Multidimensional characterization of global food supply from 1961 to 2013

Food systems are increasingly globalized and interdependent, and diets around the world are changing. Characterization of national food supplies and how they have changed can inform food policies that ensure national food security, support access to healthy diets and enhance environmental sustainability. Here we analysed data for 171 countries on the availability of 18 food groups from the United Nations Food and Agriculture Organization to identify and track multidimensional food supply patterns from 1961 to 2013. Four predominant food-group combinations were identified that explained almost 90% of the cross-country variance in food supply: animal source and sugar, vegetable, starchy root and fruit, and seafood and oilcrops. South Korea, China and Taiwan experienced the largest changes in food supply over the past five decades, with animal source foods and sugar, vegetables and seafood and oilcrops all becoming more abundant components of the food supply. In contrast, in many Western countries the supply of animal source foods and sugar declined. Meanwhile, there was remarkably little change in the food supply in countries in the sub-Saharan Africa region. These changes led to a partial global convergence in the national supply of animal source foods and sugar, and a divergence in those of vegetables and of seafood and oilcrops. Our analysis generated a novel characterization of food supply that highlights the interdependence of multiple food types in national food systems. A better understanding of how these patterns have evolved and will continue to change is needed to support the delivery of healthy and sustainable food system policies

Ten-year incidence of hypertension in a Swiss population-based sample Incidence of hypertension in Switzerland.

Few studies assessed incidence and determinants of hypertension. We assessed the incidence and determinants of hypertension in a cohort of healthy adults aged 35-75 years living in Lausanne, Switzerland. Baseline data were collected from 2003 to 2006. Follow-ups were conducted in 2009-2012 and 2014-2017. Incident hypertension, defined as a systolic BP ≥140 mm Hg or a diastolic BP ≥90 mm Hg or anti-hypertensive medication, was assessed at 1) second follow-up only; 2) first and/or second follow-up. After 10.9 years, incident hypertension was 26.8% (analysis 1, N = 3299) and 30.3% (analysis 2, N = 3728). After multivariate adjustment, the variables associated with increased hypertension incidence were male gender [incident-rate ratio (IRR) and (95% confidence interval)]: 1.20 (1.07-1.35) and 1.24 (1.13-1.37) for analyses 1 and 2, respectively; increasing age (p for trend < 0.001) and body mass index (p for trend < 0.001) and history of cardiovascular disease (CVD). Being physically active was negatively associated with incident hypertension: 0.88 (0.78-0.98) and 0.92 (0.83-1.01) for analyses 1 and 2, respectively. Except for male gender, these associations remained after adjusting for baseline BP levels, with incident rate ratios for physical activity of 0.86 (0.77-0.96) and 0.91 (0.83-0.99) for analyses 1 and 2, respectively. No association was found for education, alcohol consumption or smoking status. We conclude that over 10.9 years, between 1/4 and 1/3 of the Swiss population aged 35-75 developed hypertension. Male gender, history of CVD, increasing age and higher BMI increase the risk of hypertension, while being physically active reduces the risk

Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19.1 million participants

Background Raised blood pressure is an important risk factor for cardiovascular diseases and chronic kidney disease. We estimated worldwide trends in mean systolic and mean diastolic blood pressure, and the prevalence of, and number of people with, raised blood pressure, defined as systolic blood pressure of 140 mm Hg or higher or diastolic blood pressure of 90 mm Hg or higher. Methods For this analysis, we pooled national, subnational, or community population-based studies that had measured blood pressure in adults aged 18 years and older. We used a Bayesian hierarchical model to estimate trends from 1975 to 2015 in mean systolic and mean diastolic blood pressure, and the prevalence of raised blood pressure for 200 countries. We calculated the contributions of changes in prevalence versus population growth and ageing to the increase in the number of adults with raised blood pressure. Findings We pooled 1479 studies that had measured the blood pressures of 19·1 million adults. Global age-standardised mean systolic blood pressure in 2015 was 127·0 mm Hg (95% credible interval 125·7–128·3) in men and 122·3 mm Hg (121·0–123·6) in women; age-standardised mean diastolic blood pressure was 78·7 mm Hg (77·9–79·5) for men and 76·7 mm Hg (75·9–77·6) for women. Global age-standardised prevalence of raised blood pressure was 24·1% (21·4–27·1) in men and 20·1% (17·8–22·5) in women in 2015. Mean systolic and mean diastolic blood pressure decreased substantially from 1975 to 2015 in high-income western and Asia Pacific countries, moving these countries from having some of the highest worldwide blood pressure in 1975 to the lowest in 2015. Mean blood pressure also decreased in women in central and eastern Europe, Latin America and the Caribbean, and, more recently, central Asia, Middle East, and north Africa, but the estimated trends in these super-regions had larger uncertainty than in high-income super-regions. By contrast, mean blood pressure might have increased in east and southeast Asia, south Asia, Oceania, and sub-Saharan Africa. In 2015, central and eastern Europe, sub-Saharan Africa, and south Asia had the highest blood pressure levels. Prevalence of raised blood pressure decreased in high-income and some middle-income countries; it remained unchanged elsewhere. The number of adults with raised blood pressure increased from 594 million in 1975 to 1·13 billion in 2015, with the increase largely in low-income and middle-income countries. The global increase in the number of adults with raised blood pressure is a net effect of increase due to population growth and ageing, and decrease due to declining age-specific prevalence. Interpretation During the past four decades, the highest worldwide blood pressure levels have shifted from high-income countries to low-income countries in south Asia and sub-Saharan Africa due to opposite trends, while blood pressure has been persistently high in central and eastern Europe

Reducing Calorie Intake May Not Help You Lose Body Weight

Background Previously a meta-analysis found that multi-vitamin/mineral supplementation reduced mild psychiatric symptoms. To establish mechanisms, and to pin-point the individuals most likely to benefit, the role of various polymorphisms were examined. Supplementation was found to influence mild-psychiatric symptoms depending on the form of particular genes: genes that are risk factors for psychiatric disease and influence mechanisms by which drugs act. Methods In a double-blind trial young healthy males rated psychiatric symptoms, before and after taking vitamin/mineral supplements for three months, and the response was related to single nucleotide polymorphisms associated with catecholamines and serotonin. Outcomes With rs1800497 (Taq1A; dopamine D2 receptor), those with the CT allele benefitted from a vitamin/mineral supplement. Similarly with rs1800955 (DRD4 – dopamine D4 receptor), the mood of those with the CC allele benefitted selectively. With rs6296 (HTR1B) only those with the GC alleles responded, and with rs6311 (HTR2A) supplementation produced a beneficial response in those with the GG allele. With rs1050565 (5HTT gene - Human Serotonin Transporter gene) supplementation increased the mental health of those with the AA allele. Interpretation In a situation where a substantial proportion of patients do not benefit from drug therapy, and there is an element of trial and error when prescribing, it was proposed that future work should consider distinguishing patients depending on various polymorphisms and micro-nutrient status. In those with particular alleles, we should consider if drug administration and vitamin / mineral status interact synergistically to influence the therapeutic outcom

Effects of an exercise program on hepatic metabolism, hepatic fat, and cardiovascular health in overweight/obese adolescents from Bogotá, Colombia (the HEPAFIT study): study protocol for a randomized controlled trial

