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Relationship between first trimester physical activity and premature rupture of membranes: a birth cohort study in Chinese women

This study aimed to examine prospective associations of different intensity levels and types of physical activity (PA) in early pregnancy with premature rupture of membranes (PROM) among Chinese pregnant women.

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Highly active antiretroviral therapy is necessary but not sufficient. A systematic review and meta-analysis of mortality incidence rates and predictors among HIV-infected adults receiving treatment in Ethiopia, a surrogate study for resource-poor settings

Owing to the introduction of highly active antiretroviral therapy (HAART), the trajectory of mortality and morbidity associated with human immunodeficiency virus (HIV) infection has significantly decreased in ...

Minimum milk feeding frequency and its associated factors among non-breastfed children aged 6–23 months in sub-saharan Africa: a multilevel analysis of the recent demographic and health survey data

Poor infant and child feeding practices, in combination with increased rates of infectious diseases, are the main immediate causes of malnutrition during the first two years of life. Non-breastfed children req...

The impact of family factors and communication on recreational sedentary screen time among primary school-aged children: a cross-sectional study

Childhood obesity is increasingly recognized as a major public health challenge worldwide, and excessive sedentary screen time is emerging as a key risk factor. This study aimed to assess the recreational scre...

Geographical coverage of SARS-CoV-2 screening and care centers in Haiti: what do national surveillance data tell us?

In Haiti, reported incidence and mortality rates for COVID-19 were lower than expected. We aimed to analyze factors at communal and individual level that might lead to an underestimation of the true burden of ...

Availability of published evidence on coverage, cost components, and funding support for digitalisation of infectious disease surveillance in Africa, 2003–2022: a systematic review

The implementation of digital disease surveillance systems at national levels in Africa have been challenged by many factors. These include user applicability, utility of IT features but also stable financial ...

Association between new Life’s Essential 8 and the risk of all-cause and cardiovascular mortality in patients with hypertension: a cohort study

The American Heart Association recently introduced a new model for cardiovascular health (CVH) known as Life’s Essential 8 (LE8). The impact of LE8 on hypertensive individuals is currently unclear. In our stud...

Prevalence of Post-COVID conditions among Mexican COVID-19 survivors: a nationwide cross-sectional study

There are limited population-representative data that describe the potential burden of Post-COVID conditions (PCC) in Mexico. We estimated the prevalence of PCC overall and by sociodemographic characteristics ...

Machine learning algorithms for predicting COVID-19 mortality in Ethiopia

Coronavirus disease 2019 (COVID-19), a global public health crisis, continues to pose challenges despite preventive measures. The daily rise in COVID-19 cases is concerning, and the testing process is both tim...

An organizational working time reduction and its impact on three domains of mental well-being of employees: a panel study

Work hours are an important aspect of one’s job and these in turn have the potential to impact people’s well-being. Much research investigating the link between working hours and well-being uses cross-sectiona...

Assessment of physical literacy in 8- to 12-year-old Pakistani school children: reliability and cross-validation of the Canadian assessment of physical literacy-2 (CAPL-2) in South Punjab, Pakistan

The increasing prevalence of physical inactivity, declining fitness, and rising childhood obesity highlight the importance of physical literacy (PL), as a foundational component for fostering lifelong health a...

Decision regret after prostate biopsy for prostate cancer diagnosis: a Korean multicenter cohort study

Many people struggle with the choice in a series of processes, from prostate cancer (PCa) diagnosis to treatment. We investigated the degree of regret after the prostate biopsy (PBx) and relevant factors in pa...

Public health events and economic growth in a neoclassical framework

Public health events (PHEs) have emerged as significant threats to human life, health, and economic growth. PHEs, such as COVID-19, have prompted a reevaluation for enhanced regular prevention and control (RPC...

Association between metabolic score of visceral fat and carotid atherosclerosis in Chinese health screening population: a cross-sectional study

The metabolic score for visceral fat (METS-VF) quantifies the cumulative burden of visceral and intra-abdominal adipose tissues. However, the relationship between the METS-VF and carotid atherosclerosis (CAS) ...

Prevalence of insufficient physical activity among adult residents of Tehran: a cross-sectional report from Tehran Cohort Study (TeCS)

Insufficient physical activity (PA) is a major risk factor for non-communicable diseases (NCDs) and one of the leading causes of premature mortality worldwide. This study examined the prevalence and independen...

“If I use pad, I feel comfortable and safe” : a mixed-method analysis of knowledge, attitude, and practice of menstrual hygiene management among in-school adolescent girls in a Nigerian city

Adolescence is a pivotal stage in human development that presents unique challenges, especially for girls navigating the complexities of menstruation. Despite the importance of menstrual hygiene management for...

“Put your personality into the call”: A qualitative interview study illuminating strategies for improving men’s engagement on crisis helplines

Crisis telephone helplines are an integral part of community suicide prevention. Despite high male suicide rates, men’s experiences of these services are poorly understood. The current study explored men’s per...

The relationship between physical exercise and problematic internet use in college students: the chain-mediated role of self-control and loneliness

From the perspective of exercise psychology, to investigate the antefacts of problematic internet use (PIU) in college students, and to reveal the chain mediating effect of self-control and loneliness between ...

Facility characteristics preferred by older men seeking medical male circumcision services in Kenya: qualitative findings from the ‘Tasco’ study (May 2014-June 2016)

Primary healthcare facilities are central to the implementation of voluntary medical male circumcision (VMMC) as points of access to integrated health services in line with the Kenya AIDS Strategic Framework I...

Integrated surveillance systems for antibiotic resistance in a One Health context: a scoping review

Antibiotic resistance (ABR) has emerged as a major threat to health. Properly informed decisions to mitigate this threat require surveillance systems that integrate information on resistant bacteria and antibi...

The prevalence of adolescent fatherhood and its associated factors in East African countries

In developing nations, the phenomenon of adolescent fatherhood poses significant challenges, including increased risk of poverty, limited educational opportunities, and potential negative health outcomes for b...

Association between sedentary behavior, screen time and metabolic syndrome among Chinese children and adolescents

The aim of the study was to investigate the relationship between sedentary behavior, screen time and MetS among Chinese children and adolescents aged 7–17 years. Data was obtained from the China National Nutri...

Housing conditions and risk of incident COPD: a Danish cohort study, 2000–2018

More knowledge is needed on the risk of developing chronic obstructive pulmonary disease (COPD) associated with housing conditions and indoor environment based on cohort studies with a long follow-up time.

A systematic review and narrative synthesis of health literacy interventions among Spanish speaking populations in the United States

While many populations struggle with health literacy, those who speak Spanish preferentially or exclusively, including Hispanic, immigrant, or migrant populations, may face particular barriers, as they navigat...

Bottle-feeding practice and its associated factors among mothers of children aged 0 to 23 months in sub-Saharan Africa: a multi-level analysis of demographic and health surveys (2015–2022)

Avoidance of bottle feeding is recommended as it interferes with optimal suckling behavior, is difficult to keep clean, and is an important route for the transmission of pathogens. However, there is a current ...

Climate change and heat stress resilient outdoor workers: findings from systematic literature review

Global warming has led to an increase in the number and intensity of extreme heat events, posing a significant threat to the health and safety of workers, especially those working outdoors, as they often have ...

The effect of a self-learned virtual learning package on knowledge, attitude, and self-care behaviors of COVID-19 in people referred to health and treatment centers

COVID-19 is one of the most common diseases in recent years, the most important way to prevent is through self-care behaviors; therefore, it is important to these behaviors in people. According to the importan...

Prevalence and factors associated with illicit drug and high-risk alcohol use among adolescents living in urban slums of Kampala, Uganda

Illicit drug and high-risk alcohol use among adolescents leads to poor health outcomes. We enrolled adolescents from urban slums in Kampala, Uganda, to assess baseline prevalence and factors associated with il...

