The main objective of this paper is to introduce the proposed theory of vulnerability of water pipe network (TVWPN) and, in particular, its theoretical concepts These concepts have a basis in the structural vulnerability theory (Agarwal et al, Civ Eng Environ Syst 18(2) 141-165, 2001a, J Struct Saf 23(3) 203-220, 2001b, Lu et al, Struct Eng 77(18) 17-23, 1999, Lu 1998, Pinto 2002, Pinto et al, J Struct Saf 24 107-122, 2002, Yu 1997) The fundamental contribution of this theory is to help design water pipe networks (WPN) more robust against damage to the pipelines This is achieved through an analysis of the form of the network The application of the TVWPN is presented through an example of a water pipe network

Background & aims: Despite recent advances in treatment of viral hepatitis, liver-related mortality is high, possibly owing to the large burden of advanced alcohol-related liver disease (ALD). We investigated whether patients with ALD are initially seen at later stages of disease development than patients with hepatitis C virus (HCV) infection or other etiologies. Methods: We performed a cross-sectional study of 3453 consecutive patients with either early or advanced liver disease (1699 patients with early and 1754 with advanced liver disease) seen at 17 tertiary care liver or gastrointestinal units worldwide, from August 2015 through March 2017. We collected anthropometric, etiology, and clinical information, as well as and model for end-stage liver disease scores. We used unconditional logistic regression to estimate the odds ratios for evaluation at late stages of the disease progression. Results: Of the patients analyzed, 81% had 1 etiology of liver disease and 17% had 2 etiologies of liver disease. Of patients seen at early stages for a single etiology, 31% had HCV infection, 21% had hepatitis B virus infection, and 17% had nonalcoholic fatty liver disease, whereas only 3.8% had ALD. In contrast, 29% of patients seen for advanced disease had ALD. Patients with ALD were more likely to be seen at specialized centers, with advanced-stage disease, compared with patients with HCV-associated liver disease (odds ratio, 14.1; 95% CI, 10.5-18.9; P < .001). Of patients with 2 etiologies of liver disease, excess alcohol use was associated with 50% of cases. These patients had significantly more visits to health care providers, with more advanced disease, compared with patients without excess alcohol use. The mean model for end-stage liver disease score for patients with advanced ALD (score, 16) was higher than for patients with advanced liver disease not associated with excess alcohol use (score, 13) (P < .01). Conclusions: In a cross-sectional analysis of patients with liver disease worldwide, we found that patients with ALD are seen with more advanced-stage disease than patients with HCV-associated liver disease. Of patients with 2 etiologies of liver disease, excess alcohol use was associated with 50% of cases. Early detection and referral programs are needed for patients with ALD worldwide.

Rubem F. Menna-Barreto - Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Biologia Celular. Rio de Janeiro, RJ, Brasil Outros autores: Daniel J. Klionsky,1,2,3,* Fabio C. Abdalla,4 Hagai Abeliovich,5 Robert T. Abraham,6 Abraham Acevedo-Arozena,7 Khosrow Adeli,8 Lotta Agholme,9 Maria Agnello,10 Patrizia Agostinis,11 Julio A. Aguirre-Ghiso,12 Hyung Jun Ahn,13 Ouardia Ait-Mohamed,14 Slimane Ait-Si-Ali,14 Takahiko Akematsu,15 Shizuo Akira,16 Hesham M. Al-Younes,17 Munir A. Al-Zeer,18 Matthew L. Albert,19 Roger L. Albin,20,21 Javier Alegre-Abarrategui,22 Maria Francesca Aleo,23 Mehrdad Alirezaei,24 Alexandru Almasan,25 Maylin Almonte-Becerril,26 Atsuo Amano,27 Ravi Amaravadi,28 Shoba Amarnath,29 Amal O. Amer,30,31 Nathalie Andrieu-Abadie,32,33 Vellareddy Anantharam,34 David K. Ann,35 Shailendra Anoopkumar-Dukie,36 Hiroshi Aoki,37 Nadezda Apostolova,38 Giuseppe Arancia,39 John P. Aris,40 Katsuhiko Asanuma,41 Nana Y.O. Asare,42 Hisashi Ashida,43 Valerie Askanas,44 David S. Askew,45 Patrick Auberger,46,47 Misuzu Baba,48 