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Purpose Assessing the outcome of lean transformation journey has been of interest to both researchers and practitioners. Various qualitative and quantitative assessment methodologies have been proposed in literature to track and measure the degree of leanness attained. The purpose of this paper is to understand the evolution of this leanness assessment literature over different attributes and identify gaps for future research. Design/methodology/approach A detailed literature review of peer-reviewed journal articles and conference papers addressing leanness assessment was performed. Content analysis methodology involving a four-step process suggested by Mayring (2004) was adopted for this study. Findings The number of studies in literature on leanness assessment is low when compared to that in the area of lean implementation. Assessment methodologies developed are of wide range, varying from simple qualitative checklist to complex quantitative mathematical models. Following the trend of lean implementation literature, lean thinking assessment literature is also getting transformed from process-level monitoring to enterprise-level monitoring. Finally, based on this review, a simplified leanness assessment framework is proposed for future validation. Research limitations/implications Only peer-reviewed journals and conference papers were analyzed, while excluding the manuals, reports, and white papers from practice. Clustering of leanness assessment literature revealed that future studies in this domain would fall into two major categories, namely manufacturing leanness assessment and service leanness assessment. Practical implications Practitioners can use this review study to choose a suitable methodology for assessing the leanness attained in their organization by controlling for the structural attributes identified. Originality/value This is the first paper to review the topic “leanness assessment.” The review analyzes the entire literature available on leanness assessment to summarize its current status and identify potential future directions.

Background: Business actors need to take strategic steps to maintain and improve business performance. Studying and deepening the strategies used by micro, small, and medium-sized enterprises (MSMEs) to maintain their performance conditions are needed as a barometer of crisis resistance in the macroeconomic sector, especially those used by MSMEs in Medan, Indonesia. Thus, this research provides a real picture in the field of variables and indicators that affect the business strategy of MSMEs through the perspective of a lean approach. Methods: The population in this region was 466 business actors of MSMEs in Medan. A random stratified sampling strategy is used, and 169 businesses in the MSMEs production sector were obtained as samples, which has exceeded the standard achievement of 80 percent in detecting an R 2 value of at least 0.10 (with a 5 percent probability of error). The research variables used consisted of one endogenous variable (use of a lean strategy), two exogenous variables (external lean practice and internal lean practice), and one mediating variable (financial performance). Seven hypotheses (inner models) were tested using structural equation modelling-partial least squares, nonparametric statistical data analysis techniques with mediation effects, assisted by Smart PLS 3.0. Results: Based on the path coefficient, internal lean practice predominantly influences the financial performance of MSMEs in Medan compared to external lean practice. Internal lean practice is the primary signal for identifying the degree of lean strategy practice in the MSMEs production sector in Medan city. Conclusion: These findings can be a map for practitioners, academics, and the government to improve the financial performance of MSMEs and assist them in their business strategies through internal business practices. Moreover, this study's impact can lead to an understanding of business strategies in operations that directly or indirectly affect the environment toward global warming and various environmental problems.

Malnutrition is a major health issue among Bangladeshi under-five (U5) children. Children are malnourished if the calories and proteins they take through their diet are not sufficient for their growth and maintenance. The goal of the research was to use machine learning (ML) algorithms to detect the risk factors of malnutrition (stunted, wasted, and underweight) as well as their prediction. This work utilized malnutrition data that was derived from Bangladesh Demographic and Health Survey which was conducted in 2014. The selected dataset consisted of 7079 children with 13 factors. The potential risks of malnutrition have been identified by logistic regression (LR). Moreover, 3 ML classifiers (support vector machine (SVM), random forest (RF), and LR) have been implemented for predicting malnutrition and the performance of these ML algorithms were assessed on the basis of accuracy. The average prevalence of stunted, wasted, and underweight was 35.4%, 15.4%, and 32.8%, respectively. It was noted that LR identified five risk factors for stunting and underweight, as well as four factors for wasting. Results illustrated that RF can be accurately classified as stunted, wasted, and underweight children and obtained the highest accuracy of 88.3% for stunted, 87.7% for wasted, and 85.7% for underweight. This research focused on the identification and prediction of major risk factors for stunting, wasting, and underweight using ML algorithms which will aid policymakers in reducing malnutrition among Bangladesh's U5 children.

With the emergence of Industry 4.0, digitalization and intelligent manufacturing are vital to ensure competitivity, especially for manufacturers reliant on legacy machines. Upgrading legacy machines with cyber physical technology under Industry 4.0 frameworks can enable connection of these machines to existing IoT networks to allow the sharing and exchange of production information. In this paper, a legacy machine used in sheet metal folding operations is upgraded by integrating switch sensors which provide detailed data on the machine status to stakeholders, enabling in-depth analysis of the production activity before and after the implementation of lean manufacturing methods. Furthermore, it is shown that the data collected can be applied to conduct dynamic value stream mapping (DVSM) in near real time to provide deeper level insight into manufacturing processes. More detailed mapping enables identification of wastes involved with labour and design. Therefore, an innovative graphical technique is proposed to improve the flattened pattern to reduce manual handling and ease bottlenecks identified by VSM. From the collected VSM data, a leanness measure was established to provide objective and quantitative evaluation of the process performance.

