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.
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.
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DOI：
10.1016/s0140-6736(17)32129-3
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发表时间：
2017-12-16
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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)
儿童期和青春期体重过轻、超重和肥胖与一生中不利的健康后果有关。我们的目的是估计全球平均体重指数（BMI）的趋势，以及涵盖儿童和青少年体重不足至肥胖的一整套BMI类别，并与成年人的趋势进行比较。我们汇集了2416项基于人群的研究，对1.289亿5岁及以上的参与者进行了身高和体重测量，其中包括3150万5 - 19岁的参与者。我们使用贝叶斯分层模型估计了1975年至2016年200个国家的平均BMI和以下类别5-19岁儿童和青少年BMI患病率的趋势：低于世界卫生组织儿童和青少年生长参考值中位数2个标准差以上（以下称为中度和重度体重不足），低于中位数2个标准差至高于中位数1个标准差（轻度体重不足），低于中位数1个标准差至高于中位数1个标准差（健康体重），高于中位数1个标准差至高于中位数2个标准差（超重但不肥胖），高于中位数2个标准差（肥胖）。1975年至2016年，女孩年龄标准化平均BMI的区域变化范围从东欧几乎没有变化（- 0.01 kg/m2每十年；95%可信区间- 0.42至0.39，观察到的下降的后验概率[PP]为真实下降= 0.5098）到拉丁美洲中部每十年增加1.00 kg/m2 (0.69 - 1.35, PP >.9999)，以及波利尼西亚和密克罗尼西亚每十年增加0.95 kg/m2 （0.64 - 1.25, PP >.9999）。男孩的增长幅度从东欧的0·09 kg/m2（- 0·33 ~ 0·49，PP=0·6926）的无显著增长到波利尼西亚和密克罗尼西亚的0·77 kg/m2（0·50 ~ 1·06，PP=0·9999）。最近，在欧洲西北部、高收入英语国家和亚太地区，男性和女性的平均体重指数趋势趋于平缓，在欧洲西南部是男孩，在拉丁美洲中部和安第斯山脉是女孩。相比之下，东亚和南亚的男性和东南亚的男性体重指数都在加速上升。全球年龄标准化肥胖患病率在女孩中从1975年的0.7%（0.4 - 2.0）增加到2016年的5.6%(4.8 - 6.5)，在男孩中从1975年的0.9%（0.5 - 3.0）增加到2016年的7.8% (6.7 - 9.1)；中度和重度体重不足的患病率，女孩从1975年的9.2%（6·0 - 12.9）降至2016年的8.4%(6·8 - 10.1)，男孩从1975年的14.8%（10·4 - 19.5）降至2016年的12.4%（10·3 - 14.5）。中度和重度体重不足的患病率在印度最高，女孩为22.7%(16.7 - 29.6)，男孩为30.7%（23.5 - 38.0）。在瑙鲁、库克群岛和帕劳，女孩肥胖率超过30%；以及库克群岛、瑙鲁、帕劳、纽埃和美属萨摩亚的男孩。在波利尼西亚和密克罗尼西亚、中东和北非、加勒比地区和美国的几个国家，肥胖患病率约为20%或更多。2016年，全世界有75亿（44 - 1.17亿）女孩和117亿（70 - 1.78亿）男孩体重中度或严重不足。同年，全世界有5000万（24 - 8900万）女孩和74亿（39 - 1.25亿）男孩肥胖。在许多高收入国家，儿童和青少年体重指数的上升趋势已经趋于稳定，尽管仍处于较高水平，但在亚洲部分地区，这一趋势已经加速，与成年人的趋势不再相关。惠康信托，阿斯利康青年健康计划。
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. 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). 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. The rising trends in children's and adolescents' BMI have plateaued in many high-income countries, albeit at high levels, but have accelerated in parts of Asia, with trends no longer correlated with those of adults. Wellcome Trust, AstraZeneca Young Health Programme.