Global cardiovascular health promotion across the lifespan requires a comprehensive approach prioritising early life interventions. Paediatric hypertension is an increasingly recognised public health issue and an important modifiable risk factor for reducing future cardiovascular morbidity and mortality. This Review discusses the epidemiology, risk factors, diagnosis, and management of paediatric hypertension. We highlight the increasing prevalence of paediatric hypertension, its higher rates in low-income and middle-income countries (LMICs), and review its multifactorial causes globally, including genetic, environmental, and lifestyle influences. Barriers to early detection, particularly in LMICs, such as poor awareness of childhood-onset hypertension among families and health-care providers, are elucidated. Studies emphasising the short-term and long-term consequences of paediatric and youth hypertension and evidence-based diagnostic and management strategies, including non-pharmacological and pharmacological interventions, are also discussed. The management of hypertension in youth requires integrating public health strategies with clinical care to establish a robust foundation to improve lifelong health outcomes.
{"title":"Under pressure: the lifelong cardiovascular health of children and youth with primary hypertension","authors":"Rahul Chanchlani MD MSc , Prof Tammy Brady MD PhD , Prof Ruan Kruger PhD , Prof Manish D Sinha MRCP PhD","doi":"10.1016/S2352-4642(25)00302-5","DOIUrl":"10.1016/S2352-4642(25)00302-5","url":null,"abstract":"<div><div>Global cardiovascular health promotion across the lifespan requires a comprehensive approach prioritising early life interventions. Paediatric hypertension is an increasingly recognised public health issue and an important modifiable risk factor for reducing future cardiovascular morbidity and mortality. This Review discusses the epidemiology, risk factors, diagnosis, and management of paediatric hypertension. We highlight the increasing prevalence of paediatric hypertension, its higher rates in low-income and middle-income countries (LMICs), and review its multifactorial causes globally, including genetic, environmental, and lifestyle influences. Barriers to early detection, particularly in LMICs, such as poor awareness of childhood-onset hypertension among families and health-care providers, are elucidated. Studies emphasising the short-term and long-term consequences of paediatric and youth hypertension and evidence-based diagnostic and management strategies, including non-pharmacological and pharmacological interventions, are also discussed. The management of hypertension in youth requires integrating public health strategies with clinical care to establish a robust foundation to improve lifelong health outcomes.</div></div>","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"10 3","pages":"Pages 203-215"},"PeriodicalIF":15.5,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145784583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Diagnosis of bronchopulmonary dysplasia in very low birthweight infants is often only ascertained many weeks after birth. We aimed to investigate whether trajectories of the fractions of inspired oxygen (FiO2) required to maintain O2 saturation from birth reflect distinct clusters of preterm lung disease.
Methods
In this data-driven exploratory cluster analysis, we used latent class trajectory modelling to derive clusters of FiO2 fluctuations in the first 30 days of life among neonates with a birthweight of less than 1250 g, across two multicentre, prospective cohorts: the Discovery Bronchopulmonary Dysplasia Program (D-BPD; enrolment July 30, 2013, to Jan 1, 2020; n=376) in Argentina and the Prematurity and Respiratory Outcomes Program (PROP; enrolment Aug 1, 2011, to Nov 31, 2013; n=835) in the USA, with the PROP cohort being used for external validation. Eligible participants, in both the present and original studies, included infants with birthweight of less than 1250 g in the D-BPD cohort, and infants enrolled in the PROP study born at 23–28 weeks of gestation by best obstetrical estimate. After unsupervised clustering of patients, we evaluated cluster performance against conventional bronchopulmonary dysplasia classification, using mortality as the primary outcome.
Findings
Of the 376 D-BPD infants, 190 (51%) were female (mean birthweight 968·1 g [SD 181·2]; mean gestational age 28·9 weeks [SD 2·3]) and 186 (49%) were male (mean birthweight 976·2 g [188·3]; mean gestational age 28·6 weeks [2·3]). Four clusters based on FiO2 requirements were identified: persistently low requirement (PLR; 218 [58%] of 376), early high with subsequent improvement (EHRI; 60 [16%] of 376), late-onset high requirement (LOHR; 31 [8%] of 376), and persistently high requirement (PHR; 67 [18%] of 376). Mortality was more frequent in LOHR (six [19%] of 31) and PHR (ten [15%] of 67) clusters, with no deaths in PLR and one death in EHRI (one [2%] of 60; p<0·0001). Nine (53%) of 17 fatal cases occurred before 36 weeks' gestational age, precluding conventional bronchopulmonary dysplasia diagnosis; among infants who died later, most had severe bronchopulmonary dysplasia (six [67%] of nine). Results from the PROP cohort closely mirrored those of D-BPD, yielding the same number of clusters with similar trajectories and replicating patterns of mortality.
