Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4 (62.3 (55.1�70.8) million) to 6.4 (58.3 (47.6�70.7) million), but is predicted to remain above the World Health Organization�s Global Nutrition Target of <5 in over half of LMICs by 2025. Prevalence of overweight increased from 5.2 (30 (22.8�38.5) million) in 2000 to 6.0 (55.5 (44.8�67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic. © 2020, The Author(s)

Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950–2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Background: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings: The global TFR decreased from 2•72 (95% uncertainty interval [UI] 2•66–2•79) in 2000 to 2•31 (2•17–2•46) in 2019. Global annual livebirths increased from 134•5 million (131•5–137•8) in 2000 to a peak of 139•6 million (133•0–146•9) in 2016. Global livebirths then declined to 135•3 million (127•2–144•1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2•1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27•1% (95% UI 26•4–27•8) of global livebirths. Global life expectancy at birth increased from 67•2 years (95% UI 66•8–67•6) in 2000 to 73•5 years (72•8–74•3) in 2019. The total number of deaths increased from 50•7 million (49•5–51•9) in 2000 to 56•5 million (53•7–59•2) in 2019. Under-5 deaths declined from 9•6 million (9•1–10•3) in 2000 to 5•0 million (4•3–6•0) in 2019. Global population increased by 25•7%, from 6•2 billion (6•0–6•3) in 2000 to 7•7 billion (7•5–8•0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58•6 years (56•1–60•8) in 2000 to 63•5 years (60•8–66•1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019. Interpretation: Over the past 20 years, fertility rates have been dropping steadily and life expectancy has been increasing, with few exceptions. Much of this change follows historical patterns linking social and economic determinants, such as those captured by the GBD Socio-demographic Index, with demographic outcomes. More recently, several countries have experienced a combination of low fertility and stagnating improvement in mortality rates, pushing more populations into the late stages of the demographic transition. Tracking demographic change and the emergence of new patterns will be essential for global health monitoring. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Global burden of 87 risk factors in 204 countries and territories, 1990�2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. Methods: GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk�outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk�outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk�outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. Findings: The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10·8 million (95 uncertainty interval UI 9·51�12·1) deaths (19·2% 16·9�21·3 of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8·71 million (8·12�9·31) deaths (15·4% 14·6�16·2 of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253�350) DALYs (11·6% 10·3�13·1 of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0�9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10�24 years, alcohol use for those aged 25�49 years, and high systolic blood pressure for those aged 50�74 years and 75 years and older. Interpretation: Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Author Correction: Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017 (Nature Medicine, (2020), 26, 5, (750-759), 10.1038/s41591-020-0807-6)

An amendment to this paper has been published and can be accessed via a link at the top of the paper. © 2020, The Author(s)

Author Correction: Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017 (Nature Medicine, (2020), 26, 5, (750-759), 10.1038/s41591-020-0807-6)

An amendment to this paper has been published and can be accessed via a link at the top of the paper. © 2020, The Author(s)

Effect of white cabbage (Brassica oleracea) aqueous extract on oxidative stress in pre-diabetes – induced male albino rats

Background: Oxidative stress affects serum insulin and induces insulin resistance which results in pre-diabetic condition.Objective: This research investigated the effect of white cabbage aqueous extract on the serum insulin, insulin resistance and oxidative stress in pre-diabetes induced male albino rats.Methods: Prepared extracts from fresh and dried cabbage and thirty male albino rats grouped into six were used for the study. The positive control was fed regular diet, while negative control was fed high sucrose feed and the four test groups were fed high sucrose feed and extract. Different test group received 50 or 100 mg/kg of either of the extracts. The fasting blood sugar at baseline and at two weeks’ interval was recorded. At the end of the experiment at six weeks, the serum insulin, oral glucose tolerance test and liver oxidative stress were determined. Results were analyzed using Analysis of Variance (p &lt; 0.05) followed by Duncan Multiple Range Tests for blood glucose and Graph pad prism 5.Results: The extracts controlled the serum insulin and cell-resistance to insulin of the rats. There was a reduction in the malondialdehyde (MDA) and significant reduction in the activities ofsuperoxide dismutase (SOD) and catalase (CAT) by the extract while glutathione (GSH) increased. The MDA, SOD, CAT and GSH for the negative control group being 0.85 mg/ml, 0.8 mg/ml, 19.53 mg/ml and 5.18 μmol/ml while the highest for the test groups was; 0.84 mg/ml, 0.74 mg/ml, 17.37 mg/ml and 5.85 μmol/ml.Conclusion: Cabbage had potential of reducing liver oxidative stress in pre-diabetic condition.Keywords: Cabbage extract, blood sugar, hypoglycemic, oxidative stres

