Naslov
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

Autori
Di Cesare, Mariachiara ; ... ; Jureša, Vesna ; ... ; Mišigoj-Duraković, Marjeta ; ... ; Musil, Vera ; ... ; Sorić, Maroje. (NCD Risk Factor Collaboration (NCD-RisC))

Izvornik
The Lancet (0140-6736) 387 (2016), 10026; 1377-1396

Vrsta, podvrsta i kategorija rada
Radovi u časopisima, pregledni rad, znanstveni

Ključne riječi
body mass index ; underweight ; overweight ; obesity

Sažetak
Background Underweight 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. Methods We 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. Findings We 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 underweight decreased from 13·8% (10·5–17·4) to 8·8% (7·4–10·3) in men and from 14·6% (11·6– 17·9) to 9·7% (8·3–11·1) in women. South Asia had the highest prevalence of underweight in 2014, 23·4% (17·8–29·2) in men and 24·0% (18·9– 29·3) in women. Age-standardised prevalence of obesity increased from 3·2% (2·4–4·1) in 1975 to 10·8% (9·7–12·0) in 2014 in men, and from 6·4% (5·1–7·8) to 14·9% (13·6–16·1) in women. 2·3% (2·0–2·7) of the world's men and 5·0% (4·4–5·6) of women were severely obese (ie, have BMI ≥35 kg/m2). Globally, prevalence of morbid obesity was 0·64% (0·46–0·86) in men and 1·6% (1·3–1·9) in women. Interpretation If post-2000 trends continue, the probability of meeting the global obesity target is virtually zero. Rather, if these trends continue, by 2025, global obesity prevalence will reach 18% in men and surpass 21% in women ; severe obesity will surpass 6% in men and 9% in women. Nonetheless, underweight remains prevalent in the world's poorest regions, especially in south Asia.

Izvorni jezik
Engleski

Znanstvena područja
Javno zdravstvo i zdravstvena zaštita, Kineziologija

Napomena
Research in context Evidence before this study We searched MEDLINE (via PubMed) for manuscripts published in any language between Jan 1, 1950, and March 12, 2013, using the search terms “body size”[mh:noexp] OR “body height”[mh:noexp] OR “body weight”[mh:noexp] OR “birth weight”[mh:noexp] OR “overweight”[mh:noexp] OR “obesity”[mh] OR “thinness”[mh:noexp] OR “Waist- Hip Ratio”[mh:noexp] or “Waist Circumference”[mh:noexp] or “body mass index” [mh:noexp]) AND (“Humans”[mh]) AND(“1950”[PDAT] : “2013”[PDAT]) AND (“Health Surveys”[mh] OR “Epidemiological Monitoring”[mh] OR “Prevalence”[mh]) NOT Comment[ptyp] NOT Case Reports[ptyp]. Articles were screened according to the inclusion and exclusion criteria described in the appendix (pp 2–5)). The only global study on trends in mean body-mass index (BMI), which characterises shifts in the population distribution of BMI, reported trends to 2008 (before the global target on obesity was agreed) and no recent data are available. Two previous studies estimated global trends in the prevalence of overweight and obesity. Neither study reported trends in underweight, which is associated with increased risk of morbidity, mortality, and adverse pregnancy outcomes, or in high levels of BMI (eg, ≥35 or ≥40 kg/m2), which are associated with substantial risks of many non-communicable diseases. Added value of this study This study provides the longest and most complete picture of trends in adult BMI, including, for the first time, in underweight and severe and morbid obesity, which are of enormous clinical and public health interest. We were able to robustly depict this rich picture by reanalysing and pooling hundreds of population-based sources with measurements of height and weight according to a common protocol. We also systematically projected recent trends into the future, and assessed the probability of the global obesity target being achieved. Implications of all the available evidence The world has transitioned from an era when underweight prevalence was more than double that of obesity, to one in which more people are obese than underweight. However, underweight remains a public health problem in the world's poorest regions—namely south Asia and central and east Africa. If present trends continue, not only will the world not meet the global obesity target, but severe obesity will also surpass underweight in women by 2025. Funding Wellcome Trust, Grand Challenges Canada. Declaration of interests JJM reports funding from Medtronics Foundation, outside the submitted work. All other authors declare no competing interests. Acknowledgments We thank Christina Banks, Quentin Hennocq, Dheeya Rizmie, and Yasaman Vali for assistance with data extraction. We thank WHO country and regional offices and the World Heart Federation for support in data identification and access. NCD Risk Factor Collaboration (NCD-RisC): Pooled Analysis and Writing (*equal contribution)—Mariachiara Di Cesare (Imperial College London, London, UK ; Middlesex University, London, UK)* ; James Bentham (Imperial College London, London, UK)* ; Gretchen A Stevens (World Health Organization, Geneva, Switzerland)* ; Bin Zhou (Imperial College London, London, UK) ; Goodarz Danaei (Harvard T H Chan School of Public Health, Boston, MA, USA) ; Yuan Lu (Harvard T H Chan School of Public Health, Boston, MA, USA) ; Honor Bixby (Imperial College London, London, UK) ; Melanie J Cowan (World Health Organization, Geneva, Switzerland) ; Leanne M Riley (World Health Organization, Geneva, Switzerland) ; Kaveh Hajifathalian (Harvard T H Chan School of Public Health, Boston, MA, USA) ; Léa Fortunato (Imperial College London, London, UK) ; Cristina Taddei (University of Florence, Florence, Italy) ; James E Bennett (Imperial College London, London, UK) ; Nayu Ikeda (National Institute of Health and Nutrition, Tokyo, Japan) ; Prof Young-Ho Khang (Seoul National University, Seoul, South Korea) ; Catherine Kyobutungi (African Population and Health Research Center, Nairobi, Kenya) ; Avula Laxmaiah (Indian Council of Medical Research, New Delhi, India) ; Yanping Li (Harvard T H Chan School of Public Health, Boston, MA, USA) ; Hsien-Ho Lin (National Taiwan University, Taipei, Taiwan) ; J Jaime Miranda (Universidad Peruana Cayetano Heredia, Lima, Peru) ; Aya Mostafa (Ain Shams University, Cairo, Egypt) ; Maria L Turley (Ministry of Health, Wellington, New Zealand) ; Christopher J Paciorek (University of California, Berkeley, CA, USA) ; Marc Gunter (Imperial College London, London, UK) ; Prof Majid Ezzati (Imperial College London, London, UK). ME designed the study and oversaw research. Members of the Country and Regional Data Group collected and reanalysed data, and checked pooled data for accuracy of information about their study and other studies in their country. MDC and GAS led data collection and JB led the statistical analysis and prepared results. Members of the Pooled Analysis and Writing Group collated data, checked all data sources in consultation with the Country and Regional Data Group, analysed pooled data, and prepared results. ME wrote the first draft of the report with input from other members of Pooled Analysis and Writing Group. Members of Country and Regional Data Group commented on draft report. Country and Regional Data (*equal contribution ; listed alphabetically) from Croatia: Vesna Jureša (University of Zagreb, Croatia), Marjeta Mišigoj-Duraković (University of Zagreb, Croatia), Vera Musil (University of Zagreb, Croatia), Maroje Sorić (University of Zagreb, Croatia)

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