Imperial College London


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NCD Risk Factor Collaboration NCD-RisC, Iurilli N, 2021, Heterogeneous contributions of change in population distribution of body-mass index to change in obesity and underweight, eLife, Vol: 10, ISSN: 2050-084X

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions.

Journal article

Rodriguez-Martinez A, Zhou B, Sophiea MK, Bentham J, Paciorek CJ, Iurilli ML, Carrillo-Larco RM, Bennett JE, Di Cesare M, Taddei C, Bixby H, Stevens GA, Riley LM, Cowan MJ, Savin S, Danaei G, Chirita-Emandi A, Kengne AP, Khang YH, Laxmaiah A, Malekzadeh R, Miranda JJ, Moon JS, Popovic SR, Sørensen TI, Soric M, Starc G, Zainuddin AA, Gregg EW, Bhutta ZA, Black R, Abarca-Gómez L, Abdeen ZA, Abdrakhmanova S, Abdul Ghaffar S, Abdul Rahim HF, Abu-Rmeileh NM, Abubakar Garba J, Acosta-Cazares B, Adams RJ, Aekplakorn W, Afsana K, Afzal S, Agdeppa IA, Aghazadeh-Attari J, Aguilar-Salinas CA, Agyemang C, Ahmad MH, Ahmad NA, Ahmadi A, Ahmadi N, Ahmed SH, Ahrens W, Aitmurzaeva G, Ajlouni K, Al-Hazzaa HM, Al-Othman AR, Al-Raddadi R, Alarouj M, AlBuhairan F, AlDhukair S, Ali MM, Alkandari A, Alkerwi A, Allin K, Alvarez-Pedrerol M, Aly E, Amarapurkar DN, Amiri P, Amougou N, Amouyel P, Andersen LB, Anderssen SA, Ängquist L, Anjana RM, Ansari-Moghaddam A, Aounallah-Skhiri H, Araújo J, Ariansen I, Aris T, Arku RE, Arlappa N, Aryal KK, Aspelund T, Assah FK, Assunção MCF, Aung MS, Auvinen J, Avdicová M, Azevedo A, Azimi-Nezhad M, Azizi F, Azmin M, Babu BV, Bæksgaard Jørgensen M, Baharudin A, Bahijri S, Baker JL, Balakrishna N, Bamoshmoosh Met al., 2020, Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants, The Lancet, Vol: 396, Pages: 1511-1524, ISSN: 0140-6736

SummaryBackgroundComparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents.MethodsFor this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence.FindingsWe pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became

Journal article

NCD Risk Factor Collaboration NCD-RisC, 2020, Repositioning of the global epicentre of non-optimal cholesterol, Nature, Vol: 582, Pages: 73-77, ISSN: 0028-0836

High blood cholesterol is typically considered a feature of wealthy western countries1,2. However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world3 and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health4,5. However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol-which is a marker of cardiovascular risk-changed from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million-4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and per

Journal article

Taddei C, Jackson R, Zhou B, Bixby H, Danaei G, Di Cesare M, Kuulasmaa K, Hajifathalian K, Bentham J, Bennett JE, Aekplakorn W, Cifkova R, Dallongeville J, De Bacquer D, Giampaoli S, Gudnason V, Khang Y-H, Laatikainen T, Mann JI, Marques-Vidal P, Mensah GA, Müller-Nurasyid M, Ninomiya T, Petkeviciene J, Rodríguez-Artalejo F, Servais J, Söderberg S, Stavreski B, Wilsgaard T, Zdrojewski T, Zhao D, Stevens GA, Savin S, Cowan MJ, Riley LM, Ezzati Met al., 2020, National trends in total cholesterol obscure heterogeneous changes in HDL and non-HDL cholesterol and total-to-HDL cholesterol ratio: an analysis of trends in Asian and Western countries, International Journal of Epidemiology, Vol: 49, Pages: 173-192, ISSN: 1464-3685