Does the job performance of academics’ influence burnout and psychological counselling? A comparative analysis amongst high-, average-, low-, and non-performers

Extensive research has been conducted treating burnout as an independent variable and performance as a dependent variable to proffer possible solutions to burnout and job performance among academics. Despite t...

‘Doing culture’ in contemporary south-eastern Australia: how Indigenous people are creating and maintaining strong cultural identities for improved health and wellbeing

Indigenous people in Australia experience far poorer health than non-Indigenous Australians. A growing body of research suggests that Indigenous people who are strong in their cultural identity experience bett...

DE-PASS best evidence statement (BESt): determinants of adolescents’ device-based physical activity and sedentary behaviour in settings: a systematic review and meta-analysis

Although physical activity (PA) is associated with significant health benefits, only a small percentage of adolescents meet recommended PA levels. This systematic review with meta-analysis explored the modifia...

Tailored vs. General COVID-19 prevention for adults with mental disabilities residing in group homes: a randomized controlled effectiveness-implementation trial

People with serious mental illness (SMI) and people with intellectual disabilities/developmental disabilities (ID/DD) are at higher risk for COVID-19 and more severe outcomes. We compare a tailored versus gene...

Vulnerability factors of snake bite patients in China

To analyze the vulnerability factors of snakebite patients in China.

National burden of gambling in Japan: an estimation from an online-based cross-sectional investigation and national epidemiological survey

Gambling is a popular leisure activity in many countries, often expected to boost regional economies. Nevertheless, its negative impacts remain a significant concern. Gambling disorder is recognized as the mos...

Short-term exposure to air pollution on peripheral white blood cells and inflammation biomarkers: a cross-sectional study on rural residents

Effects of short-term exposure to ambient air pollution on systemic immunological and inflammatory biomarkers in rural population have not been adequately characterized. From May to July 2021, 5816 participant...

Risky sexual behavior and associated factors among university students in Ethiopia: a cross-sectional national survey

Risky sexual behavior (RSB) is one of the major youth sexual and reproductive health problems globally, including in Ethiopia. RSB among youth increases the risk of HIV infection, other sexually transmitted in...

Perception of Korean healthy adolescents on cancer and adolescent cancer survivors: a cross-sectional survey

As the number of adolescent cancer survivors increases, detailed and effective healthcare policies on adolescent cancer survivors returning to school and workplace are needed. The study aimed to explore the pe...

Physical activity levels and sedentary behaviour according to sex, age, BMI, academic year, and country among medical students in Latin America

Physical inactivity represents a global challenge in public health, being the second most significant factor contributing to mortality. In Latin America, the prevalence of physical inactivity and sedentary beh...

Magnitude and determinants of undernutrition among tuberculosis patients in Ethiopia: systematic review and meta-analysis

Undernutrition increases the risk of TB infection to be active TB, death and relapse of the disease. Undernutrition also disturbs the management process of tuberculosis. Therefore, this study aimed to estimate...

Age-specific association between meal-skipping patterns and the risk of hyperglycemia in Korean adults: a national cross-sectional study using the KNHANES data

Glucose metabolism regulation is influenced by age and meal skipping, although research on their interplay with hyperglycemia remains limited. This study aims to explore the intricate relationship between meal...

Health impacts of lifestyle and ambient air pollution patterns on all-cause mortality: a UK Biobank cohort study

Extensive evidence indicates that both lifestyle factors and air pollution are strongly associated with all-cause mortality. However, little studies in this field have integrated these two factors in order to ...

“A balancing act”: parents’ longitudinal perspectives of weight-related discussions with their children following obesity treatment

Weight-related discussions during childhood may have long-lasting effects on children’s body image and well-being. However, little is known about how parents frame these discussions with children who have unde...

Risk factors associated with loneliness among mexican-origin adults in southern Arizona

This study examines factors associated with symptoms of loneliness among a sample ( n  = 213) of mostly Mexican-origin adults at risk of chronic diseases in Southern Arizona’s Pima, Yuma, and Santa Cruz counties. I...

Sexual satisfaction and attitude toward marital infidelity among married people in Iran: the role of social media and entertainment preferences

Sexual satisfaction and attitudes toward marital infidelity are crucial components of marital quality and well-being. This study investigates the impact of social media and entertainment preferences on these a...

Associations among drug acquisition and use behaviors, psychosocial attributes, and opioid-involved overdoses

This study sought to develop and assess an exploratory model of how demographic and psychosocial attributes, and drug use or acquisition behaviors interact to affect opioid-involved overdoses.

Dynamics of HIV PrEP use and coverage during and after COVID-19 in Germany

Pre-exposure prophylaxis (PrEP) with oral emtricitabine/tenofovir disoproxil (FTC/TDF) proved highly efficient in preventing HIV. Since 09/2019, FTC/TDF-PrEP is covered by health insurances in Germany, if pres...

Place of residence and blood sugar testing practices among men: insights from the 2021 Madagascar demographic and health survey

In 2021, Madagascar had approximately 13,919 people living with diabetes, with 66.1% of cases being undiagnosed. The implication is that this population are at high risk of developing diabetes complications wh...

The association between problematic short video use and suicidal ideation and self-injurious behaviors: the mediating roles of sleep disturbance and depression

Prior work suggests that problematic short video use was associated with adverse psychological, physiological, and educational outcomes. With the prevailing of short video platforms, the potential relationship...

The 2017 Women’s Health Initiative study and use of hormone therapy: an emulated repeated cross-sectional study

Hormone therapy (HT) use among menopausal women declined after negative information from the 2002 Women’s Health Initiative (WHI) HT study. The 2017 post-intervention follow-up WHI study revealed that HT did n...

Global prevalence of obesity and overweight among medical students: a systematic review and meta-analysis

Obesity is a global health concern, and understanding its prevalence among medical students is crucial for shaping targeted interventions. This systematic review and meta-analysis aim to comprehensively assess...

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Collection  29 March 2022

2021 Top 25 Health Sciences Articles

We are pleased to share with you the 25 most downloaded  Nature Communications  articles* in health sciences published in 2021. (Please note we have a separate collection on the Top 25 COVID-19 papers .) Featuring authors from around the world, these papers highlight valuable research from an international community.

Browse all Top 25 subject area collections  here .

*Data obtained from SN Insights (based on Digital Science's Dimensions) and normalised to account for articles published later in the year.

Research highlights

Association of sleep duration in middle and old age with incidence of dementia

Sleep dysregulation has been linked to dementia, but it is unknown whether sleep duration earlier in life is associated with dementia risk. Here, the authors show higher dementia risk associated with short sleep duration (six hours or less) in a longitudinal study of middle and older age adults.

• Séverine Sabia
• Aurore Fayosse
• Archana Singh-Manoux

Longitudinal analysis of blood markers reveals progressive loss of resilience and predicts human lifespan limit

Aging is associated with an increased risk of chronic diseases and functional decline. Here, the authors investigate the fluctuations of physiological indices along aging trajectories and observed a characteristic decrease in the organism state recovery rate.

• Timothy V. Pyrkov
• Konstantin Avchaciov
• Peter O. Fedichev

Restoration of energy homeostasis by SIRT6 extends healthy lifespan

Aging is associated with increased frailty and disrupted energy homeostasis. Here, the authors show that SIRT6 overexpression extends the lifespan of male and female mice and demonstrate that SIRT6 optimizes energy homeostasis in old age, which delays frailty and preserves healthy aging.

