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Global, regional, and national progress towards the 2030 global nutrition targets and forecasts to 2050: a systematic analysis for the Global Burden of Disease Study 2021
(2024-12-21) Arndt M.B.; Aravkin A.Y.; Bhattacharjee N.V.; Chalek J.; Dai X.; Dandona L.; Dandona R.; Dharmaratne S.D.; Farmer S.; Feigin V.L.; Fitzgerald R.; Gakidou E.; Gardner W.M.; Hagins H.; Hay S.I.; He J.; Humphrey K.M.; Lim S.S.; Lindstedt P.A.; Lo J.; Manguerra H.; Mestrovic T.; Mokdad A.H.; Mougin V.; Murray C.J.L.; Nguyen Q.A.P.; Pasovic M.; Raggi C.; Schneider R.D.; Smith A.E.; Sorensen R.J.D.; Stanaway J.D.; Taylor H.J.; Vollset S.E.; Wolde A.A.; Yuan C.W.; Zigler B.; Kassebaum N.J.; Reiner R.C.; Iwu C.D.; Krishnamoorthy V.; Abate Y.H.; Abbasi-Kangevari M.; Ahmadi A.; Sabour S.; Ajami M.; Hashemi M.B.; Doaei S.; Ghamari S.H.; Khanali J.; Rashidi M.M.; Gholamalizadeh M.; Haj-Mirzaian A.; Heidari-Foroozan M.; Zangiabadian M.; Kashani H.R.K.; Rezaee M.; Tabatabai S.; ElHafeez S.A.; Elmeligy O.A.A.; Abdelmasseh M.; Sanabria J.; Abd-Elsalam S.; Darwish A.H.; Abdulah D.M.; Abdulkader R.S.; Abidi H.; Zoladl M.; Abiodun O.; Aboagye R.G.; Amu H.; Tarkang E.E.; Immurana M.; Alhassan R.K.; Abolhassani H.; Dadras O.; Keykhaei M.; Rezaei N.; Ghassemi F.; Moghaddam S.S.; Khanmohammadi S.; Shahbandi A.; Kompani F.; Rad E.M.; Rahimi-Movaghar V.; Sepanlou S.G.; Shafie M.; Vahabi S.M.; Yazdanpanah F.; Ghaffari K.; Kauppila J.H.; Abtew Y.D.; Bekele A.; Demissie S.; Esubalew H.; Wubetie G.A.; Abu-Gharbieh E.; Arumugam A.; Saber-Ayad M.M.; Saddik B.A.; Arndt M.B.; Mahidol University
Background: The six global nutrition targets (GNTs) related to low birthweight, exclusive breastfeeding, child growth (ie, wasting, stunting, and overweight), and anaemia among females of reproductive age were chosen by the World Health Assembly in 2012 as key indicators of maternal and child health, but there has yet to be a comprehensive report on progress for the period 2012 to 2021. We aimed to evaluate levels, trends, and observed-to-expected progress in prevalence and attributable burden from 2012 to 2021, with prevalence projections to 2050, in 204 countries and territories. Methods: The prevalence and attributable burden of each target indicator were estimated by age group, sex, and year in 204 countries and territories from 2012 to 2021 in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, the most comprehensive assessment of causes of death, disability, and risk factors to date. Country-specific relative performance to date was evaluated with a Bayesian meta-regression model that compares prevalence to expected values based on Socio-demographic Index (SDI), a composite indicator of societal development status. Target progress was forecasted from 2021 up to 2050 by modelling past trends with meta-regression using a combination of key quantities and then extrapolating future projections of those quantities. Findings: In 2021, a few countries had already met some of the GNTs: five for exclusive breastfeeding, four for stunting, 96 for child wasting, and three for child overweight, and none met the target for low birthweight or anaemia in females of reproductive age. Since 2012, the annualised rates of change (ARC) in the prevalence of child overweight increased in 201 countries and territories and ARC in the prevalence of anaemia in females of reproductive age decreased considerably in 26 countries. Between 2012 and 2021, SDI was strongly associated with indicator prevalence, apart from exclusive breastfeeding (|r-|=0·46–0·86). Many countries in sub-Saharan Africa had a decrease in the prevalence of multiple indicators that was more rapid than expected on the basis of SDI (the differences between observed and expected ARCs for child stunting and wasting were –0·5% and –1·3%, respectively). The ARC in the attributable burden of low birthweight, child stunting, and child wasting decreased faster than the ARC of the prevalence for each in most low-income and middle-income countries. In 2030, we project that 94 countries will meet one of the six targets, 21 countries will meet two targets, and 89 countries will not meet any targets. We project that seven countries will meet the target for exclusive breastfeeding, 28 for child stunting, and 101 for child wasting, and no countries will meet the targets for low birthweight, child overweight, and anaemia. In 2050, we project that seven additional countries will meet the target for exclusive breastfeeding, five for low birthweight, 96 for child stunting, nine for child wasting, and one for child overweight, and no countries are projected to meet the anaemia target. Interpretation: Based on current levels and past trends, few GNTs will be met by 2030. Major reductions in attributable burden for exclusive breastfeeding and anthropometric indicators should be recognised as huge scientific and policy successes, but the comparative lack of progress in reducing the prevalence of each, along with stagnant anaemia in women of reproductive age and widespread increases in child overweight, suggests a tenuous status quo. Continued investment in preventive and treatment efforts for acute childhood illness is crucial to prevent backsliding. Parallel development of effective treatments, along with commitment to multisectoral, long-term policies to address the determinants and causes of suboptimal nutrition, are sorely needed to gain ground. Funding: Bill & Melinda Gates Foundation.
