Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants.
Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants.
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DOI：
10.1016/s0140-6736(20)31859-6
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发表时间：
2020-11-07
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通讯作者：
NCD Risk Factor Collaboration (NCD-RisC)
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作者：
NCD Risk Factor Collaboration (NCD-RisC)
关于学龄儿童和青少年健康和营养的可比全球数据很少。我们的目的是估计学龄儿童和青少年的平均身高和平均体重指数（BMI）的年龄轨迹和时间趋势，BMI测量的体重增加超出身高增加的预期。对于这项汇总分析，我们使用了由非传染性疾病风险因素协作组整理的心脏代谢风险因素数据库。我们应用贝叶斯分层模型来估计1985年至2019年5-19岁1岁年龄组的平均身高和平均BMI的趋势。该模型考虑到平均身高和平均BMI随时间的非线性变化，以及儿童和青少年随年龄的非线性变化，包括青春期的快速生长期。我们汇总了来自2181项基于人群的研究的数据，测量了200个国家和地区的6500万参与者的身高和体重。2019年，我们估计人口最高的国家之间19岁青少年的平均身高差异为20厘米或更高（男孩为荷兰、黑山、爱沙尼亚和波斯尼亚和黑塞哥维那;女孩为荷兰、黑山、丹麦和冰岛）和人口最少的国家（男孩在东帝汶、老挝、所罗门群岛和巴布亚新几内亚;女孩在危地马拉、孟加拉国、尼泊尔和东帝汶）。同年，最高平均BMI（在太平洋岛国、科威特、巴林、巴哈马、智利、美国和新西兰，男孩和女孩，南非女孩）与最低平均BMI（在印度、孟加拉国、东帝汶、埃塞俄比亚和乍得，男孩和女孩;在日本和罗马尼亚，女孩）之间的差异约为9-10 kg/m2。在一些国家，5岁儿童开始时的身高或BMI比全球中位数更健康，在某些情况下，与表现最好的国家一样健康，但随着年龄的增长，他们的身高逐渐低于对照组（例如，奥地利和巴巴多斯的男孩，比利时和波多黎各的女孩）或体重增加过多（例如，科威特、巴林、斐济、牙买加和墨西哥的女孩和男孩;南非和新西兰的女孩）。在其他国家，成长中的儿童在儿童期后期和青春期超过了他们的比较对象（如拉脱维亚、捷克共和国、摩洛哥和伊朗）或抑制了他们的体重增加（如意大利、法国和克罗地亚）。当考虑到身高和BMI的变化时，韩国、越南、沙特阿拉伯、土耳其和一些中亚国家的女孩（如亚美尼亚和阿塞拜疆），以及中欧和西欧的男孩（如葡萄牙、丹麦、波兰和黑山）在过去3.5年中的人体测量状况变化最健康，因为与其他国家的儿童和青少年相比，他们身高的增加要比体重指数的增加大得多。最不健康的变化--与其他国家的儿童相比，身高增加太少，体重增加太多，或者两者兼而有之--发生在撒哈拉以南非洲、新西兰和美国的许多国家的男孩和女孩;马来西亚和一些太平洋岛国的男孩;墨西哥的女孩。学龄儿童和青少年的身高和BMI随年龄和时间的变化轨迹在各国之间差异很大，这表明营养质量和终身健康优势和风险存在差异。惠康信托基金，阿斯利康青年健康计划，欧盟。
Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks. Wellcome Trust, AstraZeneca Young Health Programme, EU.