• A. Roichman
• S. Elhanati
• H. Y. Cohen

Triptonide is a reversible non-hormonal male contraceptive agent in mice and non-human primates

No male contraceptive pills are currently available. Here, the authors use triptonide, a compound derived from a Chinese plant, to deform sperm so that they cannot move properly, thereby causing reversible infertility in male mice and monkeys.

• Zongliang Chang
• Weibing Qin

Fasting alters the gut microbiome reducing blood pressure and body weight in metabolic syndrome patients

Nutritional modification including fasting has been shown to reduce cardiometabolic risk linked to western diet. Here the authors show implementation of fasting resulted in alterations to the intestinal microbiota, and circulating immune cells, improving blood pressure and body weight in patients with metabolic syndrome.

• András Maifeld
• Hendrik Bartolomaeus
• Sofia K. Forslund

Transneuronal delivery of hyper-interleukin-6 enables functional recovery after severe spinal cord injury in mice

The CNS has limited ability to regenerate following injury, Here, the authors show that a single injection of AAV-hyper-interleukin-6 in the sensory motor cortex results in corticospinal and raphe spinal tracts regeneration in the injured spinal cord as well as functional recovery in mice.

• Marco Leibinger
• Charlotte Zeitler
• Dietmar Fischer

Spatially resolved transcriptomics reveals the architecture of the tumor-microenvironment interface

During tumor progression, cancer cells contact different neighboring cell types, but it is unclear how these interactions affect cancer cell behavior. Here, the authors use spatially resolved transcriptomics and single-cell RNA-seq to study the role of cilia at the tumormicroenvironment interface.

• Miranda V. Hunter
• Reuben Moncada
• Richard M. White

Adjuvant oncolytic virotherapy for personalized anti-cancer vaccination

Viruses expressing tumour antigens can prime and boost anti-tumour immunity but the efficiency of this approach depends on the capacity of the virus to infect the host. Here, the authors show that vaccination with oncolytic viruses co-administered with tumour antigenic peptides is as efficient as antigen-engineered oncolytic viruses.

• K. Geoffroy
• M.-C. Bourgeois-Daigneault

Detection and characterization of lung cancer using cell-free DNA fragmentomes

DNA from tumour cells can be detected in the blood of cancer patients. Here, the authors show that cell free DNA fragmentation patterns can identify lung cancer patients and when this information is further interrogated it can be used to predict lung cancer histological subtype.

• Dimitrios Mathios
• Jakob Sidenius Johansen
• Victor E. Velculescu

A randomized controlled trial of pharmacist-led therapeutic carbohydrate and energy restriction in type 2 diabetes

Community pharmacists are accessible healthcare providers with expertise in medication management. Here the authors show that a low-carbohydrate, low-energy diet implemented by community pharmacists reduced diabetes medication use and improved glucose control in people with type 2 diabetes.

• Cody Durrer
• Sean McKelvey
• Jonathan P. Little

A metabolome atlas of the aging mouse brain

Metabolites play an important role in physiology, yet the complexity of the metabolome and its interaction with disease and aging is poorly understood. Here the authors present a comprehensive atlas of the mouse brain metabolome and how it changes during aging.

• Oliver Fiehn

Investigating immune and non-immune cell interactions in head and neck tumors by single-cell RNA sequencing

The tumor microenvironment (TME) has an important role in Head and Neck Squamous Cell Carcinoma (HNSCC) progression. Here, using single-cell RNA sequencing and multiplexed imaging, the authors report the cellular complexity of the TME in patients with HNSCC, exploring inflammatory status, stromal heterogeneity and immune checkpoint receptor-ligand interactions.

• Cornelius H. L. Kürten
• Aditi Kulkarni
• Robert L. Ferris

Single-cell profiling of tumor heterogeneity and the microenvironment in advanced non-small cell lung cancer

Comprehensive profiles of tumour and microenvironment are critical to understand heterogeneity in non-small cell lung cancer (NSCLC). Here, the authors profile 42 late-stage NSCLC patients with single-cell RNA-seq, revealing immune landscapes that are associated with cancer subtype or heterogeneity.

• Fengying Wu
• Caicun Zhou

Biomimetic nanoparticles deliver mRNAs encoding costimulatory receptors and enhance T cell mediated cancer immunotherapy

Antibodies targeting OX40 or CD137, two T cell costimulatory receptors, have been shown to improve antitumor immunity. Here the authors design a phospholipid-derived nanoparticle to deliver OX40 or CD137 mRNA to T cells in vivo, improving efficacy of anti-OX40 and anti-CD137 antibody therapy in preclinical tumor models.

• Xinfu Zhang
• Yizhou Dong

Sexual dimorphism in glucose metabolism is shaped by androgen-driven gut microbiome

Male sex is a risk factor for impaired glucose metabolism and type 2 diabetes. Here the authors identify that androgen modulates the gut microbiome, which drives insulin resistance and contributes to sexual dimorphism in glucose metabolism in mice.

• Weiqing Wang

Blood n-3 fatty acid levels and total and cause-specific mortality from 17 prospective studies

Associations between of omega-3 fatty acids and mortality are not clear. Here the authors report that, based on a pooled analysis of 17 prospective cohort studies, higher blood omega-3 fatty acid levels correlate with lower risk of all-cause mortality.

• William S. Harris
• Nathan L. Tintle
• The Fatty Acids and Outcomes Research Consortium (FORCE)

Multi-omics analysis identifies therapeutic vulnerabilities in triple-negative breast cancer subtypes

Triple negative breast cancer can be divided into additional subtypes. Here, using omics analyses, the authors show that in the mesenchymal subtype expression of MHC-1 is repressed and that this can be restored by using drugs that target subunits of the epigenetic modifier PRC2.

• Brian D. Lehmann
• Antonio Colaprico
• X. Steven Chen

Daily caloric restriction limits tumor growth more effectively than caloric cycling regardless of dietary composition

Caloric restriction (CR) has been shown as an effective intervention to reduce tumorigenesis, but alternative less stringent dietary interventions have also been considered. Here, the authors show that in a murine model of breast cancer CR has a larger effect on preventing tumorigenesis and metastasis compared to periodic caloric cycling.

• Laura C. D. Pomatto-Watson
• Monica Bodogai
• Rafael de Cabo

Neoadjuvant immunotherapy with nivolumab and ipilimumab induces major pathological responses in patients with head and neck squamous cell carcinoma

Immune checkpoint blockade has become standard care for patients with recurrent metastatic head and neck squamous cell carcinoma (HNSCC). Here the authors present the results of a non-randomized phase Ib/IIa trial, reporting safety and efficacy of neoadjuvant nivolumab monotherapy and nivolumab plus ipilimumab prior to standard-of-care surgery in patients with HNSCC. .

• Joris L. Vos
• Joris B. W. Elbers
• Charlotte L. Zuur

9p21 loss confers a cold tumor immune microenvironment and primary resistance to immune checkpoint therapy

The molecular mechanisms of resistance to immune checkpoint therapy remain elusive. Here, the authors perform immunogenomic analysis of TCGA data and data from clinical trials for antiPD-1/PD-L1 therapy and highlight the association of 9p21 loss with a cold tumor microenvironment and resistance to therapy.

• Guangchun Han
• Guoliang Yang
• Linghua Wang

Gut bacteria identified in colorectal cancer patients promote tumourigenesis via butyrate secretion

Several bacteria in the gut microbiota have been associated with colorectal cancer (CRC) but it is not completely clear whether they have a role in tumourigenesis. Here, the authors show enrichment of 12 bacterial taxa in two cohorts of CRC patients and that two Porphyromonas species accelerate CRC onset through butyrate secretion.

