Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For schoolaged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit

Worldwide trends in underweight and obesity from 1990 to 2022 : a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

A list of authors and their affiliations appears online. A supplementary appendix is herewith attached.Background: Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods: We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI 2 SD above the median). Findings: From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation: The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity.peer-reviewe

Comparative Characteristics of Physical Development of Schoolchildren in Moscow and Kiev

The aim of this study was to find peculiarities in processes of growth and development of the child and adolescent in different megalopolises, Moscow and Kiev, on the background of various social and economic changes in society and standards of living of the child population. Comparison analysis of physical development of Moscow and Kiev children did not show statistically significant differences in body length except in boys aged between 10 and 16 years and in girls aged between 12 and 17 years. The changes in physical development of Kiev children demonstrate a domination of gracilization, accompanied by significant low values of body mass with high values of body length, especially in girls. The study showed that modern adolescents of both cities exceed their peers from previous generation in body length. Chest circumference in all ages of both sexes and body mass starting from 10 years of age were higher in adolescents from Moscow. We found a negative trend to the increase in the number of overweight Moscow children in the studied dynamics

A Study of the Effects of a Diet with Functional Foods on the Adaptogenicity of First-Year Students to the Student Lifestyle

Background: The period of rapid transition from school to university is associated with a complex of negative stress factors caused by social and professional adaptation, irregular daily routine, sleep, and nutrition. During this period, the inclusion of functional foods in students’ diets has an increasingly beneficial effect on their health. This study aimed to evaluate the impact of diets with functional foods (vegetable and protein–vegetable) on health indicators while minimizing the negative impact of adaptation and acclimatization on the body of first-year university students at the start of their studies. Materials and Methods: A total of 150 first-year students were randomly selected. Biochemical tests, enzyme immunoassays, and analyses of serum immunoglobulin levels and mineral and vitamin content in first-year students’ blood were performed. Results and discussion: Protein–vegetable products are more potent compared to plant-based ones in increasing the body’s natural resistance to all types of stress due to their high protein content. The other functional product had a higher content of carbohydrates. In addition, they differed in the content of minerals and vitamins. Conclusions: The importance of a rational diet increases exponentially during the period of adaptation and acclimatization when the emotional, mental, and physical workload increases

The health of children and adolescents in school ontogenesis as a basis for improving the system of school health care and sanitary-epidemiological wellbeing of students

Introduction. Against the background of socio-economic transformations and the digitalization of education, the health indicators of students are changing, which requires in-depth research. Aim of the study: based on the longitudinal observation of the health of schoolchildren, to identify the patterns of its formation for the scientific justification of improving the medical care of students. Material and methods. From the 1st to the 11a grade (2005-2015), the same students (199 boys and 227 girls) of 4 Moscow schools were examined annually with the performance of anthropometry, electrocardiography, functional tests, and questionnaire to identify complaints and anamnesis; specialist doctors carried out 25,298 examinations. In addition to the analysis of morbidity, a qualitative analysis of the course of pathological processes in students was carried out to determine positive and negative dynamics. Results. Over 11 years, the prevalence of functional disorders increased by 14.7%, chronic diseases by 52.8%, the frequency of visual disturbances, diseases of the musculoskeletal system, digestive organs, neurotic reactions increased; new forms of risk behaviour and information dependence appeared. An unfavourable period of development of pathological processes in schoolchildren is training in grades 9-11. Compared with the 1990 morbidity rates obtained by similar methods, there was an increase in the prevalence of functional disorders among adolescents by 2-3 times and chronic diseases by 20-70%. When comparing physical development with peers of the second half of the XX century, the observed schoolchildren increased the average values of body length and weight with a decrease in functional indicators. Distance learning during the first wave of COVID-19 in spring 2020 has increased the prevalence of computer vision, carpal tunnel syndromes, and neurotic reactions. Discussion. The main patterns of health formation in school ontogenesis, coinciding with the change of generations and the transition to the digitalization of education, are revealed. Conclusion. The study results allow predicting an increase in the prevalence of neuropsychiatric disorders, myopia, scoliosis, computer-visual and carpal tunnel syndromes. To preserve students’ health, to counteract COVID-19, a modern model of school health care is proposed.</jats:p

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background: Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods: We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5-19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI &lt;18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For school-aged children and adolescents, we report thinness (BMI &lt;2 SD below the median of the WHO growth reference) and obesity (BMI &gt;2 SD above the median). Findings: From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation: The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity. Funding: UK Medical Research Council, UK Research and Innovation (Research England), UK Research and Innovation (Innovate UK), and European Union

Worldwide trends in underweight and obesity from 1990 to 2022 : a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age =20 years) and school-aged children and adolescents (age 5-19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI = 30 kg/m(2)). For school-aged children and adolescents, we report thinness (BMI 2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries ( 6%) for women and 17 (9%) for men with a posterior probability of at least 0 center dot 80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries ( 70%) for men with a posterior probability of at least 0 center dot 80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0 center dot 80 in 177 countries (89%) for women and 145 ( 73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries ( 8%) with a posterior probability of at least 0 center dot 80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0 center dot 80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0 center dot 80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity.Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age =20 years) and school-aged children and adolescents (age 5-19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI = 30 kg/m(2)). For school-aged children and adolescents, we report thinness (BMI 2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries ( 6%) for women and 17 (9%) for men with a posterior probability of at least 0 center dot 80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries ( 70%) for men with a posterior probability of at least 0 center dot 80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0 center dot 80 in 177 countries (89%) for women and 145 ( 73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries ( 8%) with a posterior probability of at least 0 center dot 80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0 center dot 80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0 center dot 80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity.A

