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Sharman A, Shaw JE, Shayanrad A, Shayesteh AA, Shengelia L, Shi Z, Shibuya K, Shimizu-Furusawa H, Shimony T, Shiri R, Shrestha N, Si-Ramlee K, Siani A, Siantar R, Sibai AM, Sidossis LS, Silitrari N, Silva AM, Silva CRDM, Silva DAS, Silva KS, Sim X, Simon M, Simons J, Simons LA, Sjöberg A, Sjöström M, Skoblina EV, Skoblina NA, Slazhnyova T, Slowikowska-Hilczer J, Slusarczyk P, Smeeth L, So HK, Soares FC, Sobek G, Sobngwi E, Sodemann M, Söderberg S, Soekatri MYE, Soemantri A, Sofat R, Solfrizzi V, Solovieva YV, Somi MH, Sonestedt E, Song Y, Soofi S, Sørensen TIA, Sørgjerd EP, Sossa Jérome C, Soto-Rojas VE, Soumaré A, Sousa-Poza A, Sovic S, Sparboe-Nilsen B, Sparrenberger K, Spencer PR, Spinelli A, Spiroski I, Staessen JA, Stamm H, Stang A, Starc G, Staub K, Stavreski B, Steene-Johannessen J, Stehle P, Stein AD, Steinsbekk S, Stergiou GS, Stessman J, Stevanović R, Stieber J, Stöckl D, Stokwiszewski J, Stoyanova E, Stratton G, Stronks K, Strufaldi MW, Sturua L, Suárez-Medina R, Suarez-Ortegón MF, Suebsamran P, Sugiyama M, Suka M, Sulo G, Sun CA, Sun L, Sund M, Sundström J, Sung YT, Sunyer J, Suriyawongpaisal P, Sweis NWG, Swinburn BA, Sy RG, Sylva RC, Szponar L, Tabone L, Tai ES, Takuro F, Tambalis KD, Tammesoo ML, Tamosiunas A, Tan EJ, Tang X, Tanrygulyyeva M, Tanser F, Tao Y, Tarawneh MR, Tarp J, Tarqui-Mamani CB, Taxová Braunerová R, Taylor A, Taylor J, Tchibindat F, Te Velde S, Tebar WR, Tell GS, Tello T, Tessema M, Tham YC, Thankappan KR, Theobald H, Theodoridis X, Thomas N, Thorand B, Thrift AG, Tichá Ľ, Timmermans EJ, Tjandrarini DH, Tjonneland A, Tolonen HK, Tolstrup JS, Tomaszewski M, Topbas M, Topór-Mądry R, Torheim LE, Tornaritis MJ, Torrent M, Torres-Collado L, Toselli S, Touloumi G, Traissac P, Tran TTH, Tremblay MS, Triantafyllou A, Trichopoulos D, Trichopoulou A, Trinh OTH, Trivedi A, Tshepo L, Tsigga M, Tsintavis P, Tsugane S, Tuitele J, Tuliakova AM, Tulloch-Reid MK, Tullu F, Tuomainen TP, Tuomilehto J, Twig G, Tynelius P, Tzala E, Tzotzas T, Tzourio C, Udoji N, Ueda P, Ugel E, Ukoli FAM, Ulmer H, Unal B, Usupova Z, Uusitalo HMT, Uysal N, Vaitkeviciute J, Valdivia G, Vale S, Valvi D, van Dam RM, van den Born BJ, Van der Heyden J, van der Schouw YT, Van Herck K, Van Lippevelde W, Van Minh H, Van Schoor NM, van Valkengoed IGM, Vanderschueren D, Vanuzzo D, Varbo A, Varela-Moreiras G, Vargas LN, Varona-Pérez P, Vasan SK, Vasques DG, Vatasescu R, Vega T, Veidebaum T, Velasquez-Melendez G, Velika B, Verloigne M, Veronesi G, Verschuren WMM, Victora CG, Viegi G, Viet L, Vik FN, Vilar M, Villalpando S, Vioque J, Viriyautsahakul N, Virtanen JK, Visser M, Visvikis-Siest S, Viswanathan B, Vladulescu M, Vlasoff T, Vocanec D, Vollenweider P, Völzke H, Vourli G, Voutilainen A, Vrijheid M, Vrijkotte TGM, Vuletić S, Wade AN, Waldhör T, Walton J, Wambiya EOA, Wan Bebakar WM, Wan Mohamud WN, Wanderley Júnior RDS, Wang C, Wang H, Wang MD, Wang N, Wang Q, Wang X, Wang YX, Wang YW, Wannamethee SG, Wareham N, Wartha O, Weber A, Wedderkopp N, Weghuber D, Wei W, Weres A, Werner B, Westbury LD, Whincup PH, Wichstrøm L, Wickramasinghe K, Widhalm K, Widyahening IS, Więcek A, Wild PS, Wilks RJ, Willeit J, Willeit P, Williams J, Wilsgaard T, Wirth JP, Wojtyniak B, Woldeyohannes M, Wolf K, Wong-McClure RA, Wong A, Wong EB, Wong JE, Wong TY, Woo J, Woodward M, Wu FC, Wu HY, Wu J, Wu LJ, Wu S, Wyszyńska J, Xu H, Xu L, Yaacob NA, Yamborisut U, Yan L, Yan W, Yang L, Yang X, Yang Y, Yardim N, Yasuharu T, Yépez García M, Yiallouros PK, Yngve A, Yoosefi M, Yoshihara A, Yotov Y, You QS, You SL, Younger-Coleman NO, Yu YL, Yu Y, Yusof SM, Yusoff AF, Zaccagni L, Zafiropulos V, Zainuddin AA, Zakavi SR, Zamani F, Zambon S, Zampelas A, Zamrazilová H, Zapata ME, Zargar AH, Zaw KK, Zayed AA, Zdrojewski T, Żegleń M, Zejglicova K, Zeljkovic Vrkic T, Zeng Y, Zentai A, Zhang B, Zhang L, Zhang ZY, Zhao D, Zhao MH, Zhao W, Zhecheva YV, Zhen S, Zheng W, Zheng Y, Zholdin B, Zhou M, Zhu D, Zimmet P, Zins M, Zitt E, Zocalo Y, Zoghlami N, Zuñiga Cisneros J, Zuziak M, Ezzati M. Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults. Lancet 2024; 403:1027-1050. [PMID: 38432237 PMCID: PMC7615769 DOI: 10.1016/s0140-6736(23)02750-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/22/2023] [Accepted: 12/05/2023] [Indexed: 03/05/2024]
Abstract
BACKGROUND Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. METHODS We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5-19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For school-aged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). FINDINGS From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. INTERPRETATION The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity. FUNDING UK Medical Research Council, UK Research and Innovation (Research England), UK Research and Innovation (Innovate UK), and European Union.
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Zhou B, Sheffer KE, Bennett JE, Gregg EW, Danaei G, Singleton RK, Shaw JE, Mishra A, Lhoste VPF, Carrillo-Larco RM, Kengne AP, Phelps NH, Heap RA, Rayner AW, Stevens GA, Paciorek CJ, Riley LM, Cowan MJ, Savin S, Vander Hoorn S, Lu Y, Pavkov ME, Imperatore G, Aguilar-Salinas CA, Ahmad NA, Anjana RM, Davletov K, Farzadfar F, González-Villalpando C, Khang YH, Kim HC, Laatikainen T, Laxmaiah A, Mbanya JCN, Narayan KMV, Ramachandran A, Wade AN, Zdrojewski T, Abbasi-Kangevari M, Rahim HFA, Abu-Rmeileh NM, Adambekov S, Adams RJ, Aekplakorn W, Agdeppa IA, Aghazadeh-Attari J, Agyemang C, Ahmadi A, Ahmadi N, Ahmadi N, Ahmed SH, Ajlouni K, Al-Hinai H, Al-Lahou B, Al-Lawati JA, Asfoor DA, Al Qaoud NM, Alarouj M, AlBuhairan F, AlDhukair S, Aldwairji MA, Ali MM, Alinezhad F, Alkandari A, Alomirah HF, Aly E, Amarapurkar DN, Andersen LB, Anderssen SA, Andrade DS, Ansari-Moghaddam A, Aounallah-Skhiri H, Aris T, Arlappa N, Aryal KK, Assah FK, Assembekov B, Auvinen J, Avdičová M, Azad K, Azimi-Nezhad M, Azizi F, Bacopoulou F, Balakrishna N, Bamoshmoosh M, Banach M, Bandosz P, Banegas JR, Barbagallo CM, Barceló A, Baretić M, Barrera L, Basit A, Batieha AM, Batista AP, Baur LA, Belavendra A, Ben Romdhane H, Benet M, Berkinbayev S, Bernabe-Ortiz A, Berrios Carrasola X, Bettiol H, Beybey AF, Bhargava SK, Bika Lele EC, Bikbov MM, Bista B, Bjerregaard P, Bjertness E, Bjertness MB, Björkelund C, Bloch KV, Blokstra A, Bo S, Bobak M, Boggia JG, Bonaccio M, Bonilla-Vargas A, Borghs H, Bovet P, Brajkovich I, Brenner H, Brewster LM, Brian GR, Briceño Y, Brito M, Bugge A, Buntinx F, Cabrera de León A, Caixeta RB, Can G, Cândido APC, Capanzana MV, Čapková N, Capuano E, Capuano R, Capuano V, Cardoso VC, Carlsson AC, Casanueva FF, Censi L, Cervantes‐Loaiza M, Chamnan P, Chamukuttan S, Chan Q, Charchar FJ, Chaturvedi N, Chen H, Cheraghian B, Chirlaque MD, Chudek J, Cifkova R, Cirillo M, Claessens F, Cohen E, Concin H, Cooper C, Costanzo S, Cowell C, Crujeiras AB, Cruz JJ, Cureau FV, Cuschieri S, D’Arrigo G, d’Orsi E, Dallongeville J, Damasceno A, Dastgiri S, De Curtis A, de Gaetano G, De Henauw S, Deepa M, DeGennaro V, Demarest S, Dennison E, Deschamps V, Dhimal M, Dika Z, Djalalinia S, Donfrancesco C, Dong G, Dorobantu M, Dörr M, Dragano N, Drygas W, Du Y, Duante CA, Duboz P, Dushpanova A, Dziankowska-Zaborszczyk E, Ebrahimi N, Eddie R, Eftekhar E, Efthymiou V, Egbagbe EE, Eghtesad S, El-Khateeb M, El Ati J, Eldemire-Shearer D, Elosua R, Enang O, Erasmus RT, Erbel R, Erem C, Ergor G, Eriksen L, Eriksson JG, Esmaeili A, Evans RG, Fakhradiyev I, Fall CH, Faramarzi E, Farjam M, Farzi Y, Fattahi MR, Fawwad A, Felix-Redondo FJ, Ferguson TS, Fernández-Bergés D, Ferrari M, Ferreccio C, Ferreira HS, Ferrer E, Feskens EJM, Flood D, Forsner M, Fosse S, Fottrell EF, Fouad HM, Francis DK, Frontera G, Furusawa T, Gaciong Z, Garnett SP, Gasull M, Gazzinelli A, Gehring U, Ghaderi E, Ghamari SH, Ghanbari A, Ghasemi E, Gheorghe-Fronea OF, Ghimire A, Gialluisi A, Giampaoli S, Gianfagna F, Gill TK, Gironella G, Giwercman A, Goltzman D, Gomula A, Gonçalves H, Gonçalves M, Gonzalez-Chica DA, Gonzalez-Gross M, González-Rivas JP, González-Villalpando ME, Gonzalez AR, Gottrand F, Grafnetter D, Grodzicki T, Grøntved A, Guerrero R, Gujral UP, Gupta R, Gutierrez L, Gwee X, Haghshenas R, Hakimi H, Hambleton IR, Hamzeh B, Hanekom WA, Hange D, Hantunen S, Hao J, Hari Kumar R, Harooni J, Hashemi-Shahri SM, Hata J, Heidemann C, Henrique RDS, Herrala S, Herzig KH, Heshmat R, Ho SY, Holdsworth M, Homayounfar R, Hopman WM, Horimoto ARVR, Hormiga C, Horta BL, Houti L, Howitt C, Htay TT, Htet AS, Htike MMT, Huerta JM, Huhtaniemi IT, Huisman M, Husseini A, Huybrechts I, Iacoviello L, Iakupova EM, Iannone AG, Ibrahim Wong N, Ijoma C, Irazola VE, Ishida T, Isiguzo GC, Islam SMS, Islek D, Ittermann T, Iwasaki M, Jääskeläinen T, Jacobs JM, Jaddou HY, Jadoul M, Jallow B, James K, Jamil KM, Janus E, Jarvelin MR, Jasienska G, Jelaković A, Jelaković B, Jennings G, Jha AK, Jimenez RO, Jöckel KH, Jokelainen JJ, Jonas JB, Joshi P, Josipović J, Joukar F, Jóźwiak J, Kafatos A, Kajantie EO, Kalmatayeva Z, Karki KB, Katibeh M, Kauhanen J, Kazakbaeva GM, Kaze FF, Ke C, Keinänen-Kiukaanniemi S, Kelishadi R, Keramati M, Kersting M, Khader YS, Khaledifar A, Khalili D, Kheiri B, Kheradmand M, Khosravi A, Kiechl-Kohlendorfer U, Kiechl SJ, Kiechl S, Kingston A, Klakk H, Klanova J, Knoflach M, Kolsteren P, König J, Korpelainen R, Korrovits P, Kos J, Koskinen S, Kowlessur S, Koziel S, Kriemler S, Kristensen PL, Kromhout D, Kubinova R, Kujala UM, Kulimbet M, Kurjata P, Kyobutungi C, La QN, Labadarios D, Lachat C, Laid Y, Lall L, Lankila T, Lanska V, Lappas G, Larijani B, Latt TS, Laurenzi M, Lehmann N, Lehtimäki T, Lemogoum D, Leung GM, Li Y, Lima-Costa MF, Lin HH, Lind L, Lissner L, Liu X, Lopez-Garcia E, Lopez T, Lozano JE, Luksiene D, Lundqvist A, Lunet N, Lustigová M, Machado-Coelho GLL, Machado-Rodrigues AM, Macia E, Macieira LM, Madar AA, Maestre GE, Maggi S, Magliano DJ, Magriplis E, Mahasampath G, Maire B, Makdisse M, Malekpour MR, Malekzadeh F, Malekzadeh R, Mallikharjuna Rao K, Malyutina S, Maniego LV, Manios Y, Mannix MI, Mansour-Ghanaei F, Manzato E, Margozzini P, Mariño J, Marques LP, Martorell R, Mascarenhas LP, Masinaei M, Mathiesen EB, Matsha TE, Mc Donald Posso AJ, McFarlane SR, McGarvey ST, Mediene Benchekor S, Mehlig K, Mehrparvar AH, Melgarejo JD, Méndez F, Menezes AMB, Mereke A, Meshram II, Meto DT, Minderico CS, Mini GK, Miquel JF, Miranda JJ, Mirjalili MR, Modesti PA, Moghaddam SS, Mohamed MK, Mohammad K, Mohammadi MR, Mohammadi Z, Mohammadifard N, Mohammadpourhodki R, Mohan V, Mohd Yusoff MF, Mohebbi I, Møller NC, Molnár D, Momenan A, Mondo CK, Montenegro Mendoza RA, Monterrubio-Flores E, Moosazadeh M, Moradpour F, Morejon A, Moreno LA, Morgan K, Morin SN, Moslem A, Mosquera M, Mossakowska M, Mostafa A, Mostafavi SA, Motlagh ME, Motta J, Msyamboza KP, Mu TT, Muiesan ML, Mursu J, Musa KI, Mustafa N, Muyer MTMC, Nabipour I, Nagel G, Naidu BM, Najafi F, Námešná J, Nangia VB, Naseri T, Neelapaichit N, Nejatizadeh A, Nenko I, Nervi F, Ng TP, Nguyen CT, Nguyen QN, Ni MY, Nie P, Nieto-Martínez RE, Ninomiya T, Noale M, Noboa OA, Noto D, Nsour MA, Nuhoğlu I, O’Neill TW, Odili AN, Oh K, Ohtsuka R, Omar MA, Onat A, Ong SK, Onodugo O, Ordunez P, Ornelas R, Ortiz PJ, Osmond C, Ostovar A, Otero JA, Ottendahl CB, Otu A, Owusu-Dabo E, Palmieri L, Pan WH, Panda-Jonas S, Panza F, Paoli M, Park S, Parsaeian M, Patel ND, Pechlaner R, Pećin I, Pedro JM, Peixoto SV, Peltonen M, Pereira AC, Pessôa dos Prazeres TM, Peykari N, Phall MC, Pham ST, Phan HH, Pichardo RN, Pikhart H, Pilav A, Piler P, Pitakaka F, Piwonska A, Pizarro AN, Plans-Rubió P, Plata S, Porta M, Poudyal A, Pourfarzi F, Pourshams A, Poustchi H, Pradeepa R, Providencia R, Puder JJ, Puhakka S, Punab M, Qorbani M, Quintana HK, Quoc Bao T, Rahimikazerooni S, Raitakari O, Ramirez-Zea M, Ramke J, Ramos R, Rampal L, Rampal S, Rangel Reina DA, Rashidi MM, Redon J, Renner JDP, Reuter CP, Revilla L, Rezaei N, Rezaianzadeh A, Rigo F, Roa RG, Robinson L, Rodríguez-Artalejo F, Rodriguez-Perez MDC, Rodríguez-Villamizar LA, Rodríguez AY, Roggenbuck U, Rohloff P, Romeo EL, Rosengren A, Rubinstein A, Rust P, Rutkowski M, Sabbaghi H, Sachdev HS, Sadjadi A, Safarpour AR, Safi S, Safiri S, Saghi MH, Saidi O, Saki N, Šalaj S, Salanave B, Salonen JT, Salvetti M, Sánchez-Abanto J, Santos DA, Santos LC, Santos MP, Santos TR, Saramies JL, Sardinha LB, Sarrafzadegan N, Saum KU, Sbaraini M, Scazufca M, Schaan BD, Scheidt-Nave C, Schipf S, Schmidt CO, Schöttker B, Schramm S, Sebert S, Sedaghattalab M, Sein AA, Sepanlou SG, Sewpaul R, Shamah-Levy T, Shamshirgaran SM, Sharafkhah M, Sharma SK, Sharman A, Shayanrad A, Shayesteh AA, Shimizu-Furusawa H, Shiri R, Shrestha N, Si-Ramlee K, Silva DAS, Simon M, Simons J, Simons LA, Sjöström M, Slowikowska-Hilczer J, Slusarczyk P, Smeeth L, Sobngwi E, Söderberg S, Soemantri A, Sofat R, Solfrizzi V, Somi MH, Soumaré A, Sousa-Poza A, Sparrenberger K, Staessen JA, Stavreski B, Steene-Johannessen J, Stehle P, Stein AD, Stessman J, Stokwiszewski J, Stronks K, Suarez-Ortegón MF, Suebsamran P, Sundström J, Suriyawongpaisal P, Sylva RC, Szklo M, Tamosiunas A, Tarawneh MR, Tarqui-Mamani CB, Taylor A, Taylor J, Tello T, Thankappan KR, Theobald H, Theodoridis X, Thomas N, Thrift AG, Timmermans EJ, Tjandrarini DH, Tolonen HK, Tolstrup JS, Tomaszewski M, Topbas M, Torres-Collado L, Traissac P, Triantafyllou A, Tuitele J, Tuliakova AM, Tulloch-Reid MK, Tuomainen TP, Tzala E, Tzourio C, Ueda P, Ugel E, Ukoli FAM, Ulmer H, Uusitalo HMT, Valdivia G, van den Born BJ, Van der Heyden J, Van Minh H, van Rossem L, Van Schoor NM, van Valkengoed IGM, van Zutphen EM, Vanderschueren D, Vanuzzo D, Vasan SK, Vega T, Velasquez-Melendez G, Verstraeten R, Viet L, Villalpando S, Vioque J, Virtanen JK, Viswanathan B, Voutilainen A, Wan Bebakar WM, Wan Mohamud WN, Wang C, Wang N, Wang Q, Wang YX, Wang YW, Wannamethee SG, Webster-Kerr K, Wedderkopp N, Wei W, Westbury LD, Whincup PH, Widhalm K, Widyahening IS, Więcek A, Wilks RJ, Willeit J, Willeit P, Wilsgaard T, Wojtyniak B, Wong A, Wong EB, Woodward M, Wu FC, Xu H, Xu L, Yaacob NA, Yan L, Yan W, Yoosefi M, Yoshihara A, Younger-Coleman NO, Yu YL, Yu Y, Yusoff AF, Zainuddin AA, Zamani F, Zambon S, Zampelas A, Zaw KK, Zeljkovic Vrkic T, Zeng Y, Zhang ZY, Zholdin B, Zimmet P, Zitt E, Zoghlami N, Zuñiga Cisneros J, Ezzati M. Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c. Nat Med 2023; 29:2885-2901. [PMID: 37946056 PMCID: PMC10667106 DOI: 10.1038/s41591-023-02610-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 09/25/2023] [Indexed: 11/12/2023]
Abstract
Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are both used to diagnose diabetes, but these measurements can identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening, had elevated FPG, HbA1c or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardized proportion of diabetes that was previously undiagnosed and detected in survey screening ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the age-standardized proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c was more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global shortfall in diabetes diagnosis and surveillance.
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Zribi M, Mansour NB, Moussa H, Hassine HB, Aounallah-Skhiri H. Experiences and perceptions of health professionals towards the quality of care for people living with HIV in Tunisia: a qualitative study. Pan Afr Med J 2023; 46:4. [PMID: 37928224 PMCID: PMC10620327 DOI: 10.11604/pamj.2023.46.4.35184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/12/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction human immunodeficiency virus (HIV) infection continues to be a public health issue, especially in low- and middle-income countries, including Tunisia. In 2020, 32% of people living with HIV were on treatment. Management of HIV infection remains a real challenge for both patients and care providers. Our study aimed to describe the perceptions and attitudes of health professionals toward care for people living with HIV (PLHIV). Methods a qualitative study was carried out between 2020 and 2021. Interviews with key informants were conducted in order to identify the strengths and weaknesses of the care for PLHIV, as well as their suggestions for improvement. Eight key informants in HIV care from different profiles were interviewed: healthcare providers from a specialized university hospital, the Ministry of Health, and civil society representatives working in the field of HIV. Interviews were transcribed and analyzed thematically using "QDA Miner" software. Results the frequency of PLHIV who have interrupted medical follow-up was perceived as worrisome, and increasing. Along with individual factors, non-adherence to treatment was also attributed to systemic factors related to stock shortages, geographical inaccessibility, and shortfall in human resources. Stigmatization of PLHIV in healthcare facilities outside the specialized hospital was also highlighted. This has been linked to gaps in the training of care providers on the modes of the virus transmission. Conclusion health professionals face many challenges in the care of PLHIV. There is an urgent need to improve treatment availability and accessibility, strengthen social assistance for PLHIV and fight against stigmatization, especially in healthcare settings.
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Affiliation(s)
- Mariem Zribi
- National Institute of Health, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Nadia Ben Mansour
- National Institute of Health, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Hayet Moussa
- Higher Institute of Human Sciences of Tunis, Tunis, Tunisia
| | | | - Hajer Aounallah-Skhiri
- National Institute of Health, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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EP, Jérome CS, Soto-Rojas VE, Soumaré A, Sousa-Poza A, Sovic S, Sparboe-Nilsen B, Sparrenberger K, Spencer PR, Spinelli A, Spiroski I, Staessen JA, Stamm H, Staub K, Stavreski B, Steene-Johannessen J, Stehle P, Stein AD, Stergiou GS, Stessman J, Stevanović R, Stieber J, Stöckl D, Stokwiszewski J, Stoyanova E, Stratton G, Stronks K, Strufaldi MW, Sturua L, Suárez-Medina R, Suka M, Sun CA, Sun L, Sundström J, Sung YT, Sunyer J, Suriyawongpaisal P, Sweis NWG, Swinburn BA, Sy RG, Sylva RC, Szklo M, Szponar L, Tabone L, Tai ES, Tambalis KD, Tammesoo ML, Tamosiunas A, Tan EJ, Tang X, Tanrygulyyeva M, Tanser F, Tao Y, Tarawneh MR, Tarp J, Tarqui-Mamani CB, Braunerová RT, Taylor A, Taylor J, Tchibindat F, Te Velde S, Tebar WR, Tell GS, Tello T, Tham YC, Thankappan KR, Theobald H, Theodoridis X, Thomas N, Thorand B, Thuesen BH, Tichá Ľ, Timmermans EJ, Tjandrarini DH, Tjonneland A, Tolonen HK, Tolstrup JS, Topbas M, Topór-Mądry R, Torheim LE, Tormo MJ, Tornaritis MJ, Torrent M, Torres-Collado L, Toselli S, Touloumi G, Traissac P, Tran TTH, Tremblay MS, Triantafyllou A, Trichopoulos D, Trichopoulou A, Trinh OTH, Trivedi A, Tsao YH, Tshepo L, Tsigga M, Tsintavis P, Tsugane S, Tuitele J, Tuliakova AM, Tulloch-Reid MK, Tullu F, Tuomainen TP, Tuomilehto J, Turley ML, Twig G, Tynelius P, Tzala E, Tzotzas T, Tzourio C, Ueda P, Ugel E, Ukoli FAM, Ulmer H, Unal B, Usupova Z, Uusitalo HMT, Uysal N, Vaitkeviciute J, Valdivia G, Vale S, Valvi D, van Dam RM, van den Born BJ, Van der Heyden J, van der Schouw YT, Van Herck K, Van Lippevelde W, Van Minh H, Van Schoor NM, van Valkengoed IGM, Vanderschueren D, Vanuzzo D, Varbo A, Varela-Moreiras G, Vargas LN, Varona-Pérez P, Vasan SK, Vasques DG, Vega T, Veidebaum T, Velasquez-Melendez G, Velika B, Verloigne M, Veronesi G, Verschuren WMM, Victora CG, Viegi G, Viet L, Vik FN, Vilar M, Villalpando S, Vioque J, Virtanen JK, Visvikis-Siest S, Viswanathan B, Vladulescu M, Vlasoff T, Vocanec D, Vollenweider P, Völzke H, Voutilainen A, Vrijheid M, Vrijkotte TGM, Wade AN, Waldhör T, Walton J, Wambiya EOA, Bebakar WMW, Mohamud WNW, de Souza Wanderley Júnior R, Wang MD, Wang N, Wang Q, Wang X, Wang YX, Wang YW, Wannamethee SG, Wareham N, Weber A, Webster-Kerr K, Wedderkopp N, Weghuber D, Wei W, Weres A, Werner B, Westbury LD, Whincup PH, Wickramasinghe K, Widhalm K, Widyahening IS, Więcek A, Wild PS, Wilks RJ, Willeit J, Willeit P, Williams J, Wilsgaard T, Wojciech R, Wojtyniak B, Wolf K, Wong-McClure RA, Wong A, Wong EB, Wong JE, Wong TY, Woo J, Woodward M, Wu FC, Wu HY, Wu J, Wu LJ, Wu S, Wyszyńska J, Xu H, Xu L, Yaacob NA, Yamborisut U, Yan W, Yang L, Yang X, Yang Y, Yardim N, Yasuharu T, García MY, Yiallouros PK, Yngve A, Yoosefi M, Yoshihara A, You QS, You SL, Younger-Coleman NO, Yu YL, Yu Y, Yusof SM, Yusoff AF, Zaccagni L, Zafiropulos V, Zainuddin AA, Zakavi SR, Zamani F, Zambon S, Zampelas A, Zamrazilová H, Zapata ME, Zargar AH, Zaw KK, Zayed AA, Zdrojewski T, Żegleń M, Zejglicova K, Vrkic TZ, Zeng Y, Zhang L, Zhang ZY, Zhao D, Zhao MH, Zhao W, Zhecheva YV, Zhen S, Zheng W, Zheng Y, Zholdin B, Zhou M, Zhu D, Zins M, Zitt E, Zocalo Y, Zoghlami N, Cisneros JZ, Zuziak M, Bhutta ZA, Black RE, Ezzati M. Diminishing benefits of urban living for children and adolescents' growth and development. Nature 2023; 615:874-883. [PMID: 36991188 PMCID: PMC10060164 DOI: 10.1038/s41586-023-05772-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 01/30/2023] [Indexed: 03/31/2023]
Abstract
Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1-6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5-19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m-2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified.
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Ouali U, Aissa A, Rjaibi S, Zoghlami N, Zgueb Y, Larnaout A, Zid M, Kacem I, Charfi F, Moro MF, Touihri N, Melki W, Aounallah-Skhiri H, Nacef F, Gouider R, El Hechmi Z, Carta MG. Prevalence of Mood Disorders and Associated Factors at the Time of the COVID-19 Pandemic: Potocol for a Community Survey in La Manouba Governorate, Tunisia. Clin Pract Epidemiol Ment Health 2022; 18:e174501792210250. [PMID: 37274854 PMCID: PMC10156032 DOI: 10.2174/17450179-v18-e221026-2022-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 09/10/2022] [Accepted: 09/23/2022] [Indexed: 06/07/2023]
Abstract
Aims The present survey aims to assess the overall mood disorder prevalence and identify associated socio-demographic and clinical factors in a Tunisian community sample, with special attention to the COVID-19 pandemic. Background Mood disorders are one of the leading causes of all non-fatal burdens of disease, with depression being at the top of the list. The COVID-19 pandemic may have increased the prevalence of mood disorders, especially in Low and Middle-income countries (LMICs) and in vulnerable populations. Objective 1/ Assess point and lifetime prevalence of depressive and bipolar disorders as well as subthreshold bipolarity in a representative population sample of La Manouba governorate and assess treatment patterns for these disorders; 2/Study socio-demographic and clinical correlates of mood disorders 3/ Assess the association between mood disorders and quality of life 4/ Study the impact of the COVID-pandemic on the prevalence of mood disorders 5/ Assess coping mechanisms to the COVID-pandemic and whether these mechanisms moderate the appearance of mood disorders or symptoms since the beginning of the pandemic. Methods This is a household cross-sectional observational survey to be conducted in La Manouba Governorate in a sample of 4540 randomly selected individuals aged ≥ 15 years. Data collection will be carried out by trained interviewers with clinical experience, through face-to-face interviews and the use of the computer assisted personal interviewing approach (CAPI). The following assessment tools are administered. Results Structured clinical Interview for DSM IV-TR (Mood disorder section and Screening questions on Anxiety), Mood Disorder Questionnaire (MDQ), Suicide Behaviors Questionnaire-Revised (SBQ), 12-item Short Form Survey (SF-12), the Brief-COPE, and a questionnaire about a headache. In addition, socio-demographic and clinical data will be collected. Conclusion This will be one of the very few household surveys in a general population sample to assess mental health problems and COVID-19-related variables since the beginning of the pandemic. Through this research, we aim to obtain an epidemiological profile of mood disorders in Tunisia and an estimation of the impact of the COVID-19 pandemic on their prevalence. Results should contribute to improving mental health care in Tunisia.
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Affiliation(s)
- Uta Ouali
- Department Psychiatry A, Razi Hospital La Manouba, Tunis 1068, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis 1068, Tunisia
- Research Laboratory LR18SP03, Tunisia
| | - Amina Aissa
- Department Psychiatry A, Razi Hospital La Manouba, Tunis 1068, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis 1068, Tunisia
- Research Laboratory LR18SP03, Tunisia
| | - Salsabil Rjaibi
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis 1068, Tunisia
- National Institute of Health, Tunis, Tunisia
| | | | - Yosra Zgueb
- Department Psychiatry A, Razi Hospital La Manouba, Tunis 1068, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis 1068, Tunisia
- Research Laboratory LR18SP03, Tunisia
| | - Amine Larnaout
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis 1068, Tunisia
- Department Psychiatry D, Razi Hospital La Manouba, Manouba 2010, Tunisia
| | - Mejdi Zid
- National Institute of Health, Tunis, Tunisia
| | - Imen Kacem
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis 1068, Tunisia
- Research Laboratory LR18SP03, Tunisia
- Department of Neurology, Razi Hospital La Manouba, Manouba 2010, Tunisia
| | - Fatma Charfi
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis 1068, Tunisia
- Department of Child Psychiatry, Mongi Slim Hospital La Marsa, Marsa, Tunisia
| | | | | | - Wahid Melki
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis 1068, Tunisia
- Department Psychiatry D, Razi Hospital La Manouba, Manouba 2010, Tunisia
- Technical Committee for Mental Health Promotion at the Ministry of Health, Tunis, Tunisia
| | - Hajer Aounallah-Skhiri
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis 1068, Tunisia
- National Institute of Health, Tunis, Tunisia
- Laboratoire de Recherche en Epidémiologie Nutritionnelle (SURVEN), Tunis, Tunisia
| | - Fethi Nacef
- Department Psychiatry A, Razi Hospital La Manouba, Tunis 1068, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis 1068, Tunisia
- Research Laboratory LR18SP03, Tunisia
| | - Riadh Gouider
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis 1068, Tunisia
- Research Laboratory LR18SP03, Tunisia
- Department of Neurology, Razi Hospital La Manouba, Manouba 2010, Tunisia
| | | | - Mauro Giovanni Carta
- Center for Liaison Psychiatry and Psychosomatics, University Hospital, University of Cagliari, Cagliari, Italy
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Silini A, Rejaibi S, Zid M, Zoghlami N, Mallekh R, Ben Slema I, Ben Youssef S, Zribi M, Ben Salah N, Aounallah-Skhiri H. Alarming trends in Tobacco use in high school Tunisian adolescents: MedSPAD2013-2021. Eur J Public Health 2022; 32:ckac131.216. [PMCID: PMC9594819 DOI: 10.1093/eurpub/ckac131.216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023] Open
Abstract
Background Tobacco use is a global health concern, with smoking initiation often beginning in adolescence. In Tunisia, published data assessing trends of tobacco consumption at the national level only concerns middle school students aged 13 to 15 years. No data related to high school students are however published yet. We aimed to determine tobacco smoking prevalence in Tunisian adolescents and assess trends from 2013 to 2021. Methods Pooled data from three Mediterranean school surveyson alcohol and other drugs (MedSPAD surveys: 2013, 2017, and 2021) were used. Based on three-stage stratification sampling method, teenagers aged between 15 and 17 years, were enrolled. Were not included students enrolled in vocational training centers and out-of-school adolescents. Data collection was performed using a self-administered standardized questionnaire assessing socio-demographic characteristics and risky behaviours. We studied weighted prevalence estimates of cigarettes and water pipe (WP) smoking. All statistical analysis, including trend analysis, were performed with STATA software. Results A total of 14.723 students were enrolled with sex ratio (M/F) equal to 0.6 and mean age of 16.2±0.8 years. The prevalence of cigarette smoking increased from 17.8%, to 20.2% then to 24.7% for 2013, 2017 and 2021, respectively. As for WP smoking, its prevalence increased from 14.8%, to 16.7% then to 19.9% for 2013, 2017 and 2021, respectively. Trends analysis concluded to significant increase over study period for cigarettes and WP smoking (p < 10-3). The increase was most alarming for girls regarding WP smoking (consistent increase over the study period). Conclusions Our findings underscore the alarming increasing trend for different forms of tobacco smoking among Tunisian youth. It is therefore crucial to strengthen tobacco control measures among young adolescents in order to counteract the tobacco industry’s expanding marketing of new products primarily targeting this population. Key messages • The prevalence of cigarette and water pipe smoking increased significantly among high school Tunisian adolescents from 2013 to 2021. • A better commitment to the implementation of MPOWER measures for tobacco control is therefore urgent.
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Affiliation(s)
- A Silini
- Epidemiology Department, The National Health Institute, Tunis, Tunisia
| | - S Rejaibi
- Epidemiology Department, The National Health Institute, Tunis, Tunisia
- Medical Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
- Nutrition Surveillance and Epidemiology, SURVEN, Research Laboratory, Tunis, Tunisia
| | - M Zid
- Epidemiology Department, The National Health Institute, Tunis, Tunisia
| | - N Zoghlami
- Epidemiology Department, The National Health Institute, Tunis, Tunisia
| | - R Mallekh
- Epidemiology Department, The National Health Institute, Tunis, Tunisia
| | - I Ben Slema
- Epidemiology Department, The National Health Institute, Tunis, Tunisia
| | - S Ben Youssef
- Epidemiology Department, The National Health Institute, Tunis, Tunisia
| | - M Zribi
- Epidemiology Department, The National Health Institute, Tunis, Tunisia
| | - N Ben Salah
- Medical Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
- Intensive Care Unit Department, Center for Urgent Medical Assistance, Tunis, Tunisia
| | - H Aounallah-Skhiri
- Epidemiology Department, The National Health Institute, Tunis, Tunisia
- Medical Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
- Nutrition Surveillance and Epidemiology, SURVEN, Research Laboratory, Tunis, Tunisia
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Rejaibi S, Zoghalami N, Silini A, Ben Slama I, Skhiri A, Mariem I, Mensi I, Bennour MA, Taibi S, Aounallah-Skhiri H. Leading causes of death in Tunisia, 2020. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Mortality data represent a primary source of information for monitoring a population health status over years. In Tunisia, the national Information System on Causes of Death (ISCD) lacks completeness (average coverage rate of 40%); however, in order to examine covid-19’s effect on mortality data, the ISCD was reinforced. We aimed to give an overview of leading causes of death in Tunisia for 2020.
Methods
Data were obtained from Medical Certificates of Cause Of Death (MCCOD) sent by municipalities to the National Institute of Health in accordance with the legislative framework. Causes of Death (CoD) coding process was performed based on the International Classification of Diseases, Tenth Revision (ICD-10). The underlying cause of death was identified based on IRIS software, and mortality statistics were presented based on the world health organization cause-of-death lists for tabulating mortality statistics. Data analysis was performed using SPSS software.
Results
A total of 46.420 MCCOD among 75.365 deaths officially declared by the National Institute of Statistics, were analyzed (coverage rate of 61.2%). The 10 leading causes of death for both sexes, in rank order were: diabetes mellitus, cerebrovascular diseases, covid-19, ischemic heart diseases, external causes of death, digestive and pulmonary malignant neoplasms, conditions of neonatal period, hypertensive diseases, and influenza and pneumonia. Leading causes of infant deaths were: certain conditions originating in perinatal period, congenital malformations, deformations and chromosomal abnormalities, diseases of respiratory system, certain infectious and parasitic diseases, and diseases of nervous system.
Conclusions
The COVID-19 pandemic was an opportunity to improve the Tunisian ISCD’s coverage rate. However, efforts should be maintained to optimize system completeness, and decision makers should be more sensitized regarding the urgent need for system digitalization.
Key messages
• Mortality statistics have shown that covid-19 ranks third among leading causes of death in Tunisia for 2020; and non communicable disease accounted for 6 out of 10 leading causes of deaths.
• The ISCD coverage rate was improved in 2020 reaching 61.2%; however the system digitalization is an essential and sustainable solution to optimize completeness.
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Affiliation(s)
- S Rejaibi
- Epidemiology Department, NIH Tunisia , Tunis, Tunisia
- Medical Faculty of Medicine, Tunis El Manar University , Tunis, Tunisia
- Nutrition Surveillance and Epidemiology, SURVEN , Research Laboratory, Tunis, Tunisia
| | - N Zoghalami
- Epidemiology Department, NIH Tunisia , Tunis, Tunisia
| | - A Silini
- Epidemiology Department, NIH Tunisia , Tunis, Tunisia
| | - I Ben Slama
- Epidemiology Department, NIH Tunisia , Tunis, Tunisia
| | - A Skhiri
- Epidemiology and Statistics Department, Abderrahman Mami Hospital , Tunis, Tunisia
| | - I Mariem
- Epidemiology Department, NIH Tunisia , Tunis, Tunisia
| | - I Mensi
- Epidemiology Department, NIH Tunisia , Tunis, Tunisia
| | - MA Bennour
- Epidemiology Department, NIH Tunisia , Tunis, Tunisia
| | | | - H Aounallah-Skhiri
- Epidemiology Department, NIH Tunisia , Tunis, Tunisia
- Medical Faculty of Medicine, Tunis El Manar University , Tunis, Tunisia
- Nutrition Surveillance and Epidemiology, SURVEN , Research Laboratory, Tunis, Tunisia
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Rejaibi S, Zribi M, Silini A, Zid M, Zoghlami N, Mallekh R, Ben Slama I, Ben Youssef S, Ben Salah N, Aounallah-Skhiri H. Cannabis use in Tunisian adolescents: Alarming trends from 2013 to 2021. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cannabis is the most widely used illicit psychoactive substance worldwide. In Tunisia, the prevalence of cannabis use and its association with other risky behaviours were reported in several publications interesting mainly early adolescence. However, no publications exploring trends based on national epidemiological data are available yet. Our purpose was to determine cannabis prevalence in Tunisian high school adolescents and assess significant trends from 2013 to 2021.
Methods
Pooled data from Mediterranean school surveys on alcohol and other drugs conducted in 2013, 2017, and 2021, were used. Based on three-stage stratification sampling method, first and second grade secondary education students were enrolled. Were not included students enrolled in vocational training centers and out-of-school adolescents. Self-administered standardized questionnaire was used in data collection. We studied weighted lifetime prevalence of cannabis use and chi square test for trend was used for global, by gender and by sector (private/public) trends assessement. STATA software was used for statistical analysis.
Results
A total of 14.723 students were enrolled with sex ratio (M/F) equal to 0.61 and mean age of 16.2±0.8 years. The prevalence of cannabis use increased from 1.4%, to 3.8% then to 7.9% for 2013, 2017 and 2021 respectively. Trend assessement concludes to significant increase in overall cannabis use (p < 10-3). Besides, there was a significant increase in both public and private schools, and among both boys and girls. However, the greatest increase was among male students (3.5% in 2013, 9.2% in 2017 and 16.1% in 2021) (p < 10-3).
Conclusions
Despite the reinforcement of restrictive legislative measures, the prevalence of cannabis use among Tunisian high school adolescents is significantly increasing. Moreover, it’s important to further investigate problematic cannabis use and its effects on adolescents’ physical and mental health.
Key messages
• Trend assessement confirmed the significant increase in lifetime cannabis use in high school adolescents in Tunisia, for both sexes and for both private and public sector.
• This alarming public health issue requires urgent legislation review and close multisectoral collaboration to control supply and demand.
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Affiliation(s)
- S Rejaibi
- Department of Epidemiology, National Institute of Health , Tunis, Tunisia
- Medical Faculty of Medicine, Tunis El Manar University , Tunis, Tunisia
- Nutrition Surveillance and Epidemiology, SURVEN , Research Laboratory, Tunis, Tunisia
| | - M Zribi
- Department of Epidemiology, National Institute of Health , Tunis, Tunisia
| | - A Silini
- Department of Epidemiology, National Institute of Health , Tunis, Tunisia
| | - M Zid
- Department of Epidemiology, National Institute of Health , Tunis, Tunisia
| | - N Zoghlami
- Department of Epidemiology, National Institute of Health , Tunis, Tunisia
| | - R Mallekh
- Department of Epidemiology, National Institute of Health , Tunis, Tunisia
| | - I Ben Slama
- Department of Epidemiology, National Institute of Health , Tunis, Tunisia
| | - S Ben Youssef
- Department of Epidemiology, National Institute of Health , Tunis, Tunisia
| | - N Ben Salah
- Medical Faculty of Medicine, Tunis El Manar University , Tunis, Tunisia
- Intensive Care Unit Department, Center for Urgent Medical Assistance , Tunis, Tunisia
| | - H Aounallah-Skhiri
- Department of Epidemiology, National Institute of Health , Tunis, Tunisia
- Medical Faculty of Medicine, Tunis El Manar University , Tunis, Tunisia
- Nutrition Surveillance and Epidemiology, SURVEN , Research Laboratory, Tunis, Tunisia
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Silini A, Rejaibi S, Zid M, Zoghlami N, Ben Slema I, Mallekh R, Zribi M, Ben Youssef S, Ben Salah N, Aounallah-Skhiri H. Nonmedical use of anxiolytics among Tunisian students: Connecting the dots from 2013 to 2021. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Nonmedical use of prescription drugs such as sedatives and anxiolytics is a fast growing public health threat in several countries. In Tunisia, although several studies have investigated the prevalence of nonmedical use of anxiolytics among school-age students, there is a gap in knowledge regarding trends in anxiolytics misuse. We aimed to determine the prevalence of nonmedical use of anxiolytics and examine trends between 2013 and 2021.
Methods
Pooled data from three Mediterranean school surveys on alcohol and other drugs (MedSPAD I-2013, MedSPAD II-2017, MedSPAD III-2021) were used. Based on three-stage stratification sampling method, teenagers in first and second grades of secondary education, were enrolled. Were not included students enrolled in vocational training centers and out-of-school adolescents. Data collection was performed using a self-administered standardized questionnaire. We studied weighted lifetime nonmedical use of
prescription anxiolytics and performed global and by gender trend analysis. Epi data software was used for data entry and all statistical analysis, were performed with STATA software.
Results
A total of 14.723 students were enrolled with sex ratio (Male/Female) equal to 0.61 and mean age of 16.2±0.8 years. The prevalence of nonmedical anxiolytics’ use increased from 2.1% to 3% then to 8.4% for 2013, 2017 and 2021, respectively. Global and by gender trends analysis concluded to significant increase from 2017 to 2021 (p < 10-3). However, a non-significant increase was revealed from 2013 to 2017.
Conclusions
Our study is the first to confirm a significant increasing trend in non-medical use of anxiolytics among Tunisian adolescents. These findings emphasize the urgent need for early detection of psychological vulnerability among adolescents in order to prevent their engagement in such risky behaviors.
Key messages
• Decision makers should be sensitized regarding the alarming increasing trend in non-medical use of anxiolytics, among Tunisian adolescents.
• The state control of these substances accessibility and early detection of psychological vulnerability, are highly required.
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Affiliation(s)
- A Silini
- Epidemiology Department, The National Health Institute , Tunis, Tunisia
| | - S Rejaibi
- Epidemiology Department, The National Health Institute , Tunis, Tunisia
- Faculty of Medicine, Tunis El Manar University , Tunis, Tunisia
- Nutrition Surveillance and Epidemiology, SURVEN , Research Laboratory, Tunis, Tunisia
| | - M Zid
- Epidemiology Department, The National Health Institute , Tunis, Tunisia
| | - N Zoghlami
- Epidemiology Department, The National Health Institute , Tunis, Tunisia
| | - I Ben Slema
- Epidemiology Department, The National Health Institute , Tunis, Tunisia
| | - R Mallekh
- Epidemiology Department, The National Health Institute , Tunis, Tunisia
| | - M Zribi
- Epidemiology Department, The National Health Institute , Tunis, Tunisia
| | - S Ben Youssef
- Epidemiology Department, The National Health Institute , Tunis, Tunisia
| | - N Ben Salah
- Faculty of Medicine, Tunis El Manar University , Tunis, Tunisia
- Intensive Care Unit Department, Center for Urgent Medical Assistance , Tunis, Tunisia
| | - H Aounallah-Skhiri
- Epidemiology Department, The National Health Institute , Tunis, Tunisia
- Faculty of Medicine, Tunis El Manar University , Tunis, Tunisia
- Nutrition Surveillance and Epidemiology, SURVEN , Research Laboratory, Tunis, Tunisia
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Rejaibi S, Cherif I, Chemli H, Ati JE, Buse K, Hawkes S, Aounallah-Skhiri H. Trans fatty acids policy analysis to prevent non-communicable diseases in Tunisia. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Despite the widely published international guidelines for a better implementation of health policies promoting healthy eating habits; the epidemiological situation regarding most weighing heavily non-communicable diseases (NCDs) on global health, is still alarming. We aimed to analyze Tunisian health policies targeting trans fatty acids (TFA) consumption to prevent and control NCDs.
Methods
Based on in-depth policy content analysis and stakeholder interviews, Tunisian policies related to promoting healthy diets and restricting unhealthy consumption of TFA, were identified. Four sub-components of WHO best-buys were assessed: goal to eliminate industrially-produced TFA, legislation to ban their use in food chain, TFA labeling and fiscal policies, and mass media campaign to promote healthy diet and reduce TFA intake. Findings were analyzed based on three main axes of the “policy cube approach”: comprehensiveness of policy content, policy effectiveness and respect of equity principles. For each axis, final assessment was performed based on a Likert scale: low, moderate and high.
Results
Although (3/4) WHO best-buys are covered by the national strategies for NCDs and obesity prevention for 2018-2025 and 2013-2017 respectively. This analysis has revealed moderate level for comprehensiveness of policy content, because ofthe absence of specific mention regarding legislation. A moderate level in policy salience and effectiveness was also highlighted (weak accountability mechanisms and no budget line for effective implementation for all WHO best-buys). A very low respect to equity principles was also underlined with no specific attention regarding vulnerable populations.
Conclusions
Main weaknesses in TFA policies concerned legislation, budget allocation and accountability mechanisms. “Legislation measures” to ban trans-fats use in the food chain and resource mobilization for “nutrition labeling and mass-media campaigns” effective implementation, are recommended.
Key messages
Several weaknesses in TFA policies have been highlighted, mainly related to: legislation, budget allocation, accountability mechanisms and low respect to equity principles. Legislation reinforcement and efficient resource mobilization for “nutrition labeling and mass-media campaigns” effective implementation, are strongly recommended.
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Affiliation(s)
- S Rejaibi
- Faculty of Medicine of Tunis, Tunis, Tunisia
- National Institute of Health, Tunis, Tunisia
- Nutrition Surveillance and Epidemiology in Tunisia, SURVEN, Research Laboratory, Tunis, Tunisia
| | - I Cherif
- Faculty of Medicine of Tunis, Tunis, Tunisia
| | - H Chemli
- Nutrition Surveillance and Epidemiology in Tunisia, SURVEN, Research Laboratory, Tunis, Tunisia
| | - J El Ati
- Nutrition Surveillance and Epidemiology in Tunisia, SURVEN, Research Laboratory, Tunis, Tunisia
- National Institute of Nutrition and Food Technology, Tunis, Tunisia
| | - K Buse
- UNAIDS, Geneva, Switzerland
| | - S Hawkes
- Institute for Global Health, University College London, London, UK
| | - H Aounallah-Skhiri
- Faculty of Medicine of Tunis, Tunis, Tunisia
- National Institute of Health, Tunis, Tunisia
- Nutrition Surveillance and Epidemiology in Tunisia, SURVEN, Research Laboratory, Tunis, Tunisia
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Cherif I, Rejaibi S, Ben Mansour N, Zoghlami N, Saidi O, Skhiri A, Ben Slama F, Ben Romthane H, Turki Z, Aounallah-Skhiri H. Assessment of glycemic control among Tunisian diabetic adults. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Diabetes, a major public health issue in Tunisia, is responsible of an increased burden of morbidity and premature mortality. Achieving a good glycemic control is essential for reducing the morbidity-mortality associated with this disease. The purpose of our study was to assess the proportion of uncontrolled diabetes (UD) among Tunisian diabetic adults and assess associated factors.
Methods
A national household survey, stratified at three degrees, was conducted in 2016. As part of this study, we included previously diagnosed diabetic adults aged 20 years or above. Sociodemographic data and medical history were collected using an individual questionnaire, and glycated hemoglobin (HbA1C) was measured using the “A1C Now +” device. The UD was defined based on the American Diabetes Association criteria for the year 2016 (HbA1c ≥7%). Multiple logistic regression model was used to determine factors associated with UD. Adjusted Odds Ratios (AOR) were presented with 95% confidence intervals (CI). All data analysis was performed using SPSS software.
Results
A total of 873 subjects were included with a median age of 61 years and a sex-ratio equal to 0.9. The proportion of UD was (72.8%, 95% CI: [69.1-76.3]). In multivariate analysis, UD was more frequent among rural areas residents (AOR=1.8 [1.1-2.7]), those who had never seen a doctor within the year preceding the survey (AOR=2.2 [1.1-4.2]) and among those on oral antidiabetics (AOR=6.1 [1.9-18.9]) or insulin (AOR=23.8 [7.1-79.8]) compared to those who were following a diabetic diet.
Conclusions
This study highlighted a very high proportion of UD in diabetic Tunisian adults. A better involvement of primary care physicians in overall patient care, and improved availability of antidiabetic drugs for patients, are strongly recommended.
Key messages
Majority of Tunisian diabetic adults aged 20 years or older had an uncontrolled diabetes. Improving patient education and the availability of antidiabetic drugs for diabetic individuals in primary healthcare facilities is essential.
