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Background: Gallbladder and biliary tract cancer (GBTC) is a significant health burden in China, exacerbated by the rising prevalence of high body mass index (BMI). Understanding the trends and factors contributing to mortality and disability associated with GBTC is crucial for targeted public health interventions. Methods: We utilized data from the Global Burden of Disease (GBD) Study to assess the burden of GBTC attributable to high BMI in China from 1990 to 2021. Age-standardized rates of deaths, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) were analyzed. Joinpoint regression and decomposition analyses were conducted to evaluate trends and identify contributing factors, including aging, population growth, and epidemiological changes. Gender-specific differences were also assessed. Results: In 2021, GBTC deaths attributable to high BMI in China reached 4,053, with males experiencing a higher overall burden than females, particularly in older age groups. While females showed a higher mortality and overall burden in the 60 to 79 age range, this trend reversed in older age brackets, with males experiencing steeper increases in mortality and disability-related indicators beyond age 80. The age-standardized DALYs rate mirrored this pattern, with higher rates in males in advanced age groups. From 1990 to 2021, China saw a steady increase in GBTC burden attributable to high BMI, contrasting with a global decline. Joinpoint analysis indicated marked rises in mortality and DALYs rates after 2005, especially in males. Decomposition analysis identified population growth and aging as major drivers of increased deaths, while epidemiological changes primarily contributed to rising DALYs, with a stronger impact observed in males. Conclusions: The burden of GBTC attributable to high BMI in China has increased substantially over the last three decades, driven by population growth, aging, and epidemiological shifts. The trends highlight a growing gender disparity, with males experiencing a greater rise in mortality and disability. Public health strategies targeting obesity and metabolic risk factors are critical to mitigating the increasing GBTC burden. [ABSTRACT FROM AUTHOR]

Aim: Elevated body mass index (BMI) presents a significant public health challenge in the United States, contributing to considerable morbidity, mortality and economic burden. This study investigates the health burden of overweight and obesity in the United States from 1990 to 2021, leveraging the Global Burden of Disease data set to analyse trends, disparities and potential determinants of high BMI‐related health outcomes. Materials and Methods: Our study focused on the United States, analysing trends in disability‐adjusted life years (DALY) and deaths attributable to high BMI, defined as a BMI of 25 kg/m2 or higher for adults. Statistical analyses included estimated annual percentage change (EAPC) in age‐standardized DALY rates and age‐standardized death rates. Pearson correlation was performed between EAPCs and the socio‐demographic index (SDI), with significance set at p < 0.05. Results: From 1990 to 2021, age‐standardized DALY rates attributable to high BMI increased by 24.9%, whereas the age‐standardized death rates increased by 5.2%. Age disparities showed DALYs peaking at 60–64 years for males and 65–69 years for females, with deaths peaking at 65–69 years for males and 90–94 years for females. A strong negative correlation was found between the EAPC in age‐standardized DALY and death rates and the SDI. Conclusions: Overweight and obesity significantly impact public health in the United States, especially among older adults and lower socio‐demographic regions. Comprehensive public health strategies integrating behavioural, technological and environmental interventions are crucial. Future research should focus on longitudinal studies, personalized interventions and policy‐driven approaches to address the multifaceted influences on high BMI. [ABSTRACT FROM AUTHOR]

Aims: The global historical and projected health impacts of the escalating burden of obesity on young adults, who are particularly susceptible to weight gain during transitional life stages, remain insufficiently understood. Materials and Methods: Using data from the Global Burden of Disease Study 2019, we analysed the disability‐adjusted life‐years (DALYs) and deaths attributable to high body mass index (BMI) among young adults aged 20–44 years globally and by age, sex, year, location and disease between 1990 and 2019. Future projections until 2050 were further assessed. Results: The global burden for young adults attributable to high BMI more than doubled from 1990 to 2019, reaching 24,509.8 (95% uncertainty interval [UI] 20,191.8–28,966.0) thousand for DALYs and 321.9 (258.3–384.2) thousand for deaths. Males had a higher burden and faster increase than females. The burden escalated with advancing age. From 1990 to 2019, regions with middle Socio‐demographic Index (SDI) replaced regions with high‐middle SDI to have the highest age‐standardized rates of DALYs and deaths, while regions with low‐middle SDI witnessed the largest rise. Stroke, ischaemic heart disease and diabetes mellitus were consistently the top three causes of high BMI‐related burden, together accounting for 74.7% (70.8–78.4) for DALYs and 81.2% (77.6–84.2) for deaths in 2019. By 2050, the age‐standardized rates of DALYs due to high BMI tripled that in 1990, with the corresponding rates for deaths expected to double. Among the 10 most populous countries, India was projected to have the highest rates and the fastest increase in both DALYs and deaths by 2050. Conclusions: The escalating disease burden attributable to high BMI in young adults, marked by notable demographic and geographic variations, highlights the urgent need for tailored public health interventions on weight management during young adulthood. [ABSTRACT FROM AUTHOR]

Objectives: To assess the global burden of atrial fibrillation (AF) attributable to high body mass index (BMI) from 1990 to 2021 and analyze its spatiotemporal distribution characteristics. Study design: An observational study based on GBD 2021 data. Methods: Data on AF burden due to high BMI were obtained from the Global Burden of Disease Study (GBD) 2021. Estimated annual percentage change (EAPC) was calculated to evaluate temporal trends in age-standardized rates of deaths and disability-adjusted life years (DALYs) over 30 years. Results: In 2021, high BMI-related AF caused 27,000 deaths and 725,000 DALYs globally, a 376% increase since 1990. Females and the elderly (aged 70+) bore a higher burden. Upper-middle-income regions surpassed high-income regions in AF burden. Australasia had the highest age-standardized rates, while High-income Asia Pacific and South Asia had the lowest. South Asia showed rapid growth in age-standardized death rates. Conclusion: The global burden of high BMI-related AF varies across regions and time, threatening global health, especially for females and the elderly. Targeted strategies are needed to reduce AF and obesity. [ABSTRACT FROM AUTHOR]

Abstract Background Gallbladder and biliary tract cancer (GBTC) is a significant health burden in China, exacerbated by the rising prevalence of high body mass index (BMI). Understanding the trends and factors contributing to mortality and disability associated with GBTC is crucial for targeted public health interventions. Methods We utilized data from the Global Burden of Disease (GBD) Study to assess the burden of GBTC attributable to high BMI in China from 1990 to 2021. Age-standardized rates of deaths, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) were analyzed. Joinpoint regression and decomposition analyses were conducted to evaluate trends and identify contributing factors, including aging, population growth, and epidemiological changes. Gender-specific differences were also assessed. Results In 2021, GBTC deaths attributable to high BMI in China reached 4,053, with males experiencing a higher overall burden than females, particularly in older age groups. While females showed a higher mortality and overall burden in the 60 to 79 age range, this trend reversed in older age brackets, with males experiencing steeper increases in mortality and disability-related indicators beyond age 80. The age-standardized DALYs rate mirrored this pattern, with higher rates in males in advanced age groups. From 1990 to 2021, China saw a steady increase in GBTC burden attributable to high BMI, contrasting with a global decline. Joinpoint analysis indicated marked rises in mortality and DALYs rates after 2005, especially in males. Decomposition analysis identified population growth and aging as major drivers of increased deaths, while epidemiological changes primarily contributed to rising DALYs, with a stronger impact observed in males. Conclusions The burden of GBTC attributable to high BMI in China has increased substantially over the last three decades, driven by population growth, aging, and epidemiological shifts. The trends highlight a growing gender disparity, with males experiencing a greater rise in mortality and disability. Public health strategies targeting obesity and metabolic risk factors are critical to mitigating the increasing GBTC burden.

Abstract Background Qualitative studies document episodes of weight-related disrespectful care, particularly for people with high body mass index (BMI ≥ 30) and reveal implicit and explicit biases in health care providers. No large quantitative studies document the pervasiveness of weight stigma or if experiences change with increasing BMI. Methods The multi-stakeholder RESPCCT study team designed and distributed a cross-sectional survey on the experiences of perinatal services in all provinces and territories in Canada. From July 2020 to August 2021, participants who had a pregnancy within ten years responded to closed and open-ended questions. Chi square analysis assessed differences in mean scores derived from three patient-reported experience measures of autonomy (MADM), respect (MOR), and mistreatment (MIST). Controlling for socio-demographic factors, multivariate logistic regression analysis explored relationships between different BMI categories and respectful care. Results Of 4,815 Canadians who participated, 3,280 with a BMI of ≥ 18.5 completed all the questions. Pre-pregnancy BMI was significantly associated with race/ethnicity, income sufficiency, and education but not with age. Individuals with higher BMIs were more likely to experience income insufficiency, have lower levels of education, and more frequently self-identified as Indigenous or White. Those with BMI ≥ 35 exhibited notably higher odds of reduced autonomy (MADM) scores, with an unadjusted odds ratio of 1.62 and an adjusted odds ratio of 1.45 compared to individuals with a normal weight. Individuals with BMIs of 25–25.9, 30–34.9, and ≥ 35 exhibited odds of falling into the lower tercile of respect (MOR) scores of 1.34, 1.51, and 2.04, respectively (p

Abstract Objectives To assess the global burden of atrial fibrillation (AF) attributable to high body mass index (BMI) from 1990 to 2021 and analyze its spatiotemporal distribution characteristics. Study design An observational study based on GBD 2021 data. Methods Data on AF burden due to high BMI were obtained from the Global Burden of Disease Study (GBD) 2021. Estimated annual percentage change (EAPC) was calculated to evaluate temporal trends in age-standardized rates of deaths and disability-adjusted life years (DALYs) over 30 years. Results In 2021, high BMI-related AF caused 27,000 deaths and 725,000 DALYs globally, a 376% increase since 1990. Females and the elderly (aged 70+) bore a higher burden. Upper-middle-income regions surpassed high-income regions in AF burden. Australasia had the highest age-standardized rates, while High-income Asia Pacific and South Asia had the lowest. South Asia showed rapid growth in age-standardized death rates. Conclusion The global burden of high BMI-related AF varies across regions and time, threatening global health, especially for females and the elderly. Targeted strategies are needed to reduce AF and obesity.