(1) Background/Objectives: The relationship between body mass index (BMI) and probable sarcopenia, a precursor to sarcopenia diagnosis, is unclear. While low BMI has been associated with sarcopenia risk, some evidence suggests that obesity may confer protection. We aimed to investigate the association between probable sarcopenia and BMI and, furthermore, to explore associations with waist circumference (WC). (2) Methods: This cross-sectional study included 5783 community-dwelling adults (mean age 70.4 ± 7.5 years) from Wave 6 of the English Longitudinal Study of Ageing (ELSA). Probable sarcopenia was defined using the European Working Group on Sarcopenia in Older People (EWGSOP2) criteria for low hand grip strength and/or slow chair rise. Associations between BMI and probable sarcopenia were examined using multivariable regression analysis and were similarly performed for WC. (3) Results: Our overall findings show that an underweight BMI was significantly associated with an increased likelihood of probable sarcopenia [OR (CI) 2.25 (1.17, 4.33), p = 0.015]. For higher BMI categories, the findings were conflicting. Overweight and obesity were associated with an increased likelihood of probable sarcopenia when defined by lower limb strength alone, [OR (CI), 2.32 (1.15, 4.70), p = 0.019; 1.23 (1.02, 1.49), p = 0.35, and 1.49 (1.21, 1.83), p < 0.001, respectively]. In contrast, overweight and obesity appeared protective when probable sarcopenia was assessed by low hand grip strength alone [OR (CI) 0.72 (0.60, 0.88), p = 0.001, and 0.64 (0.52, 0.79), p < 0.001, respectively]. WC was not significantly associated with probable sarcopenia on multivariable regression analysis. (4) Conclusion: This study supports the evidence that low BMI is associated with an increased likelihood of probable sarcopenia, highlighting an important at-risk group. The findings for overweight and obesity were inconsistent and may be measurement dependent. It seems prudent that all older adults at risk of probable sarcopenia, including those with overweight/obesity, are assessed to prevent underdetection of probable sarcopenia alone or with the double burden of obesity.

Background Disordered Eating (DE) shows a strong association with athletics and can lead to several negative mental and physical health effects. Traditionally, sports have been grouped based upon whether or not the sport emphasizes leanness as a competing factor. Due to sociocultural factors, risk for DE may also be associated with the sport type. The aim of this review is to critically analyze the available research and data in this field to consider the relationship between DE and sport type to see which factors influence prevalence among athletes Method A systematic review was completed using keywords specific to DE and sport types. Articles were either excluded due to lack of specification of athlete type or failure to use a standardized screening tool or interview for data collection. Results 6 out of 7 studies found a significant increase in DE rates among lean sport types. When classifying by sport type reports were less consistent, but show non-lean sports also have increased rates of DE. Conclusion There are variations in prevalence of DE behaviors depending on athlete type. It is important to identify the risk for DE early in athletes so emphasis can be placed on treatment options to nullify progression to an eating disorder, lower negative impacts on an athlete’s performance, and prevent other negative health effects. Using sport groups is important to clinical practice as well as research, as certain sports may have a higher risk for development of DE.

Fatty liver is now a major cause of liver disease in the Asia-Pacific region. Liver diseases in this region have distinctive characteristics. First, fatty liver is frequently observed in lean/normal-weight individuals. However, there is no standard definition of this unique phenotype. Second, fatty liver is often observed in patients with concomitant viral hepatitis. The exclusion of viral hepatitis from non-alcoholic fatty liver disease limits its value and detracts from the investigation and holistic management of coexisting fatty liver in patients with viral hepatitis. Third, fatty liver-associated hepatocellular carcinoma (HCC) is generally categorized as non-B non-C HCC. Fourth, the population is aging rapidly, and it is imperative to develop a practicable, low-intensity exercise program for elderly patients. Fifth, most patients and nonspecialized healthcare professionals still lack an awareness of the significance of fatty liver both in terms of intrahepatic and extrahepatic disease and cancer. Recently, an international expert panel proposed a new definition of fatty liver: metabolic dysfunction-associated fatty liver disease (MAFLD). One feature of MAFLD is that metabolic dysfunction is a prerequisite for diagnosis. Pertinent to regional issues, MAFLD also provides its diagnostic criteria in lean/normal-weight individuals. Furthermore, MAFLD is independent of any concomitant liver disease, including viral hepatitis. Therefore, MAFLD may be a more suitable definition for fatty liver in the Asia-Pacific region. In this review, we introduce the regional characteristics of fatty liver and discuss the advantages of MAFLD for improving clinical practice for liver disease in the region.