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Affiliation(s)
- I Cherif
- Faculty of Medicine of Tunis, Tunis, Tunisia
| | - S Rejaibi
- Faculty of Medicine of Tunis, Tunis, Tunisia
- National Institute of Health, Tunis, Tunisia
- Research Laboratory in Nutritional Surveillance and Epidemiology, Tunis, Tunisia
| | - N Ben Mansour
- Faculty of Medicine of Tunis, Tunis, Tunisia
- National Institute of Health, Tunis, Tunisia
- Research Laboratory of Epidemiology and Prevention of Cardiovascular Diseases, Tunis, Tunisia
| | - N Zoghlami
- National Institute of Health, Tunis, Tunisia
| | - O Saidi
- National Institute of Health, Tunis, Tunisia
| | - A Skhiri
- National Institute of Health, Tunis, Tunisia
| | - F Ben Slama
- National Institute of Health, Tunis, Tunisia
| | - H Ben Romthane
- Research Laboratory of Epidemiology and Prevention of Cardiovascular Diseases, Tunis, Tunisia
| | - Z Turki
- Tunisian Society of Diabetes Endocrinology and Metabolic Diseases, Tunis, Tunisia
| | - H Aounallah-Skhiri
- Faculty of Medicine of Tunis, Tunis, Tunisia
- National Institute of Health, Tunis, Tunisia
- Research Laboratory in Nutritional Surveillance and Epidemiology, Tunis, Tunisia
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Zhou B, Carrillo-Larco RM, Danaei G, Riley LM, Paciorek CJ, Stevens GA, Gregg EW, Bennett JE, Solomon B, Singleton RK, Sophiea MK, Iurilli MLC, Lhoste VPF, Cowan MJ, Savin S, Woodward M, Balanova Y, Cifkova R, Damasceno A, Elliott P, Farzadfar F, He J, Ikeda N, Kengne AP, Khang YH, Kim HC, Laxmaiah A, Lin HH, Margozzini Maira P, Miranda JJ, Neuhauser H, Sundström J, Varghese C, Widyahening IS, Zdrojewski T, Abarca-Gómez L, Abdeen ZA, Abdul Rahim HF, Abu-Rmeileh NM, Acosta-Cazares B, Adams RJ, Aekplakorn W, Afsana K, Afzal S, Agdeppa IA, Aghazadeh-Attari J, Aguilar-Salinas CA, Agyemang C, Ahmad NA, Ahmadi A, Ahmadi N, Ahmadi N, Ahmadizar F, Ahmed SH, Ahrens W, Ajlouni K, Al-Raddadi R, Alarouj M, AlBuhairan F, AlDhukair S, Ali MM, Alkandari A, Alkerwi A, Allin K, Aly E, Amarapurkar DN, Amougou N, Amouyel P, Andersen LB, Anderssen SA, Anjana RM, Ansari-Moghaddam A, Ansong D, Aounallah-Skhiri H, Araújo J, Ariansen I, Aris T, Arku RE, Arlappa N, Aryal KK, Aspelund T, Assah FK, Assunção MCF, Auvinen J, Avdićová M, Azevedo A, Azimi-Nezhad M, Azizi F, Azmin M, Babu BV, Bahijri S, Balakrishna N, Bamoshmoosh M, Banach M, Banadinović M, Bandosz P, Banegas JR, Baran J, Barbagallo CM, Barceló A, Barkat A, Barreto M, Barros AJD, Barros MVG, Bartosiewicz A, Basit A, Bastos JLD, Bata I, Batieha AM, Batyrbek A, Baur LA, Beaglehole R, Belavendra A, Ben Romdhane H, Benet M, Benson LS, Berkinbayev S, Bernabe-Ortiz A, Bernotiene G, Bettiol H, Bezerra J, Bhagyalaxmi A, Bhargava SK, Bia D, Biasch K, Bika Lele EC, Bikbov MM, Bista B, Bjerregaard P, Bjertness E, Bjertness MB, Björkelund C, Bloch KV, Blokstra A, Bo S, Bobak M, Boeing H, Boggia JG, Boissonnet CP, Bojesen SE, Bongard V, Bonilla-Vargas A, Bopp M, Borghs H, Bovet P, Boyer CB, Braeckman L, Brajkovich I, Branca F, Breckenkamp J, Brenner H, Brewster LM, Briceño Y, Brito M, Bruno G, Bueno-de-Mesquita HB, Bueno G, Bugge A, Burns C, Bursztyn M, Cabrera de León A, Cacciottolo J, Cameron C, Can G, Cândido APC, Capanzana MV, Čapková N, Capuano E, Capuano V, Cardoso VC, Carlsson AC, Carvalho J, Casanueva FF, Censi L, Cervantes-Loaiza M, Chadjigeorgiou CA, Chamukuttan S, Chan AW, Chan Q, Chaturvedi HK, Chaturvedi N, Chee ML, Chen CJ, Chen F, Chen H, Chen S, Chen Z, Cheng CY, Cheraghian B, Cherkaoui Dekkaki I, Chetrit A, Chien KL, Chiolero A, Chiou ST, Chirita-Emandi A, Chirlaque MD, Cho B, Christensen K, Christofaro DG, Chudek J, Cinteza E, Claessens F, Clarke J, Clays E, Cohen E, Concin H, Cooper C, Coppinger TC, Costanzo S, Cottel D, Cowell C, Craig CL, Crampin AC, Crujeiras AB, Cruz JJ, Csilla S, Cui L, Cureau FV, Cuschieri S, D'Arrigo G, d'Orsi E, Dallongeville J, Dankner R, Dantoft TM, Dauchet L, Davletov K, De Backer G, De Bacquer D, De Curtis A, de Gaetano G, De Henauw S, de Oliveira PD, De Ridder D, De Smedt D, Deepa M, Deev AD, DeGennaro VJ, Delisle H, Demarest S, Dennison E, Deschamps V, Dhimal M, Di Castelnuovo AF, Dias-da-Costa JS, Diaz A, Dickerson TT, Dika Z, Djalalinia S, Do HTP, Dobson AJ, Donfrancesco C, Donoso SP, Döring A, Dorobantu M, Dörr M, Doua K, Dragano N, Drygas W, Duante CA, Duboz P, Duda RB, Dulskiene V, Dushpanova A, Džakula A, Dzerve V, Dziankowska-Zaborszczyk E, Eddie R, Eftekhar E, Eggertsen R, Eghtesad S, Eiben G, Ekelund U, El-Khateeb M, El Ati J, Eldemire-Shearer D, Eliasen M, Elosua R, Erasmus RT, Erbel R, Erem C, Eriksen L, Eriksson JG, Escobedo-de la Peña J, Eslami S, Esmaeili A, Evans A, Faeh D, Fakhretdinova AA, Fall CH, Faramarzi E, Farjam M, Fattahi MR, Fawwad A, Felix-Redondo FJ, Felix SB, Ferguson TS, Fernandes RA, Fernández-Bergés D, Ferrante D, Ferrao T, Ferrari M, Ferrario MM, Ferreccio C, Ferreira HS, Ferrer E, Ferrieres J, Figueiró TH, Fink G, Fischer K, Foo LH, Forsner M, Fouad HM, Francis DK, Franco MDC, Frikke-Schmidt R, Frontera G, Fuchs FD, Fuchs SC, Fujita Y, Fumihiko M, Furdela V, Furer A, Furusawa T, Gaciong Z, Galbarczyk A, Galenkamp H, Galvano F, Gao J, Gao P, Garcia-de-la-Hera M, Garcia P, Gareta D, Garnett SP, Gaspoz JM, Gasull M, Gazzinelli A, Gehring U, Geleijnse JM, George R, Ghanbari A, Ghasemi E, Gheorghe-Fronea OF, Ghimire A, Gialluisi A, Giampaoli S, Gieger C, Gill TK, Giovannelli J, Gironella G, Giwercman A, Gkiouras K, Goldberg M, Goldsmith RA, Gomez LF, Gomula A, Gonçalves H, Gonçalves M, Gonçalves Cordeiro da Silva B, Gonzalez-Chica DA, Gonzalez-Gross M, González-Rivas JP, González-Villalpando C, González-Villalpando ME, Gonzalez AR, Gorbea MB, Gottrand F, Graff-Iversen S, Grafnetter D, Grajda A, Grammatikopoulou MG, Gregor RD, Grodzicki T, Grosso G, Gruden G, Gu D, Guan OP, Gudmundsson EF, Gudnason V, Guerrero R, Guessous I, Guimaraes AL, Gulliford MC, Gunnlaugsdottir J, Gunter MJ, Gupta PC, Gupta R, Gureje O, Gurzkowska B, Gutierrez L, Gutzwiller F, Ha S, Hadaegh F, Haghshenas R, Hakimi H, Halkjær J, Hambleton IR, Hamzeh B, Hange D, Hanif AAM, Hantunen S, Hao J, Hardman CM, Hari Kumar R, Hashemi-Shahri SM, Hata J, Haugsgjerd T, Hayes AJ, He Y, Heier M, Hendriks ME, Henrique RDS, Henriques A, Hernandez Cadena L, Herqutanto, Herrala S, Heshmat R, Hill AG, Ho SY, Ho SC, Hobbs M, Holdsworth M, Homayounfar R, Horasan Dinc G, Horimoto ARVR, Hormiga CM, Horta BL, Houti L, Howitt C, Htay TT, Htet AS, Htike MMT, Hu Y, Huerta JM, Huhtaniemi IT, Huiart L, Huisman M, Husseini AS, Huybrechts I, Hwalla N, Iacoviello L, Iannone AG, Ibrahim MM, Ibrahim Wong N, Ikram MA, Iotova V, Irazola VE, Ishida T, Isiguzo GC, Islam M, Islam SMS, Iwasaki M, Jackson RT, Jacobs JM, Jaddou HY, Jafar T, James K, Jamrozik K, Janszky I, Janus E, Jarvelin MR, Jasienska G, Jelaković A, Jelaković B, Jennings G, Jha AK, Jiang CQ, Jimenez RO, Jöckel KH, Joffres M, Johansson M, Jokelainen JJ, Jonas JB, Jørgensen T, Joshi P, Joukar F, Jóżwiak J, Juolevi A, Jurak G, Jureša V, Kaaks R, Kafatos A, Kajantie EO, Kalmatayeva Z, Kalpourtzi N, Kalter-Leibovici O, Kampmann FB, Kannan S, Karaglani E, Kårhus LL, Karki KB, Katibeh M, Katz J, Kauhanen J, Kaur P, Kavousi M, Kazakbaeva GM, Keil U, Keinan Boker L, Keinänen-Kiukaanniemi S, Kelishadi R, Kemper HCG, Keramati M, Kerimkulova A, Kersting M, Key T, Khader YS, Khalili D, Khaw KT, Kheiri B, Kheradmand M, Khosravi A, Kiechl-Kohlendorfer U, Kiechl S, Killewo J, Kim DW, Kim J, Klakk H, Klimek M, Klumbiene J, Knoflach M, Kolle E, Kolsteren P, Kontto JP, Korpelainen R, Korrovits P, Kos J, Koskinen S, Kouda K, Kowlessur S, Koziel S, Kratenova J, Kriaucioniene V, Kristensen PL, Krokstad S, Kromhout D, Kruger HS, Kubinova R, Kuciene R, Kujala UM, Kulaga Z, Kumar RK, Kurjata P, Kusuma YS, Kutsenko V, Kuulasmaa K, Kyobutungi C, Laatikainen T, Lachat C, Laid Y, Lam TH, Landrove O, Lanska V, Lappas G, Larijani B, Latt TS, Le Coroller G, Le Nguyen Bao K, Le TD, Lee J, Lee J, Lehmann N, Lehtimäki T, Lemogoum D, Levitt NS, Li Y, Lilly CL, Lim WY, Lima-Costa MF, Lin X, Lin YT, Lind L, Lingam V, Linneberg A, Lissner L, Litwin M, Lo WC, Loit HM, Lopez-Garcia E, Lopez T, Lotufo PA, Lozano JE, Lukačević Lovrenčić I, Lukrafka JL, Luksiene D, Lundqvist A, Lundqvist R, Lunet N, Lustigová M, Luszczki E, Ma G, Ma J, Machado-Coelho GLL, Machado-Rodrigues AM, Macia E, Macieira LM, Madar AA, Maggi S, Magliano DJ, Magriplis E, Mahasampath G, Maire B, Majer M, Makdisse M, Malekzadeh F, Malekzadeh R, Malhotra R, Mallikharjuna Rao K, Malyutina SK, Maniego LV, Manios Y, Mann JI, Mansour-Ghanaei F, Manzato E, Marcil A, Mårild SB, Marinović Glavić M, Marques-Vidal P, Marques LP, Marrugat J, Martorell R, Mascarenhas LP, Matasin M, Mathiesen EB, Mathur P, Matijasevich A, Matlosz P, Matsha TE, Mavrogianni C, Mbanya JCN, Mc Donald Posso AJ, McFarlane SR, McGarvey ST, McLachlan S, McLean RM, McLean SB, McNulty BA, Mediene Benchekor S, Medzioniene J, Mehdipour P, Mehlig K, Mehrparvar AH, Meirhaeghe A, Meisinger C, Mendoza Montano C, Menezes AMB, Menon GR, Mereke A, Meshram II, Metspalu A, Meyer HE, Mi J, Michels N, Mikkel K, Milkowska K, Miller JC, Minderico CS, Mini GK, Mirjalili MR, Mirrakhimov E, Mišigoj-Duraković M, Modesti PA, Moghaddam SS, Mohajer B, Mohamed MK, Mohamed SF, Mohammad K, Mohammadi MR, Mohammadi Z, Mohammadifard N, Mohammadpourhodki R, Mohan V, Mohanna S, Mohd Yusoff MF, Mohebbi I, Mohebi F, Moitry M, Møllehave LT, Molnár D, Momenan A, Mondo CK, Monterrubio-Flores E, Monyeki KDK, Moon JS, Moosazadeh M, Moreira LB, Morejon A, Moreno LA, Morgan K, Moschonis G, Mossakowska M, Mostafa A, Mostafavi SA, Mota J, Motlagh ME, Motta J, Moura-dos-Santos MA, Mridha MK, Msyamboza KP, Mu TT, Muhihi AJ, Muiesan ML, Müller-Nurasyid M, Murphy N, Mursu J, Musa KI, Musić Milanović S, Musil V, Mustafa N, Nabipour I, Naderimagham S, Nagel G, Naidu BM, Najafi F, Nakamura H, Námešná J, Nang EEK, Nangia VB, Narake S, Ndiaye NC, Neal WA, Nejatizadeh A, Nenko I, Neovius M, Nguyen CT, Nguyen ND, Nguyen QV, Nguyen QN, Nieto-Martínez RE, Niiranen TJ, Nikitin YP, Ninomiya T, Nishtar S, Njelekela MA, Noale M, Noboa OA, Noorbala AA, Norat T, Nordendahl M, Nordestgaard BG, Noto D, Nowak-Szczepanska N, Nsour MA, Nunes B, O'Neill TW, O'Reilly D, Ochimana C, Oda E, Odili AN, Oh K, Ohara K, Ohtsuka R, Olié V, Olinto MTA, Oliveira IO, Omar MA, Onat A, Ong SK, Ono LM, Ordunez P, Ornelas R, Ortiz PJ, Osmond C, Ostojic SM, Ostovar A, Otero JA, Overvad K, Owusu-Dabo E, Paccaud FM, Padez C, Pahomova E, Paiva KMD, Pająk A, Palli D, Palmieri L, Pan WH, Panda-Jonas S, Panza F, Paoli M, Papandreou D, Park SW, Park S, Parnell WR, Parsaeian M, Pasquet P, Patel ND, Pavlyshyn H, Pećin I, Pednekar MS, Pedro JM, Peer N, Peixoto SV, Peltonen M, Pereira AC, Peres KGDA, Peres MA, Peters A, Petkeviciene J, Peykari N, Pham ST, Pichardo RN, Pigeot I, Pikhart H, Pilav A, Pilotto L, Pitakaka F, Piwonska A, Pizarro AN, Plans-Rubió P, Polašek O, Porta M, Poudyal A, Pourfarzi F, Pourshams A, Poustchi H, Pradeepa R, Price AJ, Price JF, Providencia R, Puhakka SE, Puiu M, Punab M, Qasrawi RF, Qorbani M, Queiroz D, Quoc Bao T, Radić I, Radisauskas R, Rahimikazerooni S, Rahman M, Raitakari O, Raj M, Rakhimova EM, Ramachandra Rao S, Ramachandran A, Ramos E, Rampal L, Rampal S, Rangel Reina DA, Rarra V, Rech CR, Redon J, Reganit PFM, Regecová V, Revilla L, Rezaianzadeh A, Ribeiro R, Riboli E, Richter A, Rigo F, Rinke de Wit TF, Ritti-Dias RM, Robitaille C, Rodríguez-Artalejo F, Rodriguez-Perez MDC, Rodríguez-Villamizar LA, Roggenbuck U, Rojas-Martinez R, Romaguera D, Romeo EL, Rosengren A, Roy JGR, Rubinstein A, Ruidavets JB, Ruiz-Betancourt BS, Ruiz-Castell M, Rusakova IA, Russo P, Rutkowski M, Sabanayagam C, Sabbaghi H, Sachdev HS, Sadjadi A, Safarpour AR, Safi S, Safiri S, Saidi O, Sakarya S, Saki N, Salanave B, Salazar Martinez E, Salmerón D, Salomaa V, Salonen JT, Salvetti M, Sánchez-Abanto J, Sans S, Santos DA, Santos IS, Santos LC, Santos MP, Santos R, Saramies JL, Sardinha LB, Sarganas G, Sarrafzadegan N, Sathish T, Saum KU, Savva S, Sawada N, Sbaraini M, Scazufca M, Schaan BD, Schargrodsky H, Schipf S, Schmidt CO, Schnohr P, Schöttker B, Schramm S, Schultsz C, Schutte AE, Sebert S, Sein AA, Sen A, Senbanjo IO, Sepanlou SG, Servais J, Shalnova SA, Shamah-Levy T, Shamshirgaran M, Shanthirani CS, Sharafkhah M, Sharma SK, Shaw JE, Shayanrad A, Shayesteh AA, Shi Z, Shibuya K, Shimizu-Furusawa H, Shin DW, Shirani M, Shiri R, Shrestha N, Si-Ramlee K, Siani A, Siantar R, Sibai AM, Silva CRDM, Silva DAS, Simon M, Simons J, Simons LA, Sjöström M, Slowikowska-Hilczer J, Slusarczyk P, Smeeth L, So HK, Soares FC, Sobngwi E, Söderberg S, Soemantri A, Sofat R, Solfrizzi V, Somi MH, Sonestedt E, Song Y, Sørensen TIA, Sørgjerd EP, Sorić M, Sossa Jérome C, Soumaré A, Sparboe-Nilsen B, Sparrenberger K, Staessen JA, Starc G, Stavreski B, Steene-Johannessen J, Stehle P, Stein AD, Stergiou GS, Stessman J, Stieber J, Stöckl D, Stocks T, Stokwiszewski J, Stronks K, Strufaldi MW, Suka M, Sun CA, Sung YT, Suriyawongpaisal P, Sy RG, Syddall HE, Sylva RC, Szklo M, Tai ES, Tammesoo ML, Tamosiunas A, Tan EJ, Tang X, Tanser F, Tao Y, Tarawneh MR, Tarqui-Mamani CB, Taylor A, Taylor J, Tebar WR, Tell GS, Tello T, Tham YC, Thankappan KR, Theobald H, Theodoridis X, Thijs L, Thinggaard M, Thomas N, Thorand B, Thuesen BH, Timmermans EJ, Tjandrarini DH, Tjonneland A, Toft U, Tolonen HK, Tolstrup JS, Topbas M, Topór-Madry R, Tormo MJ, Tornaritis MJ, Torrent M, Torres-Collado L, Touloumi G, Traissac P, Triantafyllou A, Trichopoulos D, Trichopoulou A, Trinh OTH, Trivedi A, Tshepo L, Tsugane S, Tuliakova AM, Tulloch-Reid MK, Tullu F, Tuomainen TP, Tuomilehto J, Turley ML, Twig G, Tynelius P, Tzourio C, Ueda P, Ugel E, Ulmer H, Uusitalo HMT, Valdivia G, Valvi D, van Dam RM, van den Born BJ, Van der Heyden J, van der Schouw YT, Van Herck K, Van Minh H, Van Schoor NM, van Valkengoed IGM, van Zutphen EM, Vanderschueren D, Vanuzzo D, Varbo A, Vasan SK, Vega T, Veidebaum T, Velasquez-Melendez G, Veronesi G, Verschuren WMM, Verstraeten R, Victora CG, Viet L, Villalpando S, Vineis P, Vioque J, Virtanen JK, Visvikis-Siest S, Viswanathan B, Vlasoff T, Vollenweider P, Voutilainen A, Wade AN, Walton J, Wambiya EOA, Wan Bebakar WM, Wan Mohamud WN, Wanderley Júnior RDS, Wang MD, Wang N, Wang Q, Wang X, Wang YX, Wang YW, Wannamethee SG, Wareham N, Wei W, Weres A, Werner B, Whincup PH, Widhalm K, Wiecek A, Wilks RJ, Willeit J, Willeit P, Williams EA, Wilsgaard T, Wojtyniak B, Wong-McClure RA, Wong A, Wong TY, Woo J, Wu FC, Wu S, Wyszynska J, Xu H, Xu L, Yaacob NA, Yan W, Yang L, Yang X, Yang Y, Yasuharu T, Ye X, Yiallouros PK, Yoosefi M, Yoshihara A, You SL, Younger-Coleman NO, Yusoff AF, Zainuddin AA, Zakavi SR, Zamani F, Zambon S, Zampelas A, Zapata ME, Zaw KK, Zejglicova K, Zeljkovic Vrkic T, Zeng Y, Zhang L, Zhang ZY, Zhao D, Zhao MH, Zhen S, Zheng Y, Zholdin B, Zhu D, Zins M, Zitt E, Zocalo Y, Zoghlami N, Zuñiga Cisneros J, Ezzati M. Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet 2021; 398:957-980. [PMID: 34450083 PMCID: PMC8446938 DOI: 10.1016/s0140-6736(21)01330-1] [Citation(s) in RCA: 938] [Impact Index Per Article: 312.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. METHODS We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. FINDINGS The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. INTERPRETATION Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. FUNDING WHO.
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Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight. eLife 2021; 10:e60060. [PMID: 33685583 PMCID: PMC7943191 DOI: 10.7554/elife.60060] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 01/07/2021] [Indexed: 02/05/2023] Open
Abstract
From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Nayu Ikeda
- National Institutes of Biomedical Innovation, Health and Nutrition
| | | | | | | | - Jing Liu
- Capital Medical University Beijing An Zhen Hospital
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Shoaib Afzal
- University of Copenhagen
- Copenhagen University Hospital
| | | | | | | | | | | | | | - Ali Ahmadi
- Shahrekord University of Medical Sciences
| | | | | | | | | | - Kamel Ajlouni
- National Center for Diabetes, Endocrinology and Genetics
| | | | | | | | | | | | | | | | | | | | | | | | - Eman Aly
- World Health Organization Regional Office for the Eastern Mediterranean
| | | | - Parisa Amiri
- Research Center for Social Determinants of Health
| | | | | | | | | | | | | | | | | | - Joana Araújo
- Institute of Public Health of the University of Porto
| | | | | | | | | | | | | | | | | | | | | | | | - Shina Avi
- Tel-Aviv University
- Hebrew University of Jerusalem
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Abdul Basit
- Baqai Institute of Diabetology and Endocrinology
| | | | | | | | | | | | | | | | | | | | | | | | - Judith Benedics
- Federal Ministry of Social Affairs, Health, Care and Consumer Protection
| | | | | | | | | | | | | | | | | | | | | | | | - Hongsheng Bi
- Shandong University of Traditional Chinese Medicine
| | - Yufang Bi
- Shanghai Jiao-Tong University School of Medicine
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - João Breda
- World Health Organization Regional Office for Europe
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Laura Censi
- Council for Agricultural Research and Economics
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- The Gertner Institute for Epidemiology and Health Policy Research
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- Canadian Fitness and Lifestyle Research Institute
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Rachel Dankner
- The Gertner Institute for Epidemiology and Health Policy Research
| | | | | | | | - Luc Dauchet
- University of Lille
- Lille University Hospital
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- Beijing Center for Disease Prevention and Control
| | | | | | | | | | | | | | - Anar Dushpanova
- Scuola Superiore Sant'Anna
- Al-Farabi Kazakh National University
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Günther Fink
- Swiss Tropical and Public Health Institute
- University of Basel
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- World Health Organization Regional Office for the Eastern Mediterranean
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- Victor Babes University of Medicine and Pharmacy Timisoara
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Marcel Goldberg
- Institut National de la Santé et de la Recherche Médicale
- Paris University
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Yin Guo
- Capital Medical University Beijing Tongren Hospital
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- Eternal Heart Care Centre and Research Institute
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- Beijing Institute of Ophthalmology
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- National Research Institute for Health and Family Planning
| | - Yuna He
- Chinese Center for Disease Control and Prevention
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- Institute of Public Health of the University of Porto
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- Institute of Molecular and Clinical Ophthalmology Basel
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- French National Research Institute for Sustainable Development
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- Johns Hopkins Bloomberg School of Public Health
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- Research Institute for Primordial Prevention of Non-communicable Disease
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- PASs Hirszfeld Institute of Immunology and Experimental Therapy
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- French National Research Institute for Sustainable Development
| | - Vera Lanska
- Institute for Clinical and Experimental Medicine
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- University of Chinese Academy of Sciences
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- Capital Medical University Beijing Tongren Hospital
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- National Research Institute for Health and Family Planning
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- Institute of Neuroscience of the National Research Council
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- French National Research Institute for Sustainable Development
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- Finnish Institute for Health and Welfare
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- CIBERCV
- Institut Hospital del Mar d'Investigacions Mèdiques
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- Capital Institute of Pediatrics
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- Women’s Social and Health Studies Foundation
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- University of Strasbourg
- Strasbourg University Hospital
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- Instituto Conmemorativo Gorgas de Estudios de la Salud
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- Banska Bystrica Regional Authority of Public Health
| | | | | | | | | | | | | | | | | | | | - Keiu Nelis
- National Institute for Health Development
| | - Liis Nelis
- National Institute for Health Development
| | | | | | | | | | | | | | | | - Yury P Nikitin
- SB RAS Federal Research Center Institute of Cytology and Genetics
| | - Guang Ning
- Shanghai Jiao-Tong University School of Medicine
| | | | | | - Marianna Noale
- Institute of Neuroscience of the National Research Council
| | | | | | | | | | | | | | | | | | | | - Eha Nurk
- National Institute for Health Development
| | | | | | | | | | | | | | - Kyungwon Oh
- Korea Centers for Disease Control and Prevention
| | | | - Claes Ohlsson
- University of Gothenburg
- Sahlgrenska University Hospital
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Domenico Palli
- Institute for Cancer Research, Prevention and Clinical Network
| | | | | | | | | | | | - Francesco Panza
- IRCCS Ente Ospedaliero Specializzato in Gastroenterologia S. de Bellis
| | | | | | - Suyeon Park
- Korea Centers for Disease Control and Prevention
| | | | | | - Ionela M Pascanu
- University of Medicine, Pharmacy, Science and Technology of Târgu Mures
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Iris Pigeot
- Leibniz Institute for Prevention Research and Epidemiology - BIPS
| | | | | | | | | | | | | | | | | | | | | | - Raluca M Pop
- University of Medicine, Pharmacy, Science and Technology of Târgu Mures
| | | | - Miquel Porta
- Institut Hospital del Mar d'Investigacions Mèdiques
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Maria Puiu
- Victor Babes University of Medicine and Pharmacy Timisoara
| | | | | | | | | | | | | | | | | | | | | | - Manu Raj
- Amrita Institute of Medical Sciences
| | | | | | - Ivo Rakovac
- World Health Organization Regional Office for Europe
| | | | | | | | | | - Rafel Ramos
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ana Rito
- National Institute of Health Doutor Ricardo Jorge
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Paola Russo
- Institute of Food Sciences of the National Research Council
| | | | | | | | | | | | | | | | | | - Nader Saki
- Ahvaz Jundishapur University of Medical Sciences
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Savvas Savva
- Research and Education Institute of Child Health
| | - Mathilde Savy
- French National Research Institute for Sustainable Development
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Aletta E Schutte
- University of New South Wales
- The George Institute for Global Health
| | | | | | | | - Abhijit Sen
- Center for Oral Health Services and Research Mid-Norway
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Alfonso Siani
- Institute of Food Sciences of the National Research Council
| | | | | | | | | | | | | | | | | | | | | | | | | | - Liam Smeeth
- London School of Hygiene & Tropical Medicine
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Igor Spiroski
- Institute of Public Health
- Ss. Cyril and Methodius University
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Lela Sturua
- National Center for Disease Control and Public Health
| | | | | | | | | | | | | | | | | | | | | | | | | | - Lucjan Szponar
- National Institute of Public Health – National Institute of Hygiene
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Pierre Traissac
- French National Research Institute for Sustainable Development
| | | | | | | | - Oanh TH Trinh
- University of Medicine and Pharmacy at Ho Chi Minh City
| | | | | | | | | | | | | | | | | | | | | | - Gilad Twig
- Tel-Aviv University
- Hebrew University of Jerusalem
| | | | | | | | | | - Eunice Ugel
- Universidad Centro-Occidental Lisandro Alvarado
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- Copenhagen University Hospital
- University of Copenhagen
| | | | | | | | - Tomas Vega
- Consejería de Sanidad Junta de Castilla y León
| | | | | | | | | | | | | | | | - Lucie Viet
- National Institute for Public Health and the Environment
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ningli Wang
- Capital Medical University Beijing Tongren Hospital
| | | | | | | | | | | | | | - Adelheid Weber
- Federal Ministry of Social Affairs, Health, Care and Consumer Protection
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Bogdan Wojtyniak
- National Institute of Public Health - National Institute of Hygiene
| | | | | | | | | | - Jean Woo
- The Chinese University of Hong Kong
| | | | | | - Jianfeng Wu
- Shandong University of Traditional Chinese Medicine
| | | | | | - Haiquan Xu
- Institute of Food and Nutrition Development of Ministry of Agriculture and Rural Affairs
| | - Liang Xu
- Beijing Institute of Ophthalmology
| | | | | | - Weili Yan
- Children's Hospital of Fudan University
| | | | | | - Yang Yang
- Shanghai Educational Development Co. Ltd
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- Peking University
- Duke University
| | | | | | - Dong Zhao
- Capital Medical University Beijing An Zhen Hospital
| | | | - Wenhua Zhao
- Chinese Center for Disease Control and Prevention
| | - Shiqi Zhen
- Jiangsu Provincial Center for Disease Control and Prevention
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- Chinese Center for Disease Control and Prevention
| | - Dan Zhu
- Inner Mongolia Medical University
| | - Marie Zins
- Institut National de la Santé et de la Recherche Médicale
- Paris University
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Rejaibi S, Mahfoudh Mchirgui R, Ben Mansour N, Barbouch F, Kaddour N, Mrabet A, Aounallah-Skhiri H. Colorectal cancer mass screening, Tunisia 2019. Evaluation of a pilot program in the Tunis region (Tunisia, 2019). Tunis Med 2021; 99:158-167. [PMID: 33899183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Colorectal cancer (CRC) is a real public health issue in Tunisia. A screening program based on fecal immunological occult blood test, followed in case of a positive test by colonoscopy, was launched in Tunis region in 2016. We aimed to evaluate this screening program in order to make recommendations for a better implementation of this program in years to come. METHODS A mixed approach has been adopted with a quantitative component based on the production of indicators related to activity, monitoring and screening quality; and a qualitative component conducted through focus groups with frontline health care professionals (HCP) and individual interviews with those lost to follow-up after a positive screening test. SWOT analysis was then performed in order to assess main strengths, weaknesses, opportunities and threats of the program. RESULTS This study showed a coverage rate of 41.2% [40.5-41.8] for population consulting the first line of care, and an effective participation rate estimated at 23.1% [22.6-23.6]. Out of 5856 tests performed, 6% (n=352) were non-treatable and 6.7 % (n=390) were positive. Only 18.6% (n=72) of those tested positive had undergone colonoscopy. A total of 26 polyps, 03 cases of cancer and 04 cases of dysplasia were recorded. SWOT analysis pointed out that the variable adherence of HCP, lack of awareness of general population regarding CRC screening, the non-acceptability of colonoscopy without sedation with a problem of affordability for its realization in the private sector, and long appointments delays in public sector, were main weaknesses and of this program. CONCLUSION This evaluation underlined certain strengths regarding the program implementation and revealed, in return, several shortcomings which certainly impair the program's effectiveness and efficiency. The involvement of the national health insurance fund in CRC screening tests and colonoscopies reimbursement, as well as the establishment of a performance-based payment modality for HCP, constitute main key pillars to reach success and sustainability for any CCR mass screening program in Tunisia.