Abstract Background The objective of this study is to evaluate the global burden of ischemic heart disease (IHD) attributable to High body mass index (HBMI) by utilizing data from Global Burden of Disease (GBD) 2019. Methods This study utilized data from the GBD 2019 to examine the impact of HBMI on deaths and disability-adjusted life years (DALYs). The analysis focused on age-standardized rates and considered a 30-year time frame. Trends were assessed using estimated annual percentage changes (EAPCs). Results Since 1990, a significant global increase in IHD attributable to HBMI has been observed. This increase is particularly notable among elderly males and in regions with low-middle Socio-Demographic Index (SDI), such as Central Asia and Eastern Europe. In 2019, IHD globally resulted in 1,662,339 deaths and 41,369,773 DALYs. Despite the high age-standardized death rate (20.73 per 100,000) and DALY rate (499.41 per 100,000), a declining trend was noted. This trend is reflected by the EAPCs of -0.35 for DALYs and − 0.67 for deaths. Notably, males and middle SDI countries exhibited higher rates of IHD, whereas high SDI regions such as High-income Asia Pacific and Western Europe showed decreasing trends in IHD. Conclusion Over the past three decades, there has been a significant increase in IHD caused by HBMI, especially in low-middle and low SDI regions. This highlights the importance of targeted interventions in addressing this issue. Notably, regions including Central Asia, Eastern Europe, North Africa, and the Middle East have been heavily affected.

Background: The objective of this study is to evaluate the global burden of ischemic heart disease (IHD) attributable to High body mass index (HBMI) by utilizing data from Global Burden of Disease (GBD) 2019. Methods: This study utilized data from the GBD 2019 to examine the impact of HBMI on deaths and disability-adjusted life years (DALYs). The analysis focused on age-standardized rates and considered a 30-year time frame. Trends were assessed using estimated annual percentage changes (EAPCs). Results: Since 1990, a significant global increase in IHD attributable to HBMI has been observed. This increase is particularly notable among elderly males and in regions with low-middle Socio-Demographic Index (SDI), such as Central Asia and Eastern Europe. In 2019, IHD globally resulted in 1,662,339 deaths and 41,369,773 DALYs. Despite the high age-standardized death rate (20.73 per 100,000) and DALY rate (499.41 per 100,000), a declining trend was noted. This trend is reflected by the EAPCs of -0.35 for DALYs and − 0.67 for deaths. Notably, males and middle SDI countries exhibited higher rates of IHD, whereas high SDI regions such as High-income Asia Pacific and Western Europe showed decreasing trends in IHD. Conclusion: Over the past three decades, there has been a significant increase in IHD caused by HBMI, especially in low-middle and low SDI regions. This highlights the importance of targeted interventions in addressing this issue. Notably, regions including Central Asia, Eastern Europe, North Africa, and the Middle East have been heavily affected. [ABSTRACT FROM AUTHOR]

Objective To understand the burden of dementia disease attributable to high body mass index (BMI) in China and provide reference for formulating dementia prevention and control strategies. Methods Data on the burden of dementia disease attributable to high BMI from the Global Burden of Disease (GBD) 2019 database were collected. The distribution of disability-adj usted life years (DALY) and standardized death rates by year, gender, and age were described. The estimated annual percentage change (EAPC) was used to analyze the trends. Results From 1990 to 2019, the standardized DALY rate for dementia disease attributable to high BMI in China increased from 13.17/100 000 to 28.22/100 000, with a growth rate of 114.29%. The standardized death rate increased from 0.86/100 000 to 1.67/100 000, with a growth rate of 95.09%. The upward trends were significant (EAPC for standardized DALY rate = 2.81%, EAPC for standardized death rate = 2.56%). The standardized DALY and death rates for dementia disease attributable to high BMI showed continuous increases for both genders, with higher rates observed in females. The DALY and death rates increased significantly with age, reaching a peak in the population aged 95 years and above. Conclusion The burden of dementia disease attributable to high BMI in China is expanding, with a significantly higher increase in standardized DALY and death rates compared to the global average. The burden of dementia disease attributable to high BMI is more severe in females and the elderly. Early identification of high-risk individuals with cognitive impairment and interventions targeting modifiable risk factors are crucial for comprehensive and scientifically managed prevention and controL [ABSTRACT FROM AUTHOR]

Background: With the increase in the aging population worldwide, Alzheimer's disease has become a rapidly increasing public health concern. In the Global Burden of Disease Study 2019, there are three risk factors judged to have evidence for a causal link to Alzheimer's disease and other dementias: smoking, high body-mass index (HBMI), and high fasting plasma glucose (HFPG). Objective: This study aimed to analyze trends in AD mortality and the relevant burden across China from 1990 to 2019, as well as their correlation with age, period, and birth cohort. Methods: The data were extracted from the GBD 2019. Trends in AD mortality attributable to metabolic risks (HFPG and HBMI) and smoking were analyzed using Joinpoint regression. The age-period-cohort (APC) model was used to evaluate cohort and period effects. Results: From 1990 to 2019, the overall age-standardized mortality rate of AD increased, especially in women. There was an increase in AD mortality due to smoking in the net drift, and it was more significant in women (0.46, 95%CI = [0.09, 0.82]) than men (-0.03, 95%CI = [-0.11, 0.05]). For the cause of HFPG, the net drift values for men and women were 0.82% and 0.43%. For HBMI, the values were 3.14% and 2.76%, respectively, reflecting substantial increases in AD mortality. Conclusion: Time trends in AD mortality caused by metabolic risks and smoking in China from 1990 to 2019 have consistently increased. Therefore, it is necessary to prevent excessive weight gain and obesity during the later stages of life, especially for females. [ABSTRACT FROM AUTHOR]

Abstract Background This study aims to analyze breast cancer burden attributable to high body mass index (BMI) and high fasting plasma glucose (FPG) in China from 1990 to 2019. Methods Data were obtained from the Global Burden of Disease (GBD) study 2019. Deaths and disability‐adjusted life years (DALYs) were used for attributable burden, and age‐period‐cohort (APC) model was used to evaluate the independent effects of age, period and birth cohort. Results In 2019, the age‐standardized mortality and DALY rates of breast cancer attributable to high BMI were 1.107 (95% UI: 0.311, 2.327) and 29.990 (8.384, 60.713) per 100 000, and mortality and DALY rates attributable to high FPG were 0.519 (0.095, 1.226) and 13.662 (2.482, 32.425) per 100 000. From 1990 to 2019, the age‐standardized mortality and DALY rates of breast cancer attributable to high BMI increased by 1.192% and 1.180%, and the trends of high FPG were not statistically significant. The APC results showed that the age effects of high BMI and high FPG‐mortality and DALY rates increased, with the highest rates in the age group over 80 years. The birth cohort effects of high BMI showed “inverted V” shapes, while high FPG showed downward trends. Conclusions Age was the main reason for the increase of attributable burden, and postmenopausal women were the high‐risk groups. Therefore, targeted prevention measures should be developed to improve postmenopausal women's awareness and effectively reduce the prevalence of obesity and diabetes, thereby reducing the breast cancer burden caused by metabolic factors in China.

Objective To analyze trends in the disease burden of esophageal cancer attributable to high body mass index (BMI) in the Chinese and United States populations from 1990 to 2019 and predict deaths over the next 10 years. Methods This study used Global Burden of Disease 2019 data to obtain mortality and disability-adjusted life-year (DALY) data by year, gender, and age for the disease burden of esophageal cancer attributable to high BMI in China and the United States from 1990 to 2019. Joinpoint regression analysis was conducted to analyze long-term trends. Bayesian age–period–cohort analysis was used to predict age-standardized mortality attributable to esophageal cancer in 2020–2030. Results From 1990 to 2019, the age-standardized mortality rate for esophageal cancer attributable to high BMI in China increased from 1.44/105 to 1.80/105 and the age-standardized DALY rate increased from 34.17/105 to 40.79/105. From the perspective of gender, the number of deaths, DALYs, and the corresponding age-standardized rate of males in China and the United States increased from 1990 to 2019. The age-standardized mortality and DALY rates of Chinese women showed a downward trend, decreasing by 21.36/105 and 29.71/105, respectively. Joinpoint analysis results revealed that the average annual percentage changes (AAPCs) in mortality attributable to esophageal cancer in the total population and men in China from 1990 to 2019 increased by 0.78% (95%CI: 0.71-0.84) and 1.52% (95%CI: 1.44-1.60), respectively, and that in females decreased by 0.88% (95%CI: −0.96-−0.80). AAPC in women in the United States rose at a slow rate of 0.07% (95%CI: 0.02-0.09). The burden of esophageal cancer deaths attributable to high BMI is predicted to continue to rise in China and the United States in 2020–2030. Conclusion The disease burden of esophageal cancer attributable to high BMI significantly increased in China from 1990 to 2019. The disease burden of esophageal cancer caused by high BMI in China is expected to increase from 2020 to 2030.