Background: A considerable proportion of contemporary youth have a high risk of obesity-related disorders such as cardiovascular disease, metabolic syndrome, or non-alcoholic fatty liver disease (NAFLD). Although there is consistent evidence for the positive effects of physical activity on several health aspects, most adolescents in Colombia are sedentary. It is, therefore, important to implement strategies that generate changes in lifestyle. The HEPAFIT study aims to examine whether a 6-month exercise program has benefits for hepatic fat content and cardiovascular health outcomes among overweight/obese adolescents from Bogotá, Colombia. Methods/design: Altogether, 100 hundred overweight/obese, sedentary adolescents (aged 11–17 years) attending two public schools in Bogotá, Colombia, will be included in a parallel-group randomized controlled trial. Adolescents will be randomly assigned to an intervention group following one of four curricula: (1) the standard physical education curriculum (60 min per week of physical activity, n = 25) at low-to-moderate intensity; (2) a high-intensity physical education curriculum (HIPE, n = 25), consisting of endurance and resistance games and non-competitive activities, such as running, gymkhanas, lifting, pushing, wrestling, or hauling, for 60-min sessions, three times per week, with an energy expenditure goal of 300 to 500 kcal/session at 75–85% maximum heart rate (HRmax); (3) a low-to-moderate intensity physical education curriculum (LIPE, n = 25) consisting of endurance and resistance games and non-competitive activities (e.g., chasing, sprinting, dribbling, or hopping) for 60-min sessions, three times per week with an energy expenditure goal of 300 kcal/session at 55–75% HRmax; and (4) a combined HIPE and LIPE curriculum (n = 25). The HIPE, LIPE, and combined interventions were performed in addition to the standard physical education curriculum. The primary outcome for effectiveness is liver fat content, as measured by the controlled attenuation parameter 1 week after the end of the intervention program. Discussion: The translational focus may be suitable for collecting new information in a school setting on the possible effects of physical activity interventions to reduce liver fat content and to improve metabolic profiles and the cardiometabolic health of overweight/obese adolescents. This may lead to the more efficient use of school physical education resources.The HEPAFIT study was carried out with the financial support of Instituto Colombiano para el Desarrollo de la Ciencia y la Tecnología “Francisco José de Caldas” COLCIENCIAS (code 59700 and no 122277757900). Katherine González-Ruíz receive a scholarship from Universidad del Rosario, Colombia, Escuela de Medicina y Ciencias de la Salud, to do a Doctorate. This article presents independent research commissioned by COLCIENCIAS under its Program Grants for Applied Research funding scheme (Convocatoria 777–2017)

Points-based physical activity: a novel approach to facilitate changes in body composition in inactive women with overweight and obesity

Background Physical activity (PA) interventions for the promotion of weight-management may benefit from increased choice and flexibility to overcome commonly-perceived barriers to PA. The aim of this study was to investigate the effects of a novel “points-based” approach to PA on body composition in inactive women, who are overweight or obese. Methods Seventy-six overweight or obese, inactive women were randomly allocated to one of three conditions: ‘Points-based’ PA (PBPA; 30 “PA points”•week− 1), Structured exercise (StructEx; 150 min moderate-intensity exercise•week− 1) or control (CONT; continue habitual inactive lifestyle) for a 24-week intervention. PA points for activities were adapted from MET values, and 30 points was equivalent to 150 min of brisk walking. Measures of body composition (dual-energy x-ray absorptiometry) and anthropometry were obtained at weeks 0, 4, 12 and 24. Self-report activities were recorded weekly, with objective measures of PA (tri-axial accelerometry) and self-report measures of food intake obtained at weeks 0 and 24. Results Fifty-eight women completed the study and provided data for primary outcomes. Of these, n = 41 and n = 19 provided data for food intake and objectively assessed PA. Mixed-design ANOVAs demonstrated that those in PBPA achieved a significant weight-loss at 24 weeks of − 3.3 ± 5.9 kg (− 3.4 ± 7.1%, p = 0.004). Waist circumference was reduced in PBPA at 24 weeks (− 2.8 ± 4.6 cm), compared with CONT (+ 2.1 ± 6.6 cm, p = 0.024). There was a trend for greater reductions in fat mass for those in PBPA vs. CONT (− 2.3 ± 4.6 kg vs. + 0.1 ± 2.0 kg, p = 0.075). Android fat was reduced in PBPA at both 12 weeks (− 6.1 ± 12.6%, p = 0.005) and 24 weeks (− 10.1 ± 18.4%, p = 0.005), while there was a trend for greater reductions in visceral adipose tissue in PBPA (− 5.8 ± 26.0%) vs. CONT at 24 weeks (+ 7.8 ± 18.3%, p = 0.053). Body composition, body weight and waist circumference were unchanged in StructEx. There were trends for increases in light-activity and reductions in sedentary time in PBPA. There was a trend for a reduction in daily energy intake of − 445 ± 564 kcal (p = 0.074), and a significant reduction in daily fat intake (p = 0.042) in PBPA. Conclusion A “points-based” approach to physical activity appears to be an effective strategy for inducing modest reductions in body weight and body fat in inactive women with overweight and obesity

