Eating disorders significantly impact adolescents and young adults globally, yet comprehensive data on their burden and trends are limited. This study aimed to analyze trends in eating disorders among individuals aged 10-24 years worldwide. Using data from the Global Burden of Disease Study (GBD) 2021, we analyzed prevalence, incidence, and disability-adjusted life years (DALYs) for eating disorders (anorexia nervosa and bulimia nervosa) across 204 countries and regions from 1990 to 2021. Trends were assessed by age, sex, and sociodemographic index (SDI). Bayesian age-period-cohort models (BAPC) predicted future burden up to 2035. Between 1990 and 2021, the global age-standardized prevalence rate of eating disorders increased from 300.73 to 354.72 per 100,000 population (EAPC: 0.57). Incidence and DALY rates also rose. Australasia had the highest burden, while East Asia saw the largest increase. High SDI regions bore the greatest burden, with countries like Australia and Monaco reporting the highest rates. Women had an 85.89 % higher prevalence than men, but men showed faster increases. Individuals aged 20-24 years had the highest burden and fastest growth. Burden estimates were positively associated with SDI levels. Projections suggest rates will continue rising through 2035. The global burden of eating disorders among adolescents and young adults is increasing. Urgent, targeted interventions are needed to address this growing public health issue. However, limitations include potential underreporting in underdeveloped areas, temporal bias in prevalence rates, and exclusion of binge eating disorder (BED) and other specific eating disorders.

Life-course adversities are important determinants of unhealthy aging. Intrinsic capacity (IC) may capture early functional vulnerability before disease onset, but evidence linking adverse childhood and adulthood experiences (ACEs and AAEs) to IC and later physical-psychological-cognitive multimorbidity (PPC-MM) remains limited. This study aimed to examine whether ACEs and AAEs are associated with intrinsic capacity and subsequent PPC-MM in a nationally representative cohort. We analyzed 2,559 middle-aged and older adults from the China Health and Retirement Longitudinal Study who were free of multimorbidity at baseline. ACEs and AAEs were assessed retrospectively. IC was constructed across cognitive, locomotor, psychological, sensory, and vitality domains and treated as the primary outcome. PPC-MM was examined as a secondary outcome using Cox regression and multistate models. Higher cumulative ACE exposure was significantly associated with lower IC (β = -0.04 per additional ACE; 95% CI -0.07 to -0.00), whereas AAEs showed no significant association with IC. Among specific adversities, childhood physical abuse was strongly associated with reduced IC (β = -0.12; 95% CI -0.22 to -0.02). Both ACEs and AAEs were independently associated with increased risks of PPC-MM. Each additional ACE increased the hazard of PPC-MM by 19% (HR 1.19; 95% CI 1.06-1.33), while each additional AAE increased risk by 18% (HR 1.18; 95% CI 1.03-1.34). Individuals exposed to both ACEs and AAEs exhibited the highest risk of physical-psychological multimorbidity (HR 1.77; 95% CI 1.28-2.46). Multistate analyses showed that multimorbidity accumulated progressively, most commonly transitioning from physical-psychological combinations to PPC-MM. Childhood adversity is associated with reduced intrinsic capacity in later life, reflecting early functional vulnerability, while both childhood and adulthood adversities contribute to downstream multimorbidity. These findings support IC as an early, adversity-sensitive marker linking life-course stress to multimorbidity and highlight opportunities for upstream intervention to promote healthy aging.

Background/aims To establish sex-specific and grade-specific reference values of cycloplegic spherical equivalent (SE) for predicting myopia onset and progression in Chinese children and adolescents. Methods Between 2020 and 2024, vision screening was conducted among 67 260 Chinese students spanning kindergarten to high school. Myopia was defined as a cycloplegic SE of ≤−0.50 diopters (D) and high myopia as ≤−6.00D. The lambda-mu-sigma method was used to estimate centiles of cycloplegic SE for −0.50D and −6.00D at each grade. Based on this, reference values for predicting future myopia and its progression to high myopia were determined for all grades. Results Among boys in grade 12 (the third year of high school), the estimated prevalence of myopia and high myopia was 82.4% and 11.6%, respectively. For boys in grades 0–11, the cycloplegic SE values at the 82.4th and 11.6th percentiles served as reference values to predict myopia and high myopia, respectively, in grade 12. For example, among senior kindergarten boys (grade 0), those with cycloplegic SE >1.54D (82.4th percentile) were predicted to remain non-myopic before grade 12, whereas those with SE >0.19D (11.6th percentile) were not expected to develop high myopia before grade 12. Conclusions Reference values for predicting myopia and high myopia among Chinese students were established, but these values may not be applicable to populations beyond China. Nevertheless, the proposed methods could be applied to settings where student myopia prevalence patterns remain relatively stable.

What is already known about this topic? China exhibits a high prevalence of myopia; however, comprehensive national data based on cycloplegic refraction to assess the current status of hyperopic reserve in children and adolescents remains unavailable. What is added by this report? This study describes different percentiles of spherical equivalent (SE) after cycloplegic refraction for children and adolescents aged 5–18 years across 10 provincial-level administrative divisions (PLADs) and cities in China. SE values declined progressively with age in both males and females, with females demonstrating significantly lower median SE values than males beginning at age 10. What are the implications for public health practice? Hyperopic reserve requires systematic monitoring, particularly among females approaching puberty and younger children. Early surveillance by relevant departments is strongly recommended to support comprehensive myopia prevention and control strategies.

Myopia represents a critical public health challenge with far-reaching implications for future development, as global prevalence is projected to reach 49.8% by 2050 (1-2). The Chinese government has implemented comprehensive policies and proactive measures (3-6) to accelerate prevention efforts through systematic interventions. Traditional monitoring approaches have focused primarily on vision screening and diopter examination following myopia onset, thereby lacking early warning systems for tracking hyperopic reserve depletion. Commissioned by the National Disease Control and Prevention Bureau, our team has spearheaded a landmark large-scale monitoring project on hyperopic reserves among children and adolescents since 2020, encompassing ten provincial-level administrative divisions (PLADs; including Beijing, Liaoning, Zhejiang, Henan, Chongqing, Shaanxi, Guangdong, Shanxi, Hunan, and Shandong). Through a multistage cluster sampling design at each site, students from senior kindergarten through high school were systematically selected, with 67,260 individuals initially surveyed. This initiative represents a transformative measure that emerged in direct response to the developmental requirements of the new era. The hyperopic reserve monitoring framework comprises two integrated components: comprehensive questionnaire surveys and detailed ophthalmic examinations. Emphasis is strategically placed on hyperopic reserve assessment rather than conventional diopter examination alone, with cycloplegic refraction methods employed to determine visual acuity status, yielding substantially more accurate results. This advancement signifies that China's myopia prevention and control efforts are transitioning toward a more scientific, precise, and forward-looking paradigm. This special issue presents five pivotal studies that collectively advance our understanding of hyperopic reserve monitoring. Gao et al. comprehensively investigated axial length (AL), corneal radius (CR), and AL/CR ratios in children and adolescents from ten provinces and municipalities, analyzing the distribution patterns of each refractive parameter and their relationships with refractive status while evaluating the monitoring effectiveness of each parameter for refractive development (7). Luo et al. characterized different percentiles of spherical equivalent (SE) following cycloplegic refraction across children and adolescents aged 5-18 years throughout ten provinces and cities in China (8). Zhang et al. examined the association between screen exposure and insufficient hyperopic reserve in Chinese children aged 6-12 years, highlighting significant regional heterogeneity (9). Liu et al. explored the application of machine learning models to predict cycloplegic spherical equivalent in children and adolescents using non-cycloplegic measurements and ocular biometric parameters (10). These investigations collectively illuminate the critical importance of hyperopic reserve for myopia prevention and control while underscoring the substantial value of the hyperopic reserve detection initiative across ten provinces and municipalities. Specifically, this monitoring program demonstrates several prominent contributions to the field. Addressing Critical Gaps: A Strategic Transformation from "Reactive Treatment" to "Proactive Prevention" Hyperopic reserve represents the physiological hyperopia (11) naturally present during ocular development in children and adolescents-functioning as a protective "buffer zone" that mitigates myopia risk. This reserve undergoes gradual depletion as the eye matures (12). When hyperopic reserve is consumed too rapidly before achieving emmetropia, myopia onset becomes imminent or has already occurred (13). Traditional, myopia monitoring has predominantly been implemented following vision deterioration or myopia development, resulting in delayed intervention opportunities. For the first time, this groundbreaking initiative has established a comprehensive, large-scale monitoring system for hyperopic reserves in preschool and school-aged children across China CDC Weekly

Introduction Cycloplegic refraction is the gold standard for assessing refractive error in children. However, logistical constraints hinder its implementation in large-scale surveys. Methods Data obtained from a nationwide ocular health survey conducted in ten provincial-level administrative divisions in China were analyzed (2020–2024). Participants aged 5–18 years underwent standardized non-cycloplegic and cycloplegic autorefraction, axial length (AL), corneal radius (CR), and AL/CR measurements. Random forest and XGBoost models were trained to predict the cycloplegic spherical equivalent (SE) using non-cycloplegic SE, uncorrected visual acuity (UCVA), and biometric parameters. Performance was evaluated using R², root mean square error (RMSE), and Bland–Altman analysis. Results Both models exhibited strong predictive performance. In the test set, random forest achieved R²=0.88 and RMSE=0.55 diopter (D), whereas XGBoost achieved R²=0.89 and RMSE=0.54 D. Non-cycloplegic SE, AL/CR ratio, AL, and UCVA were consistently the top predictors. The predicted SE exhibited strong agreement with the cycloplegic SE, with minimal residual bias. Conclusion Machine learning models incorporating noncycloplegic SE and ocular biometrics accurately estimate cycloplegic SE in children and adolescents, providing a practical alternative for large-scale refractive-error surveillance when cycloplegia is impractical.