• Shintaro Okumura
• Yusuke Konishi

Elevated circulating follistatin associates with an increased risk of type 2 diabetes

Follistatin promotes in type 2 diabetes (T2D) pathogenesis in model animals and is elevated in patients with T2D. Here the authors report that plasma follistatin associates with increased risk of incident T2D in two longitudinal cohorts, and show that follistatin regulates insulin-induced suppression lipolysis in cultured human adipocytes.

• Chuanyan Wu
• Yang De Marinis

Tau activates microglia via the PQBP1-cGAS-STING pathway to promote brain inflammation

Brain inflammation generally accelerates neurodegeneration but the mechanisms of this are not fully characterised. Here the authors show that PQBP1 in microglia is important for sensing extrinsic Tau 3 R/4 R proteins and triggers an innate immune response through cGAS and STING resulting in cognitive impairment.

• Hiroki Shiwaku
• Hitoshi Okazawa

Long-term treatment with senolytic drugs Dasatinib and Quercetin ameliorates age-dependent intervertebral disc degeneration in mice

Intervertebral disc degeneration is a leading cause of chronic back pain and disability. Here the authors show that long term treatment with senolytic compounds Dasatinib and Quercetin reduces disc senescence burden and ameliorates age-dependent degeneration in mice.

• Emanuel J. Novais
• Victoria A. Tran
• Makarand V. Risbud

DNA/RNA heteroduplex oligonucleotide technology for regulating lymphocytes in vivo

Using gene silencing to regulate lymphocyte function is a promising therapeutic approach for autommunity, inflammation and cancer. Here the authors use a heteroduplex oligonucleotide for improved potency, efficacy and longer retention times.

• Masaki Ohyagi
• Tetsuya Nagata
• Takanori Yokota

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Page 1 of 12

Correction to: Water, sanitation and hygiene (WASH) practices and deworming improve nutritional status and anemia of unmarried adolescent girls in rural Bangladesh

The original article was published in Journal of Health, Population and Nutrition 2023 42 :127

• View Full Text

Association between waist circumference and lung function in American middle-aged and older adults: findings from NHANES 2007–2012

There is a major epidemic of obesity, and many obese patients suffer from respiratory symptoms and disease. However, limited research explores the associations between abdominal obesity and lung function indic...

Dietary salt intake and kidney function in rural Senegalese populations: a cross-sectional study

High salt intake is a major risk factor for hypertension and its complications such as chronic kidney disease (CKD) and cardiovascular diseases. The present study aimed to determine level of sodium consumption...

Determinants of preventive behavior against Covid-19 in secondary school students based on Health Belief Model (HBM): a structural equations modeling (SEM)

Measures such as education, improving knowledge, attitude and taking preventive action to protect against COVID-19 are vital strategies for prevention. The aim of this study was to determine the predictability...

Prevalence and correlates of diarrhoea among children under five in selected coastal communities in Ghana

Diarrhoea is a preventable disease affecting children under five years disproportionately. Globally, thousands of children die from diarrhoea related diseases each year, most deaths occuring in sub-Saharan Afr...

Double burden of malnutrition and its socio-demographic determinants among children and adolescents in Malaysia: National Health And Morbidity Survey 2019

Malaysia faces the threat of a double burden of malnutrition where undernutrition and overweight (including obesity) coexist in the same population. This study aimed to determine the anthropometric assessment ...

Efficacy of highly bioavailable oral curcumin in asymptomatic or mild COVID-19 patients: a double-blind, randomized, placebo-controlled trial

Even after the peak of the COVID-19 pandemic, the number of mild cases remains high, requiring continuous control. Curcumin, owing to its anti-inflammatory properties, can suppress vital proliferation and cyto...

Validation and application of the Dermatology Life Quality Index score, a modification of the DLQI score, in psoriasis patients

All the scoring methods for the DLQI miss the moderate impact of the disease on patients, which may underestimate the impact of psoriasis on patients’ quality of life. To improve the accuracy of the assessment...

Dietary factors in relation to hypertension: a mendelian randomization study

Observational studies have elucidated the associations between dietary factors and hypertension. Nevertheless, the exploration of these relationships using Mendelian randomization remains scarce currently.

The association between healthy and unhealthy dietary indices with prostate cancer risk: a case-control study

According to our knowledge, the relationship between dietary patterns such as pro-healthy, pro-vegetarian, and non-healthy dietary patterns and prostate cancer risk has not been clearly investigated in Iranian...

Obesity and risk of hypertension in preadolescent urban school children: insights from Pakistan

Childhood obesity and hypertension are growing concerns globally, especially in developing countries. This study investigated the association between overall and central obesity at baseline, and prehypertensio...

Dietary compliance and its determinants among type 2 diabetes patients in Tamale Metropolis, Ghana

The prevalence of type 2 diabetes is currently high and still rising, predominantly in developing countries including Ghana. Type 2 diabetes patients’ adherence to recommended diet is shown to improve their h...

Dietary inflammatory index and its association with risk of metabolic syndrome and its components: a systematic review and Meta-analysis of Observational studies

Metabolic Syndrome (MetS), is a major risk factor for cardiovascular disease, type 2 diabetes mellitus, and cancer.

Correction to: Healthy life skills and related factors among university students: a cross‑sectional study in Istanbul, Turkey

The original article was published in Journal of Health, Population and Nutrition 2023 42 :137

Unveiling the lockdown effects: exploring behavior, dietary habits and weight changes in rural Egypt during COVID-19 lockdown: a cross-sectional retrospective study

The COVID-19 lockdown significantly impacted dietary habits and body weights globally, particularly in Egypt, where 57.03% of the population resides in rural areas, despite lack of information. The study exami...

Effect of nutrition assessment, counselling and support integration on mother-infant nutritional status, practices and health in Tororo and Butaleja districts, Uganda: A comparative non-equivalent quasi-experimental study

Malnutrition remains a health challenge for women aged 15 to 49 years and their infants. While Nutrition Assessment Counselling and Support (NACS) is considered a promising strategy, evidence of its effectiven...

Global research trends on the relationship between IBD and CRC: a bibliometric analysis from 2000 to 2023

This study aimed to conduct a bibliometric analysis of research articles on the relationship between inflammatory bowel disease (IBD) and colorectal cancer (CRC) using CiteSpace to summarize the current resear...

Prevalence of vitamin B 12 deficiency and associated factors among primary school children: North East Ethiopia: multicenter cross-sectional study

The prevalence of Vitamin B12 deficiency is common and is more frequent in low- and middle-income countries with a poor or inadequate diet of animal foods. In Ethiopia, researches related to the status of micr...

Determining the vitamin D supplementation duration to reach an adequate or optimal vitamin D status and its effect on blood lipid profiles: a longitudinal study

Recently, Serum vitamin D (Vit. D) levels evaluation and the use of Vit. D supplements have increased substantially. There is no specific guideline for the duration of Vit. D supplementation, so yet Vit. D sup...

Correlation between geriatric nutritional risk index and intradialytic hypotension in elderly patients undergoing maintenance hemodialysis: a case-control study

There is a correlation between nutritional status and treatment outcomes and long-term survival in MHD patients but there is limited research on the relationship between GNRI and IDH. This case-control study a...

Facebook addiction and its impact on depression: a cross sectional study

Facebook has become a part of daily life for its users and therefore become a very significant factor of mental health. As the number of Facebook users increases exponentially, the problems related to immense ...

