Global disease burden attributed to low physical activity in 204 countries and territories from 1990 to 2019: Insights from the Global Burden of Disease 2019 Study

Burden of Diseases Attributable to Low Physical Activity in the Middle East and North Africa: an Analysis Based on Global Burden of Disease Study

Background

Research on low physical activity (LPA) in the Middle East and North Africa (MENA) region remains limited.

Aims

To assess the disease burden associated with LPA using data from the Global Burden of Disease (GBD) study.

Study Design

Longitudinal epidemiological study.

Methods

GBD 2021 data were used to extract information on the burden of eight LPA-related conditions-breast cancer, chronic kidney disease, colorectal cancer, diabetes mellitus (DM), ischemic heart disease, lower extremity peripheral arterial disease, stroke, and tuberculosis-analyzed by age group, sex, country within MENA, and year (1990-2021).

Results

The age-standardized disability-adjusted life year (DALY) rate for LPA-related diseases in MENA declined by 8.62%, from 431.84 per 100,000 people in 1990 to 394.64 per 100,000 in 2021. In 2021, Sudan (846.47 per 100,000), Iraq (630.29 per 100,000), and Afghanistan (626.88 per 100,000) recorded the highest age-standardized DALY rates. Across all age groups, females had higher DALY rates than males in both 1990 and 2021.

Conclusion

Despite a recent decline, the MENA region continues to experience a greater LPA-attributable disease burden than the global average. The increasing contribution of DM and breast cancer highlights evolving trends, emphasizing the need for targeted interventions such as lifestyle promotion and improved access to health facilities.

Global burden of trichomoniasis: current status, trends, and projections (1990-2021)

Objectives

Trichomoniasis one of the most neglected sexually transmitted diseases (STDs), imposes a significant global disease burden. This study aims to assess the burden and trends of trichomoniasis from 1990 to 2021 and to project its incidence from 2022 to 2050.

Methods

This study utilized data from the Global Burden of Disease 2021 study for secondary analysis. We determined the age-standardized incidence rate (ASIR) and disability-adjusted life years (DALYs) of trichomoniasis by sex, age, and socio-demographic index (SDI) level. Changes in burden trends across sex and age were explored from 1990 to 2021, using joinpoint regression. The incidence of trichomoniasis was projected for the period 2022 to 2050, using R software.

Results

From 1990 to 2021, the estimated annual percentage change (EAPC) in the global ASIR of trichomoniasis was 0.09 (95% CI: 0.06 to 0.13). In 2021, the global ASIR of trichomoniasis was 4,133.41 per 100,000 people (95% UI: 3,111.37 to 5,583.56 per 100,000). By population group, the ASIR was higher in men (4,353.43 per 100,000) than in women (3,921.31 per 100,000) in 2021, while the DALY rate was significantly higher in women than in men (6.45 vs. 0.23 per 100,000). When divided by age groups, the trend in ASIR among women aged 30-54 years aligned closely with the overall population incidence trend. In 2021, ASIRs were highest in low SDI regions, and the projected ASIRs by 2050 are 5,680.57 per 100,000 in males and 5,749.47 per 100,000 in females.

Conclusion

Trichomoniasis represents a significant global disease burden, particularly among women in low-income areas and individuals aged 30-54 years. The study highlights the need for targeted strategies to reduce the burden of trichomoniasis-related infections, especially in vulnerable populations.

Physical activity and metabolic syndrome in primary care patients in Spain

PURPOSE

To determine the relationship between self-reported physical activity and the components of premorbid metabolic syndrome in patients treated in primary care according to sex.

METHODS

Cross-sectional descriptive study conducted on a sample of 2,359 patients without cardiovascular disease or diabetes, included in the cohort of the IBERICAN study. Using ANOVA models and adjusting for age, economic status, employment situation, level of education, adherence to a Mediterranean diet, tobacco use and alcohol consumption, we estimated the association of the variables blood pressure, triglycerides, HDL cholesterol, blood glucose and waist circumference with the self-reported level of physical activity (sedentary, moderate, high, very high). The analyses were performed stratifying by sex.

