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.
Journal
Lancet (London, England)
ISSN: 1474-547X
Titre abrégé: Lancet
Pays: England
ID NLM: 2985213R
Informations de publication
Date de publication:
17 07 2021
17 07 2021
Historique:
received:
15
01
2021
revised:
09
03
2021
accepted:
07
04
2021
entrez:
18
7
2021
pubmed:
19
7
2021
medline:
30
7
2021
Statut:
ppublish
Résumé
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. 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 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 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. Harvard T H Chan School of Public Health McLennan Fund: Dean's Challenge Grant Program.
Sections du résumé
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
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.
Identifiants
pubmed: 34274065
pii: S0140-6736(21)00844-8
doi: 10.1016/S0140-6736(21)00844-8
pmc: PMC8336025
mid: NIHMS1727894
pii:
doi:
Substances chimiques
Glycated Hemoglobin A
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
238-248Subventions
Organisme : Wellcome Trust
Pays : United Kingdom
Organisme : NIDDK NIH HHS
ID : UM1 DK078616
Pays : United States
Organisme : NIDDK NIH HHS
ID : K23 DK125162
Pays : United States
Organisme : NCATS NIH HHS
ID : KL2 TR003143
Pays : United States
Organisme : NIDDK NIH HHS
ID : T32 DK007028
Pays : United States
Organisme : NCATS NIH HHS
ID : KL2 TR002542
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2021 Elsevier Ltd. All rights reserved.
Déclaration de conflit d'intérêts
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.
Références
Lancet. 2004 Jan 10;363(9403):157-63
pubmed: 14726171
Metabolism. 2019 Mar;92:6-10
pubmed: 30253139
Diabetol Metab Syndr. 2014 Apr 03;6(1):50
pubmed: 24694251
Nat Rev Endocrinol. 2020 Mar;16(3):177-189
pubmed: 32020062
Glob Heart. 2016 Mar;11(1):89-96.e3
pubmed: 27102026
N Engl J Med. 2006 Aug 24;355(8):763-78
pubmed: 16926275
Diabetol Metab Syndr. 2020 Oct 27;12:93
pubmed: 33117455
Lancet. 2014 Aug 30;384(9945):766-81
pubmed: 24880830
Clin Chem. 2005 Sep;51(9):1573-6
pubmed: 16120945
BMJ Open. 2016 Jul 26;6(7):e010836
pubmed: 27466237
PLoS Med. 2019 Mar 1;16(3):e1002751
pubmed: 30822339
JAMA Cardiol. 2018 Apr 1;3(4):280-287
pubmed: 29490333
Am J Clin Nutr. 2004 Nov;80(5):1129-36
pubmed: 15531658
Diabetes Care. 2020 Apr;43(4):767-775
pubmed: 32051243
Am J Public Health. 2016 Jan;106(1):74-8
pubmed: 26696288
Diabetes Care. 2014 Apr;37(4):e64-5
pubmed: 24652731
Lancet. 2016 Apr 2;387(10026):1377-1396
pubmed: 27115820
Obes Rev. 2013 Nov;14 Suppl 2:11-20
pubmed: 24102717
Lancet. 2016 Apr 9;387(10027):1513-1530
pubmed: 27061677
Diabetes Care. 2007 Jun;30(6):1562-6
pubmed: 17372155
Obes Rev. 2012 Mar;13(3):275-86
pubmed: 22106927
Ann Saudi Med. 2009 Nov-Dec;29(6):437-45
pubmed: 19847080