Recent advances in understanding hypertension development in sub-Saharan Africa

Consistent reports indicate that hypertension is a particularly common finding in black populations. Hypertension occurs at younger ages and is often more severe in terms of blood pressure levels and organ damage than in whites, resulting in a higher incidence of cardiovascular disease and mortality. This review provides an outline of recent advances in the pathophysiological understanding of blood pressure elevation and the consequences thereof in black populations in Africa. This is set against the backdrop of populations undergoing demanding and rapid demographic transition, where infection with the Human Immunodeficiency Virus predominates, and where under and over-nutrition coexist. Collectively, recent findings from Africa illustrate an increased lifetime risk to hypertension from foetal life onwards. From young ages black populations display early endothelial dysfunction, increased vascular tone and reactivity, microvascular structural adaptions, as well as increased aortic stiffness resulting in elevated central and brachial blood pressures during the day and night, when compared to whites. Together with knowledge on the contributions of sympathetic activation and abnormal renal sodium handling, these pathophysiological adaptations result in subclinical and clinical organ damage at younger ages. This overall enhanced understanding on the determinants of blood pressure elevation in blacks encourages (a) novel approaches to assess and manage hypertension in Africa better, (b) further scientific discovery to develop more effective prevention and treatment strategies, and (c) policymakers and health advocates to collectively contribute in creating health-promoting environments in Africa

Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries1,2. However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world3 and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health4,5. However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol—which is a marker of cardiovascular risk—changed from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million–4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world

Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants

BACKGROUND: One of the global targets for non-communicable diseases is to halt, by 2025, the rise in the age-standardised adult prevalence of diabetes at its 2010 levels. We aimed to estimate worldwide trends in diabetes, how likely it is for countries to achieve the global target, and how changes in prevalence, together with population growth and ageing, are affecting the number of adults with diabetes. METHODS: We pooled data from population-based studies that had collected data on diabetes through measurement of its biomarkers. We used a Bayesian hierarchical model to estimate trends in diabetes prevalence—defined as fasting plasma glucose of 7·0 mmol/L or higher, or history of diagnosis with diabetes, or use of insulin or oral hypoglycaemic drugs—in 200 countries and territories in 21 regions, by sex and from 1980 to 2014. We also calculated the posterior probability of meeting the global diabetes target if post-2000 trends continue. FINDINGS: We used data from 751 studies including 4 372 000 adults from 146 of the 200 countries we make estimates for. Global age-standardised diabetes prevalence increased from 4·3% (95% credible interval 2·4–7·0) in 1980 to 9·0% (7·2–11·1) in 2014 in men, and from 5·0% (2·9–7·9) to 7·9% (6·4–9·7) in women. The number of adults with diabetes in the world increased from 108 million in 1980 to 422 million in 2014 (28·5% due to the rise in prevalence, 39·7% due to population growth and ageing, and 31·8% due to interaction of these two factors). Age-standardised adult diabetes prevalence in 2014 was lowest in northwestern Europe, and highest in Polynesia and Micronesia, at nearly 25%, followed by Melanesia and the Middle East and north Africa. Between 1980 and 2014 there was little change in age-standardised diabetes prevalence in adult women in continental western Europe, although crude prevalence rose because of ageing of the population. By contrast, age-standardised adult prevalence rose by 15 percentage points in men and women in Polynesia and Micronesia. In 2014, American Samoa had the highest national prevalence of diabetes (>30% in both sexes), with age-standardised adult prevalence also higher than 25% in some other islands in Polynesia and Micronesia. If post-2000 trends continue, the probability of meeting the global target of halting the rise in the prevalence of diabetes by 2025 at the 2010 level worldwide is lower than 1% for men and is 1% for women. Only nine countries for men and 29 countries for women, mostly in western Europe, have a 50% or higher probability of meeting the global target. INTERPRETATION: Since 1980, age-standardised diabetes prevalence in adults has increased, or at best remained unchanged, in every country. Together with population growth and ageing, this rise has led to a near quadrupling of the number of adults with diabetes worldwide. The burden of diabetes, both in terms of prevalence and number of adults affected, has increased faster in low-income and middle-income countries than in high-income countries. FUNDING: Wellcome Trust