RESULTS

A total of 854 men and 1,505 women with no identified diseases were included. Women were more sedentary than men (p<0.004; OR = 1,35; IC95% = 1,10-1,65) and presented lower values in all the components of the metabolic syndrome, except for HDL-cholesterol, which was higher (p<0.001). The adjusted ANOVA model shows that diastolic blood pressure, triglycerides, fasting blood glucose, and waist circumference were significantly lower the higher the level of physical activity in both men and women (p<0.05).

CONCLUSIONS

Patients served in primary care clinics without diabetes or cardiovascular disease and with high levels of physical activity showed better metabolic syndrome profiles. Given that women are more sedentary, gender approaches are needed in the promotion of physical activity to prevent metabolic syndrome and cardiovascular disease.

Assessment of Long-Term Engagement in Aerobic Versus Resistance Exercise on 20-Year Cardiovascular Disease Incidence (2002-2024): The ATTICA Epidemiological Cohort Study

Objective: The aim of this study was to assess whether aerobic exercise, as opposed to resistance training or a combination of both, is associated with long-term cardiovascular outcomes. Methods: The ATTICA study is a population-based cohort study with a 20-year follow-up (2002-2022); it was conducted in the Attica region, Greece, and included 3042 adult participants (45 ± 11 years, 1518 females). Physical activity engagement in aerobic, resistance, or combined exercise, and 20-year tracking, together with information regarding atherosclerotic cardiovascular disease (ASCVD) incidence were available for 1988 participants (45 ± 12 years old, 987 males, 1001 females). Physical activity levels were evaluated using the validated International Physical Activity Questionnaire, in all follow-up examinations (2001-2002, 2006, 2012, and 2022). Cox proportional hazard models were applied; the results are presented as hazard ratio (HR) and 95% confidence intervals (CIs). Results: Participants engaged in the combined (aerobic and resistance) physical activity group had 0.41-times [95%CI (0.20, 0.82)] lower ASCVD risk compared to inactive participants; participants in the healthy engaging aerobic physical activity (HEPA) group had 0.54-times [95%CI (0.36, 0.80)] lower ASCVD risk; no significant associations were observed regarding the minimally active aerobic group [HR, 0.81, 95%CI (0.57, 1.17)], or the resistance training only group [HR, 1.17, 95%CI (0.25, 1.52)]. Conclusions: These findings carry a strong public health message, underscoring the importance of incorporating aerobic or combined aerobic-resistance training into physical activity guidelines to enhance cardiovascular health and reduce the long-term risk of CVD.

Comparing the economic burden of disease by physical activity levels among persons with and without disabilities in the Republic of Korea

Introduction

The World Health Organization recommends at least 150 min of physical activity per week for persons with and without disabilities. This study compared the differences in the economic burden of diseases between persons with and without disabilities based on their physical activity. What is known in the field is that physical activity is beneficial to health, but there is a disparity between persons without disabilities and persons with disabilities, and our research aims to increase physical activity among persons with disabilities.

Methods

Economic burden of disease includes service costs such as outpatient, hospitalization, and pharmaceutical expenses for disease treatment, and persons with disabilities are those who have received a disability classification legally registered by the Korean Ministry of Health and Welfare, and there are 15 types of disabilities. For exercise records, we calculated the cost in 2020 for people with exercise records in 2018 so that they can have at least 1 year of exercise records, as health checkups are available from January to December of the year. Physical activity attainment is defined as 150 min or more of physical activity per week based on World Health Organization guidelines.

Results

Calculating the economic burden of disease by physical activity for persons with and without disabilities, both experienced a difference in hospitalization costs owing to fewer hospital days with physical activity achievement, with the difference being greater for persons with disabilities. Regarding disability type, achievers showed a 41.1% difference in total costs for mental class disorders, 16.7% for external bodily function disorders, and 11.1% for internal organ disorders.

Discussion

Physical inactivity has a significant impact on the economic burden of persons with disabilities compared to persons without disabilities, with 11.8% fewer persons without disabilities who were physically active for 150 min or more per week compared to 21.4% fewer persons with disabilities. In terms of healthcare spending, exercise can help keep persons with disabilities healthy. Therefore, there is a need for exercise programs tailored to persons with disabilities to increase physical activity in line with World Health Organization recommendations to reduce health inequalities between persons with and without disabilities.

