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2. Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants
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Zhou, B, Carrillo-Larco, Rm, Danaei, G, Riley, Lm, Paciorek, Cj, Stevens, Ga, Gregg, Ew, Bennett, Je, Solomon, B, Singleton, Rk, Sophiea, Mk, Iurilli, Mlc, Lhoste, Vpf, Cowan, Mj, Savin, S, Woodward, M, Balanova, Y, Cifkova, R, Damasceno, A, Elliott, P, Farzadfar, F, He, J, Ikeda, N, Kengne, Ap, Khang, Yh, Kim, Hc, Laxmaiah, A, Lin, Hh, Maira, Pm, Miranda, Jj, Neuhauser, H, Sundstrom, J, Varghese, C, Widyahening, Is, Zdrojewski, T, Ezzati, M, Abarca-Gomez, L, Abdeen, Za, Rahim, Hfa, Abu-Rmeileh, Nm, Acosta-Cazares, B, Adams, Rj, Aekplakorn, W, Afsana, K, Afzal, S, Agdeppa, Ia, Aghazadeh-Attari, J, Aguilar-Salinas, Ca, Agyemang, C, Ahmad, Na, Ahmadi, A, Ahmadi, N, Ahmadizar, F, Ahmed, Sh, Ahrens, W, Ajlouni, K, Al-Raddadi, R, Alarouj, M, Albuhairan, F, Aldhukair, S, Ali, Mm, Alkandari, A, Alkerwi, A, Allin, K, Aly, E, Amarapurkar, Dn, Amougou, N, Amouyel, P, Andersen, Lb, Anderssen, Sa, Anjana, Rm, Ansari-Moghaddam, A, Ansong, D, Aounallah-Skhiri, H, Araujo, J, Ariansen, I, Aris, T, 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Bueno, G, Bugge, A, Burns, C, Bursztyn, M, de Leon, Ac, Cacciottolo, J, Cameron, C, Can, G, Candido, Apc, Capanzana, Mv, Capkova, N, Capuano, E, Capuano, V, Cardoso, Vc, Carlsson, Ac, Carvalho, J, Casanueva, Ff, Censi, L, Cervantes-Loaiza, M, Chadjigeorgiou, Ca, Chamukuttan, S, Chan, Aw, Chan, Q, Chaturvedi, Hk, Chaturvedi, N, Chee, Ml, Chen, Cj, Chen, Ff, Chen, Hs, Chen, Sh, Chen, Zm, Cheng, Cy, Cheraghian, B, Dekkaki, Ic, Chetrit, A, Chien, Kl, Chiolero, A, Chiou, St, Chirita-Emandi, A, Chirlaque, Md, Cho, B, Christensen, K, Christofaro, Dg, Chudek, J, Cinteza, E, Claessens, F, Clarke, J, Clays, E, Cohen, E, Concin, H, Cooper, C, Coppinger, Tc, Costanzo, S, Cottel, D, Cowell, C, Craig, Cl, Crampin, Ac, Crujeiras, Ab, Cruz, Jj, Csilla, S, Cui, Lf, Cureau, Fv, Cuschieri, S, D'Arrigo, G, D'Orsi, E, Dallongeville, J, Dankner, R, Dantoft, Tm, Dauchet, L, Davletov, K, De Backer, G, De Bacquer, D, De Curtis, A, de Gaetano, G, De Henauw, S, de Oliveira, Pd, De Ridder, D, De Smedt, D, Deepa, 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Gupta, Pc, Gupta, R, Gureje, O, Gurzkowska, B, Gutierrez, L, Gutzwiller, F, Ha, S, Hadaegh, F, Haghshenas, R, Hakimi, H, Halkjaer, J, Hambleton, Ir, Hamzeh, B, Hange, D, Hanif, Aam, Hantunen, S, Hao, J, Hardman, Cm, Kumar, Rh, Hashemi-Shahri, Sm, Hata, J, Haugsgjerd, T, Hayes, Aj, Yn, He, Heier, M, Hendriks, Me, Henrique, Rd, Henriques, A, Cadena, Lh, Herrala, S, Heshmat, R, Hill, Ag, Sy, Ho, Sc, Ho, Hobbs, M, Holdsworth, M, Homayounfar, R, Dinc, Gh, Horimoto, Arvr, Hormiga, Cm, Horta, Bl, Houti, L, Howitt, C, Htay, Tt, Htet, As, Htike, Mmt, Yh, Hu, Huerta, Jm, Huhtaniemi, It, Huiart, L, Huisman, M, Husseini, As, Huybrechts, I, Hwalla, N, Iacoviello, L, Iannone, Ag, Ibrahim, Mm, Wong, Ni, Ikram, Ma, Iotova, V, Irazola, Ve, Ishida, T, Isiguzo, Gc, Islam, M, Islam, Sms, Iwasaki, M, Jackson, Rt, Jacobs, Jm, Jaddou, Hy, Jafar, T, James, K, Jamrozik, K, Janszky, I, Janus, E, Jarvelin, Mr, Jasienska, G, Jelakovic, A, Jelakovic, B, Jennings, G, Jha, Ak, Jiang, Cq, Jimenez, Ro, Jockel, Kh, 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Laatikainen, T, Lachat, C, Laid, Y, Lam, Th, Landrove, O, Lanska, V, Lappas, G, Larijani, B, Latt, Ts, Le Coroller, G, Bao, Kln, Le, THUY DUNG, Lee, J, Lehmann, N, Lehtimaki, T, Lemogoum, D, Levitt, Ns, Yp, Li, Lilly, Cl, Lim, Wy, Lima-Costa, Mf, Lin, X, Lin, Yt, Lind, L, Lingam, V, Linneberg, A, Lissner, L, Litwin, M, Wc, Lo, Loit, Hm, Lopez-Garcia, E, Lopez, T, Lotufo, Pa, Lozano, Je, Lovrencic, Il, Lukrafka, Jl, Luksiene, D, Lundqvist, A, Lundqvist, R, Lunet, N, Lustigova, M, Luszczki, E, Gs, Ma, Ma, J, Machado-Coelho, Gll, Machado-Rodrigues, Am, Macia, E, Macieira, Lm, Madar, Aa, Maggi, S, Magliano, Dj, Magriplis, E, Mahasampath, G, Maire, B, Majer, M, Makdisse, M, Malekzadeh, F, Malekzadeh, R, Malhotra, R, Mallikharjuna, K, Malyutina, Sk, Maniego, Lv, Manios, Y, Mann, Ji, Mansour-Ghanaei, F, Manzato, E, Marcil, A, Margozzini, P, Marild, Sb, Glavic, Mm, Marques-Vidal, P, Marques, Lp, Marrugat, J, Martorell, R, Mascarenhas, Lp, Matasin, M, Mathiesen, Eb, Mathur, P, Matijasevich, A, Matlosz, P, Matsha, Te, Mavrogianni, C, Mbanya, Jcn, Posso, Ajm, Mcfarlane, Sr, Mcgarvey, St, Mclachlan, S, Mclean, Rm, Mclean, Sb, Mcnulty, Ba, Benchekor, Sm, Medzioniene, J, Mehdipour, P, Mehlig, K, Mehrparvar, Ah, Meirhaeghe, A, Meisinger, C, Montano, Cm, Menezes, Amb, Menon, Gr, Mereke, A, Meshram, Ii, Metspalu, A, Meyer, He, Mi, J, Michels, N, Mikkel, K, Milkowska, K, Miller, Jc, Minderico, Cs, Mini, Gk, Mirjalili, Mr, Mirrakhimov, E, Misigoj-Durakovic, M, Modesti, Pa, Moghaddam, Ss, Mohajer, B, Mohamed, Mk, Mohamed, Sf, Mohammad, K, Mohammadi, Mr, Mohammadi, Z, Mohammadifard, N, Mohammadpourhodki, R, Mohan, V, Mohanna, S, Yusoff, Mfm, Mohebbi, I, Mohebi, F, Moitry, M, Mollehave, Lt, Molnar, D, Momenan, A, Mondo, Ck, Monterrubio-Flores, E, Monyeki, Kdk, Moon, Js, Moosazadeh, M, Moreira, Lb, Morejon, A, Moreno, La, Morgan, K, Moschonis, G, Mossakowska, M, Mostafa, A, Mostafavi, Sa, Mota, J, Motlagh, Me, Motta, J, Moura-dos-Santos, Ma, Mridha, Mk, Msyamboza, Kp, Tt, Mu, Muhihi, Aj, 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Kazakbaeva, Ulrich Keil, Lital Keinan Boker, Sirkka Keinänen-Kiukaanniemi, Roya Kelishadi, Han Cg Kemper, Maryam Keramati, Alina Kerimkulova, Mathilde Kersting, Timothy Key, Yousef Saleh Khader, Davood Khalili, Kay-Tee Khaw, Bahareh Kheiri, Motahareh Kheradmand, Alireza Khosravi, Ursula Kiechl-Kohlendorfer, Stefan Kiechl, Japhet Killewo, Dong Wook Kim, Jeongseon Kim, Heidi Klakk, Magdalena Klimek, Jurate Klumbiene, Michael Knoflach, Elin Kolle, Patrick Kolsteren, Jukka P Kontto, Raija Korpelainen, Paul Korrovits, Jelena Kos, Seppo Koskinen, Katsuyasu Kouda, Sudhir Kowlessur, Slawomir Koziel, Jana Kratenova, Vilma Kriaucioniene, Peter Lund Kristensen, Steiner Krokstad, Daan Kromhout, Herculina S Kruger, Ruzena Kubinova, Renata Kuciene, Urho M Kujala, Zbigniew Kulaga, R Krishna Kumar, Pawel Kurjata, Yadlapalli S Kusuma, Vladimir Kutsenko, Kari Kuulasmaa, Catherine Kyobutungi, Tiina Laatikainen, Carl Lachat, Youcef Laid, Tai Hing Lam, Orlando Landrove, Vera Lanska, Georg Lappas, Bagher Larijani, Tint Swe Latt, Gwenaëlle Le Coroller, Khanh Le Nguyen Bao, Tuyen D Le, Jeannette Lee, Jeonghee Lee, Nils Lehmann, Terho Lehtimäki, Daniel Lemogoum, Naomi S Levitt, Yanping Li, Christa L Lilly, Wei-Yen Lim, M Fernanda Lima-Costa, Xu Lin, Yi-Ting Lin, Lars Lind, Vijaya Lingam, Allan Linneberg, Lauren Lissner, Mieczyslaw Litwin, Wei-Cheng Lo, Helle-Mai Loit, Esther Lopez-Garcia, Tania Lopez, Paulo A Lotufo, José Eugenio Lozano, Iva Lukačević Lovrenčić, Janice L Lukrafka, Dalia Luksiene, Annamari Lundqvist, Robert Lundqvist, Nuno Lunet, Michala Lustigová, Edyta Luszczki, Guansheng Ma, Jun Ma, George Ll Machado-Coelho, Aristides M Machado-Rodrigues, Enguerran Macia, Luisa M Macieira, Ahmed A Madar, Stefania Maggi, Dianna J Magliano, Emmanuella Magriplis, Gowri Mahasampath, Bernard Maire, Marjeta Majer, Marcia Makdisse, Fatemeh Malekzadeh, Reza Malekzadeh, Rahul Malhotra, Kodavanti Mallikharjuna Rao, Sofia K Malyutina, Lynell V Maniego, Yannis Manios, Jim I Mann, Fariborz 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M., Hantunen, Sari, Hao, Jie, Hardman, Carla Meneses, Kumar, Rachakulla Hari, Hashemi-Shahri, Seyed Mohammad, Hata, Jun, Haugsgjerd, Teresa, Hayes, Alison J., He, Yuna, Heier, Margit, Hendriks, Marleen Elisabeth, Henrique, Rafael dos Santos, Henriques, Ana, Cadena, Leticia Hernandez, Herrala, Sauli, Heshmat, Ramin, Hill, Allan G., Ho, Sai Yin, Ho, Suzanne C., Hobbs, Michael, Holdsworth, Michelle, Homayounfar, Reza, Dinc, Gonul Horasan, Horimoto, Andrea R. V. R., Hormiga, Claudia M., Horta, Bernardo L., Houti, Leila, Howitt, Christina, Htay, Thein Thein, Htet, Aung Soe, Htike, Maung Maung Than, Hu, Yonghua, Huerta, Jose Maria, Huhtaniemi, Ilpo Tapani, Huiart, Laetitia, Huisman, Martijn, Husseini, Abdullatif S., Huybrechts, Inge, Hwalla, Nahla, Iacoviello, Licia, Iannone, Anna G., Ibrahim, Mohsen M., Wong, Norazizah Ibrahim, Ikram, M. Arfan, Iotova, Violeta, Irazola, Vilma E., Ishida, Takafumi, Isiguzo, Godsent C., Islam, Muhammad, Islam, Sheikh Mohammed Shariful, Iwasaki, Masanori, Jackson, Rod T., Jacobs, Jeremy M., Jaddou, Hashem Y., Jafar, Tazeen, James, Kenneth, Jamrozik, Konrad, Janszky, Imre, Janus, Edward, Jarvelin, Marjo-Riitta, Jasienska, Grazyna, Jelakovic, Ana, Jelakovic, Bojan, Jennings, Garry, Jha, Anjani Kumar, Jiang, Chao Qiang, Jimenez, Ramon O., Joeckel, Karl-Heinz, Joffres, Michel, Johansson, Mattias, Jokelainen, Jari J., Jonas, Jost B., Jorgensen, Torben, Joshi, Pradeep, Joukar, Farahnaz, Jozwiak, Jacek, Juolevi, Anne, Jurak, Gregor, Juresa, Vesna, Kaaks, Rudolf, Kafatos, Anthony, Kajantie, Eero O., Kalmatayeva, Zhanna, Kalpourtzi, Natasa, Kalter-Leibovici, Ofra, Kampmann, Freja B., Kannan, Srinivasan, Karaglani, Eva, Karhus, Line L., Karki, Khem B., Katibeh, Marzieh, Katz, Joanne, Kauhanen, Jussi, Kaur, Prabhdeep, Kavousi, Maryam, Kazakbaeva, Gyulli M., Keil, Ulrich, Boker, Lital Keinan, Keinanen-Kiukaanniemi, Sirkka, Kelishadi, Roya, Kemper, Han C. G., Keramati, Maryam, Kerimkulova, Alina, Kersting, Mathilde, Key, Timothy, Khader, Yousef Saleh, Khalili, Davood, Khaw, Kay-Tee, Kheiri, Bahareh, Kheradmand, Motahareh, Khosravi, Alireza, Kiechl-Kohlendorfer, Ursula, Kiechl, Stefan, Killewo, Japhet, Kim, Dong