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16 results on '"metabolic risks"'

1. MAFLD Criteria May Overlook a Subtype of Patient with Steatohepatitis and Significant Fibrosis

Author

Wenjuan Xue, Rajesh Kumar, Su Lin, Mingfang Wang, Jiaofeng Huang, Medha Singh, Yueyong Zhu, and Yinlian Wu

Subjects
nonalcoholic fatty liver disease, lean NAFLD, medicine.medical_specialty, Disease, Gastroenterology, metabolic associated fatty liver disease, Fibrosis, Internal medicine, Nonalcoholic fatty liver disease, Biopsy, Internal Medicine, medicine, biopsy, Targets and Therapy [Diabetes, Metabolic Syndrome and Obesity], Original Research, Pharmacology, medicine.diagnostic_test, business.industry, Fatty liver, metabolic risks, medicine.disease, digestive system diseases, Steatohepatitis, Steatosis, business, Body mass index
Abstract

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

Published
2021

2. MAFLD Criteria May Overlook a Subtype of Patient with Steatohepatitis and Significant Fibrosis

Author

Huang J, Xue W, Wang M, Wu Y, Singh M, Zhu Y, Kumar R, and Lin S

Subjects
metabolic associated fatty liver disease, nonalcoholic fatty liver disease, RC581-951, lean nafld, Specialties of internal medicine, metabolic risks, biopsy
Abstract

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

Published
2021

3. Global and regional burden of disease and injury in 2016 arising from occupational exposures: a systematic analysis for the Global Burden of Disease Study 2016

Author

Driscoll, T, Rushton, L, Hutchings, SJ, Straif, K, Steenland, K, Abate, D, Abbafat, C, Acharya, D, Adebayo, OM, Afshari, M, Akinyemiju, T, Alahdab, F, Anjomshoa, M, Antonio, CAT, Aremu, O, Ataro, Z, Quintanilla, BPA, Banoub, JAM, Barker-Collo, SL, Barnighausen, TW, Barrero, LH, Bedi, N, Behzadifar, M, Benavides, FG, Beuran, M, Bhattacharyya, K, Bijani, A, Cardenas, R, Carrero, JJ, Carvalho, F, Castaneda-Orjuela, CA, Cerin, E, Cooper, C, Dandona, L, Dandona, R, Dang, AK, Daryani, A, Desalegn, BB, Dharmaratne, SD, Dubljanin, E, El-Khatib, Z, Eskandarieh, S, Fareed, M, Faro, A, Fereshtehnejad, S-M, Fernandes, E, Filip, I, Fischer, F, Fukumoto, T, Gallus, S, Gebremichael, TG, Gezae, KE, Gill, TK, Goulart, BNG, Grada, A, Guo, Y, Gupta, R, Haj-Mirzaian, A, Hamadeh, RR, Hamidi, S, Hamzeh, B, Hassankhani, H, Hawkins, DM, Hay, SI, Hegazy, MI, Henok, A, Hoang, CL, Hole, MK, Rad, EH, Hossain, N, Hosseini, M, Hostiuc, S, Hu, G, Ilesanmi, OS, Irvani, SSN, Islam, SMS, Jakovljevic, M, Jha, RP, Jonas, JB, Shushtar, ZJ, Jozwiak, JJ, Jurisson, M, Kahsay, A, Karami, M, Karimi, N, Kasaeian, A, Kawakami, N, Khader, YS, Khan, EA, Khubchandani, J, Kim, YJ, Kisa, A, Defo, BK, Kumar, GA, Kumar, M, Lami, FH, Latif, A, Leigh, J, Levi, M, Li, S, Linn, S, Lopez, JCF, Lunevicius, R, Mahotra, NB, Majdan, M, Malekzadeh, R, Mansournia, MA, Massenburg, BB, Mehta, V, Melese, A, Memish, ZA, Mendoza, W, Mengistu, G, Meretoja, TJ, Mestrovic, T, Miazgowski, T, Miller, TR, Mini, GK, Mirrakhimov, EM, Moazen, B, Mezerji, NMG, Mohammed, S, Mohebi, F, Mokdad, AH, Molokhia, M, Monasta, L, Moodley, Y, Moosazadeh, M, Morad, G, Moradi-Lakeh, M, Morawska, L, Morrison, SD, Mousav, SM, Mustafa, G, Najaf, F, Nangia, V, Negoi, I, Negoi, RI, Neupane, S, Nguyen, CT, Nguyen, TH, Nixon, MR, Ofori-Asenso, R, Ogbo, FA, Olagunju, AT, Olusanya, BO, Otstavnov, SS, Mahesh, PA, Panda-Jonas, S, Park, E-K, Prakash, S, Qorbani, M, Radfar, A, Rafay, A, Rahim, F, Reiner, RC, Renzaho, AMN, Roever, L, Ronfani, L, Saddik, B, Safari-Faramani, R, Safi, S, Safiri, S, Salamati, P, Salimi, Y, Samy, AM, Schwebel, DC, Sepanlou, SG, Serdar, B, Shaikh, MA, Shams-Beyranvand, M, Sharif-Alhoseini, M, She, J, Shigematsu, M, Shiri, R, Shirkoohi, R, Si, S, Sinha, DN, Stanaway, JD, Soofi, M, Stokes, MA, Sufiyan, MB, Tabares-Seisdedos, R, Takahashi, K, Tassew, SG, Tehrani-Banihashemi, A, Tran, M-HTBX, Tran, KB, Car, LT, Ullah, I, Valdez, PR, Vasankari, TJ, Venketasubramanian, N, Violante, FS, Vladimirov, SK, Vlassov, V, Vu, GT, Wagner, GR, Waheed, Y, Wang, Y-P, Werdecker, A, Winkler, AS, Yimer, EM, Yip, P, Yirsaw, BD, Yisma, E, Yonemoto, N, Yousefifard, M, Bin Zaman, S, Zamani, M, Zandian, H, Zhang, Y, Zodpey, S, Lim, SS, Driscoll, Tim, Rushton, Lesley, Hutchings, Sally J, Straif, Kurt, Kumar, Manasi, Yisma, Engida, Lim, Stephen S, GBD 2016 Occupational Risk Factors Collaborators, Collaborators, GBD 2016 Occupational Risk Factors, Institute for Molecular Medicine Finland, Clinicum, HUS Comprehensive Cancer Center, GBD 2016 Occupational Risk Factors Collaborator, and Violante FS

Subjects
Male, exposure assessment, Global Health, medicine.disease_cause, Global Burden of Disease, ergonomic, GBD 2016 Occupational Risk Factors Collaborators, 0302 clinical medicine, Risk Factors, 1599 Other Commerce, Management, Tourism and Services, Neoplasms, METABOLIC RISKS, Per capita, Medicine, 030212 general & internal medicine, Public, Environmental & Occupational Health, Aged, 80 and over, education.field_of_study, Human factors and ergonomics, Middle Aged, 030210 environmental & occupational health, 3142 Public health care science, environmental and occupational health, 3. Good health, Occupational Diseases, COMPARATIVE RISK-ASSESSMENT, Female, Quality-Adjusted Life Years, Risk assessment, Life Sciences & Biomedicine, Adult, COUNTRIES, noise, Adolescent, Population, cancer, respiratory tract diseases, workplace, Risk Assessment, Environmental & Occupational Health, Asbestos, respiratory tract disease, 1117 Public Health and Health Services, Young Adult, 03 medical and health sciences, Age Distribution, Life Expectancy, Occupational Exposure, Environmental health, Humans, Disabled Persons, Sex Distribution, education, Aged, Science & Technology, business.industry, Public Health, Environmental and Occupational Health, 1103 Clinical Sciences, TRENDS, Quality-adjusted life year, Socioeconomic Factors, Attributable risk, Commentary, Life expectancy, Wounds and Injuries, CLUSTERS, business, Low Back Pain
Abstract

ObjectivesThis study provides an overview of the influence of occupational risk factors on the global burden of disease as estimated by the occupational component of the Global Burden of Disease (GBD) 2016 study.MethodsThe GBD 2016 study estimated the burden in terms of deaths and disability-adjusted life years (DALYs) arising from the effects of occupational risk factors (carcinogens; asthmagens; particulate matter, gases and fumes (PMGF); secondhand smoke (SHS); noise; ergonomic risk factors for low back pain; risk factors for injury). A population attributable fraction (PAF) approach was used for most risk factors.ResultsIn 2016, globally, an estimated 1.53 (95% uncertainty interval 1.39–1.68) million deaths and 76.1 (66.3–86.3) million DALYs were attributable to the included occupational risk factors, accounting for 2.8% of deaths and 3.2% of DALYs from all causes. Most deaths were attributable to PMGF, carcinogens (particularly asbestos), injury risk factors and SHS. Most DALYs were attributable to injury risk factors and ergonomic exposures. Men and persons 55 years or older were most affected. PAFs ranged from 26.8% for low back pain from ergonomic risk factors and 19.6% for hearing loss from noise to 3.4% for carcinogens. DALYs per capita were highest in Oceania, Southeast Asia and Central sub-Saharan Africa. On a per capita basis, between 1990 and 2016 there was an overall decrease of about 31% in deaths and 25% in DALYs.ConclusionsOccupational exposures continue to cause an important health burden worldwide, justifying the need for ongoing prevention and control initiatives.

Published
2020

4. Obesity and Metabolic Care of Children of South Asian Ethnicity in Western Society

Author

Vibha Singhal, Sonali Malhotra, Angela K. Fitch, and Ramya Sivasubramanian

Subjects
Birth weight, Population, Review, Overweight, Pediatrics, Body fat percentage, RJ1-570, Childhood obesity, medicine, South Asian, education, education.field_of_study, business.industry, central adiposity, metabolic risks, medicine.disease, Obesity, body fat percentage, Pediatrics, Perinatology and Child Health, Lean body mass, medicine.symptom, business, thin-fat phenotype, Body mass index, childhood obesity, Demography
Abstract

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.

Published
2021

5. Contribution of adipose tissue oxidative stress to obesity-associated diabetes risk and ethnic differences: Focus on women of African ancestry

Author

Pamela A. Nono Nankam, Télesphore Benoît Nguelefack, Julia H. Goedecke, and Matthias Blüher

Subjects
0301 basic medicine, obesity, Diabetes risk, Physiology, Clinical Biochemistry, Adipose tissue, 030209 endocrinology & metabolism, Inflammation, RM1-950, Type 2 diabetes, Review, Systemic inflammation, medicine.disease_cause, Biochemistry, 03 medical and health sciences, 0302 clinical medicine, Insulin resistance, medicine, oxidative stress, Molecular Biology, business.industry, metabolic risks, Cell Biology, medicine.disease, Obesity, adipose tissue, 030104 developmental biology, Adipose Tissue, Ethnicity, Metabolic Risks, Oxidative Stress, ethnicity, Therapeutics. Pharmacology, medicine.symptom, business, Oxidative stress
Abstract

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.

