Distribution of Major Health Risks: Findings from the Global Burden of Disease Study

BACKGROUND: Most analyses of risks to health focus on the total burden of their aggregate effects. The distribution of risk-factor-attributable disease burden, for example by age or exposure level, can inform the selection and targeting of specific interventions and programs, and increase cost-effectiveness. METHODS AND FINDINGS: For 26 selected risk factors, expert working groups conducted comprehensive reviews of data on risk-factor exposure and hazard for 14 epidemiological subregions of the world, by age and sex. Age-sex-subregion-population attributable fractions were estimated and applied to the mortality and burden of disease estimates from the World Health Organization Global Burden of Disease database. Where possible, exposure levels were assessed as continuous measures, or as multiple categories. The proportion of risk-factor-attributable burden in different population subgroups, defined by age, sex, and exposure level, was estimated. For major cardiovascular risk factors (blood pressure, cholesterol, tobacco use, fruit and vegetable intake, body mass index, and physical inactivity) 43%–61% of attributable disease burden occurred between the ages of 15 and 59 y, and 87% of alcohol-attributable burden occurred in this age group. Most of the disease burden for continuous risks occurred in those with only moderately raised levels, not among those with levels above commonly used cut-points, such as those with hypertension or obesity. Of all disease burden attributable to being underweight during childhood, 55% occurred among children 1–3 standard deviations below the reference population median, and the remainder occurred among severely malnourished children, who were three or more standard deviations below median. CONCLUSIONS: Many major global risks are widely spread in a population, rather than restricted to a minority. Population-based strategies that seek to shift the whole distribution of risk factors often have the potential to produce substantial reductions in disease burden

The potential use of lithium as a marker for the assessment of the sources of dietary salt: cooking studies and physiological experiments in men

Lithium was investigated for its possible use as a marker for identifying the various sources of NaCl in the diet. Micromolar concentrations of lithium can be detected in various vegetables, tap water and also in urine specimens of adult volunteers. The lithium content of vegetables varied from 6.1 to 24.5 mumol of lithium/kg dry weight, with the exception of spinach and aubergines which had much higher concentrations. The excretion of the element in 24 h urine specimens ranged from 2 to 4 mumol of lithium/day. Experiments were performed to assess whether both lithium and sodium would penetrate foods at the same rate during cooking. The rates of penetration into food for both elements were proportional to their concentration in the cooking water despite a sodium/lithium ratio of 50:1. Physiological experiments were conducted to investigate the handling of small doses of lithium by the body. A dose of 250 mumol of lithium was chosen as optimal and given orally to healthy volunteers in either single or continuous aqueous doses of lithium carbonate. The recoveries of oral lithium in urine were 92 +/- 5% (SD) and 97 +/- 4 (SD) (n = 5) for single and continuous doses respectively. The daily addition of 100 mmol of oral NaCl to the diet of volunteers receiving a standard dose of lithium did not affect urinary lithium excretion rates nor the final recovery of the administered lithium. These studies suggest that lithium carbonate may be a useful marker for the uptake of NaCl into cooked food; after eating lithium-enriched food the monitoring of urinary lithium output may then be used to quantify the amount of sodium derived from the specific foods