Interpretation
Current bronchopulmonary dysplasia definitions might not fully capture the trajectories of lung disease of preterm infants. Data-driven approaches offer opportunities to identify infants at high risk earlier and to implement more precise interventions.
Funding
US National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, and the UK MRC.
{"title":"Diagnostic labels and clusters based on oxygen requirements in preterm infants with chronic lung disease: a data-driven exploratory cluster analysis in two independent cohorts","authors":"Damian Alvarez-Paggi PhD , Anhar Ullah PhD , Gaston Ofman MD , Sadia Haider PhD , Florencia Nowogrodzki MD , Sara Fontanella PhD , Jacqui Marzec MSc , Jorge Digregorio MD , Guillermo Colantonio MD , Mariana Sorgetti MD , Mariangeles Quiros MD , Andrea Brum MD , Silvia Garcia MD , Cristina Osio MD , Santiago Lopez Garcia MD , Gonzalo Mariani MD MSc , Maria Fernanda Galletti MD MSc , Silvina Coviello MSc , Clarice R Weinberg PhD , Nestor Vain MD , Judith Voynow MD","doi":"10.1016/S2352-4642(25)00314-1","DOIUrl":"10.1016/S2352-4642(25)00314-1","url":null,"abstract":"<div><h3>Background</h3><div>Diagnosis of bronchopulmonary dysplasia in very low birthweight infants is often only ascertained many weeks after birth. We aimed to investigate whether trajectories of the fractions of inspired oxygen (FiO<sub>2</sub>) required to maintain O<sub>2</sub> saturation from birth reflect distinct clusters of preterm lung disease.</div></div><div><h3>Methods</h3><div>In this data-driven exploratory cluster analysis, we used latent class trajectory modelling to derive clusters of FiO<sub>2</sub> fluctuations in the first 30 days of life among neonates with a birthweight of less than 1250 g, across two multicentre, prospective cohorts: the Discovery Bronchopulmonary Dysplasia Program (D-BPD; enrolment July 30, 2013, to Jan 1, 2020; n=376) in Argentina and the Prematurity and Respiratory Outcomes Program (PROP; enrolment Aug 1, 2011, to Nov 31, 2013; n=835) in the USA, with the PROP cohort being used for external validation. Eligible participants, in both the present and original studies, included infants with birthweight of less than 1250 g in the D-BPD cohort, and infants enrolled in the PROP study born at 23–28 weeks of gestation by best obstetrical estimate. After unsupervised clustering of patients, we evaluated cluster performance against conventional bronchopulmonary dysplasia classification, using mortality as the primary outcome.</div></div><div><h3>Findings</h3><div>Of the 376 D-BPD infants, 190 (51%) were female (mean birthweight 968·1 g [SD 181·2]; mean gestational age 28·9 weeks [SD 2·3]) and 186 (49%) were male (mean birthweight 976·2 g [188·3]; mean gestational age 28·6 weeks [2·3]). Four clusters based on FiO<sub>2</sub> requirements were identified: persistently low requirement (PLR; 218 [58%] of 376), early high with subsequent improvement (EHRI; 60 [16%] of 376), late-onset high requirement (LOHR; 31 [8%] of 376), and persistently high requirement (PHR; 67 [18%] of 376). Mortality was more frequent in LOHR (six [19%] of 31) and PHR (ten [15%] of 67) clusters, with no deaths in PLR and one death in EHRI (one [2%] of 60; p<0·0001). Nine (53%) of 17 fatal cases occurred before 36 weeks' gestational age, precluding conventional bronchopulmonary dysplasia diagnosis; among infants who died later, most had severe bronchopulmonary dysplasia (six [67%] of nine). Results from the PROP cohort closely mirrored those of D-BPD, yielding the same number of clusters with similar trajectories and replicating patterns of mortality.</div></div><div><h3>Interpretation</h3><div>Current bronchopulmonary dysplasia definitions might not fully capture the trajectories of lung disease of preterm infants. Data-driven approaches offer opportunities to identify infants at high risk earlier and to implement more precise interventions.</div></div><div><h3>Funding</h3><div>US National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, and the UK MRC.</div></div>","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"10 2","pages":"Pages 83-93"},"PeriodicalIF":15.5,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145777484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-11DOI: 10.1016/S2352-4642(25)00301-3
