2019 ESC/EAS guidelines for the management of dyslipidaemias : Lipid modification to reduce cardiovascular risk

Correction: Volume: 292 Pages: 160-162 DOI: 10.1016/j.atherosclerosis.2019.11.020 Published: JAN 2020Peer reviewe

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For schoolaged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit

Sex- and age-related differences in the management and outcomes of chronic heart failure: an analysis of patients from the ESC HFA EORP Heart Failure Long-Term Registry

Aims: This study aimed to assess age- and sex-related differences in management and 1-year risk for all-cause mortality and hospitalization in chronic heart failure (HF) patients. Methods and results: Of 16 354 patients included in the European Society of Cardiology Heart Failure Long-Term Registry, 9428 chronic HF patients were analysed [median age: 66 years; 28.5% women; mean left ventricular ejection fraction (LVEF) 37%]. Rates of use of guideline-directed medical therapy (GDMT) were high (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers and mineralocorticoid receptor antagonists: 85.7%, 88.7% and 58.8%, respectively). Crude GDMT utilization rates were lower in women than in men (all differences: P\ua0 64 0.001), and GDMT use became lower with ageing in both sexes, at baseline and at 1-year follow-up. Sex was not an independent predictor of GDMT prescription; however, age >75 years was a significant predictor of GDMT underutilization. Rates of all-cause mortality were lower in women than in men (7.1% vs. 8.7%; P\ua0=\ua00.015), as were rates of all-cause hospitalization (21.9% vs. 27.3%; P\ua075 years. Conclusions: There was a decline in GDMT use with advanced age in both sexes. Sex was not an independent predictor of GDMT or adverse outcomes. However, age >75 years independently predicted lower GDMT use and higher all-cause mortality in patients with LVEF 6445%

Environment and Genotype Effects on the Content of Dietary Fiber and Its Components in Wheat in the HEALTHGRAIN Diversity Screen

Within the HEALTHGRAIN diversity screen, the variability of the contents of dietary fiber (DF) and components thereof was studied in wheat. Furthermore, the contribution of genotype and environment to this variability was estimated. The levels of total DF (TDF), total nonstarch polysaccharide (TOTNSP), water-extractable nonstarch polysaccharide (WENSP), total arabinoxylan (TOTAX), lignin, and beta-glucan in whole meal, flour, and/or bran varied similar to 1.8-fold. The highest variability was observed for the water-extractable arabinoxylan (WEAX) level in flour and bran (similar to 3.7-fold). Genotype and environment contributed to a similar extent to the variability in TDF, TOTNSP, and TOTAX content in wheat. The observed relatively high impact of genotype-environment interaction suggests that the levels of these constituents are weak breeding parameters. The WENSP level is a more stable parameter as the effect of the interaction term was much less than the impact of genotype. For TOTAX and WEAX in flour, WEAX in bran, beta-glucan in whole meal, and extract viscosity, wheat genotype determined similar to 50% or higher of the variation observed, whereas the impact of the genotype environment interaction was relatively low. These findings suggest that the health-related and technological functionality of wheat can be directed to a certain extent by selection of appropriate wheat varieties.status: publishe

Variation in the Content of Dietary Fiber and Components Thereof in Wheats in the HEALTHGRAIN Diversity Screen

