Impact of common cardio-metabolic risk factors on fatal and non-fatal cardiovascular disease in Latin America and the Caribbean: An individual-level pooled analysis of 31 cohort studies

Background: Estimates of the burden of cardio-metabolic risk factors in Latin America and the Caribbean (LAC) rely on relative risks (RRs) from non-LAC countries. Whether these RRs apply to LAC remains unknown. Methods: We pooled LAC cohorts. We estimated RRs per unit of exposure to body mass index (BMI), systolic blood pressure (SBP), fasting plasma glucose (FPG), total cholesterol (TC) and non-HDL cholesterol on fatal (31 cohorts, n=168,287) and non-fatal (13 cohorts, n=27,554) cardiovascular diseases, adjusting for regression dilution bias. We used these RRs and national data on mean risk factor levels to estimate the number of cardiovascular deaths attributable to non-optimal levels of each risk factor. Results: Our RRs for SBP, FPG and TC were like those observed in cohorts conducted in high-income countries; however, for BMI, our RRs were consistently smaller in people below 75 years of age. Across risk factors, we observed smaller RRs among older ages. Non-optimal SBP was responsible for the largest number of attributable cardiovascular deaths ranging from 38 per 100,000 women and 54 men in Peru, to 261 (Dominica, women) and 282 (Guyana, men). For non-HDL cholesterol, the lowest attributable rate was for women in Peru (21) and men in Guatemala (25), and the largest in men (158) and women (142) from Guyana. Interpretation: RRs for BMI from studies conducted in high-income countries may overestimate disease burden metrics in LAC; conversely, RRs for SBP, FPG and TC from LAC cohorts are similar to those estimated from cohorts in high-income countries. Funding: Wellcome Trust (214185/Z/18/Z)Fil: Carrillo Larco, Rodrigo M.. Imperial College London; Reino UnidoFil: Stern, Dalia. Instituto Nacional de Salud Publica (insp);Fil: Hambleton, Ian R.. The University Of The West Indies; BarbadosFil: Hennis, Anselm. Pan American Health Organization; Estados UnidosFil: Cesare, Mariachiara Di. Middlesex University; Reino UnidoFil: Lotufo, Paulo. Universidade de Sao Paulo; BrasilFil: Ferreccio, Catterina. Pontificia Universidad Católica de Chile; ChileFil: Irazola, Vilma. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Perel, Pablo. London School of Hygiene and Tropical Medicine; Reino UnidoFil: Gregg, Edward W. Imperial College London; Reino UnidoFil: Miranda, J. Jaime. Universidad Peruana Cayetano Heredia; PerúFil: Ezzati, Majid. Imperial College London; Reino UnidoFil: Danaei, Goodarz. Harvard Medical School; Estados UnidosFil: Aguilar Salinas, Carlos A.. Instituto Nacional de Ciencias Médicas y Nutrición; MéxicoFil: Alvarez Váz, Ramón. Universidad de la República; UruguayFil: Amadio, Marselle B.. Centro Universitario Senac Santo Amaro; BrasilFil: Baccino, Cecilia. Universidad de la República; UruguayFil: Bambs, Claudia. Pontificia Universidad Católica de Chile; ChileFil: Bastos, João Luiz. Universidade Federal de Santa Catarina; BrasilFil: Beckles, Gloria. Centers for Disease Control and Prevention; Estados UnidosFil: Bernabe Ortiz, Antonio. Universidad Peruana Cayetano Heredia; PerúFil: Bernardo, Carla DO. University of Adelaide; AustraliaFil: Bloch, Katia V.. Universidade Federal do Rio de Janeiro; BrasilFil: Blümel, Juan E.. Universidad de Chile; ChileFil: Boggia, Jose G.. Universidad de la República; UruguayFil: Borges, Pollyanna K.. Universidade Estadual do Ponta Grossa; BrasilFil: Bravo, Miguel. MELISA Institute; ChileFil: Brenes Camacho, Gilbert. Universidad de Costa Rica; Costa RicaFil: Carbajal, Horacio A.. Universidad Nacional de La Plata; ArgentinaFil: Castillo Rascón, María Susana. Universidad Nacional de Misiones; Argentin

