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1. Associations of movement behaviours and dietary intake with arterial stiffness: results from the ORISCAV-LUX 2 cross-sectional study

Author: Saverio Stranges, Ala’a Alkerwi, Guy Fagherazzi, Laurent Malisoux, Michel Vaillant, Isabelle Ernens, Manon Gantenbein, Laetitia Huiart, Jean-Claude Schmit, Dritan Bejko, Anne Backes, Farhad Vahid, María Ruiz, Gloria A Aguayo, Yvan Devaux, Magali Perquin, Paul J Collings, Berta Portugal, Lilly Carina Quintero, Gwenaëlle Le Coroller, Stephanie Noppe, Charles Delagardelle, Jean Beissel, Anna Chioti, Marie-Lise Lair, Marylène D’Incau, Jessica Pastore, Brice Appenzeller, and Sophie Couffignal
Subjects: Medicine
Abstract: Objective Adopting a physically active lifestyle and maintaining a diet rich in antioxidants can reduce the risk of vascular diseases. Arterial stiffness is an early marker for cardiovascular diseases, indicating vascular damage. This study investigates the relationship between physical activity (PA), sedentary behaviour (SB), dietary antioxidant, trace elements intake and vascular health in men and women, with a focus on pulse wave velocity (PWV), the gold standard for assessing arterial stiffness.Design This is a nationwide population-based cross-sectional study (Observation of Cardiovascular Risk Factors in Luxembourg 2 (ORISCAV-LUX 2)).Setting The study was conducted in Luxembourg, between November 2016 and January 2018.Participants In total, 988 participants from the ORISCAV-LUX 2 study, who were Luxembourg residents, aged 25–79 years, underwent the required physical examination, agreed to wear an accelerometer for 1 week and presented no personal history of myocardial infarction or stroke, were included in the analysis.Primary outcome measure PWV was assessed with the validated Complior instrument. Elastic-net models were used to investigate the associations of dietary intake (antioxidant and trace elements) and movement behaviours (PA and SB) with PWV in men and women.Results The findings reveal diverse associations between PA, SB, dietary intake and PWV, with distinct patterns observed in men and women. In women, a longer median moderate-to-vigorous PA bout length (mean coefficient (β)=−0.039), a higher long-range temporal correlation (higher scaling exponent alpha) at larger time scales (>120 min; β=−1.247) and an increased intake of vitamin C (β=−1.987) and selenium (β=−0.008) were associated with lower PWV. In men, a shorter median SB bout length (β=0.019) and a lower proportion of SB time accumulated in bouts longer than 60 min (β=1.321) were associated with lower PWV. Moreover, a higher daily intake of polyphenols (β=−0.113) and selenium (β=−0.004) was associated with lower PWV in men.Conclusion This study underscores the multifaceted nature of the associations between movement behaviours and dietary intake with PWV, as well as sex differences. These findings highlight the significance of considering both movement behaviours and dietary antioxidant intake in cardiovascular health assessments.
Published: 2024
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2. Conducting national burden of disease studies and knowledge translation in eight small European states: challenges and opportunities

Author: Sarah Cuschieri, Ala’a Alkerwi, Mary Economou, Jane Idavain, Taavi Lai, Tina Lesnik, Caine Meyers, Hanen Samouda, Inga Dóra Sigfúsdóttir, Natasa Terzic, Lilian Tzivian, and Elena Pallari
Subjects: Burden of disease, Knowledge translation, Small countries, Research, Public aspects of medicine, RA1-1270
Abstract: Abstract Background Several countries across Europe are engaging in burden of disease (BoD) studies. This article aims to understand the experiences of eight small European states in relation to their research opportunities and challenges in conducting national BoD studies and in knowledge translation of research outputs to policy-making. Methods Countries participating in the study were those outlined by the WHO/Europe Small Countries Initiative and members of the Cooperation in Science and Technology (COST) Action CA18218 European Burden of Disease Network. A set of key questions targeting the research landscape were distributed to these members. WHO’s framework approach for research development capacities was applied to gain a comprehensive understanding of shortages in relation to national BoD studies in order to help strengthen health research capacities in the small states of Europe. Results Most small states lack the resources and expertise to conduct BoD studies, but nationally representative data are relatively accessible. Public health officials and researchers tend to have a close-knit relationship with the governing body and policy-makers. The major challenge faced by small states is in knowledge generation and transfer rather than knowledge translation. Nevertheless, some policy-makers fail to make adequate use of knowledge translation. Conclusions Small states, if equipped with adequate resources, may have the capacity to conduct national BoD studies. This work can serve as a model for identifying current gaps and opportunities in each of the eight small European countries, as well as a guide for translating country BoD study results into health policy.
Published: 2022
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3. Methodological considerations in injury burden of disease studies across Europe: a systematic literature review

Author: Periklis Charalampous, Elena Pallari, Vanessa Gorasso, Elena von der Lippe, Brecht Devleesschauwer, Sara M. Pires, Dietrich Plass, Jane Idavain, Che Henry Ngwa, Isabel Noguer, Alicia Padron-Monedero, Rodrigo Sarmiento, Marek Majdan, Balázs Ádám, Ala’a AlKerwi, Seila Cilovic-Lagarija, Benjamin Clarsen, Barbara Corso, Sarah Cuschieri, Keren Dopelt, Mary Economou, Florian Fischer, Alberto Freitas, Juan Manuel García-González, Federica Gazzelloni, Artemis Gkitakou, Hakan Gulmez, Paul Hynds, Gaetano Isola, Lea S. Jakobsen, Zubair Kabir, Katarzyna Kissimova-Skarbek, Ann Kristin Knudsen, Naime Meriç Konar, Carina Ladeira, Brian Lassen, Aaron Liew, Marjeta Majer, Enkeleint A. Mechili, Alibek Mereke, Lorenzo Monasta, Stefania Mondello, Joana Nazaré Morgado, Evangelia Nena, Edmond S. W. Ng, Vikram Niranjan, Iskra Alexandra Nola, Rónán O’Caoimh, Panagiotis Petrou, Vera Pinheiro, Miguel Reina Ortiz, Silvia Riva, Hanen Samouda, João Vasco Santos, Cornelia Melinda Adi Santoso, Milena Santric Milicevic, Dimitrios Skempes, Ana Catarina Sousa, Niko Speybroeck, Fimka Tozija, Brigid Unim, Hilal Bektaş Uysal, Fabrizio Giovanni Vaccaro, Orsolya Varga, Milena Vasic, Francesco Saverio Violante, Grant M. A. Wyper, Suzanne Polinder, and Juanita A. Haagsma
Subjects: Burden of disease, Burden of Injury, Disability-adjusted life years, Review, Methodology, Public aspects of medicine, RA1-1270
Abstract: Abstract Background Calculating the disease burden due to injury is complex, as it requires many methodological choices. Until now, an overview of the methodological design choices that have been made in burden of disease (BoD) studies in injury populations is not available. The aim of this systematic literature review was to identify existing injury BoD studies undertaken across Europe and to comprehensively review the methodological design choices and assumption parameters that have been made to calculate years of life lost (YLL) and years lived with disability (YLD) in these studies. Methods We searched EMBASE, MEDLINE, Cochrane Central, Google Scholar, and Web of Science, and the grey literature supplemented by handsearching, for BoD studies. We included injury BoD studies that quantified the BoD expressed in YLL, YLD, and disability-adjusted life years (DALY) in countries within the European Region between early-1990 and mid-2021. Results We retrieved 2,914 results of which 48 performed an injury-specific BoD assessment. Single-country independent and Global Burden of Disease (GBD)-linked injury BoD studies were performed in 11 European countries. Approximately 79% of injury BoD studies reported the BoD by external cause-of-injury. Most independent studies used the incidence-based approach to calculate YLDs. About half of the injury disease burden studies applied disability weights (DWs) developed by the GBD study. Almost all independent injury studies have determined YLL using national life tables. Conclusions Considerable methodological variation across independent injury BoD assessments was observed; differences were mainly apparent in the design choices and assumption parameters towards injury YLD calculations, implementation of DWs, and the choice of life table for YLL calculations. Development and use of guidelines for performing and reporting of injury BoD studies is crucial to enhance transparency and comparability of injury BoD estimates across Europe and beyond.
Published: 2022
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4. Conducting national burden of disease studies in small countries in Europe– a feasible challenge?

Author: Sarah Cuschieri, Elena Pallari, Natasa Terzic, Ala’a Alkerwi, Rannveig Sigurvinsdottir, Inga Dora Sigfusdottir, and Brecht Devleesschauwer
Subjects: Burden of disease, DALY, YLD, YLL, Morbidity, Mortality, Public aspects of medicine, RA1-1270
Abstract: Abstract Background Burden of Disease (BoD) studies use disability-adjusted life years (DALYs) as a population health metric to quantify the years of life lost due to morbidity and premature mortality for diseases, injuries and risk factors occurring in a region or a country. Small countries usually face a number of challenges to conduct epidemiological studies, such as national BoD studies, due to the lack of specific expertise and resources or absence of adequate data. Considering Europe’s small countries of Cyprus, Iceland, Luxembourg, Malta and Montenegro, the aim was to assess whether the various national data sources identified are appropriate to perform national BoD studies. Main body The five small countries have a well-established mortality registers following the ICD10 classification, which makes calculation of years of life lost (YLL) feasible. A number of health information data sources were identified in each country, which can provide prevalence data for the calculation of years lived with disability (YLD) for various conditions. These sources include disease-specific registers, hospital discharge data, primary health care data and epidemiological studies, provided by different organisations such as health directorates, institutes of public health, statistical offices and other bodies. Hence, DALYs can be estimated at a national level through the combination of the YLL and YLD information. On the other hand, small countries face unique challenges such as difficulty to ensure sample representativeness, variations in prevalence estimates especially for rarer diseases, existence of a substantial proportion of non-residents affiliated to healthcare systems and potential exclusion from some European or international initiatives. Recently established BoD networks may provide a platform for small countries to share experiences, expertise, and engage with countries and institutions that have long-standing experience with BoD assessment. Conclusion Apart from mortality registries, adequate health data sources, notably for cancer, are potentially available at the small states to perform national BoD studies. Investing in sharing expert knowledge through engagement of researchers in BoD networks can enable the conduct of country specific BoD studies and the establishment of more accurate DALYs estimates. Such estimates can enable local policymakers to reflect on the relative burden of the different conditions that are contributing to morbidity and mortality at a country level.
Published: 2021
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5. Mapping the burden of diabetes in five small countries in Europe and setting the agenda for health policy and strategic action

Author: Sarah Cuschieri, Elena Pallari, Natasa Terzic, Ala’a Alkerwi, and Árún Kristín Sigurðardóttir
Subjects: Type 2 diabetes, Noncommunicable diseases, Healthcare systems, Health policy, Healthcare delivery, Global burden of diseases, Public aspects of medicine, RA1-1270
Abstract: Abstract Background Diabetes is a global epidemic affecting every country. Small countries, however, face distinctive challenges related to their health system governance and their ability to implement effective health systems’ reforms. The aim of this research was to perform a comparative assessment of existing diabetes management practices at the population level and explore governmental-related policy for Cyprus, Iceland, Luxembourg, Malta and Montenegro. This is the first time that such an evidence-based review study has been performed in the field of diabetes. The overall purpose was to set the agenda for health policy and inform strategic actions for small countries that can benefit from dealing with the diabetes epidemic at a country level. Methods We collected data and synthesized the evidence on dealing with diabetes for each of the five small European countries according to the (1) epidemiology of diabetes and other related metabolic abnormalities, (2) burden of diabetes status and (3) diabetes registers and national plans. We collected data by contacting Ministry representatives and other bodies in each state, and by searching through publicly available information from the respective Ministry of Health website on strategies and policies. Results Diabetes rates were highest in Cyprus and Malta. National diabetes registers are present in Cyprus and Montenegro, while national diabetes plans and diabetes-specific strategies have been established in Cyprus, Malta and Montenegro. These three countries also offer a free holistic healthcare service to their diabetes population. Conclusions Multistakeholder, national diabetes plans and public health strategies are important means to provide direction on diabetes management and health service provision at the population level. However, political support is not always present, as seen for Iceland. The absence of evidence-based strategies, lack of funding for conducting regular health examination surveys, omission of monitoring practices and capacity scarcity are among the greatest challenges faced by small countries to effectively measure health outcomes. Nevertheless, we identified means of how these can be overcome. For example, the creation of public interdisciplinary repositories enables easily accessible data that can be used for health policy and strategic planning. Health policy-makers, funders and practitioners can consider the use of regular health examination surveys and other tools to effectively manage diabetes at the population level.
Published: 2021
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6. Population-based biomonitoring of exposure to persistent and non-persistent organic pollutants in the Grand Duchy of Luxembourg: Results from hair analysis

Author: Feng-Jiao Peng, Claude Emond, Emilie M. Hardy, Nicolas Sauvageot, Ala'a Alkerwi, Marie-Lise Lair, and Brice M.R. Appenzeller
Subjects: Human biomonitoring, General adult population, Hair analysis, Multiclass pesticides, Multiclass POPs, Environmental exposure, Environmental sciences, GE1-350
Abstract: Environmental exposure of humans to pollutants has been associated with adverse health outcomes, but few studies have evaluated the multiple exposure of general populations. In the present study, we used hair analysis to assess the exposure of a general adult population (n = 497) in Luxembourg to 34 persistent and 33 non-persistent organic pollutants from 11 chemical families, such as polychlorinated biphenyls (PCBs), polybrominated diphenyl ethers (PBDEs), organochlorine pesticides (OCPs), organophosphate pesticides (OPPs), and pyrethroid pesticides (PYRs). We detected 24 persistent and 29 non-persistent organic pollutants, with 17 pollutants being detected in more than 50% of hair samples. The median concentrations for pollutants detected in 100% of the samples were 0.37 pg/mg for lindane (γ-HCH), 0.15 pg/mg for hexachlorobenzene (HCB), 14.1 pg/mg for p-nitrophenyl (PNP), and 0.10 pg/mg for trifluralin. Each participant in this study had detectable levels of at least 10 of the pollutants analyzed, and 50% of participants had 19 or more, suggesting the simultaneous exposure to numerous different pollutants among our study population. Significant correlations were often found between pollutants from the same family, with the strongest being found between two PYR metabolites, trans/cis-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane-carboxylic acid (Cl2CA) and 3-phenoxybenzoic acid (3-PBA). Results from multiple linear regression analyses showed that sex, age and/or body mass index were significantly associated with 15 out of the 17 frequently detected pollutants. The current study is the first nationwide biomonitoring investigating organic contaminants in the Luxembourg population using hair analysis.
Published: 2021
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7. Challenges and benefits of integrating diverse sampling strategies in the observation of cardiovascular risk factors (ORISCAV-LUX 2) study

Author: Ala’a Alkerwi, Jessica Pastore, Nicolas Sauvageot, Gwenaëlle Le Coroller, Valéry Bocquet, Marylène d’Incau, Gloria Aguayo, Brice Appenzeller, Dritan Bejko, Torsten Bohn, Laurent Malisoux, Sophie Couffignal, Stephanie Noppe, Charles Delagardelle, Jean Beissel, Anna Chioti, Saverio Stranges, and Jean-Claude Schmit
Subjects: Sample representativeness, Population-based study, Follow-up studies, population health, Epidemiology, Medicine (General), R5-920
Abstract: Abstract Background It is challenging to manage data collection as planned and creation of opportunities to adapt during the course of enrolment may be needed. This paper aims to summarize the different sampling strategies adopted in the second wave of Observation of Cardiovascular Risk Factors (ORISCAV-LUX, 2016–17), with a focus on population coverage and sample representativeness. Methods Data from the first nationwide cross-sectional, population-based ORISCAV-LUX survey, 2007–08 and from the newly complementary sample recruited via different pathways, nine years later were analysed. First, we compare the socio-demographic characteristics and health profiles between baseline participants and non-participants to the second wave. Then, we describe the distribution of subjects across different strategy-specific samples and performed a comparison of the overall ORISCAV-LUX2 sample to the national population according to stratification criteria. Results For the baseline sample (1209 subjects), the participants (660) were younger than the non-participants (549), with a significant difference in average ages (44 vs 45.8 years; P = 0.019). There was a significant difference in terms of education level (P
Published: 2019
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8. Prevalence and related risk factors of chronic kidney disease among adults in Luxembourg: evidence from the observation of cardiovascular risk factors (ORISCAV-LUX) study

Author: Ala’a Alkerwi, Nicolas Sauvageot, Illiasse El Bahi, Charles Delagardelle, Jean Beissel, Stephanie Noppe, Paul J. Roderick, Jennifer S. Mindell, and Saverio Stranges
Subjects: Chronic kidney disease (CKD), Glomerular filtration rate, Albuminuria, Population-based study, Epidemiology, Diseases of the genitourinary system. Urology, RC870-923
Abstract: Abstract Background Evidence on stages of renal impairment and related risk factors in Luxembourg is lacking. This study aimed to assess the prevalence of chronic kidney disease (CKD) and identify potential correlates among the general population, using the recent definition suggested by the Kidney Disease Improving Global Outcomes guidelines. Methods Data analysed from 1361 participants aged 18–69 years, enrolled in the Observation of Cardiovascular Risk Factors in Luxembourg (ORISCAV-LUX) study, 2007–08. Descriptive and multivariable logistic regression analyses were performed to identify demographic, socio-economic, behavioural, and clinical factors associated with CKD, defined as a single estimated glomerular filtration rate (eGFR) measure 30 mg/g. Results Overall, 6.3% had CKD, including 4.4% and 0.7% with moderate and severe macroalbuminuria respectively. 0.1% had kidney failure (eGFR
Published: 2017
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9. Association of Empirically Derived Dietary Patterns with Cardiovascular Risk Factors: A Comparison of PCA and RRR Methods.

Author: Nicolas Sauvageot, Sonia Leite, Ala'a Alkerwi, Leila Sisanni, Faiez Zannad, Stranges Saverio, Anne-Françoise Donneau, Adelin Albert, and Michèle Guillaume
Subjects: Medicine, Science
Abstract: INTRODUCTION:Principal component analysis is used to determine dietary behaviors of a population whereas reduced rank regression is used to construct disease-related dietary patterns. This study aimed to compare both types of DP and theirs associations with cardiovascular risk factors (CVRF). MATERIEL AND METHODS:Data were derived from the cross sectional NESCAV (Nutrition, Environment and Cardiovascular Health) study, aiming to describe the cardiovascular health of the Greater region's population (Grand duchy of Luxembourg, Wallonia (Belgium), Lorraine (France)). 2298 individuals were included for this study and dietary intake was assessed using a 134-item food frequency questionnaire. RESULTS:We found that CVRF-related patterns also reflect eating behaviours of the population. Comparing concordant food groups between both dietary pattern methods, a diet high in fruits, oleaginous and dried fruits, vegetables, olive oil, fats rich in omega 6 and tea and low in fried foods, lean and fatty meat, processed meat, ready meal, soft drink and beer was associated with lower prevalence of CVRF. In the opposite, a pattern characterized by high intakes of fried foods, meat, offal, beer, wine and aperitifs and spirits, and low intakes of cereals, sugar and sweets and soft drinks was associated with higher prevalence of CVRF. CONCLUSION:In sum, we found that a "Prudent" and "Animal protein and alcohol" patterns were both associated with CVRF and behaviourally meaningful. Moreover, the relationships of those dietary patterns with lifestyle characteristics support the theory that food choices are part of a larger pattern of healthy lifestyle.
Published: 2016
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10. Correction: Association of Empirically Derived Dietary Patterns with Cardiovascular Risk Factors: A Comparison of PCA and RRR Methods.

Author: Nicolas Sauvageot, Sonia Leite, Ala'a Alkerwi, Leila Sisanni, Faiez Zannad, Saverio Stranges, Anne-Françoise Donneau, Adelin Albert, and Michèle Guillaume
Subjects: Medicine, Science
Abstract: [This corrects the article DOI: 10.1371/journal.pone.0161298.].
Published: 2016
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11. Adherence to physical activity recommendations and its associated factors: an interregional population-based study

Author: Ala'a Alkerwi, Barbara Schuh, Nicolas Sauvageot, Faiez Zannad, Arnaud Olivier, Michèle Guillaume, Adelin Albert, Charlotte A. Larsson, and on behalf of NESCaV project group
Subjects: physical activity, cardiovascular risk factors, greater region, cross-border comparison, Public aspects of medicine, RA1-1270
Abstract: Background. Though the influence of physical activity in preventing cardiovascular diseases is well documented, only a few comparative studies have determined the degree of adherence to physical activity recommendations among populations and identified the demographic, socioeconomic, behavioural and health-related factors associated with good compliance. Design and methods. Cross-sectional interregional NESCaV survey of 3133 subjects compared three populations, Luxembourg, Lorraine (France) and Wallonia (Belgium), by using the International Physical Activity Questionnaire. Age and gender prevalence rates of physical activity were standardized to the European population. Results. The likelihood to meet the recommendations was higher in Luxembourg, after adjustment for age, gender, education, employment, weight status, morbidity score, health perception and level of importance attributed to the practice of physical activity (PConclusions. Region, education, self-perceived health and perception of importance of physical activity were emerged as independent determinants of meeting the recommendations. Awareness of the positive health effects of physical activity might thus be crucial for motivating the people to become more active. Further research is needed to explore potential region-specific factors which might explain the difference in population behaviours with respect to physical activity.
Published: 2015
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12. Cardiovascular health and cognitive function: the Maine-Syracuse Longitudinal Study.

Author: Georgina E Crichton, Merrill F Elias, Adam Davey, and Ala'a Alkerwi
Subjects: Medicine, Science
Abstract: BackgroundSmoking, physical inactivity, and poor diet, along with obesity, fasting glucose and blood pressure have been independently associated with poorer cognitive performance. Few studies have related scales representing a combination of these variables to multiple domains of cognitive performance. The aim of this study was to investigate the association between overall cardiovascular health, incorporating seven components, and cognitive function.MethodsA cross-sectional analysis employing 972 participants, from the Maine-Syracuse Longitudinal Study was undertaken. Four health behaviors (body mass index, physical activity, diet, smoking) and three health factors (total cholesterol, blood pressure, and fasting plasma glucose) were measured. Each was categorized according to the American Heart Association definitions for ideal cardiovascular health, except diet, for which two food scores were calculated. A Cardiovascular Health Score was determined by summing the number of cardiovascular metrics at ideal levels. Cognitive function was assessed using a thorough neuropsychological test battery.ResultsCardiovascular Health Score was positively associated with seven out of eight measures of cognitive function, with adjustment for age, education, and gender. With further adjustment for cardiovascular and psychological variables, these associations remained significant for Visual-Spatial Memory, Working Memory, Scanning and Tracking, Executive Function and the Global Composite score (pConclusionIncreasing cardiovascular health, indexed by a higher number of metrics at ideal levels, is associated with greater cognitive performance. Smoking, physical activity, and diet are important components of cardiovascular health that impact upon cognition.
Published: 2014
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13. Association of sedentary behavior time with ideal cardiovascular health: the ORISCAV-LUX study.

Author: Georgina E Crichton and Ala'a Alkerwi
Subjects: Medicine, Science
Abstract: BackgroundRecently attention has been drawn to the health impacts of time spent engaging in sedentary behaviors. No studies have examined sedentary behaviors in relation to the newly defined construct of ideal cardiovascular health, which incorporates three health factors (blood pressure, total cholesterol, fasting plasma glucose) and four behaviors (physical activity, smoking, body mass index, diet). The purpose of this study was to examine associations between sedentary behaviors, including sitting time, and time spent viewing television and in front of a computer, with cardiovascular health, in a representative sample of adults from Luxembourg.MethodsA cross-sectional analysis of 1262 participants in the Observation of Cardiovascular Risk Factors in Luxembourg study was conducted, who underwent objective cardiovascular health assessments and completed the International Physical Activity Questionnaire. A Cardiovascular Health Score was calculated based on the number of health factors and behaviors at ideal levels. Sitting time on a weekday, television time, and computer time (both on a workday and a day off), were related to the Cardiovascular Health Score.ResultsHigher weekday sitting time was significantly associated with a poorer Cardiovascular Health Score (p = 0.002 for linear trend), after full adjustment for age, gender, education, income and occupation. Television time was inversely associated with the Cardiovascular Health Score, on both a workday and a day off (p = 0.002 for both). A similar inverse relationship was observed between the Cardiovascular Health Score and computer time, only on a day off (p = 0.04).ConclusionHigher time spent sitting, viewing television, and using a computer during a day off may be unfavorably associated with ideal cardiovascular health.
Published: 2014
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14. Level of unawareness and management of diabetes, hypertension, and dyslipidemia among adults in Luxembourg: findings from ORISCAV-LUX study.

Author: Ala'a Alkerwi, Sybil Pagny, Marie-Lise Lair, Charles Delagardelle, and Jean Beissel
Subjects: Medicine, Science
Abstract: BACKGROUND: In the absence of evidence-based information, assessment of population awareness and management of diabetes, hypertension and dyslipidemia (treatable and preventable cardiovascular risk factors) are important to halt coronary and cerebrovascular diseases and to improve public health. METHODS: The analysis was based on a nationally representative sample of 1432 adult subjects, recruited for the ORISCAV-LUX survey (2007-2008). Descriptive and multivariable logistic regression analyses were performed. The 10-year Framingham risk score was calculated for each participant who classified at low, intermediate and high risk. RESULTS: Among the diagnosed cases, 32%, 60%, and 85% were respectively unaware of their diabetes, hypertension and dyslipidemia. Increasing age and BMI were the strongest protective factors against unawareness of hypertension and dyslipidemia. Having a family history decreased the risk of unawareness of hypertension (OR = 0.57; 95% CI 0.36, 0.92; P = 0.021), whereas, not having a family doctor increased double-fold the odd of being unaware of hypertension (P = 0.048). Poor health perception reduced significantly the risk of unawareness of dyslipidemia (OR = 0.27; 95% CI 0.11, 0.68). Concerning the management, diabetes was markedly better treated than hypertension and dyslipidemia. Among diabetic subjects (constituting 4% of the population), 3% were treated vs. 1% not treated. In contrast, 22% of the hypertensive participants (35% of the population) were not treated vs. 13% treated. Concerning dyslipidemia, only 9% of those with lipid disorder (70% of the population) were under medication vs. 61% not treated. For the treated cases of these pathologies, almost only one-third was under control. Framingham risk of developing CHD within 10 years was moderate to high among 62%, 27%, and 17% of the unaware/untreated diabetic, hypertensive, and dyslipidemic participants, respectively. CONCLUSION: The considerable lack of awareness and insufficient management underscore the urgent need for intensive efforts to reduce the gap in prevention strategies, and control of cases according to explicit clinical guidelines.
Published: 2013
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15. Monitoring COVID-19 vaccine effectiveness against COVID-19 hospitalisation and death using electronic health registries in ≥65-years-old population in six European countries, October 2021 to November 2022

Author: Irina Kislaya, Alexis Sentís, Jostein Starrfelt, Baltasar Nunes, Iván Martínez-Baz, Katrine Finderup Nielsen, Ala'a AlKerwi, Toon Braeye, Mario Fontán-Vela, Sabrina Bacci, Hinta Meijerink, Jesus Castilla, Hanne-Dorthe Emborg, Christian Holm Hansen, Susanne Schmitz, Marta Valenciano, Izaak Van Evercooren, Anthony Nardone, Nathalie Nicolay, and Susana Monge
Abstract: Background: Within the ECDC-VEBIS project, we prospectively monitored vaccine effectiveness (VE) against COVID-19 hospitalisation and COVID-19-related death, using electronic health registries (EHR), between October 2021 and November 2022, in community-dwelling residents aged 65–79 and ≥80-years in six European countries. Methods: EHR linkage was used to construct population cohorts in Belgium, Denmark, Luxembourg, Navarre (Spain), Norway and Portugal. Using a common protocol, for each outcome (hospitalisation and death), VE was estimated monthly over eight-week follow-up periods, allowing one month-lag for data consolidation. Cox proportional-hazards regression models were used to estimate adjusted hazard ratios (aHR) and VE=(1 – aHR) x100. Site-specific estimates were pooled using random-effects meta-analysis. Results: For ≥80-years, VE against COVID-19 hospitalisation decreased from 66.9% (95%CI: 60.1; 72.6) to 36.1% (95%CI: -27.3; 67.9) for the primary vaccination and from 95.6% (95%CI: 88.0; 98.4) to 67.7% (95%CI: 45.9; 80.8) for the first booster. Similar trends were observed for 65-79-years. The second booster VE against hospitalisation ranged between 82.0% (95%CI: 75.9; 87.0) and 83.9% (95%CI: 77.7; 88.4) for the ≥80-years and between 39.3% (95%CI: -3.9; 64.5) and 80.6% (95%CI: 67.2; 88.5) for 65-79-years. The first booster VE against COVID-19-related death declined over time for both age groups, while the second booster VE against death remained above 80% for the ≥80-years. Conclusions: Successive vaccine boosters played a relevant role in maintaining protection against COVID-19 hospitalisation and death, in the context of decreasing VE over time. Multi-country data from EHR facilitate robust near-real-time monitoring of VE in the EU/EEA and supports public health decision-making.
Published: 2023
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16. Burden of infectious disease studies in Europe and the United Kingdom: a review of methodological design choices

Author: Periklis Charalampous, Juanita A. Haagsma, Lea S. Jakobsen, Vanessa Gorasso, Isabel Noguer, Alicia Padron-Monedero, Rodrigo Sarmiento, João Vasco Santos, Scott A. McDonald, Dietrich Plass, Grant M. A. Wyper, Ricardo Assunção, Elena von der Lippe, Balázs Ádám, Ala'a AlKerwi, Jalal Arabloo, Ana Lúcia Baltazar, Boris Bikbov, Maria Borrell-Pages, Iris Brus, Genc Burazeri, Serafeim C. Chaintoutis, José Chen-Xu, Nino Chkhaberidze, Seila Cilovic-Lagarija, Barbara Corso, Sarah Cuschieri, Carlotta Di Bari, Keren Dopelt, Mary Economou, Theophilus I. Emeto, Peter Fantke, Florian Fischer, Alberto Freitas, Juan Manuel García-González, Federica Gazzelloni, Mika Gissler, Artemis Gkitakou, Hakan Gulmez, Sezgin Gunes, Sebastian Haller, Romana Haneef, Cesar A. Hincapié, Paul Hynds, Jane Idavain, Milena Ilic, Irena Ilic, Gaetano Isola, Zubair Kabir, Maria Kamusheva, Pavel Kolkhir, Naime Meriç Konar, Polychronis Kostoulas, Mukhtar Kulimbet, Carlo La Vecchia, Paolo Lauriola, Miriam Levi, Marjeta Majer, Enkeleint A. Mechili, Lorenzo Monasta, Stefania Mondello, Javier Muñoz Laguna, Evangelia Nena, Edmond S. W. Ng, Paul Nguewa, Vikram Niranjan, Iskra Alexandra Nola, Rónán O'Caoimh, Marija Obradović, Elena Pallari, Mariana Peyroteo, Vera Pinheiro, Nurka Pranjic, Miguel Reina Ortiz, Silvia Riva, Cornelia Melinda Adi Santoso, Milena Santric Milicevic, Tugce Schmitt, Niko Speybroeck, Maximilian Sprügel, Paschalis Steiropoulos, Aleksandar Stevanovic, Lau Caspar Thygesen, Fimka Tozija, Brigid Unim, Hilal Bektaş Uysal, Orsolya Varga, Milena Vasic, Rafael José Vieira, Vahit Yigit, Brecht Devleesschauwer, Sara M. Pires, Unión Europea. European Cooperation in Science and Technology (COST), and UCL - SSS/IRSS - Institut de recherche santé et société
Subjects: Epidemiology, Communicable diseases -- Europe, FOODBORNE DISEASES, Communicable diseases -- Europe -- Statistics, Communicable Diseases, Disability-adjusted life years, Cost of Illness, SDG 3 - Good Health and Well-being, systematic review, SURVEILLANCE, Medicine and Health Sciences, Humans, Communicable diseases -- Great Britain, Veterinary Sciences, Communicable diseases -- Epidemiology -- Europe, disability-adjusted life years, Netherlands, Disability-adjusted life years -- Europe, Methodology, Burden of disease, Burden of disease, infectious diseases, disability-adjusted life years, systematic review, methodology, methodology, GLOBAL BURDEN, United Kingdom, Europe, Infectious Diseases, Global burden of disease -- Europe, Systematic review, Infectious diseases, Quality-Adjusted Life Years, CHALLENGE
Abstract: This systematic literature review aimed to provide an overview of the characteristics and methods used in studies applying the Disability-Adjusted Life Years (DALY) concept for infectious diseases within European Union (EU)/European Economic Area (EEA)/European Free Trade Association (EFTA) countries and the United Kingdom. Electronic databases and grey literature were searched for articles reporting the assessment of DALY and its components. We considered studies in which researchers performed DALY calculations using primary epidemiological data input sources. We screened 3,053 studies of which 2,948 were excluded and 105 studies met our inclusion criteria. Of these studies, 22 were multi-country and 83 were single-country studies, of which 46 were from the Netherlands. Food- and water-borne diseases were the most frequently studied infectious diseases. Between 2015 and 2022, the number of burden of infectious disease studies was 1.6 times higher compared to that published between 2000 and 2014. Almost all studies (97%) estimated DALYs based on the incidence- and pathogen-based approach and without social weighting functions; however, there was less methodological consensus with regards to the disability weights and life tables that were applied. The number of burden of infectious disease studies undertaken across Europe has increased over time. Development and use of guidelines will promote performing burden of infectious disease studies and facilitate comparability of the results., peer-reviewed
Published: 2023
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17. Dietary patterns and type 2 diabetes—relationship to metabolic syndrome and inflammation

Author: Torsten Bohn, Hanen Samouda, and Ala'a Alkerwi
Published: 2022
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18. Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight

Author: Maryam Sharafkhah, Emanuel Zitt, Majid Ezzati, Luxia Zhang, Young-Ho Khang, Ellina Rakhimova, Kairit Mikkel, Tiina Vlasoff, Eruke E. Egbagbe, Sidsel Graff-Iversen, Ilona Nenko, Magdalena Klimek, Mathilde Savy, Sanjib Kumar Sharma, Alfonso Siani, Luís Lopes, Vanina Bongard, Gregor Jurak, Jacqueline F. Price, Christina-Paulina Lambrinou, Maria Lc Iurilli, Rainford J. Wilks, Bontha V. Babu, Fereidoun Azizi, Harunobu Nakamura, Marialaura Bonaccio, Angela Döring, Zhenyu Zhang, Naser Ahmadi, Jolanta Słowikowska-Hilczer, Ana Paula Carlos Cândido, Clive Osmond, Thirunavukkarasu Sathish, Robert J. Adams, Themistoklis Tzotzas, Reina Engle-Stone, Atul Trivedi, Shoichiro Tsugane, Niels Møller, Jorge Bezerra, Dénes Molnár, Muhammad Fadhli Mohd Yusoff, Badreya Al-Lahou, J. Jaime Miranda, Bahram Mohajer, Sigmund A. Anderssen, Lital Keinan Boker, Eero Kajantie, Martin Gulliford, Maties Torrent, Sumit Bharadwaj, Toshiharu Ninomiya, Zbigniew Gaciong, Nayu Ikeda, Li Juan Wu, Adrian Richter, Licia Iacoviello, Marc J. Gunter, Wenbin Wei, Norsyamlina Che Abdul Rahim, Eman Aly, Ambady Ramachandran, Nils Lehmann, Soile E. Puhakka, Giovanni Veronesi, Hongsheng Bi, Eiji Oda, Jia Li Duan, Per Tynelius, José María Huerta, Janne Schurmann Tolstrup, Rodrigo M. Carrillo-Larco, Rosangela Fernandes Lucena Batista, Victoria E Soto-Rojas, Hanno Ulmer, Shukri F. Mohamed, Anthony Kafatos, Suyeon Park, Mohsen Ibrahim, Hamed Pouraram, Bin Zhou, May Soe Aung, Lars Bo Andersen, Erfan Ghasemi, René Charles Sylva, Himanshu K. Chaturvedi, Luc Dauchet, Ahmad Ali Zainuddin, Angela Chetrit, Dan Zhu, Valérie Deschamps, Ko Ko Zaw, Peter Vollenweider, Tomas Vega, Yves Martin-Prével, Mahfuzar Rahman, Dorja Vočanec, Roman Topor-Madry, Vinay Nangia, Herculina S. Kruger, Asher Fawwad, Emily Sonestedt, Elena Pahomova, Aleksander Giwercman, Elżbieta Dziankowska-Zaborszczyk, Cecilia Björkelund, Tatjana Hejgaard, Maria Puiu, Maria Benedetta Donati, Andrew Wong, Carlos P. Boissonnet, Santosh K. Bhargava, Patrick Kolsteren, Dermot O'Reilly, Bahareh Kheiri, Wolfgang Kratzer, Susanne R. de Rooij, H. Bas Bueno-de-Mesquita, Günther Fink, José R. Banegas, Michele Monroy-Valle, Drude Molbo, Mahmudur Rahman, Hynek Pikhart, Rafael N. Pichardo, Massimo Salvetti, Hui Cai, Sarah Filippi, Georg Posch, Hung-Kwan So, Yonghua Hu, Katsuyasu Kouda, Joana Carvalho, Gailute Bernotiene, Hannu Uusitalo, Thein Thein Htay, Felix Kaducu, Maigeng Zhou, Lars Ängquist, Thi Tuyet-Hanh Tran, Charles Lunogelo, Michel Joffres, Sabina Zambon, Ronald D. Gregor, Vayia Rarra, Seyed Mohammad Hashemi-Shahri, Loreto Santa Marina, Galina Obreja, Rudolf Kaaks, Aya Mostafa, Maria do Carmo Franco, Beata Gurzkowska, Chien-Jen Chen, Marie Moitry, Nizal Sarrafzadegan, Xiangjun Wang, Diego Giulliano Destro Christofaro, Imperia Brajkovich, Fangfang Chen, Francesco Panza, Ling Yang, Holly E. Syddall, Cecily Kelleher, Michael Tornaritis, Ningli Wang, Lutgarde Thijs, Marjolein Visser, Angelika Schaffrath Rosario, María José Tormo, Jostein Steene-Johannessen, Norbert Amougou, Emmanuella Magriplis, Mar Alvarez-Pedrerol, Jingli Gao, Stig E. Bojesen, Giuseppe Grosso, Seongjun Ha, Lauren Lissner, Mikhail Benet, Anastasia Markaki, Sanjay Rampal, Antônio Augusto Moura da Silva, Maria Lorenza Muiesan, Angelique Chan, Yvonne T. van der Schouw, Annamari Lundqvist, Philippe Amouyel, Kristyna Zejglicova, Charalambos Hadjigeorgiou, João Breda, Jørgen Meisfjord, Fatima Zahra Laamiri, Carl Lachat, Kai-Uwe Saum, Vilma Irazola, Leng Huat Foo, Óscar Lopes, Dickman Gareta, Flavio Nervi, Imre Janszky, Ruzena Kubinova, Terho Lehtimäki, Mario V. Capanzana, Moyses Szklo, Ramfis Nieto-Martínez, Viswanathan Mohan, Shuohua Chen, Arvind Pandey, Luigi Palmieri, Roya Kelishadi, Srinivasan Kannan, Jie Mi, Robert Beaglehole, Liliana Dacica, Jyrki K. Virtanen, Mohan Deepa, Peter Ueda, Isti Ilmiati Fujiati, Hermann Pohlabeln, Morten Sodemann, Jytte Halkjær, Zbigniew Kułaga, Sophie Visvikis-Siest, Farshad Farzadfar, Mohsen Azimi-Nezhad, Henry Völzke, Karolina Milkowska, Zahra Mohammadi, Belgin Ünal, Magda Gasull, George S. Stergiou, Marshall K. Tulloch-Reid, Seppo Koskinen, James E. Bennett, Marcela González-Gross, Virginija Dulskiene, Idris Guessous, Assembekov Batyrbek, Kamarul Imran Musa, Jeannette Lee, Josep Redon, Bihungum Bista, Luisa M Macieira, Johan Sundström, Andres Metspalu, Lariane M Ono, Flora A. Ukoli, Salar Rahimikazerooni, Andrea Gualtieri, Trevor S. Ferguson, Félicité Tchibindat, Eliza Cinteza, Ha Tp Do, Tajana Zeljkovic Vrkic, Tuyen D Le, Alison J. Hayes, Abdul Basit, Chandini Nekkantti, Teresa Norat, Eunice Ugel, Gulmira Aitmurzaeva, Mariachiara Di Cesare, Abdul Hamid Zargar, Vincenzo Solfrizzi, Garry L. Jennings, Aline Meirhaeghe, Kaare Christensen, Päivi Mäki, Xu Lin, Ali Esmaeili, Joanna Baran, Aneta Grajda, Renata Cifkova, Alexandre C. Pereira, Martin Bobak, Iuliia A Rusakova, Keiu Nelis, Damian K Francis, Guansheng Ma, Axel C. Carlsson, Alejandro Diaz, Alireza Ansari-Moghaddam, N Capkova, Zumin Shi, Maria Turley, Imelda A. Agdeppa, Helena I. S. 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Jacobs, Kenneth James, Elena Sacchini, Pascal Bovet, Mahboubeh Parsaeian, Tania Lopez, Ya Xing Wang, Wojciech Drygas, Jody C Miller, Svetlana A. Shalnova, Maria Elisa Zapata, Chung T Nguyen, Nimmathota Arlappa, Edwige Landais, Thorkild I. A. Sørensen, Jeannette Klimont, Amirabbas Momenan, Erik J. Timmermans, Mari-Liis Tammesoo, Jost B. Jonas, Stefania Toselli, Maria Teresa Anselmo Olinto, Bahman Cheraghian, Kouamelan Doua, Esteban Carmuega, Marjeta Mišigoj-Duraković, Bo Werner, M. Arfan Ikram, Breige A. McNulty, Christa Meisinger, Clara Homs, Namuna Shrestha, Alina Kerimkulova, Youcef Laid, Claes Ohlsson, Alicia Matijasevich, Alison J Price, Ala'a Alkerwi, Kristine H. Allin, Lorenza Pilotto, Mohannad Al Nsour, Ingunn Holden Bergh, Marianna Noale, Heba Fouad, Vilnis Dzerve, Novie O. Younger-Coleman, Peter Willeit, Andrea R. V. R. Horimoto, Freda Pitakaka, Habiba Ben Romdhane, Savvas C. Savva, Rajeev Gupta, Jennifer Servais, Cristina Padez, Sarah P. Garnett, Maria del Cristo Rodriguez-Perez, Michala Lustigová, Tien Yin Wong, Rosa Haghshenas, Jonathan Giovannelli, Christina Howitt, Marleen E. Hendriks, Fadia AlBuhairan, Huashuai Chen, Gretchen A Stevens, Luís B. Sardinha, David Goltzman, Jenny M. Kindblom, Karina Mary de Paiva, Yousef Khader, Eric Monterrubio-Flores, Rajendra Pradeepa, Yi-Ting Lin, Martin Neovius, Juan Francisco Miquel, Ellis Owusu-Dabo, Anil Poudyal, Marzieh Katibeh, Tanja Stocks, Veronica Mocanu, Ulla Roggenbuck, Robespierre Ribeiro, Gabriele Eiben, Mary Simon, Christine Cameron, Hamid Hakimi, Kamel Ajlouni, Jakub Stokwiszewski, Iulia Jurca Simina, Pietro Amedeo Modesti, Frederick C. W. Wu, Peter Kristensen, Charles Mondo, Felix Gutzwiller, Mariana Sbaraini, Martijn Huisman, Betina H. Thuesen, Queenie Chan, Antonisamy Belavendra, Artur Mazur, Ulf Ekelund, Laura A. 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Eriksson, Margarita Samoutian, Andreia N. Pizarro, Mohammed Rasoul Tarawneh, Jean Woo, Kaspar Staub, Maria Teresa Menzano, Mojtaba Farjam, Adroaldo Cesar Araujo Gaya, Mohammad El-khateeb, Zulfiqar A Bhutta, Mukharram M. Bikbov, Hsien-Ho Lin, Oscar Noboa, Thomas Waldhör, Garry Brian, Simona Costanzo, Frank Tanser, Nor Azwany Yaacob, Michelle Cilia, Ivo Rakovac, Bill Stavreski, Ioannis Pagkalos, Ivan Pećin, Carlo M. Barbagallo, Abla M. Sibai, Yuna He, Matsuda Fumihiko, Bharathi Viswanathan, Ali Reza Safarpour, Wei Cheng Lo, Abdullatif Husseini, Jiang He, Liv Elin Torheim, Nipa Rojroongwasinkul, Aicha Soumare, Astrid Petersmann, Tomasz Grodzicki, Davide Noto, Panayiotis K. Yiallouros, Kelias P. Msyamboza, William R. 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Dennison, Jeonghee Lee, Diego Salmerón, Ida Maria Schmidt, Gao Pei, Noushin Mohammadifard, Igor Spiroski, Fernando Rodríguez-Artalejo, Xu Ma, Elin Pettersen Sørgjerd, Valéria Regecová, Cláudia S. Minderico, Johanna A. Otero, Jamila Abubakar Garba, Vesselka Duleva, Rui Ornelas, Ilpo Huhtaniemi, Cesar G. Victora, Lijuan Liu, Rody G. Sy, Mahmood Moosazadeh, Ali Ahmadi, Antonio Pedro Graça, Natalia Nowak-Szczepanska, Miao Li Chee, Michael Sjöström, Charles Agyemang, Shiqi Zhen, Xiu-Hua Guo, Pawel Kurjata, Jardena J. Puder, Mehrdad Azmin, Neil Murphy, Kaosar Afsana, Alireza Sadjadi, Johanna M. Geleijnse, Prashant Mathur, Elysée Claude Bika Lele, Raphael Mendes Ritti-Dias, Yannis Manios, Majid Shirani, Rosemary B. Duda, Liis Nelis, Jurate Klumbiene, Zhengming Chen, Wichai Aekplakorn, Alun Evans, Andrzej Wiecek, Lars Lind, Denise Eldemire-Shearer, Bernardo L. Horta, Macia Enguerran, Seyed Rasoul Zakavi, Daniel Fernández-Bergés, Kumiko Ohara, Ursula Kiechl-Kohlendorfer, Hermann Brenner, Przemyslaw Slusarczyk, Espen Bjertness, Jutta Stieber, Augusto Di Castelnuovo, Joel G. R. Roy, Aryeh D. Stein, Ruth Frikke-Schmidt, Vera Musil, Amaneh Shayanrad, Marcel Goldberg, Ramon O. Jimenez, Mohammad Reza Fattahi, Jolanda Hyska, Amir Houshang Mehrparvar, Elin Kolle, Mohamed Bamoshmoosh, Michelle Holdsworth, Felipe F. Casanueva, Børge G. Nordestgaard, Niels Wedderkopp, Eva Corpeleijn, Elias F. Gudmundsson, Antonio Mistretta, Daniel Lemogoum, Larissa Pruner Marques, Slavica Sović, Olli T. Raitakari, Marco Aurélio Peres, Alexandra Cucu, Gregorio Varela-Moreiras, Janine Clarke, Andrea Gazzinelli, Mieczysław Litwin, Sara Schramm, Xenophon Theodoridis, Harshpal Singh Sachdev, Mohammad Reza Mirjalili, Dimitrios Papandreou, Peter T. Katzmarzyk, Benjamin Acosta-Cazares, Ben Schöttker, Prabhdeep Kaur, Norlaila Mustafa, Shariq Rashid Masoodi, Sadaf G. Sepanlou, Adolfo Rubinstein, Francis Delpeuch, Julianne Williams, Abbas Dehghan, Leanne M. Riley, Heloisa Bettiol, Gabriele Nagel, Ellisiv B. Mathiesen, Ekaterina Stoyanova, Alisha N. Wade, Zhamyila Usupova, Arnaud Chiolero, Oonagh Markey, Jacqueline Ramke, Elena Bogova, Niveen M E Abu-Rmeileh, Nguyen D Nguyen, Tomasz Zdrojewski, Marjo-Riitta Järvelin, Jose Sanchez-Abanto, Rômulo Araújo Fernandes, Lourdes Ribas-Barba, Nalan Uysal, Mohamad Hasnan Ahmad, Krista Fischer, Maria Wany Louzada Strufaldi, Ramiro Guerrero, Farnam Mohebi, Tran Quoc Bao, Flávio Danni Fuchs, Salim Berkinbayev, Enisa Kujundzic, Sari Voutilainen, Farzad Hadaegh, Robert Lundqvist, Saeid Safiri, Iraj Mohebbi, George Luiz Lins Machado-Coelho, Annette Peters, Gonzalo Valdivia, Magdalena Korzycka, Rajiv T Erasmus, Masanori Iwasaki, Charmaine A. Duante, Sheikh Mohammed Shariful Islam, Quang Ngoc La, Ricky Eddie, Petra Rust, Daniela Rodrigues, Dirk De Bacquer, Karen Sparrenberger, Agneta Sjöberg, Thet Thet Mu, Katarzyna Dereń, Cora L. Craig, Jorge Motta, Janina Petkeviciene, Boyd Swinburn, Paibul Suriyawongpaisal, Visnja Djordjic, Ramón Alberto Rascón-Pacheco, Pradeep Joshi, Daan Kromhout, Marius B. Bjertness, Stefano Marventano, Juel Jarani, Alireza Khosravi, Eva Martos, David De Ridder, Lizzy M. Brewster, Nico Dragano, Liam Smeeth, Kenji Shibuya, Emma Ruiz Moreno, Hashem Jaddou, Grzegorz Sobek, Dimitrios Trichopoulos, Marvin Cervantes-Loaiza, Abu Am Hanif, Elaine M. Murtagh, Carlos A. Aguilar-Salinas, Graziella D'Arrigo, Kyungwon Oh, Heiner Boeing, Regina Heidinger-Felso, André Luiz Sena Guimarães, Balkish M. Naidu, Avula Laxmaiah, Ana M. B. Menezes, Marie Eliasen, Francesco Pistelli, Yuan He, Dusko Bjelica, José A. Casajús, Guang Ning, Lutgart Braeckman, Dirk Vanderschueren, Jochanan Stessman, Ivana Radic, Yi Zeng, Hans Concin, Damaskini Valvi, Sari Hantunen, Catherine Kyobutungi, Diego Augusto Santos Silva, Wenhua Zhao, Sok King Ong, Anne W. Taylor, Iraj Nabipour, Justyna Godos, Cyrus Cooper, Mattias Johansson, Samuel C. Dumith, Magdalena Muc, Sabine Schipf, Idowu O Senbanjo, Jim Mann, Rajaa Al-Raddadi, Yih Chung Tham, Kay-Tee Khaw, Joseph Cacciottolo, Ana Henriques, Sahar Saeedi Moghaddam, Reza Mohammadpourhodki, Bernhard O. Boehm, Songhomitra Panda-Jonas, Iveta Pudule, Elisabete Ramos, Lacramioara Aurelia Brinduse, Paul H. Lee, Terence W O'Neill, Javad Aghazadeh-Attari, Margus Punab, Bojan Jelaković, Camilla T. Damsgaard, Takafumi Ishida, Ekaterina Chikova-Iscener, Mirjam M. Heinen, Tazeen H. Jafar, Semánová Csilla, Constance Schultsz, Santiago F. Gomez, Raija Korpelainen, Edward W. Gregg, Laura Gutierrez, Pierre Traissac, Victor M. Herrera, Aristides M. Machado-Rodrigues, Fatemeh Malekzadeh, Shouling Wu, Jennifer L. Baker, Clicerio González-Villalpando, Eleonora d'Orsi, Irene G. M. van Valkengoed, Anna Fijałkowska, Wen-Harn Pan, Gregor Starc, Meghnath Dhimal, Murat Topbaş, George Moschonis, Robert Eggertsen, Abdullah Alkandari, Quang Ngoc Nguyen, Janette Walton, Elnaz Faramarzi, Saeed Dastgiri, Lien Braeckevelt, Nasheeta Peer, Radka Taxová Braunerová, Mohamed M. Ali, Steiner Krokstad, Harald Geiger, Morteza Shamshirgaran, Lela Shengelia, María Ángeles Dal Re Saavedra, Silvana Donoso, Khem Bahadur Karki, Timothy J. Key, Maria G. Grammatikopoulou, Susana Vale, Felix K. Assah, Juan A Rivera, Peter H. Whincup, Oana-Florentina Gheorghe-Fronea, Cassiano Ricardo Rech, Paul Ferdinand M. Reganit, Rachakulla Hari Kumar, Jaakko Mursu, Luis A. Moreno, Glen Gironella, Jelena Kos, Tilema Cama, Haakon E. Meyer, Jun Ma, Raphael E. Arku, Ziad Abdeen, Dianna J. Magliano, Jitendra Jonnagaddala, Konstantinos Gkiouras, Paola Nardone, Alberto Barceló, Tomi-Pekka Tuomainen, Francesco Gianfagna, Stefania Maggi, Mohammad Hossein Somi, Behrooz Hamzeh, Miquel Porta, Vesna Jureša, Alexander D. Deev, David Faeh, Antonio Bernabe-Ortiz, Sirkka Keinänen-Kiukaanniemi, Ian Hambleton, Stefan Savin, Andre Pascal Kengne, R. Krishna Kumar, Kurt Widhalm, Marco M Ferrario, Parisa Amiri, Anjani Kumar Jha, Thamara Hubler Figueiró, Jana Kratenova, Claudia M. Hormiga, Maria Tsigga, Zivka Dika, Indrapal I. Meshram, Ei Ei K. Nang, Ian Rouse, Rusidah Selamat, Paul Korrovits, Grethe S. Tell, Julie Taylor, Anabela Mota-Pinto, Paolo Vineis, Kotsedi D Monyeki, Khuong Quynh Long, Frank J Rühli, Shelly R. McFarlane, Sara Santos Sanz, Edyta Łuszczki, Maria G. Stathopoulou, Tara Coppinger, Karin De Ridder, Lucie Viet, Anna Bugge, Mehdi Yaseri, Safiah Md Yusof, Sandra C. Fuchs, Muhammad Islam, Irfan Nuhoglu, Rui Providência, Bernard Maire, Leandra Abarca-Gómez, Sinead Brophy, Maria Ruiz-Castell, Daniela Pierannunzio, Cristina Taddei, Gowri Mahasampath, Gustavo Velasquez-Melendez, Hanna Tolonen, Sudhir Kowlessur, Bagher Larijani, Laura Torres-Collado, Susi Kriemler, Ali Akbar Shayesteh, Cynthia Robitaille, Jorge Escobedo-de la Peña, Yufang Bi, Chinh Nguyen Huu, Line Tang Møllehave, Vincent Jr DeGennaro, Noor Ani Ahmad, Anar Dushpanova, Agustinus Soemantri, Susana Sans, Ionela Pascanu, Gwenaëlle Le Coroller, Inger Ariansen, Kodanda R Kanala, Gert B. M. Mensink, Abhijit Sen, Sergej M. Ostojic, Hanan F. Abdul Rahim, Hélène Delisle, Francisco J. Félix-Redondo, Yadlapalli S. Kusuma, Michael Knoflach, Moein Yoosefi, Tanja G. M. Vrijkotte, Wolfgang Ahrens, Osvaldo Santos, Bethlehem D. Solomon, Erik Lykke Mortensen, Nikhil D. Patel, Reynaldo Martorell, Ching-Yu Cheng, Stine Schramm, Hana Shimizu-Furusawa, Jacek Jóźwiak, Radwan Qasrawi, Herman Borghs, Zhanna Kalmatayeva, Heidi Klakk, Akram Pourshams, Naomi S. Levitt, Son Thai Pham, Simona Giampaoli, Dong Zhao, Indah Suci Widyahening, Merete Osler, Paula Margozzini, Silvia Bel-Serrat, Dora Romaguera, Monira Alarouj, Winsome R. Parnell, Marloes Cardol, Giota Touloumi, Janice Luisa Lukrafka, Adela Chirita-Emandi, Maryam Kavousi, Sanja Musić Milanović, Jean-Michel Gaspoz, Jalila El Ati, Sauli Herrala, Liang Xu, Pilar Guallar-Castillón, Bee Koon Poh, Luis Serra-Majem, Jonathan E. Shaw, Belong Cho, Daphne Mirkopoulou, Salvador Villalpando, Yuki Fujita, Tiffany K. Gill, Nish Chaturvedi, Erkin M. Mirrakhimov, Günay Can, Mark Woodward, Esther Lopez-Garcia, Mauro Virgílio Gomes de Barros, Ahmed A. Madar, Shoaib Afzal, Melanie J. Cowan, Gareth Stratton, Eduardo Salazar Martinez, Sameer Narake, Norie Sawada, Deepak Amarapurkar, Deepa Weerasekera, Diana A. Santos, Marjeta Majer, Herman Schargrodsky, Bruna Gonçalves Cordeiro da Silva, Ebrahim Eftekhar, Jesús Vioque, Marisa K. Sophiea, Teresa Shamah-Levy, María Dolores Chirlaque, Mohd Azahadi Omar, Stefan Söderberg, Isabel O. Oliveira, Joanne Katz, Xingwang Ye, Christophe Tzourio, Marie Zins, Aneta Weres, Ulrich Keil, Haiquan Xu, Akihiro Yoshihara, Rachel Dankner, Gabriella Gruden, Maroje Sorić, Hanspeter Stamm, Kim Overvad, Yanping Li, Carsten Oliver Schmidt, Christa L. Lilly, Veikko Salomaa, Gilad Twig, Senthil K Vasan, Qian Wang, Liufu Cui, Andrzej Galbarczyk, Sylvain Sebert, Wilma M. Hopman, Karl-Heinz Jöckel, Ari Voutilainen, Peter Schnohr, Jerzy Chudek, Katia Vergetti Bloch, Vincenzo Capuano, Jyh Eiin Wong, Torben Jørgensen, Anja Schienkiewitz, Nader Saki, Carolina Tarqui-Mamani, Maria Cecília Formoso Assunção, Kazi M. Jamil, Juraci Almeida Cesar, Pedro J Ortiz, Delphine De Smedt, Luciana Zaccagni, Lynne M. Boddy, Jie Hao, David Alejandro González-Chica, Romana Roccaldo, Sara Magnacca, Peter Stehle, Victoria Farrugia Sant'Angelo, Gry Skodje, Maryam Keramati, Tabara Yasuharu, Ali Ghanbari, Gyulli M. Kazakbaeva, Takuro Furusawa, Felicia Cañete, Kari Kuulasmaa, Justina Vaitkeviciute, (NCD-RisC), NCD Risk Factor Collaboration, Imperial College London, Harvard T.H. Chan School of Public Health, Middlesex University [London], Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), Montpellier Interdisciplinary center on Sustainable Agri-food systems (Social and nutritional sciences) (UMR MoISA), Centre de Coopération Internationale en Recherche Agronomique pour le Développement (Cirad)-Institut de Recherche pour le Développement (IRD)-Centre International de Hautes Etudes Agronomiques Méditerranéennes - Institut Agronomique Méditerranéen de Montpellier (CIHEAM-IAMM), Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Institut national d’études supérieures agronomiques de Montpellier (Montpellier SupAgro), Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Interactions Gène-Environnement en Physiopathologie Cardio-Vasculaire (IGE-PCV), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Wellcome TrustEuropean Commission, Clinical Developmental Psychology, APH - Mental Health, Sociology, The Social Context of Aging (SoCA), Nutrition and Health, Iurilli, Maria LC [0000-0003-0409-1635], Zhou, Bin [0000-0002-1741-8628], Ezzati, Majid [0000-0002-2109-8081], Apollo - University of Cambridge Repository, Epidemiology and Data Science, APH - Aging & Later Life, APH - Societal Participation & Health, Public and occupational health, APH - Health Behaviors & Chronic Diseases, VU University medical center, APH - Personalized Medicine, AGEM - Endocrinology, metabolism and nutrition, ACS - Diabetes & metabolism, APH - Global Health, ARD - Amsterdam Reproduction and Development, Adult Psychiatry, Global Health, APH - Quality of Care, APH - Methodology, ACS - Atherosclerosis & ischemic syndromes, Gómez Santos, Santiago Felipe, NCD Risk Factor Collaboration (NCD-RisC), Faculdade de Desporto, Faculdade de Ciências da Nutrição e Alimentação, Faculdade de Medicina, Tampere University, Clinical Medicine, Department of Clinical Chemistry, Eye Centre, Harvard TH Chan School of Public Health, Middlesex University, World Health Organization, Ministry of Health, University of Lausanne, Eduardo Mondlane University, Victor Babes University of Medicine and Pharmacy Timisoara, University of Sydney, Health and Nutrition, University of Auckland, Seoul National University, ICMR - National Institute of Nutrition, Capital Medical University Beijing An Zhen Hospital, Universidad Peruana Cayetano Heredia, University Tunis El Manar, University of Oulu, University of Zagreb, University of Ljubljana, Caja Costarricense de Seguro Social, Al-Quds University, National Center of Public Healthcare, Qatar University, Birzeit University, Usmanu Danfodiyo University Teaching Hospital, Instituto Mexicano del Seguro Social, Flinders University, Mahidol University, BRAC James P Grant School of Public Health, University of Copenhagen, Copenhagen University Hospital, Food and Nutrition Research Institute, Urmia University of Medical Sciences, Instituto Nacional de Ciencias Médicas y Nutrición, University of Amsterdam, Shahrekord University of Medical Sciences, Non-Communicable Diseases Research Center, University of Oslo, University of Bremen, Republican Center for Health Promotion, Endocrinology and Genetics, Princess Nourah bint Abdulrahman University, Kuwait Institute for Scientific Research, King Abdulaziz University, Dasman Diabetes Institute, Aldara Hospital and Medical Center, King Abdullah International 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Basel, University of New South Wales, World Health Organization Country Office, Guilan University of Medical Sciences, University of Opole, Finnish Institute for Health and Welfare, Gulu University, University of Crete, Sri Venkateswara University, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Hellenic Medical Association for Obesity, National and Kapodistrian University of Athens, Maharajgunj Medical Campus, Aarhus University, Johns Hopkins Bloomberg School of Public Health, Pennington Biomedical Research Center, National Institute of Epidemiology, University of Münster, Israel Center for Disease Control, Research Institute for Primordial Prevention of Non- communicable Disease, Amsterdam UMC Public Health Research Institute, South African Medical Research Council, Kyrgyz State Medical Academy, Research Institute of Child Nutrition, Shahid Beheshti University of Medical Sciences, University of Cambridge, Mazandaran University of Medical Sciences, Hypertension Research Center, Medical University of Innsbruck, VASCage, Muhimbili University of Health and Allied Sciences, Yonsei University College of Medicine, National Cancer Center, Sahlgrenska University Hospital, University College South Denmark, Statistics Austria, B P Koirala Institute of Health Sciences, University of Vienna, Oulu Deaconess Institute Foundation, Tartu University Clinics, Kansai Medical University, Hungarian School Sport Federation, Ministry of Health and Quality of Life, University Hospital Ulm, North-West University, University of Jyväskylä, Amrita Institute of Medical Sciences, Institute of Endocrinology, All India Institute of Medical Sciences, African Population and Health Research Center, Hanoi University of Public Health, Hassan First University of Settat, Harokopio University, Sahlgrenska Academy, Endocrinology and Metabolism Research Center, University of Public Health, International Food Policy Research Institute, National University of Singapore, Hong Kong Polytechnic University, Tampere University Hospital, University of Douala, University of Cape Town, National Institute for Health Development, West Virginia University, Oswaldo Cruz Foundation Rene Rachou Research Institute, National Taiwan University, University of Chinese Academy of Sciences, Uppsala University, Taipei Medical University, Sports Medical Center of Minho, Universidad San Martín de Porres, Consejería de Sanidad Junta de Castilla y León, Universidade Federal de Ciências da Saúde de Porto Alegre, Norrbotten County Council, Ilembula Lutheran Hospital, Universidade Federal de Ouro Preto, University of Coimbra, Coimbra University Hospital Center, Institute of Neuroscience of the National Research Council, Baker Heart and Diabetes Institute, Agricultural University of Athens, Hospital Israelita Albert Einstein, SB RAS Federal Research Center Institute of Cytology and Genetics, University of Otago, University of Padua, Hellenic Mediterranean University, Loughborough 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Guatemala, University of Limpopo, University of Medical Sciences of Cienfuegos, Royal College of Surgeons in Ireland, La Trobe University, International Institute of Molecular and Cell Biology, Instituto Conmemorativo Gorgas de Estudios de la Salud, University of Brescia, Ministry of Health and Social Protection, University of Limerick, Croatian Institute of Public Health, Universiti Kebangsaan Malaysia, Bushehr University of Medical Sciences, Ulm University, Kobe University, Suraj Eye Institute, UNICEF, University Medicine Greifswald, National Institute of Hygiene and Epidemiology, University of Medicine and Pharmacy at Ho Chi Minh City, Hanoi Medical University, LifeDoc Health, Heartfile, Eastern Mediterranean Public Health Network, University of Manchester, State University of Medicine and Pharmacy, Tachikawa General Hospital, Korea Centers for Disease Control and Prevention, Japan Wildlife Research Center, Istanbul University, Universidade Federal do Paraná (UFPR), University of 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Pure Earth, Institute of Epidemiology Disease Control and Research, University of Turku, Institut Universitari d’Investigacióen AtencióPrima` ria Jordi Gol, Universiti Putra Malaysia, University of Malaya, Sotiria Hospital, University of Valencia, University of the Philippines, Slovak Academy of Sciences, Nutrition Research Foundation, Minas Gerais State Secretariat for Health, CS S. Agustín Ibsalut, Amsterdam Institute for Global Health and Development, National Institute of Health Doutor Ricardo Jorge, Universidade Nove de Julho, Public Health Agency of Canada, Canarian Health Service, Universidad Industrial de Santander, Associazione Calabrese di Epatologia, University of Minho, Fiji National University, Spanish Nutrition Foundation, Public Health Agency of Sweden, Institute of Food Sciences of the National Research Council, Sitaram Bhartia Institute of Science and Research, Kindergarten of Avlonari, National Institute of Health, Catalan Department of Health, Biodonostia Health Research Institute, Instituto de Saúde Ambiental, South Karelia Social and Health Care District, McMaster University, University of Saõ Paulo Clinics Hospital, Hospital Italiano de Buenos Aires, Rigshospitalet, Academic Medical Center of University of Amsterdam, The George Institute for Global Health, Center for Oral Health Services and Research Mid-Norway, Lagos State University College of Medicine, University of Las Palmas de Gran Canaria, Comenius University, National Center for Disease Control and Public Health, Nippon Medical School, Sungkyunkwan University, Finnish Institute of Occupational Health, Public Health Promotion and Development Organization, St Vincent’s Hospital, Nes Municipality, Health Polytechnic Jakarta II Institute, Diponegoro University, University of Bari, Institut Régional de SantéPublique, University of Bordeaux, Oslo Metropolitan University, Ss. Cyril and Methodius University, University of Leuven, Lamprecht und Stamm Sozialforschung und Beratung AG, Bonn University, National Institute of Public Health - National Institute of Hygiene, Kalina Malina Kindergarten, The Jikei University School of Medicine, Fu Jen Catholic University, National Statistical Office, Scientific Research Institute of Maternal and Child Health, University of Lincoln, Central University of Kerala, Amsterdam Public Health Research Institute, Health Service of Murcia, Institut d’Investigacio Sanitaria Illes Balears, University of Bologna, Hellenic Health Foundation, Government Medical College, Sefako Makgatho Health Science University, Addis Ababa University, Universidad Centro-Occidental Lisandro Alvarado, Meharry Medical College, Dokuz Eylul University, University of Tampere Tays Eye Center, Sabiha Gokcen Ilkokulu, Polytechnic Institute of Porto, Icahn School of Medicine at Mount Sinai, Universidad CEU San Pablo, University Miguel Hernandez, Vrije Universiteit Amsterdam, Sunflower Nursery School, North Karelia Center for Public Health, University of the Witwatersrand, Medical University of Vienna, Cork Institute of Technology, Institute for Medical Research, Xinjiang Medical University, Shanghai Educational Development Co. Ltd, Orebro University, University of London, Universitas Indonesia, Institute of Food and Nutrition Development of Ministry of Agriculture and Rural Affairs, Children’s Hospital of Fudan University, University of Cyprus, Niigata University, International Medical University, Iran University of Medical Sciences, Center for Diabetes and Endocrine Care, Peking University First Hospital, Jiangsu Provincial Center for Disease Control and Prevention, Sun Yat-sen University, West Kazakhstan Medical University, Inner Mongolia Medical University, University of Ghana, Maria Lc Iurilli , Bin Zhou , James E Bennett , Rodrigo M Carrillo-Larco , Marisa K Sophiea , Andrea Rodriguez-Martinez , Honor Bixby , Bethlehem D Solomon , Cristina Taddei , Goodarz Danaei , Mariachiara Di Cesare , Gretchen A Stevens , Leanne M Riley , Stefan Savin , Melanie J Cowan , Pascal Bovet , Albertino Damasceno , Adela Chirita-Emandi , Alison J Hayes , Nayu Ikeda , Rod T Jackson , Young-Ho Khang , Avula Laxmaiah , Jing Liu , J Jaime Miranda , Olfa Saidi , Sylvain Sebert , Maroje Sorić , Gregor Starc , Edward W Gregg , Leandra Abarca-Gómez , Ziad A Abdeen , Shynar Abdrakhmanova , Suhaila Abdul Ghaffar , Hanan F Abdul Rahim , Niveen M Abu-Rmeileh , Jamila Abubakar Garba , Benjamin Acosta-Cazares , Robert J Adams , Wichai Aekplakorn , Kaosar Afsana , Shoaib Afzal , Imelda A Agdeppa , Javad Aghazadeh-Attari , Carlos A Aguilar-Salinas , Charles Agyemang , Mohamad Hasnan Ahmad , Noor Ani Ahmad , Ali Ahmadi , Naser Ahmadi , Soheir H Ahmed , Wolfgang Ahrens , Gulmira Aitmurzaeva , Kamel Ajlouni , Hazzaa M Al-Hazzaa , Badreya Al-Lahou , Rajaa Al-Raddadi , Monira Alarouj , Fadia AlBuhairan , Shahla AlDhukair , Mohamed M Ali , Abdullah Alkandari , Ala'a Alkerwi , Kristine Allin , Mar Alvarez-Pedrerol , Eman Aly , Deepak N Amarapurkar , Parisa Amiri , Norbert Amougou , Philippe Amouyel , Lars Bo Andersen , Sigmund A Anderssen , Lars Ängquist , Ranjit Mohan Anjana , Alireza Ansari-Moghaddam , Hajer Aounallah-Skhiri , Joana Araújo , Inger Ariansen , Tahir Aris , Raphael E Arku , Nimmathota Arlappa , Krishna K Aryal , Thor Aspelund , Felix K Assah , Maria Cecília F Assunção , May Soe Aung , Juha Auvinen , Mária Avdicová , Shina Avi , Ana Azevedo , Mohsen Azimi-Nezhad , Fereidoun Azizi , Mehrdad Azmin , Bontha V Babu , Maja Bæksgaard Jørgensen , Azli Baharudin , Suhad Bahijri , Jennifer L Baker , Nagalla Balakrishna , Mohamed Bamoshmoosh , Maciej Banach , Piotr Bandosz , José R Banegas , Joanna Baran , Barbagallo CM, Alberto Barceló , Amina Barkat , Aluisio Jd Barros , Mauro Virgílio Gomes Barros , Abdul Basit , Joao Luiz D Bastos , Iqbal Bata , Anwar M Batieha , Rosangela L Batista , Zhamilya Battakova , Assembekov Batyrbek , Louise A Baur , Robert Beaglehole , Silvia Bel-Serrat , Antonisamy Belavendra , Habiba Ben Romdhane , Judith Benedics , Mikhail Benet , Ingunn Holden Bergh , Salim Berkinbayev , Antonio Bernabe-Ortiz , Gailute Bernotiene , Heloísa Bettiol , Jorge Bezerra , Aroor Bhagyalaxmi , Sumit Bharadwaj , Santosh K Bhargava , Zulfiqar A Bhutta , Hongsheng Bi , Yufang Bi , Daniel Bia , Elysée Claude Bika Lele, Mukharram M Bikbov , Bihungum Bista , Dusko J Bjelica , Peter Bjerregaard , Espen Bjertness , Marius B Bjertness , Cecilia Björkelund , Katia V Bloch , Anneke Blokstra , Simona Bo , Martin Bobak , Lynne M Boddy , Bernhard O Boehm , Heiner Boeing , Jose G Boggia , Elena Bogova , Carlos P Boissonnet , Stig E Bojesen , Marialaura Bonaccio , Vanina Bongard , Alice Bonilla-Vargas , Matthias Bopp , Herman Borghs , Lien Braeckevelt , Lutgart Braeckman , Marjolijn Ce Bragt , Imperia Brajkovich , Francesco Branca , Juergen Breckenkamp , João Breda , Hermann Brenner , Lizzy M Brewster , Garry R Brian , Lacramioara Brinduse , Sinead Brophy , Graziella Bruno , H Bas Bueno-de-Mesquita , Anna Bugge , Marta Buoncristiano , Genc Burazeri , Con Burns , Antonio Cabrera de León , Joseph Cacciottolo , Hui Cai , Tilema Cama , Christine Cameron , José Camolas , Günay Can , Ana Paula C Cândido , Felicia Cañete , Mario V Capanzana , Nadežda Capková , Eduardo Capuano , Vincenzo Capuano , Marloes Cardol , Viviane C Cardoso , Axel C Carlsson , Esteban Carmuega , Joana Carvalho , José A Casajús , Felipe F Casanueva , Ertugrul Celikcan , Laura Censi , Marvin Cervantes-Loaiza , Juraci A Cesar , Snehalatha Chamukuttan , Angelique W Chan , Queenie Chan , Himanshu K Chaturvedi , Nish Chaturvedi , Norsyamlina Che Abdul Rahim , Miao Li Chee , Chien-Jen Chen , Fangfang Chen , Huashuai Chen , Shuohua Chen , Zhengming Chen , Ching-Yu Cheng , Bahman Cheraghian , Angela Chetrit , Ekaterina Chikova-Iscener , Arnaud Chiolero , Shu-Ti Chiou , María-Dolores Chirlaque , Belong Cho , Kaare Christensen , Diego G Christofaro , Jerzy Chudek , Renata Cifkova , Michelle Cilia , Eliza Cinteza , Frank Claessens , Janine Clarke , Els Clays , Emmanuel Cohen , Hans Concin , Susana C Confortin , Cyrus Cooper , Tara C Coppinger , Eva Corpeleijn , Simona Costanzo , Dominique Cottel , Chris Cowell , Cora L Craig , Amelia C Crampin , Ana B Crujeiras , Semánová Csilla , Alexandra M Cucu , Liufu Cui , Felipe V Cureau , Ewelina Czenczek-Lewandowska , Graziella D'Arrigo , Eleonora d'Orsi , Liliana Dacica , María Ángeles Dal Re Saavedra , Jean Dallongeville , Camilla T Damsgaard , Rachel Dankner , Thomas M Dantoft , Parasmani Dasgupta , Saeed Dastgiri , Luc Dauchet , Kairat Davletov , Guy De Backer , Dirk De Bacquer , Giovanni de Gaetano , Stefaan De Henauw , Paula Duarte de Oliveira , David De Ridder , Karin De Ridder , Susanne R de Rooij , Delphine De Smedt , Mohan Deepa , Alexander D Deev , Vincent Jr DeGennaro , Abbas Dehghan , Hélène Delisle , Francis Delpeuch , Stefaan Demarest , Elaine Dennison , Katarzyna Dereń , Valérie Deschamps , Meghnath Dhimal , Augusto F Di Castelnuovo , Juvenal Soares Dias-da-Costa , María Elena Díaz-Sánchez , Alejandro Diaz , Zivka Dika , Shirin Djalalinia , Visnja Djordjic , Ha Tp Do , Annette J Dobson , Maria Benedetta Donati , Chiara Donfrancesco , Silvana P Donoso , Angela Döring , Maria Dorobantu , Ahmad Reza Dorosty , Kouamelan Doua , Nico Dragano , Wojciech Drygas , Jia Li Duan , Charmaine A Duante , Priscilla Duboz , Rosemary B Duda , Vesselka Duleva , Virginija Dulskiene , Samuel C Dumith , Anar Dushpanova , Vilnis Dzerve , Elzbieta Dziankowska-Zaborszczyk , Ricky Eddie , Ebrahim Eftekhar , Eruke E Egbagbe , Robert Eggertsen , Sareh Eghtesad , Gabriele Eiben , Ulf Ekelund , Mohammad El-Khateeb , Jalila El Ati , Denise Eldemire-Shearer , Marie Eliasen , Paul Elliott , Reina Engle-Stone , Macia Enguerran , Rajiv T Erasmus , Raimund Erbel , Cihangir Erem , Louise Eriksen , Johan G Eriksson , Jorge Escobedo-de la Peña , Saeid Eslami , Ali Esmaeili , Alun Evans , David Faeh , Albina A Fakhretdinova , Caroline H Fall , Elnaz Faramarzi , Mojtaba Farjam , Victoria Farrugia Sant'Angelo , Farshad Farzadfar , Mohammad Reza Fattahi , Asher Fawwad , Francisco J Felix-Redondo , Trevor S Ferguson , Romulo A Fernandes , Daniel Fernández-Bergés , Daniel Ferrante , Thomas Ferrao , Marika Ferrari , Marco M Ferrario , Catterina Ferreccio , Eldridge Ferrer , Jean Ferrieres , Thamara Hubler Figueiró , Anna Fijalkowska , Günther Fink , Krista Fischer , Leng Huat Foo , Maria Forsner , Heba M Fouad , Damian K Francis , Maria do Carmo Franco , Ruth Frikke-Schmidt , Guillermo Frontera , Flavio D Fuchs , Sandra C Fuchs , Isti I Fujiati , Yuki Fujita , Matsuda Fumihiko , Takuro Furusawa , Zbigniew Gaciong , Mihai Gafencu , Andrzej Galbarczyk , Henrike Galenkamp , Daniela Galeone , Myriam Galfo , Fabio Galvano , Jingli Gao , Manoli Garcia-de-la-Hera , Marta García-Solano , Dickman Gareta , Sarah P Garnett , Jean-Michel Gaspoz , Magda Gasull , Adroaldo Cesar Araujo Gaya , Anelise Reis Gaya , Andrea Gazzinelli , Ulrike Gehring , Harald Geiger , Johanna M Geleijnse , Ali Ghanbari , Erfan Ghasemi , Oana-Florentina Gheorghe-Fronea , Simona Giampaoli , Francesco Gianfagna , Tiffany K Gill , Jonathan Giovannelli , Glen Gironella , Aleksander Giwercman , Konstantinos Gkiouras , Justyna Godos , Sibel Gogen , Marcel Goldberg , Rebecca A Goldsmith , David Goltzman , Santiago F Gómez , Aleksandra Gomula , Bruna Goncalves Cordeiro da Silva , Helen Gonçalves , David A Gonzalez-Chica , Marcela Gonzalez-Gross , Margot González-Leon , Juan P González-Rivas , Clicerio González-Villalpando , María-Elena González-Villalpando , Angel R Gonzalez , Frederic Gottrand , Antonio Pedro Graça , Sidsel Graff-Iversen , Dušan Grafnetter , Aneta Grajda , Maria G Grammatikopoulou , Ronald D Gregor , Tomasz Grodzicki , Else Karin Grøholt , Anders Grøntved , Giuseppe Grosso , Gabriella Gruden , Dongfeng Gu , Emanuela Gualdi-Russo , Pilar Guallar-Castillón , Andrea Gualtieri , Elias F Gudmundsson , Vilmundur Gudnason , Ramiro Guerrero , Idris Guessous , Andre L Guimaraes , Martin C Gulliford , Johanna Gunnlaugsdottir , Marc J Gunter , Xiu-Hua Guo , Yin Guo , Prakash C Gupta , Rajeev Gupta , Oye Gureje , Beata Gurzkowska , Enrique Gutiérrez-González , Laura Gutierrez , Felix Gutzwiller , Seongjun Ha , Farzad Hadaegh , Charalambos A Hadjigeorgiou , Rosa Haghshenas , Hamid Hakimi , Jytte Halkjær , Ian R Hambleton , Behrooz Hamzeh , Dominique Hange , Abu Am Hanif , Sari Hantunen , Jie Hao , Rachakulla Hari Kumar , Seyed Mohammad Hashemi-Shahri , Maria Hassapidou , Jun Hata , Teresa Haugsgjerd , Jiang He , Yuan He , Yuna He , Regina Heidinger-Felso , Mirjam Heinen , Tatjana Hejgaard , Marleen Elisabeth Hendriks , Rafael Dos Santos Henrique , Ana Henriques , Leticia Hernandez Cadena , Sauli Herrala , Victor M Herrera , Isabelle Herter-Aeberli , Ramin Heshmat , Allan G Hill , Sai Yin Ho , Suzanne C Ho , Michael Hobbs , Michelle Holdsworth , Reza Homayounfar , Clara Homs , Wilma M Hopman , Andrea Rvr Horimoto , Claudia M Hormiga , Bernardo L Horta , Leila Houti , Christina Howitt , Thein Thein Htay , Aung Soe Htet , Maung Maung Than Htike , Yonghua Hu , José María Huerta , Ilpo Tapani Huhtaniemi , Laetitia Huiart , Constanta Huidumac Petrescu , Martijn Huisman , Abdullatif Husseini , Chinh Nguyen Huu , Inge Huybrechts , Nahla Hwalla , Jolanda Hyska , Licia Iacoviello , Jesús M Ibarluzea , Mohsen M Ibrahim , Norazizah Ibrahim Wong , M Arfan Ikram , Violeta Iotova , Vilma E Irazola , Takafumi Ishida , Muhammad Islam , Sheikh Mohammed Shariful Islam , Masanori Iwasaki , Jeremy M Jacobs , Hashem Y Jaddou , Tazeen Jafar , Kenneth James , Kazi M Jamil , Konrad Jamrozik , Imre Janszky , Edward Janus , Juel Jarani , Marjo-Riitta Jarvelin , Grazyna Jasienska , Ana Jelakovic , Bojan Jelakovic , Garry Jennings , Anjani Kumar Jha , Chao Qiang Jiang , Ramon O Jimenez , Karl-Heinz Jöckel , Michel Joffres , Mattias Johansson , Jari J Jokelainen , Jost B Jonas , Jitendra Jonnagaddala , Torben Jørgensen , Pradeep Joshi , Farahnaz Joukar , Dragana P Jovic , Jacek J Jóźwiak , Anne Juolevi , Gregor Jurak , Iulia Jurca Simina , Vesna Juresa , Rudolf Kaaks , Felix O Kaducu , Anthony Kafatos , Eero O Kajantie , Zhanna Kalmatayeva , Ofra Kalter-Leibovici , Yves Kameli , Freja B Kampmann , Kodanda R Kanala , Srinivasan Kannan , Efthymios Kapantais , Argyro Karakosta , Line L Kårhus , Khem B Karki , Marzieh Katibeh , Joanne Katz , Peter T Katzmarzyk , Jussi Kauhanen , Prabhdeep Kaur , Maryam Kavousi , Gyulli M Kazakbaeva , Ulrich Keil , Lital Keinan Boker , Sirkka Keinänen-Kiukaanniemi , Roya Kelishadi , Cecily Kelleher , Han Cg Kemper , Andre P Kengne , Maryam Keramati , Alina Kerimkulova , Mathilde Kersting , Timothy Key , Yousef Saleh Khader , Davood Khalili , Kay-Tee Khaw , Bahareh Kheiri , Motahareh Kheradmand , Alireza Khosravi , Ilse Msl Khouw , Ursula Kiechl-Kohlendorfer , Stefan Kiechl , Japhet Killewo , Dong Wook Kim , Hyeon Chang Kim , Jeongseon Kim , Jenny M Kindblom , Heidi Klakk , Magdalena Klimek , Jeannette Klimont , Jurate Klumbiene , Michael Knoflach , Bhawesh Koirala , Elin Kolle , Patrick Kolsteren , Jürgen König , Raija Korpelainen , Paul Korrovits , Magdalena Korzycka , Jelena Kos , Seppo Koskinen , Katsuyasu Kouda , Viktoria A Kovacs , Sudhir Kowlessur , Slawomir Koziel , Jana Kratenova , Wolfgang Kratzer , Susi Kriemler , Peter Lund Kristensen , Steinar Krokstad , Daan Kromhout , Herculina S Kruger , Ruzena Kubinova , Renata Kuciene , Urho M Kujala , Enisa Kujundzic , Zbigniew Kulaga , R Krishna Kumar , Marie Kunešová , Pawel Kurjata , Yadlapalli S Kusuma , Kari Kuulasmaa , Catherine Kyobutungi , Quang Ngoc La , Fatima Zahra Laamiri , Tiina Laatikainen , Carl Lachat , Youcef Laid , Tai Hing Lam , Christina-Paulina Lambrinou , Edwige Landais , Vera Lanska , Georg Lappas , Bagher Larijani , Tint Swe Latt , Laura Lauria , Maria Lazo-Porras , Gwenaëlle Le Coroller , Khanh Le Nguyen Bao , Agnès Le Port , Tuyen D Le , Jeannette Lee , Jeonghee Lee , Paul H Lee , Nils Lehmann , Terho Lehtimäki , Daniel Lemogoum , Naomi S Levitt , Yanping Li , Merike Liivak , Christa L Lilly , Wei-Yen Lim , M Fernanda Lima-Costa , Hsien-Ho Lin , Xu Lin , Yi-Ting Lin , Lars Lind , Allan Linneberg , Lauren Lissner , Mieczyslaw Litwin , Lijuan Liu , Wei-Cheng Lo , Helle-Mai Loit , Khuong Quynh Long , Luis Lopes , Oscar Lopes , Esther Lopez-Garcia , Tania Lopez , Paulo A Lotufo , José Eugenio Lozano , Janice L Lukrafka , Dalia Luksiene , Annamari Lundqvist , Robert Lundqvist , Nuno Lunet , Charles Lunogelo , Michala Lustigová , Edyta Łuszczki , Guansheng Ma , Jun Ma , Xu Ma , George Ll Machado-Coelho , Aristides M Machado-Rodrigues , Luisa M Macieira , Ahmed A Madar , Stefania Maggi , Dianna J Magliano , Sara Magnacca , Emmanuella Magriplis , Gowri Mahasampath , Bernard Maire , Marjeta Majer , Marcia Makdisse , Päivi Mäki , Fatemeh Malekzadeh , Reza Malekzadeh , Rahul Malhotra , Kodavanti Mallikharjuna Rao , Sofia K Malyutina , Lynell V Maniego , Yannis Manios , Jim I Mann , Fariborz Mansour-Ghanaei , Enzo Manzato , Paula Margozzini , Anastasia Markaki , Oonagh Markey , Eliza Markidou Ioannidou , Pedro Marques-Vidal , Larissa Pruner Marques , Jaume Marrugat , Yves Martin-Prevel , Rosemarie Martin , Reynaldo Martorell , Eva Martos , Katharina Maruszczak , Stefano Marventano , Luis P Mascarenhas , Shariq R Masoodi , Ellisiv B Mathiesen , Prashant Mathur , Alicia Matijasevich , Tandi E Matsha , Christina Mavrogianni , Artur Mazur , Jean Claude N Mbanya , Shelly R McFarlane , Stephen T McGarvey , Martin McKee , Stela McLachlan , Rachael M McLean , Scott B McLean , Breige A McNulty , Sounnia Mediene Benchekor , Jurate Medzioniene , Parinaz Mehdipour , Kirsten Mehlig , Amir Houshang Mehrparvar , Aline Meirhaeghe , Jørgen Meisfjord , Christa Meisinger , Ana Maria B Menezes , Geetha R Menon , Gert Bm Mensink , Maria Teresa Menzano , Alibek Mereke , Indrapal I Meshram , Andres Metspalu , Haakon E Meyer , Jie Mi , Kim F Michaelsen , Nathalie Michels , Kairit Mikkel , Karolina Milkowska , Jody C Miller , Cláudia S Minderico , G K Mini , Juan Francisco Miquel , Mohammad Reza Mirjalili , Daphne Mirkopoulou , Erkin Mirrakhimov , Marjeta Mišigoj-Durakovic , Antonio Mistretta , Veronica Mocanu , Pietro A Modesti , Sahar Saeedi Moghaddam , Bahram Mohajer , Mostafa K Mohamed , Shukri F Mohamed , Kazem Mohammad , Zahra Mohammadi , Noushin Mohammadifard , Reza Mohammadpourhodki , Viswanathan Mohan , Salim Mohanna , Muhammad Fadhli Mohd Yusoff , Iraj Mohebbi , Farnam Mohebi , Marie Moitry , Drude Molbo , Line T Møllehave , Niels C Møller , Dénes Molnár , Amirabbas Momenan , Charles K Mondo , Michele Monroy-Valle , Eric Monterrubio-Flores , Kotsedi Daniel K Monyeki , Jin Soo Moon , Mahmood Moosazadeh , Leila B Moreira , Alain Morejon , Luis A Moreno , Karen Morgan , Suzanne N Morin , Erik Lykke Mortensen , George Moschonis , Malgorzata Mossakowska , Aya Mostafa , Anabela Mota-Pinto , Jorge Mota , Mohammad Esmaeel Motlagh , Jorge Motta , Marcos André Moura-Dos-Santos , Malay K Mridha , Kelias P Msyamboza , Thet Thet Mu , Magdalena Muc , Boban Mugoša , Maria L Muiesan , Parvina Mukhtorova , Martina Müller-Nurasyid , Neil Murphy , Jaakko Mursu , Elaine M Murtagh , Kamarul Imran Musa , Sanja Music Milanovic , Vera Musil , Norlaila Mustafa , Iraj Nabipour , Shohreh Naderimagham , Gabriele Nagel , Balkish M Naidu , Farid Najafi , Harunobu Nakamura , Jana Námešná , Ei Ei K Nang , Vinay B Nangia , Martin Nankap , Sameer Narake , Paola Nardone , Matthias Nauck , William A Neal , Azim Nejatizadeh , Chandini Nekkantti , Keiu Nelis , Liis Nelis , Ilona Nenko , Martin Neovius , Flavio Nervi , Chung T Nguyen , Nguyen D Nguyen , Quang Ngoc Nguyen , Ramfis E Nieto-Martínez , Yury P Nikitin , Guang Ning , Toshiharu Ninomiya , Sania Nishtar , Marianna Noale , Oscar A Noboa , Helena Nogueira , Teresa Norat , Maria Nordendahl , Børge G Nordestgaard , Davide Noto , Natalia Nowak-Szczepanska , Mohannad Al Nsour , Irfan Nuhoglu , Eha Nurk , Terence W O'Neill , Dermot O'Reilly , Galina Obreja , Caleb Ochimana , Angélica M Ochoa-Avilés , Eiji Oda , Kyungwon Oh , Kumiko Ohara , Claes Ohlsson , Ryutaro Ohtsuka , Örn Olafsson , Maria Teresa A Olinto , Isabel O Oliveira , Mohd Azahadi Omar , Altan Onat , Sok King Ong , Lariane M Ono , Pedro Ordunez , Rui Ornelas , Ana P Ortiz , Pedro J Ortiz , Merete Osler , Clive Osmond , Sergej M Ostojic , Afshin Ostovar , Johanna A Otero , Kim Overvad , Ellis Owusu-Dabo , Fred Michel Paccaud , Cristina Padez , Ioannis Pagkalos , Elena Pahomova , Karina Mary de Paiva , Andrzej Pajak , Domenico Palli , Alberto Palloni , Luigi Palmieri , Wen-Harn Pan , Songhomitra Panda-Jonas , Arvind Pandey , Francesco Panza , Dimitrios Papandreou , Soon-Woo Park , Suyeon Park , Winsome R Parnell , Mahboubeh Parsaeian , Ionela M Pascanu , Patrick Pasquet , Nikhil D Patel , Ivan Pecin , Mangesh S Pednekar , Nasheeta Peer , Gao Pei , Sergio Viana Peixoto , Markku Peltonen , Alexandre C Pereira , Marco A Peres , Napoleón Pérez-Farinós , Cynthia M Pérez , Valentina Peterkova , Annette Peters , Astrid Petersmann , Janina Petkeviciene , Ausra Petrauskiene , Emanuela Pettenuzzo , Niloofar Peykari , Son Thai Pham , Rafael N Pichardo , Daniela Pierannunzio , Iris Pigeot , Hynek Pikhart , Aida Pilav , Lorenza Pilotto , Francesco Pistelli , Freda Pitakaka , Aleksandra Piwonska , Andreia N Pizarro , Pedro Plans-Rubió , Bee Koon Poh , Hermann Pohlabeln , Raluca M Pop , Stevo R Popovic , Miquel Porta , Georg Posch , Anil Poudyal , Dimitrios Poulimeneas , Hamed Pouraram , Farhad Pourfarzi , Akram Pourshams , Hossein Poustchi , Rajendra Pradeepa , Alison J Price , Jacqueline F Price , Rui Providencia , Jardena J Puder , Iveta Pudule , Soile E Puhakka , Maria Puiu , Margus Punab , Radwan F Qasrawi , Mostafa Qorbani , Tran Quoc Bao , Ivana Radic , Ricardas Radisauskas , Salar Rahimikazerooni , Mahfuzar Rahman , Mahmudur Rahman , Olli Raitakari , Manu Raj , Ellina Rakhimova , Sherali Rakhmatulloev , Ivo Rakovac , Sudha Ramachandra Rao , Ambady Ramachandran , Jacqueline Ramke , Elisabete Ramos , Rafel Ramos , Lekhraj Rampal , Sanjay Rampal , Vayia Rarra , Ramon A Rascon-Pacheco , Mette Rasmussen , Cassiano Ricardo Rech , Josep Redon , Paul Ferdinand M Reganit , Valéria Regecová , Luis Revilla , Abbas Rezaianzadeh , Lourdes Ribas-Barba , Robespierre Ribeiro , Elio Riboli , Adrian Richter , Fernando Rigo , Natascia Rinaldo , Tobias F Rinke de Wit , Ana Rito , Raphael M Ritti-Dias , Juan A Rivera , Cynthia Robitaille , Romana Roccaldo , Daniela Rodrigues , Fernando Rodríguez-Artalejo , María Del Cristo Rodriguez-Perez , Laura A Rodríguez-Villamizar , Ulla Roggenbuck , Rosalba Rojas-Martinez , Nipa Rojroongwasinkul , Dora Romaguera , Elisabetta L Romeo , Rafaela V Rosario , Annika Rosengren , Ian Rouse , Joel Gr Roy , Adolfo Rubinstein , Frank J Rühli , Jean-Bernard Ruidavets , Blanca Sandra Ruiz-Betancourt , Maria Ruiz-Castell , Emma Ruiz Moreno , Iuliia A Rusakova , Kenisha Russell Jonsson , Paola Russo , Petra Rust , Marcin Rutkowski , Charumathi Sabanayagam , Elena Sacchini , Harshpal S Sachdev , Alireza Sadjadi , Ali Reza Safarpour , Saeid Safiri , Nader Saki , Benoit Salanave , Eduardo Salazar Martinez , Diego Salmerón , Veikko Salomaa , Jukka T Salonen , Massimo Salvetti , Margarita Samoutian , Jose Sánchez-Abanto , Sandjaja , Susana Sans , Loreto Santa Marina , Diana A Santos , Ina S Santos , Lèlita C Santos , Maria Paula Santos , Osvaldo Santos , Rute Santos , Sara Santos Sanz , Jouko L Saramies , Luis B Sardinha , Nizal Sarrafzadegan , Thirunavukkarasu Sathish , Kai-Uwe Saum , Savvas Savva , Mathilde Savy , Norie Sawada , Mariana Sbaraini , Marcia Scazufca , Beatriz D Schaan , Angelika Schaffrath Rosario , Herman Schargrodsky , Anja Schienkiewitz , Sabine Schipf , Carsten O Schmidt , Ida Maria Schmidt , Peter Schnohr , Ben Schöttker , Sara Schramm , Stine Schramm , Helmut Schröder , Constance Schultsz , Aletta E Schutte , Aye Aye Sein , Rusidah Selamat , Vedrana Sember , Abhijit Sen , Idowu O Senbanjo , Sadaf G Sepanlou , Victor Sequera , Luis Serra-Majem , Jennifer Servais , Ludmila Ševcíková , Svetlana A Shalnova , Teresa Shamah-Levy , Morteza Shamshirgaran , Coimbatore Subramaniam Shanthirani , Maryam Sharafkhah , Sanjib K Sharma , Jonathan E Shaw , Amaneh Shayanrad , Ali Akbar Shayesteh , Lela Shengelia , Zumin Shi , Kenji Shibuya , Hana Shimizu-Furusawa , Dong Wook Shin , Majid Shirani , Rahman Shiri , Namuna Shrestha , Khairil Si-Ramlee , Alfonso Siani , Rosalynn Siantar , Abla M Sibai , Antonio M Silva , Diego Augusto Santos Silva , Mary Simon , Judith Simons , Leon A Simons , Agneta Sjöberg , Michael Sjöström , Gry Skodje , Jolanta Slowikowska-Hilczer , Przemyslaw Slusarczyk , Liam Smeeth , Hung-Kwan So , Fernanda Cunha Soares , Grzegorz Sobek , Eugène Sobngwi , Morten Sodemann , Stefan Söderberg , Moesijanti Ye Soekatri , Agustinus Soemantri , Reecha Sofat , Vincenzo Solfrizzi , Mohammad Hossein Somi , Emily Sonestedt , Yi Song , Thorkild Ia Sørensen , Elin P Sørgjerd , Charles Sossa Jérome , Victoria E Soto-Rojas , Aïcha Soumaré , Slavica Sovic , Bente Sparboe-Nilsen , Karen Sparrenberger , Angela Spinelli , Igor Spiroski , Jan A Staessen , Hanspeter Stamm , Maria G Stathopoulou , Kaspar Staub , Bill Stavreski , Jostein Steene-Johannessen , Peter Stehle , Aryeh D Stein , George S Stergiou , Jochanan Stessman , Ranko Stevanovic , Jutta Stieber , Doris Stöckl , Tanja Stocks , Jakub Stokwiszewski , Ekaterina Stoyanova , Gareth Stratton , Karien Stronks , Maria Wany Strufaldi , Lela Sturua , Ramón Suárez-Medina , Machi Suka , Chien-An Sun , Johan Sundström , Yn-Tz Sung , Jordi Sunyer , Paibul Suriyawongpaisal , Boyd A Swinburn , Rody G Sy , Holly E Syddall , René Charles Sylva , Moyses Szklo , Lucjan Szponar , E Shyong Tai , Mari-Liis Tammesoo , Abdonas Tamosiunas , Eng Joo Tan , Xun Tang , Maya Tanrygulyyeva , Frank Tanser , Yong Tao , Mohammed Rasoul Tarawneh , Jakob Tarp , Carolina B Tarqui-Mamani , Radka Taxová Braunerová , Anne Taylor , Julie Taylor , Félicité Tchibindat , William R Tebar , Grethe S Tell , Tania Tello , Yih Chung Tham , K R Thankappan , Holger Theobald , Xenophon Theodoridis , Lutgarde Thijs , Nihal Thomas , Betina H Thuesen , Lubica Tichá , Erik J Timmermans , Anne Tjonneland , Hanna K Tolonen , Janne S Tolstrup , Murat Topbas , Roman Topór-Madry , Liv Elin Torheim , María José Tormo , Michael J Tornaritis , Maties Torrent , Laura Torres-Collado , Stefania Toselli , Giota Touloumi , Pierre Traissac , Thi Tuyet-Hanh Tran , Dimitrios Trichopoulos , Antonia Trichopoulou , Oanh Th Trinh , Atul Trivedi , Lechaba Tshepo , Maria Tsigga , Shoichiro Tsugane , Azaliia M Tuliakova , Marshall K Tulloch-Reid , Fikru Tullu , Tomi-Pekka Tuomainen , Jaakko Tuomilehto , Maria L Turley , Gilad Twig , Per Tynelius , Themistoklis Tzotzas , Christophe Tzourio , Peter Ueda , Eunice Ugel , Flora Am Ukoli , Hanno Ulmer , Belgin Unal , Zhamyila Usupova , Hannu Mt Uusitalo , Nalan Uysal , Justina Vaitkeviciute , Gonzalo Valdivia , Susana Vale , Damaskini Valvi , Rob M van Dam , Johan Van der Heyden , Yvonne T van der Schouw , Koen Van Herck , Hoang Van Minh , Natasja M 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Kujundzic, Enisa, Kulaga, Zbigniew, Kumar, R Krishna, Kunešová, Marie, Kurjata, Pawel, Kusuma, Yadlapalli S, Kuulasmaa, Kari, Kyobutungi, Catherine, La, Quang Ngoc, Laamiri, Fatima Zahra, Laatikainen, Tiina, Lachat, Carl, Laid, Youcef, Lam, Tai Hing, Lambrinou, Christina-Paulina, Landais, Edwige, Lanska, Vera, Lappas, Georg, Larijani, Bagher, Latt, Tint Swe, Lauria, Laura, Lazo-Porras, Maria, Le Coroller, Gwenaëlle, Le Nguyen Bao, Khanh, Le Port, Agnè, Le, Tuyen D, Lee, Jeannette, Lee, Jeonghee, Lee, Paul H, Lehmann, Nil, Lehtimäki, Terho, Lemogoum, Daniel, Levitt, Naomi S, Li, Yanping, Liivak, Merike, Lilly, Christa L, Lim, Wei-Yen, Lima-Costa, M Fernanda, Lin, Hsien-Ho, Lin, Xu, Lin, Yi-Ting, Lind, Lar, Linneberg, Allan, Lissner, Lauren, Litwin, Mieczyslaw, Liu, Lijuan, Lo, Wei-Cheng, Loit, Helle-Mai, Long, Khuong Quynh, Lopes, Lui, Lopes, Oscar, Lopez-Garcia, Esther, Lopez, Tania, Lotufo, Paulo A, Lozano, José Eugenio, Lukrafka, Janice L, Luksiene, Dalia, Lundqvist, Annamari, 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Claude N, McFarlane, Shelly R, McGarvey, Stephen T, McKee, Martin, McLachlan, Stela, McLean, Rachael M, McLean, Scott B, McNulty, Breige A, Benchekor, Sounnia Mediene, Medzioniene, Jurate, Mehdipour, Parinaz, Mehlig, Kirsten, Mehrparvar, Amir Houshang, Meirhaeghe, Aline, Meisfjord, Jørgen, Meisinger, Christa, Menezes, Ana Maria B, Menon, Geetha R, Mensink, Gert BM, Menzano, Maria Teresa, Mereke, Alibek, Meshram, Indrapal I, Metspalu, Andre, Meyer, Haakon E, Mi, Jie, Michaelsen, Kim F, Michels, Nathalie, Mikkel, Kairit, Milkowska, Karolina, Miller, Jody C, Minderico, Cláudia S, Mini, GK, Miquel, Juan Francisco, Mirjalili, Mohammad Reza, Mirkopoulou, Daphne, Mirrakhimov, Erkin, Mišigoj-Durakovic, Marjeta, Mistretta, Antonio, Mocanu, Veronica, Modesti, Pietro A, Moghaddam, Sahar Saeedi, Mohajer, Bahram, Mohamed, Mostafa K, Mohamed, Shukri F, Mohammad, Kazem, Mohammadi, Zahra, Mohammadifard, Noushin, Mohammadpourhodki, Reza, Mohan, Viswanathan, Mohanna, Salim, Yusoff, Muhammad Fadhli Mohd, Mohebbi, Iraj, Mohebi, Farnam, Moitry, Marie, Molbo, Drude, Møllehave, Line T, Møller, Niels C, Molnár, Déne, Momenan, Amirabba, Mondo, Charles K, Monroy-Valle, Michele, Monterrubio-Flores, Eric, Monyeki, Kotsedi Daniel K, Moon, Jin Soo, Moosazadeh, Mahmood, Moreira, Leila B, Morejon, Alain, Moreno, Luis A, Morgan, Karen, Morin, Suzanne N, Mortensen, Erik Lykke, Moschonis, George, Mossakowska, Malgorzata, Mostafa, Aya, Mota-Pinto, Anabela, Mota, Jorge, Motlagh, Mohammad Esmaeel, Motta, Jorge, Moura-dos-Santos, Marcos André, Mridha, Malay K, Msyamboza, Kelias P, Mu, Thet Thet, Muc, Magdalena, Mugoša, Boban, Muiesan, Maria L, Mukhtorova, Parvina, Müller-Nurasyid, Martina, Murphy, Neil, Mursu, Jaakko, Murtagh, Elaine M, Musa, Kamarul Imran, Milanovic, Sanja Music, Musil, Vera, Mustafa, Norlaila, Nabipour, Iraj, Naderimagham, Shohreh, Nagel, Gabriele, Naidu, Balkish M, Najafi, Farid, Nakamura, Harunobu, Námešná, Jana, Ei K Nang, Ei, Nangia, Vinay B, Nankap, Martin, Narake, Sameer, Nardone, Paola, Nauck, Matthia, Neal, William A, Nejatizadeh, Azim, Nekkantti, Chandini, Nelis, Keiu, Nelis, Lii, Nenko, Ilona, Neovius, Martin, Nervi, Flavio, Nguyen, Chung T, Nguyen, Nguyen D, Nguyen, Quang Ngoc, Nieto-Martínez, Ramfis E, Nikitin, Yury P, Ning, Guang, Ninomiya, Toshiharu, Nishtar, Sania, Noale, Marianna, Noboa, Oscar A, Nogueira, Helena, Norat, Teresa, Nordendahl, Maria, Nordestgaard, Børge G, Noto, Davide, Nowak-Szczepanska, Natalia, Al Nsour, Mohannad, Nuhoglu, Irfan, Nurk, Eha, O'Neill, Terence W, O'Reilly, Dermot, Obreja, Galina, Ochimana, Caleb, Ochoa-Avilés, Angélica M, Oda, Eiji, Oh, Kyungwon, Ohara, Kumiko, Ohlsson, Clae, Ohtsuka, Ryutaro, Olafsson, Örn, Olinto, Maria Teresa A, Oliveira, Isabel O, Omar, Mohd Azahadi, Onat, Altan, Ong, Sok King, Ono, Lariane M, Ordunez, Pedro, Ornelas, Rui, Ortiz, Ana P, Ortiz, Pedro J, Osler, Merete, Osmond, Clive, Ostojic, Sergej M, Ostovar, Afshin, Otero, Johanna A, Overvad, Kim, Owusu-Dabo, Elli, Paccaud, Fred Michel, Padez, Cristina, Pagkalos, Ioanni, Pahomova, Elena, de Paiva, Karina Mary, Pajak, Andrzej, Palli, Domenico, Palloni, Alberto, Palmieri, Luigi, Pan, Wen-Harn, Panda-Jonas, Songhomitra, Pandey, Arvind, Panza, Francesco, Papandreou, Dimitrio, Park, Soon-Woo, Park, Suyeon, Parnell, Winsome R, Parsaeian, Mahboubeh, Pascanu, Ionela M, Pasquet, Patrick, Patel, Nikhil D, Pecin, Ivan, Pednekar, Mangesh S, Peer, Nasheeta, Pei, Gao, Peixoto, Sergio Viana, Peltonen, Markku, Pereira, Alexandre C, Peres, Marco A, Pérez-Farinós, Napoleón, Pérez, Cynthia M, Peterkova, Valentina, Peters, Annette, Petersmann, Astrid, Petkeviciene, Janina, Petrauskiene, Ausra, Pettenuzzo, Emanuela, Peykari, Niloofar, Pham, Son Thai, Pichardo, Rafael N, Pierannunzio, Daniela, Pigeot, Iri, Pikhart, Hynek, Pilav, Aida, Pilotto, Lorenza, Pistelli, Francesco, Pitakaka, Freda, Piwonska, Aleksandra, Pizarro, Andreia N, Plans-Rubió, Pedro, Poh, Bee Koon, Pohlabeln, Hermann, Pop, Raluca M, Popovic, Stevo R, Porta, Miquel, Posch, Georg, Poudyal, Anil, Poulimeneas, Dimitrio, Pouraram, Hamed, Pourfarzi, Farhad, Pourshams, Akram, Poustchi, Hossein, Pradeepa, Rajendra, Price, Alison J, Price, Jacqueline F, Providencia, Rui, Puder, Jardena J, Pudule, Iveta, Puhakka, Soile E, Puiu, Maria, Punab, Margu, Qasrawi, Radwan F, Qorbani, Mostafa, Bao, Tran Quoc, Radic, Ivana, Radisauskas, Ricarda, Rahimikazerooni, Salar, Rahman, Mahfuzar, Rahman, Mahmudur, Raitakari, Olli, Raj, Manu, Rakhimova, Ellina, Rakhmatulloev, Sherali, Rakovac, Ivo, Rao, Sudha Ramachandra, Ramachandran, Ambady, Ramke, Jacqueline, Ramos, Elisabete, Ramos, Rafel, Rampal, Lekhraj, Rampal, Sanjay, Rarra, Vayia, Rascon-Pacheco, Ramon A, Rasmussen, Mette, Rech, Cassiano Ricardo, Redon, Josep, Reganit, Paul Ferdinand M, Regecová, Valéria, Revilla, Lui, Rezaianzadeh, Abba, Ribas-Barba, Lourde, Ribeiro, Robespierre, Riboli, Elio, Richter, Adrian, Rigo, Fernando, Rinaldo, Natascia, de Wit, Tobias F Rinke, Rito, Ana, Ritti-Dias, Raphael M, Rivera, Juan A, Robitaille, Cynthia, Roccaldo, Romana, Rodrigues, Daniela, Rodríguez-Artalejo, Fernando, del Cristo Rodriguez-Perez, María, Rodríguez-Villamizar, Laura A, Roggenbuck, Ulla, Rojas-Martinez, Rosalba, Rojroongwasinkul, Nipa, Romaguera, Dora, Romeo, Elisabetta L, Rosario, Rafaela V, Rosengren, Annika, Rouse, Ian, Roy, Joel GR, Rubinstein, Adolfo, Rühli, Frank J, Ruidavets, Jean-Bernard, Ruiz-Betancourt, Blanca Sandra, Ruiz-Castell, Maria, Moreno, Emma Ruiz, Rusakova, Iuliia A, Jonsson, Kenisha Russell, Russo, Paola, Rust, Petra, Rutkowski, Marcin, Sabanayagam, Charumathi, Sacchini, Elena, Sachdev, Harshpal S, Sadjadi, Alireza, Safarpour, Ali Reza, Safiri, Saeid, Saki, Nader, Salanave, Benoit, Martinez, Eduardo Salazar, Salmerón, Diego, Salomaa, Veikko, Salonen, Jukka T, Salvetti, Massimo, Samoutian, Margarita, Sánchez-Abanto, Jose, Sandjaja, null, Sans, Susana, Marina, Loreto Santa, Santos, Diana A, Santos, Ina S, Santos, Lèlita C, Santos, Maria Paula, Santos, Osvaldo, Santos, Rute, Sanz, Sara Santo, Saramies, Jouko L, Sardinha, Luis B, Sarrafzadegan, Nizal, Sathish, Thirunavukkarasu, Saum, Kai-Uwe, Savva, Savva, Savy, Mathilde, Sawada, Norie, Sbaraini, Mariana, Scazufca, Marcia, Schaan, Beatriz D, Rosario, Angelika Schaffrath, Schargrodsky, Herman, Schienkiewitz, Anja, Schipf, Sabine, Schmidt, Carsten O, Schmidt, Ida Maria, Schnohr, Peter, Schöttker, Ben, Schramm, Sara, Schramm, Stine, Schröder, Helmut, Schultsz, Constance, Schutte, Aletta E, Sein, Aye Aye, Selamat, Rusidah, Sember, Vedrana, Sen, Abhijit, Senbanjo, Idowu O, Sepanlou, Sadaf G, Sequera, Victor, Serra-Majem, Lui, Servais, Jennifer, Ševcíková, Ludmila, Shalnova, Svetlana A, Shamah-Levy, Teresa, Shamshirgaran, Morteza, Shanthirani, Coimbatore Subramaniam, Sharafkhah, Maryam, Sharma, Sanjib K, Shaw, Jonathan E, Shayanrad, Amaneh, Shayesteh, Ali Akbar, Shengelia, Lela, Shi, Zumin, Shibuya, Kenji, Shimizu-Furusawa, Hana, Shin, Dong Wook, Shirani, Majid, Shiri, Rahman, Shrestha, Namuna, Si-Ramlee, Khairil, Siani, Alfonso, Siantar, Rosalynn, Sibai, Abla M, Silva, Antonio M, Silva, Diego Augusto Santo, Simon, Mary, Simons, Judith, Simons, Leon A, Sjöberg, Agneta, Sjöström, Michael, Skodje, Gry, Slowikowska-Hilczer, Jolanta, Slusarczyk, Przemyslaw, Smeeth, Liam, So, Hung-Kwan, Soares, Fernanda Cunha, Sobek, Grzegorz, Sobngwi, Eugène, Sodemann, Morten, Söderberg, Stefan, Soekatri, Moesijanti YE, Soemantri, Agustinu, Sofat, Reecha, Solfrizzi, Vincenzo, Somi, Mohammad Hossein, Sonestedt, Emily, Song, Yi, Sørensen, Thorkild IA, Sørgjerd, Elin P, Jérome, Charles Sossa, Soto-Rojas, Victoria E, Soumaré, Aïcha, Sovic, Slavica, Sparboe-Nilsen, Bente, Sparrenberger, Karen, Spinelli, Angela, Spiroski, Igor, Staessen, Jan A, Stamm, Hanspeter, Stathopoulou, Maria G, Staub, Kaspar, Stavreski, Bill, Steene-Johannessen, Jostein, Stehle, Peter, Stein, Aryeh D, Stergiou, George S, Stessman, Jochanan, Stevanovic, Ranko, Stieber, Jutta, Stöckl, Dori, Stocks, Tanja, Stokwiszewski, Jakub, Stoyanova, Ekaterina, Stratton, Gareth, Stronks, Karien, Strufaldi, Maria Wany, Sturua, Lela, Suárez-Medina, Ramón, Suka, Machi, Sun, Chien-An, Sundström, Johan, Sung, Yn-Tz, Sunyer, Jordi, Suriyawongpaisal, Paibul, Swinburn, Boyd A, Sy, Rody G, Syddall, Holly E, Sylva, René Charle, Szklo, Moyse, Szponar, Lucjan, Tai, E Shyong, Tammesoo, Mari-Lii, Tamosiunas, Abdona, Tan, Eng Joo, Tang, Xun, Tanrygulyyeva, Maya, Tanser, Frank, Tao, Yong, Tarawneh, Mohammed Rasoul, Tarp, Jakob, Tarqui-Mamani, Carolina B, Braunerová, Radka Taxová, Taylor, Anne, Taylor, Julie, Tchibindat, Félicité, Tebar, William R, Tell, Grethe S, Tello, Tania, Tham, Yih Chung, Thankappan, KR, Theobald, Holger, Theodoridis, Xenophon, Thijs, Lutgarde, Thomas, Nihal, Thuesen, Betina H, Tichá, Lubica, Timmermans, Erik J, Tjonneland, Anne, Tolonen, Hanna K, Tolstrup, Janne S, Topbas, Murat, Topór-Madry, Roman, Torheim, Liv Elin, Tormo, María José, Tornaritis, Michael J, Torrent, Matie, Torres-Collado, Laura, Toselli, Stefania, Touloumi, Giota, Traissac, Pierre, Tran, Thi Tuyet-Hanh, Trichopoulos, Dimitrio, Trichopoulou, Antonia, Trinh, Oanh TH, Trivedi, Atul, Tshepo, Lechaba, Tsigga, Maria, Tsugane, Shoichiro, Tuliakova, Azaliia M, Tulloch-Reid, Marshall K, Tullu, Fikru, Tuomainen, Tomi-Pekka, Tuomilehto, Jaakko, Turley, Maria L, Twig, Gilad, Tynelius, Per, Tzotzas, Themistokli, Tzourio, Christophe, Ueda, Peter, Ugel, Eunice, Ukoli, Flora AM, Ulmer, Hanno, Unal, Belgin, Usupova, Zhamyila, Uusitalo, Hannu MT, Uysal, Nalan, Vaitkeviciute, Justina, Valdivia, Gonzalo, Vale, Susana, Valvi, Damaskini, van Dam, Rob M, Van der Heyden, Johan, van der Schouw, Yvonne T, Van Herck, Koen, Van Minh, Hoang, Van Schoor, Natasja M, van Valkengoed, Irene GM, Vanderschueren, Dirk, Vanuzzo, Diego, Varbo, Anette, Varela-Moreiras, Gregorio, Varona-Pérez, Patricia, Vasan, Senthil K, Vega, Toma, Veidebaum, Tooma, Velasquez-Melendez, Gustavo, Velika, Biruta, Veronesi, Giovanni, Verschuren, WM Monique, Victora, Cesar G, Viegi, Giovanni, Viet, Lucie, Villalpando, Salvador, Vineis, Paolo, Vioque, Jesu, Virtanen, Jyrki K, Visser, Marjolein, Visvikis-Siest, Sophie, Viswanathan, Bharathi, Vladulescu, Mihaela, Vlasoff, Tiina, Vocanec, Dorja, Vollenweider, Peter, Völzke, Henry, Voutilainen, Ari, Voutilainen, Sari, Vrijheid, Martine, Vrijkotte, Tanja GM, Wade, Alisha N, Wagner, Aline, Waldhör, Thoma, Walton, Janette, Wambiya, Elvis OA, Bebakar, Wan Mohamad Wan, Mohamud, Wan Nazaimoon Wan, de Souza Wanderley Júnior, Rildo, Wang, Ming-Dong, Wang, Ningli, Wang, Qian, Wang, Xiangjun, Wang, Ya Xing, Wang, Ying-Wei, Wannamethee, S Goya, Wareham, Nichola, Weber, Adelheid, Wedderkopp, Niel, Weerasekera, Deepa, Weghuber, Daniel, Wei, Wenbin, Weres, Aneta, Werner, Bo, Whincup, Peter H, Widhalm, Kurt, Widyahening, Indah S, Wiecek, Andrzej, Wilks, Rainford J, Willeit, Johann, Willeit, Peter, Williams, Julianne, Wilsgaard, Tom, Wojtyniak, Bogdan, Wong-McClure, Roy A, Wong, Andrew, Wong, Jyh Eiin, Wong, Tien Yin, Woo, Jean, Woodward, Mark, Wu, Frederick C, Wu, Jianfeng, Wu, Li Juan, Wu, Shouling, Xu, Haiquan, Xu, Liang, Yaacob, Nor Azwany, Yamborisut, Uruwan, Yan, Weili, Yang, Ling, Yang, Xiaoguang, Yang, Yang, Yardim, Nazan, Yaseri, Mehdi, Yasuharu, Tabara, Ye, Xingwang, Yiallouros, Panayiotis K, Yoosefi, Moein, Yoshihara, Akihiro, You, Qi Sheng, You, San-Lin, Younger-Coleman, Novie O, Md Yusof, Safiah, Yusoff, Ahmad Faudzi, Zaccagni, Luciana, Zafiropulos, Vassili, Zainuddin, Ahmad A, Zakavi, Seyed Rasoul, Zamani, Farhad, Zambon, Sabina, Zampelas, Antoni, Zamrazilová, Hana, Zapata, Maria Elisa, Zargar, Abdul Hamid, Ko Zaw, Ko, Zdrojewski, Tomasz, Zejglicova, Kristyna, Vrkic, Tajana Zeljkovic, Zeng, Yi, Zhang, Luxia, Zhang, Zhen-Yu, Zhao, Dong, Zhao, Ming-Hui, Zhao, Wenhua, Zhen, Shiqi, Zheng, Wei, Zheng, Yingfeng, Zholdin, Bekbolat, Zhou, Maigeng, Zhu, Dan, Zins, Marie, Zitt, Emanuel, Zocalo, Yanina, Cisneros, Julio Zuñiga, Zuziak, Monika, Ezzati, Majid, Filippi, Sarah, Cohortes épidémiologiques en population (CONSTANCES), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay-Université Paris Cité (UPCité), Université Paris Cité (UPCité), Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Institut Agro - Montpellier SupAgro, and Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)
Subjects: Population -- Health aspects, Leanness, Baixo peso/Underweight, none, Double burden, alipainoisuus, tulotaso, global health, systematic analysis, Sedentary behaviors, RC1200, Prospective associations, 0302 clinical medicine, underweight, nälänhätä, Biology (General), skin and connective tissue diseases, Children, ComputingMilieux_MISCELLANEOUS, Body mass index, Human Nutrition & Health, education.field_of_study, Humane Voeding & Gezondheid, ylipaino, General Medicine, kansainvälinen vertailu, 3. Good health, World health, Medicine, A100 Pre-clinical Medicine, Population distribution, medicine.medical_specialty, QH301-705.5, Science, Socio-culturale, Nursing, Social sciences, General Biochemistry, Genetics and Molecular Biology, 03 medical and health sciences, Thinness, SDG 3 - Good Health and Well-being, BMI, epidemiology, obesity, None, Humans, Obesidade/Obesity, SDG 2 - Zero Hunger, education, VLAG, US adults, Omvårdnad, body mass index, malnutrition, obesity, underweight, nutritional and metabolic diseases, medicine.disease, terveellisyys, Obesity, Faculdade de Ciências Sociais, Body Mass Index, Prevalence, Risk Factors, General Biochemistry, WIAS, lihavuus, RA, Demography, N.A, double burden, Settore MED/09 - Medicina Interna, alueelliset erot, Nutrition and Disease, Animal Nutrition, [SDV]Life Sciences [q-bio], Medizin, 030204 cardiovascular system & hematology, 0601 Biochemistry and Cell Biology, Change distribution of body mass index, RA0421, Voeding en Ziekte, Epidemiology, Medicine and Health Sciences, Global health, Índice de massa corporal/Body Mass Index, 030212 general & internal medicine, Underweight, painoindeksi, 2. Zero hunger, General Neuroscience, aliravitsemus, elintarvikkeet, health, Public Health, Global Health, Social Medicine and Epidemiology, Diervoeding, 3142 Public health care science, environmental and occupational health, purl.org/pe-repo/ocde/ford#3.01.03 [https], Chinese adults, pooled analysis, medicine.symptom, Diet quality, B120 Physiology, Research Article, trends, purl.org/pe-repo/ocde/ford#1.06.03 [https], prevalence, Population, Mothers, Genetics and Molecular Biology, 3121 Internal medicine, medicine, Life Science, ddc:610, 3125 Otorhinolaryngology, ophthalmology, kehonkoostumus, Nutrition, Australian adults, General Immunology and Microbiology, purl.org/pe-repo/ocde/ford#3.01.04 [https], Ciências sociais, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Malnutrition, Epidemiology and Global Health, sense organs, Estilos de Vida e Impacto na Saúde
Abstract: 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., Wellcome Trust, Medical Research Council, peer-reviewed
Published: 2021
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19. Conducting national burden of disease studies in small countries in Europe– a feasible challenge?