Published
2021

6. Retinol-binding protein 4 in obesity and metabolic dysfunctions

Author

Pamela A. Nono Nankam and Matthias Blüher

Subjects
0301 basic medicine, Adipokine, Adipose tissue, 030209 endocrinology & metabolism, Disease, Type 2 diabetes, Bioinformatics, Biochemistry, Energy homeostasis, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, Insulin resistance, Humans, Medicine, Obesity, Molecular Biology, Metabolic Syndrome, business.industry, Fatty liver, Adipocytokines, Adipose Tissue, Insulin Resistance, Metabolic Risks, medicine.disease, 030104 developmental biology, Liver, Cytokines, business, Retinol-Binding Proteins, Plasma, Dyslipidemia
Abstract

Excessive increased adipose tissue mass in obesity is associated with numerous co-morbid disorders including increased risk of type 2 diabetes, fatty liver disease, hypertension, dyslipidemia, cardiovascular diseases, dementia, airway disease and some cancers. The causal mechanisms explaining these associations are not fully understood. Adipose tissue is an active endocrine organ that secretes many adipokines, cytokines and releases metabolites. These biomolecules referred to as adipocytokines play a significant role in the regulation of whole-body energy homeostasis and metabolism by influencing and altering target tissues function. Understanding the mechanisms of adipocytokine actions represents a hot topic in obesity research. Among several secreted bioactive signalling molecules from adipose tissue and liver, retinol-binding protein 4 (RBP4) has been associated with systemic insulin resistance, dyslipidemia, type 2 diabetes and other metabolic diseases. Here, we aim to review and discuss the current knowledge on RBP4 with a focus on its role in the pathogenesis of obesity comorbid diseases.

