Estimates of global prevalence of childhood underweight in 1990 and 2015.
02 Jun 2004-JAMA (American Medical Association)-Vol. 291, Iss: 21, pp 2600-2606
TL;DR: An overall improvement in the global situation is anticipated; however, neither the world as a whole, nor the developing regions, are expected to achieve the Millennium Development goals.
Abstract: ContextOne key target of the United Nations Millennium Development goals is to reduce the prevalence of underweight among children younger than 5 years by half between 1990 and 2015.ObjectiveTo estimate trends in childhood underweight by geographic regions of the world.Design, Setting, and ParticipantsTime series study of prevalence of underweight, defined as weight 2 SDs below the mean weight for age of the National Center for Health Statistics and World Health Organization (WHO) reference population. National prevalence rates derived from the WHO Global Database on Child Growth and Malnutrition, which includes data on approximately 31 million children younger than 5 years who participated in 419 national nutritional surveys in 139 countries from 1965 through 2002.Main Outcome MeasuresLinear mixed-effects modeling was used to estimate prevalence rates and numbers of underweight children by region in 1990 and 2015 and to calculate the changes (ie, increase or decrease) to these values between 1990 and 2015.ResultsWorldwide, underweight prevalence was projected to decline from 26.5% in 1990 to 17.6% in 2015, a change of –34% (95% confidence interval [CI], –43% to –23%). In developed countries, the prevalence was estimated to decrease from 1.6% to 0.9%, a change of –41% (95% CI, –92% to 343%). In developing regions, the prevalence was forecasted to decline from 30.2% to 19.3%, a change of –36% (95% CI, –45% to –26%). In Africa, the prevalence of underweight was forecasted to increase from 24.0% to 26.8%, a change of 12% (95% CI, 8%-16%). In Asia, the prevalence was estimated to decrease from 35.1% to 18.5%, a change of –47% (95% CI, –58% to –34%). Worldwide, the number of underweight children was projected to decline from 163.8 million in 1990 to 113.4 million in 2015, a change of −31% (95% CI, −40% to −20%). Numbers are projected to decrease in all subregions except the subregions of sub-Saharan, Eastern, Middle, and Western Africa, which are expected to experience substantial increases in the number of underweight children.ConclusionsAn overall improvement in the global situation is anticipated; however, neither the world as a whole, nor the developing regions, are expected to achieve the Millennium Development goals. This is largely due to the deteriorating situation in Africa where all subregions, except Northern Africa, are expected to fail to meet the goal.
TL;DR: The high mortality and disease burden resulting from these nutrition-related factors make a compelling case for the urgent implementation of interventions to reduce their occurrence or ameliorate their consequences.
Abstract: Maternal and child undernutrition is highly prevalent in low-income and middle-income countries, resulting in substantial increases in mortality and overall disease burden. In this paper, we present new analyses to estimate the effects of the risks related to measures of undernutrition, as well as to suboptimum breastfeeding practices on mortality and disease. We estimated that stunting, severe wasting, and intrauterine growth restriction together were responsible for 2·2 million deaths and 21% of disability-adjusted life-years (DALYs) for children younger than 5 years. Deficiencies of vitamin A and zinc were estimated to be responsible for 0·6 million and 0·4 million deaths, respectively, and a combined 9% of global childhood DALYs. Iron and iodine deficiencies resulted in few child deaths, and combined were responsible for about 0·2% of global childhood DALYs. Iron deficiency as a risk factor for maternal mortality added 115 000 deaths and 0·4% of global total DALYs. Suboptimum breastfeeding was estimated to be responsible for 1·4 million child deaths and 44 million DALYs (10% of DALYs in children younger than 5 years). In an analysis that accounted for co-exposure of these nutrition-related factors, they were together responsible for about 35% of child deaths and 11% of the total global disease burden. The high mortality and disease burden resulting from these nutrition-related factors make a compelling case for the urgent implementation of interventions to reduce their occurrence or ameliorate their consequences.
TL;DR: Global Burden of Disease and Risk Factors examines the comparative importance of diseases, injuries, and risk factors; it incorporates a range of new data sources to develop consistent estimates of incidence, prevalence, severity and duration, and mortality for 136 major diseases and injuries.
Abstract: This volume is a single up-to-date source on the entire global epidemiology of diseases, injuries and risk factors with a comprehensive statement of methods and a complete presentation of results. It includes refined methods to assess data, ensure epidemiological consistency, and summarize the disease burden. Global Burden of Disease and Risk Factors examines the comparative importance of diseases, injuries, and risk factors; it incorporates a range of new data sources to develop consistent estimates of incidence, prevalence, severity and duration, and mortality for 136 major diseases and injuries. Drawing from more than 8,500 data sources that include epidemiological studies, disease registers, and notifications systems, this book incorporates information from more than 10,000 datasets relating to population health and mortality, representing one of the largest syntheses of global information on population health to date.
TL;DR: The need for effective interventions starting as early as infancy to reverse anticipated trends of childhood overweight and obesity have increased dramatically since 1990 are confirmed.
Abstract: Background: Childhood obesity is associated with serious health problems and the risk of premature illness and death later in life. Monitoring related trends is important. Objective: The objective was to quantify the worldwide prevalence and trends of overweight and obesity among preschool children on the basis of the new World Health Organization standards. Design: A total of 450 nationally representative cross-sectional surveys from 144 countries were analyzed. Overweight and obesity were defined as the proportion of preschool children with values .2 SDs and .3 SDs, respectively, from the World Health Organization growth standard median. Being “at risk of overweight” was defined as the proportion with values .1 SD and 2 SDs, respectively. Linear mixed-effects modeling was used to estimate the rates and numbers of affected children. Results: In 2010, 43 million children (35 million in developing countries) were estimated to be overweight and obese; 92 million were at risk of overweight. The worldwide prevalence of childhood overweight and obesity increased from 4.2% (95% CI: 3.2%, 5.2%) in 1990 to 6.7% (95% CI: 5.6%, 7.7%) in 2010. This trend is expected to reach 9.1% (95% CI: 7.3%, 10.9%), or ’60 million, in 2020. The estimated prevalence of childhood overweight and obesity in Africa in 2010 was 8.5% (95% CI: 7.4%, 9.5%) and is expected to reach 12.7% (95% CI: 10.6%, 14.8%) in 2020. The prevalence is lower in Asia than in Africa (4.9% in 2010), but the number of affected children (18 million) is higher in Asia. Conclusions: Childhood overweight and obesity have increased dramatically since 1990. These findings confirm the need for effective interventions starting as early as infancy to reverse anticipated trends. Am J Clin Nutr 2010;92:1257‐64.
01 Jan 2006
TL;DR: The unequivocal choice now is between continuing to fail as the global community did with HIV/AIDS for more than a decade or to finally make nutrition central to development so that a wide range of economic and social improvements that depend on nutrition can be realized.
Abstract: It has long been known that malnutrition undermines economic growth and perpetuates poverty. Yet the international community and most governments in developing countries have failed to tackle malnutrition over the past decades even though well-tested approaches for doing so exist. The consequences of this failure to act are now evident in the worlds inadequate progress toward the Millennium Development Goals (MDGs) and toward poverty reduction more generally. Persistent malnutrition is contributing not only to widespread failure to meet the first MDG--to halve poverty and hunger--but to meet other goals in maternal and child health HIV/AIDS education and gender equity. The unequivocal choice now is between continuing to fail as the global community did with HIV/AIDS for more than a decade or to finally make nutrition central to development so that a wide range of economic and social improvements that depend on nutrition can be realized. (excerpt)
TL;DR: These global data provide the best estimates to date of nutrition transitions across the world and inform policies and priorities for reducing the health and economic burdens of poor diet quality.
Abstract: Summary Background Healthy dietary patterns are a global priority to reduce non-communicable diseases. Yet neither worldwide patterns of diets nor their trends with time are well established. We aimed to characterise global changes (or trends) in dietary patterns nationally and regionally and to assess heterogeneity by age, sex, national income, and type of dietary pattern. Methods In this systematic assessment, we evaluated global consumption of key dietary items (foods and nutrients) by region, nation, age, and sex in 1990 and 2010. Consumption data were evaluated from 325 surveys (71·7% nationally representative) covering 88·7% of the global adult population. Two types of dietary pattern were assessed: one reflecting greater consumption of ten healthy dietary items and the other based on lesser consumption of seven unhealthy dietary items. The mean intakes of each dietary factor were divided into quintiles, and each quintile was assigned an ordinal score, with higher scores being equivalent to healthier diets (range 0–100). The dietary patterns were assessed by hierarchical linear regression including country, age, sex, national income, and time as exploratory variables. Findings From 1990 to 2010, diets based on healthy items improved globally (by 2·2 points, 95% uncertainty interval (UI) 0·9 to 3·5), whereas diets based on unhealthy items worsened (−2·5, −3·3 to −1·7). In 2010, the global mean scores were 44·0 (SD 10·5) for the healthy pattern and 52·1 (18·6) for the unhealthy pattern, with weak intercorrelation ( r =–0·08) between countries. On average, better diets were seen in older adults compared with younger adults, and in women compared with men (p Interpretation Consumption of healthy items improved, while consumption of unhealthy items worsened across the world, with heterogeneity across regions and countries. These global data provide the best estimates to date of nutrition transitions across the world and inform policies and priorities for reducing the health and economic burdens of poor diet quality. Funding The Bill & Melinda Gates Foundation and Medical Research Council.
TL;DR: In this article, categorical data analysis was used for categorical classification of categorical categorical datasets.Categorical Data Analysis, categorical Data analysis, CDA, CPDA, CDSA
Abstract: categorical data analysis , categorical data analysis , کتابخانه مرکزی دانشگاه علوم پزشکی تهران
TL;DR: In this article, a unified approach to fitting two-stage random-effects models, based on a combination of empirical Bayes and maximum likelihood estimation of model parameters and using the EM algorithm, is discussed.
Abstract: Models for the analysis of longitudinal data must recognize the relationship between serial observations on the same unit. Multivariate models with general covariance structure are often difficult to apply to highly unbalanced data, whereas two-stage random-effects models can be used easily. In two-stage models, the probability distributions for the response vectors of different individuals belong to a single family, but some random-effects parameters vary across individuals, with a distribution specified at the second stage. A general family of models is discussed, which includes both growth models and repeated-measures models as special cases. A unified approach to fitting these models, based on a combination of empirical Bayes and maximum likelihood estimation of model parameters and using the EM algorithm, is discussed. Two examples are taken from a current epidemiological study of the health effects of air pollution.
26 Mar 2013
TL;DR: Using data of 955 men, Brant et al showed that the average rates of increase of systolic blood pressure (SBP) are smallest in the younger age groups, and greatest in the older agegroups, and that obese individuals tend to have a higher SBP than non-obese individuals.
Abstract: In medical science, studies are often designed to investigate changes in a specific parameter which is measured repeatedly over time in the participating subjects. This allows one to model the process of change within individuals. Although this process occurs in every individual, the inter subject variability can be high. For example, using data of 955 men, Brant et al showed that the average rates of increase of systolic blood pressure (SBP) are smallest in the younger age groups, and greatest in the older age groups, that obese individuals tend to have a higher SBP than non-obese individuals, and that individuals in more recent birth cohorts have lower SBP’s than those born before 1910. However, these factors are not sufficient to explain all the heterogeneity between individuals since, after correction for age, obesity and birth cohort, individuals with SBP’s above (below) average at initial examination, still have slower (faster) rates of longitudinal change in SBP.
TL;DR: Substantial proportions of global disease burden are attributable to these major risks, to an extent greater than previously estimated.
Abstract: Summary Background Reliable and comparable analysis of risks to health is key for preventing disease and injury. Causal attribution of morbidity and mortality to risk factors has traditionally been in the context of individual risk factors, Often in a limited number of settings, restricting comparability. Our aim was to estimate the contributions of selected major risk factors to global and regional burden of disease in a unified framework. Methods For 26 selected risk factors, expert working groups undertook a comprehensive review of published work and other sources-eg, government reports and international databases-to obtain data on the prevalence of risk factor exposure and hazard size for 14 epidemiological regions of the world. Population attributable fractions were estimated by applying the potential impact fraction relation, and applied to the mortality and burden of disease estimates from the global burden of disease (GBD) database. Findings Childhood and maternal underweight (138 million disability adjusted life years [DALY], 9·5%), unsafe sex (92 million DALY, 6·3%), high blood pressure (64 million DALY, 4·4%), tobacco (59 million DALY, 4·1%), and alcohol (58 million DALY, 4·0%) were the leading causes of global burden of disease. In the poorest regions of the world, childhood and maternal underweight, unsafe sex, unsafe water, sanitation, and hygiene, indoor smoke from solid fuels, and various micronutrient deficiencies were major contributors to loss of healthy life. In both developing and developed regions, alcohol, tobacco, high blood pressure, and high cholesterol were major causes of disease burden. Interpretation Substantial proportions of global disease burden are attributable to these major risks, to an extent greater than previously estimated. Developing countries suffer most or all of the burden due to many of the leading risks. Strategies that target these known risks can provide substantial and underestimated public-health gains. Published online Oct 30, 2002 http://image.thelancet.com/extras/02art9066web.pdf