Wook, Kim, Jeongseon, Klakk, Heidi, Klimek, Magdalena, Klumbiene, Jurate, Knoflach, Michael, Kolle, Elin, Kolsteren, Patrick, Kontto, Jukka P., Korpelainen, Raija, Korrovits, Paul, Kos, Jelena, Koskinen, Seppo, Kouda, Katsuyasu, Kowlessur, Sudhir, Koziel, Slawomir, Kratenova, Jana, Kriaucioniene, Vilma, Kristensen, Peter Lund, Krokstad, Steiner, Kromhout, Daan, Kruger, Herculina S., Kubinova, Ruzena, Kuciene, Renata, Kujala, Urho M., Kulaga, Zbigniew, Kumar, R. Krishna, Kurjata, Pawel, Kusuma, Yadlapalli S., Kutsenko, Vladimir, Kuulasmaa, Kari, Kyobutungi, Catherine, Laatikainen, Tiina, Lachat, Carl, Laid, Youcef, Lam, Tai Hing, Landrove, Orlando, Lanska, Vera, Lappas, Georg, Larijani, Bagher, Latt, Tint Swe, Le Coroller, Gwenaelle, Khanh Le Nguyen Bao, Le, Tuyen D., Lee, Jeannette, Lee, Jeonghee, Lehmann, Nils, Lehtimaki, Terho, Lemogoum, Daniel, Levitt, Naomi S., Li, Yanping, Lilly, Christa L., Lim, Wei-Yen, Lima-Costa, M. Fernanda, Lin, Xu, Lin, Yi-Ting, Lind, Lars, Lingam, Vijaya, Linneberg, Allan, Lissner, Lauren, Litwin, Mieczyslaw, Lo, Wei-Cheng, Loit, Helle-Mai, Lopez-Garcia, Esther, Lopez, Tania, Lotufo, Paulo A., Lozano, Jose Eugenio, Lovrencic, Iva Lukacevic, Lukrafka, Janice L., Luksiene, Dalia, Lundqvist, Annamari, Lundqvist, Robert, Lunet, Nuno, Lustigova, Michala, Luszczki, Edyta, Ma, Guansheng, Ma, Jun, Machado-Coelho, George L. L., Machado-Rodrigues, Aristides M., Macia, Enguerran, Macieira, Luisa M., Madar, Ahmed A., Maggi, Stefania, Magliano, Dianna J., Magriplis, Emmanuella, Mahasampath, Gowri, Maire, Bernard, Majer, Marjeta, Makdisse, Marcia, Malekzadeh, Fatemeh, Malekzadeh, Reza, Malhotra, Rahul, Mallikharjuna, Kodavanti, Malyutina, Sofia K., Maniego, Lynell V., Manios, Yannis, Mann, Jim I., Mansour-Ghanaei, Fariborz, Manzato, Enzo, Marcil, Anie, Margozzini, Paula, Marild, Staffan B., Glavic, Mihalea Marinovic, Marques-Vidal, Pedro, Marques, Larissa Pruner, Marrugat, Jaume, Martorell, Reynaldo, Mascarenhas, Luis P., Matasin, Marija, Mathiesen, Ellisiv B., Mathur, Prashant, Matijasevich, Alicia, Matlosz, Piotr, Matsha, Tandi E., Mavrogianni, Christina, Mbanya, Jean Claude N., Mc Donald Posso, Anselmo J., McFarlane, Shelly R., McGarvey, Stephen T., McLachlan, Stela, McLean, Rachael M., McLean, Scott B., McNulty, Breige A., Benchekor, Sounnia Mediene, Medzioniene, Jurate, Mehdipour, Parinaz, Mehlig, Kirsten, Mehrparvar, Amir Houshang, Meirhaeghe, Aline, Meisinger, Christa, Mendoza Montano, Carlos, Menezes, Ana Maria B., Menon, Geetha R., Mereke, Alibek, Meshram, Indrapal I., Metspalu, Andres, Meyer, Haakon E., Mi, Jie, Michels, Nathalie, Mikkel, Kairit, Milkowska, Karolina, Miller, Jody C., Minderico, Claudia S., Mini, G. K., Mirjalili, Mohammad Reza, Mirrakhimov, Erkin, Misigoj-Durakovic, Marjeta, Modesti, Pietro A., Moghaddam, Sahar Saeedi, Mohajer, Bahram, Mohamed, Mostafa K., Mohamed, Shukri F., Mohammad, Kazem, Mohammadi, Mohammad Reza, Mohammadi, Zahra, Mohammadifard, Noushin, Mohammadpourhodki, Reza, Mohan, Viswanathan, Mohanna, Salim, Yusoff, Muhammad Fadhli Mohd, Mohebbi, Iraj, Mohebi, Farnam, Moitry, Marie, Mollehave, Line T., Molnar, Denes, Momenan, Amirabbas, Mondo, Charles K., Monterrubio-Flores, Eric, Monyeki, Kotsedi Daniel K., Moon, Jin Soo, Moosazadeh, Mahmood, Moreira, Leila B., Morejon, Alain, Moreno, Luis A., Morgan, Karen, Moschonis, George, Mossakowska, Malgorzata, Mostafa, Aya, Mostafavi, Seyed-Ali, Mota, Jorge, Motlagh, Mohammad Esmaeel, Motta, Jorge, Andre Moura-dos-Santos, Marcos, Mridha, Malay K., Msyamboza, Kelias P., Mu, Thet Thet, Muhihi, Alfa J., Muiesan, Maria L., Muller-Nurasyid, Martina, Murphy, Neil, Mursu, Jaakko, Musa, Kamarul Imran, Milanovic, Sanja Music, Musil, Vera, Mustafa, Norlaila, Nabipour, Iraj, Naderimagham, Shohreh, Nagel, Gabriele, Naidu, Balkish M., Najafi, Farid, Nakamura, Harunobu, Namesna, Jana, Nang, Ei Ei K., Nangia, Vinay B., Narake, Sameer, Ndiaye, Ndeye Coumba, Neal, William A., Nejatizadeh, Azim, Nenko, Ilona, Neovius, Martin, Neuhauser, Hannelore K., Nguyen, Chung T., Nguyen, Nguyen D., Nguyen, Quang V., Quang Ngoc Nguyen, Nieto-Martinez, Ramfis E., Niiranen, Teemu J., Nikitin, Yury P., Ninomiya, Toshiharu, Nishtar, Sania, Njelekela, Marina A., Noale, Marianna, Noboa, Oscar A., Noorbala, Ahmad Ali, Norat, Teresa, Nordendahl, Maria, Nordestgaard, Borge G., Noto, Davide, Nowak-Szczepanska, Natalia, Al Nsour, Mohannad, Nunes, Baltazar, O'Neill, Terence W., O'Reilly, Dermot, Ochimana, Caleb, Oda, Eiji, Odili, Augustine N., Oh, Kyungwon, Ohara, Kumiko, Ohtsuka, Ryutaro, Olie, Valerie, Olinto, Maria Teresa A., Oliveira, Isabel O., Omar, Mohd Azahadi, Onat, Altan, Ong, Sok King, Ono, Lariane M., Ordunez, Pedro, Ornelas, Rui, Ortiz, Pedro J., Osmond, Clive, Ostojic, Sergej M., Ostovar, Afshin, Otero, Johanna A., Overvad, Kim, Owusu-Dabo, Ellis, Paccaud, Fred Michel, Padez, Cristina, Pahomova, Elena, de Paiva, Karina Mary, Pajak, Andrzej, Palli, Domenico, Palmieri, Luigi, Pan, Wen-Harn, Panda-Jonas, Songhomitra, Panza, Francesco, Paoli, Mariela, Papandreou, Dimitrios, Park, Soon-Woo, Park, Suyeon, Parnell, Winsome R., Parsaeian, Mahboubeh, Pasquet, Patrick, Patel, Nikhil D., Pavlyshyn, Halyna, Pecin, Ivan, Pednekar, Mangesh S., Pedro, Joao M., Peer, Nasheeta, Peixoto, Sergio Viana, Peltonen, Markku, Pereira, Alexandre C., Peres, Karen G. D. A., Peres, Marco A., Peters, Annette, Petkeviciene, Janina, Peykari, Niloofar, Son Thai Pham, Pichardo, Rafael N., Pigeot, Iris, Pikhart, Hynek, Pilav, Aida, Pilotto, Lorenza, Pitakaka, Freda, Piwonska, Aleksandra, Pizarro, Andreia N., Plans-Rubio, Pedro, Polasek, Ozren, Porta, Miquel, Poudyal, Anil, Pourfarzi, Farhad, Pourshams, Akram, Poustchi, Hossein, Pradeepa, Rajendra, Price, Alison J., Price, Jacqueline F., Providencia, Rui, Puhakka, Soile E., Puiu, Maria, Punab, Margus, Qasrawi, Radwan F., Qorbani, Mostafa, Queiroz, Daniel, Tran Quoc Bao, Radic, Ivana, Radisauskas, Ricardas, Rahimikazerooni, Salar, Rahman, Mahfuzar, Raitakari, Olli, Raj, Manu, Rakhimova, Ellina M., Rao, Sudha Ramachandra, Ramachandran, Ambady, Ramos, Elisabete, Rampal, Lekhraj, Rampal, Sanjay, Rangel Reina, Daniel A., Rarra, Vayia, Rech, Cassiano Ricardo, Redon, Josep, Reganit, Paul Ferdinand M., Regecova, Valeria, Revilla, Luis, Rezaianzadeh, Abbas, Ribeiro, Robespierre, Riboli, Elio, Richter, Adrian, Rigo, Fernando, de Wit, Tobias F. Rinke, Ritti-Dias, Raphael M., Robitaille, Cynthia, Rodriguez-Artalejo, Fernando, del Cristo Rodriguez-Perez, Maria, Rodriguez-Villamizar, Laura A., Roggenbuck, Ulla, Rojas-Martinez, Rosalba, Romaguera, Dora, Romeo, Elisabetta L., Rosengren, Annika, Roy, Joel G. R., Rubinstein, Adolfo, Ruidavets, Jean-Bernard, Sandra Ruiz-Betancourt, Blanca, Ruiz-Castell, Maria, Rusakova, Iuliia A., Russo, Paola, Rutkowski, Marcin, Sabanayagam, Charumathi, Sabbaghi, Hamideh, Sachdev, Harshpal S., Sadjadi, Alireza, Safarpour, Ali Reza, Safi, Sare, Safiri, Saeid, Saidi, Olfa, Saki, Nader, Salanave, Benoit, Salazar Martinez, Eduardo, Salmeron, Diego, Salomaa, Veikko, Salonen, Jukka T., Salvetti, Massimo, Sanchez-Abanto, Jose, Sans, Susana, Santos, Diana A., Santos, Ina S., Santos, Lelita C., Santos, Maria Paula, Santos, Rute, Saramies, Jouko L., Sardinha, Luis B., Sarganas, Giselle, Sarrafzadegan, Nizal, Sathish, Thirunavukkarasu, Saum, Kai-Uwe, Savva, Savvas, Sawada, Norie, Sbaraini, Mariana, Scazufca, Marcia, Schaan, Beatriz D., Schargrodsky, Herman, Schipf, Sabine, Schmidt, Carsten O., Schnohr, Peter, Schoettker, Ben, Schramm, Sara, Schultsz, Constance, Schutte, Aletta E., Sebert, Sylvain, Sein, Aye Aye, Sen, Abhijit, Senbanjo, Idowu O., Sepanlou, Sadaf G., Servais, Jennifer, Shalnova, Svetlana A., Shamah-Levy, Teresa, Shamshirgaran, Morteza, Shanthirani, Coimbatore Subramaniam, Sharafkhah, Maryam, Sharma, Sanjib K., Shaw, Jonathan E., Shayanrad, Amaneh, Shayesteh, Ali Akbar, Shi, Zumin, Shibuya, Kenji, Shimizu-Furusawa, Hana, Shin, Dong Wook, Shirani, Majid, Shiri, Rahman, Shrestha, Namuna, Si-Ramlee, Khairil, Siani, Alfonso, Siantar, Rosalynn, Sibai, Abla M., de Moura Silva, Caroline Ramos, Santos Silva, Diego Augusto, Simon, Mary, Simons, Judith, Simons, Leon A., Sjostrom, Michael, Slowikowska-Hilczer, Jolanta, Slusarczyk, Przemyslaw, Smeeth, Liam, So, Hung-Kwan, Soares, Fernanda Cunha, Sobngwi, Eugene, Soderberg, Stefan, Soemantri, Agustinus, Sofat, Reecha, Solfrizzi, Vincenzo, Somi, Mohammad Hossein, Sonestedt, Emily, Song, Yi, Sorensen, Thorkild I. A., Sorgjerd, Elin P., Soric, Maroje, Jerome, Charles Sossa, Soumare, Aicha, Sparboe-Nilsen, Bente, Sparrenberger, Karen, Staessen, Jan A., Starc, Gregor, Stavreski, Bill, Steene-Johannessen, Jostein, Stehle, Peter, Stein, Aryeh D., Stergiou, George S., Stessman, Jochanan, Stieber, Jutta, Stoeckl, Doris, Stocks, Tanja, Stokwiszewski, Jakub, Stronks, Karien, Strufaldi, Maria Wany, Suka, Machi, Sun, Chien-An, Sung, Yn-Tz, Suriyawongpaisal, Paibul, Sy, Rody G., Syddall, Holly E., Sylva, Rene Charles, Szklo, Moyses, Tai, E. Shyong, Tammesoo, Mari-Liis, Tamosiunas, Abdonas, Tan, Eng Joo, Tang, Xun, Tanser, Frank, Tao, Yong, Tarawneh, Mohammed Rasoul, Tarqui-Mamani, Carolina B., Taylor, Anne, Taylor, Julie, Tebar, William R., Tell, Grethe S., Tello, Tania, Tham, Yih Chung, Thankappan, K. R., Theobald, Holger, Theodoridis, Xenophon, Thinggaard, Mikael, Thomas, Nihal, Thorand, Barbara, Thuesen, Betina H., Timmermans, Erik J., Tjandrarini, Dwi H., Tjonneland, Anne, Toft, Ulla, Tolonen, Hanna K., Tolstrup, Janne S., Topbas, Murat, Topor-Madry, Roman, Jose Tormo, Maria, Tornaritis, Michael J., Torrent, Maties, Torres-Collado, Laura, Touloumi, Giota, Traissac, Pierre, Triantafyllou, Areti, Trichopoulos, Dimitrios, Trichopoulou, Antonia, Trinh, Oanh