Published
2021

7. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Author

Soufiane Boufous, Yousef Veisani, Mehran Asadi-Aliabadi, Sharath Burugina Nagaraja, Maziar Moradi-Lakeh, Getachew Mullu Kassa, Edward J Mills, Dimas Ria Angga Pribadi, William James Dangel, Mohamad-Hani Temsah, Catherine O. Johnson, Gregory A. Roth, Giuseppe Gorini, Fariborz Mansour-Ghanaei, Alberto Ortiz, Samad Azari, Assefa Ayalew Ayalew Ayalew Gebreslassie, Salime Goharinezhad, Stephanie R. M. Zimsen, Peng Zheng, Michael Assmus, Elisabetta Pupillo, Bach Xuan Tran, Lal B. Rawal, Narayanaswamy Venketasubramanian, Noushin Mohammadifard, Stephen S Lim, Ata Rafiee, Maria Inês Schmidt, Vincent C. Iannucci, Suzanne Lyn Barker-Collo, Leah E. Cahill, Tauseef Ahmad, Platon D. Lopukhov, Kazumasa Yamagishi, Abdullah Al Mamun, Iqbal R. F. Elyazar, Giovanni Damiani, Mohammad Hossein Bakhshaei, Mehdi Fazlzadeh, Virginia Núñez-Samudio, Alyssa Pennini, Dietrich Plass, Atkilt Esaiyas Etisso, Gebre Teklemariam Demoz, Alexandrea Watson, Arvin Haj-Mirzaian, Paul S Briant, Frank B. Osei, Blair R. Bumgarner, Maciej Banach, Ravensara S. Travillian, Kai-Lan Chang, Shirin Djalalinia, Hasan Yusefzadeh, Silvano Gallus, Seyyed Meysam Mousavi, Bernhard T. Baune, Aaron van Donkelaar, Azeem Majeed, Hans Kromhout, Robert Ancuceanu, Blessing J. Akombi, Pushpendra Singh, Nayu Ikeda, William M. Gardner, Zahid A Butt, Mohammad Abdollahi, Temesgen Yihunie Akalu, Rahman Shiri, Benn Sartorius, Ai-Min Wu, Bing Fang Hwang, Flavia M. Cicuttini, Hiroyasu Iso, Luis Camera, Amin Soheili, Félix Carvalho, Yun Jin Kim, Caleb Mackay Salpeter Irvine, Mehdi Mirzaei-Alavijeh, Iman Halvaei, Saqib Ali, Giulio Castelpietra, Catalina Liliana Andrei, Ali Kazemi Karyani, Parkes J Kendrick, Hamidreza Haririan, Lucas Guimarães Abreu, Mukhammad David Naimzada, Jeff T. Zhao, Samiah Alam, Sorin Hostiuc, Shaun Wen Huey Lee, João Mauricio Castaldelli-Maia, Behzad Karami Matin, Cyrus Alinia, Takahiro Tabuchi, Manu Raj Mathur, Søren Thorgaard Skou, Thomas Khaled Dwayne Classen, Reza Heidari-Soureshjani, Massimo Cirillo, Nikita Otstavnov, Mehdi Bohluli, Ruth W. Kimokoti, Animut Tagele Tamiru, Masoumeh Sadeghi, Mohammad Ali Jahani, Itamar S. Santos, Mekdes Tigistu Yilma, Lars Johansson, Arielle Wilder Eagan, Nevine El Nahas, Silvia Schiavolin, Kevin D. Shield, Dinh-Toi Chu, Shiva Borzouei, Paul S. F. Yip, Beatrix Haddock, Gianfranco Alicandro, Vasily Vlassov, Deanna Anderlini, Giuseppe Remuzzi, Khalid A Altirkawi, Farahnaz Joukar, Aso Mohammad Darwesh, Ratilal Lalloo, Panniyammakal Jeemon, Rohollah Kalhor, Daniel Youngwhan Cho, Weijia Fu, João Pedro Silva, Rodrigo Sarmiento-Suarez, Seth Christopher Yaw Appiah, Mehdi Ahmadi, Jacob Olusegun Olusanya, José Neves, Gaorui Guo, Tomas Y. Yeheyis, John S. Ji, Charles D. H. Parry, Maryam Ghadimi, Seyed-Mohammad Fereshtehnejad, Serge Resnikoff, Anna E. Torre, Vinod C Nayak, Jamileh Shadid, Susanne Breitner, Mohammad Khammarnia, Mathilde Touvier, Ensiyeh Jenabi, Hosna Janjani, Floriane Ausloos, Irmina Maria Michalek, Alexandra S. Boon-Dooley, Jessica A. Cruz, Syed Mohamed Aljunid, Abiodun M. Adeoye, André Faro, Bartosz Miazgowski, Jobert Richie Nansseu, Erin C Mullany, Giannina Ferrara, Martin McKee, Emmanuel Peprah, Oommen John, Reza Saeedi, Yasser Vasseghian, Dragos Virgil Davitoiu, Sarah Wulf Hanson, Yingxi Zhao, Omid Shafaat, Ali Rajabpour-Sanati, Farid Najafi, Ana Maria Mantilla Herrera, Fatemeh Rajati, Tarun Gupta, Łukasz Szumowski, Mohammed Ibrahim Mohialdeen Gubari, Peter Njenga Keiyoro, Dharmesh Kumar Lal, Zhi Jiang Zhang, Osayomwanbo Osarenotor, Tanvir M. Huda, Perminder S. Sachdev, Farhad Ghamari, Era Upadhyay, Vivek Kumar, Guoqing Hu, Vinay Nangia, Vladimir Andreevich Korshunov, Saeed Shahabi, Golnaz Heidari, Ashraf Nabhan, Robert C. Reiner, Aziz Rezapour, Justin J. Lang, Rakhi Dandona, Josephine W. Ngunjiri, Anna-Karin Danielsson, André Karch, Filippo Ariani, Ahmed Abdelalim, Masih Tajdini, Stefanos Tyrovolas, Mohamed Hsairi, Jae Il Shin, Jasvinder A. Singh, Meghan D. Mooney, Fiona B. Bennitt, Hesam Alizade, Segun Emmanuel Ibitoye, Pradhum Ram, Soraya Siabani, Evanson Z. Sambala, Reza Malekzadeh, Falk Schwendicke, Lalit Dandona, Masoud Moradi, Molly R Nixon, Roya Mirzaei, Rachel Feldman, Hosni Salem, Alberto L. García-Basteiro, Lorainne Tudor Car, Sharareh Eskandarieh, Ramesh Holla, Ritesh G. Menezes, Taraneh Yousefinezhadi, Hai Quang Pham, Hamideh Salimzadeh, Luisa Sorio Flor, Priya Rathi, Ali Bijani, Harvey Whiteford, Shanshan Li, Aleksandr Y. Aravkin, Joshua A. Salomon, Franz Castro, Lisa M. Force, Abdilahi Yousuf Yousuf, Mina Anjomshoa, Ken Takahashi, Maigeng Zhou, Telma Zahirian Moghadam, Maseer Khan, Irina Filip, Santi Martini, Randah R. Hamadeh, Somayeh Bohlouli, Joana Morgado-da-Costa, Tim Driscoll, Jingkai Wei, Hermann Brenner, Reza Rawassizadeh, Radoslaw Sierpinski, Saman Esmaeilnejad, Emmanuel Wandera Okunga, Marisa Freitas, Srikanta Banerjee, Feleke Mekonnen Demeke, Shahin Soltani, Naser Mohammad Gholi Mezerji, Reed J D Sorensen, Elena V. Gnedovskaya, Johan Ärnlöv, Ivo Rakovac, Reza Mohammadpourhodki, Hussain Jafari, Atte Meretoja, Yasir Waheed, Fahad Alanezi, Arya Haj-Mirzaian, Sezer Kisa, Jaifred Christian F. Lopez, Khalid F. Alhabib, Basema Saddik, Michael R. Phillips, Vishnu Renjith, Yafeng Wang, Kevan R. Polkinghorne, Liliana G Ciobanu, Jacek Jerzy Jozwiak, Gelin Xu, Richard C. Franklin, Junjie Wu, Thomas R. Hird, Mohammad Zamani, Diana Silva, Fotis Topouzis, Irena Ilic, Jeffrey D. Stanaway, Hadi Pourjafar, Huong Lan Thi Nguyen, Khaled Khatab, Ammas Siraj Mohammed, Ziyad Al-Aly, A. A. Fomenkov, Charlie Ashbaugh, Mowafa Househ, Paul I. Dargan, Endalkachew Worku Mengesha, Shaimaa I. El-Jaafary, Ernoiz Antriyandarti, Iffat Elbarazi, Dara K. Mohammad, Naznin Hossain, Reza Shirkoohi, João M. Furtado, Arash Ziapour, Morteza Jafarinia, M. Mofizul Islam, Anamika Pandey, Ahmed I. Hasaballah, Tanuj Kanchan, Lee Ling Lim, Muktar Omer Omer, Charles D.A. Wolfe, Ulrich O Mueller, Helen Bitew, V. Prakash, Fereshteh Mehri, Randall V. Martin, Claudiu Herteliu, Constance D. Pond, Min Jeong Shin, Morteza Oladnabi, Antonio Maria Borzì, Yousef Mohammad, Yuichiro Yano, Luke D. Knibbs, Kevin S Ikuta, Maryam Mirzaei, Andreea Mirica, Sofia Boston Redford, Siamak Sabour, Mariya Vladimirovna Titova, Davood Anvari, Ghobad Moradi, Jordi Alonso, Shiwei Liu, Theo Vos, Tuomo J. Meretoja, Ireneous N. Soyiri, Owen R. Cooper, Seyed Sina Naghibi Irvani, Kejia Hu, Hannah J. Henrikson, Sanni Yaya, Robert P. Dellavalle, Chidozie Declan Iwu, Sergey Soshnikov, Jee-Young Jasmine Choi, Satinath Mukhopadhyay, Zabihollah Yousefi, Iman El Sayed, Biresaw Wassihun Alemu, Neeti Kapoor, Ahmad Daryani, Cathleen Keller, Ibrahim Abdollahpour, Nuno Taveira, Masoud Foroutan, Fatemeh Amiri, Mariam Molokhia, Songhomitra Panda-Jonas, Amy E. Peden, Rufus Akinyemi, Ejaz Ahmad Khan, Mostafa Amini-Rarani, J. Becker, Hamidreza Pazoki Toroudi, Ben Lacey, Kidanemaryam Berhe, Simon Yadgir, Spencer L. James, Cory N. Spencer, Aletta E. Schutte, Mu'awiyyah Babale Sufiyan, Arash Tehrani-Banihashemi, Govinda Prasad Dhungana, Fereshteh Ansari, Rixing Xu, Jonathan F. Mosser, Josep Maria Haro, Enrico Rubagotti, Anurag Agrawal, Zahiruddin Quazi Syed, Hoa Thi Do, Ettore Beghi, Seyed Mohammad Kazem Aghamir, Abraham Geremew, Alireza Esteghamati, Paramjit Gill, Farzad Jalilian, J. Jason West, Mikhail Sergeevich Zastrozhin, Albertino Damasceno, Bruce Bartholow Duncan, Nazir Fattahi, Daniel Cury Ribeiro, Michael Brauer, Mark A. 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Cross, Vera Marisa Costa, Eduarda Fernandes, Chandrashekhar T Sreeramareddy, Odgerel Chimed-Ochir, Sonia Rodríguez-Ramírez, Bo Norrving, Kerem Shuval, Jacob L. Stubbs, Muhammad Ali, Shuhei Nomura, Man Mohan Mehndiratta, Chisom Joyqueenet Akunna, Abdollah Mohammadian-Hafshejani, Navid Rabiee, Dana Bryazka, Hussen Mohammed, Asadollah Gholamian, Ashley Marks, Rizwan Kalani, Molly E. Herbert, Islam Y. Elgendy, Moritz U. G. Kraemer, Chuanhua Yu, Suzanne Polinder, Pascual R. Valdez, Jennifer Rickard, Kylie Ball, Turki Alanzi, Mohsen Bayati, Hamed Mirzaei, Christopher M Odell, Amira Shaheen, Ziad A. Memish, Thirunavukkarasu Sathish, Michael A. Piradov, Hamed Kalani, Lorenzo Monasta, Christopher S Yilgwan, Desalegn Getnet Demsie, Riaz Uddin, Rizwan Suliankatchi Abdulkader, Vinay Srinivasan, Hamid Ahmadieh, Claudio Alberto Dávila-Cervantes, Raffaele Palladino, Chukwudi A Nnaji, Mika Shigematsu, Stein Emil Vollset, Abbas Sheikhtaheri, Paulo A. Lotufo, Nasir Salam, Binyam Minuye Birihane, Mohammad Ali Mansournia, Tomislav Mestrovic, Samer Hamidi, Rajesh Sagar, Mayowa O. Owolabi, Kara Estep, Ester Cerin, Michael T. Chung, Simon Øverland, Amir Taherkhani, Sheng Chia Chung, Martin Amogre Ayanore, Nikolaos Dervenis, Joan B. Soriano, Tahereh Javaheri, Victor Adekanmbi, Seid Tiku Mereta, Gbenga A. Kayode, Christopher R. Cederroth, Razique Anwer, Rajan Nikbakhsh, Kaja Abbas, Fatemeh Heydarpour, Louisa Degenhardt, Tahiya Alam, Mohammad Miri, Alibek Mereke, David Laith Rawaf, Ippazio Cosimo Antonazzo, Erkin M. Mirrakhimov, Seyed Hossein Yahyazadeh Jabbari, Desta Debalkie Atnafu, Davide Sattin, Moslem Soofi, Edris Hasanpoor, Krittika Bhattacharyya, Mika Kivimäki, Nikolay Ivanovich Briko, Joanna L Whisnant, Christopher J L Murray, Simin Mouodi, Alize J. Ferrari, Damian Santomauro, Katrin Burkart, Tudorel Andrei, Alberto Baldasseroni, Hafiz Ansar Rasul Suleria, Valery L. Feigin, Nauman Khalid, Ewerton Cousin, S. Mohammad Sajadi, Francisco Rogerlândio Martins-Melo, Shankar M Bakkannavar, Themba G.G. Ginindza, Sadaf G. Sepanlou, Sheikh Mohammed Shariful Islam, Sanjay Basu, Getinet Ayano, Paula Moraga, Soheil Hassanipour, Jason A. Anderson, Catherine Bisignano, Iyad Sultan, Deepak Kumar Pasupula, Keivan Ahmadi, Fariba Dorostkar, Rajeev Gupta, David M. Pereira, Mustafa Z. Younis, Adel Spotin, Rasmus Havmoeller, Yeshambel T. Nigatu, Barthelemy Kuate Defo, Mithila Faruque, Alan D. Lopez, Shailesh Advani, Behshad Naghshtabrizi, Shane D. Morrison, Inga Dora Sigfusdottir, Konrad Pesudovs, Anna Gershberg Hayoon, Raaj Kishore Biswas, Reshmi Bhageerathy, H. Dean Hosgood, Giulia Carreras, Sarika Chaturvedi, James L. Fisher, In-Hwan Oh, G Anil Kumar, Christoph Nowak, Vijay Kumar Chattu, Puja C Rao, Marcel Ausloos, Ali Kabir, Rannveig Sigurvinsdottir, Leeberk Raja Inbaraj, Edgar Denova-Gutiérrez, Rafael Tabarés-Seisdedos, Minh Nguyen, Ashkan Afshin, Payman Salamati, Colin Angus, Mona M. 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Campos-Nonato, Biniyam Sahiledengle Geberemariyam, Godfrey Mutashambara Rwegerera, Alaa Badawi, James Leigh, Morteza Arab-Zozani, Kyle E. Simpson, Muluken Bekele Sorrie, Roghiyeh Faridnia, Vivekanand Jha, Tomasz Miazgowski, Aaron J Cohen, Chukwuma David Umeokonkwo, Alessandra Lugo, Adhanom Gebreegziabher Baraki, Akshaya Srikanth Bhagavathula, Caitlyn Steiner, Gholamreza Roshandel, Cuong Tat Nguyen, Tania G Sánchez-Pimienta, Ahamarshan Jayaraman Nagarajan, Laura Kemmer, Ihoghosa Osamuyi Iyamu, Seyedeh Zahra Masoumi, Vivian Chia-Rong Hsieh, Kris J. Krohn, Phoebe Anne Rhinehart, Sarah Wozniak, Sahar Saeedi Moghaddam, Kate E. LeGrand, Christian Kieling, Vahid Yazdi-Feyzabadi, Robin Room, Zelalem Nigussie Azene, Kelly Cercy, Paul H. Lee, Stanislav S. Otstavnov, Dinesh Bhandari, Rafael Alves Guimarães, Zemenu Tadesse Tessema, Aziz Sheikh, Michellr L. Bell, Marwa Rashad Salem, Kirsten E. Wiens, Emma U.R. Smith, Hassan Abolhassani, Cristiano Piccinelli, Kedir Hussein Abegaz, G.K. Mini, Christian Razo, Manuela L. Ferreira, Diego De Leo, Francesco Saverio Violante, Aristidis Tsatsakis, Zahra Sadat Dibaji Forooshani, Tea Lallukka, Dickson A. Amugsi, Anna Poznańska, Graeme J. Hankey, Kewal Krishan, Maryam Zamanian, Eirini Skiadaresi, Jai K Das, Felix Greaves, Tessa M. Pilz, Sameer Vali Gopalani, Mansour Ghafourifard, M. DeLang, Morteza Mahmoudi, Alton Lu, Brian J. Hall, Ravi Prakash Jha, David Edvardsson, Xiu Ju George Zhao, Farshad Farzadfar, Hadi Hassankhani, Samuel M. Ostroff, Gerhard Sulo, Keyghobad Ghadiri, Neeraj Bhala, Stefan Lorkowski, Mohammad Rabiee, Sivan Yegnanarayana Iyer Saraswathy, Amirhossein Sahebkar, Rashid Abdi Guled, Abdallah M. Samy, Roman Topor-Madry, Michal Grivna, Afsaneh Arzani, Ayesha Humayun, Simin Liu, Maryam Khayamzadeh, Davoud Adham, Ahad Bakhtiari, Shafiu Mohammed, Paolo Lauriola, Abbas Mosapour, Sophia Emmons-Bell, Khurshid Alam, Rajat Das Gupta, Matilde Leonardi, Muktar Beshir Ahmed, Jeffrey V. Lazarus, Mohamed M. 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Leonardi, M, Lescinsky, H, Leung, J, Levi, M, Li, S, Lim, L, Linn, S, Liu, S, Liu, Y, Lo, J, Lopez, A, Lopez, J, Lopukhov, P, Lorkowski, S, Lotufo, P, Lu, A, Lugo, A, Maddison, E, Mahasha, P, Mahdavi, M, Mahmoudi, M, Majeed, A, Maleki, A, Maleki, S, Malekzadeh, R, Malta, D, Mamun, A, Manda, A, Manguerra, H, Mansour-Ghanaei, F, Mansouri, B, Mansournia, M, Mantilla Herrera, A, Maravilla, J, Marks, A, Martin, R, Martini, S, Martins-Melo, F, Masaka, A, Masoumi, S, Mathur, M, Matsushita, K, Maulik, P, Mcalinden, C, Mcgrath, J, Mckee, M, Mehndiratta, M, Mehri, F, Mehta, K, Memish, Z, Mendoza, W, Menezes, R, Mengesha, E, Mereke, A, Mereta, S, Meretoja, A, Meretoja, T, Mestrovic, T, Miazgowski, B, Miazgowski, T, Michalek, I, Miller, T, Mills, E, Mini, G, Miri, M, Mirica, A, Mirrakhimov, E, Mirzaei, H, Mirzaei, M, Mirzaei, R, Mirzaei-Alavijeh, M, Misganaw, A, Mithra, P, Moazen, B, Mohammad, D, Mohammad, Y, Mohammad Gholi Mezerji, N, Mohammadian-Hafshejani, A, Mohammadifard, N, Mohammadpourhodki, R, Mohammed, A, Mohammed, H, Mohammed, J, Mohammed, S, Mokdad, A, Molokhia, M, Monasta, L, Mooney, M, Moradi, G, Moradi, M, Moradi-Lakeh, M, Moradzadeh, R, Moraga, P, Morawska, L, Morgado-Da-Costa, J, Morrison, S, Mosapour, A, Mosser, J, Mouodi, S, Mousavi, S, Khaneghah, A, Mueller, U, Mukhopadhyay, S, Mullany, E, Musa, K, Muthupandian, S, Nabhan, A, Naderi, M, Nagarajan, A, Nagel, G, Naghavi, M, Naghshtabrizi, B, Naimzada, M, Najafi, F, Nangia, V, Nansseu, J, Naserbakht, M, Nayak, V, Negoi, I, Ngunjiri, J, Nguyen, C, Nguyen, H, Nguyen, M, Nigatu, Y, Nikbakhsh, R, Nixon, M, Nnaji, C, Nomura, S, Norrving, B, Noubiap, J, Nowak, C, Nunez-Samudio, V, Oancea, B, Odell, C, Ogbo, F, Oh, I, Okunga, E, Oladnabi, M, Olagunju, A, Olusanya, B, Olusanya, J, Omer, M, Ong, K, Onwujekwe, O, Orpana, H, Ortiz, A, Osarenotor, O, Osei, F, Ostroff, S, Otoiu, A, Otstavnov, N, Otstavnov, S, Overland, S, Owolabi, M, Mahesh, P, Padubidri, J, Palladino, R, Panda-Jonas, S, Pandey, A, Parry, C, Pasovic, M, Pasupula, D, Patel, S, Pathak, M, Patten, S, Patton, G, Toroudi, H, Peden, A, Pennini, A, Pepito, V, Peprah, E, Pereira, D, Pesudovs, K, Pham, H, Phillips, M, Piccinelli, C, Pilz, T, Piradov, M, Pirsaheb, M, Plass, D, Polinder, S, Polkinghorne, K, Pond, C, Postma, M, Pourjafar, H, Pourmalek, F, Poznanska, A, Prada, S, Prakash, V, Pribadi, D, Pupillo, E, Syed, Z, Rabiee, M, Rabiee, N, Radfar, A, Rafiee, A, Raggi, A, Rahman, M, Rajabpour-Sanati, A, Rajati, F, Rakovac, I, Ram, P, Ramezanzadeh, K, Ranabhat, C, Rao, P, Rao, S, Rashedi, V, Rathi, P, Rawaf, D, Rawaf, S, Rawal, L, Rawassizadeh, R, Rawat, R, Razo, C, Redford, S, Reiner, R, Reitsma, M, Remuzzi, G, Renjith, V, Renzaho, A, Resnikoff, S, Rezaei, N, Rezapour, A, Rhinehart, P, Riahi, S, Ribeiro, D, Rickard, J, Rivera, J, Roberts, N, Rodriguez-Ramirez, S, Roever, L, Ronfani, L, Room, R, Roshandel, G, Roth, G, Rothenbacher, D, Rubagotti, E, Rwegerera, G, Sabour, S, Sachdev, P, Saddik, B, Sadeghi, E, Sadeghi, M, Saeedi, R, Saeedi Moghaddam, S, Safari, Y, Safi, S, Safiri, S, Sagar, R, Sahebkar, A, Sajadi, S, Salam, N, Salamati, P, Salem, H, Salem, M, Salimzadeh, H, Salman, O, Salomon, J, Samad, Z, Samadi Kafil, H, Sambala, E, Samy, A, Sanabria, J, Sanchez-Pimienta, T, Santomauro, D, Santos, I, Santos, J, Santric-Milicevic, M, Saraswathy, S, Sarmiento-Suarez, R, Sarrafzadegan, N, Sarveazad, A, Sathian, B, Sathish, T, Sattin, D, Saxena, S, Schaeffer, L, Schiavolin, S, Schlaich, M, Schmidt, M, Schutte, A, Schwebel, D, Schwendicke, F, Senbeta, A, Senthilkumaran, S, Sepanlou, S, Serdar, B, Serre, M, Shadid, J, Shafaat, O, Shahabi, S, Shaheen, A, Shaikh, M, Shalash, A, Shams-Beyranvand, M, Shamsizadeh, M, Sharafi, K, Sheikh, A, Sheikhtaheri, A, Shibuya, K, Shield, K, Shigematsu, M, Shin, J, Shin, M, Shiri, R, Shirkoohi, R, Shuval, K, Siabani, S, Sierpinski, R, Sigfusdottir, I, Sigurvinsdottir, R, Silva, J, Simpson, K, Singh, J, Singh, P, Skiadaresi, E, Skou, S, Skryabin, V, Smith, E, Soheili, A, Soltani, S, Soofi, M, Sorensen, R, Soriano, J, Sorrie, M, Soshnikov, S, Soyiri, I, Spencer, C, Spotin, A, Sreeramareddy, C, Srinivasan, V, Stanaway, J, Stein, C, Stein, D, Steiner, C, Stockfelt, L, Stokes, M, Straif, K, Stubbs, J, Sufiyan, M, Suleria, H, Suliankatchi Abdulkader, R, Sulo, G, Sultan, I, Tabares-Seisdedos, R, Tabb, K, Tabuchi, T, Taherkhani, A, Tajdini, M, Takahashi, K, Takala, J, Tamiru, A, Taveira, N, Tehrani-Banihashemi, A, Temsah, M, Tesema, G, Tessema, Z, Thurston, G, Titova, M, Tohidinik, H, Tonelli, M, Topor-Madry, R, Topouzis, F, Torre, A, Touvier, M, Tovani-Palone, M, Tran, B, Travillian, R, Tsatsakis, A, Tudor Car, L, Tyrovolas, S, Uddin, R, Umeokonkwo, C, Unnikrishnan, B, Upadhyay, E, Vacante, M, Valdez, P, van Donkelaar, A, Vasankari, T, Vasseghian, Y, Veisani, Y, Venketasubramanian, N, Violante, F, Vlassov, V, Vollset, S, Vos, T, Vukovic, R, Waheed, Y, Wallin, M, Wang, Y, Watson, A, Wei, J, Wei, M, Weintraub, R, Weiss, J, Werdecker, A, West, J, Westerman, R, Whisnant, J, Whiteford, H, Wiens, K, Wolfe, C, Wozniak, S, Wu, A, Wu, J, Wulf Hanson, S, Xu, G, Xu, R, Yadgir, S, Yahyazadeh Jabbari, S, Yamagishi, K, Yaminfirooz, M, Yano, Y, Yaya, S, Yazdi-Feyzabadi, V, Yeheyis, T, Yilgwan, C, Yilma, M, Yip, P, Yonemoto, N, Younis, M, Younker, T, Yousefi, B, Yousefi, Z, Yousefinezhadi, T, Yousuf, A, Yu, C, Yusefzadeh, H, Moghadam, T, Zamani, M, Zamanian, M, Zandian, H, Zastrozhin, M, Zhang, Y, Zhang, Z, Zhao, J, Zhao, X, Zhao, Y, Zheng, P, Zhou, M, Ziapour, A, Zimsen, S, Lim, S, Murray, C, GBD 2019 Risk Factors Collaborator, Violante FS, Biosciences, Department of Public Health, Clinicum, Department of Neurosciences, HUS Comprehensive Cancer Center, Environmental Sciences, Sub Foundations&PhilosophyofNaturSc begr, IRAS OH Epidemiology Chemical Agents, dIRAS RA-2, Public Health, Bin Sayeed, M. S. B., Caetano Dos Santos, F. L., Camera, L. A., Elyazar, I. R. F., Ayalew Gebreslassie, A. A. A., Ginindza, T. G., Matin, B. K., Morgado-Da-Costa, J., Khaneghah, A. M., Mahesh, P. A., Toroudi, H. P., Syed, Z. Q., Salem, M. R., Skou, S. T., Tovani-Palone, M. R., Tudor Car, L. T., and Moghadam, T. Z.

