Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions

Hypocalcaemia- The detrimental effect of phototherapy.

Background: Jaundice is the single most common abnormal physical finding in the first week of life. Jaundice is observed during the 1st week of life in approximately 60% of term infants and 80% of preterm infants. The most common used methods of treating hyperbilirubinemia are phototherapy, exchange transfusion and pharmacological therapy. Potential but lesser known complication of phototherapy is hypocalcaemia. Our objective is to study the effect of phototherapy used for the management of   hyperbilirubinemia and   its   consequent effect on calcium homeostasis. Methodology: This study was conducted on total 180 neonates admitted to Neonatal intensive care unit of a tertiary care center of ‘Steel city of Central India’. All study participants are included in two groups. One group included   45 preterm neonates (gestational   age >32 week but <37 week) and  other group included  45  full term neonates (gestational   age >37 week). In   addition, 45 neonates served   in   each   group as control. All had hyperbilirubinemia. The controls were fully matched with the study group. All the neonates included in the study group required management with phototherapy. The neonates in the control group were managed without phototherapy. Total Serum bilirubin levels and serum calcium levels were checked before and after phototherapy. Result: The mean total serum calcium showed a statistically significant fall after exposure to phototherapy in the study group. The commonest complication observed after phototherapy was loose stools and rashes in preterm and full term neonates. Conclusion: In neonates with hyperbilirubinemia serum calcium level significantly decreases due to phototherapy. Preterm new-borns suffer more from hypocalcaemia than full term new-borns after receiving phototherapy

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Not AvailableThe land resources of Bareli watershed in Seoni district of Madhya Pradesh were characterized, classified and evaluated using IRS-LISS-IV and LISS-III data and GIS. Five major landforms viz. plateau, escarpement, isolated mound, hills and ridges and pediment were identified and delineated. Based on image characteristics, five major land use/land cover viz. forest, cultivated land, wasteland, habitation and water bodies were identified. Five slope classes viz., very gently sloping (1–3%), gently sloping (35%), moderately sloping (5–10%), strongly sloping (10–15%) and moderately step to steep sloping (1515%) lands have been identified using Cartosat-1 DEM (30 m resolution) and topographic information. Five soil series (Diwartola, Diwara, Bareli-1, Bareli-2 and Bareli-3) were tentatively identified and mapped as mono series on 1: 10000 scale based on landform-soil relationship. Soils are shallow, clayey, well drained and severely eroded at upper elevations, whereas, they are moderately deep, clayey, moderately well drained with moderate erosion at lower elevations. The soils are, in general, clayey, neutral in reaction, non-saline and non-calcareous and qualify for Lithic Haplustepts/Lithic Ustorthents/Vertic Haplustepts/Typic Ustorthents at subgroup level. The soils were grouped under land capability sub classes IVs and IVst and 2st, 3s, 3st and 4st land irrigability sub-classes. The soils of Diwartola are moderately suitable for growing sorghum and marginally suitable for growing cotton, pigeonpea, maize and rice and not suitable for growing soybean. The soils of Diwara and Bareli-2 are marginally suitable for sorghum and not suitable for growing cotton, pigeonpea, soybean, maize and rice. The soils of Bareli-1 and Bareli-3 are moderately suitable for growing sorghum and marginally suitable for growing cotton, pigeonpea, soybean, maize and rice. Suitable land use interventions and soil and water conservation measures have been suggested for better management of land resources in the watershed.Not Availabl