SummaryBackgroundUnderweight, 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.MethodsWe 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).FindingsRegional 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 wor...

SummaryBackgroundRaised blood pressure is an important risk factor for cardiovascular diseases and chronic kidney disease. We estimated worldwide trends in mean systolic and mean diastolic blood pressure, and the prevalence of, and number of people with, raised blood pressure, defined as systolic blood pressure of 140 mm Hg or higher or diastolic blood pressure of 90 mm Hg or higher.MethodsFor this analysis, we pooled national, subnational, or community population-based studies that had measured blood pressure in adults aged 18 years and older. We used a Bayesian hierarchical model to estimate trends from 1975 to 2015 in mean systolic and mean diastolic blood pressure, and the prevalence of raised blood pressure for 200 countries. We calculated the contributions of changes in prevalence versus population growth and ageing to the increase in the number of adults with raised blood pressure.FindingsWe pooled 1479 studies that had measured the blood pressures of 19·1 million adults. Global age-standardised mean systolic blood pressure in 2015 was 127·0 mm Hg (95% credible interval 125·7–128·3) in men and 122·3 mm Hg (121·0–123·6) in women; age-standardised mean diastolic blood pressure was 78·7 mm Hg (77·9–79·5) for men and 76·7 mm Hg (75·9–77·6) for women. Global age-standardised prevalence of raised blood pressure was 24·1% (21·4–27·1) in men and 20·1% (17·8–22·5) in women in 2015. Mean systolic and mean diastolic blood pressure decreased substantially from 1975 to 2015 in high-income western and Asia Pacific countries, moving these countries from having some of the highest worldwide blood pressure in 1975 to the lowest in 2015. Mean blood pressure also decreased in women in central and eastern Europe, Latin America and the Caribbean, and, more recently, central Asia, Middle East, and north Africa, but the estimated trends in these super-regions had larger uncertainty than in high-income super-regions. By contrast, mean blood pressure might have increased in east and southeast Asia, south Asia, Oceania, and sub-Saharan Africa. In 2015, central and eastern Europe, sub-Saharan Africa, and south Asia had the highest blood pressure levels. Prevalence of raised blood pressure decreased in high-income and some middle-income countries; it remained unchanged elsewhere. The number of adults with raised blood pressure increased from 594 million in 1975 to 1·13 billion in 2015, with the increase largely in low-income and middle-income countries. The global increase in the number of adults with raised blood pressure is a net effect of increase due to population growth and ageing, and decrease due to declining age-specific prevalence.InterpretationDuring the past four decades, the highest worldwide blood pressure levels have shifted from high-income countries to low-income countries in south Asia and sub-Saharan Africa due to opposite trends, while blood pressure has been persistently high in central and eastern Europe.FundingWellcome Trust.

Low back pain is associated with signs of disc degeneration and sciatic pain with posterior disc bulges. Low back pain is strongly associated with occupation.

Epicondylitis is a common disorder of the arm, yet the role of individual- and work-related factors has not been addressed in a population study. The aims of this study were to estimate the prevalence of lateral and medial epicondylitis and to investigate their risk factors. The target population of this study comprised a representative sample of people aged 30-64 years residing in Finland during 2000-2001. Of the 5,871 subjects, 4,783 (81.5%) were included in this study. The prevalence of definite lateral epicondylitis was 1.3%, and that of medial epicondylitis was 0.4%. The prevalence did not differ between men and women and was highest in subjects aged 45-54 years. Current smoking (adjusted odds ratio (OR) = 3.4, 95% confidence interval (CI): 1.4, 8.3) and former smoking (OR = 3.0, 95% CI: 1.3, 6.6) were associated with definite lateral epicondylitis. An interaction (p = 0.002) was found between repetitive movements of the arms and forceful activities for the risk of possible or definite lateral epicondylitis (for both repetitive and forceful activities vs. no such activity: OR = 5.6, 95% CI: 1.9, 16.5). Smoking, obesity, repetitive movements, and forceful activities independently of each other showed significant associations with medial epicondylitis. Epicondylitis is relatively common among working-age individuals in the general population. Physical load factors, smoking, and obesity are strong determinants of epicondylitis.

