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

Travel to Asia is a strong predictor for carriage of cephalosporin resistant E. coli and Klebsiella spp. but does not explain everything; prevalence study at a Norwegian hospital 2014–2016

Background We aimed to estimate the prevalence of faecal carriage of extended-spectrum cephalosporin (ESC) resistant E. coli and K. pneumoniae (ESCr-EK) and vancomycin resistant enterococci (VRE) in patients upon hospital admission and identify factors associated with carriage to better target interventions and to guide empirical antibiotic treatment. Methods Between October 2014 and December 2016, we recruited patients admitted to a Norwegian university hospital. A rectal swab and questionnaire covering possible risk factors for colonisation were collected upon admission. Isolates were characterized by phenotypic methods. ESCr-EK isolates were subject to whole genome sequencing. We calculated prevalence and adjusted prevalence ratios (aPR) using binomial regression. Results Of 747 patients, 45 (6.0%) were colonised with ESCr-EK, none with VRE. The ESCr-EK isolates in 41 patients were multidrug resistant; no isolates were non-suceptible to meropenem. Prevalence of ESCr-EK was higher among travellers to Asia (aPR = 6.6; 95%CI 3.6–12; p < 0.001). No statistical significant difference in carriage was observed between departments, age or any other factors in the univariable analyses. Conclusions The observed prevalence of ESCr-EK colonisation upon admission was in the same range but lower than that reported in similar studies from Europe. Travel to Asia was a strong predictor for colonisation of ESCr-EK to be considered when administering empirical antimicrobial treatment. As less than one third of colonised patients had travelled to Asia, and no other factors investigated were found to be strongly associated with carriage, these findings underscore that healthcare personnel must apply standard infection control precautions for all patients

Fecal carriage of extended spectrum β-lactamase producing <i>Escherichia coli</i> and <i>Klebsiella pneumoniae</i> after urinary tract infection – A three year prospective cohort study

<div><p>We have performed a prospective cohort study to investigate the duration of and risk factors for prolonged fecal carriage of ESBL-producing <i>Escherichia coli</i> or <i>Klebsiella pneumoniae</i> in patients with community acquired urinary tract infection caused by these bacteria. From 2009 to 2011, 101 Norwegian patients were recruited. Stool swabs and questionnaires were collected every three months for one year and at the end of the study in 2012. Information on antibiotic prescriptions was collected from the Norwegian Prescription Database. Stool samples were cultured directly on ChromID ESBL agar as well as in an enrichment broth, and culture positive isolates were examined by <i>bla</i>_CTX-M multiplex PCR. Isolates without <i>bla</i>_CTX-M were investigated for alternative ESBL-determinants with a commercial microarray system. Time to fecal clearance of ESBL producing <i>Enterobacteriaceae</i> was also analysed using Kaplan-Meier estimates. Uni- and multivariate logistic regression was used to compare groups according to previously described risk factors. The ESBL point prevalence of fecal carriage were 61% at 4 months, 56% at 7 months, 48% at 10 months, 39% at 13 months, 19% after two years, and 15% after three years or more. We found no correlation between duration of carriage, comorbidity, antibiotic use or travel to ESBL high-prevalence countries. Prolonged carriage was associated with <i>E</i>. <i>coli</i> isolates of phylogroup B2 or D. Importantly, comparative MLST and MLVA analyses of individual paired urine and fecal <i>E</i>. <i>coli</i> isolates revealed that ESBL production commonly occurred in diverse strains within the same host. When investigating cross-transmission of ESBL producing bacteria in health care institutions, this notion should be taken into account.</p></div

Comparison of participants according to follow-up time.

<p>Comparison of participants according to follow-up time.</p

Minimum spanning tree of <i>E</i>. <i>coli</i> urine isolates (97 isolates from 95 patients) and fecal isolates (168 isolates from 35 patients).

<p>Urine isolates are marked with red colour, fecal isolates with green colour. Short, fat lines between two nodes signify that the strains in each node have a different band number in only one locus. Long, thin lines between two nodes signify different band numbers in more than one locus. ST131 strains are marked with #.</p

Flow diagram of study patient inclusion.

<p>Flow diagram of study patient inclusion.</p

Species, <i>E</i>. <i>coli</i> MLVA types and ß-lactamase enzymes in long-term fecal carriers (n = 35).

<p>Each ß-lactamase enzyme is marked with a distinct colour: grey square = CTX-M group 1, green square = CTX-M group 9, pink square. = SHV, blue square. = KPC, yellow square = several different ß-lactamases. Variation in <i>E</i>. <i>coli</i> MLVA-type is marked by separate symbols: ● = <i>E</i>. <i>coli</i> first MLVA-type, ○ = <i>E</i>. <i>coli</i> second MLVA-type, ◘ = <i>E</i>. <i>coli</i> third MLVA-type, ◙ = <i>E</i>. <i>coli</i> fourth MLVA-type, ■ = <i>E</i>. <i>coli</i> fifth MLVA-type. Species other than <i>E</i>. <i>coli</i> are marked by triangles: ▲ = <i>K</i>. <i>pneumoniae</i>, ▼ = <i>Enterobacteriaceae</i> other than <i>E</i>. <i>coli</i> or <i>K</i>. <i>pneumonia</i>. ns = no sample, - = no ESBL-producing isolate found, miss = lost sample.</p

Multiple logistic regression model of potential risk factors for ESBL-E carriage 13 months after urinary tract infection.

<p>Multiple logistic regression model of potential risk factors for ESBL-E carriage 13 months after urinary tract infection.</p