Evolving Patterns of Nutritional Deficiencies Burden in Low- and Middle-Income Countries: Findings from the 2019 Global Burden of Disease Study

Low- and middle-income countries (LMICs) suffered the most from nutritional deficiencies (NDs). Although decades of efforts have reduced it, little is known about the changing trajectory of ND burden in LMICs. By extracting data of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, we calculated indicators of incidence and disability-adjusted life years (DALYs) to measure the burden of NDs and its main subcategories in LMICs, including protein-energy malnutrition, iodine deficiency, vitamin A deficiency, dietary iron deficiency, and other nutritional deficiencies by sex, age and spatial patterns. In LMICs, ND incidence still increased in the age group 15+ born before 2005, especially in males. The effort of reducing the DALYs of NDs has generated a strong decline in per age group. In the main subcategories of NDs, protein-energy malnutrition incidence in males age 45+ born before 1970 still increased. Despite vitamin A deficiency incidence and dietary iron deficiency, DALYs strongly experienced decreases over three decades while still remaining at the heaviest level in 2019, especially in females and children under 5 years. The top largest tendency estimates occurred in Mali’ females and Bhutan’ males. Zimbabwe was the only country with increased DALYs rate tendency in both sexes.     

Prevalence of Malnutrition in Patients with Parkinson’s Disease: A Systematic Review

Objectives: This systematic review analyzed the prevalence of malnutrition in patients with Parkinson’s Disease. Study design: a systematic review. Method: Four databases—Cochrane, PubMed, Embase and Web of Science—were searched from October 2021 to June 2022 by two independent researchers. The inclusion criteria were as follows: patients above 18 years old with confirmed Parkinson’s Disease, performed screening nutritional assessment, cohort studies, case-control studies, and cross-sectional studies. Patients without Parkinson’s Disease and with other parkinsonian syndromes were excluded. Results: 49 studies were included in this systematic review. Patients ranged in age from 20 to 96 years. There were 5613 subjects included. According to Mini Nutritional Assessment, 23.9% (n = 634) participants were at risk of malnutrition and 11.1% (n = 294) were malnourished. According to BMI score, most patients were either obese or overweight. Conclusions: the prevalence of malnutrition or risk of malnutrition in the study group was significant. Therefore, more specific and detailed studies on the prevalence of malnutrition in patients with Parkinson’s Disease are needed.     

Global,Regional, and National Estimates of Nutritional Deficiency Burden among Reproductive Women from 2010 to 2019

Women of reproductive age (15–49 years) are often considered a vulnerable population affected by nutritional deficiencies, impairing their health and that of their offspring. We briefly introduced (a) the incidence and disability-adjusted life years (DALYs) trends from 2010 to 2019 and (b) the correlation between sex differences and income levels and nutritional deficiencies of reproductive women firstly. Notably, the burden of overall nutritional deficiencies among reproductive women remained generally stable from 2010 to 2019, whereas the iodine and vitamin A deficiencies as a subcategory were associated with increased incidence rates and DALYs, respectively. A significant increasing trend occurred in South Asia, Southeast Asia, and Turkey for incidence, and Western Sub-Saharan Africa and Zimbabwe had a strong increase for DALYs. Further analysis of the correlation between nutritional deficiency incidence and economic capacity showed that they were not correlated with the income of women themselves, as was the result of income difference with men. The results of this study will help to identify gaps in nutritional deficiency burden among reproductive women and facilitate the development of regional or national responses. Compared with economic capital, macroscopic political guarantees and social and cultural capital are important measures to remedy the nutritional deficiencies of reproductive women.     