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Health Status and Mental Health of Transgender and Gender-Diverse Adults

• 1 Harvard Medical School, Boston, Massachusetts
• 2 Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
• 3 Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
• 4 The Fenway Institute, Fenway Health, Boston, Massachusetts
• 5 Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor
• 6 Department of Psychiatry, Massachusetts General Hospital, Boston
• Invited Commentary Association of Political Assaults With the Health of Transgender and Nonbinary Persons Carl G. Streed Jr, MD, MPH; Kellan E. Baker, PhD, MPH, MA; Arjee Javellana Restar, PhD, MPH JAMA Internal Medicine

The National Institutes of Health has designated transgender and gender-diverse (TGD) people as a population that experiences health disparities. A 2017 US study documented physical and mental health inequities between TGD and cisgender adults. 1 Since then, a record number of enacted laws has threatened the rights and protections of TGD people, including restricting access to gender-affirming care and permitting discrimination in public accommodations. 2 , 3 Little is known about how the health of TGD people has changed during this surge in legislation. This study evaluated recent trends in health status and mental health among TGD adults in the US.

• Invited Commentary Association of Political Assaults With the Health of Transgender and Nonbinary Persons JAMA Internal Medicine

Read More About

Liu M , Patel VR , Reisner SL , Keuroghlian AS. Health Status and Mental Health of Transgender and Gender-Diverse Adults. JAMA Intern Med. Published online June 24, 2024. doi:10.1001/jamainternmed.2024.2544

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Scientific breakthroughs: 2024 emerging trends to watch

December 28, 2023

Across disciplines and industries, scientific discoveries happen every day, so how can you stay ahead of emerging trends in a thriving landscape? At CAS, we have a unique view of recent scientific breakthroughs, the historical discoveries they were built upon, and the expertise to navigate the opportunities ahead. In 2023, we identified the top scientific breakthroughs , and 2024 has even more to offer. New trends to watch include the accelerated expansion of green chemistry, the clinical validation of CRISPR, the rise of biomaterials, and the renewed progress in treating the undruggable, from cancer to neurodegenerative diseases. To hear what the experts from Lawrence Liverpool National Lab and Oak Ridge National Lab are saying on this topic, join us for a free webinar on January 25 from 10:00 to 11:30 a.m. EDT for a panel discussion on the trends to watch in 2024.

The ascension of AI in R&D

While the future of AI has always been forward-looking, the AI revolution in chemistry and drug discovery has yet to be fully realized. While there have been some high-profile set-backs , several breakthroughs should be watched closely as the field continues to evolve. Generative AI is making an impact in drug discovery , machine learning is being used more in environmental research , and large language models like ChatGPT are being tested in healthcare applications and clinical settings.

Many scientists are keeping an eye on AlphaFold, DeepMind’s protein structure prediction software that revolutionized how proteins are understood. DeepMind and Isomorphic Labs have recently announced how their latest model shows improved accuracy, can generate predictions for almost all molecules in the Protein Data Bank, and expand coverage to ligands, nucleic acids, and posttranslational modifications . Therapeutic antibody discovery driven by AI is also gaining popularity , and platforms such as the RubrYc Therapeutics antibody discovery engine will help advance research in this area.

Though many look at AI development with excitement, concerns over accurate and accessible training data , fairness and bias , lack of regulatory oversight , impact on academia, scholarly research and publishing , hallucinations in large language models , and even concerns over infodemic threats to public health are being discussed. However, continuous improvement is inevitable with AI, so expect to see many new developments and innovations throughout 2024.

‘Greener’ green chemistry

Green chemistry is a rapidly evolving field that is constantly seeking innovative ways to minimize the environmental impact of chemical processes. Here are several emerging trends that are seeing significant breakthroughs:

• Improving green chemistry predictions/outcomes : One of the biggest challenges in green chemistry is predicting the environmental impact of new chemicals and processes. Researchers are developing new computational tools and models that can help predict these impacts with greater accuracy. This will allow chemists to design safer and more environmentally friendly chemicals.
• Reducing plastics: More than 350 million tons of plastic waste is generated every year. Across the landscape of manufacturers, suppliers, and retailers, reducing the use of single-use plastics and microplastics is critical. New value-driven approaches by innovators like MiTerro that reuse industrial by-products and biomass waste for eco-friendly and cheaper plastic replacements will soon be industry expectations. Lowering costs and plastic footprints will be important throughout the entire supply chain.    
• Alternative battery chemistry: In the battery and energy storage space, finding alternatives to scarce " endangered elements" like lithium and cobalt will be critical. While essential components of many batteries, they are becoming scarce and expensive. New investments in lithium iron phosphate (LFP) batteries that do not use nickel and cobalt have expanded , with 45% of the EV market share being projected for LFP in 2029. Continued research is projected for more development in alternative materials like sodium, iron, and magnesium, which are more abundant, less expensive, and more sustainable.
• More sustainable catalysts : Catalysts speed up a chemical reaction or decrease the energy required without getting consumed. Noble metals are excellent catalysts; however, they are expensive and their mining causes environmental damage. Even non-noble metal catalysts can also be toxic due to contamination and challenges with their disposal. Sustainable catalysts are made of earth-abundant elements that are also non-toxic in nature. In recent years, there has been a growing focus on developing sustainable catalysts that are more environmentally friendly and less reliant on precious metals. New developments with catalysts, their roles, and environmental impact will drive meaningful progress in reducing carbon footprints.  
• Recycling lithium-ion batteries: Lithium-ion recycling has seen increased investments with more than 800 patents already published in 2023. The use of solid electrolytes or liquid nonflammable electrolytes may improve the safety and durability of LIBs and reduce their material use. Finally, a method to manufacture electrodes without solvent s could reduce the use of deprecated solvents such as N-methylpyrrolidinone, which require recycling and careful handling to prevent emissions.

Rise of biomaterials

New materials for biomedical applications could revolutionize many healthcare segments in 2024. One example is bioelectronic materials, which form interfaces between electronic devices and the human body, such as the brain-computer interface system being developed by Neuralink. This system, which uses a network of biocompatible electrodes implanted directly in the brain, was given FDA approval to begin human trials in 2023.

• Bioelectronic materials: are often hybrids or composites, incorporating nanoscale materials, highly engineered conductive polymers, and bioresorbable substances. Recently developed devices can be implanted, used temporarily, and then safely reabsorbed by the body without the need for removal. This has been demonstrated by a fully bioresorbable, combined sensor-wireless power receiver made from zinc and the biodegradable polymer, poly(lactic acid).
• Natural biomaterials: that are biocompatible and naturally derived (such as chitosan, cellulose nanomaterials, and silk) are used to make advanced multifunctional biomaterials in 2023. For example, they designed an injectable hydrogel brain implant for treating Parkinson’s disease, which is based on reversible crosslinks formed between chitosan, tannic acid, and gold nanoparticles.
• Bioinks : are used for 3D printing of organs and transplant development which could revolutionize patient care. Currently, these models are used for studying organ architecture like 3D-printed heart models for cardiac disorders and 3D-printed lung models to test the efficacy of drugs. Specialized bioinks enhance the quality, efficacy, and versatility of 3D-printed organs, structures, and outcomes. Finally, new approaches like volumetric additive manufacturing (VAM) of pristine silk- based bioinks are unlocking new frontiers of innovation for 3D printing.

To the moon and beyond

The global Artemis program is a NASA-led international space exploration program that aims to land the first woman and the first person of color on the Moon by 2025 as part of the long-term goal of establishing a sustainable human presence on the Moon. Additionally, the NASA mission called Europa Clipper, scheduled for a 2024 launch, will orbit around Jupiter and fly by Europa , one of Jupiter’s moons, to study the presence of water and its habitability. China’s mission, Chang’e 6 , plans to bring samples from the moon back to Earth for further studies. The Martian Moons Exploration (MMX) mission by Japan’s JAXA plans to bring back samples from Phobos, one of the Mars moons. Boeing is also expected to do a test flight of its reusable space capsule Starliner , which can take people to low-earth orbit.