This meta-analysis assessed the association between overweight/obesity and low back pain. The authors systematically searched the Medline (National Library of Medicine, Bethesda, Maryland) and Embase (Elsevier, Amsterdam, the Netherlands) databases until May 2009. Ninety-five studies were reviewed and 33 included in the meta-analyses. In cross-sectional studies, obesity was associated with increased prevalence of low back pain in the past 12 months (pooled odds ratio (OR) = 1.33, 95% confidence interval (CI): 1.14, 1.54), seeking care for low back pain (OR = 1.56, 95% CI: 1.46, 1.67), and chronic low back pain (OR = 1.43, 95% CI: 1.28, 1.60). Compared with non-overweight people, overweight people had a higher prevalence of low back pain but a lower prevalence of low back pain compared with obese people. In cohort studies, only obesity was associated with increased incidence of low back pain for > or =1 day in the past 12 months (OR = 1.53, 95% CI: 1.22, 1.92). Results remained consistent after adjusting for publication bias and limiting the analyses to studies that controlled for potential confounders. Findings indicate that overweight and obesity increase the risk of low back pain. Overweight and obesity have the strongest association with seeking care for low back pain and chronic low back pain.

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Objectives-To evaluate the eVects of work related and individual factors as well as physical activity and sports on the incidence and persistence of shoulder pain among forestry workers. Methods-Workers in a large Finnish forestry company replied to a questionnaire (a modified version of the Nordic questionnaire) on musculoskeletal pain and its possible risk factors for 4 consecutive years 1992-5. This 1 year follow up study covers the time 1994-5. Year 1994 was chosen as baseline because in that year the questionnaire contained for the first time more detailed questions about diVerent sports. The response rate in 1995 was 90%. The eVects of the predictors on 1 year incidence and persistence of shoulder pain were studied with multivariate logistic regression modelling. Results-At baseline, 2094 subjects had been free of shoulder pain during the preceding 12 months. After 1 year, 14% (n=285) reported having mild or severe shoulder pain. Higher age, obesity, and mental stress as well as physically strenuous work and working with trunk forward flexed or with a hand above shoulder level increased the risk of incident shoulder pain. Of the diVerent sports activities, dancing increased the risk of incident pain whereas jogging decreased the risk significantly. Of those 419 workers who had severe shoulder pain at baseline, 55% (n=230) still had severe pain 1 year later. Higher age, overload at work, and working with a hand above shoulder level increased the risk of persistent severe shoulder pain whereas cross country skiing and general sports activity decreased the risk. Conclusion-Our results support the current view that shoulder pain is the result of many factors, including occupational and individual factors. In this longitudinal study, physical work with a heavy load, awkward work postures, mental stress, and obesity were the risk factors at which preventive measures could be aimed. As a new finding, physical exercise had more protective than impairing eVects on the shoulders. (Occup Environ Med 2001;58:528-534) Keywords: mental stress; physical work load; sportsThe prevalence of shoulder symptoms seems to be relatively high, varying from 6% to 25% in the general population.1 2 During the past decades, the knowledge of aetiological factors, and occupational exposures in particular, has increased and work related factors such as repetitive work, vibration, and awkward postures-for example, severe shoulder flexion or abduction-have been related to shoulder disorders.1 3 4 Other factors such as age, smoking, and stress have been significant risk factors in some studies. [5][6][7] This knowledge is, however, mainly based on studies with cross sectional or case-control design. In a recent systematic review of the available evidence on occupational risk factors for shoulder pain, no longitudinal studies fulfilled the quality criteria. As well as prospective studies, more studies of the eVects of leisure time activities were called for.