Sex Differences in Dietary Patterns of Adults and Their Associations with the Double Burden of Malnutrition: A Population-Based National Survey in the Philippines

A dietary pattern transition is a risk factor for the double burden of malnutrition (DBM), but related information is limited. This study aimed to identify sex differences in dietary patterns of adults in a low–middle income country and to examine their association with DBM. A total of 8957 adults (4465 men and 4492 non-pregnant and non-lactating women) who participated in the 2013 Philippine National Nutrition Survey were included in the analysis. Logistic regression models were formulated to investigate the relationship between dietary patterns and DBM. The factor analysis derived seven dietary patterns for males and six patterns for females. Results showed that approximately 30% of Filipino adults suffered from DBM. The rice pattern was associated with lower odds of DBM for males only. The meat and sugar pattern in males and the protein-rich foods, cereal, and sugar pattern in females decreased DBM likelihood. An inverse relationship was observed for the vegetables and corn patterns, wherein females had an increased risk for DBM. Our findings suggest that rice-based and meat-containing patterns could play protective roles in DBM development among adults in the Philippines. Understanding sex-specific dietary patterns can be utilized to guide public health nutrition interventions in the prevention of malnutrition in all its forms.     

Magnitude,Temporal Trends,and Inequalities in the DALYs and YLDs of Nutritional Deficiency among Older Adults in the Western Pacific Region: Findings from the Global Burden of Disease Study 1990–2019

The population in the Western Pacific region is aging rapidly. Nutritional deficiency is prevalent in older adults; however, information regarding nutritional deficiency in this population is scarce. Using the 2019 Global Burden of Disease (GBD) results, the age-standardized disability-adjusted life years (DALYs) and years of healthy life lost due to disability (YLDs) from nutritional deficiency were estimated between 1990 and 2019 for this population. Average annual percentage change (AAPC) was used to assess temporal trends, and linear mixed-effects models were used to examine socioeconomic and sex inequalities. From 1990 to 2019, the age-standardized DALYs of nutritional deficiency in this population decreased from 697.95 to 290.95 per 100,000, and their age-standardized YLDs decreased from 459.03 to 195.65 per 100,000, with the greatest declines seen in South Korea (AAPCs < −5.0). Tonga had the least decline in DALYs (AAPC = −0.8), whereas Fiji experienced an increase in YLDs (AAPC = 0.1). Being female and having a lower sociodemographic index score was significantly associated with higher age-standardized DALYs and YLDs. The magnitude and temporal trends of the nutritional deficiency burden among older adults varied across countries and sex in the region, indicating that health policies on nutritional deficiency among older adults must be crafted to local conditions.     

Global Burden of Vitamin A Deficiency in 204 Countries and Territories from 1990–2019

Vitamin A deficiency (VAD) is one of the important public health issues worldwide. However, a detailed understanding of the incidence and disability-adjusted life years (DALYs) due to VAD in recent years is lacking. We aimed to estimate the incidence and DALYs of VAD at global, regional, and national levels in terms of sex, age, and socio-demographic index (SDI). Using data from the 2019 Global Burden of Disease (GBD) study, the estimated annual percentage change (EAPC) was measured to assess trends in the age-standardized incidence and DALY rates from 1990 to 2019. The global age-standardized incidence and DALY rates of VAD decreased with an EAPC of −3.11% (95% confidence interval (CI): −3.24% to −2.94%) and −2.18% (95% CI: −2.38% to −1.93%), respectively. The age-standardized incidence and DALY rates decreased least in low-SDI regions, which had the highest age-standardized incidence and DALY rates of all SDI regions. Sub-Saharan Africa, especially central sub-Saharan Africa, had the highest age-standardized incidence and DALY rates in 2019. At the national level, Somalia and Niger had the highest age-standardized incidence and DALY rates. The age-standardized incidence and DALY rates were higher in males than in females. Younger children, especially those aged < 5 years in low-SDI regions, had a higher VAD burden than other age groups. Although the global burden of VAD has decreased, future work should aim to improve the prevention and treatment strategies for VAD, particularly in children aged < 5 years in countries and territories with low SDI values, such as sub-Saharan Africa.     