Prof Rashida A Ferrand PhD , Nyasha V Dzavakwa MSc , Tsitsi Bandason MSc , Molly Chisenga MSc , Prof Suzanne Filteau PhD , Prof Katharina Kranzer PhD , Hildah Banda Mabuda Diploma , Grace Mchugh MD , Prof Hilda Mujuru MSc , Nicol Redzo MSc , Prof Sarah L Rowland-Jones DM , Prof Ulrich E Schaible Dr rer nat , Victoria Simms PhD , Jonathan C Y Tang PhD , Lackson Kasonka MMed , Prof Celia L Gregson FRCP
<div><h3>Background</h3><div>HIV has adverse impact on skeletal development in children despite antiretroviral therapy (ART). We investigated the effect of high-dose (20 000 IU) weekly vitamin D<sub>3</sub> and daily calcium carbonate (500 mg) supplementation for 48 weeks on bone density and muscle strength and power among peripubertal individuals (11–19 years) with perinatally acquired HIV.</div></div><div><h3>Methods</h3><div>We conducted an individually randomised, double-blind, placebo-controlled trial. Individuals taking ART for at least 6 months who had a defined caregiver, and knew their HIV status (in those aged >12 years) were recruited from HIV clinics in Harare, Zimbabwe and Lusaka, Zambia. The primary outcome was total body less-head bone mineral density (TBLH-BMD) Z score and secondary outcome was lumbar spine bone mineral apparent density (LS-BMAD) Z score (both measured by dual-energy x-ray absorptiometry). Linear regression was used to compare arms adjusting for country and baseline value of the measure. Pre-specified subgroup analyses by country, age-group, sex, pubertal stage, calcium intake, tenofovir disproxil fumarate use, and baseline vitamin D insufficiency (defined as 25[OH]D <75 nmol/L), and a post-hoc subgroup analysis by viral suppression, were performed. A Participant Advisory Board that included adolescents with HIV, their guardians, and health providers guided study conduct. The trial is registered with the Pan African Clinical Trials Registry, PACTR20200989766029.</div></div><div><h3>Findings</h3><div>Of 842 participants (median age 15 years [IQR 13–17], 448 [53%] female and 394 [47%] male) enrolled between Feb 4 to Nov 23, 2021, 639 (76%) were vitamin D insufficient. At 48 weeks, outcomes were available for 751 (89%) participants. There was no difference by arm in TBLH-BMD Z score (intervention <em>vs</em> control: mean –1·53 [SD 1·18] <em>vs</em> –1·56 [1·12], adjusted mean difference –0·04 [95% CI –0·01 to 0·09]) or in LS-BMAD Z score (intervention <em>vs</em> control: –0·64 [1·17] <em>vs</em> –0·71 [SD 1·16], adjusted mean difference –0·05 [95% CI –0·01 to 0·12]). However, among participants with vitamin D insufficiency at baseline, there was a significantly higher LS-BMAD Z score (adjusted mean difference 0·09 [95% CI 0·02 to 0·16], p<sub>interaction</sub>=0·025) in the intervention arm than in the control arm. The corresponding adjusted mean difference in TBLH-BMD Z score was 0·06 (0·00–0·11), p<sub>interaction</sub>=0·15. There was no statistical evidence of interaction in other subgroups. No drug-related severe adverse events were observed.</div></div><div><h3>Interpretation</h3><div>There was no difference in bone density between arms overall, but among those with vitamin D insufficiency the intervention improved bone density. High-dose vitamin D<sub>3</sub> and calcium supplementation, a safe and cheap intervention, during adolescence might promote bone accrual and mineralisation in those with vitami
{"title":"Impact of high-dose vitamin D and calcium carbonate supplementation on bone density in adolescents living with HIV: a randomised, placebo-controlled trial","authors":"Prof Rashida A Ferrand PhD , Nyasha V Dzavakwa MSc , Tsitsi Bandason MSc , Molly Chisenga MSc , Prof Suzanne Filteau PhD , Prof Katharina Kranzer PhD , Hildah Banda Mabuda Diploma , Grace Mchugh MD , Prof Hilda Mujuru MSc , Nicol Redzo MSc , Prof Sarah L Rowland-Jones DM , Prof Ulrich E Schaible Dr rer nat , Victoria Simms PhD , Jonathan C Y Tang PhD , Lackson Kasonka MMed , Prof Celia L Gregson FRCP","doi":"10.1016/S2352-4642(25)00301-3","DOIUrl":"10.1016/S2352-4642(25)00301-3","url":null,"abstract":"<div><h3>Background</h3><div>HIV has adverse impact on skeletal development in children despite antiretroviral therapy (ART). We investigated the effect of high-dose (20 000 IU) weekly vitamin D<sub>3</sub> and daily calcium carbonate (500 mg) supplementation for 48 weeks on bone density and muscle strength and power among peripubertal individuals (11–19 years) with perinatally acquired HIV.