Author: Rannveig Sigurvinsdottir, Natasa Terzic, Brecht Devleesschauwer, Ala'a Alkerwi, Elena Pallari, Inga Dora Sigfusdottir, and Sarah Cuschieri
Subjects: medicine.medical_specialty, Luxembourg, Iceland, Population health, YLD, Health informatics, Mortality -- Europe -- Data processing, YLL, Environmental health, Epidemiology, medicine, Mortality, Health policy, DALY, Malta, business.industry, Health status indicators -- Europe, Primary health care -- Europe -- Data processing, Public health, Burden of disease, Europe -- Statistics, Medical, Public Health, Environmental and Occupational Health, Health services research, Montenegro, European Burden of Disease Network, Diseases -- Europe -- Data processing, Years of potential life lost, Cyprus, States, Small -- Case studies, Diseases -- Malta -- Data processing, Commentary, Business, Metric (unit), Public aspects of medicine, RA1-1270, Morbidity
Abstract: Background: Burden of Disease (BoD) studies use disability-adjusted life years (DALYs) as a population health metric to quantify the years of life lost due to morbidity and premature mortality for diseases, injuries and risk factors occurring in a region or a country. Small countries usually face a number of challenges to conduct epidemiological studies, such as national BoD studies, due to the lack of specific expertise and resources or absence of adequate data. Considering Europe’s small countries of Cyprus, Iceland, Luxembourg, Malta and Montenegro, the aim was to assess whether the various national data sources identified are appropriate to perform national BoD studies. Main body: The five small countries have a well-established mortality registers following the ICD10 classification, which makes calculation of years of life lost (YLL) feasible. A number of health information data sources were identified in each country, which can provide prevalence data for the calculation of years lived with disability (YLD) for various conditions. These sources include disease-specific registers, hospital discharge data, primary health care data and epidemiological studies, provided by different organisations such as health directorates, institutes of public health, statistical offices and other bodies. Hence, DALYs can be estimated at a national level through the combination of the YLL and YLD information. On the other hand, small countries face unique challenges such as difficulty to ensure sample representativeness, variations in prevalence estimates especially for rarer diseases, existence of a substantial proportion of non-residents affiliated to healthcare systems and potential exclusion from some European or international initiatives. Recently established BoD networks may provide a platform for small countries to share experiences, expertise, and engage with countries and institutions that have long-standing experience with BoD assessment. Conclusion: Apart from mortality registries, adequate health data sources, notably for cancer, are potentially available at the small states to perform national BoD studies. Investing in sharing expert knowledge through engagement of researchers in BoD networks can enable the conduct of country specific BoD studies and the establishment of more accurate DALYs estimates. Such estimates can enable local policymakers to reflect on the relative burden of the different conditions that are contributing to morbidity and mortality at a country level., peer-reviewed
Published: 2021
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20. Mapping the burden of diabetes in five small countries in Europe and setting the agenda for health policy and strategic action