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Rodriguez-Martinez A, Zhou B, Sophiea MK, Bentham J, Paciorek CJ, Iurilli MLC, Carrillo-Larco RM, Bennett JE, Di Cesare M, Taddei C, Bixby H, Stevens GA, Riley LM, Cowan MJ, Savin S, Danaei G, Chirita-Emandi A, Kengne AP, Khang YH, Laxmaiah A, Malekzadeh R, Miranda JJ, Moon JS, Popovic SR, Sørensen TIA, Soric M, Starc G, Zainuddin AA, Gregg EW, Bhutta ZA, Black R, Abarca-Gómez L, Abdeen ZA, Abdrakhmanova S, Abdul Ghaffar S, Abdul Rahim HF, Abu-Rmeileh NM, Abubakar Garba J, Acosta-Cazares B, Adams RJ, Aekplakorn W, Afsana K, Afzal S, Agdeppa IA, Aghazadeh-Attari J, Aguilar-Salinas CA, Agyemang C, Ahmad MH, Ahmad NA, Ahmadi A, Ahmadi N, Ahmed SH, Ahrens W, Aitmurzaeva G, Ajlouni K, Al-Hazzaa HM, Al-Othman AR, Al-Raddadi R, Alarouj M, AlBuhairan F, AlDhukair S, Ali MM, Alkandari A, Alkerwi A, Allin K, Alvarez-Pedrerol M, Aly E, Amarapurkar DN, Amiri P, Amougou N, Amouyel P, Andersen LB, Anderssen SA, Ängquist L, Anjana RM, Ansari-Moghaddam A, Aounallah-Skhiri H, Araújo J, Ariansen I, Aris T, Arku RE, Arlappa N, Aryal KK, Aspelund T, Assah FK, Assunção MCF, Aung MS, Auvinen J, Avdicová M, Azevedo A, Azimi-Nezhad M, Azizi F, Azmin M, Babu BV, Bæksgaard Jørgensen M, Baharudin A, Bahijri S, Baker JL, Balakrishna N, Bamoshmoosh M, Banach M, Bandosz P, Banegas JR, Baran J, Barbagallo CM, Barceló A, Barkat A, Barros AJD, Barros MVG, Basit A, Bastos JLD, Bata I, Batieha AM, Batista RL, Battakova Z, Batyrbek A, Baur LA, Beaglehole R, Bel-Serrat S, Belavendra A, Ben Romdhane H, Benedics J, Benet M, Bennett JE, Berkinbayev S, Bernabe-Ortiz A, Bernotiene G, Bettiol H, Bezerra J, Bhagyalaxmi A, Bharadwaj S, Bhargava SK, Bhutta ZA, Bi H, Bi Y, Bia D, Bika Lele EC, Bikbov MM, Bista B, Bjelica DJ, Bjerregaard P, Bjertness E, Bjertness MB, Björkelund C, Bloch KV, Blokstra A, Bo S, Bobak M, Boddy LM, Boehm BO, Boeing H, Boggia JG, Bogova E, Boissonnet CP, Bojesen SE, Bonaccio M, Bongard V, Bonilla-Vargas A, Bopp M, Borghs H, Bovet P, Braeckevelt L, Braeckman L, Bragt MCE, Brajkovich I, Branca F, Breckenkamp J, Breda J, Brenner H, Brewster LM, Brian GR, Brinduse L, Brophy S, Bruno G, Bueno-de-Mesquita HB, Bugge A, Buoncristiano M, Burazeri G, Burns C, Cabrera de León A, Cacciottolo J, Cai H, Cama T, Cameron C, Camolas J, Can G, Cândido APC, Cañete F, Capanzana MV, Capková N, Capuano E, Capuano V, Cardol M, Cardoso VC, Carlsson AC, Carmuega E, Carvalho J, Casajús JA, Casanueva FF, Celikcan E, Censi L, Cervantes-Loaiza M, Cesar JA, Chamukuttan S, Chan AW, Chan Q, Chaturvedi HK, Chaturvedi N, Che Abdul Rahim N, Chen CJ, Chen F, Chen H, Chen S, Chen Z, Cheng CY, Cheraghian B, Chetrit A, Chikova-Iscener E, Chiolero A, Chiou ST, Chirita-Emandi A, Chirlaque MD, Cho B, Christensen K, Christofaro DG, Chudek J, Cifkova R, Cilia M, Cinteza E, Claessens F, Clarke J, Clays E, Cohen E, Concin H, Confortin SC, Cooper C, Coppinger TC, Corpeleijn E, Costanzo S, Cottel D, Cowell C, Craig CL, Crampin AC, Crujeiras AB, Csilla S, Cucu AM, Cui L, Cureau FV, D'Arrigo G, d'Orsi E, Dacica L, Dal Re Saavedra MÁ, Dallongeville J, Damasceno A, Damsgaard CT, Danaei G, Dankner R, Dantoft TM, Dasgupta P, Dastgiri S, Dauchet L, Davletov K, De Backer G, De Bacquer D, de Gaetano G, De Henauw S, de Oliveira PD, De Ridder D, De Ridder K, de Rooij SR, De Smedt D, Deepa M, Deev AD, DeGennaro VJ, Dehghan A, Delisle H, Delpeuch F, Demarest S, Dennison E, Deren K, Deschamps V, Dhana K, Dhimal M, Di Castelnuovo AF, Dias-da-Costa JS, Díaz-Sánchez ME, Diaz A, Dika Z, Djalalinia S, Djordjic V, Do HTP, Dobson AJ, Donati MB, Donfrancesco C, Donoso SP, Döring A, Dorobantu M, Dorosty AR, Doua K, Drygas W, Duan JL, Duante CA, Duboz P, Duda RB, Duleva V, Dulskiene V, Dumith SC, Dushpanova A, Dzerve V, Dziankowska-Zaborszczyk E, Eddie R, Eftekhar E, Egbagbe EE, Eggertsen R, Eghtesad S, Eiben G, Ekelund U, El-Khateeb M, El Ati J, Eldemire-Shearer D, Eliasen M, Elliott P, Engle-Stone R, Enguerran M, Erasmus RT, Erbel R, Erem C, Eriksen L, Eriksson JG, Escobedo-de la Peña J, Eslami S, Esmaeili A, Evans A, Faeh D, Fakhretdinova AA, Fall CH, Faramarzi E, Farjam M, Farrugia Sant'Angelo V, Farzadfar F, Fattahi MR, Fawwad A, Felix-Redondo FJ, Ferguson TS, Fernandes RA, Fernández-Bergés D, Ferrante D, Ferrao T, Ferrari M, Ferrario MM, Ferreccio C, Ferrer E, Ferrieres J, Figueiró TH, Fijalkowska A, Fink G, Fischer K, Föger B, Foo LH, Forsner M, Fouad HM, Francis DK, Franco MDC, Franco OH, Frikke-Schmidt R, Frontera G, Fuchs FD, Fuchs SC, Fujiati II, Fujita Y, Fumihiko M, Furusawa T, Gaciong Z, Gafencu M, Galbarczyk A, Galenkamp H, Galeone D, Galfo M, Galvano F, Gao J, Garcia-de-la-Hera M, García-Solano M, Gareta D, Garnett SP, Gaspoz JM, Gasull M, Gaya ACA, Gaya AR, Gazzinelli A, Gehring U, Geiger H, Geleijnse JM, Ghanbari A, Ghasemi E, Gheorghe-Fronea OF, Giampaoli S, Gianfagna F, Gill TK, Giovannelli J, Gironella G, Giwercman A, Gkiouras K, Godos J, Gogen S, Goldsmith RA, Goltzman D, Gómez SF, Gomula A, Goncalves Cordeiro da Silva B, Gonçalves H, Gonzalez-Chica DA, Gonzalez-Gross M, 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D, Rodríguez-Artalejo F, Rodriguez-Perez MDC, Rodríguez-Villamizar LA, Roggenbuck U, Rojas-Martinez R, Rojroongwasinkul N, Romaguera D, Romeo EL, Rosario RV, Rosengren A, Rouse I, Roy JGR, Rubinstein A, Rühli FJ, Ruidavets JB, Ruiz-Betancourt BS, Ruiz Moreno E, Rusakova IA, Russell Jonsson K, Russo P, Rust P, Rutkowski M, Sabanayagam C, Sacchini E, Sachdev HS, Sadjadi A, Safarpour AR, Safi S, Safiri S, Saidi O, Saki N, Salanave B, Salazar Martinez E, Salmerón D, Salomaa V, Salonen JT, Salvetti M, Samoutian M, Sánchez-Abanto J, Sandjaja, Sans S, Santa Marina L, Santos DA, Santos IS, Santos LC, Santos MP, Santos O, Santos R, Santos Sanz S, Saramies JL, Sardinha LB, Sarrafzadegan N, Sathish T, Saum KU, Savva S, Savy M, Sawada N, Sbaraini M, Scazufca M, Schaan BD, Schaffrath Rosario A, Schargrodsky H, Schienkiewitz A, Schindler K, Schipf S, Schmidt CO, Schmidt IM, Schnohr P, Schöttker B, Schramm S, Schramm S, Schröder H, Schultsz C, Schutte AE, Sebert S, Sein AA, Selamat R, Sember V, Sen A, Senbanjo IO, Sepanlou SG, Sequera V, Serra-Majem L, Servais J, Ševcíková L, Shalnova SA, Shamah-Levy T, Shamshirgaran M, Shanthirani CS, Sharafkhah M, Sharma SK, Shaw JE, Shayanrad A, Shayesteh AA, Shengelia L, Shi Z, Shibuya K, Shimizu-Furusawa H, Shin DW, Shin Y, Shirani M, Shiri R, Shrestha N, Si-Ramlee K, Siani A, Siantar R, Sibai AM, Silva AM, Silva DAS, Simon M, Simons J, Simons LA, Sjöberg A, Sjöström M, Skodje G, Slowikowska-Hilczer J, Slusarczyk P, Smeeth L, So HK, Soares FC, Sobek G, Sobngwi E, Sodemann M, Söderberg S, Soekatri MYE, Soemantri A, Sofat R, Solfrizzi V, Somi MH, Sonestedt E, Song Y, Sørensen TIA, Sørgjerd EP, Soric M, Sossa Jérome C, Soto-Rojas VE, Soumaré A, Sovic S, Sparboe-Nilsen B, Sparrenberger K, Spinelli A, Spiroski I, Staessen JA, Stamm H, Starc G, Stathopoulou MG, Staub K, Stavreski B, Steene-Johannessen J, Stehle P, Stein AD, Stergiou GS, Stessman J, Stevanovic R, Stieber J, Stöckl D, Stocks T, Stokwiszewski J, Stoyanova E, Stratton G, Stronks K, Strufaldi MW, Sturua L, Suárez-Medina R, Suka M, Sun CA, Sundström J, Sung YT, Sunyer J, Suriyawongpaisal P, Swinburn BA, Sy RG, Syddall HE, Sylva RC, Szklo M, Szponar L, Tai ES, Tammesoo ML, Tamosiunas A, Tan EJ, Tang X, Tanser F, Tao Y, Tarawneh MR, Tarp J, Tarqui-Mamani CB, Taxová Braunerová R, Taylor A, Taylor J, Tchibindat F, Tebar WR, Tell GS, Tello T, Thankappan KR, Theobald H, Theodoridis X, Thijs L, Thomas N, Thuesen BH, Tichá L, Timmermans EJ, Tjonneland A, Tolonen HK, Tolstrup JS, Topbas M, Topór-Madry R, Torheim LE, Tormo MJ, Tornaritis MJ, Torrent M, Torres-Collado L, Toselli S, Traissac P, Tran TTH, Trichopoulos D, Trichopoulou A, Trinh OTH, Trivedi A, Tshepo L, Tsigga M, Tsugane S, Tuliakova AM, Tulloch-Reid MK, Tullu F, Tuomainen TP, Tuomilehto J, Turley ML, Tynelius P, Tzotzas T, Tzourio C, Ueda P, Ugel E, Ukoli FAM, Ulmer H, Unal B, Usupova Z, Uusitalo HMT, Uysal N, Vaitkeviciute J, Valdivia G, Vale S, Valvi D, van Dam RM, Van der Heyden J, van der Schouw YT, Van Herck K, Van Minh H, van Valkengoed IGM, Vanderschueren D, Vanuzzo D, Varbo A, Varela-Moreiras G, Varona-Pérez P, Vasan SK, Vega T, Veidebaum T, Velasquez-Melendez G, Velika B, Veronesi G, Verschuren WMM, Victora CG, Viegi G, Viet L, Villalpando S, Vineis P, Vioque J, Virtanen JK, Visser M, Visvikis-Siest S, Viswanathan B, Vladulescu M, Vlasoff T, Vocanec D, Völzke H, Voutilainen A, Voutilainen S, Vrijheid M, Vrijkotte TGM, Wade AN, Wagner A, Waldhör T, Walton J, Wambiya EOA, Wan Bebakar WM, Wan Mohamud WN, Wanderley Júnior RDS, Wang MD, Wang N, Wang Q, Wang X, Wang YX, Wang YW, Wannamethee SG, Wareham N, Weber A, Wedderkopp N, Weerasekera D, Weghuber D, Wei W, Weres A, Werner B, Whincup PH, Widhalm K, Widyahening IS, Wiecek A, Wilks RJ, Willeit J, Willeit P, Williams J, Wilsgaard T, Wojtyniak B, Wong-McClure RA, Wong A, Wong JE, Wong TY, Woo J, Woodward M, Wu FC, Wu J, Wu LJ, Wu S, Xu H, Xu L, Yaacob NA, Yamborisut U, Yan W, Yang L, Yang X, Yang Y, Yardim N, Yaseri M, Yasuharu T, Ye X, Yiallouros PK, Yoosefi M, Yoshihara A, You QS, You SL, Younger-Coleman NO, Yusof SM, Yusoff AF, Zaccagni L, Zafiropulos V, Zainuddin AA, Zakavi SR, Zamani F, Zambon S, Zampelas A, Zamrazilová H, Zapata ME, Zargar AH, Zaw KK, Zdrojewski T, Zeljkovic Vrkic T, Zeng Y, Zhang L, Zhang ZY, Zhao D, Zhao MH, Zhao W, Zhen S, Zheng W, Zheng Y, Zholdin B, Zhou M, Zhu D, Zocalo Y, Zuñiga Cisneros J, Zuziak M, Ezzati M. 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. Lancet 2020; 396:1511-1524. [PMID: 33160572 PMCID: PMC7658740 DOI: 10.1016/s0140-6736(20)31859-6] [Citation(s) in RCA: 171] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 08/03/2020] [Accepted: 08/19/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND 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. METHODS 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. FINDINGS 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. INTERPRETATION 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. FUNDING Wellcome Trust, AstraZeneca Young Health Programme, EU.
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Rejaibi S, Cherif I, Ben Mansour N, Zoghlami N, Saidi O, Skhiri A, Ben Slama F, Ben Romthane H, Turki Z, Aounallah-Skhiri H. Health care renunciation in Tunisian diabetic patients, 2016. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Diabetes management requires access to health care, patient awareness about hygiene and diet measures, and patient adherence to prescribed treatment. Health care renunciation (HCR) can make diabetes management really challenging. We aimed to determine the prevalence of HCR in diabetic Tunisian patients and assess associated factors.
Methods
Data were obtained from the 2016 Tunisian Health Examination Survey, a household survey stratified at three degrees. For each household, two people aged 18 and over were randomly selected. Data were collected using: a household questionnaire and an individual questionnaire (risk behaviours and medical history). Diabetic patients were asked whether, they had renounced any health care service, the last time they needed to seek healthcare. Data analysis was performed with R software.
Results
A total of 880 diabetic patients were included in this survey, with a mean age of 61±12 years and a sex ratio M/F equal to 0.9. The prevalence of HCR was 4.9% (95% CI [3.3-6.5]), higher in men (7.4% VS 2.6% in women, p = 0.003) and higher in urban areas (5.4% VS 3.1 in rural areas, p = 0.09). After multivariate adjustment (taking into consideration age, gender, profession, health insurance and place of residence as independent variables), having no health insurance and being aged more than 50, were significantly associated to HCR, with adjusted Odds Ratios equal to (3.8, 95% CI [1.4-9.2]) and (3.4, 95% CI [1.9-10.1]), respectively.
Conclusions
Our study has highlighted a relatively low prevalence of HCR compared to literature data (4.9% VS 10-15%), explained mostly by methodological differences regarding HCR assessment. HCR in diabetic patients is mostly explained by economic reasons, which show how important is a better organisation of Tunisian public health system to ensure equity in access to health care.
Key messages
Health care renunciation in diabetic Tunisian patients is explained mainly by financial reasons (having no health insurance). Moving further towards improving universal health coverage is a key pillar in the proper management of chronic diseases such as diabetes.
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Affiliation(s)
- S Rejaibi
- National Institute of Health, Tunis, Tunisia
- Department of Preventive Medicine, Faculty of medicine of Tunis, Tunis, Tunisia
- Research Laboratory of Epidemiology and Prevention of cardiovascular Diseases, Tunis, Tunisia
| | - I Cherif
- Department of Preventive Medicine, Faculty of medicine of Tunis, Tunis, Tunisia
| | - N Ben Mansour
- National Institute of Health, Tunis, Tunisia
- Department of Preventive Medicine, Faculty of medicine of Tunis, Tunis, Tunisia
- Research Laboratory of Epidemiology and Prevention of cardiovascular Diseases, Tunis, Tunisia
| | - N Zoghlami
- National Institute of Health, Tunis, Tunisia
| | - O Saidi
- National Institute of Health, Tunis, Tunisia
| | - A Skhiri
- National Institute of Health, Tunis, Tunisia
| | - F Ben Slama
- National Institute of Health, Tunis, Tunisia
| | - H Ben Romthane
- Research Laboratory of Epidemiology and Prevention of cardiovascular Diseases, Tunis, Tunisia
| | - Z Turki
- Tunisian Society of Diabetes Endocrinology and Metabolic Diseases, Tunis, Tunisia
| | - H Aounallah-Skhiri
- National Institute of Health, Tunis, Tunisia
- Department of Preventive Medicine, Faculty of medicine of Tunis, Tunis, Tunisia
- Research Laboratory of Nutritional Surveillance and Epidemiology, Tunis, Tunisia
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Cherif I, Ben Mansour N, Rejaibi S, Zoghlami N, Saidi O, Skhiri A, Ben Slama F, Ben Romthane H, Turki Z, Aounallah-Skhiri H. Prevalence, awareness and control of hypertension among Tunisian adults, 2016. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Hypertension is becoming increasingly frequent mainly in low and middle income countries. We aimed to assess the prevalence, awareness and control of hypertension among Tunisian adults and identify associated factors with hypertension control.
Methods
Data were obtained from the 2016 Tunisian Health Examination Survey, a household survey stratified at three degrees. Adults (age≥18 years old) were interviewed using an individual questionnaire, then three blood pressure measurement were performed. Participants were considered hypertensive if they were previously diagnosed or had a systolic blood pressure (SBP) ≥140mmhg and/or a diastolic blood pressure (DBP) ≥ 90mmhg during the survey. Were considered under control, treated persons with SBP<140 mmhg and a DBP<90 mmhg. A weighted binary logistic regression was used to assess associated factors with hypertension control. Input model variables were: sociodemographic variables, comorbidities and lifestyle factors.
Results
In this study, 8908 adults were enrolled with a mean age of 42.8±0.2 years old and a sex ratio (M/F) equal to 0.96. Among respondents, 29.3% (95% CI: 28.2-30.5) had hypertension, 60.7% (95% CI: 58.7-62.6) of them were unaware of their disease and only (29.5%, 95% CI: 28.2-30.5) of treated patients had a controlled hypertension. In multivariate analysis, eating more than five fruits and vegetables per day was independently associated with a better hypertension control (AOR=1.7, 95% CI: 1.1-2.5). In addition, participants living in northern Tunisia were more likely to have a controlled hypertension than those living in the south (AOR=1.9, 95% CI: 1.2-2.9).
Conclusions
Almost third of Tunisian adults were hypertensive. Low level of awareness and control of hypertension were found in this study. This highlights the urge to reinforce hypertension screening interventions and to strengthen educational programs on this disease with a focus on blood pressure monitoring and healthy lifestyle measures.
Key messages
Tunisian adults had a low level of awareness and control of hypertension. Reinforcing hypertension screening interventions and increasing awareness about healthy lifestyle measures are recommended.