Background: Although high-density lipoprotein (HDL) and non-HDL cholesterol have opposite associations with coronary heart disease (CHD), multi-country reports of lipid trends only use total cholesterol (TC). Our aim was to compare trends in total, HDL and non-HDL cholesterol and total-to-HDL cholesterol ratio in Asian and Western countries.Methods: We pooled 458 population-based studies with 82.1 million participants in 23 Asian and Western countries. We estimated changes in mean total, HDL and non-HDL cholesterol, and mean total-to-HDL cholesterol ratio by country, sex and age group.Results: Since ~1980, mean TC increased in Asian countries. In Japan and South Korea, TC rise was due to rising HDL cholesterol, which increased by up to 0.17 mmol/L per decade in Japanese women; in China, it was due to rising non-HDL cholesterol. TC declined in Western countries, except in Polish men. The decline was largest in Finland and Norway, ~0.4 mmol/Lper decade. The decline in TC in most Western countries was the net effect of an increase in HDL cholesterol and a decline in non-HDL cholesterol, with the HDL cholesterol increase largest in New Zealand and Switzerland. Mean total-to-HDL cholesterol ratio declined in Japan, South Korea and most Western countries, by as much as ~0.7 per decade in Swiss men (equivalent to ~26% decline in CHD risk per decade). The ratio increased in China. Conclusions: HDL cholesterol has risen and total-to-HDL cholesterol ratio has declined in many Western countries, Japan and South Korea, with only weak correlation to changes in TC or non-HDL cholesterol.

Journal article

Jaime Miranda J, Carrillo-Larco RM, Ferreccio C, Hambleton IR, Lotufo PA, Nieto-Martinez R, Zhou B, Bentham J, Bixby H, Hajifathalian K, Lu Y, Taddei C, Abarca-Gomez L, Acosta-Cazares B, Aguilar-Salinas CA, Andrade DS, Assuncao MCF, Barcelo A, Barros AJD, Barros MVG, Bata I, Batista RL, Benet M, Bernabe-Ortiz A, Bettiol H, Boggia JG, Boissonnet CP, Brewster LM, Cameron C, Candido APC, Cardoso VC, Chan Q, Christofaro DG, Confortin SC, Craig CL, d'Orsi E, Delisle H, de Oliveira PD, Dias-da-Costa JS, Diaz A, Donoso SP, Elliott P, Escobedo-de la Pena J, Ferguson TS, Fernandes RA, Ferrante D, Monterubio Flores E, Francis DK, Franco MDC, Fuchs FD, Fuchs SC, Goltzman D, Goncalves H, Gonzalez-Rivas JP, Bonet Gorbea M, Gregor RD, Guerrero R, Guimaraes AL, Gulliford MC, Gutierrez L, Hernandez Cadena L, Herrera VM, Hopman WM, Horimoto ARVR, Hormiga CM, Horta BL, Howitt C, Irazola VE, Magaly Jimenez-Acosta S, Joffres M, Kolsteren P, Landrove O, Li Y, Lilly CL, Fernanda Lima-Costa M, Louzada Strufaldi MW, Machado-Coelho GLL, Makdisse M, Margozzini P, Marques LP, Martorell R, Matijasevich A, Posso AJMD, McFarlane SR, McLean SB, Menezes AMB, Miquel JF, Mohanna S, Monterrubio EA, Moreira LB, Morejon A, Motta J, Neal WA, Nervi F, Noboa OA, Ochoa-Aviles AM, Anselmo Olinto MT, Oliveira IO, Ono LM, Ordunez P, Ortiz AP, Otero JA, Palloni A, Peixoto SV, Pereira AC, Perez CM, Reina DAR, Ribeiro R, Ritti-Dias RM, Rivera JA, Robitaille C, Rodriguez-Villamizar LA, Rojas-Martinez R, Roy JGR, Rubinstein A, Sandra Ruiz-Betancourt B, Salazar Martinez E, Sanchez-Abanto J, Santos IS, dos Santos RN, Scazufca M, Schargrodsky H, Silva AM, Santos Silva DA, Stein AD, Suarez-Medina R, Tarqui-Mamani CB, Tulloch-Reid MK, Ueda P, Ugel EE, Valdivia G, Varona P, Velasquez-Melendez G, Verstraeten R, Victora CG, Wanderley RS, Wang M-D, Wilks RJ, Wong-McClure RA, Younger-Coleman NO, Zuniga Cisneros J, Danaei G, Stevens GA, Riley LM, Ezzati M, Di Cesare Met al., 2020, Trends in cardiometabolic risk factors in the Americas between 1980 and 2014: a pooled analysis of population-based surveys, The Lancet Global Health, Vol: 8, Pages: E123-E133, ISSN: 2214-109X

