Nature volume 569, pages260–264 (2019) : Full Text: Rising rural body-mass index is the main driver of the global obesity epidemic in adults
- Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017.
- We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017—and more than 80% in some low- and middle-income regions—was due to increases in BMI in rural areas.
- In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women.
It looks like living in the boonies (URBAN DICTIONARY: BOONIES) does not make a big difference in pediatric liver transplantation (LT) outcomes (J Pediatr 2013; 162: 313-8).
The authors analyzed 3307 pediatric patients using the United Network Organ Sharing (UNOS) database between 2004-09.
Key outcomes for rural location:
- Associated with greater risk of allograft rejection in the first 6 months after LT with an OR 1.27 (27% compared with 22.9% of urban patients). The risk allograft rejection was not statistically significant at 1 year post LT (OR 1.18).
- Associated with lower risk of post transplantation lymphoproliferative disorder (PTLD) with an OR of 0.64. In total, 2.4% of rural patients experienced PTLD compared with 3.8% of urban patients.
- Allograft loss and survival were similar for rural patients as for patients: 21.3% and 14.1% respectively compared with 20.7% and 12.7%.
The opposite risk ratios with regard to rejection and PTLD indicates that rural status may have greater rates of nonadherence with maintenance immune-suppression. However, the lack of a larger discrepancy in outcomes comes as a pleasant surprise, particularly as rural status is a known risk factor for worse health outcomes in many other complex chronic diseases. Perhaps, this study validates the high level of skill and teaching on the part of pediatric liver transplant teams as well.