Subjects
Male, Nutritional Sciences, Specific risk, Contaminación del Aire Interior, 030204 cardiovascular system & hematology, Socioeconomic Factor, systematic analysis, Global Health, Body Mass Index, Global Burden of Disease, Health Risk Behavior, Health Risk Behaviors, Disease studies, 0302 clinical medicine, Risk Factors, METABOLIC RISKS, 030212 general & internal medicine, 11 Medical and Health Sciences, Factores de Riesgo, 2. Zero hunger, education.field_of_study, Public health, Injuries, Public Health, Global Health, Social Medicine and Epidemiology, General Medicine, GBD, risck factors, attributable burden of disease, 3142 Public health care science, environmental and occupational health, 3. Good health, Relative risk, Environmental health, Health, Hypertension, Global Burden of Diseases, Injuries, Risk Factors, A990 Medicine and Dentistry not elsewhere classified, Female, Leading risk factors, Global Health Metrics, Cohort study, Human, medicine.medical_specialty, Substance-Related Disorders, Population, UNITED-STATES, Risk Assessment, DIET, ITC-HYBRID, 03 medical and health sciences, Life Expectancy, MORTALITY, DISABILITY, POLLUTION, CLUSTERS, SDG 3 - Good Health and Well-being, General & Internal Medicine, medicine, Humans, Global Burden of Disease Study, Risk factor, education, Global burden, business.industry, Risk Factor, Malnutrition, Klinisk medicin, Global Burden of Diseases, Environmental Exposure, medicine.disease, Enfermedades, purl.org/pe-repo/ocde/ford#3.02.00 [https], Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Years of potential life lost, Socioeconomic Factors, Risk factors, Disease study, Hyperglycemia, ITC-ISI-JOURNAL-ARTICLE, NA, Clinical Medicine, business, RA
Abstract

Background Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. Methods GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk-outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk-outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk-outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. Findings The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10.8 million (95% uncertainty interval [UI] 9.51-12.1) deaths (19.2% [16.9-21.3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8.71 million (8.12-9.31) deaths (15.4% [14.6-16.2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253-350) DALYs (11.6% [10.3-13.1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0-9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10-24 years, alcohol use for those aged 25-49 years, and high systolic blood pressure for those aged 50-74 years and 75 years and older. Interpretation Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.