BackgroundDescribing the prevalence and trends of cardiometabolic risk factors that are associated with non-communicable diseases (NCDs) is crucial for monitoring progress, planning prevention, and providing evidence to support policy efforts. We aimed to analyse the transition in body-mass index (BMI), obesity, blood pressure, raised blood pressure, and diabetes in the Americas, between 1980 and 2014.MethodsWe did a pooled analysis of population-based studies with data on anthropometric measurements, biomarkers for diabetes, and blood pressure from adults aged 18 years or older. A Bayesian model was used to estimate trends in BMI, raised blood pressure (systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg), and diabetes (fasting plasma glucose ≥7·0 mmol/L, history of diabetes, or diabetes treatment) from 1980 to 2014, in 37 countries and six subregions of the Americas.Findings389 population-based surveys from the Americas were available. Comparing prevalence estimates from 2014 with those of 1980, in the non-English speaking Caribbean subregion, the prevalence of obesity increased from 3·9% (95% CI 2·2–6·3) in 1980, to 18·6% (14·3–23·3) in 2014, in men; and from 12·2% (8·2–17·0) in 1980, to 30·5% (25·7–35·5) in 2014, in women. The English-speaking Caribbean subregion had the largest increase in the prevalence of diabetes, from 5·2% (2·1–10·4) in men and 6·4% (2·6–10·4) in women in 1980, to 11·1% (6·4–17·3) in men and 13·6% (8·2–21·0) in women in 2014). Conversely, the prevalence of raised blood pressure has decreased in all subregions; the largest decrease was found in North America from 27·6% (22·3–33·2) in men and 19·9% (15·8–24·4) in women in 1980, to 15·

Journal article

Zhou B, Danaei G, Stevens GA, Bixby H, Taddei C, Carrillo Larco R, Solomon B, Riley LM, Di Cesare M, Iurilli N, Rodriguez Martinez A, Zhu A, Hajifathalian K, Amuzu A, Banegas JR, Bennett JE, Cameron C, Cho Y, Clarke J, Craig CL, Cruz JJ, Gates L, Giampaoli S, Gregg EW, Hardy R, Hayes AJ, Ikeda N, Jackson RT, Jennings G, Joffres M, Khang Y-H, Koskinen S, Kuh D, Kujala UM, Laatikainen T, Lehtimaki T, Lopez-Garcia E, Lundqvist A, Maggi S, Magliano DJ, Mann JI, McLean RM, McLean SB, Miller JC, Morgan K, Neuhauser HK, Niiranen TJ, Noale M, Oh K, Palmieri L, Panza F, Parnell WR, Peltonen M, Raitakari O, Rodriguez-Artalejo F, Roy JGR, Salomaa V, Sarganas G, Servais J, Shaw JE, Shibuya K, Solfrizzi V, Stavreski B, Tan EJ, Turley ML, Vanuzzo D, Viikari-Juntura E, Weerasekera D, Ezzati Met al., 2019, Long-term and recent trends in hypertension awareness, treatment, and control in 12 high-income countries: an analysis of 123 nationally representative surveys, Lancet, Vol: 394, Pages: 639-651, ISSN: 0140-6736

