Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c

Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are both used to diagnose diabetes, but these measurements can identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening, had elevated FPG, HbA1c or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardized proportion of diabetes that was previously undiagnosed and detected in survey screening ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the age-standardized proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c was more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global shortfall in diabetes diagnosis and surveillance

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

Global variations in diabetes mellitus based on fasting glucose and haemogloblin A1c

Fasting plasma glucose (FPG) and haemoglobin A1c (HbA1c) are both used to diagnose diabetes, but may identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening had elevated FPG, HbA1c, or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardised proportion of diabetes that was previously undiagnosed, and detected in survey screening, ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the agestandardised proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global gap in diabetes diagnosis and surveillance.peer-reviewe

INVESTIGACIÓN - ESTIMACIÓN DE LA FIJACIÓN BIOLÓGICA DE NITRÓGENO EN LEGUMINOSAS FORRAJERAS MEDIANTE LA METODOLOGÍA DEL 15N (Estimation of biological nitrogen fixation in forage legumes using a 15N labeling methodology)

Se estudió la contribución de la fijación biológica de N2 (FBN) en cuatro leguminosas forrajeras, trébol blanco (Trifolium repens L.), trébol rosado (Trifolium pratense L.), trébol subterráneo (Trifolium subterraneum L.) y alfalfa (Medicago sativa L.), con y sin inoculación específica de rhizobio, mediante la metodología isotópica del Valor A, empleando tres gramíneas, avena (Avena sativa L.), ballica perenne (Lolium perenne L.) y festuca (Festuca arundinacea Schreb.) como cultivos de referencia. El estudio se llevó a cabo en un andisol (Typic fulvudand), en el Centro Regional de Investigación Carillanca, del Instituto de Investigaciones Agropecuarias, IX Región, Chile, durante tres temporadas. Las dosis aplicadas de N correspondieron a 10 kg ha-1 como sulfato de amonio (10% átomos exceso 15N) para las especies leguminosas y de 30 kg ha-1 como sulfato de amonio (5% átomos exceso 15N) para las gramíneas de referencia. En las muestras de material vegetal se analizó N total (Kjeldahl) y 15N (espectrometría de emisión óptica). Los tres cultivos de referencia mostraron estimaciones similares de la FBN en las leguminosas. La capacidad de FBN alcanzó el 90% en todas las temporadas y para todas las leguminosas. No se encontró efecto significativo respecto a la inoculación con rhizobium, excepto en alfalfa y sólo en la primera temporada. La cantidad de N fijado en todas las temporadas fue alta y con todas las leguminosas, variando entre 60 y 770 kg ha-1 a?o-1, para trébol subterráneo y alfalfa, respectivamente, ratificando la gran eficiencia del mecanismo de FBN en las leguminosas forrajeras en estudio. Estimation of biological nitrogen fixation in forage legumes using a 15N labeling methodology. The contribution of biological nitrogen N2 fixation (FBN) in four forage legumes: white clover (Trifolium repens L.), red clover (Trifolium pratense L.), subterranean clover (Trifolium subterraneum L.) and alfalfa (Medicago sativa L.), with and without specific rhizobium inoculation, was evaluated by the A value isotope technique, using three grasses: oats (Avena sativa L.), perennial ryegrass (Lolium perenne L.) and fescue (Festuca arundinacea Schreb.) as reference crops. The study was carried out for three years on an andisol (Typic fulvudand), at the Carillanca Regional Research Center of de National Agricultural Research Institute, IX Region, Chile. The dose of N applied was 10 kg N ha-1 using ammonium sulfate (10 atom % 15N excess) for legume species, and 30 kg ha-1 as ammonium sulfate (5 atom % 15N excess) for grass species. Plant samples were analyzed for total N (Kjeldahl) and atom % 15N excess (optical emission spectrometry). All the three reference crops showed similar values of FBN to the legumes. The FBN capacity reached 90% in all seasons and by all the legumes. No significant influence of inoculation with rhizobium was found, except for alfalfa and only in the first season. The quantity of N fixed in all seasons was high and for all the legumes, ranging from 60 to 770 kg ha-1 year-1, for subterranean clover and alfalfa, respectively, confirming the great efficiency of the FBN mechanism on the forage legumes under study

