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(PDF) Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants
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Abstract
Introduction
Methods
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Added Value of This Study
Implications of All the Available Evidence
Statistical Analysis
Results
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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
Lacramioara Brinduse
2020, The Lancet
April 20, 2026
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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.
Edinburgh Research Explorer

Height and body-mass index trajectories of school-aged children
and adolescents from 1985 to 2019 in 200 countries: Pooled
analysis of 2,182 population-based studies with 65 million
participants
Citation for published version:
NCD Risk Factor Collaboration (NCD-RisC) 2020, 'Height and body-mass index trajectories of school-aged
children and adolescents from 1985 to 2019 in 200 countries: Pooled analysis of 2,182 population-based
studies with 65 million participants', The Lancet. https://doi.org/10.1016/S0140-6736(20)31859-6

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10.1016/S0140-6736(20)31859-6
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Articles

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
NCD Risk Factor Collaboration (NCD-RisC)*

Summary
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.

Lancet 2020; 396: 1511–24
See Comment page 1465
*Members listed at the end of
the Article, and affiliations listed
in the appendix
Correspondence to:
Prof Majid Ezzati, School of
Public Health, Imperial College
London, London W2 1PG, UK
[email protected]
See Online for appendix

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 subSaharan 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.
Copyright © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.

Introduction
Growth and development through childhood and
adolescence are aﬀected by social, nutritional, and
environmental factors at home, at school, and in the
www.thelancet.com Vol 396 November 7, 2020

community. During school ages (typically 5–19 years),
these factors amplify or mitigate adversity in infancy and
early childhood and, if healthy, can help consolidate
gains from early childhood and correct some nutritional
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Research in context
Evidence before this study
We searched MEDLINE (through PubMed) for articles published
from inception up to Aug 2, 2020, with no language restrictions,
using the following search terms: (“body size”[mh:noexp]
OR “body height”[mh:noexp] OR “body weight”[mh:noexp] OR
“birth weight”[mh:noexp] OR “overweight”[mh:noexp] OR
“obesity”[mh] OR “thinness”[mh:noexp] OR “Waist-Hip
Ratio”[mh:noexp] OR “Waist Circumference”[mh:noexp] OR
“body mass index”[mh:noexp]) AND (“Humans”[mh]) AND
(“Health Surveys”[mh] OR “Epidemiological Monitoring”[mh]
OR “Prevalence”[mh]) NOT Comment[ptyp] NOT Case
Reports[ptyp]. Articles were screened according to the inclusion
and exclusion criteria described in the Methods section.
We found global or multicountry studies on trends over time in
height for adults and for children younger than 5 years, but not
for school-aged children and adolescents. One multicountry
study used cross-sectional height data in 53 community-based
samples and reported height differences in children aged
10–17 years. We found three studies on trends in body-mass
index (BMI) or overweight in children and adolescents, but only
one of these studies separately reported trends for children aged
5–19 years. We found multiple studies in individual or small
groups of countries on trends in height, BMI, or both. In terms
of considering combined changes in height and BMI, the Lancet
Series on the double burden of malnutrition used data on

inadequacies and imbalances.1–3 Therefore, investing in
the nutrition of school-aged children and adolescents is
crucial for a healthy transition to adulthood.
Height and body-mass index (BMI) are anthropometric
measures of the quality of nutrition and healthiness of
the living environment during childhood and adolescence
and are highly predictive of health and developmental
outcomes throughout life.4–7 Having low height and
excessively low weight for one’s height, represented by
low BMI, increases the risk of morbidity and mortality,
impairs cognitive development, and reduces educational
performance and work productivity in later life.4,5,7 High
BMI is associated with higher risk of disability and
premature death in adulthood and with poor mental
health and educational outcomes.6,8
Much of global health and nutrition research and
policy has focused on the period from preconception to
age 5 years.9,10 For school-aged children and adolescents,
global information is available only for BMI11 and, to our
knowledge, no study has reported global trends in height
for these ages. In this study, we present consistent and
comparable global estimates of height and BMI for
school-aged children from 1985 to 2019 and assess how
countries perform in terms of children and adolescents
growing taller without excessive weight gain. We also
evaluate height and BMI trajectories by age to understand
when growth is more or less healthy and to identify the
need for intervention.
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stunting in children younger than 5 years together with data on
various measures of underweight and overweight at different
ages, but did not have data on height in older children and
adolescents, nor did it analyse trends.
Added value of this study
To our knowledge, this study presents the first comparable
estimates of height in school-aged children and adolescents for
all countries in the world and does so alongside estimates of
BMI, which together are pathways from nutrition and
environment during childhood and adolescence to lifelong
health. We also analysed age trajectories of mean height and
BMI to investigate ages when growth in different countries was
more versus less healthy and to identify the need for
intervention.
Implications of all the available evidence
Age trajectories and time trends in mean height and BMI of
school-aged children and adolescents were highly variable
across countries and indicated heterogeneous nutritional
quality and life-long health advantages and risks. Global and
national nutrition and health programmes should extend to
children and adolescents in school years to consolidate gains in
children younger than 5 years and enable healthy growth
through the entire developmental period.

Methods
Data sources
For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable
Disease Risk Factor Collaboration (NCD-RisC). The database and its criteria for data inclusion and exclusion are
described in the appendix (pp 39–42). We used data from
the NCD-RisC database from 1985 to 2019 for analysis of
BMI and from 1971 to 2019 for analysis of height. Children
aged 5 years in data from 1971 were born in 1966, and
hence were 19 years old in 1985, as were children aged
6 years in data from 1972 through to 19-year-old adolescents
in data from 1985. Additionally, for analysis of height,
participants aged 20–30 years were included and assigned
to their corresponding birth cohort, because mean height
in these ages would be at least that when they were aged
19 years, given that the decline of height with age begins
in the third and fourth decades of life. The inclusion of
data from diﬀerent years provided multiple observations
of each birth cohort during their life course, which in turn
helped to estimate the relevant parameters in the height
model that used birth year as its time scale. A list of the
data sources we used in this analysis and their characteristics is provided in the appendix (pp 49–89).

Primary outcomes
Our primary outcomes were population mean height
and mean BMI from ages 5 to 19 years. BMI accounts for
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Articles

the weight gain that is simply due to becoming taller, and
hence measures being underweight or overweight for a
person’s height. When presenting results, we refer to
gains in height as a healthy trend because the relationship
between height and health is positive and continuous.
We refer to BMI gain as unhealthy except in countries
where mean BMI was more than 1 SD lower than the
median of the WHO reference (ie, lower than 18·7 kg/m²
for girls and 19·6 kg/m² for boys at age 19 years). We also
compared mean height and BMI with the median of the
WHO growth reference12 (appendix pp 90–93) at each age
from 5 to 19 years. We used the WHO reference because
it provides growth curves for both height and BMI and is
used for monitoring in most countries. We started our
analysis from age 5 years because children enter school
at or around this age, and their nutrition, physical activity,
and health are influenced by food and environment at
their homes, schools, and communities.

Statistical analysis
We used a Bayesian hierarchical model to estimate
mean height and mean BMI by country, year, sex, and
age. The model is described in detail in a statistical
paper13 and related substantive papers11,14 and is summarised in the appendix (pp 43–45). Briefly, the model
had a hierarchical structure in which estimates for each
country and year were informed by its own data, if
available, and by data from other years in the same
country and from other countries, especially those in
the same region and super-region, with data for similar
time periods. The extent to which estimates for each
country-year were influenced by data from other years
and other countries depended on whether the country
had data, the sample size of the data, whether they were
national, and the within-country and within-region
variability of the available data.
The model allowed for non-linear time trends and nonlinear changes in mean height and BMI with age,
including periods of rapid growth during puberty, and
the earlier age of these growth spurts in girls than in
boys. We used observation year—the year in which data
were collected—as the time scale for the analysis of BMI
and birth year as the time scale for the analysis of height,
consistent with previous analyses.11,14 For BMI, substantial
societal changes that aﬀect nutrition and physical activity
might aﬀect children of diﬀerent ages simultaneously,
whereas for height, these eﬀects accumulate in each
birth cohort and a cohort’s height-for-age monotonically
increases from childhood to late adolescence.
The computer code for the model is available online, as
are our country and regional estimates both in numerical
format and as interactive visualisations. All analyses
were done with R (version 3.5.1).

Role of the funding source
The funders of the study had no role in study design,
data collection, analysis, interpretation, or writing of the
www.thelancet.com Vol 396 November 7, 2020

paper. Country and Regional Data Group members,
ARM, BZ, and MS had full access to the data in the study.
The corresponding author had final responsibility for the
decision to submit for publication.

Results
We pooled 2181 population-based measurement surveys
and studies, with anthropometric measurements on
50 million people aged 5–19 years and 15 million people
aged 20–30 years. We used at least one data source for
193 of 200 countries and territories for which estimates
were made, covering 98·7% of the world’s population
in 2019 (appendix p 94–95), and at least two data sources
for 177 countries, covering 98·0% of the world’s
population. Of these 2181 data sources, 1289 (59·1%)
were sampled from national populations, 360 (16·5%)
covered one or more subnational regions, and the
remaining 532 (24·4%) were from one or a small number of communities. Regionally, data availability ranged
from approximately three data sources per country in
Oceania to approximately 46 sources per country in the
high-income Asia-Pacific region.
In 2019, the 19-year-olds who were on average the tallest
in the world lived in northwestern and central European
countries: the Netherlands (mean height 183·8 cm,
95% credible interval [CrI] 181·5–186·2), followed by
Montenegro, Estonia, and Bosnia and Herzegovina for
boys; and the Netherlands (170·4 cm, 168·3–172·4),
followed by Montenegro, Denmark, and Iceland for girls
(figure 1A). The 19-year-olds who were on average the
shortest in 2019 lived in south and southeast Asia,
Latin America, and east Africa: Timor-Leste (160·1 cm,
158·0–162·2), followed by Laos, Solomon Islands, and
Papua New Guinea for boys; and Guatemala (150·9 cm;
149·4–152·4), followed by Bangladesh, Nepal, and TimorLeste for girls. The 20 cm or higher diﬀerence between
countries with the tallest and shortest mean height
represents approximately 8 years of growth gap for girls
and approximately 6 years for boys. For example, 19-yearold girls in four countries (Guatemala, Bangladesh,
Nepal, and Timor-Leste) had the same mean height as
that of 11-year-old Dutch girls, and those in another
53 countries—such as Burundi, India, Indonesia, Laos,
Pakistan, Peru, the Philippines, and Yemen—had the
same mean height as that of 12-year-old Dutch girls
(figure 2). Similarly, 19-year-old boys in 11 countries
throughout Asia, Latin America, and sub-Saharan Africa
had the same mean height as that of Dutch boys
aged 13 years.
Although northwestern European children and
adolescents were on average the tallest in the world in
2019, much of this advantage was achieved before the
late 20th century, and many of these countries had below
median height change from 1985 to 2019 (figure 1B,
appendix pp 96–296). By contrast, central European
countries such as Montenegro and Poland achieved a
substantial part of their height advantage since 1985,

For the model code, estimates,
and visualisations see

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Articles

Girls

Boys

Caribbean

American Samoa
Bahrain
Bermuda
Brunei
Cape Verde
Comoros
Cook Islands

Montenegro
Seychelles
Fiji
Solomon Islands
Nauru
French Polynesia
Tokelau
Kiribati
Niue
Tonga
Maldives
Palau
Tuvalu
Marshall Islands
Samoa
Mauritius
São Tomé and Príncipe
Federated States of Micronesia
Vanuatu

155

Height (cm)

Height (cm)
150

American Samoa
Bahrain
Bermuda
Brunei
Cape Verde
Comoros
Cook Islands

160

166

160

171

166

172

178

184

Caribbean

American Samoa
Bahrain
Bermuda
Brunei
Cape Verde
Comoros
Cook Islands

Height change (cm)
–1 0

American Samoa
Bahrain
Bermuda
Brunei
Cape Verde
Comoros
Cook Islands

Height change (cm)

−3

Figure 1: Height and height change by country and territory
(A) Mean height of 19-year-olds in 2019. (B) Change in mean height of 19-year-olds from 1985 to 2019.
Dutch-equivalent age (years)
11
12
13
14

Girls

Caribbean
American Samoa
Bahrain
Bermuda
Brunei
Cape Verde
Comoros
Cook Islands

Boys

Caribbean
Montenegro
Seychelles
Fiji
Solomon Islands
Nauru
French Polynesia
Tokelau
Kiribati
Niue
Tonga
Maldives
Palau
Tuvalu
Marshall Islands
Samoa
Mauritius
São Tomé and Príncipe
Federated States of Micronesia
Vanuatu

American Samoa
Bahrain
Bermuda
Brunei
Cape Verde
Comoros
Cook Islands

Figure 2: Growth gap for 19-year-olds in 2019 by country and territory
The growth gap is the difference between 19 years and the age at which a Dutch girl or boy, who had the highest height in the world, achieved the height of 19-yearolds in different countries.

1514

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especially in boys. However, the largest gains in height
over the past 3·5 decades were those in some emerging
economies, including China (largest gain for boys and
third largest for girls) and South Korea (third largest for
boys and second largest for girls), and through parts
of southeast Asia, the Middle East and north Africa,
and Latin America and the Caribbean. Nonetheless, how
much mean height changed from 1985 to 2019 varied
substantially, even within this group of countries. For
example, gains in mean height at age 19 years in China
were larger than in India by 3·5 cm (95% CrI 1·8–5·1)
for boys and 2·3 cm (0·9–3·7) for girls. By contrast
with emerging economies, the height of children and
adolescents, especially boys, has on average stagnated or
become shorter since 1985 in many countries in subSaharan Africa.10
Pacific island countries in Oceania had the highest
mean BMI in the world in 2019, surpassing 28 kg/m²
for 19-year-olds in many of these nations (figure 3A).

Late-adolescence BMI was also high for boys and girls in
Middle Eastern and north African countries such as
Kuwait and Bahrain; in Caribbean islands such as the
Bahamas; in Chile, the USA, and New Zealand; and, for
girls, in South Africa. The mean BMI of 19-year-old boys
and girls was lowest (approximately 21 kg/m² or lower)
in countries in south Asia (eg, India and Bangladesh),
southeast Asia (eg, Timor-Leste), and east and central
Africa (eg, Ethiopia and Chad), as was it for 19-year-old
girls in Japan and some central European countries (eg,
Romania and Bosnia and Herzegovina). The highest and
lowest worldwide BMIs were approximately 9–10 kg/m²
apart, equivalent to about 25 kg of weight.
Change in late-adolescence BMI from 1985 to 2019
ranged from small changes (less than 0·5 kg/m²) in both
sexes in Japan and some European countries (eg, Italy,
Russia, and Denmark) and, for girls, in some central
Asian (eg, Armenia) and sub-Saharan African countries,
to increases higher than 3 kg/m² in Malaysia and some

Girls

Caribbean

Boys

American Samoa
Bahrain
Bermuda
Brunei
Cape Verde
Comoros
Cook Islands

BMI (kg/m2)
22

Caribbean

American Samoa
Bahrain
Bermuda
Brunei
Cape Verde
Comoros
Cook Islands

Montenegro
Seychelles
Fiji
Solomon Islands
Nauru
French Polynesia
Niue
Tokelau
Kiribati
Tonga
Maldives
Palau
Tuvalu
Marshall Islands
Samoa
Mauritius
São Tomé and Príncipe
Federated States of Micronesia
Vanuatu

BMI change (kg/m2)
–1

Figure 3: BMI and BMI change by country and territory
(A) Mean BMI of 19-year-olds in 2019. (B) Change in mean BMI of 19-year-olds from 1985 to 2019. BMI=body-mass index.