Author: Ala'a Alkerwi, Elena Pallari, Sarah Cuschieri, Natasa Terzic, and Árún Kristín Sigurðardóttir
Subjects: medicine.medical_specialty, Economic growth, media_common.quotation_subject, Population, Global burden of diseases, 030209 endocrinology & metabolism, Healthcare delivery, Non-insulin-dependent diabetes -- Government policy -- Iceland, Non-insulin-dependent diabetes -- Government policy -- Luxembourg, Health administration, Scarcity, Non-insulin-dependent diabetes -- Government policy -- Cyprus, 03 medical and health sciences, 0302 clinical medicine, Diabetes -- Europe -- Data processing, Medical policy -- Europe, Diabetes management, Noncommunicable diseases, Diabetes Mellitus, medicine, Humans, Non-insulin-dependent diabetes -- Government policy -- Montenegro, 030212 general & internal medicine, education, Health policy, media_common, Strategic planning, education.field_of_study, Research, lcsh:Public aspects of medicine, Health Policy, Public health, Healthcare systems, Health services research, Type 2 diabetes, lcsh:RA1-1270, Small countries, Cyprus, Non-insulin-dependent diabetes -- Government policy -- Malta, States, Small -- Case studies, Business
Abstract: Background: Diabetes is a global epidemic affecting every country. Small countries, however, face distinctive challenges related to their health system governance and their ability to implement effective health systems’ reforms. The aim of this research was to perform a comparative assessment of existing diabetes management practices at the population level and explore governmental-related policy for Cyprus, Iceland, Luxembourg, Malta and Montenegro. This is the first time that such an evidence-based review study has been performed in the field of diabetes. The overall purpose was to set the agenda for health policy and inform strategic actions for small countries that can benefit from dealing with the diabetes epidemic at a country level. Methods: We collected data and synthesized the evidence on dealing with diabetes for each of the five small European countries according to the (1) epidemiology of diabetes and other related metabolic abnormalities, (2) burden of diabetes status and (3) diabetes registers and national plans. We collected data by contacting Ministry representatives and other bodies in each state, and by searching through publicly available information from the respective Ministry of Health website on strategies and policies. Results: Diabetes rates were highest in Cyprus and Malta. National diabetes registers are present in Cyprus and Montenegro, while national diabetes plans and diabetes-specific strategies have been established in Cyprus, Malta and Montenegro. These three countries also offer a free holistic healthcare service to their diabetes population. Conclusions: Multistakeholder, national diabetes plans and public health strategies are important means to provide direction on diabetes management and health service provision at the population level. However, political support is not always present, as seen for Iceland. The absence of evidence-based strategies, lack of funding for conducting regular health examination surveys, omission of monitoring practices and capacity scarcity are among the greatest challenges faced by small countries to effectively measure health outcomes. Nevertheless, we identified means of how these can be overcome. For example, the creation of public interdisciplinary repositories enables easily accessible data that can be used for health policy and strategic planning. Health policy-makers, funders and practitioners can consider the use of regular health examination surveys and other tools to effectively manage diabetes at the population level., peer-reviewed
Published: 2021
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21. Author response: Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight

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Geleijnse, Elysée Claude Bika Lele, Yannis Manios, Jorge Escobedo-de la Peña, Yufang Bi, Chinh Nguyen Huu, Sibel Gogen, Viviane Cunha Cardoso, Kristine H. Allin, Ana Azevedo, Line Tang Møllehave, Vincent Jr DeGennaro, Novie O. Younger-Coleman, Gretchen A Stevens, Dickman Gareta, Holger Theobald, Anja Schienkiewitz, Bekbolat Zholdin, Janice Luisa Lukrafka, Adela Chirita-Emandi, Ulla Roggenbuck, Kenisha Russell Jonsson, Robespierre Ribeiro, Gabriele Eiben, Eero Kajantie, Sounnia Mediene Benchekor, Fariborz Mansour-Ghanaei, Mary Simon, Prakash C. Gupta, Mohammad Esmaeel Motlagh, Emanuela Gualdi-Russo, María Elena Díaz-Sánchez, Pilar Guallar-Castillón, Bee Koon Poh, Cristina Padez, Azaliia M Tuliakova, Sarah P. Garnett, William R. Tebar, Yingfeng Zheng, Suhad Bahijri, Christina Mavrogianni, Mihaela Vladulescu, Jan A. Staessen, Paula Duarte de Oliveira, Rui Ornelas, Michael Sjöström, Charles Agyemang, Slawomir Koziel, Shohreh Naderimagham, Jari Jokelainen, Stephen T. 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Otero, Jamila Abubakar Garba, Antonio Pedro Graça, Sumit Bharadwaj, Shiqi Zhen, Xiu-Hua Guo, Prashant Mathur, Raphael Mendes Ritti-Dias, Kouamelan Doua, Esteban Carmuega, Majid Shirani, Przemyslaw Slusarczyk, Petra Rust, Visnja Djordjic, Farahnaz Joukar, Johanna Gunnlaugsdottir, Leila Houti, Nayu Ikeda, Imperia Brajkovich, Amirabbas Momenan, Erik J. Timmermans, Marcin Rutkowski, Biruta Velika, Joana Araújo, Jostein Steene-Johannessen, Christa L. Lilly, Per Tynelius, Michael Tornaritis, Anne Juolevi, Fatima Zahra Laamiri, Carl Lachat, Kai-Uwe Saum, Espen Bjertness, Ana P. Ortiz, Joel G. R. Roy, Himanshu K. Chaturvedi, Michelle Holdsworth, Niels Wedderkopp, Johan Van der Heyden, Mukharram M. Bikbov, Hsien-Ho Lin, Eva Corpeleijn, Harshpal Singh Sachdev, Mohammad Reza Mirjalili, Maria del Cristo Rodriguez-Perez, Michala Lustigová, Tuyen D Le, Teresa Norat, Hana Zamrazilová, Garry Brian, Tien Yin Wong, Rosa Haghshenas, Clive Osmond, Diego Giulliano Destro Christofaro, Mahmood Moosazadeh, Vilma Irazola, Olli T. Raitakari, Marco Aurélio Peres, Terho Lehtimäki, Shuohua Chen, Dimitrios Papandreou, Robert J. Adams, Sigmund A. Anderssen, Peter T. Katzmarzyk, Luisa M Macieira, Félicité Tchibindat, Lital Keinan Boker, Toshiharu Ninomiya, Morten Sodemann, Jytte Halkjær, Zbigniew Kułaga, Sophie Visvikis-Siest, Farshad Farzadfar, N Capkova, Zumin Shi, Maria Turley, Zbigniew Gaciong, Giovanni Veronesi, Martin McKee, Veikko Salomaa, Gilad Twig, Elisabetta L. Romeo, Peter Kristensen, Grazyna Jasienska, Victor Guillermo Sequera, Mario V. Capanzana, Con Burns, Emanuela Pettenuzzo, Ming-Dong Wang, Jonathan Giovannelli, Stela McLachlan, Ellis Owusu-Dabo, Stefania Toselli, Maria Teresa Anselmo Olinto, Senthil K Vasan, Sara Schramm, Xenophon Theodoridis, Moyses Szklo, Ramfis Nieto-Martínez, Viswanathan Mohan, Guillermo Frontera, Rahul Malhotra, Thomas Ferrao, Dongfeng Gu, Tomas Vega, Hynek Pikhart, Päivi Mäki, Heba Fouad, Vilnis Dzerve, Christina Howitt, Seyed Mohammad Hashemi-Shahri, Jenny M. Kindblom, Marjolijn C. E. Bragt, G. K. Mini, Qian Wang, Liufu Cui, Andrzej Galbarczyk, Sylvain Sebert, Vilmundur Gudnason, Loreto Santa Marina, Kairat Davletov, Afshin Ostovar, Niloofar Peykari, Nicholas J. Wareham, Wilma M. Hopman, Karl-Heinz Jöckel, Jussi Kauhanen, Breige A. McNulty, Alina Kerimkulova, Youcef Laid, Claes Ohlsson, Stefan Kiechl, Alicia Matijasevich, Boban Mugoša, Srinivasan Kannan, Jyrki K. Virtanen, Mohan Deepa, Mangesh S. Pednekar, Shahla AlDhukair, Cynthia M. Pérez, Vera Lanska, Tint Swe Latt, Dominique Hange, João Luiz Bastos, Eliza Markidou Ioannidou, Leticia Hernandez Cadena, Maya Tanrygulyyeva, Reza Malekzadeh, Dimitrios Poulimeneas, Pedro Ordunez, Thomas Waldhör, Ioannis Pagkalos, Carlo M. Barbagallo, Abla M. Sibai, Peter Vollenweider, Asher Fawwad, Emily Sonestedt, Elena Pahomova, Santosh K. Bhargava, Patrick Kolsteren, Aya Mostafa, Fangfang Chen, Flavio Nervi, Imre Janszky, Arvind Pandey, Renata Cifkova, Alexandre C. Pereira, Alejandro Diaz, Alireza Ansari-Moghaddam, Rachakulla Hari Kumar, Jaakko Mursu, Luis A. Moreno, Glen Gironella, Jelena Kos, Tilema Cama, Haakon E. Meyer, Jun Ma, Raphael E. Arku, Ziad Abdeen, Rusidah Selamat, Dianna J. Magliano, Jitendra Jonnagaddala, Konstantinos Gkiouras, Paul Korrovits, Paola Nardone, Paolo Vineis, Kotsedi D Monyeki, Khuong Quynh Long, Alberto Barceló, Camilla T. Damsgaard, Constance Schultsz, Frank J Rühli, Santiago F. Gomez, Tara Coppinger, Muhammad Islam, Pierre Traissac, Eleonora d'Orsi, Irfan Nuhoglu, Rui Providência, Bernard Maire, Leandra Abarca-Gómez, Sinead Brophy, Daniela Pierannunzio, Cristina Taddei, Wen-Harn Pan, Gregor Starc, Abdullah Alkandari, Saeed Dastgiri, Lien Braeckevelt, Gustavo Velasquez-Melendez, Sudhir Kowlessur, Bagher Larijani, Cynthia Robitaille, Mohamed M. Ali, Steiner Krokstad, Noor Ani Ahmad, Anar Dushpanova, Agustinus Soemantri, Susana Sans, Ionela Pascanu, Gwenaëlle Le Coroller, Inger Ariansen, Abhijit Sen, Sergej M. Ostojic, Silvana Donoso, Felix K. Assah, Juan A Rivera, Peter H. Whincup, Oana-Florentina Gheorghe-Fronea, Hanan F. Abdul Rahim, Yadlapalli S. Kusuma, Michael Knoflach, Moein Yoosefi, Cassiano Ricardo Rech, Paul Ferdinand M. Reganit, Tomi-Pekka Tuomainen, Francesco Gianfagna, Stefania Maggi, Mohammad Hossein Somi, Behrooz Hamzeh, Bethlehem D. Solomon, Herman Borghs, Zhanna Kalmatayeva, Heidi Klakk, Akram Pourshams, Naomi S. Levitt, Miquel Porta, Vesna Jureša, Alexander D. Deev, Son Thai Pham, Paula Margozzini, Silvia Bel-Serrat, Dora Romaguera, Monira Alarouj, Winsome R. Parnell, Marloes Cardol, David Faeh, Antonio Bernabe-Ortiz, Giota Touloumi, Maryam Kavousi, Sanja Musić Milanović, Jalila El Ati, Sauli Herrala, Liang Xu, Sirkka Keinänen-Kiukaanniemi, Ian Hambleton, Stefan Savin, Andre Pascal Kengne, R. Krishna Kumar, Kurt Widhalm, Marco M Ferrario, Parisa Amiri, Yi Song, Jianfeng Wu, Jeannette Klimont, Jean Ferrières, Farhad Zamani, Shina Avi, Luis Paulo Gomes Mascarenhas, Aluísio J D Barros, Reecha Sofat, Koen Van Herck, Hoang Van Minh, Enrique Gutiérrez-González, Martine Vrijheid, Susana Cararo Confortin, Antonis Zampelas, Bogdan Wojtyniak, Ausra Petrauskiene, Juha Auvinen, Maryam Sharafkhah, Emanuel Zitt, Majid Ezzati, Young-Ho Khang, Ellina Rakhimova, Magdalena Klimek, Luís Lopes, Erkin M. Mirrakhimov, Maria Lc Iurilli, Günay Can, Mark Woodward, Esther Lopez-Garcia, Mauro Virgílio Gomes de Barros, Ahmed A. Madar, Rainford J. Wilks, Shoaib Afzal, Melanie J. Cowan, Gareth Stratton, Eduardo Salazar Martinez, Sameer Narake, Norie Sawada, Li Juan Wu, Adrian Richter, Licia Iacoviello, Hanno Ulmer, Deepak Amarapurkar, Mohsen Ibrahim, Hamed Pouraram, Massimo Salvetti, Hung-Kwan So, Yonghua Hu, Lars Ängquist, Thi Tuyet-Hanh Tran, Charles Lunogelo, Sabina Zambon, Angelika Schaffrath Rosario, Lauren Lissner, Kamarul Imran Musa, Deepa Weerasekera, Bihungum Bista, Takafumi Ishida, Ekaterina Chikova-Iscener, Mirjam M. Heinen, Tazeen H. Jafar, Semánová Csilla, Raija Korpelainen, Edward W. Gregg, Laura Gutierrez, Victor M. Herrera, Aristides M. Machado-Rodrigues, Fatemeh Malekzadeh, Shouling Wu, Jennifer L. Baker, Clicerio González-Villalpando, Irene G. M. van Valkengoed, Anna Fijałkowska, Meghnath Dhimal, Murat Topbaş, George Moschonis, Robert Eggertsen, Quang Ngoc Nguyen, Janette Walton, Elnaz Faramarzi, Nasheeta Peer, Radka Taxová Braunerová, Harald Geiger, Morteza Shamshirgaran, Lela Shengelia, María Ángeles Dal Re Saavedra, Khem Bahadur Karki, Timothy J. Key, Maria G. Grammatikopoulou, Susana Vale, Bernhard O. Boehm, Songhomitra Panda-Jonas, Iveta Pudule, Elisabete Ramos, Lacramioara Aurelia Brinduse, Paul H. Lee, Terence W O'Neill, Javad Aghazadeh-Attari, Margus Punab, Bojan Jelaković, Eliza Cinteza, Ha Tp Do, and Alison J. Hayes
Subjects: education.field_of_study, business.industry, Population, Distribution (economics), medicine.disease, Obesity, Geography, medicine, Underweight, medicine.symptom, education, business, Body mass index, Demography
Published: 2020
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22. Objective and subjective sleep measures are associated with HbA1c and insulin sensitivity in the general population: Findings from the ORISCAV-LUX-2 study

Author: Daniel R. Witte, Saverio Stranges, Ala'a Alkerwi, Laurent Malisoux, Gloria A. Aguayo, Anne Backes, Nico J. Diederich, Maria Ruiz-Castell, Laetitia Huiart, Guy Fagherazzi, and Jessica Pastore
Subjects: Male, Sleep Wake Disorders, HbA1c, Luxembourg, Endocrinology, Diabetes and Metabolism, Population, Type 2 diabetes, Overweight, general population, Pittsburgh Sleep Quality Index, Endocrinology, Surveys and Questionnaires, Internal Medicine, medicine, Humans, education, Slow-wave sleep, Glycated Hemoglobin, education.field_of_study, business.industry, Quantitative insulin sensitivity check index, sleep patterns, General Medicine, medicine.disease, Sleep in non-human animals, Obesity, accelerometer, Cross-Sectional Studies, type 2 diabetes, Insulin Resistance, medicine.symptom, Sleep, business, Demography
Abstract: AIM: To analyze the association of objective and subjective sleep measures with HbA1c and insulin sensitivity in the general population.METHODS: Using a cross-sectional design, data from 1028 participants in the ORISCAV-LUX-2 study from the general population in Luxembourg were analyzed. Objective sleep measures were assessed using accelerometers whereas subjective measures were assessed using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Sleep measures were defined as predictors, while HbA1c and quantitative insulin sensitivity check index (QUICKI) scores were considered outcomes. Linear and spline regression models were fitted by progressively adjusting for demographic and lifestyle variables in the total sample population as well as by stratified analyses using gender, obesity status, depressive symptoms and diabetes status.RESULTS: In fully adjusted models, total and deep sleep durations were associated with lower HbA1c (mmol/mol) levels, whereas sleep coefficients of variation (%) and poor sleep efficiency, as measured by PSQI scores (units), were associated with higher HbA1c levels. In stratified models, such associations were observed mainly in men, and in subjects who had depressive symptoms, were overweight and no diabetes. In addition, total sleep, deep sleep, coefficients of variation and poor sleep efficiency as measured by PSQI revealed non-linear associations. Similarly, greater insulin sensitivity was associated with longer total sleep time and with PSQI-6 (use of sleep medication).CONCLUSION: Associations were more frequently observed between sleep characteristics and glycaemic control with the use of objective sleep measures. Also, such associations varied within subgroups of the population. Our results highlight the relevance of measuring sleep patterns as key factors in the prevention of diabetes.
Published: 2022
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23. Population-based biomonitoring of exposure to persistent and non-persistent organic pollutants in the Grand Duchy of Luxembourg: Results from hair analysis

Author: Ala'a Alkerwi, Feng-Jiao Peng, Emilie M. Hardy, Claude Emond, Marie -Lise Lair, Brice M.R. Appenzeller, and Nicolas Sauvageot
Subjects: Adult, 010504 meteorology & atmospheric sciences, Luxembourg, General adult population, Population, Population based, 010501 environmental sciences, Biology, 01 natural sciences, chemistry.chemical_compound, Polybrominated diphenyl ethers, Environmental health, Biomonitoring, Halogenated Diphenyl Ethers, Hydrocarbons, Chlorinated, Humans, GE1-350, Pesticides, education, 0105 earth and related environmental sciences, General Environmental Science, Pollutant, education.field_of_study, Multiclass pesticides, Hair analysis, Environmental exposure, Hexachlorobenzene, Polychlorinated Biphenyls, Grand duchy, Human biomonitoring, Environmental sciences, Geography, Multiclass POPs, chemistry, Environmental chemistry, General Earth and Planetary Sciences, Environmental Pollutants, Lindane, Biological Monitoring, Environmental Monitoring
Abstract: Environmental exposure of humans to pollutants has been associated with adverse health outcomes, but few studies have evaluated the multiple exposure of general populations. In the present study, we used hair analysis to assess the exposure of a general adult population (n = 497) in Luxembourg to 34 persistent and 33 non-persistent organic pollutants from 11 chemical families, such as polychlorinated biphenyls (PCBs), polybrominated diphenyl ethers (PBDEs), organochlorine pesticides (OCPs), organophosphate pesticides (OPPs), and pyrethroid pesticides (PYRs). We detected 24 persistent and 29 non-persistent organic pollutants, with 17 pollutants being detected in more than 50% of hair samples. The median concentrations for pollutants detected in 100% of the samples were 0.37 pg/mg for lindane (γ-HCH), 0.15 pg/mg for hexachlorobenzene (HCB), 14.1 pg/mg for p-nitrophenyl (PNP), and 0.10 pg/mg for trifluralin. Each participant in this study had detectable levels of at least 10 of the pollutants analyzed, and 50% of participants had 19 or more, suggesting the simultaneous exposure to numerous different pollutants among our study population. Significant correlations were often found between pollutants from the same family, with the strongest being found between two PYR metabolites, trans/cis-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane-carboxylic acid (Cl2CA) and 3-phenoxybenzoic acid (3-PBA). Results from multiple linear regression analyses showed that sex, age and/or body mass index were significantly associated with 15 out of the 17 frequently detected pollutants. The current study is the first nationwide biomonitoring investigating organic contaminants in the Luxembourg population using hair analysis.
Published: 2021
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24. Hypothalamic-pituitary-adrenal-axis dysregulation and double product increases potentiate ischemic heart disease risk in a Black male cohort: the SABPA study

Author: Nicolaas T. Malan, Saverio Stranges, Christiaan E. Schutte, Ala'a Alkerwi, and Leoné Malan
Subjects: Adult, Male, Hypothalamo-Hypophyseal System, endocrine system, medicine.medical_specialty, Hydrocortisone, Physiology, Myocardial Ischemia, Black People, Pituitary-Adrenal System, 030204 cardiovascular system & hematology, White People, Cohort Studies, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Dehydroepiandrosterone sulfate, Adrenocorticotropic Hormone, Internal medicine, Heart rate, Internal Medicine, Humans, Medicine, double product, Myocardial infarction, Depression (differential diagnoses), Dehydroepiandrosterone Sulfate, business.industry, Adrenal cortex, Middle Aged, medicine.disease, myocardial ischemia, Cross-Sectional Studies, Endocrinology, medicine.anatomical_structure, Blood pressure, chemistry, hypothalamic-pituitary-adrenal-axis, Cohort, Female, Cardiology and Cardiovascular Medicine, business, Biomarkers, Stress, Psychological, hormones, hormone substitutes, and hormone antagonists, 030217 neurology & neurosurgery, Hypothalamic–pituitary–adrenal axis, Africans
Abstract: Emotional distress has been associated with a poorer prognosis in myocardial infarction patients. Elevated adrenocorticotrophic hormone (ACTH), lower cortisol, dehydroepiandrosterone sulfate (DHEAS) and cortisol:DHEAS, as measures of emotional distress, might correlate with silent myocardial ischemia (SMI) and workload. Thus, we assessed the relationship between emotional distress, SMI and double product (systolic blood pressure (SBP) × heart rate). Cross-sectional South African biethnic single-set cohorts (N=378), aged 44.7±9.52 years, were investigated. Depressive symptoms (Patient Health Questionnaire-9), anthropometric, fasting blood, 24-h double product and 24-h 2-lead electrocardiogram (ST-segment depression) values were obtained. Blacks, mostly men, had increased depressive symptoms, hyperglycemia, SMI, double product, SBP hypertension and ACTH but lower cortisol, DHEAS and cortisol:DHEAS than their White counterparts. Black men had the highest combined SBP hypertension and below-median cortisol prevalence, 38%, compared with 5.9-13.8% in the other groups. Their SMI was associated with ACTH and cortisol:DHEAS (adj. R 0.29; β 0.27-0.31 (0.12-0.64); P≤ 1/20.05), double product (adj. R 0.29; β 0.38 (0.18-0.57); P=0.050) and SBP hypertension (area under the curve: 0.68 (95% CI: 0.56, 0.80); P=0.042; sensitivity/specificity 49/85%). Double product was positively associated with central obesity in all sex groups and with cortisol in the Black men (P
Published: 2017
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25. Challenges and benefits of integrating diverse sampling strategies in the observation of cardiovascular risk factors (ORISCAV-LUX 2) study

Author: Torsten Bohn, Jean-Claude Schmit, Laurent Malisoux, Jean Beissel, Dritan Bejko, Charles Delagardelle, Sophie Couffignal, Stephanie Noppe, Ala'a Alkerwi, Anna Chioti, Nicolas Sauvageot, Brice M.R. Appenzeller, Marylène d’Incau, Gloria A. Aguayo, Jessica Pastore, Gwenaëlle Le Coroller, Valery Bocquet, and Saverio Stranges
Subjects: Adult, Male, medicine.medical_specialty, Luxembourg, Epidemiology, Cardiovascular risk factors, Population, Health Informatics, Sample (statistics), Follow-up studies, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Prevalence, medicine, Humans, Sampling (medicine), 030212 general & internal medicine, education, Population-based study, lcsh:R5-920, education.field_of_study, Data collection, business.industry, Patient Selection, 030503 health policy & services, Middle Aged, medicine.disease, Health Surveys, Obesity, Sample representativeness, Cross-Sectional Studies, Cardiovascular Diseases, Female, Follow-up studies, population health, Patient Participation, lcsh:Medicine (General), 0305 other medical science, business, population health, Research Article, Demography
Abstract: Background It is challenging to manage data collection as planned and creation of opportunities to adapt during the course of enrolment may be needed. This paper aims to summarize the different sampling strategies adopted in the second wave of Observation of Cardiovascular Risk Factors (ORISCAV-LUX, 2016–17), with a focus on population coverage and sample representativeness. Methods Data from the first nationwide cross-sectional, population-based ORISCAV-LUX survey, 2007–08 and from the newly complementary sample recruited via different pathways, nine years later were analysed. First, we compare the socio-demographic characteristics and health profiles between baseline participants and non-participants to the second wave. Then, we describe the distribution of subjects across different strategy-specific samples and performed a comparison of the overall ORISCAV-LUX2 sample to the national population according to stratification criteria. Results For the baseline sample (1209 subjects), the participants (660) were younger than the non-participants (549), with a significant difference in average ages (44 vs 45.8 years; P = 0.019). There was a significant difference in terms of education level (P
Published: 2019
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26. Additional file 1: of Challenges and benefits of integrating diverse sampling strategies in the observation of cardiovascular risk factors (ORISCAV-LUX 2) study

Author: Ala’a Alkerwi, Pastore, Jessica, Sauvageot, Nicolas, Coroller, Gwenaëlle, Bocquet, Valéry, D’Incau, Marylène, Aguayo, Gloria, Appenzeller, Brice, Bejko, Dritan, Bohn, Torsten, Malisoux, Laurent, Couffignal, Sophie, Noppe, Stephanie, Delagardelle, Charles, Beissel, Jean, Chioti, Anna, Stranges, Saverio, and Schmit, Jean-Claude
Abstract: Questionnaires ORISCAV-LUX 2. (Nurse Questionnaire) English version. (PDF 872 kb)
Published: 2019
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27. Additional file 2: of Challenges and benefits of integrating diverse sampling strategies in the observation of cardiovascular risk factors (ORISCAV-LUX 2) study

Author: Ala’a Alkerwi, Pastore, Jessica, Sauvageot, Nicolas, Coroller, Gwenaëlle, Bocquet, Valéry, D’Incau, Marylène, Aguayo, Gloria, Appenzeller, Brice, Bejko, Dritan, Bohn, Torsten, Malisoux, Laurent, Couffignal, Sophie, Noppe, Stephanie, Delagardelle, Charles, Beissel, Jean, Chioti, Anna, Stranges, Saverio, and Schmit, Jean-Claude
Abstract: Questionnaires ORISCAV-LUX 2. (Home-based Questionnaire) English version. (PDF 898 kb)
Published: 2019
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28. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017

Author: Gregory A Roth, Degu Abate, Kalkidan Hassen Abate, Solomon M Abay, Cristiana Abbafati, Nooshin Abbasi, Hedayat Abbastabar, Foad Abd-Allah, Jemal Abdela, Ahmed Abdelalim, Ibrahim Abdollahpour, Rizwan Suliankatchi Abdulkader, Haftom Temesgen Abebe, Molla Abebe, Zegeye Abebe, Ayenew Negesse Abejie, Semaw F Abera, Olifan Zewdie Abil, Haftom Niguse Abraha, Aklilu Roba Abrham, Laith Jamal Abu-Raddad, Manfred Mario Kokou Accrombessi, Dilaram Acharya, Abdu A Adamu, Oladimeji M Adebayo, Rufus Adesoji Adedoyin, Victor Adekanmbi, Olatunji O Adetokunboh, Beyene Meressa Adhena, Mina G Adib, Amha Admasie, Ashkan Afshin, Gina Agarwal, Kareha M Agesa, Anurag Agrawal, Sutapa Agrawal, Alireza Ahmadi, Mehdi Ahmadi, Muktar Beshir Ahmed, Sayem Ahmed, Amani Nidhal Aichour, Ibtihel Aichour, Miloud Taki Eddine Aichour, Mohammad Esmaeil Akbari, Rufus Olusola Akinyemi, Nadia Akseer, Ziyad Al-Aly, Ayman Al-Eyadhy, Rajaa M Al-Raddadi, Fares Alahdab, Khurshid Alam, Tahiya Alam, Animut Alebel, Kefyalew Addis Alene, Mehran Alijanzadeh, Reza Alizadeh-Navaei, Syed Mohamed Aljunid, Ala'a Alkerwi, François Alla, Peter Allebeck, Jordi Alonso, Khalid Altirkawi, Nelson Alvis-Guzman, Azmeraw T Amare, Leopold N Aminde, Erfan Amini, Walid Ammar, Yaw Ampem Amoako, Nahla Hamed Anber, Catalina Liliana Andrei, Sofia Androudi, Megbaru Debalkie Animut, Mina Anjomshoa, Hossein Ansari, Mustafa Geleto Ansha, Carl Abelardo T Antonio, Palwasha Anwari, Olatunde Aremu, Johan Ärnlöv, Amit Arora, Monika Arora, Al Artaman, Krishna K Aryal, Hamid Asayesh, Ephrem Tsegay Asfaw, Zerihun Ataro, Suleman Atique, Sachin R Atre, Marcel Ausloos, Euripide F G A Avokpaho, Ashish Awasthi, Beatriz Paulina Ayala Quintanilla, Yohanes Ayele, Rakesh Ayer, Peter S Azzopardi, Arefeh Babazadeh, Umar Bacha, Hamid Badali, Alaa Badawi, Ayele Geleto Bali, Katherine E Ballesteros, Maciej Banach, Kajori Banerjee, Marlena S Bannick, Joseph Adel Mattar Banoub, Miguel A Barboza, Suzanne Lyn Barker-Collo, Till Winfried Bärnighausen, Simon Barquera, Lope H Barrero, Quique Bassat, Sanjay Basu, Bernhard T Baune, Habtamu Wondifraw Baynes, Shahrzad Bazargan-Hejazi, Neeraj Bedi, Ettore Beghi, Masoud Behzadifar, Meysam Behzadifar, Yannick Béjot, Bayu Begashaw Bekele, Abate Bekele Belachew, Ezra Belay, Yihalem Abebe Belay, Michelle L Bell, Aminu K Bello, Derrick A Bennett, Isabela M Bensenor, Adam E Berman, Eduardo Bernabe, Robert S Bernstein, Gregory J Bertolacci, Mircea Beuran, Tina Beyranvand, Ashish Bhalla, Suraj Bhattarai, Soumyadeeep Bhaumik, Zulfiqar A Bhutta, Belete Biadgo, Molly H Biehl, Ali Bijani, Boris Bikbov, Ver Bilano, Nigus Bililign, Muhammad Shahdaat Bin Sayeed, Donal Bisanzio, Tuhin Biswas, Brigette F Blacker, Berrak Bora Basara, Rohan Borschmann, Cristina Bosetti, Kayvan Bozorgmehr, Oliver J Brady, Luisa C Brant, Carol Brayne, Alexandra Brazinova, Nicholas J K Breitborde, Hermann Brenner, Paul Svitil Briant, Gabrielle Britton, Traolach Brugha, Reinhard Busse, Zahid A Butt, Charlton S K H Callender, Ismael R Campos-Nonato, Julio Cesar Campuzano Rincon, Jorge Cano, Mate Car, Rosario Cárdenas, Giulia Carreras, Juan J Carrero, Austin Carter, Félix Carvalho, Carlos A Castañeda-Orjuela, Jacqueline Castillo Rivas, Chris D Castle, Clara Castro, Franz Castro, Ferrán Catalá-López, Ester Cerin, Yazan Chaiah, Jung-Chen Chang, Fiona J Charlson, Pankaj Chaturvedi, Peggy Pei-Chia Chiang, Odgerel Chimed-Ochir, Vesper Hichilombwe Chisumpa, Abdulaal Chitheer, Rajiv Chowdhury, Hanne Christensen, Devasahayam J Christopher, Sheng-Chia Chung, Flavia M Cicuttini, Liliana G Ciobanu, Massimo Cirillo, Aaron J Cohen, Leslie Trumbull Cooper, Paolo Angelo Cortesi, Monica Cortinovis, Ewerton Cousin, Benjamin C Cowie, Michael H Criqui, Elizabeth A Cromwell, Christopher Stephen Crowe, John A Crump, Matthew Cunningham, Alemneh Kabeta Daba, Abel Fekadu Dadi, Lalit Dandona, Rakhi Dandona, Anh Kim Dang, Paul I Dargan, Ahmad Daryani, Siddharth K Das, Rajat Das Gupta, José Das Neves, Tamirat Tesfaye Dasa, Aditya Prasad Dash, Adrian C Davis, Nicole Davis Weaver, Dragos Virgil Davitoiu, Kairat Davletov, Fernando Pio De La Hoz, Jan-Walter De Neve, Meaza Girma Degefa, Louisa Degenhardt, Tizta T Degfie, Selina Deiparine, Gebre Teklemariam Demoz, Balem Betsu Demtsu, Edgar Denova-Gutiérrez, Kebede Deribe, Nikolaos Dervenis, Don C Des Jarlais, Getenet Ayalew Dessie, Subhojit Dey, Samath D Dharmaratne, Daniel Dicker, Mesfin Tadese Dinberu, Eric L Ding, M Ashworth Dirac, Shirin Djalalinia, Klara Dokova, David Teye Doku, Christl A Donnelly, E Ray Dorsey, Pratik P Doshi, Dirk Douwes-Schultz, Kerrie E Doyle, Tim R Driscoll, Manisha Dubey, Eleonora Dubljanin, Eyasu Ejeta Duken, Bruce B Duncan, Andre R Duraes, Hedyeh Ebrahimi, Soheil Ebrahimpour, Dumessa Edessa, David Edvardsson, Anne Elise Eggen, Charbel El Bcheraoui, Maysaa El Sayed Zaki, Ziad El-Khatib, Hajer Elkout, Christian Lycke Ellingsen, Matthias Endres, Aman Yesuf Endries, Benjamin Er, Holly E Erskine, Babak Eshrati, Sharareh Eskandarieh, Reza Esmaeili, Alireza Esteghamati, Mahdi Fakhar, Hamed Fakhim, Mahbobeh Faramarzi, Mohammad Fareed, Farzaneh Farhadi, Carla Sofia E sá Farinha, Andre Faro, Maryam S Farvid, Farshad Farzadfar, Mohammad Hosein Farzaei, Valery L Feigin, Andrea B Feigl, Netsanet Fentahun, Seyed-Mohammad Fereshtehnejad, Eduarda Fernandes, Joao C Fernandes, Alize J Ferrari, Garumma Tolu Feyissa, Irina Filip, Samuel Finegold, Florian Fischer, Christina Fitzmaurice, Nataliya A Foigt, Kyle J Foreman, Carla Fornari, Tahvi D Frank, Takeshi Fukumoto, John E Fuller, Nancy Fullman, Thomas Fürst, João M Furtado, Neal D Futran, Silvano Gallus, Alberto L Garcia-Basteiro, Miguel A Garcia-Gordillo, William M Gardner, Abadi Kahsu Gebre, Tsegaye Tewelde Gebrehiwot, Amanuel Tesfay Gebremedhin, Bereket Gebremichael, Teklu Gebrehiwo Gebremichael, Tilayie Feto Gelano, Johanna M Geleijnse, Ricard Genova-Maleras, Yilma Chisha Dea Geramo, Peter W Gething, Kebede Embaye Gezae, Mohammad Rasoul Ghadami, Reza Ghadimi, Khalil Ghasemi Falavarjani, Maryam Ghasemi-Kasman, Mamata Ghimire, Katherine B Gibney, Paramjit Singh Gill, Tiffany K Gill, Richard F Gillum, Ibrahim Abdelmageed Ginawi, Maurice Giroud, Giorgia Giussani, Shifalika Goenka, Ellen M Goldberg, Srinivas Goli, Hector Gómez-Dantés, Philimon N Gona, Sameer Vali Gopalani, Taren M Gorman, Atsushi Goto, Alessandra C Goulart, Elena V Gnedovskaya, Ayman Grada, Giuseppe Grosso, Harish Chander Gugnani, Andre Luiz Sena Guimaraes, Yuming Guo, Prakash C Gupta, Rahul Gupta, Rajeev Gupta, Tanush Gupta, Reyna Alma Gutiérrez, Bishal Gyawali, Juanita A Haagsma, Nima Hafezi-Nejad, Tekleberhan B Hagos, Tewodros Tesfa Hailegiyorgis, Gessessew Bugssa Hailu, Arvin Haj-Mirzaian, Arya Haj-Mirzaian, Randah R Hamadeh, Samer Hamidi, Alexis J Handal, Graeme J Hankey, Hilda L Harb, Sivadasanpillai Harikrishnan, Josep Maria Haro, Mehedi Hasan, Hadi Hassankhani, Hamid Yimam Hassen, Rasmus Havmoeller, Roderick J Hay, Simon I Hay, Yihua He, Akbar Hedayatizadeh-Omran, Mohamed I Hegazy, Behzad Heibati, Mohsen Heidari, Delia Hendrie, Andualem Henok, Nathaniel J Henry, Claudiu Herteliu, Fatemeh Heydarpour, Pouria Heydarpour, Sousan Heydarpour, Desalegn Tsegaw Hibstu, Hans W Hoek, Michael K Hole, Enayatollah Homaie Rad, Praveen Hoogar, H Dean Hosgood, Seyed Mostafa Hosseini, Mehdi Hosseinzadeh, Mihaela Hostiuc, Sorin Hostiuc, Peter J Hotez, Damian G Hoy, Thomas Hsiao, Guoqing Hu, John J Huang, Abdullatif Husseini, Mohammedaman Mama Hussen, Susan Hutfless, Bulat Idrisov, Olayinka Stephen Ilesanmi, Usman Iqbal, Seyed Sina Naghibi Irvani, Caleb Mackay Salpeter Irvine, Nazrul Islam, Sheikh Mohammed Shariful Islam, Farhad Islami, Kathryn H Jacobsen, Leila Jahangiry, Nader Jahanmehr, Sudhir Kumar Jain, Mihajlo Jakovljevic, Moti Tolera Jalu, Spencer L James, Mehdi Javanbakht, Achala Upendra Jayatilleke, Panniyammakal Jeemon, Kathy J Jenkins, Ravi Prakash Jha, Vivekanand Jha, Catherine O Johnson, Sarah C Johnson, Jost B Jonas, Ankur Joshi, Jacek Jerzy Jozwiak, Suresh Banayya Jungari, Mikk Jürisson, Zubair Kabir, Rajendra Kadel, Amaha Kahsay, Rizwan Kalani, Manoochehr Karami, Behzad Karami Matin, André Karch, Corine Karema, Hamidreza Karimi-Sari, Amir Kasaeian, Dessalegn H Kassa, Getachew Mullu Kassa, Tesfaye Dessale Kassa, Nicholas J Kassebaum, Srinivasa Vittal Katikireddi, Anil Kaul, Zhila Kazemi, Ali Kazemi Karyani, Dhruv Satish Kazi, Adane Teshome Kefale, Peter Njenga Keiyoro, Grant Rodgers Kemp, Andre Pascal Kengne, Andre Keren, Chandrasekharan Nair Kesavachandran, Yousef Saleh Khader, Behzad Khafaei, Morteza Abdullatif Khafaie, Alireza Khajavi, Nauman Khalid, Ibrahim A Khalil, Ejaz Ahmad Khan, Muhammad Shahzeb Khan, Muhammad Ali Khan, Young-Ho Khang, Mona M Khater, Abdullah T Khoja, Ardeshir Khosravi, Mohammad Hossein Khosravi, Jagdish Khubchandani, Aliasghar A Kiadaliri, Getiye D Kibret, Zelalem Teklemariam Kidanemariam, Daniel N Kiirithio, Daniel Kim, Young-Eun Kim, Yun Jin Kim, Ruth W Kimokoti, Yohannes Kinfu, Adnan Kisa, Katarzyna Kissimova-Skarbek, Mika Kivimäki, Ann Kristin Skrindo Knudsen, Jonathan M Kocarnik, Sonali Kochhar, Yoshihiro Kokubo, Tufa Kolola, Jacek A Kopec, Parvaiz A Koul, Ai Koyanagi, Michael A Kravchenko, Kewal Krishan, Barthelemy Kuate Defo, Burcu Kucuk Bicer, G Anil Kumar, Manasi Kumar, Pushpendra Kumar, Michael J Kutz, Igor Kuzin, Hmwe Hmwe Kyu, Deepesh P Lad, Sheetal D Lad, Alessandra Lafranconi, Dharmesh Kumar Lal, Ratilal Lalloo, Tea Lallukka, Jennifer O Lam, Faris Hasan Lami, Van C Lansingh, Sonia Lansky, Heidi J Larson, Arman Latifi, Kathryn Mei-Ming Lau, Jeffrey V Lazarus, Georgy Lebedev, Paul H Lee, James Leigh, Mostafa Leili, Cheru Tesema Leshargie, Shanshan Li, Yichong Li, Juan Liang, Lee-Ling Lim, Stephen S Lim, Miteku Andualem Limenih, Shai Linn, Shiwei Liu, Yang Liu, Rakesh Lodha, Chris Lonsdale, Alan D Lopez, Stefan Lorkowski, Paulo A Lotufo, Rafael Lozano, Raimundas Lunevicius, Stefan Ma, Erlyn Rachelle King Macarayan, Mark T Mackay, Jennifer H MacLachlan, Emilie R Maddison, Fabiana Madotto, Hassan Magdy Abd El Razek, Muhammed Magdy Abd El Razek, Dhaval P Maghavani, Marek Majdan, Reza Majdzadeh, Azeem Majeed, Reza Malekzadeh, Deborah Carvalho Malta, Ana-Laura Manda, Luiz Garcia Mandarano-Filho, Helena Manguerra, Mohammad Ali Mansournia, Chabila Christopher Mapoma, Dadi Marami, Joemer C Maravilla, Wagner Marcenes, Laurie Marczak, Ashley Marks, Guy B Marks, Gabriel Martinez, Francisco Rogerlândio Martins-Melo, Ira Martopullo, Winfried März, Melvin B Marzan, Joseph R Masci, Benjamin Ballard Massenburg, Manu Raj Mathur, Prashant Mathur, Richard Matzopoulos, Pallab K Maulik, Mohsen Mazidi, Colm McAlinden, John J McGrath, Martin McKee, Brian J McMahon, Suresh Mehata, Man Mohan Mehndiratta, Ravi Mehrotra, Kala M Mehta, Varshil Mehta, Tefera C Mekonnen, Addisu Melese, Mulugeta Melku, Peter T N Memiah, Ziad A Memish, Walter Mendoza, Desalegn Tadese Mengistu, Getnet Mengistu, George A Mensah, Seid Tiku Mereta, Atte Meretoja, Tuomo J Meretoja, Tomislav Mestrovic, Haftay Berhane Mezgebe, Bartosz Miazgowski, Tomasz Miazgowski, Anoushka I Millear, Ted R Miller, Molly Katherine Miller-Petrie, G K Mini, Parvaneh Mirabi, Mojde Mirarefin, Andreea Mirica, Erkin M Mirrakhimov, Awoke Temesgen Misganaw, Habtamu Mitiku, Babak Moazen, Karzan Abdulmuhsin Mohammad, Moslem Mohammadi, Noushin Mohammadifard, Mohammed A Mohammed, Shafiu Mohammed, Viswanathan Mohan, Ali H Mokdad, Mariam Molokhia, Lorenzo Monasta, Ghobad Moradi, Maziar Moradi-Lakeh, Mehdi Moradinazar, Paula Moraga, Lidia Morawska, Ilais Moreno Velásquez, Joana Morgado-Da-Costa, Shane Douglas Morrison, Marilita M Moschos, Simin Mouodi, Seyyed Meysam Mousavi, Kindie Fentahun Muchie, Ulrich Otto Mueller, Satinath Mukhopadhyay, Kate Muller, John Everett Mumford, Jonah Musa, Kamarul Imran Musa, Ghulam Mustafa, Saravanan Muthupandian, Jean B Nachega, Gabriele Nagel, Aliya Naheed, Azin Nahvijou, Gurudatta Naik, Sanjeev Nair, Farid Najafi, Luigi Naldi, Hae Sung Nam, Vinay Nangia, Jobert Richie Nansseu, Bruno Ramos Nascimento, Gopalakrishnan Natarajan, Nahid Neamati, Ionut Negoi, Ruxandra Irina Negoi, Subas Neupane, Charles R J Newton, Frida N Ngalesoni, Josephine W Ngunjiri, Anh Quynh Nguyen, Grant Nguyen, Ha Thu Nguyen, Huong Thanh Nguyen, Long Hoang Nguyen, Minh Nguyen, Trang Huyen Nguyen, Emma Nichols, Dina Nur Anggraini Ningrum, Yirga Legesse Nirayo, Molly R Nixon, Nomonde Nolutshungu, Shuhei Nomura, Ole F Norheim, Mehdi Noroozi, Bo Norrving, Jean Jacques Noubiap, Hamid Reza Nouri, Malihe Nourollahpour Shiadeh, Mohammad Reza Nowroozi, Peter S Nyasulu, Christopher M Odell, Richard Ofori-Asenso, Felix Akpojene Ogbo, In-Hwan Oh, Olanrewaju Oladimeji, Andrew T Olagunju, Pedro R Olivares, Helen Elizabeth Olsen, Bolajoko Olubukunola Olusanya, Jacob Olusegun Olusanya, Kanyin L Ong, Sok King Sk Ong, Eyal Oren, Heather M Orpana, Alberto Ortiz, Justin R Ortiz, Stanislav S Otstavnov, Simon Øverland, Mayowa Ojo Owolabi, Raziye Özdemir, Mahesh P A, Rosana Pacella, Smita Pakhale, Abhijit P Pakhare, Amir H Pakpour, Adrian Pana, Songhomitra Panda-Jonas, Jeyaraj Durai Pandian, Andrea Parisi, Eun-Kee Park, Charles D H Parry, Hadi Parsian, Shanti Patel, Sanghamitra Pati, George C Patton, Vishnupriya Rao Paturi, Katherine R Paulson, Alexandre Pereira, David M Pereira, Norberto Perico, Konrad Pesudovs, Max Petzold, Michael R Phillips, Frédéric B Piel, David M Pigott, Julian David Pillay, Meghdad Pirsaheb, Farhad Pishgar, Suzanne Polinder, Maarten J Postma, Akram Pourshams, Hossein Poustchi, Ashwini Pujar, Swayam Prakash, Narayan Prasad, Caroline A Purcell, Mostafa Qorbani, Hedley Quintana, D Alex Quistberg, Kirankumar Waman Rade, Amir Radfar, Anwar Rafay, Alireza Rafiei, Fakher Rahim, Kazem Rahimi, Afarin Rahimi-Movaghar, Mahfuzar Rahman, Mohammad Hifz Ur Rahman, Muhammad Aziz Rahman, Rajesh Kumar Rai, Sasa Rajsic, Usha Ram, Chhabi Lal Ranabhat, Prabhat Ranjan, Puja C Rao, David Laith Rawaf, Salman Rawaf, Christian Razo-García, K Srinath Reddy, Robert C Reiner, Marissa B Reitsma, Giuseppe Remuzzi, Andre M N Renzaho, Serge Resnikoff, Satar Rezaei, Shahab Rezaeian, Mohammad Sadegh Rezai, Seyed Mohammad Riahi, Antonio Luiz P Ribeiro, Maria Jesus Rios-Blancas, Kedir Teji Roba, Nicholas L S Roberts, Stephen R Robinson, Leonardo Roever, Luca Ronfani, Gholamreza Roshandel, Ali Rostami, Dietrich Rothenbacher, Ambuj Roy, Enrico Rubagotti, Perminder S Sachdev, Basema Saddik, Ehsan Sadeghi, Hosein Safari, Mahdi Safdarian, Sare Safi, Saeid Safiri, Rajesh Sagar, Amirhossein Sahebkar, Mohammad Ali Sahraian, Nasir Salam, Joseph S Salama, Payman Salamati, Raphael De Freitas Saldanha, Zikria Saleem, Yahya Salimi, Sundeep Santosh Salvi, Inbal Salz, Evanson Zondani Sambala, Abdallah M Samy, Juan Sanabria, Maria Dolores Sanchez-Niño, Damian Francesco Santomauro, Itamar S Santos, João Vasco Santos, Milena M Santric Milicevic, Bruno Piassi Sao Jose, Abdur Razzaque Sarker, Rodrigo Sarmiento-Suárez, Nizal Sarrafzadegan, Benn Sartorius, Shahabeddin Sarvi, Brijesh Sathian, Maheswar Satpathy, Arundhati R Sawant, Monika Sawhney, Sonia Saxena, Mehdi Sayyah, Elke Schaeffner, Maria Inês Schmidt, Ione J C Schneider, Ben Schöttker, Aletta Elisabeth Schutte, David C Schwebel, Falk Schwendicke, James G Scott, Mario Sekerija, Sadaf G Sepanlou, Edson Serván-Mori, Seyedmojtaba Seyedmousavi, Hosein Shabaninejad, Katya Anne Shackelford, Azadeh Shafieesabet, Mehdi Shahbazi, Amira A Shaheen, Masood Ali Shaikh, Mehran Shams-Beyranvand, Mohammadbagher Shamsi, Morteza Shamsizadeh, Kiomars Sharafi, Mehdi Sharif, Mahdi Sharif-Alhoseini, Rajesh Sharma, Jun She, Aziz Sheikh, Peilin Shi, Mekonnen Sisay Shiferaw, Mika Shigematsu, Rahman Shiri, Reza Shirkoohi, Ivy Shiue, Farhad Shokraneh, Mark G Shrime, Si Si, Soraya Siabani, Tariq J Siddiqi, Inga Dora Sigfusdottir, Rannveig Sigurvinsdottir, Donald H Silberberg, Diego Augusto Santos Silva, João Pedro Silva, Natacha Torres Da Silva, Dayane Gabriele Alves Silveira, Jasvinder A Singh, Narinder Pal Singh, Prashant Kumar Singh, Virendra Singh, Dhirendra Narain Sinha, Karen Sliwa, Mari Smith, Badr Hasan Sobaih, Soheila Sobhani, Eugène Sobngwi, Samir S Soneji, Moslem Soofi, Reed J D Sorensen, Joan B Soriano, Ireneous N Soyiri, Luciano A Sposato, Chandrashekhar T Sreeramareddy, Vinay Srinivasan, Jeffrey D Stanaway, Vladimir I Starodubov, Vasiliki Stathopoulou, Dan J Stein, Caitlyn Steiner, Leo G Stewart, Mark A Stokes, Michelle L Subart, Agus Sudaryanto, Mu'awiyyah Babale Sufiyan, Patrick John Sur, Ipsita Sutradhar, Bryan L Sykes, P N Sylaja, Dillon O Sylte, Cassandra E I Szoeke, Rafael Tabarés-Seisdedos, Takahiro Tabuchi, Santosh Kumar Tadakamadla, Ken Takahashi, Nikhil Tandon, Segen Gebremeskel Tassew, Nuno Taveira, Arash Tehrani-Banihashemi, Tigist Gashaw Tekalign, Merhawi Gebremedhin Tekle, Mohamad-Hani Temsah, Omar Temsah, Abdullah Sulieman Terkawi, Manaye Yihune Teshale, Belay Tessema, Gizachew Assefa Tessema, Kavumpurathu Raman Thankappan, Sathish Thirunavukkarasu, Nihal Thomas, Amanda G Thrift, George D Thurston, Binyam Tilahun, Quyen G To, Ruoyan Tobe-Gai, Marcello Tonelli, Roman Topor-Madry, Anna E Torre, Miguel Tortajada-Girbés, Mathilde Touvier, Marcos Roberto Tovani-Palone, Bach Xuan Tran, Khanh Bao Tran, Suryakant Tripathi, Christopher E Troeger, Thomas Clement Truelsen, Nu Thi Truong, Afewerki Gebremeskel Tsadik, Derrick Tsoi, Lorainne Tudor Car, E Murat Tuzcu, Stefanos Tyrovolas, Kingsley N Ukwaja, Irfan Ullah, Eduardo A Undurraga, Rachel L Updike, Muhammad Shariq Usman, Olalekan A Uthman, Selen Begüm Uzun, Muthiah Vaduganathan, Afsane Vaezi, Gaurang Vaidya, Pascual R Valdez, Elena Varavikova, Tommi Juhani Vasankari, Narayanaswamy Venketasubramanian, Santos Villafaina, Francesco S Violante, Sergey Konstantinovitch Vladimirov, Vasily Vlassov, Stein Emil Vollset, Theo Vos, Gregory R Wagner, Fasil Shiferaw Wagnew, Yasir Waheed, Mitchell Taylor Wallin, Judd L Walson, Yanping Wang, Yuan-Pang Wang, Molla Mesele Wassie, Elisabete Weiderpass, Robert G Weintraub, Fitsum Weldegebreal, Kidu Gidey Weldegwergs, Andrea Werdecker, Adhena Ayaliew Werkneh, T Eoin West, Ronny Westerman, Harvey A Whiteford, Justyna Widecka, Lauren B Wilner, Shadrach Wilson, Andrea Sylvia Winkler, Charles Shey Wiysonge, Charles D A Wolfe, Shouling Wu, Yun-Chun Wu, Grant M A Wyper, Denis Xavier, Gelin Xu, Simon Yadgir, Ali Yadollahpour, Seyed Hossein Yahyazadeh Jabbari, Bereket Yakob, Lijing L Yan, Yuichiro Yano, Mehdi Yaseri, Yasin Jemal Yasin, Gökalp Kadri Yentür, Alex Yeshaneh, Ebrahim M Yimer, Paul Yip, Biruck Desalegn Yirsaw, Engida Yisma, Naohiro Yonemoto, Gerald Yonga, Seok-Jun Yoon, Marcel Yotebieng, Mustafa Z Younis, Mahmoud Yousefifard, Chuanhua Yu, Vesna Zadnik, Zoubida Zaidi, Sojib Bin Zaman, Mohammad Zamani, Zohreh Zare, Ayalew Jejaw Zeleke, Zerihun Menlkalew Zenebe, Anthony Lin Zhang, Kai Zhang, Maigeng Zhou, Sanjay Zodpey, Liesl Joanna Zuhlke, Mohsen Naghavi, and Christopher J L Murray., Rubagotti, Enrico, Abay, Solomon M., Roth, Gregory, Abd Allah, Foad, Abdela, Jemal, Abbastabar, Hedayat, and Abbasi, Nooshin
Subjects: Overview, Disease, Territory, Causes of death, humanities
Abstract: Global development goals increasingly rely on country-specific estimates for benchmarking a nation's progress. To meet this need, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 estimated global, regional, national, and, for selected locations, subnational cause-specific mortality beginning in the year 1980. Here we report an update to that study, making use of newly available data and improved methods. GBD 2017 provides a comprehensive assessment of cause-specific mortality for 282 causes in 195 countries and territories from 1980 to 2017. The Lancet Publishing Group
Published: 2019

29. Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970–2016: a systematic analysis for the Global Burden of Disease Study 2016

Author: Haidong, Wang, Amanuel, Alemu, Kalkidan, Hassen, Cristiana, Abbafati, Kaja, M, Foad, Abd Allah, Semaw, Ferede, Haftom, Niguse, Laith, J, Niveen, M, Isaac, Akinkunmi, Rufus, Adesoji, Ifedayo, Morayo, Olatunji, Adetokunboh, Ashkan, Afshin, Rakesh, Aggarwal, Anurag, Agrawal, Sutapa, Agrawal, Aliasghar, Ahmad, Muktar, Beshir, Amani, Nidhal, Ibthiel, Aichour, Miloud, Taki, Sneha, Aiyar, Ali, Shafqat, Tomi, F, Nadia, Akseer, Ayman, Al Eyadhy, Faris, Hasan, Samer, Alabed, Fares, Alahdab, Ziyad, Al Aly, Khurshid, Alam, Noore, Alam, Deena, Alasfoor, Robert, William, Kefyalew, Addis, Samia, Alhabib, Raghib, Ali, Reza, Alizadeh Navaei, Syed, M, Juma, M, Ala’A, Alkerwi, François, Alla, Shalini, D, Peter, Allebeck, Rajaa, Al Raddadi, Ubai, Alsharif, Khalid, A, Elena, Alvarez, Nelson, Alvis Guzman, Azmeraw, T, Emmanuel, A, Erfan, Amini, Walid, Ammar, Yaw, Ampem, Nahla, Anber, Catalina, Liliana, Sofia, Androudi, Hossein, Ansari, Mustafa, Geleto, Carl, Abelardo, Palwasha, Anwari, Johan, Ärnlöv, Megha, Arora, Artaman, Al, Krishna, Kumar, Hamid, Asayesh, Solomon, Weldegebreal, Rana, Jawad, Reza, Assadi, Tesfay, Mehari, Sachin, R, Leticia, Avila Burgos, Euripide, Frinel, Ashish, Awasthi, Beatriz, Paulina, Tesleem, Kayode, Umar, Bacha, Alaa, Badawi, Kalpana, Balakrishnan, Shivanthi, Balalla, Aleksandra, Barac, Ryan, M, Miguel, A, Suzanne, L, Till, Bärnighausen, Simon, Barquera, Lars, Barregard, Lope, H, Bernhard, T, Shahrzad, Bazargan Hejazi, Neeraj, Bedi, Ettore, Beghi, Yannick, Béjot, Bayu, Begashaw, Michelle, L, Aminu, K, Derrick, A, James, R, Isabela, M, Jennifer, Benson, Adugnaw, Berhane, Derbew, Fikadu, Eduardo, Bernabé, Mircea, Beuran, Addisu, Shunu, Neeraj, Bhala, Anil, Bhansali, Soumyadeep, Bhaumik, Zulfiqar, A, Boris, Bikbov, Charles, Birungi, Stan, Biryukov, Donal, Bisanzio, Habtamu, Mellie, Peter, Bjerregaard, Christopher, D, Dube, Jara, Soufiane, Boufous, Rupert, R, Alexandra, Brazinova, Nicholas, J, Hermann, Brenner, Traolach, S, Gene, Bukhman, Lemma, Negesa, Blair, Randal, Michael, Burch, Zahid, A, Leah, E, Lucero, Cahuana Hurtado, Ismael, Ricardo, Josip, Car, Mate, Car, Rosario, Cárdenas, David, O, Juan, Jesus, Austin, Carter, Carlos, A, Jacqueline, Castillo, Franz, F, Ruben, Estanislao, Ferrán, Catalá López, Honglei, Chen, Peggy, Pei Chia, Mirriam, Chibalabala, Vesper, Hichilombwe, Abdulaal, A, Jee Young, Jasmine, Hanne, Christensen, Devasahayam, Jesudas, Liliana, G, Cirillo, Massimo, Aaron, J, Samantha, M, Josef, Coresh, Michael, H, Elizabeth, A, John, A., Haidong, Wang, Amanuel, Alemu, Kalkidan, Hassen, Cristiana, Abbafati, Kaja, M, Foad, Abd Allah, Semaw, Ferede, Haftom, Niguse, Laith, J, Niveen, M, Isaac, Akinkunmi, Rufus, Adesoji, Ifedayo, Morayo, Olatunji, Adetokunboh, Ashkan, Afshin, Rakesh, Aggarwal, Anurag, Agrawal, Sutapa, Agrawal, Aliasghar, Ahmad, Muktar, Beshir, Amani, Nidhal, Ibthiel, Aichour, Miloud, Taki, Sneha, Aiyar, Ali, Shafqat, Tomi, F, Nadia, Akseer, Ayman, Al Eyadhy, Faris, Hasan, Samer, Alabed, Fares, Alahdab, Ziyad, Al Aly, Khurshid, Alam, Noore, Alam, Deena, Alasfoor, Robert, William, Kefyalew, Addi, Samia, Alhabib, Raghib, Ali, Reza, Alizadeh Navaei, Syed, M, Juma, M, Ala’A, Alkerwi, François, Alla, Shalini, D, Peter, Allebeck, Rajaa, Al Raddadi, Ubai, Alsharif, Khalid, A, Elena, Alvarez, Nelson, Alvis Guzman, Azmeraw, T, Emmanuel, A, Erfan, Amini, Walid, Ammar, Yaw, Ampem, Nahla, Anber, Catalina, Liliana, Sofia, Androudi, Hossein, Ansari, Mustafa, Geleto, Carl, Abelardo, Palwasha, Anwari, Johan, Ärnlöv, Megha, Arora, Al, Artaman, Krishna, Kumar, Hamid, Asayesh, Solomon, Weldegebreal, Rana, Jawad, Reza, Assadi, Tesfay, Mehari, Sachin, R, Leticia, Avila Burgo, Euripide, Frinel, Ashish, Awasthi, Beatriz, Paulina, Tesleem, Kayode, Umar, Bacha, Alaa, Badawi, Kalpana, Balakrishnan, Shivanthi, Balalla, Aleksandra, Barac, Ryan, M, Miguel, A, Suzanne, L, Till, Bärnighausen, Simon, Barquera, Lars, Barregard, Lope, H, Bernhard, T, Shahrzad, Bazargan Hejazi, Neeraj, Bedi, Ettore, Beghi, Yannick, Béjot, Bayu, Begashaw, Michelle, L, Aminu, K, Derrick, A, James, R, Isabela, M, Jennifer, Benson, Adugnaw, Berhane, Derbew, Fikadu, Eduardo, Bernabé, Mircea, Beuran, Addisu, Shunu, Neeraj, Bhala, Anil, Bhansali, Soumyadeep, Bhaumik, Zulfiqar, A, Boris, Bikbov, Charles, Birungi, Stan, Biryukov, Donal, Bisanzio, Habtamu, Mellie, Peter, Bjerregaard, Christopher, D, Dube, Jara, Soufiane, Boufou, Rupert, R, Alexandra, Brazinova, Nicholas, J, Hermann, Brenner, Traolach, S, Gene, Bukhman, Lemma, Negesa, Blair, Randal, Michael, Burch, Zahid, A, Leah, E, Lucero, Cahuana Hurtado, Ismael, Ricardo, Josip, Car, Mate, Car, Rosario, Cárdena, David, O, Juan, Jesu, Austin, Carter, Carlos, A, Jacqueline, Castillo, Franz, F, Ruben, Estanislao, Ferrán, Catalá López, Honglei, Chen, Peggy, Pei Chia, Mirriam, Chibalabala, Vesper, Hichilombwe, Abdulaal, A, Jee Young, Jasmine, Hanne, Christensen, Devasahayam, Jesuda, Liliana, G, Cirillo, Massimo, Aaron, J, Samantha, M, Josef, Coresh, Michael, H, Elizabeth, A, and John, A.
Subjects: GBD, GBD, mortality, mortality
Abstract: Background Detailed assessments of mortality patterns, particularly age-specific mortality, represent a crucial input that enables health systems to target interventions to specific populations. Understanding how all-cause mortality has changed with respect to development status can identify exemplars for best practice. To accomplish this, the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) estimated age-specific and sex-specific all-cause mortality between 1970 and 2016 for 195 countries and territories and at the subnational level for the five countries with a population greater than 200 million in 2016. Methods We have evaluated how well civil registration systems captured deaths using a set of demographic methods called death distribution methods for adults and from consideration of survey and census data for children younger than 5 years. We generated an overall assessment of completeness of registration of deaths by dividing registered deaths in each location-year by our estimate of all-age deaths generated from our overall estimation process. For 163 locations, including subnational units in countries with a population greater than 200 million with complete vital registration (VR) systems, our estimates were largely driven by the observed data, with corrections for small fluctuations in numbers and estimation for recent years where there were lags in data reporting (lags were variable by location, generally between 1 year and 6 years). For other locations, we took advantage of different data sources available to measure under-5 mortality rates (U5MR) using complete birth histories, summary birth histories, and incomplete VR with adjustments; we measured adult mortality rate (the probability of death in individuals aged 15–60 years) using adjusted incomplete VR, sibling histories, and household death recall. We used the U5MR and adult mortality rate, together with crude death rate due to HIV in the GBD model life table system, to estimate age-specific and sex-specific death rates for each location-year. Using various international databases, we identified fatal discontinuities, which we defined as increases in the death rate of more than one death per million, resulting from conflict and terrorism, natural disasters, major transport or technological accidents, and a subset of epidemic infectious diseases; these were added to estimates in the relevant years. In 47 countries with an identified peak adult prevalence for HIV/AIDS of more than 0·5% and where VR systems were less than 65% complete, we informed our estimates of age-sex-specific mortality using the Estimation and Projection Package (EPP)-Spectrum model fitted to national HIV/AIDS prevalence surveys and antenatal clinic serosurveillance systems. We estimated stillbirths, early neonatal, late neonatal, and childhood mortality using both survey and VR data in spatiotemporal Gaussian process regression models. We estimated abridged life tables for all location-years using age-specific death rates. We grouped locations into development quintiles based on the Sociodemographic Index (SDI) and analysed mortality trends by quintile. Using spline regression, we estimated the expected mortality rate for each age-sex group as a function of SDI. We identified countries with higher life expectancy than expected by comparing observed life expectancy to anticipated life expectancy on the basis of development status alone. Findings Completeness in the registration of deaths increased from 28% in 1970 to a peak of 45% in 2013; completeness was lower after 2013 because of lags in reporting. Total deaths in children younger than 5 years decreased from 1970 to 2016, and slower decreases occurred at ages 5–24 years. By contrast, numbers of adult deaths increased in each 5-year age bracket above the age of 25 years. The distribution of annualised rates of change in age-specific mortality rate differed over the period 2000 to 2016 compared with earlier decades: increasing annualised rates of change were less frequent, although rising annualised rates of change still occurred in some locations, particularly for adolescent and younger adult age groups. Rates of stillbirths and under-5 mortality both decreased globally from 1970. Evidence for global convergence of death rates was mixed; although the absolute difference between age-standardised death rates narrowed between countries at the lowest and highest levels of SDI, the ratio of these death rates—a measure of relative inequality—increased slightly. There was a strong shift between 1970 and 2016 toward higher life expectancy, most noticeably at higher levels of SDI. Among countries with populations greater than 1 million in 2016, life expectancy at birth was highest for women in Japan, at 86·9 years (95% UI 86·7–87·2), and for men in Singapore, at 81·3 years (78·8–83·7) in 2016. Male life expectancy was generally lower than female life expectancy between 1970 and 2016, and the gap between male and female life expectancy increased with progression to higher levels of SDI. Some countries with exceptional health performance in 1990 in terms of the difference in observed to expected life expectancy at birth had slower progress on the same measure in 2016. Interpretation Globally, mortality rates have decreased across all age groups over the past five decades, with the largest improvements occurring among children younger than 5 years. However, at the national level, considerable heterogeneity remains in terms of both level and rate of changes in age-specific mortality; increases in mortality for certain age groups occurred in some locations. We found evidence that the absolute gap between countries in age-specific death rates has declined, although the relative gap for some age-sex groups increased. Countries that now lead in terms of having higher observed life expectancy than that expected on the basis of development alone, or locations that have either increased this advantage or rapidly decreased the deficit from expected levels, could provide insight into the means to accelerate progress in nations where progress has stalled.
Published: 2017

30. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Author: Vos, Theo, Amanuel, Alemu, Abajobir, Cristiana, Abbafati, Kaja, M, Abbas, Kalkidan, Hassen, Abate, Foad, Abd Allah, Abdishakur, M, Abdulle, Teshome, Abuka, Abebo, Semaw, Ferede, Abera, Victor, Aboyans, Laith, J, Abu, Raddad, Ilana, N, Ackerman, Abdu, Abdullahi, Adamu, Olatunji, Adetokunboh, Mohsen, Afarideh, Ashkan, Afshin, Sanjay, Kumar, Agarwal, Rakesh, Aggarwal, Anurag, Agrawal, Sutapa, Agrawal, Aliasghar, Ahmad, Kiadaliri, Hamid, Ahmadieh, Muktar, Beshir, Ahmed, Amani, Nidhal, Aichour, Ibtihel, Aichour, Miloud, Taki, Eddine, Aichour, Sneha, Aiyar, Rufus, Olusola, Akinyemi, Nadia, Akseer, Faris, Hasan, Lami, Al, Fares, Alahdab, Ziyad, Al Aly, Khurshid, Alam, Noore, Alam, Tahiya, Alam, Deena, Alasfoor, Kefyalew, Addis, Alene, Raghib, Ali, Reza, Alizadeh Navaei, Ala’A, Alkerwi, François, Alla, Peter, Allebeck, Christine, Allen, Fatma, Al Maskari, Rajaa, Al Raddadi, Ubai, Alsharif, Shirina, Alsowaidi, Khalid, A, Altirkawi, Azmeraw, Amare, T, Erfan, Amini, Walid, Ammar, Yaw, Ampem, Amoako, Hjalte, Andersen, H, Carl, Abelardo, Antonio, T, Palwasha, Anwari, Johan, Ärnlöv, Artaman, Al, Krishna, Kumar, Aryal, Hamid, Asayesh, Solomon, W, Asgedom, Reza, Assadi, Tesfay, Mehari, Atey, Niguse, Tadele, Atnafu, Sachin, R, Atre, Leticia, Avila Burgos, Euripide, Frinel, Arthur, G, Avokpaho, Ashish, Awasthi, Beatriz, Paulina, Ayala, Quintanilla, Huda, Omer, Saleem, Ba, Umar, Bacha, Alaa, Badawi, Kalpana, Balakrishnan, Amitava, Banerjee, Marlena, S, Bannick, Aleksandra, Barac, Ryan, M, Barber, Suzanne, L, Barker, Collo, Till, Bärnighausen, Simon, Barquera, Lars, Barregard, Lope, H, Barrero, Sanjay, Basu, Bob, Battista, Katherine, E, Battle, Bernhard, Baune, T, Shahrzad, Bazargan Hejazi, Justin, Beardsley, Neeraj, Bedi, Ettore, Beghi, Yannick, Béjot, Bayu, Begashaw, Bekele, Michelle, Bell, L, Derrick, A, Bennett, Isabela, Bensenor, M, Jennifer, Benson, Adugnaw, Berhane, Derbew, Fikadu, Berhe, Eduardo, Bernabé, Balem, Demtsu, Betsu, Mircea, Beuran, Addisu, Shunu, Beyene, Neeraj, Bhala, Anil, Bhansali, Samir, Bhatt, Zulfiqar, A, Bhutta, Sibhatu, Biadgilign, Kelly, Bienhoff, Boris, Bikbov, Charles, Birungi, Stan, Biryukov, Donal, Bisanzio, Habtamu, Mellie, Bizuayehu, Dube, Jara, Boneya, Soufiane, Boufous, Rupert, R, Bourne, A, Alexandra, Brazinova, Traolach, S, Brugha, Rachelle, Buchbinder, Lemma, Negesa, Bulto, Bulto, Blair, R, Bumgarner, Zahid, Butt, A, Lucero, Cahuana Hurtado, Ewan, Cameron, Mate, Car, Hélène, Carabin, Jonathan, R, Carapetis, Rosario, Cárdenas, David, O, Carpenter, Juan, Jesus, Carrero, Austin, Carter, Felix, Carvalho, Daniel, C, Casey, Valeria, Caso, Carlos, A, Castañeda, Orjuela, Chris, D, Castle, Ferrán, Catalá López, Hsing Yi, Chang, Jung Chen, Chang, Fiona, J, Charlson, Honglei, Chen, Mirriam, Chibalabala, Chioma, Ezinne, Chibueze, Vesper, Hichilombwe, Chisumpa, Abdulaal, A, Chitheer, Devasahayam, Jesudas, Christopher, Liliana, G, Ciobanu, Cirillo, Massimo, Vos, Theo, Amanuel, Alemu, Abajobir, Cristiana, Abbafati, Kaja, M, Abbas, Kalkidan, Hassen, Abate, Foad, Abd Allah, Abdishakur, M, Abdulle, Teshome, Abuka, Abebo, Semaw, Ferede, Abera, Victor, Aboyan, Laith, J, Abu, Raddad, Ilana, N, Ackerman, Abdu, Abdullahi, Adamu, Olatunji, Adetokunboh, Mohsen, Afarideh, Ashkan, Afshin, Sanjay, Kumar, Agarwal, Rakesh, Aggarwal, Anurag, Agrawal, Sutapa, Agrawal, Aliasghar, Ahmad, Kiadaliri, Hamid, Ahmadieh, Muktar, Beshir, Ahmed, Amani, Nidhal, Aichour, Ibtihel, Aichour, Miloud, Taki, Eddine, Aichour, Sneha, Aiyar, Rufus, Olusola, Akinyemi, Nadia, Akseer, Faris, Hasan, Al, Lami, Fares, Alahdab, Ziyad, Al Aly, Khurshid, Alam, Noore, Alam, Tahiya, Alam, Deena, Alasfoor, Kefyalew, Addi, Alene, Raghib, Ali, Reza, Alizadeh Navaei, Ala’A, Alkerwi, François, Alla, Peter, Allebeck, Christine, Allen, Fatma, Al Maskari, Rajaa, Al Raddadi, Ubai, Alsharif, Shirina, Alsowaidi, Khalid, A, Altirkawi, Azmeraw, T, Amare, Erfan, Amini, Walid, Ammar, Yaw, Ampem, Amoako, Hjalte, H, Andersen, Carl, Abelardo, T, Antonio, Palwasha, Anwari, Johan, Ärnlöv, Al, Artaman, Krishna, Kumar, Aryal, Hamid, Asayesh, Solomon, W, Asgedom, Reza, Assadi, Tesfay, Mehari, Atey, Niguse, Tadele, Atnafu, Sachin, R, Atre, Leticia, Avila Burgo, Euripide, Frinel, G, Arthur, Avokpaho, Ashish, Awasthi, Beatriz, Paulina, Ayala, Quintanilla, Huda, Omer, Ba, Saleem, Umar, Bacha, Alaa, Badawi, Kalpana, Balakrishnan, Amitava, Banerjee, Marlena, S, Bannick, Aleksandra, Barac, Ryan, M, Barber, Suzanne, L, Barker, Collo, Till, Bärnighausen, Simon, Barquera, Lars, Barregard, Lope, H, Barrero, Sanjay, Basu, Bob, Battista, Katherine, E, Battle, Bernhard, T, Baune, Shahrzad, Bazargan Hejazi, Justin, Beardsley, Neeraj, Bedi, Ettore, Beghi, Yannick, Béjot, Bayu, Begashaw, Bekele, Michelle, L, Bell, Derrick, A, Bennett, Isabela, M, Bensenor, Jennifer, Benson, Adugnaw, Berhane, Derbew, Fikadu, Berhe, Eduardo, Bernabé, Balem, Demtsu, Betsu, Mircea, Beuran, Addisu, Shunu, Beyene, Neeraj, Bhala, Anil, Bhansali, Samir, Bhatt, Zulfiqar, A, Bhutta, Sibhatu, Biadgilign, Kelly, Bienhoff, Boris, Bikbov, Charles, Birungi, Stan, Biryukov, Donal, Bisanzio, Habtamu, Mellie, Bizuayehu, Dube, Jara, Boneya, Soufiane, Boufou, Rupert, R, A, Bourne, Alexandra, Brazinova, Traolach, S, Brugha, Rachelle, Buchbinder, Lemma, Negesa, Bulto, Bulto, Blair, R, Bumgarner, Zahid, A, Butt, Lucero, Cahuana Hurtado, Ewan, Cameron, Mate, Car, Hélène, Carabin, Jonathan, R, Carapetis, Rosario, Cárdena, David, O, Carpenter, Juan, Jesus, Carrero, Austin, Carter, Felix, Carvalho, Daniel, C, Casey, Valeria, Caso, Carlos, A, Castañeda, Orjuela, Chris, D, Castle, Ferrán, Catalá López, Hsing Yi, Chang, Jung Chen, Chang, Fiona, J, Charlson, Honglei, Chen, Mirriam, Chibalabala, Chioma, Ezinne, Chibueze, Vesper, Hichilombwe, Chisumpa, Abdulaal, A, Chitheer, Devasahayam, Jesudas, Christopher, Liliana, G, Ciobanu, and Cirillo, Massimo
Subjects: GBD, GBD, years lived with disability, years lived with disability
Abstract: As mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016. METHODS: We estimated prevalence and incidence for 328 diseases and injuries and 2982 sequelae, their non-fatal consequences. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between incidence, prevalence, remission, and cause of death rates for each condition. For some causes, we used alternative modelling strategies if incidence or prevalence needed to be derived from other data. YLDs were estimated as the product of prevalence and a disability weight for all mutually exclusive sequelae, corrected for comorbidity and aggregated to cause level. We updated the Socio-demographic Index (SDI), a summary indicator of income per capita, years of schooling, and total fertility rate. GBD 2016 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). FINDINGS: Globally, low back pain, migraine, age-related and other hearing loss, iron-deficiency anaemia, and major depressive disorder were the five leading causes of YLDs in 2016, contributing 57·6 million (95% uncertainty interval [UI] 40·8-75·9 million [7·2%, 6·0-8·3]), 45·1 million (29·0-62·8 million [5·6%, 4·0-7·2]), 36·3 million (25·3-50·9 million [4·5%, 3·8-5·3]), 34·7 million (23·0-49·6 million [4·3%, 3·5-5·2]), and 34·1 million (23·5-46·0 million [4·2%, 3·2-5·3]) of total YLDs, respectively. Age-standardised rates of YLDs for all causes combined decreased between 1990 and 2016 by 2·7% (95% UI 2·3-3·1). Despite mostly stagnant age-standardised rates, the absolute number of YLDs from non-communicable diseases has been growing rapidly across all SDI quintiles, partly because of population growth, but also the ageing of populations. The largest absolute increases in total numbers of YLDs globally were between the ages of 40 and 69 years. Age-standardised YLD rates for all conditions combined were 10·4% (95% UI 9·0-11·8) higher in women than in men. Iron-deficiency anaemia, migraine, Alzheimer's disease and other dementias, major depressive disorder, anxiety, and all musculoskeletal disorders apart from gout were the main conditions contributing to higher YLD rates in women. Men had higher age-standardised rates of substance use disorders, diabetes, cardiovascular diseases, cancers, and all injuries apart from sexual violence. Globally, we noted much less geographical variation in disability than has been documented for premature mortality. In 2016, there was a less than two times difference in age-standardised YLD rates for all causes between the location with the lowest rate (China, 9201 YLDs per 100 000, 95% UI 6862-11943) and highest rate (Yemen, 14 774 YLDs per 100 000, 11 018-19 228). INTERPRETATION: The decrease in death rates since 1990 for most causes has not been matched by a similar decline in age-standardised YLD rates. For many large causes, YLD rates have either been stagnant or have increased for some causes, such as diabetes. As populations are ageing, and the prevalence of disabling disease generally increases steeply with age, health systems will face increasing demand for services that are generally costlier than the interventions that have led to declines in mortality in childhood or for the major causes of mortality in adults. Up-to-date information about the trends of disease and how this varies between countries is essential to plan for an adequate health-system response.
Published: 2017

31. Measuring progress and projecting attainment on the basis of past trends of the health-related Sustainable Development Goals in 188 countries: an analysis from the Global Burden of Disease Study 2016

Author: Nancy, Fullman, Ryan, M, Barber, Amanuel, Alemu, Abajobir, Kalkidan, Hassen, Abate, Cristiana, Abbafati, Kaja, M, Abbas, Foad, Abd Allah, Abdishakur, M, Abdulle, Semaw, Ferede, Abera, Victor, Aboyans, Laith, J, Abu Raddad, Niveen, M, E, Abu Rmeileh, Isaac, Akinkunmi, Adedeji, Olatunji, Adetokunboh, Ashkan, Afshin, Anurag, Agrawal, Sutapa, Agrawal, Aliasghar, Ahmad, Kiadaliri, Hamid, Ahmadieh, Muktar, Beshir, Ahmed, Amani, Nidhal, Aichour, Ibtihel, Aichour, Miloud, Taki, Eddine, Aichour, Sneha, Aiyar, Rufus, Olusola, Akinyemi, Nadia, Akseer, Ziyad, Al Aly, Khurshid, Alam, Noore, Alam, Deena, Alasfoor, Kefyalew, Addis, Alene, Reza, Alizadeh Navaei, Ala’a, Alkerwi, Francois, Alla, Peter, Allebeck, Christine, Allen, Rajaa, Al Raddadi, Ubai, Alsharif, Khalid, A, Altirkawi, Nelson, Alvis Guzman, Azmeraw, T, Amare, Erfan, Amini, Walid, Ammar, Carl, Abelardo, T, Antonio, Hossein, Ansari, Palwasha, Anwari, Megha, Arora, Al, Artaman, Krishna, Kumar, Aryal, Hamid, Asayesh, Solomon, Weldegebreal, Asgedom, Reza, Assadi, Tesfay, Mehari, Atey, Sachin, R, Atre, Leticia, Avila Burgos, Euripide, Frinel, G, Arthur, Avokpaho, Ashish, Awasthi, Peter, Azzopardi, Umar, Bacha, Alaa, Badawi, Kalpana, Balakrishnan, Marlena, S, Bannick, Aleksandra, Barac, Suzanne, L, Barker Collo, Till, Barnighausen, Lope, H, Barrero, Sanjay, Basu, Katherine, E, Battle, Bernhard, T, Baune, Justin, Beardsley, Neeraj, Bedi, Yannick, Bejot, Michelle, L, Bell, Derrick, A, Bennett, James, R, Bennett, Isabela, M, Bensenor, Adugnaw, Berhane, Derbew, Fikadu, Berhe, Eduardo, Bernabe, Balem, Demtsu, Betsu, Mircea, Beuran, Addisu, Shunu, Beyene, Anil, Bhansali, Samir, Bhatt, Zulfiqar, A, Bhutta, Boris, Bikbov, Arebu, I, Bilal, Charles, Birungi, Stan, Biryukov, Habtamu, Mellie, Bizuayehu, Christopher, D, Blosser, Dube, Jara, Boneya, Dipan, Bose, Ibrahim, R, Bou Orm, Michael, Brauer, Nicholas, J, K, Breitborde, Traolach, S, Brugha, Lemma, Negesa, Bulto, Bulto, Zahid, A, Butt, Lucero, Cahuana Hurtado, Ewan, Cameron, Julio, Cesar, Campuzano, Rosario, Cardenas, Juan, Jesus, Carrero, Austin, Carter, Daniel, C, Casey, Carlos, A, Castaneda Orjuela, Jacqueline, Castillo, Rivas, Ruben, Estanislao, Castro, Ferran, Catala Lopez, Kelly, Cercy, Hsing Yi, Chang, Jung Chen, Chang, Fiona, J, Charlson, Adrienne, Chew, Vesper, Hichilombwe, Chisumpa, Abdulaal, A, Chitheer, Hanne, Christensen, Devasahayam, Jesudas, Christopher, CIRILLO, Massimo, Cyrus, Cooper, et, a.l., Nancy, Fullman, Ryan, M, Barber, Amanuel, Alemu, Abajobir, Kalkidan, Hassen, Abate, Cristiana, Abbafati, Kaja, M, Abbas, Foad, Abd Allah, Abdishakur, M, Abdulle, Semaw, Ferede, Abera, Victor, Aboyan, Laith, J, Abu, Raddad, Niveen, M, E, Abu, Rmeileh, Isaac, Akinkunmi, Adedeji, Olatunji, Adetokunboh, Ashkan, Afshin, Anurag, Agrawal, Sutapa, Agrawal, Aliasghar, Ahmad, Kiadaliri, Hamid, Ahmadieh, Muktar, Beshir, Ahmed, Amani, Nidhal, Aichour, Ibtihel, Aichour, Miloud, Taki, Eddine, Aichour, Sneha, Aiyar, Rufus, Olusola, Akinyemi, Nadia, Akseer, Ziyad, Al Aly, Khurshid, Alam, Noore, Alam, Deena, Alasfoor, Kefyalew, Addi, Alene, Reza, Alizadeh Navaei, Ala’A, Alkerwi, Francois, Alla, Peter, Allebeck, Christine, Allen, Rajaa, Al Raddadi, Ubai, Alsharif, Khalid, A, Altirkawi, Nelson, Alvis Guzman, Azmeraw, T, Amare, Erfan, Amini, Walid, Ammar, Carl, Abelardo, T, Antonio, Hossein, Ansari, Palwasha, Anwari, Megha, Arora, Al, Artaman, Krishna, Kumar, Aryal, Hamid, Asayesh, Solomon, Weldegebreal, Asgedom, Reza, Assadi, Tesfay, Mehari, Atey, Sachin, R, Atre, Leticia, Avila Burgo, Euripide, Frinel, G, Arthur, Avokpaho, Ashish, Awasthi, Peter, Azzopardi, Umar, Bacha, Alaa, Badawi, Kalpana, Balakrishnan, Marlena, S, Bannick, Aleksandra, Barac, Suzanne, L, Barker, Collo, Till, Barnighausen, Lope, H, Barrero, Sanjay, Basu, Katherine, E, Battle, Bernhard, T, Baune, Justin, Beardsley, Neeraj, Bedi, Yannick, Bejot, Michelle, L, Bell, Derrick, A, Bennett, James, R, Bennett, Isabela, M, Bensenor, Adugnaw, Berhane, Derbew, Fikadu, Berhe, Eduardo, Bernabe, Balem, Demtsu, Betsu, Mircea, Beuran, Addisu, Shunu, Beyene, Anil, Bhansali, Samir, Bhatt, Zulfiqar, A, Bhutta, Boris, Bikbov, Arebu, I, Bilal, Charles, Birungi, Stan, Biryukov, Habtamu, Mellie, Bizuayehu, Christopher, D, Blosser, Dube, Jara, Boneya, Dipan, Bose, Ibrahim, R, Bou, Orm, Michael, Brauer, Nicholas, J, K, Breitborde, Traolach, S, Brugha, Lemma, Negesa, Bulto, Bulto, Zahid, A, Butt, Lucero, Cahuana Hurtado, Ewan, Cameron, Julio, Cesar, Campuzano, Rosario, Cardena, Juan, Jesu, Carrero, Austin, Carter, Daniel, C, Casey, Carlo, A, Castaneda, Orjuela, Jacqueline, Castillo, Rivas, Ruben, Estanislao, Castro, Ferran, Catala Lopez, Kelly, Cercy, Hsing Yi, Chang, Jung Chen, Chang, Fiona, J, Charlson, Adrienne, Chew, Vesper, Hichilombwe, Chisumpa, Abdulaal, A, Chitheer, Hanne, Christensen, Devasahayam, Jesuda, Christopher, Cirillo, Massimo, Cyrus, Cooper, and Et, a. l.
Subjects: GBD, Sustainable Development Goals, GBD, Sustainable Development Goals
Abstract: Background The UN’s Sustainable Development Goals (SDGs) are grounded in the global ambition of “leaving no one behind”. Understanding today’s gains and gaps for the health-related SDGs is essential for decision makers as they aim to improve the health of populations. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016), we measured 37 of the 50 health-related SDG indicators over the period 1990–2016 for 188 countries, and then on the basis of these past trends, we projected indicators to 2030. Methods We used standardised GBD 2016 methods to measure 37 health-related indicators from 1990 to 2016, an increase of four indicators since GBD 2015. We substantially revised the universal health coverage (UHC) measure, which focuses on coverage of essential health services, to also represent personal health-care access and quality for several non-communicable diseases. We transformed each indicator on a scale of 0–100, with 0 as the 2·5th percentile estimated between 1990 and 2030, and 100 as the 97·5th percentile during that time. An index representing all 37 health-related SDG indicators was constructed by taking the geometric mean of scaled indicators by target. On the basis of past trends, we produced projections of indicator values, using a weighted average of the indicator and country-specific annualised rates of change from 1990 to 2016 with weights for each annual rate of change based on out-of-sample validity. 24 of the currently measured health-related SDG indicators have defined SDG targets, against which we assessed attainment. Findings Globally, the median health-related SDG index was 56·7 (IQR 31·9–66·8) in 2016 and country-level performance markedly varied, with Singapore (86·8, 95% uncertainty interval 84·6–88·9), Iceland (86·0, 84·1–87·6), and Sweden (85·6, 81·8–87·8) having the highest levels in 2016 and Afghanistan (10·9, 9·6–11·9), the Central African Republic (11·0, 8·8–13·8), and Somalia (11·3, 9·5–13·1) recording the lowest. Between 2000 and 2016, notable improvements in the UHC index were achieved by several countries, including Cambodia, Rwanda, Equatorial Guinea, Laos, Turkey, and China; however, a number of countries, such as Lesotho and the Central African Republic, but also high-income countries, such as the USA, showed minimal gains. Based on projections of past trends, the median number of SDG targets attained in 2030 was five (IQR 2–8) of the 24 defined targets currently measured. Globally, projected target attainment considerably varied by SDG indicator, ranging from more than 60% of countries projected to reach targets for under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria, to less than 5% of countries projected to achieve targets linked to 11 indicator targets, including those for childhood overweight, tuberculosis, and road injury mortality. For several of the health-related SDGs, meeting defined targets hinges upon substantially faster progress than what most countries have achieved in the past. Interpretation GBD 2016 provides an updated and expanded evidence base on where the world currently stands in terms of the health-related SDGs. Our improved measure of UHC offers a basis to monitor the expansion of health services necessary to meet the SDGs. Based on past rates of progress, many places are facing challenges in meeting defined health-related SDG targets, particularly among countries that are the worst off. In view of the early stages of SDG implementation, however, opportunity remains to take actions to accelerate progress, as shown by the catalytic effects of adopting the Millennium Development Goals after 2000. With the SDGs’ broader, bolder development agenda, multisectoral commitments and investments are vital to make the health-related SDGs within reach of all populations.
Published: 2017

32. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Author: Emmanuela, Gakidou, Ashkan, Afshin, Amanuel, Alemu, Abajobir, Kalkidan, Hassen, Abate, Cristiana, Abbafati, Kaja, M, Abbas, Foad, Abd Allah, Abdishakur, M, Abdulle, Semaw, Ferede, Abera, Victor, Aboyans, Laith, J, Abu Raddad, Niveen, M, E, Abu Rmeileh, Gebre, Yitayih, Abyu, Isaac, Akinkunmi, Adedeji, Olatunji, Adetokunboh, Mohsen, Afarideh, Anurag, Agrawal, Sutapa, Agrawal, Aliasghar, Ahmad, Kiadaliri, Hamid, Ahmadieh, Muktar, Beshir, Ahmed, Amani, Nidhal, Aichour, Ibtihel, Aichour, Miloud, Taki, Eddine, Aichour, Rufus, Olusola, Akinyemi, Nadia, Akseer, Fares, Alahdab, Ziyad, Al Aly, Khurshid, Alam, Noore, Alam, Tahiya, Alam, Deena, Alasfoor, Kefyalew, Addis, Alene, Komal, Ali, Reza, Alizadeh Navaei, Ala’a, Alkerwi, François, Alla, Peter, Allebeck, Rajaa, Al Raddadi, Ubai, Alsharif, Khalid, A, Altirkawi, Nelson, Alvis Guzman, Azmeraw, T, Amare, Erfan, Amini, Walid, Ammar, Yaw, Ampem, Amoako, Hossein, Ansari, Josep, M, Antó, Carl, Abelardo, T, Antonio, Palwasha, Anwari, Nicholas, Arian, Johan, Ärnlöv, Al, Artaman, Krishna, Kumar, Aryal, Hamid, Asayesh, Solomon, Weldegebreal, Asgedom, Tesfay, Mehari, Atey, Leticia, Avila Burgos, Euripide, Frinel, G, Arthur, Avokpaho, Ashish, Awasthi, Peter, Azzopardi, Umar, Bacha, Alaa, Badawi, Kalpana, Balakrishnan, Shoshana, H, Ballew, Aleksandra, Barac, Ryan, M, Barber, Suzanne, L, Barker Collo, Till, Bärnighausen, Simon, Barquera, Lars, Barregard, Lope, H, Barrero, Carolina, Batis, Katherine, E, Battle, Bernhard, T, Baune, Justin, Beardsley, Neeraj, Bedi, Ettore, Beghi, Michelle, L, Bell, Derrick, A, Bennett, James, R, Bennett, Isabela, M, Bensenor, Adugnaw, Berhane, Derbew, Fikadu, Berhe, Eduardo, Bernabé, Balem, Demtsu, Betsu, Mircea, Beuran, Addisu, Shunu, Beyene, Anil, Bhansali, Zulfiqar, A, Bhutta, Boris, Bikbov, Charles, Birungi, Stan, Biryukov, Christopher, D, Blosser, Dube, Jara, Boneya, Ibrahim, R, Bou Orm, Michael, Brauer, Nicholas, J, K, Breitborde, Hermann, Brenner, Traolach, S, Brugha, Lemma, Negesa, Bulto, Bulto, Blair, R, Baumgarner, Zahid, A, Butt, Lucero, Cahuana Hurtado, Rosario, Cárdenas, Juan, Jesus, Carrero, Carlos, A, Castañeda Orjuela, Ferrán, Catalá López, Kelly, Cercy, Hsing Yi, Chang, Fiona, J, Charlson, Odgerel, Chimed Ochir, Vesper, Hichilombwe, Chisumpa, Abdulaal, A, Chitheer, Hanne, Christensen, Devasahayam, Jesudas, Christopher, CIRILLO, Massimo, Aaron, J, Cohen, et, a.l., Emmanuela, Gakidou, Ashkan, Afshin, Amanuel, Alemu, Abajobir, Kalkidan, Hassen, Abate, Cristiana, Abbafati, Kaja, M, Abbas, Foad, Abd Allah, Abdishakur, M, Abdulle, Semaw, Ferede, Abera, Victor, Aboyan, Laith, J, Abu, Raddad, Niveen, M, E, Abu, Rmeileh, Gebre, Yitayih, Abyu, Isaac, Akinkunmi, Adedeji, Olatunji, Adetokunboh, Mohsen, Afarideh, Anurag, Agrawal, Sutapa, Agrawal, Aliasghar, Ahmad, Kiadaliri, Hamid, Ahmadieh, Muktar, Beshir, Ahmed, Amani, Nidhal, Aichour, Ibtihel, Aichour, Miloud, Taki, Eddine, Aichour, Rufus, Olusola, Akinyemi, Nadia, Akseer, Fares, Alahdab, Ziyad, Al Aly, Khurshid, Alam, Noore, Alam, Tahiya, Alam, Deena, Alasfoor, Kefyalew, Addi, Alene, Komal, Ali, Reza, Alizadeh Navaei, Ala’A, Alkerwi, François, Alla, Peter, Allebeck, Rajaa, Al Raddadi, Ubai, Alsharif, Khalid, A, Altirkawi, Nelson, Alvis Guzman, Azmeraw, T, Amare, Erfan, Amini, Walid, Ammar, Yaw, Ampem, Amoako, Hossein, Ansari, Josep, M, Antó, Carl, Abelardo, T, Antonio, Palwasha, Anwari, Nicholas, Arian, Johan, Ärnlöv, Al, Artaman, Krishna, Kumar, Aryal, Hamid, Asayesh, Solomon, Weldegebreal, Asgedom, Tesfay, Mehari, Atey, Leticia, Avila Burgo, Euripide, Frinel, G, Arthur, Avokpaho, Ashish, Awasthi, Peter, Azzopardi, Umar, Bacha, Alaa, Badawi, Kalpana, Balakrishnan, Shoshana, H, Ballew, Aleksandra, Barac, Ryan, M, Barber, Suzanne, L, Barker, Collo, Till, Bärnighausen, Simon, Barquera, Lars, Barregard, Lope, H, Barrero, Carolina, Bati, Katherine, E, Battle, Bernhard, T, Baune, Justin, Beardsley, Neeraj, Bedi, Ettore, Beghi, Michelle, L, Bell, Derrick, A, Bennett, James, R, Bennett, Isabela, M, Bensenor, Adugnaw, Berhane, Derbew, Fikadu, Berhe, Eduardo, Bernabé, Balem, Demtsu, Betsu, Mircea, Beuran, Addisu, Shunu, Beyene, Anil, Bhansali, Zulfiqar, A, Bhutta, Boris, Bikbov, Charles, Birungi, Stan, Biryukov, Christopher, D, Blosser, Dube, Jara, Boneya, Ibrahim, R, Bou, Orm, Michael, Brauer, Nicholas, J, K, Breitborde, Hermann, Brenner, Traolach, S, Brugha, Lemma, Negesa, Bulto, Bulto, Blair, R, Baumgarner, Zahid, A, Butt, Lucero, Cahuana Hurtado, Rosario, Cárdena, Juan, Jesu, Carrero, Carlo, A, Castañeda, Orjuela, Ferrán, Catalá López, Kelly, Cercy, Hsing Yi, Chang, Fiona, J, Charlson, Odgerel, Chimed Ochir, Vesper, Hichilombwe, Chisumpa, Abdulaal, A, Chitheer, Hanne, Christensen, Devasahayam, Jesuda, Christopher, Cirillo, Massimo, Aaron, J, Cohen, and Et, a. l.
Subjects: GBD, risk, GBD, risk
Abstract: Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of risk factor exposure and attributable burden of disease. By providing estimates over a long time series, this study can monitor risk exposure trends critical to health surveillance and inform policy debates on the importance of addressing risks in context. Methods We used the comparative risk assessment framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2016. This study included 481 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk (RR) and exposure estimates from 22 717 randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources, according to the GBD 2016 source counting methods. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. Finally, we explored four drivers of trends in attributable burden: population growth, population ageing, trends in risk exposure, and all other factors combined. Findings Since 1990, exposure increased significantly for 30 risks, did not change significantly for four risks, and decreased significantly for 31 risks. Among risks that are leading causes of burden of disease, child growth failure and household air pollution showed the most significant declines, while metabolic risks, such as body-mass index and high fasting plasma glucose, showed significant increases. In 2016, at Level 3 of the hierarchy, the three leading risk factors in terms of attributable DALYs at the global level for men were smoking (124·1 million DALYs [95% UI 111·2 million to 137·0 million]), high systolic blood pressure (122·2 million DALYs [110·3 million to 133·3 million], and low birthweight and short gestation (83·0 million DALYs [78·3 million to 87·7 million]), and for women, were high systolic blood pressure (89·9 million DALYs [80·9 million to 98·2 million]), high body-mass index (64·8 million DALYs [44·4 million to 87·6 million]), and high fasting plasma glucose (63·8 million DALYs [53·2 million to 76·3 million]). In 2016 in 113 countries, the leading risk factor in terms of attributable DALYs was a metabolic risk factor. Smoking remained among the leading five risk factors for DALYs for 109 countries, while low birthweight and short gestation was the leading risk factor for DALYs in 38 countries, particularly in sub-Saharan Africa and South Asia. In terms of important drivers of change in trends of burden attributable to risk factors, between 2006 and 2016 exposure to risks explains an 9·3% (6·9–11·6) decline in deaths and a 10·8% (8·3–13·1) decrease in DALYs at the global level, while population ageing accounts for 14·9% (12·7–17·5) of deaths and 6·2% (3·9–8·7) of DALYs, and population growth for 12·4% (10·1–14·9) of deaths and 12·4% (10·1–14·9) of DALYs. The largest contribution of trends in risk exposure to disease burden is seen between ages 1 year and 4 years, where a decline of 27·3% (24·9–29·7) of the change in DALYs between 2006 and 2016 can be attributed to declines in exposure to risks. Interpretation Increasingly detailed understanding of the trends in risk exposure and the RRs for each risk-outcome pair provide insights into both the magnitude of health loss attributable to risks and how modification of risk exposure has contributed to health trends. Metabolic risks warrant particular policy attention, due to their large contribution to global disease burden, increasing trends, and variable patterns across countries at the same level of development. GBD 2016 findings show that, while it has huge potential to improve health, risk modification has played a relatively small part in the past decade.
Published: 2017

33. Relation of Habitual Chocolate Consumption to Arterial Stiffness in a Community-Based Sample: Preliminary Findings

Author: Georgina E. Crichton, Merrill F. Elias, Ala'a Alkerwi, Saverio Stranges, and Walter P. Abhayaratna
Subjects: Community based, Original Paper, medicine.medical_specialty, Longitudinal study, business.industry, Cardiovascular risk factors, Dietary factors, 030204 cardiovascular system & hematology, medicine.disease, 3. Good health, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Diabetes mellitus, Arterial stiffness, Cardiology, Medicine, Food science, Cardiology and Cardiovascular Medicine, business, Pulse wave velocity, 030217 neurology & neurosurgery, Subclinical infection
Abstract: Background: The consumption of chocolate and cocoa has established cardiovascular benefits. Less is known about the effects of chocolate on arterial stiffness, a marker of subclinical cardiovascular disease. The aim of this study was to investigate whether chocolate intakes are independently associated with pulse wave velocity (PWV), after adjustment for cardiovascular, lifestyle and dietary factors. Methods: Prospective analyses were undertaken on 508 community-dwelling participants (mean age 61 years, 60% women) from the Maine-Syracuse Longitudinal Study (MSLS). Habitual chocolate intakes, measured using a food frequency questionnaire, were related to PWV, measured approximately 5 years later. Results: Chocolate intake was significantly associated with PWV in a non-linear fashion with the highest levels of PWV in those who never or rarely ate chocolate and lowest levels in those who consumed chocolate once a week. This pattern of results remained and was not attenuated after multivariate adjustment for diabetes, cardiovascular risk factors and dietary variables (p = 0.002). Conclusions: Weekly chocolate intake may be of benefit to arterial stiffness. Further studies are needed to explore the underlying mechanisms that may mediate the observed effects of habitual chocolate consumption on arterial stiffness.
Published: 2016
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34. Reply-Letter to the Editor - Smoking status is inversely associated with overall diet quality: Findings from the ORISCAV-LUX study

Author: James R. Hébert, Nitin Shivappa, Paul Lemmens, Burcu Baydarlioglu, Ala'a Alkerwi, Saverio Stranges, Nicolas Sauvageot, RS: CAPHRI - R6 - Promoting Health & Personalised Care, and Health promotion
Subjects: 0301 basic medicine, 030109 nutrition & dietetics, Nutrition and Dietetics, Letter to the editor, business.industry, Life style, Smoking, DETERMINANTS, Critical Care and Intensive Care Medicine, Diet, 03 medical and health sciences, Diet quality, Medicine, Smoking status, business, Life Style, Demography
Published: 2018

35. Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016

Author: Nancy, Fullman, Jamal, Yearwood, Solomon, M, Abay, Cristiana, Abbafati, Foad, Abd-Allah, Jemal, Abdela, Ahmed, Abdelalim, Zegeye, Abebe, Teshome, Abuka, Abebo, Victor, Aboyans, Haftom, Niguse, Abraha, Daisy, M, X, Abreu, Laith, Abu-Raddad, J, Akilew, Awoke, Adane, Rufus, Adesoji, Adedoyin, Olatunji, Adetokunboh, Tara, Ballav, Adhikari, Mohsen, Afarideh, Ashkan, Afshin, Gina, Agarwal, Dominic, Agius, Anurag, Agrawal, Sutapa, Agrawal, Aliasghar, Ahmad, Kiadaliri, Miloud, Taki, Eddine, Aichour, Mohammed, Akibu, Rufus, Olusola, Akinyemi, Tomi, Akinyemiju, F, Nadia, Akseer, Faris, Hasan, Lami, Al, Fares, Alahdab, Ziyad, Al-Aly, Khurshid, Alam, Tahiya, Alam, Deena, Alasfoor, Mohammed, I, Albittar, Kefyalew, Addis, Alene, Ayman, Al-Eyadhy, Syed, Danish, Ali, Mehran, Alijanzadeh, Syed, M, Aljunid, Ala’A, Alkerwi, François, Alla, Peter, Allebeck, Christine, Allen, Mahmoud, A, Alomari, Rajaa, Al-Raddadi, Ubai, Alsharif, Khalid, A, Altirkawi, Nelson, Alvis-Guzman, Azmeraw, T, Amare, Kebede, Amenu, Walid, Ammar, Yaw, Ampem, Amoako, Nahla, Anber, Catalina, Liliana, Andrei, Sofia, Androudi, Carl, Abelardo, Antonio, T, Valdelaine, E, Araújo, M, Olatunde, Aremu, Johan, Ärnlöv, Artaman, Al, Krishna, Kumar, Aryal, Hamid, Asayesh, Ephrem, Tsegay, Asfaw, Solomon, Weldegebreal, Asgedom, Rana, Jawad, Asghar, Mengistu, Mitiku, Ashebir, Netsanet, Abera, Asseffa, Tesfay, Mehari, Atey, Sachin, R, Atre, Madhu, Atteraya, S, Leticia, Avila-Burgos, Euripide, Frinel, Arthur, G, Avokpaho, Ashish, Awasthi, Beatriz, Paulina, Ayala, Quintanilla, Animut, Alebel, Ayalew, Henok, Tadesse, Ayele, Rakesh, Ayer, Tambe, Betrand, Ayuk, Peter, Azzopardi, Natasha, Azzopardi-Muscat, Tesleem, Kayode, Babalola, Hamid, Badali, Alaa, Badawi, Maciej, Banach, Amitava, Banerjee, Amrit, Banstola, Ryan, M, Barber, Miguel, Barboza, A, Suzanne, L, Barker-Collo, Till, Bärnighausen, Simon, Barquera, Lope, H, Barrero, Quique, Bassat, Sanjay, Basu, Bernhard, T, Baune, Shahrzad, Bazargan-Hejazi, Neeraj, Bedi, Ettore, Beghi, Masoud, Behzadifar, Meysam, Behzadifar, Bayu, Begashaw, Bekele, Abate, Bekele, Belachew, Saba, Abraham, Belay, Yihalem, Abebe, Belay, Michelle, L, Bell, Aminu, Bello, K, Derrick, A, Bennett, James, Bennett, R, Isabela, M, Bensenor, Derbew, Fikadu, Berhe, Eduardo, Bernabé, Robert, Steven, Bernstein, Mircea, Beuran, Ashish, Bhalla, Paurvi, Bhatt, Soumyadeep, Bhaumik, Zulfiqar, A, Bhutta, Belete, Biadgo, Ali, Bijani, Boris, Bikbov, Charles, Birungi, Stan, Biryukov, Hailemichael, Bizuneh, Ian, W, Bolliger, Kaylin, Bolt, Ibrahim, R, Bou-Orm, Kayvan, Bozorgmehr, Oliver, Jerome, Brady, Alexandra, Brazinova, Nicholas, J, Breitborde, K, Hermann, Brenner, Gabrielle, Britton, Traolach, S, Brugha, Zahid, Butt, A, Lucero, Cahuana-Hurtado, Ismael, Ricardo, Campos-Nonato, Julio, Cesar, Campuzano, Josip, Car, Mate, Car, Rosario, Cárdenas, Juan, Jesus, Carrero, Felix, Carvalho, Carlos, A, Castañeda-Orjuela, Jacqueline, Castillo, Rivas, Ferrán, Catalá-López, Kelly, Cercy, Julian, Chalek, Hsing-Yi, Chang, Jung-Chen, Chang, Aparajita, Chattopadhyay, Pankaj, Chaturvedi, Peggy, Pei-Chia, Chiang, Vesper, Hichilombwe, Chisumpa, Jee-Young, J, Choi, Hanne, Christensen, Devasahayam, Jesudas, Christopher, Sheng-Chia, Chung, Liliana, G, Ciobanu, Cirillo, Massimo, Danny, Colombara, Sara, Conti, Cyrus, Cooper, Leslie, Cornaby, Paolo, Angelo, Cortesi, Monica, Cortinovis, Alexandre, Costa, Pereira, Ewerton, Cousin, Michael, H, Criqui, Elizabeth, Cromwell, A, Christopher, Stephen, Crowe, John, Crump, A, Alemneh, Kabeta, Daba, Berihun, Assefa, Dachew, Abel, Fekadu, Dadi, Lalit, Dandona, Rakhi, Dandona, Paul, I, Dargan, Ahmad, Daryani, Maryam, Daryani, Jai, Das, Siddharth, Kumar, Das, José, Das, Neves, Nicole, Davis, Weaver, Kairat, Davletov, Barbora, De, Courten, Diego, Leo, De, Jan-Walter, De, Neve, Robert, Dellavalle, P, Gebre, Demoz, Kebede, Deribe, Don, C, Des, Jarlais, Subhojit, Dey, Samath, D, Dharmaratne, Meghnath, Dhimal, Shirin, Djalalinia, David, Teye, Doku, Kate, Dolan, Ray, E, Dorsey, Kadine, Priscila, Bender, Dos, Santos, Kerrie, E, Doyle, Tim, Driscoll, R, Manisha, Dubey, Eleonora, Dubljanin, Bruce, Bartholow, Duncan, Michelle, Echko, Dumessa, Edessa, David, Edvardsson, Joshua, R, Ehrlich, Erika, Eldrenkamp, Ziad, El-Khatib, Matthias, Endres, Aman, Yesuf, Endries, Babak, Eshrati, Sharareh, Eskandarieh, Alireza, Esteghamati, Mahdi, Fakhar, Tamer, Farag, Mahbobeh, Faramarzi, Emerito, Jose, Aquino, Faraon, André, Faro, Farshad, Farzadfar, Adesegun, Fatusi, Mir, Sohail, Fazeli, Valery, Feigin, L, Andrea, B, Feigl, Netsanet, Fentahun, Seyed-Mohammad, Fereshtehnejad, Eduarda, Fernandes, João, C, Fernandes, Daniel, Obadare, Fijabi, Irina, Filip, Florian, Fischer, Christina, Fitzmaurice, Abraham, D, Flaxman, Luisa, Sorio, Flor, Nataliya, Foigt, Kyle, J, Foreman, Joseph, Frostad, J, Thomas, Fürst, Neal, D, Futran, Emmanuela, Gakidou, Silvano, Gallus, Ketevan, Gambashidze, Amiran, Gamkrelidze, Morsaleh, Ganji, Abadi, Kahsu, Gebre, Tsegaye, Tewelde, Gebrehiwot, Amanuel, Tesfay, Gebremedhin, Yalemzewod, Assefa, Gelaw, Johanna, M, Geleijnse, Demeke, Geremew, Peter, W, Gething, Reza, Ghadimi, Khalil, Ghasemi, Falavarjani, Maryam, Ghasemi-Kasman, Paramjit, Singh, Gill, Ababi, Zergaw, Giref, Maurice, Giroud, Melkamu, Dedefo, Gishu, Giorgia, Giussani, William, W, Godwin, Srinivas, Goli, Hector, Gomez-Dantes, Philimon, N, Gona, Amador, Goodridge, Sameer, Vali, Gopalani, Yevgeniy, Goryakin, Alessandra, Carvalho, Goulart, Ayman, Grada, Max, Griswold, Giuseppe, Grosso, Harish, Chander, Gugnani, Yuming, Guo, Rahul, Gupta, Rajeev, Gupta, Tanush, Gupta, Tarun, Gupta, Vipin, Gupta, Juanita, A, Haagsma, Vladimir, Hachinski, Nima, Hafezi-Nejad, Gessessew, Bugssa, Hailu, Randah, Ribhi, Hamadeh, Samer, Hamidi, Graeme, J, Hankey, Hilda, Harb, L, Heather, C, Harewood, Sivadasanpillai, Harikrishnan, Josep, Maria, Haro, Hamid, Yimam, Hassen, Rasmus, Havmoeller, Caitlin, Hawley, Simon, I, Hay, Jiawei, He, Stephen, J, Hearps, C, Mohamed, I, Hegazy, Behzad, Heibati, Mohsen, Heidari, Delia, Hendrie, Nathaniel, J, Henry, Victor, Hugo, Herrera, Ballesteros, Claudiu, Herteliu, Desalegn, Tsegaw, Hibstu, Molla, Kahssay, Hiluf, Hans, W, Hoek, Enayatollah, Homaie, Rad, Nobuyuki, Horita, Dean, H, Hosgood, Mostafa, Hosseini, Seyed, Reza, Hosseini, Mihaela, Hostiuc, Sorin, Hostiuc, Damian, G, Hoy, Mohamed, Hsairi, Aung, Soe, Htet, Guoqing, Hu, John, J, Huang, Kim, Moesgaard, Iburg, Fachmi, Idris, Ehimario, Uche, Igumbor, Chad, Ikeda, Bogdan, Vasile, Ileanu, Olayinka, Ilesanmi, S, Kaire, Innos, Seyed, Sina, Naghibi, Irvani, Caleb, M, Irvine, S, Farhad, Islami, Troy, A, Jacobs, Kathryn, Jacobsen, H, Nader, Jahanmehr, Rajesh, Jain, Sudhir, Kumar, Jain, Mihajlo, Jakovljevic, M, Moti, Tolera, Jalu, Amr, Jamal, A, Mehdi, Javanbakht, Achala, Upendra, Jayatilleke, Panniyammakal, Jeemon, Ravi, Prakash, Jha, Vivekanand, Jha, Jacek, Józwiak, Oommen, John, Sarah, Charlotte, Johnson, Jost, Jonas, B, Vasna, Joshua, Mikk, Jürisson, Zubair, Kabir, Rajendra, Kadel, Amaha, Kahsay, Rizwan, Kalani, Chittaranjan, Kar, Marina, Karanikolos, André, Karch, Corine, Kakizi, Karema, Seyed, Karimi, M, Amir, Kasaeian, Dessalegn, Haile, Kassa, Getachew, Mullu, Kassa, Tesfaye, Dessale, Kassa, Nicholas, Kassebaum, J, Srinivasa, Vittal, Katikireddi, Anil, Kaul, Norito, Kawakami, Konstantin, Kazanjan, Seifu, Kebede, Peter, Njenga, Keiyoro, Grant, Rodgers, Kemp, Andre, Pascal, Kengne, Maia, Kereselidze, Ezra, Belay, Ketema, Yousef, Saleh, Khader, Morteza, Abdullatif, Khafaie, Alireza, Khajavi, Ibrahim, A, Khalil, Ejaz, Ahmad, Khan, Gulfaraz, Khan, Nuruzzaman, Md, Khan, Muhammad, Ali, Khan, Mukti, Nath, Khanal, Young-Ho, Khang, Mona, M, Khater, Abdullah, Tawfih, Abdullah, Khoja, Ardeshir, Khosravi, Jagdish, Khubchandani, Getiye, Dejenu, Kibret, Daniel, Ngari, Kiirithio, Daniel, Kim, Yun, Jin, Kim, Ruth, Kimokoti, W, Yohannes, Kinfu, Sanjay, Kinra, Adnan, Kisa, Niranjan, Kissoon, Sonali, Kochhar, Yoshihiro, Kokubo, Jacek, A, Kopec, Soewarta, Kosen, Parvaiz, A, Koul, 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Mohammed, Magdy, Abd, Razek, El, Marek, Majdan, Reza, Majdzadeh, Azeem, Majeed, Reza, Malekzadeh, Rajesh, Malhotra, Deborah, Carvalho, Malta, Abdullah, Mamun, A, Helena, Manguerra, Treh, Manhertz, Mohammad, Ali, Mansournia, Lorenzo, Mantovani, G, Tsegahun, Manyazewal, Chabila, C, Mapoma, Christopher, Margono, Jose, Martinez-Raga, Sheila, Cristina, Ouriques, Martins, Francisco, Rogerlândio, Martins-Melo, Ira, Martopullo, Winfried, März, Benjamin, Ballard, Massenburg, Manu, Raj, Mathur, Pallab, K, Maulik, Mohsen, Mazidi, Colm, Mcalinden, Mcgrath, Martin, Mckee, Suresh, Mehata, Ravi, Mehrotra, Kala, M, Mehta, Varshil, Mehta, Toni, Meier, Fabiola, Mejia-Rodriguez, Kidanu, Gebremariam, Meles, Mulugeta, Melku, Peter, Memiah, Ziad, A, Memish, Walter, Mendoza, Degu, Abate, Mengiste, Desalegn, Tadese, Mengistu, Bereket, Gebremichael, Menota, George, Mensah, A, Atte, Meretoja, Tuomo, J, Meretoja, Haftay, Berhane, Mezgebe, Tomasz, Miazgowski, Renata, Micha, Robert, Milam, Anoushka, Millear, Ted, 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Stathopoulou, Vasiliki, Steel, Nichola, Stein, Dan J., Stokes, Mark Andrew, Sturua, Lela, Sufiyan, Muawiyyah Babale, Suliankatchi, Rizwan Abdulkader, Sunguya, Bruno F., Sur, Patrick J., Sykes, Bryan L., Sylaja, P.N., Szoeke, Cassandra E.I., Tabarés-Seisdedos, Rafael, Tadakamadla, Santosh Kumar, Tadesse, Andualem Henok, Taffere, Getachew Redae, Tandon, Nikhil, Tariku, Amare Tariku, Taveira, Nuno, Tehrani-Banihashemi, Arash, Temam Shifa, Girma, Temsah, Mohamad-Hani, Terkawi, Abdullah Sulieman, Tesema, Azeb Gebresilassie, Tesfaye, Dawit Jember, Tessema, Belay, Thakur, J.S., Thomas, Nihal, Thompson, Matthew J., Tillmann, Taavi, To, Quyen G., Tobe-Gai, Ruoyan, Tonelli, Marcello, Topor-Madry, Roman, Topouzis, Foti, Torre, Anna, Tortajada, Miguel, Tran, Bach Xuan, Tran, Khanh Bao, Tripathi, Avnish, Tripathy, Srikanth Prasad, Troeger, Christopher, Truelsen, Thoma, Tsoi, Derrick, Tudor Car, Lorainne, Tuem, Kald Beshir, Tyrovolas, Stefano, Uchendu, Uche S., Ukwaja, Kingsley Nnanna, Ullah, Irfan, Updike, Rachel, Uthman, Olalekan A., Uzochukwu, Benjamin S. Chudi, Valdez, Pascual Rubén, Van Boven, Job F.M., Varughese, Santosh, Vasankari, Tommi, Venketasubramanian, Narayanaswamy, Violante, Francesco S., Vladimirov, Sergey K., Vlassov, Vasiliy Victorovich, Vollset, Stein Emil, Vos, Theo, Wagnew, Fasil, Waheed, Yasir, Wallin, Mitchell T., Walson, Judd L., Wang, Yafeng, Wang, Yuan-Pang, Wassie, Molla Mesele, Weaver, Marcia R., Weiderpass, Elisabete, Weintraub, Robert G., Weiss, Jordan, Weldegwergs, Kidu Gidey, Werdecker, Andrea, West, T. Eoin, Westerman, Ronny, White, Richard G., Whiteford, Harvey A., Widecka, Justyna, Winkler, Andrea Sylvia, Wiysonge, Charles Shey, Wolfe, Charles D.A., Wondimkun, Yohanes Ayele, Workicho, Abdulhalik, Wyper, Grant M.A., Xavier, Deni, Xu, Gelin, Yan, Lijing L., Yano, Yuichiro, Yaseri, Mehdi, Yimer, Nigus Bililign, Yin, Peng, Yip, Paul, Yirsaw, Biruck Desalegn, Yonemoto, Naohiro, Yonga, Gerald, Yoon, Seok-Jun, Yotebieng, Marcel, Younis, Mustafa Z., Yu, Chuanhua, Zadnik, Vesna, Zaidi, Zoubida, El Sayed Zaki, Maysaa, Zaman, Sojib Bin, Zamani, Mohammad, Zenebe, Zerihun Menlkalew, Zhou, Maigeng, Zhu, Jun, Zimsen, Stephanie R.M., Zipkin, Ben, Zodpey, Sanjay, Zuhlke, Liesl Joanna, Murray, Christopher J.L., Lozano, Rafael, Viðskiptadeild (HR), School of Business (RU), Háskólinn í Reykjavík, Reykjavik University, Abay, Sm, Abebo, Ta, Abraha, Hn, Abreu, Dmx, Abu-Raddad, Lj, Adane, Aa, Adedoyin, Ra, Adhikari, Tb, Aichour, Mte, Akinyemi, Ro, Akinyemiju, Tf, Al Lami, Fh, Albittar, Mi, Alene, Ka, Ali, Sd, Aljunid, Sm, Alomari, Ma, Altirkawi, Ka, Amare, At, Amoako, Ya, Andrei, Cl, Antonio, Cat, Araújo, Vem, Aryal, Kk, Asfaw, Et, Asgedom, Sw, Asghar, Rj, Ashebir, Mm, Asseffa, Na, Atey, Tm, Atre, Sr, Avokpaho, Efga, Ayala Quintanilla, Bp, Ayalew, Aa, Ayele, Ht, Ayuk, Tb, Babalola, Tk, Barber, Rm, Barboza, Ma, Barker-Collo, Sl, Barrero, Lh, Baune, Bt, Bekele, Bb, Belachew, Ab, Belay, Sa, Belay, Ya, Bell, Ml, Bello, Ak, Bennett, Da, Bennett, Jr, Bensenor, Im, Berhe, Df, Bhutta, Za, Bolliger, Iw, Bou-Orm, Ir, Brady, Oj, Breitborde, Njk, Butt, Za, Campos-Nonato, Ir, Campuzano, Jc, Carrero, Jj, Castañeda-Orjuela, Ca, Chang, Hy, Chang, Jc, Chiang, Pp, Chisumpa, Vh, Choi, Jj, Christopher, Dj, Chung, Sc, Ciobanu, Lg, Cortesi, Pa, Criqui, Mh, Cromwell, Ea, Crump, Ja, Daba, Ak, Dachew, Ba, Dadi, Af, Dargan, Pi, Das, Sk, De Neve, Jw, Dellavalle, Rp, Des Jarlais, Dc, Dharmaratne, Sd, Doku, Dt, Dorsey, Er, Dos Santos, Kpb, Doyle, Ke, Driscoll, Tr, Duncan, Bb, Ehrlich, Jr, El-Khatib, Zz, Endries, Ay, Faraon, Eja, Feigin, Vl, Feigl, Ab, Fereshtehnejad, Sm, Fernandes, Jc, Fijabi, Do, Flaxman, Ad, Foreman, Kj, Frostad, Jj, Futran, Nd, Gebre, Ak, Gebrehiwot, Tt, Gebremedhin, At, Gelaw, Ya, Geleijnse, Jm, Gething, Pw, Giref, Az, Gishu, Md, Godwin, Ww, Gona, Pn, Gopalani, Sv, Goulart, Ac, Gugnani, Hc, Haagsma, Ja, Hailu, Gb, Hamadeh, Rr, Hankey, Gj, Harb, Hl, Harewood, Hc, Haro, Jm, Hassen, Hy, Hay, Si, Hearps, Sjc, Hegazy, Mi, Henry, Nj, Herrera Ballesteros, Vh, Hibstu, Dt, Hiluf, Mk, Hoek, Hw, Hosgood, Hd, Hosseini, Sr, Hoy, Dg, Huang, Jj, Iburg, Km, Igumbor, Eu, Ileanu, Bv, Irvani, Ssn, Irvine, Cm, Jacobs, Ta, Jacobsen, Kh, Jain, Sk, Jakovljevic, Mb, Jalu, Mt, Jamal, Aa, Jayatilleke, Au, Jha, Rp, Johnson, Sc, Jonas, Jb, Karema, Ck, Karimi, Sm, Kassa, Dh, Kassa, Gm, Kassa, Td, Kassebaum, Nj, Katikireddi, Sv, Keiyoro, Pn, Kemp, Gr, Kengne, Ap, Ketema, Eb, Khafaie, Ma, Khalil, Ia, Khan, Ea, Khan, Mn, Khan, Ma, Khanal, Mn, Khang, Yh, Khater, Mm, Khoja, Ata, Kibret, Gd, Kiirithio, Dn, Kim, Yj, Kimokoti, Rw, Kopec, Ja, Koul, Pa, Krohn, Kj, Kumar, Ga, Kyu, Hh, Lad, Dp, Lal, Dk, Lang, Jj, Lansingh, Vc, Lazarus, Jv, Leasher, Jl, Lee, Ph, Leshargie, Ct, Liben, Ml, Lim, Ll, Lopez, Ad, Lorch, Sa, Lotufo, Pa, Lucas, Tcd, Lyons, Ra, Macarayan, Erk, Mackay, Mt, Maddison, Er, Malta, Dc, Mamun, Aa, Mansournia, Ma, Mantovani, Lg, Mapoma, Cc, Martins, Sco, Martins-Melo, Fr, Massenburg, Bb, Mathur, Mr, Maulik, Pk, Mcgrath, Jj, Mehta, Km, Meles, Kg, Memish, Za, Mengiste, Da, Mengistu, Dt, Menota, Bg, Mensah, Ga, Meretoja, Tj, Mezgebe, Hb, Miller, Tr, Mini, Gk, Mirrakhimov, Em, Mitchell, Pb, Mlashu, Fw, Mohammad, Ka, Mohammed, Ma, Mokdad, Ah, Mola, Gl, Montañez Hernandez, Jc, Morrison, Sd, Mousavi, Sm, Mueller, Uo, Murthy, Gv, Musa, Ki, Naik, Ga, Nansseu, Jrn, Narayan, Kv, Nascimento, Br, Negoi, Ri, Newton, Cr, Ngunjiri, Jw, Nguyen, Th, Ningrum, Dna, Nong, Vm, Norheim, Of, Noubiap, Jjn, Obermeyer, Cm, Ogbo, Fa, Oh, Ih, Olagunju, At, Olagunju, To, Olivares, Pr, Oliveira, Ppv, Olsen, He, Olusanya, Bo, Olusanya, Jo, Opio, Jn, Ortega-Altamirano, Dv, Pain, Aw, Palone, Mrt, Pandian, Jd, Park, Ek, Patil, St, Patton, Gc, Paturi, Vr, Pedroso, Mm, Pedroza, Sp, Pereira, Dm, Phillips, Mr, Piel, Fb, Pigott, Dm, Pillay, Jd, Piradov, Ma, Pond, Cd, Postma, Mj, Prasad, Nm, Quintana, Hk, Rahman, Ma, Rahman, Su, Rai, Rk, Raju, Sb, Rana, Sm, Rawaf, Dl, Ray, Se, Razo-García, Ca, Reiner, Rc, Reitsma, Mb, Renzaho, Amn, Ribeiro, Al, Rios Blancas, Mj, Rivera, Ja, Roth, Ga, Ruhago, Gm, Sabde, Yd, Sahraian, Ma, Saldanha, Rf, Salomon, Ja, Samy, Am, Sanabria, Jr, Sancheti, Pk, Sanchez-Niño, Md, Santric Milicevic, Mm, Sarker, Ar, Saylan, Mi, Schmidt, Mi, Schneider, Ijc, Schumacher, Ae, Schutte, Ae, Schwebel, Dc, Sepanlou, Sg, Servan-Mori, Ee, Shaikh, Ma, Shariful Islam, Sm, Shfare, Mt, Shrime, Mg, Shukla, Sr, Sigfusdottir, Id, Silberberg, Dh, Silva, Da, Silva, Jp, Silveira, Dga, Singh, Ja, Singh, Np, Sinha, Dn, Sinke, Ah, Soares Filho, Am, Sobaih, Bha, Sorensen, Rjd, Soriano, Jb, Soyiri, In, Sposato, La, Sreeramareddy, Ct, Stanaway, Jd, Stein, Dj, Stokes, Ma, Sufiyan, Mb, Suliankatchi, Ra, Sunguya, Bf, Sur, Pj, Sykes, Bl, Sylaja, Pn, Tadakamadla, Sk, Tadesse, Ah, Taffere, Gr, Tariku, At, Temsah, Mh, Tesema, Ag, Tesfaye, Dj, Thompson, Mj, To, Qg, Tran, Bx, Tran, Kb, Tripathy, Sp, Tuem, Kb, Ukwaja, Kn, Uthman, Oa, Uzochukwu, Bsc, Valdez, Pr, van Boven, Jfm, Vladimirov, Sk, Vlassov, Vv, Vollset, Se, Wallin, Mt, Walson, Jl, Wang, Yp, Wassie, Mm, Weaver, Mr, Weintraub, Rg, Weldegwergs, Kg, West, Te, White, Rg, Whiteford, Ha, Wolfe, Cd, Wondimkun, Ya, Wyper, Gma, Yan, Ll, Yimer, Nb, Yirsaw, Bd, Yoon, Sj, Younis, Mz, Zaki, Me, Zaman, Sb, Zenebe, Zm, Zimsen, Srm, Zuhlke, Lj, Murray, Cjl, and Lozano, R.
Subjects: Peformance, Coverage, Dánartíðni, Lífslíkur, Life expectancy, GBD, Background A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0–100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best), universal health coverage, Article, access quality health care, health care access and quality index, Nations, Healthcare Acce, Cause-specific mortality, Psychology, Healthcare Access and Quality Index, Mælitæki, States, Medicine (all), Health care, Þjóðir, Public Health, Global Health, Social Medicine and Epidemiology, Quality, Heilbrigðisþjónusta, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Sálfræði, Indicator, Amenable mortality, Transition, we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0–100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8–98·1) in Iceland, followed by 96·6 (94·9–97·9) in Norway and 96·1 (94·5–97·3) in the Netherlands, to values as low as 18·6 (13·1–24·4) in the Central African Republic, 19·0 (14·3–23·7) in Somalia, and 23·4 (20·2–26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1–93·6) in Beijing to 48·0 (43·4–53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6–68·8) in Goa to 34·0 (30·3–38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle-SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view—and subsequent provision—of quality health care for all populations, Trends, Inequalities
Abstract: Background A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97.1 (95% UI 95.8-98.1) in Iceland, followed by 96.6 (94.9-97.9) in Norway and 96.1 (94.5-97.3) in the Netherlands, to values as low as 18.6 (13.1-24.4) in the Central African Republic, 19.0 (14.3-23.7) in Somalia, and 23.4 (20.2-26.8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91.5 (89.1-936) in Beijing to 48.0 (43.4-53.2) in Tibet (a 43.5-point difference), while India saw a 30.8-point disparity, from 64.8 (59.6-68.8) in Goa to 34.0 (30.3-38.1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4.8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20.9-point to 17.0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17.2-point to 20.4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle-SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view and subsequent provision of quality health care for all populations., Bill & Melinda Gates Foundation. Barbora de Courten is supported by a National Heart Foundation Future Leader Fellowship (100864). Ai Koyanagi’s work is supported by the Miguel Servet contract financed by the CP13/00150 and PI15/00862 projects, integrated into the National R + D + I and funded by the ISCIII —General Branch Evaluation and Promotion of Health Research—and the European Regional Development Fund (ERDF-FEDER). Alberto Ortiz was supported by Spanish Government (Instituto de Salud Carlos III RETIC REDINREN RD16/0019 FEDER funds). Ashish Awasthi acknowledges funding support from Department of Science and Technology, Government of India through INSPIRE Faculty scheme Boris Bikbov has received funding from the European Union’s Horizon 2020 research and innovation programme under Marie Sklodowska-Curie grant agreement No. 703226. Boris Bikbov acknowledges that work related to this paper has been done on the behalf of the GBD Genitourinary Disease Expert Group. Panniyammakal Jeemon acknowledges support from the clinical and public health intermediate fellowship from the Wellcome Trust and Department of Biotechnology, India Alliance (2015–20). Job F M van Boven was supported by the Department of Clinical Pharmacy & Pharmacology of the University Medical Center Groningen, University of Groningen, Netherlands. Olanrewaju Oladimeji is an African Research Fellow hosted by Human Sciences Research Council (HSRC), South Africa and he also has honorary affiliations with Walter Sisulu University (WSU), Eastern Cape, South Africa and School of Public Health, University of Namibia (UNAM), Namibia. He is indeed grateful for support from HSRC, WSU and UNAM. EUI is supported in part by the South African National Research Foundation (NRF UID: 86003). Ulrich Mueller acknowledges funding by the German National Cohort Study grant No 01ER1511/D, Gabrielle B Britton is supported by Secretaría Nacional de Ciencia, Tecnología e Innovación and Sistema Nacional de Investigación de Panamá. Giuseppe Remuzzi acknowledges that the work related to this paper has been done on behalf of the GBD Genitourinary Disease Expert Group. Behzad Heibati would like to acknowledge Air pollution Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran. Syed Aljunid acknowledges the National University of Malaysia for providing the approval to participate in this GBD Project. Azeem Majeed and Imperial College London are grateful for support from the Northwest London National Insititute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research & Care. Tambe Ayuk acknowledges the Institute of Medical Research and Medicinal Plant Studies for office space provided. José das Neves was supported in his contribution to this work by a Fellowship from Fundação para a Ciência e a Tecnologia, Portugal (SFRH/BPD/92934/2013). João Fernandes gratefully acknowledges funding from FCT–Fundação para a Ciência e a Tecnologia (grant number UID/Multi/50016/2013). Jan-Walter De Neve was supported by the Alexander von Humboldt Foundation. Kebede Deribe is funded by a Wellcome Trust Intermediate Fellowship in Public Health and Tropical Medicine (201900). Kazem Rahimi was supported by grants from the Oxford Martin School, the NIHR Oxford BRC and the RCUK Global Challenges Research Fund. Laith J Abu-Raddad acknowledges the support of Qatar National Research Fund (NPRP 9-040-3-008) who provided the main funding for generating the data provided to the GBD-IHME effort. Liesl Zuhlke is funded by the national research foundation of South Africa and the Medical Research Council of South Africa. Monica Cortinovis acknowledges that work related to this paper has been done on the behalf of the GBD Genitourinary Disease Expert Group. Chuanhua Yu acknowleges support from the National Natural Science Foundation of China (grant number 81773552 and grant number 81273179) Norberto Perico acknowledges that work related to this paper has been done on behalf of the GBD Genitourinary Disease Expert Group. Charles Shey Wiysonge’s work is supported by the South African Medical Research Council and the National Research Foundation of South Africa (grant numbers 106035 and 108571). John J McGrath is supported by grant APP1056929 from the John Cade Fellowship from the National Health and Medical Research Council and the Danish National Research Foundation (Niels Bohr Professorship). Quique Bassat is an ICREA (Catalan Institution for Research and Advanced Studies) research professor at ISGlobal. Richard G White is funded by the UK MRC and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement that is also part of the EDCTP2 programme supported by the European Union (MR/P002404/1), the Bill & Melinda Gates Foundation (TB Modelling and Analysis Consortium: OPP1084276/OPP1135288, CORTIS: OPP1137034/OPP1151915, Vaccines: OPP1160830), and UNITAID (4214-LSHTM-Sept15; PO 8477-0-600). Rafael Tabarés-Seisdedos was supported in part by grant number PROMETEOII/2015/021 from Generalitat Valenciana and the national grant PI17/00719 from ISCIII-FEDER. Mihajlo Jakovljevic acknowleges contribution from the Serbian Ministry of Education Science and Technological Development of the Republic of Serbia (grant OI 175 014). Shariful Islam is funded by a Senior Fellowship from Institute for Physical Activity and Nutrition, Deakin University and received career transition grants from High Blood Pressure Research Council of Australia. Sonia Saxena is funded by various grants from the NIHR. Stefanos Tyrovolas was supported by the Foundation for Education and European Culture, the Sara Borrell postdoctoral program (reference number CD15/00019 from the Instituto de Salud Carlos III (ISCIII–Spain) and the Fondos Europeo de Desarrollo Regional. Stefanos was awarded with a 6 months visiting fellowship funding at IHME from M-AES (reference no. MV16/00035 from the Instituto de Salud Carlos III). S Vittal Katikreddi was funded by a NHS Research Scotland Senior Clinical Fellowship (SCAF/15/02), the MRC (MC_UU_12017/13 & MC_ UU_12017/15) and the Scottish Government Chief Scientist Office (SPHSU13 & SPHSU15). Traolach S Brugha has received funding from NHS Digital UK to collect data used in this study. The work of Hamid Badali was financially supported by Mazandaran University of Medical Sciences, Sari, Iran. The work of Stefan Lorkowski is funded by the German Federal Ministry of Education and Research (nutriCARD, Grant agreement number 01EA1411A). Mariam Molokhia’s research was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. We also thank the countless individuals who have contributed to GBD 2016 in various capacities.
Published: 2018

36. Association between Nutritional Awareness and Diet Quality: Evidence from the Observation of Cardiovascular Risk Factors in Luxembourg (ORISCAV-LUX) Study

Author: James R. Hébert, Nitin Shivappa, Nicolas Sauvageot, Ala'a Alkerwi, Leoné Malan, and 10060871 - Malan, Leoné
Subjects: Male, Gerontology, Health Knowledge, Attitudes, Practice, Luxembourg, 030309 nutrition & dietetics, Cross-sectional study, Body Mass Index, 0302 clinical medicine, Risk Factors, Surveys and Questionnaires, Medicine, 030212 general & internal medicine, Young adult, 2. Zero hunger, 0303 health sciences, Nutrition and Dietetics, diet quality, Middle Aged, Explained variation, Observational Studies as Topic, Cardiovascular Diseases, Female, lcsh:Nutrition. Foods and food supply, Adult, Adolescent, socio-economic status, Nutritional Status, lcsh:TX341-641, Health Promotion, Article, Young Adult, 03 medical and health sciences, Environmental health, Humans, Socioeconomic status, Aged, General linear model, business.industry, Diet, Cross-Sectional Studies, Health promotion, Socioeconomic Factors, food diversity, Linear Models, Household income, nutritional awareness, Energy Intake, business, Body mass index, dietary energy density, Food Science
Abstract: This study examined the association between nutritional awareness and diet quality, as indicated by energy density, dietary diversity and adequacy to achieve dietary recommendations, while considering the potentially important role of socioeconomic status (SES). Data were derived from 1351 subjects, aged 18–69 years and enrolled in the ORISCAV-LUX study. Energy density score (EDS), dietary diversity score (DDS) and Recommendation Compliance Index (RCI) were calculated based on data derived from a food frequency questionnaire. Nutritional awareness was defined as self-perception of the importance assigned to eating balanced meals, and classified as high, moderate, or of little importance. Initially, a General Linear Model was fit that adjusted for age, sex, country of birth, and body mass index (BMI). Furthermore, simultaneous contributions to diet quality of individual-level socioeconomic factors, education, and household income were examined across levels of nutritional awareness. Attributing high importance was associated inversely with energy density (p = 0.02), positively with both dietary diversity (p &lt, 0.0001), and adequacy to dietary recommendations (p &lt, 0.0001), independent of demographic factors, weight status and SES. Further adjustment for household income in the EDS-related multivariable model, reduced the β coefficient by 47% for the “moderate importance” category and 36% for the “high importance” category. Likewise, the β coefficient decreased by 13.6% and 10.7% in the DDS-related model, and by 12.5%, and 7.1% in the RCI-related model, respectively, across awareness categories. Nutritional awareness has a direct effect on diet quality, with a minor component of variance explained by improved income. The impact of nutritional awareness on diet quality seems to be a promising area for both health promotion and health policy research.
Published: 2015
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37. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015

Author: Haidong, Wang, Mohsen, Naghavi, Christine, Allen, Ryan M, Barber Zulfi, qar A, Bhutta, Austin, Carter, Daniel C, Casey Fiona, J Charlson, Alan Zian, Chen Matthew, M Coates, Megan, Coggeshall, Lalit, Dandona, Daniel J, Dicker Holly, E Erskine, Alize J, Ferrari, Christina, Fitzmaurice, Kyle, Foreman, Mohammad H, Forouzanfar Maya, S Fraser, Nancy, Fullman, Peter W, Gething Ellen, M Goldberg, Nicholas, Graetz, Juanita A, Haagsma Simon, I Hay, Chantal, Huynh, Catherine O, Johnson Nicholas, J Kassebaum, Yohannes, Kinfu, Xie Rachel, Kulikoff, Michael, Kutz, Hmwe H, Kyu Heidi, J Larson, Janni, Leung, Xiaofeng, Liang, Stephen S, Lim, Margaret, Lind, Rafael, Lozano, Neal, Marquez, George A, Mensah, Joe, Mikesell, Ali H, Mokdad Meghan, D Mooney, Grant, Nguyen, Elaine, Nsoesie, David M, Pigott, Christine, Pinho, Gregory A, Roth Joshua, A Salomon, Logan, Sandar, Naris, Silpakit, Amber, Sligar, Reed J, D Sorensen, Jeff rey, Stanaway, Caitlyn, Steiner, Stephanie, Teeple, Bernadette A, Thomas, Christopher, Troeger, Amelia, VanderZanden, Stein Emil, Vollset, Valentine, Wanga, Harvey A, Whiteford, Timothy, Wolock, Leo, Zoeckler, Kalkidan Hassen, Abate, Cristiana, Abbafati, Kaja M, Abbas, Foad, Abd-Allah, Semaw Ferede, Abera Daisy, M X, Abreu Laith, J Abu-Raddad, Gebre Yitayih, Abyu, Tom, Achoki, Ademola Lukman, Adelekan Zanfi, na Ademi, Arsène Kouablan, Adou José, C Adsuar, Kossivi Agbelenko, Afanvi, Ashkan, Afshin, Emilie Elisabet, Agardh, Arnav, Agarwal, Anurag, Agrawal, Aliasghar Ahmad, Kiadaliri Oluremi, N Ajala, Ali Shafqat, Akanda Rufus, Olusola Akinyemi, Tomi F, Akinyemiju, Nadia, Akseer, Faris Hasan, Al Lami, Samer, Alabed, Ziyad, Al-Aly, Khurshid, Alam, Noore K, M Alam, Deena, Alasfoor, Saleh Fahed, Aldhahri Robert, William Aldridge, Miguel Angel, Alegretti Alicia, V Aleman, Zewdie Aderaw, Alemu Lily, T Alexander, Samia, Alhabib, Raghib, Ali, Ala’a, Alkerwi, François, Alla, Peter, Allebeck, Rajaa, Al-Raddadi, Ubai, Alsharif, Khalid A, Altirkawi Elena, Alvarez Martin, Nelson, Alvis-Guzman, Azmeraw T, Amare Adeladza, Kofi Amegah, Emmanuel A, Ameh, Heresh, Amini, Walid, Ammar, Stephen Marc, Amrock Hjalte, H Andersen, Benjamin O, Anderson Gregory, M Anderson, Carl Abelardo, T Antonio, Atsede Fantahun, Aregay, Johan, Ärnlöv, Valentina S, Arsic Arsenijevic, Al, Artaman, Hamid, Asayesh, Rana Jawad, Asghar, Suleman, Atique, Euripide Frinel, G Arthur, Avokpaho, Ashish, Awasthi, Peter, Azzopardi, Umar, Bacha, Alaa, Badawi, Maria C, Bahit, Kalpana, Balakrishnan, Amitava, Banerjee, Aleksandra, Barac, Suzanne L, Barker-Collo, Till, Bärnighausen, Lars, Barregard, Lope H, Barrero, Arindam, Basu, Sanjay, Basu, Yibeltal Tebekaw, Bayou, Shahrzad, Bazargan-Hejazi, Justin, Beardsley, Neeraj, Bedi, Ettore, Beghi, Haileeyesus Adamu, Belay, Brent, Bell, Michelle L, Bell Aminu, K Bello, Derrick A, Bennett Isabela, M Bensenor, Adugnaw, Berhane, Eduardo, Bernabé, Balem Demtsu, Betsu Addisu, Shunu Beyene, Neeraj, Bhala, Ashish, Bhalla, Sibhatu, Biadgilign, Boris, Bikbov, Aref A, Bin Abdulhak, Brian J, Biroscak, Stan, Biryukov, Espen, Bjertness, Jed D, Blore Christopher, D Blosser, Megan A, Bohensky, Rohan, Borschmann, Dipan, Bose, Rupert R, A Bourne, Michael, Brainin, Carol E, G Brayne, Alexandra, Brazinova, Nicholas J, K Breitborde, Hermann, Brenner, Jerry D, Brewer, Alexandria, Brown, Jonathan, Brown, Traolach S, Brugha Geoff, rey Colin, Buckle Zahid, A Butt, Bianca, Calabria, Ismael Ricardo, Campos-Nonato Julio, Cesar Campuzano, Jonathan R, Carapetis, Rosario, Cárdenas, David O, Carpenter Juan, Jesus Carrero, Carlos A, Castañeda-Orjuela Jacqueline, Castillo Rivas, Ferrán, Catalá-López, Fiorella, Cavalleri, Kelly, Cercy, Jorge, Cerda, Wanqing, Chen, Adrienne, Chew, Peggy Pei-Chia, Chiang, Mirriam, Chibalabala, Chioma Ezinne, Chibueze, Odgerel, Chimed-Ochir, Vesper Hichilombwe, Chisumpa Jee-Young, Jasmine Choi, Rajiv, Chowdhury, Hanne, Christensen, Devasahayam Jesudas, Christopher Liliana, G Ciobanu, Cirillo Massimo, Aaron J, Cohen, Valentina, 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Horino, Masako, Horita, Nobuyuki, Hosgood, H Dean, Hotez, Peter J, Hoy, Damian G, Hsairi, Mohamed, Htet, Aung Soe, Htike, Maung Maung Than, Hu, Guoqing, Huang, Cheng, Huang, Hsiang, Huiart, Laetitia, Husseini, Abdullatif, Huybrechts, Inge, Huynh, Grace, Iburg, Kim Moesgaard, Innos, Kaire, Inoue, Manami, Iyer, Veena J, Jacobs, Troy A, Jacobsen, Kathryn H, Jahanmehr, Nader, Jakovljevic, Mihajlo B, James, Peter, Javanbakht, Mehdi, Jayaraman, Sudha P, Jayatilleke, Achala Upendra, Jeemon, Panniyammakal, Jensen, Paul N, Jha, Vivekanand, Jiang, Guohong, Jiang, Ying, Jibat, Tariku, Jimenez-Corona, Aida, Jonas, Jost B, Joshi, Tushar Kant, Kabir, Zubair, Kamal, Ritul, Kan, Haidong, Kant, Surya, Karch, André, Karema, Corine Kakizi, Karimkhani, Chante, Karletsos, Dimitri, Karthikeyan, Ganesan, Kasaeian, Amir, Katibeh, Marzieh, Kaul, Anil, Kawakami, Norito, Kayibanda, Jeanne Françoise, Keiyoro, Peter Njenga, Kemmer, Laura, Kemp, Andrew Haddon, Kengne, Andre Pascal, Keren, Andre, Kereselidze, Maia, Kesavachandran, Chandrasekharan Nair, Khader, Yousef Saleh, Khalil, Ibrahim A, Khan, Abdur Rahman, Khan, Ejaz Ahmad, Khang, Young-Ho, Khera, Sahil, Khoja, Tawfik Ahmed Muthafer, Kieling, Christian, Kim, Daniel, Kim, Yun Jin, Kissela, Brett M, Kissoon, Niranjan, Knibbs, Luke D, Knudsen, Ann Kristin, Kokubo, Yoshihiro, Kolte, Dhaval, Kopec, Jacek A, Kosen, Soewarta, Koul, Parvaiz A, Koyanagi, Ai, Krog, Norun Hjertager, Defo, Barthelemy Kuate, Bicer, Burcu Kucuk, Kudom, Andreas A, Kuipers, Ernst J, Kulkarni, Veena S, Kumar, G Anil, Kwan, Gene F, Lal, Aparna, Lal, Dharmesh Kumar, Lalloo, Ratilal, Lam, Hilton, Lam, Jennifer O, Langan, Sinead M, Lansingh, Van C, Larsson, Ander, Laryea, Dennis Odai, Latif, Asma Abdul, Lawrynowicz, Alicia Elena Beatriz, Leigh, Jame, Levi, Miriam, Li, Yongmei, Lindsay, M Patrice, Lipshultz, Steven E, Liu, Patrick Y, Liu, Shiwei, Liu, Yang, Lo, Loon-Tzian, Logroscino, Giancarlo, Lotufo, Paulo A, Lucas, Robyn M, Lunevicius, Raimunda, Lyons, Ronan A, Ma, Stefan, Machado, Vasco Manuel Pedro, Mackay, Mark T, Maclachlan, Jennifer H, Razek, Hassan Magdy Abd El, Magdy, Mohammed, Razek, Abd El, Majdan, Marek, Majeed, Azeem, Malekzadeh, Reza, Manamo, Wondimu Ayele Ayele, Mandisarisa, John, Mangalam, Srikanth, Mapoma, Chabila C, Marcenes, Wagner, Margolis, David Joel, Martin, Gerard Robert, Martinez-Raga, Jose, Marzan, Melvin Barriento, Masiye, Felix, Mason-Jones, Amanda J, Massano, João, Matzopoulos, Richard, Mayosi, Bongani M, Mcgarvey, Stephen Theodore, Mcgrath, John J, Mckee, Martin, Mcmahon, Brian J, Meaney, Peter A, Mehari, Alem, Mehndiratta, Man Mohan, Mejia-Rodriguez, Fabiola, Mekonnen, Alemayehu B, Melaku, Yohannes Adama, Memiah, Peter, Memish, Ziad A, Mendoza, Walter, Meretoja, Atte, Meretoja, Tuomo J, Mhimbira, Francis Apolinary, Micha, Renata, Miller, Ted R, Mirarefin, Mojde, Misganaw, Awoke, Mock, Charles N, Mohammad, Karzan Abdulmuhsin, Mohammadi, Alireza, Mohammed, Shafiu, Mohan, Viswanathan, Mola, Glen Liddell D, Monasta, Lorenzo, Hernandez, Julio Cesar Montañez, Montero, Pablo, Montico, Marcella, Montine, Thomas J, Moradi-Lakeh, Maziar, Morawska, Lidia, Morgan, Katherine, Mori, Rintaro, Mozaffarian, Dariush, Mueller, Ulrich O, Murthy, Gudlavalleti Venkata Satyanarayana, Murthy, Sriniva, Musa, Kamarul Imran, Nachega, Jean B, Nagel, Gabriele, Naidoo, Kovin S, Naik, Nitish, Naldi, Luigi, Nangia, Vinay, Nash, Deni, Nejjari, Chakib, Neupane, Suba, Newton, Charles R, Newton, John N, Ng, Marie, Ngalesoni, Frida Namnyak, de Dieu Ngirabega, Jean, Nguyen, Quyen Le, Nisar, Muhammad Imran, Pete, Patrick Martial Nkamedjie, Nomura, Marika, Norheim, Ole F, Norman, Paul E, Norrving, Bo, Nyakarahuka, Luke, Ogbo, Felix Akpojene, Ohkubo, Takayoshi, Ojelabi, Foluke Adetola, Olivares, Pedro R, Olusanya, Bolajoko Olubukunola, Olusanya, Jacob Olusegun, Opio, John Nelson, Oren, Eyal, Ortiz, Alberto, Osman, Majdi, Ota, Erika, Ozdemir, Raziye, Pa, Mahesh, Pandian, Jeyaraj D, Pant, Puspa Raj, Papachristou, Christina, Park, Eun-Kee, Park, Jae-Hyun, Parry, Charles D, Parsaeian, Mahboubeh, Caicedo, Angel J Paternina, Patten, Scott B, Patton, George C, Paul, Vinod K, Pearce, Neil, Pedro, João Mário, Stokic, Ljiljana Pejin, Pereira, David M, Perico, Norberto, Pesudovs, Konrad, Petzold, Max, Phillips, Michael Robert, Piel, Frédéric B, Pillay, Julian David, Plass, Dietrich, Platts-Mills, James A, Polinder, Suzanne, Pope, C Arden, Popova, Svetlana, Poulton, Richie G, Pourmalek, Farshad, Prabhakaran, Dorairaj, Qorbani, Mostafa, Quame-Amaglo, Justice, Quistberg, D Alex, Rafay, Anwar, Rahimi, Kazem, Rahimi-Movaghar, Vafa, Rahman, Mahfuzar, Rahman, Mohammad Hifz Ur, Rahman, Sajjad Ur, Rai, Rajesh Kumar, Rajavi, Zhale, Rajsic, Sasa, Raju, Murugesan, Rakovac, Ivo, Rana, Saleem M, Ranabhat, Chhabi L, Rangaswamy, Thara, Rao, Puja, Rao, Sowmya R, Refaat, Amany H, Rehm, Jürgen, Reitsma, Marissa B, Remuzzi, Giuseppe, Resnikoff, Serge, Ribeiro, Antonio L, Ricci, Stefano, Blancas, Maria Jesus Rio, Roberts, Bayard, Roca, Anna, Rojas-Rueda, David, Ronfani, Luca, Roshandel, Gholamreza, Rothenbacher, Dietrich, Roy, Ambuj, Roy, Nawal K, Ruhago, George Mugambage, Sagar, Rajesh, Saha, Sukanta, Sahathevan, Ramesh, Saleh, Muhammad Muhammad, Sanabria, Juan R, Sanchez-Niño, Maria Dolore, Sanchez-Riera, Lidia, Santos, Itamar S, Sarmiento-Suarez, Rodrigo, Sartorius, Benn, Satpathy, Maheswar, Savic, Miloje, Sawhney, Monika, Schaub, Michael P, Schmidt, Maria Inê, Schneider, Ione J C, Schöttker, Ben, Schutte, Aletta E, Schwebel, David C, Seedat, Soraya, Sepanlou, Sadaf G, Servan-Mori, Edson E, Shackelford, Katya A, Shaddick, Gavin, Shaheen, Amira, Shahraz, Saeid, Shaikh, Masood Ali, Shakh-Nazarova, Marina, Sharma, Rajesh, She, Jun, Sheikhbahaei, Sara, Shen, Jiabin, Shen, Ziyan, Shepard, Donald S, Sheth, Kevin N, Shetty, Balakrishna P, Shi, Peilin, Shibuya, Kenji, Shin, Min-Jeong, Shiri, Rahman, Shiue, Ivy, Shrime, Mark G, Sigfusdottir, Inga Dora, Silberberg, Donald H, Silva, Diego Augusto Santo, Silveira, Dayane Gabriele Alve, Silverberg, Jonathan I, Simard, Edgar P, Singh, Abhishek, Singh, Gitanjali M, Singh, Jasvinder A, Singh, Om Prakash, Singh, Prashant Kumar, Singh, Virendra, Soneji, Samir, Søreide, Kjetil, Soriano, Joan B, Sposato, Luciano A, Sreeramareddy, Chandrashekhar T, Stathopoulou, Vasiliki, Stein, Dan J, Stein, Murray B, Stranges, Saverio, Stroumpoulis, Konstantino, Sunguya, Bruno F, Sur, Patrick, Swaminathan, Soumya, Sykes, Bryan L, Szoeke, Cassandra E I, Tabarés-Seisdedos, Rafael, Tabb, Karen M, Takahashi, Ken, Takala, Jukka S, Talongwa, Roberto Tchio, Tandon, Nikhil, Tavakkoli, Mohammad, Taye, Bineyam, Taylor, Hugh R, Ao, Braden J Te, Tedla, Bemnet Amare, Tefera, Worku Mekonnen, Have, Margreet Ten, Terkawi, Abdullah Sulieman, Tesfay, Fisaha Haile, Tessema, Gizachew Assefa, Thomson, Alan J, Thorne-Lyman, Andrew L, Thrift, Amanda G, Thurston, George D, Tillmann, Taavi, Tirschwell, David L, Tonelli, Marcello, Topor-Madry, Roman, Topouzis, Foti, Towbin, Jeffrey Allen, Traebert, Jefferson, Tran, Bach Xuan, Truelsen, Thoma, Trujillo, Ulise, Tura, Abera Kenay, Tuzcu, Emin Murat, Uchendu, Uche S, Ukwaja, Kingsley N, Undurraga, Eduardo A, Uthman, Olalekan A, Dingenen, Rita Van, van Donkelaar, Aaron, Vasankari, Tommi, Vasconcelos, Ana Maria Nogale, Venketasubramanian, Narayanaswamy, Vidavalur, Ramesh, Vijayakumar, Lakshmi, Villalpando, Salvador, Violante, Francesco S, Vlassov, Vasiliy Victorovich, Wagner, Joseph A, Wagner, Gregory R, Wallin, Mitchell T, Wang, Linhong, Watkins, David A, Weichenthal, Scott, Weiderpass, Elisabete, Weintraub, Robert G, Werdecker, Andrea, Westerman, Ronny, White, Richard A, Wijeratne, Tissa, Wilkinson, James D, Williams, Hywel C, Wiysonge, Charles Shey, Woldeyohannes, Solomon Meseret, Wolfe, Charles D A, Won, Sungho, Wong, John Q, Woolf, Anthony D, Xavier, Deni, Xiao, Qingyang, Xu, Gelin, Yakob, Bereket, Yalew, Ayalnesh Zemene, Yan, Lijing L, Yano, Yuichiro, Yaseri, Mehdi, Ye, Pengpeng, Yebyo, Henock Gebremedhin, Yip, Paul, Yirsaw, Biruck Desalegn, Yonemoto, Naohiro, Yonga, Gerald, Younis, Mustafa Z, Yu, Shicheng, Zaidi, Zoubida, Zaki, Maysaa El Sayed, Zannad, Faiez, Zavala, Diego E, Zeeb, Hajo, Zeleke, Berihun M, Zhang, Hao, Zodpey, Sanjay, Zonies, David, Zuhlke, Liesl Joanna, Vos, Theo, Lopez, Alan D, and Murray, Christopher J L
Subjects: VITAL-STATISTICS, INTEGRATED APPROACH, ECONOMIC-DEVELOPMENT, DEVELOPMENT ASSISTANCE, UNITED-STATES, Global Health, Communicable Disease, Communicable Diseases, cause of death, Medicine, General & Internal, Life Expectancy, General & Internal Medicine, Humans, Mortality, Medicine(all), Science & Technology, Mortality, Premature, Medicine (all), EPIDEMIOLOGIC TRANSITION, GBD 2015 Mortality and Causes of Death Collaborators, CIVIL REGISTRATION, Public Health, Global Health, Social Medicine and Epidemiology, Articles, 11 Medical And Health Sciences, ROAD TRAFFIC INJURIES, ALZHEIMERS-DISEASE, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, VERBAL AUTOPSY, Life Sciences & Biomedicine, Human
Abstract: Background Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures. Methods We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography-year datapoints. For GBD 2015, eight causes, including Ebola virus disease, were added to the previous GBD cause list for mortality. We used six modelling approaches to assess cause-specific mortality, with the Cause of Death Ensemble Model (CODEm) generating estimates for most causes. We used a series of novel analyses to systematically quantify the drivers of trends in mortality across geographies. First, we assessed observed and expected levels and trends of cause-specific mortality as they relate to the Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Second, we examined factors affecting total mortality patterns through a series of counterfactual scenarios, testing the magnitude by which population growth, population age structures, and epidemiological changes contributed to shifts in mortality. Finally, we attributed changes in life expectancy to changes in cause of death. We documented each step of the GBD 2015 estimation processes, as well as data sources, in accordance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Findings Globally, life expectancy from birth increased from 61.7 years (95% uncertainty interval 61.4-61.9) in 1980 to 71.8 years (71.5-72.2) in 2015. Several countries in sub-Saharan Africa had very large gains in life expectancy from 2005 to 2015, rebounding from an era of exceedingly high loss of life due to HIV/AIDS. At the same time, many geographies saw life expectancy stagnate or decline, particularly for men and in countries with rising mortality from war or interpersonal violence. From 2005 to 2015, male life expectancy in Syria dropped by 11.3 years (3.7-17.4), to 62.6 years (56.5-70.2). Total deaths increased by 4.1% (2.6-5.6) from 2005 to 2015, rising to 55.8 million (54.9 million to 56.6 million) in 2015, but age-standardised death rates fell by 17.0% (15.8-18.1) during this time, underscoring changes in population growth and shifts in global age structures. The result was similar for non-communicable diseases (NCDs), with total deaths from these causes increasing by 14.1% (12.6-16.0) to 39.8 million (39.2 million to 40.5 million) in 2015, whereas age-standardised rates decreased by 13.1% (11.9-14.3). Globally, this mortality pattern emerged for several NCDs, including several types of cancer, ischaemic heart disease, cirrhosis, and Alzheimer's disease and other dementias. By contrast, both total deaths and age-standardised death rates due to communicable, maternal, neonatal, and nutritional conditions significantly declined from 2005 to 2015, gains largely attributable to decreases in mortality rates due to HIV/AIDS (42.1%, 39.1-44.6), malaria (43.1%, 34.7-51.8), neonatal preterm birth complications (29.8%, 24.8-34.9), and maternal disorders (29.1%, 19.3-37.1). Progress was slower for several causes, such as lower respiratory infections and nutritional deficiencies, whereas deaths increased for others, including dengue and drug use disorders. Age-standardised death rates due to injuries significantly declined from 2005 to 2015, yet interpersonal violence and war claimed increasingly more lives in some regions, particularly in the Middle East. In 2015, rotaviral enteritis (rotavirus) was the leading cause of under-5 deaths due to diarrhoea (146 000 deaths, 118 000-183 000) and pneumococcal pneumonia was the leading cause of under-5 deaths due to lower respiratory infections (393 000 deaths, 228 000-532 000), although pathogen-specific mortality varied by region. Globally, the effects of population growth, ageing, and changes in age-standardised death rates substantially differed by cause. Our analyses on the expected associations between cause-specific mortality and SDI show the regular shifts in cause of death composition and population age structure with rising SDI. Country patterns of premature mortality (measured as years of life lost [YLLs]) and how they differ from the level expected on the basis of SDI alone revealed distinct but highly heterogeneous patterns by region and country or territory. Ischaemic heart disease, stroke, and diabetes were among the leading causes of YLLs in most regions, but in many cases, intraregional results sharply diverged for ratios of observed and expected YLLs based on SDI. Communicable, maternal, neonatal, and nutritional diseases caused the most YLLs throughout sub-Saharan Africa, with observed YLLs far exceeding expected YLLs for countries in which malaria or HIV/AIDS remained the leading causes of early death. Interpretation At the global scale, age-specific mortality has steadily improved over the past 35 years; this pattern of general progress continued in the past decade. Progress has been faster in most countries than expected on the basis of development measured by the SDI. Against this background of progress, some countries have seen falls in life expectancy, and age-standardised death rates for some causes are increasing. Despite progress in reducing age-standardised death rates, population growth and ageing mean that the number of deaths from most non-communicable causes are increasing in most countries, putting increased demands on health systems. Copyright (C) The Author(s). Published by Elsevier Ltd.
Published: 2016

38. Prevalence and related risk factors of chronic kidney disease among adults in Luxembourg: evidence from the observation of cardiovascular risk factors (ORISCAV-LUX) study

Author: Jean Beissel, Illiasse El Bahi, Charles Delagardelle, Paul Roderick, Stephanie Noppe, Nicolas Sauvageot, Ala'a Alkerwi, Saverio Stranges, and Jennifer S. Mindell
Subjects: Adult, Male, Nephrology, medicine.medical_specialty, Epidemiology, Luxembourg, Population, 030232 urology & nephrology, Renal function, Chronic kidney disease (CKD), Comorbidity, lcsh:RC870-923, Logistic regression, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Diabetes mellitus, Prevalence, medicine, Albuminuria, Humans, 030212 general & internal medicine, Renal Insufficiency, Chronic, education, Exercise, Population-based study, Demography, education.field_of_study, business.industry, Middle Aged, lcsh:Diseases of the genitourinary system. Urology, medicine.disease, Early Diagnosis, Socioeconomic Factors, Cardiovascular Diseases, Creatinine, Female, Glomerular filtration rate, medicine.symptom, business, Research Article, Kidney disease
Abstract: Background Evidence on stages of renal impairment and related risk factors in Luxembourg is lacking. This study aimed to assess the prevalence of chronic kidney disease (CKD) and identify potential correlates among the general population, using the recent definition suggested by the Kidney Disease Improving Global Outcomes guidelines. Methods Data analysed from 1361 participants aged 18–69 years, enrolled in the Observation of Cardiovascular Risk Factors in Luxembourg (ORISCAV-LUX) study, 2007–08. Descriptive and multivariable logistic regression analyses were performed to identify demographic, socio-economic, behavioural, and clinical factors associated with CKD, defined as a single estimated glomerular filtration rate (eGFR) measure 30 mg/g. Results Overall, 6.3% had CKD, including 4.4% and 0.7% with moderate and severe macroalbuminuria respectively. 0.1% had kidney failure (eGFR
Published: 2017
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39. Smoking status is inversely associated with overall diet quality: Findings from the ORISCAV-LUX study

Author: Nicolas Sauvageot, Nitin Shivappa, Paul Lemmens, Burcu Baydarlioglu, James R. Hébert, Saverio Stranges, Ala'a Alkerwi, Health promotion, and RS: CAPHRI - R6 - Promoting Health & Personalised Care
Subjects: 0301 basic medicine, Male, Cross-sectional study, Luxembourg, CARDIOVASCULAR-DISEASE PREVENTION, medicine.medical_treatment, Critical Care and Intensive Care Medicine, Recommended Dietary Allowances, Body Mass Index, 0302 clinical medicine, Risk Factors, Surveys and Questionnaires, Medicine, Insulin, Smoking status, 030212 general & internal medicine, education.field_of_study, Nutrition and Dietetics, Smoking, Middle Aged, C-REACTIVE PROTEIN, Cholesterol, Diet quality, Cardiovascular Diseases, Female, CIGARETTE SMOKERS, Adult, LOW-ENERGY-DENSITY, NUTRIENT INTAKE, Adolescent, Dietary Approaches To Stop Hypertension, Population, UNITED-STATES, 03 medical and health sciences, Young Adult, Environmental health, Humans, CORONARY-HEART-DISEASE, education, Life Style, Glycemic, Glycated Hemoglobin, 030109 nutrition & dietetics, business.industry, Public Health, Environmental and Occupational Health, medicine.disease, Former Smoker, Obesity, Diet, Cross-Sectional Studies, Socioeconomic Factors, INFLAMMATORY INDEX, CLINICAL-PRACTICE, Smoking cessation, business, Body mass index, Dyslipidemia, TASK-FORCE
Abstract: Background & aims: Relationships between food consumption/nutrient intake and tobacco smoking have been described in the literature. However, little is known about the association between smoking and overall diet quality. This study examined the associations between eight diet quality indices, namely, the Diet Quality Index-International (DQI-I), Recommendation Compliance Index (RCI), Dietary Approach to Stop Hypertension (DASH) score, Energy Density Score (EDS), Dietary Diversity Score (DDS), Recommended Food Score (RFS), non-Recommended Food Score (non-RFS), and Dietary Inflammatory Index (DII), and smoking status with a focus on smoking intensity.Methods: Analyses were based on a sample of 1352 participants in the Observation of Cardiovascular Risk Factors in Luxembourg (ORISCAV-LUX) survey, a nationwide population-based cross-sectional study of adults aged 18-69 years. Nutritional data from food frequency questionnaire (FFQ) were used to compute selected diet quality indices. Participants were classified as never smoker, former smoker (>= 12 months cessation period), occasional or light smokers (20 cig/d). Descriptive and linear regression analyses were performed, after adjustment for several potential covariates.Results: Compared to the other groups, heavy smokers had significantly higher prevalence of dyslipidemia (83%), obesity (34%), and elevated glycemic biomarkers. About 50% of former smokers had hypertension. Diet quality of heavy smokers was significantly poorer than those who never smoked independent of several socioeconomic, lifestyle, and biologic confounding factors (all p Conclusion: This study provides new evidence concerning an inverse relationship between the intensity of tobacco consumption and overall diet quality. The implication is that efforts aimed at tobacco control should target heavy smokers and intervention on smoking cessation should take into account diet quality of smokers and their nutritional habits, to increase effectiveness and relevance of public health messages. (C) 2016 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
Published: 2017

40. Geographic Variations in Cardiometabolic Risk Factors in Luxembourg

Author: Illiasse El Bahi, Jean Beissel, Stephanie Noppe, Charles Delagardelle, Saverio Stranges, Ngianga-Bakwin Kandala, and Ala'a Alkerwi
Subjects: Adult, Male, medicine.medical_specialty, hypertension, Luxembourg, Health, Toxicology and Mutagenesis, Cardio metabolic, Disease, 030204 cardiovascular system & hematology, Overweight, geographic variation, Article, Metabolic equivalent, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Environmental health, Diabetes mellitus, Geographic variation, Prevalence, medicine, Humans, Obesity, 030212 general & internal medicine, Exercise, Abdominal obesity, Aged, cardio metabolic, Geography, business.industry, Public health, G300, Smoking, Public Health, Environmental and Occupational Health, Middle Aged, medicine.disease, B900, Cardiovascular Diseases, Obesity, Abdominal, Hypertension, Female, medicine.symptom, business, Blood sampling
Abstract: Cardiovascular disease (CVD) and associated behavioural and metabolic risk factors constitute a major public health concern at a global level. Many reports worldwide have documented different risk profiles for populations with demographic variations. The objective of this study was to examine geographic variations in the top leading cardio metabolic and behavioural risk factors in Luxembourg, in order to provide an overall picture of CVD burden across the country. The analysis conducted was based on data from the nationwide ORISCAV-LUX survey, including 1432 subjects, aged 18-69 years. A self-reported questionnaire, physical examination and blood sampling were performed. Age and sex-adjusted risk profile maps were generated using multivariate Bayesian geo-additive regression models, based on Markov Chain Monte Carlo techniques and were used to evaluate the significance of the spatial effects on the distribution of a range of cardio metabolic risk factors, namely smoking, high body mass index (BMI), high blood pressure, high fasting plasma glucose, alcohol use, high total cholesterol, low glomerular filtration rate, and physical inactivity. Higher prevalence of smoking was observed in the northern regions, higher overweight/obesity and abdominal obesity clustered in the central belt, whereas hypertension was spotted particularly in the southern part of the country. Maps revealed that subjects residing in Luxembourg canton were significantly less likely to be hypertensive or overweight/obese, whereas they were less likely to practice physical activity of ≥8000 Metabolic Equivalent of Task (MET)-min/week. These patterns were also observed at the municipality level in Luxembourg. Statistically, there were non-significant spatial patterns regarding smoking, diabetes, total serum cholesterol and low glomerular filtration rate risk distribution. This comprehensive risk profile mapping showed remarkable geographic variations in cardio metabolic and behavioural risk factors. Considering the prominent burden of CVD this research provides opportunities for tailored interventions and may help to better fight against this escalating public health problem. nivå1
Published: 2017
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41. Abstract P353: New Evidence on the Association of Physical Activity and Chronic Kidney Disease: ORISCAV-LUX Study

Author: Ala’a Alkerwi, Nicolas Sauvageot, Saverio Stranges, Charles Delagardelle, and Jean Beissel
Subjects: Physiology (medical), Cardiology and Cardiovascular Medicine
Abstract: Background: Evidence on stages of renal impairment and related risk factors in Luxembourg adults is lacking. This study aimed to assess the prevalence of chronic kidney disease (CKD) and identify potential correlates among general population in Luxembourg, using the recent definition suggested by the Kidney Disease Improving Global Outcomes (KDIGO) guidelines. Methods: Analyses were based on data from 1361 adult participants aged 18-69 years, enrolled in the Observation of Cardiovascular Risk Factors in Luxembourg (ORISCAV-LUX) study, 2007-2008. Descriptive and multivariable logistic regression analyses were performed to identify demographic, socio-economic, clinical and behavioral factors associated with CKD, defined as single estimated glomerular filtration rate (eGFR) measure 2 and/or urinary albumin creatinine ratio (ACR)>30mg/g. Results: Overall, 6.3% had CKD, including 4.4% and 0.7% presented with moderate and severe macroalbuminuria respectively, and 0.1% had kidney failure (eGFR < 15 mL/min/1.73 m 2 ). CKD risk increased significantly with age; the odds ratio increased more than two folds among subjects aged 50-69 years, with no sex-specific difference. CKD was higher among subjects with primary education. Hypertension and diabetes were associated with more than 3-fold and 4-fold higher risk of CKD [adjusted odd ratio (95%CI): 3.11 (1.76, 5.52); P Conclusion: The prevalence estimate of CKD in Luxembourg may represent a neglected public health issue, stressing the benefit of early detection of CKD, particularly in subjects with hypertension, diabetes, lipid disorders and obesity. Promoting physical activity among these high-risk subjects should be considered to prevent CKD. These measures altogether could defray costs related to eventual complications and decrease risk of associated cardiovascular events.
Published: 2017
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42. Stability-based validation of dietary patterns obtained by cluster analysis

Author: Saverio Stranges, Sylvie Streel, Faiez Zannad, Adelin Albert, Ala'a Alkerwi, Michèle Guillaume, Anne-Françoise Donneau, Sonia Leite, Axelle Hoge, Nicolas Sauvageot, and Anna Schritz
Subjects: Adult, Male, 0301 basic medicine, medicine.medical_specialty, Adolescent, Cross-sectional study, Rand index, Population, Stability (learning theory), Medicine (miscellaneous), Clinical nutrition, Young Adult, 03 medical and health sciences, Cluster analysis, Risk Factors, Surveys and Questionnaires, Environmental health, medicine, Humans, Dietary patterns, education, Exercise, Life Style, Aged, Principal Component Analysis, education.field_of_study, 030109 nutrition & dietetics, Nutrition and Dietetics, business.industry, Research, Public health, Reproducibility of Results, Middle Aged, Diet, Cross-Sectional Studies, Health promotion, Socioeconomic Factors, Cardiovascular Diseases, Female, business, Stability
Abstract: Background Cluster analysis is a data-driven method used to create clusters of individuals sharing similar dietary habits. However, this method requires specific choices from the user which have an influence on the results. Therefore, there is a need of an objective methodology helping researchers in their decisions during cluster analysis. The objective of this study was to use such a methodology based on stability of clustering solutions to select the most appropriate clustering method and number of clusters for describing dietary patterns in the NESCAV study (Nutrition, Environment and Cardiovascular Health), a large population-based cross-sectional study in the Greater Region (N = 2298). Methods Clustering solutions were obtained with K-means, K-medians and Ward’s method and a number of clusters varying from 2 to 6. Their stability was assessed with three indices: adjusted Rand index, Cramer’s V and misclassification rate. Results The most stable solution was obtained with K-means method and a number of clusters equal to 3. The “Convenient” cluster characterized by the consumption of convenient foods was the most prevalent with 46% of the population having this dietary behaviour. In addition, a “Prudent” and a “Non-Prudent” patterns associated respectively with healthy and non-healthy dietary habits were adopted by 25% and 29% of the population. The “Convenient” and “Non-Prudent” clusters were associated with higher cardiovascular risk whereas the “Prudent” pattern was associated with a decreased cardiovascular risk. Associations with others factors showed that the choice of a specific dietary pattern is part of a wider lifestyle profile. Conclusion This study is of interest for both researchers and public health professionals. From a methodological standpoint, we showed that using stability of clustering solutions could help researchers in their choices. From a public health perspective, this study showed the need of targeted health promotion campaigns describing the benefits of healthy dietary patterns. Electronic supplementary material The online version of this article (doi:10.1186/s12937-017-0226-9) contains supplementary material, which is available to authorized users.
Published: 2017
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43. Health effects of overweight and obesity in 195 countries over 25 years

Author: Yun Jin Kim, Kalkidan Hassen Abate, Hirbos Shore Roba, Rafael Lozano, Lalit Dandona, Xiaofeng Liang, Azeem Majeed, Stephen M. Amrock, Yousef Khader, Derrick A Bennett, Theo Vos, Stephen T. McGarvey, Carla Makhlouf Obermeyer, Johan Ärnlöv, Liliana G Ciobanu, Diego Augusto Santos Silva, Rajaa Al-Raddadi, Tommi Vasankari, Tsegaye Tewelde Gebrehiwot, Samath D Dharmaratne, Sibhatu Biadgilign, Azmeraw T. Amare, Erkin M. Mirrakhimov, Rakhi Dandona, Philimon Gona, Jonathan I. Silverberg, Andre Pascal Kengne, Amir Kasaeian, Sadaf G. Sepanlou, Colm McAlinden, Stefanos Tyrovolas, Ivy Shiue, Saverio Stranges, Moretza Shamsizadeh, Kelly Cercy, Nima Hafezi-Nejad, Alireza Esteghamati, Patrick Liu, Maziar Moradi-Lakeh, Zerihun Menlkalew Zenebe, Saeid Safiri, Marissa B Reitsma, Abdullah Sulieman Terkawi, Jean Jacques Noubiap, Mall Leinsalu, Mohammad H. Forouzanfar, Jarnail Singh Thakur, Kingsley N. Ukwaja, Ismael R. Campos-Nonato, Barthelemy Kuate Defo, Rajesh Kumar Rai, Ala'a Alkerwi, Nikolas Reinig, Joshua Wesana, Christopher J L Murray, Benn Sartorius, Adeladza Kofi Amegah, Alan D. Lopez, João C. Fernandes, Elisabete Weiderpass, Kokeb T. Hadush, Aleksandra Barac, Amitava Banerjee, Juan Sanabria, Leslie Cornaby, Ritul Kamal, Felix Akpojene Ogbo, Joseph Salama, Yuichiro Yano, Gerald Yonga, Maria Inês Schmidt, Simon I. Hay, Solomon Abrha Damtew, Deborah Carvalho Malta, Haftay Berhane Mezgebe, Addisu Shunu Beyene, Gert B. M. Mensink, Audra L Gold, Dube Jara Boneya, George C Patton, Mayowa O. Owolabi, Mohsen Naghavi, Estifanos Baye, Chhabi Lal Ranabhat, Laurie B. Marczak, Patrick J Sur, Zoubida Zaidi, Stein Emil Vollset, Andrea Werdecker, Olalekan A. Uthman, Reza Malekzadeh, Kara Estep, Alexander Lee, Jasvinder A. Singh, Masako Horino, Chandrasekharan Nair Kesavachandran, Cristiana Abbafati, Vasiliy Victorovich Vlassov, Balewgizie Sileshi Tegegne, Ulrich O Mueller, Min Jeong Shin, Farhad Islami, Ben Zipkin, Srinivasa Vittal Katikireddi, Ali H. Mokdad, Soumya Swaminathan, Monika Sawhney, Mostafa Qorbani, Marcello Tonelli, Juan Jesus Carrero, Jagdish Khubchandani, Pedro Cecilio, Valery L. Feigin, Thomas Fürst, Bruce Bartholow Duncan, Joshua A. Salomon, Mohsen Mazidi, Tiffany Ku, Ziad Al-Aly, Alemayehu Amberbir, Itamar S. Santos, Soewarta Kosen, Atsushi Goto, Ronny Westerman, Anwar Rafay, Desalegn Tadese Mengistu, Stephen S Lim, Espen Bjertness, Tesfa Dejenie Habtewold, Muktar Beshir Ahmed, Naohiro Yonemoto, Hamid Asayesh, Young-Ho Khang, Rafael Tabarés-Seisdedos, Ashkan Afshin, Heidi J. Larson, Farshad Pourmalek, Sara Sheikhbahaei, Josef Schmidhuber, Yohannes Kinfu, Roman Topor-Madry, Babak Eshrati, Aletta E. Schutte, Rahman Shiri, Masoud Vaezghasemi, Ranjit Mohan Anjana, Erfan Amini, Stan Biryukov, Fentaw Tadese, George A. Mensah, Anil Kumar, Daniel Kim, Bemnet Amare Tedla, Afshin, Ashkan, Forouzanfar, Mohammad H, Reitsma, Marissa B, Sur, Patrick, Ciobanu, Liliana G, Murray, Christopher JL, and Veritati - Repositório Institucional da Universidade Católica Portuguesa
Subjects: Male, Gerontology, Pediatric Obesity, obesity, VDP::Medisinske Fag: 700::Helsefag: 800::Epidemiologi medisinsk og odontologisk statistikk: 803, global health, Disease, Overweight, Global Health, VDP::Social science: 200::Demography: 300, DISEASE, VDP::Medical disciplines: 700::Health sciences: 800::Nutrition: 811, Body Mass Index, 0302 clinical medicine, RA0421, Pandemic, Prevalence, adults, Global health, 030212 general & internal medicine, Child, humans, ALL-CAUSE MORTALITY, child, adult, 1. No poverty, pediatric obesity/epidemiology, 11 Medical And Health Sciences, General Medicine, CANCER, 3. Good health, female, VDP::Medical disciplines: 700::Health sciences: 800::Epidemiology medical and dental statistics: 803, Cardiovascular Diseases, Cohort, Female, medicine.symptom, Life Sciences & Biomedicine, obesitat, Research Article, Adult, prevalence, overweight/complications/epidemiology, WEIGHT-LOSS, 030209 endocrinology & metabolism, KNEE OSTEOARTHRITIS, VDP::Samfunnsvitenskap: 200::Demografi: 300, VDP::Medisinske Fag: 700::Helsefag: 800::Ernæring: 811, 03 medical and health sciences, cardiovascular diseases/complications/mortality, Medicine, General & Internal, children, male, General & Internal Medicine, Environmental health, medicine, Humans, overweight, COHORT, Obesity, Disease burden, METAANALYSIS, Science & Technology, GBD 2015 Obesity Collaborators, business.industry, ADULTS, medicine.disease, PREVENTION, BODY-MASS INDEX, Cross-Sectional Studies, business, Body mass index, obesity/complications/*epidemiology
Abstract: Source at: http://doi.org/10.1056/NEJMoa1614362 Background: Although the rising pandemic of obesity has received major attention in many countries, the effects of this attention on trends and the disease burden of obesity remain uncertain. Methods: We analyzed data from 68.5 million persons to assess the trends in the prevalence of overweight and obesity among children and adults between 1980 and 2015. Using the Global Burden of Disease study data and methods, we also quantified the burden of disease related to high body-mass index (BMI), according to age, sex, cause, and BMI in 195 countries between 1990 and 2015. Restults: In 2015, a total of 107.7 million children and 603.7 million adults were obese. Since 1980, the prevalence of obesity has doubled in more than 70 countries and has continuously increased in most other countries. Although the prevalence of obesity among children has been lower than that among adults, the rate of increase in childhood obesity in many countries has been greater than the rate of increase in adult obesity. High BMI accounted for 4.0 million deaths globally, nearly 40% of which occurred in persons who were not obese. More than two thirds of deaths related to high BMI were due to cardiovascular disease. The disease burden related to high BMI has increased since 1990; however, the rate of this increase has been attenuated owing to decreases in underlying rates of death from cardiovascular disease. Conclusions: The rapid increase in the prevalence and disease burden of elevated BMI highlights the need for continued focus on surveillance of BMI and identification, implementation, and evaluation of evidence-based interventions to address this problem.
Published: 2017

44. Consumption of ready-made meals and increased risk of obesity: findings from the Observation of Cardiovascular Risk Factors in Luxembourg (ORISCAV-LUX) study

Author: Georgina E. Crichton, James R. Hébert, Ala'a Alkerwi, Alkerwi, Ala'a, Crichton, Georgina, and Hebert, JR
Subjects: Male, Gerontology, Luxembourg, 030309 nutrition & dietetics, Cross-sectional study, Medicine (miscellaneous), Body Mass Index, Nutrition Policy, 0302 clinical medicine, Ready-made meals, Risk Factors, 030212 general & internal medicine, Meals, Abdominal obesity, 2. Zero hunger, 0303 health sciences, Meal, education.field_of_study, Nutrition and Dietetics, digestive, oral, and skin physiology, Dietary Surveys and Nutritional Epidemiology, Middle Aged, Full Papers, Nutrition Surveys, Micronutrient, Cardiovascular Diseases, Obesity, Abdominal, Female, medicine.symptom, Adult, Adolescent, Population, Young Adult, 03 medical and health sciences, Environmental health, medicine, Humans, Obesity, education, Aged, Consumption (economics), business.industry, Portion Size, Cardiovascular risk, medicine.disease, Diet, Cross-Sectional Studies, Fast Foods, Patient Compliance, Energy Intake, business, Body mass index
Abstract: The consumption of ready-made meals, such as pre-packaged dishes, available at grocery stores and fast-food restaurants, is a habit related to our modern fast-paced lives. No study has examined the association of daily ready-made meal consumption with diet quality or health-related outcomes. The present study aimed to investigate the association between self-reported ready-made meal consumption and diet quality, as measured by compliance with dietary recommendations and with a set of adiposity measures, in a nationally representative sample of 1352 subjects, aged 18–69 years, participating in the nationwide population-based ORISCAV-LUX (Observation of Cardiovascular Risk Factors in Luxembourg) survey. The daily consumption of ready-made meals was calculated as follows: frequency of consumption × portion size × number of portions consumed. The sum of the daily consumption values of the eleven pre-packaged dishes included in the FFQ represented the total daily consumption of ready-made meals (g/d) for each participant. About 97 % of the participants reported daily consumption of ready-made meals. The intake was highly prevalent in men living alone and varied according to education level. Ready-made meal consumption provided >7 % of total daily energy. The fractions (%) of macro- and micronutrients derived from daily consumption of ready-made meals varied from 10 % for total cholesterol to 0·65 % for total fibre. Increased consumption of ready-made meals was found to be independently associated with abdominal obesity. On controlling for age, sex, socio-economic status and lifestyle factors, daily consumption of ready-made meals was found to be associated with higher energy intake and with poor compliance with national nutritional recommendations, and hence it could plausibly increase the risk of central obesity and fat deposition.
Published: 2014
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45. Dairy food intake is positively associated with cardiovascular health: findings from Observation of Cardiovascular Risk Factors in Luxembourg study

Author: Georgina E. Crichton, Ala'a Alkerwi, Crichton, Georgina E, and Alkerwi, A
Subjects: Adult, Male, Luxembourg, Endocrinology, Diabetes and Metabolism, Cardiovascular health, Health Behavior, Cardiovascular risk factors, Food consumption, Disease, Endocrinology, Cheese, Risk Factors, Surveys and Questionnaires, Environmental health, Animals, Humans, Medicine, Food science, yoghurt, milk, Nutrition and Dietetics, business.industry, cardiovascular health, Feeding Behavior, Middle Aged, Yogurt, Dietary Fats, Dairy food intake, Diet, Milk, Lifestyle factors, Blood pressure, Cardiovascular Diseases, Health, Female, Dairy Products, dairy food, diet, business, Body mass index
Abstract: Conflicting findings have been reported about dairy food consumption and risk for cardiovascular disease. Furthermore, few studies have examined dairy food intake in relation to cardiovascular health and the incorporation of lifestyle factors such as diet and physical activity. This study examined whether dairy food consumption was associated with cardiovascular health, recently defined by the American Heart Association. Data were analyzed from 1352 participants from the Observation of Cardiovascular Risk Factors in Luxembourg survey. A validated food frequency questionnaire was used to measure intakes of milk, yogurt, cheese, dairy desserts, ice cream, and butter. Seven cardiovascular health metrics were assessed: smoking, body mass index, physical activity, diet, total cholesterol, blood pressure, and fasting plasma glucose. A total cardiovascular health score (CHS) was determined by summing the total number of health metrics at ideal levels. It was hypothesized that greater dairy food consumption (both low fat and whole fat) would be associated with better global cardiovascular health, as indicated by a higher CHS. Total dairy food intake was positively associated with the CHS. Higher intakes of whole fat milk, yogurt, and cheese were associated with better cardiovascular health. Even when controlling for demographic and dietary variables, those who consumed at least 5 servings per week of these dairy products had a significantly higher CHS than those who consumed these products less frequently. Higher total whole fat dairy food intake was also associated with other positive health behaviors, including being a nonsmoker, consuming the suggested dietary intakes of recommended foods, and having a normal body mass index. Increased dairy food consumption was associated with better cardiovascular health. Refereed/Peer-reviewed
Published: 2014
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46. No significant independent relationships with cardiometabolic biomarkers were detected in the Observation of Cardiovascular Risk Factors in Luxembourg study population

Author: Ala'a Alkerwi, Nitin Shivappa, James R. Hébert, Georgina E. Crichton, Alkerwi, Ala'a, Shivappa, Nitin, Crichton, Georgina Elinor, and Hébert, James R
Subjects: Male, Luxembourg, Cross-sectional study, Endocrinology, Diabetes and Metabolism, Blood Pressure, Body Mass Index, Endocrinology, Risk Factors, Surveys and Questionnaires, Odds Ratio, Medicine, Mass index, Metabolic Syndrome, Nutrition and Dietetics, Middle Aged, C-Reactive Protein, nutritional assessment, Cardiovascular Diseases, Population study, Female, Waist Circumference, Adult, medicine.medical_specialty, Adolescent, metabolic syndrome, Article, Young Adult, nutritional index, Internal medicine, cross-sectional study, Humans, human, Aged, Glycemic, Inflammation, business.industry, Cholesterol, HDL, Odds ratio, medicine.disease, Confidence interval, population-based, Diet, Cross-Sectional Studies, Logistic Models, inflammation, Metabolic syndrome, business, Body mass index, Biomarkers
Abstract: Recently, there has been an influx of research interest regarding the anti-inflammatory role that diet has in chronic and metabolic diseases. A literature-based dietary inflammatory index (DII) that can be used to characterize the inflammation-modulating capacity of individuals' diets has even been developed and validated in an American population. We hypothesized that the DII could predict levels of high-sensitivity C-reactive protein (CRP), which is an important inflammatory marker, as well as metabolic measures that include the metabolic syndrome and its components in European adults. This hypothesis was tested according to data from 1352 participants from the Observation of Cardiovascular Risk Factors in Luxembourg study, a nationwide, cross-sectional survey based in Luxembourg. Statistical methods consisted of descriptive and multivariable logistic regression analyses. The DII ranged from a minimum of -4.02 (most anti-inflammatory) to a maximum of 4.00 points, with a mean value of -0.41. Participants with higher DII score were significantly younger and had lower body mass index, waist circumferences, and systolic blood pressure levels. Other cardiovascular biomarkers including diastolic blood pressure, CRP, lipids, and glycemic biomarkers did not vary significantly across DII tertiles. Participants with proinflammatory (>1) DII scores had increased adjusted odds (odds ratio, 1.46; 95% confidence interval, 1.00-2.13) of having a low high-density lipoprotein cholesterol, compared with those with anti-inflammatory scores (DII ≤1). There were no significant relationships between high-sensitivity CRP and the DII. This study, which tested the inflammatory capacity of the DII outside the United States, did not detect a significant independent relationship with cardiometabolic biomarkers, by using Food Frequency Questionnaire-collected data. These results are informative and representative of a relevant step in directing future research for nutrition and Refereed/Peer-reviewed
Published: 2014
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47. Acute cardiometabolic responses facilitating a state of chronic hyperglycemia and renal impairment

Author: Ala'a Alkerwi, Leoné Malan, Aletta S. Uys, Nico T. Malan, and Liezl Joosten
Subjects: Creatinine, medicine.medical_specialty, Endocrine and Autonomic Systems, business.industry, Endocrinology, Diabetes and Metabolism, Albumin, chemistry.chemical_compound, Blood pressure, Chronic hyperglycemia, chemistry, Internal Medicine, medicine, Cardiology and Cardiovascular Medicine, Intensive care medicine, business
Published: 2014
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48. Diet quality concept

Author: Ala'a Alkerwi
Subjects: Nutrition and Dietetics, Databases, Factual, Endocrinology, Diabetes and Metabolism, media_common.quotation_subject, Health Behavior, Dietary compliance, Feeding Behavior, Viewpoints, Diet, Research objectives, Term (time), Diet quality, Risk analysis (engineering), Functional Food, Terminology as Topic, Food Quality, Selection (linguistics), Humans, Quality (business), Construct (philosophy), Psychology, Nutritive Value, media_common
Abstract: The term diet quality has recently gained considerable attention in nutritional research. Despite widespread use, it is often poorly defined and remains difficult to measure. Confusion surrounds the term, as there is no consensus on how to define quality of the diet or to pin down a framework for producing a standard indicator. The composite and cut-off selection of most diet quality indices depend on investigator choices in line with research objectives. In addition to the frequently used dietary compliance-based approach, innovative approaches have emerged to construct diet quality indices based on antioxidant and anti-inflammatory profiles of diet. Different viewpoints and overlapping interests may yield different interpretations. Most of the unresolved issues are related directly or indirectly to the multidimensional and open-textured nature of the concept. This review aims to elucidate several debated key points to understand the reasons behind this confusion and address the complexity of how to define and quantify this concept. A standardized and well-defined framework of diet quality is of great importance for both consumers and scientists from different disciplines.
Published: 2014
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49. A2953 An overview on the epidemiology of hypertension in Luxembourg

Author: Jean Beissel, Jessica Pastore, Stephanie Noppe, Charles Delagardelle, Nicolas Sauvageot, and Ala'a Alkerwi
Subjects: medicine.medical_specialty, Physiology, business.industry, Family medicine, Epidemiology, Internal Medicine, medicine, Cardiology and Cardiovascular Medicine, business
Published: 2018
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50. Geographic variations of cardio metabolic risk factors in Luxembourg

Author: I El Bahi, Saverio Stranges, Ala'a Alkerwi, and N-B Kandala
Subjects: medicine.medical_specialty, business.industry, Internal medicine, Public Health, Environmental and Occupational Health, medicine, Cardiology, Cardio metabolic risk, business
Published: 2016
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