The R&D impact of Artemis extends to more fields than just aerospace engineering, though:

• Robotics: Robots will play a critical role in the Artemis program, performing many tasks, such as collecting samples, building infrastructure, and conducting scientific research. This will drive the development of new robotic technologies, including autonomous systems and dexterous manipulators.
• Space medicine: The Artemis program will require the development of new technologies to protect astronauts from the hazards of space travel, such as radiation exposure and microgravity. This will include scientific discoveries in medical diagnostics, therapeutics, and countermeasures.
• Earth science: The Artemis program will provide a unique opportunity to study the Moon and its environment. This will lead to new insights into the Earth's history, geology, and climate.
• Materials science: The extreme space environment will require new materials that are lightweight, durable, and radiation resistant. This will have applications in many industries, including aerospace, construction, and energy.
• Information technology: The Artemis program will generate a massive amount of data, which will need to be processed, analyzed, and shared in real time. This will drive the development of new IT technologies, such as cloud computing, artificial intelligence, and machine learning.

The CRISPR pay-off

After years of research, setbacks, and minimal progress, the first formal evidence of CRISPR as a therapeutic platform technology in the clinic was realized. Intellia Therapeutics received FDA clearance to initiate a pivotal phase 3 trial of a new drug for the treatment of hATTR, and using the same Cas9 mRNA, got a new medicine treating a different disease, angioedema. This was achieved by only changing 20 nucleotides of the guide RNA, suggesting that CRISPR can be used as a therapeutic platform technology in the clinic.

The second great moment for CRISPR drug development technology came when Vertex and CRISPR Therapeutics announced the authorization of the first CRISPR/Cas9 gene-edited therapy, CASGEVY™, by the United Kingdom MHRA, for the treatment of sickle cell disease and transfusion-dependent beta-thalassemia. This was the first approval of a CRISPR-based therapy for human use and is a landmark moment in realizing the potential of CRISPR to improve human health.

In addition to its remarkable genome editing capability, the CRISPR-Cas system has proven to be effective in many applications, including early cancer diagnosis . CRISPR-based genome and transcriptome engineering and CRISPR-Cas12a and CRISPR-Cas13a appear to have the necessary characteristics to be robust detection tools for cancer therapy and diagnostics. CRISPR-Cas-based biosensing system gives rise to a new era for precise diagnoses of early-stage cancers.

MIT engineers have also designed a new nanoparticle DNA-encoded nanosensor for urinary biomarkers that could enable early cancer diagnoses with a simple urine test. The sensors, which can detect cancerous proteins, could also distinguish the type of tumor or how it responds to treatment.

Ending cancer

The immuno-oncology field has seen tremendous growth in the last few years. Approved products such as cytokines, vaccines, tumor-directed monoclonal antibodies, and immune checkpoint blockers continue to grow in market size. Novel therapies like TAC01-HER2 are currently undergoing clinical trials. This unique therapy uses autologous T cells, which have been genetically engineered to incorporate T cell Antigen Coupler (TAC) receptors that recognize human epidermal growth factor receptor 2 (HER2) presence on tumor cells to remove them. This could be a promising therapy for metastatic, HER2-positive solid tumors.

Another promising strategy aims to use the CAR-T cells against solid tumors in conjunction with a vaccine that boosts immune response. Immune boosting helps the body create more host T cells that can target other tumor antigens that CAR-T cells cannot kill.

Another notable trend is the development of improved and effective personalized therapies. For instance, a recently developed personalized RNA neoantigen vaccine, based on uridine mRNA–lipoplex nanoparticles, was found effective against pancreatic ductal adenocarcinoma (PDAC). Major challenges in immuno-oncology are therapy resistance, lack of predictable biomarkers, and tumor heterogenicity. As a result, devising novel treatment strategies could be a future research focus.

Decarbonizing energy

Multiple well-funded efforts are underway to decarbonize energy production by replacing fossil fuel-based energy sources with sources that generate no (or much less) CO2 in 2024.

One of these efforts is to incorporate large-scale energy storage devices into the existing power grid. These are an important part of enabling the use of renewable sources since they provide additional supply and demand for electricity to complement renewable sources. Several types of grid-scale storage that vary in the amount of energy they can store and how quickly they can discharge it into the grid are under development. Some are physical (flywheels, pumped hydro, and compressed air) and some are chemical (traditional batteries, flow batteries , supercapacitors, and hydrogen ), but all are the subject of active chemistry and materials development research. The U.S. government is encouraging development in this area through tax credits as part of the Inflation Reduction Act and a $7 billion program to establish regional hydrogen hubs.

Meanwhile, nuclear power will continue to be an active R&D area in 2024. In nuclear fission, multiple companies are developing small modular reactors (SMRs) for use in electricity production and chemical manufacturing, including hydrogen. The development of nuclear fusion reactors involves fundamental research in physics and materials science. One major challenge is finding a material that can be used for the wall of the reactor facing the fusion plasma; so far, candidate materials have included high-entropy alloys and even molten metals .

Neurodegenerative diseases

Neurodegenerative diseases are a major public health concern, being a leading cause of death and disability worldwide. While there is currently no cure for any neurodegenerative disease, new scientific discoveries and understandings of these pathways may be the key to helping patient outcomes.

• Alzheimer’s disease: Two immunotherapeutics have received FDA approval to reduce both cognitive and functional decline in individuals living with early Alzheimer's disease. Aducannumab (Aduhelm®) received accelerated approval in 2021 and is the first new treatment approved for Alzheimer’s since 2003 and the first therapy targeting the disease pathophysiology, reducing beta-amyloid plaques in the brains of early Alzheimer’s disease patients. Lecanemab (Leqembi®) received traditional approval in 2023 and is the first drug targeting Alzheimer’s disease pathophysiology to show clinical benefits, reducing the rate of disease progression and slowing cognitive and functional decline in adults with early stages of the disease.
• Parkinson’s disease: New treatment modalities outside of pharmaceuticals and deep brain stimulation are being researched and approved by the FDA for the treatment of Parkinson’s disease symptoms. The non-invasive medical device, Exablate Neuro (approved by the FDA in 2021), uses focused ultrasound on one side of the brain to provide relief from severe symptoms such as tremors, limb rigidity, and dyskinesia. 2023 brought major news for Parkinson’s disease research with the validation of the biomarker alpha-synuclein. Researchers have developed a tool called the α-synuclein seeding amplification assay which detects the biomarker in the spinal fluid of people diagnosed with Parkinson’s disease and individuals who have not shown clinical symptoms.
• Amyotrophic lateral sclerosis (ALS): Two pharmaceuticals have seen FDA approval in the past two years to slow disease progression in individuals with ALS. Relyvrio ® was approved in 2022 and acts by preventing or slowing more neuron cell death in patients with ALS. Tofersen (Qalsody®), an antisense oligonucleotide, was approved in 2023 under the accelerated approval pathway. Tofersen targets RNA produced from mutated superoxide dismutase 1 (SOD1) genes to eliminate toxic SOD1 protein production. Recently published genetic research on how mutations contribute to ALS is ongoing with researchers recently discovering how NEK1 gene mutations lead to ALS. This discovery suggests a possible rational therapeutic approach to stabilizing microtubules in ALS patients.

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• v.14(10); 2022 Oct

A Systematic Review of Major Cardiovascular Risk Factors: A Growing Global Health Concern

Dipannita adhikary.