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Central and eastern Europe
Central Asia, the Middle East, and north Africa

East and southeast Asia
High-income Asia-Pacific

High-income western countries*
Latin America and the Caribbean

Oceania
South Asia

Sub-Saharan Africa

Girls
30

Mean BMI (kg/m2)

28
26
24
22
20
18
145

150

155

160

165

170

175

145

150

155

160

165

170

175

145

150

155

160

165

170

175

160

165

170

175

180

185

155

160

165

170

175

180

185

155

160

165

170

175

180

185

Boys
30

Mean BMI (kg/m2)

28
26
24
22
20
18
155

Mean height (cm)

Figure 4: Combined change from 1985 to 2019 in mean height and mean BMI of 19-year-olds
Each arrow shows one country. For each country, the arrow begins at mean height and BMI values in 1985 and ends in mean height and BMI values in 2019. Each arrow
colour refers to countries in one region. BMI=body-mass index. *Countries in northwestern Europe, southwestern Europe, and English-speaking high-income countries
(Australia, Canada, Ireland, New Zealand, the UK and the USA).

countries in Oceania for both sexes, in China for boys,
and in Mexico for girls (figure 3B).
From 1985 to 2019, 19-year-old girls in some countries
in central Asia (eg, Armenia and Azerbaijan) and 19-yearold boys in some European countries (eg, Portugal,
Denmark, Poland, and Montenegro) had moderate-tolarge gains in height alongside small or no increases in
BMI (figure 4). Meanwhile, children grew much taller
in some countries (eg, girls in South Korea, Turkey,
Vietnam, and Saudi Arabia), while their BMI increased
about the same as the global median. Both these trends
were healthier than those of boys and girls in much of
sub-Saharan Africa and in New Zealand and the USA,
boys in Malaysia and some countries in Oceania, and
girls in Mexico, where little or no height gain occurred,
much larger weight was gained, or both, relative to other
countries.
Boys born in 2000 (ie, who were aged 19 years
in 2019) gained from 53·4 cm to 71·3 cm of height
from their 5th to 19th birthday in diﬀerent countries
(appendix pp 96–296); for girls born in the same year,
height gain from their 5th to 19th birthday ranged
from 43·8 cm to 55·5 cm in diﬀerent countries. We
compared the mean height and mean BMI of children
born in 2000 in each country with the median of the
1516

respective WHO growth reference12 at each age
from 5 to 19 years (figure 5A). This comparison showed
that, in many countries, mean height throughout late
childhood and adolescence was lower than the median
of the WHO growth reference (figure 5A, appendix
pp 297–98). Exceptions to this pattern were much of
Europe and a few countries in the Caribbean and
Polynesia (eg, Dominica for boys and girls and French
Polynesia for girls), where mean height throughout
late childhood and adolescence was higher than the
median of the WHO reference by about 3 cm or more.
Elsewhere, either height advantage (ie, having mean
height higher than the WHO reference median) at
5 years was diminished or reversed as children grew
older, or height disadvantage (ie, having mean height
lower than the WHO reference median) increased.
This progressive falling behind as children grew older
was especially noticeable in middle-income countries
in Latin America and the Caribbean (eg, Chile and
Uruguay), the Middle East and north Africa (eg, United
Arab Emirates), and sub-Saharan Africa (eg, Mauritius
and South Africa), where children had optimal height
at age 5 years, but by the time they reached age 19 years,
their height was shorter than the median of the WHO
reference, by about 2 cm or more. A small number of
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Tun guay
Uru enland
Gre rbaijan
Aze ina Faso
itory
n terr
Burk pore
stinia
Singa ied Pale
Occup al
Portug ina
Argent Korea
North an Republic
Dominic

Sã

Height gap (cm)
−15 −10 −5

Netherland
Monteneg s
Estonia ro
Bosnia
Icelan and Herzego
vina
Denm d
Czec ark
Latv h Republ
ic
Slova ia
Slo kia
Ukravenia
Cro ine
Se atia
Lit rbia
Po hua
Fin land nia
No land
S rw
G wed ay
D erm en
B om an
Pu erm inic y
er ud a
to a
Ric

19
18
17
16
15
14
13
12
11
10

Barbados
Jamaica
USA
Tunisia
Russia
Hungary
Saint Lucia
North Mac
edonia
Libya
Turkey
Moroc
Cape co
Sene Verde
Spai gal
Toke n
Trin lau
Isra idad an
d To
Geo el
bag
rg
Se
ia
Bra ychell
Ch zil es
Ira ina
Mo n
So ldo
Ka th
To zak Ko
O ng hs rea
A ccu a tan
M lger pied
ali ia
Pa
les
tin
ian
te
rrit
or

ng
o(
Br
az
za
T vil
N uv le
Th ige alu )
ail ria
Ky
rgy Syr nd
zst ia
Om an
C an
Burk Colom had
ina bia
Fa
Jap so
Cam Sudan
ero
Guya on
na
Hai
Cypr ti
Bahraius
Chile
Mauriti
us
Botswan
Qatar
Singapore
Taiwan (province
of China)
Venezuela
Cuba
Armenia
S aint K itts and Nevis
Iraq
Paraguay
Greenland
Fiji

Pa cuad
Bu kist or
Z ru an
lan ay
Co am ndi
Fin orw any
Ma mor bia
N erm uda
os
ld
G rm
iv
Be nga u
Sri esoth es
La o
To kela a
Equ Guine Boli nka
To nad
ato a B via
uda
Gre ece
iss
ria
arb
Côte l Guin au
Gre land and B
d'Iv ea
Po tigua s
oir
ines
An ado
The anuatu e
nad
Gam
Barb orra
e Gre
Tajik bia
And t Lucia nt and th
ista
Sain t Vince
Beni n
Sain mbourg
An
Afghan gola
Luxe ania
ist
Rom
DR Congan
da
Cana a
Uganda
Australi aland
Ethiopia
New Ze
ria
Viet
nam
Bulga
Central African Repub
lic
Russia
Malaysia
Ireland
Eswatini
France
Switzerland
Nauru
Jamaica
Federated States of Micronesia
Fiji
Honduras
UK
South Africa
Senegal
Namibia
Samoa
Nicaragua
Lebanon
Kiribati
Tuvalu
Togo
China
Panam
The Ba
Niger
ha
as
Belgiu
Mexic a
Trinid m
Ghanpé
USA ad and To
bago
nci
Geo
d Pri enya
é an
Sou rgia
Tom
abo
Cap th Kore
ão
ze
Pue e Verd a
Beli ea
Mo rto R e
Eritr lau
Ma ldov ico
Pa bia
Turk lta a
ra r
Sa me
d A ado a
Sau l Salv goli e
Lib int K nista
E on bw
H ya itts a n
M ba ea
nd
Se ung
in i
Ne
Zim Gu out n
Br ych ary
b a
is
A az elle
Dji kist alia
S lge il
be m
Alb urin ria
Uz So
an am
ia e

éa P
nd ar
Pr agu
inc ay
N ip
Zim Djib ige é
o r
Ar babw uti
me e
Mo oma nia
Ven ngo lia
ezu lia
Ma Gabo ela
urita n
Kuw nia
ait
Kyrg Cuba
yz
Nam stan
Uzbek ibia
Costa istan
Rica
Sudan
Camero
on
United Ara Vanuatu
b Emirates
Cyprus
Haiti
Hong Kong SAR, China
Taiwan (province of China)
Qatar
North Macedonia
Egypt
Kiribati
Morocco
Iran

19
18
17
16
15
14
13
12
11
10

ina
Ch
R,
it
SA
wa n ng
Ku rda Ko a
lic
Jo ong tin rea pub
H rgen Ko n Re
A r th ica
No min
Do ypt e
Eg rinam
Su ly
Ita oa mas
Sam Baha
The lta
tan
Ma menis
Turk ugal
Port ay
Uruguaria
irates
Bulg d Arab Em
Unite a
Albani a
Costa Ric n
Azerbaija

gh
an
D M ist
El R Co alaw an
Sa n
Co lvad go i
mo or
Lib ros
Rw eria
Solo
mo Leso anda
n Is th
Pap
ua N Tan land o
ew zan s
Gu ia
Mala inea
Ethio ysia
pia
Sierra Zambia
Leon
Eritre e
Naurua
Mexico
Co
Equatori lombia
al Guine
Angola
Belize
Tajikistan
Nigeria
Panama
Bahrain
Benin
Vietnam
Oman
Japan
Uganda
rica
South Af ire
vo
Côte d'I ssau
Bi
Guinea Iraq
Guine e)
avill
razz
ia
go (B Arab
Con Saudi hana
G tini
sw
E ritius
Ma Togo a
Syri nd
aila e
Th Chil a
ny
Ke dan
Jor alau a
P an
y lic
Gu pub sia
Re ne
an ro
ric ic
Af of M
ra s
nt ate
Ce d St
te
ra
de
Fe

Boys
Timor-Leste
Laos
ds
Solomon Islan
Guinea
Papua New bique
Mozam
la
Guatemapal
Ne
Yemen
ladesh
Bang ascar
ag
Mad ppines
Phili lands
l Is dia
shal
Mar Camb ria
Libe nia
urita wi
Ma Mala da
an
Rw nesia i
Ind Brun e
Le dia
rra In ar
Sie
an eru
My P ania n
nz ta
Ta Bhu

Guatemala
Bangladesh
Nepal
Timor-Leste
ar
Madagasc
Laos
es
Philippinives
Mald sia
IndonePeru
nmar
Mya odia
Cam men
Ye ds
lan
all Is tan
rsh akis ei
Ma
Bru ndi
ru
Bu utan
Bh India s
ura
nd or
Ho cuad ue
E biq via
za Boli gua a
ara ank
Nic ri L
Mo

Girls
Netherland
Monteneg s
Denmark ro
Iceland
Latvia
Estoni
Serb a
Cze ia
Lith ch Repu
Am uania blic
Bo rican
Co snia a Samo
Slo ok Isla nd He a
Slo venia nds rzego
vin
Niu vakia
Be e
A laru
D ustr s
C om ia
Sw roat inica
U e ia
Fr krain den
en e
ch
Po
lyn
es
ia

A Height gap to WHO reference

dP
ep
hin
An ales
Au Be
,C
tig tin
hR
str lize
AR
ec an
ua ian
ali
Cz akist ives ng S
an te
d B rrit Fiji a
P ald Ko
ar or
Sain olo
M ong ia
t K mo Br buda y
H str rlan ro
itts n Is un
Au itze neg
ei
la
d N ds
Sw onte
M ev
M raine go
Suri exic is
Uk Con
nam o
DR nmark
Cost Cypru e
lic
De iland
pub
Barb Rica
Tha uania ican Re
ado
Lith tral Afr
Iraq
Cen ina Faso
Burk nd
Vene man
zuela
Pola stan
Egyp
Kyrgyz sia
Canada t
Indone
Vanuatu
Cyprus
Saint Vin
cent and
Niger
the GrenadHaiti
Moldova
ines
Burund
Libya
Andorra
Portugal
Serbia
Serbia
South Korea
Austria
Kazakhstan
Bulgaria
Namibia
Malta
The Gambia
Slovakia
France
Peru
Benin
Uruguay
Nigeria
mark
Den
Somalia
Greece
Angola
Israel
Haiti
ary
Hung
Tajikist
UK
Singap an
Bots ore
lvador
El Sa nama
Slov wana
Pa
ak
jan
Equ ia
rbai s
at
ze
ru
Sierr rial
Bela an
Gu a Leo Guinea
Jord nia
Bela inea B ne
ve
is
lo
ru
sau
S ntina
Cô
Cap te d'Iv
rg
A rman ia
Tu e V oire
Ge ston ia
Se rkm erde
E nes r
Ma yche enist
icr ad a
Ta li lles an
f M Ecu aic a
Lib iwa
Jam enad zil
tes
M er n (
Sta
G oz ia prov
Gr Bra gro
ted
inc
Lu eor amb
ne ia
xe gia iq
eo
te org
ue
Fed
fC
on Ge
bo
hin
ur
a)

ia
en
ia
Ar aly ritan
It au uti
nia
M jibo nia cedo
D ve Ma
Slo rth a
No and
Ug inea
Gu ina
Ch ania
Alb ce
Gre ia
Russ h Kore
Norto
Tog name
Suri bia
Zam i
Malaw ius
Maurit
Morocco
Spain

Pa Finla
rag n
u d
G Cu ay
Ma uya ba
Afg Arge laysia a
Ne han tin
the ist a
rla an
Lat nds
Zim Keny ia
ba
No bwe
Mon rway
goli
Bulg a
aria
Bhut
an
Trinid
Is
ad an
d Tobarael
go
Irelan
Turkey
Gabon
Estonia
Germany
Azerbaijan
Sweden
Tanzania
Ghana
Comoros
Hungary
Principé
São Tomé and
Uzbekistan
Iran

pie

BMI gap (kg/m2)
−4 −2

Central and eastern Europe
Central Asia, the Middle East, and north Africa
East and southeast Asia
Latin America and the Caribbean
Oceania
South Asia
Sub-Saharan Africa

19
18
17
16
15
14
13
12
11
10

Ethiopia
Niger
DR Cong
Senega o
India l
Timor
Bang -Leste
Cen ladesh
Nep tral Afric
an R
Cha al
epubl
Eritr d
ic
Leso ea
Bu tho
Pak rundi
Su ista
Ke dan n
Bh nya
B ut
M otsw an
Z oro an
M im cc a
Co yan babw o
m m e
or ar
os

lic
ub

an
Tu Nic To
rk a b
Sw me rag ago
itz nis ua
erla tan
nd
Ic y
Ma elan ria
la d
Sou Hond ysia
th ura
Alb orea
ania
Nort
pa
São
hM
Ch in
Bosn omé an acedo ina
ia an
d Pri nia
d Her
zego cipé
Dom vina
inic
Domin
Ru a
ican Re ssia
pu
Saint Lu blic
cia
Turkey
Romania
Nor th Kore
Lithuania
Portugal
F inland
Ireland
L atvia
C olombia
Singapore
Poland
Cameroon

19
18
17
16
15
14
13
12
11
10

High-income Asia-Pacific

sa
Bis
ea
in la
Gu ngo ibia
A am n
N abo i
G alaw ines
M ilipp m
Ph tna
Vie ana eone
Gh rra L
Sie eria
Nig ldives l Guine
Ma atoria r
Equ agasca
Mad
Japan da
Rwan
Liberia
Yemen
Mali
Zambia
Uganda
Sri Lanka
Indonesia
Congo (Brazzaville
Laos
South Africa
Somalia
Seychelles
Togo
The Gambia
Belgium
Cambod
Cape Ve ia
Guinea rde
Burkin
Kyrgyz a Faso
Eswat stan
Tanza ini
Hon nia
Mo g Kong
Mo zambiq SAR, C
hina
Cu ngolia ue
Ma ba
Gu urita
Cô yan nia
Dji te d a
Be bou 'Ivoir
Pa nin ti
It rag
C aly uay
K zec
Ira azak h Re
n hs pu
ta bli

ia ds
en n g
m rla ur
Ar ethe mbo tan
N xe anis
Lu fgh ia
A nis n
Tu de s
iu
Sw aurit d
M ailan
Th raine ala
Uk atem
Gu eria
Alg
Norwkistan
Taji land
Greence
Fran
ia
a)
Boliv
of Chin
Croatia (province
Taiwanva
Moldo
tan
Uzbekis