Steven K. Backues,1 Eric H. Baehrecke,49 Ben A. Bahr,50 Xue-Yuan Bai,51 Yannick Bailly,52 Robert Baiocchi,53 Giulia Baldini,54 Walter Balduini,55 Andrea Ballabio,56,57 Bruce A. Bamber,58 Edward T.W. Bampton,59 Gábor Bánhegyi,60 Clinton R. Bartholomew,1 Diane C. Bassham,61 Robert C. Bast, Jr.,62 Henri Batoko,63 Boon-Huat Bay,64 Isabelle Beau,65 Daniel M. Béchet,66 Thomas J. Begley,67 Christian Behl,68 Christian Behrends,69 Soumeya Bekri,70 Bryan Bellaire,71 Linda J. Bendall,72 Luca Benetti,73 Laura Berliocchi,74 Henri Bernardi,75 Francesca Bernassola,76 Sébastien Besteiro,77 Ingrid Bhatia-Kissova,78 Xiaoning Bi,79 Martine Biard-Piechaczyk,80 Janice S. Blum,81 Lawrence H. Boise,82 Paolo Bonaldo,83 David L. Boone,84 Beat C. Bornhauser,85 Karina R. Bortoluci,86 Ioannis Bossis,87 Frédéric Bost,46 Jean-Pierre Bourquin,85 Patricia Boya,88 Michaël Boyer-Guittaut,89 Peter V. Bozhkov,90 Nathan R. Brady,91 Claudio Brancolini,92 Andreas Brech,93 Jay E. Brenman,94 Ana Brennand,95 Emery H. Bresnick,96 Patrick Brest,97 Dave Bridges,1 Molly L. Bristol,98 Paul S. Brookes,99 Eric J. Brown,100 John H. Brumell,101a,101b Nicola Brunetti-Pierri,56 Ulf T. Brunk,102 Dennis E. Bulman,103 Scott J. Bultman,104 Geert Bultynck,105 Lena F. Burbulla,106 Wilfried Bursch,107 Jonathan P. Butchar,108 Wanda Buzgariu,109 Sergio P. Bydlowski,110 Ken Cadwell,111 Monika Cahová,112 Dongsheng Cai,113 Jiyang Cai,114 Qian Cai,115 Bruno Calabretta,116 Javier Calvo-Garrido,117 Nadine Camougrand,118 Michelangelo Campanella,119,120 Jenny Campos-Salinas,121 Eleonora Candi,122 Lizhi Cao,123 Allan B. Caplan,124 Simon R. Carding,125,126 Sandra M. Cardoso,127 Jennifer S. Carew,128 Cathleen R. Carlin,129 Virginie Carmignac,130 Leticia A.M. Carneiro,131 Serena Carra,132,133 Rosario A. Caruso,134 Giorgio Casari,135 Caty Casas,136 Roberta Castino,137 Eduardo Cebollero,138,139 Francesco Cecconi,140,141 Jean Celli,142 Hassan Chaachouay,143 Han-Jung Chae,144 Chee-Yin Chai,145 David C. Chan,146 Edmond Y. Chan,147 Raymond Chuen-Chung Chang,148 Chi-Ming Che,149 Ching-Chow Chen,150 Guang-Chao Chen,151 Guo-Qiang Chen,152 Min Chen,153 Quan Chen,154,155 Steve S.-L. Chen,156 WenLi Chen,157 Xi Chen,158 Xiangmei Chen,51 Xiequn Chen,159 Ye-Guang Chen,160 Yingyu Chen,161 Yongqiang Chen,162 Yu-Jen Chen,163 Zhixiang Chen,164 Alan Cheng,165 Christopher H.K. Cheng,166 Yan Cheng,167,168 Heesun Cheong,169 Jae-Ho Cheong,170 Sara Cherry,171 Russ Chess-Williams,172 Zelda H. Cheung,173 Eric Chevet,174 Hui-Ling Chiang,175 Roberto Chiarelli,10 Tomoki Chiba,176 Lih-Shen Chin,177 Shih-Hwa Chiou,178 Francis V. Chisari,24 Chi Hin Cho,179 Dong-Hyung Cho,180 Augustine M.K. Choi,181 DooSeok Choi,182 Kyeong Sook Choi,183 Mary E. Choi,184 Salem Chouaib,185 Divaker Choubey,186 Vinay Choubey,187 Charleen T. Chu,188,189 Tsung-Hsien Chuang,190 Sheau-Huei Chueh,191 Taehoon Chun,192 Yong-Joon Chwae,193 Mee-Len Chye,194 Roberto Ciarcia,195 Maria R. Ciriolo,141,196 Michael J. Clague,197 Robert S.B. Clark,198 Peter G.H. Clarke,199 Robert Clarke,200 Patrice Codogno,201 Hilary A. Coller,202 María I. Colombo,203 Sergio Comincini,204 Maria Condello,39 Fabrizio Condorelli,205 Mark R. Cookson,206 Graham H. Coombs,147 Isabelle Coppens,207 Ramon Corbalan,208 Pascale Cossart,209,210 Paola Costelli,211 Safia Costes,212 Ana Coto-Montes,213 Eduardo Couve,214 Fraser P. Coxon,215 James M. Cregg,216 José L. Crespo,217 Marianne J. Cronjé,218 Ana Maria Cuervo,219,220,221 Joseph J. Cullen,222 Mark J. Czaja,221,223 Marcello D’Amelio,224 Arlette Darfeuille-Michaud,225,226 Lester M. Davids,228 Faith E. Davies,229 Massimo De Felici,230 John F. de Groot,231 Cornelis A.M. de Haan,232 Luisa De Martino,233 Angelo De Milito,234 Vincenzo De Tata,235 Jayanta Debnath,236 Alexei Degterev,237 Benjamin Dehay,238 Lea M.D. Delbridge,239 Francesca Demarchi,240 Yi Zhen Deng,241 Jörn Dengjel,242 Paul Dent,243 Donna Denton,244,245 Vojo Deretic,246 Shyamal D. Desai,247 Rodney J. Devenish,248,249 Mario Di Gioacchino,250 Gilbert Di Paolo,251,252 Chiara Di Pietro,253 Guillermo Díaz-Araya,254 Inés Díaz-Laviada,255 Maria T. Diaz-Meco,256 Javier