26 research outputs found
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.Peer reviewe
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
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
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
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
Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)
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
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Ion exchange distribution coefficients for {sup 137}Cs and {sup 99}Tc removal from Hanford tank supernatants AW-101 (Envelope A) and AN-107 (Envelope C)
The current BNFL Inc. flow sheet for the pretreatment of the Hanford High-Level tank wastes includes the use of Superlig{reg_sign} materials in a dual column system for the removal of {sup 137}Cs and {sup 99}Tc from the aqueous fraction of the waste. The Superlig{reg_sign} materials include the cesium selective Superlig 632and Superlig 644 for removal of {sup 137}Csband Superlig 639 for the removal of {sup 99}Tc present as TcO{sub 4}{sup {minus}}. These materials have been developed and supplied by IBC Technologies, Inc., American Fork, UT. The objectives of this work were to: Evaluate the equilibrium behavior of the Superlig materials for the removal of {sup 137}Cs and {sup 99}Tc (as pertechnetate) from AW-101 (Envelope A) and AN-107 (Envelope C) clarified supernatants; Obtain information of the composition of ion exchange feed streams and the pertechnetate/nonpertechnetate fraction in the samples; and Determine some of the Superlig material physical properties including particle size distribution, dry density and water content. To evaluate the equilibrium behavior, batch contacts at a phase ratio of 100 (5 mL of waste solution: 0.05g of exchanger) were conducted with each of the Superlig materials and each of the waste envelope samples. In order to obtain equilibrium data that bounds the expected feed compositions, some of the envelope subsamples were spiked with either CsNO{sub 3} or {sup 99}Tc as pertechnetate. The fraction of nonpertechnetate in the AN-107 sample was estimated by contacting some of the AN-107 sample with a large excess of Superlig 639 (phase ratio of about 1)
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Small Column Ion Exchange Testing of Superlig 644 for Removal of 137Cs from Hanford Tank Waste Envelope C (Tank 241-AN-107)
The current BNFL Inc. flowsheet for the pretreatment of the Hanford high-level tank wastes includes the use of Superlig{reg_sign} materials for removing {sup 137}Cs from the aqueous fraction of the waste. The Superlig materials applicable to cesium removal include the cesium-selective Superlig 632and Superlig 644. These materials have been developed and supplied by IBC Advanced Technologies, Inc., American Fork, Utah. This report describes the testing of the Superlig 644 ion exchange material in a small dual-column system. The bed volume of the lead column was 18.6 mL (L/D = 7), and the bed volume of the lag column was 15.9 mL (L/D = 6) during the loading phase. The sample processed was approximately 1.6 L of diluted waste ([Na{sup +}] = 4.84 M) from Tank 241-AN-107 (Envelope C). This sample had been previously treated for removal of Sr/transuranic (TRU) values and clarified in a single tube cross-flow filtration unit. All ion exchange process steps were tested, including resin-bed preparation, loading, feed displacement, water rinse, elution, eluant rinse, and resin regeneration. A summary of performance measures for both columns is shown in Table S1. The Cs {lambda} values represent a measure of the effective capacity of the SL-644 resin. The Cs {lambda} of 20 for the lead column is much lower than the estimated 150 obtained by the Savannah River Technology Center during Phase 1A testing. Equilibrium data obtained with batch contacts using the AN-107 Cs IX feed predicts a Cs {lambda} of 183. A Cs {lambda} for the lag column could not be determined due to insufficient breakthrough, but it appeared to work well and removed nearly all of the cesium not removed by the lead column. The low value for the lead column indicates that it did not perform as expected. This may have been due to air or gas in the bed that caused fluid channeling or blinding of the resin. The maximum decontamination factor (DF) for {sup 137}Cs listed in Table S1 is based on {sup 137}Cs concentration in the first samples collected from each column and the {sup 137}Cs concentration in the feed. The composite DF for {sup 137}Cs was 1,760, which provided an effluent with a {sup 137}Cs concentration of 8.7E-02 Ci/m{sup 3}. The {sup 137}Cs concentration is below the basis of design limit and is 7.2% of the contract limit for {sup 137}Cs