Background: This study aims to analyze breast cancer burden attributable to high body mass index (BMI) and high fasting plasma glucose (FPG) in China from 1990 to 2019. Methods: Data were obtained from the Global Burden of Disease (GBD) study 2019. Deaths and disability‐adjusted life years (DALYs) were used for attributable burden, and age‐period‐cohort (APC) model was used to evaluate the independent effects of age, period and birth cohort. Results: In 2019, the age‐standardized mortality and DALY rates of breast cancer attributable to high BMI were 1.107 (95% UI: 0.311, 2.327) and 29.990 (8.384, 60.713) per 100 000, and mortality and DALY rates attributable to high FPG were 0.519 (0.095, 1.226) and 13.662 (2.482, 32.425) per 100 000. From 1990 to 2019, the age‐standardized mortality and DALY rates of breast cancer attributable to high BMI increased by 1.192% and 1.180%, and the trends of high FPG were not statistically significant. The APC results showed that the age effects of high BMI and high FPG‐mortality and DALY rates increased, with the highest rates in the age group over 80 years. The birth cohort effects of high BMI showed "inverted V" shapes, while high FPG showed downward trends. Conclusions: Age was the main reason for the increase of attributable burden, and postmenopausal women were the high‐risk groups. Therefore, targeted prevention measures should be developed to improve postmenopausal women's awareness and effectively reduce the prevalence of obesity and diabetes, thereby reducing the breast cancer burden caused by metabolic factors in China. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to study the primary risk factors for the long-term trends of mortality rates in ischemic stroke (IS) in China. Methods: Using the Global Burden of Disease Study 2019 (GBD 2019) database, research was conducted on the 11 primary risk factors for the mortality rates of IS in China from 1990 to 2019. This study employed joinpoint regression software and the age-period-cohort method to evaluate the trends of mortality rates divided by age, period, and cohort over time. Results: From 1990 to 2019, the age-standardized mortality rate (ASMR) caused by a diet high in red meat and high body mass index in China showed an upward trend. ASMR increased first and then decreased due to smoking, diet high in sodium, particulate matter pollution, high fasting plasma glucose, and high systolic blood pressure. Low-density lipoprotein cholesterol (LDL-C), kidney dysfunction, low temperature, and lead exposure remained relatively stable during this period. In the 35–45 age group, the mortality rate of IS due to high LDL-C was up to about 60%, and smoking affected men more than women. Overall, high LDL-C, high systolic blood pressure, and particulate matter pollution were the most common risk factors in patients with IS. The risk of death rose with age. The period and cohort relative risks showed that metabolic risk factors had the greatest impact on the mortality of IS. Conclusion: Metabolic risk factors have become the primary risk factors for the ASMR of IS in China. Relevant authorities should pay attention to their long-term effects on IS. Effective public health policies and interventions should be implemented to reduce the burden of IS. [ABSTRACT FROM AUTHOR]

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

Background: The changing patterns of obesity have had a significant impact on the epidemiology of esophageal cancer (EC). Aims: This study aimed to investigate the specific burden of EC associated with high body mass index (BMI) across different geographical and Sociodemographic Index (SDI) regions, using data from the Global Burden of Disease Study 2019. Methods: Mortality, age-standardized death rates (ASDR), and disability-adjusted life-years (DALYs) from 1990 to 2019 were analyzed for 204 countries and territories. Decomposition analysis, frontier and health inequality analyses, and age-period-cohort models were employed to examine the factors driving disease burden and to predict future trends. Results: High BMI contributed to 89,903.9 [95% uncertainty interval (UI): 27,878.9–171,254.6] EC-related deaths, an ASDR of 1.1 (95% UI 0.3–2.1) per 100,000 population, and 2,202,314.1 (681,901.4–4,173,080.3) DALYs in 2019. There was an increasing trend in these figures over the 29-year period. The middle SDI region (31,023.8, 95% UI 9,180.4–62,631.5) and East Asia (36,939.9, 95% UI 9,620.5–81,495) carried the highest burden of EC-related deaths. Disease burden increased across all age groups and genders globally. Population growth was a major factor driving EC deaths across all SDI quintiles. Disparities in disease burden were observed across countries at all development levels. Predictive models indicated a continued increase in EC-related deaths in the next decade. Conclusions: The study provided a comprehensive understanding of the global burden of EC associated with high BMI over the past decades. Opportunities exist to reduce this burden at all SDI levels through targeted interventions and policies. [ABSTRACT FROM AUTHOR]

Objective To analyze trends in the disease burden of esophageal cancer attributable to high body mass index (BMI) in the Chinese and United States populations from 1990 to 2019 and predict deaths over the next 10 years. Methods This study used Global Burden of Disease 2019 data to obtain mortality and disability-adjusted life-year (DALY) data by year, gender, and age for the disease burden of esophageal cancer attributable to high BMI in China and the United States from 1990 to 2019. Joinpoint regression analysis was conducted to analyze long-term trends. Bayesian age–period–cohort analysis was used to predict age-standardized mortality attributable to esophageal cancer in 2020– 2030. Results From 1990 to 2019, the age-standardized mortality rate for esophageal cancer attributable to high BMI in China increased from 1.44/105 to 1.80/105 and the age-standardized DALY rate increased from 34.17/105 to 40.79/105. From the perspective of gender, the number of deaths, DALYs, and the corresponding age-standardized rate of males in China and the United States increased from 1990 to 2019. The age-standardized mortality and DALY rates of Chinese women showed a downward trend, decreasing by 21.36/105 and 29.71/105, respectively. Joinpoint analysis results revealed that the average annual percentage changes (AAPCs) in mortality attributable to esophageal cancer in the total population and men in China from 1990 to 2019 increased by 0.78% (95%CI: 0.71-0.84) and 1.52% (95%CI: 1.44-1.60), respectively, and that in females decreased by 0.88% (95%CI: − 0.96-−0.80). AAPC in women in the United States rose at a slow rate of 0.07% (95%CI: 0.02-0.09). The burden of esophageal cancer deaths attributable to high BMI is predicted to continue to rise in China and the United States in 2020–2030. Conclusion The disease burden of esophageal cancer attributable to high BMI significantly increased in China from 1990 to 2019. The disease burden of esophageal cancer caused by high BMI in China is expected to increase from 2020 to 2030. [ABSTRACT FROM AUTHOR]

Introduction Gout is an inflammatory and metabolic disease characterized by arthritis and elevation of the serum uric acid (SUA) level. More and more studies have shown that high body mass index (BMI) has become one of the most important risk factors for gout. Material and Methods We used the data of gout burden attributed to high body mass index (BMI) from global burden of disease (GBD) study 2019 to provide insights for reducing the global burden of gout. Results From 1990 to 2019, the prevalence and DALYs of gout caused by high BMI worldwide has been increasing. The burden of gout caused by high BMI is heavier in the elderly male group and regions with high SDI worldwide. Conclusions Our findings provide evidence for the burden of gout caused by high BMI. Developing a weight management plan and lifestyle habits for groups severely affected by gout will effectively reduce the global disease and economic burden.

PurposeWith the prevalence of high body mass index (HBMI) increasing over the past 30 years, it is essential to examine the impact of obesity on kidney cancer. This study aims to explore the attributable burden of kidney cancer associated with HBMI and its proportion at different levels.Methods and materialsThe data used in this research were obtained from the Global Burden of Diseases Study 2019. We utilized DisMod-MR 2.1, a Bayesian meta-regression tool, to estimate the burden of kidney cancer attributable to HBMI, which was measured by age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life years rate (ASDR). Correlation analysis was conducted by the Spearman rank order correlation method. The temporal trends were analyzed by estimating the estimated annual percentage change (EAPC).ResultsGlobally in 2019, there were a total of 31.7 thousand deaths and 751.89 thousand disability-adjusted life years (DALYs) attributable to kidney cancer caused by HBMI, increased by 183.1 and 164%, respectively. Over the period from 1990 to 2019, the burden of kidney cancer attributable to HBMI increased in all regions, with the most significant increases occurring in Low-middle socio-demographic index (SDI) and Low SDI regions. At the national level, countries with lower SDI had lower ASMR and ASDR compared to developed nations. However, the EAPC values, which indicate the rate of increase, were significantly higher in these countries than in developed nations. Furthermore, across all years from 1990 to 2019, males experienced a greater and more rapidly increasing burden of kidney cancer attributable to HBMI than females.ConclusionAs the population grows and dietary patterns shift, the burden of kidney cancer attributable to HBMI is expected to become even more severe. Males and developed regions have borne a heavier burden from 1990 to 2019. However, the EAPC values for both ASMR and ASDR were higher in males but not in regions with higher SDI values.

Background: A high body mass index (BMI) can indicate overweight or obesity and is a crucial risk factor for breast cancer survivors. However, the association between high BMI and prognosis in early-stage breast cancer (EBC) remains unclear. We aimed to assess the effects of high BMI on the prognosis of patients with EBC. Methods: The PubMed, Embase, and Cochrane Library databases and proceedings of major oncological conferences related to the effects of BMI on the prognosis of breast cancer were searched up to November 2021. Fixed- and random-effects models were used for meta-analyses. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) for disease-free survival (DFS) and overall survival (OS) were extracted from the included literature. Results: Twenty retrospective cohort studies with 33,836 patients with EBC were included. Overweight patients had worse DFS (HR: 1.16, 95% CI: 1.05–1.27, P = 0.002) and OS (HR: 1.20; 95% CI: 1.09–1.33, P

Abstract Background Previous studies have quantified the current burden of diseases attributable to overweight in Chile. However, no study has estimated the attributable burden of overweight in the future. Herein, we estimated the potential impact of different trajectories in the prevalence of overweight on the incidence and mortality from non-communicable diseases (NCDs) in Chilean adults from 2019 to 2030. Methods A multistate life table modelling was used to estimate the business-as-usual (BAU: if the current rate of increase in BMI persist through the next 11 years; i.e., 0.4% per year from 2003 to 2017) and three counterfactual scenarios (1: the increase rate of overweight is reduced by half; 2: maintanance of the current prevalence of overweight; 3: the prevalence of overweight is reduced by 6.7%) over a 11-year simulation period for burden of NCDs attributable to overweight in Chilean adults aged 20 to 80 years. The model inputs included nationally representative data of body mass index, national official demographic records, NCDs from the Global Burden of Disease study in 2019, and relative risks from a published meta-analysis. Results If the current trends of increase in overweight are maintained in Chile, approximately, 669 thousand cases and 117 thousand deaths from NCDs will occur from 2020 to 2030. In case the increase rate of overweight is reduced by half during this period, around 7 thousand cases and 1.4 thousand deaths from NCDs would be prevented, while achieving no increase in the prevalence of overweight would avert 10 thousand cases and 2 thousand deaths. In the optimistic scenario of reducing the prevalence of overweight by 6.7% until 2030, approximately 25 thousand cases and 5 thousand deaths from NCDs would be prevented. Conclusion We estimated that the number of NCDs cases and deaths that could be avoided by decreasing the prevalence of overweight in Chilean adults. Preventive programs aimed to reduce overweight may have a high impact on the future burden of NCDs in Chile.

ObjectiveAnalyzing the association between sociodemographic status and the type 2 diabetes mellitus (T2DM)-related risks in China to reduce the disease burden of T2DM.MethodsWe downloaded data from the Global Burden of Disease Study 2019 to estimate the disease burden of T2DM in China. Secondary analyses were performed by year, age, gender, summary exposure value (SEV), and sociodemographic index (SDI).ResultsIn China, it is estimated that 3.74 (3.44–4.10) million incidence, 90.0 (82.3–98.5) million prevalence, 168.4 (143.2–194.0) thousand deaths, and 9.6 (7.6–11.9) million DALYs occurred in 2019, showing an increase of 96.8, 156.7, 162.8, and 145.4% compared to 1990. An inverse U-shaped curve was observed for the correlations between T2DM-related burden and SDI. A heavier burden was found in males. The top four risk factors were high body mass index (HBMI), dietary risks, air pollution and tobacco. HBMI, as the key risk, accounted for half of the disease burden of T2DM in China. Lower degree of SEV and higher level of attributable T2DM-related burden could be found in main risks, meaning their critical role of them in the development and progression of T2DM. An inverse U-shaped curve could be found in the association between age-standardized incidence, mortality, DALYs rate, and SDI.ConclusionThe disease burden of T2DM has rapidly increased in China. Gender disparities, different age distributions and inconsistent socioeconomic levels all played an important role in it. The key risk was HBMI. With the improvement of socioeconomic level, the main risk factors for T2DM have changed from environmental factors to lifestyle factors. Targeted control and preventative strategies to address adjustable risk factors could put an end to this soaring burden.

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

Background: Previous studies have quantified the current burden of diseases attributable to overweight in Chile. However, no study has estimated the attributable burden of overweight in the future. Herein, we estimated the potential impact of different trajectories in the prevalence of overweight on the incidence and mortality from non-communicable diseases (NCDs) in Chilean adults from 2019 to 2030. Methods: A multistate life table modelling was used to estimate the business-as-usual (BAU: if the current rate of increase in BMI persist through the next 11 years; i.e., 0.4% per year from 2003 to 2017) and three counterfactual scenarios (1: the increase rate of overweight is reduced by half; 2: maintanance of the current prevalence of overweight; 3: the prevalence of overweight is reduced by 6.7%) over a 11-year simulation period for burden of NCDs attributable to overweight in Chilean adults aged 20 to 80 years. The model inputs included nationally representative data of body mass index, national official demographic records, NCDs from the Global Burden of Disease study in 2019, and relative risks from a published meta-analysis. Results: If the current trends of increase in overweight are maintained in Chile, approximately, 669 thousand cases and 117 thousand deaths from NCDs will occur from 2020 to 2030. In case the increase rate of overweight is reduced by half during this period, around 7 thousand cases and 1.4 thousand deaths from NCDs would be prevented, while achieving no increase in the prevalence of overweight would avert 10 thousand cases and 2 thousand deaths. In the optimistic scenario of reducing the prevalence of overweight by 6.7% until 2030, approximately 25 thousand cases and 5 thousand deaths from NCDs would be prevented. Conclusion: We estimated that the number of NCDs cases and deaths that could be avoided by decreasing the prevalence of overweight in Chilean adults. Preventive programs aimed to reduce overweight may have a high impact on the future burden of NCDs in Chile. [ABSTRACT FROM AUTHOR]

Background: Overweight and obesity are well-known risk factors for developing type 2 diabetes (T2DM). However, details on the evolution of the T2DM burden attributed to China's high body mass index (BMI) in China have not been thoroughly studied. This study aimed to investigate the temporal trends of the T2DM burden attributable to a high BMI in China from 1990 to 2019 and to evaluate the independent effects of age, period, and cohort on the burden of T2DM attributed to a high BMI. Methods: Data on T2DM burden attributable to a high BMI from 1990 to 2019 were obtained from the Global Burden of Disease Study 2019. Deaths, disability-adjusted life years (DALYs), age-standardized mortality rate (ASMR), and age-standardized DALY rate (ASDR) of T2DM attributable to a high BMI were estimated by age and sex. The joinpoint regression model was performed to calculate the annual percentage change (APC) and the average annual percentage change (AAPC) in the burden of T2DM attributed to a high BMI. The age-period-cohort analysis was applied to estimate the independent effects of age, period, and cohort on the temporal trends of mortality and the DALY rate. Results: In 2019, deaths and DALYs from T2DM attributable to a high BMI in China were 47.53 thousand and 3.74 million, respectively, five times higher than in 1990. Among those under 60 years of age, men had higher deaths and DALYs than women, while the gender differences reversed in those over 60 years of age. Furthermore, the ASMR and ASDR in 2019 were 2.39 per 100,000 (95%UI 1.12-3.90) and 181.54 per 100,000 (95%UI 93.71-286.33), respectively, representing a 91% and 126% increase since 1990. In China, women previously had a higher ASMR and ASDR than men, while the differences in the ASMR and ASDR between the sexes were reversed in recent years. From 1990 to 2019, the ASMR in women increased before 2004 and then decreased from 2004 to 2015, and increased again after, with an overall AAPC value of 1.6%. In contrast, the ASMR in men continued to increase, with an overall AAPC value of 3.2%. The ASDR continued to increase in men and women, with AAPCs of 2.2% and 3.5%, respectively. The age effect showed that the relative risk of mortality increased with age in both men and women, except for the 75-84 age group. The impact of the age on the DALY rate revealed a trend of first rising and then decreasing, peaking at 65-69 years. The effect of the period on the burden of T2DM attributable to a high BMI increased from 1990 to 2019. The cohort effect generally showed a downward trend. Conclusion: The burden of T2DM attributed to a high BMI in China increased substantially from 1990 to 2019, particularly in men. Therefore, there is an urgent need for gender- and age-based public health guidelines on prevention strategies, early diagnosis, and effective management of T2DM, overweight, and obesity in China. [ABSTRACT FROM AUTHOR]

BackgroundExcess body mass index (BMI) plays a key role in the onset and progression of knee osteoarthritis (knee OA). However, the burden of knee OA attributable to high BMI at the global, Chinese, and regional levels have received far too little attention. The aim of this study is to provide evidence to support the design of policy by investigating long-term trends of years lived with disability (YLDs) for knee OA.MethodsTo illustrate the trends of YLDs for knee OA attributable to high BMI and the temporal trends of the YLDs rate by age, period, and cohort, Joinpoint regression software and age-period-cohort (APC) were used to analyze the YLDs data of knee OA from the Global Burden of Disease (GBD) 2019.ResultsIn China, there were 549,963.5 YLDs for knee OA attributable to high BMI in 2019, which had increased by 460.7% since 1990. From 1990 to 2019, age-standardized disability-adjusted life year rate (ASDR) of knee OA attributable to high BMI trended upwards. The average annual percent change (AAPC) of knee OA attributable to high BMI in China and globe were 3.019, 1.419%, respectively. The longitudinal age curve of the APC model showed that the YLDs rates of knee OA due to high BMI increased with age, and YLDs rates were higher among females than males. The period rate ratios (RRs) of knee OA due to high BMI increased significantly. The cohort RRs of knee OA due to high BMI increased among those born between 1900 and 1970. The net drifts of knee OA attributable to high BMI in China and globe were above 1. Compared with global condition, the net drift values of knee OA attributable to high BMI in China was higher. Compared with females, males had higher net drift value. Countries with high socio-demographic index (SDI) have a much higher burden of knee OA caused by high BMI than countries with low SDI.ConclusionIn China, high BMI is a substantial cause of knee OA, the incidence of which has been increasing since 1990. In addition, women and the elderly are more vulnerable to knee OA caused by high BMI. The Chinese government must take the long-term impact of high BMI on knee OA into account and implement effective public health policies and resort to interventions to reduce the burden as soon as possible.

BackgroundModifiable risk factors are major drivers of cardiovascular disease (CVD). We aimed to determine the epidemiological trend and age-period-cohort effects on CVD burden attributable to dietary risks and high body mass index (BMI) across China and Pakistan from 1990 to 2019.MethodsData on the all-ages and age-specific CVD burden, age-standardized CVD mortality and disability-adjusted life years (DALYs) rates were obtained from the Global Burden of Disease Study 2019. Joinpoint regression analysis was conducted to find temporal trends and age-period-cohort (APC) modeling was used to estimate age, period, and cohort effects on CVD burden.ResultsBetween 1990 and 2019, the all-ages CVD burden attributable to dietary risks and high BMI increased by ~2-3-fold in China and by 3-5-fold in Pakistan. The diet-related CVD age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life years (DALYs) rate significantly decreased in China but increased in Pakistan. Both countries showed a marked increasing trend of CVD ASMR and the age-standardized DALYs rate attributable to high BMI. Taiwan in China showed a remarkable reduction in CVD burden. However, in Pakistan, all regions observed a significantly increasing trend of CVD burden attributable to modifiable risk factors. A higher risk ratio of premature CVD mortality (

Background: Women who have polycystic ovary syndrome (PCOS) with high body mass index (BMI) typically have an attenuated ovarian response and decreased follicular size, which are linked to unfavourable clinical outcomes following in vitro fertilization (IVF) therapy. The follicular output rate (FORT), a qualitative indicator of follicular response, seems to be positively linked to the clinical outcomes of IVF. Progestin-primed ovarian stimulation (PPOS) has become an alternative to gonadotropin-releasing hormone (GnRH) analogues to inhibit the premature luteinizing hormone (LH) surge. As letrozole (LE) shows promise in enhancing ovarian response, we compared PPOS with and without LE for PCOS in high BMI women with a focus on the FORT and associated clinical and pregnancy outcomes. Methods: For the recruited 1508 women, ten variables including AFC; age; basal sex hormone level; BMI; infertility type; period of infertility and number of previous IVF attempts were chosen in the propensity score matching (PSM) model to match 1374 women who taken the MPA+ hMG protocol with 134 women who received the MPA+ hMG+ LE treatment at a 1:1 ratio. FORT was selected as the primary outcome measure. The number of oocytes retrieved, viable embryos, hMG dosage, duration, oocyte maturity rate, fertilization rate, and implantation rate were established as secondary outcomes. Results: FORT was substantially elevated in the MPA+hMG+LE group compared with the MPA+hMG group (61% [35%, 86%] vs. 40% [25%, 60%], P <.001). Interestingly, the LE cotreatment group had a considerably lower mature oocyte rate despite having a similar number of mature oocytes and embryos recovered. The average hMG dosages and durations in the study group were similar to those in the control group. The implantation rate in the study group was numerically higher but without statistic significant than that in the control groups (43.15% (107/248) vs. 38.59% (115/298), OR 1.008, 95% CI 0.901-1.127; P >.05). Conclusion: The effect of LE combined with PPOS on FORT is better than the effect of the standard PPOS treatment in women with PCOS and a high BMI, but there is no substantially beneficial impact on pregnancy outcomes or the cycle features of COS, including consumption of hMG. [ABSTRACT FROM AUTHOR]

Objective: To quantify the burden of osteoarthritis (OA) associated with high body mass index (BMI) across 204 countries and territories from 1990 to 2019. Methods: This study extracted global, regional, and national data on years lived with disability (YLD) of OA associated with high BMI from GBD 2019. The YLD burden of OA associated with high BMI was systematically analyzed by age, SDI, sex, and EAPC. Results: At the global level, ~2.67 million (95% UI: 1.04, 5.75) YLD were attributable to OA associated with high BMI, with an age-standardized rate of 31.9 (95% UI: 12.4, 68.75) YLD per 100,000 population in 2019. There was a 0.5 increase (95% UI: 0.35, 0.79) over the 30 years with an EAPC of 1.45. In 2019, Australasia {57.49 (95% UI: 23.62, 125.38)}, high-income North America {56.2 (95% UI: 23.32, 121.97)}, and Andean Latin America {49.77 (95% UI: 19.73, 111.73)} had the highest age-standardized YLD rates. The population aged at 60-74 group had a higher YLD rate for both males and females. Females tended to be more sensitive to the OA associated with high BMI than male in any region. Conclusions: In summary, the YLD rate of OA associated with high BMI presented a continuous upward trend in most countries. Women and older people are more sensitive to OA due to physiological and psychological factors. Controlling modifiable risk factors such as maintaining an appropriate BMI is needed for disease prevention. [ABSTRACT FROM AUTHOR]

Abstract Background Uterine cancer is one of the most common female cancers worldwide, with huge heterogeneity in morbidity and mortality. Although a high body‐mass index (BMI) has been linked to uterine cancer, systematic reports about the influence of high BMI and its temporal trends are scarce. Methods The annual morbidity, mortality, and disability‐adjusted life years (DALYs) of uterine cancer in 204 countries or territories were retrieved from the GBD 2019 study. To reflect trends in disease burden, we also calculated the estimated annual percentage change (EAPC) based on the age‐standardized rates of uterine cancer from 1990 to 2019. Results The global incident cases of uterine cancer increased 2.3 times from 187,190 in 1990 to 435,040 in 2019. Although the age‐standardized incidence rate (ASIR) of uterine cancer increased worldwide from 8.67/100,000 in 1990 to 9.99/100,000 in 2019, the age‐standardized death rate (ASDR) and DALY rate decreased during the same period. High socio‐demographic index (SDI) countries tended to have a higher ASIR than developing regions, and their increasing trend in ASIR was also more pronounced. The disease was rare before 40 years old, but its risk rose sharply among women aged 50–70. A high BMI was linked to more than one‐third of deaths from uterine cancer in 2019. Conclusions The incidence in developed areas was significantly higher than in developing areas and also increased much more rapidly. Elderly females, especially those with a high BMI, have a higher risk of uterine cancer. Therefore, more health resources may be needed to curb the rising burden in specific populations.

Background. Osmolarity is used to detect symptoms of dry eye disease (DED) and can be measured using TearLab™ and I-Pen® systems. Objectives. To investigate the correlation between osmolarity measurements using the TearLab™ and I-Pen® systems in subjects with a high body mass index (BMI). Materials and methods. Thirty male subjects with a high BMI (27-48 kg/m2; 23.3 ±2.1 years old) participated in this study. The control group consisting of 30 healthy males (24.9 kg/m2; 22.9 ±2.1 years old) was also enrolled. Osmolarity measurements were recorded from the right eye using the TearLab™ and I-Pen® systems, and interviews were conducted to determine ocular surface disease index (OSDI) scores. Results. The OSDI (p = 0.042), TearLab™ (p < 0.001) and I-Pen® (p < 0.001) scores were significantly higher in the study group than in the control group. In the study group, OSDI scores ranged from 2 to 16 (median 8.0, interquartile range (IQR) 6.8), while it was from 0 to 10 (median 6.3, IQR 4.1) in the control group. The TearLab™ osmolarity scores were in the range of 278-309 mOsm/L in the study group, whereas the I-Pen® osmolarity measurements were in the range of 294-336 mOsm/L in the study group, compared with 263-304 mOsm/L and 278-317 mOsm/L in the control group, respectively. In the study group, there was a strong correlation between the TearLab™ and I-Pen® osmolarity scores (r = 0.934; p = 0.001). In addition, strong correlations were found between the BMI and both TearLab™ (r = 0.736; p = 0.001) and I-Pen® (r = 0.707; p = 0.001) scores, as well as between the OSDI scores and both TearLab™ (r = 0.731; p = 0.001) and I-Pen® measurements (r = 0.666; p = 0.001). Conclusions. Osmolarity measurements using the I-Pen® system were significantly higher than those recorded using the TearLab™ system in subjects with a high BMI. The I-Pen® measurements showed large variations in osmolarity scores and were highly unreliable in correctly identifying normal eyes compared to the TearLab™ system. Also, a strong correlation was found between the osmolarity scores obtained from the TearLab™ and I-Pen® systems. [ABSTRACT FROM AUTHOR]

Abstract Background High body mass index (BMI) is associated with stroke, ischemic heart disease (IHD), and type 2 diabetes mellitus (T2DM). An epidemiological analysis of the prevalence of high BMI, stroke, IHD, and T2DM was conducted for 16 Southern Africa Development Community (SADC) using Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study data. Methods GBD obtained data from vital registration, verbal autopsy, and ICD codes. Prevalence of high BMI (≥25 kg/m2), stroke, IHD, and T2DM attributed to high BMI were calculated. Cause of Death Ensemble Model and Spatiotemporal Gaussian regression was used to estimate mortality due to stroke, IHD, and T2DM attributable to high BMI. Results Obesity in adult females increased 1.54‐fold from 12.0% (uncertainty interval [UI]: 11.5–12.4) to 18.5% (17.9–19.0), whereas in adult males, obesity nearly doubled from 4.5 (4.3–4.8) to 8.8 (8.5–9.2). In children, obesity more than doubled in both sexes, and overweight increased by 27.4% in girls and by 37.4% in boys. Mean BMI increased by 0.7 from 22.4 (21.6–23.1) to 23.1 (22.3–24.0) in adult males, and by 1.0 from 23.8 (22.9–24.7) to 24.8 (23.8–25.8) in adult females. South Africa 44.7 (42.5–46.8), Swaziland 33.9 (31.7–36.0) and Lesotho 31.6 (29.8–33.5) had the highest prevalence of obesity in 2019. The corresponding prevalence in males for the three countries were 19.1 (17.5–20.7), 19.3 (17.7–20.8), and 9.2 (8.4–10.1), respectively. The DRC and Madagascar had the least prevalence of adult obesity, from 5.6 (4.8–6.4) and 7.0 (6.1–7.9), respectively in females in 2019, and in males from 4.9 (4.3–5.4) in the DRC to 3.9 (3.4–4.4) in Madagascar. Conclusions The prevalence of high BMI is high in SADC. Obesity more than doubled in adults and nearly doubled in children. The 2019 mean BMI for adult females in seven countries exceeded 25 kg/m2. SADC countries are unlikely to meet UN2030 SDG targets. Prevalence of high BMI should be studied locally to help reduce morbidity.

BackgroundGallbladder and biliary diseases are common gastrointestinal conditions associated with huge socioeconomic costs and are considered risk factors for cardiovascular diseases and digestive system cancers. The prevalence and incidence of gallbladder and biliary diseases have not received enough attention from 1990 to 2019. Several non-communicable diseases were associated with the incidence of gallbladder and biliary diseases. It is necessary to clarify the change in the incidence and disability burden of gallbladder and biliary diseases worldwide.MethodsData on high body mass index (BMI)-related disease burden and incidence, years of life lost prematurely, and years lived with disability (YLDs) due to gallbladder and biliary diseases were obtained from the Global Burden of Disease 2019. The estimated annual percentage change was calculated to qualify the gallbladder and biliary disease burden change.ResultsThe global age-standardized incidence rate has increased from 585.35 per 100,000 (95% UI: 506.05–679.86) in 1990 to 634.32 per 100,000 (95% UI: 540.21–742.93) in 2019. And the increase in incidence was positively correlated with rising high BMI-related summary exposure value. The high BMI-related YLDs of gallbladder and biliary diseases have increased worldwide over time. Globally, the 25–49 age group suffered a rapid rise in incidence and high BMI attributable to the YLDs rate of gallbladder and biliary diseases.ConclusionThe global incidence and high BMI-related YLDs of gallbladder and biliary diseases remain prominent to increase over the past 30 years. Notably, the incidence and high BMI-related YLDs among people aged 25–49 years have rapidly increased over time. Therefore, high BMI should be emphasized in strategic priorities for controlling gallbladder and biliary diseases.

BackgroundHigh body mass index (BMI) is an important risk factor for stroke. The aim of this study was to assess the long-term trend of high BMI-attributed stroke mortality and make projections through 2030.MethodsData were extracted from the Global Burden of Disease Study 2019 and World Population Prospects 2019. An age-period-cohort framework was used in the analysis.ResultsFrom 1990 to 2019, the age-standardized mortality rate (ASMR) of high BMI-attributed stroke among females decreased by 15.2%, while among males, it increased by 31.1%. All of the age groups studied showed an increasing pattern over the last 30 years in males, and in female, the age groups encompassing participants who were 25–69 years old showed a decreasing pattern. In the same birth cohort, high BMI-attributable stroke mortality rates increased exponentially with age in both sexes. For females, the period rate ratios (RR) showed a downward trend after 2000–2004, and the cohort RR also showed a downward trend after the birth cohort 1930–1934. For males, the period RR showed an upward trend, but this increase was halted in the most recent period, and the cohort RRs showed a monotonic increasing pattern. It was projected that the ASMR of high BMI-attributed stroke would decrease among females and increase among males in the near future and that the proportion of elderly individuals with death due to high BMI-attributed stroke was projected to increase.ConclusionsOver the last three decades, the high BMI-attributed stroke mortality rate decreased among females and increased among males, and these trends are projected to continue in the future. In addition, the proportion of elderly individuals with high BMI-attributed stroke mortality was projected to increase gradually in both men and women. More health-promoting efforts are needed, especially for elderly individuals and males.

BackgroundHigh body mass index (BMI) plays a critical role in the initiation and development of type 2 diabetes (T2D). Up to now, far too little attention has been paid to the global burden of T2D attributable to high BMI. This study aims to report the deaths and disability-adjusted life years (DALYs) of T2D related to high BMI in 204 countries and territories from 1990 to 2019.MethodsData on T2D burden attributable to high BMI were retrieved from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. The global cases, age-standardized rates of mortality (ASMR), and disability-adjusted life years (ASDR) attributable to high BMI were estimated by age, sex, geographical location, and socio-demographic index (SDI). The estimated annual percentage change (EAPC) was calculated to quantify the trends of ASMR and ASDR during the period 1990–2019.ResultsGlobally, there were 619,494.8 deaths and 34,422,224.8 DALYs of T2D attributed to high BMI in 2019, more than triple in 1990. Moreover, the pace of increase in ASMR and ASDR accelerated during 1990–2019, with EAPC of 1.36 (95% CI: 1.27 to 1.45) and 2.13 (95% CI: 2.10 to 2.17) separately, especially in men, South Asia, and low-middle SDI regions. Oceania was the high-risk area of standardized T2D deaths and DALYs attributable to high BMI in 2019, among which Fiji was the country with the heaviest burden. In terms of SDI, middle SDI regions had the biggest T2D-related ASMR and ASDR in 2019.ConclusionThe global deaths and DALYs of T2D attributable to high BMI substantially increased from 1990 to 2019. High BMI as a major public health problem needs to be tackled properly and timely in patients with T2D.

ObjectiveThe purpose of the study was to describe the burden and temporal trend of cancer attributable to high body mass index (BMI), with major patterns highlighted by sex, Socio-demographic Index (SDI), and geographical region.MethodsThis population-based observational study collected epidemiological data on cancer attributable to high BMI from the Global Burden of Diseases (GBD) 2019. The obtained data included deaths, disability-adjusted life-years (DALYs), and their age-standardized rates at the global, gender, SDI, regional, and country levels. The trend magnitudes and directions over time for mortality were analyzed. The associations between SDI and burden of cancer attributable to high BMI were also evaluated by Pearson correlation analysis.ResultsWorldwide, 462.55 thousand deaths and 11.18 million DALYs of cancer were related to high BMI in 2019, and both have more than doubled since 1990. An annual 0.6% increase was observed for the age-standardized mortality rate (ASMR), and the rate of increase slowed after 2000. In general, the burden of cancer attributable to high BMI was heavier in regions with higher SDI levels, whereas the increase slowed down or even showed a decreasing trend in the recent years. In contrast, in regions with lower SDI levels, although the baseline burden of cancer attributable to high BMI was relatively low, both the numbers and rates of deaths and DALYs showed a significantly increasing trend and may not stop increasing for a period of time. The trend and magnitude of high BMI-related cancer burden varied substantially in different anatomical sites. The leading three cancers of DALYs attributable to high BMI in 2019 were esophageal, colorectal, and liver cancer.ConclusionThe high BMI-related burden of cancers is worsening, particularly in developing countries. Concerted action should be suggested to increase awareness of the harmful effects of high BMI and decrease the burden of disease attributable to high BMI, including cancer.

Introduction: Gestational diabetes mellitus (GDM), heart disease (HD) and high body mass index (BMI) are strongly related to Alzheimer's disease (AD) dementia in pregnant women. Therefore, we aimed to determine the total effects of GDM, heart disease, and high BMI on maternal AD dementia. Methods: We used data from the genome-wide association studies of European populations including more than 30,000 participants. We performed two-sample Mendelian randomization (MR) and multivariable MR (MVMR) to systematically estimate the direct effects of GDM, HD, and high BMI on maternal AD and dementia. Multiple sensitivity analyses involving classical MR approaches and expanded MR-pleiotropy residual sum and outlier analysis. Results: In two-sample MR analysis, the inverse-variance weighted method in our study demonstrated no significant causality between GDM and maternal dementia (β = −0.006 ± 0.0026, p = 0.82). This method also revealed no significant causality between high BMI and maternal dementia (β = 0.0024 ± 0.0043, p = 0.57), and it was supported by the MR-Egger regression results, which showed no causal effect of high BMI on maternal Alzheimer's disease and dementia (β = 0.0027 ± 0.0096, p = 0.78). The IVW method showed no significant causal relationship between maternal HD and maternal Alzheimer's disease and dementia (β = −0.05 ± 0.0042, p = 0.117) and MR-Egger regression analysis gave a similar result (β = −0.12 ± 0.0060, p = 0.079). In MVMR analysis, we found no significant causal relationship between GDM, high BMI, or HD and maternal Alzheimer's disease and dementia (p = 0.94, 0.82, and 0.13, respectively). Thus, the MVMR estimates were consistent with our results from the two-sample MR analysis. We confirmed that these results showed no horizontal pleiotropy and enhanced the robustness of our results through multiple sensitivity analyses. Conclusion: In two-sample MR analysis, we found no significant causal relationship between GDM, HD, high BMI and maternal AD and dementia. These results differed from previous observational studies showing HD is a significant predictor of dementia. MVMR analysis supported no significant causal relationship between GDM, HD, high BMI and maternal AD and dementia. Sensitivity analysis broadly increased the robustness of two-sample MR and MVMR analysis results. [ABSTRACT FROM AUTHOR]

Background: Uterine cancer is one of the most common female cancers worldwide, with huge heterogeneity in morbidity and mortality. Although a high body‐mass index (BMI) has been linked to uterine cancer, systematic reports about the influence of high BMI and its temporal trends are scarce. Methods: The annual morbidity, mortality, and disability‐adjusted life years (DALYs) of uterine cancer in 204 countries or territories were retrieved from the GBD 2019 study. To reflect trends in disease burden, we also calculated the estimated annual percentage change (EAPC) based on the age‐standardized rates of uterine cancer from 1990 to 2019. Results: The global incident cases of uterine cancer increased 2.3 times from 187,190 in 1990 to 435,040 in 2019. Although the age‐standardized incidence rate (ASIR) of uterine cancer increased worldwide from 8.67/100,000 in 1990 to 9.99/100,000 in 2019, the age‐standardized death rate (ASDR) and DALY rate decreased during the same period. High socio‐demographic index (SDI) countries tended to have a higher ASIR than developing regions, and their increasing trend in ASIR was also more pronounced. The disease was rare before 40 years old, but its risk rose sharply among women aged 50–70. A high BMI was linked to more than one‐third of deaths from uterine cancer in 2019. Conclusions: The incidence in developed areas was significantly higher than in developing areas and also increased much more rapidly. Elderly females, especially those with a high BMI, have a higher risk of uterine cancer. Therefore, more health resources may be needed to curb the rising burden in specific populations. [ABSTRACT FROM AUTHOR]

Obesity poses deleterious consequences on every organ system, especially the lymphatic network. However, the underlying cellular mechanisms through which obesity causes lymphatic dysfunction remains unclear. We aimed to summarize experimental studies that evaluated the effect of obesity on the lymphatic system on animal models. We used the following terms to search the Ovid EMBASE, Ovid MEDLINE(R), Cochrane, and Scopus databases: "lymphedema", "lymphatic diseases", "lymphatic system/complications* ", "lymphatic system/injuries* ", "lymphatic system/abnormalities* ", AND "obesity/complications* ", "diet/high-fat", "adipogenesis" and "lipid metabolism disorder". From a total of 166 articles identified in the initial search, 13 met our eligibility criteria. Long-term exposure to high-fat diet in mice demonstrated significant amount of adipose tissue deposition which sets off an inflammatory cascade resulting in disruption of the chemokine gradient, inhibition of lymphangiogenesis, and changes in gene expression of lymphatic endothelial cells, that alter vessel permeability and induce cell death. Reduced contractile properties of lymphatic collectors, dilated capillaries, increased tissue pressure, and reduced hydraulic conductivity collectively contribute to reduced impaired lymphatic drainage. Aerobic exercise has shown reversal of lymphatic dysfunction in the obese and pharmacological interventions targeting T-cells, iNOS and VEGFR-3 signaling have the potential to combat acquired lymphedema. Scientists should focus their future experiments on developing therapies that regulate expression of T-cell derived cytokines and VEGFR-3 expression whereas clinicians are urged to counsel their patients to reduce weight through aerobic exercise. [ABSTRACT FROM AUTHOR]

Background: Hyperinsulinemia, a common feature in PCOS, have been found to contribute to metabolic disturbance, such as dyslipidaemia and diabetes mellitus type 2. Oral anti-diabetic medications have been prescribed to alleviate this effect. We sought to fnd whether DLBS3233, an insulin sensitizer, could alleviate dyslipidaemia in women with PCOS with high BMI. Aim: This study aimed to investigate the effect of DLBS3233, an herbal combination of C burmanii and L spesiosa extract, on lipid profle, insulin resistance, and free testosterone of women with PCOS with high BMI. Study Setting and Design: This was a controlled trial conducted in Dr. Cipto Mangunkusumo Hospital, Jakarta, and Dr Hasan Sadikin Hospital, Bandung, Indonesia.Materials and Methods: A controlled trial was conducted on 62 volunteers diagnosed with PCOS according to Rotterdam criteria and exhibited insulin resistance as signifed by HOMA-IR > 2.0; baseline lipid profile (LDL, HDL, Triglyceride and Total cholesterol) and free testosterone concentration were obtained. Participants were given 100 mg of DLBS3233 in the morning, and volunteers were followed up monthly, with laboratory tests conducted at the third and sixth months. Data were analysed through intention-to-treat analysis, separating high BMI (≥25 kg/m2) subjects. Statistical Analysis: Repeated-measures model. Results: DLBS3233 improved lipid profle and insulin sensitivity by reducing triglycerides, HOMA-IR, and free testosterone in subjects with high BMI. Limitations and Implications: The current study does not compare the effect of DLBS3233 with a control group. A larger study with a proper control group would have to be conducted to have more conclusive results. Conclusion: This study showed that DLBS3233 holds promise as a novel therapy to improve lipid profle for women with PCOS.

Introduction: Gestational diabetes mellitus (GDM), heart disease (HD) and high body mass index (BMI) are strongly related to Alzheimer’s disease (AD) dementia in pregnant women. Therefore, we aimed to determine the total effects of GDM, heart disease, and high BMI on maternal AD dementia.Methods: We used data from the genome-wide association studies of European populations including more than 30,000 participants. We performed two-sample Mendelian randomization (MR) and multivariable MR (MVMR) to systematically estimate the direct effects of GDM, HD, and high BMI on maternal AD and dementia. Multiple sensitivity analyses involving classical MR approaches and expanded MR-pleiotropy residual sum and outlier analysis.Results: In two-sample MR analysis, the inverse-variance weighted method in our study demonstrated no significant causality between GDM and maternal dementia (β = −0.006 ± 0.0026, p = 0.82). This method also revealed no significant causality between high BMI and maternal dementia (β = 0.0024 ± 0.0043, p = 0.57), and it was supported by the MR-Egger regression results, which showed no causal effect of high BMI on maternal Alzheimer’s disease and dementia (β = 0.0027 ± 0.0096, p = 0.78). The IVW method showed no significant causal relationship between maternal HD and maternal Alzheimer’s disease and dementia (β = −0.05 ± 0.0042, p = 0.117) and MR-Egger regression analysis gave a similar result (β = −0.12 ± 0.0060, p = 0.079). In MVMR analysis, we found no significant causal relationship between GDM, high BMI, or HD and maternal Alzheimer’s disease and dementia (p = 0.94, 0.82, and 0.13, respectively). Thus, the MVMR estimates were consistent with our results from the two-sample MR analysis. We confirmed that these results showed no horizontal pleiotropy and enhanced the robustness of our results through multiple sensitivity analyses.Conclusion: In two-sample MR analysis, we found no significant causal relationship between GDM, HD, high BMI and maternal AD and dementia. These results differed from previous observational studies showing HD is a significant predictor of dementia. MVMR analysis supported no significant causal relationship between GDM, HD, high BMI and maternal AD and dementia. Sensitivity analysis broadly increased the robustness of two-sample MR and MVMR analysis results.

A 58-year-old Japanese man, with a body mass index of 41.7 kg/m2 (height: 179.8 cm; weight: 133.8 kg), underwent a laparoscopic pull-through procedure with delayed coloanal anastomosis performed in two surgical stages for lower rectal cancer. This method was selected because the volume of the abdominal wall was fairly thick and it would have been impossible to perform diverting ileostomy and colostomy, which are routinely conducted. First, a colonic pull-through segment of about 10 cm was left outside the anal canal without any tension and was fixed by sutures under indocyanine green fluorescence imaging (ICG FI). The second surgical stage was performed 10 days after the first operation under general anesthesia. Final coloanal anastomosis was performed with near-infrared light without diverting the stoma under ICG FI. The patient demonstrated a good postoperative course and was discharged from our hospital in remission 15 days after the latest operation. We could inspect the coloanal flow of the anastomosis under ICG FI before the reconstruction. This procedure was considered to be a standard method, but it was overtaken by new technology, ICG FI. This procedure is an ultimate stomaless surgery for ultralow rectal cancer that can be performed in selected cases, such as in patients with a high body mass index and with hope for stomaless operation.

Objective: Overweight and obesity are increasingly epidemic and negatively related to reproductive outcome. The aim of this study was to investigate the advantages of a modified ultra-long downregulation protocol on pregnancy outcomes of patients with high body mass index (BMI) undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI), compared to the long protocol (LP). Methods: We retrospectively analyzed the clinical data of 3,920 infertile patients at the Reproductive and Genetic Hospital of Citic-Xiangya from January 2012 to December 2017 by propensity score matching (PSM). Patients were divided into two groups: modified ultra-LP (MULP) (n = 1,960) and LP (n = 1,960). Results: In the MULP group, live birth rate (52.65% vs. 46.79%,P < 0.001, odds ratio [OR]: 1.784, 95% confidence interval [CI]: 1.563–2.036), clinical pregnancy rate (62.50% vs. 57.91%, P = 0.003, OR: 1.211, 95% CI: 1.066–1.377), and implantation rate (53.24% vs. 49.65%, P = 0.004, OR: 1.155, 95% CI: 1.048–1.272) were statistically significantly higher than those of the LP group. Moreover, the cycle cancellation rates (12.70% vs. 15.15%, P = 0.027, OR: 0.815, 95% CI: 0.68–0.977), abortion rates (12% vs. 14.8%, P = 0.046, OR: 0.785, 95% CI: 0.619–0.996), and ectopic pregnancy rates (1.06% vs. 2.11%, P = 0.04, OR: 0.497, 95% CI: 0.252–0.98) were lower than those in the LP group. Conclusion: The modified ultra-long downregulation protocol improved the pregnancy outcomes in patients with high BMI undergoing IVF/ICSI treatment, providing a potential option for physicians when deciding an optimized ovary stimulation protocol for high BMI patients.

Background: With the increase in the aging population worldwide, Alzheimer's disease has become a rapidly increasing public health concern. In the Global Burden of Disease Study 2019, there are three risk factors judged to have evidence for a causal link to Alzheimer's disease and other dementias: smoking, high body-mass index (HBMI), and high fasting plasma glucose (HFPG)., Objective: This study aimed to analyze trends in AD mortality and the relevant burden across China from 1990 to 2019, as well as their correlation with age, period, and birth cohort., Methods: The data were extracted from the GBD 2019. Trends in AD mortality attributable to metabolic risks (HFPG and HBMI) and smoking were analyzed using Joinpoint regression. The age-period-cohort (APC) model was used to evaluate cohort and period effects., Results: From 1990 to 2019, the overall age-standardized mortality rate of AD increased, especially in women. There was an increase in AD mortality due to smoking in the net drift, and it was more significant in women (0.46, 95%CI = [0.09, 0.82]) than men (-0.03, 95%CI = [-0.11, 0.05]). For the cause of HFPG, the net drift values for men and women were 0.82% and 0.43%. For HBMI, the values were 3.14% and 2.76%, respectively, reflecting substantial increases in AD mortality., Conclusion: Time trends in AD mortality caused by metabolic risks and smoking in China from 1990 to 2019 have consistently increased. Therefore, it is necessary to prevent excessive weight gain and obesity during the later stages of life, especially for females., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Sun, Zhang, Yu, Xia, Yao, Sun, Liang, Huang, Wang, Yang and Hong.)

Background: High body mass index (BMI) is associated with stroke, ischemic heart disease (IHD), and type 2 diabetes mellitus (T2DM). An epidemiological analysis of the prevalence of high BMI, stroke, IHD, and T2DM was conducted for 16 Southern Africa Development Community (SADC) using Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study data. Methods: GBD obtained data from vital registration, verbal autopsy, and ICD codes. Prevalence of high BMI (≥25 kg/m2), stroke, IHD, and T2DM attributed to high BMI were calculated. Cause of Death Ensemble Model and Spatiotemporal Gaussian regression was used to estimate mortality due to stroke, IHD, and T2DM attributable to high BMI. Results: Obesity in adult females increased 1.54‐fold from 12.0% (uncertainty interval [UI]: 11.5–12.4) to 18.5% (17.9–19.0), whereas in adult males, obesity nearly doubled from 4.5 (4.3–4.8) to 8.8 (8.5–9.2). In children, obesity more than doubled in both sexes, and overweight increased by 27.4% in girls and by 37.4% in boys. Mean BMI increased by 0.7 from 22.4 (21.6–23.1) to 23.1 (22.3–24.0) in adult males, and by 1.0 from 23.8 (22.9–24.7) to 24.8 (23.8–25.8) in adult females. South Africa 44.7 (42.5–46.8), Swaziland 33.9 (31.7–36.0) and Lesotho 31.6 (29.8–33.5) had the highest prevalence of obesity in 2019. The corresponding prevalence in males for the three countries were 19.1 (17.5–20.7), 19.3 (17.7–20.8), and 9.2 (8.4–10.1), respectively. The DRC and Madagascar had the least prevalence of adult obesity, from 5.6 (4.8–6.4) and 7.0 (6.1–7.9), respectively in females in 2019, and in males from 4.9 (4.3–5.4) in the DRC to 3.9 (3.4–4.4) in Madagascar. Conclusions: The prevalence of high BMI is high in SADC. Obesity more than doubled in adults and nearly doubled in children. The 2019 mean BMI for adult females in seven countries exceeded 25 kg/m2. SADC countries are unlikely to meet UN2030 SDG targets. Prevalence of high BMI should be studied locally to help reduce morbidity. [ABSTRACT FROM AUTHOR]

Background: A paradoxical association of obesity with lower risk of transcatheter aortic valve replacement (TAVR) outcomes has been reported. We aimed to systematically review the literature and compare TAVR-related morbidity and mortality among individuals with overweight or obesity and their peers with normal body mass index (BMI). Methods: PubMed and Embase databases were systematically searched for studies reporting TAVR outcomes in different BMI groups. Separate meta-analyses were conducted for studies reporting hazard ratios (HR) and odds ratios/relative risks. Short- and mid-/long-term outcomes were examined. Results: 26 studies with a total of 74,163 patients were included in our study. Overweight was associated with lower risk of short-term mortality (HR: 0.77; 95% CI: 0.60–0.98) and mid-/long-term mortality (HR: 0.79; 95% CI: 0.70–0.89). Obesity was associated with lower risk for mid-/long-term mortality (HR: 0.79; 95% CI: 0.73–0.86), but no difference was observed in short-term mortality, although a trend was noted (HR: 0.87l 95% CI: 0.74–1.01). Individuals with obesity demonstrated an association with higher odds of major vascular complications (OR: 1.33; 95% CI: 1.05–1.68). Both overweight (OR: 1.16; 95% CI: 1.03–1.30) and obesity (OR: 1.26; 95% CI: 1.06–1.50) were associated with higher likelihood for receiving permanent pacemakers after TAVR. Conclusion: Individuals with overweight and obesity were associated with lower mortality risk compared to those with normal BMI but with higher likelihood of major vascular complications and permanent pacemaker implantation after TAVR.

Introduction: Nationally representative studies of the combined impact of drinking and body mass (BMI) on mortality outcomes are unavailable. We investigate whether both act together to elevate risk of all‐cause or liver mortality. Methods: We obtained self‐reported histories of drinking and BMI from 129 098 women (mean age 47.2 years) and 102 568 men (mean age 45.6 years) ≥18 years interviewed from 1997 to 2004 in the National Health Interview Survey and related these data to the deaths that occurred by 31 December 2006 (women = 8486; men = 7819 deaths). Death hazards among current drinkers in different BMI groups were adjusted for age, education, race and smoking. Results: Obese (≥30 kg m−2) adults with consumption of >40 g day−1 (women) or >60 g day−1 (men) pure ethanol were at risk of increased mortality from all‐cause and chronic liver disease (P trend <0.0001). For heavy drinkers with BMI ≥30 kg m−2, each 5 kg m−2 higher BMI was associated with an elevated all‐cause mortality in men (hazard ratios 1.27, 95% confidence interval [CI]: 1.16–1.40) and women (1.12, [1.02–1.24]). The excess risk due to interaction was more pronounced in men (7.30, [3.60–11.00]) than women (2.90, [0.50–5.30]). Discussion and Conclusions: Obesity and excess alcohol are both related to all‐cause and liver mortality—the latter with evidence of a supra‐additive interaction between the risk factors. The presence of both factors in the same population and their impact should inform treatment, public health policies and research. [ABSTRACT FROM AUTHOR]