Methodologic Considerations in Estimating Burden of Disease from Environmental Risk Factors at National and Global Levels

Abstract

Evidence from environmental burden-of-disease studies can provide valuable input in the decision-making process in environmental health, facilitating priority setting and cost effectiveness evaluation. This paper discusses important aspects of environmental burden-of-disease estimates in the light of published examples. To produce reliable and comparable burden-of-disease estimates for environmental and occupational risk factors, harmonized methods are needed. Such methods should address the feasibility of data collection at national, regional, and global levels, the reliability of estimates, the uncertainty around estimates, and scenario tools to investigate the health gains of options for preventive action in different domains of policy. Any such method will require a framework (i.e., causal inference model) able to take into account the contributions of distal and proximal causes, and the possible interactions between risk factors.     

江苏省狂犬病疾病负担研究

目的 通过对江苏省狂犬病的疾病负担进行统计分析和综合评价,为制定疾病防制策略提供参考依据.方法 收集2008-2018年江苏省狂犬病疫情资料,进行流行病学特征分析,同时使用世界卫生组织(WHO)公布的计算工具评估因狂犬病早死导致的伤残调整寿命年(DALYs),并结合人力资本法评估早死间接经济负担.结果 2008-201...     

十堰市2007—2009年城区居民心血管疾病负担分析

目的了解2007—2009年湖北省十堰市城区居民心血管疾病死亡流行特征及疾病负担情况,为确定疾病防治重点、制定预防控制策略和措施提供科学依据。方法采用粗死亡率、标化死亡率、伤残调整寿命年(DALYs)等作为反映疾病负担的量化指标,对十堰市2007—2009年城区居民死因监测资料中心血管疾病死亡数据进行分析。结果2007—2009年十堰市城区居民心血管疾病的死亡率为201.9/10万,标化死亡率为173.9/10万,男性标化死亡率(211.9/10万)高于女性(137.6/10万);男性、女性居民每千人口因心血管疾病分别损失31.7、20.9个DALYs;十堰市城区居民心血管疾病死亡率及每千人口DALYs随着年龄的增加逐渐升高,≥60岁城区居民是心血管疾病死亡高发人群;脑血管病、缺血性心脏病、高血压病是导致十堰市城区居民心血管疾病死亡的主要原因,其中脑血管病导致的疾病负担最大。结论心血管疾病已成为危害十堰市城区居民健康的主要疾病,其中老人和男性应该成为防治的重点。     

疾病负担研究证据的现状分析

分析2010年和2020年四川省疾病负担,为疾病防治提供决策参考。

收集2010年和2020年四川省死因监测数据,计算伤残调整生命年（DALY）、早死寿命损失年（YLL）和伤残寿命损失年（YLD）来评估四川省疾病负担。

2020年DALY为700.40万人年,其中YLL和YLD分别为371.96万人年、328.44万人年。与2010年比较,2020年DALY增长了8.27%,其中大部分来自YLL的增长（16.66%）。2020年DALY标化率为69.91‰,较2010年降低了9.87%,其中女性降低了15.87%,男性降低了5.28%。≥60岁老年人2020年的DALY疾病负担较2010年增长了34.55%。传染病和母婴疾病的负担降低幅度最大,2020年男性和女性DALY标化率分别较2010年下降了47.03%、55.50%。其次为损伤,男性和女性分别降低了32.97%、26.92%。慢性病DALY标化率男性增长了5.41%,女性降低了10.67%。2020年男性DALY标化率较2010年增加显著的疾病为糖尿病（82.02%）、神经系统和精神障碍疾病（26.31%）和心脑血管疾病（19.86%）;女性增加显著的疾病为糖尿病（54.74%）、神经系统和精神障碍疾病（35.52%）、肌肉骨骼和结缔组织病（23.51%）。

四川省疾病负担整体呈现下降趋势,主要来自传染病和母婴疾病和损伤的降低。≥60岁老年人的疾病负担增长明显,重点控制疾病为糖尿病、心脑血管疾病、神经系统和精神障碍疾病、肌肉骨骼和结缔组织病等慢性病。

     