D Bar
So
lom Gr omin bud
on eenla ica a
Sain
Isla nd
tK
Qa nds
itts
an Beli tar
d N ze
Sou Pan evis
th am
BermAfrica a
Sau Austra da
di A lia
ra
Jam bia
ai
Mex ca
ico
Peru
Boliv
Esw ia
El Salvaatini
do
Ecuado r
Vanuatu
United Arab Algeria
Emirates
Venezuela
Jordan
UK
Andorra
Oman
Costa Rica
Malta
Nicaragua
la
Guatema o
Lesoth
Libya
uras
Hond ei
Brun co
to Ri
Puer wanda
R ium
Belg uay
Uru ada
Gre razil
B lic
ub
Rep nisia
ican Tu nada
in
Ca roon
Do
me bia
Ca lom nd
Co Icela ria
Sy cia
Lu ory
int rit n
Sa ter ano
ian Le
tin
ale
pie
Oc

Trin

tig

Cook Islands
Nauru
Tuvalu
Niue
Tonga
Samoa
American Tokelau
Palau
sia
Polyne ti
French Kiriba es
irat
rab Em Qatar
it
ed A
Unit
uwa
ano
Leb moa
Sa SA
U in
ra
Bah mas
ah bia
e B Ara e
Th udi Chil nd
Sa
ala a
Ze ud
w rm ds
Ne Be Islan ico
R ea
ll
ha rto in
ars Pue Gu
ew
aN
pu
Pa

cen

Vin

Tonga
Cook Islands
Nauru
Niue
Tokelau
Samoa
Tuvalu
moa
ican Sa lau
Pa
Amer
lynesi
ch Po Kuwait
Fren
Iraq
rain
Bah Fiji
nesi
icro ibati
of M Kir hile
C as
tes
Sta
am
ted
ah USA t
era
eB
yp
Fed
Th
Eg ines
ad ea
ren uin os
e G G ad d
th ew arb lan s
nd a N B Zea land
t a apu
w Is
Ne hall
ar

int

Timor-Leste
Romania
India
Vietna
Madag m
Sri La ascar
Cam nka
Mya bodia
Ban nmar
Jap gladesh
Ph an
Bo ilippin
Eth snia a es
Ch iopia nd He
rze
Se ad
gov
Ye neg
ina
La men al
S os
C uda
Er roat n
it
ia
N r
Co epa ea
ng l
o(
Br
az
za
vil
le)

BMI gap to WHO reference

High-income western countries*

(Figure 5 continues on next page)

www.thelancet.com Vol 396 November 7, 2020

1517

Articles

Height gap (cm)
−15 −10 −5

Netherland
Monteneg s
Estonia ro
Bosnia
Icelan and Herzego
vina
Denm d
Czec ark
Latv h Republ
ic
Slova ia
Slov kia
Uk
ia
Cro raine
Se atia
Lit rbia
Po hua
Fin land nia
la
S orw d
G wed ay
D erm en
B om an
Pu erm inic y
er ud a
to a
Ric

ce
ee m
Gr elgiu d
ud
B elan on
arb
Ir ban rra nd B
Le do a a
An tigu lia
An stra
Au nada and
Ca itzerl
Sw nada
Gre rus
Bela nce
Fra ria
Aust mbourg
Luxe Islands sia
Cook ch Polyne
Fren
UK
ia
Roman aland
nadines
New Ze cent and the Gre
Saint Vin
Niue
oa
American Sam
Barbados
Jamaica
USA
Tunisia
Russia
Hungary
Saint Lucia
North Mac
edonia
Libya
Turkey
Moroc
Cape co
Sene Verde
ga
Spai l
Toke n
Trin lau
Isra idad an
d To
Ge el
bag
Sey orgia
Bra chell
Ch zil es
Ira ina
Mo n
So ldo
Ka uth va
To zak Ko
O ng hs rea
A ccu a tan
M lger pied
ali ia
Pa
les
tin
ian
te
rrit
or

o(
Br
az
za
T vil
N uv le
Th ige alu )
ail ria
Ky
rgy Syr nd
ia
zs
Om tan
C an
Burk Colo had
ina mbia
Fa
Jap so
Cam Sudan
ero
Guya on
na
Hai
Cypr ti
us
Bahrai
Chile
Mauriti
Botswanus
Qatar
Taiwan (province Singapore
of China)
Venezuela
C uba
Armenia
S aint K itts and Nevis
Iraq
Paraguay
Greenland
Fiji

19
18
17
16
15
14
13
12
11
10

Să

ae
Isr had wan
C s
Bo ain
Sp ali
M ly
Ita rkey stan
Tu zakh bia
Ka Gam
Th isia
Tun guay d
Uru enlan
Gre rbaijan
Aze ina Faso
itory
n terr
Burk pore
stinia
Singa ied Pale
Occup al
Portug ina
Argent Korea
North an Republic
Dominic

éa P
nd ara
Pr gu
in ay
N cip
Zim Djib ige é
o r
Ar abw uti
So enia e
Mo ma
li
Ven goli a
ezu a
Ma Gabo ela
urita n
Kuw nia
ait
Kyrg Cuba
yz
Nam stan
Uzbek ibia
Costa istan
Rica
Sudan
Camero
on
United Ara Vanuatu
b Emirates
Cyprus
Haiti
Hong Kong SAR, China
Taiwan (province of China)
Qatar
North Macedonia
Egypt
Kiribati
Morocco
Iran

Pa cuad
Bu kist or
lan ay
Z ru an
Co am ndi
Fin orw any
N erm uda
Ma mor bia
G rm
L ldiv s
Be nga u
Sri esoth es
To kela a
Lan o
To nad
Equ Guine Boli ka
uda
ato a Bis via
Gre ece
arb
rial
sau
Gre land and B
ôte uine
Po tigua s
d'I
ines
An ado
V voir
nad
The anuat e
Barb orra
e Gre
Gam u
And t Lucia nt and th
Tajik bia
istan
Sain t Vince
in
Be
ur
ni
Sa mbo
An n
Luxe ania
Afghan gola
Rom
ist
da
DR Cong an
Cana a
Uganda
Australi aland
Ethiopia
New Ze
Vietnam
Bulgaria
Central African Repub
Russia
lic
Ireland
Malaysia
France
Eswatini
Switzerland
Nauru
Jamaica
Micronesia
of
Federated States
Fiji
Honduras
UK
South Africa
Senegal
Namibia
Samoa
Nicaragua
Lebanon
Kiribati
Tuvalu
Togo
China
The Ba
Panam er
Nig
Belgiu hamas
Trinid
Mexic a
USA ad and To
Ghanpé
bago
ci
Geo
ri
Sou rgia
and Kenya n
th
Cap Kore
To
Gab lize
Săo
Pue e Verd a
Be ea
Mo rto R e
Eritr lau
Ma ldov ico
Pa bia
Tu lta a
ra
Sainrkme
i A ador a
Lib t K ist
Sau l Salv ngoli e
H ya itts a an
nd
Mo bab ea i
Se ung
Ne
in t
Br ych ary
vis
Zim Gu bou n
Alg azil elle
Dji kista lia
S e
Alb urin ria
be ma
an am
Uz So
ia e

ina
Ch
R,
it
SA
wa n ng
Ku rda Ko a
lic
Jo ong ntin rea pub
H rge Ko n Re
A r th ica
No min
Do ypt e
Eg rinam
Su ly
Ita oa mas
Sam Baha
The lta
tan
Ma menis
Turk ugal
Port ay
Uruguaria
irates
Bulg d Arab Em
Unite a
Albani a
Costa Ric n
Azerbaija

an
D M ist
El R Co alaw an
Co alvad go i
mo o
Rw iberia s
Solo
mo Leso anda
n Is th
Pap
ua N Tan lands o
ew zan
Guin ia
Mala ea
Ethio ysia
pia
Sierra Zambia
Leon
Eritre e
Naurua
Mexico
Co
Equatori lombia
al Guine
Angola
Belize
Tajikistan
Nigeria
Panama
Bahrain
Benin
Vietnam
Oman
Japan
Uganda
rica
South Afvoire
Côte d'I ssau
Bi
Guinea Iraq
Guine e)
avill
razz rabia
go (B
Con Saudi Ghana
atin
Esw ritius
Ma Togo a
Syri d
aila e
Th Chil a
ny
Ke dan
Jor alau a
P an
y c
Gu publi sia
Re ne
an ro
ric f Mic
A o
ral tes
n a
Ce d St
te
ra
de
Fe

19
18
17
16
15
14
13
12
11
10

Boys
Timor-Leste
Laos
ds
Solomon Islan
Guinea
Papua New bique
Mozam
la
Guatemapal
Ne
Yemen
ladesh
Bang ascar
ag
Mad ppines
Phili lands
l Is
odia
shal
Mar Camb eria
Lib nia
urita i
Ma Malawda
an
Rw esia
on ei
Ind Brun ne
Le dia
rra In mar
Sie
an eru
My P nia
a n
nz ta
Ta Bhu

Guatemala
Bangladesh
Nepal
Timor-Leste
ar
Madagasc os
La
es
Philippinives
Mald sia
IndonePeru
nmar
Mya odia
Cam men
Ye
land
all Is tan
rsh Pakis nei
Ma
Bru ndi
ru
Bu utan
Bh India s
ura
nd or
Ho cua ique
E b via
za Boli gua a
ar ank
Nic ri L
Mo

Girls
Netherland
Monteneg s
Denmark ro
Icelan
Latvia d
Estoni
Serb a
Cze ia
Lith ch Repu
Am uania blic
Bosnerican
Co ia a Samo
Slo ok Isla nd He a
Slo venia nds rzego
vin
Niu vak
Be e ia
Au laru
D tr
C om ia
S roa inic
Uk wed tia a
Fr rain en
en e
ch
Po
lyn
es
ia

B Height gap to world median

Timor-Leste
Romania
India
Vietna
Madag m
Sri La ascar
Cam nka
Mya bodia
Ban nmar
Jap gladesh
Ph an
Bo ilippin
Eth snia a es
Ch iopia nd He
rze
Se ad
gov
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1518

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BMI gap to world median

High-income western countries*

www.thelancet.com Vol 396 November 7, 2020

Articles

countries (eg, Russia for boys and girls and Iran for
boys) slightly reduced the gap to the WHO reference
median during late childhood and adolescence.
For BMI, the deficit relative to the WHO reference
median at age 5 years, which was seen mainly in subSaharan Africa and south and southeast Asia, generally
became smaller or disappeared as children grew to
adolescence and reached age 19 years (figure 5A). For
girls in South Africa and girls and boys in Canada, China,
and some countries in Oceania, the Middle East and
north Africa, and Latin America and the Caribbean,
mean BMI was similar to the WHO reference median for
5-year-old children, but exceeded the WHO reference
median as the children became older.
Comparing height and BMI in each country with the
median of all countries (figure 5B) showed that children
and adolescents in some countries had a consistent
height advantage or disadvantage relative to those in
other countries at every age. This was especially the case
for countries at the top (eg, the Netherlands, Denmark,
Montenegro, Estonia, and Iceland) and the bottom
(eg, Timor-Leste, Laos, Nepal, Yemen, and Guatemala) of
the global ranks at age 19 years. For other countries,
children’s height caught up with or fell behind their
comparators during school ages. For example, children in
some European countries (eg, girls in Belgium and boys
in Austria) and Latin America and the Caribbean (eg, girls
in Puerto Rico and boys in Barbados) had about the same
height as Dutch children at age 5 years, but progressively
fell behind such that, by the time they were 19 years old,
they were more than 5 cm shorter than Dutch adolescents.
By contrast, the height of children and adolescents in
Latvia, Czech Republic, Morocco, and Iran progressively
improved relative to others as they approached age
19 years.
When age-specific mean BMI was compared with the
global median (figure 5B), whether a country had low
(eg, countries in south and southeast Asia) or high
(eg, the USA, Chile, and countries in Oceania) mean
BMI relative to others, persisted more than was the case
for height. Nonetheless, some diﬀerences in age trajectories of BMI occurred across countries. For example,
girls and boys in some European countries (eg, Italy,

Figure 5: Age trajectory of height and BMI for 19-year-olds in 2019
Mean height and BMI of 19-year-olds in 2019 (ie, those born in 2000) at each age
from 5 to 19 years compared with the median of the WHO growth reference12 (A)
and the world median (B). Each cell represents the difference between the height
or BMI of children and adolescents in one country and the median value for a
given age of the WHO growth reference (A) and all countries (B). Countries are
ordered by decreasing height or increasing BMI in adolescents at age 19 years in
2019. The median of the WHO growth reference and world median are presented
in the appendix (pp 90–93). Results reported as Z scores of the WHO growth
reference are presented in the appendix (pp 297–98). A comparison of height and
BMI gap between boys and girls is presented in the appendix (pp 299–300).
BMI=body-mass index. SAR=Special Administrative Region. *Countries in
northwestern Europe, southwestern Europe, and English-speaking high-income
countries (Australia, Canada, Ireland, New Zealand, the UK and the USA).

www.thelancet.com Vol 396 November 7, 2020

France, and Croatia), Japan, and Seychelles progressively
moved towards healthier BMIs relative to other countries,
and the diﬀerence between their BMI and the global
median changed from positive to negative. By contrast,
girls and boys in countries such as Kuwait, Bahrain,
Fiji, Jamaica, and Mexico; and girls in South Africa and
New Zealand had a progressively higher BMI relative to
the global median as they became older.

