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

Bioelectrical impedance outperforms waist circumference for predicting cardiometabolic risk in Congolese hypertensive subjects: a cross-sectional study.

BACKGROUND: Waist circumference threshold values used in sub-Saharan Africa correspond to those of European populations and are therefore inappropriate. Thus, they may over predict insulin resistance, especially in hypertensive Africans, in whom there is often no association between blood pressure and insulin resistance. Using bioelectrical impedance measurement in sub-Saharan Africa could possibly be advantageous to overcome the shortcomings of waist circumference measurement. The aim of this study was to evaluate the contribution of body composition estimation by bioelectrical impedance to predict cardiometabolic risk in Congolese hypertensive subjects. METHODS: Cardiovascular profiling and body composition analysis by bioelectrical impedance was measured in 400 patients (men = 40%; age = 51.1 ± 12.6 years). Patients were diagnosed with a metabolic syndrome (MS) according to the IDF Criteria with and without the "blood pressure" criterion to remove any confounding autocorrelation bias, a visceral fat-MS (with and without the "blood pressure" criterion) being defined by the presence of ≥ 2 criteria with the precondition of excess visceral fat defined by a bio impedance measurement score >10/30. Total cardiovascular risk was assessed using the criteria of Framingham-2008. RESULTS: The frequencies of enlarged waist circumference (71.9% vs 68.9%, p = 0.52) and IDF-MS without blood pressure criterion (24.9% vs 21.9%, p = 0.48) were similar among hypertensive vs. non hypertensive however excess visceral fat (57.6% vs 33.8%, p 0.05). CONCLUSIONS: Pending the determination of thresholds values for pathological waist circumference adapted to sub-Saharan populations, using bioelectrical impedance measurement may contribute to better characterize the cardiometabolic risk and the insulin resistant phenotype of hypertensive sub-Saharan Africans

The trend in blood pressure and hypertension prevalence in the general population of South Kivu between 2012 and 2016: Results from two representative cross-sectional surveys-The Bukavu observational study.

ObjectiveData on blood pressure trends are scarce or unavailable in Sub-Saharan Africa in general and especially in the Democratic Republic of the Congo. This work addresses this gap by analyzing the dynamics in the prevalence and control of hypertension in a cohort of Congolese adults in South Kivu.MethodsTwo phases of data collection were conducted including a baseline at the beginning in 2012 and a follow up in 2016. The subjects were ≥ 18 years old living in urban (n = 4413) or rural areas (n = 6453). Hypertension was defined as a blood pressure ≥ 140/90 mmHg and/or taking antihypertensive medications. The crude prevalence of hypertension was age-adjusted to the WHO population.ResultsBetween 2012 and 2016, there was a significant increase in blood pressure (+2.5/+1.4 mmHg; p = 0.001), age standardized prevalence of hypertension [19.0% vs. 18.0%; OR = 1.05 (1.02-1.08); p 60 years old (8.8% to 11.3%; pConclusionThere was an increase in the prevalence of hypertension as well as cardiovascular-associated risk factors in the population. However, this trend did not increase for treated subjects with no improvements in the level of AHT control. Therefore, improved strategies for the prevention and management of non-communicable diseases are very important in Sub-Saharan Africa

Ferroportin Q248H mutation, hyperferritinemia and atypical type 2 diabetes mellitus in South Kivu

Background: The ferroportin Q248H mutation is relatively common in sub-Saharan Africa. No previous study examined its relationship with atypical diabetes mellitus (DM) in this area. Objective: To determine the potential interactions between ferroportin Q248H mutation, hyperferritinemia and DM in South Kivu (RDC). Methodology: Presence of ferroportin Q248H mutation and iron status were investigated in diabetic patients (n = 179, age (mean) 57.7 years, CRP (median) 0.16 mg/L) and non-diabetic subjects (n = 86, age 44.5 years, CRP 0.07 mg/L) living in the city of Bukavu. Hyperferritinemia was considered for values greater than 200 and 300 μg/L in women and in men, respectively. Results: The prevalence of ferroportin Q248H mutation [12.1%] was non-significantly higher in diabetics than non-diabetics [14.0% vs. 8.1%, p = 0.17]. Similarly, hyperferritinemia frequency was higher in diabetic patients with Q248H mutation [44.0% vs. 14.3%, p = 0.16] and in mutation carriers [37.0% vs 16.5%, p = 0.001] than in the control groups, respectively. The association between Q248H mutation and DM was nevertheless not significant [adjusted OR 1.70 (95% CI: 0.52-5.58), p = 0.37], whereas hyperferritinemia [OR 2.72 (1.24-5.98), p = 0.01] showed an independent effect after adjustment for age and metabolic syndrome. Conclusions: The present work suggests a potential association between abnormal iron metabolism, ferroportin Q248H mutation and atypical DM in Africans, which may be modulated by environmental factors. © 2013 Diabetes India. Published by Elsevier Ltd. All rights reserved