T. H., Trivedi, Atul, Tshepo, Lechaba, Tsugane, Shoichiro, Tuliakova, Azaliia M., Tulloch-Reid, Marshall K., Tullu, Fikru, Tuomainen, Tomi-Pekka, Tuomilehto, Jaakko, Turley, Maria L., Twig, Gilad, Tynelius, Per, Tzourio, Christophe, Ueda, Peter, Ugel, Eunice, Ulmer, Hanno, Uusitalo, Hannu M. T., Valdivia, Gonzalo, Valvi, Damaskini, van Dam, Rob M., van den Born, Bert-Jan, Van der Heyden, Johan, van der Schouw, Yvonne T., Van Herck, Koen, Hoang Van Minh, Van Schoor, Natasja M., van Valkengoed, Irene G. M., van Zutphen, Elisabeth M., Vanuzzo, Diego, Varbo, Anette, Vasan, Senthil K., Vega, Tomas, Veidebaum, Toomas, Velasquez-Melendez, Gustavo, Veronesi, Giovanni, Verschuren, W. M. Monique, Verstraeten, Roosmarijn, Victora, Cesar G., Viet, Lucie, Villalpando, Salvador, Vineis, Paolo, Vioque, Jesus, Virtanen, Jyrki K., Visvikis-Siest, Sophie, Viswanathan, Bharathi, Vlasoff, Tiina, Vollenweider, Peter, Voutilainen, Ari, Wade, Alisha N., Walton, Janette, Wambiya, Elvis O. A., Bebakar, Wan Mohamad Wan, Mohamud, Wan Nazaimoon Wan, Wanderley Junior, Rildo de Souza, Wang, Ming-Dong, Wang, Ningli, Wang, Qian, Wang, Xiangjun, Wang, Ya Xing, Wang, Ying-Wei, Wannamethee, S. Goya, Wareham, Nicholas, Wei, Wenbin, Weres, Aneta, Werner, Bo, Whincup, Peter H., Widhalm, Kurt, Wiecek, Andrzej, Wilks, Rainford J., Willeit, Johann, Willeit, Peter, Williams, Emmanuel A., Wilsgaard, Tom, Wojtyniak, Bogdan, Wong-McClure, Roy A., Wong, Andrew, Wong, Tien Yin, Woo, Jean, Wu, Frederick C., Wu, Shouling, Wyszynska, Justyna, Xu, Haiquan, Xu, Liang, Yaacob, Nor Azwany, Yan, Weili, Yang, Ling, Yang, Xiaoguang, Yang, Yang, Yasuharu, Tabara, Ye, Xingwang, Yiallouros, Panayiotis K., Yoosefi, Moein, Yoshihara, Akihiro, You, San-Lin, Younger-Coleman, Novie O., Yusoff, Ahmad Faudzi, Zainuddin, Ahmad A., Zakavi, Seyed Rasoul, Zamani, Farhad, Zambon, Sabina, Zampelas, Antonis, Elisa Zapata, Maria, Zaw, Ko Ko, Zejglicova, Kristyna, Vrkic, Tajana Zeljkovic, Zeng, Yi, Zhang, Luxia, Zhao, Dong, Zhao, Ming-Hui, Zhen, Shiqi, Zheng, Yingfeng, Zholdin, Bekbolat, Zhu, Dan, Zins, Marie, Zitt, Emanuel, Zocalo, Yanina, Zoghlami, Nada, Zuniga Cisneros, Julio., School of Medicine, ACS - Diabetes & metabolism, APH - Global Health, Pulmonology, Medical Informatics, Adult Psychiatry, Global Health, APH - Quality of Care, APH - Methodology, Vascular Medicine, ACS - Atherosclerosis & ischemic syndromes, Anesthesiology, Graduate School, and ACS - Heart failure & arrhythmias
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Male ,Latin Americans ,Nutrition and Disease ,Epidemiology ,[SDV]Life Sciences [q-bio] ,Medizin ,BLOOD-PRESSURE ,030204 cardiovascular system & hematology ,Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants ,Hypertension ,Prevalence ,Control ,Tretament ,GUIDELINES ,Global Health ,Worldwide trends ,0302 clinical medicine ,Hypertension prevalence ,Voeding en Ziekte ,Medicine and Health Sciences ,kohonnut verenpaine ,Medicine ,030212 general & internal medicine ,Prevention and Control ,11 Medical and Health Sciences ,ComputingMilieux_MISCELLANEOUS ,education.field_of_study ,food and beverages ,Public Health, Global Health, Social Medicine and Epidemiology ,General Medicine ,Noncommunicable diseases ,Period prevalence ,Middle Aged ,kansainvälinen vertailu ,3142 Public health care science, environmental and occupational health ,3. Good health ,MIDDLE-INCOME ,Pooled analysis ,SYSTEMATIC ANALYSIS ,INCOME COUNTRIES ,ADULTS ,PREVENTION ,MANAGEMENT ,ADHERENCE ,DIAGNOSIS ,Western europe ,[SDE]Environmental Sciences ,Hypertension/diagnosis ,NCD Risk Factor Collaboration (NCD-RisC) ,Female ,B990 Subjects Allied to Medicine not elsewhere classified ,Life Sciences & Biomedicine ,Adult ,health-care ,esiintyvyys ,Central asia ,Population ,Nursing ,3121 Internal medicine ,03 medical and health sciences ,Medicine, General & Internal ,Drug Therapy ,General & Internal Medicine ,Life Science ,Humans ,ddc:610 ,education ,Antihypertensive Agents ,VLAG ,Aged ,Science & Technology ,Antihypertensive Agents/therapeutic use ,business.industry ,Omvårdnad ,fungi ,General and internal medicine ,Estados de Saúde e de Doença ,Taking medication ,Treatment ,Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi ,Blood pressure ,Faculdade de Ciências Sociais ,3121 General medicine, internal medicine and other clinical medicine ,lääkehoito ,1182 Biochemistry, cell and molecular biology ,business ,Demography - Abstract
Background: hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods: we used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings: the number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings., British Heart Foundation Centre of Research Excellence Grant; World Health Organization (WHO); Abdul Latif Jameel Institute for Disease and Emergency Analytics Fellowship
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- 2021
3. Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight
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Sanz, S.S. Saramies, J.L. Sardinha, L.B. Sarrafzadegan, N. Sathish, T. Saum, K.-U. Savva, S. Savy, M. Sawada, N. Sbaraini, M. Scazufca, M. Schaan, B.D. Rosario, A.S. Schargrodsky, H. Schienkiewitz, A. Schipf, S. Schmidt, C.O. Schmidt, I.M. Schnohr, P. Schöttker, B. Schramm, S. Schramm, S. Schröder, H. Schultsz, C. Schutte, A.E. Sein, A.A. Selamat, R. Sember, V. Sen, A. Senbanjo, I.O. Sepanlou, S.G. Sequera, V. Serra-Majem, L. Servais, J. Ševcíková, L. Shalnova, S.A. Shamah-Levy, T. Shamshirgaran, M. Shanthirani, C.S. Sharafkhah, M. Sharma, S.K. Shaw, J.E. Shayanrad, A. Shayesteh, A.A. Shengelia, L. Shi, Z. Shibuya, K. Shimizu-Furusawa, H. Shin, D.W. Shirani, M. Shiri, R. Shrestha, N. Si-Ramlee, K. Siani, A. Siantar, R. Sibai, A.M. Silva, A.M. Silva, D.A.S. Simon, M. Simons, J. Simons, L.A. Sjöberg, A. Sjöström, M. Skodje, G. Slowikowska-Hilczer, J. Slusarczyk, P. Smeeth, L. So, H.-K. Soares, F.C. Sobek, G. Sobngwi, E. Sodemann, M. Söderberg, S. Soekatri, M.Y.E. Soemantri, A. Sofat, R. Solfrizzi, V. Somi, M.H. Sonestedt, E. Song, Y. Sørensen, T.I.A. Sørgjerd, E.P. Jérome, C.S. Soto-Rojas, V.E. Soumaré, A. Sovic, S. Sparboe-Nilsen, B. Sparrenberger, K. Spinelli, A. Spiroski, I. Staessen, J.A. Stamm, H. Stathopoulou, M.G. Staub, K. Stavreski, B. Steene-Johannessen, J. Stehle, P. Stein, A.D. Stergiou, G.S. Stessman, J. Stevanovic, R. Stieber, J. Stöckl, D. Stocks, T. Stokwiszewski, J. Stoyanova, E. Stratton, G. Stronks, K. Strufaldi, M.W. Sturua, L. Suárez-Medina, S. Suka, M. Sun, C.-A. Sundström, J. Sung, Y.-T. Sunyer, J. Suriyawongpaisal, P. Swinburn, B.A. Sy, R.G. Syddall, H.E. Sylva, R.C. Szklo, M. Szponar, L. Tai, E.S. Tammesoo, M.-L. Tamosiunas, A. Tan, E.J. Tang, X. Tanrygulyyeva, M. Tanser, F. Tao, Y. Tarawneh, M.R. Tarp, J. Tarqui-Mamani, C.B. Braunerová, R.T. Taylor, A. Taylor, J. Tchibindat, F. Tebar, W.R. Tell, G.S. Tello, T. Tham, Y.C. Thankappan, K.R. Theobald, H. Theodoridis, X. Thijs, L. Thomas, N. Thuesen, B.H. Tichá, L. Timmermans, E.J. Tjonneland, A. Tolonen, H.K. Tolstrup, J.S. Topbas, M. Topór-Madry, R. Torheim, L.E. Tormo, M.J. Tornaritis, M.J. Torrent, M. Torres-Collado, L. Toselli, S. Touloumi, G. Traissac, P. Tran, T.T.-H. Trichopoulos, D. Trichopoulou, A. Trinh, D.T.H. Trivedi, A. Tshepo, L. Tsigga, M. Tsugane, S. Tuliakova, A.M. Tulloch-Reid, M.K. Tullu, F. Tuomainen, T.-P. Tuomilehto, J. Turley, M.L. Twig, G. Tynelius, P. Tzotzas, T. Tzourio, C. Ueda, P. Ugel, E. Ukoli, F.A.M. Ulmer, H. Unal, B. Usupova, Z. Uusitalo, H.M.T. Uysal, N. Vaitkeviciute, J. Valdivia, G. Vale, S. Valvi, D. van Dam, R.M. Van der Heyden, J. van der Schouw, Y.T. Van Herck, K. Van Minh, H. Van Schoor, N.M. van Valkengoed, I.G.M. Vanderschueren, D. Vanuzzo, D. Varbo, A. Varela-Moreiras, G. Varona-Pérez, P. Vasan, S.K. Vega, T. Veidebaum, T. Velasquez-Melendez, G. Velika, B. Veronesi, G. Verschuren, W.M.M. Victora, C.G. Viegi, G. Viet, L. Villalpando, S. Vineis, P. Vioque, J. Virtanen, J.K. Visser, M. Visvikis-Siest, S. Viswanathan, B. Vladulescu, M. Vlasoff, T. Vocanec, D. Vollenweider, P. Völzke, H. Voutilainen, A. Voutilainen, S. Vrijheid, M. Vrijkotte, T.G.M. Wade, A.N. Wagner, A. Waldhör, T. Walton, J. Wambiya, E.O.A. Bebakar, A.M.W. Mohamud, W.N.W. de Souza Wanderley Júnior, R. Wang, M.-D. Wang, N. Wang, Q. Wang, X. Wang, Y.X. Wang, Y.-W. Wannamethee, S.G. Wareham, N. Weber, A. Wedderkopp, N. Weerasekera, D. Weghuber, D. Wei, W. Weres, A. Werner, B. Whincup, P.H. Widhalm, K. Widyahening, I.S. Wiecek, A. Wilks, R.J. Willeit, J. Willeit, P. Williams, J. Wilsgaard, T. Wojtyniak, B. Wong-McClure, R.A. Wong, A. Wong, J.E. Wong, T.Y. Woo, J. Woodward, M. Wu, F.C. Wu, J. Wu, L.J. Wu, S. Xu, H. Xu, L. Yaacob, N.A. Yamborisut, U. Yan, W. Yang, L. Yang, X. Yang, Y. Yardim, N. Yaseri, M. Yasuharu, T. Ye, X. Yiallouros, P.K. Yoosefi, M. Yoshihara, A. You, Q.S. You, S.-L. Younger-Coleman, N.O. Yusof, S.M. Yusoff, A.F. Zaccagni, L. Zafiropulos, V. Zainuddin, A.A. Zakavi, S.R. Zamani, F. Zambon, S. Zampelas, A. Zamrazilová, H. Zapata, M.E. Zargar, A.H. Zaw, K.K. Zdrojewski, T. Zejglicova, K. Vrkic, T.Z. Zeng, Y. Zhang, L. Zhang, Z.-Y. Zhao, D. Zhao, M.-H. Zhao, W. Zhen, S. Zheng, W. Zheng, Y. Zholdin, B. Zhou, M. Zhu, D. Zins, M. Zitt, E. Zocalo, Y. Cisneros, J.Z. Zuziak, M. Ezzati, M. Filippi, S. NCD Risk Factor Collaboration (NCD-RisC)
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nutritional and metabolic diseases ,sense organs ,skin and connective tissue diseases - Abstract
From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions. © Copyright.