Background: Antihypertensive medicines are effective in reducing adverse cardiovascular events. Our aim was to compare hypertension awareness, treatment and control, and how they have changed over time, in high-income countries. Methods: We used data on 526,336 participants aged 40-79 years in 123 national health examination surveys from 1976 to 2017 in twelve high-income countries: Australia, Canada, Finland, Germany, Ireland, Italy, Japan, New Zealand, South Korea, Spain, the UK, and the USA. We calculated the percent of participants with hypertension – defined as systolic blood pressure ≥140mmHg or diastolic blood pressure ≥90mmHg or being on pharmacological treatment for hypertension – who were aware of their condition, who were treated, and whose hypertension was controlled (i.e. lower than 140/90 mmHg). Findings: Canada, South Korea, Australia and the UK have the lowest prevalence of hypertension, and Finland the highest. In the 1980s and early 1990s, treatment rates were at most 40% and control rates were below 25% in most countries and age-sex groups. Over time, hypertension awareness and treatment increased and control rate improved in all twelve countries, with South Korea and Germany experiencing the largest improvements. Most of the increase occurred in the 1990s and early-mid 2000s, having plateaued since in most countries.Canada, Germany, South Korea and the USA have the highest rates of awareness, treatment and control, while Finland, Ireland, Japan and Spain the lowest. Even in the best performing countries, treatment coverage was at most 80% and control rates were below 70%. Interpretation: Hypertension awareness, treatment and control have improved substantially in high-income countries since the 1980s and 1990s. However, control rates have plateaued in the past decade, at levels lower than those in high-quality hypertension

Journal article

Bixby H, Bentham J, Zhou B, Di Cesare M, Paciorek CJ, Bennett JE, Taddei C, Stevens GA, Rodriguez-Martinez A, Carrillo-Larco RM, Khang Y-H, Soric M, Gregg E, Miranda JJ, Bhutta ZA, Savin S, Sophiea MK, Iurilli MLC, Solomon BD, Cowan MJ, Riley LM, Danaei G, Bovet P, Christa-Emandi A, Hambleton IR, Hayes AJ, Ikeda N, Kengne AP, Laxmaiah A, Li Y, McGarvey ST, Mostafa A, Neovius M, Starc G, Zainuddin AA, Ezzati Met al., 2019, Rising rural body-mass index is the main driver of the global obesity epidemic, Nature, Vol: 569, Pages: 260-264, ISSN: 0028-0836

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities1,2. This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity3,4,5,6. 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. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing—and in some countries reversal—of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.

Journal article

Zhou B, Bentham J, Di Cesare M, Bixby HRH, Danaei G, Hajifathalian K, Taddei C, Carrillo-Larco R, Khatibzadeh S, Lugero C, Peykari N, Zhang WZ, Bennett J, Bilano V, Stevens G, Riley L, Cowan M, Chen Z, Hambleton I, Jackson RT, Kengne A-P, Khang Y-H, Laxmaiah A, Liu J, Malekzadeh R, Neuhauser H, Soric M, Starc G, Sundstrom J, Woodward M, Ezzati Met al., 2018, Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: a pooled analysis of 1,018 population-based measurement studies with 88.6 million participants, International Journal of Epidemiology, Vol: 47, Pages: 872-883i, ISSN: 1464-3685

BackgroundChange in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure.MethodsWe pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20–29 years to 70–79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probit-transformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure.ResultsIn 2005–16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the high-income Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association.ConclusionsChange in mean bloo

Journal article

NCD Risk Factor Collaboration NCD-RisC, 2017, Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults., Lancet, Vol: 390, Pages: 2627-2642, ISSN: 0140-6736

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/m(2) 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/m(2) per decade (0·69-1·35, PP>0·9999) in central Latin America and an increase of 0·95 kg/m(2) 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/m(2) per decade (-0·33 to 0·49, PP=0·6926) in eastern Europe to an increase of 0·77 kg/m(2) per decade (0·50-1·06, PP>0·9999) in Polynesia and Micronesia. Tre

Journal article

Kenge AP, Bentham J, Zhou B, Bixby H, Taddei C, Chan Q, Elliott P, Ezzati M, Mbanya JCNet al., 2017, Trends in obesity and diabetes across regions in Africa from 1980 to 2014: an analysis of pooled population-based studies., International Journal of Epidemiology, Vol: 46, Pages: 1421-1432, ISSN: 1464-3685