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Affiliation(s)
- I Cherif
- Department of preventive medicine, Faculty of medicine of Tunis, Tunis, Tunisia
| | - N Ben Mansour
- National Institute of Health, Tunis, Tunisia
- Department of preventive medicine, Faculty of medicine of Tunis, Tunis, Tunisia
- Research Laboratory of Epidemiology and Prevention of Cardiovascular Diseases, Tunis, Tunisia
| | - S Rejaibi
- National Institute of Health, Tunis, Tunisia
- Department of preventive medicine, Faculty of medicine of Tunis, Tunis, Tunisia
- Research Laboratory of Epidemiology and Prevention of Cardiovascular Diseases, Tunis, Tunisia
| | - N Zoghlami
- National Institute of Health, Tunis, Tunisia
| | - O Saidi
- National Institute of Health, Tunis, Tunisia
| | - A Skhiri
- National Institute of Health, Tunis, Tunisia
| | - F Ben Slama
- National Institute of Health, Tunis, Tunisia
| | - H Ben Romthane
- Research Laboratory of Epidemiology and Prevention of Cardiovascular Diseases, Tunis, Tunisia
| | - Z Turki
- Tunisian Society of Diabetes Endocrinology and Metabolic Diseases, Tunis, Tunisia
| | - H Aounallah-Skhiri
- National Institute of Health, Tunis, Tunisia
- Department of preventive medicine, Faculty of medicine of Tunis, Tunis, Tunisia
- Research Laboratory of Nutritional Surveillance and Epidemiology, Tunis, Tunisia
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Taddei C, Zhou B, Bixby H, Carrillo-Larco RM, Danaei G, Jackson RT, Farzadfar F, Sophiea MK, Di Cesare M, Iurilli MLC, Martinez AR, Asghari G, Dhana K, Gulayin P, Kakarmath S, Santero M, Voortman T, Riley LM, Cowan MJ, Savin S, Bennett JE, Stevens GA, Paciorek CJ, Aekplakorn W, Cifkova R, Giampaoli S, Kengne AP, Khang YH, Kuulasmaa K, Laxmaiah A, Margozzini P, Mathur P, Nordestgaard BG, Zhao D, Aadahl M, Abarca-Gómez L, Rahim HA, Abu-Rmeileh NM, Acosta-Cazares B, Adams RJ, Agdeppa IA, Aghazadeh-Attari J, Aguilar-Salinas CA, Agyemang C, Ahluwalia TS, Ahmad NA, Ahmadi A, Ahmadi N, Ahmed SH, Ahrens W, Ajlouni K, Alarouj M, AlBuhairan F, AlDhukair S, Ali MM, Alkandari A, Alkerwi A, Aly E, Amarapurkar DN, Amouyel P, Andersen LB, Anderssen SA, Anjana RM, Ansari-Moghaddam A, Aounallah-Skhiri H, Araújo J, Ariansen I, Aris T, Arku RE, Arlappa N, Aryal KK, Aspelund T, Assunção MCF, Auvinen J, Avdicová M, Azevedo A, Azizi F, Azmin M, Balakrishna N, Bamoshmoosh M, Banach M, Bandosz P, Banegas JR, Barbagallo CM, Barceló A, Barkat A, Bata I, Batieha AM, Batyrbek A, Baur LA, Beaglehole R, Belavendra A, Ben Romdhane H, Benet M, Benn M, Berkinbayev S, Bernabe-Ortiz A, Bernotiene G, Bettiol H, Bhargava SK, Bi Y, Bienek A, Bikbov M, Bista B, Bjerregaard P, Bjertness E, Bjertness MB, Björkelund C, Bloch KV, Blokstra A, Bo S, Boehm BO, Boggia JG, Boissonnet CP, Bonaccio M, Bongard V, Borchini R, Borghs H, Bovet P, Brajkovich I, Breckenkamp J, Brenner H, Brewster LM, Bruno G, Bugge A, Busch MA, de León AC, Cacciottolo J, Can G, Cândido APC, Capanzana MV, Capuano E, Capuano V, Cardoso VC, Carvalho J, Casanueva FF, Censi L, Chadjigeorgiou CA, Chamukuttan S, Chaturvedi N, Chen CJ, Chen F, Chen S, Cheng CY, Cheraghian B, Chetrit A, Chiou ST, Chirlaque MD, Cho B, Cho Y, Chudek J, Claessens F, Clarke J, Clays E, Concin H, Confortin SC, Cooper C, Costanzo S, Cottel D, Cowell C, Crujeiras AB, Csilla S, Cui L, Cureau FV, D’Arrigo G, d’Orsi E, Dallongeville J, Damasceno A, Dankner R, Dantoft TM, Dauchet L, Davletov K, De Backer G, De Bacquer D, de Gaetano G, De Henauw S, de Oliveira PD, De Ridder D, De Smedt D, Deepa M, Deev AD, Dehghan A, Delisle H, Dennison E, Deschamps V, Dhimal M, Di Castelnuovo AF, Dika Z, Djalalinia S, Dobson AJ, Donfrancesco C, Donoso SP, Döring A, Dorobantu M, Dragano N, Drygas W, Du Y, Duante CA, Duda RB, Dzerve V, Dziankowska-Zaborszczyk E, Eddie R, Eftekhar E, Eggertsen R, Eghtesad S, Eiben G, Ekelund U, El Ati J, Eldemire-Shearer D, Eliasen M, Elosua R, Erasmus RT, Erbel R, Erem C, Eriksen L, Eriksson JG, Escobedo-de la Peña J, Eslami S, Esmaeili A, Evans A, Faeh D, Fall CH, Faramarzi E, Farjam M, Fattahi MR, Felix-Redondo FJ, Ferguson TS, Fernández-Bergés D, Ferrante D, Ferrari M, Ferreccio C, Ferrieres J, Föger B, Foo LH, Forslund AS, Forsner M, Fouad HM, Francis DK, do Carmo Franco M, Franco OH, Frontera G, Fujita Y, Fumihiko M, Furusawa T, Gaciong Z, Galvano F, Gao J, Garcia-de-la-Hera M, Garnett SP, Gaspoz JM, Gasull M, Gazzinelli A, Geleijnse JM, Ghanbari A, Ghasemi E, Gheorghe-Fronea OF, Ghimire A, Gianfagna F, Gill TK, Giovannelli J, Gironella G, Giwercman A, Goltzman D, Gonçalves H, Gonzalez-Chica DA, Gonzalez-Gross M, González-Rivas JP, González-Villalpando C, González-Villalpando ME, Gonzalez AR, Gottrand F, Graff-Iversen S, Grafnetter D, Gregor RD, Grodzicki T, Grøntved A, Grosso G, Gruden G, Gu D, Guallar-Castillón P, Guan OP, Gudmundsson EF, Gudnason V, Guerrero R, Guessous I, Gunnlaugsdottir J, Gupta R, Gutierrez L, Gutzwiller F, Ha S, Hadaegh F, Haghshenas R, Hakimi H, Hambleton IR, Hamzeh B, Hantunen S, Kumar RH, Hashemi-Shahri SM, Hata J, Haugsgjerd T, Hayes AJ, He J, He Y, Hendriks ME, Henriques A, Herrala S, Heshmat R, Hill AG, Ho SY, Ho SC, Hobbs M, Hofman A, Homayounfar R, Hopman WM, Horimoto ARVR, Hormiga CM, Horta BL, Houti L, Howitt C, Htay TT, Htet AS, Htike MMT, Huerta JM, Huhtaniemi IT, Huisman M, Hunsberger ML, Husseini AS, Huybrechts I, Hwalla N, Iacoviello L, Iannone AG, Ibrahim MM, Wong NI, Iglesia I, Ikeda N, Ikram MA, Iotova V, Irazola VE, Ishida T, Islam M, al-Safi Ismail A, Iwasaki M, Jacobs JM, Jaddou HY, Jafar T, James K, Jamrozik K, Janszky I, Janus E, Jarvelin MR, Jasienska G, Jelakovic A, Jelakovic B, Jennings G, Jensen GB, Jeong SL, Jha AK, Jiang CQ, Jimenez RO, Jöckel KH, Joffres M, Jokelainen JJ, Jonas JB, Jørgensen T, Joshi P, Joukar F, Józwiak J, Juolevi A, Kafatos A, Kajantie EO, Kalter-Leibovici O, Kamaruddin NA, Kamstrup PR, Karki KB, Katz J, Kauhanen J, Kaur P, Kavousi M, Kazakbaeva G, Keil U, Keinänen-Kiukaanniemi S, Kelishadi R, Keramati M, Kerimkulova A, Kersting M, Khader YS, Khalili D, Khateeb M, Kheradmand M, Khosravi A, Kiechl-Kohlendorfer U, Kiechl S, Killewo J, Kim HC, Kim J, Kim YY, Klumbiene J, Knoflach M, Ko S, Kohler HP, Kohler IV, Kolle E, Kolsteren P, König J, Korpelainen R, Korrovits P, Kos J, Koskinen S, Kouda K, Kowlessur S, Kratzer W, Kriemler S, Kristensen PL, Krokstad S, Kromhout D, Kujala UM, Kurjata P, Kyobutungi C, Laamiri FZ, Laatikainen T, Lachat C, Laid Y, Lam TH, Lambrinou CP, Lanska V, Lappas G, Larijani B, Latt TS, Laugsand LE, Lazo-Porras M, Lee J, Lee J, Lehmann N, Lehtimäki T, Levitt NS, Li Y, Lilly CL, Lim WY, Lima-Costa MF, Lin HH, Lin X, Lin YT, Lind L, Linneberg A, Lissner L, Liu J, Loit HM, Lopez-Garcia E, Lopez T, Lotufo PA, Lozano JE, Luksiene D, Lundqvist A, Lundqvist R, Lunet N, Ma G, Machado-Coelho GLL, Machado-Rodrigues AM, Machi S, Madar AA, Maggi S, Magliano DJ, Magriplis E, Mahasampath G, Maire B, Makdisse M, Malekzadeh F, Malekzadeh R, Rao KM, Manios Y, Mann JI, Mansour-Ghanaei F, Manzato E, Marques-Vidal P, Martorell R, Mascarenhas LP, Mathiesen EB, Matsha TE, Mavrogianni C, McFarlane SR, McGarvey ST, McLachlan S, McLean RM, McLean SB, McNulty BA, Mediene-Benchekor S, Mehdipour P, Mehlig K, Mehrparvar AH, Meirhaeghe A, Meisinger C, Menezes AMB, Menon GR, Merat S, Mereke A, Meshram II, Metcalf P, Meyer HE, Mi J, Michels N, Miller JC, Minderico CS, Mini GK, Miquel JF, Miranda JJ, Mirjalili MR, Mirrakhimov E, Modesti PA, Moghaddam SS, Mohajer B, Mohamed MK, Mohammad K, Mohammadi Z, Mohammadifard N, Mohammadpourhodki R, Mohan V, Mohanna S, Yusoff MFM, Mohebbi I, Mohebi F, Moitry M, Møllehave LT, Møller NC, Molnár D, Momenan A, Mondo CK, Monterrubio-Flores E, Moosazadeh M, Morejon A, Moreno LA, Morgan K, Morin SN, Moschonis G, Mossakowska M, Mostafa A, Mota J, Motlagh ME, Motta J, Msyamboza KP, Muiesan ML, Müller-Nurasyid M, Mursu J, Mustafa N, Nabipour I, Naderimagham S, Nagel G, Naidu BM, Najafi F, Nakamura H, Námešná J, Nang EEK, Nangia VB, Nauck M, Neal WA, Nejatizadeh A, Nenko I, Nervi F, Nguyen ND, Nguyen QN, Nieto-Martínez RE, Nihal T, Niiranen TJ, Ning G, Ninomiya T, Noale M, Noboa OA, Noto D, Nsour MA, Nuhoğlu I, O’Neill TW, O’Reilly D, Ochoa-Avilés AM, Oh K, Ohtsuka R, Olafsson Ö, Olié V, Oliveira IO, Omar MA, Onat A, Ong SK, Ordunez P, Ornelas R, Ortiz PJ, Osmond C, Ostojic SM, Ostovar A, Otero JA, Owusu-Dabo E, Paccaud FM, Pahomova E, Pajak A, Palmieri L, Pan WH, Panda-Jonas S, Panza F, Parnell WR, Patel ND, Peer N, Peixoto SV, Peltonen M, Pereira AC, Peters A, Petersmann A, Petkeviciene J, Peykari N, Pham ST, Pichardo RN, Pigeot I, Pilav A, Pilotto L, Piwonska A, Pizarro AN, Plans-Rubió P, Plata S, Pohlabeln H, Porta M, Portegies MLP, Poudyal A, Pourfarzi F, Poustchi H, Pradeepa R, Price JF, Providencia R, Puder JJ, Puhakka SE, Punab M, Qorbani M, Bao TQ, Radisauskas R, Rahimikazerooni S, Raitakari O, Rao SR, Ramachandran A, Ramos E, Ramos R, Rampal L, Rampal S, Redon J, Reganit PFM, Revilla L, Rezaianzadeh A, Ribeiro R, Richter A, Rigo F, Rinke de Wit TF, Rodríguez-Artalejo F, del Cristo Rodriguez-Perez M, Rodríguez-Villamizar LA, Roggenbuck U, Rojas-Martinez R, Romaguera D, Romeo EL, Rosengren A, Roy JGR, Rubinstein A, Ruidavets JB, Ruiz-Betancourt BS, Russo P, Rust P, Rutkowski M, Sabanayagam C, Sachdev HS, Sadjadi A, Safarpour AR, Safiri S, Saidi O, Saki N, Salanave B, Salmerón D, Salomaa V, Salonen JT, Salvetti M, Sánchez-Abanto J, Sans S, Santaliestra-Pasías AM, Santos DA, Santos MP, Santos R, Saramies JL, Sardinha LB, Sarrafzadegan N, Saum KU, Savva SC, Sawada N, Sbaraini M, Scazufca M, Schaan BD, Schargrodsky H, Scheidt-Nave C, Schienkiewitz A, Schipf S, Schmidt CO, Schöttker B, Schramm S, Sebert S, Sein AA, Sen A, Sepanlou SG, Servais J, Shakeri R, Shalnova SA, Shamah-Levy T, Sharafkhah M, Sharma SK, Shaw JE, Shayanrad A, Shi Z, Shibuya K, Shimizu-Furusawa H, Shin DW, Shin Y, Shirani M, Shiri R, Shrestha N, Si-Ramlee K, Siani A, Siantar R, Sibai AM, Silva DAS, Simon M, Simons J, Simons LA, Sjöström M, Skaaby T, Slowikowska-Hilczer J, Slusarczyk P, Smeeth L, Snijder MB, Söderberg S, Soemantri A, Sofat R, Solfrizzi V, Somi MH, Sonestedt E, Sørensen TIA, Jérome CS, Soumaré A, Sozmen K, Sparrenberger K, Staessen JA, Stathopoulou MG, Stavreski B, Steene-Johannessen J, Stehle P, Stein AD, Stessman J, Stevanović R, Stieber J, Stöckl D, Stokwiszewski J, Stronks K, Strufaldi MW, Suárez-Medina R, Sun CA, Sundström J, Suriyawongpaisal P, Sy RG, Sylva RC, Szklo M, Tai ES, Tamosiunas A, Tan EJ, Tarawneh MR, Tarqui-Mamani CB, Taylor A, Taylor J, Tell GS, Tello T, Thankappan KR, Thijs L, Thuesen BH, Toft U, Tolonen HK, Tolstrup JS, Topbas M, Topór-Madry R, Tormo MJ, Tornaritis MJ, Torrent M, Torres-Collado L, Traissac P, Trinh OTH, Truthmann J, Tsugane S, Tulloch-Reid MK, Tuomainen TP, Tuomilehto J, Tybjaerg-Hansen A, Tzourio C, Ueda P, Ugel E, Ulmer H, Unal B, Uusitalo HMT, Valdivia G, Valvi D, van Dam RM, van der Schouw YT, Van Herck K, Van Minh H, van Rossem L, Van Schoor NM, van Valkengoed IGM, Vanderschueren D, Vanuzzo D, Varbo A, Varona-Pérez P, Vasan SK, Vatten L, Vega T, Veidebaum T, Velasquez-Melendez G, Venero-Fernández SJ, Veronesi G, Verschuren WMM, Victora CG, Vidiawati D, Viet L, Villalpando S, Vioque J, Virtanen JK, Visvikis-Siest S, Viswanathan B, Vlasoff T, Vollenweider P, Voutilainen A, Wade AN, Wagner A, Walton J, Bebakar WMW, Mohamud WNW, Wang MD, Wang N, Wang Q, Wang YX, Wang YW, Wannamethee SG, Wedderkopp N, Wei W, Whincup PH, Widhalm K, Widyahening IS, Wiecek A, Wijga AH, Wilks RJ, Willeit J, Willeit P, Wilsgaard T, Wojtyniak B, Wong-McClure RA, Wong A, Wong TY, Woo J, Woodward M, Wu FC, Wu S, Xu H, Xu L, Yan W, Yang X, Yasuharu T, Ye X, Yeow TP, Yiallouros PK, Yoosefi M, Yoshihara A, You SL, Younger-Coleman NO, Yusoff AF, Zainuddin AA, Zakavi SR, Zali MR, Zamani F, Zambon S, Zampelas A, Zaw KK, Zdrojewski T, Vrkic TZ, Zhang ZY, Zhao W, Zhen S, Zheng Y, Zholdin B, Zhussupov B, Zoghlami N, Cisneros JZ, Gregg EW, Ezzati M. Repositioning of the global epicentre of non-optimal cholesterol. Nature 2020; 582:73-77. [PMID: 32494083 PMCID: PMC7332422 DOI: 10.1038/s41586-020-2338-1] [Citation(s) in RCA: 111] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 04/02/2020] [Indexed: 11/25/2022]
Abstract
High blood cholesterol is typically considered a feature of wealthy western countries1,2. However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world3 and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health4,5. However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol-which is a marker of cardiovascular risk-changed from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million-4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.
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Saidi O, Hajjem S, Zoghlami N, Aounallah-Skhiri H, Ben Mansour N, Hsairi M, Romdhane HB, Critchley JA, Mallouche D, O'Flaherty M, Fakhfakh R. Premature mortality attributable to smoking among Tunisian men in 2009. Tob Induc Dis 2019; 17:77. [PMID: 31768169 PMCID: PMC6843183 DOI: 10.18332/tid/112666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 05/12/2019] [Accepted: 09/28/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Tobacco smoking is a significant public health threat in the world, a risk factor for many diseases, and has been increasing in prevalence in many developing countries. In this study, we aimed to estimate the burden of premature deaths attributable to smoking among Tunisian men aged 35–69 years in 2009. METHODS The number of deaths attributable to smoking was estimated using the population attributable risk fraction method. Smoking prevalence was obtained from a nationally representative survey. Causes of death were obtained from the registry of the National Public Health Institute. Relative risks were taken from the American Cancer Society Prevention Study (CPS-II). RESULTS Total estimated premature deaths attributable to smoking among men in Tunisia were 2601 (95% CI: 2268–2877), accounting for 25% (95% CI: 23.3–26.6) of total male adult mortality. Cancer, cardiovascular and respiratory diseases were the major causes of premature deaths attributable to smoking with 1272 (95% CI: 1188–1329), 966 (95% CI: 779–1133) and 364 (300–415) deaths, respectively. CONCLUSIONS Tobacco smoking is highly relevant and is related to substantial premature mortality in Tunisia, around double that estimated for the region as a whole. This also has not decreased over the past 20 years. Urgent actions are needed to reduce this pandemic.
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Affiliation(s)
- Olfa Saidi
- National Institute of Public Health, Ministry of Health, Tunis, Tunisia.,Research Laboratory of Epidemiology and Prevention of Cardiovascular Diseases, Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia
| | - Said Hajjem
- National Institute of Public Health, Ministry of Health, Tunis, Tunisia
| | - Nada Zoghlami
- National Institute of Public Health, Ministry of Health, Tunis, Tunisia.,Research Laboratory of Epidemiology and Prevention of Cardiovascular Diseases, Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia
| | - Hajer Aounallah-Skhiri
- National Health Institute, Tunis, Tunisia.,Faculty of Medicine of Tunis, University of Tunis El-Manar, Tunis, Tunisia.,The SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Laboratory, National Institute of Nutrition and Food Technology, Tunis, Tunisia
| | - Nadia Ben Mansour
- National Institute of Public Health, Ministry of Health, Tunis, Tunisia.,Research Laboratory of Epidemiology and Prevention of Cardiovascular Diseases, Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia
| | | | - Habiba Ben Romdhane
- Research Laboratory of Epidemiology and Prevention of Cardiovascular Diseases, Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia
| | - Julia A Critchley
- Division of Population Health Sciences and Education, St George's, University of London, London, United Kingdom
| | - Dhafer Mallouche
- National Institute of Statistics and Data Analysis, Tunis, Tunisia
| | - Martin O'Flaherty
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
| | - Radhouane Fakhfakh
- National Institute of Public Health, Ministry of Health, Tunis, Tunisia.,Unit of Research in Tobacco Epidemiology and Control, Tunis, Tunisia
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Yang L, Kelishadi R, Hong YM, Khadilkar A, Nawarycz T, Krzywińska-Wiewiorowska M, Aounallah-Skhiri H, Motlagh ME, Kim HS, Khadilkar V, Krzyżaniak A, Ben Romdhane H, Heshmat R, Chiplonkar S, Stawińska-Witoszyńska B, El Ati J, Qorbani M, Kajale N, Traissac P, Ostrowska-Nawarycz L, Ardalan G, Ekbote V, Zhao M, Heiland EG, Liang Y, Xi B. Impact of the 2017 American Academy of Pediatrics Guideline on Hypertension Prevalence Compared With the Fourth Report in an International Cohort. Hypertension 2019; 74:1343-1348. [PMID: 31630571 DOI: 10.1161/hypertensionaha.119.13807] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
In 2017, the American Academy of Pediatrics (AAP) updated the clinical practice guideline for high blood pressure (BP) in the pediatric population. In this study, we compared the difference in prevalence of elevated and hypertensive BP values defined by the 2017 AAP guideline and the 2004 Fourth Report and estimated the cardiovascular risk associated with the reclassification of BP status defined by the AAP guideline. A total of 47 200 children and adolescents aged 6 to 17 years from 6 countries (China, India, Iran, Korea, Poland, and Tunisia) were included in this study. Elevated BP and hypertension were defined according to 2 guidelines. In addition, 1606 children from China, Iran, and Korea who were reclassified upward by the AAP guideline compared with the Fourth Report and for whom laboratory data were available were 1:1 matched with children from the same countries who were normotensive by both guidelines. Compared with the Fourth Report, the prevalence of elevated BP defined by the AAP guideline was lower (14.9% versus 8.6%), whereas the prevalence of stages 1 and 2 hypertension was higher (stage 1, 6.6% versus 14.5%; stage 2, 0.4% versus 1.7%). Additionally, comparison of laboratory data in the case-control study showed that children who were reclassified upward were more likely to have adverse lipid profiles and high fasting blood glucose compared with normotensive children. In conclusion, the prevalence of elevated BP and hypertension varied significantly between both guidelines. Applying the new AAP guideline could identify more children with hypertension who are at increased cardiovascular risk.
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Affiliation(s)
- Liu Yang
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (L.Y., B.X.)
| | - Roya Kelishadi
- Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.)
| | - Young Mi Hong
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.)
| | - Anuradha Khadilkar
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A.K., V.K., S.C., N.K., V.E.)
| | - Tadeusz Nawarycz
- Department of Biophysics, Medical University of Lodz, Poland (T.N., L.O.-N.)
| | | | - Hajer Aounallah-Skhiri
- National Institute of Public Health, Nutrition Surveillance and Epidemiology in Tunisia Research Laboratory, Tunis, Tunisia (H.A.-S.)
| | | | - Hae Soon Kim
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.)
| | - Vaman Khadilkar
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A.K., V.K., S.C., N.K., V.E.)
| | - Alicja Krzyżaniak
- Department of Epidemiology and Hygiene, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W., A.K., B.S.-W.)
| | - Habiba Ben Romdhane
- Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia (H.B.R.)
| | - Ramin Heshmat
- Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.)
| | - Shashi Chiplonkar
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A.K., V.K., S.C., N.K., V.E.)
| | - Barbara Stawińska-Witoszyńska
- Department of Epidemiology and Hygiene, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W., A.K., B.S.-W.)
| | - Jalila El Ati
- Nutrition Surveillance and Epidemiology Unit, National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.)
| | - Mostafa Qorbani
- Department of Epidemiology, Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran (M.Q.)
| | - Neha Kajale
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A.K., V.K., S.C., N.K., V.E.)
| | - Pierre Traissac
- Institut de Recherche pour le Développement, UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.)
| | | | - Gelayol Ardalan
- Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.)
| | - Veena Ekbote
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A.K., V.K., S.C., N.K., V.E.)
| | - Min Zhao
- Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Emerald G Heiland
- Swedish School of Sport and Health Sciences (GIH), Stockholm, Sweden (E.G.H.)
| | - Yajun Liang
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden (Y.L.)
| | - Bo Xi
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (L.Y., B.X.)
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Affiliation(s)
- Sarah Hawkes
- Centre for Gender and Global Health, Institute for Global Health, University College London, London WC1N 1EH, UK.
| | - Fariha Haseen
- Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Hajer Aounallah-Skhiri
- Faculty of Medicine of Tunis, University of Tunis El-Manar National Health Institute, Tunis, Tunisia
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Hou Y, Bovet P, Kelishadi R, Litwin M, Khadilkar A, Hong YM, Nawarycz T, Stawińska-Witoszyńska B, Aounallah-Skhiri H, Motlagh ME, Kim HS, Khadilkar V, Krzyżaniak A, Ben Romdhane H, Heshmat R, Chiplonkar S, Krzywińska-Wiewiorowska M, Ati JE, Qorbani M, Kajale N, Traissac P, Ostrowska-Nawarycz L, Ardalan G, Parthasarathy L, Yang L, Zhao M, Chiolero A, Xi B. Height-specific blood pressure cutoffs for screening elevated and high blood pressure in children and adolescents: an International Study. Hypertens Res 2018; 42:845-851. [PMID: 30587855 DOI: 10.1038/s41440-018-0178-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 10/11/2018] [Accepted: 11/05/2018] [Indexed: 11/09/2022]
Abstract
Pediatric blood pressure (BP) reference tables are generally based on sex, age, and height and tend to be cumbersome to use in routine clinical practice. In this study, we aimed to develop a new, height-specific simple BP table according to the international child BP reference table based on sex, age and height and to evaluate its performance using international data. We validated the simple table in a derivation cohort that included 58,899 children and adolescents aged 6-17 years from surveys in 7 countries (China, India, Iran, Korea, Poland, Tunisia, and the United States) and in a validation cohort that included 70,072 participants from three other surveys (China, Poland and Seychelles). The BP cutoff values for the simple table were calculated for eight height categories for both the 90th ("elevated BP") and 95th ("high BP") percentiles of BP. The simple table had a high performance to predict high BP compared to the reference table, with high values (boys/girls) of area under the curve (0.94/0.91), sensitivity (88.5%/82.9%), specificity (99.3%/99.7%), positive predictive values (93.9%/97.3%), and negative predictive values (98.5%/97.8%) in the pooled data from 10 studies. The simple table performed similarly well for predicting elevated BP. A simple table based on height only predicts elevated BP and high BP in children and adolescents nearly as well as the international table based on sex, age, and height. This has important implications for simplifying the detection of pediatric high BP in clinical practice.
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Affiliation(s)
- Yaping Hou
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, China
| | - Pascal Bovet
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Roya Kelishadi
- Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mieczysław Litwin
- Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland
| | - Anuradha Khadilkar
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Young Mi Hong
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Tadeusz Nawarycz
- Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland
| | | | - Hajer Aounallah-Skhiri
- National Institute of Public Health (INSP), Nutrition Surveillance and Epidemiology in Tunisia (SURVEN) Research Laboratory, 1002, Tunis, Tunisia
| | | | - Hae Soon Kim
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Vaman Khadilkar
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Alicja Krzyżaniak
- Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Habiba Ben Romdhane
- Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia
| | - Ramin Heshmat
- Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shashi Chiplonkar
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | | | - Jalila El Ati
- Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia
| | - Mostafa Qorbani
- Department of Epidemiology, Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Neha Kajale
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Pierre Traissac
- Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France
| | - Lidia Ostrowska-Nawarycz
- Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland
| | - Gelayol Ardalan
- Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Lavanya Parthasarathy
- Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Liu Yang
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, China
| | - Min Zhao
- Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China
| | - Arnaud Chiolero
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of Epidemiology, McGill University, Montreal, Canada
| | - Bo Xi
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, China.
