Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

BACKGROUND: Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. METHODS: We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. FINDINGS: The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. INTERPRETATION: Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. FUNDING: WHO

Repositioning of the global epicentre of non-optimal cholesterol

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 personal interventions to improve nutrition and enhance access to treatment throughout the world

Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: a pooled analysis of 1018 population-based measurement studies with 88.6 million participants

Background: Change 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. Methods: We 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 (probittransformed) 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. Results: In 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 highincome 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. Conclusions: Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups

Effects of diabetes definition on global surveillance of diabetes prevalence and diagnosis: a pooled analysis of 96 population-based studies with 331 288 participants.

BACKGROUND: Diabetes has been defined on the basis of different biomarkers, including fasting plasma glucose (FPG), 2-h plasma glucose in an oral glucose tolerance test (2hOGTT), and HbA1c. We assessed the effect of different diagnostic definitions on both the population prevalence of diabetes and the classification of previously undiagnosed individuals as having diabetes versus not having diabetes in a pooled analysis of data from population-based health examination surveys in different regions. METHODS: We used data from 96 population-based health examination surveys that had measured at least two of the biomarkers used for defining diabetes. Diabetes was defined using HbA1c (HbA1c ≥6·5% or history of diabetes diagnosis or using insulin or oral hypoglycaemic drugs) compared with either FPG only or FPG-or-2hOGTT definitions (FPG ≥7·0 mmol/L or 2hOGTT ≥11·1 mmol/L or history of diabetes or using insulin or oral hypoglycaemic drugs). We calculated diabetes prevalence, taking into account complex survey design and survey sample weights. We compared the prevalences of diabetes using different definitions graphically and by regression analyses. We calculated sensitivity and specificity of diabetes diagnosis based on HbA1c compared with diagnosis based on glucose among previously undiagnosed individuals (ie, excluding those with history of diabetes or using insulin or oral hypoglycaemic drugs). We calculated sensitivity and specificity in each survey, and then pooled results using a random-effects model. We assessed the sources of heterogeneity of sensitivity by meta-regressions for study characteristics selected a priori. FINDINGS: Population prevalence of diabetes based on FPG-or-2hOGTT was correlated with prevalence based on FPG alone (r=0·98), but was higher by 2-6 percentage points at different prevalence levels. Prevalence based on HbA1c was lower than prevalence based on FPG in 42·8% of age-sex-survey groups and higher in another 41·6%; in the other 15·6%, the two definitions provided similar prevalence estimates. The variation across studies in the relation between glucose-based and HbA1c-based prevalences was partly related to participants\u27 age, followed by natural logarithm of per person gross domestic product, the year of survey, mean BMI, and whether the survey population was national, subnational, or from specific communities. Diabetes defined as HbA1c 6·5% or more had a pooled sensitivity of 52·8% (95% CI 51·3-54·3%) and a pooled specificity of 99·74% (99·71-99·78%) compared with FPG 7·0 mmol/L or more for diagnosing previously undiagnosed participants; sensitivity compared with diabetes defined based on FPG-or-2hOGTT was 30·5% (28·7-32·3%). None of the preselected study-level characteristics explained the heterogeneity in the sensitivity of HbA1c versus FPG. INTERPRETATION: Different biomarkers and definitions for diabetes can provide different estimates of population prevalence of diabetes, and differentially identify people without previous diagnosis as having diabetes. Using an HbA1c-based definition alone in health surveys will not identify a substantial proportion of previously undiagnosed people who would be considered as having diabetes using a glucose-based test. FUNDING: Wellcome Trust, US National Institutes of Health