盐城市2009年居民恶性肿瘤疾病负担分析

目的 分析江苏省盐城市居民2009年恶性肿瘤疾病负担情况,为制定肿瘤防治干预措施和公共卫生规划提供参考依据。方法 对盐城市居民2009年恶性肿瘤发病和死亡病例资料进行分析,通过计算恶性肿瘤的死亡损失生命年(YLL)、伤残损失年(YLD)和伤残调整寿命年(DALY)评价盐城市居民恶性肿瘤的疾病负担。结果 盐城市居民2009年恶性肿瘤发病率和标化发病率分别为282.60/10万和217.58/10万,死亡率和标化死亡率分别为215.81/10万和150.02/10万;居于恶性肿瘤发病率和死亡率前5位的恶性肿瘤分别为胃癌、食管癌、肺癌、肝癌和结直肠癌;盐城市居民2009年恶性肿瘤YLL、YLD和DALY分别为27.41、2.70和30.11 DALYs/千人,其中男性分别为33.04、3.28和36.32 DALYs/千人,女性分别为21.52、2.07和23.59 DALYs/千人;居于恶性肿瘤疾病负担前4位的恶性肿瘤分别为肝癌、胃癌、肺癌和食管癌,分别为5.77、5.67、5.54、5.44和1.01 DALYs/千人;恶性肿瘤的疾病负担主要集中在≥45岁居民,其中0~29、30~59、60~79和≥80岁居民疾病负担最高的恶性肿瘤分别为白血病、肝癌、胃癌和食管癌。结论 盐城市居民恶性肿瘤疾病负担较重,其中肝癌、胃癌、肺癌、食管癌和结直肠癌的疾病负担较重。     

Small and Medium Enterprises’ Perspectives on Food Fortification Amid the Growing Burden of Malnutrition

The need for a profound food system transformation has never been greater. The growing burden of malnutrition has become the new normal, with two billion people who are overweight, over 140 million children under five who are stunted and over two billion people affected by hidden hunger. Food fortification has been recognized as a cost-effective strategy to address micronutrient deficiencies. Small and medium enterprises (SMEs) play a strategic role in the food supply chain in low- and middle-income countries, accounting for over 80% of food sales. It is therefore critical to create an enabling environment to facilitate SMEs’ involvement in food fortification practices as a potential solution to tackle all forms of malnutrition. This review highlights SMEs’ relevance as agents of change in the food system through food fortification practices and their indirect yet key role in producing nutritious, tasty and affordable foods. It discusses their challenges (e.g., access to long-term finance, sustainable technical assistance, limited capacity), presents solutions and discusses how different actors can help SMEs to overcome these challenges. Furthermore, it presents a relevant public–private partnership case study to demonstrate how SMEs can address the growing burden of malnutrition through food fortification practices, nutrient profiling schemes and demand generation.     

Burden of Disease from Toxic Waste Sites in India,Indonesia, and the Philippines in 2010

Background: Prior calculations of the burden of disease from toxic exposures have not included estimates of the burden from toxic waste sites due to the absence of exposure data.Objective: We developed a disability-adjusted life year (DALY)-based estimate of the disease burden attributable to toxic waste sites. We focused on three low- and middle-income countries (LMICs): India, Indonesia, and the Philippines.Methods: Sites were identified through the Blacksmith Institute’s Toxic Sites Identification Program, a global effort to identify waste sites in LMICs. At least one of eight toxic chemicals was sampled in environmental media at each site, and the population at risk estimated. By combining estimates of disease incidence from these exposures with population data, we calculated the DALYs attributable to exposures at each site.Results: We estimated that in 2010, 8,629,750 persons were at risk of exposure to industrial pollutants at 373 toxic waste sites in the three countries, and that these exposures resulted in 828,722 DALYs, with a range of 814,934–1,557,121 DALYs, depending on the weighting factor used. This disease burden is comparable to estimated burdens for outdoor air pollution (1,448,612 DALYs) and malaria (725,000 DALYs) in these countries. Lead and hexavalent chromium collectively accounted for 99.2% of the total DALYs for the chemicals evaluated.Conclusions: Toxic waste sites are responsible for a significant burden of disease in LMICs. Although some factors, such as unidentified and unscreened sites, may cause our estimate to be an underestimate of the actual burden of disease, other factors, such as extrapolation of environmental sampling to the entire exposed population, may result in an overestimate of the burden of disease attributable to these sites. Toxic waste sites are a major, and heretofore underrecognized, global health problem.     