Estimaci\uf3n de la Fijaci\uf3n Biol\uf3gica de Nitr\uf3geno en Leguminosas Forrajeras Mediante la Metodolog\ueda del 15N

The contribution of biological nitrogen N2 fixation (FBN) in four forage legumes: white clover (Trifolium repens L.), red clover (Trifolium pratense L.), subterranean clover (Trifolium subterraneum L.) and alfalfa (Medicago sativa L.), with and without specific rhizobium inoculation, was evaluated by the A value isotope technique, using three grasses: oats (Avena sativa L.), perennial ryegrass (Lolium perenne L.) and fescue (Festuca arundinacea Schreb.) as reference crops. The study was carried out for three years on an andisol (Typic fulvudand), at the Carillanca Regional Research Center of de National Agricultural Research Institute, IX Region, Chile. The dose of N applied was 10 kg N ha-1 using ammonium sulfate (10 atom % 15N excess) for legume species, and 30 kg ha-1 as ammonium sulfate (5 atom % 15N excess) for grass species. Plant samples were analyzed for total N (Kjeldahl) and atom % 15N excess (optical emission spectrometry). All the three reference crops showed similar values of FBN to the legumes. The FBN capacity reached 90% in all seasons and by all the legumes. No significant influence of inoculation with rhizobium was found, except for alfalfa and only in the first season. The quantity of N fixed in all seasons was high and for all the legumes, ranging from 60 to 770 kg ha-1 year-1, for subterranean clover and alfalfa, respectively, confirming the great efficiency of the FBN mechanism on the forage legumes under study.Se estudi\uf3 la contribuci\uf3n de la fijaci\uf3n biol\uf3gica de N2 (FBN) en cuatro leguminosas forrajeras, tr\ue9bol blanco (Trifolium repens L.), tr\ue9bol rosado (Trifolium pratense L.), tr\ue9bol subterr\ue1neo (Trifolium subterraneum L.) y alfalfa (Medicago sativa L.), con y sin inoculaci\uf3n espec\uedfica de rhizobio, mediante la metodolog\ueda isot\uf3pica del Valor A, empleando tres gram\uedneas, avena (Avena sativa L.), ballica perenne (Lolium perenne L.) y festuca (Festuca arundinacea Schreb.) como cultivos de referencia. El estudio se llev\uf3 a cabo en un andisol (Typic fulvudand), en el Centro Regional de Investigaci\uf3n Carillanca, del Instituto de Investigaciones Agropecuarias, IX Regi\uf3n, Chile, durante tres temporadas. Las dosis aplicadas de N correspondieron a 10 kg ha-1 como sulfato de amonio (10% \ue1tomos exceso 15N) para las especies leguminosas y de 30 kg ha-1 como sulfato de amonio (5% \ue1tomos exceso 15N) para las gram\uedneas de referencia. En las muestras de material vegetal se analiz\uf3 N total (Kjeldahl) y 15N (espectrometr\ueda de emisi\uf3n \uf3ptica). Los tres cultivos de referencia mostraron estimaciones similares de la FBN en las leguminosas. La capacidad de FBN alcanz\uf3 el 90% en todas las temporadas y para todas las leguminosas. No se encontr\uf3 efecto significativo respecto a la inoculaci\uf3n con rhizobium, excepto en alfalfa y s\uf3lo en la primera temporada. La cantidad de N fijado en todas las temporadas fue alta y con todas las leguminosas, variando entre 60 y 770 kg ha-1 a\uf1o-1, para tr\ue9bol subterr\ue1neo y alfalfa, respectivamente, ratificando la gran eficiencia del mecanismo de FBN en las leguminosas forrajeras en estudio

Critical Uncertainties and Gaps in the Environmental- and Social-Impact Assessment of the Proposed Interoceanic Canal through Nicaragua