Discussion
We identified highly variable age trajectories and trends
over time in the height and BMI of school-aged children
and adolescents across countries and territories. These
cross-country diﬀerences show that childhood and adolescence are crucial periods in diﬀerentiating countries in
terms of how they shape these determinants of lifelong
health.
Our results are consistent with findings from both
studies of adolescents in individual countries and global
studies of adult height, which show substantial variation
in how much height has changed throughout the
world.14 One study,15 assessing cross-sectional height in
53 community-based samples, found substantial crosspopulation variation in height diﬀerences from ages
10–17 years, which is consistent with our findings on
age trajectories. Our results are also consistent with
previous global analyses11 in terms of regions and
countries with the highest and lowest BMI, but previous
studies had not considered age trajectories.
Our study has strengths in scope, data, and methods:
we presented novel estimates of height in school-aged
children and adolescents for all countries in the world,
and we did so alongside estimates of BMI. We used
an unprecedented scale of population-based data from
193 countries and territories covering approximately
99% of the world’s population, while maintaining a high
standard of data representativeness and quality. Data
were analysed according to a consistent protocol, and
the characteristics and quality of data from each country
were rigorously verified through repeated checks by
NCD-RisC members. We used a statistical model that
accounted for non-linear changes in height and BMI
throughout childhood and adolescence, and we used all
available data while giving more weight to national data
than to subnational and community sources.
As with all global analyses, our study has some
limitations. Despite our extensive eﬀorts to identify
and access worldwide population-based data, some
countries, especially those in the Caribbean, Polynesia
and Micronesia, Melanesia, and sub-Saharan Africa, had
fewer data sources than in other regions. The scarcity of
data is reflected in the larger uncertainty of our estimates
for these countries and regions compared with those for
other countries. Of the studies used, less than half
had data for children aged 5–9 years compared with
nearly 90% with data for children aged 10–19 years,
which increases the uncertainty of findings for the
1519

Articles

younger age groups. BMI is an imperfect measure of the
extent and distribution of fat in the body, but it has the
major advantage of having consistent and comparable
data in many population-based surveys, especially compared with measures such as body fat measured by dualenergy x-ray absorptiometry (DEXA), which is complex
and costly and cannot be used in surveys. A systematic
review reported that BMI and DEXA-measured body
fat were highly correlated.16 We compared height and
BMI in each country with the median of the WHO
growth reference.12 Although the reference is the current
international comparison tool,17 unlike that of children
younger than 5 years, it is not based on a multicountry
sample of predominantly healthy and well-nourished
children.12 Consequently, the reference might be aﬀected
by slower growth as the sample children grew older.18
Future studies should also evaluate the socioeconomic
and geographical patterns of height and BMI in these
ages, as has been done for children younger than 5 years
and adults.19,20
Several factors that interact throughout childhood and
adolescence, and possibly across generations, might
be responsible for the heterogeneous worldwide age
trajectories and trends of height and BMI.21 First, there
is an important genetic component to height22,23 and, to
a lesser extent, to BMI24 within populations. However,
genetics explains a small part of the variation across
countries or the changes over time, especially for
BMI.25–28 That genetics has a small role in height and
BMI at the population level relative to nutrition and
environment is also supported by the finding that the
height of migrant descendents typically converges to the
height of their new country within a few generations.29–31
Second, some of the observed diﬀerences in height and
BMI might be intergenerational or due to exposures
and experiences during pregnancy, mediated through
birth length and weight.21 Third, the age of puberty
onset, which is influenced by diet, physical activity,
and weight gain during childhood, might aﬀect height
gain during the adolescent growth spurt and in late
adolescence.32 Although some studies have found a
negative association between age of pubertal onset and
final height,33 others have found that age of pubertal
onset does not aﬀect final height, because an earlier
puberty onset might be compensated by a more intense
or longer period of peak height velocity.34 No comparable
global data exist on age at menarche and timing of
pubertal growth, but national data indicate substantial
changes in some countries. Finally, all of these pathways
are influenced by food and nutrition,28,35,36 including
energy balance, and adequacy and quality of nutrients,
especially proteins, fats, and micronutrients.18,21,37 There
is also an important eﬀect from the occurrence and
treatment of infections, which itself is influenced by
water and sanitation, and whether episodes of infections
are eﬀectively treated in a timely manner. Similarly,
physical activity at home and school can influence BMI.
1520

Fully establishing the drivers of the observed height
and BMI trajectories and trends requires data on these
determinants and their distributions in diﬀerent
countries.
Our findings on the heterogeneous age trajectories
and time trends of height and BMI in late childhood and
adolescence raise the need to rethink and revise two
common features of global health and nutrition programmes. First, we need to overcome the disconnect in
research and practice between reducing undernutrition,
particularly short stature, and preventing and managing
overweight and obesity.11,19,21 Second, the finding that
children in some countries grow healthily to age 5 years
but do not continue to do so during school years shows
an imbalance between investment in improving nutrition
and growth before age 5 years and doing so in schoolaged children and adolescents.38 Therefore, our findings
should motivate policies and interventions at home, at
school, in the community, and through the health system
to support healthy growth during the entire period
from birth to adolescence through enhanced nutritional
quality, healthier living environment, and provision of
high-quality preventive and curative care. These measures include agricultural and food system policies39 that
increase the availability and reduce the cost of nutritious
foods that help children grow taller without gaining
excessive weight for their height; (conditional) cash
transfers and food vouchers towards nutritious foods
for low-income families; free healthy school meal
programmes; fiscal and regulatory policies that restrict
the consumption of unhealthy foods, especially processed carbohydrates; the provision of aﬀordable healthy
housing, clean water, and sanitation; and the provision of
facilities for play and sports in the community and at
school. Taking these actions would enable children to
grow taller without gaining excessive weight, with
lifelong benefits for their health and wellbeing.
Contributors
ARM, ZB, RB, and ME designed the study. Members of the Country and
Regional Data Group collected and re-analysed data and checked pooled
data for accuracy of information about their study and other studies in
their country. ARM, BZ, and MS led the data collection. ARM led the
statistical analysis with input from BZ, JB, JEB, CJP, and ME and
prepared results. Members of the Pooled Analysis and Writing Group
contributed to study design, collated data, and checked all data sources
in consultation with the Country and Regional Data Group. ARM and
ME wrote the first draft of the report with input from other members of
the Pooled Analysis and Writing Group. Members of the Country and
Regional Data Group commented on the draft report. ME oversaw
research. The authors alone are responsible for the views expressed in
this Article and they do not necessarily represent the views, decisions,
or policies of the institutions with which they are aﬃliated.
NCD Risk Factor Collaboration (NCD-RisC) pooled analysis and writing
Andrea Rodriguez-Martinez, Bin Zhou, Marisa K Sophiea,
James Bentham, Prof Christopher J Paciorek, Maria LC Iurilli,
Rodrigo M Carrillo-Larco, James E Bennett, Mariachiara Di Cesare,
Cristina Taddei, Honor Bixby, Gretchen A Stevens, Leanne M Riley,
Melanie J Cowan, Stefan Savin, Goodarz Danaei, Adela Chirita-Emandi,
Prof Andre P Kengne, Prof Young-Ho Khang, Prof Avula Laxmaiah,
Prof Reza Malekzadeh, Prof J Jaime Miranda, Prof Jin Soo Moon,
Stevo R Popovic, Prof Thorkild IA Sørensen, Maroje Sorić, Gregor Starc,

www.thelancet.com Vol 396 November 7, 2020

Articles

Ahmad A Zainuddin, Prof Edward W Gregg, Prof Zulfiqar A Bhutta,
Prof Robert Black, Prof Majid Ezzati.
NCD Risk Factor Collaboration (NCD-RisC) country and regional data, listed
alphabetically
Leandra Abarca-Gómez*, Ziad A Abdeen*, Shynar Abdrakhmanova*,
Suhaila Abdul Ghaﬀar*, Hanan F Abdul Rahim*,
Niveen M Abu-Rmeileh*, Jamila Abubakar Garba*,
Benjamin Acosta-Cazares*, Robert J Adams*, Wichai Aekplakorn*,
Kaosar Afsana*, Shoaib Afzal*, Imelda A Agdeppa*,
Javad Aghazadeh-Attari*, Carlos A Aguilar-Salinas*,
Charles Agyemang*, Mohamad Hasnan Ahmad*, Noor Ani Ahmad*,
Ali Ahmadi*, Naser Ahmadi*, Soheir H Ahmed*, Wolfgang Ahrens*,
Gulmira Aitmurzaeva*, Kamel Ajlouni*, Hazzaa M Al-Hazzaa*,
Amani Rashed Al-Othman*, Rajaa Al-Raddadi*, Monira Alarouj*,
Fadia AlBuhairan*, Shahla AlDhukair*, Mohamed M Ali*,
Abdullah Alkandari*, Ala’a Alkerwi*, Kristine Allin*,
Mar Alvarez-Pedrerol*, Eman Aly*, Deepak N Amarapurkar*,
Parisa Amiri*, Norbert Amougou*, Philippe Amouyel*,
Lars Bo Andersen*, Sigmund A Anderssen*, Lars Ängquist*,
Ranjit Mohan Anjana*, Alireza Ansari-Moghaddam*,
Hajer Aounallah-Skhiri*, Joana Araújo*, Inger Ariansen*, Tahir Aris*,
Raphael E Arku*, Nimmathota Arlappa*, Krishna K Aryal*,
Thor Aspelund*, Felix K Assah*, Maria Cecília F Assunção*,
May Soe Aung*, Juha Auvinen*, Mária Avdicová*, Ana Azevedo*,
Mohsen Azimi-Nezhad*, Fereidoun Azizi*, Mehrdad Azmin*,
Bontha V Babu*, Maja Bæksgaard Jørgensen*, Azli Baharudin*,
Suhad Bahijri*, Jennifer L Baker*, Nagalla Balakrishna*,
Mohamed Bamoshmoosh*, Maciej Banach*, Piotr Bandosz*,
José R Banegas*, Joanna Baran*, Carlo M Barbagallo*, Alberto Barceló*,
Amina Barkat*, Aluisio JD Barros*, Mauro Virgílio Gomes Barros*,
Abdul Basit*, Joao Luiz D Bastos*, Iqbal Bata*, Anwar M Batieha*,
Rosangela L Batista*, Zhamilya Battakova*, Assembekov Batyrbek*,
Louise A Baur*, Robert Beaglehole*, Silvia Bel-Serrat*,
Antonisamy Belavendra*, Habiba Ben Romdhane*, Judith Benedics*,
Mikhail Benet*, James E Bennett*, Salim Berkinbayev*,
Antonio Bernabe-Ortiz*, Gailute Bernotiene*, Heloísa Bettiol*,
Jorge Bezerra*, Aroor Bhagyalaxmi*, Sumit Bharadwaj*,
Santosh K Bhargava*, Zulfiqar A Bhutta*, Hongsheng Bi*, Yufang Bi*,
Daniel Bia*, Elysée Claude Bika Lele*, Mukharram M Bikbov*,
Bihungum Bista*, Dusko J Bjelica*, Peter Bjerregaard*,
Espen Bjertness*, Marius B Bjertness*, Cecilia Björkelund*,
Katia V Bloch*, Anneke Blokstra*, Simona Bo*, Martin Bobak*,
Lynne M Boddy*, Bernhard O Boehm*, Heiner Boeing*,
Jose G Boggia*, Elena Bogova*, Carlos P Boissonnet*, Stig E Bojesen*,
Marialaura Bonaccio*, Vanina Bongard*, Alice Bonilla-Vargas*,
Matthias Bopp*, Herman Borghs*, Pascal Bovet*, Lien Braeckevelt*,
Lutgart Braeckman*, Marjolijn CE Bragt*, Imperia Brajkovich*,
Francesco Branca*, Juergen Breckenkamp*, João Breda*,
Hermann Brenner*, Lizzy M Brewster*, Garry R Brian*,
Lacramioara Brinduse*, Sinead Brophy*, Graziella Bruno*,
H Bas Bueno-de-Mesquita*, Anna Bugge*, Marta Buoncristiano*,
Genc Burazeri*, Con Burns*, Antonio Cabrera de León*,
Joseph Cacciottolo*, Hui Cai*, Tilema Cama*, Christine Cameron*,
José Camolas*, Günay Can*, Ana Paula C Cândido*, Felicia Cañete*,
Mario V Capanzana*, Nadežda Capková*, Eduardo Capuano*,
Vincenzo Capuano*, Marloes Cardol*, Viviane C Cardoso*,
Axel C Carlsson*, Esteban Carmuega*, Joana Carvalho*,
José A Casajús*, Felipe F Casanueva*, Ertugrul Celikcan*, Laura Censi*,
Marvin Cervantes-Loaiza*, Juraci A Cesar*, Snehalatha Chamukuttan*,
Angelique W Chan*, Queenie Chan*, Himanshu K Chaturvedi*,
Nish Chaturvedi*, Norsyamlina Che Abdul Rahim*, Chien-Jen Chen*,
Fangfang Chen*, Huashuai Chen*, Shuohua Chen*, Zhengming
Chen*, Ching-Yu Cheng*, Bahman Cheraghian*, Angela Chetrit*,
Ekaterina Chikova-Iscener*, Arnaud Chiolero*, Shu-Ti Chiou*,
Adela Chirita-Emandi*, María-Dolores Chirlaque*, Belong Cho*,
Kaare Christensen*, Diego G Christofaro*, Jerzy Chudek*,
Renata Cifkova*, Michelle Cilia*, Eliza Cinteza*, Frank Claessens*,
Janine Clarke*, Els Clays*, Emmanuel Cohen*, Hans Concin*,
Susana C Confortin*, Cyrus Cooper*, Tara C Coppinger*,
Eva Corpeleijn*, Simona Costanzo*, Dominique Cottel*, Chris Cowell*,
Cora L Craig*, Amelia C Crampin*, Ana B Crujeiras*, Semánová Csilla*,

www.thelancet.com Vol 396 November 7, 2020

Alexandra M Cucu*, Liufu Cui*, Felipe V Cureau*, Graziella D’Arrigo*,
Eleonora d’Orsi*, Liliana Dacica*, María Ángeles Dal Re Saavedra*,
Jean Dallongeville*, Albertino Damasceno*, Camilla T Damsgaard*,
Goodarz Danaei*, Rachel Dankner*, Thomas M Dantoft*,
Parasmani Dasgupta*, Saeed Dastgiri*, Luc Dauchet*, Kairat Davletov*,
Guy De Backer*, Dirk De Bacquer*, Giovanni de Gaetano*,
Stefaan De Henauw*, Paula Duarte de Oliveira*, David De Ridder*,
Karin De Ridder*, Susanne R de Rooij*, Delphine De Smedt*,
Mohan Deepa*, Alexander D Deev*, Vincent Jr DeGennaro*,
Abbas Dehghan*, Hélène Delisle*, Francis Delpeuch*,
Stefaan Demarest*, Elaine Dennison*, Katarzyna Dereń*,
Valérie Deschamps*, Klodian Dhana*, Meghnath Dhimal*,
Augusto F Di Castelnuovo*, Juvenal Soares Dias-da-Costa*,
María Elena Díaz-Sánchez*, Alejandro Diaz*, Zivka Dika*,
Shirin Djalalinia*, Visnja Djordjic*, Ha TP Do*, Annette J Dobson*,
Maria Benedetta Donati*, Chiara Donfrancesco*, Silvana P Donoso*,
Angela Döring*, Maria Dorobantu*, Ahmad Reza Dorosty*,
Kouamelan Doua*, Wojciech Drygas*, Jia Li Duan*,
Charmaine A Duante*, Priscilla Duboz*, Rosemary B Duda*,
Vesselka Duleva*, Virginija Dulskiene*, Samuel C Dumith*,
Anar Dushpanova*, Vilnis Dzerve*, Elzbieta Dziankowska-Zaborszczyk*,
Ricky Eddie*, Ebrahim Eftekhar*, Eruke E Egbagbe*, Robert Eggertsen*,
Sareh Eghtesad*, Gabriele Eiben*, Ulf Ekelund*,
Mohammad El-Khateeb*, Jalila El Ati*, Denise Eldemire-Shearer*,
Marie Eliasen*, Paul Elliott*, Reina Engle-Stone*, Macia Enguerran*,
Rajiv T Erasmus*, Raimund Erbel*, Cihangir Erem*, Louise Eriksen*,
Johan G Eriksson*, Jorge Escobedo-de la Peña*, Saeid Eslami*,
Ali Esmaeili*, Alun Evans*, David Faeh*, Albina A Fakhretdinova*,
Caroline H Fall*, Elnaz Faramarzi*, Mojtaba Farjam*,
Victoria Farrugia Sant’Angelo*, Farshad Farzadfar*,
Mohammad Reza Fattahi*, Asher Fawwad*, Francisco J Felix-Redondo*,
Trevor S Ferguson*, Romulo A Fernandes*, Daniel Fernández-Bergés*,
Daniel Ferrante*, Thomas Ferrao*, Marika Ferrari*, Marco M Ferrario*,
Catterina Ferreccio*, Eldridge Ferrer*, Jean Ferrieres*,
Thamara Hubler Figueiró*, Anna Fijalkowska*, Günther Fink*,
Krista Fischer*, Bernhard Föger*, Leng Huat Foo*, Maria Forsner*,
Heba M Fouad*, Damian K Francis*, Maria do Carmo Franco*,
Oscar H Franco*, Ruth Frikke-Schmidt*, Guillermo Frontera*,
Flavio D Fuchs*, Sandra C Fuchs*, Isti I Fujiati*, Yuki Fujita*,
Matsuda Fumihiko*, Takuro Furusawa*, Zbigniew Gaciong*,
Mihai Gafencu*, Andrzej Galbarczyk*, Henrike Galenkamp*,
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Manoli Garcia-de-la-Hera*, Marta García-Solano*, Dickman Gareta*,
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Adroaldo Cesar Araujo Gaya*, Anelise Reis Gaya*, Andrea Gazzinelli*,
Ulrike Gehring*, Harald Geiger*, Johanna M Geleijnse*, Ali Ghanbari*,
Erfan Ghasemi*, Oana-Florentina Gheorghe-Fronea*,
Simona Giampaoli*, Francesco Gianfagna*, Tiﬀany K Gill*,
Jonathan Giovannelli*, Glen Gironella*, Aleksander Giwercman*,
Konstantinos Gkiouras*, Justyna Godos*, Sibel Gogen*,
Rebecca A Goldsmith*, David Goltzman*, Santiago F Gómez*,
Aleksandra Gomula*, Bruna Goncalves Cordeiro da Silva*,
Helen Gonçalves*, David A Gonzalez-Chica*, Marcela Gonzalez-Gross*,
Margot González-Leon*, Juan P González-Rivas*,
Clicerio González-Villalpando*, María-Elena González-Villalpando*,
Angel R Gonzalez*, Frederic Gottrand*, Antonio Pedro Graça*,
Sidsel Graﬀ-Iversen*, Dušan Grafnetter*, Aneta Grajda*,
Maria G Grammatikopoulou*, Ronald D Gregor*, Tomasz Grodzicki*,
Else Karin Grøholt*, Anders Grøntved*, Giuseppe Grosso*,
Gabriella Gruden*, Dongfeng Gu*, Emanuela Gualdi-Russo*,
Pilar Guallar-Castillón*, Andrea Gualtieri*, Elias F Gudmundsson*,
Vilmundur Gudnason*, Ramiro Guerrero*, Idris Guessous*,
Andre L Guimaraes*, Martin C Gulliford*, Johanna Gunnlaugsdottir*,
Marc J Gunter*, Xiu-Hua Guo*, Yin Guo*, Prakash C Gupta*,
Rajeev Gupta*, Oye Gureje*, Beata Gurzkowska*,
Enrique Gutiérrez-González*, Laura Gutierrez*, Felix Gutzwiller*,
Seongjun Ha*, Farzad Hadaegh*, Charalambos A Hadjigeorgiou*,
Rosa Haghshenas*, Hamid Hakimi*, Jytte Halkjær*, Ian R Hambleton*,
Behrooz Hamzeh*, Dominique Hange*, Abu AM Hanif*,
Sari Hantunen*, Rachakulla Hari Kumar*,
Seyed Mohammad Hashemi-Shahri*, Maria Hassapidou*, Jun Hata*,