Diaz-Nido,257 Ivan Dikic,69,258 Savithramma P. Dinesh-Kumar,259 Wen-Xing Ding,260 Clark W. Distelhorst,261,262,263,264,265 Abhinav Diwan,266,267 Mojgan Djavaheri-Mergny,268 Svetlana Dokudovskaya,269 Zheng Dong,270 Frank C. Dorsey,272 Victor Dosenko,273 James J. Dowling,20,274 Stephen Doxsey,275 Marlène Dreux,276 Mark E. Drew,30 Qiuhong Duan,277 Michel A. Duchosal,278 Karen Duff,251,252 Isabelle Dugail,279,280 Madeleine Durbeej,130 Michael Duszenko,281 Charles L. Edelstein,282 Aimee L. Edinger,283 Gustavo Egea,284 Ludwig Eichinger,285 N. Tony Eissa,286 Suhendan Ekmekcioglu,287 Wafik S. El-Deiry,168,288 Zvulun Elazar,289 Mohamed Elgendy,290 Lisa M. Ellerby,291 Kai Er Eng,292 Anna-Mart Engelbrecht,293 Simone Engelender,294 Jekaterina Erenpreisa,295 Ricardo Escalante,117 Audrey Esclatine,65 Eeva-Liisa Eskelinen,296 Lucile Espert,80 Virginia Espina,297 Huizhou Fan,298 Jia Fan,299 Qi-Wen Fan,300 Zhen Fan,62 Shengyun Fang,301,302 Yongqi Fang,303 Manolis Fanto,304 Alessandro Fanzani,23 Thomas Farkas,305 Jean-Claude Farré,306 Mathias Faure,307 Marcus Fechheimer,308 Carl G. Feng,309 Jian Feng,310 Qili Feng,311 Youji Feng,312 László Fésüs,313 Ralph Feuer,314 Maria E. Figueiredo-Pereira,315 Gian Maria Fimia,316 Diane C. Fingar,317 Steven Finkbeiner,318 Toren Finkel,319 Kim D. Finley,320 Filomena Fiorito,233 Edward A. Fisher,321 Paul B. Fisher,322 Marc Flajolet,323 Maria L. Florez-McClure,324 Salvatore Florio,195 Edward A. Fon,325 Francesco Fornai,326 Franco Fortunato,327 Rati Fotedar,256 Daniel H. Fowler,29 Howard S. Fox,328 Rodrigo Franco,329 Lisa B. Frankel,330 Marc Fransen,331 José M. Fuentes,332 Juan Fueyo,231 Jun Fujii,333 Kozo Fujisaki,334 Eriko Fujita,335 Mitsunori Fukuda,336 Ruth H. Furukawa,308 Matthias Gaestel,337 Philippe Gailly,338 Malgorzata Gajewska,339 Brigitte Galliot,109 Vincent Galy,340 Subramaniam Ganesh,341 Barry Ganetzky,342 Ian G. Ganley,343 Fen-Biao Gao,344 George F. Gao,345 Jinming Gao,346 Lorena Garcia,347 Guillermo Garcia-Manero,348 Mikel Garcia-Marcos,349 Marjan Garmyn,350 Andrei L. Gartel,351 Evelina Gatti,352 Mathias Gautel,353 Thomas R. Gawriluk,354 Matthew E. Gegg,355 Jiefei Geng,356 Marc Germain,357 Jason E. Gestwicki,1,3,358 David A. Gewirtz,98 Saeid Ghavami,359 Pradipta Ghosh,360 Anna M. Giammarioli,361 Alexandra N. Giatromanolaki,362 Spencer B. Gibson,363 Robert W. Gilkerson,364 Michael L. Ginger,365 Henry N. Ginsberg,366 Jakub Golab,367 Michael S. Goligorsky,368 Pierre Golstein,352 Candelaria Gomez-Manzano,231,369 Ebru Goncu,370 Céline Gongora,371 Claudio D. Gonzalez,372 Ramon Gonzalez,373 Cristina González-Estévez,374 Rosa Ana González-Polo,332 Elena Gonzalez-Rey,121 Nikolai V. Gorbunov,375 Sharon Gorski,376 Sandro Goruppi,377 Roberta A. Gottlieb,320 Devrim Gozuacik,378 Giovanna Elvira Granato,195 Gary D. Grant,36 Kim N. Green,379 Aleš Gregorc,380 Frédéric Gros,381 Charles Grose,382 Thomas W. Grunt,383 Philippe Gual,46,47 Jun-Lin Guan,162,317 Kun-Liang Guan,384 Sylvie M. Guichard,385 Anna S. Gukovskaya,386 Ilya Gukovsky,386 Jan Gunst,387 Asa B. Gustafsson,388 Andrew J. Halayko,359,389 Amber N. Hale,354 Sandra K. Halonen,390 Maho Hamasaki,391 Feng Han,392 Ting Han,1,317 Michael K. Hancock,393 Malene Hansen,256 Hisashi Harada,394 Masaru Harada,395 Stefan E. Hardt,396 J. Wade Harper,356 Adrian L. Harris,397 James Harris,398 Steven D. Harris,399 Makoto Hashimoto,400 Jeffrey A. Haspel,181,401 Shin-ichiro Hayashi,402 Lori A. Hazelhurst,403 Congcong He,404 You-Wen He,405 Marie-Josée Hébert,406 Kim A. Heidenreich,407 Miep H. Helfrich,215 Gudmundur V. Helgason,408 Elizabeth P. Henske,181 Brian Herman,409 Paul K. Herman,410 Claudio Hetz,411 Sabine Hilfiker,412 Joseph A. Hill,413 Lynne J. Hocking,215 Paul Hofman,97 Thomas G. Hofmann,415 Jörg Höhfeld,416 Tessa L. Holyoake,408 Ming-Huang Hong,417 David A. Hood,418 Gökhan S. Hotamisligil,419 Ewout J. Houwerzijl,420 Maria Høyer-Hansen,421 Bingren Hu,422 Chien-An A. Hu,423 Hong-Ming Hu,424 Ya Hua,425 Canhua Huang,426 Ju Huang,101a Shengbing Huang,427 Wei-Pang Huang,428 Tobias B. Huber,429 Won-Ki Huh,430 Tai-Ho Hung,431 Ted R. Hupp,432 Gang Min Hur,433 