Factors Affecting Knowledge Management for the Elderly Health System: Case Studies from Sub-district Municipalities and Administrative Organizations in Thailand
(2024-01-01) Limmethee A.; Dhirathiti N.S.; Limmethee A.; Mahidol University
Background: Thailand is in the process of transitioning into an aging society, which will significantly impact the health system for the elderly. Local administrative organizations play a crucial role in providing public health services for the elderly, as they are the closest level of government management to the people. Employing knowledge management in the government sector has enabled the provision of various forms of public services. Objective: The study aims to explore the factors and conditions related to knowledge management for elderly health within local administrative organizations in Thailand. Methods: This qualitative research methodology uses a case study design, with the unit of analysis being the Sub-district municipality and Sub-district Administrative Organization. The research tools are interviews and focus groups. The data are analyzed by content and thematic analysis. Results: The findings indicate that the main factors related to knowledge management for the elderly health system include organizational culture, leadership and vision, supporting networks within the local area, and government agencies. Supporting factors include local culture and community philosophers. Policy suggestions, including local administrative organizations, must act as a coordinator and supporters of the health system for the elderly, emphasizing the creation of a network both inside and outside the area, drawing people of various age groups to join the health network in the local area, and preparing the population to be healthy before they enter the elderly stage. Conclusion: The study recommends that local administrative organizations prioritize promoting factors within their area to support knowledge management for the elderly health system, which significantly impacts operational success. Furthermore, they should collaborate with other government agencies to address diverse health issues for the elderly.
Risk Factors of Distal Radius Fracture in Elderly Thai Population
(2025-04-01) Jaruwan C.; Sitthisen P.; Eaimjinnasuwat W.; Jongjaid T.; Harnroongroj T.; Jaruwan C.; Mahidol University
Background: Advances in medical technology have increased the life expectancy of the elderly population, leading to a higher proportion of elderly people in the healthcare system. As people grow older, their organ systems, including the musculoskeletal system, degenerate. This degeneration, including decreased muscle mass, reduced bone mass, and poor body balance, increases the risk of falls and fractures. Distal radius fractures are the second most common fractures in the elderly, following hip fractures. Objective: To investigate risk factors for low-energy distal radius fractures in the elderly in Bang Khae District. Materials and Methods: The retrospective study included patients aged 60 years and older with distal radius fractures due to low-energy trauma, residing in Bang Khae District. Data was collected between January 1, 2018, and December 31, 2022. Eighty patients met the inclusion criteria, with 60 patients in the fracture group and 20 patients in the no-fracture group. The comparison focused on identifying risk factors between the two groups. Results: The risk of distal radius fracture was higher in females (OR 4.17, 95% CI 1.25 to 17.72, p=0.022). Protective factors included calcium intake (OR 0.06, 95% CI 0.01 to 0.34, p=0.001) and vitamin D intake (OR 0.03, 95% CI 0.00 to 0.28, p=0.002). No significant risk factors were found for surgical treatment and malunion. Conclusion: Elderly female patients have a higher risk of distal radius fractures compared to males. The intake of calcium and vitamin D seem to be protective factors against distal radius fractures in the elderly.
