Growth and proximate composition of tropical marine Chaetoceros calcitrans and Nannochloropsis oculata cultured outdoors and under laboratory conditions

The growth and proximate composition of two marine microalgae, Chaetoceros calcitrans and Nannochloropsis oculata, cultured outdoors under shade (24 to 36°C, 140 μmol/m2/s) and laboratory conditions (environmental chamber, 23°C for C. calcitrans and 20°C for N. oculata, 150 μmol/m2/s) were compared. Outdoor cultures of both C. calcitrans and N. oculata had significantly higher (p < 0.05) biomass, cell count, optical density and specific growth rate compared to the cultures grown under laboratory conditions. Lipid content was significantly higher in C. calcitrans grown outdoors, whereas, protein and carbohydrate composition did not show any significant differences (p > 0.05) between the outdoor and laboratory cultures. In the case of N. oculata, no significant differences (p > 0.05) were found in protein and lipid composition, but carbohydrate was significantly higher (p < 0.05) in the outdoor culture. In addition, the results showed that both C. calcitrans and N. oculata cultures grew faster outdoors, producing more biomass within a shorter period of time. This study illustrated that outdoor culture of microalgae was viable despite the fluctuating environmental conditions.Key words: Growth, proximate composition, Chaetoceros calcitrans, Nannochloropsis oculata, outdoor culture

Molecular Characterization of Glucose-6-Phosphate Dehydrogenase Deficiency in a University Community in Malaysia

Purpose: To determine the prevalence of glucose-6-phosphate dehydrogenase (G6PD) deficiency among staff and students of a university community in Malaysia as well as to identify molecular genetics by determination of G6PD mutations.Methods: Cross-sectional and experimental studies were carried out on the staff and students of Advanced Medical and Dental Institute (AMDI) of Universiti Sains Malaysia (USM) from July 2009 to April 2010. Venous blood samples were collected from 87 individuals (45 males and 42 females), all of whom gave informed consent. Full blood count, reticulocyte count, screening test and quantitative determination of G6PD were performed. The deficient subjects were confirmed by standard PCR restriction enzyme. DNA samples from these subjects were analyzed for certain known G6PDmutations by digesting them with appropriate restriction enzymes.Results: Out of the 87 subjects (80 were Malay, 2 were Chinese, 1 was Indian and 4 were others). The total prevalence of G6PD deficiency among the subjects was 4.59 % (4/87), all of whom were Malay males. One of the deficient subjects had G6PD Viangchan, while the other three were G6PDMahidol (487 G>A).Conclusion: The finding of this study demonstrate that the most common mutation among AMDI staff and students is Mahidol (487G>A), followed by mutation Viangchan (871G>A).Keywords: Glucose-6-Phosphate Dehydrogenase, Mahidol, Viangchan, Haemolytic anaemi

Phytoplankton evolution during the creation of a biofloc system for shrimp culture

[EN] Microalgae play a key role in the dynamics of biofloc technology aquaculture systems. Some phytoplankton groups, such as diatoms, are desired for their high nutritional value and contribution to water quality. Other groups, such as cyanobacteria, are undesired because of their low nutritional value and capacity of producing toxins. So, monitoring the phytoplankton community structure and succession is key for managing biofloc systems. However, research on phytoplankton in these systems is scarce and mostly done by microscopy. The primary objective of this research was to estimate phytoplankton community structure in shrimp biofloc system water samples, using high-performance liquid chromatography methods and CHEMTAX software. The major groups present in our system were diatoms, euglenophytes, cyanobacteria and chlorophytes, while dinoflagellates were only remarkable at the initial period. We observed a clear dominance of diatoms all along the 5 months that comprised a complete biofloc system culture. The