Published
2020

8. Prevalence and attributable health burden of chronic respiratory diseases, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Author

Mohsen Naghavi, Maarten J. Postma, Mahesh P A, Milena Santric-Milicevic, Barbora de Courten, Parvaiz A Koul, Elias Merdassa Roro, Marek Majdan, Ali H. Mokdad, Mihaela Hostiuc, Félix Carvalho, Rufus A. Adedoyin, Miriam Levi, Ejaz Ahmad Khan, Rakhi Dandona, Mohamad-Hani Temsah, Catalina Liliana Andrei, Benn Sartorius, Gebre Teklemariam Demoz, Derrick A Bennett, Ahmad Daryani, Paulo A. Lotufo, Fereshteh Ansari, Elissa M. Abrams, Luke D. Knibbs, Seyyed Meysam Mousavi, Azeem Majeed, Tomislav Mestrovic, Rajeev Gupta, Irina Filip, Leonardo Roever, G.K. Mini, Lorainne Tudor Car, Ghulam Mustafa, Josip Car, Lalit Dandona, Masoud Moradi, Molly R Nixon, Mohammad Zamani, Babak Moazen, Devasahayam J. Christopher, Chi Linh Hoang, Aaron J Cohen, Hossein Poustchi, Luca Ronfani, Sheikh Mohammed Shariful Islam, Nefsu Awoke, Miguel Tortajada-Girbés, Khalid A Altirkawi, Justin R. Ortiz, Adane Teshome Kefale, Shailesh Advani, Alireza Rafiei, Kristina E. Rudd, Tim Driscoll, Yousef Khader, Heather J. Zar, Josep M. Antó, Milena Ilic, Fakher Rahim, Jost B. Jonas, Trang Huyen Nguyen, Yonatal Mesfin Tefera, Simon I. Hay, Aloke Gopal Ghoshal, Adnan Kisa, Ranjani Somayaji, Gholamreza Roshandel, Smita Pakhale, Francesco Saverio Violante, Monika Sawhney, Eyal Oren, Ali Bijani, Gebrekiros Gebremichael Meles, Hajer Elkout, Shanshan Li, Michael Soljak, Masoud Foroutan, Narayan Bahadur Mahotra, Mina Anjomshoa, Jasvinder A. Singh, Mika Shigematsu, Abdel Douiri, Naohiro Yonemoto, Amir Kasaeian, Lorenzo Monasta, Hagazi Gebre Meles, Rupak Desai, Hai Quang Pham, Feleke Mekonnen Demeke, Marissa B Reitsma, Samath D Dharmaratne, Amr Jamal, Miguel Ángel García-Gordillo, Seyed Sina Naghibi Irvani, Michael K. Hole, Aman Yesuf Endries, Vinay Gupta, Mehdi Naderi, Tham Thi Le, Houman Goudarzi, Hamid Yimam Hassen, Siamak Sabour, Theo Vos, Anurag Agrawal, Ireneous N. Soyiri, Kathleen S Sachiko Berfield, Charles D.A. Wolfe, Jobert Richie Nansseu, Robert C. Reiner, Carlo La Vecchia, Michael Brauer, Jagdish Khubchandani, Alaa Badawi, Sezer Kisa, Basema Saddik, Amir Hasanzadeh, H. Dean Hosgood, Berhe Etsay Tesfay, Ibtihal Fadhil, Ketema Bizuwork Gebremedhin, Ai Koyanagi, Maheswar Satpathy, James Leigh, Si Si, Gregory R. Wagner, Eduarda Fernandes, Huong Lan Thi Nguyen, Isabela M. Benseñor, Tommi Vasankari, Gebreamlak Gebremedhn Gebremeskel, Andrew T Olagunju, Moslem Soofi, Jalal Arabloo, Muhammad Aziz Rahman, Mowafa Househ, Amir Radfar, Gebremicheal Gebreslassie Kasahun, Tara Ballav Adhikari, Songhomitra Panda-Jonas, Gessessew Bugssa Hailu, Komal Saleem, Bach Xuan Tran, Lal B. Rawal, Jee-Young Jasmine Choi, Hadi Pourjafar, Robert S. Bernstein, Ghobad Moradi, Farnam Mohebi, Mariam Molokhia, Kamarul Imran Musa, Elham Ahmadian, Pascual R. Valdez, Irfan Ullah, Ritesh G. Menezes, Dawit Zewdu Wondafrash, Olayinka Stephen Ilesanmi, Masood Ali Shaikh, Richard F. Gillum, Aziz Sheikh, Eun-Kee Park, Virendra Singh, Aziz Eftekhari, Yogesh Sabde, Florian Fischer, Krittika Bhattacharyya, Syed Mohamed Aljunid, Alemayehu Toma, Ruxandra Irina Negoi, Kebede Embaye Gezae, Abadi Kahsu Gebre, Abdullah Al Mamun, Junaid Khan, Yuming Guo, Parkes J Kendrick, Reza Malekzadeh, Bruno Piassi Sao Jose, Mohammad Hifz Ur Rahman, Lidia Morawska, Soraya Siabani, Tinuke O Olagunju, Zahid A Butt, Ronny Westerman, Eyasu Ejeta Duken, Khanh Bao Tran, Yousef Veisani, Getachew Mullu Kassa, Erkin M. Mirrakhimov, Miloje Savic, Anh Kim Dang, Vinay Nangia, Job F M van Boven, Adam Belay Wondmieneh, Alan D. Lopez, G Anil Kumar, Navid Manafi, Andre Pascal Kengne, Joan B. Soriano, Luis Camera, Seok Jun Yoon, Paramjit Gill, Yun Jin Kim, Seyyede Masoume Athari, Gurudatta Naik, Sadaf G. Sepanlou, Sanjeev Nair, Jarnail Singh Thakur, André Faro, Javad Nazari, Gene Bukhman, Nelson Alvis-Guzman, Mayowa O. Owolabi, Lorenzo G. Mantovani, Nobuyuki Horita, Zubair Kabir, Felix Akpojene Ogbo, Birhanu Geta Meharie, Daniel Diaz, Adrian Pana, Salman Rawaf, Mihajlo Jakovljevic, Ted R. Miller, Savita Lasrado, Joseph Adel Mattar Banoub, Fares Alahdab, Jan-Walter De Neve, Carlos A Castañeda-Orjuela, Saeed Safari, Farzad Manafi, Marco Vacante, Katherine R. Paulson, Hamidreza Komaki, Reza Shirkoohi, Young Eun Kim, Duduzile Ndwandwe, Nahla Anber, Ravi Prakash Jha, Farshad Farzadfar, Abdallah M. Samy, Richard Ofori-Asenso, Shafiu Mohammed, Paolo Lauriola, Fabiana Madotto, Yunquan Zhang, Qing Lan, David Laith Rawaf, Zoubida Zaidi, Karzan Abdulmuhsin Mohammad, Juan Jesus Carrero, Morteza Abdullatif Khafaie, Seyyed Shamsadin Athari, Cuong Tat Nguyen, UAM. Departamento de Medicina, Instituto de Investigación Sanitaria Hospital Universitario de La Princesa (IIS-IP), Soriano, J, Kendrick, P, Paulson, K, Gupta, V, Abrams, E, Adedoyin, R, Adhikari, T, Advani, S, Agrawal, A, Ahmadian, E, Alahdab, F, Aljunid, S, Altirkawi, K, Alvis-Guzman, N, Anber, N, Andrei, C, Anjomshoa, M, Ansari, F, Anto, J, Arabloo, J, Athari, S, Awoke, N, Badawi, A, Banoub, J, Bennett, D, Bensenor, I, Berfield, K, Bernstein, R, Bhattacharyya, K, Bijani, A, Brauer, M, Bukhman, G, Butt, Z, Camera, L, Car, J, Carrero, J, Carvalho, F, Castaneda-Orjuela, C, Choi, J, Christopher, D, Cohen, A, Dandona, L, Dandona, R, Dang, A, Daryani, A, de Courten, B, Demeke, F, Demoz, G, De Neve, J, Desai, R, Dharmaratne, S, Diaz, D, Douiri, A, Driscoll, T, Duken, E, Eftekhari, A, Elkout, H, Endries, A, Fadhil, I, Faro, A, Farzadfar, F, Fernandes, E, Filip, I, Fischer, F, Foroutan, M, Garcia-Gordillo, M, Gebre, A, Gebremedhin, K, Gebremeskel, G, Gezae, K, Ghoshal, A, Gill, P, Gillum, R, Goudarzi, H, Guo, Y, Gupta, R, Hailu, G, Hasanzadeh, A, Hassen, H, Hay, S, Hoang, C, Hole, M, Horita, N, Hosgood, H, Hostiuc, M, Househ, M, Ilesanmi, O, Ilic, M, Irvani, S, Islam, S, Jakovljevic, M, Jamal, A, Jha, R, Jonas, J, Kabir, Z, Kasaeian, A, Kasahun, G, Kassa, G, Kefale, A, Kengne, A, Khader, Y, Khafaie, M, Khan, E, Khan, J, Khubchandani, J, Kim, Y, Kisa, S, Kisa, A, Knibbs, L, Komaki, H, Koul, P, Koyanagi, A, Kumar, G, Lan, Q, Lasrado, S, Lauriola, P, La Vecchia, C, Le, T, Leigh, J, Levi, M, Li, S, Lopez, A, Lotufo, P, Madotto, F, Mahotra, N, Majdan, M, Majeed, A, Malekzadeh, R, Mamun, A, Manafi, N, Manafi, F, Mantovani, L, Meharie, B, Meles, H, Meles, G, Menezes, R, Mestrovic, T, Miller, T, Mini, G, Mirrakhimov, E, Moazen, B, Mohammad, K, Mohammed, S, Mohebi, F, Mokdad, A, Molokhia, M, Monasta, L, Moradi, M, Moradi, G, Morawska, L, Mousavi, S, Musa, K, Mustafa, G, Naderi, M, Naghavi, M, Naik, G, Nair, S, Nangia, V, Nansseu, J, Nazari, J, Ndwandwe, D, Negoi, R, Nguyen, T, Nguyen, C, Nguyen, H, Nixon, M, Ofori-Asenso, R, Ogbo, F, Olagunju, A, Olagunju, T, Oren, E, Ortiz, J, Owolabi, M, P A, M, Pakhale, S, Pana, A, Panda-Jonas, S, Park, E, Pham, H, Postma, M, Pourjafar, H, Poustchi, H, Radfar, A, Rafiei, A, Rahim, F, Rahman, M, Rawaf, S, Rawaf, D, Rawal, L, Reiner, R, Reitsma, M, Roever, L, Ronfani, L, Roro, E, Roshandel, G, Rudd, K, Sabde, Y, Sabour, S, Saddik, B, Safari, S, Saleem, K, Samy, A, Santric-Milicevic, M, Sao Jose, B, Sartorius, B, Satpathy, M, Savic, M, Sawhney, M, Sepanlou, S, Shaikh, M, Sheikh, A, Shigematsu, M, Shirkoohi, R, Si, S, Siabani, S, Singh, V, Singh, J, Soljak, M, Somayaji, R, Soofi, M, Soyiri, I, Tefera, Y, Temsah, M, Tesfay, B, Thakur, J, Toma, A, Tortajada-Girbes, M, Tran, K, Tran, B, Tudor Car, L, Ullah, I, Vacante, M, Valdez, P, van Boven, J, Vasankari, T, Veisani, Y, Violante, F, Wagner, G, Westerman, R, Wolfe, C, Wondafrash, D, Wondmieneh, A, Yonemoto, N, Yoon, S, Zaidi, Z, Zamani, M, Zar, H, Zhang, Y, Vos, T, GBD Chronic Respiratory Disease Collaborator, Violante FS, GBD Chronic Respiratory Disease Collaborators, Collaborators, GBD Chronic Respiratory Disease, Groningen Research Institute for Asthma and COPD (GRIAC), Value, Affordability and Sustainability (VALUE), and Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET)