Weight change, haematology and lipid profile of normal male Wistar rats fed on high-calorie diet and vegetables

Background: The decline in vegetable consumption, some of which are gradually getting extinct because of insufficient information on their health benefits, is a major factor for the rise in the incidence of nutritional disorders. Objective: Effect of Amaranthus hybridus, Crassocephalum crepidioides, Senecio biafrae and Corchorus olitorius on the weight, haematology, and lipid profile of rats fed on high-calorie diet. Methods: The study comprised of six groups of male Wistar rats. Positive control (A) was fed on regular feed and water while the negative control (B) was fed a high-calorie diet. The four treatment groups were given high-calorie diet along with 5 % of one of the four vegetables for five weeks respectively. The weights of the rats were obtained before and after the experiment. The feed and water consumption of the rats were recorded daily. The haematology and the lipid profile were determined at the end of the experiment. Results: The composition of the feeds was significantly different (p&lt;0.05). The mean weekly water intake (332 ml) and feed consumption (92 g) of the positive control were not significantly different while its mean weight change (22 g) was significant at p&lt;0.05. S. biafrae increased non-significantly the PCV (48.25 %), 9 haemoglobin (16.25 g/dl) and platelet count (289 ×109 / L). A. hybridus lowered the total cholesterol (89.93 mg/dl), triglyceride (45.38 mg/dl) and LDL (77.65 mg/dl) while S. biafrae increased the HDL (44.65 mg/dl) level. Conclusion: The effect of the high-calorie diet was better ameliorated by A. hybridus and S. biafrae

Quality effect of repetitive use of frying oil by street food vendors on quality of the oil

Background: Frying of food triggers different chemical reactions and most street food vendors use oils repeatedly before discarding in order to reduce cost. This repetitive use coupled with exposure to air can however cause degradation in the oil leading to unpleasant odour and flavor.Objective: The study determined the effect of repetitive use of frying oil by street fried food vendors on the oil quality.Methods: Questionnaire was administered to ten vendors in Ilishan-Remo to ascertain how frying oils are stored and how often they reuse oil to fry. Three samples of frying oils (10ml each) of three randomly selected street fried foods (fish, yam and akara) were obtained every other day for four days and taken to the laboratory where peroxide value and free fatty acid content were analyzed. Data were statistically analyzed using descriptive statistics and the results were presented as mean and standard deviation.Results: All (100%) respondents reused frying oil frequently and mixed fresh oil with degraded oil constantly. Majority (80%) of the vendors did not store the oil properly after each use. The amount of peroxides (43.125- 95.625mEeq/kg) in oil samples exceeded the maximum level of Codex standards (10mEq/kg). The range (0.7% to 3.29 %) of free fatty acids of the oil samples also exceeded the maximum accepted level of 0.3%.Conclusion: There was a high level of deterioration and rancidity in all the oil samples due to poor storage and excessive repetitive use by the street vendors.Keywords: Rancidity, repetitive use, oil, storage, street food