characteristic succession of autotrophic processes by heterotrophs of the biofloc systems, was observed by the reduction of net primary production. Light intensity played a key role in determining the phytoplankton composition and abundance. Algal pigment analyses using high-performance liquid chromatography and subsequent CHEMTAX analysis in water samples was useful for estimating the phytoplankton community structure in the biofloc systems. However, we found some limitations when the biofloc system was in heterotrophic mode. Under these conditions, some dinoflagellates and cyanobacteria behaved as heterotrophs and lost or decreased their biomarkers pigments. So, further research is needed to increase knowledge on the accuracy of high-performance liquid chromatography /CHEMTAX under these conditions.Financial support for this research was provided by Conselleria d’Educació, Investigació, Cultura i Esport of the Generalitat Valenciana, through the program VALi+D, fle number ACIF/2014/244. We would like to express our deepest thanks to Professor Luis Henrique da Silva Poersch of FURG (Universidade Federal do Rio Grande) and Ivan Vidal (Langostinos el Real) for his support. Finally, the authors wish to thank Le Gouessant and Michaël Metz for providing the commercial feed.Llario-Sempere, F.; Rodilla, M.; Escrivá-Perales, J.; Falco, S.; Sebastiá-Frasquet, M. (2018). Phytoplankton evolution during the creation of a biofloc system for shrimp culture. International Journal of Environmental Science and Technology. 1-12. https://doi.org/10.1007/s13762-018-1655-5S112Ahmed A, Kurian S, Gauns M, Chndrasekhararao AV, Mulla A, Naik B, Naik H, Naqvi SWA (2016) Spatial variability in phytoplankton community structure along the eastern Arabian Sea during the onset of south-west monsoon. Cont Shelf Res 119:30–39. https://doi.org/10.1016/j.csr.2016.03.005Avnimelech Y (1999) Carbon/nitrogen ratio as a control element in aquaculture systems. Aquaculture 176:227–235. https://doi.org/10.1016/S0044-8486(99)00085-XAvnimelech Y (2007) Feeding with microbial flocs by tilapia in minimal discharge bio-flocs technology ponds. Aquaculture 264:140–147. https://doi.org/10.1016/j.aquaculture.2006.11.025Avnimelech Y (2009) Biofloc technology. A practical guide book. The World Aquaculture Society, Baton RougeAzim ME, Little DC (2008) The biofloc technology (BFT) in indoor tanks: water quality, biofloc composition, and growth and welfare of Nile tilapia (Oreochromis niloticus). Aquaculture 283:29–35. https://doi.org/10.1016/j.aquaculture.2008.06.036Ballester ELC, Abreu PC, Cavalli RO, Emerenciano M, de Abreu L, Wasielesky WJ (2010) Effect of practical diets with different protein levels on the performance of Farfantepenaeus paulensis juveniles nursed in a zero exchange suspended microbial flocs intensive system. Aquac Nutr 16:163–172. https://doi.org/10.1111/j.1365-2095.2009.00648.xBaloi M, Arantes R, Schveitzer R, Magnotti C, Vinatea L (2013) Performance of Pacific white shrimp Litopenaeus vannamei raised in biofloc systems with varying levels of light exposure. Aquac Eng 52:39–44. https://doi.org/10.1016/j.aquaeng.2012.07.003Baumgarten MGZ, Wallner-Kersanach M, Niencheski LFH (2010) Manual de análises em oceanografia química. Furg, Rio GrandeBecerra-Dórame MJ, Martínez-Córdova LR, Martínez-Porchas M, Lopez-Elías JA (2011) Evaluation of autotrophic and heterotrophic microcosm- based systems on the production response of Litopenaeus vannamei intensively nursed without Artemia and with zero water exchange. Isr J Aquac Bamidgeh 63:7Brito LO, dos Santos IGS, de Abreu JL, de Araújo MT, Severi W, Gàlvez AO (2016) Effect of the addition of diatoms (Navicula spp.) and rotifers (Brachionus plicatilis) on water quality and growth of the Litopenaeus vannamei postlarvae reared in a biofloc system. Aquac Res 47:3990–3997. https://doi.org/10.1111/are.12849Campa-Córdova AI, Núñez-Vázquez EJ, Luna-González A, Romero-Geraldo MJ, Ascencio F (2009) Superoxide dismutase activity in juvenile Litopenaeus vannamei and Nodipecten subnodosus exposed to the toxic dinoflagellate Prorocentrum