Physical fitness profile of primary school learners in the Eastern Cape province of South Africa

Background

Low levels of physical activity in high- to low-income countries, including South Africa, pose a great risk of cardiovascular-related diseases.

Aim

This study aimed to assess and compare the physical fitness profile among children.

Setting

The study setting comprised rural and urban primary school learners in the Eastern Cape province, South Africa.

Methods

A cross-sectional study was adopted utilising a randomly selected sample of boys and girls aged 9-14 years. Physical fitness measures were assessed using the Euro-fit test battery. Some parametric tests were used for mean comparisons of the various anthropometric measurements and physical fitness characteristics across demographics.

Results

The sample consisted of 870 primary school learners. The average weight and height of the sample were 39.29 ± 10.34 kg and 144.06 ± 10.81 cm, respectively, with a mean body mass index (BMI) of 18.80 ± 4.11 kg/m2. The results showed that boys reported significantly high levels of physical fitness. Sit-ups (p ≤ 0.001) and VO2 max (p ≤ 0.001) significantly increase with age, while all the physical fitness measures were significantly higher among rural-based learners.

Conclusion

Rural-based learners and boys generally had better physical fitness performance than their peers. The effect of gender and place of residence should be considered when designing physical fitness interventions.

Contribution

This study adds to the existing body of knowledge about the effect of demographic factors on the physical fitness profile of children, where boys and rural-based learners are reported to be more physically fit than their counterparts.

Differences in Physical Activity Levels by Sociodemographic and Health Risk Factors Among Persons With Disabilities in South Korea

The World Health Organization (WHO) recommends physical activity for more than 150 minutes a week to improve health and reduce disease burden; however, previous studies have shown a lack of participation among persons with disabilities. Logistic regression analysis was performed on National Health Insurance Service data to analyze the relationship between physical activity levels by disability type and socioeconomic factors. The results showed that women with disabilities exercised 0.663 times compared to men with disabilities and individuals with severe disabilities exercised 0.719 times compared to those with mild disabilities. Those from the highest income level households (adjusted odds ratio [AOR] = 1.442) and the re-employed (AOR = 1.119) exercised adequately. Thus, physical activity levels and socioeconomic factors are related in persons with disabilities. Exercise policies and programs are required to support persons with disabilities by income level.

Burden of diseases due to high systolic blood pressure in the Middle East and North Africa region from 1990 to 2019

High systolic blood pressure (HSBP) is associated with several metabolic and non-metabolic disorders. This research aimed to document the deaths and disability-adjusted life-years (DALYs) attributable to HSBP in the Middle East and North Africa (MENA) region between 1990 and 2019, by age, sex, underlying cause and socio-demographic index (SDI). We used the methodological framework and data drawn from the Global Burden of Disease study 2019 to identify the burden of diseases attributable to HSBP, from 1990 to 2019, in the MENA region. The estimates reported were presented as counts, population-attributable fractions, and age-standardised rates (per 100,000), along with 95% uncertainty intervals. In 2019, 803.6 thousand (687.1 to 923.8) deaths were attributed to HSBP in MENA, which accounted for 25.9% (22.9-28.6%) of all deaths. The number of regional DALYs caused by HSBP in 2019 was 19.0 million (16.3-21.9 million), which accounted for 11.6% (10.1-13.3%) of all DALYs, and was 23.4% (15.9-31.5%) lower than in 1990. The highest age-standardised DALY rate for 2019 was observed in Afghanistan, with the lowest in Kuwait. Additionally, the DALY rate in MENA rose with age for both sexs. Furthermore, a negative linear relationship was found between SDI and the age-standardised DALY rates. The region has a substantial HSBP-related burden. Policymakers and healthcare professionals should prioritize interventions that effectively promote the early detection of HSBP, access to quality healthcare, and lifestyle modifications to mitigate the HSBP burden in the MENA countries.

Longitudinal trends in physical activity levels and lifetime cardiovascular disease risk: insights from the ATTICA cohort study (2002-2022)

Objective

To evaluate trends in physical activity levels and their associations with demographic characteristics, health status, and lifetime cardiovascular disease (CVD) risk.