James B. Hurley,434 Sabah N.A. Hussain,435 Patrick J. Hussey,436 Jung Jin Hwang,437 Seungmin Hwang,438 Atsuhiro Ichihara,439 Shirin Ilkhanizadeh,300 Ken Inoki,440 Takeshi Into,441 Valentina Iovane,233 Juan L. Iovanna,442 Nancy Y. Ip,443 Yoshitaka Isaka,444 Hiroyuki Ishida,445 Ciro Isidoro,137 Ken-ichi Isobe,446 Akiko Iwasaki,447 Marta Izquierdo,257 Yotaro Izumi,448 Panu M. Jaakkola,449 Marja Jäättelä,305 George R. Jackson,450 William T. Jackson,451 Bassam Janji,452 Marina Jendrach,453 Ju-Hong Jeon,454 Eui-Bae Jeung,455 Hong Jiang,231 Hongchi Jiang,456 Jean X. Jiang,457 Ming Jiang,458 Qing Jiang,459 Xuejun Jiang,460 Xuejun Jiang,461 Alberto Jiménez,462 Meiyan Jin,1,2 Shengkan Jin,463 Cheol O. Joe,464 Terje Johansen,465 Daniel E. Johnson,466 Gail V.W. Johnson,99 Nicola L. Jones,467 Bertrand Joseph,234 Suresh K. Joseph,468 Annie M. Joubert,469 Gábor Juhász,470 Lucienne Juillerat-Jeanneret,471 Chang Hwa Jung,472 Yong-Keun Jung,473 Kai Kaarniranta,474 Allen Kaasik,187 Tomohiro Kabuta,475 Motoni Kadowaki,476 Katarina Kagedal,477 Yoshiaki Kamada,478 Vitaliy O. Kaminskyy,479 Harm H. Kampinga,133 Hiromitsu Kanamori,480 Chanhee Kang,481 Khong Bee Kang,482 Kwang Il Kang,483 Rui Kang,484 Yoon-A Kang,96 Tomotake Kanki,485 Thirumala-Devi Kanneganti,486 Haruo Kanno,487 Anumantha G. Kanthasamy,34 Arthi Kanthasamy,34 Vassiliki Karantza,488 Gur P. Kaushal,489 Susmita Kaushik,219,220,221 Yoshinori Kawazoe,490 Po-Yuan Ke,156,491 John H. Kehrl,492 Ameeta Kelekar,493 Claus Kerkhoff,494 David H. Kessel,495 Hany Khalil,496 Jan A.K.W. Kiel,497 Amy A. Kiger,498 Akio Kihara,499 Deok Ryong Kim,500 Do-Hyung Kim,501 Dong-Hou Kim,502 Eun-Kyoung Kim,503 Hyung-Ryong Kim,504 Jae-Sung Kim,505 Jeong Hun Kim,506 Jin Cheon Kim,507 John K. Kim,1,508 Peter K. Kim,101a,509 Seong Who Kim,510 Yong-Sun Kim,511,512 Yonghyun Kim,513 Adi Kimchi,514 Alec C. Kimmelman,515 Jason S. King,516 Timothy J. Kinsella,517 Vladimir Kirkin,518 Lorrie A. Kirshenbaum,359,519 Katsuhiko Kitamoto,520 Kaio Kitazato,521 Ludger Klein,522 Walter T. Klimecki,523 Jochen Klucken,524 Erwin Knecht,525 Ben C.B. Ko,526 Jan C. Koch,527 Hiroshi Koga,220,221 Jae-Young Koh,528 Young Ho Koh,511 Masato Koike,529 Masaaki Komatsu,530 Eiki Kominami,531 Hee Jeong Kong,532 Wei-Jia Kong,533 Viktor I. Korolchuk,534 Yaichiro Kotake,535 Michael I. Koukourakis,536 Juan B. Kouri Flores,26 Attila L. Kovács,470 Claudine Kraft,537 Dimitri Krainc,538 Helmut Krämer,539 Carole Kretz-Remy,540 Anna M. Krichevsky,541 Guido Kroemer,279,542 Rejko Krüger,106 Oleg Krut,543 Nicholas T. Ktistakis,544 Chia-Yi Kuan,545 Roza Kucharczyk,546 Ashok Kumar,547 Raj Kumar,548 Sharad Kumar,244,245 Mondira Kundu,549 Hsing-Jien Kung,550 Tino Kurz,102 Ho Jeong Kwon,551 Albert R. La Spada,552,553 Frank Lafont,554 Trond Lamark,465 Jacques Landry,555 Jon D. Lane,556 Pierre Lapaquette,557 Jocelyn F. Laporte,558 Lajos László,470 Sergio Lavandero,347,413 Josée N. Lavoie,555 Robert Layfield,559 Pedro A. Lazo,560 Weidong Le,561,562 Laurent Le Cam,371 Daniel J. Ledbetter,354 Alvin J.X. Lee,563 Byung-Wan Lee,564 Gyun Min Lee,464 Jongdae Lee,360 Ju-Hyun Lee,565 Michael Lee,566 Myung-Shik Lee,567 Sug Hyung Lee,568 Christiaan Leeuwenburgh,569 Patrick Legembre,570 Renaud Legouis,571 Michael Lehmann,572 Huan-Yao Lei,573 Qun-Ying Lei,574 David A. Leib,575 José Leiro,576 John J. Lemasters,577 Antoinette Lemoine,578 Maciej S. Lesniak,579 Dina Lev,580 Victor V. Levenson,581 Beth Levine,404 Efrat Levy,565,583 Faqiang Li,584 Jun-Lin Li,585 Lian Li,177 Sheng Li,562,586 Weijie Li,587 Xue-Jun Li,588 Yan-bo Li,589 Yi-Ping Li,590 Chengyu Liang,591 Qiangrong Liang,592 Yung-Feng Liao,593 Pawel P. Liberski,594 Andrew Lieberman,358 Hyunjung J. Lim,595 Kah-Leong Lim,596 Kyu Lim,597 Chiou-Feng Lin,598 Fu-Cheng Lin,599 Jian Lin,600 Jiandie D. Lin,1,317 Kui Lin,601 Wan-Wan Lin,150 Weei-Chin Lin,286,602 Yi-Ling Lin,156 Rafael Linden,603 Paul Lingor,527 Jennifer Lippincott-Schwartz,604 Michael P. Lisanti,605 Paloma B. Liton,606 Bo Liu,426 Chun-Feng Liu,607 Kaiyu Liu,608 Leyuan Liu,609 - Qiong A. Liu,610 Wei Liu,611 Young-Chau Liu,612 Yule Liu,160 Richard