lima. Comp Biochem Physiol C Toxicol Pharmacol 149:317–322. https://doi.org/10.1016/j.cbpc.2008.08.006Casé M, Leça EE, Leitão SN, SantAnna EE, Schwamborn R, de Moraes Junior AT (2008) Plankton community as an indicator of water quality in tropical shrimp culture ponds. Mar Pollut Bull 56:1343–1352. https://doi.org/10.1016/j.marpolbul.2008.02.008Chen YC (2001) Immobilized microalga Scenedesmus quadricauda (Chlorophyta, Chlorococcales) for long-term storage and for application for water quality control in fish culture. Aquaculture 195:71–80. https://doi.org/10.1016/S0044-8486(00)00540-8Correia ES, Wilkenfeld JS, Morris TC, Wei L, Prangnell DI, Samocha TM (2014) Intensive nursery production of the Pacific white shrimp Litopenaeus vannamei using two commercial feeds with high and low protein content in a biofloc-dominated system. Aquac Eng 59:48–54. https://doi.org/10.1016/j.aquaeng.2014.02.002Duarte CM, Marrasé C, Vaqué D, Estrada M (1990) Counting error and the quantitative analysis of phytoplankton communities. J Plankton Res 12:295–304. https://doi.org/10.1093/plankt/12.2.295Ebeling J, Timmons M, Bisogni J (2006) Engineering analysis of the stoichiometry of photoautotrophic, autotrophic, and heterotrophic removal of ammonia–nitrogen in aquaculture systems. Aquaculture 257:346–358. https://doi.org/10.1016/j.aquaculture.2006.03.019El-Dahhar AA, Salama M, Elebiary EH (2015) Effect of energy to protein ratio in biofloc technology on water quality, survival and growth of mullet (Mugil cephalus). J Arab Aquac Soc 10:15–32. https://doi.org/10.12816/0026633Emerenciano MGC, Martínez-Córdova LR, Martínez-Porchas M, Miranda-Baeza A (2017) Biofloc technology (BFT): a tool for water quality management. In: Tutu H (ed) water quality. InTech, Rijeka. https://doi.org/10.5772/66416Figueroa F, Niell F, Figueiras F, Villarino M (1998) Diel migration of phytoplankton and spectral light field in the Ria de Vigo (NW Spain). Mar Biol 130:491–499Gaona CAP, Poersch LH, Krummenauer D, Foes GK, Wasielesky WJ (2011) The effect of solids removal on water quality, growth and survival of Litopenaeus vannamei in a biofloc technology culture system. Int J Recirc Aquac. https://doi.org/10.21061/ijra.v12i1.1354Garrido JL, Airs RL, Rodríguez F, Van Heukelem L, Zapata M (2011) New HPLC separation techniques. In: Roy S, Llewellyn CA, Egeland ES, Johnsen G (eds) Phytoplankton pigments: characterization, chemotaxonomy, and applications in oceanography. University Press, Cambridge, pp 165–194Ge H, Li J, Chang Z, Chen P, Shen M, Zhao F (2016) Effect of microalgae with semicontinuous harvesting on water quality and zootechnical performance of white shrimp reared in the zero water exchange system. Aquac Eng 72–73:70–76. https://doi.org/10.1016/j.aquaeng.2016.04.006Godoy LC, Odebrecht C, Ballester E, Martins TG, Wasielesky WJ (2012) Effect of diatom supplementation during the nursery rearing of Litopenaeus vannamei (Boone, 1931) in a heterotrophic culture system. Aquac Int 20:559–569. https://doi.org/10.1007/s10499-011-9485-1Grasshoff K (1976) Methods of seawater analysis. Verlag Chemie: Weinstei, New YorkGreen BW, Schrader KK, Perschbacher PW (2014) Effect of stocking biomass on solids, phytoplankton communities, common off-flavors, and production parameters in a channel catfish biofloc technology production system. Aquac Res 45:1442–1458. https://doi.org/10.1111/are.12096Gris B, Sforza E, Morosinotto T, Bertucco A, La Rocca N (2017) Influence of light and temperature on growth and high-value molecules productivity from Cyanobacterium aponinum. J Appl Phycol 29:1781–1790. https://doi.org/10.1007/s10811-017-1133-3Higgins HW, Wright SW, Schlüter L (2011) Quantitative interpretation of chemotaxonomic pigment data. In: Roy S, Llewellyn CA, Egeland ES, Johnsen G (eds) Phytoplankton pigments: characterization, chemotaxonomy, and applications in oceanography. Cambridge University Press, Cambridge, pp 257–313Hooker S, Firestone E, Claustre H, Ras J (2001) The first SeaWiFS HPLC analysis round-robin experiment (SeaHARRE-1). https://ntrs.nasa.gov/search.jsp?R=20010072242 . Accessed 19 July 