The proposed interoceanic canal will connect the Caribbean Sea with the Pacific Ocean, traversing Lake Nicaragua, the major freshwater reservoir in Central America. If completed, the canal would be the largest infrastructure-related excavation project on Earth. In November 2015, the Nicaraguan government approved an environmental and social impact assessment (ESIA) for the canal. A group of international experts participated in a workshop organized by the Academy of Sciences of Nicaragua to review this ESIA. The group concluded that the ESIA does not meet international standards; essential information is lacking regarding the potential impacts on the lake, freshwater and marine environments, and biodiversity. The ESIA presents an inadequate assessment of natural hazards and socioeconomic disruptions. The panel recommends that work on the canal project be suspended until an appropriate ESIA is completed. The project should be resumed only if it is demonstrated to be economically feasible, environmentally acceptable, and socially beneficial

Health-related quality of life in patients with type 1 diabetes mellitus in the different geographical regions of Brazil : data from the Brazilian Type 1 Diabetes Study Group

Background: In type 1 diabetes mellitus (T1DM) management, enhancing health-related quality of life (HRQoL) is as important as good metabolic control and prevention of secondary complications. This study aims to evaluate possible regional differences in HRQoL, demographic features and clinical characteristics of patients with T1DM in Brazil, a country of continental proportions, as well as investigate which variables could influence the HRQoL of these individuals and contribute to these regional disparities. Methods: This was a retrospective, cross-sectional, multicenter study performed by the Brazilian Type 1 Diabetes Study Group (BrazDiab1SG), by analyzing EuroQol scores from 3005 participants with T1DM, in 28 public clinics, among all geographical regions of Brazil. Data on demography, economic status, chronic complications, glycemic control and lipid profile were also collected. Results: We have found that the North-Northeast region presents a higher index in the assessment of the overall health status (EQ-VAS) compared to the Southeast (74.6 ± 30 and 70.4 ± 19, respectively; p < 0.05). In addition, North- Northeast presented a lower frequency of self-reported anxiety-depression compared to all regions of the country (North-Northeast: 1.53 ± 0.6; Southeast: 1.65 ± 0.7; South: 1.72 ± 0.7; Midwest: 1.67 ± 0.7; p < 0.05). These findings could not be entirely explained by the HbA1c levels or the other variables examined. Conclusions: Our study points to the existence of additional factors not yet evaluated that could be determinant in the HRQoL of people with T1DM and contribute to these regional disparities

Health-related quality of life in patients with type 1 diabetes mellitus in the different geographical regions of Brazil : data from the Brazilian Type 1 Diabetes Study Group

Background: In type 1 diabetes mellitus (T1DM) management, enhancing health-related quality of life (HRQoL) is as important as good metabolic control and prevention of secondary complications. This study aims to evaluate possible regional differences in HRQoL, demographic features and clinical characteristics of patients with T1DM in Brazil, a country of continental proportions, as well as investigate which variables could influence the HRQoL of these individuals and contribute to these regional disparities. Methods: This was a retrospective, cross-sectional, multicenter study performed by the Brazilian Type 1 Diabetes Study Group (BrazDiab1SG), by analyzing EuroQol scores from 3005 participants with T1DM, in 28 public clinics, among all geographical regions of Brazil. Data on demography, economic status, chronic complications, glycemic control and lipid profile were also collected. Results: We have found that the North-Northeast region presents a higher index in the assessment of the overall health status (EQ-VAS) compared to the Southeast (74.6 ± 30 and 70.4 ± 19, respectively; p < 0.05). In addition, North- Northeast presented a lower frequency of self-reported anxiety-depression compared to all regions of the country (North-Northeast: 1.53 ± 0.6; Southeast: 1.65 ± 0.7; South: 1.72 ± 0.7; Midwest: 1.67 ± 0.7; p < 0.05). These findings could not be entirely explained by the HbA1c levels or the other variables examined. Conclusions: Our study points to the existence of additional factors not yet evaluated that could be determinant in the HRQoL of people with T1DM and contribute to these regional disparities

Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c

International audienceAbstract Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are both used to diagnose diabetes, but these measurements can identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening, had elevated FPG, HbA1c or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardized proportion of diabetes that was previously undiagnosed and detected in survey screening ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the age-standardized proportion who had elevated levels of both FPG and HbA1c was 29–39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c was more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global shortfall in diabetes diagnosis and surveillance