Underweight, overweight, and obesity in childhood and adolescence are associated with adverse health consequences throughout the life-course. Our aim was to estimate worldwide trends in mean body-mass index (BMI) and a comprehensive set of BMI categories that cover underweight to obesity in children and adolescents, and to compare trends with those of adults. We pooled 2416 population-based studies with measurements of height and weight on 128·9 million participants aged 5 years and older, including 31·5 million aged 5-19 years. We used a Bayesian hierarchical model to estimate trends from 1975 to 2016 in 200 countries for mean BMI and for prevalence of BMI in the following categories for children and adolescents aged 5-19 years: more than 2 SD below the median of the WHO growth reference for children and adolescents (referred to as moderate and severe underweight hereafter), 2 SD to more than 1 SD below the median (mild underweight), 1 SD below the median to 1 SD above the median (healthy weight), more than 1 SD to 2 SD above the median (overweight but not obese), and more than 2 SD above the median (obesity). Regional change in age-standardised mean BMI in girls from 1975 to 2016 ranged from virtually no change (-0·01 kg/m2 per decade; 95% credible interval -0·42 to 0·39, posterior probability [PP] of the observed decrease being a true decrease=0·5098) in eastern Europe to an increase of 1·00 kg/m2 per decade (0·69-1·35, PP>0·9999) in central Latin America and an increase of 0·95 kg/m2 per decade (0·64-1·25, PP>0·9999) in Polynesia and Micronesia. The range for boys was from a non-significant increase of 0·09 kg/m2 per decade (-0·33 to 0·49, PP=0·6926) in eastern Europe to an increase of 0·77 kg/m2 per decade (0·50-1·06, PP>0·9999) in Polynesia and Micronesia. Trends in mean BMI have recently flattened in northwestern Europe and the high-income English-speaking and Asia-Pacific regions for both sexes, southwestern Europe for boys, and central and Andean Latin America for girls. By contrast, the rise in BMI has accelerated in east and south Asia for both sexes, and southeast Asia for boys. Global age-standardised prevalence of obesity increased from 0·7% (0·4-1·2) in 1975 to 5·6% (4·8-6·5) in 2016 in girls, and from 0·9% (0·5-1·3) in 1975 to 7·8% (6·7-9·1) in 2016 in boys; the prevalence of moderate and severe underweight decreased from 9·2% (6·0-12·9) in 1975 to 8·4% (6·8-10·1) in 2016 in girls and from 14·8% (10·4-19·5) in 1975 to 12·4% (10·3-14·5) in 2016 in boys. Prevalence of moderate and severe underweight was highest in India, at 22·7% (16·7-29·6) among girls and 30·7% (23·5-38·0) among boys. Prevalence of obesity was more than 30% in girls in Nauru, the Cook Islands, and Palau; and boys in the Cook Islands, Nauru, Palau, Niue, and American Samoa in 2016. Prevalence of obesity was about 20% or more in several countries in Polynesia and Micronesia, the Middle East and north Africa, the Caribbean, and the USA. In 2016, 75 (44-117) million girls and 117 (70-178) million boys worldwide were moderately or severely underweight. In the same year, 50 (24-89) million girls and 74 (39-125) million boys worldwide were obese. The rising trends in children's and adolescents' BMI have plateaued in many high-income countries, albeit at high levels, but have accelerated in parts of Asia, with trends no longer correlated with those of adults. Wellcome Trust, AstraZeneca Young Health Programme.

Background— Heart failure (HF) is responsible for a huge burden in hospital care. Our goal was to evaluate the value of N-terminal–pro-brain natriuretic peptide (NT-proBNP) in predicting death or hospital readmission after discharge of HF patients. Methods and Results— We included 182 patients consecutively admitted to hospital because of decompensated HF. Patients were followed up for 6 months. The primary end point was death or readmission. Twenty-six patients died in hospital. The median admission NT-proBNP level was 6778.5 pg/mL, and the median level at discharge was 4137.0 pg/mL ( P <0.001). Patients were classified into 3 groups: (1) decreasing NT-proBNP levels by at least 30% (n=82), (2) no significant modifications on NT-proBNP levels (n=49), and (3) increasing NT-proBNP levels by at least 30% (n=25). The primary end point was observed in 42.9% patients. Variables associated with an increased hazard of death and/or hospital readmission in univariate analysis were length of hospitalization, heart rate, signs of volume overload, no use of ACE inhibitors, higher NYHA class at discharge, admission and discharge NT-proBNP, and the change in NT-proBNP levels. The variation in NT-proBNP was the strongest predictor of an adverse outcome. Independent variables associated with an increased risk of readmission or death were signs of volume overload and the change in NT-proBNP levels. Conclusions— Variations in NT-proBNP levels are related to hospital readmission and death within 6 months. NT-proBNP levels are potentially useful in the evaluation of treatment efficacy and might help clinicians in planning discharge of HF patients. Whether therapeutic strategies aimed to lower NT-proBNP levels modify prognosis warrants future investigation.