2017Horabun T (1997) Relationships between water quality and phytoplankton in the Bangpakong river. http://agris.fao.org/agris-search/search.do?recordID=TH2000001898 . Accessed 19 July 2017Ismael AA (2003) Succession of heterotrophic and mixotrophic dinoflagellates as well as autotrophic microplankton in the harbour of Alexandria, Egypt. J Plankton Res 25:193–202. https://doi.org/10.1093/plankt/25.2.193Jeffrey SW, Sielicki M, Haxo FT (1975) Chloroplast pigment patterns in dinoflagellates. J Phycol 11:374–384. https://doi.org/10.1111/j.1529-8817.1975.tb02799.xJeong HJ, Yoo YD, Kim JS, Seong KA, Kang NS, Kim TH (2010) Growth, feeding and ecological roles of the mixotrophic and heterotrophic dinoflagellates in marine planktonic food webs. Ocean Sci J 45:65–91. https://doi.org/10.1007/s12601-010-0007-2Jory DE, Cabrera TR, Dugger DM, Fegan D, Lee PG, Lawrence L, Jackson C, Mcintosh R, Castañeda J, International B, Park H, Hwy N, Pierce F (2001) A global review of shrimp feed management: status and perspectives. Aquaculture 318:104–152Ju ZY, Forster I, Conquest L, Dominy W, Kuo WC, Horgen FD (2008) Determination of microbial community structures of shrimp floc cultures by biomarkers and analysis of floc amino acid profiles. Aquac Res 39:118–133. https://doi.org/10.1111/j.1365-2109.2007.01856.xKingston MB (1999) Effect of light on vertical migration and photosynthesis of Euglena proxima (euglenophyta). J Phycol 35:245–253. https://doi.org/10.1046/j.1529-8817.1999.3520245.xLatasa M, Scharek R, Vidal M, Vila-Reixach G (2010) Preferences of phytoplankton groups for waters of different trophic status in the northwestern Mediterranean Sea. Mar Ecol Prog Ser 40:27–42. https://doi.org/10.3354/meps08559Li Y, Swift E, Buskey EJ (1996) Photoinhibition of mechanically stimulable bioluminescence in the heterotrophic dinoflagellate Protoperidinium depressum (pyrrophyta). J Phycol 32:974–982. https://doi.org/10.1111/j.0022-3646.1996.00974.xLi A, Stoecker D, Adolf J (1999) Feeding, pigmentation, photosynthesis and growth of the mixotrophic dinoflagellate Gyrodinium galatheanum. Aquat Microb Ecol 19:163–176. https://doi.org/10.3354/ame019163Lin YC, Chen JC (2001) Acute toxicity of ammonia on Litopenaeus vannamei (Boone) juveniles at different salinity levels. J Exp Mar Biol Ecol 259:109–119. https://doi.org/10.1016/S0022-0981(01)00227-1Lin YC, Chen JC (2003) Acute toxicity of nitrite on Litopenaeus vannamei (Boone) juveniles at different salinity levels. Aquaculture 224:93–201. https://doi.org/10.1016/S0044-8486(03)00220-5Lohscheider JN, Strittmatter M, Küpper H, Adamska I, Heaney S, Cunningham C (2011) Vertical distribution of epibenthic freshwater cyanobacterial Synechococcus spp. Strains depends on their ability for photoprotection. PLoS ONE. https://doi.org/10.1371/journal.pone.0020134Lukwambe B, Qiuqian L, Wu J, Zhang D, Wang K, Zheng Z (2015) The effects of commercial microbial agents (probiotics) on phytoplankton community structure in intensive white shrimp (Litopenaeus vannamei) aquaculture ponds. Aquac Int 23:1443–1455. https://doi.org/10.1007/s10499-015-9895-6Mackey MD, Mackey DJ, Higgins HW, Wright SW (1996) CHEMTAX—a program for estimating class abundances from chemical markers: application to HPLC measurements of phytoplankton. Mar Ecol Prog Ser 144:265–283Maicá PF, de Borba MR, Wasielesky WJ (2012) Effect of low salinity on microbial floc composition and performance of Litopenaeus vannamei (Boone) juveniles reared in a zero-water-exchange super-intensive system. Aquac Res 43:361–370. https://doi.org/10.1111/j.1365-2109.2011.02838.xManan H, Moh JHZ, Kasan NA, Suratman S, Ikhwanuddin M (2016) Identification of biofloc microscopic composition as the natural bioremediation in zero water exchange of Pacific white shrimp, Penaeus vannamei, culture in closed hatchery system. Appl Water Sci. https://doi.org/10.1007/s13201-016-0421-4Marinho YF, Brito LO, Campos S, Severi W, Andrade HA, Galvez AO (2016) Effect of the addition of Chaetoceros calcitrans, Navicula sp. and Phaeodactylum tricornutum (diatoms) on phytoplankton composition and growth of