2008—2010年乳山市居民脑卒中、冠心病疾病负担分析

目的应用疾病负担指标衡量乳山市脑卒中、冠心病的危害程度,定量估计疾病对健康状况的影响程度和经济损失。方法利用乳山市2008—2010年本地户籍的脑卒中、冠心病患者资料,计算脑卒中、冠心病的潜在寿命损失年(years of potential life lost,PYLL)、致残率、经济损失。结果乳山市脑卒中、冠心病的总体死亡率分别为167.71/10万、117.60/10万,平均每例因脑卒中、冠心病死亡的PYLL分别为10.34、10.02年,PYLL率(减寿率)为3.68‰、2.92‰。结论乳山市脑卒中、冠心病的死亡率随着年龄的增加而增加,男性高于女性;脑卒中的疾病负担和济负担均于冠心病;40岁以上的疾病负担总负担的90%以上。     

Global Burden of Invasive Nontyphoidal Salmonella Disease, 2010

Nontyphoidal Salmonella is a major cause of bloodstream infections worldwide, and HIV-infected persons and malaria-infected and malnourished children are at increased risk for the disease. We conducted a systematic literature review to obtain age group–specific, population-based invasive nontyphoidal Salmonella (iNTS) incidence data. Data were categorized by HIV and malaria prevalence and then extrapolated by using 2010 population data. The case-fatality ratio (CFR) was determined by expert opinion consensus. We estimated that 3.4 (range 2.1–6.5) million cases of iNTS disease occur annually (overall incidence 49 cases [range 30–94] per 100,000 population). Africa, where infants, young children, and young adults are most affected, had the highest incidence (227 cases [range 152–341] per 100,000 population) and number of cases (1.9 [range 1.3–2.9] million cases). An iNTS CFR of 20% yielded 681,316 (range 415,164–1,301,520) deaths annually. iNTS disease is a major cause of illness and death globally, particularly in Africa. Improved understanding of the epidemiology of iNTS is needed.     

城镇居民基本医疗保险覆盖人群疾病负担测量分析

目的:测算城镇居民的疾病负担,提出城镇居民基本医疗保险覆盖人群主要健康问题。方法:利用伤残调整生命年(DALY)作为衡量疾病负担的指标。结果:2006年城镇居民主要疾病负担是非感染性疾病,其疾病负担强度为105.8DALYs/千人,疾病负担谱前五类疾病是循环系统疾病、恶性肿瘤、神经和精神疾病、呼吸系统疾病和意外伤害。0～44岁人群中,神经和精神疾病均为第1顺位疾病;45～59岁人群中,恶性肿瘤疾病负担居首位;60岁以上人群,循环系统、恶性肿瘤和呼吸系统疾病为疾病负担的主要病因。结论:城镇居民疾病负担以非感染性疾病为主,城镇居民基本医疗保险应重点加强对循环系统疾病、恶性肿瘤、神经和精神疾病及呼吸系统疾病的保障。     

