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.Peer reviewe

Towards a wastewater energy recovery system: The utilization of humidified ammonia by a solid oxide fuel cell stack

This study presents the results of investigations on performance and durability of an ammonia-supplied MK352 solid oxide fuel cell stack with electrolyte supported cells and chromium based interconnects. The performance evaluation revealed no significant differences between ammonia and equivalent hydrogen/nitrogen gases as fuel, which was a result of the excellent ammonia conversion rates up to 99.99%. When using high ammonia flow rates, temperature measurements inside the stack revealed a temperature drop due to the endothermic ammonia decomposition of up to 18.8 K, which proceeded preferentially at the fuel inlet region. An 1000 h durability test with humidified ammonia in 80% fuel utilization condition was performed, which resulted in a stack performance degradation rate of about 1.1%/1000 h. Tests with hydrogen/nitrogen fueled reference stacks revealed similar degradation rates during the initial 1000 h. Post-mortem analyses by scanning electron microscopy and energy-dispersive X-ray spectroscopy revealed no significant micro-structural deterioration of the functional layers of the anode, but nitriding effects on the nickel contact meshes and chromium nitrides were found in the material structure of the interconnects. Also, an oxide layer was found between interconnect and contact meshes at the anode, which appears to be the main cause of the performance degradation

Fast fuel variation and identification of SOFC system changes using online health monitoring tools and fault diagnosis

The greatest challenges of the solid oxide fuel cell (SOFC) technology are its reliability and durability, both of them considering a variety of possible fuels. To address those issues, understanding of the ongoing processes in SOFCs is of crucial importance. The ability to monitor electrochemical processes online and to identify fast alternating operating conditions offers a possibility to determine degradation-inducing processes at their preliminary stage. Thus, their early identification would provide timely counteractions and inhibit irreversible SOFC degradation. To guarantee the safe SOFC operation, the present study focuses on: (1) investigation of SOFC behavior during feeding with different fuels, (2) development and application of non-conventional tools for online-monitoring, and (3) identification of failure modes at the early stage

Long-term trends in the prescription of antidiabetic drugs: real-world evidence from the Diabetes Registry Tyrol 2012–2018

Introduction Prescription patterns of antidiabetic drugs in the period from 2012 to 2018 were investigated based on the Diabetes Registry Tyrol. To validate the findings, we compared the numbers with trends of different national registries conducted in a comparable period of time.Research design and methods Medication data, prescription patterns, age groups, antidiabetic therapies and quality parameters (hemoglobin A1c, body mass index, complications) of 10 875 patients with type 2 diabetes from 2012 to 2018 were retrospectively assessed and descriptively analyzed. The changes were assessed using a time series analysis with linear regression and prescription trends were plotted over time.Results Sodium/glucose cotransporter 2 inhibitors (SGLT-2i) showed a significant increase in prescription from 2012 to 2018 (p<0.001), as well as metformin (p=0.002), gliptins (p=0.013) and glucagon-like peptide-1 agonists (GLP-1a) (p=0.017). Significant reduction in sulfonylurea prescriptions (p<0.001) was observed. Metformin was the most frequently prescribed antidiabetic drug (51.3%), followed by insulin/analogs (34.6%), gliptins (28.2%), SGLT-2i (11.7%), sulfonylurea (9.1%), glitazones (3.7%), GLP-1a (2.8%) and glucosidase inhibitors (0.4%).Conclusions In this long-term, real-world study on prescription changes in the Diabetes Registry Tyrol, we observed significant increase in SGLT-2i, metformin, gliptins and GLP-1a prescriptions. In contrast prescriptions for sulfonylureas declined significantly. Changes were consistent over the years 2012–2018. Changes in prescription patterns occurred even before the publication of international and national guidelines. Thus, physicians change their prescription practice not only based on published guidelines, but even earlier on publication of cardiovascular outcome trials