1 Faculty of Life Sciences and Medicine, King’s College London, London, GBR

2 Cardiovascular Science, Impulse Hospital, Dhaka, BGD

Shanto Barman

3 College of Medicine, Mugda Medical College and Hospital, Dhaka, BGD

Redoy Ranjan

4 Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD

5 Institute of Cardiovascular Research, Royal Holloway University of London, London, GBR

6 Surgical Science Programme, The University of Edinburgh, Edinburgh, GBR

Cardiovascular disease has become a growing global and public health concern among non-communicable diseases (NCDs). The purpose of the study was to focus on the increasing prevalence of the risk factors of cardiovascular diseases (CVD), irrespective of age and gender, and its effect on public health worldwide. A literature search was done in the electronic database: Medline, PubMed, Web of Science, Google Scholar, and the World Health Organization (WHO) website, based on recent research and the prevalence of the risk factors of cardiovascular diseases. Moreover, a manual search for published work has also been done. The coronary heart disease studies were not restricted during the search by sample size because of the limited number of studies in selected countries. The study reviews the potential risk factors responsible for coronary heart disease globally. Smoking was highly prevalent among the United States and Pakistani populations, but hypertension and diabetes were more common in Tanzania and the United Kingdom. However, dyslipidaemia and obesity were common in almost all the selected countries. CVD risk factors are highly prevalent in some countries, varying socioeconomic, gender, and educational levels. Furthermore, there has always been a need for awareness in the public and educational programs for a healthy lifestyle, intake of nutritional food, and increased physical activity to improve health conditions and reduce the risk of cardiovascular diseases.

Introduction and background

Atherosclerosis is the process of formation of plaque composed of cholesterol, fat, calcium, and other substances in the wall of large and medium-sized arteries causing diminished blood flow to an area of the body [ 1 , 2 ]. Moreover, atherosclerotic vascular disease can be classified into two arenas: a cardiovascular disease affecting the heart and peripheral blood vessels and cerebrovascular disease, which causes ischemic stroke in the brain [ 2 - 4 ]. Regrettably, cardiovascular and cerebrovascular diseases are the first and third leading causes of all deaths globally. Approximately 28% and a total of 247.9 deaths per one hundred thousand populations per year occurred from complications of ischemic heart diseases [ 5 , 6 ].

Coronary artery disease, also known as ischemic heart disease, occurs due to the formation of plaque, which is caused by the accumulation of cholesterol particles, and if the process continues, it may eventually reduce and block blood flow and decrease oxygen supply to the heart muscle [ 3 - 5 ]. Moreover, patients may not complain of chest pain or may have breathlessness and severe chest pain [ 7 ]. An estimated seven million people had ischemic strokes, which comprise 90% of all strokes, of which approximately 10% are caused by carotid artery stenosis [ 8 ]. Many studies attempted to evaluate the rate of asymptomatic carotid artery stenosis and unwanted neurologic events [ 9 - 12 ].

Atherosclerotic heart disease can be managed through medicines, surgical treatments, and lifestyle modifications, such as eating healthy, physical exercise, maintaining body weight, avoiding smoking and less salt intake [ 10 - 12 ]. The published study results stated that intake of more saturated fat could increase the risk of cardiovascular disease, a sedentary lifestyle increases weight, and hypertension is more likely to develop [ 8 - 14 ]. In recent studies, authors observed that physical activity could improve cardiorespiratory functions, and physical inactivity is a modifiable risk factor for developing CVD [ 5 - 10 ]. Researchers believe that women of young age who suffer from coronary heart disease have a higher risk of depression than men of the same age. The risk of developing heart disease in women was almost 50% in a whole life compared to men; the female had a high mortality rate after suffering from acute myocardial infarction (MI) [ 15 - 20 ]. 

This systematic review focuses on the prevalence of the potential risk factors of cardiovascular diseases, irrespective of age and gender, and its impacts on global public health. Furthermore, the study aims to draw attention to the need for health practitioners to ensure early interventions to prevent cardiovascular disease and its complications.

Methods and material

Search Strategy  

A literature search was conducted in the electronic database Medline, PubMed, Web of Science, Google Scholar, and the World Health Organization (WHO) website on all recent research work in the last five years (2015-2019) based on risk factors of CVD patients from a global perspective. Countries were selected from the European Union, Africa, Asia, and America to compare the global view of increasing risk factors of cardiovascular disease and gender differences. A strong association was found in those areas for cardiovascular disease burden among the non-communicable diseases (NCD) that significantly focus on global health strategy [ 14 - 18 ]. The keywords or MeSH (Medical Subject Headings) used during the search were ‘coronary artery disease, ‘coronary heart disease, ‘ischemic heart disease, ‘atherosclerosis’, ‘risk factors, ‘associated factors’, and ‘cardiovascular disease’.

Study Eligibility Criteria

The review included published papers covering both a healthy subject and a population with existing cardiovascular disease with different atherosclerosis risk factors during the literature search. All the abstracts were reviewed, and the selection of articles was made by the following eligibility criteria: This systematic review included cross-sectional and prospective cohort studies that evaluated major risk factors and family history associated with cardiovascular disease. The selected language was English for all the research articles, and each gender was given priority. Duplicate articles and papers with incomplete information, like conference proceedings, were excluded from the study.

Data Extraction

The initial search led to 506 publications from the existing published literature according to the eligibility criteria. After careful evaluation of the unique titles, abstracts, and availability of entire texts a total of 10 studies (Table ​ (Table1) 1 ) were selected that were relevant and fulfilled the study eligibility criteria. Data were extracted using structured data extractions sheets designed for this study and entered into a database.

This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines for our search strategy. The medical subject headings (MeSH) terms were utilised to find the preceding search terms in PubMed and Embase databases. The literature search covers additional references from the thesis or dissertation repositories, preprint servers, and manual searching of the reference lists from the preferred articles. Furthermore, the reasons for exclusion were duplication, irrelevant and review articles, articles with inadequate information, and reports we could not retrieve the full text. The cardiovascular disease studies were not restricted during the search by sample size because of the limited number of studies in selected countries. A PRISMA diagram explained the study sampling (Figure ​ (Figure1 1 ).

PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses

The extracted data from each database covered details of the published paper-like year of publication, type of the study, number of cohorts, sociodemographic variables, risk factors, and a global view of heart disease with the relation of different ethnic groups in various countries. Table 2 shows the prevalence of risk factors among included study population in percentages.

Note: BMI- Body mass index; HTN- Hypertension; TG- Triglycerides; LDL- Low-density lipoproteins; HDL- High-density lipoproteins

A nationwide survey of the rural population in Bangladesh evaluated subjects aged 20 to 69 and found a higher prevalence of CVD and coexistence of multiple risk factors than the Japanese and Chinese populations [ 19 , 20 ]. In Pakistan, Nadeem and coworkers studied ischemic heart disease (IHD) patients and the observed age limit below 45 years, where the common risk factors were increased BMI, uncontrolled diabetes, hypertension, family history, increased cholesterol, obesity, and smoking history [ 21 ]. Moreover, an Indian study concluded a strong association between low socioeconomic status, less education and less occupational status, increased obesity, imbalanced lipid profile, smoking, and less physical activity [ 22 ].

According to the researchers, potential risk factors for coronary artery diseases are hypertension, obesity, and physical inactivity [ 23 - 25 ]. A study among the Nigerian population predicted an increase in CVD risk factors and mortality in developing countries linked with rising urbanization and socio-demographic changes with an age range from 18 to 75 years [ 26 ]. The UK highlights the importance of drug treatment in reducing the cardiovascular risk factors that helped decrease the incidence of stroke [ 27 ]. The risk factor for cardiovascular diseases is changing with the global trend, and this study will be elaborated on potential risk factors: smoking, diabetes, hypertension, dyslipidaemia, obesity, and family history.

Smoking: The prevalence of smoking has been addressed in nine of the studies, and the rates of smoking were 45.9% [ 21 ], 90% [ 24 ], 6.5% [ 22 ], and 4.7% [ 26 ]. Although smoking was an insignificant risk factor for CVD in Bangladesh and Tanzania, the USA, Pakistan, and Romania have significantly higher percentages of heavy smokers, about 44.2% [ 25 ], 43.1% [ 21 ], and 63.02% [ 28 ], respectively with the highest prevalence of ~80% among Nigerian male smokers [ 26 ].

