Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions. Funding: Bill & Melinda Gates Foundation

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities 1,2 . This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity 3�6 . Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55 of the global rise in mean BMI from 1985 to 2017�and more than 80 in some low- and middle-income regions�was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing�and in some countries reversal�of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories. © 2019, The Author(s)

Aptidão física relacionada ao desempenho motor em escolares de sete a 15 anos

Os benefícios do desenvolvimento da aptidão física sobre a saúde estão bem evidenciados na literatura científica. O objetivo do presente estudo foi descrever a aptidão física relacionada ao desempenho motor de crianças e adolescentes e examinar as diferenças de acordo com sexo, idade, tipo de escola (pública ou privada) e região geográfi ca da escola (urbana ou rural). Uma bateria de cinco testes motores foi aplicada a 526 alunos entre sete e 15 anos do ensino fundamental de Rio Grande, RS: salto em distância parado, arremesso de “medicineball”, barra modifi cada, corrida de 20 metros e quadrado. Os resultados apontam que o desempenho em todos os testes foi superior para os rapazes e aumentou diretamente com a faixa etária. Estes foram os principais preditores da aptidão física dentre as variáveis examinadas. O tipo de escola só teve infl uência sobre o desempenho no teste de arremesso de “medicine-ball”, em que alunos da rede privada obtiveram valores médios maiores. Escolares da zona urbana atingiram um melhor desempenho em todos os testes, exceto no teste de barra modifi cada (sem diferença por região geográfica). A realização de pesquisas com o mesmo enfoque em outras regiões do Brasil permitirá explorar a consistência destes achados e compreender possíveis diferenças.There is strong evidence regarding the benefi ts of physical fi tness development upon health. The aim of this study was to describe the physical fi tness related to motor performance in children and adolescents, and to examine if there are differences according to sex, age, type of school (public or private) and geographic region (urban or rural). A battery comprising of fi ve motor tests were administered to 526 students aged seven to 15 years from elementary schools of Rio Grande, Brazil: stationary long jump, medicine-ball throw, modifi ed pull-up, 20-meter run and 4-meter shuttle-run. The results indicate that the performance in all tests were higher among boys and increased directly with age group. These two factors (sex and age) were the main predictors of physical fi tness amongst the investigated variables. Type of school infl uenced only the performance in the medicine-ball throw, being higher for students from private schools. Students from urban zone achieved a better performance in all tests, except in the modifi ed pull-up, in which there was no difference between geographic regions. The development of researches with the same approach in other Brazilian regions will allow evaluating the consistency of these fi ndings and understanding possible differences

Intenção de mudança de comportamento em adolescentes para a prática de atividades físicas de lazer

O objetivo deste estudo foi investigar a intenção da mudança de comportamento de adolescentes de diferentes níveis socioeconómicos (NSE) para a prática de atividades físicas de lazer, adotando o Modelo Transteorético e a Teoria do Comportamento Planejado (TCP). Foi realizado um estudo transversal com a participação de 416 adolescentes, pertencentes a escolas do ensino médio nas cidades de Belo Horizonte e Contagem/MG, com média de idade de 16,4 ± 1,2 anos. As análises foram feitas utilizando estatísticas descritivas e paramétricas (ANOVA e regressão logística). Os resultados encontrados demonstraram que a maioria dos adolescentes é inativa no lazer, e às variáveis, sexo, atitude e controle percebido são os fatores mais relevantes para classificar o nível de atividade física de lazer, sendo que as variáveis sociais (nível socioeconómico e norma subjetiva) têm pouca importância para predizer a intenção de mudança de comportamento para a prática dessas atividades.El objetivo de este estudio fue investigar la intención de cambiar el comportamiento de los adolescentes de diferentes niveles socioeconómicos (NSE) para la práctica de actividades físicas de ocio, por la que se aprueba el modelo Transteoretico y la teoría de la Conducta Planificada (TCP). Se realizó un estudio transversal con la participación de 416 adolescentes, pertenecientes a las escuelas de enseñanza secundaria de las ciudades de Belo Horizonte y Contagem/MG, con una edad media de 16,4 ±1,2 años. Los análisis se realizaron mediante estadísticas descriptivas y paramétrico (ANOVA y regresión logística), con p The aim of this study was to investigate the intention of behavior changing in adolescents from different socioeconomic status (SES) to leisure physical activities, adopting the transtheoretical model and the Theory of Planned Behavior (TPB). We conducted a cross-sectional study involving 416 adolescents belonging to high schools in the cities of Belo Horizonte and Contagem / MG, with a mean age of 16.4 ± 1.2 years. Analyses were performed using descriptive and parametric statistics (ANOVA and logistic regression). The results show that most of teenagers are inactive during leisure time, and the variables, sex, attitude and perceived control are the most relevant factors to rate the level of leisure physical activity, and social variables (socioeconomic status and standard subjective) are of less importance in predicting the intention to change behavior to practice these activities

Um pouco de história, desenvolvimentos recentes e perspectivas para a pesquisa em atividade física e saúde no Brasil A short history, recent developments, and perspectives for research in physical activity and health in Brazil

As grandes transformações mundiais das últimas décadas provocaram mudanças sociais e na saúde, individual e coletiva, jamais imaginadas. O perfil dos problemas de saúde atuais faz com que a promoção de estilos de vida saudáveis (e ativos fisicamente) seja valorizada e colocada como uma das prioridades em saúde pública no planeta. A Educação Física Brasileira está atenta a essas evoluções nas ciências e nas práticas que envolvem a atividade física relacionada à saúde, e precisa responder aos anseios da sociedade em termos de formação profissional competente e produção científica de qualidade nesta área. Este artigo discute desenvolvimentos recentes e perspectivas na pesquisa em atividade física e saúde, com repercussões para a Educação Física no Brasil.<br>The tremendous modifications observed in the world during the past few decades caused unthinkable changes in social and health (both individual and collective). Current health problems turned lifestyle characteristics as public health matter all over the world, specially the promotion of healthy (and active lifestyles). The area of Physical Education in Brazil is aware of that global movement related to the promotion of health enhancing physical activity, and needs to respond to the society's needs in terms of professional preparation, and quality research in this area. This paper discusses recent developments and perspectives for physical activity and health research, and it's consequences for Physical Education in Brazil

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions. © Copyright