Robust Compensation of Delay and Diffusive Actuator Dynamics Without Distributed Feedback

[EN] This paper deals with robust observer-based output-feedback stabilization of systems whose actuator dynamics can be described in terms of partial differential equations (PDEs). More specifically, delay dynamics (first-order hyperbolic PDE) and diffusive dynamics (parabolic PDE) are considered. The proposed controllers have a PDE observer-based structure. The main novelty is that stabilization for an arbitrarily large delay or diffusion domain length is achieved, while distributed integral terms in the control law are avoided. The exponential stability of the closed loop in both cases is proved using Lyapunov functionals, even in the presence of small uncertainties in the time delay or the diffusion coefficient. The feasibility of this approach is illustrated in simulations using a second-order plant with an exponentially unstable mode.This work was supported in part by Project TIN2017-86520-C3-1-R, Ministerio de Economia y Competitividad, in part by the 16/17 UPV Mobility Award, and in part by the FPI-UPV 2014 Ph.D. Grant, Universitat Politecnica de Valencia, Spain.Sanz Diaz, R.; García Gil, PJ.; Krstic, M. (2019). Robust Compensation of Delay and Diffusive Actuator Dynamics Without Distributed Feedback. IEEE Transactions on Automatic Control. 64(9):3663-3675. https://doi.org/10.1109/TAC.2018.2887148S3663367564

Robust Predictive Extended State Observer for a Class of Nonlinear Systems with Time-Varying Input Delay