CUIDADOS PRESTADOS AS PESSOAS QUE SOFRERAM ACIDENTE VASCULAR ENCEFÁLICO

The present study aims to analyze the existing literature about the multidisciplinary team in front of people who have suffered stroke. This is an integrative review of the qualitative literature. The search for the studies involved in the research occurred in the following databases: SCIELO, LILACS, BDENF and MEDLINE, from the descriptors in health sciences: "Patient Care", "Multidisciplinary Team" and "Stroke". The inclusion criteria were: publications made between 2012 and 2022, with free access to the journal and full texts, articles in Portuguese, English and Spanish and related to the theme. Exclusion criteria were: duplicate, incomplete articles, abstracts, reviews, debates, articles published in events' annais and unavailable in full. In most cases, individuals with a ve7 seek the emergency to conduct investigations about the origin, severity and degree of impairment of bodily functions, to later perform the treatment and prevention of possible sequelae. The present study demonstrates that ischemic stroke is one of the most common types, where the highest prevalence of cases occurs, while hemorrhagic stroke has a lower incidence, but deserves care like the other, one of the main risk factors that cause its occurrence is arterial hypertension.El presente estudio tiene como objetivo analizar la literatura existente sobre el equipo multidisciplinario frente a personas que han sufrido un ictus. Esta es una revisión integradora de la literatura cualitativa. La búsqueda de los estudios involucrados en la investigación se realizó en las siguientes bases de datos: SCIELO, LILACS, BDENF y MEDLINE, a partir de los descriptores en ciencias de la salud: "Atención al Paciente", "Equipo Multidisciplinario" y "Accidente Cerebrovascular". Los criterios de inclusión fueron: publicaciones realizadas entre 2012 y 2022, con acceso libre a la revista y textos completos, artículos en portugués, inglés y español y relacionados con el tema. Los criterios de exclusión fueron: artículos duplicados, incompletos, resúmenes, revisiones, debates, artículos publicados en los annais de los eventos y no disponibles en su totalidad. En la mayoría de los casos, los individuos con un ve7 buscan la emergencia para realizar investigaciones sobre el origen, gravedad y grado de deterioro de las funciones corporales, para posteriormente realizar el tratamiento y prevención de posibles secuelas. El presente estudio demuestra que el ictus isquémico es uno de los tipos más comunes, donde se produce la mayor prevalencia de casos, mientras que el ictus hemorrágico tiene una menor incidencia, pero merece cuidados como el otro, uno de los principales factores de riesgo que provocan su aparición es la hipertensión arterial.O presente estudo tem como objetivo analisar a literatura existente acerca da equipe multidisciplinar diante de pessoas que sofreram Acidente Vascular Encefálico (AVE). Trata-se de uma revisão integrativa da literatura de caráter qualitativo. A buscas dos trabalhos envolvidos na pesquisa ocorreram nas seguintes bases de dados: SCIELO, LILACS, BDENF e MEDLINE, a partir dos descritores em ciências da saúde: “Assistência ao paciente”, “Equipe multiprofissional” e “Acidente vascular encefálico”. Os critérios de inclusão foram: publicações feitas entre 2012 e 2022, com acesso livre ao periódico e textos completos, artigos em idioma português, inglês e espanhol e relacionados à temática. Critérios de exclusão foram: artigos duplicados, incompletos, resumos, resenhas, debates, artigos publicados em anais de eventos e indisponíveis na íntegra. Na maioria dos casos, os indivíduos com AVE procuram a emergência para a realização de investigações acerca da origem, gravidade e grau de comprometimento das funções corporais, para posteriormente realizarem o tratamento e prevenção das possíveis sequelas. O presente estudo demonstra que a AVE isquêmico é um dos tipos mais comuns, onde ocorre a maior prevalência de casos, já o AVE hemorrágico tem menor incidência, mas merece um cuidado assim como o outro, um dos principais fatores de risco que acarretam sua ocorrência é a hipertensão arterial.O presente estudo tem como objetivo analisar a literatura existente acerca da equipe multidisciplinar diante de pessoas que sofreram acidente vascular encefálico. Trata-se de uma revisão integrativa da literatura de caráter qualitativo. A buscas dos trabalhos envolvidos na pesquisa foram buscados nas seguintes bases de dados: SCIELO, LILACS, BDENF e MEDLINE, a partir dos descritores em ciências da saúde: “Assistência ao paciente”, “Equipe multiprofissional” e “Acidente vascular encefálico”. Os critérios de inclusão foram: publicados no período entre 2012 e 2022, cujo acesso ao periódico era livre aos textos completos, artigos em idioma português, inglês e espanhol e relacionados a temática. Critérios de exclusão foram: artigos duplicados, incompletos, resumos, resenhas, debates, artigos publicados em anais de eventos e indisponíveis na íntegra. Na maioria dos casos, os indivíduos com AVE procuram a emergência para a realização de investigações acerca da origem, gravidade e grau de comprometimento das funções corporais, para posteriormente, realizarem o tratamento e prevenção das possíveis sequelas. O presente estudo demonstra que a AVE isquêmico é um dos tipos mais comuns, onde ocorre a maior prevalência de casos, já o AVE hemorrágico tem menos incidência, mas merece um cuidado assim como o outro, um dos principais fatores de risco que acarretam a isso é a hipertensão arterial