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Teresa Haugsgjerd*, Alison J Hayes*, Jiang He*, Yuan He*, Yuna He*,
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Allan G Hill*, Sai Yin Ho*, Suzanne C Ho*, Michael Hobbs*,
Albert Hofman*, Ingunn Holden Bergh*, Michelle Holdsworth*,
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Andrea RVR Horimoto*, Claudia M Hormiga*, Bernardo L Horta*,
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Maung Maung Than Htike*, Yonghua Hu*, José María Huerta*,
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Jacek J Jóźwiak*, Anne Juolevi*, Gregor Jurak*, Iulia Jurca Simina*,
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Yves Kameli*, Kodanda R Kanala*, Srinivasan Kannan*,
Efthymios Kapantais*, Khem B Karki*, Marzieh Katibeh*, Joanne Katz*,
Peter T Katzmarzyk*, Jussi Kauhanen*, Prabhdeep Kaur*,
Maryam Kavousi*, Gyulli M Kazakbaeva*, Ulrich Keil*,
Lital Keinan Boker*, Sirkka Keinänen-Kiukaanniemi*, Roya Kelishadi*,
Cecily Kelleher*, Han CG Kemper*, Andre P Kengne*,
Maryam Keramati*, Alina Kerimkulova*, Mathilde Kersting*,
Timothy Key*, Yousef Saleh Khader*, Davood Khalili*,
Young-Ho Khang*, Kay-Tee Khaw*, Bahareh Kheiri*,
Motahareh Kheradmand*, Alireza Khosravi*, Ilse MSL Khouw*,
Ursula Kiechl-Kohlendorfer*, Stefan Kiechl*, Japhet Killewo*,
Dong Wook Kim*, Hyeon Chang Kim*, Jeongseon Kim*,
Jenny M Kindblom*, Heidi Klakk*, Magdalena Klimek*,
Jeannette Klimont*, Jurate Klumbiene*, Michael Knoflach*,
Bhawesh Koirala*, Elin Kolle*, Patrick Kolsteren*, Jürgen König*,
Raija Korpelainen*, Paul Korrovits*, Magdalena Korzycka*, Jelena Kos*,
Seppo Koskinen*, Katsuyasu Kouda*, Viktoria A Kovacs*,
Sudhir Kowlessur*, Slawomir Koziel*, Wolfgang Kratzer*,
Susi Kriemler*, Peter Lund Kristensen*, Steiner Krokstad*,
Daan Kromhout*, Branimir Krtalic*, Herculina S Kruger*,
Ruzena Kubinova*, Renata Kuciene*, Urho M Kujala*,
Enisa Kujundzic*, Zbigniew Kulaga*, R Krishna Kumar*,
Marie Kunešová*, Pawel Kurjata*, Yadlapalli S Kusuma*,
Kari Kuulasmaa*, Catherine Kyobutungi*, Quang Ngoc La*,
Fatima Zahra Laamiri*, Tiina Laatikainen*, Carl Lachat*, Youcef Laid*,
Tai Hing Lam*, Christina-Paulina Lambrinou*, Edwige Landais*,
Vera Lanska*, Georg Lappas*, Bagher Larijani*, Tint Swe Latt*,
Laura Lauria*, Avula Laxmaiah*, Maria Lazo-Porras*,
Khanh Le Nguyen Bao*, Agnès Le Port*, Tuyen D Le*, Jeannette Lee*,
Jeonghee Lee*, Paul H Lee*, Nils Lehmann*, Terho Lehtimäki*,
Daniel Lemogoum*, Naomi S Levitt*, Yanping Li*, Merike Liivak*,
Christa L Lilly*, Wei-Yen Lim*, M Fernanda Lima-Costa*,
Hsien-Ho Lin*, Xu Lin*, Yi-Ting Lin*, Lars Lind*, Allan Linneberg*,
Lauren Lissner*, Mieczyslaw Litwin*, Jing Liu*, Lijuan Liu*,
Wei-Cheng Lo*, Helle-Mai Loit*, Khuong Quynh Long*, Luis Lopes*,
Oscar Lopes*, Esther Lopez-Garcia*, Tania Lopez*, Paulo A Lotufo*,
José Eugenio Lozano*, Janice L Lukrafka*, Dalia Luksiene*,
Annamari Lundqvist*, Robert Lundqvist*, Nuno Lunet*,
Charles Lunogelo*, Michala Lustigová*, Edyta Łuszczki*,
Guansheng Ma*, Jun Ma*, Xu Ma*, George LL Machado-Coelho*,
Aristides M Machado-Rodrigues*, Suka Machi*, Luisa M Macieira*,
Ahmed A Madar*, Stefania Maggi*, Dianna J Magliano*,
Sara Magnacca*, Emmanuella Magriplis*, Gowri Mahasampath*,

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Bernard Maire*, Marjeta Majer*, Marcia Makdisse*, Päivi Mäki*,
Fatemeh Malekzadeh*, Reza Malekzadeh*, Rahul Malhotra*,
Kodavanti Mallikharjuna Rao*, Sofia K Malyutina*, Lynell V Maniego*,
Yannis Manios*, Jim I Mann*, Fariborz Mansour-Ghanaei*,
Enzo Manzato*, Paula Margozzini*, Anastasia Markaki*,
Oonagh Markey*, Eliza Markidou Ioannidou*, Pedro Marques-Vidal*,
Larissa Pruner Marques*, Jaume Marrugat*, Yves Martin-Prevel*,
Rosemarie Martin*, Reynaldo Martorell*, Eva Martos*,
Stefano Marventano*, Luis P Mascarenhas*, Shariq R Masoodi*,
Ellisiv B Mathiesen*, Prashant Mathur*, Alicia Matijasevich*,
Tandi E Matsha*, Christina Mavrogianni*, Artur Mazur*,
Jean Claude N Mbanya*, Shelly R McFarlane*, Stephen T McGarvey*,
Martin McKee*, Stela McLachlan*, Rachael M McLean*,
Scott B McLean*, Breige A McNulty*, Sounnia Mediene-Benchekor*,
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Amir Houshang Mehrparvar*, Aline Meirhaeghe*, Jørgen Meisfjord*,
Christa Meisinger*, Ana Maria B Menezes*, Geetha R Menon*,
Gert BM Mensink*, Maria Teresa Menzano*, Alibek Mereke*,
Indrapal I Meshram*, Andres Metspalu*, Jie Mi*, Kim F Michaelsen*,
Nathalie Michels*, Kairit Mikkel*, Karolina Milkowska*, Jody C Miller*,
Cláudia S Minderico*, GK Mini*, Juan Francisco Miquel*,
J Jaime Miranda*, Mohammad Reza Mirjalili*, Daphne Mirkopoulou*,
Erkin Mirrakhimov*, Marjeta Mišigoj-Durakovic*, Antonio Mistretta*,
Veronica Mocanu*, Pietro A Modesti*, Sahar Saeedi Moghaddam*,
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Reza Mohammadpourhodki*, Viswanathan Mohan*, Salim Mohanna*,
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Dénes Molnár*, Amirabbas Momenan*, Charles K Mondo*,
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Leila B Moreira*, Alain Morejon*, Luis A Moreno*, Karen Morgan*,
Suzanne N Morin*, Erik Lykke Mortensen*, George Moschonis*,
Malgorzata Mossakowska*, Aya Mostafa*, Anabela Mota-Pinto*,
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Farid Najafi*, Harunobu Nakamura*, Jana Námešná*, Ei Ei K Nang*,
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Chung T Nguyen*, Nguyen D Nguyen*, Quang Ngoc Nguyen*,
Ramfis E Nieto-Martínez*, Yury P Nikitin*, Guang Ning*,
Toshiharu Ninomiya*, Sania Nishtar*, Marianna Noale*,
Oscar A Noboa*, Helena Nogueira*, Teresa Norat*, Maria Nordendahl*,
Børge G Nordestgaard*, Davide Noto*, Natalia Nowak-Szczepanska*,
Mohannad Al Nsour*, Irfan Nuhoglu*, Eha Nurk*, Terence W O’Neill*,
Dermot O’Reilly*, Galina Obreja*, Caleb Ochimana*,
Angélica M Ochoa-Avilés*, Eiji Oda*, Kyungwon Oh*, Kumiko Ohara*,
Claes Ohlsson*, Ryutaro Ohtsuka*, Örn Olafsson*,
Maria Teresa A Olinto*, Isabel O Oliveira*, Mohd Azahadi Omar*,
Altan Onat*, Sok King Ong*, Lariane M Ono*, Pedro Ordunez*,
Rui Ornelas*, Ana P Ortiz*, Pedro J Ortiz*, Merete Osler*,
Clive Osmond*, Sergej M Ostojic*, Afshin Ostovar*, Johanna A Otero*,
Kim Overvad*, Ellis Owusu-Dabo*, Fred Michel Paccaud*,
Cristina Padez*, Ioannis Pagkalos*, Elena Pahomova*,
Karina Mary de Paiva*, Andrzej Pajak*, Domenico Palli*,
Alberto Palloni*, Luigi Palmieri*, Wen-Harn Pan*,
Songhomitra Panda-Jonas*, Arvind Pandey*, Francesco Panza*,
Dimitrios Papandreou*, Soon-Woo Park*, Suyeon Park*,
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Patrick Pasquet*, Nikhil D Patel*, Mangesh S Pednekar*,
Nasheeta Peer*, Sergio Viana Peixoto*, Markku Peltonen*,
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Hynek Pikhart*, Aida Pilav*, Lorenza Pilotto*, Francesco Pistelli*,
Freda Pitakaka*, Aleksandra Piwonska*, Andreia N Pizarro*,
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Raluca M Pop*, Stevo R Popovic*, Miquel Porta*, Georg Posch*,
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Rui Providencia*, Jardena J Puder*, Iveta Pudule*, Soile E Puhakka*,
Maria Puiu*, Margus Punab*, Radwan F Qasrawi*, Mostafa Qorbani*,
Tran Quoc Bao*, Ivana Radic*, Ricardas Radisauskas*,
Salar Rahimikazerooni*, Mahfuzar Rahman*, Mahmudur Rahman*,
Olli Raitakari*, Manu Raj*, Ellina Rakhimova*, Sherali Rakhmatulloev*,
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Daniela Rodrigues*, Fernando Rodríguez-Artalejo*,
María del Cristo Rodriguez-Perez*, Laura A Rodríguez-Villamizar*,
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Frank J Rühli*, Jean-Bernard Ruidavets*,
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Iuliia A Rusakova*, Kenisha Russell Jonsson*, Paola Russo*,
Petra Rust*, Marcin Rutkowski*, Charumathi Sabanayagam*,
Elena Sacchini*, Harshpal S Sachdev*, Alireza Sadjadi*,
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Benoit Salanave*, Eduardo Salazar Martinez*, Diego Salmerón*,
Veikko Salomaa*, Jukka T Salonen*, Massimo Salvetti*,
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Helmut Schröder*, Constance Schultsz*, Aletta E Schutte*,
Sylvain Sebert*, Aye Aye Sein*, Rusidah Selamat*, Vedrana Sember*,
Abhijit Sen*, Idowu O Senbanjo*, Sadaf G Sepanlou*, Victor Sequera*,
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Coimbatore Subramaniam Shanthirani*, Maryam Sharafkhah*,
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Hana Shimizu-Furusawa*, Dong Wook Shin*, Youchan Shin*,
Majid Shirani*, Rahman Shiri*, Namuna Shrestha*, Khairil Si-Ramlee*,
Alfonso Siani*, Rosalynn Siantar*, Abla M Sibai*, Antonio M Silva*,
Diego Augusto Santos Silva*, Mary Simon*, Judith Simons*,
Leon A Simons*, Agneta Sjöberg*, Michael Sjöström*, Gry Skodje*,
Jolanta Slowikowska-Hilczer*, Przemyslaw Slusarczyk*, Liam Smeeth*,
Hung-Kwan So*, Fernanda Cunha Soares*, Grzegorz Sobek*,
Eugène Sobngwi*, Morten Sodemann*, Stefan Söderberg*,
Moesijanti YE Soekatri*, Agustinus Soemantri*, Reecha Sofat*,
Vincenzo Solfrizzi*, Mohammad Hossein Somi*, Emily Sonestedt*,
Yi Song*, Thorkild IA Sørensen*, Elin P Sørgjerd*, Maroje Sorić*,
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Maria Wany Strufaldi*, Lela Sturua*, Ramón Suárez-Medina*,
Machi Suka*, Chien-An Sun*, Johan Sundström*, Yn-Tz Sung*,
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Rody G Sy*, Holly E Syddall*, René Charles Sylva*, Moyses Szklo*,
Lucjan Szponar*, E Shyong Tai*, Mari-Liis Tammesoo*,
Abdonas Tamosiunas*, Eng Joo Tan*, Xun Tang*, Frank Tanser*,
Yong Tao*, Mohammed Rasoul Tarawneh*, Jakob Tarp*,
Carolina B Tarqui-Mamani*, Radka Taxová Braunerová*, Anne Taylor*,
Julie Taylor*, Félicité Tchibindat*, William R Tebar*, Grethe S Tell*,
Tania Tello*, KR Thankappan*, Holger Theobald*,
Xenophon Theodoridis*, Lutgarde Thijs*, Nihal Thomas*,
Betina H Thuesen*, Lubica Tichá*, Erik J Timmermans*,
Anne Tjonneland*, Hanna K Tolonen*, Janne S Tolstrup*,
Murat Topbas*, Roman Topór-Madry*, Liv Elin Torheim*,
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Thi Tuyet-Hanh Tran*, Dimitrios Trichopoulos*, Antonia Trichopoulou*,
Oanh TH Trinh*, Atul Trivedi*, Lechaba Tshepo*, Maria Tsigga*,
Shoichiro Tsugane*, Azaliia M Tuliakova*, Marshall K Tulloch-Reid*,
Fikru Tullu*, Tomi-Pekka Tuomainen*, Jaakko Tuomilehto*,
Maria L Turley*, Per Tynelius*, Themistoklis Tzotzas*,
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Hanno Ulmer*, Belgin Unal*, Zhamyila Usupova*,
Hannu MT Uusitalo*, Nalan Uysal*, Justina Vaitkeviciute*,
Gonzalo Valdivia*, Susana Vale*, Damaskini Valvi*, Rob M van Dam*,
Johan Van der Heyden*, Yvonne T van der Schouw*, Koen Van Herck*,
Hoang Van Minh*, Irene GM van Valkengoed*, Dirk Vanderschueren*,
Diego Vanuzzo*, Anette Varbo*, Gregorio Varela-Moreiras*,
Patricia Varona-Pérez*, Senthil K Vasan*, Tomas Vega*,
Toomas Veidebaum*, Gustavo Velasquez-Melendez*, Biruta Velika*,
Giovanni Veronesi*, WM Monique Verschuren*, Cesar G Victora*,
Giovanni Viegi*, Lucie Viet*, Salvador Villalpando*, Paolo Vineis*,
Jesus Vioque*, Jyrki K Virtanen*, Marjolein Visser*,
Sophie Visvikis-Siest*, Bharathi Viswanathan*, Mihaela Vladulescu*,
Tiina Vlasoﬀ*, Dorja Vocanec*, Henry Völzke*, Ari Voutilainen*,
Sari Voutilainen*, Martine Vrijheid*, Tanja GM Vrijkotte*,
Alisha N Wade*, Aline Wagner*, Thomas Waldhör*, Janette Walton*,
Elvis OA Wambiya*, Wan Mohamad Wan Bebakar*,
Wan Nazaimoon Wan Mohamud*, Rildo de Souza Wanderley Júnior*,
Ming-Dong Wang*, Ningli Wang*, Qian Wang*, Xiangjun Wang*,
Ya Xing Wang*, Ying-Wei Wang*, S Goya Wannamethee*,
Nicholas Wareham*, Adelheid Weber*, Niels Wedderkopp*,
Deepa Weerasekera*, Daniel Weghuber*, Wenbin Wei*, Aneta Weres*,
Bo Werner*, Peter H Whincup*, Kurt Widhalm*,
Indah S Widyahening*, Andrzej Wiecek*, Rainford J Wilks*,
Johann Willeit*, Peter Willeit*, Julianne Williams*, Tom Wilsgaard*,
Bogdan Wojtyniak*, Roy A Wong-McClure*, Andrew Wong*,
Jyh Eiin Wong*, Tien Yin Wong*, Jean Woo*, Mark Woodward*,
Frederick C Wu*, Jianfeng Wu*, Li Juan Wu*, Shouling Wu*,
Haiquan Xu*, Liang Xu*, Nor Azwany Yaacob*, Uruwan Yamborisut*,
Weili Yan*, Ling Yang*, Xiaoguang Yang*, Yang Yang*, Nazan Yardim*,
Mehdi Yaseri*, Tabara Yasuharu*, Xingwang Ye*,
Panayiotis K Yiallouros*, Moein Yoosefi*, Akihiro Yoshihara*,
Qi Sheng You*, San-Lin You*, Novie O Younger-Coleman*,
Safiah Md Yusof*, Ahmad Faudzi Yusoﬀ*, Luciana Zaccagni*,
Vassilis Zafiropulos*, Ahmad A Zainuddin*, Seyed Rasoul Zakavi*,
Farhad Zamani*, Sabina Zambon*, Antonis Zampelas*,
Hana Zamrazilová*, Maria Elisa Zapata*, Abdul Hamid Zargar*,
Ko Ko Zaw*, Tomasz Zdrojewski*, Tajana Zeljkovic Vrkic*, Yi Zeng*,
Luxia Zhang*, Zhen-Yu Zhang*, Dong Zhao*, Ming-Hui Zhao*,
Wenhua Zhao*, Shiqi Zhen*, Wei Zheng*, Yingfeng Zheng*,
Bekbolat Zholdin*, Maigeng Zhou*, Dan Zhu*, Yanina Zocalo*,
Julio Zuñiga Cisneros*, Monika Zuziak*.
*Contributed equally.
Declaration of interests
ME reports a charitable grant from the AstraZeneca Young Health
Programme, and personal fees from Prudential and Scor, outside the