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- 2021
4. The association between late-adolescent smoking and long-term mortality: a dose-response relationship
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Tiosano, S, primary, Afek, A, additional, Fink, N, additional, Avramovich, E, additional, Derazne, E, additional, Tzur, D, additional, and Twig, G, additional
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- 2020
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5. Associations of exposure to particulate matter and nitrogen oxides with prevalent asthma and other atopic diseases at age 17 in Israel: A population-based national study
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Raz, R., primary, Lev Bar-Or, R., additional, Gileles-Hillel, A., additional, Levy, I., additional, Sinnereich, R., additional, Kloog, I., additional, Lyubarsky, A., additional, and Twig, G., additional
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- 2020
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6. Population-based trends in overweight and obesity: a comparative study of 2 148 342 Israeli male and female adolescents born 1950–1993
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Meydan, C., Afek, A., Derazne, E., Tzur, D., Twig, G., Gordon, B., and Shamiss, A.
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- 2013
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7. Allergic Rhinitis and Asthma Among Adolescents with Psoriasis: A Population-based Cross-sectional Study
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Galili, E, primary, Barzilai, A, additional, Twig, G, additional, Caspi, T, additional, Daniely, D, additional, Shreberk-Hassidim, R, additional, and Astman, N, additional
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- 2020
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8. Nitric oxide modulates the transfer function between cones and horizontal cells during changing conditions of ambient illumination
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Levy, H., Twig, G., and Perlman, I.
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- 2004
9. P09.06 Risk factors associated with Meningioma in a Cohort of 2 Million Israeli Adolescents
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Yust-Katz, S, primary, Derzane, E, additional, Keinan, L, additional, Amiel, A, additional, Honig, A, additional, Laviv, Y, additional, Kanner, A, additional, Twig, G, additional, and Siegal, T, additional
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- 2019
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10. Body mass index and infectious disease mortality in midlife in a cohort of 2.3 million adolescents
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Twig, G, primary, Geva, N, additional, Levine, H, additional, Derazne, E, additional, Goldberger, N, additional, Haklai, Z, additional, Leiba, A, additional, and Kark, J D, additional
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- 2017
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11. THU0376 Cardiovascular and Metabolic Risk Factors in Inherited Auto-Inflammation
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Twig, G., primary, Livneh, A., additional, Vivante, A., additional, Afek, A., additional, Derazne, E., additional, Leiba, A., additional, Ben-Ami Shor, D., additional, Meydan, C., additional, Ben-Zvi, I., additional, Tzur, D., additional, Furer, A., additional, Imazio, M., additional, Adler, Y., additional, and Amital, H., additional
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- 2014
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12. Body mass index and infectious disease mortality in midlife in a cohort of 2.3 million adolescents
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Twig, G, Geva, N, Levine, H, Derazne, E, Goldberger, N, Haklai, Z, Leiba, A, and Kark, J D
- Abstract
Background:Obesity was linked to altered immunity, but also to favorable outcomes among patients with infectious disease (ID) in some settings. We assessed the association between adolescent body mass index (BMI) and ID mortality.Methods:BMI of 2 294 139 Israeli adolescents (60% men; age 17.4±0.3 years) was measured between 1967 and 2010. The outcome, obtained by linkage with official national records, was death due to ID as the underlying cause. Multivariable Cox proportional hazards models were applied.Results:During 42 297 007 person-years of follow-up (median 18.4 years), there were 689 deaths from ID (mean age 44.1±10.5 years). Adjusted hazard ratios (HR) were 1.039 (1.011–1.068) and 1.146 (1.099–1.194) among men and women, respectively, per unit increment in BMI (P for sex interaction=4.4 × 10−5). Adjusted hazard ratios among men were 1.2 (1.0–1.5), 1.9 (1.4–2.5) and 2.5 (1.5–4.2) for those with high-normal BMI (22.0–24.9 kg m−2), overweight and obese, respectively, compared with the 18.5⩽BMI<22 kg m−2reference group, and 1.7 (1.1–2.6), 2.6 (1.6–4.3) and 6.6 (3.3–13.1) among women, respectively. The increased risk among underweight (<18.5 kg m−2) boys was attenuated when the study sample was restricted to those with unimpaired health at baseline. A multivariable spline model indicated a minimum risk for total ID mortality at 20.7 and 18.0 kg m−2for men and women, respectively, with significantly increased risk seen above adolescent BMI values of 23.6 and 24.0 kg m−2, respectively. The association with BMI was particularly evident for bacterial infections (predominantly sepsis), airways and central nervous system infections (63% of the ID deaths).Conclusions:Adolescent overweight and obesity were strongly associated with ID mortality, especially of bacterial origin and among women.
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- 2018
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13. Population‐based trends in overweight and obesity: a comparative study of 2 148 342 Israeli male and female adolescents born 1950–1993
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Meydan, C., primary, Afek, A., additional, Derazne, E., additional, Tzur, D., additional, Twig, G., additional, Gordon, B., additional, and Shamiss, A., additional
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- 2012
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14. Homogeneity and diversity of color-opponent horizontal cells in the turtle retina: Consequences for potential wavelength discrimination
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Twig, G., primary and Perlman, I., additional
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- 2004
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15. Color opponency in horizontal cells of the vertebrate retina
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Twig, G, primary
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- 2003
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16. Spatial-chromatic interactions in C-type horizontal cells of the turtle (Mauremys caspica) retina
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TWIG, G., primary, LEVY, H., additional, and PERLMAN, I., additional
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- 2002
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17. Turtle C-type horizontal cells act as push–pull devices
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TWIG, G., primary, LEVY, H., additional, and PERLMAN, I., additional
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- 2001
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18. Mitochondrial networking protects beta-cells from nutrient-induced apoptosis.
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Molina AJ, Wikstrom JD, Stiles L, Las G, Mohamed H, Elorza A, Walzer G, Twig G, Katz S, Corkey BE, Shirihai OS, Molina, Anthony J A, Wikstrom, Jakob D, Stiles, Linsey, Las, Guy, Mohamed, Hibo, Elorza, Alvaro, Walzer, Gil, Twig, Gilad, and Katz, Steve
- Abstract
Objective: Previous studies have reported that beta-cell mitochondria exist as discrete organelles that exhibit heterogeneous bioenergetic capacity. To date, networking activity, and its role in mediating beta-cell mitochondrial morphology and function, remains unclear. In this article, we investigate beta-cell mitochondrial fusion and fission in detail and report alterations in response to various combinations of nutrients.Research Design and Methods: Using matrix-targeted photoactivatable green fluorescent protein, mitochondria were tagged and tracked in beta-cells within intact islets, as isolated cells and as cell lines, revealing frequent fusion and fission events. Manipulations of key mitochondrial dynamics proteins OPA1, DRP1, and Fis1 were tested for their role in beta-cell mitochondrial morphology. The combined effects of free fatty acid and glucose on beta-cell survival, function, and mitochondrial morphology were explored with relation to alterations in fusion and fission capacity.Results: beta-Cell mitochondria are constantly involved in fusion and fission activity that underlies the overall morphology of the organelle. We find that networking activity among mitochondria is capable of distributing a localized green fluorescent protein signal throughout an isolated beta-cell, a beta-cell within an islet, and an INS1 cell. Under noxious conditions, we find that beta-cell mitochondria become fragmented and lose their ability to undergo fusion. Interestingly, manipulations that shift the dynamic balance to favor fusion are able to prevent mitochondrial fragmentation, maintain mitochondrial dynamics, and prevent apoptosis.Conclusions: These data suggest that alterations in mitochondrial fusion and fission play a critical role in nutrient-induced beta-cell apoptosis and may be involved in the pathophysiology of type 2 diabetes. [ABSTRACT FROM AUTHOR]- Published
- 2009
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19. beta-Cell mitochondria exhibit membrane potential heterogeneity that can be altered by stimulatory or toxic fuel levels.
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Wikstrom JD, Katzman SM, Mohamed H, Twig G, Graf SA, Heart E, Molina AJA, Corkey BE, de Vargas LM, Danial NN, Collins S, Shirihai OS, Wikstrom, Jakob D, Katzman, Shana M, Mohamed, Hibo, Twig, Gilad, Graf, Solomon A, Heart, Emma, Molina, Anthony J A, and Corkey, Barbara E
- Abstract
Objective: beta-Cell response to glucose is characterized by mitochondrial membrane potential (Delta Psi) hyperpolarization and the production of metabolites that serve as insulin secretory signals. We have previously shown that glucose-induced mitochondrial hyperpolarization accompanies the concentration-dependent increase in insulin secretion within a wide range of glucose concentrations. This observation represents the integrated response of a large number of mitochondria within each individual cell. However, it is currently unclear whether all mitochondria within a single beta-cell represent a metabolically homogenous population and whether fuel or other stimuli can recruit or silence sizable subpopulations of mitochondria. This study offers insight into the different metabolic states of beta-cell mitochondria.Results: We show that mitochondria display a wide heterogeneity in Delta Psi and a millivolt range that is considerably larger than the change in millivolts induced by fuel challenge. Increasing glucose concentration recruits mitochondria into higher levels of homogeneity, while an in vitro diabetes model results in increased Delta Psi heterogeneity. Exploration of the mechanism behind heterogeneity revealed that temporary changes in Delta Psi of individual mitochondria, ATP-hydrolyzing mitochondria, and uncoupling protein 2 are not significant contributors to Delta Psi heterogeneity. We identified BAD, a proapoptotic BCL-2 family member previously implicated in mitochondrial recruitment of glucokinase, as a significant factor influencing the level of heterogeneity.Conclusions: We suggest that mitochondrial Delta Psi heterogeneity in beta-cells reflects a metabolic reservoir recruited by an increased level of fuels and therefore may serve as a therapeutic target. [ABSTRACT FROM AUTHOR]- Published
- 2007
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20. Dynamic changes in the receptive fields of L1-type horizontal cells in the retina of the turtle Mauremys caspica.
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BORNSTEIN, O., TWIG, G., BENDA, J., WEILER, R., and PERLMAN, I.
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- 2002
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21. Dynamic changes in the receptive fields of L1-type horizontal cells in the retina of the turtle <e1>Mauremys caspica</e1>
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BORNSTEIN, O., TWIG, G., BENDA, J., and WEILER, R.
- Abstract
The resistances of the horizontal cell syncytium in the vertebrate retina are modulated in a time-dependent fashion during light stimulation. Therefore, the spatial properties of horizontal cells are expected to change with time after the illumination conditions are altered. This study was designed to investigate time- and intensity-dependent changes in the receptive-field properties of L1-type horizontal cells in the turtle
Mauremys caspica . Photoresponses were elicited by monochromatic (650 nm) light stimuli of 2-s duration covering retinal spots of different radii. The length constants were derived from the relationships between amplitude and spot radius that were constructed for different time intervals after onset of the light stimulus. For a given stimulus intensity, the length constant transiently increased to a peak value and then slowly recovered to a plateau level. When the length constant was compared to the amplitude of the response to full-field illumination for the entire duration of the light stimulus, an ellipse-like curve was obtained indicating that for a given membrane potential, two different values of the length constant could be obtained. Dopamine considerably reduced the size of the receptive fields but did not affect the time-dependent changes in the length constant. These results indicate that changes in the membrane resistance underlie short-term modulation of the receptive-field properties of turtle L1-type horizontal cells after onset of a light stimulus.- Published
- 2002
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22. Spatial-chromatic interactions in C-type horizontal cells of the turtle (<e1>Mauremys caspica</e1>) retina
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TWIG, G. and LEVY, H.
- Abstract
Horizontal cells are second-order retinal neurons that play a key role in spatial information processing. In some cold-blooded vertebrates such as turtles, a subtype of these cells, the chromaticity horizontal cells exhibit color-opponent responses and therefore are considered to be important also for color information processing. To reveal spatial and color interactions, the receptive-field properties of Red/Green and Yellow/Blue chromaticity horizontal cells in the retina of the turtle
Mauremys caspica were studied by intracellular recordings from the everted eyecup preparation. We found that the polarity of the photoresponses depended not only upon the wavelength and intensity of the stimulus, but also upon its spatial configuration. Thus, a hyperpolarizing photoresponse that was elicited by full-field stimulation with bright light of wavelength close to the neutral one was reversed in polarity to a pure depolarizing one when a small spot or a thin annular pattern were used for stimulation. This finding could not be explained either by different balances between depolarizing and hyperpolarizing inputs to different cells or by stray light that effectively reduced the light intensity in the center of the small spot. Rather, it was found that the depolarizing and hyperpolarizing components were characterized by different receptive-field size and that these differences could account for the dependency of response polarity upon the spatial pattern of the stimulus. These findings indicate that color information processing in turtle C-type horizontal cells is a complex process that depends upon the wavelength and intensity of the light stimulus as well as upon its spatial properties.- Published
- 2002
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23. Turtle C-type horizontal cells act as pushpull devices
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TWIG, G. and LEVY, H.