Diminishing benefits of urban living for children and adolescents’ growth and development

AbstractOptimal 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 &lt;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.</jats:p

Diminishing benefits of urban living for children and adolescents’ growth and development

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

General and abdominal adiposity and hypertension in eight world regions : a pooled analysis of 837 population-based studies with 7·5 million participants

Background Adiposity can be measured using BMI (which is based on weight and height) as well as indices ofabdominal adiposity. We examined the association between BMI and waist-to-height ratio (WHtR) within and acrosspopulations of different world regions and quantified how well these two metrics discriminate between people withand without hypertension.Methods We used data from studies carried out from 1990 to 2023 on BMI, WHtR and hypertension in people aged20–64 years in representative samples of the general population in eight world regions. We graphically compared theregional distributions of BMI and WHtR, and calculated Pearson’s correlation coefficients between BMI and WHtRwithin each region. We used mixed-effects linear regression to estimate the extent to which WHtR varies acrossregions at the same BMI. We graphically examined the prevalence of hypertension and the distribution of people whohave hypertension both in relation to BMI and WHtR, and we assessed how closely BMI and WHtR discriminatebetween participants with and without hypertension using C-statistic and net reclassification improvement (NRI).Findings The correlation between BMI and WHtR ranged from 0·76 to 0·89 within different regions. After adjustingfor age and BMI, mean WHtR was highest in south Asia for both sexes, followed by Latin America and the Caribbeanand the region of central Asia, Middle East and north Africa. Mean WHtR was lowest in central and eastern Europefor both sexes, in the high-income western region for women, and in Oceania for men. Conversely, to achieve anequivalent WHtR, the BMI of the population of south Asia would need to be, on average, 2·79 kg/m² (95% CI2·31–3·28) lower for women and 1·28 kg/m² (1·02–1·54) lower for men than in the high-income western region. Inevery region, hypertension prevalence increased with both BMI and WHtR. Models with either of these two adipositymetrics had virtually identical C-statistics and NRIs for every region and sex, with C-statistics ranging from0·72 to 0·81 and NRIs ranging from 0·34 to 0·57 in different region and sex combinations. When both BMI andWHtR were used, performance improved only slightly compared with using either adiposity measure alone.Interpretation BMI can distinguish young and middle-aged adults with higher versus lower amounts of abdominaladiposity with moderate-to-high accuracy, and both BMI and WHtR distinguish people with or without hypertension.However, at the same BMI level, people in south Asia, Latin America and the Caribbean, and the region of centralAsia, Middle East and north Africa, have higher WHtR than in the other regions.Background Adiposity can be measured using BMI (which is based on weight and height) as well as indices ofabdominal adiposity. We examined the association between BMI and waist-to-height ratio (WHtR) within and acrosspopulations of different world regions and quantified how well these two metrics discriminate between people withand without hypertension.Methods We used data from studies carried out from 1990 to 2023 on BMI, WHtR and hypertension in people aged20–64 years in representative samples of the general population in eight world regions. We graphically compared theregional distributions of BMI and WHtR, and calculated Pearson’s correlation coefficients between BMI and WHtRwithin each region. We used mixed-effects linear regression to estimate the extent to which WHtR varies acrossregions at the same BMI. We graphically examined the prevalence of hypertension and the distribution of people whohave hypertension both in relation to BMI and WHtR, and we assessed how closely BMI and WHtR discriminatebetween participants with and without hypertension using C-statistic and net reclassification improvement (NRI).Findings The correlation between BMI and WHtR ranged from 0·76 to 0·89 within different regions. After adjustingfor age and BMI, mean WHtR was highest in south Asia for both sexes, followed by Latin America and the Caribbeanand the region of central Asia, Middle East and north Africa. Mean WHtR was lowest in central and eastern Europefor both sexes, in the high-income western region for women, and in Oceania for men. Conversely, to achieve anequivalent WHtR, the BMI of the population of south Asia would need to be, on average, 2·79 kg/m² (95% CI2·31–3·28) lower for women and 1·28 kg/m² (1·02–1·54) lower for men than in the high-income western region. Inevery region, hypertension prevalence increased with both BMI and WHtR. Models with either of these two adipositymetrics had virtually identical C-statistics and NRIs for every region and sex, with C-statistics ranging from0·72 to 0·81 and NRIs ranging from 0·34 to 0·57 in different region and sex combinations. When both BMI andWHtR were used, performance improved only slightly compared with using either adiposity measure alone.Interpretation BMI can distinguish young and middle-aged adults with higher versus lower amounts of abdominaladiposity with moderate-to-high accuracy, and both BMI and WHtR distinguish people with or without hypertension.However, at the same BMI level, people in south Asia, Latin America and the Caribbean, and the region of centralAsia, Middle East and north Africa, have higher WHtR than in the other regions.A