Diabetes: This study addressed the rates of diabetes in the ten existing studies, and the overall prevalence was 5-27% among different nations. Recent studies observed a higher prevalence of diabetes mellitus in Pakistan (18%) [ 21 ], India (15.7%) [ 22 ], Romania (15.13%) [ 28 ], and the UK (12%) [ 27 ]. However, diabetes as a risk factor for CVD was almost controlled and found only in 5.3% and 0.4% of Nigerian and Egyptian people, respectively [ 24 , 26 ]. The prevalence of diabetes in the US increased from 9% to 23% over the last decades [ 25 ]. Although studies in India, Pakistan, and Romania showed that men had a higher prevalence of diabetes than women, in a study in Tanzania, females were more affected than males. [ 21 - 23 , 28 ].

Hypertension: The rate of hypertension was highest, approximately ~65% among males from Tanzania and British [ 23 , 27 , 29 ]. Several studies observed that increased age (more than 45 years) was significantly associated with increased blood pressure [ 23 , 29 ]. In comparison to Egypt and the United States [ 24 , 25 ], Bangladeshi people carry a slightly higher risk (2% vs 7%) of developing hypertension [ 19 ]. Across all the studies, the prevalence of hypertension among males and females were 20.2% vs 16.5%, 32.5% vs 30.4% and 25% vs 16.4% among Pakistani, Indian, and Nigerian population [ 21 , 22 , 26 ].

Dyslipidaemia: In India, total cholesterol was comparatively low, about 25%, but had raised LDL in 36.9% of cases, significantly higher than the Nigerian population [ 26 ]. Nonetheless, another Indian study found that 52% and 65% of males and females had low HDL, compared to 33% of the Pakistani population [ 21 , 22 ]. In Tanzania, high LDL and low HDL were in 65% and 79% of the population, respectively, and both abnormalities were more common in the female population [ 23 ]. Moreover, In Egypt, raised cholesterol was found in only 8.3% of cases, a minimum range, and no other abnormality has been detected [ 24 ]. About 39%, 22%, and 6% of patients in the UK and the United States had increased cholesterol, low HDL, and high LDL, respectively [ 25 , 27 ].

Obesity: In Bangladesh, the mean BMI was 19.4 kg/m 2 , and about 7.2% and 8.7% population aged <23 and ≥23 years, respectively, had obesity [ 19 ]. However, the prevalence of obesity was significantly higher in Pakistan (63.3%) and lowest in the U.S. (5.13%) [ 21 , 25 ]. Also, the prevalence of obesity in females was found to be lowest in the U.S. (5.6%) [ 25 ] and higher in Nigeria (29.3%) [ 26 ]. In India, approximately 43% and 12% of the population had BMI ≥25kg/m 2 and ≥30kg/m 2 , respectively, and females are more prone to have higher BMI than men [ 22 ]. Nonetheless, in Egypt, about 11% and 28%, and in Tanzania, 39% and 36% were obese and overweight, respectively, and obesity was more common in females [ 23 , 24 ]. In Nigeria, a total of 21.3% of cases had BMI >30 kg/m 2 , and females were significantly higher (29.2%) than males (10.9%) [ 26 ]. In Romania, obesity was 51% population, and the male and female ratio was almost the same [ 28 ]. In Great Britain, about 20% of men in the age group of 71-92 years had BMI ≥30 kg/m 2 , and based on frailty scoring high BMI, British men were subgroups into frail (24%), pre-frail (21%), not frail (16%) [ 29 ].

Family history: Albeit positive family history is a known risk factor for CVD, recent studies from Tanzania, Pakistan, and Bangladesh observed that ~53%, ~43%, and ~4% population had a positive family history of coronary heart disease [ 19 , 21 , 23 ].

Global Health Impact

The World Health Organization (WHO) has defined average weight as a body mass index (BMI) between 18.5 and 24.9 kg/m 2 , overweight as BMI between 25 and 29.9 kg/m 2 , and obesity as BMI ≥30 kg/m 2 [ 30 ]. In the new global economy, there has been a declining trend in communicable diseases and malnutrition; but the cardiovascular disease has become a central issue for people of high, middle, or lower-class socioeconomic statuses [ 31 , 32 ]. Moreover, low socioeconomic people reported the most harmful CVD risk factors due to less access to advanced treatments, less education, and poor economic situation [ 30 - 34 ]. In the United Kingdom, over 11.6 years of follow-up of 1.2 million women, there was a significant relationship between increased risk of CVD and females at the age of menarche [ 35 ]. Over the two decades, Sub-Saharan Africa has been experiencing relatively decreased CVD burden levels; however, this area's mortality has increased steadily, precisely due to hypertensive heart disease [ 9 , 20 ]. A recent study shows that the women population had increased physical activity, but the incidence of hypertension (HTN), obesity, and diabetes are increasing daily [ 15 - 22 , 30 - 35 ].

Future Directions in Measuring the Global Cardiovascular Disease Burden

In a recent study, authors observed more influence of behavioural factors than preventive medicine in managing cardiovascular diseases [ 10 - 15 ]. According to current study results, smokers who did not follow a healthy diet or active life like regular exercise were more likely to be given medication like antiplatelet, statin, and anti-hypertensive, similar to other existing study results [ 25 - 30 ]. Furthermore, recent studies suggested that mortality related to cardiovascular disease can be low if there is a reduction in specific risk factors like cholesterol, HTN, and obesity [ 19 - 24 , 30 - 34 ]. Albeit physical exercise and a healthy diet lessen the risk of CVD, heavy smokers with a healthy diet and exercise still had a 3.8-fold increased risk of CVD, in concordance with existing articles [ 35 - 38 ]. 

Recent works show that health policymakers should not be waiting for a perfect epidemiological study that may guide them to certain decisions anymore [ 28 - 32 ]. The US health organizations guidelines enforced the following issues to decrease the burden of cardiovascular disease, prevention of disease and promotion of health concerning smoking, improve public health policy and health advocacy on adverse effects of increased salt in food, unhealthy eating habits, physical inactivity; and also reduction of the CVD risk factors especially hypertension [ 34 ]. Existing research recognizes that the critical role played for the forthcoming measurements of global burden in CVD will be increased, informed by new vital registration systems [ 35 - 40 ]. Sustainable development goals, along with human resources, technical capacity, infrastructures, and funding, will be in need, particularly in LMICs [ 38 - 45 ].

Strength and limitations

This study is based on a global population covering different ethnic groups of the population, which compares all age groups and gender. Although there has been some lack of presenting data at some national levels, there was an identical pattern of risk factors for CVD in most countries, especially the region that shared the same culture, environment, cuisine, and lifestyle. Moreover, we only included English-language papers, which may preclude important study findings published in other languages. Albeit, this systematic review was based on globally acceptable major cardiovascular risk factors, the availability of the papers was limited to some parts of Asia, Europe, Africa, and the United States. Moreover, we could not perform the sensitivity analyses due to insufficient data, and primary authors have not been contacted, which may give some unadjusted results to the review.

Conclusions

The potential risk factors for CVDs are highly prevalent in different geographical regions, varying with the nation's socioeconomic, gender and educational levels. Furthermore, atherosclerosis and hypertensive heart disease are significant global health problems, and this review recommends a combined and intensive multi-disciplinary team approach at the population and individual level to diminish the burden of CVDs in all regions. Thus, this review could help to improvise practice and policy and provide the newest insight from a large group of data syntheses to reduce the global burden of cardiovascular disease morbidity and mortality.

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The authors have declared that no competing interests exist.