- Abstract
Chromaticity (C-type) horizontal cells in the retina of cold-blooded vertebrates receive antagonistic inputs from cone photoreceptors of different spectral types leading to color opponency. The relative contribution of each spectral type of cones can be selectively altered by chromatic background illumination. Therefore, the spectral properties of C-type horizontal cells are expected to change when the intensity and color of ambient illumination are altered. In this study, we investigated the effects of chromatic background lights upon color opponency in Red/Green (RGH) and Yellow/Blue (YBH) C-type horizontal cells in the everted eyecup preparation of the turtle
Mauremys caspica . Photoresponses were elicited by long-wavelength and short-wavelength light stimuli in the dark-adapted state and under conditions of chromatic background illumination. We found that the total voltage range, within which graded depolarizing and the hyperpolarizing photoresponses could be elicited, either increased or decreased depending upon the color of the background light. However, the maximal and minimal potential levels determined respectively by long-wavelength and short-wavelength light stimuli of supersaturating intensity remained unchanged, regardless of the wavelength and intensity of the background. These findings indicate that turtle C-type horizontal cells operate as pushpull devices. A sufficiently bright short-wavelength stimulus can push them all the way to the maximal hyperpolarizing level while a very bright long-wavelength stimulus can pull them towards the most depolarizing potential.- Published
- 2001
24. Cognitive function in adolescence and the risk of early-onset stroke.
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Bardugo A, Bendor CD, Libruder C, Lutski M, Zucker I, Tsur AM, Derazne E, Yaniv G, Gardner RC, Gerstein HC, Cukierman-Yaffe T, Lebenthal Y, Batty D, Tanne D, Furer A, Afek A, and Twig G
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- Humans, Female, Male, Adolescent, Israel epidemiology, Risk Factors, Young Adult, Cohort Studies, Age of Onset, Registries, Ischemic Stroke epidemiology, Adult, Middle Aged, Stroke epidemiology, Cognition
- Abstract
Background: Stroke is increasingly prevalent at younger ages but the risk factors are uncertain. We examined the association between adolescent cognitive function and early-onset stroke., Methods: This was a nationwide population-based cohort study of 1 741 345 Israeli adolescents (42% women) who underwent comprehensive cognitive function tests at age 16-20 years, before mandatory military service, during 1987-2012. Cognitive function (range: 1-9) was categorised as low (1-3, corresponding to IQ score below 89), medium (4-7, IQ score range: 89-118), or high (8-9, IQ score above 118). Participant data were linked to the Israeli National Stroke Registry. Cox proportional hazard models were used to estimate risks for the first occurrence of ischaemic stroke during 2014-2018., Results: During 8 689 329 person-years of follow-up, up to a maximum age of 50 years, 908 first stroke events occurred (767 ischaemic and 141 haemorrhagic). Compared with a reference group of people with high cognitive function, body mass index-adjusted and sociodemographic-adjusted HRs (95% CIs) for early-onset stroke were 1.78 (1.33-2.38) in medium and 2.68 (1.96-3.67) in low cognitive function groups. There was evidence of a dose-response relationship ( P for trend <0.0001) such that one-unit of lower cognitive function z-score was associated with a 33% increased risk of stroke (1.33; 1.23-1.42). These associations were similar for ischaemic stroke but lower for haemorrhagic stroke; persisted in sensitivity analyses that accounted for diabetes status and hypertension; and were evident before age 40 years., Conclusions: Alongside adolescent obesity and hypertension, lower cognitive function may be a risk factor for early-onset stroke., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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25. Body mass index and astigmatism: A nationwide study.
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Nitzan I, Akavian I, Shmueli O, Erdinest N, Hanina Y, Twig G, and Safir M
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- Humans, Male, Female, Adolescent, Cross-Sectional Studies, Retrospective Studies, Israel epidemiology, Prevalence, Risk Factors, Astigmatism epidemiology, Astigmatism physiopathology, Body Mass Index
- Abstract
Background: Existing research on the relationship between body mass index (BMI) and astigmatism yields inconsistent results. This study analyses this association in a nationally representative sample of adolescents., Methods: This retrospective, cross-sectional study included Israeli adolescents who underwent medical assessments before mandatory military service between 2011 and 2022. BMI was categorised based on the US age- and sex-matched percentiles. Astigmatism was categorised by magnitude [low-moderate: 0.75 to <3.00 diopters (D), high: ≥3.00 D], and axis orientation [with-the-rule (WTR), against-the-rule (ATR), or oblique (OBL)]. Sex-stratified regression models adjusted for sociodemographic variables were used., Results: Of 935 989 adolescents evaluated, 887 325 were included [511 465 (57.6%) males, mean age 17.2 years]. Astigmatism was diagnosed in 123 675 (13.9%) adolescents, of whom 117 081 (13.2%) had low-moderate and 6594 (0.7%) had high astigmatism. WTR astigmatism was the most prevalent (8.2%), followed by ATR (4.1%) and OBL (1.6%) types. Compared with low-normal BMI (5th to 50th percentile), the adjusted ORs for total astigmatism increased with increasing BMI, peaking at 1.65 (1.57-1.74) in males and 1.74 (1.64-1.86) in females with severe obesity. ORs were accentuated for high astigmatism, reaching 3.51 (3.01-4.09) in males, and 3.45 (2.83-4.22) in females with severe obesity. WTR astigmatism demonstrated the strongest association with BMI, with ORs reaching 2.26 (2.13-2.40) in males and 2.04 (1.90-2.20) in females with severe obesity. The results persisted in a series of subgroup analyses., Conclusions: Obesity is associated with higher odds of astigmatism in adolescence. Further investigation into the role of weight management in astigmatism development is warranted., (© 2024 The Author(s). Clinical & Experimental Ophthalmology published by John Wiley & Sons Australia, Ltd on behalf of Royal Australian and New Zealand College of Ophthalmologists.)
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- 2024
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26. Stuttering in adolescence and the risk for dysglycemia in early adulthood.
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Rabotin A, Schwarz Y, Pinhas-Hamiel O, Amir O, Derazne E, Tzur D, Chodick G, Afek A, Tsur AM, and Twig G
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- Humans, Female, Male, Adolescent, Adult, Young Adult, Risk Factors, Incidence, Follow-Up Studies, Blood Glucose analysis, Cohort Studies, Prognosis, Stuttering epidemiology, Stuttering etiology, Stuttering complications, Diabetes Mellitus, Type 2 complications, Diabetes Mellitus, Type 2 epidemiology, Prediabetic State epidemiology, Prediabetic State complications
- Abstract
Aims: To investigate the association between stuttering during adolescence and the onset of dysglycemia (prediabetes or type 2 diabetes) in early adulthood among men and women., Materials and Methods: This cohort study included Maccabi Health Services members assessed for mandatory military service at ages 16-19 during 1990-2019 and followed until 31 December 2020. Stuttering status was recorded in the baseline medical evaluation. Incident cases of dysglycemia were identified systematically using prediabetes and diabetes registries. Cox proportional hazard models were applied for men and women separately, adjusting for sociodemographics and medical status., Results: The study cohort comprised 866,304 individuals (55% men; 0.21% with stuttering) followed for a total of 12,696,250 person-years. During the study period, 7.6% (n = 36,603) of men and 9.0% (n = 34,723) of women were diagnosed with dysglycemia. The mean ages at diagnosis were 34 and 32 years for men and women, respectively. Women with stuttering exhibited the highest dysglycemia incidence rate (102.3 per 10,000 person-years) compared with the other groups (61.4, 69.0, and 51.9 per 10,000 person-years for women without stuttering, men with stuttering, and men without stuttering, respectively). For both men and women, those with stuttering showed an increased risk of being diagnosed with dysglycemia compared with those without (adjusted hazard ratios 1.18 [1.01-1.38] and 1.61 [1.15-2.26], respectively). The associations persisted in extensive sub-analyses., Conclusions: Stuttering in adolescence is associated with a higher risk of dysglycemia in early adulthood for men and women. Screening and targeted prevention in this population, especially women, may be beneficial., (© 2024 The Author(s). Diabetes/Metabolism Research and Reviews published by John Wiley & Sons Ltd.)
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- 2024
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27. Association between BMI and COVID-19 on hospital budgets.
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Nitecki M, Afek A, and Twig G
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- Humans, SARS-CoV-2, Hospitals statistics & numerical data, COVID-19 economics, COVID-19 epidemiology, Body Mass Index, Budgets
- Abstract
Competing Interests: We declare no competing interests.
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- 2024
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28. First-trimester fasting plasma glucose levels and progression to type 2 diabetes: A 5-year cohort study.
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Maor-Sagie E, Hallak M, Twig G, Toledano Y, and Gabbay-Benziv R
- Abstract
Objective: Impaired fasting glucose is a prediabetic condition defined as glucose levels of 100-125 mg/dL and is considered a risk factor for type 2 diabetes. However, this definition does not confer to pregnancy. The significance of first-trimester fasting glucose and future progression to diabetes is not well defined. Therefore, we aimed to evaluate the progression to type 2 diabetes according to first- trimester fasting plasma glucose levels, as compared with gestational diabetes, a well-established risk factor for diabetes, in up to 5-year follow-up postpartum., Methods: A retrospective analysis of 69 001 parturients, evaluating fasting plasma glucose levels measured during the first trimester. The primary outcome was the incidence of type 2 diabetes within 5 years post-delivery. Fasting plasma glucose levels were categorized in 10 mg/dL increments. Receiver operating characteristic-area under the curve (ROC-AUC) statistics and the Youden index were employed to identify the optimal fasting plasma glucose cutoff for progression to type 2 diabetes. Survival analysis was applied to calculate the adjusted hazard ratios (aHRs) for type 2 diabetes progression with further stratification to maternal obesity status., Results: The identified fasting plasma glucose cutoff for progression to type 2 diabetes was 86.5 mg/dL. This cut-off demonstrated superior performance compared with gestational diabetes diagnosis. Stratification by maternal obesity revealed enhanced predictive capabilities for type 2 diabetes, particularly among patients without obesity., Conclusions: Increased first-trimester fasting plasma glucose levels are associated with progression to type 2 diabetes, at least as gestational diabetes. For patients without obesity, first-trimester fasting plasma glucose has a more pronounced impact on progression to diabetes., (© 2024 International Federation of Gynecology and Obstetrics.)
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- 2024
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29. Heritability of Body Mass Index Among Familial Generations.
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Chodick G, Simchoni M, Jensen BW, Derazne E, Pinhas-Hamiel O, Landau R, Abramovich A, Afek A, Baker JL, and Twig G
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- Humans, Male, Female, Israel epidemiology, Adolescent, Cohort Studies, Adult, Fathers statistics & numerical data, Body Mass Index, Obesity genetics, Obesity epidemiology
- Abstract
Importance: Studies on the familial effects of body mass index (BMI) status have yielded a wide range of data on its heritability., Objective: To assess the heritability of obesity by measuring the association between the BMIs of fathers, mothers, and their offspring at the same age., Design, Setting, and Participants: This cohort study used data from population-wide mandatory medical screening before compulsory military service in Israel. The study included participants examined between January 1, 1986, and December 31, 2018, whose both parents had their BMI measurement taken at their own prerecruitment evaluation in the past. Data analysis was performed from May to December 2023., Main Outcomes and Measures: Spearman correlation coefficients were calculated for offsprings' BMI and their mothers', fathers', and midparental BMI percentile (the mean of the mothers' and fathers' BMI cohort- and sex-specific BMI percentile) to estimate heritability. Logistic regression models were applied to estimate the odds ratios (ORs) and 95% CIs of obesity compared with healthy BMI, according to parental BMI status., Results: A total of 447 883 offspring (235 105 male [52.5%]; mean [SD] age, 17.09 [0.34] years) with both parents enrolled and measured for BMI at 17 years of age were enrolled in the study, yielding a total study population of 1 343 649 individuals. Overall, the correlation between midparental BMI percentile at 17 years of age and the offspring's BMI at 17 years of age was moderate (ρ = 0.386). Among female offspring, maternal-offspring BMI correlation (ρ = 0.329) was somewhat higher than the paternal-offspring BMI correlation (ρ = 0.266). Among trios in which both parents had a healthy BMI, the prevalence of overweight or obesity in offspring was 15.4%; this proportion increased to 76.6% when both parents had obesity and decreased to 3.3% when both parents had severe underweight. Compared with healthy weight, maternal (OR, 4.96; 95% CI, 4.63-5.32), paternal (OR, 4.48; 95% CI, 4.26-4.72), and parental (OR, 6.44; 95% CI, 6.22-6.67) obesity (midparent BMI in the ≥95th percentile) at 17 years of age were associated with increased odds of obesity among offspring., Conclusions and Relevance: In this cohort study of military enrollees whose parents also underwent prerecruitment evaluations, the observed correlation between midparental and offspring BMI, coupled with a calculated narrow-sense heritability of 39%, suggested a substantive contribution of genetic factors to BMI variation at 17 years of age.
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- 2024
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30. Dry eye disease management.
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Safir M, Twig G, and Mimouni M
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- Humans, Ophthalmic Solutions therapeutic use, Disease Management, Dry Eye Syndromes etiology, Dry Eye Syndromes therapy
- Abstract
Competing Interests: Competing interests: The BMJ has judged that the authors have no disqualifying financial ties to commercial companies that are relevant to this paper. The authors have read and understood BMJ policy on declaration of interests and have no relevant interests to declare. Provenance and peer review: Not commissioned; externally peer reviewed.
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- 2024
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31. Adolescent Body Mass Index and Early Chronic Kidney Disease in Young Adulthood.
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Tsur AM, Akavian I, Landau R, Derazne E, Tzur D, Vivante A, Grossman E, Rotem RS, Fishman B, Pinhas-Hamiel O, Afek A, Coresh J, Chodick G, and Twig G
- Subjects
- Adolescent, Humans, Male, Female, Young Adult, Adult, Middle Aged, Body Mass Index, Overweight complications, Cohort Studies, Albuminuria, Risk Factors, Pediatric Obesity, Obesity, Morbid complications, Hypertension, Renal Insufficiency, Chronic epidemiology, Renal Insufficiency, Chronic etiology
- Abstract
Importance: Despite increasing obesity rates in adolescents, data regarding early kidney sequelae are lacking., Objective: To assess the association between adolescent body mass index (BMI) and early chronic kidney disease (CKD) in young adulthood (<45 years of age)., Design, Setting, and Participants: This cohort study linked screening data of mandatory medical assessments of Israeli adolescents to data from a CKD registry of a national health care system. Adolescents who were aged 16 to 20 years; born since January 1, 1975; medically evaluated for mandatory military service through December 31, 2019; and insured by Maccabi Healthcare Services were assessed. Individuals with kidney pathology, albuminuria, hypertension, dysglycemia, or missing blood pressure or BMI data were excluded. Body mass index was calculated as weight in kilograms divided by height in meters squared and categorized by age- and sex-matched percentiles according to the US Centers for Disease Control and Prevention. Follow-up started at the time of medical evaluation or January 1, 2000 (whichever came last), and ended at early CKD onset, death, the last day insured, or August 23, 2020 (whichever came first). Data analysis was performed from December 19, 2021, to September 11, 2023., Main Outcomes and Measures: Early CKD, defined as stage 1 to 2 CKD by moderately or severely increased albuminuria, with an estimated glomerular filtration rate of 60 mL/min/1.73 m2 or higher., Results: Of 629 168 adolescents evaluated, 593 660 (mean [SD] age at study entry, 17.2 [0.5] years; 323 293 [54.5%] male, 270 367 [45.5%] female) were included in the analysis. During a mean (SD) follow-up of 13.4 (5.5) years for males and 13.4 (5.6) years for females, 1963 adolescents (0.3%) developed early CKD. Among males, the adjusted hazard ratios were 1.8 (95% CI, 1.5-2.2) for adolescents with high-normal BMI, 4.0 (95% CI, 3.3-5.0) for those with overweight, 6.7 (95% CI, 5.4-8.4) for those with mild obesity, and 9.4 (95% CI, 6.6-13.5) for those with severe obesity. Among females, the hazard ratios were 1.4 (95% CI, 1.2-1.6) for those with high-normal BMI, 2.3 (95% CI, 1.9-2.8) for those with overweight, 2.7 (95% CI, 2.1-3.6) for those with mild obesity, and 4.3 (95% CI, 2.8-6.5) for those with severe obesity. The results were similar when the cohort was limited to individuals who were seemingly healthy as adolescents, individuals surveyed up to 30 years of age, or those free of diabetes and hypertension at the end of the follow-up., Conclusions and Relevance: In this cohort study, high BMI in late adolescence was associated with early CKD in young adulthood. The risk was also present in seemingly healthy individuals with high-normal BMI and before 30 years of age, and a greater risk was seen among those with severe obesity. These findings underscore the importance of mitigating adolescent obesity rates and managing risk factors for kidney disease in adolescents with high BMI.