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

NCD Risk Factor Collaboration (NCD-RisC) collaborator: Ana I. Rito (National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal)Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1,2,3,4,5,6. 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.This study was funded by the UK Medical Research Council (grant number MR/V034057/1), the Wellcome Trust (Pathways to Equitable Healthy Cities grant 209376/Z/17/Z), the AstraZeneca Young Health Programme and the European Commission (STOP project through EU Horizon 2020 research and innovation programme under Grant Agreement 774548). For the purpose of open access, the author has applied a Creative Commons Attribution (CC BY) licence to the Author Accepted Manuscript version arising from this submission. We thank W. Dietz, L. Jaacks and W. Johnson for recommendations of relevant citations. The authors alone are responsible for the views expressed in this Article and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated.info:eu-repo/semantics/publishedVersio

A century of trends in adult human height

Being taller is associated with enhanced longevity, and higher education and earnings. We reanalysed 1472 population-based studies, with measurement of height on more than 18.6 million participants to estimate mean height for people born between 1896 and 1996 in 200 countries. The largest gain in adult height over the past century has occurred in South Korean women and Iranian men, who became 20.2 cm (95% credible interval 17.5–22.7) and 16.5 cm (13.2– 19.7) taller, respectively. In contrast, there was little change in adult height in some sub-Saharan African countries and in South Asia over the century of analysis. The tallest people over these 100 years are men born in the Netherlands in the last quarter of 20th century, whose average heights surpassed 182.5 cm, and the shortest were women born in Guatemala in 1896 (140.3 cm; 135.8– 144.8). The height differential between the tallest and shortest populations was 19-20 cm a century ago, and has remained the same for women and increased for men a century later despite substantial changes in the ranking of countries

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

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/m² 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/m² per decade (0·69–1·35, PP>0·9999) in central Latin America and an increase of 0·95 kg/m² 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/m² per decade (–0·33 to 0·49, PP=0·6926) in eastern Europe to an increase of 0·77 kg/m² per decade (0·50–1·06, PP>0·9999) in Polynesia and Micronesia. Trends in mean BMI have recently flattened in northwestern Europe and the high-income English-speaking and Asia-Pacific regions for both sexes, southwestern Europe for boys, and central and Andean Latin America for girls. By contrast, the rise in BMI has accelerated in east and south Asia for both sexes, and southeast Asia for boys. Global age-standardised prevalence of obesity increased from 0·7% (0·4–1·2) in 1975 to 5·6% (4·8–6·5) in 2016 in girls, and from 0·9% (0·5–1·3) in 1975 to 7·8% (6·7–9·1) in 2016 in boys; the prevalence of moderate and severe underweight decreased from 9·2% (6·0–12·9) in 1975 to 8·4% (6·8–10·1) in 2016 in girls and from 14·8% (10·4–19·5) in 1975 to 12·4% (10·3–14·5) in 2016 in boys. Prevalence of moderate and severe underweight was highest in India, at 22·7% (16·7–29·6) among girls and 30·7% (23·5–38·0) among boys. Prevalence of obesity was more than 30% in girls in Nauru, the Cook Islands, and Palau; and boys in the Cook Islands, Nauru, Palau, Niue, and American Samoa in 2016. Prevalence of obesity was about 20% or more in several countries in Polynesia and Micronesia, the Middle East and north Africa, the Caribbean, and the USA. In 2016, 75 (44–117) million girls and 117 (70–178) million boys worldwide were moderately or severely underweight. In the same year, 50 (24–89) million girls and 74 (39–125) million boys worldwide were obese.Wellcome Trust, AstraZeneca Young Health Programme

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). 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