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submitted work. MS reports grants from the EU Horizon 2020 research
and innovation programme under Grant Agreement number 774548,
during the conduct of the study. All other authors declare no competing
interests.
Acknowledgments
The NCD-RisC database was supported by a Biomedical Resource and
Multi-user Equipment Grant from the Wellcome Trust (101506/Z/13/Z) and
was expanded to include children and adolescents with partial support by a
charitable grant from AstraZeneca Young Health Programme. The analysis
in this paper was partly supported by the STOP project which received
funding from EU Horizon 2020 research and innovation programme
under Grant Agreement 774548. The content of this publication reflects
only the views of the authors, and the European Commission is not liable
for any use that may be made of the information it contains.
Editorial note: the Lancet Group takes a neutral position with respect to
territorial claims in published maps and institutional aﬃliations.
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NCD Risk Factor Collaboration (NCD-RisC) pooled analysis and writing Andrea Rodriguez-Martinez, Bin Zhou, Marisa K Sophiea, James Bentham, Prof Christopher J Paciorek, Maria LC Iurilli, Rodrigo M Carrillo-Larco, James E Bennett, Mariachiara Di Cesare, Cristina Taddei, Honor Bixby, Gretchen A Stevens, Leanne M Riley, Melanie J Cowan, Stefan Savin, Goodarz Danaei, Adela Chirita-Emandi, Prof Andre P Kengne, Prof Young-Ho Khang, Prof Avula Laxmaiah, Prof Reza Malekzadeh, Prof J Jaime Miranda, Prof Jin Soo Moon, Stevo R Popovic, Prof Thorkild IA Sørensen, Maroje Sorić, Gregor Starc, Ahmad A Zainuddin, Prof Edward W Gregg, Prof Zulfiqar A Bhutta, Prof Robert Black, Prof Majid Ezzati.
NCD Risk Factor Collaboration (NCD-RisC) country and regional data, listed alphabetically
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Alexandra M Cucu*, Liufu Cui*, Felipe V Cureau*, Graziella D'Arrigo*, Eleonora d'Orsi*, Liliana Dacica*, María Ángeles Dal Re Saavedra*, Jean Dallongeville*, Albertino Damasceno*, Camilla T Damsgaard*, Goodarz Danaei*, Rachel Dankner*, Thomas M Dantoft*, Parasmani Dasgupta*, Saeed Dastgiri*, Luc Dauchet*, Kairat Davletov*, Guy De Backer*, Dirk De Bacquer*, Giovanni de Gaetano*, Stefaan De Henauw*, Paula Duarte de Oliveira*, David De Ridder*, Karin De Ridder*, Susanne R de Rooij*, Delphine De Smedt*, Mohan Deepa*, Alexander D Deev*, Vincent Jr DeGennaro*, Abbas Dehghan*, Hélène Delisle*, Francis Delpeuch*, Stefaan Demarest*, Elaine Dennison*, Katarzyna Dereń*, Valérie Deschamps*, Klodian Dhana*, Meghnath Dhimal*, Augusto F Di Castelnuovo*, Juvenal Soares Dias-da-Costa*, María Elena Díaz-Sánchez*, Alejandro Diaz*, Zivka Dika*, Shirin Djalalinia*, Visnja Djordjic*, Ha TP Do*, Annette J Dobson*, Maria Benedetta Donati*, Chiara Donfrancesco*, Silvana P Donoso*, Angela Döring*, Maria Dorobantu*, Ahmad Reza Dorosty*, Kouamelan Doua*, Wojciech Drygas*, Jia Li Duan*, Charmaine A Duante*, Priscilla Duboz*, Rosemary B Duda*, Vesselka Duleva*, Virginija Dulskiene*, Samuel C Dumith*, Anar Dushpanova*, Vilnis Dzerve*, Elzbieta Dziankowska-Zaborszczyk*, Ricky Eddie*, Ebrahim Eftekhar*, Eruke E Egbagbe*, Robert Eggertsen*, Sareh Eghtesad*, Gabriele Eiben*, Ulf Ekelund*, Mohammad El-Khateeb*, Jalila El Ati*, Denise Eldemire-Shearer*, Marie Eliasen*, Paul Elliott*, Reina Engle-Stone*, Macia Enguerran*, Rajiv T Erasmus*, Raimund Erbel*, Cihangir Erem*, Louise Eriksen*, Johan G Eriksson*, Jorge Escobedo-de la Peña*, Saeid Eslami*, Ali Esmaeili*, Alun Evans*, David Faeh*, Albina A Fakhretdinova*, Caroline H Fall*, Elnaz Faramarzi*, Mojtaba Farjam*, Victoria Farrugia Sant'Angelo*, Farshad Farzadfar*, Mohammad Reza Fattahi*, Asher Fawwad*, Francisco J Felix-Redondo*, Trevor S Ferguson*, Romulo A Fernandes*, Daniel Fernández-Bergés*, Daniel Ferrante*, Thomas Ferrao*, Marika Ferrari*, Marco M Ferrario*, Catterina Ferreccio*, Eldridge Ferrer*, Jean Ferrieres*, Thamara Hubler Figueiró*, Anna Fijalkowska*, Günther Fink*, Krista Fischer*, Bernhard Föger*, Leng Huat Foo*, Maria Forsner*, Heba M Fouad*, Damian K Francis*, Maria do Carmo Franco*, Oscar H Franco*, Ruth Frikke-Schmidt*, Guillermo Frontera*, Flavio D Fuchs*, Sandra C Fuchs*, Isti I Fujiati*, Yuki Fujita*, Matsuda Fumihiko*, Takuro Furusawa*, Zbigniew Gaciong*, Mihai Gafencu*, Andrzej Galbarczyk*, Henrike Galenkamp*, Daniela Galeone*, Myriam Galfo*, Fabio Galvano*, Jingli Gao*, Manoli Garcia-de-la-Hera*, Marta García-Solano*, Dickman Gareta*, Sarah P Garnett*, Jean-Michel Gaspoz*, Magda Gasull*, Adroaldo Cesar Araujo Gaya*, Anelise Reis Gaya*, Andrea Gazzinelli*, Ulrike Gehring*, Harald Geiger*, Johanna M Geleijnse*, Ali Ghanbari*, Erfan Ghasemi*, Oana-Florentina Gheorghe-Fronea*, Simona Giampaoli*, Francesco Gianfagna*, Tiffany K Gill*, Jonathan Giovannelli*, Glen Gironella*, Aleksander Giwercman*, 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Modesti*, Sahar Saeedi Moghaddam*, Bahram Mohajer*, Mostafa K Mohamed*, Shukri F Mohamed*, Kazem Mohammad*, Zahra Mohammadi*, Noushin Mohammadifard*, Reza Mohammadpourhodki*, Viswanathan Mohan*, Salim Mohanna*, Muhammad Fadhli Mohd Yusoff*, Iraj Mohebbi*, Farnam Mohebi*, Marie Moitry*, Drude Molbo*, Line T Møllehave*, Niels C Møller*, Dénes Molnár*, Amirabbas Momenan*, Charles K Mondo*, Michele Monroy-Valle*, Eric Monterrubio-Flores*, Kotsedi Daniel K Monyeki*, Jin Soo Moon*, Mahmood Moosazadeh*, Leila B Moreira*, Alain Morejon*, Luis A Moreno*, Karen Morgan*, Suzanne N Morin*, Erik Lykke Mortensen*, George Moschonis*, Malgorzata Mossakowska*, Aya Mostafa*, Anabela Mota-Pinto*, Jorge Mota*, Mohammad Esmaeel Motlagh*, Jorge Motta*, Marcos André Moura-dos-Santos*, Malay K Mridha*, Kelias P Msyamboza*, Thet Thet Mu*, Magdalena Muc*, Boban Mugoša*, Maria L Muiesan*, Parvina Mukhtorova*, Martina Müller-Nurasyid*, Neil Murphy*, Jaakko Mursu*, Elaine M Murtagh*, Kamarul Imran Musa*, Sanja Music Milanovic*, Vera Musil*, Norlaila Mustafa*, Iraj Nabipour*, Shohreh Naderimagham*, Gabriele Nagel*, Balkish M Naidu*, Farid Najafi*, Harunobu Nakamura*, Jana Námešná*, Ei Ei K Nang*, Vinay B Nangia*, Martin Nankap*, Sameer Narake*, Paola Nardone*, Matthias Nauck*, William A Neal*, Azim Nejatizadeh*, Keiu Nelis*, Liis Nelis*, Ilona Nenko*, Martin Neovius*, Flavio Nervi*, Chung T Nguyen*, Nguyen D Nguyen*, Quang Ngoc Nguyen*, Ramfis E Nieto-Martínez*, Yury P Nikitin*, Guang Ning*, Toshiharu Ninomiya*, Sania Nishtar*, Marianna Noale*, Oscar A Noboa*, Helena Nogueira*, Teresa Norat*, Maria Nordendahl*, Børge G Nordestgaard*, Davide Noto*, Natalia Nowak-Szczepanska*, Mohannad Al Nsour*, Irfan Nuhoglu*, Eha Nurk*, Terence W O'Neill*, Dermot O'Reilly*, Galina Obreja*, Caleb Ochimana*, Angélica M Ochoa-Avilés*, Eiji Oda*, Kyungwon Oh*, Kumiko Ohara*, Claes Ohlsson*, Ryutaro Ohtsuka*, Örn Olafsson*, Maria Teresa A Olinto*, Isabel O Oliveira*, Mohd Azahadi Omar*, Altan Onat*, Sok King Ong*, Lariane M Ono*, Pedro Ordunez*, Rui Ornelas*, Ana P Ortiz*, Pedro J Ortiz*, Merete Osler*, Clive Osmond*, Sergej M Ostojic*, Afshin Ostovar*, Johanna A Otero*, Kim Overvad*, Ellis Owusu-Dabo*, Fred Michel Paccaud*, Cristina Padez*, Ioannis Pagkalos*, Elena Pahomova*, Karina Mary de Paiva*, Andrzej Pajak*, Domenico Palli*, Alberto Palloni*, Luigi Palmieri*, Wen-Harn Pan*, Songhomitra Panda-Jonas*, Arvind Pandey*, Francesco Panza*, Dimitrios Papandreou*, Soon-Woo Park*, Suyeon Park*, Winsome R Parnell*, Mahboubeh Parsaeian*, Ionela M Pascanu*, Patrick Pasquet*, Nikhil D Patel*, Mangesh S Pednekar*, Nasheeta Peer*, Sergio Viana Peixoto*, Markku Peltonen*, Alexandre C Pereira*, Marco A Peres*, Napoleón Pérez-Farinós*, Cynthia M Pérez*, Valentina Peterkova*, Annette Peters*, Astrid Petersmann*, Janina Petkeviciene*, Ausra Petrauskiene*, Emanuela Pettenuzzo*, Niloofar Peykari*, Son Thai Pham*, Rafael N Pichardo*, Daniela Pierannunzio*, Iris Pigeot*, Hynek Pikhart*, Aida Pilav*, Lorenza Pilotto*, Francesco Pistelli*, Freda Pitakaka*, Aleksandra Piwonska*, Andreia N Pizarro*, Pedro Plans-Rubió*, Bee Koon Poh*, Hermann Pohlabeln*, Raluca M Pop*, Stevo R Popovic*, Miquel Porta*, Georg Posch*, Anil Poudyal*, Dimitrios Poulimeneas*, Hamed Pouraram*, Farhad Pourfarzi*, Akram Pourshams*, Hossein Poustchi*, Rajendra Pradeepa*, Alison J Price*, Jacqueline F Price*, Rui Providencia*, Jardena J Puder*, Iveta Pudule*, Soile E Puhakka*, Maria Puiu*, Margus Punab*, Radwan F Qasrawi*, Mostafa Qorbani*, Tran Quoc Bao*, Ivana Radic*, Ricardas Radisauskas*, Salar Rahimikazerooni*, Mahfuzar Rahman*, Mahmudur Rahman*, Olli Raitakari*, Manu Raj*, Ellina Rakhimova*, Sherali Rakhmatulloev*, Ivo Rakovac*, Sudha Ramachandra Rao*, Ambady Ramachandran*, Jacqueline Ramke*, Elisabete Ramos*, Rafel Ramos*, Lekhraj Rampal*, Sanjay Rampal*, Vayia Rarra*, Ramon A Rascon-Pacheco*, Mette Rasmussen*, Cassiano Ricardo Rech*, Josep Redon*, Paul Ferdinand M Reganit*, Valéria Regecová*, Luis Revilla*, Abbas Rezaianzadeh*, Lourdes Ribas-Barba*, Robespierre Ribeiro*, Elio Riboli*, Adrian Richter*, Fernando Rigo*, Natascia Rinaldo*, Tobias F Rinke de Wit*, Ana Rito*, Raphael M Ritti-Dias*, Juan A Rivera*, Cynthia Robitaille*, Romana Roccaldo*, Daniela Rodrigues*, Fernando Rodríguez-Artalejo*, María del Cristo Rodriguez-Perez*, Laura A Rodríguez-Villamizar*, Ulla Roggenbuck*, Rosalba Rojas-Martinez*, Nipa Rojroongwasinkul*, Dora Romaguera*, Elisabetta L Romeo*, Rafaela V Rosario*, Annika Rosengren*, Ian Rouse*, Joel GR Roy*, Adolfo Rubinstein*, Frank J Rühli*, Jean-Bernard Ruidavets*, Blanca Sandra Ruiz-Betancourt*, Emma Ruiz Moreno*, Iuliia A Rusakova*, Kenisha Russell Jonsson*, Paola Russo*, Petra Rust*, Marcin Rutkowski*, Charumathi Sabanayagam*, Elena Sacchini*, Harshpal S Sachdev*, Alireza Sadjadi*, Ali Reza Safarpour*, Sare Safi*, Saeid Safiri*, Olfa Saidi*, Nader Saki*, Benoit Salanave*, Eduardo Salazar Martinez*, Diego Salmerón*, Veikko Salomaa*, Jukka T Salonen*, Massimo Salvetti*, Margarita Samoutian*, Jose Sánchez-Abanto*, Sandjaja*, Susana Sans*, Loreto Santa Marina*, Diana A Santos*, Ina S Santos*, Lèlita C Santos*, Maria Paula Santos*, Osvaldo Santos*, Rute Santos*, Sara Santos Sanz*, Jouko L Saramies*, Luis B Sardinha*, Nizal Sarrafzadegan*, Thirunavukkarasu Sathish*, Kai-Uwe Saum*, Savvas Savva*, Mathilde Savy*, Norie Sawada*, Mariana Sbaraini*, Marcia Scazufca*, Beatriz D Schaan*, Angelika Schaffrath Rosario*, Herman Schargrodsky*, Anja Schienkiewitz*, Karin Schindler*, Sabine Schipf*, Carsten O Schmidt*, Ida Maria Schmidt*, Peter Schnohr*, Ben Schöttker*, Sara Schramm*, Stine Schramm*, Helmut Schröder*, Constance Schultsz*, Aletta E Schutte*, Sylvain Sebert*, Aye Aye Sein*, Rusidah Selamat*, Vedrana Sember*, Abhijit Sen*, Idowu O Senbanjo*, Sadaf G Sepanlou*, Victor Sequera*, Luis Serra-Majem*, Jennifer Servais*, Ludmila Ševcíková*, Svetlana A Shalnova*, Teresa Shamah-Levy*, Morteza Shamshirgaran*, Coimbatore Subramaniam Shanthirani*, Maryam Sharafkhah*, Sanjib K Sharma*, Jonathan E Shaw*, Amaneh Shayanrad*, Ali Akbar Shayesteh*, Lela Shengelia*, Zumin Shi*, Kenji Shibuya*, Hana Shimizu-Furusawa*, Dong Wook Shin*, Youchan Shin*, Majid Shirani*, Rahman Shiri*, Namuna Shrestha*, Khairil Si-Ramlee*, Alfonso Siani*, Rosalynn Siantar*, Abla M Sibai*, Antonio M Silva*, Diego Augusto Santos Silva*, Mary Simon*, Judith Simons*, Leon A Simons*, Agneta Sjöberg*, Michael Sjöström*, Gry Skodje*, Jolanta Slowikowska-Hilczer*, Przemyslaw Slusarczyk*, Liam Smeeth*, Hung-Kwan So*, Fernanda Cunha Soares*, Grzegorz Sobek*, Eugène Sobngwi*, Morten Sodemann*, Stefan Söderberg*, Moesijanti YE Soekatri*, Agustinus Soemantri*, Reecha Sofat*, Vincenzo Solfrizzi*, Mohammad Hossein Somi*, Emily Sonestedt*, Yi Song*, Thorkild IA Sørensen*, Elin P Sørgjerd*, Maroje Sorić*, Charles Sossa Jérome*, Victoria E Soto-Rojas*, Aïcha Soumaré*, Slavica Sovic*, Bente Sparboe-Nilsen*, Karen Sparrenberger*, Angela Spinelli*, Igor Spiroski*, Jan A Staessen*, Hanspeter Stamm*, Gregor Starc*, Maria G Stathopoulou*, Kaspar Staub*, Bill Stavreski*, Jostein Steene-Johannessen*, Peter Stehle*, Aryeh D Stein*, George S Stergiou*, Jochanan Stessman*, Ranko Stevanovic*, Jutta Stieber*, Doris Stöckl*, Tanja Stocks*, Jakub Stokwiszewski*, Ekaterina Stoyanova*, Gareth Stratton*, Karien Stronks*, Maria Wany Strufaldi*, Lela Sturua*, Ramón Suárez-Medina*, Machi Suka*, Chien-An Sun*, Johan Sundström*, Yn-Tz Sung*, Jordi Sunyer*, Paibul Suriyawongpaisal*, Boyd A Swinburn*, Rody G Sy*, Holly E Syddall*, René Charles Sylva*, Moyses Szklo*, Lucjan Szponar*, E Shyong Tai*, Mari-Liis Tammesoo*, Abdonas Tamosiunas*, Eng Joo Tan*, Xun Tang*, Frank Tanser*, Yong Tao*, Mohammed Rasoul Tarawneh*, Jakob Tarp*, Carolina B Tarqui-Mamani*, Radka Taxová Braunerová*, Anne Taylor*, Julie Taylor*, Félicité Tchibindat*, William R Tebar*, Grethe S Tell*, Tania Tello*, KR Thankappan*, Holger Theobald*, Xenophon Theodoridis*, Lutgarde Thijs*, Nihal Thomas*, Betina H Thuesen*, Lubica Tichá*, Erik J Timmermans*, Anne Tjonneland*, Hanna K Tolonen*, Janne S