A. Lockshin,613 Chun-Nam Lok,149 Sagar Lonial,82 Benjamin Loos,293 Gabriel Lopez-Berestein,62 Carlos López-Otín,614 Laura Lossi,615 Michael T. Lotze,484 Peter Lőw,470 Binfeng Lu,616 Bingwei Lu,617 Bo Lu,618 Zhen Lu,62 Frédéric Luciano,46,47 Nicholas W. Lukacs,358 Anders H. Lund,330 Melinda A. Lynch-Day,1,2 Yong Ma,456 Fernando Macian,619 Jeff P. MacKeigan,620 Kay F. Macleod,621 Frank Madeo,622 Luigi Maiuri,623 Maria Chiara Maiuri,279 Davide Malagoli,624 May Christine V. Malicdan,625 Walter Malorni,361,626 Na Man,627 Eva-Maria Mandelkow,628 Stéphen Manon,118 Irena Manov,629 Kai Mao,1,2 Xiang Mao,630 Zixu Mao,177,631 Philippe Marambaud,632 Daniela Marazziti,253 Yves L. Marcel,633 Katie Marchbank,634 Piero Marchetti,635 Stefan J. Marciniak,636 Mateus Marcondes,4 Mohsen Mardi,637 Gabriella Marfe,76 Guillermo Mariño,638 Maria Markaki,639a Mark R. Marten,513 Seamus J. Martin,640 Camille Martinand-Mari,641 Wim Martinet,642 Marta Martinez-Vicente,643 Matilde Masini,644 Paola Matarrese,645 Saburo Matsuo,646 Raffaele Matteoni,253 Andreas Mayer,647 Nathalie M. Mazure,648 David J. McConkey,580,649 Melanie J. McConnell,650 Catherine McDermott,651 Christine McDonald,652 Gerald M. McInerney,292 Sharon L. McKenna,653 BethAnn McLaughlin,654 Pamela J. McLean,538 Christopher R. McMaster,655 G. Angus McQuibban,509 Alfred J. Meijer,656 Miriam H. Meisler,508 Alicia Meléndez,613,657 Thomas J. Melia,658 Gerry Melino,59,659 Maria A. Mena,660 Javier A. Menendez,661 Rubem F. S. Menna-Barreto,662 Manoj B. Menon,337 Fiona M. Menzies,663 Carol A. Mercer,664 Adalberto Merighi,615 Diane E. Merry,665 Stefania Meschini,39 Christian G. Meyer,666 Thomas F. Meyer,18 Chao-Yu Miao,667 Jun-Ying Miao,668 Paul A.M. Michels,95 Carine Michiels,669 Dalibor Mijaljica,248 Ana Milojkovic,670 Saverio Minucci,290 Clelia Miracco,671 Cindy K. Miranti,672 Ioannis Mitroulis,673 Keisuke Miyazawa,674 Noboru Mizushima,675 Baharia Mograbi,97 Simin Mohseni,677 Xavier Molero,678 Bertrand Mollereau,679 Faustino Mollinedo,560 Takashi Momoi,680 Iryna Monastyrska,232 Martha M. Monick,681 Mervyn J. Monteiro,301,682 Michael N. Moore,683 Rodrigo Mora,684 Kevin Moreau,663 Paula I. Moreira,127 Yuji Moriyasu,685 Jorge Moscat,256 Serge Mostowy,686 Jeremy C. Mottram,687 Tomasz Motyl,339 Charbel E.-H. Moussa,688 Sylke Müller,687 Sylviane Muller,381 Karl Münger,689 Christian Münz,690 Leon O. Murphy,691 Maureen E. Murphy,692 Antonio Musarò,693 Indira Mysorekar,694 Eiichiro Nagata,695 Kazuhiro Nagata,696 Aimable Nahimana,697 Usha Nair,1 Toshiyuki Nakagawa,698 Kiichi Nakahira,181 Hiroyasu Nakano,699 Hitoshi Nakatogawa,700 Meera Nanjundan,701 Naweed I. Naqvi,241 Derek P. Narendra,702 Masashi Narita,703 Miguel Navarro,412 Steffan T. Nawrocki,128 Taras Y. Nazarko,306 Andriy Nemchenko,413 Mihai G. Netea,704 Thomas P. Neufeld,705 Paul A. Ney,706 Ioannis P. Nezis,93 Huu Phuc Nguyen,707 Daotai Nie,708 Ichizo Nishino,709 Corey Nislow,710 Ralph A. Nixon,565 Takeshi Noda,391 Angelika A. Noegel,285 Anna Nogalska,44 Satoru Noguchi,709 Lucia Notterpek,711 Ivana Novak,712 Tomoyoshi Nozaki,713 Nobuyuki Nukina,714 Thorsten Nürnberger,715 Beat Nyfeler,691 Keisuke Obara,499 Terry D. Oberley,716 Salvatore Oddo,717 Michinaga Ogawa,718 Toya Ohashi,719,720 Koji Okamoto,721 Nancy L. Oleinick,264,722,723 F. Javier Oliver,121 Laura J. Olsen,2 Stefan Olsson,724 Onya Opota,725 Timothy F. Osborne,726 Gary K. Ostrander,727 Kinya Otsu,728 Jing-hsiung James Ou,591 Mireille Ouimet,633 Michael Overholtzer,460 Bulent Ozpolat,62 Paolo Paganetti,729 Ugo Pagnini,233 Nicolas Pallet,730 Glen E. Palmer,731 Camilla Palumbo,76 Tianhong Pan,732 Theocharis Panaretakis,234 Udai Bhan Pandey,733 Zuzana Papackova,112 Issidora Papassideri,734 Irmgard Paris,735 Junsoo Park,736 Ohkmae K. Park,192 Jan B. Parys,105 Katherine R. Parzych,1,2 Susann Patschan,737 Cam Patterson,738 Sophie Pattingre,371 John M. Pawelek,739 Jianxin Peng,740 David H. Perlmutter,741 Ida Perrotta,742 George Perry,743 Shazib Pervaiz,596,744 Matthias Peter,745 Godefridus J. Peters,746 Morten Petersen,747 Goran Petrovski,748 James M. Phang,611 Mauro Piacentini,141 