Background: The 2016 Dar Es Salaam Call to Action on Diabetes and other NCDs advocates national multi-sectoral NCD strategies and action plans based on available data and information from countries of sub-Saharan Africa and beyond. We estimated trends, from 1980 to 2014, in age-standardised mean body mass index (BMI) and diabetes prevalence in these countries in order to assess the co-progression and assist policy formulation.Methods: We pooled data from African and world-wide population-based studies which measured height, weight, and biomarkers to assess diabetes status in adults aged >18 years. A Bayesian hierarchical model was used to estimate trends, by sex, for 200 countries and territories including 53 countries across five African regions, (central, eastern, northern, southern and western) in mean BMI and diabetes prevalence (defined as either fasting plasma glucose of >7.0 mmol/L, history of diabetes diagnosis, or use of insulin or oral glucose control agents). ResultsAfrican data came from 245 population-based surveys (1.2 million participants) for BMI and 76 surveys (182 000 participants) for diabetes prevalence estimates. Countries with the highest number of data sources for BMI were South Africa (n=17), Nigeria (n=15) and Egypt (n=13); and for diabetes estimates, Tanzania (n=8), Tunisia (n=7), Cameroon, Egypt and South Africa (all n=6). The age-standardised mean BMI increased from 21.0 kg/m2 (95% credible interval: 20.3-21.7) to 23.0 kg/m2 (22.7-23.3) in men, and from 21.9 kg/m2 (21.3-22.5) to 24.9 kg/m2 (24.6-25.1) in women. The age-standardised prevalence of diabetes increased from 3.4% (1.5-6.3) to 8.5% (6.5-10.8) in men, and from 4.1% (2.0-7.5) to 8.9 % (6.9-11.2) in women. Estimates in northern and southern regions were mostly higher than the global average; those in central, eastern and western regions were lower than global averages. A positive association (correlation coefficient ≃0.9) was observed between mean BMI and diabetes prevalence

Journal article

Zhou B, Lu Y, Hajifathalian K, Bentham J, Di Cesare M, Danaei G, Bixby H, Cowan MJ, Ali MK, Taddei C, Lo W-C, Reis-Santos B, Stevens GA, Riley LM, Miranda JJ, Bjerregaard P, Rivera JA, Fouad HM, Ma G, Mbanya JCN, McGarvey ST, Mohan V, Onat A, Ramachandran A, Ben Romdhane H, Paciorek CJ, Bennett JE, Ezzati M, Abdeen ZA, Kadir KA, Abu-Rmeileh NM, Acosta-Cazares B, Adams R, Aekplakorn W, Aguilar-Salinas CA, Agyemang C, Ahmadvand A, Al-Othman AR, Alkerwi A, Amouyel P, Amuzu A, Andersen LB, Anderssen SA, Anjana RM, Aounallah-Skhiri H, Aris T, Arlappa N, Arveiler D, Assah FK, Avdicova M, Azizi F, Balakrishna N, Bandosz P, Barbagallo CM, Barcelo A, Batieha AM, Baur LA, Ben Romdhane H, Benet M, Bernabe-Ortiz A, Bharadwaj S, Bhargava SK, Bi Y, Bjerregaard P, Bjertness E, Bjertness MB, Bjorkelund C, Blokstra A, Bo S, Boehm BO, Boissonnet CP, Bovet P, Brajkovich I, Breckenkamp J, Brenner H, Brewster LM, Brian GR, Bruno G, Bugge A, Cabrera de Leon A, Can G, Candido APC, Capuano V, Carlsson AC, Carvalho MJ, Casanueva FF, Casas J-P, Caserta CA, Castetbon K, Chamukuttan S, Chaturvedi N, Chen C-J, Chen F, Chen S, Cheng C-Y, Chetrit A, Chiou S-T, Cho Y, Chudek J, Cifkova R, Claessens F, Concin H, Cooper C, Cooper R, Costanzo S, Cottel D, Cowell C, Crujeiras AB, D'Arrigo G, Dallongeville J, Dankner R, Dauchet L, de Gaetano G, De Henauw S, Deepa M, Dehghan A, Deschamps V, Dhana K, Di Castelnuovo AF, Djalalinia S, Doua K, Drygas W, Du Y, Dzerve V, Egbagbe EE, Eggertsen R, El Ati J, Elosua R, Erasmus RT, Erem C, Ergor G, Eriksen L, Escobedo-de la Pena J, Fall CH, Farzadfar F, Felix-Redondo FJ, Ferguson TS, Fernandez-Berges D, Ferrari M, Ferreccio C, Feskens EJM, Finn JD, Foeger B, Foo LH, Forslund A-S, Fouad HM, Francis DK, Franco MDC, Franco OH, Frontera G, Furusawa T, Gaciong Z, Garnett SP, Gaspoz J-M, Gasull M, Gates L, Geleijnse JM, Ghasemian A, Ghimire A, Giampaoli S, Gianfagna F, Giovannelli J, Giwercman A, Gonzalez Gross M, Gonzalez Rivas JP, Bonet Gorbea M, Gottrand F, Grafnetteet al., 2016, Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4·4 million participants, Lancet, Vol: 387, Pages: 1513-1530, ISSN: 1474-547X

