Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries1,2. However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world3 and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health4,5. However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol—which is a marker of cardiovascular risk—changed from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million–4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.</p

Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries1,2. However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world3 and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health4,5. However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol�which is a marker of cardiovascular risk�changed from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95 credible interval 3.7 million�4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world. © 2020, The Author(s), under exclusive licence to Springer Nature Limited

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)

Thrust measurements and mesothermal plasma plume of the Alternative Low Power Hybrid Ion Engine (alphie)

The high specific impulse Alternative Low Power Ion Engine (alphie) is a gridded plasma thruster different from conventional (Kaufman) ion engines. In this disruptive concept, the ionization of the propellant neutral gas and the neutralization of ion outflow is achieved with only one cathode located in front and outside of the thruster. Electrons and ions move under the self-consistent field created by the DC voltage applied to its two planar grids together with the currents of charges flowing through them, unlike to conventional ion engines, where only ions move through its ion optics system. The stationary mesothermal flow of ions and electrons in the plasma plume is characterized with a retarded field energy analyzer in conjunction with Langmuir and emissive probes. The ion velocity distribution functions and the electron energy spectra for different operating conditions of the alphie thruster are discussed. The observed high ion temperatures are explained by the collisional interaction between the fast ionizing electrons and the neutral atoms that increases their average kinetic energy. Finally, the alphie delivers 0.8-3.5 mN throttleable thrusts giving specific impulses in the range of 14000-20000 s with estimated thruster efficiencies between 8% and 40%

Thrust measurements and mesothermal plasma plume of the Alternative Low Power Hybrid Ion Engine (alphie)

The high specific impulse Alternative Low Power Ion Engine (alphie) is a gridded plasma thruster different from conventional (Kaufman) ion engines. In this disruptive concept, the ionization of the propellant neutral gas and the neutralization of ion outflow is achieved with only one cathode located in front and outside of the thruster. Electrons and ions move under the self-consistent field created by the DC voltage applied to its two planar grids together with the currents of charges flowing through them, unlike to conventional ion engines, where only ions move through its ion optics system. The stationary mesothermal flow of ions and electrons in the plasma plume is characterized with a retarded field energy analyzer in conjunction with Langmuir and emissive probes. The ion velocity distribution functions and the electron energy spectra for different operating conditions of the alphie thruster are discussed. The observed high ion temperatures are explained by the collisional interaction between the fast ionizing electrons and the neutral atoms that increases their average kinetic energy. Finally, the alphie delivers 0.8-3.5 mN throttleable thrusts giving specific impulses in the range of 14000-20000 s with estimated thruster efficiencies between 8% and 40%

Physics of the high specific impulse alternative low power hybrid ion engine (alphie): Direct thrust measurements and plasma plume kinetics

The Alternative Low Power Ion Engine (alphie) is a high specific impulse plasma thruster different from conventional gridded ion engines (GIEs). It uses only one external cathode and ions and electrons flow through the open spaces of its two grids, whereas only ions are transported through the GIE ion optics. Ionizing electrons from the cathode move inward to the alphie ionization chamber and ions, which are neutralized by electrons from the same cathode, exit along the opposite direction. These currents together with the voltages applied to the grids produce a self-consistent electric field that accelerates the charges. The one-dimensional ion velocity distribution and the electron energy spectra in the collisionless alphie plasma plume are studied along its axial axis of symmetry. The thruster produces a mesothermal plasma flow with a non-monotone plasma potential profile along the axial direction. The ion populations observed are of those accelerated by the self-consistent electric field and a low velocity group that results from the charge exchange collisions in the thruster. Both populations remain essentially unaltered in the plasma flow. Conversely, the two electron groups observed merge along the axial direction of the plume following the changes in the plasma potential. The temperatures of ion populations are high by the neutral gas heating inside the thruster by high-energy ionizing electrons. The direct measurement of thrusts of 0.8–3.5 mN for argon gives 13 900–20 000 s specific impulses. These high values might be explained by the additional contribution to the thrust by the remaining non-ionized hot neutral gas effusion through the apertures of grids

Physics of the high specific impulse alternative low power hybrid ion engine (alphie): Direct thrust measurements and plasma plume kinetics

The Alternative Low Power Ion Engine (alphie) is a high specific impulse plasma thruster different from conventional gridded ion engines (GIEs). It uses only one external cathode and ions and electrons flow through the open spaces of its two grids, whereas only ions are transported through the GIE ion optics. Ionizing electrons from the cathode move inward to the alphie ionization chamber and ions, which are neutralized by electrons from the same cathode, exit along the opposite direction. These currents together with the voltages applied to the grids produce a self-consistent electric field that accelerates the charges. The one-dimensional ion velocity distribution and the electron energy spectra in the collisionless alphie plasma plume are studied along its axial axis of symmetry. The thruster produces a mesothermal plasma flow with a non-monotone plasma potential profile along the axial direction. The ion populations observed are of those accelerated by the self-consistent electric field and a low velocity group that results from the charge exchange collisions in the thruster. Both populations remain essentially unaltered in the plasma flow. Conversely, the two electron groups observed merge along the axial direction of the plume following the changes in the plasma potential. The temperatures of ion populations are high by the neutral gas heating inside the thruster by high-energy ionizing electrons. The direct measurement of thrusts of 0.8–3.5 mN for argon gives 13 900–20 000 s specific impulses. These high values might be explained by the additional contribution to the thrust by the remaining non-ionized hot neutral gas effusion through the apertures of grids