</div></div><div><h3>Methods</h3><div>We conducted an individually randomised, double-blind, placebo-controlled trial. Individuals taking ART for at least 6 months who had a defined caregiver, and knew their HIV status (in those aged >12 years) were recruited from HIV clinics in Harare, Zimbabwe and Lusaka, Zambia. The primary outcome was total body less-head bone mineral density (TBLH-BMD) Z score and secondary outcome was lumbar spine bone mineral apparent density (LS-BMAD) Z score (both measured by dual-energy x-ray absorptiometry). Linear regression was used to compare arms adjusting for country and baseline value of the measure. Pre-specified subgroup analyses by country, age-group, sex, pubertal stage, calcium intake, tenofovir disproxil fumarate use, and baseline vitamin D insufficiency (defined as 25[OH]D <75 nmol/L), and a post-hoc subgroup analysis by viral suppression, were performed. A Participant Advisory Board that included adolescents with HIV, their guardians, and health providers guided study conduct. The trial is registered with the Pan African Clinical Trials Registry, PACTR20200989766029.</div></div><div><h3>Findings</h3><div>Of 842 participants (median age 15 years [IQR 13–17], 448 [53%] female and 394 [47%] male) enrolled between Feb 4 to Nov 23, 2021, 639 (76%) were vitamin D insufficient. At 48 weeks, outcomes were available for 751 (89%) participants. There was no difference by arm in TBLH-BMD Z score (intervention <em>vs</em> control: mean –1·53 [SD 1·18] <em>vs</em> –1·56 [1·12], adjusted mean difference –0·04 [95% CI –0·01 to 0·09]) or in LS-BMAD Z score (intervention <em>vs</em> control: –0·64 [1·17] <em>vs</em> –0·71 [SD 1·16], adjusted mean difference –0·05 [95% CI –0·01 to 0·12]). However, among participants with vitamin D insufficiency at baseline, there was a significantly higher LS-BMAD Z score (adjusted mean difference 0·09 [95% CI 0·02 to 0·16], p<sub>interaction</sub>=0·025) in the intervention arm than in the control arm. The corresponding adjusted mean difference in TBLH-BMD Z score was 0·06 (0·00–0·11), p<sub>interaction</sub>=0·15. There was no statistical evidence of interaction in other subgroups. No drug-related severe adverse events were observed.</div></div><div><h3>Interpretation</h3><div>There was no difference in bone density between arms overall, but among those with vitamin D insufficiency the intervention improved bone density. High-dose vitamin D<sub>3</sub> and calcium supplementation, a safe and cheap intervention, during adolescence might promote bone accrual and mineralisation in those with vitami","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"10 2","pages":"Pages 111-121"},"PeriodicalIF":15.5,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145731757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-08DOI: 10.1016/S2352-4642(25)00311-6
Frédéric Thériault-Couture PhD , Flora Blangis PhD , Niamh Dooley PhD , Prof Helen L Fisher PhD , Timothy Matthews PhD , Prof Candice L Odgers PhD , Prof Louise Arseneault PhD
<div><h3>Background</h3><div>Cybervictimisation has been linked to poor mental health in young people, but doubts remain about the robustness of this association. We examined mental health outcomes for adolescents who experienced cybervictimisation using a genetically informative longitudinal design to strengthen causal inference by accounting for alternative explanations.</div></div><div><h3>Methods</h3><div>We used data from the Environmental Risk (E-Risk) Longitudinal Twin Study, a nationally representative cohort of 2232 British twins born in 1994–95. We included participants who completed interviews assessing cybervictimisation and mulitple offline forms of victimisation since age 12 years, and a range of mental health conditions at age 18 years. Confounders were measured prospectively from ages 5 years to 18 years. Unmeasured confounders including genetic and shared environmental factors were controlled for using discordant twin analyses. People with lived experience were not involved in this study.</div></div><div><h3>Findings</h3><div>2066 participants completed assessments at age 18 years, of whom 2063 (99·9%) had data on cybervictimisation. The mean age of the twins at the time of the assessment was 18·4 years (SD 0·4), and 1870 (90·5%) identified as White, 84 (4·1%) as Asian, 40 (1·9%) as Black, eight (0·4%) as mixed race, and 64 (3·1%) as other ethnicities. 