Within the HEALTHGRAIN diversity screening program, the variation in the content of dietary fiber and components thereof in different types of wheat was studied. The wheat types were winter (131 varieties) and spring (20 varieties) wheats (both Triticum aestivum L., also referred to as common wheats), durum wheat (Triticum durum Desf., 10 varieties), spelt wheat (Triticum spelta L., 5 varieties), einkorn wheat (T. monococcum L., 5 varieties), and emmer wheat (Triticum dicoccum Schubler, 5 varieties). Common wheats contained, on average, the highest level of dietary fiber [11.5-18.3% of dry matter (dm)], whereas einkorn and emmer wheats contained the lowest level (7.2-12.8% of dm). Intermediate levels were measured in durum and spelt wheats (10.7-15.5% of dm). Also, on the basis of the arabinoxylan levels in bran, the different wheat types could be divided this way, with ranges of 12.7-22.1% of dm for common wheats, 6.1-14.4% of dm for einkorn and emmer wheats, and 10.9-13.9% of dm for durum and spelt wheats. On average, bran arabinoxylan made up ca. 29% of the total dietary fiber content of wheat. In contrast to what was the case for bran, the arabinoxylan levels in flour were comparable between the different types of wheat. For wheat, in general, they varied between 1.35 and 2.75% of dm. Einkorn, emmer, and durum wheats contained about half the level of mixed-linkage beta-glucan (0.25-0.45% of dm) present in winter, spring, and spelt wheats (0.50-0.95% of dm). All wheat types had Klason lignin, the levels of which varied from 1.40 to 3.25% of dm. The arabinoxylan contents in bran and the dietary fiber contents in wholemeal were inversely and positively related with bran yield, respectively. Aqueous wholemeal extract viscosity, a measure for the level of soluble dietary fiber, was determined to large extent by the level of water-extractable arabinoxylan. In conclusion, the present study revealed substantial variation in the contents of dietary fiber and constituents thereof between different wheat types and varieties.status: publishe

The Efficiency of Xylanase in Broiler Chickens Fed with Increasing Dietary Levels of Rye

In this paper, we present a study on the evaluation of the effect of xylanase addition to a diet with an increasing content of modern hybrid rye (Brasetto variety) on the performance indices and viscosity of small intestine content in broiler chickens. A total of 560 1-day-old male Ross 308 chickens were randomly assigned to 1 of 10 treatments, each comprising 7 replicate cages, with 8 male birds per cage. A 5 × 2 factorial arrangement was employed, with five dietary levels of ground rye (0%, 5%, 10%, 15%, and 20%). All the diets were either unsupplemented or supplemented with xylanase (200 mg/kg of feed; with minimum xylanase activity 1000 FXU/g). In the starter rearing period (1⁻21 days of age), the inclusion of rye (without xylanase supplementation) to the diet, even at the lowest dietary level (5%), negatively affected body weight gain (p < 0.05); there was no effect on feed intake and feed conversion ratio. In older chickens (the grower-finisher rearing period; 22⁻42 days of age), none of the dietary levels of rye (5⁻20%) affected growth performance indices. Similarly, no significant effect of increasing dietary level of rye was found for the entire rearing period (1⁻42 days of age). Diet supplementation with xylanase improved body weight gain and feed conversion ratio in chickens from 1 to 21 days of age. No positive effect of enzyme was found in older birds. No significant effects of the experimental factors used were noticed on the results of slaughter analysis, i.e., the carcass yield, breast meat yield, abdominal fat, and relative weight of the liver and gizzard. A high dietary concentration of rye (20%) increased the viscosity of small intestine content (p < 0.05); however, diet supplementation with xylanase significantly alleviated this effect. The findings of this experiment indicated that modern hybrid rye grain may be used at a 20% dietary level in broiler diets during the second feeding phase, i.e., from 22 to 42 days of age, without any detrimental influence on growth performance indices, while enzyme (xylanase) positively affected body weight gain and feed conversion ratio in younger chicks (1⁻21 days of age)

Phytochemicals and Dietary Fiber Components in Rye Varieties in the HEALTHGRAIN Diversity Screen

Ten rye varieties grown in one location were analyzed for their contents of dietary fiber (arabinoxylan and beta-glucan) and phytochemicals (folate, tocols, phenolic acids, alkylresorcinols, and sterols). The varieties included old and modern varieties from five European countries. Significant differences were observed in the contents of all phytochemicals in whole grains and in the fiber contents in the flour and bran. The old French varieties Haute Loire and Queyras had high contents of most phytochemicals, whereas the Polish varieties Dankowskie-Zlote and Warko were relatively poor in phytochemicals. The varieties with a high content of folate tended to have low alkylresorcinol contents and vice versa. Furthermore, high contents of arabinoxylans were associated with high contents in tocols and sterols. The 10 selected rye samples comprising old populations and old and modern varieties from different ecological regions of Europe demonstrate high natural variation in their composition and show that landraces and old populations are useful genetic resources for plant breeding. The contents of single phytochemicals can likely be affected by breeding, and they may be adjusted by the right selection of genotype.status: publishe