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. Funding: Bill & Melinda Gates Foundation

Composition and Potential Health Benefits of Pomegranate: A Review

Background: Pomegranate (Punica granatum L.) fruits are widely consumed and used as preventive and therapeutic agents since ancient times. Pomegranate is a rich source of a variety of phytochemicals, which are responsible for its strong antioxidative and anti-inflammatory potential. Objective: The aim of this review is to provide an up-to-date overview of the current knowledge of chemical structure and potential health benefits of pomegranate. Methods: A comprehensive search of available literature. Results: The review of the literature confirms that juice and extracts obtained from different parts of this plant, including fruit peel, seeds, and leaves exert health benefits in both in vitro and in vivo studies. The antidiabetic, antihypertensive, antimicrobial and anti-tumour effects of pomegranate fruit are of particular scientific and clinical interest. Conclusion: Further investigations are required to clarify the mechanism of action of the bioactive ingredients and to reveal full potential of pomegranate as both preventive and therapeutic agent

Excess of charged over neutral KK meson production in high-energy collisions of atomic nuclei

Collisions of atomic nuclei at relativistic velocities produce new particles, predominantly mesons containing one valence quark and one valence anti-quark. These particles are produced in strong interactions, which preserve an approximate symmetry between up ($u$) and down ($d$) quarks. In the case of $K$ meson production, if this symmetry were exact, it would result in equal numbers of charged ($K^+$ and $K^-$) and neutral ($K^0$ and $\overline K^0$) mesons in the final state. In this Letter, we report a measurement of the relative abundance of charged over neutral $K$ meson production in collisions of argon and scandium nuclei at a center-of-mass energy of 11.9~GeV per nucleon pair. We find that production of $\mathit{K^+}$ and $\mathit{K^-}$ mesons at mid-rapidity displays a significant excess of $(23.3\pm 5.7)\%$ relative to that of the neutral $K$ mesons. The origin of this unexpected excess remains to be elucidated.Collisions of atomic nuclei at relativistic velocities produce new particles, predominantly mesons containing one valence quark and one valence anti-quark. These particles are produced in strong interactions, which preserve an approximate symmetry between up ($u$) and down ($d$) quarks. In the case of $K$ meson production, if this symmetry were exact, it would result in equal numbers of charged ($K^+$ and $K^-$) and neutral ($K^0$ and $\overline{K}$$^0$) mesons in the final state. In this Letter, we report a measurement of the relative abundance of charged over neutral $K$ meson production in collisions of argon and scandium nuclei at a center-of-mass energy of 11.9~GeV per nucleon pair. We find that production of $K^+$ and $K^-$ mesons at mid-rapidity displays a significant excess of $(23.3\pm 5.7)\%$ relative to that of the neutral $K$ mesons. The origin of this unexpected excess remains to be elucidated

Excess of charged over neutral KK meson production in high-energy collisions of atomic nuclei

International audienceCollisions of atomic nuclei at relativistic velocities produce new particles, predominantly mesons containing one valence quark and one valence anti-quark. These particles are produced in strong interactions, which preserve an approximate symmetry between up ($u$) and down ($d$) quarks. In the case of $K$ meson production, if this symmetry were exact, it would result in equal numbers of charged ($K^+$ and $K^-$) and neutral ($K^0$ and $\overline{K}$$^0$) mesons in the final state. In this Letter, we report a measurement of the relative abundance of charged over neutral $K$ meson production in collisions of argon and scandium nuclei at a center-of-mass energy of 11.9~GeV per nucleon pair. We find that production of $K^+$ and $K^-$ mesons at mid-rapidity displays a significant excess of $(23.3\pm 5.7)\%$ relative to that of the neutral $K$ mesons. The origin of this unexpected excess remains to be elucidated

Measurements of higher-order cumulants of multiplicity and net-electric charge distributions in inelastic proton-proton interactions by NA61/SHINE

International audienceThis paper presents the energy dependence of multiplicity and net-electric charge fluctuations in $p+p$ interactions at beam momenta 20, 31, 40, 80, and 158 GeV/$c$. Results are corrected for the experimental biases and quantified with the use of cumulants and factorial cumulants. Data are compared with the Epos1.99 and FTFP-BERT model predictions

Measurements of higher-order cumulants of multiplicity and net-electric charge distributions in inelastic proton-proton interactions by NA61/SHINE

This paper presents the energy dependence of multiplicity and net-electric charge fluctuations in $p+p$ interactions at beam momenta 20, 31, 40, 80, and 158 GeV/$c$. Results are corrected for the experimental biases and quantified with the use of cumulants and factorial cumulants. Data are compared with the Epos1.99 and FTFP-BERT model predictions