Key Points The prevalence of obesity has increased in most of the world over the past few decades Patients with obesity have more cardiovascular and metabolic risk factors than people of normal weight and have an increased risk of developing cardiovascular diseases Data suggest that metabolically healthy obesity, especially when combined with a high level of fitness, is associated with at most a minimal increase in overall risk of cardiovascular diseases and mortality In patients with established cardiovascular diseases and other chronic conditions (kidney disease, severe arthritis), those with overweight and class I obesity have a better prognosis than lean patients—the 'obesity paradox' Fitness is more important than fatness for long-term prognosis; in the obesity paradox, fitness markedly alters the relationship between adiposity and long-term health outcomes Despite accumulating evidence on the obesity paradox, the available data still support purposeful weight loss for long-term health, particularly when combined with increased physical activity, muscular strength and fitness The prevalence of obesity has increased to epidemic proportions. In the past few years, whether patients with obesity can be metabolically healthy has been debated. This Review discusses the controversy regarding metabolically healthy obesity, as well as the debate regarding the relative importance of fatness versus fitness for overall, and particularly cardiovascular, health. Overweight and obesity have reached epidemic proportions in the USA and most of the rest of the world. Particularly concerning is the very high prevalence of class III obesity (BMI ≥40 kg/m 2 ), which has reached ∼3% in the USA. In the past few years, controversy has surrounded the idea that some individuals with obesity can be considered healthy with regards to their metabolic and cardiorespiratory fitness, which has been termed the 'obesity paradox'. These controversies are reviewed in detail here, including discussion of the very favourable prognosis in patients with obesity who have no notable metabolic abnormalities and who have preserved fitness. The article also discusses the suggestion that greater emphasis should be placed on improving fitness rather than weight loss per se in the primary and secondary prevention of cardiovascular diseases, at least in patients with overweight and class I obesity (BMI 30–35 kg/m 2 ).

Background The existing epidemiological data cannot represent the situation of undernutrition among Chinese children, particularly those in rural China. Hence, in this community-based cross-sectional study, the prevalence and associated factors of stunting, underweight and wasting among children (age < 6 years) from rural Hunan Province were analyzed. Methods Totally 5529 children aged 0 to 71 months and their caregivers were randomly chosen by multistage stratified cluster sampling from 72 villages from rural Hunan, which were distributed in 24 towns of 12 counties. Data about the children and their mothers, caregivers and family conditions was acquired using unified questionnaire, and the length/height and weight of each child were measured using unified instruments. The prevalence of undernutrition among children was evaluated using the length/height for age, weight for age, weight for length/height, and body mass index for age z scores, which were computed according to the 2006 and 2007 WHO Child Growth Standards. Results The prevalence of stunting, underweight, and wasting among the 5529 children were 4.4% (241), 3.9% (217), and 4.0% (221), respectively. The significant associated factors on higher risks of undernutrition in the children were low birth weight, maternal gestational weight gain <10 kg (stunting); low birth weight, maternal gestational weight gain <10 kg, ethnicity of caregivers being minority, large family size (underweight); low birth weight, ethnicity of caregivers being minority, large family size (wasting). High education level of caregivers and high family food expenditure were common protective factors for all three types of undernutrition, except that high family food expenditure was not protective against wasting. Conclusions The prevalence of stunting, underweight and wasting is low among rural children under age of 6 years in Hunan. As for the measures, the gestational care and reasonable diet of mothers should be strengthened, and nutritional deficiency during pregnancy be avoided, which will prevent low birth weight. The local economic development and the education level of caregivers need to be further improved, especially for minorities.

Global epidemiological transition across various countries have documented the coexistence of undernutrition and overnutrition. South Asian countries are facing this public health hazard in remarkable manner. To enrich the evidence and relation with women's health in the Maldives, this study was undertaken to examine the prevalence and associated factors of underweight, overweight and obesity among reproductive age women. This study was conducted utilizing data from the Maldives Demographic and Health Survey 2016-17. After presenting descriptive analyses, multivariable logistic regression analysis method was used to examine the prevalence and associations between different nutritional status categories. These were grouped based on the WHO recommended cut-off value and relevant socio-demographic determinants among reproductive age women. A total weighted sample of 6,634 reproductive age Maldivian women (15-49 years) were included in the analysis. The overall prevalence of overweight and obesity was 63%, while the underweight prevalence was 10%. The younger age group (15-24 years) had a higher prevalence of underweight (26%). On the other hand, an overweight and obesity prevalence of 82.6% was observed among the older age group (35-49 years). Regression analysis showed that residents of the North and Central Provinces, those in the higher quintiles of wealth index, married women and those with parity of more than two children, were all significantly negatively correlated to being underweight. Increased age, being married or separated/divorced/widowed and having more than three children was found to have a significant positive association with overweight and obesity. Maldives is facing nutritional transition and a major public health hazard demonstrated by the high burden of overweight and obesity and persistence of chronic problem of undernutrition. Surveillance of vulnerable individuals with identified socio-demographic factors and cost-effective interventions are highly recommended to address the persistent underweight status and the emerging problem of overweight/obesity.