal obesity among Chinese adults at the national level from 1993 to 2015.

Methods: A total of 70,242 Chinese adults aged 18-80 years were from the cross-sectional surveys conducted from 1993 to 2015. According to the World Health Organization criteria, overweight was defined as body mass index (BMI) ≥23.0 kg/m and <27.5 kg/m, and obesity was defined as BMI ≥27.5 kg/m. According to the International Diabetes Federation criteria, abdominal obesity was defined as waist circumference (WC) ≥90 cm for men and ≥80 cm for women. Mean values and prevalence of adiposity markers were standardized to the age distribution of the China population in 2010.

Results: Between 1993 and 2015, and based on age-standardized values, mean BMI increased from 21.9 kg/m in 1993 to 23.9 kg/m (+2.0 kg/m) in 2015 (P for trend < 0.001), and mean WC increased from 76.0 cm to 83.4 cm (+7.4 cm) (P for trend <0.001). From 1993 to 2015, the prevalence increased from 26.6% to 41.3% (+14.7%) for overweight, from 4.2% to 15.7% (+11.5%) for obesity, and from 20.2% to 46.9% (+26.7%) for abdominal obesity (all P for trends < 0.001). In multivariate linear regression analysis, time (calendar years), older age and urban regions were strongly and independently associated with BMI.

Conclusions: The prevalence of overweight, obesity, and abdominal obesity increased markedly among Chinese adults during the past two decades. Weight control programs and public health measures to address the societal causes of obesity should be strengthened.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41366-020-00698-xDOI Listing
February 2021

Prevalence and determinants of blood pressure variability in pygmies of Southern region Cameroon.

J Hypertens 2020 11;38(11):2198-2204

Cameroon Heart Foundation, Douala, Cameroon.

Introduction: The impact of urbanization and living conditions on the prevalence of hypertension in the Cameroonian population is poorly known.

Aim: To evaluate the prevalence and determinants of blood pressure (BP) in adult Pygmies and Bantus living in urban and rural areas of Southern Cameroon.

Participants And Methods: This was a cross-sectional comparative study of 406 adults (96 urban Bantus, 100 urban Pygmies, 111 rural Bantus and 99 tropical rainforest Pygmies with a traditional Pygmies way of life), recruited in Southern Cameroon (mean age 42 ± 17 years; 56.7% women). Sociodemographic, anthropometric and BP parameters were collected. Hypertension was defined as BP at least 140/90 mmHg and/or use of BP-lowering drug(s).

Results: The age-standardized prevalence of hypertension in urban Bantus, rural Bantus, urban Pygmies and traditional Pygmies was 18.0, 13.5, 9.3 and 4.1%, respectively. Mean SBP and DBP differed significantly according to Bantu vs. Pygmy ethnicity, and urban vs. rural residency. After multiple adjustments, mean arterial pressure was significantly associated with age, BMI, Bantu ancestry and urban residency.

Conclusion: Bantu ethnicity and urban residency are significantly associated with high-BP among people from Southern Cameroon.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/HJH.0000000000002529DOI Listing
November 2020

Elevated blood pressure in childhood and hypertension risk in adulthood: a systematic review and meta-analysis.

J Hypertens 2020 12;38(12):2346-2355

Department of Epidemiology.

Objective: Several longitudinal studies have investigated the association between elevated blood pressure (BP) in childhood and hypertension in adulthood but the strength of the association has not been always consistent. This study aimed at quantitatively assessing the strength of the association between elevated BP in childhood and hypertension in adulthood based on both a meta-analysis and a systematic review.

Methods: We identified eligible studies using PubMed and Embase databases up to 1 November, 2019 and by manually searching the reference lists of all identified studies. All longitudinal studies on the association between elevated BP in childhood and hypertension in adulthood were included. Summary odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random-effects model in this meta-analysis.

Results: Eleven articles (N = 39 714) were included in our meta-analysis and five additional articles were used for systematic review (two providing ORs without 95% CIs, one not using standard cut-offs for elevated BP in childhood, and two not using standard criteria for adult hypertension). Elevated BP in childhood (3--18 years in the included studies) was significantly associated with hypertension in adulthood (18--57 years in the included studies), with a summary OR of 2.02 (95% CI 1.62--2.53). We also found that an increase of 1 standard deviation in systolic BP and diastolic BP, respectively, in childhood (3--19 years in the included studies) was associated with hypertension in adulthood (21--49 years in the included studies), with summary ORs of 1.71 (1.50-1.95) and 1.57 (1.37-1.81). Our systematic review of the five additional articles not eligible for meta-analysis also suggested a significant association between elevated BP in childhood and hypertension in adulthood.

