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

Analyzing the major drivers of NEE in a Mediterranean alpine shrubland

Two years of continuous measurements of net ecosystem exchange (NEE) using the eddy covariance technique were made over a Mediterranean alpine shrubland. This ecosystem was found to be a net source of CO2 (+ 52±7 g C m−2 and + 48±7 g C m−2 for 2007 and 2008) during the two-year study period. To understand the reasons underlying this net release of CO2 into the atmosphere, we analysed the drivers of seasonal variability in NEE over these two years. We observed that the soil water availability – driven by the precipitation pattern – and the photosynthetic photon flux density (PPFD) are the key factors for understanding both the carbon sequestration potential and the duration of the photosynthetic period during the growing season. Finally, the effects of the self-heating correction to CO2 and H2O fluxes measured with the open-path infrared gas analyser were evaluated. Applying the correction turned the annual CO2 budget in 2007 from a sink (−135±7 g C m−2) to a source (+ 52±7 g C m−2). The magnitude of this change is larger than reported previously and is shown to be due to the low air density and cold temperatures at this high elevation study site

Adjustment of annual NEE and ET for the open-path IRGA self-heating correction : magnitude and approximation over a range of climate

The self-heating correction is known to modify open-path eddy covariance estimates of net ecosystem CO2 exchange, typically towards reduced uptake or enhanced emissions, but with a magnitude heretofore not generally documented. We assess the magnitude of this correction to be of order 1 μmol m−2 s−1 (daytime) for half-hourly fluxes and consistently over 100 g C m−2 for annual integrations, across a tower network (CARBORED-ES) spanning climate zones from Mediterranean temperate to cool alpine. We furthermore examine the sensitivity of the correction to its determining factors. Due to significant diurnal variation, the means of discriminating day versus night can lead to differences of up to several tens of g C m−2 year−1. Since its principal determinants – temperature and wind speed – do not include gas flux data, the annual correction can be estimated using only meteorological data so as to avoid uncertainties introduced when filling gaps in flux data. For fast retro-correction of annual integrations published prior to the recognition of this instrument surface heating effect, the annual impact can be roughly approximated to within 12 g C m−2 year−1 by a linear function of mean annual temperature. These determinations highlight the need for the flux community to reach a consensus regarding the need for and the specific form of this correction

Safety of hospital discharge before return of bowel function after elective colorectal surgery

Background Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function. Methods A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien-Dindo classification system. Results A total of 3288 patients were included in the analysis, of whom 301 (9 center dot 2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4-7) and 7 (6-8) days respectively (P < 0 center dot 001). There were no significant differences in rates of readmission between these groups (6 center dot 6 versus 8 center dot 0 per cent; P = 0 center dot 499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0 center dot 90, 95 per cent c.i. 0 center dot 55 to 1 center dot 46; P = 0 center dot 659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34 center dot 7 versus 39 center dot 5 per cent; major 3 center dot 3 versus 3 center dot 4 per cent; P = 0 center dot 110). Conclusion Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients