Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For schoolaged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit

An analysis of the role of continuous pulse oximetry monitoring during the six-minute walk test in predicting mortality in patients with precapillary pulmonary hypertension

Introdução: O teste da caminhada de seis minutos (TC6m) é um teste de fácil execução e baixo custo, que tem papel importante na avaliação e seguimento dos pacientes com hipertensão arterial pulmonar com implicação prognóstica bem estabelecida. Além da distância percorrida, o teste avalia a presença de dessaturação durante a realização de exercício submáximo. A última diretriz da ATS/ERS de padronização do TC6m recomenda a monitorização contínua da oximetria durante o teste, alegando maior sensibilidade na detecção de dessaturação induzida pelo exercício, porém a utilidade dessa prática ainda não está bem estabelecida. Objetivo: Comparar sobrevida em 3 anos de pacientes com hipertensão pulmonar pré-capilar que dessaturam durante o TC6m utilizando a SpO2 mais baixa durante o teste (nadir) e utilizando a SpO2 ao final do teste com os pacientes que não dessaturam durante o TC6m e avaliar fatores associados com mortalidade. Métodos: Coorte retrospectiva de pacientes com diagnóstico de hipertensão pulmonar grupo 1 e grupo 4 que realizaram TC6m com monitorização contínua da SpO2 durante os anos 2015 a 2019. Realizada revisão no prontuário médico das informações clínicas, exames complementares e seguimento para obtenção do desfecho clínico (estado de vida). Indivíduos sem informações de seguimento disponíveis no prontuário foram contatados por telefone e consultados dados de mortalidade da Central de Registro Civil do Estado do Rio Grande do Sul. O cálculo da sobrevida foi feito pelo método de Kaplan-Meier e para a análise de fatores associados com a mortalidade foi utilizado o método de regressão de Cox. Resultados: Noventa e dois pacientes foram incluídos na coorte. Do total, 25% da amostra apresentou critérios de dessaturação durante o teste, que não foi detectada ao utilizar a SpO2 final. Ocorreram 23 óbitos durante o seguimento, 29% dos que dessaturaram no final, 13% dos dessaturaram apenas no nadir e 25% dos que não dessaturaram, não atingindo diferença estatisticamente significativa de mortalidade entre os grupos. Mesmo com ajustes para confundidores como idade, classe funcional, peptídeo natriurético tipo-B e distância percorrida, não houve diferença de mortalidade entre os grupos. Pausar o TC6m e uma menor distância percorrida (<165 m) e níveis de aumentados de BNP foram marcadores de pior prognóstico. Caminhar mais de 440 m se associou com melhor sobrevida. Conclusão: O estudo 10 corrobora que a monitorização contínua da SpO2 aumenta a sensibilidade para detecção de dessaturação ao esforço, porém o achado de dessaturação com a saturação nadir não foi um marcador de maior mortalidade.Introduction: The six-minute walk test (6MWT) is an easy and inexpensive test that has an important role in the evaluation and follow-up of patients with pulmonary hypertension. The distance walked during the test has well-established prognostic implications. The test can also evaluate the presence of desaturation during submaximal exercise. The most recent ATS/ERS guideline for the standardization of the 6MWT recommends continuous monitoring of oximetry during the test, claiming greater sensitivity in detecting exercise-induced desaturation, but the usefulness of this practice has not been well established. Objective: To compare the survival of patients with pre-capillary pulmonary hypertension who desaturate at the 6MWT using the lowest SpO2 during continuous monitoring (nadir SpO2), who desaturate using only the SpO2 at the end of the test and those who do not desaturate during the 6MWT and to evaluate characteristics associated with mortality. Methods: A retrospective cohort of patients diagnosed with pulmonary hypertension group 1 and group 4 who underwent a 6MWT with continuous SpO2 monitoring at the Pulmonary Physiology Unit of the Pulmonology Service of the Hospital de Clínicas de Porto Alegre during the years 2015, 2016, 2017, 2018 and 2019. A review was carried out in the medical record of clinical information, complementary exams and follow-up to obtain the clinical outcome (state of life). Individuals who did not have follow-up information available in their medical records were contacted by telephone. Survival was calculated using the Kaplan-Meier method and the Cox regression method was used to analyze factors associated with mortality. Results: Ninety-two patients were included in the cohort. In the sample, 25% of the individuals presented criteria for desaturation using the lowest SpO2 during the test (nadir), which was not detected when using the final SpO2. There were 23 deaths during the 3 year follow-up, 29% of which desaturated at the end, 13% of which desaturated only at the nadir and 25% of which did not desaturate, with no statistically significant difference between the groups. Even with adjustments for confounders such as age, functional class, B-type natriuretic peptide and distance walked, there was no difference in mortality. Pausing during the 6MWT and a shorter distance covered were markers of worse prognosis. Conclusion: The study corroborates that continuous monitoring of SpO2 increases the sensitivity for detecting desaturation on exertion, however the finding of desaturation with the nadir saturation was not a marker of worst survival