Methods

A longitudinal analysis was conducted using data from 987 males and 1,001 females (45 ± 12 years old) participating in the ATTICA cohort study. Physical activity levels were assessed at baseline (2001-2002) and subsequent follow-ups (2006, 2012, and 2022). Four physical activity trajectories according to participants' physical activity tracking were defined, i.e., consistently active/inactive and changed from active/inactive. Twenty-year incidence of hypertension, hypercholesterolemia, and diabetes were evaluated in relation to physical activity trajectories; the life-table method was utilized to forecast the lifetime CVD risk (death without CVD was regarded as a competing event).

Results

in total, 47% of the participants were categorized as being consistently inactive, whereas only 9% of males and 15% of females sustained physical activity levels throughout the 20-year follow-up period (p < 0.001). Participants being consistently inactive were from lower socioeconomic backgrounds (p = 0.002). Transitioning to being physically active was associated with higher education level and being married (p < 0.001). Consistently active individuals had up to 35% reduced lifetime CVD risk, and lower 20-year incidence of hypertension, and hypercholesterolemia (p < 0.01); no association was observed regarding diabetes incidence.

Conclusions

Promoting and maintaining regular physical activity throughout lifespan is crucial for reducing lifetime CVD risk and related risk factors. Tailored interventions addressing demographic and socioeconomic factors may help enhance cardiovascular health outcomes.

Global burden of cardiovascular diseases attributed to low physical activity: An analysis of 204 countries and territories between 1990 and 2019

Background

Low physical activity is a major risk factor for cardiovascular diseases (CVDs). This study aimed to estimate the global, regional, national, and sex-age-specific burden of CVDs attributed to low physical activity from 1990 to 2019.

Methods

We leveraged data from the Global Burden of Disease Study 2019 to compute the number of fatalities, disability-adjusted life years (DALYs), age-adjusted mortality rates (ASMR), and age-adjusted DALY rates (ASDR) attributed to CVDs resulting from low physical activity. Furthermore, we scrutinized the trends and correlations of these metrics in connection with the socio-demographic index (SDI) across 21 regions and 204 countries and territories.

Results

The global deaths and DALYs due to CVDs caused by low physical activity increased from 371,042.96 [95 % UI: 147,621.82-740,490] and 6,282,524.95 [95 % UI: 2,334,970.61-13,255,090.08] in 1990 to 639,174.92 [95 % UI: 272,011.34-1,216,528.4] and 9,996,080.17 [95 % UI: 4,130,111.16-20,323,339.89] in 2019, respectively. The corresponding ASMR and ASDR decreased from 12.55 [95 % UI: 5.12-24.23] and 181.64 [95 % UI: 71.59-374.01] in 1990 to 8.6 [95 % UI: 3.68-16.28] and 127.52 [95 % UI: 53.07-256.55] in 2019, respectively. Deaths and DALYs attributed to low physical activity were initially higher in males but shifted to females after 70-74 age group. Both genders had increasing death rates, peaking at 80-84 age group. Most CVDs deaths and DALYs number are caused by ischemic heart disease. The highest burden of CVDs attributed to low physical activity was observed in North Africa and the Middle East. The lowest burden was observed in Oceania and High-income Asia Pacific. There was a distinctive 'n-shape' relationship between the regional SDI and the ASDR of CVDs attributed to low physical activity from 1990 to 2019.

Conclusion

The global impact of CVDs stemming from low physical activity remains substantial and demonstrates substantial regional disparities. As individuals age, this burden becomes more prominent, particularly among females. Efficacious interventions are imperative to promote physical activity and mitigate the risk of CVDs across diverse populations and regions.

Neuroprotective Effect of Natural Indole and β-carboline Alkaloids against Parkinson's Disease: An Overview