Tolstrup*, Murat Topbas*, Roman Topór-Madry*, Liv Elin Torheim*, María José Tormo*, Michael J Tornaritis*, Maties Torrent*, Laura Torres-Collado*, Stefania Toselli*, Pierre Traissac*, Thi Tuyet-Hanh Tran*, Dimitrios Trichopoulos*, Antonia Trichopoulou*, Oanh TH Trinh*, Atul Trivedi*, Lechaba Tshepo*, Maria Tsigga*, Shoichiro Tsugane*, Azaliia M Tuliakova*, Marshall K Tulloch-Reid*, Fikru Tullu*, Tomi-Pekka Tuomainen*, Jaakko Tuomilehto*, Maria L Turley*, Per Tynelius*, Themistoklis Tzotzas*, Christophe Tzourio*, Peter Ueda*, Eunice Ugel*, Flora AM Ukoli*, Hanno Ulmer*, Belgin Unal*, Zhamyila Usupova*, Hannu MT Uusitalo*, Nalan Uysal*, Justina Vaitkeviciute*, Gonzalo Valdivia*, Susana Vale*, Damaskini Valvi*, Rob M van Dam*, Johan Van der Heyden*, Yvonne T van der Schouw*, Koen Van Herck*, Hoang Van Minh*, Irene GM van Valkengoed*, Dirk Vanderschueren*, Diego Vanuzzo*, Anette Varbo*, Gregorio Varela-Moreiras*, Patricia Varona-Pérez*, Senthil K Vasan*, Tomas Vega*, Toomas Veidebaum*, Gustavo Velasquez-Melendez*, Biruta Velika*, Giovanni Veronesi*, WM Monique Verschuren*, Cesar G Victora*, Giovanni Viegi*, Lucie Viet*, Salvador Villalpando*, Paolo Vineis*, Jesus Vioque*, Jyrki K Virtanen*, Marjolein Visser*, Sophie Visvikis-Siest*, Bharathi Viswanathan*, Mihaela Vladulescu*, Tiina Vlasoff*, Dorja Vocanec*, Henry Völzke*, Ari Voutilainen*, Sari Voutilainen*, Martine Vrijheid*, Tanja GM Vrijkotte*, Alisha N Wade*, Aline Wagner*, Thomas Waldhör*, Janette Walton*, Elvis OA Wambiya*, Wan Mohamad Wan Bebakar*, Wan Nazaimoon Wan Mohamud*, Rildo de Souza Wanderley Júnior*, Ming-Dong Wang*, Ningli Wang*, Qian Wang*, Xiangjun Wang*, Ya Xing Wang*, Ying-Wei Wang*, S Goya Wannamethee*, Nicholas Wareham*, Adelheid Weber*, Niels Wedderkopp*, Deepa Weerasekera*, Daniel Weghuber*, Wenbin Wei*, Aneta Weres*, Bo Werner*, Peter H Whincup*, Kurt Widhalm*, Indah S Widyahening*, Andrzej Wiecek*, Rainford J Wilks*, Johann Willeit*, Peter Willeit*, Julianne Williams*, Tom Wilsgaard*, Bogdan Wojtyniak*, Roy A Wong-McClure*, Andrew Wong*, Jyh Eiin Wong*, Tien Yin Wong*, Jean Woo*, Mark Woodward*, Frederick C Wu*, Jianfeng Wu*, Li Juan Wu*, Shouling Wu*, Haiquan Xu*, Liang Xu*, Nor Azwany Yaacob*, Uruwan Yamborisut*, Weili Yan*, Ling Yang*, Xiaoguang Yang*, Yang Yang*, Nazan Yardim*, Mehdi Yaseri*, Tabara Yasuharu*, Xingwang Ye*, Panayiotis K Yiallouros*, Moein Yoosefi*, Akihiro Yoshihara*, Qi Sheng You*, San-Lin You*, Novie O Younger-Coleman*, Safiah Md Yusof*, Ahmad Faudzi Yusoff*, Luciana Zaccagni*, Vassilis Zafiropulos*, Ahmad A Zainuddin*, Seyed Rasoul Zakavi*, Farhad Zamani*, Sabina Zambon*, Antonis Zampelas*, Hana Zamrazilová*, Maria Elisa Zapata*, Abdul Hamid Zargar*, Ko Ko Zaw*, Tomasz Zdrojewski*, Tajana Zeljkovic Vrkic*, Yi Zeng*, Luxia Zhang*, Zhen-Yu Zhang*, Dong Zhao*, Ming-Hui Zhao*, Wenhua Zhao*, Shiqi Zhen*, Wei Zheng*, Yingfeng Zheng*, Bekbolat Zholdin*, Maigeng Zhou*, Dan Zhu*, Yanina Zocalo*, Julio Zuñiga Cisneros*, Monika Zuziak*. *Contributed equally. 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Lacramioara Brinduse
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Secular Trends in Height, Body Mass and Mean Menarche Age in Romanian Children and Adolescents, 1936–2016
Arava Tenenboum
International Journal of Environmental Research and Public Health
Secular trends in anthropometric parameters have been documented in most European countries, but no data is available regarding Romanian. The aim of the study was to calculate secular trend in height, body mass and mean menarche age for Romanian children and adolescents. Methods: A secondary data analysis was performed using ten data sets for urban and eight data sets for rural boys and girls, age 5–15 years, covering 80 years (1936 to 2016). Secular trend in height (cm/decade), body mass(kg/decade) and mean menarche age (years) were calculated. Results: Overall, there was a positive secular trend for height in both genders, which parallels the gross domestic product (GDP)/capita difference, more pronounced in boys, across all age-groups, with a maximum for 15 years-old boys (~3 cm/decade) and 13 years-old girls (~2 cm/decade). Body mass trend was also positive, more accentuated in the rural population. Mean age at menarche was higher in rural compared to urban girls, had a negative...
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Associations of MC4R, LEP, and LEPR Polymorphisms with Obesity-Related Parameters in Childhood and Adulthood
Alina Smalinskiene
Genes
MC4R, LEP, and LEPR genes are involved in the hypothalamic leptin-melanocortin regulation pathway, which is important for energy homeostasis. Our study aimed to evaluate the associations between the MC4R rs17782313, LEP rs7799039, and LEPR rs1137101 polymorphisms with obesity-related parameters in childhood and adulthood. The data were obtained from the Kaunas Cardiovascular Risk Cohort study, which started in 1977 with 1082 participants aged 12–13 years. In 2012–2014, the follow-up survey was carried out. Genotype analysis of all respondents (n = 509) aged 48–49 years was performed for the gene polymorphisms using Real-Time Polymerase Chain Reaction. Anthropometric measurements were performed in childhood and adulthood. In childhood, only skinfold thicknesses were associated with gene variants being the lowest in children with MC4R TT genotype and LEP AG genotype. In adulthood, odds of obesity and metabolic syndrome was higher in MC4R CT/CC genotype than TT genotype carriers (OR 1....
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Density of Fast Food Outlets around Educational Facilities in Riyadh, Saudi Arabia: Geospatial Analysis
hala Aljishi
International Journal of Environmental Research and Public Health
Background: Childhood obesity remains a public health issue globally. The latest estimate from the World Health Organization showed that over 340 million children and adolescents aged 5–19 were overweight or obese in 2016. Objective: Our study aimed to assess the density of fast food outlets around educational facilities in Riyadh, Saudi Arabia. Methods: We employed geospatial and quantitative analyses using data on fast food outlets (from surveys conducted between November 2019 and May 2020) and educational facilities in Riyadh city. Data analyses conducted using ArcMap 10.6 and Stata 15 compared the density within 500 m and 500–1000 m from the facilities. Results: We found a high density of fast food outlets around educational facilities. Nearly 80% of fast food were within twelve-minute walking or five-minute driving distances from schools, and nearly 70% of all educational facilities had at least one fast food outlet within the buffer. We also found the densities were high withi...
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Can Anthropometry and Body Composition Explain Physical Fitness Levels in School-Aged Children?
Hai-Hua Chuang
2021
Physical fitness (PF) is closely related to various health outcomes and quality of life among children. However, the associations between anthropometry, body composition (BC), and PF are not fully elucidated. This cross-sectional study aimed to investigate the associations between demographic metrics (age, sex), anthropometric measures (body mass index z-score (BMI z-score) waist/height ratio (WHtR)), BC parameters (body-fat percentage (BF%), muscle weight), and PF levels (800-m run, sit-and-reach, 1-min sit-ups, standing long jump) in school-aged children. Continuous variables were dichotomized by median splits. The results of 180 girls and 180 boys (mean age: 10.0 ± 0.7 years; mean BMI z-score: 0.366 ± 1.216) were analyzed. Multivariable linear regressions revealed that BF% (regression coefficient (B) = 3.4, 95% confidence interval (CI) = 2.5–4.3) was independently correlated with the 800-m run. Sex (B = 4.6, 95% CI = 3.0–6.3), age (B = 3.1, 95% CI = 1.9–4.3), and BMI z-score (B =...
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Physical Activity for Health and Wellness
Luciana Zaccagni
International Journal of Environmental Research and Public Health
Regular physical activity (PA) is both a preventive measure and a cure for non-communicable diseases (NCDs) [...]
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Body Mass Index and Height in Friedreich Ataxia
Sylvia Boesch
Neurology Genetics, 2021
Go to Neurology.org/NG for full disclosures. Funding information is provided at the end of the article.
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Longitudinal Associations between Intake of Fruit and Vegetables and Height Attainment from Preschool to School Entry
Rafaela Rosário
2021
To examine associations between fruit and vegetable intake in young childhood and height attainment during preschool and at school entry. Data for this study was based on “The Healthy Start” primary intervention study, which included 635 obesity-prone children, (58% boys), from the greater Copenhagen area, with a mean (SD) age of 4.0 (1.1) years (age range 2–6 years) at baseline. In the current study, 553 children (57% boys) were included with information on dietary intake at baseline and height measured at baseline (preschool age), and 511 children (56.8% boys) with the height measured at school entry (~6 years old). Height was measured by trained health professionals during the intervention and by school nurses at school entry. Information on intakes of fruit and vegetables, separately and combined, was gathered with four-day dietary records reported by parents. Participants were grouped into tertiles for their intakes at baseline. Compared to boys with low consumption, those with...
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Association of Obesity with Food Choices among Children Between Age Group of 5 To 12 Years in Different Areas of Lahore
Hafsa Tahir
Pakistan BioMedical Journal
The relationship between the socioeconomic status (SES) of parents and the effect of socio-economic status on the food intake pattern of their children was examined in this study. Children of low SES generally have poorer diets than children of high SES. Objective: To observe the association of child obesity with food choices in different areas of Lahore Methods: Data were collected from 38 participants, from different areas of Lahore, Pakistan. From which 20 were female and 18 were male children. Their parents were requested to solve a questionnaire which comprised of different questions related to child age, height, weight, eating habits and parent’s socioeconomic status and their education. Results: Study showed that children growing up in families with a lower SES had a higher body mass index (BMI), lower quality of life, less healthy nutrition, and less physical activity as compared to children growing up in families with a higher SES. The food frequency questionnaire showed t...
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Predicting the earliest deviation in weight gain in the course towards manifest overweight in offspring exposed to obesity in pregnancy: a longitudinal cohort study
Maria Delius
BMC Medicine
Background Obesity in pregnancy and related early-life factors place the offspring at the highest risk of being overweight. Despite convincing evidence on these associations, there is an unmet public health need to identify “high-risk” offspring by predicting very early deviations in weight gain patterns as a subclinical stage towards overweight. However, data and methods for individual risk prediction are lacking. We aimed to identify those infants exposed to obesity in pregnancy at ages 3 months, 1 year, and 2 years who likely will follow a higher-than-normal body mass index (BMI) growth trajectory towards manifest overweight by developing an early-risk quantification system. Methods This study uses data from the prospective mother-child cohort study Programming of Enhanced Adiposity Risk in CHildhood–Early Screening (PEACHES) comprising 1671 mothers with pre-conception obesity and without (controls) and their offspring. Exposures were pre- and postnatal risks documented in patien...
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Secular Trends of Underweight, Overweight, and Obesity in Children and Adolescents from Ukraine
Olena Nyankovska
International Journal of Environmental Research and Public Health, 2021
Overweight and obesity, as well as underweight in children and adolescents, pose a significant public health issue. This study aimed to investigate the secular trend of the incidence of underweight, overweight, and obesity in children from Ukraine in 2013/2014 and 2018/2019. The studies were conducted in randomly selected primary and secondary schools in Ukraine. In total, 13,447 children (6468 boys and 6979 girls) participated in the study in 2013/2014 and 18,144 children (8717 boys and 9427 girls) participated in 2018/2019. Measurements of body weight and height were performed in triplicate. Underweight, overweight, and obesity were diagnosed according to the standards of the World Health Organization (WHO). In the group of girls, a significant difference between 2013/2014 and 2018/2019 measurements was found only among 7-year-olds. The percentage of girls at this age exceeding the body mass index (BMI) norm was lower in the 2018/2019 study. In boys, a significant difference was a...