[EN] This paper deals with asymptotic stabilisation of a class of nonlinear input-delayed systems via dynamic output feedback in the presence of disturbances. The proposed strategy has the structure of an observer-based control law, in which the observer estimates and predicts both the plant state and the external disturbance. A nominal delay value is assumed to be known and stability conditions in terms of linear matrix inequalities are derived for fast-varying delay uncertainties. Asymptotic stability is achieved if the disturbance or the time delay is constant. The controller design problem is also addressed and a numerical example with an unstable system is provided to illustrate the usefulness of the proposed strategy.This work was partially supported by: Ministerio de Economía y Competitividad, Spain (TIN2017-86520-C3-1-R); Universitat Politècnica de València (FPI-UPV 2014 PhD Grant); and Israel Science Foundation (Grant No. 1128/14).Sanz Diaz, R.; García Gil, PJ.; Fridman, E.; Albertos Pérez, P. (2020). Robust Predictive Extended State Observer for a Class of Nonlinear Systems with Time-Varying Input Delay. International Journal of Control. 93(2):217-225. https://doi.org/10.1080/00207179.2018.1562204S217225932Ahmed-Ali, T., Cherrier, E., & Lamnabhi-Lagarrigue, F. (2012). Cascade High Gain Predictors for a Class of Nonlinear Systems. IEEE Transactions on Automatic Control, 57(1), 221-226. doi:10.1109/tac.2011.2161795Artstein, Z. (1982). Linear systems with delayed controls: A reduction. IEEE Transactions on Automatic Control, 27(4), 869-879. doi:10.1109/tac.1982.1103023Basturk, H. I. (2017). Cancellation of unmatched biased sinusoidal disturbances for unknown LTI systems in the presence of state delay. Automatica, 76, 169-176. doi:10.1016/j.automatica.2016.10.006Basturk, H. I., & Krstic, M. (2015). Adaptive sinusoidal disturbance cancellation for unknown LTI systems despite input delay. Automatica, 58, 131-138. doi:10.1016/j.automatica.2015.05.013Bekiaris-Liberis, N., & Krstic, M. (2011). Compensation of Time-Varying Input and State Delays for Nonlinear Systems. Journal of Dynamic Systems, Measurement, and Control, 134(1). doi:10.1115/1.4005278Besançon, G., Georges, D. & Benayache, Z. (2007). Asymptotic state prediction for continuous-time systems with delayed input and application to control. 2007 European control conference (ECC) (pp. 1786–1791).Engelborghs, K., Dambrine, M., & Roose, D. (2001). Limitations of a class of stabilization methods for delay systems. IEEE Transactions on Automatic Control, 46(2), 336-339. doi:10.1109/9.905705Fridman, E. (2001). New Lyapunov–Krasovskii functionals for stability of linear retarded and neutral type systems. Systems & Control Letters, 43(4), 309-319. doi:10.1016/s0167-6911(01)00114-1Fridman, E. (2014). Introduction to Time-Delay Systems. Systems & Control: Foundations & Applications. doi:10.1007/978-3-319-09393-2Fridman, E. (2014). Tutorial on Lyapunov-based methods for time-delay systems. European Journal of Control, 20(6), 271-283. doi:10.1016/j.ejcon.2014.10.001Furtat, I., Fridman, E., & Fradkov, A. (2018). Disturbance Compensation With Finite Spectrum Assignment for Plants With Input Delay. IEEE Transactions on Automatic Control, 63(1), 298-305. doi:10.1109/tac.2017.2732279Germani, A., Manes, C., & Pepe, P. (2002). A new approach to state observation of nonlinear systems with delayed output. IEEE Transactions on Automatic Control, 47(1), 96-101. doi:10.1109/9.981726Guo, L., & Chen, W.-H. (2005). Disturbance attenuation and rejection for systems with nonlinearity via DOBC approach. International Journal of Robust and Nonlinear Control, 15(3), 109-125. doi:10.1002/rnc.978Karafyllis, I., & Krstic, M. (2017). Predictor Feedback for Delay Systems: Implementations and Approximations. Systems & Control: Foundations & Applications. doi:10.1007/978-3-319-42378-4Krstic, M. (2008). Lyapunov tools for predictor feedbacks for delay systems: Inverse optimality and robustness to delay mismatch. Automatica, 44(11), 2930-2935. doi:10.1016/j.automatica.2008.04.010Léchappé, V., Moulay, E., Plestan, F., Glumineau, A., & Chriette, A. (2015). New predictive scheme for the control of LTI systems with input delay and unknown disturbances. Automatica, 52, 179-184. doi:10.1016/j.automatica.2014.11.003Léchappé, V., Moulay, E. & Plestan, F. (2016). Dynamic observation-prediction for LTI systems with a time-varying delay in the input. 2016 IEEE 55th conference on decision and control (CDC) (pp. 2302–2307).Manitius, A., & Olbrot, A. (1979). Finite spectrum assignment problem for systems with delays. IEEE Transactions on Automatic Control, 24(4), 541-552. doi:10.1109/tac.1979.1102124Mazenc, F. & Malisoff, M. (2016). New prediction approach for stabilizing time-varying systems under time-varying input delay. 2016 IEEE 55th conference on decision and control (CDC) (pp. 3178–3182).Mondie, S., & Michiels, W. (2003). Finite spectrum assignment of unstable time-delay systems with a safe implementation. IEEE Transactions on Automatic Control, 48(12), 2207-2212. doi:10.1109/tac.2003.820147Najafi, M., Hosseinnia, S., Sheikholeslam, F., & Karimadini, M. (2013). Closed-loop control of dead time systems via sequential sub-predictors. International Journal of Control, 86(4), 599-609. doi:10.1080/00207179.2012.751627Najafi, M., Sheikholeslam, F., Hosseinnia, S., & Wang, Q.-G. (2014). Robust H ∞ control of single input-delay systems based on sequential sub-predictors. IET Control Theory & Applications, 8(13), 1175-1184. doi:10.1049/iet-cta.2012.1004Sanz, R., Garcia, P., & Albertos, P. (2016). Enhanced disturbance rejection for a predictor-based control of LTI systems with input delay. Automatica, 72, 205-208. doi:10.1016/j.automatica.2016.05.019Sanz, R., García, P., & Albertos, P. (2018). A generalized smith predictor for unstable time-delay SISO systems. ISA Transactions, 72, 197-204. doi:10.1016/j.isatra.2017.09.020Sanz, R., García, P., Fridman, E. & Albertos, P. (2017). A predictive extended state observer for a class of nonlinear systems with input delay subject to external disturbances. 2017 IEEE 56th annual conference on decision and control (CDC) (pp. 4345–4350).Sanz, R., Garcia, P., Fridman, E., & Albertos, P. (2018). Rejection of mismatched disturbances for systems with input delay via a predictive extended state observer. International Journal of Robust and Nonlinear Control, 28(6), 2457-2467. doi:10.1002/rnc.4027Shustin, E., & Fridman, E. (2007). On delay-derivative-dependent stability of systems with fast-varying delays. Automatica, 43(9), 1649-1655. doi:10.1016/j.automatica.2007.02.009Suplin, V., Fridman, E., & Shaked, U. (2007). Sampled-data H∞ control and filtering: Nonuniform uncertain sampling. Automatica, 43(6), 1072-1083. doi:10.1016/j.automatica.2006.11.024Yao, J., Jiao, Z., & Ma, D. (2014). RISE-Based Precision Motion Control of DC Motors With Continuous Friction Compensation. IEEE Transactions on Industrial Electronics, 61(12), 7067-7075. doi:10.1109/tie.2014.2321344Zhong, Q.-C. (2004). On Distributed Delay in Linear Control Laws—Part I: Discrete-Delay Implementations. IEEE Transactions on Automatic Control, 49(11), 2074-2080. doi:10.1109/tac.2004.83753

Artificial Pancreas System With Unannounced Meals Based on a Disturbance Observer and Feedforward Compensation