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- 2024
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32. Blepharoptosis and cognitive performance: a population-based study of 1.4 million adolescents.
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Nitzan I, Derazne E, Afek A, Gur Z, Weinstein O, Twig G, and Zloto O
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- Humans, Adolescent, Child, Female, Male, Prospective Studies, Quality of Life, Retrospective Studies, Cross-Sectional Studies, Cognition, Blepharoptosis epidemiology, Blepharoptosis etiology
- Abstract
The purpose of this study is to examine the association between blepharoptosis and cognitive performance in late adolescence. This population-based, retrospective, cross-sectional study included 1,411,570 Israeli-born adolescents (620,107 women, 43.9%) aged 16-19 years who were medically examined before compulsory military service between 1993 and 2017. The diagnosis of blepharoptosis was verified by an ophthalmologist. Cognitive performance was assessed by a validated intelligence-quotient-equivalent test, comprising four domains (problem-solving, verbal abstraction and categorization, verbal comprehension, and mathematical abilities). Cognitive Z-scores were calculated and categorized as high (≥ 1 standard deviation (SD)), medium (- 1 to < 1 SD), and low (less than - 1 SD). Relationships were analyzed using regression models adjusted for sociodemographic variables including sex, year of birth, residential socioeconomic status, education level, body mass index, and familial country of origin. A total of 577 (41 per 100,000, 32.2% women) adolescents were diagnosed with blepharoptosis. The proportions of unilateral and bilateral visual impairment among adolescents with blepharoptosis were 13.0% and 3.5%, respectively. In a multivariable analysis, blepharoptosis was associated with a 0.18 SD reduction in cognitive Z-score (p < 0.001). The adjusted odds ratios for low and high cognitive Z-scores in adolescents with blepharoptosis were 1.54 (1.25-1.89) and 0.80 (0.62-1.04), respectively. This relationship persisted when adolescents with normal best-corrected visual acuity or unimpaired health status were analyzed separately. Conclusions: Blepharoptosis is associated with reduced cognitive performance determined in late adolescence. Future prospective studies should investigate the causes of this link and their underlying mechanisms. What is Known: • While earlier investigations have examined the effects of blepharoptosis on vision and quality of life, the association between blepharoptosis and cognitive outcomes in youth has remained unexplored. What is New: • This nationwide study involving 1.4 million Israeli adolescents found a correlation between blepharoptosis and reduced cognitive performance. • Our findings suggest a potential interplay between blepharoptosis and cognitive development in the pediatric population, calling for increased focus on the educational needs of affected individuals., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
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- 2024
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33. Pharmaceutical Agents as Potential Drivers in the Development of Early-Onset Colorectal Cancer: Case-Control Study.
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Ben-Aharon I, Rotem R, Melzer-Cohen C, Twig G, Cercek A, Half E, Goshen-Lago T, Chodik G, and Kelsen D
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- Young Adult, Humans, Adolescent, Case-Control Studies, Bayes Theorem, Anti-Bacterial Agents, Inflammatory Bowel Diseases, Colorectal Neoplasms drug therapy, Colorectal Neoplasms epidemiology, Colorectal Neoplasms genetics
- Abstract
Background: The incidence of early-onset colorectal cancer (EOCRC) rose abruptly in the mid 1990s, is continuing to increase, and has now been noted in many countries. By 2030, 25% of American patients diagnosed with rectal cancer will be 49 years or younger. The large majority of EOCRC cases are not found in patients with germline cancer susceptibility mutations (eg, Lynch syndrome) or inflammatory bowel disease. Thus, environmental or lifestyle factors are suspected drivers. Obesity, sedentary lifestyle, diabetes mellitus, smoking, alcohol, or antibiotics affecting the gut microbiome have been proposed. However, these factors, which have been present since the 1950s, have not yet been conclusively linked to the abrupt increase in EOCRC. The sharp increase suggests the introduction of a new risk factor for young people. We hypothesized that the driver may be an off-target effect of a pharmaceutical agent (ie, one requiring regulatory approval before its use in the general population or an off-label use of a previously approved agent) in a genetically susceptible subgroup of young adults. If a pharmaceutical agent is an EOCRC driving factor, regulatory risk mitigation strategies could be used., Objective: We aimed to evaluate the possibility that pharmaceutical agents serve as risk factors for EOCRC., Methods: We conducted a case-control study. Data including demographics, comorbidities, and complete medication dispensing history were obtained from the electronic medical records database of Maccabi Healthcare Services, a state-mandated health provider covering 26% of the Israeli population. The participants included 941 patients with EOCRC (≤50 years of age) diagnosed during 2001-2019 who were density matched at a ratio of 1:10 with 9410 control patients. Patients with inflammatory bowel disease and those with a known inherited cancer susceptibility syndrome were excluded. An advanced machine learning algorithm based on gradient boosted decision trees coupled with Bayesian model optimization and repeated data sampling was used to sort through the very high-dimensional drug dispensing data to identify specific medication groups that were consistently linked with EOCRC while allowing for synergistic or antagonistic interactions between medications. Odds ratios for the identified medication classes were obtained from a conditional logistic regression model., Results: Out of more than 800 medication classes, we identified several classes that were consistently associated with EOCRC risk across independently trained models. Interactions between medication groups did not seem to substantially affect the risk. In our analysis, drug groups that were consistently positively associated with EOCRC included beta blockers and valerian (Valeriana officinalis). Antibiotics were not consistently associated with EOCRC risk., Conclusions: Our analysis suggests that the development of EOCRC may be correlated with prior use of specific medications. Additional analyses should be used to validate the results. The mechanism of action inducing EOCRC by candidate pharmaceutical agents will then need to be determined., (©Irit Ben-Aharon, Ran Rotem, Cheli Melzer-Cohen, Gilad Twig, Andrea Cercek, Elizabeth Half, Tal Goshen-Lago, Gabriel Chodik, David Kelsen. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 13.12.2023.)
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- 2023
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34. High BMI and the risk for incident type 1 Diabetes Mellitus: a systematic review and meta-analysis of aggregated cohort studies.
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Nitecki M, Gerstein HC, Balmakov Y, Tsur E, Babushkin V, Michaeli T, Afek A, Pinhas-Hamiel O, Cukierman-Yaffe T, and Twig G
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- Humans, Child, Preschool, Body Mass Index, Obesity diagnosis, Obesity epidemiology, Cohort Studies, Overweight diagnosis, Overweight epidemiology, Diabetes Mellitus, Type 1 diagnosis, Diabetes Mellitus, Type 1 epidemiology
- Abstract
Background: There is uncertainty regarding the role of obesity in type 1 diabetes development. The aim of this systematic review and meta-analysis was to collect and synthesize evidence regarding BMI and the risk of developing type 1 diabetes., Methods: A systematic review and meta-analysis were conducted to assess the association between BMI and incident type 1 diabetes. Databases were searched up to June 2022. Cohort studies were included reporting the association between overweight and/or obesity, as measured by BMI after age 2 years, with incident type 1 diabetes. Independent reviewers extracted data and assessed study quality. Risk estimates were pooled using a random-effects model., Results: Ten cohort studies met the inclusion criteria. The seven studies that classified BMI into categories were of high quality and involved 1,690,660 individuals and 1979 incident type 1 diabetes cases. The pooled risk ratio (RR) for type 1 diabetes was 1.35 (95% CI 0.93-1.97) among people with overweight (3 studies); 2.17 (95% CI 1.75-2.69) among people with obesity (5 studies); and 1·87 (95% CI 1.52-2.29) among people with overweight/obesity (two studies merged the categories). These point estimates persisted in sensitivity analyses that addressed the duration of follow-up, variability in baseline risk for incident type 1 diabetes, and potential misclassifications related to exposure or outcome definitions. People with overweight/obesity had a 2.55 (95% CI 1.11-5.86) greater risk for incident type 1 diabetes with positive islet autoantibodies., Conclusion: This systematic review and meta-analysis of high-quality observational cohort studies indicated an association between high BMI and the risk of type 1 diabetes, in a graded manner., (© 2023. The Author(s).)
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- 2023
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35. Protecting the Brains of People With Type 2 Diabetes.
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Milloh-Raz H and Twig G
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- Humans, Glucagon-Like Peptide-1 Receptor agonists, Randomized Controlled Trials as Topic, Hypoglycemic Agents therapeutic use, Brain, Diabetes Mellitus, Type 2
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- 2023
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36. Body mass index and migraine in adolescence: A nationwide study.
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Zloof Y, Tsur AM, Simchoni M, Derazne E, Tzur D, Honig A, Braun M, Ganelin-Cohen E, Amarilyo G, Pinhas-Hamiel O, Afek A, and Twig G
- Subjects
- Adult, Child, Male, Adolescent, Humans, Female, Body Mass Index, Overweight, Thinness, Pediatric Obesity, Migraine Disorders epidemiology
- Abstract
Background: The association between body mass index (BMI) and migraine in adults has been well established. However, studies in children and adolescents are inconclusive. We aimed to study the association between BMI and migraine using a national dataset that comprises the electronic medical records of more than two million adolescents., Methods: This study included all Israeli adolescents (57.7% males, 42.3% females; mean age 17 years) who were medically assessed before mandatory military service during 1990-2020. As part of the pre-recruitment medical assessment, all the adolescents were screened for migraine and their height and weight were measured. Diagnoses of migraine were confirmed by board-certified neurologists. Prevalences and odds ratios (ORs) for migraine were computed across BMI subgroups. Spline models were applied., Results: A total of 2,094,862 adolescents were included, of whom 57,385 (2.8%) had active migraine. Among males, the adjusted ORs for migraine were 1.11 (95% confidence interval, 1.06-1.16), 1.13 (1.08-1.17), and 1.24 (1.19-1.30), for the underweight, overweight, and obesity subgroups, respectively, compared to the reference group of low-normal BMI (5th-49th percentile). Among females, the respective adjusted ORs were 1.12 (1.05-1.19), 1.23 (1.19-1.28), and 1.38 (1.31-1.46). Results persisted in sensitivity analyses accounting for other medical and psychiatric comorbidities and parental history of migraine. Spline models demonstrated a J-shaped relation between BMI and migraine., Conclusions: Both adolescent obesity and underweight were associated with migraine in a sex-dependent manner. This association peaked in female adolescents with overweight and obesity., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2023
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37. The impact on clinical outcomes after 1 year of implementation of an artificial intelligence solution for the detection of intracranial hemorrhage.
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Kotovich D, Twig G, Itsekson-Hayosh Z, Klug M, Simon AB, Yaniv G, Konen E, Tau N, Raskin D, Chang PJ, and Orion D
- Abstract
Background: To assess the effect of a commercial artificial intelligence (AI) solution implementation in the emergency department on clinical outcomes in a single level 1 trauma center., Methods: A retrospective cohort study for two time periods-pre-AI (1.1.2017-1.1.2018) and post-AI (1.1.2019-1.1.2020)-in a level 1 trauma center was performed. The ICH algorithm was applied to 587 consecutive patients with a confirmed diagnosis of ICH on head CT upon admission to the emergency department. Study variables included demographics, patient outcomes, and imaging data. Participants admitted to the emergency department during the same time periods for other acute diagnoses (ischemic stroke (IS) and myocardial infarction (MI)) served as control groups. Primary outcomes were 30- and 120-day all-cause mortality. The secondary outcome was morbidity based on Modified Rankin Scale for Neurologic Disability (mRS) at discharge., Results: Five hundred eighty-seven participants (289 pre-AI-age 71 ± 1, 169 men; 298 post-AI-age 69 ± 1, 187 men) with ICH were eligible for the analyzed period. Demographics, comorbidities, Emergency Severity Score, type of ICH, and length of stay were not significantly different between the two time periods. The 30- and 120-day all-cause mortality were significantly reduced in the post-AI group when compared to the pre-AI group (27.7% vs 17.5%; p = 0.004 and 31.8% vs 21.7%; p = 0.017, respectively). Modified Rankin Scale (mRS) at discharge was significantly reduced post-AI implementation (3.2 vs 2.8; p = 0.044)., Conclusion: The added value of this study emphasizes the introduction of artificial intelligence (AI) computer-aided triage and prioritization software in an emergent care setting that demonstrated a significant reduction in a 30- and 120-day all-cause mortality and morbidity for patients diagnosed with intracranial hemorrhage (ICH). Along with mortality rates, the AI software was associated with a significant reduction in the Modified Ranking Scale (mRs)., (© 2023. Springer-Verlag GmbH Germany, part of Springer Nature.)