溺水流行特征与预防控制研究进展

  目的  了解1990年与2015年湖北省人群溺水的疾病负担及变化情况,为溺水的预防和控制工作提供参考依据。  方法  利用2015年全球疾病负担（GBD）研究结果,采用患病率、死亡率、伤残损失寿命年（YLD）、过早死亡损失寿命年（YLL）、伤残调整寿命年（DALY）等指标对1990年和2015年湖北省人群溺水的疾病负担状况进行描述;应用2015年GBD的标准人口对各指标进行标化,描述其疾病负担的变化情况。  结果  2015年与1990年比较,湖北省人群溺水患病数由1990年的7.86万例降至2015年的5.00万例（下降36.39 %）,标化患病率由1990年的175.43/10万降至2015年的79.90/10万（下降54.45 %）;死亡数由1990年的1.36万例降至2015年的0.38万例（下降72.06 %）,标化死亡率由1990年的24.23/10万降至2015年的7.96/10万（下降67.15 %）;湖北省人群溺水的YLD由1990年的0.57万人年降至2015年的0.22万人年（下降61.40 %）,标化YLD率由1990年的12.33/10万降至2015年的3.55/10万（下降71.21 %）;YLL由1990年的96.54万人年降至2015年的17.88万人年（下降81.48 %）,标化YLL率由1990年的1 598.76/10万降至2015年的425.41/10万（下降73.39 %）;DALY由1990年的97.11万人年降至2015年的18.10万人年（下降81.36 %）,标化DALY率由1990年的1 611.09/10万降至2015年的428.96/10万（下降73.37 %）。不同年龄组人群中,1990年与2015年溺水患病率均以 ≥ 70岁老年人为最高（505.73/10万和331.62/10万）;溺水死亡率1990年以 < 5岁儿童为最高（88.94/10万）,2015年以 ≥ 70岁老年人为最高（21.39/10万）;1990年和2015年YLL率、DALY率均以 < 5岁儿童为最高（7 526.43/10万和1 109.36/10万、7 528.24/10万和1 109.64/10万）,YLD率均以 ≥ 70岁老年人为最高（28.99/10万和14.29/10万）;2015年与1990年比较,2015年溺水患病率、死亡率、YLD率、YLL率和DALY率在各年龄段均有下降,其下降幅度随年龄增长而减少,其中 < 5岁儿童的下降幅度均最大。  结论  2015年较1990年湖北省人群溺水的疾病负担有所下降,溺水的疾病负担主要由早死所致,儿童、青少年和老年人仍是溺水关注的重点人群。     

The Disease and Economic Burdens of Esophageal Cancer in China from 2013 to 2030: Dynamic Cohort Modeling Study

BackgroundEsophageal cancer (EC) is the sixth leading cause of tumor-related deaths worldwide. Estimates of the EC burden are necessary and could offer evidence-based suggestions for local cancer control.ObjectiveThe aim of this study was to predict the disease burden of EC in China through the estimation of disability-adjusted life years (DALYs) and direct medical expenditure by sex from 2013 to 2030.MethodsA dynamic cohort Markov model was developed to simulate EC prevalence, DALYs, and direct medical expenditure by sex. Input data were collected from the China Statistical Yearbooks, Statistical Report of China Children’s Development, World Population Prospects 2019, and published papers. The JoinPoint Regression Program was used to calculate the average annual percentage change (AAPC) of DALY rates, whereas the average annual growth rate (AAGR) was applied to analyze the changing direct medical expenditure trend over time.ResultsFrom 2013 to 2030, the predicted EC prevalence is projected to increase from 61.0 to 64.5 per 100,000 people, with annual EC cases increasing by 11.5% (from 835,600 to 931,800). The DALYs will increase by 21.3% (from 30,034,000 to 36,444,000), and the years of life lost (YLL) will account for over 90% of the DALYs. The DALY rates per 100,000 people will increase from 219.2 to 252.3; however, there was a difference between sexes, with an increase from 302.9 to 384.3 in males and a decline from 131.2 to 115.9 in females. The AAPC was 0.8% (95% CI 0.8% to 0.9%), 1.4% (95% CI 1.3% to 1.5%), and –0.7% (95% CI –0.8% to –0.7%) for both sexes, males, and females, respectively. The direct medical expenditure will increase by 128.7% (from US $33.4 to US $76.4 billion), with an AAGR of 5.0%. The direct medical expenditure is 2-3 times higher in males than in females.ConclusionsEC still causes severe disease and economic burdens. YLL are responsible for the majority of DALYs, which highlights an urgent need to establish a beneficial policy to reduce the EC burden.     

