Body-mass index and diabetes risk in 57 low-income and middle-income countries: a cross-sectional study of nationally representative, individual-level data in 685 616 adults.
| Autor: | Teufel F; Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany., Seiglie JA; Diabetes Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA., Geldsetzer P; Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany; Department of Medicine, Division of Primary Care and Population Health, Stanford University, Stanford, CA, USA., Theilmann M; Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany., Marcus ME; Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany., Ebert C; RWI-Leibniz Institute for Economic Research, Essen (Berlin Office), Germany., Arboleda WAL; Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany., Agoudavi K; Togo Ministry of Health, Lome, Togo., Andall-Brereton G; Caribbean Public Health Agency, Port of Spain, Trinidad and Tobago., Aryal KK; Nepal Health Sector Programme 3, Monitoring Evaluation and Operational Research Project, Abt Associates, Kathmandu, Nepal., Bicaba BW; Institut National de Santé Publique, Ministère de la santé, Ouagadougou, Burkina Faso., Brian G; The Fred Hollows Foundation New Zealand, Auckland, New Zealand., Bovet P; Ministry of Health, Victoria, Seychelles; University Center for Primary Care and Public Health, Lausanne, Switzerland., Dorobantu M; University of Medicine and Pharmacy Carol Davila, Bucharest, Romania., Gurung MS; Health Research and Epidemiology Unit, Ministry of Health, Thimphu, Bhutan., Guwatudde D; Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda., Houehanou C; Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin., Houinato D; Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin., Jorgensen JMA; Department of Public Health, University of Copenhagen, Copenhagen, Denmark., Kagaruki GB; National Institute for Medical Research, Dar es Salaam, Tanzania., Karki KB; Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal., Labadarios D; Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa., Martins JS; Faculty of Medicine and Health Sciences, Universidade Nacional Timor Lorosae, Rua Jacinto Candido, Dili, Timor-Leste., Mayige MT; National Institute for Medical Research, Dar es Salaam, Tanzania., McClure RW; Epidemiology Office and Surveillance, Caja Costarricense de Seguro Social, San Jose, Costa Rica., Mwangi JK; Division of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya; Faculté de Médecine, Université de Genève, Geneva, Switzerland., Mwalim O; Zanzibar Ministry of Health, Mnazi Mmoja, Zanzibar, Tanzania., Norov B; National Center for Public Health, Ulaanbaatar, Mongolia., Crooks S; Caribbean Public Health Agency, Port of Spain, Trinidad and Tobago., Farzadfar F; Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran., Moghaddam SS; Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran., Silver BK; St Francis Hospital, Nsambya, Kampala, Uganda., Sturua L; Non-Communicable Diseases Department, National Center for Disease Control and Public Health, Tbilisi, Georgia; Petre Shotadze Tbilisi Medical Academy, Tbilisi, Georgia., Wesseh CS; Liberia Ministry of Health, Monrovia, Liberia., Stokes AC; Department of Global Health, Boston University School of Public Health, Boston, MA, USA., Essien UR; Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA., De Neve JW; Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany., Atun R; Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA; Department of Global Health and Social Medicine, Harvard University, Boston, MA, USA., Davies JI; Department of Global Health, Centre for Global Surgery, Stellenbosch University, Stellenbosch, South Africa; MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of Witwatersrand, Johannesburg, South Africa; Institute of Applied Health Research, University of Birmingham, Birmingham, UK., Vollmer S; Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany., Bärnighausen TW; Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany; Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA; Africa Health Research Institute, Somkhele, South Africa., Ali MK; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA., Meigs JB; Department of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA., Wexler DJ; Diabetes Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA., Manne-Goehler J; Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: jmanne@partners.org. |
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| Jazyk: | angličtina |
| Zdroj: | Lancet (London, England) [Lancet] 2021 Jul 17; Vol. 398 (10296), pp. 238-248. |
| DOI: | 10.1016/S0140-6736(21)00844-8 |
| Abstrakt: | Background: The prevalence of overweight, obesity, and diabetes is rising rapidly in low-income and middle-income countries (LMICs), but there are scant empirical data on the association between body-mass index (BMI) and diabetes in these settings. Methods: In this cross-sectional study, we pooled individual-level data from nationally representative surveys across 57 LMICs. We identified all countries in which a WHO Stepwise Approach to Surveillance (STEPS) survey had been done during a year in which the country fell into an eligible World Bank income group category. For LMICs that did not have a STEPS survey, did not have valid contact information, or declined our request for data, we did a systematic search for survey datasets. Eligible surveys were done during or after 2008; had individual-level data; were done in a low-income, lower-middle-income, or upper-middle-income country; were nationally representative; had a response rate of 50% or higher; contained a diabetes biomarker (either a blood glucose measurement or glycated haemoglobin [HbA Findings: Our pooled dataset from 58 nationally representative surveys in 57 LMICs included 685 616 individuals. The overall prevalence of overweight was 27·2% (95% CI 26·6-27·8), of obesity was 21·0% (19·6-22·5), and of diabetes was 9·3% (8·4-10·2). In the pooled analysis, a higher risk of diabetes was observed at a BMI of 23 kg/m 2 or higher, with a 43% greater risk of diabetes for men and a 41% greater risk for women compared with a BMI of 18·5-22·9 kg/m 2 . Diabetes risk also increased steeply in individuals aged 35-44 years and in men aged 25-34 years in sub-Saharan Africa. In the stratified analyses, there was considerable regional variability in this association. Optimal BMI thresholds for diabetes screening ranged from 23·8 kg/m 2 among men in east, south, and southeast Asia to 28·3 kg/m 2 among women in the Middle East and north Africa and in Latin America and the Caribbean. Interpretation: The association between BMI and diabetes risk in LMICs is subject to substantial regional variability. Diabetes risk is greater at lower BMI thresholds and at younger ages than reflected in currently used BMI cutoffs for assessing diabetes risk. These findings offer an important insight to inform context-specific diabetes screening guidelines. Funding: Harvard T H Chan School of Public Health McLennan Fund: Dean's Challenge Grant Program. Competing Interests: Declaration of interests MKA reports receiving a grant from Merck and Co awarded to Emory University, outside the submitted work. DJW reports serving on a data monitoring committee for Novo Nordisk SOUL and FLOW trials. JBM reports serving as an academic associate for the American clinical laboratory, Quest Diagnostics. All other authors declare no competing interests. (Copyright © 2021 Elsevier Ltd. All rights reserved.) |
| Databáze: | MEDLINE |
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