Conclusion: This meta-analysis and systematic review demonstrated a significant association between elevated BP in childhood and hypertension in adulthood. The findings support measures to promote healthy BP during childhood to reduce the risk of hypertension later in life.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/HJH.0000000000002550DOI Listing
December 2020

Sleep duration and cardiovascular risk factors in children and adolescents: A systematic review.

Sleep Med Rev 2020 10 19;53:101338. Epub 2020 May 19.

Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China. Electronic address:

An association between short sleep duration and cardiovascular risk factors and outcomes is well demonstrated in adults. However, findings on the association in children and adolescents have been inconsistent. In this review, we searched PubMed, Embase and ISI Web of Science for eligible publications until March 16, 2020. We identified 37 reviews/meta-analyses on the association between sleep duration and cardiovascular risk factors and 15 studies on the association between sleep duration and metabolic syndrome (MetS) in children and adolescents. We found strong evidence on the association between short sleep duration and increased adiposity markers and high blood pressure, some evidence on the association between short sleep duration and insulin resistance, but inconsistent findings on the association between sleep duration and blood lipids, inflammation and MetS. Although more studies are needed to further assess the association between sleep duration and selected cardiovascular risk factors, our findings support interventions to improve sleep duration and quality as a potential means to promote cardiovascular health in children and adolescents.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.smrv.2020.101338DOI Listing
October 2020

Weight Status Change From Adolescence to Young Adulthood and the Risk of Hypertension and Diabetes Mellitus.

Hypertension 2020 08 29;76(2):583-588. Epub 2020 Jun 29.

Department of Epidemiology (B.X.), School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.

It is still unclear whether the risk of hypertension and diabetes mellitus in adulthood remains increased if excess weight in adolescence recedes later in life. This study examines the effect of change in weight status from adolescence to young adulthood on the risk of hypertension and diabetes mellitus. A total of 4454 adolescents aged 12 to 19 years from the US National Longitudinal Study of Adolescent Health (1994-1995) were followed up to young adulthood (25-32 years, 2007-2008). After a median follow-up time of 13 years, compared with normal weight in both adolescence and young adulthood (n=1328, 29.8%), excess weight in the 2 periods (n=1077, 24.2%) was associated with an increased risk of hypertension (odds ratio, 3.72 [95% CI, 2.86-4.84]) and diabetes mellitus (3.32 [2.11-5.21]). Normal weight in adolescence but excess weight in young adulthood (n=1983, 44.5%) was associated with a lower but still significant risk of hypertension (2.49 [1.98-3.15]) and diabetes mellitus (1.59 [1.01-2.51]). In contrast, the risk of hypertension (1.37 [0.64-2.95]) and diabetes mellitus (1.65 [0.45-6.05]) was low in the few participants with excess weight in adolescence but normal weight in young adulthood (n=66, 1.5%). In conclusion, excess weight in young adulthood was associated with an increased risk of hypertension and diabetes mellitus, irrespective of weight status in adolescence. In contrast, excess weight in adolescence but normal weight in young adulthood did not seem to be associated with an increased cardiovascular risk in young adulthood.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/HYPERTENSIONAHA.120.14882DOI Listing
August 2020

Sociodemographic inequities associated with participation in leisure-time physical activity in sub-Saharan Africa: an individual participant data meta-analysis.

BMC Public Health 2020 Jun 15;20(1):927. Epub 2020 Jun 15.

Department of Medicine, University of Cambridge, Cambridge, UK.

Background: Leisure-time physical activity (LTPA) is an important contributor to total physical activity and the focus of many interventions promoting activity in high-income populations. Little is known about LTPA in sub-Saharan Africa (SSA), and with expected declines in physical activity due to rapid urbanisation and lifestyle changes we aimed to assess the sociodemographic differences in the prevalence of LTPA in the adult populations of this region to identify potential barriers for equitable participation.

Methods: A two-step individual participant data meta-analysis was conducted using data collected in SSA through 10 population health surveys that included the Global Physical Activity Questionnaire. For each sociodemographic characteristic, the pooled adjusted prevalence and risk ratios (RRs) for participation in LTPA were calculated using the random effects method. Between-study heterogeneity was explored through meta-regression analyses and tests for interaction.

Results: Across the 10 populations (N = 26,022), 18.9% (95%CI: 14.3, 24.1; I = 99.0%) of adults (≥ 18 years) participated in LTPA. Men were more likely to participate in LTPA compared with women (RR for women: 0.43; 95%CI: 0.32, 0.60; P < 0.001; I = 97.5%), while age was inversely associated with participation. Higher levels of education were associated with increased LTPA participation (RR: 1.30; 95%CI: 1.09, 1.55; P = 0.004; I = 98.1%), with those living in rural areas or self-employed less likely to participate in LTPA. These associations remained after adjusting for time spent physically active at work or through active travel.

