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Made available in DSpace on 2018-11-26T20:04:45Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-12-16 Wellcome Trust AstraZeneca Background 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. Methods 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). Findings Regional change in age-standardised mean BMI in girls from 1975 to 2016 ranged from virtually no change (-0.01 kg/m (2) 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/m(2) per decade (0.69-1.35, PP> 0.9999) in central Latin America and an increase of 0.95 kg/m (2) 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/m(2) per decade (-0.33 to 0.49, PP= 0.6926) in eastern Europe to an increase of 0.77 kg/m (2) 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. Interpretation 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. 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Malta Ctr Salud Villanueva Norte, Villanueva De La Serena, Spain Univ West Indies, Mona, Jamaica Hosp Don Benito Villanueva de la Serena, Villanueva De La Serena, Spain Minist Hlth, Buenos Aires, DF, Argentina Council Agr Res & Econ, Rome, Italy Pontificia Univ Catolica Chile, Santiago, Chile Univ Toulouse, Sch Med, Toulouse, France Univ Manchester, Manchester, Lancs, England Univ Tartu, Tartu, Estonia Inst Nacl Salud Publ, Cuernavaca, Morelos, Mexico Univ Sains Malaysia, George Town, Malaysia Umea Univ, Umea, Sweden Dalarna University, Falun, Sweden Univ West Indies, Kingston, Jamaica Univ Fed Sao Paulo, Sao Paulo, Brazil Hosp Univ Son Espases, Palma De Mallorca, Spain Hosp Clin Porto Alegre, Porto Alegre, RS, Brazil Univ Fed Rio Grande do Sul, Rio Grande, Brazil Kindai Univ, Higashiosaka, Osaka, Japan Kyoto Univ, Kyoto, Japan Med Univ Warsaw, Warsaw, Poland Minist Hlth, Rome, Italy Univ Catania, Catania, Italy CIBER Epidemiol & Salud Publ, Barcelona, Spain Univ KwaZulu Natal, Durban, 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Einstein, Sao Paulo, Brazil Shiraz Univ Med Sci, Shiraz, Iran Inst Internal & Prevent Med, Novosibirsk, Russia Harokopio Univ, Kallithea, Greece Univ Otago, Dunedin, New Zealand Univ Padua, Padua, Italy Technol Educ Inst Crete, Iraklion, Greece Loughborough Univ Technol, Loughborough, Leics, England Univ Fed Santa Catarina, Florianopolis, SC, Brazil Lausanne Univ Hosp, Lausanne, Switzerland Inst Hosp Mard Invest Med, Barcelona, Spain Mary Immaculate Coll, Limerick, Ireland Emory Univ, Atlanta, GA 30322 USA Hungarian Soc Sports Med, Budapest, Hungary Sherikashmir Inst Med Sci, Srinagar, Jammu & Kashmir, India UiT Arctic Univ Norway, Tromso, Norway Cape Peninsula Univ Technol, Cape Town, South Africa Univ Rzeszow, Rzeszow, Poland Univ Yaounde I, Yaounde, Cameroon Brown Univ, Providence, RI 02912 USA Univ Edinburgh, Edinburgh, Midlothian, Scotland Stat Canada, Ottawa, ON, Canada Int Med Univ, Kuala Lumpur, Malaysia INSERM, Villejuif, France Helmholtz Zentrum Munchen, Oberschleissheim, Germany Robert Koch Inst, Berlin, Germany Lusofona Univ, Lisbon, Portugal Democritus Univ Greece, Komotini, Greece Grigore T Popa Univ Med & Pharm, Iasi, Romania Univ Firenze, Florence, Italy Hypertens Res Ctr, Esfahan, Iran Mulago Hosp, Kampala, Uganda Univ Limpopo, Polokwane, South Africa Seoul Natl Univ, Childrens Hosp, Seoul, South Korea Univ Fed Rio Grande do Sul, Porto Alegre, RS, Brazil Univ Med Sci, Havana, Cuba Univ Zaragoza, Zaragoza, Spain R CSI Dublin, Dublin, Ireland Int Inst Mol & Cell Biol, Warsaw, Poland Ain Shams University, Cairo, Egypt Ahvaz Jundishapur Univ Med Sci, Ahwaz, Iran Gorgas Memorial Inst Publ Hlth, Panama City, Panama Dept Publ Hlth, Nay Pyi Taw, Myanmar Univ Brescia, Brescia, Italy Helmholtz Zentrum Munchen, Neuherberg, Germany Univ Eastern Finland, Kuopio, Finland Mary Immaculate Coll, Tours, France Bushehr Univ Med Sci, Bushehr, Iran Ulm Univ, Ulm, Germany Inst Publ Hlth, Kuala Lumpur, Malaysia Kobe Univ, Kobe, Hyogo, Japan Banska Bystrica Reg Author Publ Hlth, Banska Bystrica, Slovakia Suraj Eye Inst, Nagpur, Maharashtra, India Helen Keller Int, Yaounde, Cameroon Karolinska Inst, Solna, Sweden Natl Inst Hyg & Epidemiol, Hanoi, Vietnam Univ Pharm & Med Ho Chi Minh City, Ho Chi Minh City, Vietnam Hanoi Med Univ, Hanoi, Vietnam Miami Vet Affairs Healthcare Syst, Miami, FL USA Heartfile, Islamabad, Pakistan Natl Canc Ctr, Tokyo, Japan Eastern Mediterranean Publ Hlth Network, Amman, Jordan State Univ Med & Pharm, Kishinev, Moldova Tachikawa Gen Hosp, Tachikawa, Tokyo, Japan Acad Hosp Paramaribo, Paramaribo, Surinam Univ Vale Rio dos Sinos, Sao Leopoldo, Brazil Natl Food & Nutr Inst, Warsaw, Poland Minist Hlth, Bandar Seri Begawan, Brunei Univ Fed Santa Catarin, Florianopolis, SC, Brazil Univ Madeira, Funchal, Portugal Univ Puerto Rico, San Juan, PR USA MRC Lifecourse Epidemiol Unit, Southampton, Hants, England Aarhus Univ, Aarhus, Denmark Kwame Nkrumah Univ Sci & Technol, Kumasi, Ghana Inst Social & Prevent, Lausanne, Switzerland Canc Prevent & Res Inst, Florence, Italy Univ Wisconsin Madison, Madison, WI USA IRCCS Casa Sollievo Sofferenz, San Giovanni Rotondo, Italy Zayed Univ, Dubai, U Arab Emirates Catholic Univ Daegu, Gyongsan, South Korea Tg Mures Univ Med & Pharm, Targu Mures, Romania Jivandeep Hosp, Surat, India South African Med Res Council, Tygerberg, South Africa Univ Med Ctr Utrecht, Utrecht, Netherlands Fundacao Oswaldo Cruz, Rene Rachou Res Inst, Rio De Janeiro, Brazil Spanish Agcy Consumer Affairs Social Serv & Nutr, Madrid, Spain Univ Puerto Rico, Med Sci Campus, San Juan, PR USA Minist Hlth & Med Educ, Tehran, Iran Vietnam Natl Heart Inst, Hanoi, Vietnam Leibniz Inst Prevent Res & Epidemiol BIPS, Bremen, Germany Univ Sarajevo, Sarajevo, Bosnia & Herceg Cardiovasc Prevent Ctr Udine, Udine, Italy Univ Hosp Pisa, Pisa, Italy Minist Hlth & Med Serv, Honiara, Solomon Islands Publ Hlth Agcy Catalonia, Barcelona, Spain Univ Kebangsaan Malaysia, Kuala Lumpur, Malaysia Univ Montenegro, Podgorica, Montenegro Inst Hosp Mar Invest Med, Barcelona, Spain Agcy Prevent and Social Med, Innsbruck, Austria Digest Oncol Res Ctr, Tehran, Iran Digest Dis Res Inst, Tehran, Iran CHU Vaudois, Lausanne, Switzerland Ctr Dis & Prevent Control, Riga, Latvia Al Quds Univ, Jerusalem, Israel Alborz Univ Med Sci, Karaj, Iran Minist Hlth, Hanoi, Vietnam BRAC, Dhaka, Bangladesh Inst Epidemiol Dis Control & Res, Dhaka, Bangladesh Univ Turku, Turku, Finland India Diabet Res Fdn, Madras, Tamil Nadu, India Univ New South Wales, Sydney, NSW, Australia Inst Univ Invest Atencio Primaria Jordi Gol, Barcelona, Spain Univ Malaya, Kuala Lumpur, Malaysia Univ Valencia, Valencia, Spain Univ Philippines, Quezon City, Philippines Nutr Res Fdn, Barcelona, Spain Minas Gerais State Secretariat Hlth, Belo Horizonte, MG, Brazil Hlth Ctr San Agustin, San AgustIn, Spain PharmAccess Fdn, Amsterdam, Netherlands Natl Inst Hlth Doutor Ricardo Jorge, Lisbon, Portugal Publ Hlth Agcy Canada, Ottawa, ON, Canada Canarian Hlth Serv, Barcelona, Spain Univ Ind Santander, Bucaramanga, Colombia Inst Nacl Salud Publ, Mexico City, DF, Mexico CIBEROBN, Madrid, Spain Gothenburg Univ, Gothenburg, Sweden Fiji Natl Univ, Suva, Fiji CNR, Inst Food Sci, Rome, Italy Sitaram Bhartia Inst Sci & Res, New Delhi, India Univ Tunis El Mana, Tunis, Tunisia Natl Inst Publ Hlth, Mexico City, DF, Mexico Univ Helsinki, Helsinki, Finland