Litopenaeus vannamei (Boone) postlarvae reared in a biofloc system. Aquac Res 48:4155–4164. https://doi.org/10.1111/are.13235Martins TG, Odebrecht C, Jensen LV, D’Oca MG, Wasielesky WJ (2016) The contribution of diatoms to bioflocs lipid content and the performance of juvenile Litopenaeus vannamei (Boone, 1931) in a BFT culture system. Aquac Res 47:1315–1326. https://doi.org/10.1111/are.12592Murphy J, Riley JP (1962) A modified single solution method for the determination of phosphate in natural waters. Anal Chim Acta 27:31–36. https://doi.org/10.1016/S0003-2670(00)88444-5Natrah FMI, Bossier P, Sorgeloos P, Yusoff FM, Defoirdt T (2014) Significance of microalgal-bacterial interactions for aquaculture. Rev Aquac 6:48–61. https://doi.org/10.1111/raq.12024Niemi G, Wardrop D, Brooks R, Anderson S, Brady V, Paerl H, Rakocinski C, Brouwer M, Levinson B, McDonald M (2004) Rationale for a new generation of indicators for coastal waters. Environ Health Perspect 112:979–986. https://doi.org/10.1289/ehp.6903Paerl H, Tucker C (1995) Ecology of blue-green algae in aquaculture ponds. J World Aquac 26:109–131. https://doi.org/10.1111/j.1749-7345.1995.tb00235.xPérez-Linares J, Ochoa JL, GagoMartínez A (2008) Effect of PSP toxins in white leg shrimp Litopenaeus vannamei Boone, 1931. J Food Sci 73:T69–T73. https://doi.org/10.1111/j.1750-3841.2008.00710.xPérez-Morales A, Band-Schmidt CJ, Martínez-Díaz SF (2017) Mortality on zoea stage of the Pacific white shrimp Litopenaeus vannamei caused by Cochlodinium polykrikoides (Dinophyceae) and Chattonella spp. (Raphidophyceae). Mar Biol 164:57. https://doi.org/10.1007/s00227-017-3083-3Ray AJ, Dillon KS, Lotz JM (2011) Water quality dynamics and shrimp (Litopenaeus vannamei) production in intensive, mesohaline culture systems with two levels of biofloc management. Aquac Eng 45:127–136. https://doi.org/10.1016/j.aquaeng.2011.09.001Schlüter L, Lauridsen T, Krogh G (2006) Identification and quantification of phytoplankton groups in lakes using new pigment ratios–a comparison between pigment analysis by HPLC and microscopy. Freshwater 51:1474–1485. https://doi.org/10.1111/j.1365-2427.2006.01582.x/fullSchlüter L, Behl S, Striebel M, Stibor H (2016) Comparing microscopic counts and pigment analyses in 46 phytoplankton communities from lakes of different trophic state. Freshw Biol 61:1627–1639. https://doi.org/10.1111/fwb.12803Schrader KK, Green BW, Perschbacher PW (2011) Development of phytoplankton communities and common off-flavors in a biofloc technology system used for the culture of channel catfish (Ictalurus punctatus). Aquac Eng 45:118–126. https://doi.org/10.1016/j.aquaeng.2011.08.004Sebastiá M, Rodilla M (2013) Nutrient and phytoplankton analysis of a Mediterranean Coastal area. Environ Manage 51:225–240. https://doi.org/10.1007/s00267-012-9986-3Sebastiá M, Rodilla M, Sanchis J, Altur V (2012) Influence of nutrient inputs from a wetland dominated by agriculture on the phytoplankton community in a shallow harbour at the Spanish Mediterranean coast. Agric Ecosyst Environ 152:10–20. https://doi.org/10.1016/j.agee.2012.02.006Seoane S, Garmendia M, Revilla M, Borja Á, Franco J, Orive E, Valencia V (2011) Phytoplankton pigments and epifluorescence microscopy as tools for ecological status assessment in coastal and estuarine waters, within the Water Framework. Mar Pollut 62:1484–1497. https://doi.org/10.1016/j.marpolbul.2011.04.010Sinden A, Sinang SC (2016) Cyanobacteria in aquaculture systems: linking the occurrence, abundance and toxicity with rising temperatures. Int J Environ Sci Technol 13:2855–2862. https://doi.org/10.1007/s13762-016-1112-2Sospedra J, Niencheski LFH, Falco S, Andrade CF, Attisano KK, Rodilla M (2017) Identifying the main sources of silicate in coastal waters of the Southern Gulf of Valencia (Western Mediterranean Sea). Oceanologia. https://doi.org/10.1016/j.oceano.2017.07.004Strickland J (1960) Measuring the production of marine phytoplankton. Bull Fish Res Bd Canada 122:172Ter Braak CJF (1994) Canonical community ordination. Part I: basic theory and linear methods. Écoscience 