Burden of Cervical Cancer in the Eastern Mediterranean Region During the Years 2000 and 2017: Retrospective Data Analysis of the Global Burden of Disease Study

BackgroundCervical cancer is a growing health concern, especially in resource-limited settings.ObjectiveThe objective of this study was to assess the burden of cervical cancer mortality and disability-adjusted life years (DALYs) in the Eastern Mediterranean Region (EMR) and globally between the years 2000 and 2017 by using a pooled data analysis approach.MethodsWe used an ecological approach at the country level. This included extracting data from publicly available databases and linking them together in the following 3 steps: (1) extraction of data from the Global Burden of Disease (GBD) study in the years 2000 and 2017, (2) categorization of EMR countries according to the World Bank gross domestic product per capita, and (3) linking age-specific population data from the Population Statistics Division of the United Nations (20-29 years, 30-49 years, and >50 years) and GBD’s data with gross national income per capita and globally extracted data, including cervical cancer mortality and DALY numbers and rates per country. The cervical cancer mortality rate was provided by the GBD study using the following formula: number of cervical cancer deaths × 100,000/female population in the respective age group.ResultsThe absolute number of deaths due to cervical cancer increased from the year 2000 (n=6326) to the year 2017 (n=8537) in the EMR; however, the mortality rate due to this disease decreased from the year 2000 (2.7 per 100,000) to the year 2017 (2.5 per 100,000). According to age-specific data, the age group ≥50 years showed the highest mortality rate in both EMR countries and globally, and the age group of 20-29 years showed the lowest mortality rate both globally and in the EMR countries. Further, the rates of cervical cancer DALYs in the EMR were lower compared to the global rates (2.7 vs 6.8 in 2000 and 2.5 vs 6.8 in 2017 for mortality rate per 100,000; 95.8 vs 222.2 in 2000 and 86.3 vs 211.8 in 2017 for DALY rate per 100,000; respectively). However, the relative difference in the number of DALYs due to cervical cancer between the year 2000 and year 2017 in the EMR was higher than that reported globally (34.9 vs 24.0 for the number of deaths and 23.5 vs 18.1 for the number of DALYs, respectively).ConclusionsWe found an increase in the burden of cervical cancer in the EMR as per the data on the absolute number of deaths and DALYs. Further, we found that the health care system has an increased number of cases to deal with, despite the decrease in the absolute number of deaths and DALYs. Cervical cancer is preventable if human papilloma vaccination is taken and early screening is performed. Therefore, we recommend identifying effective vaccination programs and interventions to reduce the burden of this disease.     

Effect of Protein-Rich Breakfast on Subsequent Energy Intake and Subjective Appetite in Children and Adolescents: Systematic Review and Meta–Analysis of Randomized Controlled Trials

Breakfast has been labeled “the most important meal of the day”, especially for children and adolescents. Dietary protein intake may benefit and regulate appetite and energy balance. However, few meta–analyses have been conducted to examine the effect of protein–rich (PR) breakfast on both children and adolescents. This meta–analytic study was conducted to examine the effect of consuming a PR breakfast on short–term energy intake and appetite in children and adolescents. PubMed, Embase, Cochrane Central Register of Controlled Trials, China Biology Medicine disc (CBM), and China National Knowledge Infrastructure (CNKI) were searched for randomized controlled trials (RCTs) published in January 1990–January 2021. The inclusion criteria applied were RCTs in children and adolescents (7–19 year) comparing PR breakfast consumption with normal protein (NP)/traditional breakfast consumption. Finally, ten studies were included in the analysis, eight studies examined the effect of consuming PR breakfast on SEI (n = 824), and nine studies examined the effect on appetite (fullness = 736, hunger = 710). Our meta-analysis using the random–effects model shows that participants assigned to consume PR breakfast had lower SEI (MD, −111.2 kcal; 95% CI: −145.4, −76.9), higher fullness (MD, 7.4 mm; 95% CI: 6.0, 8.8), and lower hunger (MD, −8.5 mm; 95% CI: −9. 7, −7.3) than those assigned to consume NP/traditional breakfast. However, there was considerable inconsistency across the trial results. Our review suggests that the consumption of PR breakfast could be an excellent strategy for weight management by declining SEI and suppressing appetite, and provides new evidence of the relationship between energy balance and obesity. However, since most eligible studies were of low quality, the results ought to be interpreted cautiously.