Subjects
Male, Respiratory diseases, Respiratory Tract Diseases, Disease, Chronic respiratory diseases, Global Burden of Disease, Pulmonary Disease, Chronic Obstructive, 0302 clinical medicine, Cost of Illness, 11. Sustainability, METABOLIC RISKS, EPIDEMIOLOGY, 030212 general & internal medicine, Child, Cause of death, Aged, 80 and over, COPD, DALY, Chronic obstructive pulmonary disease, Mortality rate, Respiratory disease, 1. No poverty, Age Factors, Middle Aged, Death causes, 3. Good health, PREVALENCE, Health risks, Child, Preschool, COMPARATIVE RISK-ASSESSMENT, Female, death and disability worldwide, Quality-Adjusted Life Years, TERRITORIES, BURDEN, growth in absolute numbers, Pulmonary and Respiratory Medicine, Adult, ADJUSTED LIFE-YEARS, Health burdens, Adolescent, Medicina, 195 COUNTRIES, chronic respiratory diseases, Article, 1117 Public Health and Health Services, 03 medical and health sciences, Young Adult, Life Expectancy, Sex Factors, Burden of Disease, Respiratory disease, Sarcoidosis, Pulmonary, Environmental health, medicine, Disability-adjusted life year, Humans, EXPOSURE, Risk factor, Mortality, Aged, per-capita basis, business.industry, DISABILITY, Infant, Newborn, Infant, 1103 Clinical Sciences, asthma, medicine.disease, Asthma, Years of potential life lost, 030228 respiratory system, Risk factors, 13. Climate action, Systematic analyses, Chronic Disease, INJURIES, Human medicine, Pneumoconiosis, Morbidity, business, Lung Diseases, Interstitial, 1199 Other Medical and Health Sciences
Abstract

Artículo con numerosos autores. Sólo se hace referencia al primero que coincide con el de la UAM y al colectivo, Background Previous attempts to characterise the burden of chronic respiratory diseases have focused only on specific disease conditions, such as chronic obstructive pulmonary disease (COPD) or asthma. In this study, we aimed to characterise the burden of chronic respiratory diseases globally, providing a comprehensive and up-to-date analysis on geographical and time trends from 1990 to 2017. Methods Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, we estimated the prevalence, morbidity, and mortality attributable to chronic respiratory diseases through an analysis of deaths, disability-adjusted life-years (DALYs), and years of life lost (YLL) by GBD super-region, from 1990 to 2017, stratified by age and sex. Specific diseases analysed included asthma, COPD, interstitial lung disease and pulmonary sarcoidosis, pneumoconiosis, and other chronic respiratory diseases. We also assessed the contribution of risk factors (smoking, second-hand smoke, ambient particulate matter and ozone pollution, household air pollution from solid fuels, and occupational risks) to chronic respiratory disease-attributable DALYs. Findings In 2017, 544·9 million people (95% uncertainty interval [UI] 506·9–584·8) worldwide had a chronic respiratory disease, representing an increase of 39·8% compared with 1990. Chronic respiratory disease prevalence showed wide variability across GBD super-regions, with the highest prevalence among both males and females in high-income regions, and the lowest prevalence in sub-Saharan Africa and south Asia. The age-sex-specific prevalence of each chronic respiratory disease in 2017 was also highly variable geographically. Chronic respiratory diseases were the third leading cause of death in 2017 (7·0% [95% UI 6·8–7·2] of all deaths), behind cardiovascular diseases and neoplasms. Deaths due to chronic respiratory diseases numbered 3 914 196 (95% UI 3 790 578–4 044 819) in 2017, an increase of 18·0% since 1990, while total DALYs increased by 13·3%. However, when accounting for ageing and population growth, declines were observed in age-standardised prevalence (14·3% decrease), agestandardised death rates (42·6%), and age-standardised DALY rates (38·2%). In males and females, most chronic respiratory disease-attributable deaths and DALYs were due to COPD. In regional analyses, mortality rates from chronic respiratory diseases were greatest in south Asia and lowest in sub-Saharan Africa, also across both sexes. Notably, although absolute prevalence was lower in south Asia than in most other super-regions, YLLs due to chronic respiratory diseases across the subcontinent were the highest in the world. Death rates due to interstitial lung disease and pulmonary sarcoidosis were greater than those due to pneumoconiosis in all super-regions. Smoking was the leading risk factor for chronic respiratory disease-related disability across all regions for men. Among women, household air pollution from solid fuels was the predominant risk factor for chronic respiratory diseases in south Asia and sub-Saharan Africa, while ambient particulate matter represented the leading risk factor in southeast Asia, east Asia, and Oceania, and in the Middle East and north Africa super-region. Interpretation Our study shows that chronic respiratory diseases remain a leading cause of death and disability worldwide, with growth in absolute numbers but sharp declines in several age-standardised estimators since 1990. Premature mortality from chronic respiratory diseases seems to be highest in regions with less-resourced health systems on a per-capita basis, Bill & Melinda Gates Foundation.

Published
2020

9. Global and regional burden of chronic respiratory disease in 2016 arising from non-infectious airborne occupational exposures: a systematic analysis for the Global Burden of Disease Study 2016

Author

Driscoll T, Steenland K, Pearce N, Rushton L, Hutchings S, Straif K, Abate D, Acharya D, Agrawal A, Alahdab F, Alene K, Androudi S, Anjomshoa M, Antonio C, Aremu O, Ataro Z, Badaw A, Banoub J, Barker-Collo S, Bedi N, Bennett D, Bernstein R, Beuran M, Bhattacharyya K, Bijani A, Butt Z, Carrero J, Castaneda-Orjuela C, Chimed-Ochir O, Dandona L, Dandona R, Dang A, Daryani A, Desalegn B, Dharmaratne S, Djalalinia S, Dubljanin E, Ebrahimpour S, El-Khatib Z, Fareed M, Faro A, Fernandes E, Fischer F, Fukumoto T, Gallus S, Gebremichae T, Gezae K, Grada A, Guo Y, Gupta R, Haj-Mirzaian A, Hamidi S, Hasan M, Hasankhani M, Hay S, Hoang C, Hole M, Hosgood H, Hostiuc M, Hostiuc S, Irvani S, Islam S, Jakovljevic M, Jha R, Jonas J, Kahsay A, Kasaeian A, Kawakami N, Khader Y, Khafaie M, Khan E, Khosravi M, Khubchandani J, Kim Y, Kimokoti R, Kisa A, Kogevinas M, Kosen S, Koul P, Koyanagi A, Defo B, Kumar G, Lal D, Latif A, Leigh J, Levi M, Li S, Linn S, Mahotra N, Majdan M, Malekzadeh R, Mansournia M, Martins-Melo F, Massenburg B, Mehta V, Melese A, Melku M, Memish Z, Mendoza W, Meretoja T, Mestrovic T, Mini G, Mirrakhimov E, Moazen B, Mezerji N, Mohammed S, Mokdad A, Monasta L, Moodley Y, Moosazadeh M, Moradi G, Morawska L, Morrison S, Mousav S, Mustafa G, Nangia V, Nego I, Negoi R, Nguyen C, Nguyen T, Nixon M, Ofori-Asenso R, Ogbo F, Olagunju A, Olusanya B, Mahesh P, Panda-Jonas S, Park E, Pati S, Qorbani M, Rafay A, Rafiei A, Rahim F, Rahimi-Movaghar V, Rajati F, Reiner R, Rezaei S, Roever L, Ronfani L, Roshandel G, Saddik B, Safir S, Sahraian M, Samy A, Schwebel D, Sepanlou S, Serdar B, Shaikh M, Sheikh A, Shigematsu M, Shiri R, Shirkoohi R, Si S, Silva J, Sinha D, Soofi M, Soriano J, Sreeramareddy C, Stanaway J, Stokes M, Sufiyan M, Sutradhar I, Tabares-Seisdedos R, Takahashi K, Tefera Y, Temsah M, Tovani-Palone M, Tran B, Tran K, Car L, Ullah I, Valdez P, van Boven J, Vasankari T, Violante F, Vu G, Wagner G, Waheed Y, Wang Y, Yirsaw B, Yonemoto N, Yu C, Zamani M, Lim S, GBD 2016 Occupational Chronic, Collaborators, GBD 2016 Occupational Chronic Respiratory Risk Factors, GBD 2016 Occupational Chronic Respiratory Risk Factors Collaborator, Violante FS, Groningen Research Institute for Asthma and COPD (GRIAC), Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), and Value, Affordability and Sustainability (VALUE)

Subjects
pneumoconiosis, Population, GBD 2016 occupational chronic respiratory risk factors collaborators, OBSTRUCTIVE PULMONARY-DISEASE, Environmental & Occupational Health, 1117 Public Health and Health Services, 03 medical and health sciences, 0302 clinical medicine, 1599 Other Commerce, Management, Tourism and Services, Environmental health, METABOLIC RISKS, Medicine, COPD, 030212 general & internal medicine, Workplace, education, Public, Environmental & Occupational Health, Cause of death, Asthma, WORK, education.field_of_study, Science & Technology, ONSET ASTHMA, business.industry, STATEMENT, Pneumoconiosis, Public Health, Environmental and Occupational Health, 1103 Clinical Sciences, occupational exposure, medicine.disease, 3. Good health, Quality-adjusted life year, PREVALENCE, occupational asthma, work, 030228 respiratory system, Relative risk, Attributable risk, COMPARATIVE RISK-ASSESSMENT, NA, business, CLUSTERS, Life Sciences & Biomedicine, LUNG
Abstract

ObjectivesThis paper presents detailed analysis of the global and regional burden of chronic respiratory disease arising from occupational airborne exposures, as estimated in the Global Burden of Disease 2016 study.MethodsThe burden of chronic obstructive pulmonary disease (COPD) due to occupational exposure to particulate matter, gases and fumes, and secondhand smoke, and the burden of asthma resulting from occupational exposure to asthmagens, was estimated using the population attributable fraction (PAF), calculated using exposure prevalence and relative risks from the literature. PAFs were applied to the number of deaths and disability-adjusted life years (DALYs) for COPD and asthma. Pneumoconioses were estimated directly from cause of death data. Age-standardised rates were based only on persons aged 15 years and above.ResultsThe estimated PAFs (based on DALYs) were 17% (95% uncertainty interval (UI) 14%–20%) for COPD and 10% (95% UI 9%–11%) for asthma. There were estimated to be 519 000 (95% UI 441,000–609,000) deaths from chronic respiratory disease in 2016 due to occupational airborne risk factors (COPD: 460,100 [95% UI 382,000–551,000]; asthma: 37,600 [95% UI 28,400–47,900]; pneumoconioses: 21,500 [95% UI 17,900–25,400]. The equivalent overall burden estimate was 13.6 million (95% UI 11.9–15.5 million); DALYs (COPD: 10.7 [95% UI 9.0–12.5] million; asthma: 2.3 [95% UI 1.9–2.9] million; pneumoconioses: 0.58 [95% UI 0.46–0.67] million). Rates were highest in males; older persons and mainly in Oceania, Asia and sub-Saharan Africa; and decreased from 1990 to 2016.ConclusionsWorkplace exposures resulting in COPD, asthma and pneumoconiosis continue to be important contributors to the burden of disease in all regions of the world. This should be reducible through improved prevention and control of relevant exposures.