419 (20·3%) of 2063 young people reported being moderately or severely cybervictimised between ages 12 years and 18 years, with ten (2·4%) participants reporting online abuse without having experienced offline victimisation. Cybervictimised adolescents were more likely to report generalised anxiety disorder, major depressive disorder, self-harm or suicide attempt, post-traumatic stress disorder, conduct disorder, and psychotic experiences compared with those not cybervictimised. These associations remained after adjusting for confounders, including individual characteristics (sex assigned at birth, minority ethnicity, socioeconomic status, and childhood intelligence quotient), pre-existing vulnerabilities (previous mental health conditions and online and offline victimisation), and concurrent vulnerabilities (problematic digital technology use and loneliness). Offline victimisation accounted for the associations, with modest to substantial attenuation in odds ratios (17·7–28·0% for generalised anxiety disorder and major depressive disorder; 33·5–52·3% for other outcomes). Cybervictimisation was uniquely associated with generalised anxiety disorder independently of genetic and shared environmental factors and offline victimisation (odds ratio 2·14 [95% CI 1·18–3·88]).</div></div><div><h3>Interpretation</h3><div>Amid ongoing policy debates on digital safety and to support targeted intervention strategies, mental health responses to cybervictimisation should consider the broader context of victimisation experienced by young people.</div></div><div><h3>Funding</h3><div>UK Medical Resea
{"title":"Cybervictimisation and mental health conditions in young people: findings from a nationally representative longitudinal cohort","authors":"Frédéric Thériault-Couture PhD , Flora Blangis PhD , Niamh Dooley PhD , Prof Helen L Fisher PhD , Timothy Matthews PhD , Prof Candice L Odgers PhD , Prof Louise Arseneault PhD","doi":"10.1016/S2352-4642(25)00311-6","DOIUrl":"10.1016/S2352-4642(25)00311-6","url":null,"abstract":"<div><h3>Background</h3><div>Cybervictimisation has been linked to poor mental health in young people, but doubts remain about the robustness of this association. We examined mental health outcomes for adolescents who experienced cybervictimisation using a genetically informative longitudinal design to strengthen causal inference by accounting for alternative explanations.</div></div><div><h3>Methods</h3><div>We used data from the Environmental Risk (E-Risk) Longitudinal Twin Study, a nationally representative cohort of 2232 British twins born in 1994–95. We included participants who completed interviews assessing cybervictimisation and mulitple offline forms of victimisation since age 12 years, and a range of mental health conditions at age 18 years. Confounders were measured prospectively from ages 5 years to 18 years. Unmeasured confounders including genetic and shared environmental factors were controlled for using discordant twin analyses. People with lived experience were not involved in this study.</div></div><div><h3>Findings</h3><div>2066 participants completed assessments at age 18 years, of whom 2063 (99·9%) had data on cybervictimisation. The mean age of the twins at the time of the assessment was 18·4 years (SD 0·4), and 1870 (90·5%) identified as White, 84 (4·1%) as Asian, 40 (1·9%) as Black, eight (0·4%) as mixed race, and 64 (3·1%) as other ethnicities. 419 (20·3%) of 2063 young people reported being moderately or severely cybervictimised between ages 12 years and 18 years, with ten (2·4%) participants reporting online abuse without having experienced offline victimisation. Cybervictimised adolescents were more likely to report generalised anxiety disorder, major depressive disorder, self-harm or suicide attempt, post-traumatic stress disorder, conduct disorder, and psychotic experiences compared with those not cybervictimised. These associations remained after adjusting for confounders, including individual characteristics (sex assigned at birth, minority ethnicity, socioeconomic status, and childhood intelligence quotient), pre-existing vulnerabilities (previous mental health conditions and online and offline victimisation), and concurrent vulnerabilities (problematic digital technology use and loneliness). Offline victimisation accounted for the associations, with modest to substantial attenuation in odds ratios (17·7–28·0% for generalised anxiety disorder and major depressive disorder; 33·5–52·3% for other outcomes). Cybervictimisation was uniquely associated with generalised anxiety disorder independently of genetic and shared environmental factors and offline victimisation (odds ratio 2·14 [95% CI 1·18–3·88]).