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Fitness, Food, and Biomarkers: Characterizing Body Composition in 19,634 Early Adolescents
Alina Rodriguez
Nutrients
Adolescent obesity persists as a major concern, especially in Central and Eastern Europe, yet evidence gaps exist regarding the pivotal early adolescent years. Our objective was to provide a comprehensive picture using a holistic approach of measured anthropometry in early adolescence, including body composition, cardiorespiratory fitness (CRF), and reported lifestyle characteristics. We aimed to elucidate potential sex/gender differences throughout and associations to biomarkers of disease risk for obese adolescents. Methods: Trained nurses measured 19,634 early adolescents (12–14-year-olds), we collected parental reports, and, for obese adolescents, fasting blood samples in four major Polish cities using a cross-sectional developmental design. Results: 24.7% boys and 18.6% girls were overweight/obese, and 2886 had BMI ≥ 90th percentile. With increasing age, there was greater risk of obesity among boys (p for trend = 0.001) and a decreasing risk of thinness for girls (p for trend =...
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Realising the potential of schools to improve adolescent nutrition
Regina Guthold
BMJ
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Evolution of Lactase Persistence: Turbo-Charging Adaptation in Growth Under the Selective Pressure of Maternal Mortality?
Emma Pomeroy
Frontiers in Physiology, 2021
The emergence of the capacity to digest milk in some populations represents a landmark in human evolution, linking genetic change with a component of niche construction, namely dairying. Alleles promoting continued activity of the enzyme lactase through the life-course (lactase persistence) evolved in several global regions within the last 7,000 years. In some European regions, these alleles underwent rapid selection and must have profoundly affected fertility or mortality. Elsewhere, alleles spread more locally. However, the functional benefits underlying the rapid spread of lactase persistence remain unclear. Here, we set out the hypothesis that lactase persistence promoted skeletal growth, thereby offering a generic rapid solution to childbirth complications arising from exposure to ecological change, or to new environments through migration. Since reduced maternal growth and greater neonatal size both increase the risk of obstructed labour, any ecological exposure impacting thes...
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Assessment of the Long-Term Exposure to Lead in Four European Countries Using PBPK Modeling
Mouhamadou Sy
Exposure and Health
Lead (Pb) is a naturally occurring heavy metal that received, in the last decades, much attention in the human health risk assessment community. In the European Human Biomonitoring Initiative (HBM4EU), Pb was identified as a priority substance as various scientific and policy questions were open and still to be answered. They included the further investigation of the internal exposure to Pb, the factors determining it, and its variations within European populations. The aim of this work was to develop an integrative modeling framework for the assessment of the aggregated long-term exposure to Pb in Belgium, Czech Republic, Germany, and Norway. This framework enabled predicting the concentrations of Pb in human blood (PbB) from estimates of the external exposure. The effect of past and current exposure events was accounted for, as multiple country-specific Pb concentration data in environmental compartments and diet, and estimates of the dietary intake of Pb covering a period from th...
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Adiposity and High Blood Pressure during Childhood: A Prospective Analysis of the Role of Physical Activity Intensity and Sedentary Time in the GECKO Drenthe Cohort
Esther Hartman
International Journal of Environmental Research and Public Health, 2020
Whereas in adults, physical inactivity is strongly related to obesity and hypertension, in young children the evidence is inconsistent and scarce. We examined the association between physical activity (PA) behaviours at 5–6 years of age and adiposity and blood pressure (BP) at 10–11 years in 947 children (51% boys) from the Groningen Expert Center for Kids with Obesity (GECKO) Drenthe cohort. Sedentary time (ST) and light, moderate, and vigorous PA were assessed using accelerometry (ActiGraph GT3X, wear time > 600 min/day, ≥3 days). Body mass index (BMI), waist circumference (WC), and systolic and diastolic BP were measured at 5–6 and 10–11 years of age and standardized as age- and sex-adjusted (and height-adjusted, for BP) z-scores. Adjusted linear and logistic regression models showed that most PA behaviours were not related to standardized BMI or WC, overweightness/obesity, abdominal overweightness/obesity, standardized systolic or diastolic BP, pulse pressure, or prehypertens...
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Anthropometric Assessment of General and Central Obesity in Urban Moroccan Women
Amina Gihbid
International Journal of Environmental Research and Public Health
In the last few decades, North African countries have faced the nutrition transition, leading to an increase in obesity, exacerbated by an extremely low rate of physical activity (PA). Particular attention must be paid to abdominal obesity (one of the metabolic syndrome criteria), which has been linked to several health problems. The present study aims to investigate the prevalence of overweight/obesity, particularly abdominal obesity, in a sample of urban Moroccan women and to analyze the anthropometric indicators of metabolic syndrome risk among subsamples with different PA and socio-demographic characteristics. Urban Moroccan women living in Casablanca (n = 304; mean age 37.4 ± 15.6 years) were recruited for this cross-sectional study. Data concerning socio-demographic variables, PA behavior, and anthropometric measures (height, weight, waist, and hip circumferences) were directly collected. Body mass index, waist-to-hip ratio, waist-to-height ratio, and relative fat mass were co...
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A Review of Anthropometric Measurements for Saudi Adults and Elderly, Directions for Future Work and Recommendations to Establish Saudi Guidelines in Line with the Saudi 2030 Vision
Abeer Aljaadi
Healthcare
Body weight is a significant risk factor for the disease burden of noncommunicable diseases (NCDs). Anthropometric measurements are the first step in determining NCDs risk, and clinicians must have access to valid cutoffs. This study aims to review the literature of Saudi national guidelines and studies previously conducted in Saudi Arabia (SA) and to provide insights and recommendations to establish national guidelines in anthropometric measurements for Saudi adults/elderly in line with the Saudi 2030 Vision. In total, 163 studies were included, and 12 of them contributed to the development of specific anthropometric cutoffs. Cutoffs for metabolic syndrome, waist circumference, and body mass index were established in Saudi adults. However, limited studies were conducted in the elderly. This review warrants establishing standard cutoffs of Saudi adult anthropometrics to avoid over/underreporting of malnutrition and adiposity. This review will help policymakers and the Ministry of He...
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The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) Trial: Protocol for school-age follow-up
eddington mpofu
Wellcome Open Research
Background: There is a need for follow-up of early-life stunting intervention trials into childhood to determine their long-term impact. A holistic school-age assessment of health, growth, physical and cognitive function will help to comprehensively characterise the sustained effects of early-life interventions. Methods: The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial in rural Zimbabwe assessed the effects of improved infant and young child feeding (IYCF) and/or improved water, sanitation and hygiene (WASH) on stunting and anaemia at 18 months. Among children enrolled to SHINE, 1,275 have been followed up at 7-8 years of age (1,000 children who have not been exposed to HIV, 268 exposed to HIV antenatally who remain HIV negative and 7 HIV positive children). Children were assessed using the School-Age Health, Activity, Resilience, Anthropometry and Neurocognitive (SAHARAN) toolbox, to measure their growth, body composition, cognitive and physical function. In parallel,...
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Investigating the Association between Unhealthy Dietary Habits and Obesity among Libyan Adults
hamdi Abdulla lemamsha
International Journal of Environmental Research and Public Health
Background: Although an increasing number of studies have reported on nutrition transition and unhealthy eating habits (UEHs) worldwide, there is a paucity of studies on UEHs in the Arab region, particularly in Libya. Aim: This study investigated the associations between obesity among Libyan adults and UEHs. Methods: A cross-sectional survey was conducted at the five major districts in Benghazi, Libya. A multistage cluster sampling strategy was implemented to choose and recruit Libyan adults. Anthropometric measurements were gathered by highly qualified nurses, using the Segmental Body Composition Monitor and a portable Stadiometer. The study used and adapted the two Self-administered questionnaires: the WHO STEPS Instrument and eating behaviors linked with obesity questionnaire. Results: Among a total of 401 participants who were successfully recruited in this study, 253 (63%) were female (aged 20–65 years), the response rate achieved was 78%. The prevalence of obesity amongst Liby...
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Endocrine Health and Health Care Disparities in the Pediatric and Sexual and Gender Minority Populations: An Endocrine Society Scientific Statement
Adda Grimberg
The Journal of Clinical Endocrinology and Metabolism, 2023
Endocrine care of pediatric and adult patients continues to be plagued by health and health care disparities that are perpetuated by the basic structures of our health systems and research modalities, as well as policies that impact access to care and social determinants of health. This scientific statement expands the Society's 2012 statement by focusing on endocrine disease disparities in the pediatric population and sexual and gender minority populations. These include pediatric and adult lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA) persons. The writing group focused on highly prevalent conditions-growth disorders, puberty, metabolic bone disease, type 1 (T1D) and type 2 (T2D) diabetes mellitus, prediabetes, and obesity. Several important findings emerged. Compared with females and non-White children, non-Hispanic White males are more likely to come to medical attention for short stature. Racially and ethnically diverse populations and males are underrepresented in studies of pubertal development and attainment of peak bone mass, with current norms based on European populations. Like adults, racial and ethnic minority youth suffer a higher burden of disease from obesity, T1D and T2D, and have less access to diabetes treatment technologies and bariatric surgery. LGBTQIA youth and adults also face discrimination and multiple barriers to endocrine care due to pathologizing sexual orientation and gender identity, lack of culturally competent care providers, and policies. Multilevel interventions to address these disparities are required. Inclusion of racial, ethnic, and LGBTQIA populations in longitudinal life course studies is needed to assess growth, puberty, and attainment of peak bone mass. Growth and development charts may need to be adapted to non-European populations. In addition, extension of these studies will be required to understand the clinical and physiologic consequences of interventions to address abnormal development in these populations. Health policies should be recrafted to remove barriers in care for children with obesity and/or diabetes and for LGBTQIA children and adults to facilitate comprehensive access to care, therapeutics, and technological advances. Public health interventions encompassing collection of accurate demographic and social needs data, including the intersection of social determinants of health with health outcomes, and enactment of population health level interventions will be essential tools.
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