BackgroundOne of the global targets for non-communicable diseases is to halt, by 2025, the rise in the age-standardised adult prevalence of diabetes at its 2010 levels. We aimed to estimate worldwide trends in diabetes, how likely it is for countries to achieve the global target, and how changes in prevalence, together with population growth and ageing, are affecting the number of adults with diabetes.MethodsWe pooled data from population-based studies that had collected data on diabetes through measurement of its biomarkers. We used a Bayesian hierarchical model to estimate trends in diabetes prevalence—defined as fasting plasma glucose of 7·0 mmol/L or higher, or history of diagnosis with diabetes, or use of insulin or oral hypoglycaemic drugs—in 200 countries and territories in 21 regions, by sex and from 1980 to 2014. We also calculated the posterior probability of meeting the global diabetes target if post-2000 trends continue.FindingsWe used data from 751 studies including 4 372 000 adults from 146 of the 200 countries we make estimates for. Global age-standardised diabetes prevalence increased from 4·3% (95% credible interval 2·4–7·0) in 1980 to 9·0% (7·2–11·1) in 2014 in men, and from 5·0% (2·9–7·9) to 7·9% (6·4–9·7) in women. The number of adults with diabetes in the world increased from 108 million in 1980 to 422 million in 2014 (28·5% due to the rise in prevalence, 39·7% due to population growth and ageing, and 31·8% due to interaction of these two factors). Age-standardised adult diabetes prevalence in 2014 was lowest in northwestern Europe, and highest in Polynesia and Micronesia, at nearly 25%, followed by Melanesia and the Middle East and north Africa. Between 1980 and 2014 there was little change in age-standardised diabetes prevalence in adult women in continental western Europe, although crude prevalenc