Parkinson's disease (PD) is a devastating neurodegenerative condition that mostly damages dopaminergic neurons in the substantia nigra and impairs human motor function. Males are more likely than females to have PD. There are two main pathways associated with PD: one involves the misfolding of α-synuclein, which causes neurodegeneration, and the other is the catalytic oxidation of dopamine via MAO-B, which produces hydrogen peroxide that can cause mitochondrial damage. Parkin (PRKN), α- synuclein (SNCA), heat shock protein (HSP), and leucine-rich repeat kinase-2 (LRRK2) are some of the target areas for genetic alterations that cause neurodegeneration in Parkinson's disease (PD). Under the impact of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP), which is also important in Parkinson's disease (PD), inhibition of mitochondrial complex 1 results in enhanced ROS generation in neuronal cells. Natural products are still a superior option in the age of synthetic pharmaceuticals because of their lower toxicity and moderate side effects. A promising treatment for PD has been discovered using betacarboline (also known as "β-carboline") and indole alkaloids. However, there are not many studies done on this particular topic. In the herbs containing β-carbolines and indoles, the secondary metabolites and alkaloids, β-carbolines and indoles, have shown neuroprotective and cognitive-enhancing properties. In this review, we have presented results from 18 years of research on the effects of indole and β-carboline alkaloids against oxidative stress and MAO inhibition, two key targets in PD. In the SAR analysis, the activity has been correlated with their unique structural characteristics. This study will undoubtedly aid researchers in looking for new PD treatment options.

Burden of Cardiovascular Diseases in Nepal from 1990 to 2019: The Global Burden of Disease Study, 2019

Cardiovascular diseases (CVDs) have emerged as the leading cause of deaths worldwide in 2019. Globally, more than three-quarters of the total deaths due to CVDs occur in low- and middle-income countries like Nepal. Although increasing number of studies is available on the prevalence of CVDs, there is limited evidence presenting a complete picture on the burden of CVDs in Nepal. In this context, this study aims to provide comprehensive picture on the burden of CVDs in the country. This study is based on the Global Burden of Disease (GBD) study 2019, which is a multinational collaborative research covering 204 countries and territories across the world. The estimations made from the study are publicly available in the GBD Compare webpage operated by the Institute for Health Metrics and Evaluation (IHME), University of Washington. This article makes use of those data available on the GBD Compare page of IHME website to present the comprehensive picture of the burden of CVDs in Nepal. Overall, in 2019, there were an estimated 1,214,607 cases, 46,501 deaths, and 1,104,474 disability-adjusted life years (DALYs) due to CVDs in Nepal. The age-standardized mortality rates for CVDs witnessed a marginal reduction from 267.60 per 100,000 population in 1990 to 245.38 per 100,000 population in 2019. The proportion of deaths and DALYs attributable to CVDs increased from 9.77% to 24.04% and from 4.82% to 11.89%, respectively, between 1990 and 2019. Even though there are relatively stable rates of age-standardized prevalence, and mortality, the proportion of deaths and DALYs attributed to CVDs have risen sharply between 1990 and 2019. Besides implementing the preventive measures, the health system also needs to prepare itself for the delivery of long-term care of patients with CVDs which could have significant implications on resources and operations.

Examination of sleep in relation to dietary and lifestyle behaviors during Ramadan: A multi-national study using structural equation modeling among 24,500 adults amid COVID-19

BACKGROUND

Of around 2 billion Muslims worldwide, approximately 1.5 billion observe Ramadan fasting (RF) month. Those that observe RF have diverse cultural, ethnic, social, and economic backgrounds and are distributed over a wide geographical area. Sleep is known to be significantly altered during the month of Ramadan, which has a profound impact on human health. Moreover, sleep is closely connected to dietary and lifestyle behaviors.

METHODS

This cross-sectional study collected data using a structured, self-administered electronic questionnaire that was translated into 13 languages and disseminated to Muslim populations across 27 countries. The questionnaire assessed dietary and lifestyle factors as independent variables, and three sleep parameters (quality, duration, and disturbance) as dependent variables. We performed structural equation modeling (SEM) to examine how dietary and lifestyle factors affected these sleep parameters.

RESULTS

In total, 24,541 adults were enrolled in this study. SEM analysis revealed that during RF, optimum sleep duration (7-9 h) was significantly associated with sufficient physical activity (PA) and consuming plant-based proteins. In addition, smoking was significantly associated with greater sleep disturbance and lower sleep quality. Participants that consumed vegetables, fruits, dates, and plant-based proteins reported better sleep quality. Infrequent consumption of delivered food and infrequent screen time were also associated with better sleep quality. Conflicting results were found regarding the impact of dining at home versus dining out on the three sleep parameters.