Philippe Pierre,352 Valérie Pierrefite-Carle,749 Gérard Pierron,750 Ronit Pinkas-Kramarski,751 Antonio Piras,752 Natik Piri,753 Leonidas C. Platanias,754 Stefanie Pöggeler,755 Marc Poirot,32,756 Angelo Poletti,757 Christian Poüs,758 Mercedes Pozuelo-Rubio,759 Mette Prætorius-Ibba,760 Anil Prasad,761 Mark Prescott,248 Muriel Priault,118 Nathalie Produit-Zengaffinen,762 Ann Progulske-Fox,763 Tassula Proikas-Cezanne,764 Serge Przedborski,252,364,765 Karin Przyklenk,766 Rosa Puertollano,767 Julien Puyal,199 Shu-Bing Qian,768 Liang Qin,769 Zheng-Hong Qin,770 Susan E. Quaggin,771 Nina Raben,772 Hannah Rabinowich,188 Simon W. Rabkin,773 Irfan Rahman,774 Abdelhaq Rami,775 Georg Ramm,248,776 Glenn Randall,777 Felix Randow,778 V. Ashutosh Rao,779 Jeffrey C. Rathmell,405,780 Brinda Ravikumar,781 Swapan K. Ray,782 Bruce H. Reed,783 John C. Reed,256 Fulvio Reggiori,138 Anne Régnier-Vigouroux,784 Andreas S. Reichert,785 John J. Reiners, Jr.,786 Russel J. Reiter,409 Jun Ren,787 José L. Revuelta,462 Christopher J. Rhodes,788 Konstantinos Ritis,673 Elizete Rizzo,789 Jeffrey Robbins,790 Michel Roberge,791 Hernan Roca,792 Maria C. Roccheri,10 Stephane Rocchi,46,793 H. Peter Rodemann,143 Santiago Rodríguez de Córdoba,794 Bärbel Rohrer,795 Igor B. Roninson,796 Kirill Rosen,655 Magdalena M. Rost-Roszkowska,797 Mustapha Rouis,798 Kasper M.A. Rouschop,799 Francesca Rovetta,23 Brian P. Rubin,800 David C. Rubinsztein,663 Klaus Ruckdeschel,801 Edmund B. Rucker, III,354 Assaf Rudich,802 Emil Rudolf,803 Nelson Ruiz-Opazo,804 Rossella Russo,805 Tor Erik Rusten,93 Kevin M. Ryan,516 Stefan W. Ryter,181 David M. Sabatini,806,807 Junichi Sadoshima,808 Tapas Saha,200 Tatsuya Saitoh,16 Hiroshi Sakagami,809 Yasuyoshi Sakai,810 Ghasem Hoseini Salekdeh,811 Paolo Salomoni,812 Paul M. Salvaterra,813 Guy Salvesen,256 Rosa Salvioli,814 Anthony M.J. Sanchez,75 José A. Sánchez-Alcázar,815 Ricardo Sánchez-Prieto,816 Marco Sandri,83,817,818 Uma Sankar,819 Poonam Sansanwal,820 Laura Santambrogio,619,821 Shweta Saran,822 Sovan Sarkar,807 Minnie Sarwal,820,823 Chihiro Sasakawa,718 Ausra Sasnauskiene,824 Miklós Sass,470 Ken Sato,825 Miyuki Sato,825 Anthony H.V. Schapira,355 Michael Scharl,826 Hermann M. Schätzl,827 Wiep Scheper,828 Stefano Schiaffino,818 Claudio Schneider,240 Marion E. Schneider,829 Regine Schneider-Stock,830 Patricia V. Schoenlein,831 Daniel F. Schorderet,762,832 Christoph Schüller,833 Gary K. Schwartz,834 Luca Scorrano,817,835 Linda Sealy,836 Per O. Seglen,837 Juan Segura-Aguilar,838 Iban Seiliez,839 Oleksandr Seleverstov,840 Christian Sell,841 Jong Bok Seo,842 Duska Separovic,843 Vijayasaradhi Setaluri,844 Takao Setoguchi,845 Carmine Settembre,56,57 John J. Shacka,846 Mala Shanmugam,754 Irving M. Shapiro,847 -Eitan Shaulian,848 Reuben J. Shaw,849 James H. Shelhamer,850 Han-Ming Shen,851 Wei-Chiang Shen,852 Zu-Hang Sheng,853 Yang Shi,854 Kenichi Shibuya,855 Yoshihiro Shidoji,856 Jeng-Jer Shieh,857 Chwen-Ming Shih,858 Yohta Shimada,719 Shigeomi Shimizu,859 Takahiro Shintani,860 Orian S. Shirihai,861 Gordon C. Shore,862 Andriy A. Sibirny,863 Stan B. Sidhu,864 Beata Sikorska,594 Elaine C.M. Silva-Zacarin,4 Alison Simmons,865 Anna Katharina Simon,866 Hans-Uwe Simon,867 Cristiano Simone,868 Anne Simonsen,869 David A. Sinclair,870 Rajat Singh,871 Debasish Sinha,872 Frank A. Sinicrope,427,873 Agnieszka Sirko,546 Parco M. Siu,874 Efthimios Sivridis,362 Vojtech Skop,875 Vladimir P. Skulachev,876 Ruth S. Slack,357 Soraya S. Smaili,877 Duncan R. Smith,878 Maria S. Soengas,879 Thierry Soldati,880 Xueqin Song,881 Anil K. Sood,882 Tuck Wah Soong,596 Federica Sotgia,116 Stephen A. Spector,553,883 Claudia D. Spies,884 Wolfdieter Springer,885 Srinivasa M. Srinivasula,886 Leonidas Stefanis,887 Joan S. Steffan,888 Ruediger Stendel,889 Harald Stenmark,93 Anastasis Stephanou,890 Stephan T. Stern,891 Cinthya Sternberg,892 Björn Stork,893 Peter Strålfors,677 Carlos S. Subauste,261,894 Xinbing Sui,895 David Sulzer,364,896 Jiaren Sun,897 Shi-Yong Sun,82 Zhi-Jun Sun,898 Joseph J.Y. Sung,899 Kuninori Suzuki,900 Toshihiko Suzuki,901 Michele S. Swanson,902 Charles