Demographics and deprivation in obstetric brachial plexus palsy: a retrospective cohort study

The present study analyses the relationships between deprivation and obstetric brachial plexus palsy (OBPP). A retrospective observational study was conducted of infants with OBPP seen between 2008 and 2020 (n = 321). The index of multiple deprivation (IMD) was used to assign an IMD rank to patients based on birth postcode and the relationship with OBPP was analysed, including deprivation, gestational diabetes, age at referral and at first assessment. Quintile-based analysis demonstrated over-representation of patients from more deprived neighbourhoods (n = 109, 39%) living in the top 20% most deprived neighbourhoods. A total of 48 (15%) mothers had diabetes and 98 (31%) infants underwent surgical brachial plexus exploration (a marker of disease severity). Neither diabetes, age at referral nor age at first assessment were associated with IMD score. This suggests that neighbourhood deprivation is associated with OBPP, though the mechanisms are unclear. Further studies in this area may enable targeted health intervention for more deprived maternal and infant groups.Level of evidence: III.

Global burden and epidemic trends of gout attributable to high body mass index from 1990 to 2019

Introduction

Gout is an inflammatory and metabolic disease characterized by arthritis and elevation of the serum uric acid (SUA) level. More and more studies have shown that high body mass index (BMI) has become one of the most important risk factors for gout.

Material and methods

We used the data of gout burden attributed to high body mass index (BMI) from global burden of disease (GBD) study 2019 to provide insights for reducing the global burden of gout.

Results

From 1990 to 2019, the prevalence and DALYs of gout caused by high BMI worldwide has been increasing. The burden of gout caused by high BMI is heavier in the elderly male group and regions with high SDI worldwide.

Conclusions

Our findings provide evidence for the burden of gout caused by high BMI. Developing a weight management plan and lifestyle habits for groups severely affected by gout will effectively reduce the global disease and economic burden.

Association between sociodemographic status and the T2DM-related risks in China: implication for reducing T2DM disease burden

Objective

Analyzing the association between sociodemographic status and the type 2 diabetes mellitus (T2DM)-related risks in China to reduce the disease burden of T2DM.

Methods

We downloaded data from the Global Burden of Disease Study 2019 to estimate the disease burden of T2DM in China. Secondary analyses were performed by year, age, gender, summary exposure value (SEV), and sociodemographic index (SDI).

Results

In China, it is estimated that 3.74 (3.44-4.10) million incidence, 90.0 (82.3-98.5) million prevalence, 168.4 (143.2-194.0) thousand deaths, and 9.6 (7.6-11.9) million DALYs occurred in 2019, showing an increase of 96.8, 156.7, 162.8, and 145.4% compared to 1990. An inverse U-shaped curve was observed for the correlations between T2DM-related burden and SDI. A heavier burden was found in males. The top four risk factors were high body mass index (HBMI), dietary risks, air pollution and tobacco. HBMI, as the key risk, accounted for half of the disease burden of T2DM in China. Lower degree of SEV and higher level of attributable T2DM-related burden could be found in main risks, meaning their critical role of them in the development and progression of T2DM. An inverse U-shaped curve could be found in the association between age-standardized incidence, mortality, DALYs rate, and SDI.

Conclusion

The disease burden of T2DM has rapidly increased in China. Gender disparities, different age distributions and inconsistent socioeconomic levels all played an important role in it. The key risk was HBMI. With the improvement of socioeconomic level, the main risk factors for T2DM have changed from environmental factors to lifestyle factors. Targeted control and preventative strategies to address adjustable risk factors could put an end to this soaring burden.

The Effect of Obesity and Body Mass Index on Hematologic Malignancies

A thorough examination of the available literature has revealed a well-established association of obesity and high body mass index (BMI) with an increased risk of various types of cancers, including hematologic malignancies. Specifically, the studies reviewed indicate a clear correlation between obesity and an increased risk of leukemias, lymphomas, multiple myeloma, myelodysplastic syndrome, and myeloproliferative diseases. Despite the established association of obesity and high BMI with hematologic malignancies, the underlying mechanisms remain largely undetermined. The development of hematologic malignancies may be influenced by several mechanisms associated with obesity and high BMI, including chronic inflammation, hormonal imbalances, adiposopathies, and metabolic dysregulation. Furthermore, there is mounting evidence indicating that obesity and high BMI may have a negative impact on the response to treatment and overall survival in patients with hematologic malignancies. This article aims to increase awareness and summarize the current state of research on the impact of obesity on hematologic malignancies, including the mechanisms by which obesity may influence the development and progression of these diseases. In addition, the current review highlights the need for effective weight management strategies in patients with hematologic malignancies to improve outcomes and mitigate the risk of complications.