Published
2020

10. Global and regional burden of cancer in 2016 arising from occupational exposure to selected carcinogens: a systematic analysis for the Global Burden of Disease Study 2016

Author

Driscoll, T, Rushton, L, Steenland, K, Hutchings, S, Straif, K, Abate, D, Abdel-Rahman, O, Acharya, D, Afarideh, M, Alahdab, F, Al-Aly, Z, Anjomshoa, M, Aremu, O, Artaman, A, Ataro, Z, Quintanilla, BPA, Badawi, A, Behzadifar, M, Beuran, M, Bhattacharyya, K, Bijani, A, Bjorge, T, Butt, ZA, Carrero, JJ, Carvalho, F, Castaneda-Orjuela, CA, Cerin, E, Chaturvedi, P, Chimed-Ochir, O, Crider, R, Crowe, CS, Dandona, L, Dandona, R, Dang, AK, Daryani, A, Desalegn, BB, Dharmaratne, SD, Djalalinia, S, Effiong, A, El-Khatib, Z, Esteghamati, A, Fareed, M, Fernandes, E, Filip, I, Fischer, F, Fukumoto, T, Gallus, S, Gebremichael, TG, Gezae, KE, Grada, A, Guimaraes, ALS, Gupta, R, Hafezi-Nejad, N, Haj-Mirzaian, A, Hamadeh, RR, Hamidi, S, Hassankhani, H, Hay, SI, Hegazy, MI, Henok, A, Hoang, CL, Hole, MK, Hosgood, HD, Hosseini, M, Hostiuc, M, Hostiuc, S, Irvani, SSN, Islam, SMS, Jakovljevic, M, Jha, RP, Jurisson, M, Kahsay, A, Karim, N, Kasaeian, A, Kassa, ZY, Khader, YS, Khafaie, MA, Khan, EA, Khosravi, MH, Khubchandani, J, Kiadaliri, AA, Kim, YJ, Kogevinas, M, Koh, D, Kosen, S, Koyanagi, A, Kumar, GA, Lad, DP, Lal, DK, Lami, FH, Latifi, A, Leigh, J, Linn, S, Majdan, M, Malekzadeh, R, Malta, DC, Mansournia, MA, Massenburg, BB, Melese, A, Melku, M, Memish, ZA, Mendoza, W, Mengistu, G, Meretoja, TJ, Mestrovic, T, Miazgowski, B, Miazgowski, T, Mirrakhimov, EM, Moazen, B, Mohammed, S, Mohebi, F, Mokdad, AH, Moodley, Y, Moosazadeh, M, Moradi, G, Morawska, L, Morrison, SD, Mousavi, SM, Mustafa, G, Negoi, I, Negoi, RI, Nguyen, CT, Nguyen, TH, Ningrum, DNA, Nixon, MR, Ofori-Asenso, R, Ogbo, FA, Olagunju, AT, Olusanya, BO, Ortega-Altamirano, DDV, Mahesh, PA, Park, E-K, Pereira, DM, Prakash, S, Qorbani, M, Radfar, A, Rafay, A, Rafiei, A, Rahim, F, Rahimi-Movaghar, V, Rajati, F, Reiner, RC, Renzaho, AMN, Rezaei, S, Roever, L, Saadat, M, Saddik, B, Safari, S, Safiri, S, Sahebkar, A, Sahraian, MA, Salimzadeh, H, Samy, AM, Sanabria, J, Sarmiento-Suarez, R, Sathian, B, Schwebel, DC, Sepanlou, SG, Serdar, B, Shaikh, MA, Sharma, R, She, J, Shigematsu, M, Shirkoohi, R, Si, S, Sinha, DN, Soofi, M, Stanaway, JD, Stokes, MA, Tabares-Seisdedos, R, Tabuchi, T, Takahashi, K, Tefera, YM, Temsah, M-H, Tovani-Palone, MR, Tran, BX, Tran, KB, Ullah, I, Valdez, PR, Vasankari, TJ, Violante, FS, Vlassov, V, Vu, GT, Waheed, Y, Wang, Y-P, Yeshaneh, A, Yirsaw, BD, Yisma, E, Yonemoto, N, Yousefifard, M, Yu, C, Zadnik, V, Zamani, M, Zandian, H, Zodpey, S, Lim, SS, Driscoll, Tim, Rushton, Lesley, Steenland, Kyle, Hutchings, Sally, Yisma, Engida, Lim, Stephen S, GBD 2016 Occupational Carcinogens Collaborators, GBD 2016 Occupational Carcinogens Collaborator, and Violante FS

Subjects
AUSTRALIA, medicine.disease_cause, asbesto, mesothelioma incidence, 0302 clinical medicine, 1599 Other Commerce, Management, Tourism and Services, Sílice, 030212 general & internal medicine, clusters, Asbestos-related diseases, asbestos, diesel engine exhaust, epidemiology, occupational exposure, silica, Public, Environmental & Occupational Health, education.field_of_study, Mortality rate, metabolic risks, 030210 environmental & occupational health, 3. Good health, COMPARATIVE RISK-ASSESSMENT, comparative risk-assessment, Exposición Profesional, Life Sciences & Biomedicine, epidemiology occupational exposure, trends, Population, MESOTHELIOMA INCIDENCE, GBD 2016 Occupational Carcinogens Collaborators, Asbestos, Environmental & Occupational Health, 1117 Public Health and Health Services, 03 medical and health sciences, Environmental health, medicine, Epidemiología, education, Disease burden, Motores diesel, Science & Technology, business.industry, Public Health, Environmental and Occupational Health, Cancer, 1103 Clinical Sciences, medicine.disease, TRENDS, ASBESTOS-RELATED DISEASES, asbestos-related diseases, 13. Climate action, Relative risk, Attributable risk, business, CLUSTERS
Abstract

ObjectivesThis study provides a detailed analysis of the global and regional burden of cancer due to occupational carcinogens from the Global Burden of Disease 2016 study.MethodsThe burden of cancer due to 14 International Agency for Research on Cancer Group 1 occupational carcinogens was estimated using the population attributable fraction, based on past population exposure prevalence and relative risks from the literature. The results were used to calculate attributable deaths and disability-adjusted life years (DALYs).ResultsThere were an estimated 349 000 (95% Uncertainty Interval 269 000 to 427 000) deaths and 7.2 (5.8 to 8.6) million DALYs in 2016 due to exposure to the included occupational carcinogens—3.9% (3.2% to 4.6%) of all cancer deaths and 3.4% (2.7% to 4.0%) of all cancer DALYs; 79% of deaths were of males and 88% were of people aged 55 –79 years. Lung cancer accounted for 86% of the deaths, mesothelioma for 7.9% and laryngeal cancer for 2.1%. Asbestos was responsible for the largest number of deaths due to occupational carcinogens (63%); other important risk factors were secondhand smoke (14%), silica (14%) and diesel engine exhaust (5%). The highest mortality rates were in high-income regions, largely due to asbestos-related cancers, whereas in other regions cancer deaths from secondhand smoke, silica and diesel engine exhaust were more prominent. From 1990 to 2016, there was a decrease in the rate for deaths (−10%) and DALYs (−15%) due to exposure to occupational carcinogens.ConclusionsWork-related carcinogens are responsible for considerable disease burden worldwide. The results provide guidance for prevention and control initiatives.

Published
2020

11. Karakteristike prehrane pacijenata s nealkoholnom masnom bolesti jetre i arterijskom hipertenzijom

Author

Mandarić, Jelena, Banjari, Ines, and Savić, Željka

Subjects
nonalcoholic fatty liver disease, lifestyle, prehrana, Nealkoholna masna jetra, jednostavni ugljikohidrati, metabolički rizici, životne navike, nealkoholna masna jetra, BIOTECHNICAL SCIENCES. Nutrition. Dietotherapy, simple carbohydrates, metabolic risks, BIOTEHNIČKE ZNANOSTI. Nutricionizam. Dijetoterapija, diet
Abstract

Nealkoholna masna jetra (NAFLD) jedna je od komponenti metaboličkog sindroma, koju često prate pretilost, dijabetes tipa 2 i hipertenzija. Prevalencija NAFLD-a pa tako i opterećenje na zdravstveni sustav i društvo u cjelini raste zbog rastućih prevalencija pretilosti i DMT2. Cilj ovog rada bio je utvrditi razlikuje li se prehrana NAFLD pacijenata od zdravih odraslih osoba te u kojoj mjeri je u skladu s preporukama za prehranu kod NAFLD-a. Istraživanjem je obuhvaćeno 13 zdravih i sedam NAFLD pacijenata regrutiranih u Kliničkom centru Vojvodine, Novi Sad, Republika Srbija. NAFLD pacijenti su u manjem broju pušači i češće izbjegavaju alkohol, no konzumiraju manje kave i dolazi do pada u fizičkoj aktivnosti nakon postavljanja dijagnoze NAFLD-a. Također, značajno češće izbjegavaju određenu hranu (P=0,022). Energija iz hrane bogate jednostavnim ugljikohidratima zadovoljava 63,2 % dnevnih preporuka, a posebno zabrinjava omjer mono i polisaharida od 5,14. Unos monosahardia iz ove hrane povezan je s višim vrijednostima alanin aminotransferaze (r=0,786). Nije utvrđen negativan utjecaj NAFLD-a na psihofizičko stanje oboljelih u odnosu na kontrolnu skupinu. Rezultati naglašavaju potrebu edukacije oboljelih o izvorima i kvaliteti ugljikohidrata u hrani na kojoj bi trebali bazirati svoju prehranu. Nonalcoholic fatty liver (NAFLD) is one of the components of the metabolic syndrome, often accompanied by obesity, type 2 diabetes and hypertension. NAFLD prevalence and thus its burden on the health system and society as a whole is increasing due to the increasing prevalence of obesity and DMT2. The aim was to determine whether NAFLD patients' diet differs from healthy counterparts and to what extent it is consistent with the dietary recommendations for NAFLD. The study included 13 healthy and 7 NAFLD patients recruited at the Clinical Center of Vojvodina, Novi Sad, Republic of Serbia. Fewer NAFLD patients are smokers, they avoid alcohol more often, but they consume less coffee and experience a decline in physical activity after being diagnosed with NAFLD. Also, they significantly more often avoid certain foods (P=0.022). Energy from foods rich in simple carbohydrates meets 63.2% of daily recommendations, with particular concern of the monopolysaccharide ratio of 5.14. The intake of monosaccharides from these foods is associated with higher values of alanine aminotransferase (r=0.786). In comparison to the control, no negative impact of NAFLD was found on the psychophysical status of the patients. The results highlight the need to educate patients on the sources and quality of carbohydrates in foods which should be the basis of their diet.

