Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: A systematic analysis for the Global Burden of Disease Study 2015

Background: The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods: We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors—the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings: Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6–58·8) of global deaths and 41·2% (39·8–42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation: Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Funding: Bill & Melinda Gates Foundation

Conservação de caqui (Diospyros kaki, L.), cv. fuyu, pela aplicação de 1-metilciclopropeno Conservation of persimmons fruits (Diospyros kaki, L.), cv. fuyu with aplication of 1-methylyclopropene

O presente trabalho teve por objetivo avaliar o efeito do 1-metilciclopropeno (1-MCP) na conservação pós-colheita do caqui (Diospyrus kaki L.) cv. Fuyu. Foram utilizadas frutas provenientes de um pomar comercial de Farroupilha-RS. Os caquis foram colhidos quando apresentavam coloração amarelo-alaranjada. Foram aplicadas três concentrações de 1-MCP (312, 625 e 1250 nL.L-1) durante 24 horas à temperatura ambiente (±25ºC). Após a aplicação dos tratamentos, as frutas foram armazenadas em câmara fria sob ar refrigerado a 0ºC e aproximadamente 90% de umidade relativa, por um período de até 90 dias. As avaliações da qualidade foram realizadas na instalação do experimento, aos 30; 60 e 90 dias de armazenagem refrigerada, sendo as análises efetuadas 3 dias após a retirada da frigoconservação, para simular um período de comercialização. Ao final do período, observou-se que as variáveis pH, sólidos solúveis totais e acidez total titulável não foram influenciadas pela aplicação de 1-MCP. A produção de etileno não alcançou níveis detectáveis nas condições do experimento. Nas frutas tratadas com 1-MCP houve maior desenvolvimento de cor vermelha. A firmeza de polpa apresentou valores significativamente maiores nos caquis tratados com 1-MCP em relação às frutas do tratamento-testemunha. Não houve diferença significativa entre as concentrações de 1-MCP.<br>The present work evaluated the effects of the 1-MCP (1-methylcyclopropene) on persimmons fruits (Diospyrus kaki L.) of cv. Fuyu stored at 0ºC for up to 90 days. Fruits were picked from a commercial orchard in Farroupilha-RS, when skin color was yellow-orange. Three concentrations of 1-MCP (312, 625 and 1250 nL.L-1) were applied for 24 hours in an ambient temperature (±25ºC). Control fruit were kept under identical conditions without 1-MCP treatment. Immediately after treatment application, the fruits were transferred to a cold storage at 0ºC and approximately 90% of relative humidity. Persimmons were analysed on the day of harvest, after 30, 60 and 90 days of refrigerated storage plus 3 more days at ambient temperature to simulate the commercialization period. Total soluble solids, pH and titratable acidity were not influenced by 1-MCP treatments. Ethylene production rates did not reach detectable levels. Skin color showed a higher development of red color in fruits treated with 1-MCP. Flesh firmness was significantly higher in treated fruits in comparison to control fruits, indicating a positive effect of 1-MCP in the postharvest life of persimmons fruits. There was no significant difference among the different concentrations of 1-MCP

Manejo da podridão de melão pelo controle do amadurecimento através do 1-mcp, sob duas condições de armazenamento Melon rot management by ripening control whith 1-MCP treatment under two storage conditions

Objetivou-se neste trabalho avaliar o efeito de 1-MCP (300 nL.L¹) nas alterações fisiológicas que ocorrem durante o amadurecimento do melão, tipo Orange cv. Orange Flesh e sua influência no controle da podridão causada por Fusarium pallidoroseum, em dois ambientes de armazenamento, sem refrigeração (29 ± 1 ºC e umidade relativa de 65 ± 2 %) e refrigerado (10 ± 2 ºC e umidade relativa 90 ± 3 %) durante 15 dias e nove dias adicionais em condição ambiente. Avaliouse a atividade respiratória, produção de etileno, perda de matéria fresca, cor da casca e da polpa, firmeza da polpa, pH, acidez total titulável, sólidos solúveis totais, açúcares solúveis totais e severidade da doença. O delineamento foi inteiramente casualizado em arranjo fatorial com quatro repetições/tratamento. Frutos tratados com 1-MCP, armazenados em ambiente sem refrigeração, mantiveram firmeza da polpa praticamente inalterada até o 15º dia e quando em refrigeração mantiveram-se inalterados até o final da avaliação aos 24 dias após a colheita, retardando também a abscisão do pedúnculo, uma variável indicativa de maturação. O tratamento com 1-MCP retardou o amadurecimento de frutos controlando a podridão de F. pallidoroseum. Este tratamento também reduziu a respiração, produção, etileno, perda de peso, não influenciando significativamente as variáveis de qualidade do fruto: coloração da casca e polpa dos frutos, teor de sólidos solúveis totais e açúcares solúveis totais durante o período de armazenamento, bem como pH e acidez total titulável nas diferentes condições de armazenamento estudadas. A refrigeração interagiu positivamente com o 1-MCP, aumentando o tempo de conservação e sanidade do melão.<br>The objective of this experiment was to evaluate the effect of 1-replicates. Fruit treated with 1-MCP stored at room temperature MCP (at 300 nL.L-1)on de physiological changes occurring during kept the pulp firmness until 15th day and when combined with ripening of Orange type melon fruits cv. Orange flesh and on the refrigeration firmness was kept until the end of evaluation on 24th control of Fusarium pallidoroseum, causal agent of rot in melon day after harvest delaying the peduncle abscission. The treatment fruit, under two environment conditions at room temperature (29 ± with 1-MCP delayed fruit ripening by controlling the rot caused by F. 1 ºC) and 65 ± 2 % R. H. and at refrigeration temperature (10 ± 2 ºC pallidoroseum. The use of 1-MCP contributed to reduce the and 90 ± 3 % RH) during 15 days and additional 9 days at room respiration, etilene production, weight loss. Non significant changes temperature. Respiratory rate, ethylene production, weight loss, skin on skin and pulp color, soluble solids and total soluble sugar was and pulp color pulp firmness, pH, total soluble sugars, total titrable observed during the storage period. For pH and total titratable acidity acidity, total soluble solids, and disease severity were evaluated. The the treatment with 1-MCP had no significant effect at both storage experimental design was completely randomized, factorial with four conditions