A comparison of the burden of knee osteoarthritis attributable to high body mass index in China and globally from 1990 to 2019

Background

Excess body mass index (BMI) plays a key role in the onset and progression of knee osteoarthritis (knee OA). However, the burden of knee OA attributable to high BMI at the global, Chinese, and regional levels have received far too little attention. The aim of this study is to provide evidence to support the design of policy by investigating long-term trends of years lived with disability (YLDs) for knee OA.

Methods

To illustrate the trends of YLDs for knee OA attributable to high BMI and the temporal trends of the YLDs rate by age, period, and cohort, Joinpoint regression software and age-period-cohort (APC) were used to analyze the YLDs data of knee OA from the Global Burden of Disease (GBD) 2019.

Results

In China, there were 549,963.5 YLDs for knee OA attributable to high BMI in 2019, which had increased by 460.7% since 1990. From 1990 to 2019, age-standardized disability-adjusted life year rate (ASDR) of knee OA attributable to high BMI trended upwards. The average annual percent change (AAPC) of knee OA attributable to high BMI in China and globe were 3.019, 1.419%, respectively. The longitudinal age curve of the APC model showed that the YLDs rates of knee OA due to high BMI increased with age, and YLDs rates were higher among females than males. The period rate ratios (RRs) of knee OA due to high BMI increased significantly. The cohort RRs of knee OA due to high BMI increased among those born between 1900 and 1970. The net drifts of knee OA attributable to high BMI in China and globe were above 1. Compared with global condition, the net drift values of knee OA attributable to high BMI in China was higher. Compared with females, males had higher net drift value. Countries with high socio-demographic index (SDI) have a much higher burden of knee OA caused by high BMI than countries with low SDI.

Conclusion

In China, high BMI is a substantial cause of knee OA, the incidence of which has been increasing since 1990. In addition, women and the elderly are more vulnerable to knee OA caused by high BMI. The Chinese government must take the long-term impact of high BMI on knee OA into account and implement effective public health policies and resort to interventions to reduce the burden as soon as possible.

Epidemiological trend and age-period-cohort effects on cardiovascular disease mortality and disability-adjusted life years attributable to dietary risks and high body mass index at the regional and country level across China and Pakistan

Background

Modifiable risk factors are major drivers of cardiovascular disease (CVD). We aimed to determine the epidemiological trend and age-period-cohort effects on CVD burden attributable to dietary risks and high body mass index (BMI) across China and Pakistan from 1990 to 2019.

Methods

Data on the all-ages and age-specific CVD burden, age-standardized CVD mortality and disability-adjusted life years (DALYs) rates were obtained from the Global Burden of Disease Study 2019. Joinpoint regression analysis was conducted to find temporal trends and age-period-cohort (APC) modeling was used to estimate age, period, and cohort effects on CVD burden.

Results

Between 1990 and 2019, the all-ages CVD burden attributable to dietary risks and high BMI increased by ~2-3-fold in China and by 3-5-fold in Pakistan. The diet-related CVD age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life years (DALYs) rate significantly decreased in China but increased in Pakistan. Both countries showed a marked increasing trend of CVD ASMR and the age-standardized DALYs rate attributable to high BMI. Taiwan in China showed a remarkable reduction in CVD burden. However, in Pakistan, all regions observed a significantly increasing trend of CVD burden attributable to modifiable risk factors. A higher risk ratio of premature CVD mortality (<70 years) was observed among Chinese attributable to high BMI and among Pakistani attributable to dietary risks. In China, early birth cohorts showed a higher risk ratio and recent birth cohorts experienced a lower risk ratio of CVD burden compared with Pakistan.