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Zhou B, Bentham J, Di Cesare M, Bixby H, Danaei G, Hajifathalian K, Taddei C, Carrillo-Larco RM, Djalalinia S, Khatibzadeh S, Lugero C, Peykari N, Zhang WZ, Bennett J, Bilano V, Stevens GA, Cowan MJ, Riley LM, Chen Z, Hambleton IR, Jackson RT, Kengne AP, Khang YH, Laxmaiah A, Liu J, Malekzadeh R, Neuhauser HK, Sorić M, Starc G, Sundström J, Woodward M, Ezzati M, Abarca-Gómez L, Abdeen ZA, Abu-Rmeileh NM, Acosta-Cazares B, Adams RJ, Aekplakorn W, Afsana K, Aguilar-Salinas CA, Agyemang C, Ahmad NA, Ahmadvand A, Ahrens W, Ajlouni K, Akhtaeva N, Al-Raddadi R, Ali MM, Ali O, Alkerwi A, Aly E, Amarapurkar DN, Amouyel P, Amuzu A, Andersen LB, Anderssen SA, Ängquist LH, Anjana RM, Ansong D, Aounallah-Skhiri H, Araújo J, Ariansen I, Aris T, Arlappa N, Arveiler D, Aryal KK, Aspelund T, Assah FK, Assunção MCF, Avdicová M, Azevedo A, Azizi F, Babu BV, Bahijri S, Balakrishna N, Bamoshmoosh M, Banach M, Bandosz P, Banegas JR, Barbagallo CM, Barceló A, Barkat A, Barros AJD, Barros MV, Bata I, Batieha AM, Batyrbek A, Baur LA, Beaglehole R, Romdhane HB, Benet M, Benson LS, Bernabe-Ortiz A, Bernotiene G, Bettiol H, Bhagyalaxmi A, Bharadwaj S, Bhargava SK, Bi Y, Bikbov M, Bista B, Bjerregaard P, Bjertness E, Bjertness MB, Björkelund C, Blokstra A, Bo S, Bobak M, Boeing H, Boggia JG, Boissonnet CP, Bongard V, Borchini R, Bovet P, Braeckman L, Brajkovich I, Branca F, Breckenkamp J, Brenner H, Brewster LM, Bruno G, Bueno-de-Mesquita HB, Bugge A, Burns C, Bursztyn M, de León AC, Cacciottolo J, Cai H, Cameron C, Can G, Cândido APC, Capuano V, Cardoso VC, Carlsson AC, Carvalho MJ, Casanueva FF, Casas JP, Caserta CA, Chamukuttan S, Chan AW, Chan Q, Chaturvedi HK, Chaturvedi N, Chen CJ, Chen F, Chen H, Chen S, Chen Z, Cheng CY, Dekkaki IC, Chetrit A, Chiolero A, Chiou ST, Chirita-Emandi A, Chirlaque MD, Cho B, Cho Y, Christofaro DG, Chudek J, Cifkova R, Cinteza E, Claessens F, Clays E, Concin H, Cooper C, Cooper R, Coppinger TC, Costanzo S, Cottel D, Cowell C, Craig CL, Crujeiras AB, Cruz JJ, D'Arrigo G, d'Orsi E, Dallongeville J, Damasceno A, Danaei G, Dankner R, Dantoft TM, Dauchet L, Davletov K, De Backer G, De Bacquer D, de Gaetano G, De Henauw S, de Oliveira PD, De Smedt D, Deepa M, Dehghan A, Delisle H, Deschamps V, Dhana K, Di Castelnuovo AF, Dias-da-Costa JS, Diaz A, Dickerson TT, Djalalinia S, Do HTP, Donfrancesco C, Donoso SP, Döring A, Dorobantu M, Doua K, Drygas W, Dulskiene V, Džakula A, Dzerve V, Dziankowska-Zaborszczyk E, Eggertsen R, Ekelund U, El Ati J, Elliott P, Elosua R, Erasmus RT, Erem C, Eriksen L, Eriksson JG, Escobedo-de la Peña J, Evans A, Faeh D, Fall CH, Farzadfar F, Felix-Redondo FJ, Ferguson TS, Fernandes RA, Fernández-Bergés D, Ferrante D, Ferrari M, Ferreccio C, Ferrieres J, Finn JD, Fischer K, Föger B, Foo LH, Forslund AS, Forsner M, Fouad HM, Francis DK, do Carmo Franco M, Franco OH, Frontera G, Fuchs FD, Fuchs SC, Fujita Y, Furusawa T, Gaciong Z, Galvano F, Garcia-de-la-Hera M, Gareta D, Garnett SP, Gaspoz JM, Gasull M, Gates L, Geleijnse JM, Ghasemian A, Ghimire A, Giampaoli S, Gianfagna F, Gill TK, Giovannelli J, Goldsmith RA, Gonçalves H, Gonzalez-Gross M, González-Rivas JP, Gorbea MB, Gottrand F, Graff-Iversen S, Grafnetter D, Grajda A, Grammatikopoulou MG, Gregor RD, Grodzicki T, Grøntved A, Grosso G, Gruden G, Grujic V, Gu D, Guan OP, Gudmundsson EF, Gudnason V, Guerrero R, Guessous I, Guimaraes AL, Gulliford MC, Gunnlaugsdottir J, Gunter M, Gupta PC, Gupta R, Gureje O, Gurzkowska B, Gutierrez L, Gutzwiller F, Hadaegh F, Halkjær J, Hambleton IR, Hardy R, Hari Kumar R, Hata J, Hayes AJ, He J, He Y, Elisabeth M, Henriques A, Cadena LH, Herrala S, Heshmat R, Hihtaniemi IT, Ho SY, Ho SC, Hobbs M, Hofman A, Dinc GH, Horimoto ARVR, Hormiga CM, Horta BL, Houti L, Howitt C, Htay TT, Htet AS, Than Htike MM, Hu Y, Huerta JM, Huisman M, Husseini AS, Huybrechts I, Hwalla N, Iacoviello L, Iannone AG, Ibrahim MM, Wong NI, Ikeda N, Ikram MA, Irazola VE, Islam M, al-Safi Ismail A, Ivkovic V, Iwasaki M, Jackson RT, Jacobs JM, Jaddou H, Jafar T, Jamrozik K, Janszky I, Jasienska G, Jelaković A, Jelaković B, Jennings G, Jeong SL, Jiang CQ, Joffres M, Johansson M, Jokelainen JJ, Jonas JB, Jørgensen T, Joshi P, Jóźwiak J, Juolevi A, Jurak G, Jureša V, Kaaks R, Kafatos A, Kajantie EO, Kalter-Leibovici O, Kamaruddin NA, Karki KB, Kasaeian A, Katz J, Kauhanen J, Kaur P, Kavousi M, Kazakbaeva G, Keil U, Boker LK, Keinänen-Kiukaanniemi S, Kelishadi R, Kemper HCG, Kengne AP, Kerimkulova A, Kersting M, Key T, Khader YS, Khalili D, Khang YH, Khateeb M, Khaw KT, Kiechl-Kohlendorfer U, Kiechl S, Killewo J, Kim J, Kim YY, Klumbiene J, Knoflach M, Kolle E, Kolsteren P, Korrovits P, Koskinen S, Kouda K, Kowlessur S, Koziel S, Kriemler S, Kristensen PL, Krokstad S, Kromhout D, Kruger HS, Kubinova R, Kuciene R, Kuh D, Kujala UM, Kulaga Z, Krishna Kumar R, Kurjata P, Kusuma YS, Kuulasmaa K, Kyobutungi C, Laatikainen T, Lachat C, Lam TH, Landrove O, Lanska V, Lappas G, Larijani B, Laugsand LE, Laxmaiah A, Le Nguyen Bao K, Le TD, Leclercq C, Lee J, Lee J, Lehtimäki T, León-Muñoz LM, Levitt NS, Li Y, Lilly CL, Lim WY, Lima-Costa MF, Lin HH, Lin X, Lind L, Linneberg A, Lissner L, Litwin M, Liu J, Lorbeer R, Lotufo PA, Lozano JE, Luksiene D, Lundqvist A, Lunet N, Lytsy P, Ma G, Ma J, Machado-Coelho GLL, Machi S, Maggi S, Magliano DJ, Magriplis E, Majer M, Makdisse M, Malekzadeh R, Malhotra R, Mallikharjuna Rao K, Malyutina S, Manios Y, Mann JI, Manzato E, Margozzini P, Marques-Vidal P, Marques LP, Marrugat J, Martorell R, Mathiesen EB, Matijasevich A, Matsha TE, Mbanya JCN, Mc Donald Posso AJ, McFarlane SR, McGarvey ST, McLachlan S, McLean RM, McLean SB, McNulty BA, Mediene-Benchekor S, Medzioniene J, Meirhaeghe A, Meisinger C, Menezes AMB, Menon GR, Meshram II, Metspalu A, Meyer HE, Mi J, Mikkel K, Miller JC, Minderico CS, Francisco J, Miranda JJ, Mirrakhimov E, Mišigoj-Durakovic M, Modesti PA, Mohamed MK, Mohammad K, Mohammadifard N, Mohan V, Mohanna S, Mohd Yusoff MF, Møllehave LT, Møller NC, Molnár D, Momenan A, Mondo CK, Monyeki KDK, Moon JS, Moreira LB, Morejon A, Moreno LA, Morgan K, Moschonis G, Mossakowska M, Mostafa A, Mota J, Esmaeel Motlagh M, Motta J, Msyamboza KP, Mu TT, Muiesan ML, Müller-Nurasyid M, Murphy N, Mursu J, Musil V, Nabipour I, Nagel G, Naidu BM, Nakamura H, Námešná J, Nang EEK, Nangia VB, Narake S, Nauck M, Navarrete-Muñoz EM, Ndiaye NC, Neal WA, Nenko I, Neovius M, Nervi F, Neuhauser HK, Nguyen CT, Nguyen ND, Nguyen QN, Nguyen QV, Nieto-Martínez RE, Niiranen TJ, Ning G, Ninomiya T, Nishtar S, Noale M, Noboa OA, Noorbala AA, Norat T, Noto D, Al Nsour M, O'Reilly D, Oda E, Oehlers G, Oh K, Ohara K, Olinto MTA, Oliveira IO, Omar MA, Onat A, Ong SK, Ono LM, Ordunez P, Ornelas R, Osmond C, Ostojic SM, Ostovar A, Otero JA, Overvad K, Owusu-Dabo E, Paccaud FM, Padez C, Pahomova E, Pajak A, Palli D, Palmieri L, Pan WH, Panda-Jonas S, Panza F, Papandreou D, Park SW, Parnell WR, Parsaeian M, Patel ND, Pecin I, Pednekar MS, Peer N, Peeters PH, Peixoto SV, Peltonen M, Pereira AC, Peters A, Petersmann A, Petkeviciene J, Peykari N, Pham ST, Pigeot I, Pikhart H, Pilav A, Pilotto L, Pitakaka F, Piwonska A, Plans-Rubió P, Polašek O, Porta M, Portegies MLP, Pourshams A, Poustchi H, Pradeepa R, Prashant M, Price JF, Puder JJ, Puiu M, Punab M, Qasrawi RF, Qorbani M, Bao TQ, Radic I, Radisauskas R, Rahman M, Raitakari O, Raj M, Ramachandra Rao S, Ramachandran A, Ramos E, Rampal L, Rampal S, Rangel Reina DA, Redon J, Reganit PFM, Ribeiro R, Riboli E, Rigo F, Rinke de Wit TF, Ritti-Dias RM, Robinson SM, Robitaille C, Rodríguez-Artalejo F, del Cristo Rodriguez-Perez M, Rodríguez-Villamizar LA, Rojas-Martinez R, Romaguera D, Ronkainen K, Rosengren A, Roy JGR, Rubinstein A, Sandra Ruiz-Betancourt B, Rutkowski M, Sabanayagam C, Sachdev HS, Saidi O, Sakarya S, Salanave B, Salazar Martinez E, Salmerón D, Salomaa V, Salonen JT, Salvetti M, Sánchez-Abanto J, Sans S, Santos DA, Santos IS, Nunes dos Santos R, Santos R, Saramies JL, Sardinha LB, Sarganas G, Sarrafzadegan N, Saum KU, Savva S, Scazufca M, Schargrodsky H, Schipf S, Schmidt CO, Schöttker B, Schultsz C, Schutte AE, Sein AA, Sen A, Senbanjo IO, Sepanlou SG, Sharma SK, Shaw JE, Shibuya K, Shin DW, Shin Y, Si-Ramlee K, Siantar R, Sibai AM, Santos Silva DA, Simon M, Simons J, Simons LA, Sjöström M, Skovbjerg S, Slowikowska-Hilczer J, Slusarczyk P, Smeeth L, Smith MC, Snijder MB, So HK, Sobngwi E, Söderberg S, Solfrizzi V, Sonestedt E, Song Y, Sørensen TIA, Soric M, Jérome CS, Soumare A, Staessen JA, Starc G, Stathopoulou MG, Stavreski B, Steene-Johannessen J, Stehle P, Stein AD, Stergiou GS, Stessman J, Stieber J, Stöckl D, Stocks T, Stokwiszewski J, Stronks K, Strufaldi MW, Sun CA, Sundström J, Sung YT, Suriyawongpaisal P, Sy RG, Shyong Tai E, Tammesoo ML, Tamosiunas A, Tan EJ, Tang X, Tanser F, Tao Y, Tarawneh MR, Tarqui-Mamani CB, Tautu OF, Taylor A, Theobald H, Theodoridis X, Thijs L, Thuesen BH, Tjonneland A, Tolonen HK, Tolstrup JS, Topbas M, Topór-Madry R, Tormo MJ, Torrent M, Traissac P, Trichopoulos D, Trichopoulou A, Trinh OTH, Trivedi A, Tshepo L, Tulloch-Reid MK, Tullu F, Tuomainen TP, Tuomilehto J, Turley ML, Tynelius P, Tzourio C, Ueda P, Ugel EE, Ulmer H, Uusitalo HMT, Valdivia G, Valvi D, van der Schouw YT, Van Herck K, Van Minh H, van Rossem L, Van Schoor NM, van Valkengoed IGM, Vanderschueren D, Vanuzzo D, Vatten L, Vega T, Velasquez-Melendez G, Veronesi G, Monique Verschuren WM, Verstraeten R, Victora CG, Viet L, Viikari-Juntura E, Vineis P, Vioque J, Virtanen JK, Visvikis-Siest S, Viswanathan B, Vlasoff T, Vollenweider P, Voutilainen S, Wade AN, Wagner A, Walton J, Wan Bebakar WM, Wan Mohamud WN, Wanderley RS, Wang MD, Wang Q, Wang YX, Wang YW, Wannamethee SG, Wareham N, Wedderkopp N, Weerasekera D, Whincup PH, Widhalm K, Widyahening IS, Wiecek A, Wijga AH, Wilks RJ, Willeit J, Willeit P, Williams EA, Wilsgaard T, Wojtyniak B, Wong-McClure RA, Wong JYY, Wong TY, Woo J, Woodward M, Giwercman Wu A, Wu FC, Wu S, Xu H, Yan W, Yang X, Ye X, Yiallouros PK, Yoshihara A, Younger-Coleman NO, Yusoff AF, Zainuddin AA, Zambon S, Zampelas A, Zdrojewski T, Zeng Y, Zhao D, Zhao W, Zheng W, Zheng Y, Zhu D, Zhussupov B, Zimmermann E, Cisneros JZ. Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: a pooled analysis of 1018 population-based measurement studies with 88.6 million participants. Int J Epidemiol 2018; 47:872-883i. [PMID: 29579276 PMCID: PMC6005056 DOI: 10.1093/ije/dyy016] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/16/2018] [Accepted: 01/24/2018] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. METHODS We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20-29 years to 70-79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probit-transformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. RESULTS In 2005-16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the high-income Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. CONCLUSIONS Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups.
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Abarca-Gómez L, Abdeen ZA, Hamid ZA, Abu-Rmeileh NM, Acosta-Cazares B, Acuin C, Adams RJ, Aekplakorn W, Afsana K, Aguilar-Salinas CA, Agyemang C, Ahmadvand A, Ahrens W, Ajlouni K, Akhtaeva N, Al-Hazzaa HM, Al-Othman AR, Al-Raddadi R, Al Buhairan F, Al Dhukair S, Ali MM, Ali O, Alkerwi A, Alvarez-Pedrerol M, Aly E, Amarapurkar DN, Amouyel P, Amuzu A, Andersen LB, Anderssen SA, Andrade DS, Ängquist LH, Anjana RM, Aounallah-Skhiri H, Araújo J, Ariansen I, Aris T, Arlappa N, Arveiler D, Aryal KK, Aspelund T, Assah FK, Assunção MCF, Aung MS, Avdicová M, Azevedo A, Azizi F, Babu BV, Bahijri S, Baker JL, Balakrishna N, Bamoshmoosh M, Banach M, Bandosz P, Banegas JR, Barbagallo CM, Barceló A, Barkat A, Barros AJD, Barros MVG, Bata I, Batieha AM, Batista RL, Batyrbek A, Baur LA, Beaglehole R, Romdhane HB, Benedics J, Benet M, Bennett JE, Bernabe-Ortiz A, Bernotiene G, Bettiol H, Bhagyalaxmi A, Bharadwaj S, Bhargava SK, Bhatti Z, Bhutta ZA, Bi H, Bi Y, Biehl A, Bikbov M, Bista B, Bjelica DJ, Bjerregaard P, Bjertness E, Bjertness MB, Björkelund C, Blokstra A, Bo S, Bobak M, Boddy LM, Boehm BO, Boeing H, Boggia JG, Boissonnet CP, Bonaccio M, Bongard V, Bovet P, Braeckevelt L, Braeckman L, Bragt MCE, Brajkovich I, Branca F, Breckenkamp J, Breda J, Brenner H, Brewster LM, Brian GR, Brinduse L, Bruno G, Bueno-de-Mesquita HB, Bugge A, Buoncristiano M, Burazeri G, Burns C, de León AC, Cacciottolo J, Cai H, Cama T, Cameron C, Camolas J, Can G, Cândido APC, Capanzana M, Capuano V, Cardoso VC, Carlsson AC, Carvalho MJ, Casanueva FF, Casas JP, Caserta CA, Chamukuttan S, Chan AW, Chan Q, Chaturvedi HK, Chaturvedi N, Chen CJ, Chen F, Chen H, Chen S, Chen Z, Cheng CY, Chetrit A, Chikova-Iscener E, Chiolero A, Chiou ST, Chirita-Emandi A, Chirlaque MD, Cho B, Cho Y, Christensen K, Christofaro DG, Chudek J, Cifkova R, Cinteza E, Claessens F, Clays E, Concin H, Confortin SC, Cooper C, Cooper R, Coppinger TC, Costanzo S, Cottel D, Cowell C, Craig CL, Crujeiras AB, Cucu A, D'Arrigo G, d'Orsi E, Dallongeville J, Damasceno A, Damsgaard CT, Danaei G, Dankner R, Dantoft TM, Dastgiri S, Dauchet L, Davletov K, De Backer G, De Bacquer D, De Curtis A, de Gaetano G, De Henauw S, de Oliveira PD, De Ridder K, De Smedt D, Deepa M, Deev AD, Dehghan A, Delisle H, Delpeuch F, Deschamps V, Dhana K, Di Castelnuovo AF, Dias-da-Costa JS, Diaz A, Dika Z, Djalalinia S, Do HTP, Dobson AJ, Donati MB, Donfrancesco C, Donoso SP, Döring A, Dorobantu M, Dorosty AR, Doua K, Drygas W, Duan JL, Duante C, Duleva V, Dulskiene V, Dzerve V, Dziankowska-Zaborszczyk E, Egbagbe EE, Eggertsen R, Eiben G, Ekelund U, El Ati J, Elliott P, Engle-Stone R, Erasmus RT, Erem C, Eriksen L, Eriksson JG, la Peña JED, Evans A, Faeh D, Fall CH, Sant'Angelo VF, Farzadfar F, Felix-Redondo FJ, Ferguson TS, Fernandes RA, Fernández-Bergés D, Ferrante D, Ferrari M, Ferreccio C, Ferrieres J, Finn JD, Fischer K, Flores EM, Föger B, Foo LH, Forslund AS, Forsner M, Fouad HM, Francis DK, Franco MDC, Franco OH, Frontera G, Fuchs FD, Fuchs SC, Fujita Y, Furusawa T, Gaciong Z, Gafencu M, Galeone D, Galvano F, Garcia-de-la-Hera M, Gareta D, Garnett SP, Gaspoz JM, Gasull M, Gates L, Geiger H, Geleijnse JM, Ghasemian A, Giampaoli S, Gianfagna F, Gill TK, Giovannelli J, Giwercman A, Godos J, Gogen S, Goldsmith RA, Goltzman D, Gonçalves H, González-Leon M, González-Rivas JP, Gonzalez-Gross M, Gottrand F, Graça AP, Graff-Iversen S, Grafnetter D, Grajda A, Grammatikopoulou MG, Gregor RD, Grodzicki T, Grøntved A, Grosso G, Gruden G, Grujic V, Gu D, Gualdi-Russo E, Guallar-Castillón P, Guan OP, Gudmundsson EF, Gudnason V, Guerrero R, Guessous I, Guimaraes AL, Gulliford MC, Gunnlaugsdottir J, Gunter M, Guo X, Guo Y, Gupta PC, Gupta R, Gureje O, Gurzkowska B, Gutierrez L, Gutzwiller F, Hadaegh F, Hadjigeorgiou CA, Si-Ramlee K, Halkjær J, Hambleton IR, Hardy R, Kumar RH, Hassapidou M, Hata J, Hayes AJ, He J, Heidinger-Felso R, Heinen M, Hendriks ME, Henriques A, Cadena LH, Herrala S, Herrera VM, Herter-Aeberli I, Heshmat R, Hihtaniemi IT, Ho SY, Ho SC, Hobbs M, Hofman A, Hopman WM, Horimoto ARVR, Hormiga CM, Horta BL, Houti L, Howitt C, Htay TT, Htet AS, Htike MMT, Hu Y, Huerta JM, Petrescu CH, Huisman M, Husseini A, Huu CN, Huybrechts I, Hwalla N, Hyska J, Iacoviello L, Iannone AG, Ibarluzea JM, Ibrahim MM, Ikeda N, Ikram MA, Irazola VE, Islam M, Ismail AAS, Ivkovic V, Iwasaki M, Jackson RT, Jacobs JM, Jaddou H, Jafar T, Jamil KM, Jamrozik K, Janszky I, Jarani J, Jasienska G, Jelakovic A, Jelakovic B, Jennings G, Jeong SL, Jiang CQ, Jiménez-Acosta SM, Joffres M, Johansson M, Jonas JB, Jørgensen T, Joshi P, Jovic DP, Józwiak J, Juolevi A, Jurak G, Jureša V, Kaaks R, Kafatos A, Kajantie EO, Kalter-Leibovici O, Kamaruddin NA, Kapantais E, Karki KB, Kasaeian A, Katz J, Kauhanen J, Kaur P, Kavousi M, Kazakbaeva G, Keil U, Boker LK, Keinänen-Kiukaanniemi S, Kelishadi R, Kelleher C, Kemper HCG, Kengne AP, Kerimkulova A, Kersting M, Key T, Khader YS, Khalili D, Khang YH, Khateeb M, Khaw KT, Khouw IMSL, Kiechl-Kohlendorfer U, Kiechl S, Killewo J, Kim J, Kim YY, Klimont J, Klumbiene J, Knoflach M, Koirala B, Kolle E, Kolsteren P, Korrovits P, Kos J, Koskinen S, Kouda K, Kovacs VA, Kowlessur S, Koziel S, Kratzer W, Kriemler S, Kristensen PL, Krokstad S, Kromhout D, Kruger HS, Kubinova R, Kuciene R, Kuh D, Kujala UM, Kulaga Z, Kumar RK, Kunešová M, Kurjata P, Kusuma YS, Kuulasmaa K, Kyobutungi C, La QN, Laamiri FZ, Laatikainen T, Lachat C, Laid Y, Lam TH, Landrove O, Lanska V, Lappas G, Larijani B, Laugsand LE, Lauria L, Laxmaiah A, Bao KLN, Le TD, Lebanan MAO, Leclercq C, Lee J, Lee J, Lehtimäki T, León-Muñoz LM, Levitt NS, Li Y, Lilly CL, Lim WY, Lima-Costa MF, Lin HH, Lin X, Lind L, Linneberg A, Lissner L, Litwin M, Liu J, Loit HM, Lopes L, Lorbeer R, Lotufo PA, Lozano JE, Luksiene D, Lundqvist A, Lunet N, Lytsy P, Ma G, Ma J, Machado-Coelho GLL, Machado-Rodrigues AM, Machi S, Maggi S, Magliano DJ, Magriplis E, Mahaletchumy A, Maire B, Majer M, Makdisse M, Malekzadeh R, Malhotra R, Rao KM, Malyutina S, Manios Y, Mann JI, Manzato E, Margozzini P, Markaki A, Markey O, Marques LP, Marques-Vidal P, Marrugat J, Martin-Prevel Y, Martin R, Martorell R, Martos E, Marventano S, Masoodi SR, Mathiesen EB, Matijasevich A, Matsha TE, Mazur A, Mbanya JCN, McFarlane SR, McGarvey ST, McKee M, McLachlan S, McLean RM, McLean SB, McNulty BA, Yusof SM, Mediene-Benchekor S, Medzioniene J, Meirhaeghe A, Meisfjord J, Meisinger C, Menezes AMB, Menon GR, Mensink GBM, Meshram II, Metspalu A, Meyer HE, Mi J, Michaelsen KF, Michels N, Mikkel K, Miller JC, Minderico CS, Miquel JF, Miranda JJ, Mirkopoulou D, Mirrakhimov E, Mišigoj-Durakovic M, Mistretta A, Mocanu V, Modesti PA, Mohamed MK, Mohammad K, Mohammadifard N, Mohan V, Mohanna S, Yusoff MFM, Molbo D, Møllehave LT, Møller NC, Molnár D, Momenan A, Mondo CK, Monterrubio EA, Monyeki KDK, Moon JS, Moreira LB, Morejon A, Moreno LA, Morgan K, Mortensen EL, Moschonis G, Mossakowska M, Mostafa A, Mota J, Mota-Pinto A, Motlagh ME, Motta J, Mu TT, Muc M, Muiesan ML, Müller-Nurasyid M, Murphy N, Mursu J, Murtagh EM, Musil V, Nabipour I, Nagel G, Naidu BM, Nakamura H, Námešná J, Nang EEK, Nangia VB, Nankap M, Narake S, Nardone P, Navarrete-Muñoz EM, Neal WA, Nenko I, Neovius M, Nervi F, Nguyen CT, Nguyen ND, Nguyen QN, Nieto-Martínez RE, Ning G, Ninomiya T, Nishtar S, Noale M, Noboa OA, Norat T, Norie S, Noto D, Nsour MA, O'Reilly D, Obreja G, Oda E, Oehlers G, Oh K, Ohara K, Olafsson Ö, Olinto MTA, Oliveira IO, Oltarzewski M, Omar MA, Onat A, Ong SK, Ono LM, Ordunez P, Ornelas R, Ortiz AP, Osler M, Osmond C, Ostojic SM, Ostovar A, Otero JA, Overvad K, Owusu-Dabo E, Paccaud FM, Padez C, Pahomova E, Pajak A, Palli D, Palloni A, Palmieri L, Pan WH, Panda-Jonas S, Pandey A, Panza F, Papandreou D, Park SW, Parnell WR, Parsaeian M, Pascanu IM, Patel ND, Pecin I, Pednekar MS, Peer N, Peeters PH, Peixoto SV, Peltonen M, Pereira AC, Perez-Farinos N, Pérez CM, Peters A, Petkeviciene J, Petrauskiene A, Peykari N, Pham ST, Pierannunzio D, Pigeot I, Pikhart H, Pilav A, Pilotto L, Pistelli F, Pitakaka F, Piwonska A, Plans-Rubió P, Poh BK, Pohlabeln H, Pop RM, Popovic SR, Porta M, Portegies MLP, Posch G, Poulimeneas D, Pouraram H, Pourshams A, Poustchi H, Pradeepa R, Prashant M, Price JF, Puder JJ, Pudule I, Puiu M, Punab M, Qasrawi RF, Qorbani M, Bao TQ, Radic I, Radisauskas R, Rahman M, Rahman M, Raitakari O, Raj M, Rao SR, Ramachandran A, Ramke J, Ramos E, Ramos R, Rampal L, Rampal S, Rascon-Pacheco RA, Redon J, Reganit PFM, Ribas-Barba L, Ribeiro R, Riboli E, Rigo F, de Wit TFR, Rito A, Ritti-Dias RM, Rivera JA, Robinson SM, Robitaille C, Rodrigues D, Rodríguez-Artalejo F, del Cristo Rodriguez-Perez M, Rodríguez-Villamizar LA, Rojas-Martinez R, Rojroongwasinkul N, Romaguera D, Ronkainen K, Rosengren A, Rouse I, Roy JGR, Rubinstein A, Rühli FJ, Ruiz-Betancourt BS, Russo P, Rutkowski M, Sabanayagam C, Sachdev HS, Saidi O, Salanave B, Martinez ES, Salmerón D, Salomaa V, Salonen JT, Salvetti M, Sánchez-Abanto J, Sandjaja, Sans S, Marina LS, Santos DA, Santos IS, Santos O, dos Santos RN, Santos R, Saramies JL, Sardinha LB, Sarrafzadegan N, Saum KU, Savva S, Savy M, Scazufca M, Rosario AS, Schargrodsky H, Schienkiewitz A, Schipf S, Schmidt CO, Schmidt IM, Schultsz C, Schutte AE, Sein AA, Sen A, Senbanjo IO, Sepanlou SG, Serra-Majem L, Shalnova SA, Sharma SK, Shaw JE, Shibuya K, Shin DW, Shin Y, Shiri R, Siani A, Siantar R, Sibai AM, Silva AM, Silva DAS, Simon M, Simons J, Simons LA, Sjöberg A, Sjöström M, Skovbjerg S, Slowikowska-Hilczer J, Slusarczyk P, Smeeth L, Smith MC, Snijder MB, So HK, Sobngwi E, Söderberg S, Soekatri MYE, Solfrizzi V, Sonestedt E, Song Y, Sørensen TIA, Soric M, Jérome CS, Soumare A, Spinelli A, Spiroski I, Staessen JA, Stamm H, Starc G, Stathopoulou MG, Staub K, Stavreski B, Steene-Johannessen J, Stehle P, Stein AD, Stergiou GS, Stessman J, Stieber J, Stöckl D, Stocks T, Stokwiszewski J, Stratton G, Stronks K, Strufaldi MW, Suárez-Medina R, Sun CA, Sundström J, Sung YT, Sunyer J, Suriyawongpaisal P, Swinburn BA, Sy RG, Szponar L, Tai ES, Tammesoo ML, Tamosiunas A, Tan EJ, Tang X, Tanser F, Tao Y, Tarawneh MR, Tarp J, Tarqui-Mamani CB, Tautu OF, Braunerová RT, Taylor A, Tchibindat F, Theobald H, Theodoridis X, Thijs L, Thuesen BH, Tjonneland A, Tolonen HK, Tolstrup JS, Topbas M, Topór-Madry R, Tormo MJ, Tornaritis MJ, Torrent M, Toselli S, Traissac P, Trichopoulos D, Trichopoulou A, Trinh OTH, Trivedi A, Tshepo L, Tsigga M, Tsugane S, Tulloch-Reid MK, Tullu F, Tuomainen TP, Tuomilehto J, Turley ML, Tynelius P, Tzotzas T, Tzourio C, Ueda P, Ugel EE, Ukoli FAM, Ulmer H, Unal B, Uusitalo HMT, Valdivia G, Vale S, Valvi D, van der Schouw YT, Van Herck K, Van Minh H, van Rossem L, Van Schoor NM, van Valkengoed IGM, Vanderschueren D, Vanuzzo D, Vatten L, Vega T, Veidebaum T, Velasquez-Melendez G, Velika B, Veronesi G, Verschuren WMM, Victora CG, Viegi G, Viet L, Viikari-Juntura E, Vineis P, Vioque J, Virtanen JK, Visvikis-Siest S, Viswanathan B, Vlasoff T, Vollenweider P, Völzke H, Voutilainen S, Vrijheid M, Wade AN, Wagner A, Waldhör T, Walton J, Bebakar WMW, Mohamud WNW, Wanderley RS, Wang MD, Wang Q, Wang YX, Wang YW, Wannamethee SG, Wareham N, Weber A, Wedderkopp N, Weerasekera D, Whincup PH, Widhalm K, Widyahening IS, Wiecek A, Wijga AH, Wilks RJ, Willeit J, Willeit P, Wilsgaard T, Wojtyniak B, Wong-McClure RA, Wong JYY, Wong JE, Wong TY, Woo J, Woodward M, Wu FC, Wu J, Wu S, Xu H, Xu L, Yamborisut U, Yan W, Yang X, Yardim N, Ye X, Yiallouros PK, Yngve A, Yoshihara A, You QS, Younger-Coleman NO, Yusoff F, Yusoff MFM, Zaccagni L, Zafiropulos V, Zainuddin AA, Zambon S, Zampelas A, Zamrazilová H, Zdrojewski T, Zeng Y, Zhao D, Zhao W, Zheng W, Zheng Y, Zholdin B, Zhou M, Zhu D, Zhussupov B, Zimmermann E, Cisneros JZ, Bentham J, Di Cesare M, Bilano V, Bixby H, Zhou B, Stevens GA, Riley LM, Taddei C, Hajifathalian K, Lu Y, Savin S, Cowan MJ, Paciorek CJ, Chirita-Emandi A, Hayes AJ, Katz J, Kelishadi R, Kengne AP, Khang YH, Laxmaiah A, Li Y, Ma J, Miranda JJ, Mostafa A, Neovius M, Padez C, Rampal L, Zhu A, Bennett JE, Danaei G, Bhutta ZA, Ezzati M. 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. Lancet 2017; 390:2627-2642. [PMID: 29029897 PMCID: PMC5735219 DOI: 10.1016/s0140-6736(17)32129-3] [Citation(s) in RCA: 3623] [Impact Index Per Article: 517.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/12/2017] [Accepted: 07/19/2017] [Indexed: 02/07/2023]
Abstract
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/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. 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. FUNDING Wellcome Trust, AstraZeneca Young Health Programme.