1:127–140. https://doi.org/10.1080/11956860.1994.11682237Ter Braak C, Smilauer P (2002) CANOCO reference manual and CanoDraw for Windows user’s guide: software for canonical community ordination (version 4.5). http://library.wur.nl/WebQuery/wurpubs/wever/341885 . Accessed 19 July 2017Utermohl M (1985) Zur Vervollkommnung der quantitative Phytoplankton-Methodik. Limnologie 9:1–38Van Wyk P, Scarpa J (1999) Water quality requirements and management. In: Institution Harbor Branch Oceanographic (ed) Farming marine shrimp in recirculating freshwater systems. Florida Department of Agriculture and Consumer Services, Florida, pp 128–138Vinatea L, Gálvez AO, Browdy CL, Stokes A, Venero J, Haveman J, Lewis BL, Lawson A, Shuler A, Leffler JW (2010) Photosynthesis, water respiration and growth performance of Litopenaeus vannamei in a super-intensive raceway culture with zero water exchange: interaction of water quality variables. Aquac Eng 42:17–24. https://doi.org/10.1016/j.aquaeng.2009.09.001Wright S, Jeffrey S, Mantoura R (1991) Improved HPLC method for the analysis of chlorophylls and carotenoids from marine phytoplankton. Mar Ecol Prog Ser 77:186–196Yu H, Jia S, Dai Y (2009) Growth characteristics of the cyanobacterium Nostoc flagelliforme in photoautotrophic, mixotrophic and heterotrophic cultivation. J Appl Phycol 21:127–133. https://doi.org/10.1007/s10811-008-9341-5Yusoff FM, Zubaidah MS, Matias HB, Kwan TS (2002) Phytoplankton succession in intensive marine shrimp culture ponds treated with a commercial bacterial product. Aquac Res 33:269–278. https://doi.org/10.1046/j.1355-557x.2002.00671.

Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults.

BACKGROUND: Underweight, overweight, and obesity in childhood and adolescence are associated with adverse health consequences throughout the life-course. Our aim was to estimate worldwide trends in mean body-mass index (BMI) and a comprehensive set of BMI categories that cover underweight to obesity in children and adolescents, and to compare trends with those of adults. METHODS: We pooled 2416 population-based studies with measurements of height and weight on 128·9 million participants aged 5 years and older, including 31·5 million aged 5-19 years. We used a Bayesian hierarchical model to estimate trends from 1975 to 2016 in 200 countries for mean BMI and for prevalence of BMI in the following categories for children and adolescents aged 5-19 years: more than 2 SD below the median of the WHO growth reference for children and adolescents (referred to as moderate and severe underweight hereafter), 2 SD to more than 1 SD below the median (mild underweight), 1 SD below the median to 1 SD above the median (healthy weight), more than 1 SD to 2 SD above the median (overweight but not obese), and more than 2 SD above the median (obesity). FINDINGS: Regional change in age-standardised mean BMI in girls from 1975 to 2016 ranged from virtually no change (-0·01 kg/m2 per decade; 95% credible interval -0·42 to 0·39, posterior probability [PP] of the observed decrease being a true decrease=0·5098) in eastern Europe to an increase of 1·00 kg/m2 per decade (0·69-1·35, PP>0·9999) in central Latin America and an increase of 0·95 kg/m2 per decade (0·64-1·25, PP>0·9999) in Polynesia and Micronesia. The range for boys was from a non-significant increase of 0·09 kg/m2 per decade (-0·33 to 0·49, PP=0·6926) in eastern Europe to an increase of 0·77 kg/m2 per decade (0·50-1·06, PP>0·9999) in Polynesia and Micronesia. Trends in mean BMI have recently flattened in northwestern Europe and the high-income English-speaking and Asia-Pacific regions for both sexes, southwestern Europe for boys, and central and Andean Latin America for girls. By contrast, the rise in BMI has accelerated in east and south Asia for both sexes, and southeast Asia for boys. Global age-standardised prevalence of obesity increased from 0·7% (0·4-1·2) in 1975 to 5·6% (4·8-6·5) in 2016 in girls, and from 0·9% (0·5-1·3) in 1975 to 7·8% (6·7-9·1) in 2016 in boys; the prevalence of moderate and severe underweight decreased from 9·2% (6·0-12·9) in 1975 to 8·4% (6·8-10·1) in 