Journal article

Di Cesare M, Bentham J, Stevens GA, Zhou B, Danaei G, Lu Y, Bixby H, Cowan MJ, Riley LM, Hajifathalian K, Fortunato L, Taddei C, Bennett JE, Ikeda N, Khang Y-H, Kyobutungi C, Laxmaiah A, Li Y, Lin H-H, Miranda JJ, Mostafa A, Turley ML, Paciorek CJ, Gunter M, Ezzati M, Abdeen ZA, Hamid ZA, Abu-Rmeileh NM, Acosta-Cazares B, Adams R, Aekplakorn W, Aguilar-Salinas CA, Ahmadvand A, Ahrens W, Ali MM, Alkerwi A, Alvarez-Pedrerol M, Aly E, Amouyel P, Amuzu A, Andersen LB, Anderssen SA, Andrade DS, Anjana RM, Aounallah-Skhiri H, Ariansen I, Aris T, Arlappa N, Arveiler D, Assah FK, Avdicova M, Azizi F, Babu BV, Balakrishna N, Bandosz P, Banegas JR, Barbagallo CM, Barcelo A, Barkat A, Barros MV, Bata I, Batieha AM, Batista RL, Baur LA, Beaglehole R, Ben Romdhane H, Benet M, Bernabe-Ortiz A, Bernotiene G, Bettiol H, Bhagyalaxmi A, Bharadwaj S, Bhargava SK, Bhatti Z, Bhutta ZA, Bi H, Bi Y, Bjerregaard P, Bjertness E, Bjertness MB, Bjorkelund C, Blake M, Blokstra A, Bo S, Bobak M, Boddy LM, Boehm BO, Boeing H, Boissonnet CP, Bongard V, Bovet P, Braeckman L, Bragt MCE, Brajkovich I, Branca F, Breckenkamp J, Brenner H, Brewster LM, Brian GR, Bruno G, Bueno-de-Mesquita HBA, Bugge A, Burns C, Cabrera de Leon A, Cacciottolo J, Cama T, Cameron C, Camolas J, Can G, Candido APC, Capuano V, Cardoso VC, Carvalho MJ, Casanueva FF, Casas J-P, Caserta CA, Castetbon K, Chamukuttan S, Chan AW, Chan Q, Chaturvedi HK, Chaturvedi N, Chen C-J, Chen F, Chen H, Chen S, Chen Z, Cheng C-Y, Chetrit A, Chiolero A, Chiou S-T, Chirita-Emandi A, Cho Y, Christensen K, Chudek J, Cifkova R, Claessens F, Clays E, Concin H, Cooper C, Cooper R, Coppinger TC, Costanzo S, Cottel D, Cowell C, Craig CL, Crujeiras AB, D'Arrigo G, d'Orsi E, Dallongeville J, Damasceno A, Damsgaard CT, Danaei G, Dankner R, Dauchet L, De Backer G, De Bacquer D, de Gaetano G, De Henauw S, De Smedt D, Deepa M, Deev AD, Dehghan A, Delisle H, Delpeuch F, Dhana K, Di Castelnuovo AF, Dias-da-Costa JS, Diaz A, Djalalinia S, Do HTP, Dobson AJ, Doet al., 2016, Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants, Lancet, Vol: 387, Pages: 1377-1396, ISSN: 1474-547X

BackgroundUnderweight and severe and morbid obesity are associated with highly elevated risks of adverse health outcomes. We estimated trends in mean body-mass index (BMI), which characterises its population distribution, and in the prevalences of a complete set of BMI categories for adults in all countries.MethodsWe analysed, with use of a consistent protocol, population-based studies that had measured height and weight in adults aged 18 years and older. We applied a Bayesian hierarchical model to these data to estimate trends from 1975 to 2014 in mean BMI and in the prevalences of BMI categories (<18·5 kg/m2 [underweight], 18·5 kg/m2 to <20 kg/m2, 20 kg/m2 to <25 kg/m2, 25 kg/m2 to <30 kg/m2, 30 kg/m2 to <35 kg/m2, 35 kg/m2 to <40 kg/m2, ≥40 kg/m2 [morbid obesity]), by sex in 200 countries and territories, organised in 21 regions. We calculated the posterior probability of meeting the target of halting by 2025 the rise in obesity at its 2010 levels, if post-2000 trends continue.FindingsWe used 1698 population-based data sources, with more than 19·2 million adult participants (9·9 million men and 9·3 million women) in 186 of 200 countries for which estimates were made. Global age-standardised mean BMI increased from 21·7 kg/m2 (95% credible interval 21·3–22·1) in 1975 to 24·2 kg/m2 (24·0–24·4) in 2014 in men, and from 22·1 kg/m2 (21·7–22·5) in 1975 to 24·4 kg/m2 (24·2–24·6) in 2014 in women. Regional mean BMIs in 2014 for men ranged from 21·4 kg/m2 in central Africa and south Asia to 29·2 kg/m2 (28·6–29·8) in Polynesia and Micronesia; for women the range was from 21·8 kg/m2 (21·4–22·3) in south Asia to 32·2 kg/m2 (31·5–32·8) in Polynesia and Micronesia. Over these four decades, age-standardised global prevalence of un

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