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight

Funding Information: Banska Bystrica Regional Authority of Public Health, Banska Bystrica, Slovakia; Shina Avi: Tel-Aviv University, Tel-Aviv, Israel; Hebrew University of Jerusalem, Jerusalem, Israel; Ana Azevedo: University of Porto Medical School, Porto, Portugal; Mohsen Azimi-Nezhad: Neyshabur University of Medical Sciences, Neyshabur, Islamic Republic of Iran; Fereidoun Azizi: Research Institute for Endocrine Sciences, Tehran, Islamic Republic of Iran; Mehrdad Azmin: NonCommunicable Diseases Research Center, Tehran, Islamic Republic of Iran; Bontha V Babu: Indian Council of Medical Research, New Delhi, India; Maja Bæksgaard Jørgensen: National Institute of Public Health, Copenhagen, Denmark; Azli Baharudin: Ministry of Health, Kuala Lumpur, Malaysia; Suhad Bahijri: King Abdulaziz University, Jeddah, Saudi Arabia; Jennifer L Baker: Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Nagalla Balakrishna: ICMR - National Institute of Nutrition, Hyderabad, India; Mohamed Bamoshmoosh: University of Science and Technology, Sana’a, Yemen; Maciej Banach: Medical University of Lodz, Lodz, Poland; Piotr Bandosz: Medical University of Gdansk, Gdansk, Poland; José R Banegas: Universidad Autónoma de Madrid CIBERESP, Madrid, Spain; Joanna Baran: University of Rzeszów, Rzeszów, Poland; Carlo M Barbagallo: University of Palermo, Palermo, Italy; Alberto Barceló: Pan American Health Organization, Washington DC, United States; Amina Barkat: Mohammed V University de Rabat, Rabat, Morocco; Aluisio JD Barros: Federal University of Pelotas, Pelotas, Brazil; Mauro Virgílio Gomes Barros: University of Pernambuco, Recife, Brazil; Abdul Basit: Baqai Institute of Diabetology and Endocrinology, Karachi, Pakistan; Joao Luiz D Bastos: Federal University of Santa Catarina, Florianópolis, Brazil; Iqbal Bata: Dalhousie University, Halifax, Canada; Anwar M Batieha: Jordan University of Science and Technology, Irbid, Jordan; Rosangela L Batista: Federal University of Maranhão, São Luís, Brazil; Zhamilya Battakova: National Center of Public Healthcare, Nur-Sultan, Kazakhstan; Assembekov Batyrbek: Al-Farabi Kazakh National University, Almaty, Kazakhstan; Louise A Baur: University of Sydney, Sydney, Australia; Robert Beaglehole: University of Auckland, Auckland, New Zealand; Silvia Bel-Serrat: University College Dublin, Dublin, Ireland; Antonisamy Belavendra: Christian Medical College, Vellore, India; Habiba Ben Romdhane: University Tunis El Manar, Tunis, Tunisia; Judith Benedics: Federal Ministry of Social Affairs, Health, Care and Consumer Protection, Vienna, Austria; Mikhail Benet: Cafam University Foundation, Bogota, Colombia; Ingunn Holden Bergh: Norwegian Institute of Public Health, Oslo, Norway; Salim Berkinbayev: Kazakh National Medical University, Almaty, Kazakhstan; Antonio Bernabe-Ortiz: Universidad Peruana Cayetano Heredia, Lima, Peru; Gailute Bernotiene: Lithuanian University of Health Sciences, Kaunas, Lithuania; Heloísa Bettiol: University of São Paulo, São Paulo, Brazil; Jorge Bezerra: University of Pernambuco, Recife, Brazil; Aroor Bhagyalaxmi: B J Medical College, Ahmedabad, India; Sumit Bharadwaj: Chirayu Medical College, New Delhi, India; Santosh K Bhargava: Sunder Lal Jain Hospital, Delhi, India; Zulfiqar A Bhutta: The Hospital for Sick Children, Toronto, Canada; Aga Khan University, Karachi, Pakistan; Hongsheng Bi: Shandong University of Traditional Chinese Medicine, Jinan, China; Yufang Bi: Shanghai Jiao-Tong University School of Medicine, Shanghai, China; Daniel Bia: Universidad de la República, Montevideo, Uruguay; Elysée Claude Bika Lele: Institute of Medical Research and Medicinal Plant Studies, Yaoundé, Cameroon; Mukharram M Bikbov: Ufa Eye