Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries1,2. However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world3 and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health4,5. However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol—which is a marker of cardiovascular risk—changed from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million–4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.</p

A century of trends in adult human height

Being taller is associated with enhanced longevity, and higher education and earnings. We reanalysed 1472 population-based studies, with measurement of height on more than 18.6 million participants to estimate mean height for people born between 1896 and 1996 in 200 countries. The largest gain in adult height over the past century has occurred in South Korean women and Iranian men, who became 20.2 cm (95% credible interval 17.5-22.7) and 16.5 cm (13.3-19.7) taller, respectively. In contrast, there was little change in adult height in some sub-Saharan African countries and in South Asia over the century of analysis. The tallest people over these 100 years are men born in the Netherlands in the last quarter of 20th century, whose average heights surpassed 182.5 cm, and the shortest were women born in Guatemala in 1896 (140.3 cm; 135.8-144.8). The height differential between the tallest and shortest populations was 19-20 cm a century ago, and has remained the same for women and increased for men a century later despite substantial changes in the ranking of countries

Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries1,2. However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world3 and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health4,5. However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol�which is a marker of cardiovascular risk�changed from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95 credible interval 3.7 million�4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world. © 2020, The Author(s), under exclusive licence to Springer Nature Limited

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. © 2019, The Author(s)

Cardiovascular risk in various medical specialities. The results of the Russian multi-centre scientific and educational programme "Russian Doctors' Health"

Aim. To assess the risk of fatal cardiovascular (CVD) events in medical doctors of various specialities, using modern risk scales, and to identify the target groups for primary prevention with a fixed-dose combination of enalapril/hydrochlorothiazide (HCT) and simvastatin. Material and methods. The programme included 12 non-teaching Russian hospitals and was divided into epidemiological, educational, therapeutic, and control phases. In 699 doctors, aged >40 years and representing 43 specialities (22,8% men; mean age 50,5 +/- 11,7 years), the risk of fatal CVD events and coronary events was assessed with SCORE and Framingham scales, respectively. All doctors were informed about their individual risk and target levels of risk factors (RFs), and also taught to self-control their blood pressure, physical activity, and body mass. In total, 287 doctors participated in the therapeutic phase (6 months): 52 were included in the antihypertensive therapy (AHT) group (enalapril/HCT); 38 - in the simvastatin group; and 197 - in the combined therapy group (AHT and simvastatin). Six months after the end of the therapeutic phase, the prevalence of continuing pharmaceutical and non-pharmaceutical primary prevention was analysed. Results. The prevalence of the main RFs was high: dyslipidemia was observed in 69,2% of the participants, AH - in 55,6%, abdominal obesity - in 34,5%, and smoking - in 14%. As many as 54,5% of the doctors had at least 3 RFs, while 25,8% had high SCORE-assessed risk, and 47,1% had indications for pharmaceutical primary prevention. The most adverse RF profile was registered in surgeons. Pharmaceutical primary prevention with a fixed-dose combination of enalapril/HCT and/or simvastatin significantly reduced both SCORE and Framingham risk levels. Six months after the therapeutic phase, 30,2% of the doctors stopped the treatment, and 37,2% continued pharmaceutical primary prevention. Conclusion. The results of the programme point to the high prevalence of modifiable RFs in middle-aged medical doctors. The data obtained could be a basis for the programs of primary CVD prevention

Cardiovascular risk in various medical specialities. The results of the Russian multi-centre scientific and educational programme "Russian Doctors' Health"

Aim. To assess the risk of fatal cardiovascular (CVD) events in medical doctors of various specialities, using modern risk scales, and to identify the target groups for primary prevention with a fixed-dose combination of enalapril/hydrochlorothiazide (HCT) and simvastatin. Material and methods. The programme included 12 non-teaching Russian hospitals and was divided into epidemiological, educational, therapeutic, and control phases. In 699 doctors, aged >40 years and representing 43 specialities (22,8% men; mean age 50,5 +/- 11,7 years), the risk of fatal CVD events and coronary events was assessed with SCORE and Framingham scales, respectively. All doctors were informed about their individual risk and target levels of risk factors (RFs), and also taught to self-control their blood pressure, physical activity, and body mass. In total, 287 doctors participated in the therapeutic phase (6 months): 52 were included in the antihypertensive therapy (AHT) group (enalapril/HCT); 38 - in the simvastatin group; and 197 - in the combined therapy group (AHT and simvastatin). Six months after the end of the therapeutic phase, the prevalence of continuing pharmaceutical and non-pharmaceutical primary prevention was analysed. Results. The prevalence of the main RFs was high: dyslipidemia was observed in 69,2% of the participants, AH - in 55,6%, abdominal obesity - in 34,5%, and smoking - in 14%. As many as 54,5% of the doctors had at least 3 RFs, while 25,8% had high SCORE-assessed risk, and 47,1% had indications for pharmaceutical primary prevention. The most adverse RF profile was registered in surgeons. Pharmaceutical primary prevention with a fixed-dose combination of enalapril/HCT and/or simvastatin significantly reduced both SCORE and Framingham risk levels. Six months after the therapeutic phase, 30,2% of the doctors stopped the treatment, and 37,2% continued pharmaceutical primary prevention. Conclusion. The results of the programme point to the high prevalence of modifiable RFs in middle-aged medical doctors. The data obtained could be a basis for the programs of primary CVD prevention