Moringa leaf extract potential in the incidence of allergy in experimental rats

The incidence of food allergy outbreak worldwide is becoming a public health concern. Food allergy is growing at an epidemic proportion affecting all age groups of human population especially&nbsp;such occurrence in young children is worrisome. Management of food allergy without side effect is still a challenge to the medical community. The objective of this study was to investigate the effectiveness of moringa leaf extract in the treatment of food allergy without side effects in experimental rats. Sixty (60) Wistar male rats, (4-6) weeks old, weighing between (100-120) g were grouped into five (5) sections. They were grouped under: Positive Control group, Negative Control group, Epinephrine control group,Chemotherapeutic and Chemo-preventive groups. The animals were allowed to acclimatize for two weeks where the rats were given free food ration and distilled water. After 15 days of consecutive administration of 1 ml crude peanut extract and 10μlcholera toxin as a potent adjuvant&nbsp;in rats, made food allergy established. Results from the study indicated that the means&nbsp;of rectal temperatures after 20th day of allergy induction were declined from (37.17-34.47) ?C, (37.0-34.67) ?C, and (37.52-3542) ?C in Positive control group, Chemopreventiveand Chemotherapeutic groups respectively. The reductions in rectal temperatures confirmed that food allergy was established in experimental rats. Also the study showed that moringa&nbsp;leaf extract reduced serum Immunoglobulin E levels from (324.50-275.4)ng/ml,(181.20-170.50)ng/ml, (279.50-44.38)ng/ml respectively under Epinephrine treatment, Chemopreventive and Chemotherapeutic experimental group treatments. This suggested that&nbsp;moringa leaf extract had potential to prevent and control food allergy

Global, regional, and national burden of neurological disorders, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Background: Neurological disorders are increasingly recognised as major causes of death and disability worldwide. The aim of this analysis from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 is to provide the most comprehensive and up-to-date estimates of the global, regional, and national burden from neurological disorders. Methods: We estimated prevalence, incidence, deaths, and disability-adjusted life-years (DALYs; the sum of years of life lost [YLLs] and years lived with disability [YLDs]) by age and sex for 15 neurological disorder categories (tetanus, meningitis, encephalitis, stroke, brain and other CNS cancers, traumatic brain injury, spinal cord injury, Alzheimer&apos;s disease and other dementias, Parkinson&apos;s disease, multiple sclerosis, motor neuron diseases, idiopathic epilepsy, migraine, tension-type headache, and a residual category for other less common neurological disorders) in 195 countries from 1990 to 2016. DisMod-MR 2.1, a Bayesian meta-regression tool, was the main method of estimation of prevalence and incidence, and the Cause of Death Ensemble model (CODEm) was used for mortality estimation. We quantified the contribution of 84 risks and combinations of risk to the disease estimates for the 15 neurological disorder categories using the GBD comparative risk assessment approach. Findings: Globally, in 2016, neurological disorders were the leading cause of DALYs (276 million [95% UI 247–308]) and second leading cause of deaths (9·0 million [8·8–9·4]). The absolute number of deaths and DALYs from all neurological disorders combined increased (deaths by 39% [34–44] and DALYs by 15% [9–21]) whereas their age-standardised rates decreased (deaths by 28% [26–30] and DALYs by 27% [24–31]) between 1990 and 2016. The only neurological disorders that had a decrease in rates and absolute numbers of deaths and DALYs were tetanus, meningitis, and encephalitis. The four largest contributors of neurological DALYs were stroke (42·2% [38·6–46·1]), migraine (16·3% [11·7–20·8]), Alzheimer&apos;s and other dementias (10·4% [9·0–12·1]), and meningitis (7·9% [6·6–10·4]). For the combined neurological disorders, age-standardised DALY rates were significantly higher in males than in females (male-to-female ratio 1·12 [1·05–1·20]), but migraine, multiple sclerosis, and tension-type headache were more common and caused more burden in females, with male-to-female ratios of less than 0·7. The 84 risks quantified in GBD explain less than 10% of neurological disorder DALY burdens, except stroke, for which 88·8% (86·5–90·9) of DALYs are attributable to risk factors, and to a lesser extent Alzheimer&apos;s disease and other dementias (22·3% [11·8–35·1] of DALYs are risk attributable) and idiopathic epilepsy (14·1% [10·8–17·5] of DALYs are risk attributable). Interpretation: Globally, the burden of neurological disorders, as measured by the absolute number of DALYs, continues to increase. As populations are growing and ageing, and the prevalence of major disabling neurological disorders steeply increases with age, governments will face increasing demand for treatment, rehabilitation, and support services for neurological disorders. The scarcity of established modifiable risks for most of the neurological burden demonstrates that new knowledge is required to develop effective prevention and treatment strategies. Funding: Bill &amp; Melinda Gates Foundation. © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens