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BackgroundWith 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).ObjectiveThis 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.MethodsThe 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.ResultsFrom 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.ConclusionTime 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.

ObjectiveMetabolic risks (MRs) are the primary determinants of breast cancer (BC) mortality among women. This study aimed to examine the changing trends in BC mortality associated with MRs and explore how they related to age, time period, and birth cohorts in Chinese women aged 25 and above.MethodsData were sourced from the Global Burden of Disease Study 2019 (GBD2019). The BC mortality trajectories and patterns attributable to MRs were assessed using Joinpoint regression. The age-period-cohort (APC) model was employed to evaluate cohort and time period effects.ResultsThe age-standardized mortality rate (ASMR) of BC mortality linked to MRs displayed an escalating trend from 1990 to 2019, demonstrating an average annual percentage change (AAPC) of 1.79% (95% CI: 1.69~1.87). AAPCs attributable to high fasting plasma glucose (HFPG) and high body mass index (HBMI) were 0.41% (95% CI: 0.32~0.53) and 2.75% (95% CI: 2.68~2.82), respectively. APC analysis revealed that BC mortality due to HBMI in women aged 50 and above showed a rise with age and mortality associated with HFPG consistently demonstrated a positive correlation with age. The impact of HBMI on BC mortality significantly outweighed that of HFPG. The risk of BC mortality linked to HBMI has steadily increased since 2005, while HFPG demonstrated a trend of initial increase followed by a decrease in the period effect. Regarding the cohort effect, the relative risk of mortality was greater in the birth cohort of women after the 1960s of MRs on BC mortality, whereas those born after 1980 displayed a slight decline in the relative risk (RR) associated with BC mortality due to HBMI.ConclusionThis study suggests that middle-aged and elderly women should be considered as a priority population, and control of HBMI and HFPG should be used as a primary tool to control metabolic risk factors and effectively reduce BC mortality.

We analyze the socioeconomic and political contextual determinants of the burden of disease attributable to three metabolic risks in children: kidney dysfunction, high fasting plasma glucose, and high body-mass index. We use data from 121 countries. We matched data of the Global Burden of Disease project, World Bank and United Nations databases. The burden of disease is measured with the Disability Adjusted Life Years lost. We explore associations with four groups of variables: (i) income level, which measures differences in socioeconomic conditions between countries; (ii) income inequality, which measures within country inequalities in the income distribution; (iii) health care expenditure, which measures the resources allocated to health and healthcare, and (iv) women empowerment, which we measure in terms of both educational and political participation. Our findings point toward the need to act at the root of the underlying factors underpinning the disease burden, namely: reducing between and, particularly, within-country income inequalities, increasing the role of expenditure on health, and ensuring women empowerment and girls education. To our knowledge, this is the first study that have identified the associations of these variables with the burden of disease that is specifically attributable to metabolic risks in childhood.

Jiaofeng Huang,1,&ast; Wenjuan Xue,2,&ast; Mingfang Wang,1 Yinlian Wu,1 Medha Singh,3 Yueyong Zhu,1,4 Rahul Kumar,5 Su Lin1 1Department of Hepatology, Hepatology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, 350005, People’s Republic of China; 2Department of Traditional Chinese Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, 350005, People’s Republic of China; 3Department of General Medicine, Tan Tock Seng Hospital, Singapore; 4Fujian Key Laboratory of Precison Medicine for Cancer, the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, People’s Republic of China; 5Department of Gastroenterology and Hepatology, Duke-NUS Academic Medical Centre, Changi General Hospital, Singapore&ast;These authors contributed equally to this workCorrespondence: Su LinDepartment of Hepatology, Hepatology Research Institute, The First Affiliated Hospital, Fujian Medical University, No. 20, Chazhong Road, Taijiang District, Fuzhou, Fujian, 350005, People’s Republic of ChinaTel +86 591-87981657Fax +86 591-87982526Email sumer5129@fjmu.edu.cnIntroduction: Metabolic associated fatty liver disease (MAFLD) is a novel concept for fatty liver disease. Different from non-alcoholic fatty liver disease (NAFLD), the diagnosis of MAFLD requires the presence of metabolic risks. This study aimed to characterize patients with liver steatosis but without metabolic risks (non-MR-steatosis) which may not be diagnosed by MAFLD criteria.Methods: Consecutive patients who underwent biopsy were included in this study. The clinic-pathological characteristics of non-MR-steatosis, NAFLD and MAFLD were compared.Results: A total of 1217 cases were included. There were 426 (35.00%) cases with MAFLD, 585 (48.07%) with NAFLD and 168 (13.80%) with non-MR-steatosis. The majority of the cases were infected with HBV (93.26%). The age and metabolic profiles were highest in MAFLD and lowest in non-MR-steatosis. The body mass index (BMI) level was also lowest in non-MR-steatosis (20.78 ± 1.54 kg/m2). The ALT and AST levels of the non-MR-steatosis group were not statistically different from those of MAFLD or NAFLD groups (p > 0.05). Histologically, there was no significant difference in the degrees of inflammation and fibrosis among the three groups. The severity of steatosis in non-MR-steatosis group was lower than MAFLD or NAFLD groups (p < 0.05). These results were consistent in both HBV and non-HBV subgroups.Conclusion: MAFLD criteria may overlook some steatotic patients without metabolic risks, who may also have steatohepatitis and significant fibrosis.Keywords: metabolic associated fatty liver disease, nonalcoholic fatty liver disease, metabolic risks, lean NAFLD, biopsy

Abstract Background Twelve of the 17 Sustainable Development Goals (SDGs) are related to malnutrition (both under- and overnutrition), other behavioral, and metabolic risk factors. However, comparative evidence on the impact of behavioral and metabolic risk factors on disease burden is limited in sub-Saharan Africa (SSA), including Ethiopia. Using data from the Global Burden of Disease (GBD) Study, we assessed mortality and disability-adjusted life years (DALYs) attributable to child and maternal undernutrition (CMU), dietary risks, metabolic risks and low physical activity for Ethiopia. The results were compared with 14 other Eastern SSA countries. Methods Databases from GBD 2015, that consist of data from 1990 to 2015, were used. A comparative risk assessment approach was utilized to estimate the burden of disease attributable to CMU, dietary risks, metabolic risks and low physical activity. Exposure levels of the risk factors were estimated using spatiotemporal Gaussian process regression (ST-GPR) and Bayesian meta-regression models. Results In 2015, there were 58,783 [95% uncertainty interval (UI): 43,653–76,020] or 8.9% [95% UI: 6.1–12.5] estimated all-cause deaths attributable to CMU, 66,269 [95% UI: 39,367–106,512] or 9.7% [95% UI: 7.4–12.3] to dietary risks, 105,057 [95% UI: 66,167–157,071] or 15.4% [95% UI: 12.8–17.6] to metabolic risks and 5808 [95% UI: 3449–9359] or 0.9% [95% UI: 0.6–1.1] to low physical activity in Ethiopia. While the age-adjusted proportion of all-cause mortality attributable to CMU decreased significantly between 1990 and 2015, it increased from 10.8% [95% UI: 8.8–13.3] to 14.5% [95% UI: 11.7–18.0] for dietary risks and from 17.0% [95% UI: 15.4–18.7] to 24.2% [95% UI: 22.2–26.1] for metabolic risks. In 2015, Ethiopia ranked among the top four countries (of 15 Eastern SSA countries) in terms of mortality and DALYs based on the age-standardized proportion of disease attributable to dietary and metabolic risks. Conclusions In Ethiopia, while there was a decline in mortality and DALYs attributable to CMU over the last two and half decades, the burden attributable to dietary and metabolic risks have increased during the same period. Lifestyle and metabolic risks of NCDs require more attention by the primary health care system of the country.

South Asians constitute one-fourth of the world’s population and are distributed significantly in western countries. With exponentially growing numbers, childhood obesity is of global concern. Children of South Asian ancestry have a higher likelihood of developing obesity and associated metabolic risks. The validity of commonly used measures for quantifying adiposity and its impact on metabolic outcomes differ by race and ethnicity. In this review we aim to discuss the validity of body mass index (BMI) and other tools in screening for adiposity in South Asian children. We also discuss the prevalence of overweight and obesity amongst South Asian children in western countries and the differences in body fat percentage, adiposity distribution, and metabolic risks specific to these children compared to Caucasian children. South Asian children have a characteristic phenotype: lower lean mass and higher body fat percentage favoring central fat accumulation. Hence, BMI is a less reliable predictor of metabolic status in these children than it is for Caucasian children. Furthermore, the relatively lower birth weight and rapid growth acceleration in early childhood of South Asian children increase the risk of their developing cardiometabolic disorders at a younger age than that of Caucasians. We emphasize the need to use modified tools for assessment of adiposity, which take into consideration the ethnic differences and provide early and appropriate intervention to prevent obesity and its complications.

Adipose tissue (AT) storage capacity is central in the maintenance of whole-body homeostasis, especially in obesity states. However, sustained nutrients overflow may dysregulate this function resulting in adipocytes hypertrophy, AT hypoxia, inflammation and oxidative stress. Systemic inflammation may also contribute to the disruption of AT redox equilibrium. AT and systemic oxidative stress have been involved in the development of obesity-associated insulin resistance (IR) and type 2 diabetes (T2D) through several mechanisms. Interestingly, fat accumulation, body fat distribution and the degree of how adiposity translates into cardio-metabolic diseases differ between ethnicities. Populations of African ancestry have a higher prevalence of obesity and higher T2D risk than populations of European ancestry, mainly driven by higher rates among African women. Considering the reported ethnic-specific differences in AT distribution and function and higher levels of systemic oxidative stress markers, oxidative stress is a potential contributor to the higher susceptibility for metabolic diseases in African women. This review summarizes existing evidence supporting this hypothesis while acknowledging a lack of data on AT oxidative stress in relation to IR in Africans, and the potential influence of other ethnicity-related modulators (e.g., genetic-environment interplay, socioeconomic factors) for consideration in future studies with different ethnicities.