Age and living in an urban environment are major determinants of diabetes among South Kivu Congolese adults

OBJECTIVES: This study aimed to determine the risk factors for diabetes mellitus (DM) in the eastern part of the Democratic Republic of Congo. METHODOLOGY: Multilevel sampling identified 200 households (444 adults aged ≥ 20 years) from 20 neighbourhoods in the city of Bukavu, and 90 households (255 adults aged ≥ 20 years) from 10 villages in the Kaziba (South Kivu) chiefdom (the South Kivu VITARAA study). DM was defined as a personal history of the disorder or a casual glycaemia greater or equal to 200 mg/dL. Standardization according to age and sample readjustment based on the urban-rural distribution of the population was applied accordance with the typical Congolese population. The probability of DM was assessed by multiple logistic regressions. RESULTS: Total prevalence of DM was 3.5%. DM was significantly more prevalent in urban areas (age-standardized prevalence: 4.0%) than in rural areas (1.7%). City-dwelling DM patients were characterized by higher rates of indices of abdominal obesity (P < 0.05) whereas, in rural areas, no patients were obese. In the study group as a whole, only 25.0% of diabetic patients were obese. On multivariate analyses, only age [adjusted OR (95% CI): 4.79 (1.60-14.25); P = 0.004] was independently associated with the prevalence of DM, while the effect of obesity was not significant [2.64 (0.99-7.02); P = 0.051]. CONCLUSION: Age and living in an urban environment appeared to be major determinants of DM in South Kivu. Also, obesity prevalence was relatively low in these diabetic patients, confirming the peculiar, relatively lean, phenotype of type 2 DM in indigenous sub-Saharan African

Hypertension, insulin resistance and chronic kidney disease in type 2 diabetes patients from South Kivu, DR Congo

Objectif : Évaluer la fréquence et les déterminants de l’hypertension artérielle dans un groupe de diabétiques de race noire habitant l’Est de la République Démocratique du Congo. Méthodologie : Les dossiers de 98 patients diabétiques suivis à l’hôpital général de référence de Bukavu entre 2005 et 2007 ont été analysés. L’hypertension artérielle était définie par une pression artérielle supérieure ou égale à 140/90 mmHg et l’insulinosensibilité (HOMA S) déterminée à partir du modèle HOMA (insulinorésistance (IR), définine par HOMA S < 50 %). Les patients ont été phénotypés sur le plan cardiométabolique selon les critères non-tensionnels du syndrome métabolique. La probabilité de l’hypertension artérielle a été modélisée par régression logistique multiple. Résultats : La présente étude note une prévalence élevée de l’hypertension artérielle (59,6 %) et de la maladie rénale chronique (66 %) contrastant avec une fréquence faible de l’insulinorésistance (5,2 %) et de l’obésité (18,6 %). De plus, l’hypertension artérielle n’était pas corrélée à l’insulinorésistance [régression de PAS par %S : coefficient de régression (IC à 95 %) par %, 0,007 (−0,090–0,104) mmHg ; coefficient de corrélation, 0,00 ; p = 0,89], [régression de PAD par %S :−0,004 (−0,053–0,045) mmHg ; 0,00 ; 0,87], de même qu’il n’y avait pas de différence quant à la fréquence du syndrome métabolique modifié entre les hypertendus et les non hypertendus [38,6 % versus 33,3 % ; p = 0,60]. En analyse multivariée, l’excès pondéral [OR ajusté=3,20 (IC à 95 % :1,19–8,61) ; p = 0,02] et la MRC [2,49 (0,98–6,34 ; 0,05] étaient retrouvés comme déterminants majeurs de l’hypertension artérielle. Conclusion : Le syndrome métabolique est faiblement prédictif d’insulinorésistance absolue dans une population de diabétiques de type 2 au sein de laquelle la fréquence d’hypertension artérielle est élevée et celle de l’insulinorésistance basse. L’excès pondéral indépendamment de l‘insulinorésistance et la maladie rénale chronique fréquente chez les diabétiques du type 2 en Afrique sub-saharienne chez lesquels la maladie est mal contrôlée pourraient jouer un rôle majeur dans le déterminisme de l’hypertension artérielle.Objective: To assess the frequency and determinants of high blood pressure (HBP) in a group of type 2 black diabetics living in the east of Democratic Republic of Congo. Methodology: The medical records of 98 diabetic patients followed at the General Reference Hospital in Bukavu between 2005 and 2007 were collected and analyzed. Hypertension was defined as blood pressure ≥ 140/90 mmHg. Insulin sensitivity (HOMA S; %) was determined with the HOMA model, with insulin resistance (IR) representing HOMA S-1 and defined from HOMA S values < 50%). Patients were phenotyped regarding their cardiometabolic profile using metabolic syndrome criteria (minus that for HBP). The probability of hypertension was assessed by multiple logistic regression. Results: There was an overall high prevalence of HBP (59.6%) and of chronic kidney disease (66%) contrasting with a low frequency of insulin resistance (5.2%) and obesity (18.6%). In addition, hypertension was not associated with insulin resistance [regression of SBP by % S: regression coefficient, 0.007 (-0.090-0.104) mmHg; correlation coefficient, 0.00; p = 0.89], [regression of DBP by % S: -0.004 (-0.053-0.045) mmHg; 0.00; 0.87]. There was no significant difference in prevalence of metabolic syndrome changed between hypertensive and normotensive patients [38.6% versus 33.3%, p = 0.60]. In multivariate analysis, overweight [OR adjusted = 3.20 (95%: 1.19-8.61), p = 0.02] and CKD [2.49 (0,98-6.34; 0.05] were found as major determinants of hypertension. Conclusion: The metabolic syndrome is poorly predictive of an absolute decrease in insulin sensitivity in a type 2 diabetes population, in which the prevalence of hypertension was high, and that of insulin resistance low. Overweight independently of insulin resistance and chronic kidney disease common in type 2 diabetes in Sub-Saharan Africa in which the disease is poorly controlled may play a major role in the determinism of hypertensio