Pan-Asia adapted ESMO Clinical Practice Guideline for the management of patients with newly diagnosed and relapsed epithelial ovarian cancer
(2025-06-01) Nag S.; Ray Coquard I.; Gupta S.; Pathak A.; Li N.; Mulya Sari R.; Harano K.; Kim G.M.; Ang S.F.; Que F.V.; Chay W.Y.; Lai H.C.; Ativitavas T.; Tangjitgamol S.; Lai C.H.; Heong V.Y.M.; Contreras Tolentino J.; Ngu M.R.; Yun J.; Yunokawa M.; Hanafi W.L.H.; Li J.; Smyth E.; Yoshino T.; Mehta J.; Pentheroudakis G.; Maheshwari A.; Cervantes A.; Basade M.; Oaknin A.; Nag S.; Mahidol University
The European Society for Medical Oncology (ESMO) Clinical Practice Guideline for the diagnosis, treatment and follow-up of patients with newly diagnosed and relapsed epithelial ovarian cancer (EOC), published in 2023, was adapted in July 2024, according to established standard methodology, to produce the Pan-Asian adapted ESMO consensus guideline for the management of Asian patients with EOC. The adapted guideline presented in this manuscript represents the consensus opinions reached by a panel of Asian experts in the treatment of patients with EOC representing the oncological societies of China, Indonesia, India, Japan, Korea, Malaysia, the Philippines, Singapore, Taiwan and Thailand, coordinated by ESMO and the Indian Society of Medical and Pediatric Oncology. Voting was based on scientific evidence and was independent of current treatment practices, drug access restrictions and reimbursement decisions in the represented countries. Drug access and reimbursement across Asia are discussed separately in the manuscript. The Pan-Asian consensus aims to guide the optimisation and harmonisation of management of patients with EOC in Asia, drawing on the evidence provided by both Western and Asian trials. Attention is drawn to the disparity in the drug approvals and reimbursement strategies between countries.
Repurposing of an inotropic drug dobutamine to enhance the production of human hematopoietic stem cells from human induced pluripotent stem cells
(2025-12-01) Laowtammathron C.; Srisook P.; Kheolamai P.; Parnpai R.; Lorthongpanich C.; Issaragrisil S.; Laowtammathron C.; Mahidol University
Background: Dobutamine hydrochloride (DH), a common inotropic drug used for heart failure, has recently been discovered to inhibit Yes-Associated Protein (YAP). YAP is a key component of the Hippo signaling pathway and plays a crucial role in the regulation of hematopoietic cell growth. The decrease in YAP activity has been shown to increase hematogenic differentiation and the generation of hematopoietic stem and progenitor cells (HSPCs) from human induced pluripotent stem cells (hiPSCs). Therefore, this study investigates the effect of DH on enhancing the hematopoietic differentiation of hiPSCs toward HSPCs. Methods: This study used isogenic hiPSCs to study the effect of DH during various stages of their hematogenic differentiation using an in vitro culture system. The differentiating hiPSCs were cultured under specific conditions, including defined differentiation media composition and controlled oxygen tension throughout the differentiation process. The percentages of iPSC-derived HSPCs were assessed using flow cytometry to evaluate the expression of HSPC markers, including CD34⁺, CD43⁺, and CD45⁺/⁻. The HSPC production yield and the multilineage differentiation capacity of the resulting hiPSC-derived HSPCs were determined at the end of culture. Results: The findings indicate that DH treatment significantly inhibits YAP activity and increases the hematogenic differentiation of hiPSCs and the yield of HSPCs at the end of culture. Specifically, inhibiting YAP activity with DH during the transition of hiPSCs from the hematoendothelial progenitor (HE) stage to the hematopoietic stage (endothelial to hematopoietic transition, EHT) proved to be the most effective in increasing HSPC production from hiPSCs. Conclusions: This study highlights the potential of the inotropic drug DH as a novel agent to enhance hematogenic differentiation and improve the yield of hiPSC-derived hematopoietic stem and progenitor cells (HSPCs). DH was found to significantly inhibit YAP activity, which in turn promoted hematopoietic specification, particularly when administered during the critical endothelial-to-hematopoietic transition (EHT) stage. These findings suggest that repurposing DH could offer a valuable strategy to increase the efficiency of hiPSC-derived HSPC production, advancing its potential for therapeutic and clinical applications in regenerative medicine and hematopoietic cell therapies.