Research Institute, Ufa, Russian Federation; Bihungum Bista: Nepal Health Research Council, Kathmandu, Nepal; Dusko J Bjelica: University of Montenegro, Niksic, Montenegro; Peter Bjerregaard: University of Southern Denmark, Copenhagen, Denmark; Espen Bjertness: University of Oslo, Oslo, Norway; Marius B Bjertness: University of Oslo, Oslo, Norway; Cecilia Björkelund: University of Gothenburg, Gothenburg, Sweden; Katia V Bloch: Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Anneke Blokstra: National Institute for Public Health and the Environment, Bilthoven, Netherlands; Simona Bo: University of Turin, Turin, Italy; Martin Bobak: University College London, London, United Kingdom; Lynne M Boddy: Liverpool John Moores University, Liverpool, United Kingdom; Bernhard O Boehm: Nanyang Technological University Singapore, Singapore, Singapore; Heiner Boeing: German Institute of Human Nutrition, Potsdam, Germany; Jose G Boggia: Universidad de la República, Montevideo, Uruguay; Elena Bogova: Endocrinology Research Centre, Moscow, Russian Federation; Carlos P Boissonnet: Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires, Argentina; Stig E Bojesen: Copenhagen University Hospital, Copenhagen, Denmark; University of Copenhagen, Copenhagen, Denmark; Marialaura Bonaccio: IRCCS Neuromed, Pozzilli, Italy; Vanina Bongard: Toulouse University School of Medicine, Toulouse, France; Alice Funding Information: We thank WHO country and regional offices and World Heart Federation for support in data identification and access. The NCD-RisC database was funded by the Wellcome Trust. Maria LC Iurilli was supported by a Medical Research Council studentship. Sylvain Sebert received funding by the European Commission with grant agreements 633595 and 874739, respectively, for the DynaHEALTH and LongITools projects. The following contributors have deceased: Konrad Jamrozik, Altan Onat, Robespierre Ribeiro, Michael Sjöström, Agustinus Soemantri, Jutta Stieber, and Dimitrios Trichopou-los. The list of authors shows their last affiliation. Funding Information: Alison J Hayes: University of Sydney, Sydney, Australia; Nayu Ikeda: National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan; Rod T Jackson: University of Auckland, Auckland, New Zealand; Young-Ho Khang: Seoul National University, Seoul, Republic of Korea; Avula Laxmaiah: ICMR - National Institute of Nutrition, Hyderabad, India; Jing Liu: Capital Medical University Beijing An Zhen Hospital, Beijing, China; J Jaime Miranda: Universidad Peruana Cayetano Heredia, Lima, Peru; Olfa Saidi: University Tunis El Manar, Tunis, Tunisia; Sylvain Sebert: University of Oulu, Oulu, Finland; Maroje Sorić: University of Zagreb, Zagreb, Croatia; Gregor Starc: University of Ljubljana, Ljubljana, Slovenia; Edward W Gregg: Imperial College London, London, United Kingdom; Leandra Abarca-Gómez: Caja Costarricense de Seguro Social, San José, Costa Rica; Ziad A Abdeen: Al-Quds University, East Jerusalem, State of Palestine; Shynar Abdrakhmanova: National Center of Public Healthcare, Nur-Sultan, Kazakhstan; Suhaila Abdul Ghaffar: Ministry of Health, Kuala Lumpur, Malaysia; Hanan F Abdul Rahim: Qatar University, Doha, Qatar; Niveen M Abu-Rmeileh: Birzeit University, Birzeit, State of Palestine; Jamila Abubakar Garba: Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria; Benjamin Acosta-Cazares: Instituto Mexicano del Seguro Social, Mexico City, Mexico; Robert J Adams: Flinders University, Adelaide, Australia; Wichai Aekplakorn: Mahidol University, Nakhon Pathom, Thailand; Kaosar Afsana: BRAC James P Grant School of Public Health, Dhaka, Bangladesh; Shoaib Afzal: University of Copenhagen, Copenhagen, Denmark; Copenhagen University Hospital, Copenhagen, Denmark; Imelda A Agdeppa: Food and Nutrition Research Institute, Taguig, Philippines; Javad Aghazadeh-Attari: Urmia University of Medical Sciences, Urmia, Islamic Republic of Iran; Carlos A Aguilar-Salinas: Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Charles Agyemang: University of Amsterdam, Amsterdam, Netherlands; Mohamad Hasnan Ahmad: Ministry of Health, Kuala Lumpur, Malaysia; Noor Ani Ahmad: Ministry of Health, Kuala Lumpur, Malaysia; Ali Ahmadi: Shahrekord University of Medical Sciences, Shahrekord, Islamic Republic of Iran; Naser Ahmadi: Non-Communicable Diseases Research Center, Tehran, Islamic Republic of Iran; Soheir H Ahmed: University of Oslo, Oslo, Norway; Wolfgang Ahrens: University of Bremen, Bremen, Germany; Gulmira Aitmurzaeva: Republican Center for Health Promotion, Bishkek, Kyrgyzstan; Kamel Ajlouni: National Center for Diabetes, Endocrinology and Genetics, Amman, Jordan; Hazzaa M Al-Hazzaa: Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia; Badreya Al-Lahou: Kuwait Institute for Scientific Research, Kuwait City, Kuwait; Rajaa Al-Raddadi: King Abdulaziz University, Jeddah, Saudi Arabia; Monira Alarouj: Dasman Diabetes Institute, Kuwait City, Kuwait; Fadia AlBuhairan: Aldara Hospital and Medical Center, Riyadh, Saudi Arabia; Shahla AlDhukair: King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Mohamed M Ali: World Health Organization, Geneva, Switzerland; Abdullah Alkandari: Dasman Diabetes Institute, Kuwait City, Kuwait; Ala’a Alkerwi: Luxembourg Institute of Health, Strassen, Luxembourg; Kristine Allin: Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Mar Alvarez-Pedrerol: Barcelona Institute for Global Health CIBERESP, Barcelona, Spain; Eman Aly: World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt; Deepak N Amarapurkar: Bombay Hospital and Medical Research Centre, Mumbai, India; Parisa Amiri: Research Center for Social Determinants of Health, Tehran, Islamic Republic of Iran; Norbert Amougou: UMR CNRS-MNHN 7206 Eco-anthropologie, Paris, France; Philippe Amouyel: University of Lille, France; Lille University Hospital, Lille, France; Lars Bo Andersen: Western Norway University of Applied Sciences, Sogndal, Norway; Sigmund A Anderssen: Norwegian School of Sport Sciences, Oslo, Norway; Lars Ängquist: University of Copenhagen, Copenhagen, Denmark; Ranjit Mohan Anjana: Madras Diabetes Research Foundation, Chennai, India; Alireza Ansari-Moghaddam: Zahedan University of Medical Sciences, Zahedan, Islamic Republic of Iran; Hajer Aounallah-Skhiri: National Institute of Public Health, Tunis, Tunisia; Joana Araújo: Institute of Public Health of the University of Porto, Porto, Portugal; Inger Ariansen: Norwegian Institute of Public Health, Oslo, Norway; Tahir Aris: Ministry of Health, Kuala Lumpur, Malaysia; Raphael E Arku: University of Massachusetts Amherst, Amherst, United States; Nimmathota Arlappa: ICMR -National Institute of Nutrition, Hyderabad, India; Krishna K Aryal: Abt Associates, Kathmandu, Nepal; Thor Aspelund: University of Iceland, Reykjavik, Iceland; Felix K Assah: University of Yaoundé 1, Yaoundé, Cameroon; Maria Cecília F Assunc¸ão: Federal University of Pelotas, Pelotas, Brazil; May Soe Aung: University of Medicine 1, Yangon, Myanmar; Juha Auvinen: University of Oulu, Oulu, Finland; Oulu University Hospital, Oulu, Finland; Mária Avdicová: Publisher Copyright: © Copyright.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.Peer reviewe

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

Optimal growth and development in childhood and adolescence are 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 places 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, the 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.info:eu-repo/semantics/publishedVersio