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Kengne AP, Bentham J, Zhou B, Peer N, Matsha TE, Bixby H, Di Cesare M, Hajifathalian K, Lu Y, Taddei C, Bovet P, Kyobutungi C, Agyemang C, Aounallah-Skhiri H, Assah FK, Barkat A, Romdhane HB, Chan Q, Chaturvedi N, Damasceno A, Delisle H, Delpeuch F, Doua K, Egbagbe EE, Ati JE, Elliott P, Engle-Stone R, Erasmus RT, Fouad HM, Gareta D, Gureje O, Hendriks ME, Houti L, Ibrahim MM, Kemper HCG, Killewo J, Kowlessur S, Kruger HS, Laamiri FZ, Laid Y, Levitt NS, Lunet N, Magliano DJ, Maire B, Martin-Prevel Y, Mediene-Benchekor S, Mohamed MK, Mondo CK, Monyeki KD, Mostafa A, Nankap M, Owusu-Dabo E, Rinke de Wit TF, Saidi O, Schultsz C, Schutte AE, Senbanjo IO, Shaw JE, Smeeth L, Sobngwi E, Jérome CS, Stronks K, Tanser F, Tchibindat F, Traissac P, Tshepo L, Tullu F, Ukoli FAM, Viswanathan B, Wade AN, Danaei G, Stevens GA, Riley LM, Ezzati M, Mbanya JCN. Trends in obesity and diabetes across Africa from 1980 to 2014: an analysis of pooled population-based studies. Int J Epidemiol 2017; 46:1421-1432. [PMID: 28582528 PMCID: PMC5837192 DOI: 10.1093/ije/dyx078] [Citation(s) in RCA: 155] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/09/2017] [Accepted: 04/18/2017] [Indexed: 12/12/2022] Open
Abstract
Background The 2016 Dar Es Salaam Call to Action on Diabetes and Other non-communicable diseases (NCDs) advocates national multi-sectoral NCD strategies and action plans based on available data and information from countries of sub-Saharan Africa and beyond. We estimated trends from 1980 to 2014 in age-standardized mean body mass index (BMI) and diabetes prevalence in these countries, in order to assess the co-progression and assist policy formulation. Methods We pooled data from African and worldwide population-based studies which measured height, weight and biomarkers to assess diabetes status in adults aged ≥ 18 years. A Bayesian hierarchical model was used to estimate trends by sex for 200 countries and territories including 53 countries across five African regions (central, eastern, northern, southern and western), in mean BMI and diabetes prevalence (defined as either fasting plasma glucose of ≥ 7.0 mmol/l, history of diabetes diagnosis, or use of insulin or oral glucose control agents). Results African data came from 245 population-based surveys (1.2 million participants) for BMI and 76 surveys (182 000 participants) for diabetes prevalence estimates. Countries with the highest number of data sources for BMI were South Africa (n = 17), Nigeria (n = 15) and Egypt (n = 13); and for diabetes estimates, Tanzania (n = 8), Tunisia (n = 7), and Cameroon, Egypt and South Africa (all n = 6). The age-standardized mean BMI increased from 21.0 kg/m2 (95% credible interval: 20.3-21.7) to 23.0 kg/m2 (22.7-23.3) in men, and from 21.9 kg/m2 (21.3-22.5) to 24.9 kg/m2 (24.6-25.1) in women. The age-standardized prevalence of diabetes increased from 3.4% (1.5-6.3) to 8.5% (6.5-10.8) in men, and from 4.1% (2.0-7.5) to 8.9% (6.9-11.2) in women. Estimates in northern and southern regions were mostly higher than the global average; those in central, eastern and western regions were lower than global averages. A positive association (correlation coefficient ≃ 0.9) was observed between mean BMI and diabetes prevalence in both sexes in 1980 and 2014. Conclusions These estimates, based on limited data sources, confirm the rapidly increasing burden of diabetes in Africa. This rise is being driven, at least in part, by increasing adiposity, with regional variations in observed trends. African countries' efforts to prevent and control diabetes and obesity should integrate the setting up of reliable monitoring systems, consistent with the World Health Organization's Global Monitoring System Framework.
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Pisa PT, Landais E, Margetts B, Vorster HH, Friedenreich CM, Huybrechts I, Martin-Prevel Y, Branca F, Lee WTK, Leclercq C, Jerling J, Zotor F, Amuna P, Al Jawaldeh A, Aderibigbe OR, Amoussa WH, Anderson CAM, Aounallah-Skhiri H, Atek M, Benhura C, Chifamba J, Covic N, Dary O, Delisle H, El Ati J, El Hamdouchi A, El Rhazi K, Faber M, Kalimbira A, Korkalo L, Kruger A, Ledo J, Machiweni T, Mahachi C, Mathe N, Mokori A, Mouquet-Rivier C, Mutie C, Nashandi HL, Norris SA, Onabanjo OO, Rambeloson Z, Saha FBU, Ubaoji KI, Zaghloul S, Slimani N. Inventory on the dietary assessment tools available and needed in africa: a prerequisite for setting up a common methodological research infrastructure for nutritional surveillance, research, and prevention of diet-related non-communicable diseases. Crit Rev Food Sci Nutr 2017; 58:37-61. [PMID: 25486107 DOI: 10.1080/10408398.2014.981630] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To carry out an inventory on the availability, challenges, and needs of dietary assessment (DA) methods in Africa as a pre-requisite to provide evidence, and set directions (strategies) for implementing common dietary methods and support web-research infrastructure across countries. METHODS The inventory was performed within the framework of the "Africa's Study on Physical Activity and Dietary Assessment Methods" (AS-PADAM) project. It involves international institutional and African networks. An inventory questionnaire was developed and disseminated through the networks. Eighteen countries responded to the dietary inventory questionnaire. RESULTS Various DA tools were reported in Africa; 24-Hour Dietary Recall and Food Frequency Questionnaire were the most commonly used tools. Few tools were validated and tested for reliability. Face-to-face interview was the common method of administration. No computerized software or other new (web) technologies were reported. No tools were standardized across countries. CONCLUSIONS The lack of comparable DA methods across represented countries is a major obstacle to implement comprehensive and joint nutrition-related programmes for surveillance, programme evaluation, research, and prevention. There is a need to develop new or adapt existing DA methods across countries by employing related research infrastructure that has been validated and standardized in other settings, with the view to standardizing methods for wider use.
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Affiliation(s)
- Pedro T Pisa
- a Dietary Exposure Assessment Group, International Agency for Research on Cancer (IARC-WHO) , Lyon , France
| | - Edwige Landais
- a Dietary Exposure Assessment Group, International Agency for Research on Cancer (IARC-WHO) , Lyon , France.,b Institut de Recherche pour le Développement (IRD), UMR 204 Nutripass, IRD-UM2-UM1 , Montpellier , France
| | - Barrie Margetts
- c Institute of Human Nutrition, University of Southampton , Southampton , UK , and World Public Health Nutrition
| | - Hester H Vorster
- d Centre of Excellence for Nutrition (CEN), North-West University , Potchefstroom , South Africa , and African Nutrition Leadership Programme
| | - Christine M Friedenreich
- e Department of Population Health Research, Cancer Control Alberta, Alberta Health Services , and Departments of Oncology and Community Health Sciences, Faculty of Medicine , University of Calgary , Calgary, Alberta , Canada
| | - Inge Huybrechts
- a Dietary Exposure Assessment Group, International Agency for Research on Cancer (IARC-WHO) , Lyon , France
| | - Yves Martin-Prevel
- b Institut de Recherche pour le Développement (IRD), UMR 204 Nutripass, IRD-UM2-UM1 , Montpellier , France
| | - Francesco Branca
- f Department of Nutrition for Health and Development, World Health Organization (WHO) Headquarter , Geneva , Switzerland
| | - Warren T K Lee
- g Nutrition Division, Food and Agriculture Organization (FAO) of the United Nations , Rome , Italy
| | - Catherine Leclercq
- g Nutrition Division, Food and Agriculture Organization (FAO) of the United Nations , Rome , Italy
| | - Johann Jerling
- d Centre of Excellence for Nutrition (CEN), North-West University , Potchefstroom , South Africa , and African Nutrition Leadership Programme
| | - Francis Zotor
- h University of Health and Allied Sciences, Hohoe, and African Nutrition Society (ANS) , Accra , Ghana
| | - Paul Amuna
- i Department of Life Sciences , University of Greenwich , Kent , UK , and African Nutrition Society (ANS), Accra, Ghana
| | - Ayoub Al Jawaldeh
- j Regional Office for the Eastern Mediterranean (EMRO), World Health Organization (WHO) , Cairo , Egypt
| | | | - Waliou Hounkpatin Amoussa
- l Département de Nutrition et de Sciences Alimentaires , Faculté des Sciences Agronomiques, Université d'Abomey-Calavi , Cotonou , Bénin
| | - Cheryl A M Anderson
- m Department of Family and Preventive Medicine , San Diego School of Medicine, University of California , San Diego , CA , USA
| | - Hajer Aounallah-Skhiri
- n National Institute of Public Health, and Research Laboratory SURVEN (Nutritional Surveillance and Epidemiology in Tunisia) , Tunis , Tunisia
| | - Madjid Atek
- o National Institute of Public Health (INSP) , Algiers , Algeria
| | - Chakare Benhura
- p Institute of Food, Nutrition and Family Sciences, University of Zimbabwe , Harare , Zimbabwe
| | - Jephat Chifamba
- q Physiology Department, College of Health Sciences , University of Zimbabwe , Harare , Zimbabwe
| | - Namukolo Covic
- r Centre of Excellence for Nutrition (CEN), School of Physiology, Nutrition and Consumer Sciences, North-West University , Potchefstroom , South Africa
| | - Omar Dary
- s Abt Associates , Cambridge , Uganda
| | - Hélène Delisle
- t TRANSNUT, WHO Collaborating Centre on Nutrition Changes and Development, Department of Nutrition , University of Montreal , Montreal , Canada
| | - Jalila El Ati
- u National Institute of Nutrition and Food Technology (INNTA), and Research Laboratory SURVEN (Nutritional Surveillance and Epidemiology in Tunisia) , Tunis , Tunisia
| | - Asmaa El Hamdouchi
- v Unité Mixte de Recherche en Nutrition et Alimentation (URAC 39), Université Ibn Tofaïl - CNESTEN , Rabat-Kénitra , Morocco
| | - Karima El Rhazi
- w Faculté de Médecine et de Pharmacie de Fès, Laboratoire d'Epidémiologie , Recherche Clinique et Santé Communautaire , Fès , Morocco
| | - Mieke Faber
- x Non-Communicable Diseases Research Unit, Medical Research Council , Cape Town , South Africa
| | - Alexander Kalimbira
- y Lilongwe University of Agriculture and Natural Resources , Lilongwe , Malawi
| | - Liisa Korkalo
- z Department of Food and Environmental Sciences , University of Helsinki , Finland
| | - Annamarie Kruger
- aa Africa Unit for Transdisciplinary Health Research (AUTHeR), Faculty of Health Sciences, North-West University , Potchefstroom , South Africa
| | | | - Tatenda Machiweni
- q Physiology Department, College of Health Sciences , University of Zimbabwe , Harare , Zimbabwe
| | - Carol Mahachi
- q Physiology Department, College of Health Sciences , University of Zimbabwe , Harare , Zimbabwe
| | - Nonsikelelo Mathe
- ac Alliance for Canadian Health Outcomes Research in Diabetes, School of Public Health, University of Alberta , Edmonton , Canada
| | - Alex Mokori
- ad John Snow Inc. (JSI), Research and Training Institute , Kampala , Uganda
| | - Claire Mouquet-Rivier
- b Institut de Recherche pour le Développement (IRD), UMR 204 Nutripass, IRD-UM2-UM1 , Montpellier , France
| | - Catherine Mutie
- ae Ministry of Education, Science and Technology , Nairobi , Kenya
| | - Hilde Liisa Nashandi
- af Ministry of Health and Social Services, Non-Communicable Diet-Related Diseases and Nutrition in HIV, Food and Nutrition Subdivision , Windhoek , Namibia
| | - Shane A Norris
- ag MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Oluseye Olusegun Onabanjo
- ah Department of Human Nutrition & Dietetics , Federal University of Agriculture , Abeokuta , Ogun State , Nigeria
| | | | - Foudjo Brice U Saha
- aj Department of Biochemistry, Faculty of Science , University of Yaoundé I , Yaoundé , Cameroon
| | - Kingsley Ikechukwu Ubaoji
- ak Department of Applied Biochemistry, Faculty of Biosciences , Nnamdi Azikiwe University , Awka , Anambra State , Nigeria
| | | | - Nadia Slimani
- a Dietary Exposure Assessment Group, International Agency for Research on Cancer (IARC-WHO) , Lyon , France
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Ma C, Kelishadi R, Hong YM, Bovet P, Khadilkar A, Nawarycz T, Krzywińska-Wiewiorowska M, Aounallah-Skhiri H, Zong X, Motlagh ME, Kim HS, Khadilkar V, Krzyżaniak A, Ben Romdhane H, Heshmat R, Chiplonkar S, Stawińska-Witoszyńska B, El Ati J, Qorbani M, Kajale N, Traissac P, Ostrowska-Nawarycz L, Ardalan G, Parthasarathy L, Zhao M, Xi B. Performance of Eleven Simplified Methods for the Identification of Elevated Blood Pressure in Children and Adolescents. Hypertension 2016; 68:614-20. [PMID: 27432869 DOI: 10.1161/hypertensionaha.116.07659] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 06/26/2016] [Indexed: 02/06/2023]
Abstract
The identification of elevated blood pressure (BP) in children and adolescents relies on complex percentile tables. The present study compares the performance of 11 simplified methods for assessing elevated or high BP in children and adolescents using individual-level data from 7 countries. Data on BP were available for a total of 58 899 children and adolescents aged 6 to 17 years from 7 national surveys in China, India, Iran, Korea, Poland, Tunisia, and the United States. Performance of the simplified methods for screening elevated or high BP was assessed with receiver operating characteristic curve (area under the curve), sensitivity, specificity, positive predictive value, and negative predictive value. When pooling individual data from the 7 countries, all 11 simplified methods performed well in screening high BP, with high area under the curve values (0.84-0.98), high sensitivity (0.69-1.00), high specificity (0.87-1.00), and high negative predictive values (≥0.98). However, positive predictive value was low for most simplified methods, but reached ≈0.90 for each of the 3 methods, including sex- and age-specific BP references (at the 95th percentile of height), the formula for BP references (at the 95th percentile of height), and the simplified method relying on a child's absolute height. These findings were found independently of sex, age, and geographical location. Similar results were found for simplified methods for screening elevated BP. In conclusion, all 11 simplified methods performed well for identifying high or elevated BP in children and adolescents, but 3 methods performed best and may be most useful for screening purposes.
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Affiliation(s)
- Chuanwei Ma
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Roya Kelishadi
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Young Mi Hong
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Pascal Bovet
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Anuradha Khadilkar
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Tadeusz Nawarycz
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Małgorzata Krzywińska-Wiewiorowska
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Hajer Aounallah-Skhiri
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Xin'nan Zong
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Mohammad Esmaeil Motlagh
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Hae Soon Kim
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Vaman Khadilkar
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Alicja Krzyżaniak
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Habiba Ben Romdhane
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Ramin Heshmat
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Shashi Chiplonkar
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Barbara Stawińska-Witoszyńska
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Jalila El Ati
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Mostafa Qorbani
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Neha Kajale
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Pierre Traissac
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Lidia Ostrowska-Nawarycz
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Gelayol Ardalan
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Lavanya Parthasarathy
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Min Zhao
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.)
| | - Bo Xi
- From the Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (C.M., B.X.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland (P.B.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. Khadilkar, V.K., S.C., N.K., L.P.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poland (M.K.-W., A. Krzyżaniak, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Iran (M.E.M.); Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunisia (H.B.R.); Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Iran (R.H.); Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia (J.E.A.); Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran (M.Q.); Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France (P.T.); and Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China (M.Z.).
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Xi B, Zong X, Kelishadi R, Hong YM, Khadilkar A, Steffen LM, Nawarycz T, Krzywińska-Wiewiorowska M, Aounallah-Skhiri H, Bovet P, Chiolero A, Pan H, Litwin M, Poh BK, Sung RYT, So HK, Schwandt P, Haas GM, Neuhauser HK, Marinov L, Galcheva SV, Motlagh ME, Kim HS, Khadilkar V, Krzyżaniak A, Romdhane HB, Heshmat R, Chiplonkar S, Stawińska-Witoszyńska B, El Ati J, Qorbani M, Kajale N, Traissac P, Ostrowska-Nawarycz L, Ardalan G, Parthasarathy L, Zhao M, Zhang T. Establishing International Blood Pressure References Among Nonoverweight Children and Adolescents Aged 6 to 17 Years. Circulation 2015; 133:398-408. [PMID: 26671979 DOI: 10.1161/circulationaha.115.017936] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 11/20/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Several distributions of country-specific blood pressure (BP) percentiles by sex, age, and height for children and adolescents have been established worldwide. However, there are no globally unified BP references for defining elevated BP in children and adolescents, which limits international comparisons of the prevalence of pediatric elevated BP. We aimed to establish international BP references for children and adolescents by using 7 nationally representative data sets (China, India, Iran, Korea, Poland, Tunisia, and the United States). METHODS AND RESULTS Data on BP for 52 636 nonoverweight children and adolescents aged 6 to 19 years were obtained from 7 large nationally representative cross-sectional surveys in China, India, Iran, Korea, Poland, Tunisia, and the United States. BP values were obtained with certified mercury sphygmomanometers in all 7 countries by using standard procedures for BP measurement. Smoothed BP percentiles (50th, 90th, 95th, and 99th) by age and height were estimated by using the Generalized Additive Model for Location Scale and Shape model. BP values were similar between males and females until the age of 13 years and were higher in males than females thereafter. In comparison with the BP levels of the 90th and 95th percentiles of the US Fourth Report at median height, systolic BP of the corresponding percentiles of these international references was lower, whereas diastolic BP was similar. CONCLUSIONS These international BP references will be a useful tool for international comparison of the prevalence of elevated BP in children and adolescents and may help to identify hypertensive youths in diverse populations.
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Affiliation(s)
- Bo Xi
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Xin'nan Zong
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Roya Kelishadi
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Young Mi Hong
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Anuradha Khadilkar
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Lyn M Steffen
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Tadeusz Nawarycz
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Małgorzata Krzywińska-Wiewiorowska
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Hajer Aounallah-Skhiri
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Pascal Bovet
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Arnaud Chiolero
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Haiyan Pan
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Mieczysław Litwin
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Bee Koon Poh
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Rita Y T Sung
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Hung-Kwan So
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Peter Schwandt
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Gerda-Maria Haas
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Hannelore K Neuhauser
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Lachezar Marinov
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Sonya V Galcheva
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Mohammad Esmaeil Motlagh
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Hae Soon Kim
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Vaman Khadilkar
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Alicja Krzyżaniak
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Habiba Ben Romdhane
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Ramin Heshmat
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Shashi Chiplonkar
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Barbara Stawińska-Witoszyńska
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Jalila El Ati
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Mostafa Qorbani
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Neha Kajale
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Pierre Traissac
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Lidia Ostrowska-Nawarycz
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Gelayol Ardalan
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Lavanya Parthasarathy
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Min Zhao
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
| | - Tao Zhang
- From Department of Epidemiology, School of Public Health, Shandong University, Jinan, China (B.X.); Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China (X.Z.); Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran (R.K., G.A.); Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea (Y.M.H., H.S.K.); Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India (A. K, V.K., S.C., N.K., L.P.); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN (L.M.S.); Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland (T.N., L.O.-N.); Department of Epidemiology, Poznan University of Medical Sciences, Poznan, Poland (M.K.-W.,A. K, B.S.-W.); National Institute of Public Health (INSP), Tunis, Tunisia (H.A.-S.); Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland (P.B., A.C.); Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada (A.C.); Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical College, Dongguan, China (H.P.); Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland (M.L.); Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia (B.K.P.); Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (R.Y.T.S., H.-K.S.); Atherosclerosis Prevention Institute, Munich-Nuremberg, Germany (P.S., G.-M.H.); Medical Department, Ludwig-Maximilian University of Munich, Munich, German (P.S.) Department of
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Peltzer K, Pengpid S, Yung TKC, Aounallah-Skhiri H, Rehman R. Comparison of health risk behavior, awareness, and health benefit beliefs of health science and non-health science students: An international study. Nurs Health Sci 2015; 18:180-7. [DOI: 10.1111/nhs.12242] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 08/02/2015] [Accepted: 08/05/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Karl Peltzer
- ASEAN Institute for Health Development; Mahidol University; Nakhonpathom Thailand
- University of Limpopo; Turfloop Campus; Sovenga South Africa
- HIV/AIDS/STIs/and TB (HAST); Human Sciences Research Council; Pretoria South Africa
| | - Supa Pengpid
- ASEAN Institute for Health Development; Mahidol University; Nakhonpathom Thailand
- University of Limpopo; Turfloop Campus; Sovenga South Africa
| | - Tony K. C. Yung
- Jockey Club School of Public Health and Primary Care; The Chinese University of Hong Kong; Hong Kong China
| | - Hajer Aounallah-Skhiri
- National Public Health Institute
- Nutritional Surveillance and Epidemiology in Tunisia research laboratory (SURVEN); Tunis Tunisia
| | - Rehana Rehman
- Department of Biological & Biomedical Sciences; Aga Khan University; Karachi Pakistan
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Traissac P, Pradeilles R, El Ati J, Aounallah-Skhiri H, Eymard-Duvernay S, Gartner A, Béji C, Bougatef S, Martin-Prével Y, Kolsteren P, Delpeuch F, Ben Romdhane H, Maire B. Abdominal vs. overall obesity among women in a nutrition transition context: geographic and socio-economic patterns of abdominal-only obesity in Tunisia. Popul Health Metr 2015; 13:1. [PMID: 25745363 PMCID: PMC4350904 DOI: 10.1186/s12963-015-0035-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 01/13/2015] [Indexed: 01/31/2023] Open
Abstract
Background Most assessments of the burden of obesity in nutrition transition contexts rely on body mass index (BMI) only, even though abdominal adiposity might be specifically predictive of adverse health outcomes. In Tunisia, a typical country of the Middle East and North Africa (MENA) region, where the burden of obesity is especially high among women, we compared female abdominal vs. overall obesity and its geographic and socio-economic cofactors, both at population and within-subject levels. Methods The cross-sectional study used a stratified, three-level, clustered sample of 35- to 70-year-old women (n = 2,964). Overall obesity was BMI = weight/height2 ≥ 30 kg/m2 and abdominal obesity waist circumference ≥ 88 cm. We quantified the burden of obesity for overall and abdominal obesity separately and their association with place of residence (urban/rural, the seven regions that compose Tunisia), plus physiological and socio-economic cofactors by logistic regression. We studied the within-subject concordance of the two obesities and estimated the prevalence of subject-level “abdominal-only” obesity (AO) and “overall-only” obesity (OO) and assessed relationships with the cofactors by multinomial logistic regression. Results Abdominal obesity was much more prevalent (60.4% [57.7-63.0]) than overall obesity (37.0% [34.5-39.6]), due to a high proportion of AO status (25.0% [22.8-27.1]), while the proportion of OO was small (1.6% [1.1-2.2]). We found mostly similar associations between abdominal and overall obesity and all the cofactors except that the regional variability of abdominal obesity was much larger than that of overall obesity. There were no adjusted associations of AO status with urban/rural area of residence (P = 0.21), education (P = 0.97) or household welfare level (P = 0.94) and only non-menopausal women (P = 0.093), lower parity women (P = 0.061) or worker/employees (P = 0.038) were somewhat less likely to be AO. However, there was a large residual adjusted regional variability of AO status (from 16.6% to 34.1%, adjusted P < 0.0001), possibly of genetic, epigenetic, or developmental origins. Conclusion Measures of abdominal adiposity need to be included in population-level appraisals of the burden of obesity, especially among women in the MENA region. The causes of the highly prevalent abdominal-only obesity status among women require further investigation.