2016 in girls and from 14·8% (10·4-19·5) in 1975 to 12·4% (10·3-14·5) in 2016 in boys. Prevalence of moderate and severe underweight was highest in India, at 22·7% (16·7-29·6) among girls and 30·7% (23·5-38·0) among boys. Prevalence of obesity was more than 30% in girls in Nauru, the Cook Islands, and Palau; and boys in the Cook Islands, Nauru, Palau, Niue, and American Samoa in 2016. Prevalence of obesity was about 20% or more in several countries in Polynesia and Micronesia, the Middle East and north Africa, the Caribbean, and the USA. In 2016, 75 (44-117) million girls and 117 (70-178) million boys worldwide were moderately or severely underweight. In the same year, 50 (24-89) million girls and 74 (39-125) million boys worldwide were obese. INTERPRETATION: The rising trends in children's and adolescents' BMI have plateaued in many high-income countries, albeit at high levels, but have accelerated in parts of Asia, with trends no longer correlated with those of adults. FUNDING: Wellcome Trust, AstraZeneca Young Health Programme

Effects of alirocumab on types of myocardial infarction: insights from the ODYSSEY OUTCOMES trial

Aims  The third Universal Definition of Myocardial Infarction (MI) Task Force classified MIs into five types: Type 1, spontaneous; Type 2, related to oxygen supply/demand imbalance; Type 3, fatal without ascertainment of cardiac biomarkers; Type 4, related to percutaneous coronary intervention; and Type 5, related to coronary artery bypass surgery. Low-density lipoprotein cholesterol (LDL-C) reduction with statins and proprotein convertase subtilisin–kexin Type 9 (PCSK9) inhibitors reduces risk of MI, but less is known about effects on types of MI. ODYSSEY OUTCOMES compared the PCSK9 inhibitor alirocumab with placebo in 18 924 patients with recent acute coronary syndrome (ACS) and elevated LDL-C (≥1.8 mmol/L) despite intensive statin therapy. In a pre-specified analysis, we assessed the effects of alirocumab on types of MI. Methods and results  Median follow-up was 2.8 years. Myocardial infarction types were prospectively adjudicated and classified. Of 1860 total MIs, 1223 (65.8%) were adjudicated as Type 1, 386 (20.8%) as Type 2, and 244 (13.1%) as Type 4. Few events were Type 3 (n = 2) or Type 5 (n = 5). Alirocumab reduced first MIs [hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.77–0.95; P = 0.003], with reductions in both Type 1 (HR 0.87, 95% CI 0.77–0.99; P = 0.032) and Type 2 (0.77, 0.61–0.97; P = 0.025), but not Type 4 MI. Conclusion  After ACS, alirocumab added to intensive statin therapy favourably impacted on Type 1 and 2 MIs. The data indicate for the first time that a lipid-lowering therapy can attenuate the risk of Type 2 MI. Low-density lipoprotein cholesterol reduction below levels achievable with statins is an effective preventive strategy for both MI types.For complete list of authors see http://dx.doi.org/10.1093/eurheartj/ehz299</p

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. This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity. 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

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background: Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories.Methods: We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age.Findings: The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran.Interpretation: Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings.Copyright (C) 2021 World Health Organization; licensee Elsevier.</p

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30–79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30–79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306–359) million women and 317 (292–344) million men in 1990 to 626 (584–668) million women and 652 (604–698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55–62) of women and 49% (46–52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43–51) of women and 38% (35–41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20–27) for women and 18% (16–21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. Funding WHO