Natl Inst Hlth Peru, Lima, Peru Minist Hlth, South Jakarta, Indonesia Catalan Dept Hlth, Barcelona, Spain Publ Hlth Subdelegate Off, Barcelona, Spain Univ Lisbon, Lisbon, Portugal Prevent Med & Publ Hlth, Lisbon, Portugal Univ Sao Paulo, Clin Hosp, Sao Paulo, Brazil South Karelia Social & Hlth Care Dist, Lappeenranta, Finland Isfahan Cardiovasc Res Ctr, Esfahan, Iran Hosp Italiano Buenos Aires, Buenos Aires, DF, Argentina Rigshosp, Copenhagen, Denmark Minist Hlth, Naypyidaw, Myanmar Lagos State Univ, Coll Med, Lagos, Nigeria Univ Las Palmas Gran Canaria, Las Palmas Gran Canaria, Spain Baker Heart and Diabet Inst, Melbourne, Vic, Australia Univ Tokyo, Tokyo, Japan Samsung Med Ctr, Seoul, South Korea Finnish Inst Occupat Hlth, Helsinki, Finland St Vincents Hosp, Melbourne, Vic, Australia Acad Med Ctr Amsterdam, Amsterdam, Netherlands Hlth Polytech Jakarta II Inst, Jakarta, Indonesia Univ Bari, Bari, Italy Inst Reg Sante Publ, Cotonou, Benin Univ Bordeaux, Bordeaux, France Inst Publ Hlth Republ Macedonia, Skopje, Macedonia Univ Leuven, Leuven, Belgium Lamprecht & Stamm Sozialforsch & Beratung AG, Zurich, Switzerland INSERM, Paris, France Univ Bonn, Bonn, Germany Sotiria Hosp, Athens, Greece Natl Inst Publ Hlth, Natl Inst Hyg, Warsaw, Poland Swansea Univ, Swansea, W Glam, Wales Fu Jen Catholic Univ, New Taipei, Taiwan Minist Hlth, Amman, Jordan Natl Inst Hlth, Lima, Peru UNICEF, Yaounde, Cameroon Danish Canc Soc Res Ctr, Copenhagen, Denmark Hlth Serv Murcia, Murcia, Spain Res & Educ Inst, Nicosia, Cyprus IB SALUT Area Salut Menorca, Palma de Mallorca, Spain Univ Bologna, Bologna, Italy Hellen Hlth Fdn, Athens, Greece Univ Pharm & Med Ho Chi Min City, Ho Chi Minh, Vietnam Governm Med Coll, Secunderabad, India Sefako Makgatho Hlth Sci Univ, Kangnung, South Korea Addis Ababa Univ, Addis Ababa, Ethiopia Dasman Diabet Inst, Kuwait, Kuwait Minist Hlth, Thorndon, New Zealand Hellen Med Associat Obes, Athens, Greece Univ Ctr Occidental Lisandro Alvarado, Barquisimeto, Venezuela Meharry Med Coll, Nashville, TN USA Dokuz Eylul Univ, Izmir, Turkey Univ Tampere, Tays Eye Ctr, Tampere, Finland Polytech Inst Porto, Oporto, Portugal Univ Utrecht, Utrecht, Netherlands Amsterdam Publ Hlth Res Inst, Amsterdam, Netherlands Univ Fed Minas Gerais, Belo Horizonte, MG, Brazil Natl Inst Publ Hlth & Environm, Bilthoven, Netherlands Fed Univ Pelota, Pelotas, Brazil Italian Natl Res Council, Rome, Italy Univ Miguel Hernandez, Elche, Spain Minist Hlth, Victoria, Seychelles North Karelian Ctr Publ Hlth, Joensuu, Finland ISGlobal Ctr Res Environm Epidemiol, Barcelona, Spain Univ Witwatersrand, Johannesburg, South Africa Med Univ Vienna, Vienna, Austria Univ Coll Cork, Cork, Ireland Inst Med Res, Kuala Lumpur, Malaysia Xinjiang Med Univ, Urumqi, Peoples R China St Georges Univ London, London, England Univ Indonesia, Depok, Indonesia Natl Inst Hyg, Warsaw, Poland Caja Costarricense Seguro Social, Atenas, Costa Rica Univ Kebangsaan Malaysia, Bangi Selangor, Malaysia Univ New South Wales, Kensington, NSW, Australia Univ Mancheste, Manchester, Lancs, England Shandong Univ Tradit Chinese Med, Jinan, Shandong, Peoples R China Kailuan Gen Hosp, Tangshan, Peoples R China Minist Agr, Inst Food & Dev, Beijing, Peoples R China Fudan Univ, Childrens Hosp, Shanghai, Peoples R China Chinese Ctr Dis Control & Prevent, Beijing, Peoples R China Univ Cyprus, Nicosia, Cyprus Univ Teknol MARA, Shah Alam, Malaysia Capital Med Univ Beijing, An Zhen Hosp, Beijing, Peoples R China West Kazakhstan State Med Univ, Aktobe, Kazakhstan Inner Mongolia Med Univ, Hohhot, Peoples R China Gorgas Mem Inst Publ Hlth, Panama City, Panama Univ Estadual Paulista, Sao Paulo, Brazil