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Affiliation(s)
- Pierre Traissac
- IRD (Institut de Recherche pour le Développement), NUTRIPASS Unit, IRD-UM-SupAgro, 911 av. Agropolis, 34394 Montpellier, France
| | - Rebecca Pradeilles
- IRD (Institut de Recherche pour le Développement), NUTRIPASS Unit, IRD-UM-SupAgro, 911 av. Agropolis, 34394 Montpellier, France
| | - Jalila El Ati
- INNTA (National Institute of Nutrition and Food Technology), 11 rue Jebel Lakhdar, Bab Saadoun, 1007 Tunis, Tunisia ; SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Laboratory, 11 rue Jebel Lakhdar, Bab Saadoun, 1007 Tunis, Tunisia
| | - Hajer Aounallah-Skhiri
- SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Laboratory, 11 rue Jebel Lakhdar, Bab Saadoun, 1007 Tunis, Tunisia ; INSP (National Institute of Public Health), 5-7 rue de Khartoum, 1002 Tunis, Tunisia ; Faculty of Medicine, Tunis El Manar University, 15 rue Jebel Lakhdar, Bab Saadoun, 1007 Tunis, Tunisia
| | - Sabrina Eymard-Duvernay
- IRD (Institut de Recherche pour le Développement), NUTRIPASS Unit, IRD-UM-SupAgro, 911 av. Agropolis, 34394 Montpellier, France
| | - Agnès Gartner
- IRD (Institut de Recherche pour le Développement), NUTRIPASS Unit, IRD-UM-SupAgro, 911 av. Agropolis, 34394 Montpellier, France
| | - Chiraz Béji
- INNTA (National Institute of Nutrition and Food Technology), 11 rue Jebel Lakhdar, Bab Saadoun, 1007 Tunis, Tunisia
| | - Souha Bougatef
- INSP (National Institute of Public Health), 5-7 rue de Khartoum, 1002 Tunis, Tunisia
| | - Yves Martin-Prével
- IRD (Institut de Recherche pour le Développement), NUTRIPASS Unit, IRD-UM-SupAgro, 911 av. Agropolis, 34394 Montpellier, France
| | - Patrick Kolsteren
- ITM (Institute of Tropical Medicine), 155 Nationalestraat, 2000 Antwerp, Belgium
| | - Francis Delpeuch
- SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Laboratory, 11 rue Jebel Lakhdar, Bab Saadoun, 1007 Tunis, Tunisia
| | - Habiba Ben Romdhane
- Epidemiology and Prevention of Cardiovascular Diseases Research Laboratory, Faculty of Medicine, 15 rue Jebel Lakhdar, Bab Saadoun, 1007 Tunis, Tunisia
| | - Bernard Maire
- IRD (Institut de Recherche pour le Développement), NUTRIPASS Unit, IRD-UM-SupAgro, 911 av. Agropolis, 34394 Montpellier, France
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Traissac P, Aounallah-Skhiri H, El Ati J, Martin-Prével Y, Delpeuch F, Maire B. La modernisation de l’alimentation des adolescents diminue-t-elle sa qualité ? Rev Epidemiol Sante Publique 2014. [DOI: 10.1016/j.respe.2014.06.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Mansour NB, Skhiri H, Aounallah-Skhiri H, Hsairi M, Hajjem S. [Causes of death in Tunisia: estimates of years of life lost]. East Mediterr Health J 2014; 20:257-264. [PMID: 24952123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 03/14/2013] [Indexed: 06/03/2023]
Abstract
This study estimated the number of years of life lost (YLL) by cause due to premature death in Tunisia for the year 2006. We adopted the methodology (SEYLL) proposed by Murray and Lopez. The crude rate of YLL was 58.1 per 1000 inhabitants. After age-standardization using the world population, we obtained a rate of 57.7 YLL per 1000. Cardiovascular diseases (CVD) (19.3% of total YLL) and cancers (17.8%) dominated the burden of premature mortality, followed by perinatal conditions (13.6%). Excluding extreme age groups where perinatal conditions (0-4 years) and CVD (> 60 years) dominated the YLL's causes, injuries (road traffic crashes, falls, etc.) and cancers were most responsible for YLL. The present study highlights the major contribution of noncommunicable diseases to YLL in Tunisia. The promotion of healthy lifestyle and the reinforcement of secondary prevention in primary health care are the best ways to tackle these diseases.
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Affiliation(s)
- N Ben Mansour
- Institut National de Santé Publique, Tunis (Tunisie)
| | - H Skhiri
- Institut National de Santé Publique, Tunis (Tunisie)
| | - H Aounallah-Skhiri
- Institut National de Santé Publique, Tunis (Tunisie); Faculté de Médecine, Université de Tunis El Manar, Tunis (Tunisie)
| | - M Hsairi
- Institut National de Santé Publique, Tunis (Tunisie); Faculté de Médecine, Université de Tunis El Manar, Tunis (Tunisie)
| | - S Hajjem
- Institut National de Santé Publique, Tunis (Tunisie)
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Ben Romdhane H, Ben Ali S, Aissi W, Traissac P, Aounallah-Skhiri H, Bougatef S, Maire B, Delpeuch F, Achour N. Prevalence of diabetes in Northern African countries: the case of Tunisia. BMC Public Health 2014; 14:86. [PMID: 24472619 PMCID: PMC3933383 DOI: 10.1186/1471-2458-14-86] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 11/26/2013] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Although diabetes is recognized as an emerging disease in African and Middle East, few population-based surveys have been conducted in this region. We performed a national survey to estimate the prevalence of type 2 diabetes (T2D) and to evaluate the relationship between this diagnosis, demographic and socioeconomic variables. METHODS The study was conducted on a random sample of 6580 households (940 in each region). 7700 subjects adults 35-70 years old were included in the analyses. T2D was assessed on the basis of a questionnaire and fasting blood glucose level according to the WHO criteria. Access to health care and diabetes management were also assessed. RESULTS Overall, the prevalence of T2D was 15.1%. There were sharp urban vs. rural contrasts, the prevalence of diabetes being twice higher in urban area. However, the ratio urban/rural varied from 3 in the less developed region to 1.6 in the most developed ones. A sharp increase of prevalence of T2D with economic level of the household was observed. For both genders those with a family history of T2D were much more at risk of T2D than those without. Awareness increase with age, economic level and were higher amongst those with family history of T2D. Drugs were supplied by primary health care centers for 57.7% with a difference according to gender, 48.9% for men vs. 66.0% women (p < 0.001) and area, 53.3% on urban area vs. 75.2% on rural one (p < 0.001). CONCLUSIONS Through its capacity to provide the data on the burden of diabetes in the context of the epidemiological transition that North Africa is facing, this survey will not only be valuable source for health care planners in Tunisia, but will also serve as an important research for the study of diabetes in the region where data is scarce. In this context, NCDs emerge as an intersectoral challenge and their social determinants requiring social, food and environmental health policy.
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Affiliation(s)
- Habiba Ben Romdhane
- Cardiovascular Epidemiology and Prevention Research Laboratory, Faculty of Medicine, 15 rue Djebel Akdhar-La Rabta-1007 Bab Saâdoun, Tunis, Tunisia.
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Dhaouadi T, Sfar I, Aounallah-Skhiri H, Jendoubi-Ayed S, Bouacha H, Ben Abdallah T, Gorgi Y. MCP-1, CCR2 and CCR5 polymorphisms in Tunisian patients with atopic asthma. Iran J Allergy Asthma Immunol 2013; 12:29-36. [PMID: 23454776 DOI: 012.01/ijaai.2936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Chemokines and their receptors play an important role in the late inflammatory stage of asthma. In this study, we aimed to investigate polymorphisms of MCP-1 (CCL2), CCR2 and CCR5 which can affect qualitatively and/or quantitatively their production and thus influence both susceptibility and severity of asthma and its clinical and biological features.MCP-1 (A/G -2518), CCR2 (+/64I), CCR5 (G/A -59029) and CCR5 (∆32) polymorphisms were evaluated by PCR in 107 Tunisian patients with asthma and 169 healthy controls.No significant association was found between the four investigated polymorphisms and asthma. Nevertheless the haplotype MCP1*AG/CCR2*+/+ was significantly l ess frequent in patients (20.5%) compared to controls (32.5%) (p=0.03; OR=0.54; 95% CI: 0.29-0.98). Whereas no difference was observed in CCR2/CCR5 haplotypes between patients and controls. Analysis of polymorphisms with clinical and biological features showed that the concomitant presence of MCP-1*G/CCR2*64I alleles was less frequent in severe forms (4.34%) compared to moderate disease (12%) but the difference was not significant (p=0.27). No association was observed between the four polymorphisms and the presence of atopic rhinitis or atopic conjunctivitis and an elevated rate of serum IgE over 200 IU/ml.Additional effects of MCP-1 and its receptor CCR2 polymorphisms seem to be involved in disease susceptibility to asthma in Tunisian patients; nevertheless they could be protective against its severe forms.
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Affiliation(s)
- Tarak Dhaouadi
- Laboratory of Research in Immunology of Renal Transplantation and Immunopathology (LR03SP01), Charles Nicolle Hospital, Tunis, El Manar University, Bd 9 Avril, 1006 Bab Saadoun, Tunis, Tunisia.
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Atek M, Traissac P, El Ati J, Laid Y, Aounallah-Skhiri H, Eymard-Duvernay S, Mézimèche N, Bougatef S, Béji C, Boutekdjiret L, Martin-Prével Y, Lebcir H, Gartner A, Kolsteren P, Delpeuch F, Romdhane HB, Maire B. Obesity and association with area of residence, gender and socio-economic factors in Algerian and Tunisian adults. PLoS One 2013; 8:e75640. [PMID: 24116063 PMCID: PMC3792975 DOI: 10.1371/journal.pone.0075640] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 08/18/2013] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION The epidemiological transition has resulted in a major increase in the prevalence of obesity in North Africa. This study investigated differences in obesity and its association with area of residence, gender and socio-economic position among adults in Algeria and Tunisia, two countries with socio-economic and socio-cultural similarities. METHODS Cross-sectional studies used stratified, three-level, clustered samples of 35-70 year old adults in Algeria, (women n = 2741, men n = 2004) and Tunisia (women n = 2964, men n = 2379). Thinness was defined as Body Mass Index (BMI) = weight/height <18.5 kg/m(2), obesity as BMI ≥30, and abdominal obesity as waist circumference/height ≥0.6. Associations with area of residence, gender, age, education, profession and household welfare were assessed. RESULTS Prevalence of thinness was very low except among men in Algeria (7.3% C.I.[5.9-8.7]). Prevalence of obesity among women was high in Algeria (30.1% C.I.[27.8-32.4]) and Tunisia (37.0% C.I.[34.4-39.6]). It was less so among men (9.1% C.I.[7.1-11.0] and 13.3% C.I.[11.2-15.4]).The results were similar for abdominal obesity. In both countries women were much more obesity-prone than men: the women versus men obesity Odds-Ratio was 4.3 C.I.[3.4-5.5] in Algeria and 3.8 C.I.[3.1-4.7] in Tunisia. Obesity was more prevalent in urban versus rural areas in Tunisia, but not in Algeria (e.g. for women, urban versus rural Odds-Ratio was 2.4 C.I.[1.9-3.1] in Tunisia and only 1.2 C.I.[1.0-5.5] in Algeria). Obesity increased with household welfare, but more markedly in Tunisia, especially among women. Nevertheless, in both countries, even in the lowest quintile of welfare, a fifth of the women were obese. CONCLUSION The prevention of obesity, especially in women, is a public health issue in both countries, but there were differences in the patterning of obesity according to area of residence and socio-economic position. These specificities must be taken into account in the management of obesity inequalities.
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Affiliation(s)
- Madjid Atek
- INSP (National Institute of Public Health), Algiers, Algeria
| | - Pierre Traissac
- IRD (Institut de Recherche pour le Développement), NUTRIPASS Research Unit, Montpellier, France
| | - Jalila El Ati
- INNTA (National Institute of Nutrition and Food Technology), Tunis, Tunisia
- SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Unit, Tunis, Tunisia
| | - Youcef Laid
- INSP (National Institute of Public Health), Algiers, Algeria
| | - Hajer Aounallah-Skhiri
- SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Unit, Tunis, Tunisia
- INSP (National Institute of Public Health), Tunis, Tunisia
- Faculty of Medicine, El Manar University, Tunis, Tunisia
| | - Sabrina Eymard-Duvernay
- IRD (Institut de Recherche pour le Développement), NUTRIPASS Research Unit, Montpellier, France
| | - Nadia Mézimèche
- INSP (National Institute of Public Health), Algiers, Algeria
| | - Souha Bougatef
- INSP (National Institute of Public Health), Tunis, Tunisia
| | - Chiraz Béji
- INNTA (National Institute of Nutrition and Food Technology), Tunis, Tunisia
- SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Unit, Tunis, Tunisia
| | | | - Yves Martin-Prével
- IRD (Institut de Recherche pour le Développement), NUTRIPASS Research Unit, Montpellier, France
| | - Hassiba Lebcir
- INSP (National Institute of Public Health), Algiers, Algeria
| | - Agnès Gartner
- IRD (Institut de Recherche pour le Développement), NUTRIPASS Research Unit, Montpellier, France
| | | | - Francis Delpeuch
- IRD (Institut de Recherche pour le Développement), NUTRIPASS Research Unit, Montpellier, France
| | - Habiba Ben Romdhane
- Epidemiology and Prevention of Cardiovascular Diseases Unit, Faculty of Medicine, Tunis, Tunisia
| | - Bernard Maire
- IRD (Institut de Recherche pour le Développement), NUTRIPASS Research Unit, Montpellier, France
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Habibi I, Sfar I, Kort F, Aounallah-Skhiri H, Chebil A, Chouchene I, Bouraoui R, Limaiem R, Largheche L, Jendoubi-Ayed S, Makhlouf M, Ben Abdallah T, Ayed K, El Matri L, Gorgi Y. Y402H polymorphism in complement factor H and age-related macular degeneration in the Tunisian population. Ophthalmic Res 2013; 49:177-84. [PMID: 23306536 DOI: 10.1159/000345068] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 09/28/2012] [Indexed: 11/19/2022]
Abstract
To evaluate a possible association between the complement factor H (CFH) Y402H polymorphism and susceptibility to age-related macular degeneration (AMD) in the Tunisian population, as well as the impact of the genotype distribution among different phenotypes and the response to treatment with intravitreal bevacizumab, exon 9 of CFH was analyzed for the Y402H polymorphism by direct sequencing in 135 healthy controls and 127 sporadic unrelated AMD patients classified into the following groups: 12 atrophic AMD (group G1), 115 exudative AMD (G2) and 10 AMD patients who had fibrovascular scarring (G3) that did not allow a precise grading of the phenotype. Seventy patients in G2 were treated with 1.25 mg intravitreal bevacizumab at 6-week intervals until choroidal neovascularization (CNV) was no longer active. The frequency of the CFH 402H allele was significantly higher in AMD patients than in controls (p = 2.62 × 10(-16)). However, subgroup analysis does not reveal any association between the variant allele H and phenotypes of AMD or CNV. Also, there was no significant difference in response to bevacizumab treatment according to Y402H CFH genotype (p = 0.59). A strong association of the 402H allele with susceptibility to AMD in the Tunisian population was confirmed; however, this variant does not appear to be involved in the clinical progression of this disease or in the postintravitreal bevacizumab response.
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Affiliation(s)
- I Habibi
- Immunology Research Laboratory of Kidney Transplantation and Immunopathology LR03SP01, University of Tunis El Manar, Charles Nicolle Hospital, Tunis 1006, Tunisia
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El Ati J, Traissac P, Delpeuch F, Aounallah-Skhiri H, Béji C, Eymard-Duvernay S, Bougatef S, Kolsteren P, Maire B, Ben Romdhane H. Gender obesity inequities are huge but differ greatly according to environment and socio-economics in a North African setting: a national cross-sectional study in Tunisia. PLoS One 2012; 7:e48153. [PMID: 23118943 PMCID: PMC3485235 DOI: 10.1371/journal.pone.0048153] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 09/21/2012] [Indexed: 11/30/2022] Open
Abstract
Introduction Southern Mediterranean countries have experienced a marked increase in the prevalence of obesity whose consequences for gender related health inequities have been little studied. We assessed gender obesity inequalities and their environmental and socio-economic modifiers among Tunisian adults. Methods Cross-sectional survey in 2005; national, 3 level random cluster sample of 35–70 years Tunisians (women: n = 2964, men: n = 2379). Overall adiposity was assessed by BMI = weight(kg)/height(m)2 and obesity was BMI≥30, WHtR = waist circumference to height ratio defined abdominal obesity as WHtR≥0.6. Gender obesity inequality measure was women versus men Prevalence Proportion Odds-Ratio (OR); models featuring gender x covariate interaction assessed variation of gender obesity inequalities with area (urban versus rural), age, marital status or socio-economic position (profession, education, household income proxy). Results BMI was much higher among women (28.4(0.2)) versus men (25.3(0.1)), P<0.0001) as was obesity (37.0% versus 13.3%, OR = 3.8[3.1–7.4], P<0.0001) and abdominal obesity (42.6% versus 15.6%, 4.0[3.3–4.8], P<0.0001). Gender obesity inequalities (women versus men adjusted OR) were higher in urban (OR = 3.3[1.3–8.7]) than rural (OR = 2.0[0.7–5.5]) areas. These gender obesity inequalities were lower for subjects with secondary education or more (OR = 3.3[1.3–8.6]), than among those with no schooling (OR = 6.9[2.0–23.3]). They were also lower for those with upper/intermediate profession (OR = 1.4[0.5–4.3]) or even employees/workers OR = 2.3[1.0–5.4] than those not professionaly active at all (OR = 3.3[1.3–8.6]). Similar results were observed for addominal obesity. Conclusion The huge overall gender obesity inequities (women much more corpulent than men) were higher in urban settings, but lower among subjects of higher education and professional activity. Reasons for gender inequalities in obesity and their variation with socio-economic position should be sought so that appropriate policies to reduce these inequalities can be implemented in Tunisia and similar settings.
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Affiliation(s)
- Jalila El Ati
- INNTA (National Institute of Nutrition and Food Technology), Tunis, Tunisia
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Aounallah-Skhiri H, Traissac P, El Ati J, Delpeuch F, Ben Romdhane H, Maire B. Y-a-t-il équité en santé entre adolescents scolarisés et non-scolarisés ? Étude nationale, Tunisie. Rev Epidemiol Sante Publique 2012. [DOI: 10.1016/j.respe.2012.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Aounallah-Skhiri H, Traissac P, El Ati Innta J, Delpeuch F, Ben Romdhane H, Maire B. Modernisation de l’alimentation, corpulence et pression artérielle chez les adolescents, Tunisie. Rev Epidemiol Sante Publique 2012. [DOI: 10.1016/j.respe.2012.06.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Atek M, El Ati Innta J, Traissac P, Aounallah-Skhiri H, Ben Romdhane H, Maire B. Corpulence des adultes âgés de 35 à 70ans en Algérie versus Tunisie : des similarités mais aussi des différences. Rev Epidemiol Sante Publique 2012. [DOI: 10.1016/j.respe.2012.06.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Aounallah-Skhiri H, Lazaar-Ben Gobrane H, Hsairi M, Achour N, Zouari B, Nacef T. [Medical demography in Tunisia: current situation and perspectives]. Tunis Med 2012; 90:166-171. [PMID: 22407630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Health human resources management is one of the important determinants of health care access equity. AIMS To analyse the trend of Tunisian medical density during 2000-2009 and to predict its situation by 2024. METHODS Current medical density was calculated using Bar Council of Physicians of Tunisia database. Medical density was calculated and analysed for the period 2000-2009 then modelled by 2024 (estimate of needs and supply). RESULTS The active medical density raised by 36% during the period 2000-2009 with a higher increase for specialists. The proportion of non-active physicians rose from 4.6% to 15.2% in 2009. Increasing feminization of medical density and persistence of its regional disparities. By the year 2024, 217 physicians for 100,000 inhabitants would be required while the supply would correspond to 212/100 000 inhabitants. CONCLUSION medical human resources have indeed globally improved. However, some lacks remain and adequate measures are required, based on a rational planning directed to satisfy the population needs and to allow health equity.
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Ben Gobrane, H, Aounallah-Skhiri H, Ben Hamida A, Somrani N, Ayachi M, Achour N, Hsairi M. Motifs du recours aux services d’urgence des principaux hôpitaux du Grand Tunis. East Mediterr Health J 2012. [DOI: 10.26719/2012.18.1.56] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Ben Gobrane HL, Aounallah-Skhiri H, Ben Hamida A, Somrani N, Ayachi M, Achour N, Hsairi M. [Reasons for using emergency departments of major hospitals in Greater Tunis]. East Mediterr Health J 2012; 18:56-65. [PMID: 22360012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Tunisia, similar to many countries, has a problem of overcrowding of the emergency departments (ED). This study aimed to analyse the reasons for using EDs, and to describe the seriousness of the attendees' condition and their itinerary before their arrival at ED. This cross-sectional study in 2009 was conducted in ED of 4 hospitals in GreaterTunis and targeted 1058 patients of both sexes, aged 18 years, with stratification according to time of day of presentation to ED (morning, afternoon and evening). Information was recorded on the sociodemographic characteristics of the study participants, reasons for choosing ED, time of and reason for consultation, diagnosis and severity of illness. Over half the patients (52.5%) were male and the mean age was 46.0 (SD 18.1) years. The main reasons for choosing the ED were: speed (54.0%) and ease of access (47.7%) of ER and occurrence of an acute episode (26.4%). Patients with serious illness accounted for only 6.3% of those interviewed. Implementation of good practices and better coordination between public and private services and the ED are needed to reduce unnecessary visits to ED.
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Fekih N, Aounallah-Skhiri H, Trabelsi S, Kharfi M, Khaled S, Fazaa B. Les mycoses de l’enfant : étude transversale à propos de 240 patients. Ann Dermatol Venereol 2011. [DOI: 10.1016/j.annder.2011.10.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fekih N, Aounallah-Skhiri H, Hajlaoui K, El Ati J, Fazaa B, Kamoun R. Évaluation du rôle de l’alimentation dans la survenue de l’acné de l’adolescent. Ann Dermatol Venereol 2011. [DOI: 10.1016/j.annder.2011.10.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Aounallah-Skhiri H, Traissac P, El Ati J, Eymard-Duvernay S, Landais E, Achour N, Delpeuch F, Ben Romdhane H, Maire B. P001 Association d’un score de modernisation de l’alimentation avec les facteurs socio-économiques, la corpulence et la pression artérielle chez les adolescents tunisiens. NUTR CLIN METAB 2011. [DOI: 10.1016/s0985-0562(11)70069-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Dhaouadi T, Sfar I, Aounallah-Skhiri H, Jendoubi-Ayed S, Amri M, Bouacha H, Abdallah TB, Ayed K, Gorgi Y. MCP-1, CCR2 and CCR5 polymorphisms in Tunisian patients with atopic asthma. Lab Invest 2011. [PMCID: PMC3242236 DOI: 10.1186/1479-5876-9-s2-p10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Ksiaa Cheikhrouhou L, Sfar I, Aounallah-Skhiri H, Aouadi H, Jendoubi-Ayed S, Ben Abdallah T, Ayed K, Lakhoua-Gorgi Y. Cytokine and apoptosis gene polymorphisms influence the outcome of hepatitis C virus infection. Hepatobiliary Pancreat Dis Int 2011; 10:280-8. [PMID: 21669572 DOI: 10.1016/s1499-3872(11)60047-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is thought to be chronic and the factors leading to viral clearance or persistence are poorly understood. This study was undertaken to investigate the possibility of a significant relationship between the spontaneous clearance or the persistence of hepatitis C virus (HCV) infection and cytokine and apoptosis gene polymorphisms in Tunisian patients on hemodialysis. METHODS Polymorphisms of the genes IL-1 (-889 IL-1alpha, -511 and +3954 IL-1beta, IL-1Ra), IL-18 (-137 and -607), IL-12 (-1188) and Apo1/Fas (-670) were determined by PCR-RFLP, PCR-SSP and PCR-VNTR in 100 healthy blood donors and 100 patients infected with HCV and undergoing hemodialysis. The patients were classified into two groups: G1 consisted of 76 active chronic hepatitis patients (positive for HCV RNA) and G2 consisted of 24 hemodialysed patients who spontaneously eliminated the virus (negative for HCV RNA). RESULTS The frequency of genotype association [-137GC/-607CA] IL-18 was higher in G2 (41.7%) than in G1 (15.8%) (P=0.008; OR=0.26; 95% CI, 0.10-0.73). We also found a higher frequency of the AA genotype of the Apo1/Fas gene in G2 (41.6%) than in G1 (17.5%) (P=0.026; OR=3.49; 95% CI, 1.13-10.69). Adjustment for known covariate factors (age, gender and genotype) confirmed these univariate findings and revealed that the genotype association GC-CA of the (-137 and -607) IL-18 gene and the AA genotype of the Apo1/Fas gene were associated with the clearance of HCV (P=0.041 and 0.017, respectively). CONCLUSION The two genotypes GC-CA of the (-137 and -607) IL-18 polymorphism and the AA genotype of the Apo1/Fas gene influence the outcome of HCV infection in Tunisian patients on hemodialysis.
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Affiliation(s)
- Leila Ksiaa Cheikhrouhou
- Immunology Research Laboratory of Kidney Transplantation and Immunopathology, Charles Nicolle Hospital, Thunis, Tunisia
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Aounallah-Skhiri H, Traissac P, El Ati J, Eymard-Duvernay S, Landais E, Achour N, Delpeuch F, Ben Romdhane H, Maire B. Nutrition transition among adolescents of a south-Mediterranean country: dietary patterns, association with socio-economic factors, overweight and blood pressure. A cross-sectional study in Tunisia. Nutr J 2011; 10:38. [PMID: 21513570 PMCID: PMC3098773 DOI: 10.1186/1475-2891-10-38] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Accepted: 04/24/2011] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The increase in the burden of chronic diseases linked to the nutrition transition and associated dietary and lifestyle changes is of growing concern in south and east Mediterranean countries and adolescents are at the forefront of these changes. This study assessed dietary intake and association with socio-economic factors and health outcomes among adolescents in Tunisia. METHODS Cross-sectional survey (year 2005); 1019 subjects 15-19 y. from a clustered random sample. Dietary intake was assessed by a validated semi-quantitative frequency questionnaire (134 items) as was physical activity; the Diet Quality Index International measured diet quality; dietary patterns were derived by multiple correspondence analysis from intakes of 43 food groups. Body Mass Index (BMI) ≥ 85th and 95th percentile defined overweight and obesity. Waist Circumference (WC) assessed abdominal fat. High blood pressure was systolic (SBP) or diastolic blood pressure (DBP) ≥ 90th of the international reference for 15-17 y., and SBP/DBP ≥ 120/80 mm Hg for 18-19 y. RESULTS Energy intake levels were quite high, especially for females. The macro-nutrient structure was close to recommendations but only 38% had a satisfactory diet quality. A main traditional to modern dietary gradient, linked to urbanisation and increased economic level, featured an increasing consumption of white bread, dairy products, sugars, added fats and fruits and decreasing consumption of oils, grains, legumes and vegetables; regarding nutrients this modern diet score featured a decreasing relationship with total fat and an increase of calcium intake, but with an increase of energy, sugars and saturated fat, while vitamin C, potassium and fibre decreased. Adjusted for age, energy and physical activity, this modern pattern was associated with increased overweight in males (2nd vs. 1st tertile: Prevalence Odds-Ratio (POR) = 4.0[1.7-9.3], 3rd vs. 1st: POR = 3.3[1.3-8.7]) and a higher WC. Adjusting also for BMI and WC, among females, it was associated with decreased prevalence of high blood pressure (2nd vs. 1st tertile: POR = 0.5[0.3-0.8], 3rd vs. 1st tertile: POR = 0.4[0.2-0.8]). CONCLUSION The dietary intake contrasts among Tunisian adolescents, linked to socio-economic differentials are characteristic of a nutrition transition situation. The observed gradient of modernisation of dietary intake features associations with several nutrients involving a higher risk of chronic diseases but might have not only negative characteristics regarding health outcomes.
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Affiliation(s)
- Hajer Aounallah-Skhiri
- IRD (Institut de Recherche pour le Développement), UMR 204 NUTRIPASS, IRD-UM1-UM2, Montpellier, France
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Ben Gobrane H, Aounallah-Skhiri H, Oueslati F, Hsairi M, Nacef T. [Opinion of the Population of Tunis about the physician social image]. Tunis Med 2011; 89:236-242. [PMID: 21387225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND The image of the Tunisian doctor seems to have lost some of its aura and social value. AIM To evaluate the medical profession's social image and to identify the reasons of a possible dissatisfaction by interviewing a sample of 200 adults in the District of Tunis. METHODS Population was selected according to the method of quotas depending of sex, age and instruction degree. One hundred and ninety nine persons aged 20 years and above were included. Collection of data was made by an interview and included 4 items: identification of respondent, expected qualities of medical doctor, satisfaction level regarding health services, comparison between general medicine and specialists. Chi-2 test was done for comparison of proportions. In order to classify professions according to income and prestige a score was calculated. It ranged from 10% (10th rank) to 100% (1st rank). RESULTS Patience and availability were quoted as particularly essential requirements in a doctor. Yet only 35.7% of the interviewees reported being satisfied by their doctor's qualities. A general dissatisfaction regarding health services was also noted. Our sample's perception of professional prestige rated industrials over doctors by placing them in first position. With regards to the perception of best-paid jobs, doctors were classed third after industrials and important traders. CONCLUSION In order to counter these deficiencies and to preserve doctors' social image and their place in society, it is imperative to change our understanding of their training and recycling and also to improve their purchasing power as it is the unquestionable guarantee of the preservation and durability of their public image.
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