CONCLUSION

Increasing the intake of fruits, vegetables, and plant-based proteins are important factors that could help improve healthy sleep for those observing RF. In addition, regular PA and avoiding smoking may contribute to improving sleep during RF.

Total sugar intake is associated with higher prevalence of depressive symptoms in obese adults

Background

The existing literature has repeatedly assessed the association between sugar-sweetened beverages and depressive symptoms, but studies of the association of total dietary sugar with depressive symptoms and of this association in obese adults are scarce. Thus, the purpose of this cross-sectional study was to assess the association between total sugar consumption and depressive symptoms in the study population and then in the population stratified by body mass index.

Methods

This study was conducted in a nationally representative sample of 16,009 adults from the 2011-2018 National Health and Nutrition Examination Survey in the US. Total sugar intake was assessed by 24 h dietary recalls, and depressive symptoms were assessed by the nine-item Patient Health Questionnaire. Logistic regression models were used to evaluate the association between total sugar consumption and depressive symptoms.

Results

Total sugar intake was positively associated with higher prevalence of depressive symptoms, and the adjusted odds ratio (95% confidence interval) of depressive symptoms for the highest vs. lowest quintile of total sugar intake was 1.56 (1.18, 2.05). In stratified analysis, we found a positive association between total sugar intake and depressive symptoms in adults with body mass index ≥30 kg/m2 (P for trend = 0.013), whereas no association was found in normal weight or overweight adults.

Conclusions

A higher intake of total sugar was associated with increased odds of clinically relevant depressive symptoms among obese adults. Further studies are necessary to confirm the role of total sugar in depressive symptoms among obese adults.

The Impact of Exercise Training Intensity on Physiological Adaptations and Insulin Resistance in Women with Abdominal Obesity

Abdominal obesity has emerged globally as a major public health issue due to its high prevalence and morbidity. The benefits of physical exercise among the obese population are well documented. However, the optimal exercise intensity for reducing body fat and preventing insulin resistance and metabolic disorders is still under debate. This study aimed to examine the effects of three different intensities of combined endurance and strength training programs on anthropometric variables, physiological and muscular adaptations, and insulin sensitivity. Forty-three obese young women (age 26.4 ± 4.7 years, BMI 33.1 ± 2.5 kg/m2) were randomly assigned to one of four groups: a control group (G0), a moderate-intensity training group (G50, exercising brisk walking at 50% heart rate reserve HRR), a high-intensity training group (G75, exercise jogging at 75% HRR), and an alternated-intensity training group (G50/75, exercise brisk-walking/jogging at 50−75% HRR) with additional strength training once a week for each group. Body composition, waist circumference (WC), fasting blood glucose, insulin sensitivity and resistance (Homa-IR), resting heart rate (RHR), 6-min walk distance (6MWD), 1-repetition maximum (1-RM), and time to exhaustion (TTE) at 45% and 75% maximal voluntary contraction (MVC) for both the flexor and extensor muscle groups of the knees, were recorded before and after three months of exercise training. All training groups showed significant decreases in body mass, BMI, total body fat, body fat percentage, WC, abdominal and visceral mass (p < 0.001), with a greater reduction of body mass and BMI in G75 (p < 0.05). Lean mass increased significantly only in G50/75 (p < 0.05). The insulin sensitivity and Homa-IR decreased in the three training groups (p < 0.01), with greater enhanced resistance in G50 compared to G75 and G50/75 (p < 0.05). In contrast, there were no pre-post changes in all groups for fasting blood glucose (p > 0.05). 1-RM and TTE of the knee flexor and extensor muscles were improved in the three groups (p < 0.01), with greater improvement in G50/75 for 1RM and G75 in most of the TTE parameters (p < 0.05). RHR decreased and 6MWD increased significantly in the three training groups (p < 0.01), with greater 6MWD improvement in G75 (p < 0.05). In conclusion, the three training intensities seem to generate benefits in terms of body composition, physiological and muscular adaptations, and insulin resistance. High training intensity resulted in greater improvements in body mass, BMI, and endurance and strength, whereas moderate training intensity resulted in greater improvements of insulin resistance and homo-IR. Following alternate-intensity training, greater improvements were observed in lean mass and maximal strength performance.