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Small Column Ion Exchange Testing of Superlig 644 for Removal of 137Cs from Hanford Tank Waste Envelope A (Tank 241-AW-101)
The current BNFL Inc. flow sheet for the pretreatment of the Hanford High-Level tank wastes includes the use of Superlig{reg_sign} materials for the removal of {sup 137}Cs from the aqueous fraction of the waste. The Superlig materials applicable to cesium removal include the cesium selective Superlig 632 and Superlig 644. These materials have been developed and supplied by IBC Advanced Technologies, Inc., American Fork, UT. The work contained in this report involves testing the Superlig 644 ion exchange material in a small dual column system (15 mL each; L/D = 5.7). The sample processed was approximately 2.5 L of diluted waste [Na{sup +}] = 4.6M from Tank 241-AW-101 (Envelope A). This waste had been previously clarified in a single tube cross-flow filtration unit. All ion exchange process steps were tested including resin bed preparation, loading, feed displacement water rinse, elution and resin regeneration. During the initial run, the lag column did not perform as expected so that the {sup 137}Cs concentration in the effluent composite was above the LAW treatment limits. This required a second column run with the partially decontaminated feed that was conducted at a higher flow rate. A summary of performance measures for both runs is shown in Table S1. The Cs {lambda} values represent a measure of the effective capacity of the SL-644 resin. The Cs {lambda} of 143 for the lead column in run 1 is very similar to the value obtained by the Savannah River Technology Center during Phase 1A testing. The larger Cs {lambda} value for run 2 reflects a general trend for the effective capacity of the SL-644 material to increase as the cesium concentration decreases. The low value for the lag column during the first run indicates that it did not perform as expected. This may have been due to insufficient conditioning of the bed prior to the start of the loading step or to air in the bed that caused channeling. Equilibrium data obtained with batch contacts using the AW-101 Cs IX feed indicates a range for the Cs {lambda} of 80--97. The maximum decontamination factor (DF) for {sup 137}CS is based on analysis of the first samples collected from each column and the concentration in the feed for each run. While the DF's are lower for the second run, this is attributed to the lower {sup 137}Cs concentration in the feed and the increased flowrate. The overall composite DF for run 2 was quite good since both columns functioned well. The overall DF for both runs was 3,000, which provided an effluent with a {sup 137}Cs concentration of 5.89E-02 Ci/m{sup 3} (C/C{sub 0} = 3.3 IE-04). The {sup 137}Cs concentration in the effluent composite was 7.3% of the contract limit for {sup 137}Cs and also below the basis of design limit
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Demonstration and Optimization of BNFL's Pulsed Jet Mixing and RFD Sampling Systems Using NCAW Simulant
The BNFL Inc. flowsheet for the pretreatment and vitrification of the Hanford High Level Tank waste includes the use of several hundred Reverse Flow Diverters (RFDs) for sampling and transferring the radioactive slurries and Pulsed Jet mixers to homogenize or suspend the tank contents. The Pulsed Jet mixing and the RFD sampling devices represent very simple and efficient methods to mix and sample slurries, respectively, using compressed air to achieve the desired operation. The equipment has no moving parts, which makes them very suitable for mixing and sampling highly radioactive wastes. However, the effectiveness of the mixing and sampling systems are yet to be demonstrated when dealing with Hanford slurries, which exhibit a wide range of physical and theological properties. This report describes the results of the testing of BNFL's Pulsed Jet mixing and RFD sampling systems in a 13-ft ID and 15-ft height dish-bottomed tank at Battelle's 336 building high-bay facility using AZ-101/102 simulants containing up to 36-wt% insoluble solids. The specific objectives of the work were to: Demonstrate the effectiveness of the Pulsed Jet mixing system to thoroughly homogenize Hanford-type slurries over a range of solids loading; Minimize/optimize air usage by changing sequencing of the Pulsed Jet mixers or by altering cycle times; and Demonstrate that the RFD sampler can obtain representative samples of the slurry up to the maximum RPP-WTP baseline concentration of 25-wt%