Conclusions: In these populations, participation in LTPA was low, and strongly associated with sex, age, education, self-employment and urban residence. Identifying the potential barriers that reduce participation in these groups is necessary to enable equitable access to the health and social benefits associated with LTPA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12889-020-08987-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7296740PMC
June 2020

Reply.

Authors:
Bo Xi Pascal Bovet

J Hypertens 2020 07;38(7):1387-1388

Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/HJH.0000000000002422DOI Listing
July 2020

Spot urine samples to estimate 24-hour urinary calcium excretion in school-age children.

Eur J Pediatr 2020 Nov 9;179(11):1673-1681. Epub 2020 May 9.

Faculty of Medicine, University of Geneva, Geneva, Switzerland.

Urinary calcium/creatinine ratio (UCa/Cr) on a single spot urine sample is frequently used in children to evaluate calciuria, but its accuracy to estimate 24-h urinary calcium excretion (24hUCa) has not been properly assessed. We analyzed the correlation between UCa/Cr in various spot samples and 24hUCa among healthy children. A 24-h urine specimen and three spot urine samples (evening, first, and second morning) were collected in a convenience sample of children aged 6 to 16 years (n = 101). Measured 24hUCa was compared with UCa/Cr in each of the three spot samples. The ability of UCa/Cr to discriminate between children with and without hypercalciuria (calciuria > 4 mg/kg/24 h, 1 mmol/kg/24 h) and optimal timing of the spot sample were determined. Eighty-five children completed an adequate 24-h urine collection. Pearson correlation coefficients between the UCa/Cr on the spot sample and 24hUCa were 0.64, 0.71, and 0.52 for the evening, first, and second morning spot samples, respectively. Areas under the ROC curve were 0.90, 0.82, and 0.75, respectively, for the corresponding spot samples.Conclusion: The relatively strong correlation between 24hUCa and UCa/Cr in evening and first morning spot urine samples suggests that these spots could be preferred in clinical practice.Trial registration: ClinicalTrials.gov , NCT02900261, date of trial registration 14 September 2016. What is Known: •Urinary calcium/creatinine ratio on a single spot urine sample is frequently used as a proxy for 24-h urinary calcium excretion. •Correlation of these indicators, including the best timing for spot urine sampling, has not been properly assessed. What is New: •Relatively strong correlations were found between the calcium/creatinine ratio on a single spot urine sample and 24-h urinary calcium excretion in healthy children. •Evening and first morning spot samples had the highest correlation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00431-020-03662-zDOI Listing
November 2020

Breastfeeding and Mortality Under 2 Years of Age in Sub-Saharan Africa.

Pediatrics 2020 05 22;145(5). Epub 2020 Apr 22.

Epidemiology and Health Statistics, School of Public Health, Shandong University, Jinan, China;

Background: Several studies have investigated the association of breastfeeding status with offspring mortality in Africa, but most studies were from one center only or had limited statistical power to draw robust conclusions.

Methods: Data came from 75 nationally representative cross-sectional Demographic and Health Surveys in 35 countries in sub-Saharan Africa conducted between 2000 and 2016. Our study relied on 217 112 individuals aged 4 days to 23 months for breastfeeding pattern analysis, 161 322 individuals aged 6 to 23 months for breastfeeding history analysis, and 104 427 individuals aged 12 to 23 months for breastfeeding duration analysis.

Results: Compared with children aged 4 days to 23 months exclusively breastfed in the first 3 days of life, those not breastfed had a high risk of mortality at <2 years of age (odds ratio [OR] = 13.45; 95% confidence interval [CI] = 11.43-15.83). Young children who were predominantly breastfed or partially breastfed had moderately increased risk of mortality at <2 years of age (OR = 1.11, 95% CI = 1.03-1.21 for predominant pattern; OR = 1.12, 95% CI = 0.99-1.27 for partial pattern). Compared with children aged 6 to 23 months who were breastfed within the first 6 months of life, those not breastfed had a high risk of mortality (OR = 5.65; 95% CI = 4.27-7.47). Compared with children aged 12 to 23 months who were breastfed for ≥6 months, those who were breastfed for shorter periods had a higher risk of mortality (OR = 2.78, 95% CI = 1.45-5.32 for duration of <3 months; OR = 5.28, 95% CI = 3.24-8.61 for those who were not breastfed).

Conclusions: Our findings support exclusive breastfeeding during the first 6 months of life and continued breastfeeding up to 2 years of age recommended by the World Health Organization for reducing mortality of children <2 years old in sub-Saharan Africa.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1542/peds.2019-2209DOI Listing
May 2020
-->