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- 2023
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38. Association Between Body Mass Index and Nonspecific Recurrent Low Back Pain in Over 600,000 Healthy Young Adults.
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Nitecki M, Shapiro G, Orr O, Levitin E, Sharshevsky H, Tzur D, Twig G, and Shapira S
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- Female, Humans, Male, Young Adult, Adolescent, Body Mass Index, Obesity epidemiology, Obesity complications, Overweight complications, Causality, Low Back Pain epidemiology, Low Back Pain etiology
- Abstract
An association between body mass index (BMI; weight (kg)/height (m)2) and low back pain (LBP) has long been debated, but inconsistent measurements of BMI and varying definitions of LBP have produced conflicting findings. We explored this association using measured BMI and physician documentation of recurrent LBP among healthy young adults. Data were extracted from the Israel Defense Forces electronic medical record system. All Israeli citizens with compulsory military service during January 2008-March 2019 were included (n = 705,840). Exclusion criteria were spine deformities, disc pathologies, spinal surgeries, arthropathies, connective tissue diseases, pain syndromes, low bone density disorders, cancers, and psychiatric illnesses. LBP was defined as electronic medical record system documentation of 1) 2 medical visits at least 6 weeks apart with a diagnosis of LBP or "LBP with radiation" or 2) 1 medical visit resulting in referral to an orthopedic surgeon. Logistic regression models were used to explore the association between BMI category and LBP; 619,969 (87.8%) individuals (mean age = 18.9 (standard deviation, 0.97) years; 56.9% male) were included. LBP prevalence was 9.2% (n = 56,918) and higher among males (9.7%) than females (8.5%). Overweight (odds ratio = 1.123, 95% confidence interval: 1.096, 1.151) and obesity (odds ratio = 1.137, 95% confidence interval: 1.096, 1.179) were associated with LBP. The association remained significant after accounting for various sociodemographic factors. Maintaining a healthy BMI may aid in the prevention of LBP in young adults., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
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- 2023
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39. Adolescent body mass index and cognitive performance: a nationwide study of 2.48 million Israeli adolescents.
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Simchoni M, Derazne E, Pinhas-Hamiel O, Cukierman-Yaffe T, Bendor CD, Bardugo A, Chodick G, Tzur D, Endevelt R, Gerstein HC, Afek A, and Twig G
- Subjects
- Female, Humans, Adolescent, Male, Body Mass Index, Cross-Sectional Studies, Israel epidemiology, Overweight epidemiology, Pediatric Obesity epidemiology, Pediatric Obesity complications, Obesity, Morbid
- Abstract
Importance: The increased incidence of adolescent obesity over recent decades may be associated with lower cognitive performance than the expected potential., Objective: We aimed to assess the association between adolescent body mass index (BMI) and cognitive function., Design: A nationwide, cross-sectional, population-based study., Setting: Pre-recruitment evaluation for military service during 1967-2018., Participants: All Israeli-born adolescents, 1 459 522 males and 1 027 953 females aged 16 to ≤20 years., Exposures: Weight and height were measured to calculate BMI., Main Outcome: Cognitive performance was assessed by using a validated intelligence-quotient-equivalent test and was standardized to the year- and sex-Z-score. For 445 385 persons, parental cognitive scores could be identified. Multinomial logistic regression models were applied., Results: Among male adolescents with severe obesity, 29.4% achieved a cognitive score below the 25th percentile, compared with 17.7% among their normal-weight (50th-84th percentile) counterparts. A J-shaped relation was observed between BMI and the odds ratio (OR) for a low cognitive score among male adolescents: underweight, 1.45 (1.43-1.48); overweight, 1.13 (1.12-1.15); mild obesity, 1.36 (1.33-1.39); and severe obesity, 1.58 (1.52-1.64). Similar findings were observed in females. For both sexes, point estimates were overall consistent in models adjusted for sociodemographic confounders, coexisting morbidities, and parental cognitive scores. Examinees with abnormal BMI had higher ORs for a lower-than-expected cognitive score, based on their parents' data as adolescents, in a manner that depends on obesity severity., Conclusion and Relevance: Obesity, is associated with increased odds for a lower cognitive performance, and the inability to fully achieve cognitive potential, regardless of sociodemographic background., Competing Interests: Conflict of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported., (© The Author(s) 2023. Published by Oxford University Press on behalf of European Society of Endocrinology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
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- 2023
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40. Adolescent Hypertension Is Associated With Stroke in Young Adulthood: A Nationwide Cohort of 1.9 Million Adolescents.
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Fishman B, Bardugo A, Zloof Y, Bendor CD, Libruder C, Zucker I, Lutski M, Ram A, Hershkovitz Y, Orr O, Omer M, Furer A, Goldman A, Yaniv G, Tanne D, Derazne E, Tzur D, Afek A, Grossman E, and Twig G
- Subjects
- Male, Young Adult, Humans, Adolescent, Adult, Middle Aged, Female, Retrospective Studies, Risk Factors, Incidence, Hypertension epidemiology, Stroke epidemiology, Diabetes Mellitus, Ischemic Stroke
- Abstract
Background: Adult hypertension is a well-established risk factor for stroke in young adults (aged <55 years), and the effects are even more deleterious than at an older age. However, data are limited regarding the association between adolescent hypertension and the risk of stroke in young adulthood., Methods: A nationwide, retrospective cohort study of adolescents (aged 16-19 years) who were medically evaluated before compulsory military service in Israel during 1985 to 2013. For each candidate for service, hypertension was designated after constructed screening, and the diagnosis was confirmed through a comprehensive workup process. The primary outcome was ischemic and hemorrhagic stroke incidence as registered at the national stroke registry. Cox proportional-hazards models were used. We conducted sensitivity analyses by excluding people with a diabetes diagnosis at adolescence or a new diabetes diagnosis during the follow-up period, analysis of adolescents with overweight, and adolescents with baseline unimpaired health status., Results: The final sample included 1 900 384 adolescents (58% men; median age, 17.3 years). In total, 1474 (0.08%) incidences of stroke (1236 [84%] ischemic) were recorded, at a median age of 43 (interquartile range, 38-47) years. Of these, 18 (0.35%) occurred among the 5221 people with a history of adolescent hypertension. The latter population had a hazard ratio of 2.4 (95% CI, 1.5-3.9) for incident stroke after adjustment for body mass index and baseline sociodemographic factors. Further adjustment for diabetes status yielded a hazard ratio of 2.1 (1.3-3.5). We found similar results when the outcome was ischemic stroke with a hazard ratio of 2.0 (1.2-3.5). Sensitivity analyses for overall stroke, and ischemic stroke only, yielded consistent findings., Conclusions: Adolescent hypertension is associated with an increased risk of stroke, particularly ischemic stroke, in young adulthood., Competing Interests: Disclosures None.
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- 2023
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41. Glucose intolerance in pregnancy and risk of early-onset type 2 diabetes: a population-based cohort study.
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Bardugo A, Bendor CD, Rotem RS, Tsur AM, Derazne E, Gerstein HC, Tzur D, Pinhas-Hamiel O, Cukierman-Yaffe T, Raz I, Hod M, Tirosh A, Lebenthal Y, Afek A, Chodick G, and Twig G
- Subjects
- Pregnancy, Female, Humans, Young Adult, Adult, Adolescent, Blood Glucose, Cohort Studies, Glucose, Retrospective Studies, Glucose Intolerance epidemiology, Glucose Intolerance diagnosis, Diabetes, Gestational diagnosis, Diabetes, Gestational epidemiology, Diabetes Mellitus, Type 2 diagnosis, Diabetes Mellitus, Type 2 epidemiology, Diabetes Mellitus, Type 2 etiology
- Abstract
Background: The risk of type 2 diabetes among women with glucose intolerance during pregnancy that does not meet gestational diabetes criteria requires further investigation. We aimed to explore the associations between various degrees of gestational glucose intolerance and the risk of type 2 diabetes in young adulthood., Methods: For this population-based cohort study, the national Israeli conscription database was linked to Maccabi Healthcare Services (MHS), the second-largest state-mandated health provider in Israel. We included 177 241 women who underwent a pre-recruitment evaluation at adolescence (age 16-20 years), 1 year before mandatory military service, and later underwent, from Jan 1, 2001, to Dec 31, 2019, two-step gestational diabetes screening with a 50 g glucose challenge test (GCT) based on a threshold of 140 mg/dL (7·8 mmol/L), followed as needed by a 100 g oral glucose tolerance test (OGTT). Abnormal OGTT values were defined according to the Carpenter-Coustan thresholds: 95 mg/dL (5·3 mmol/L) or higher in the fasting state; 180 mg/dL (10·0 mmol/L) or higher at 1 h; 155 mg/dL (8·6 mmol/L) or higher at 2 h; and 140 mg/dL (7·8 mmol/L) or higher at 3 h. The primary outcome was incident type 2 diabetes in the MHS diabetes registry. Cox proportional hazards models were applied to estimate adjusted hazard ratios (HRs) with 95% CIs for incident type 2 diabetes., Findings: During a cumulative follow-up of 1 882 647 person-years, and with a median follow-up of 10·8 (IQR 5·2-16·4) years, 1262 women were diagnosed with type 2 diabetes. Crude incidence rates of type 2 diabetes were 2·6 (95% CI 2·4-2·9) per 10 000 person-years in women with gestational normoglycaemia, 8·9 (7·4-10·6) per 10 000 person-years in women with an abnormal GCT and normal OGTT, 26·1 (22·4-30·1) per 10 000 person-years in women with one abnormal OGTT value (in the fasting state or 1 h, 2 h, or 3 h post-challenge), and 71·9 (66·0-78·3) per 10 000 person-years in women with gestational diabetes. After adjustment for sociodemographic characteristics, adolescent BMI, and age at gestational screening, the risk of type 2 diabetes was higher, compared to the gestational normoglycaemia group, in women with an abnormal GCT and normal OGTT (adjusted hazard ratio [HR] 3·39 [95% CI 2·77-4·16]; p<0·0001), in women with one abnormal OGTT value (9·11 [7·64-10·86]; p<0·0001), and in women with gestational diabetes (24·84 [21·78-28·34]; p<0·0001). The risk of type 2 diabetes was modestly increased in women with isolated elevated fasting glucose (adjusted HR 11·81 [95% CI 8·58-16·25]; p<0·0001), and in women with gestational diabetes and an abnormal fasting glucose (38·02 [32·41-44·61]; p<0·0001)., Interpretation: Gestational glucose intolerance, including conditions not meeting gestational diabetes criteria of the two-step strategy, confers a high risk of type 2 diabetes in young adulthood. These conditions should be recognised as risk factors for type 2 diabetes, especially among women with abnormal fasting glucose concentrations during pregnancy., Funding: None., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2023 Elsevier Ltd. All rights reserved.)
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- 2023
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42. Comparison of Commonly Used Methods to Predict the Final Height in Constitutional Tall Stature
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Matias AK, Muginshtein-Simkovitch E, Twig G, Pearl L, and Laron Z
- Subjects
- Child, Adult, Humans, Male, Female, Adolescent, Growth Disorders diagnosis, Body Height, Puberty, Precocious
- Abstract
Objective: To determine the accuracy of adult height prediction in children with constitutional tall stature., Methods: The medical records of 138 non-syndromatic prepubertal and early pubertal children (52 male, 86 female) with a height of ≥90
th percentile born between the years 1975 and 1988 were included in this study. Using the Bayley-Pinneau (BP) and Tanner-Whitehouse I (TWI) prediction methods, their height standard deviation score (SDS) at referral was compared with their height SDS at age 17 years when measured at the IDF conscription center., Results: While remaining tall, the height SDS at age 17 years was lower than that at referral decreasing from 2.13±1 to 1.65±1.21 in boys and from 2.48±1 to 2.15±1 in girls., Conclusion: The prediction by the BP and TWI methods can be useful for estimating adult height in constitutional tall stature even in the prepubertal and early pubertal period. However, the fallibility of these methods should be kept in mind during clinical practice. We think that this study will shed light on these issues., (©Copyright 2023 by Turkish Society for Pediatric Endocrinology and Diabetes | The Journal of Clinical Research in Pediatric Endocrinology published by Galenos Publishing House.)- Published
- 2023
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43. The real-world safety profile of sodium-glucose co-transporter-2 inhibitors among older adults (≥ 75 years): a retrospective, pharmacovigilance study.
- Author
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Goldman A, Fishman B, Twig G, Raschi E, Cukierman-Yaffe T, Moshkovits Y, Pomerantz A, Ben-Zvi I, Dankner R, and Maor E
- Subjects
- Humans, Aged, Middle Aged, Retrospective Studies, Pharmacovigilance, Insulin therapeutic use, Glucose, Sodium, Sodium-Glucose Transporter 2 Inhibitors adverse effects, Symporters, Diabetes Mellitus, Type 2 diagnosis, Diabetes Mellitus, Type 2 drug therapy, Diabetes Mellitus, Type 2 epidemiology
- Abstract
Background: As indications for sodium-glucose co-transporter-2 inhibitors (SGLT2i) are expanding, a growing number of older adults have become candidates for treatment. We studied the safety profile of SGLT2i among older adults., Methods: A retrospective, pharmacovigilance study of the FDA's global database of safety reports. To assess reporting of pre-specified adverse events following SGLT2i among adults (< 75 years) and older adults (≥ 75), we performed a disproportionality analysis using the sex-adjusted reporting odds ratio (adj.ROR)., Results: We identified safety reports of 129,795 patients who received non-insulin anti-diabetic drugs (NIAD), including 24,253 who were treated with SGLT2i (median age 60 [IQR: 51-68] years, 2,339 [9.6%] aged ≥ 75 years). Compared to other NIAD, SGLT2i were significantly associated with amputations (adj.ROR = 355.1 [95%CI: 258.8 - 487.3] vs adj.ROR = 250.2 [79.3 - 789.5]), Fournier gangrene (adj.ROR = 45.0 [34.5 - 58.8] vs adj.ROR = 88.0 [27.0 - 286.6]), diabetic ketoacidosis (adj.ROR = 32.3 [30.0 - 34.8] vs adj.ROR = 23.3 [19.2 - 28.3]), genitourinary infections (adj.ROR = 10.3 [9.4 - 11.2] vs adj.ROR = 8.6 [7.2 - 10.3]), nocturia (adj.ROR = 5.5 [3.7 - 8.2] vs adj.ROR = 6.7 [2.8 - 15.7]), dehydration (adj.ROR = 2.5 [2.3 - 2.8] vs adj.ROR = 2.6 [2.1 - 3.3]), and fractures (adj.ROR = 1.7 [1.4 - 2.1] vs adj.ROR = 1.5 [1.02 - 2.1]) in both adults and older adults, respectively. None of these safety signals was significantly greater in older adults (P
interaction threshold of 0.05). Acute kidney injury was associated with SGLT2i in adults (adj.ROR = 1.97 [1.85 - 2.09]) but not in older adults (adj.ROR = 0.71 [0.59 - 0.84]). Falls, hypotension, and syncope were not associated with SGLT2i among either adults or older adults., Conclusion: In this global post-marketing study, none of the adverse events was reported more frequently among older adults. Our findings provide reassurance regarding SGLT2i treatment in older adults, although careful monitoring is warranted., (© 2023. The Author(s).)- Published
- 2023
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44. SARS-CoV-2 Epidemic in the Israeli Defense Force-Lessons Learned From Our rt-PCR Screening Policy.