</div></div><div><h3>Interpretation</h3><div>Amid ongoing policy debates on digital safety and to support targeted intervention strategies, mental health responses to cybervictimisation should consider the broader context of victimisation experienced by young people.</div></div><div><h3>Funding</h3><div>UK Medical Resea","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"10 2","pages":"Pages 94-102"},"PeriodicalIF":15.5,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145728378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-02DOI: 10.1016/S2352-4642(25)00347-5
Peter Ranscombe
{"title":"Asking the big questions about health inequalities","authors":"Peter Ranscombe","doi":"10.1016/S2352-4642(25)00347-5","DOIUrl":"10.1016/S2352-4642(25)00347-5","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"10 1","pages":"Page 9"},"PeriodicalIF":15.5,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145652083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-02DOI: 10.1016/S2352-4642(25)00303-7
<div><h3>Background</h3><div>Child growth failure (CGF), which includes underweight, wasting, and stunting, is among the factors most strongly associated with mortality and morbidity in children younger than 5 years worldwide. Poor height and bodyweight gain arise from a variety of biological and sociodemographic factors and are associated with increased vulnerability to infectious diseases. We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 to estimate CGF prevalence, the risk of infectious diseases associated with CGF, and the disease mortality, morbidity, and overall burden associated with CGF.</div></div><div><h3>Methods</h3><div>In this analysis we estimated the all-cause and cause-specific (diarrhoea, lower respiratory tract infections, malaria, and measles) disability-adjusted life-years (DALYs) lost and mortality associated with stunting, wasting, underweight, and CGF in aggregate. We combined the burden associated with mild, moderate, and severe forms of CGF: stunting was defined as height-for-age Z scores (HAZ) less than –1, underweight was defined as weight-for-age Z scores (WAZ) less than –1, and wasting was defined as weight-for-height Z scores (WHZ) less than –1, according to WHO Child Growth Standards. Population-level continuous distributions of HAZ, WAZ, and WHZ were estimated for 2000 to 2023 using data from surveys, literature, and individual-level study data. The risk of incidence of, and mortality due to, diarrhoea, lower respiratory infections, malaria, and measles was separately estimated in a meta-regression framework from longitudinal cohort data for Z scores less than –1. Finally, fatal outcomes associated with these diseases were estimated with vital registration, verbal autopsy, and case-fatality data, while non-fatal outcomes were estimated with surveys as well as health-care utilisation and case reporting data. The exposure prevalence and relative risk estimates were from continuous distributions, allowing for direct assessment of the attributable fractions for mild, moderate, and severe stunting, underweight, wasting, and the combined impact of child growth failure within populations. All estimates were age-specific, sex-specific, geography-specific, and year-specific.</div></div><div><h3>Findings</h3><div>We estimated that, in children younger than 5 years in 2023, CGF was associated with 79·4 million (95% uncertainty interval [UI] 47·0–106) DALYs lost and 880 000 (517 000–1 170 000) deaths. This represented 17·9% (10·6–23·8) of 444 million (434–457) total under-5 DALYs and 18·8% (11·1–25·0) of all 4·67 million (4·59–4·75) under-5 deaths. Compared to stunting (33·0 million [24·1–42·2] DALYs, 373 000 [272 000–477 000] deaths) and wasting (39·2 million [23·8–53·0] DALYs, 428 000 [256 000–583 000] deaths), childhood underweight was associated with the largest share of CGF-related disease burden: 52·2 million (21·9–75·1) DALYs and 573 000 (236 000–824 000) deaths in children yo
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