CUIDADOS PRESTADOS AS PESSOAS QUE SOFRERAM ACIDENTE VASCULAR ENCEFÁLICO

The present study aims to analyze the existing literature about the multidisciplinary team in front of people who have suffered stroke. This is an integrative review of the qualitative literature. The search for the studies involved in the research occurred in the following databases: SCIELO, LILACS, BDENF and MEDLINE, from the descriptors in health sciences: "Patient Care", "Multidisciplinary Team" and "Stroke". The inclusion criteria were: publications made between 2012 and 2022, with free access to the journal and full texts, articles in Portuguese, English and Spanish and related to the theme. Exclusion criteria were: duplicate, incomplete articles, abstracts, reviews, debates, articles published in events' annais and unavailable in full. In most cases, individuals with a ve7 seek the emergency to conduct investigations about the origin, severity and degree of impairment of bodily functions, to later perform the treatment and prevention of possible sequelae. The present study demonstrates that ischemic stroke is one of the most common types, where the highest prevalence of cases occurs, while hemorrhagic stroke has a lower incidence, but deserves care like the other, one of the main risk factors that cause its occurrence is arterial hypertension.El presente estudio tiene como objetivo analizar la literatura existente sobre el equipo multidisciplinario frente a personas que han sufrido un ictus. Esta es una revisión integradora de la literatura cualitativa. La búsqueda de los estudios involucrados en la investigación se realizó en las siguientes bases de datos: SCIELO, LILACS, BDENF y MEDLINE, a partir de los descriptores en ciencias de la salud: "Atención al Paciente", "Equipo Multidisciplinario" y "Accidente Cerebrovascular". Los criterios de inclusión fueron: publicaciones realizadas entre 2012 y 2022, con acceso libre a la revista y textos completos, artículos en portugués, inglés y español y relacionados con el tema. Los criterios de exclusión fueron: artículos duplicados, incompletos, resúmenes, revisiones, debates, artículos publicados en los annais de los eventos y no disponibles en su totalidad. En la mayoría de los casos, los individuos con un ve7 buscan la emergencia para realizar investigaciones sobre el origen, gravedad y grado de deterioro de las funciones corporales, para posteriormente realizar el tratamiento y prevención de posibles secuelas. El presente estudio demuestra que el ictus isquémico es uno de los tipos más comunes, donde se produce la mayor prevalencia de casos, mientras que el ictus hemorrágico tiene una menor incidencia, pero merece cuidados como el otro, uno de los principales factores de riesgo que provocan su aparición es la hipertensión arterial.O presente estudo tem como objetivo analisar a literatura existente acerca da equipe multidisciplinar diante de pessoas que sofreram Acidente Vascular Encefálico (AVE). Trata-se de uma revisão integrativa da literatura de caráter qualitativo. A buscas dos trabalhos envolvidos na pesquisa ocorreram nas seguintes bases de dados: SCIELO, LILACS, BDENF e MEDLINE, a partir dos descritores em ciências da saúde: “Assistência ao paciente”, “Equipe multiprofissional” e “Acidente vascular encefálico”. Os critérios de inclusão foram: publicações feitas entre 2012 e 2022, com acesso livre ao periódico e textos completos, artigos em idioma português, inglês e espanhol e relacionados à temática. Critérios de exclusão foram: artigos duplicados, incompletos, resumos, resenhas, debates, artigos publicados em anais de eventos e indisponíveis na íntegra. Na maioria dos casos, os indivíduos com AVE procuram a emergência para a realização de investigações acerca da origem, gravidade e grau de comprometimento das funções corporais, para posteriormente realizarem o tratamento e prevenção das possíveis sequelas. O presente estudo demonstra que a AVE isquêmico é um dos tipos mais comuns, onde ocorre a maior prevalência de casos, já o AVE hemorrágico tem menor incidência, mas merece um cuidado assim como o outro, um dos principais fatores de risco que acarretam sua ocorrência é a hipertensão arterial.O presente estudo tem como objetivo analisar a literatura existente acerca da equipe multidisciplinar diante de pessoas que sofreram acidente vascular encefálico. Trata-se de uma revisão integrativa da literatura de caráter qualitativo. A buscas dos trabalhos envolvidos na pesquisa foram buscados nas seguintes bases de dados: SCIELO, LILACS, BDENF e MEDLINE, a partir dos descritores em ciências da saúde: “Assistência ao paciente”, “Equipe multiprofissional” e “Acidente vascular encefálico”. Os critérios de inclusão foram: publicados no período entre 2012 e 2022, cujo acesso ao periódico era livre aos textos completos, artigos em idioma português, inglês e espanhol e relacionados a temática. Critérios de exclusão foram: artigos duplicados, incompletos, resumos, resenhas, debates, artigos publicados em anais de eventos e indisponíveis na íntegra. Na maioria dos casos, os indivíduos com AVE procuram a emergência para a realização de investigações acerca da origem, gravidade e grau de comprometimento das funções corporais, para posteriormente, realizarem o tratamento e prevenção das possíveis sequelas. O presente estudo demonstra que a AVE isquêmico é um dos tipos mais comuns, onde ocorre a maior prevalência de casos, já o AVE hemorrágico tem menos incidência, mas merece um cuidado assim como o outro, um dos principais fatores de risco que acarretam a isso é a hipertensão arterial