Published
2019

12. Hormone profiling, including anti-Müllerian hormone (AMH), for the diagnosis of polycystic ovary syndrome (PCOS) and characterization of PCOS phenotypes

Author

Maritta Hippeläinen, Henri Sova, Juha S. Tapanainen, Helena Tinkanen, Aila Tiitinen, Antti Perheentupa, Terhi Piltonen, Risto Bloigu, Laure Morin-Papunen, Katri Puukka, Leila Unkila-Kallio, HUS Gynecology and Obstetrics, Department of Obstetrics and Gynecology, Clinicum, and Reproductive Disease Modeling

Subjects
MEDICAL PROGRESS, Anti-Mullerian Hormone, Blood Glucose, endocrine system diseases, Endocrinology, Diabetes and Metabolism, phenotype of PCOS, 0302 clinical medicine, Endocrinology, 3123 Gynaecology and paediatrics, Sex Hormone-Binding Globulin, Insulin, 030219 obstetrics & reproductive medicine, biology, Polycystic ovary syndrome (PCOS), Obstetrics and Gynecology, WOMEN, Anti-Müllerian hormone, metabolic risks, Serum concentration, Phenotype, Polycystic ovary, female genital diseases and pregnancy complications, 3. Good health, CARDIOVASCULAR-DISEASE, Androgens, Female, HEALTH, Polycystic Ovary Syndrome, EXPRESSION, Adult, medicine.medical_specialty, 030209 endocrinology & metabolism, FOLLICLE COUNT, 03 medical and health sciences, Young Adult, Internal medicine, medicine, Endocrine system, Humans, business.industry, Hyperandrogenism, Luteinizing Hormone, medicine.disease, ta3123, SERUM CONCENTRATIONS, SEVERITY, DEFINITION, biology.protein, Follicle Stimulating Hormone, Insulin Resistance, business, CONSENSUS, Hormone
Abstract

Objective was to evaluate serum anti-Mullerian hormone (AMH) levels in polycystic ovary syndrome (PCOS) and in its different phenotypes in relation to clinical, endocrine and metabolic parameters using a new automated VIDAS((R)) method and to compare it with the Gen II method. Study design was multi-center study including 319 PCOS women and 109 healthy controls. Serum AMH levels measured using VIDAS((R)) were significantly higher in PCOS women than controls (p

Published
2019

13. Genetic Polymorphisms Associated with the Neutrophil⁻Lymphocyte Ratio and Their Clinical Implications for Metabolic Risk Factors

Author

Eun-Soon Shin, Sungho Won, Boram Park, Eun Kyung Choe, Hae Yeon Kang, and Sangwoo Lee

Subjects
0301 basic medicine, Oncology, medicine.medical_specialty, Waist, lcsh:Medicine, Single-nucleotide polymorphism, lymphocyte, Article, polymorphism, 03 medical and health sciences, Internal medicine, Medicine, SNP, 2. Zero hunger, business.industry, lcsh:R, fungi, neutrophil, metabolic risks, General Medicine, Odds ratio, medicine.disease, Phenotype, Confidence interval, 030104 developmental biology, Metabolic syndrome, business, Body mass index
Abstract

Background: The neutrophil–lymphocyte ratio (NLR) is a valuable prognostic or predictive biomarker in various diseases, but the genetic factors that underlie the NLR have not been studied. We attempted to investigate polymorphisms related to NLR phenotype and analyze their ability to predict metabolic risks. Methods: A genome-wide association study was performed with log-transformed NLR using an Affymetrix Axiom™ KORV1.1-96 Array. Regression models for metabolic risk status were designed using the identified significant single-nucleotide polymorphisms (SNPs). Results: We identified four SNPs near the TMEM116, NAA25, and PTPN11 genes that were associated with the NLR. The top SNP associated with the log-transformed NLR was rs76181728 in TMEM116. A case–control study was performed to analyze the metabolic risks associated with each SNP after adjusting for age, sex, and body mass index (BMI). Three SNPs displayed significant odds ratios (ORs) for increased blood pressure and increased waist circumference. In the regression model for metabolic syndrome, rs76181728 showed a significant association (OR = 1.465, 95% confidence interval (CI) = 1.091–1.969, P = 0.011) after adjustment for the NLR phenotype. Conclusions: We identified four novel SNPs that are associated with the NLR in healthy Koreans. SNPs in relevant genes might therefore serve as biomarkers for metabolic risks.

Published
2018

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

Author

Gakidou, E, Afshin, A, Abajobir, AA, Abate, KH, Ahmed, Muktar, Murray, CJL, and GBD Risk Factors Collaborators

Subjects
metabolic risks, risk exposure, child growth failure
Abstract

Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of risk factor exposure and attributable burden of disease. By providing estimates over a long time series, this study can monitor risk exposure trends critical to health surveillance and inform policy debates on the importance of addressing risks in context.Methods We used the comparative risk assessment framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2016. This study included 481 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk (RR) and exposure estimates from 22 717 randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources, according to the GBD 2016 source counting methods. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. Finally, we explored four drivers of trends in attributable burden: population growth, population ageing, trends in risk exposure, and all other factors combined.Findings Since 1990, exposure increased significantly for 30 risks, did not change significantly for four risks, and decreased significantly for 31 risks. Among risks that are leading causes of burden of disease, child growth failure and household air pollution showed the most significant declines, while metabolic risks, such as body-mass index and high fasting plasma glucose, showed significant increases. In 2016, at Level 3 of the hierarchy, the three leading risk factors in terms of attributable DALYs at the global level for men were smoking (124.1 million DALYs [95% UI 111.2 million to 137.0 million]), high systolic blood pressure (122.2 million DALYs [110.3 million to 133.3 million], and low birthweight and short gestation (83.0 million DALYs [78.3 million to 87.7 million]), and for women, were high systolic blood pressure (89.9 million DALYs [80.9 million to 98.2 million]), high body-mass index (64.8 million DALYs [44.4 million to 87.6 million]), and high fasting plasma glucose (63.8 million DALYs [53.2 million to 76.3 million]). In 2016 in 113 countries, the leading risk factor in terms of attributable DALYs was a metabolic risk factor. Smoking remained among the leading five risk factors for DALYs for 109 countries, while low birthweight and short gestation was the leading risk factor for DALYs in 38 countries, particularly in sub-Saharan Africa and South Asia. In terms of important drivers of change in trends of burden attributable to risk factors, between 2006 and 2016 exposure to risks explains an 9.3% (6.9-11.6) decline in deaths and a 10.8% (8.3-13.1) decrease in DALYs at the global level, while population ageing accounts for 14.9% (12.7-17.5) of deaths and 6.2% (3.9-8.7) of DALYs, and population growth for 12.4% (10.1-14.9) of deaths and 12.4% (10.1-14.9) of DALYs. The largest contribution of trends in risk exposure to disease burden is seen between ages 1 year and 4 years, where a decline of 27.3% (24.9-29.7) of the change in DALYs between 2006 and 2016 can be attributed to declines in exposure to risks.Interpretation Increasingly detailed understanding of the trends in risk exposure and the RRs for each risk-outcome pair provide insights into both the magnitude of health loss attributable to risks and how modification of risk exposure has contributed to health trends. Metabolic risks warrant particular policy attention, due to their large contribution to global disease burden, increasing trends, and variable patterns across countries at the same level of development. GBD 2016 findings show that, while it has huge potential to improve health, risk modification has played a relatively small part in the past decade. usc Refereed/Peer-reviewed

Published
2017

15. Potential unfavorable impacts of BDNF Val66Met polymorphisms on metabolic risks in average population in a longevous area

Author

Hao Huang, Ze-Ping Lv, Hua-Yu Wu, Zhang-Ya Bian, Ling Huang, Rui-Xing Yin, Rui-Jing Gan, Cheng-Wu Liu, Qinghua Liang, Shang-Ling Pan, Jun-Hua Peng, Xiao-Ling Zhou, and Yi Ding

Subjects
0301 basic medicine, Male, medicine.medical_specialty, China, Genotype, Offspring, Population, Longevity, Blood Pressure, Disease, Overweight, 03 medical and health sciences, 0302 clinical medicine, Metabolic Diseases, Internal medicine, Survivorship curve, medicine, Metabolic risks, Ethnicity, Humans, Allele, Polymorphism, education, Aged, Aged, 80 and over, education.field_of_study, Polymorphism, Genetic, business.industry, Brain-Derived Neurotrophic Factor, BDNF gene, Middle Aged, Lipid Metabolism, Correlation, 030104 developmental biology, Endocrinology, Blood pressure, Female, Geriatrics and Gerontology, medicine.symptom, business, 030217 neurology & neurosurgery, Research Article
Abstract

Background Brain-derived neurotrophic factor (BDNF) has been implicated in cognitive performance and the modulation of several metabolic parameters in some disease models, but its potential roles in successful aging remain unclear. We herein sought to define the putative correlation between BDNF Val66Met and several metabolic risk factors including BMI, blood pressure, fasting plasma glucose (FPG) and lipid levels in a long-lived population inhabiting Hongshui River Basin in Guangxi. Methods BDNF Val66Met was typed by ARMS-PCR for 487 Zhuang long-lived individuals (age ≥ 90, long-lived group, LG), 593 of their offspring (age 60–77, offspring group, OG) and 582 ethnic-matched healthy controls (aged 60–75, control group, CG) from Hongshui River Basin. The correlations of genotypes with metabolic risks were then determined. Results As a result, no statistical difference was observed on the distribution of allelic and genotypic frequencies of BDNF Val66Met among the three groups (all P > 0.05) except that AA genotype was dramatically higher in females than in males of CG. The HDL-C level of A allele (GA/AA genotype) carriers was profoundly lower than was non-A (GG genotype) carriers in the total population and the CG (P = 0.009 and 0.006, respectively), which maintained in females, hyperglycemic and normolipidemic subgroup of CG after stratification by gender, BMI, glucose and lipid status. Furthermore, allele A carriers, with a higher systolic blood pressure, exhibited 1.63 folds higher risk than non-A carriers to be overweight in CG (OR = 1.63, 95% CI: 1.05 - 2.55, P = 0.012). Multiple regression analysis displayed that the TC level of LG reversely associated with BDNF Val66Met genotype. Conclusions These data suggested that BDNF 66Met may play unfavorable roles in blood pressure and lipid profiles in the general population in Hongshui River area which might in part underscore their poorer survivorship versus the successful aging individuals and their offspring. Electronic supplementary material The online version of this article (doi:10.1186/s12877-016-0393-0) contains supplementary material, which is available to authorized users.

Published
2017

16. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015

Author

GBD 2015 Risk Factors Collaborators and Faro, André

Subjects
Riscos metabólicos, Occupational risks, Risk factors, Environmental risks, Riscos ocupacionais, Metabolic risks, Clusters of risks, Global Burden of Disease (GBD), Behavioural risks, Fatores comportamentais de risco, Grupos de risco
Abstract

Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors—the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6–58·8) of global deaths and 41·2% (39·8–42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden.

Published
2016

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