Swanton,563 Sean T. Sweeney,903 Lai-King Sy,149 Gyorgy Szabadkai,904 Ira Tabas,366 Heinrich Taegtmeyer,905 Marco Tafani,906 Krisztina Takács-Vellai,907 Yoshitaka Takano,908 Kaoru Takegawa,909 Genzou Takemura,480 Fumihiko Takeshita,910 Nicholas J. Talbot,911 Kevin S.W. Tan,912 Keiji Tanaka,530 Kozo Tanaka,913 Daolin Tang,484 Dingzhong Tang,914,915 Isei Tanida,916 Bakhos A. Tannous,538,917 Nektarios Tavernarakis,639a,639b Graham S. Taylor,918 Gregory A. Taylor,405,919 J. Paul Taylor,920 Lance S. Terada,404 Alexei Terman,921 Gianluca Tettamanti,922 Karin Thevissen,923 Craig B. Thompson,169 Andrew Thorburn,924 Michael Thumm,925 FengFeng Tian,926 Yuan Tian,323 Glauco Tocchini-Valentini,253 Aviva M. Tolkovsky,927 Yasuhiko Tomino,41 Lars Tönges,527 Sharon A. Tooze,928 Cathy Tournier,929 John Tower,930 Roberto Towns,162 Vladimir Trajkovic,931 Leonardo H. Travassos,932 Ting-Fen Tsai,933 Mario P. Tschan,934 Takeshi Tsubata,935 Allan Tsung,936 Boris Turk,937 Lorianne S. Turner,938 Suresh C. Tyagi,939 Yasuo Uchiyama,529 Takashi Ueno,531 Midori Umekawa,1 Rika Umemiya-Shirafuji,334 Vivek K. Unni,940 Maria I. Vaccaro,372 Enza Maria Valente,941 Greet Van den Berghe,387 Ida J. van der Klei,497 Wouter G. van Doorn,942 Linda F. van Dyk,943 Marjolein van Egmond,944 Leo A. van Grunsven,945 Peter Vandenabeele,946 Wim P. Vandenberghe,947 Ilse Vanhorebeek,387 Eva C. Vaquero,948 Guillermo Velasco,949 Tibor Vellai,907 Jose Miguel Vicencio,904 Richard D. Vierstra,584 Miquel Vila,643,950 Cécile Vindis,33,951 Giampietro Viola,952 Maria Teresa Viscomi,953 Olga V. Voitsekhovskaja,954 Clarissa von Haefen,884 Marcela Votruba,955 Keiji Wada,475 Richard Wade-Martins,22 Cheryl L. Walker,956 Craig M. Walsh,957 Jochen Walter,958 Xiang-Bo Wan,959 Aimin Wang,960 Chenguang Wang,961 Dawei Wang,456 Fan Wang,962 Fen Wang,609 Guanghui Wang,770 Haichao Wang,963 Hong-Gang Wang,167,168 Horng-Dar Wang,964 Jin Wang,153 Ke Wang,1,2 Mei Wang,744 Richard C. Wang,965 Xinglong Wang,263 Xuejun Wang,966 Ying-Jan Wang,967 Yipeng Wang,628 Zhen Wang,968 Zhigang Charles Wang,969 Zhinong Wang,970 Derick G. Wansink,971 Diane M. Ward,972 Hirotaka Watada,973 Sarah L. Waters,634,728,974 Paul Webster,975 Lixin Wei,976 Conrad C. Weihl,977 William A. Weiss,300 Scott M. Welford,722 Long-Ping Wen,978 Caroline A. Whitehouse,634 J. Lindsay Whitton,24 Alexander J. Whitworth,979 Tom Wileman,980 John W. Wiley,162 Simon Wilkinson,981 Dieter Willbold,982 Roger L. Williams,778 Peter R. Williamson,983 Bradly G. Wouters,984 Chenghan Wu,985 Dao-Cheng Wu,986 William K.K. Wu,899 Andreas Wyttenbach,987 Ramnik J. Xavier,988 Zhijun Xi,989 Pu Xia,990 Gengfu Xiao,991 Zhiping Xie,992 Zhonglin Xie,993 Da-zhi Xu,994 Jianzhen Xu,995 Liang Xu,996 Xiaolei Xu,997 Ai Yamamoto,252,364 Akitsugu Yamamoto,998 Shunhei Yamashina,999 Michiaki Yamashita,1000 Xianghua Yan,1001 Mitsuhiro Yanagida,1002 Dun-Sheng Yang,565 Elizabeth Yang,1003 Jin-Ming Yang,167,168 Shi Yu Yang,1004 Wannian Yang,1005 Wei Yuan Yang,151 Zhifen Yang,256 Meng-Chao Yao,1006 Tso-Pang Yao,780 Behzad Yeganeh,359 Wei-Lien Yen,1 Jia-jing Yin,589 Xiao-Ming Yin,1007 Ook-Joon Yoo,1008 Gyesoon Yoon,1009 Seung-Yong Yoon,502 Tomohiro Yorimitsu,1010 Yuko Yoshikawa,1011 Tamotsu Yoshimori,391 Kohki Yoshimoto,1012 Ho Jin You,1013 Richard J. Youle,702 Anas Younes,1014 Li Yu,160 Long Yu,1015 Seong-Woon Yu,503 Wai Haung Yu,251,252 Zhi-Min Yuan,1016 Zhenyu Yue,1017 Cheol-Heui Yun,1018 Michisuke Yuzaki,1019 Olga Zabirnyk,611 Elaine Silva-Zacarin,4 David Zacks,1021 Eldad Zacksenhaus,1022 Nadia Zaffaroni,1023 Zahra Zakeri,613 Herbert J. Zeh, III,1024 Scott O. Zeitlin,1025 Hong Zhang,1026 Hui-Ling Zhang,770,1027 Jianhua Zhang,846 Jing-Pu Zhang,968 Lin Zhang,1028 Long Zhang,1029 Ming-Yong Zhang,1030 Xu Dong Zhang,1031 Mantong Zhao,1,2 Yi-Fang Zhao,898 Ying Zhao,1032,1033 Zhizhuang J. Zhao,1034 Xiaoxiang Zheng,1035 Boris Zhivotovsky,479 Qing Zhong,1036 Cong-Zhao Zhou,627 Changlian Zhu,1037 Wei-Guo Zhu,1033 Xiao-Feng Zhu,1038 Xiongwei Zhu,263 Yuangang Zhu,915 Teresa Zoladek,546 Wei-Xing Zong,1039 Antonio Zorzano,1040 Jürgen Zschocke1041 and Brian Zuckerbraun 1042.

Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1–6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5–19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m–2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified.

Global reporting of obesity is commonly based on comparisons over multiple decades1 and lacks a granular and systematic analysis of its dynamics. We used 4,050 population-based studies with measured height and weight data on 232 million participants to assess the worldwide dynamics of obesity from 1980 to 2024. The rise in obesity decelerated in school-aged children and adolescents throughout the 1990s in many high-income countries, and subsequently plateaued in most at age-standardized prevalences spanning 20 percentage points, from 3-4% for girls in Japan, Denmark, and France to 23% for boys in the USA. There were indications of a small decline in obesity in children and adolescents in some high-income western countries (for example, Italy, Portugal, and France) since the 2000s. Similar trends were seen in some countries in Central and Eastern Europe. In adults, the rise in obesity slowed down in high-income western countries about a decade after children, followed by a plateau or possibly a small reversal of the rise in some countries (for example, Spain). In most low- and middle-income countries, the annual absolute change in prevalence has remained stable or increased over time, even though prevalence has surpassed that of high-income countries. These highly varied dynamics suggest that the social, economic, and technological trends that influence the availability, affordability, and use of different foods may have helped control the rise in obesity in high-income countries, but require policy interventions in low-income and middle-income countries.

Background Underweight, overweight, and obesity in childhood and adolescence are associated with adverse health consequences throughout the life-course. Our aim was to estimate worldwide trends in mean body-mass index (BMI) and a comprehensive set of BMI categories that cover underweight to obesity in children and adolescents, and to compare trends with those of adults. Methods We pooled 2416 population-based studies with measurements of height and weight on 128·9 million participants aged 5 years and older, including 31·5 million aged 5–19 years. We used a Bayesian hierarchical model to estimate trends from 1975 to 2016 in 200 countries for mean BMI and for prevalence of BMI in the following categories for children and adolescents aged 5–19 years: more than 2 SD below the median of the WHO growth reference for children and adolescents (referred to as moderate and severe underweight hereafter), 2 SD to more than 1 SD below the median (mild underweight), 1 SD below the median to 1 SD above the median (healthy weight), more than 1 SD to 2 SD above the median (overweight but not obese), and more than 2 SD above the median (obesity). Findings Regional change in age-standardised mean BMI in girls from 1975 to 2016 ranged from virtually no change (–0·01 kg/m² per decade; 95% credible interval –0·42 to 0·39, posterior probability [PP] of the observed decrease being a true decrease=0·5098) in eastern Europe to an increase of 1·00 kg/m² per decade (0·69–1·35, PP>0·9999) in central Latin America and an increase of 0·95 kg/m² per decade (0·64–1·25, PP>0·9999) in Polynesia and Micronesia. The range for boys was from a non-significant increase of 0·09 kg/m² per decade (–0·33 to 0·49, PP=0·6926) in eastern Europe to an increase of 0·77 kg/m² per decade (0·50–1·06, PP>0·9999) in Polynesia and Micronesia. Trends in mean BMI have recently flattened in northwestern Europe and the high-income English-speaking and Asia-Pacific regions for both sexes, southwestern Europe for boys, and central and Andean Latin America for girls. By contrast, the rise in BMI has accelerated in east and south Asia for both sexes, and southeast Asia for boys. Global age-standardised prevalence of obesity increased from 0·7% (0·4–1·2) in 1975 to 5·6% (4·8–6·5) in 2016 in girls, and from 0·9% (0·5–1·3) in 1975 to 7·8% (6·7–9·1) in 2016 in boys; the prevalence of moderate and severe underweight decreased from 9·2% (6·0–12·9) in 1975 to 8·4% (6·8–10·1) in 2016 in girls and from 14·8% (10·4–19·5) in 1975 to 12·4% (10·3–14·5) in 2016 in boys. Prevalence of moderate and severe underweight was highest in India, at 22·7% (16·7–29·6) among girls and 30·7% (23·5–38·0) among boys. Prevalence of obesity was more than 30% in girls in Nauru, the Cook Islands, and Palau; and boys in the Cook Islands, Nauru, Palau, Niue, and American Samoa in 2016. Prevalence of obesity was about 20% or more in several countries in Polynesia and Micronesia, the Middle East and north Africa, the Caribbean, and the USA. In 2016, 75 (44–117) million girls and 117 (70–178) million boys worldwide were moderately or severely underweight. In the same year, 50 (24–89) million girls and 74 (39–125) million boys worldwide were obese. Interpretation The rising trends in children’s and adolescents’ BMI have plateaued in many high-income countries, albeit at high levels, but have accelerated in parts of Asia, with trends no longer correlated with those of adults.