Conclusion

In conclusion, dietary risks and high BMI caused a huge CVD burden across China and Pakistan.

Trends of the burden of type 2 diabetes mellitus attributable to high body mass index from 1990 to 2019 in China

Background

Overweight and obesity are well-known risk factors for developing type 2 diabetes (T2DM). However, details on the evolution of the T2DM burden attributed to China's high body mass index (BMI) in China have not been thoroughly studied. This study aimed to investigate the temporal trends of the T2DM burden attributable to a high BMI in China from 1990 to 2019 and to evaluate the independent effects of age, period, and cohort on the burden of T2DM attributed to a high BMI.

Methods

Data on T2DM burden attributable to a high BMI from 1990 to 2019 were obtained from the Global Burden of Disease Study 2019. Deaths, disability-adjusted life years (DALYs), age-standardized mortality rate (ASMR), and age-standardized DALY rate (ASDR) of T2DM attributable to a high BMI were estimated by age and sex. The joinpoint regression model was performed to calculate the annual percentage change (APC) and the average annual percentage change (AAPC) in the burden of T2DM attributed to a high BMI. The age-period-cohort analysis was applied to estimate the independent effects of age, period, and cohort on the temporal trends of mortality and the DALY rate.

Results

In 2019, deaths and DALYs from T2DM attributable to a high BMI in China were 47.53 thousand and 3.74 million, respectively, five times higher than in 1990. Among those under 60 years of age, men had higher deaths and DALYs than women, while the gender differences reversed in those over 60 years of age. Furthermore, the ASMR and ASDR in 2019 were 2.39 per 100,000 (95%UI 1.12-3.90) and 181.54 per 100,000 (95%UI 93.71-286.33), respectively, representing a 91% and 126% increase since 1990. In China, women previously had a higher ASMR and ASDR than men, while the differences in the ASMR and ASDR between the sexes were reversed in recent years. From 1990 to 2019, the ASMR in women increased before 2004 and then decreased from 2004 to 2015, and increased again after, with an overall AAPC value of 1.6%. In contrast, the ASMR in men continued to increase, with an overall AAPC value of 3.2%. The ASDR continued to increase in men and women, with AAPCs of 2.2% and 3.5%, respectively. The age effect showed that the relative risk of mortality increased with age in both men and women, except for the 75-84 age group. The impact of the age on the DALY rate revealed a trend of first rising and then decreasing, peaking at 65-69 years. The effect of the period on the burden of T2DM attributable to a high BMI increased from 1990 to 2019. The cohort effect generally showed a downward trend.

Conclusion

The burden of T2DM attributed to a high BMI in China increased substantially from 1990 to 2019, particularly in men. Therefore, there is an urgent need for gender- and age-based public health guidelines on prevention strategies, early diagnosis, and effective management of T2DM, overweight, and obesity in China.

Letrozole cotreatment improves the follicular output rate in high-body-mass-index women with polycystic ovary syndrome undergoing IVF treatment

BACKGROUND

Women who have polycystic ovary syndrome (PCOS) with high body mass index (BMI) typically have an attenuated ovarian response and decreased follicular size, which are linked to unfavourable clinical outcomes following in vitro fertilization (IVF) therapy. The follicular output rate (FORT), a qualitative indicator of follicular response, seems to be positively linked to the clinical outcomes of IVF. Progestin-primed ovarian stimulation (PPOS) has become an alternative to gonadotropin-releasing hormone (GnRH) analogues to inhibit the premature luteinizing hormone (LH) surge. As letrozole (LE) shows promise in enhancing ovarian response, we compared PPOS with and without LE for PCOS in high BMI women with a focus on the FORT and associated clinical and pregnancy outcomes.

METHODS

For the recruited 1508 women, ten variables including AFC; age; basal sex hormone level; BMI; infertility type; period of infertility and number of previous IVF attempts were chosen in the propensity score matching (PSM) model to match 1374 women who taken the MPA+ hMG protocol with 134 women who received the MPA+ hMG+ LE treatment at a 1:1 ratio. FORT was selected as the primary outcome measure. The number of oocytes retrieved, viable embryos, hMG dosage, duration, oocyte maturity rate, fertilization rate, and implantation rate were established as secondary outcomes.

RESULTS

FORT was substantially elevated in the MPA+hMG+LE group compared with the MPA+hMG group (61% [35%, 86%] vs. 40% [25%, 60%], P <.001). Interestingly, the LE cotreatment group had a considerably lower mature oocyte rate despite having a similar number of mature oocytes and embryos recovered. The average hMG dosages and durations in the study group were similar to those in the control group. The implantation rate in the study group was numerically higher but without statistic significant than that in the control groups (43.15% (107/248) vs. 38.59% (115/298), OR 1.008, 95% CI 0.901-1.127; P >.05).

CONCLUSION

The effect of LE combined with PPOS on FORT is better than the effect of the standard PPOS treatment in women with PCOS and a high BMI, but there is no substantially beneficial impact on pregnancy outcomes or the cycle features of COS, including consumption of hMG.

The increasing incidence and high body mass index-related burden of gallbladder and biliary diseases-A results from global burden of disease study 2019

BACKGROUND

Gallbladder and biliary diseases are common gastrointestinal conditions associated with huge socioeconomic costs and are considered risk factors for cardiovascular diseases and digestive system cancers. The prevalence and incidence of gallbladder and biliary diseases have not received enough attention from 1990 to 2019. Several non-communicable diseases were associated with the incidence of gallbladder and biliary diseases. It is necessary to clarify the change in the incidence and disability burden of gallbladder and biliary diseases worldwide.

METHODS

Data on high body mass index (BMI)-related disease burden and incidence, years of life lost prematurely, and years lived with disability (YLDs) due to gallbladder and biliary diseases were obtained from the Global Burden of Disease 2019. The estimated annual percentage change was calculated to qualify the gallbladder and biliary disease burden change.

RESULTS

The global age-standardized incidence rate has increased from 585.35 per 100,000 (95% UI: 506.05-679.86) in 1990 to 634.32 per 100,000 (95% UI: 540.21-742.93) in 2019. And the increase in incidence was positively correlated with rising high BMI-related summary exposure value. The high BMI-related YLDs of gallbladder and biliary diseases have increased worldwide over time. Globally, the 25-49 age group suffered a rapid rise in incidence and high BMI attributable to the YLDs rate of gallbladder and biliary diseases.

CONCLUSION

The global incidence and high BMI-related YLDs of gallbladder and biliary diseases remain prominent to increase over the past 30 years. Notably, the incidence and high BMI-related YLDs among people aged 25-49 years have rapidly increased over time. Therefore, high BMI should be emphasized in strategic priorities for controlling gallbladder and biliary diseases.

Health Impacts of High BMI in China: Terrible Present and Future

Temporal trends and future expectations of health effects due to high body mass index (BMI) remain uncertain in China. The trends of high-BMI-related death in China were evaluated and predicted until 2040 using data and methods from the Global Burden of Disease study. The absolute numbers and age-standardized rates of death and disability-adjusted life years (DALYs) were also calculated by age, gender, and cause. From 1990 to 2019, the high-BMI-related death percent, number and rate were all significantly increased in China, and death rate may exceed that globally in the next 10 years. High BMI caused more deaths and DALYs for men than for women, and the gap appeared to increase over time. In 2019, the burden of high BMI among ages 0−14 and 15−19 for children and adolescents were lower than that among adults (>20 years). The most common cause of death associated with high BMI was stroke, followed by ischemic heart disease and hypertensive heart disease. High BMI burden is a significant public health challenges in China. BMI surveillance and evaluation of evidence-based preventive strategies should be immediately initiated in Chinese residents due to the rapid increase in the burden of high BMI.

The epidemic of stroke mortality attributed to high body mass index in mainland China: Current trends and future prediction

Background

High body mass index (BMI) is an important risk factor for stroke. The aim of this study was to assess the long-term trend of high BMI-attributed stroke mortality and make projections through 2030.

Methods

Data were extracted from the Global Burden of Disease Study 2019 and World Population Prospects 2019. An age-period-cohort framework was used in the analysis.

Results

From 1990 to 2019, the age-standardized mortality rate (ASMR) of high BMI-attributed stroke among females decreased by 15.2%, while among males, it increased by 31.1%. All of the age groups studied showed an increasing pattern over the last 30 years in males, and in female, the age groups encompassing participants who were 25-69 years old showed a decreasing pattern. In the same birth cohort, high BMI-attributable stroke mortality rates increased exponentially with age in both sexes. For females, the period rate ratios (RR) showed a downward trend after 2000-2004, and the cohort RR also showed a downward trend after the birth cohort 1930-1934. For males, the period RR showed an upward trend, but this increase was halted in the most recent period, and the cohort RRs showed a monotonic increasing pattern. It was projected that the ASMR of high BMI-attributed stroke would decrease among females and increase among males in the near future and that the proportion of elderly individuals with death due to high BMI-attributed stroke was projected to increase.

Conclusions

Over the last three decades, the high BMI-attributed stroke mortality rate decreased among females and increased among males, and these trends are projected to continue in the future. In addition, the proportion of elderly individuals with high BMI-attributed stroke mortality was projected to increase gradually in both men and women. More health-promoting efforts are needed, especially for elderly individuals and males.

The global burden of type 2 diabetes attributable to high body mass index in 204 countries and territories, 1990-2019: An analysis of the Global Burden of Disease Study

Background

High body mass index (BMI) plays a critical role in the initiation and development of type 2 diabetes (T2D). Up to now, far too little attention has been paid to the global burden of T2D attributable to high BMI. This study aims to report the deaths and disability-adjusted life years (DALYs) of T2D related to high BMI in 204 countries and territories from 1990 to 2019.

Methods

Data on T2D burden attributable to high BMI were retrieved from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. The global cases, age-standardized rates of mortality (ASMR), and disability-adjusted life years (ASDR) attributable to high BMI were estimated by age, sex, geographical location, and socio-demographic index (SDI). The estimated annual percentage change (EAPC) was calculated to quantify the trends of ASMR and ASDR during the period 1990-2019.

Results

Globally, there were 619,494.8 deaths and 34,422,224.8 DALYs of T2D attributed to high BMI in 2019, more than triple in 1990. Moreover, the pace of increase in ASMR and ASDR accelerated during 1990-2019, with EAPC of 1.36 (95% CI: 1.27 to 1.45) and 2.13 (95% CI: 2.10 to 2.17) separately, especially in men, South Asia, and low-middle SDI regions. Oceania was the high-risk area of standardized T2D deaths and DALYs attributable to high BMI in 2019, among which Fiji was the country with the heaviest burden. In terms of SDI, middle SDI regions had the biggest T2D-related ASMR and ASDR in 2019.

Conclusion

The global deaths and DALYs of T2D attributable to high BMI substantially increased from 1990 to 2019. High BMI as a major public health problem needs to be tackled properly and timely in patients with T2D.

Global burden of asthma associated with high body mass index from 1990 to 2019

BACKGROUND

High body mass index (BMI) plays a key role in the progression of asthma and asthma related to high BMI resulted in a high burden of disease globally.

OBJECTIVE

This study aimed to explore the geographical and temporal trends in the global burden of asthma associated with high BMI from 1990 to 2019.

METHODS

This is a retrospective analysis with data based on the Global Burden of Disease Study 2019 database. The deaths, disability-adjusted life-years (DALYs), age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) were estimated according to sex, age and sociodemographic indexes (SDI) levels. Estimated annual percentage change (EAPC) was used to evaluate the variation trends of ASMR and ASDR from 1990 to 2019.

RESULTS

In 2019, the number of global asthma deaths and DALYs related to high BMI increased by 69.69% and 63.91% respectively compared with 1990, among which more deaths and DALYs occurred in females. The corresponding ASMR and ASDR showed a slightly decreasing tendency globally. South Asia accounted for the highest number of deaths and DALYs, with India ranked first worldwide in 2019. The number of deaths and DALYs mainly appeared in individuals 60-79 years old and 55-69 years old respectively from 1990 to 2019. The heaviest burden existed in the low-middle SDI region.

CONCLUSION

The global asthma burden associated with obesity increased in absolute value but the standardized burden decreased slightly. Large variations existed in the high BMI-related asthma burdens among sexes, ages and regions.

The global burden and temporal trend of cancer attributable to high body mass index: Estimates from the Global Burden of Disease Study 2019

Objective

The purpose of the study was to describe the burden and temporal trend of cancer attributable to high body mass index (BMI), with major patterns highlighted by sex, Socio-demographic Index (SDI), and geographical region.

Methods

This population-based observational study collected epidemiological data on cancer attributable to high BMI from the Global Burden of Diseases (GBD) 2019. The obtained data included deaths, disability-adjusted life-years (DALYs), and their age-standardized rates at the global, gender, SDI, regional, and country levels. The trend magnitudes and directions over time for mortality were analyzed. The associations between SDI and burden of cancer attributable to high BMI were also evaluated by Pearson correlation analysis.

Results

Worldwide, 462.55 thousand deaths and 11.18 million DALYs of cancer were related to high BMI in 2019, and both have more than doubled since 1990. An annual 0.6% increase was observed for the age-standardized mortality rate (ASMR), and the rate of increase slowed after 2000. In general, the burden of cancer attributable to high BMI was heavier in regions with higher SDI levels, whereas the increase slowed down or even showed a decreasing trend in the recent years. In contrast, in regions with lower SDI levels, although the baseline burden of cancer attributable to high BMI was relatively low, both the numbers and rates of deaths and DALYs showed a significantly increasing trend and may not stop increasing for a period of time. The trend and magnitude of high BMI-related cancer burden varied substantially in different anatomical sites. The leading three cancers of DALYs attributable to high BMI in 2019 were esophageal, colorectal, and liver cancer.

Conclusion

The high BMI-related burden of cancers is worsening, particularly in developing countries. Concerted action should be suggested to increase awareness of the harmful effects of high BMI and decrease the burden of disease attributable to high BMI, including cancer.

Spatiotemporal trends in burden of uterine cancer and its attribution to body mass index in 204 countries and territories from 1990 to 2019

BACKGROUND

Uterine cancer is one of the most common female cancers worldwide, with huge heterogeneity in morbidity and mortality. Although a high body-mass index (BMI) has been linked to uterine cancer, systematic reports about the influence of high BMI and its temporal trends are scarce.

METHODS

The annual morbidity, mortality, and disability-adjusted life years (DALYs) of uterine cancer in 204 countries or territories were retrieved from the GBD 2019 study. To reflect trends in disease burden, we also calculated the estimated annual percentage change (EAPC) based on the age-standardized rates of uterine cancer from 1990 to 2019.

RESULTS

The global incident cases of uterine cancer increased 2.3 times from 187,190 in 1990 to 435,040 in 2019. Although the age-standardized incidence rate (ASIR) of uterine cancer increased worldwide from 8.67/100,000 in 1990 to 9.99/100,000 in 2019, the age-standardized death rate (ASDR) and DALY rate decreased during the same period. High socio-demographic index (SDI) countries tended to have a higher ASIR than developing regions, and their increasing trend in ASIR was also more pronounced. The disease was rare before 40 years old, but its risk rose sharply among women aged 50-70. A high BMI was linked to more than one-third of deaths from uterine cancer in 2019.

CONCLUSIONS

The incidence in developed areas was significantly higher than in developing areas and also increased much more rapidly. Elderly females, especially those with a high BMI, have a higher risk of uterine cancer. Therefore, more health resources may be needed to curb the rising burden in specific populations.

Changes in body mass index, obesity, and overweight in Southern Africa development countries, 1990 to 2019: Findings from the Global Burden of Disease, Injuries, and Risk Factors Study

BACKGROUND

High body mass index (BMI) is associated with stroke, ischemic heart disease (IHD), and type 2 diabetes mellitus (T2DM). An epidemiological analysis of the prevalence of high BMI, stroke, IHD, and T2DM was conducted for 16 Southern Africa Development Community (SADC) using Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study data.

METHODS

GBD obtained data from vital registration, verbal autopsy, and ICD codes. Prevalence of high BMI (≥25 kg/m2), stroke, IHD, and T2DM attributed to high BMI were calculated. Cause of Death Ensemble Model and Spatiotemporal Gaussian regression was used to estimate mortality due to stroke, IHD, and T2DM attributable to high BMI.

RESULTS

Obesity in adult females increased 1.54-fold from 12.0% (uncertainty interval [UI]: 11.5-12.4) to 18.5% (17.9-19.0), whereas in adult males, obesity nearly doubled from 4.5 (4.3-4.8) to 8.8 (8.5-9.2). In children, obesity more than doubled in both sexes, and overweight increased by 27.4% in girls and by 37.4% in boys. Mean BMI increased by 0.7 from 22.4 (21.6-23.1) to 23.1 (22.3-24.0) in adult males, and by 1.0 from 23.8 (22.9-24.7) to 24.8 (23.8-25.8) in adult females. South Africa 44.7 (42.5-46.8), Swaziland 33.9 (31.7-36.0) and Lesotho 31.6 (29.8-33.5) had the highest prevalence of obesity in 2019. The corresponding prevalence in males for the three countries were 19.1 (17.5-20.7), 19.3 (17.7-20.8), and 9.2 (8.4-10.1), respectively. The DRC and Madagascar had the least prevalence of adult obesity, from 5.6 (4.8-6.4) and 7.0 (6.1-7.9), respectively in females in 2019, and in males from 4.9 (4.3-5.4) in the DRC to 3.9 (3.4-4.4) in Madagascar.

CONCLUSIONS

The prevalence of high BMI is high in SADC. Obesity more than doubled in adults and nearly doubled in children. The 2019 mean BMI for adult females in seven countries exceeded 25 kg/m2. SADC countries are unlikely to meet UN2030 SDG targets. Prevalence of high BMI should be studied locally to help reduce morbidity.

Impact of body mass and alcohol consumption on all-cause and liver mortality in 240 000 adults in the United States

INTRODUCTION

Nationally representative studies of the combined impact of drinking and body mass (BMI) on mortality outcomes are unavailable. We investigate whether both act together to elevate risk of all-cause or liver mortality.

METHODS

We obtained self-reported histories of drinking and BMI from 129 098 women (mean age 47.2 years) and 102 568 men (mean age 45.6 years) ≥18 years interviewed from 1997 to 2004 in the National Health Interview Survey and related these data to the deaths that occurred by 31 December 2006 (women = 8486; men = 7819 deaths). Death hazards among current drinkers in different BMI groups were adjusted for age, education, race and smoking.

RESULTS

Obese (≥30 kg m-2 ) adults with consumption of >40 g day-1 (women) or >60 g day-1 (men) pure ethanol were at risk of increased mortality from all-cause and chronic liver disease (P trend <0.0001). For heavy drinkers with BMI ≥30 kg m-2 , each 5 kg m-2 higher BMI was associated with an elevated all-cause mortality in men (hazard ratios 1.27, 95% confidence interval [CI]: 1.16-1.40) and women (1.12, [1.02-1.24]). The excess risk due to interaction was more pronounced in men (7.30, [3.60-11.00]) than women (2.90, [0.50-5.30]).

DISCUSSION AND CONCLUSIONS

Obesity and excess alcohol are both related to all-cause and liver mortality-the latter with evidence of a supra-additive interaction between the risk factors. The presence of both factors in the same population and their impact should inform treatment, public health policies and research.

A 21st Century Epidemy-Obesity: And Its Impact on Pregnancy Loss

The prevalence of obesity among women of reproductive age is growing significantly over the last years. Being obese or having a high body mass index (BMI) contributes to many diseases and pregnancy complications. This is concerning as an obese woman is at increased risk for developing several complications during pregnancy and is at increased risk for pregnancy loss, stillbirth, and metabolic disorders of a live-born child in his future. The pregnant woman's body mass index has to be monitored well during the whole pregnancy, and their diet should also be monitored to avoid future complications. Better results can be achieved if every woman would watch their weight before being pregnant for better outcomes in their future pregnancies. This review article aimed to determine the relationship between being obese or having a high BMI and pregnancy loss. Additionally, we tried to find the mechanism that is involved in pregnancy loss in obese women. 

Administration of Cinnamon and Lagersroemia speciosa Extract on Lipid Profile of Polycystic Ovarian Syndrome Women with High Body Mass Index

BACKGROUND

Hyperinsulinemia, a common feature in PCOS, have been found to contribute to metabolic disturbance, such as dyslipidaemia and diabetes mellitus type 2. Oral anti-diabetic medications have been prescribed to alleviate this effect. We sought to fnd whether DLBS3233, an insulin sensitizer, could alleviate dyslipidaemia in women with PCOS with high BMI.

AIM

This study aimed to investigate the effect of DLBS3233, an herbal combination of C burmanii and L spesiosa extract, on lipid profle, insulin resistance, and free testosterone of women with PCOS with high BMI.

STUDY SETTING AND DESIGN

This was a controlled trial conducted in Dr. Cipto Mangunkusumo Hospital, Jakarta, and Dr Hasan Sadikin Hospital, Bandung, Indonesia.

MATERIALS AND METHODS

A controlled trial was conducted on 62 volunteers diagnosed with PCOS according to Rotterdam criteria and exhibited insulin resistance as signifed by HOMA-IR > 2.0; baseline lipid profile (LDL, HDL, Triglyceride and Total cholesterol) and free testosterone concentration were obtained. Participants were given 100 mg of DLBS3233 in the morning, and volunteers were followed up monthly, with laboratory tests conducted at the third and sixth months. Data were analysed through intention-to-treat analysis, separating high BMI (≥25 kg/m2) subjects.

STATISTICAL ANALYSIS

Repeated-measures model.

RESULTS

DLBS3233 improved lipid profle and insulin sensitivity by reducing triglycerides, HOMA-IR, and free testosterone in subjects with high BMI. Limitations and Implications: The current study does not compare the effect of DLBS3233 with a control group. A larger study with a proper control group would have to be conducted to have more conclusive results.

CONCLUSION

This study showed that DLBS3233 holds promise as a novel therapy to improve lipid profle for women with PCOS.

A Hierarchical Age-Period-Cohort Analysis of Breast Cancer Mortality and Disability Adjusted Life Years (1990-2015) Attributable to Modified Risk Factors among Chinese Women

Limited studies quantified the age, period, and cohort effects attributable to different risk factors on mortality rates (MRs) and disability-adjusted life years (DALYs) due to breast cancer among Chinese women. We used data from the Global Burden of Disease Study (GBD) in 2017. Mixed-effect and hierarchical age–period–cohort (HAPC) models were used to assess explicit and implicit fluctuations in MRs and DALYs attributable to different breast cancer associated risk factors. As the only risk factor, high body mass index (HBMI) showed continuously increasing trends in MRs and DALYs across ages, periods, and cohorts. Age, recent periods (2010–2015), and risk factor HBMI showed significant positive effect on MRs and DALYs (p < 0.05). Moreover, we reported significant interaction effects of older age and period in recent years in addition to the interplay of older age and risk factor HBMI on MRs and DALYs. Increased age and obesity contribute to substantially raised breast cancer MRs and DALYs in China and around the globe. These discoveries shed light on protective health policies and provision of healthy lifestyle for improving the subsequent breast cancer morbidity and mortality for China, as well as other related Asian regions that are presently facing the same public health challenges.

Maternal rubella immunity status and pre-eclampsia

PROBLEM

To determine if maternal immune maladaptation associated with pre-eclampsia is reflected in the rubella immunity status.

METHOD OF STUDY

Incidence of pre-eclampsia was compared between rubella non-immune and immune gravidae carrying a singleton pregnancy beyond 24 weeks, taking into account maternal characteristics and reported risk factors for pre-eclampsia.

RESULTS

The 9870 (10.4%) rubella non-immune gravidae among the 95 024 in the cohort exhibited no difference in incidence of underlying medical disorders, but they were slightly but significantly older, shorter, heavier, and had more pre-eclampsia (OR 1.24, 95% CI 1.05-1.47) despite having fewer nulliparas. Regression analysis confirmed an overall association between rubella non-immunity with pre-eclampsia (aOR 1.27, 95% CI 1.06-1.54), which was related to multiparas (aOR 1.42, 95% CI 1.05-1.91) and carrying a male fetus (aOR 1.37, 95% CI 1.06-1.78).

CONCLUSION

The association between rubella non-immunity and pre-eclampsia reflects immune maladaptation in multiparas and toward a male fetus.