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Tsur A, Furer A, Avramovich E, Karp E, Twig G, Bader T, Almakias M, and Fink N
- Subjects
- Humans, Israel epidemiology, Pandemics prevention & control, Personal Protective Equipment, COVID-19 Testing, SARS-CoV-2, COVID-19 diagnosis, COVID-19 epidemiology
- Abstract
Background: During the SARS-CoV-2 pandemic, multiple preventative measures were used to prevent the virus from spreading in the population. The Israeli defense force deployed further means to contain the disease, including putting units in quarantine, physical distancing and using masks, gowns and disinfectants when in contact with suspected patients., Methods: We used reverse transcriptase-polymerase chain reaction (rt-PCR) tests to screen for patients among asymptomatic soldiers within units participating in civilian aid or in close contact with known patients, using personal protective equipment. Positive results were repeated and followed with serological testing to verify the nature of results., Results: Between April and May 2020, we screened a total of 1,453 soldiers in 13 different units. We found 11 false positive results, leading to unnecessary measures until resolution, and three true positive results (0.2%). All true positive results had unreported symptoms concomitant with SARS-CoV-2 disease. These results led to the resolution of this screening policy., Conclusion: Screening asymptomatic army personnel in this setting with rt-PCR test for SARS-CoV-2 is not warranted and leads to unnecessary false positive results. Efforts should be directed at identifying symptomatic patients., (© The Association of Military Surgeons of the United States 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
- Published
- 2023
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45. Obesity in late adolescence and incident type 1 diabetes in young adulthood.
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Zucker I, Zloof Y, Bardugo A, Tsur AM, Lutski M, Cohen Y, Cukierman-Yaffe T, Minsky N, Derazne E, Tzur D, Melzer Cohen C, Pinhas-Hamiel O, Chodick G, Raz I, Afek A, Gerstein HC, Tirosh A, and Twig G
- Subjects
- Adolescent, Adult, Body Mass Index, Child, Humans, Incidence, Obesity complications, Overweight complications, Risk Factors, Young Adult, Diabetes Mellitus, Type 1 complications, Diabetes Mellitus, Type 1 epidemiology
- Abstract
Aims/hypothesis: Studies in children have reported an association between increased BMI and risk for developing type 1 diabetes, but evidence in late adolescence is limited. We studied the association between BMI in late adolescence and incident type 1 diabetes in young adulthood., Methods: All Israeli adolescents, ages 16-19 years, undergoing medical evaluation in preparation for mandatory military conscription between January 1996 and December 2016 were included for analysis unless they had a history of dysglycaemia. Data were linked with information about adult onset of type 1 diabetes in the Israeli National Diabetes Registry. Weight and height were measured at study entry. Cox proportional models were applied, with BMI being analysed both as a categorical and as a continuous variable., Results: There were 777 incident cases of type 1 diabetes during 15,819,750 person-years (mean age at diagnosis 25.2±3.9 years). BMI was associated with incident type 1 diabetes. In a multivariable model adjusted for age, sex and sociodemographic variables, the HRs for type 1 diabetes were 1.05 (95% CI 0.87, 1.27) for the 50th-74th BMI percentiles, 1.41 (95% CI 1.11, 1.78) for the 75th-84th BMI percentiles, 1.54 (95% CI 1.23, 1.94) for adolescents who were overweight (85th-94th percentiles), and 2.05 (95% CI 1.58, 2.66) for adolescents with obesity (≥95th percentile) (reference group: 5th-49th BMI percentiles). One increment in BMI SD was associated with a 25% greater risk for incidence of type 1 diabetes (HR 1.25, 95% CI 1.17, 1.32)., Conclusions: Excessively high BMI in otherwise healthy adolescents is associated with increased risk for incident type 1 diabetes in early adulthood., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
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- 2022
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46. Myopia and BMI: a nationwide study of 1.3 million adolescents.
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Peled A, Nitzan I, Megreli J, Derazne E, Tzur D, Pinhas-Hamiel O, Afek A, and Twig G
- Subjects
- Adolescent, Body Mass Index, Cross-Sectional Studies, Female, Humans, Male, Risk Factors, Thinness, Myopia epidemiology, Obesity, Morbid
- Abstract
Objective: This study analyzed the association between adolescent BMI and myopia severity., Methods: This cross-sectional study comprised 1,359,153 adolescents who were medically examined before mandatory military service. Mild-to-moderate and high myopia were defined based on right-eye refractive data. BMI was categorized based on the US age- and sex-matched percentiles. Logistic regression models were applied separately for women and men to estimate odds ratios (ORs) for myopia per BMI category., Results: A total of 318,712 adolescents had mild-to-moderate myopia and 23,569 had high myopia. Compared with low-normal BMI (reference group), adjusted ORs for mild-to-moderate and high myopia increased with increasing BMI status, reaching 1.39 (95% CI: 1.23-1.57) and 1.73 (95% CI: 1.19-2.51) for men with severe obesity, respectively, and 1.19 (95% CI: 1.12-1.27) and 1.38 (95% CI: 1.14-1.65) for women with mild obesity, respectively. ORs for mild-to-moderate and high myopia were also higher in men with underweight (OR = 1.20; 95% CI: 1.18-1.23 and OR = 1.39; 95% CI: 1.30-1.47) and women with underweight (OR = 1.06; 95% CI: 1.03-1.09 and OR = 1.12; 95% CI: 1.04-1.22). The overall size effect was greater for men than women (p
interaction < 0.001), in whom the group with severe obesity did not reach statistical significance., Conclusions: BMI was associated with myopia in a J-shaped pattern, with the size effect being greater for adolescent men than women. This study indicates that both low BMI and high BMI are associated with mild-to-moderate and severe myopia., (© 2022 The Obesity Society.)- Published
- 2022
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47. Glucose Intolerance in Pregnancy and Offspring Obesity in Late Adolescence.
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Bendor CD, Bardugo A, Rotem RS, Derazne E, Gerstein HC, Tzur D, Pinhas-Hamiel O, Tsur AM, Cukierman-Yaffe T, Lebenthal Y, Afek A, Chodick G, and Twig G
- Subjects
- Adolescent, Adult, Blood Glucose, Body Mass Index, Female, Humans, Infant, Newborn, Male, Overweight, Pregnancy, Diabetes, Gestational diagnosis, Diabetes, Gestational epidemiology, Glucose Intolerance epidemiology, Pediatric Obesity
- Abstract
Objective: Gestational hyperglycemia is associated with deleterious neonatal outcomes, but long-term risks for offspring obesity are less clear. We estimated the odds for offspring adolescent overweight and obesity among mothers with gestational glucose intolerance., Research Design and Methods: In a mother-offspring historical cohort, the Israel military conscription data set was linked to a large health maintenance organization. Included were women who were evaluated at adolescence and underwent two-step gestational diabetes screening (mean age, 31 years) with a 50-g glucose challenge test (GCT), followed by a 100-g oral glucose tolerance test (OGTT) if the result was abnormal. Glucose tolerance categories included gestational normoglycemia, abnormal GCT with normal OGTT, impaired glucose tolerance (IGT; one abnormal OGTT value), and gestational diabetes. The primary outcome was offspring overweight/obesity (BMI ≥85th percentile) at adolescence, measured prior to military conscription. Logistic regression models were applied., Results: Of 33,482 mother-offspring pairs, overweight and obesity were observed in 6,516 offspring. Across increasing categories of pregnancy glycemia, the proportions of offspring with adolescent overweight/obesity increased: normoglycemia, 19%; abnormal GCT with normal OGTT, 22%; gestational IGT, 24%; and gestational diabetes, 25% (P < 0.0001). Corresponding odds ratios after adjustment for the mother's late adolescent characteristics (sociodemographic confounders and BMI) and pregnancy age were 1.2 (95% CI 1.1-1.4), 1.3 (1.2-1.5), and 1.4 (1.3-1.6), respectively. Further adjustment for offspring birth weight percentile and sociodemographic variables did not materially change results. Associations were more pronounced with increasing obesity severity., Conclusions: Gestational glucose intolerance, including categories not meeting the gestational diabetes threshold, was associated with increased odds for offspring overweight/obesity at late adolescence., (© 2022 by the American Diabetes Association.)
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- 2022
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48. Personality disorders and cause-specific mortality: a nationwide study of 2 million adolescents.
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Tiosano S, Laur L, Tirosh A, Furer A, Afek A, Fink N, Derazne E, Tzur D, Fruchter E, Ben-Yehuda A, Bader T, Amital H, Szklo M, Weiser M, and Twig G
- Subjects
- Adolescent, Adult, Cause of Death, Female, Humans, Longitudinal Studies, Male, Mortality, Proportional Hazards Models, Prospective Studies, Risk Factors, Young Adult, Cardiovascular Diseases epidemiology, Personality Disorders epidemiology
- Abstract
Background: Personality disorders are prevalent in 6-10% of the population, but their risk for cause-specific mortality is unclear. The aim of the study was to assess the association between personality disorders diagnosed in late adolescence and all-cause as well as cause-specific (cardiovascular-related, external-related) mortality., Methods: We performed a longitudinal study on a historical prospective cohort based on nationwide screening prior to recruitment to the Israeli army. The study participants were 16-19-year-old persons who attended the army screening (medical and cognitive, including screening for psychiatric disorders) between 1967 and 2006. Participants were followed from 1967 till 2011., Results: The study included 2 051 606 subjects, of whom 1 229 252 (59.9%) were men and 822 354 (40.1%) were women, mean age 17.36 years. There were 55 508 (4.5%) men and 8237 (1.0%) women diagnosed with personality disorders. The adjusted hazard ratio (HRs) for coronary, stroke, cardiovascular, external-related causes and all-cause mortality among men with personality disorders were 1.34 (1.03-1.74), 1.82 (1.20-2.76), 1.45 (1.23-1.71), 1.41 (1.30-1.53) and 1.44 (1.36-1.51), respectively. The absolute rate difference for all-cause mortality was 56.07 and 13.19 per 10
5 person-years among men and women, respectively. Among women with personality disorders, the adjusted HRs for external-related causes and all-cause mortality were 2.74 (1.87-4.00) and 2.01 (1.56-2.58). Associations were already evident within 10 years of follow-up., Conclusions: Personality disorder in late adolescence is associated with increased risk of cardiovascular, external- and all-cause mortality. Increased cardiovascular mortality is evident before the age of 40 years and may point to the importance of lifestyle education already in youth.- Published
- 2022
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49. Adolescent Blood Pressure and the Risk for Early Kidney Damage in Young Adulthood.
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Tsur AM, Akavian I, Derazne E, Tzur D, Vivante A, Grossman E, Rotem RS, Fishman B, Afek A, Coresh J, Chodick G, and Twig G
- Subjects
- Adolescent, Adult, Blood Pressure physiology, Body Mass Index, Child, Cohort Studies, Female, Humans, Kidney, Male, Risk Factors, Young Adult, Hypertension diagnosis, Hypertension epidemiology, Kidney Diseases diagnosis, Kidney Diseases epidemiology, Kidney Diseases etiology
- Abstract
Background: Recent guidelines classified blood pressure above 130/80 mm Hg as hypertension. However, outcome data were lacking., Objective: To determine the association between blood pressure in adolescence and the risk for early kidney damage in young adulthood., Methods: In this nationwide cohort study, we included 629 168 adolescents aged 16 to 20 who underwent medical examinations before mandatory military service in Israel. We excluded 30 466 adolescents with kidney pathology, hypertension, or missing blood pressure or anthropometric data at study entry. Blood pressure measurements at study entry were categorized according to the Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents: group A (<120/<80 mm Hg; Reference group), group B (120/<80-129/<80 mm Hg), group C (130/80-139/89 mm Hg), and group D (≥140/90 mm Hg). Early kidney damage in young adulthood was defined as albuminuria of ≥30 mg/g with an estimated glomerular filtration rate of 60 mL/(min·1.73 m
2 ) or over., Results: Of 598 702 adolescents (54% men), 2004 (0.3%) developed early kidney damage during a mean follow-up of 15.1 (7.2) years. The adjusted hazard ratios for early kidney damage in blood pressure group C were 1.17 (1.03-1.32) and 1.51 (1.22-1.86) among adolescents with lean (body mass index <85th percentile) and high body mass index (body mass index ≥85th percentile), respectively. Corresponding hazard ratios for kidney disease in group D were 1.49 (1.15-1.93) and 1.79 (1.35-2.38) among adolescents with lean and high body mass index, respectively., Conclusions: Blood pressure of ≥130/80 mm Hg was associated with early kidney damage in young adulthood, especially in adolescents with overweight and obesity.- Published
- 2022
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50. The actual burden of obesity-accounting for multimorbidity.
- Author
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Tsur AM and Twig G
- Subjects
- Chronic Disease, Humans, Multimorbidity, Obesity epidemiology
- Abstract
Competing Interests: We declare no competing interests.
- Published
- 2022
- Full Text
- View/download PDF
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