Síndrome de Seckel: relato de caso de uma rara condição genética / Seckel's Syndrome: case report of a rare genetic condition

O presente artigo objetivou relatar o caso clínico de uma paciente, sabidamente portadora de Síndrome de Seckel, em acompanhamento no ambulatório de endocrinologia e metabologia para avaliação de seu desenvolvimento. Trata-se de um estudo descritivo, do tipo relato de caso, que visou analisar as principais características clínicas apresentadas pela criança em questão e estabelecer comparativos com a literatura disponível até o momento. A paciente apresentou baixa estatura, baixo peso e dismorfismos clássicos desta alteração genética como nanismo, fronte curta, nariz proeminente com ponte e dorso elevados, face plana, orelhas pequenas e normoimplantadas e clinodactilia de 5 dedos. As manifestações evidenciadas neste relato de caso se assemelham àquelas retratadas na maioria dos estudos publicados. Ressalta-se o papel fundamental empenhado pelo conhecimento da doença, sobretudo no que tange à realização precoce do diagnóstico e ao estabelecimento do manejo multidisciplinar aos pacientes portadores da síndrome

Rhinitis associated with asthma is distinct from rhinitis alone: TARIA‐MeDALL hypothesis

Asthma, rhinitis, and atopic dermatitis (AD) are interrelated clinical phenotypes that partly overlap in the human interactome. The concept of “one-airway-one-disease,” coined over 20 years ago, is a simplistic approach of the links between upper- and lower-airway allergic diseases. With new data, it is time to reassess the concept. This article reviews (i) the clinical observations that led to Allergic Rhinitis and its Impact on Asthma (ARIA), (ii) new insights into polysensitization and multimorbidity, (iii) advances in mHealth for novel phenotype definitions, (iv) confirmation in canonical epidemiologic studies, (v) genomic findings, (vi) treatment approaches, and (vii) novel concepts on the onset of rhinitis and multimorbidity. One recent concept, bringing together upper- and lower-airway allergic diseases with skin, gut, and neuropsychiatric multimorbidities, is the “Epithelial Barrier Hypothesis.” This review determined that the “one-airway-one-disease” concept does not always hold true and that several phenotypes of disease can be defined. These phenotypes include an extreme “allergic” (asthma) phenotype combining asthma, rhinitis, and conjunctivitis.info:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic

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

Impact of common cardio-metabolic risk factors on fatal and non-fatal cardiovascular disease in Latin America and the Caribbean: an individual-level pooled analysis of 31 cohort studies

Background: Estimates of the burden of cardio-metabolic risk factors in Latin America and the Caribbean (LAC) rely on relative risks (RRs) from non-LAC countries. Whether these RRs apply to LAC remains un- known. Methods: We pooled LAC cohorts. We estimated RRs per unit of exposure to body mass index (BMI), systolic blood pressure (SBP), fasting plasma glucose (FPG), total cholesterol (TC) and non-HDL cholesterol on fatal (31 cohorts, n = 168,287) and non-fatal (13 cohorts, n = 27,554) cardiovascular diseases, adjusting for regression dilution bias. We used these RRs and national data on mean risk factor levels to estimate the number of cardiovascular deaths attributable to non-optimal levels of each risk factor. Results: Our RRs for SBP, FPG and TC were like those observed in cohorts conducted in high-income countries; however, for BMI, our RRs were consistently smaller in people below 75 years of age. Across risk factors, we observed smaller RRs among older ages. Non-optimal SBP was responsible for the largest number of attributable cardiovascular deaths ranging from 38 per 10 0,0 0 0 women and 54 men in Peru, to 261 (Dominica, women) and 282 (Guyana, men). For non-HDL cholesterol, the lowest attributable rate was for women in Peru (21) and men in Guatemala (25), and the largest in men (158) and women (142) from Guyana. Interpretation: RRs for BMI from studies conducted in high-income countries may overestimate disease burden metrics in LAC; conversely, RRs for SBP, FPG and TC from LAC cohorts are similar to those esti- mated from cohorts in high-income countries