© 2021 IEEE. Personal use of this material is permitted. Permissíon from IEEE must be obtained for all other uses, in any current or future media, including reprinting/republishing this material for advertisíng or promotional purposes, creating new collective works, for resale or redistribution to servers or lists, or reuse of any copyrighted component of this work in other works.[EN] This brief is focused on the closed-loop control of postprandial glucose levels of patients with type 1 diabetes mellitus after unannounced meals, which is still a major challenge toward a fully autonomous artificial pancreas. The main limitations are the delays introduced by the subcutaneous insulin pharmacokinetics and the glucose sensor, which typically leads to insulin overdelivery. Current solutions reported in the literature typically resort to meal announcement, which requires patient intervention. In this brief, a disturbance observer (DOB) is used to estimate the effect of unannounced meals, and the insulin pharmacokinetics is taken into account by means of a feedforward compensator. The proposed strategy is validated in silico with the UVa/Padova metabolic simulator. It is demonstrated how the DOB successfully estimates and counteracts not only the effect of meals but also the sudden drops in the glucose levels that may lead to hypoglycemia. For unannounced meals, results show a median time-in-range of 80% in a 30-day scenario with high carbohydrate content and large intrasubject variability. Optionally, users may decide to announce meals. In this case, considering severe bolus mismatch due to carbohydrate counting errors, the median time-in-range is increased up to 88%. In every case, hypoglycemia is avoided.This work was supported in part by the Ministerio de Economia y Competitividad under Grant DPI2016-78831-C2-1-R and in part by the European Union through FEDER Funds.Sanz Diaz, R.; García Gil, PJ.; Diez, J.; Bondía Company, J. (2021). Artificial Pancreas System With Unannounced Meals Based on a Disturbance Observer and Feedforward Compensation. IEEE Transactions on Control Systems Technology. 29(1):454-460. https://doi.org/10.1109/TCST.2020.2975147S45446029

New Predictor and 2DOF Control Scheme for Industrial Processes with Long Time Delay

© 2018 IEEE. Personal use of this material is permitted. Permissíon from IEEE must be obtained for all other uses, in any current or future media, including reprinting/republishing this material for advertisíng or promotional purposes, creating new collective works, for resale or redistribution to servers or lists, or reuse of any copyrighted component of this work in other works.[EN] To address the difficulty of controlling industrial processes with long time delay, a novel design of dead-time compensator (DTC) is introduced, which can be used to predict the undelayed output response of any process (no matter stable or unstable) such that the control design may be focused on the delay-free part of the process for performance optimization. Based on the undelayed output estimation, a two-degree-of-freedom (2DOF) control scheme is analytically developed for optimizing the set-point tracking and disturbance rejection, respectively. By proposing the desired transfer functions, the corresponding controllers are analytically derived based on commonly used low-order process models. A notable advantage is that there is a single adjustable parameter in the proposed DTC, as well as in each controller, which can be monotonically tuned to meet a good tradeoff between the prediction (or control) performance and its robustness. Illustrative examples from the literature and a practical application to a temperature control system of a jacketed reactor are used to demonstrate the effectiveness of the proposed predictor-based control scheme.This work was supported in part by the NSF China under Grant 61633006 and Grant 61473054; in part by the National Thousand Talents Program of China, the PROMETEOII/2013/004, Conselleria d'Educacio, Generalitat Valenciana, and TIN2014-56158-C4-4-P-AR; in part by the Ministerio de Economia y Competitividad; and in part by the FPI-UPV 2014 Grant Program from the Universidad Politecnica de Valencia, Valencia, SpainLiu, T.; García Gil, PJ.; Chen, Y.; Ren, X.; Albertos Pérez, P.; Sanz Diaz, R. (2018). New Predictor and 2DOF Control Scheme for Industrial Processes with Long Time Delay. IEEE Transactions on Industrial Electronics. 65(5):4247-4256. https://doi.org/10.1109/TIE.2017.2760839S4247425665

Cost-Effectiveness of Therapeutic Drug Monitoring of Anti-TNF Therapy in Inflammatory Bowel Disease: A Systematic Review

Infliximab and adalimumab are monoclonal antibodies against tumor necrosis factor (anti-TNF) used to manage inflammatory bowel disease (IBD). Therapeutic Drug Monitoring (TDM) has been proven to prevent immunogenicity, to achieve better long-term clinical results and to save costs in IBD treatment. The aim of this study was to conduct a systematic review on cost-effectiveness analyses of studies that apply TDM of anti-TNF in IBD and to provide a critical analysis of the best scientific knowledge available in the literature. The quality of the included studies was assessed using Consolidated Health Economic Evaluation Reporting Standards (CHEERS). Cost-effectiveness of the TDM strategies was presented as total costs, cost savings, quality-adjusted life-years (QALY) and incremental cost-effectiveness ratio (ICER). Thirteen studies that examined the health economics of TDM of anti-TNF in IBD from 2013 to 2021 were included. Eight of them (61.5%) achieved a score between 17 and 23 on the CHEERS checklist. The comparison between the TDM strategy and an empirical strategy was cost saving. The ICER between reactive TDM and an empirical strategy was dominated (favorable) by reactive TDM, whereas the ICER value for proactive TDM compared to an empirical strategy ranged from EUR 56,845 to 3,901,554. This systematic review demonstrated that a TDM strategy is cost-effective or cost-saving in IBD.S.M.-M. received a predoctoral fellowship from Miguel Hernandez University (“Ayudas a la contratación de personal investigador en formación 2021”).S

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks