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- Caracterização das lesões numa equipa do futebol profissional portuguêsPublication . Martins, Francisco; Santos, Francisco; Caldeira, Romualdo; Henriques, Ricardo; França, Cíntia; Ornelas, Rui; Gouveia, Élvio RúbioO futebol profissional caracteriza-se pelas suas exigências físicas, fazendo com que a exposição dos jogadores a riscos elevados de lesão seja uma problemática em ascensão. O objetivo deste estudo é caracterizar as lesões de uma equipa profissional de futebol ao longo de uma época. Trinta e seis atletas do sexo masculino, enquadrados na 1.ª Liga Portuguesa de Futebol, foram acompanhados ao longo da época desportiva 2020/2021. Caracterizou-se uma lesão desportiva como a incapacidade demonstrada pelo atleta, devido a um momento de treino ou jogo, que exigiu intervenção médica ou interrupção parcial ou total da sua atividade desportiva. No total, 34 lesões foram registadas. Cada jogador falhou em média 14.3 dias devido a lesão. As lesões mais recorrentes foram as entorses (35.3%) e as lesões musculares (35.3%), sendo os membros inferiores a zona do corpo mais afetada (85.29%). As lesões ocorreram maioritariamente em treino (58.8%) e as de jogo registaram-se sobretudo nos últimos 15 minutos (57.14%). Os resultados obtidos neste estudo vêm auxiliar o staff técnico das equipas profissionais de futebol na identificação de fatores de risco associados às lesões no futebol profissional. O estudo desta temática é fundamental para a otimização dos protocolos de prevenção e de recuperação de lesões.
- Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweightPublication . NCD Risk Factor Collaboration; Ornelas, Rui T.From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions.
- Changes in cardiorespiratory fitness predict changes in body composition from childhood to adolescence: findings from the European Youth Heart StudyPublication . Ornelas, Rui T.; Silva, Analiza M.; Minderico, Cláudia S.; Sardinha, Luís B.Background: Several variables, such as waist circumference (WC) and trunk skinfolds (TS), are indicators of body fat. There is interest in evaluating the effect of cardiorespiratory fi tness (CRF) measures on changes in these markers from childhood to adolescence. Purpose: To examine CRF as a potential predictor of changes in body fat over an 8-year follow-up period in a pedi atric population. Methods: A cohort study of 86 children (44 girls, 42 boys) with a mean age of 9.8 ± 0.3 years who participated in the Portuguese arm of the European Youth Heart Study in 2000 completed a follow-up evaluation in 2008 at a mean age of 17.0 ± 0.4 years. Cardio respiratory fi tness, expressed as maximal oxygen consumption (VO2 max) (mL⋅kg−1 ⋅min−1 ), was assessed during an incremental multistage bicycle test to exhaustion. Physical activity (PA) was objectively measured by accelerometry at both periods of evaluation. Fat mass (FM) was assessed using anthropometric models, sum of TS, and WC. Changes were expressed as a percentage of the baseline value. Comparison of means and linear regression analysis were used for data analysis. Results: While CRF signifi cantly increased among boys (P 0.05) and decreased in girls (P 0.01), the percentage of body fat decreased over time in boys (P 0.01) and increased among girls. Alone, CRF explained 39%, 26%, and 25% of the total variance in WC, FM, and TS, respectively (P 0.01). Adjusting for PA, sex, and maturation changes, CRF remained a signifi cant predictor of WC (β = −0.335; P 0.01), FM (β = −2.084; P 0.01), and TS (β = −1.500; P 0.01). Conclusion: Changes in CRF are a signifi cant predictor of changes in body fat percentage from childhood to adolescence. School-based PA interventions are encouraged to maintain or improve CRF from childhood and throughout adolescence to prevent increased percentages of body fat, particularly in the abdominal region.
- Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1cPublication . NCD Risk Factor Collaboration (NCD-RisC); Ornelas, RuiFasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are both used to diagnose diabetes, but these measurements can identify diferent people as having diabetes. We used data from 117 population-based studies and quantifed, in diferent world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening, had elevated FPG, HbA1c or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specifc level of FPG, had elevated HbA1c, and vice versa. The age-standardized proportion of diabetes that was previously undiagnosed and detected in survey screening ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the age-standardized proportion who had elevated levels of both FPG and HbA1c was 29–39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c was more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate fnite resources for measuring HbA1c to reduce the global shortfall in diabetes diagnosis and surveillance.
- Effects of diabetes definition on global surveillance of diabetes prevalence and diagnosis: a pooled analysis of 96 population-based studies with 331 288 participantsPublication . Danaei, G; Fahimi, S; Lu, Y; Zhou, B; Hajifathalian, K; Di Cesare, M; Lo, WC; Reis-Santos, B; Cowan, MJ; Shaw, JE; Bentham, J; Mohammad, K; Mohan, V; Mohd Yusoff, MF; Møller, NC; Molnár, D; Aguilar-Salinas, CA; Mondo, CK; Moreno, LA; Morgan, K; El Ati, J; Jonas, JB; Moschonis, G; Mossakowska, M; Mostafa, A; Mota, J; Muiesan, ML; Müller-Nurasyid, M; Mursu, J; Ahmadvand, A; Nagel, G; Námešná, J; Joshi, P; Elosua, R; Nang, EE; Nangia, VB; Navarrete-Muñoz, EM; Ndiaye, NC; Nervi, F; Nguyen, ND; Nieto-Martínez, RE; Alvarado, L; Al Nsour, M; Kafatos, A; Ning, G; Lin, JK; Ninomiya, T; Noale, M; Noto, D; Ochoa-Avilés, M; Oh, K; Onat, A; Osmond, C; Otero, JA; Kalter-Leibovici, O; Palmieri, L; Alkerwi, A; Erasmus, RT; Panda-Jonas, S; Panza, F; Parsaeian, M; Peixoto, SV; Pereira, AC; Peters, A; Peykari, N; Kasaeian, A; Pilav, A; Pitakaka, F; Piwonska, A; Erem, C; Amouyel, P; Piwonski, J; Plans-Rubió, P; Porta, M; Portegies, ML; Poustchi, H; Katz, J; Pradeepa, R; Price, JF; Punab, M; Qasrawi, RF; Ergor, G; Qorbani, M; Andersen, L. B.; Raitakari, O; Ramachandra Rao, S; Ramachandran, A; Kaur, P; Ramos, R; Rampal, S; Rathmann, W; Redon, J; Reganit, PF; Eriksen, L; Rigo, F; Robinson, SM; Anderssen, S. A.; Robitaille, C; Kavousi, M; Rodríguez, LA; Rodríguez-Artalejo, F; del Cristo Rodriguez-Perez, M; Rojas-Martinez, R; Romaguera, D; Rosengren, A; Escobedo-de la Peña, J; Rubinstein, A; Ornelas, Rui; Ruiz-Betancourt, BS; Kelishadi, R; Andrade, DS; Rutkowski, M; Sabanayagam, C; Sachdev, HS; Saidi, O; Sakarya, S; Salanave, B; Fall, CH; Salonen, JT; Salvetti, M; Ali, MK; Sánchez-Abanto, J; Santos, RN; Anjana, RM; Santos, R; Sardinha, LB; Scazufca, M; Schargrodsky, H; Scheidt-Nave, C; Farzadfar, F; Shaw, JE; Dhana, K; Shibuya, K; Shin, Y; Shiri, R; Siantar, R; Aounallah-Skhiri, H; Sibai, AM; Simon, M; Simons, J; Simons, LA; Felix-Redondo, FJ; Kengne, AP; Sjostrom, M; Slowikowska-Hilczer, J; Slusarczyk, P; Smeeth, L; Snijder, MB; Solfrizzi, V; Aris, T; Sonestedt, E; Soumare, A; Staessen, JA; Kersting, M; Ferguson, TS; Steene-Johannessen, J; Stehle, P; Stein, AD; Stessman, J; Stöckl, D; Stokwiszewski, J; Strufaldi, MW; Arlappa, N; Sun, CA; Khader, YS; Sundström, J; Fernández-Bergés, D; Suriyawongpaisal, P; Sy, RG; Tai, ES; Tarawneh, M; Tarqui-Mamani, CB; Thijs, L; Tolstrup, JS; Topbas, M; Khang, YH; Arveiler, D; Torrent, M; Bixby, H; Traissac, P; Trinh, OT; Tulloch-Reid, MK; Tuomainen, TP; Turley, ML; Tzourio, C; Ueda, P; Kiechl, S; Ukoli, FM; Ulmer, H; Assah, FK; Ferrari, M; Valdivia, G; van Valkengoed, IG; Vanderschueren, D; Vanuzzo, D; Vega, T; Velasquez-Melendez, G; Kim, J; Veronesi, G; Verschuren, M; Vioque, J; Virtanen, J; Ferreccio, C; Avdicová, M; Visvikis-Siest, S; Viswanathan, B; Vollenweider, P; Voutilainen, S; Kiyohara, Y; Wade, AN; Wagner, A; Walton, J; Mohamud, WN; Wang, MD; Finn, JD; Wang, YX; Balakrishna, N; Wannamethee, SG; Weerasekera, D; Kolsteren, P; Whincup, PH; Widhalm, K; Wiecek, A; Wilks, RJ; Willeit, J; Wojtyniak, B; Föger, B; Wong, TY; Woo, J; Bandosz, P; Korrovits, P; Woodward, M; Wu, AG; Wu, FC; Wu, SL; Xu, H; Yang, X; Ye, X; Foo, LH; Yoshihara, A; Younger-Coleman, NO; Koskinen, S; Zambon, S; Barbagallo, CM; Zargar, AH; Zdrojewski, T; Zhao, W; Zheng, Y; Barceló, A; Batieha, AM; Fouad, HM; Baur, LA; Di Castelnuovo, AF; Ben Romdhane, H; Bernabe-Ortiz, A; Bhargava, SK; Bi, Y; Bjerregaard, P; Björkelund, C; Blake, M; Blokstra, A; Bo, S; Francis, DK; Ezzati, M; Boehm, BO; Boissonnet, CP; Bovet, P; Brajkovich, I; Breckenkamp, J; Brewster, LM; Brian, GR; Bruno, G; Bugge, A; Cabrera de León, A; Kratzer, W; Franco Mdo, C; Can, G; Cândido, AP; Capuano, V; Carvalho, M. J.; Casanueva, FF; Caserta, CA; Castetbon, K; Chamukuttan, S; Chaturvedi, N; Kromhout, D; Chen, CJ; Frontera, G; Chen, F; Chen, S; Cheng, CY; Chetrit, A; Chiou, ST; Cho, Y; Chudek, J; Cifkova, R; Kula, K; Claessens, F; Concin, H; Furusawa, T; Cooper, C; Cooper, R; Costanzo, S; Cottel, D; Cowell, C; Crujeiras, AB; D'Arrigo, G; Kurjata, P; Dallongeville, J; Dankner, R; Dauchet, L; Magliano, D; de Gaetano, G; De Henauw, S; Deepa, M; Dehghan, A; Gaciong, Z; Galbarczyk, A; Kyobutungi, C; Garnett, SP; Gaspoz, JM; Gasull, M; Gates, L; Geleijnse, JM; Ghasemain, A; Giampaoli, S; Gianfagna, F; Bovet, P; Giovannelli, J; Lachat, C; Gonzalez Gross, M; González Rivas, JP; Gorbea, MB; Gottrand, F; Grant, JF; Grodzicki, T; Grøntved, A; Gruden, G; Gu, D; Miranda, JJ; Laid, Y; Guan, OP; Guerrero, R; Guessous, I; Guimaraes, AL; Gutierrez, L; Hardy, R; Hari Kumar, R; Heidemann, C; Hihtaniemi, IT; Ho, SY; Lam, TH; Khang, YH; Ho, SC; Hofman, A; Horimoto, AR; Hormiga, CM; Horta, BL; Houti, L; Hussieni, AS; Huybrechts, I; Hwalla, N; Lanska, V; Iacoviello, L; Stevens, GA; Iannone, AG; Ibrahim, MM; Ikeda, N; Ikram, MA; Irazola, VE; Islam, M; Iwasaki, M; Jacobs, JM; Djalalinia, S; Jafar, T; Jasienska, G; Riley, LM; Jiang, CQ; Lappas, G; Abdeen, ZA; Laxmaiah, A; Leclercq, C; Lee, J; Lee, J; Lehtimäki, T; Lekhraj, R; León-Muñoz, LM; Li, Y; Doua, K; Lim, WY; Lima-Costa, MF; Kadir, KA; Lin, HH; Lin, X; Lissner, L; Lorbeer, R; Lozano, JE; Lundqvist, A; Lytsy, P; Drygas, W; Ma, G; Machado-Coelho, GL; Machi, S; Abu-Rmeileh, M; Maggi, S; Magliano, D; Makdisse, M; Mallikharjuna v, K; Manios, Y; Manzato, E; Du, Y; Margozzini, P; Marques-Vidal, P; Martorell, R; Masoodi, SR; Acosta-Cazares, B; Matsha, TE; Mbanya, JC; McFarlane, SR; McGarvey, ST; McLachlan, S; Egbagbe, EE; McNulty, BA; Mediene-Benchekor, S; Meirhaeghe, A; Menezes, AM; Merat, S; Aekplakorn, W; Meshram, II; Mi, J; Miquel, JF; Miranda, JJ; Eggertsen, R; Mohamed, MKBackground Diabetes has been defi ned on the basis of diff erent biomarkers, including fasting plasma glucose (FPG), 2-h plasma glucose in an oral glucose tolerance test (2hOGTT), and HbA1c. We assessed the eff ect of diff erent diagnostic defi nitions on both the population prevalence of diabetes and the classifi cation of previously undiagnosed individuals as having diabetes versus not having diabetes in a pooled analysis of data from population-based health examination surveys in diff erent regions. Methods We used data from 96 population-based health examination surveys that had measured at least two of the biomarkers used for defi ning diabetes. Diabetes was defi ned using HbA1c (HbA1c ≥6·5% or history of diabetes diagnosis or using insulin or oral hypoglycaemic drugs) compared with either FPG only or FPG-or-2hOGTT defi nitions (FPG ≥7·0 mmol/L or 2hOGTT ≥11·1 mmol/L or history of diabetes or using insulin or oral hypoglycaemic drugs). We calculated diabetes prevalence, taking into account complex survey design and survey sample weights. We compared the prevalences of diabetes using diff erent defi nitions graphically and by regression analyses. We calculated sensitivity and specifi city of diabetes diagnosis based on HbA1c compared with diagnosis based on glucose among previously undiagnosed individuals (ie, excluding those with history of diabetes or using insulin or oral hypoglycaemic drugs). We calculated sensitivity and specifi city in each survey, and then pooled results using a random-eff ects model. We assessed the sources of heterogeneity of sensitivity by meta-regressions for study characteristics selected a priori. Findings Population prevalence of diabetes based on FPG-or-2hOGTT was correlated with prevalence based on FPG alone (r=0·98), but was higher by 2–6 percentage points at diff erent prevalence levels. Prevalence based on HbA1c was lower than prevalence based on FPG in 42·8% of age–sex–survey groups and higher in another 41·6%; in the other 15·6%, the two defi nitions provided similar prevalence estimates. The variation across studies in the relation between glucose-based and HbA1c-based prevalences was partly related to participants’ age, followed by natural logarithm of per person gross domestic product, the year of survey, mean BMI, and whether the survey population was national, subnational, or from specifi c communities. Diabetes defi ned as HbA1c 6·5% or more had a pooled sensitivity of 52·8% (95% CI 51·3–54·3%) and a pooled specifi city of 99·74% (99·71–99·78%) compared with FPG 7·0 mmol/L or more for diagnosing previously undiagnosed participants; sensitivity compared with diabetes defi ned based on FPG or-2hOGTT was 30·5% (28·7–32·3%). None of the preselected study-level characteristics explained the heterogeneity in the sensitivity of HbA1c versus FPG. Interpretation Diff erent biomarkers and defi nitions for diabetes can provide diff erent estimates of population prevalence of diabetes, and diff erentially identify people without previous diagnosis as having diabetes. Using an HbA1c-based defi nition alone in health surveys will not identify a substantial proportion of previously undiagnosed people who would be considered as having diabetes using a glucose-based test.
- Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19·1 million participantsPublication . Zhou, Bin; Bentham, James; Di Cesare, Mariachiara; Bixby, Honor; Danaei, Goodarz; Cowan, Melanie J; Paciorek, Christopher J; Singh, Gitanjali; Hajifathalian, Kaveh; Bennett, James E; Taddei, Cristina; Deschamps, Valérie; Dhana, Klodian; Di Castelnuovo, Augusto F; Dias-da-Costa, Juvenal Soares; Diaz, Alejandro; Dickerson, Ty T; Do, Ha T P; Dobson, Annette J; Donfrancesco, Chiara; Stevens, Gretchen A; Bikbov, Mukharram; Donoso, Silvana P; Döring, Angela; Doua, Kouamelan; Drygas, Wojciech; Dulskiene, Virginija; Džakula, Aleksandar; Dzerve, Vilnis; Dziankowska-Zaborszczyk, Elzbieta; Eggertsen, Robert; Ekelund, Ulf; Bjerregaard, Peter; Riley, Leanne M; El Ati, Jalila; Ellert, Ute; Elliott, Paul; Elosua, Roberto; Erasmus, Rajiv T; Erem, Cihangir; Eriksen, Louise; de la Peña, Jorge Escobedo; Evans, Alun; Bjertness, Espen; Faeh, David; Bovet, Pascal; Fall, Caroline H; Farzadfar, Farshad; Felix-Redondo, Francisco J; Ferguson, Trevor S; Fernández-Bergés, Daniel; Ferrante, Daniel; Ferrari, Marika; Ferreccio, Catterina; Björkelund, Cecilia; Ferrieres, Jean; Finn, Joseph D; Elliott, Paul; Fischer, Krista; Föger, Bernhard; Foo, Leng Huat; Forslund, Ann-Sofie; Forsner, Maria; Fortmann, Stephen P; Fouad, Heba M; Blokstra, Anneke; Francis, Damian K; Franco, Maria do Carmo; Franco, Oscar H; Gu, Dongfeng; Frontera, Guillermo; Fuchs, Flavio D; Fuchs, Sandra C; Fujita, Yuki; Furusawa, Takuro; Gaciong, Zbigniew; Bo, Simona; Gareta, Dickman; Garnett, Sarah P; Gaspoz, Jean-Michel; Gasull, Magda; Ikeda, Nayu; Gates, Louise; Gavrila, Diana; Geleijnse, Johanna M; Ghasemian, Anoosheh; Ghimire, Anup; Bobak, Martin; Giampaoli, Simona; Gianfagna, Francesco; Giovannelli, Jonathan; Goldsmith, Rebecca A; Gonçalves, Helen; Jackson, Rod T; Gross, Marcela Gonzalez; Rivas, Juan P González; Gottrand, Frederic; Graff-Iversen, Sidsel; Boeing, Heiner; Grafnetter, Dušan; Grajda, Aneta; Gregor, Ronald D; Grodzicki, Tomasz; Grøntved, Anders; Gruden, Grabriella; Joffres, Michel; Grujic, Vera; Gu, Dongfeng; Guan, Ong Peng; Boggia, Jose G; Gudnason, Vilmundur; Guerrero, Ramiro; Guessous, Idris; Guimaraes, Andre L; Gulliford, Martin C; Gunnlaugsdottir, Johanna; Gunter, Marc; Kengne, Andre Pascal; Gupta, Prakash C; Gureje, Oye; Boissonnet, Carlos P; Gurzkowska, Beata; Gutierrez, Laura; Gutzwiller, Felix; Hadaegh, Farzad; Halkjær, Jytte; Hambleton, Ian R; Hardy, Rebecca; Harikumar, Rachakulla; Laatikainen, Tiina; Hata, Jun; Bilano, Ver; Hayes, Alison J; He, Jiang; Hendriks, Marleen Elisabeth; Henriques, Ana; Cadena, Leticia Hernandez; Herrala, Sauli; Heshmat, Ramin; Hihtaniemi, Ilpo Tapani; Ho, Sai Yin; Lam, Tai Hing; Bongard, Vanina; Ho, Suzanne C; Hobbs, Michael; Hofman, Albert; Dinc, Gonul Horasan; Hormiga, Claudia M; Horta, Bernardo L; Houti, Leila; Howitt, Christina; Htay, Thein Thein; Htet, Aung Soe; Braeckman, Lutgart; Laxmaiah, Avula; Hu, Yonghua; Huerta, José María; Husseini, Abdullatif S; Huybrechts, Inge; Hwalla, Nahla; Iacoviello, Licia; Iannone, Anna G; Ibrahim, M Mohsen; Ikram, M Arfan; Brajkovich, Imperia; Irazola, Vilma E; Liu, Jing; Islam, Muhammad; Ivkovic, Vanja; Iwasaki, Masanori; Jackson, Rod T; Jacobs, Jeremy M; Jafar, Tazeen; Jamrozik, Konrad; Janszky, Imre; Branca, Francesco; Jasienska, Grazyna; Jelakovic, Bojan; Miranda, J Jaime; Jiang, Chao Qiang; Joffres, Michel; Johansson, Mattias; Jonas, Jost B; Jørgensen, Torben; Joshi, Pradeep; Juolevi, Anne; Breckenkamp, Juergen; Jurak, Gregor; Jureša, Vesna; Kaaks, Rudolf; Mondo, Charles K; Kafatos, Anthony; Kalter-Leibovici, Ofra; Kamaruddin, Nor Azmi; Kasaeian, Amir; Katz, Joanne; Kauhanen, Jussi; Brenner, Hermann; Kaur, Prabhdeep; Kavousi, Maryam; Kazakbaeva, Gyulli; Keil, Ulrich; Neuhauser, Hannelore K; Boker, Lital Keinan; Keinänen-Kiukaanniemi, Sirkka; Kelishadi, Roya; Kemper, Han C G; Kengne, Andre Pascal; Brewster, Lizzy M; Kersting, Mathilde; Key, Timothy; Khader, Yousef Saleh; Khalili, Davood; Khang, Young-Ho; Sundström, Johan; Khaw, Kay-Tee; Kiechl, Stefan; Killewo, Japhet; Kim, Jeongseon; Bruno, Graziella; Klumbiene, Jurate; Kolle, Elin; Kolsteren, Patrick; Korrovits, Paul; Koskinen, Seppo; Kouda, Katsuyasu; Smeeth, Liam; Koziel, Slawomir; Kristensen, Peter Lund; Krokstad, Steinar; Bueno-de-Mesquita, H B(as); Kromhout, Daan; Kruger, Herculina S; Kubinova, Ruzena; Kuciene, Renata; Kuh, Diana; Kujala, Urho M; Kula, Krzysztof; Soric, Maroje; Kulaga, Zbigniew; Kumar, R Krishna; Bugge, Anna; Kurjata, Pawel; Kusuma, Yadlapalli S; Kuulasmaa, Kari; Kyobutungi, Catherine; Laatikainen, Tiina; Lachat, Carl; Lam, Tai Hing; Landrove, Orlando; Woodward, Mark; Lanska, Vera; Carrillo-Larco, Rodrigo M; Lappas, Georg; Larijani, Bagher; Laugsand, Lars E; Laxmaiah, Avula; Bao, Khanh Le Nguyen; Le, Tuyen D; Leclercq, Catherine; Lee, Jeannette; Lee, Jeonghee; Ezzati, Majid; Burns, Con; Lehtimäki, Terho; Lekhraj, Rampal; León-Muñoz, Luz M; Levitt, Naomi S; Li, Yanping; Lilly, Christa L; Lim, Wei-Yen; Lima-Costa, M Fernanda; Lin, Hsien-Ho; Lin, Xu; Bursztyn, Michael; Abarca-Gómez, Leandra; Linneberg, Allan; Lissner, Lauren; Litwin, Mieczyslaw; Lorbeer, Roberto; Lotufo, Paulo A; Lozano, José Eugenio; Luksiene, Dalia; Lundqvist, Annamari; Lunet, Nuno; de León, Antonio Cabrera; Lytsy, Per; Abdeen, Ziad A; Ma, Guansheng; Ma, Jun; Machado-Coelho, George L L; Machi, Suka; Maggi, Stefania; Magliano, Dianna J; Majer, Marjeta; Makdisse, Marcia; Cacciottolo, Joseph; Malekzadeh, Reza; Malhotra, Rahul; Rahim, Hanan Abdul; Rao, Kodavanti Mallikharjuna; Malyutina, Sofia; Manios, Yannis; Mann, Jim I; Manzato, Enzo; Margozzini, Paula; Marques-Vidal, Pedro; Cameron, Christine; Marrugat, Jaume; Martorell, Reynaldo; Mathiesen, Ellisiv B; Abu-Rmeileh, Niveen M; Matijasevich, Alicia; Matsha, Tandi E; Mbanya, Jean Claude N; Posso, Anselmo J Mc Donald; McFarlane, Shelly R; McGarvey, Stephen T; Can, Günay; McLachlan, Stela; McLean, Rachael M; McNulty, Breige A; Khir, Amir Sharifuddin Md; Acosta-Cazares, Benjamin; Mediene-Benchekor, Sounnia; Medzioniene, Jurate; Meirhaeghe, Aline; Meisinger, Christa; Menezes, Ana Maria B; Cândido, Ana Paula C; Menon, Geetha R; Meshram, Indrapal I; Metspalu, Andres; Mi, Jie; Mikkel, Kairit; Adams, Robert; Miller, Jody C; Miquel, Juan Francisco; Mišigoj-Durakovic, Marjeta; Mohamed, Mostafa K; Capuano, Vincenzo; Mohammad, Kazem; Mohammadifard, Noushin; Mohan, Viswanathan; Yusoff, Muhammad Fadhli Mohd; Møller, Niels C; Molnár, Dénes; Aekplakorn, Wichai; Momenan, Amirabbas; Mondo, Charles K; Monyeki, Kotsedi Daniel K; Cardoso, Viviane C; Moreira, Leila B; Morejon, Alain; Moreno, Luis A; Morgan, Karen; Moschonis, George; Mossakowska, Malgorzata; Mostafa, Aya; Afsana, Kaosar; Mota, Jorge; Motlagh, Mohammad Esmaeel; Carlsson, Axel C; Motta, Jorge; Muiesan, Maria L; Müller-Nurasyid, Martina; Murphy, Neil; Mursu, Jaakko; Musil, Vera; Nagel, Gabriele; Naidu, Balkish M; Aguilar-Salinas, Carlos A; Nakamura, Harunobu; Djalalinia, Shirin; Námešná, Jana; Nang, Ei Ei K; Nangia, Vinay B; Narake, Sameer; Navarrete-Muñoz, Eva Maria; Ndiaye, Ndeye Coumba; Neal, William A; Nenko, Ilona; Nervi, Flavio; Agyemang, Charles; Carvalho, Maria J.; Nguyen, Nguyen D; Nguyen, Quang Ngoc; Nieto-Martínez, Ramfis E; Niiranen, Teemu J; Ning, Guang; Ninomiya, Toshiharu; Nishtar, Sania; Noale, Marianna; Noboa, Oscar A; Noorbala, Ahmad Ali; Casanueva, Felipe F; Ahmadvand, Alireza; Noorbala, Teresa; Noto, Davide; Al Nsour, Mohannad; O'Reilly, Dermot; Oh, Kyungwon; Olinto, Maria Teresa A; Oliveira, Isabel O; Omar, Mohd Azahadi; Onat, Altan; Casas, Juan-Pablo; Ordunez, Pedro; Ahrens, Wolfgang; Osmond, Clive; Ostojic, Sergej M; Otero, Johanna A; Overvad, Kim; Owusu-Dabo, Ellis; Paccaud, Fred Michel; Padez, Cristina; Pahomova, Elena; Caserta, Carmelo A; Pajak, Andrzej; Palli, Domenico; Al Raddadi, Rajaa; Palmieri, Luigi; Panda-Jonas, Songhomitra; Panza, Francesco; Papandreou, Dimitrios; Parnell, Winsome R; Parsaeian, Mahboubeh; Pecin, Ivan; Chamukuttan, Snehalatha; Pednekar, Mangesh S; Peer, Nasheeta; Peeters, Petra H; Al Woyatan, Rihab; Peixoto, Sergio Viana; Pelletier, Catherine; Peltonen, Markku; Pereira, Alexandre C; Pérez, Rosa Marina; Peters, Annette; Chan, Angelique W; Petkeviciene, Janina; Pham, Son Thai; Pigeot, Iris; Pikhart, Hynek; Ali, Mohamed M; Pilav, Aida; Pilotto, Lorenza; Pitakaka, Freda; Plans-Rubió, Pedro; Polakowska, Maria; Chan, Queenie; Polašek, Ozren; Porta, Miquel; Portegies, Marileen LP; Pourshams, Akram; Pradeepa, Rajendra; Alkerwi, Ala'a; Prashant, Mathur; Price, Jacqueline F; Puiu, Maria; Punab, Margus; Chaturvedi, Himanshu K; Qasrawi, Radwan F; Qorbani, Mostafa; Radic, Ivana; Radisauskas, Ricardas; Rahman, Mahfuzar; Raitakari, Olli; Aly, Eman; Raj, Manu; Rao, Sudha Ramachandra; Ramachandran, Ambady; Chaturvedi, Nishi; Ramos, Elisabete; Rampal, Sanjay; Reina, Daniel A Rangel; Rasmussen, Finn; Redon, Josep; Reganit, Paul Ferdinand M; Ribeiro, Robespierre; Amouyel, Philippe; Riboli, Elio; Rigo, Fernando; Chen, Chien-Jen; de Wit, Tobias F Rinke; Ritti-Dias, Raphael M; Robinson, Sian M; Robitaille, Cynthia; Rodríguez-Artalejo, Fernando; Rodriguez-Perez del Cristo, María; Rodríguez-Villamizar, Laura A; Rojas-Martinez, Rosalba; Amuzu, Antoinette; Rosengren, Annika; Khatibzadeh, Shahab; Rubinstein, Adolfo; Ornelas, Rui; Ruiz-Betancourt, Blanca Sandra; Horimoto, Andrea R V Russo; Rutkowski, Marcin; Sabanayagam, Charumathi; Sachdev, Harshpal S; Saidi, Olfa; Sakarya, Sibel; Andersen, Lars Bo; Chen, Fangfang; Salanave, Benoit; Salazar Martinez, Eduardo; Salmerón, Diego; Salomaa, Veikko; Salonen, Jukka T; Salvetti, Massimo; Sánchez-Abanto, Jose; Sans, Susana; Santos, Diana; Santos, Ina S; Chen, Huashuai; Anderssen, Sigmund A; Santos, Renata Nunes dos; Santos, Rute; Saramies, Jouko L; Sardinha, Luis B; Margolis, Giselle Sarganas; Sarrafzadegan, Nizal; Saum, Kai-Uwe; Savva, Savvas C; Scazufca, Marcia; Chen, Shuohua; Schargrodsky, Herman; Ängquist, Lars; Schneider, Ione J; Schultsz, Constance; Schutte, Aletta E; Sen, Abhijit; Senbanjo, Idowu O; Sepanlou, Sadaf G; Sharma, Sanjib K; Shaw, Jonathan E; Chen, Zhengming; Shibuya, Kenji; Shin, Dong Wook; Anjana, Ranjit Mohan; Shin, Youchan; Siantar, Rosalynn; Sibai, Abla M; Silva, Diego Augusto Santos; Simon, Mary; Simons, Judith; Simons, Leon A; Cheng, Ching-Yu; Sjöström, Michael; Skovbjerg, Sine; Slowikowska-Hilczer, Jolanta; Ansong, Daniel; Slusarczyk, Przemyslaw; Smeeth, Liam; Smith, Margaret C; Snijder, Marieke B; So, Hung-Kwan; Sobngwi, Eugène; Dekkaki, Imane Cherkaoui; Söderberg, Stefan; Solfrizzi, Vincenzo; Sonestedt, Emily; Song, Yi; Aounallah-Skhiri, Hajer; Sørensen, Thorkild IA; Jérome, Charles Sossa; Soumare, Aicha; Staessen, Jan A; Starc, Gregor; Chetrit, Angela; Stathopoulou, Maria G; Stavreski, Bill; Steene-Johannessen, Jostein; Stehle, Peter; Stein, Aryeh D; Araújo, Joana; Stergiou, George S; Stessman, Jochanan; Stieber, Jutta; Stöckl, Doris; Chiolero, Arnaud; Stocks, Tanja; Stokwiszewski, Jakub; Stronks, Karien; Strufaldi, Maria Wany; Sun, Chien-An; Sundström, Johan; Ariansen, Inger; Sung, Yn-Tz; Suriyawongpaisal, Paibul; Sy, Rody G; Chiou, Shu-Ti; Tai, E Shyong; Tammesoo, Mari-Liis; Tamosiunas, Abdonas; Tang, Line; Tang, Xun; Tanser, Frank; Tao, Yong; Aris, Tahir; Tarawneh, Mohammed Rasoul; Tarqui-Mamani, Carolina B; Chirita-Emandi, Adela; Taylor, Anne; Theobald, Holger; Thijs, Lutgarde; Thuesen, Betina H; Tjonneland, Anne; Tolonen, Hanna K; Tolstrup, Janne S; Topbas, Murat; Arlappa, Nimmathota; Topór-Madry, Roman; Lugero, Charles; Tormo, María José; Torrent, Maties; Traissac, Pierre; Trichopoulos, Dimitrios; Trichopoulou, Antonia; Trinh, Oanh T H; Trivedi, Atul; Tshepo, Lechaba; Tulloch-Reid, Marshall K; Aryal, Krishna; Cho, Belong; Tuomainen, Tomi-Pekka; Tuomilehto, Jaakko; Turley, Maria L; Tynelius, Per; Tzourio, Christophe; Ueda, Peter; Ugel, Eunice; Ulmer, Hanno; Uusitalo, Hannu M T; Valdivia, Gonzalo; Cho, Yumi; Arveiler, Dominique; Valvi, Damaskini; van der Schouw, Yvonne T; Van Herck, Koen; van Rossem, Lenie; van Valkengoed, Irene GM; Vanderschueren, Dirk; Vanuzzo, Diego; Vatten, Lars; Vega, Tomas; Chudek, Jerzy; Velasquez-Melendez, Gustavo; Assah, Felix K; Veronesi, Giovanni; Verschuren, W M Monique; Verstraeten, Roosmarijn; Victora, Cesar G; Viet, Lucie; Viikari-Juntura, Eira; Vineis, Paolo; Vioque, Jesus; Cifkova, Renata; Virtanen, Jyrki K; Visvikis-Siest, Sophie; Assunção, Maria Cecília F; Viswanathan, Bharathi; Vollenweider, Peter; Voutilainen, Sari; Vrdoljak, Ana; Vrijheid, Martine; Wade, Alisha N; Wagner, Aline; Claessens, Frank; Walton, Janette; Mohamud, Wan Nazaimoon Wan; Wang, Ming-Dong; Avdicová, Mária; Wang, Qian; Wang, Ya Xing; Wannamethee, S Goya; Wareham, Nicholas; Wedderkopp, Niels; Weerasekera, Deepa; Clays, Els; Whincup, Peter H; Widhalm, Kurt; Widyahening, Indah S; Wiecek, Andrzej; Azevedo, Ana; Wijga, Alet H; Wilks, Rainford J; Willeit, Johann; Willeit, Peter; Williams, Emmanuel A; Concin, Hans; Wilsgaard, Tom; Wojtyniak, Bogdan; Wong, Tien Yin; Wong-McClure, Roy A; Woo, Jean; Azizi, Fereidoun; Woodward, Mark; Wu, Aleksander Giwercman; Wu, Frederick C; Wu, Shou Ling; Cooper, Cyrus; Xu, Haiquan; Yan, Weili; Yang, Xiaoguang; Ye, Xingwang; Yiallouros, Panayiotis K; Yoshihara, Akihiro; Babu, Bontha V; Younger-Coleman, Novie O; Yusoff, Ahmad F; Yusoff, Muhammad Fadhli M; Cooper, Rachel; Zambon, Sabina; Zdrojewski, Tomasz; Zeng, Yi; Zhao, Dong; Zhao, Wenhua; Zheng, Yingffeng; Zhu, Dan; Bahijri, Suhad; Zimmermann, Esther; Zuñiga Cisneros, Julio; Coppinger, Tara C; Balakrishna, Nagalla; Bandosz, Piotr; Banegas, José R; Barbagallo, Carlo M; Barceló, Alberto; Barkat, Amina; Barros, Aluisio J D; Barros, Mauro V; Bata, Iqbal; Batieha, Anwar M; Peykari, Niloofar; Baur, Louise A; Beaglehole, Robert; Romdhane, Habiba Ben; Benet, Mikhail; Benson, Lowell S; Bernabe-Ortiz, Antonio; Bernotiene, Gailute; Bettiol, Heloisa; Bhagyalaxmi, Aroor; Bharadwaj, Sumit; Costanzo, Simona; Bhargava, Santosh K; Bi, Yufang; Cottel, Dominique; Cowell, Chris; Craig, Cora L; Crujeiras, Ana B; Cruz, Juan J; D'Arrigo, Graziella; d'Orsi, Eleonora; Dallongeville, Jean; Damasceno, Albertino; Zhang, Wan Zhu; Dankner, Rachel; Dantoft, Thomas M; Dauchet, Luc; De Backer, Guy; De Bacquer, Dirk; de Gaetano, Giovanni; De Henauw, Stefaan; De Smedt, Delphine; Deepa, Mohan; Dehghan, Abbas; Lu, Yuan; Delisle, HélèneBackground 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.
- Rising rural body-mass index is the main driver of the global obesity epidemic in adultsPublication . NCD Risk Factor Collaboration; Ornelas, RuiBody-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities1,2 . This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity3–6 . Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017—and more than 80% in some low- and middle-income regions—was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing—and in some countries reversal—of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.
- Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19·2 million participantsPublication . NCD Risk Factor Collaboration; Ornelas, RuiBackground Underweight and severe and morbid obesity are associated with highly elevated risks of adverse health outcomes. We estimated trends in mean body-mass index (BMI), which characterises its population distribution, and in the prevalences of a complete set of BMI categories for adults in all countries. Methods We analysed, with use of a consistent protocol, population-based studies that had measured height and weight in adults aged 18 years and older. We applied a Bayesian hierarchical model to these data to estimate trends from 1975 to 2014 in mean BMI and in the prevalences of BMI categories (<18·5 kg/m² [underweight], 18·5 kg/m² to <20 kg/m², 20 kg/m² to <25 kg/m², 25 kg/m² to <30 kg/m², 30 kg/m² to <35 kg/m², 35 kg/m² to <40 kg/m², ≥40 kg/m² [morbid obesity]), by sex in 200 countries and territories, organised in 21 regions. We calculated the posterior probability of meeting the target of halting by 2025 the rise in obesity at its 2010 levels, if post-2000 trends continue. Findings We used 1698 population-based data sources, with more than 19·2 million adult participants (9·9 million men and 9·3 million women) in 186 of 200 countries for which estimates were made. Global age-standardised mean BMI increased from 21·7 kg/m² (95% credible interval 21·3–22·1) in 1975 to 24·2 kg/m² (24·0–24·4) in 2014 in men, and from 22·1 kg/m² (21·7–22·5) in 1975 to 24·4 kg/m² (24·2–24·6) in 2014 in women. Regional mean BMIs in 2014 for men ranged from 21·4 kg/m² in central Africa and south Asia to 29·2 kg/m² (28·6–29·8) in Polynesia and Micronesia; for women the range was from 21·8 kg/m² (21·4–22·3) in south Asia to 32·2 kg/m² (31·5–32·8) in Polynesia and Micronesia. Over these four decades, age-standardised global prevalence of underweight decreased from 13·8% (10·5–17·4) to 8·8% (7·4–10·3) in men and from 14·6% (11·6–17·9) to 9·7% (8·3–11·1) in women. South Asia had the highest prevalence of underweight in 2014, 23·4% (17·8–29·2) in men and 24·0% (18·9–29·3) in women. Age-standardised prevalence of obesity increased from 3·2% (2·4–4·1) in 1975 to 10·8% (9·7–12·0) in 2014 in men, and from 6·4% (5·1–7·8) to 14·9% (13·6–16·1) in women. 2·3% (2·0–2·7) of the world’s men and 5·0% (4·4–5·6) of women were severely obese (ie, have BMI ≥35 kg/m²). Globally, prevalence of morbid obesity was 0·64% (0·46–0·86) in men and 1·6% (1·3–1·9) in women. Interpretation If post-2000 trends continue, the probability of meeting the global obesity target is virtually zero. Rather, if these trends continue, by 2025, global obesity prevalence will reach 18% in men and surpass 21% in women; severe obesity will surpass 6% in men and 9% in women. Nonetheless, underweight remains prevalent in the world’s poorest regions, especially in south Asia.
- Objectively measured time spent sedentary is associated with insulin resistance independent of overall and central body fat in 9-to 10-year-old portuguese childrenPublication . Sardinha, L. B.; Andersen, L. B.; Anderssen, S. A.; Quiterio, A. L.; Ornelas, Rui; Froberg, K.; Riddoch, C. J.; Ekelund, U.OBJECTIVE — We examined the independent relationships between objectively measured physical activity and insulin resistance in Portuguese children. RESEARCH DESIGN AND METHODS — This is a school-based, cross-sectional study in 147 randomly selected girls (aged 9.8 0.3 years; 27.8 9.3% body fat) and 161 boys (aged 9.8 0.3 years; 22.0 9.2% body fat). Physical activity was assessed by the Actigraph accel erometer for 4 days and summarized as time spent sedentary (accelerometer counts 500/min), in light-intensity (accelerometer counts 500–2,000/min), and in moderate- and vigorous intensity activity (accelerometer counts 2,001/min). We measured total and central fat mass by dual-energy X-ray absorptiometry. Insulin resistance was expressed as the homeostasis model assessment score. RESULTS — Time (min/day) spent sedentary was significantly and positively associated with insulin resistance ( -coefficient 0.001 [95% CI 0.0002–0.002]; P 0.013). Time spent in moderate- and vigorous-intensity physical activity ( 0.002 [ 0.003 to 0.001]; P 0.0009) and overall physical activity ( 0.001 [ 0.008 to 0.003]; P 0.0001) were significantly and inversely associated with insulin resistance. All associations remained statistically significant, although they were attenuated after further adjustments for sex, birth weight, sexual maturity, and total or central fat mass (P 0.03). CONCLUSIONS — Physical activity is associated with insulin resistance independent of total and central fat mass in children. Our results emphasize the importance of decreasing sedentary behavior and increasing time spent in moderate- and vigorous-intensity activity in children, which may have beneficial effects on metabolic risk factors regardless of the degree of adiposity.
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