To systematically review quantitative differences in the prevalence, awareness, treatment and control of hypertension between developed and developing countries over the past 6 years. We searched Medline [prevalence AND awareness AND treatment AND control AND (hypertension OR high blood pressure)] for population-based surveys. Prevalence, awareness, treatment and control of hypertension were compared between men and women, and between developing and developed countries, adjusting for age. The proportions of awareness, treatment and control were defined relative to the total number of hypertensive patients. We identified 248 articles, of which 204 did not fulfill inclusion criteria. The remaining articles reported data from 35 countries. Among men, the mean prevalence, awareness, treatment and control of hypertension were 32.2, 40.6, 29.2 and 9.8%, respectively, in developing countries and 40.8, 49.2, 29.1 and 10.8%, respectively, in developed countries. Among women, the mean prevalence, awareness, treatment and control of hypertension were 30.5, 52.7, 40.5, and 16.2%, respectively, in developing countries and 33.0, 61.7, 40.6 and 17.3%, respectively, in developed countries. After adjusting for age, the prevalence of hypertension among men was lower in developing than in developed countries (difference, −6.5%; 95% confidence interval, −11.3 to −1.8%). There were no significant differences in mean prevalence, awareness, treatment and control of hypertension between developed and developing countries, except for a higher prevalence among men in developed countries. The prevalence, awareness, treatment and control of hypertension in developing countries are coming closer to those in developed countries.

The prediction of cardiovascular risk profile trends in low-income countries and timely action to modulate their transitions are among the greatest global health challenges. In 2005 we evaluated a nationally representative sample of the Mozambican population (n=3323; 25 to 64 years old) following the Stepwise Approach to Chronic Disease Risk Factor Surveillance. Prevalence of hypertension (systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg and/or antihypertensive drug therapy), awareness (having been informed of the hypertensive status by a health professional in the previous year), treatment among the aware (use of antihypertensive medication in the previous fortnight), and control among those treated (blood pressure <140/90 mm Hg) were 33.1% (women: 31.2%; men: 35.7%), 14.8% (women: 18.4%; men: 10.6%), 51.9% (women: 61.1%; men: 33.3%), and 39.9% (women: 42.9%; men: 28.7%), respectively. Urban/rural comparisons are presented as age- and education-adjusted odds ratios (ORs) and 95% CIs. Among women, hypertension (OR: 2.0; 95% CI: 1.2 to 3.0) and awareness (OR: 4.3; 95% CI: 1.9 to 9.5) were more frequent in urban areas. No urban/rural differences were observed in men (hypertension: OR: 1.3, 95% CI: 0.9 to 2.0; awareness: OR: 1.5, 95% CI: 0.5 to 4.7). Treatment prevalence was not significantly different across urban/rural settings (women: OR: 1.4, 95% CI: 0.5 to 4.4; men: OR: 0.3, 95% CI: 0.1 to 1.4). Control was less frequent in urban women (OR: 0.2; 95% CI: 0.0 to 1.0) and more frequent in urban men (OR: 78.1; 95% CI: 2.2 to 2716.6). Our results illustrate the changing paradigms of “diseases of affluence” and the dynamic character of epidemiological transition. The urban/rural differences across sexes support a trend toward smaller differences, emphasizing the need for strategies to improve prevention, correct diagnosis, and access to effective treatment.

Diastolic dysfunction (DD) is frequent in the general population; however, the assessment of diastolic function remains challenging. We aimed to evaluate the impact of the recent 2016 American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) recommendations in the prevalence and grades of DD compared with the 2009 guidelines and the Canberra Study Criteria (CSC). Within a population-based cohort, a total of 1000 individuals, aged ≥45 years, were evaluated retrospectively. Patients with previously known cardiac disease or ejection fraction <50% were excluded. Diastolic function was assessed by transthoracic echocardiography. DD prevalence and grades were determined according to the three classifications. The mean age was 62.0 ± 10.5 years and 37% were men. The prevalence of DD was 1.4% (n = 14) with the 2016 recommendations, 38.1% (n = 381) with the 2009 recommendations, and 30.4% (n = 304) using the CSC. The concordance between the updated recommendations and the other two was poor (from k = 0.13 to k = 0.18, P < 0.001). Regarding the categorization in DD grades, none of the 14 individuals with DD by the 2016 guidelines were assigned to Grade 1 DD, 64% were classified as Grade 2, 7% had Grade 3, and 29% had indeterminate grade. The application of the new 2016 ASE/EACVI recommendations resulted in a much lower prevalence of DD. The concordance between the classifications was poor. The updated algorithm seems to be able to diagnose only the most advanced cases.