Rationale and design of the Newer Versus Older Antihypertensive Agents in African Hypertensive Patients (NOAAH) trial

Abstract Background. Sub-Saharan Africa experiences an epidemic surge in hypertension. Studies in African Americans led to the recommendation to initiate antihypertensive treatment in Blacks with a diuretic or a low-dose fixed combination including a diuretic. We mounted the Newer versus Older Antihypertensive Agents in African Hypertensive Patients (NOAAH) trial to compare in native African patients a fixed combination of newer drugs, not involving a diuretic, with a combination of older drugs including a diuretic. Methods. Patients aged 30-69 years with uncomplicated hypertension (140-179/90-109 mmHg) and two or fewer associated risk factors are eligible. After a 4-week run-in period off treatment, 180 patients will be randomized to once daily bisoprolol/hydrochlorothiazide 5/6.25 mg or amlodipine/valsartan 5/160 mg. To attain and maintain blood pressure below 140/90 mmHg during 6 months of follow-up, the doses of bisoprolol and amlodipine in the combination tablets will be increased to 10 mg/day with the possible addition of α-methyldopa or hydralazine. NOAAH is powered to demonstrate a 5-mmHg between-group difference in sitting systolic pressure with a two-sided p-value of 0.01 and 90% power. NOAAH is investigator-led and complies with the Helsinki declaration. Results. Six centers in four sub-Saharan countries started patient recruitment on September 1, 2010. On December 1, 195 patients were screened, 171 were enrolled, and 51 were randomized and followed up. The trial will be completed in the third quarter of 2011. Conclusions. NOAAH (NCT01030458) is the first randomized multicenter trial of antihypertensive medications in hypertensive patients born and living in sub-Saharan Africa.status: publishe

Progress report on the first sub-Saharan trial of newer versus older antihypertensive drugs in native black patients

ABSTRACT: BACKGROUND: The epidemic surge in hypertension in sub-Saharan Africa is not matched by clinical trials of antihypertensive agents in Black patients recruited in this area of the world. We mounted the Newer versus Older Antihypertensive agents in African Hypertensive patients (NOAAH) trial to compare, in native African patients, a single-pill combination of newer drugs, not involving a diuretic, with a combination of older drugs including a diuretic. METHODS: Patients aged 30 to 69 years with uncomplicated hypertension (140 to 179/90 to 109 mmHg) and [less than or equal to]2 associated risk factors are eligible. After a four week run-in period off treatment, 180 patients have to be randomized to once daily bisoprolol/hydrochlorothiazide 5/6.25 mg (R) or amlodipine/valsartan 5/160 mg (E). To attain blood pressure 65% already at two weeks. At 12 weeks, 12 patients (24.5%) had progressed to the higher dose of R or E and/or had alpha-methyldopa added. Cohort analyses of 49 patients up to 12 weeks were confirmatory. Only two patients dropped out of the study. CONCLUSIONS: NOAAH (NCT01030458) demonstrated that blood pressure control can be achieved fast in Black patients born and living in Africa with a simple regimen consisting of a single-pill combination of two antihypertensive agents. NOAAH proves that randomized clinical trials of cardiovascular drugs in the indigenous populations of sub-Saharan Africa are feasible.status: publishe