TY - JOUR
T1 - Body mass index and diabetes risk in fifty-seven low- and middle-income countries
T2 - a cross-sectional study of nationally representative individual-level data
AU - Teufel , Felix
AU - Seiglie , Jacqueline A.
AU - Geldsetzer, Pascal
AU - Theilmann, Michaela
AU - Marcus , Maja-Emilia
AU - Ebert, Cara
AU - Lopez Arboleda , William Andres
AU - Agoudavi, Kokou
AU - Andall-Brereton, Glennis
AU - Aryal, Krishna K
AU - Brian, Garry
AU - Bovet, Pascal
AU - Dorobantu, Maria
AU - Singh Gurung, Mongal
AU - Guwatudde, David
AU - Houehanou, Corine
AU - Houinato, Dismand
AU - Jorgensen, Jutta Mari Adelin
AU - Kagaruki, Gibson B
AU - Karki, Khem B
AU - Labadarios, Demetre
AU - Martins, Joao S
AU - Mayige, Mary T
AU - McClure, Roy Wong
AU - Mwangi, Joseph Kibachio
AU - Mwalim, Omar
AU - Norov, Bolormaa
AU - Crooks , Sarah
AU - Farzadfar, Farshad
AU - Moghaddam, Sahar Saeedi
AU - Silver, Bahendeka K
AU - Sturua, Lela
AU - Wesseh, Chea Stanford
AU - Stokes, Andrew
AU - Essien , Utibe R.
AU - Neve , Jan-Walter De Pascal Geldsetzer
AU - Atun, Rifat
AU - Davies, Justine
AU - Vollmer, Sebastian
AU - Bärnighausen, Till W
AU - Ali, Mohammed K.
AU - Meigs , James B.
AU - Wexler , Deborah J.
AU - Manne-Goehler, Jennifer
PY - 2021/7/17
Y1 - 2021/7/17
N2 - BackgroundThe prevalence of overweight, obesity, and diabetes is rising rapidly in low-income and middle-income countries (LMICs), but there are scant empirical data on the association between body-mass index (BMI) and diabetes in these settings.MethodsIn this cross-sectional study, we pooled individual-level data from nationally representative surveys across 57 LMICs. We identified all countries in which a WHO Stepwise Approach to Surveillance (STEPS) survey had been done during a year in which the country fell into an eligible World Bank income group category. For LMICs that did not have a STEPS survey, did not have valid contact information, or declined our request for data, we did a systematic search for survey datasets. Eligible surveys were done during or after 2008; had individual-level data; were done in a low-income, lower-middle-income, or upper-middle-income country; were nationally representative; had a response rate of 50% or higher; contained a diabetes biomarker (either a blood glucose measurement or glycated haemoglobin [HbA1c]); and contained data on height and weight. Diabetes was defined biologically as a fasting plasma glucose concentration of 7·0 mmol/L (126·0 mg/dL) or higher; a random plasma glucose concentration of 11·1 mmol/L (200·0 mg/dL) or higher; or a HbA1c of 6·5% (48·0 mmol/mol) or higher, or by self-reported use of diabetes medication. We included individuals aged 25 years or older with complete data on diabetes status, BMI (defined as normal [18·5–22·9 kg/m2], upper-normal [23·0–24·9 kg/m2], overweight [25·0–29·9 kg/m2], or obese [≥30·0 kg/m2]), sex, and age. Countries were categorised into six geographical regions: Latin America and the Caribbean, Europe and central Asia, east, south, and southeast Asia, sub-Saharan Africa, Middle East and north Africa, and Oceania. We estimated the association between BMI and diabetes risk by multivariable Poisson regression and receiver operating curve analyses, stratified by sex and geographical region.FindingsOur pooled dataset from 58 nationally representative surveys in 57 LMICs included 685 616 individuals. The overall prevalence of overweight was 27·2% (95% CI 26·6–27·8), of obesity was 21·0% (19·6–22·5), and of diabetes was 9·3% (8·4–10·2). In the pooled analysis, a higher risk of diabetes was observed at a BMI of 23 kg/m2 or higher, with a 43% greater risk of diabetes for men and a 41% greater risk for women compared with a BMI of 18·5–22·9 kg/m2. Diabetes risk also increased steeply in individuals aged 35–44 years and in men aged 25–34 years in sub-Saharan Africa. In the stratified analyses, there was considerable regional variability in this association. Optimal BMI thresholds for diabetes screening ranged from 23·8 kg/m2 among men in east, south, and southeast Asia to 28·3 kg/m2 among women in the Middle East and north Africa and in Latin America and the Caribbean.InterpretationThe association between BMI and diabetes risk in LMICs is subject to substantial regional variability. Diabetes risk is greater at lower BMI thresholds and at younger ages than reflected in currently used BMI cutoffs for assessing diabetes risk. These findings offer an important insight to inform context-specific diabetes screening guidelines.FundingHarvard T H Chan School of Public Health McLennan Fund: Dean's Challenge Grant Program.
AB - BackgroundThe prevalence of overweight, obesity, and diabetes is rising rapidly in low-income and middle-income countries (LMICs), but there are scant empirical data on the association between body-mass index (BMI) and diabetes in these settings.MethodsIn this cross-sectional study, we pooled individual-level data from nationally representative surveys across 57 LMICs. We identified all countries in which a WHO Stepwise Approach to Surveillance (STEPS) survey had been done during a year in which the country fell into an eligible World Bank income group category. For LMICs that did not have a STEPS survey, did not have valid contact information, or declined our request for data, we did a systematic search for survey datasets. Eligible surveys were done during or after 2008; had individual-level data; were done in a low-income, lower-middle-income, or upper-middle-income country; were nationally representative; had a response rate of 50% or higher; contained a diabetes biomarker (either a blood glucose measurement or glycated haemoglobin [HbA1c]); and contained data on height and weight. Diabetes was defined biologically as a fasting plasma glucose concentration of 7·0 mmol/L (126·0 mg/dL) or higher; a random plasma glucose concentration of 11·1 mmol/L (200·0 mg/dL) or higher; or a HbA1c of 6·5% (48·0 mmol/mol) or higher, or by self-reported use of diabetes medication. We included individuals aged 25 years or older with complete data on diabetes status, BMI (defined as normal [18·5–22·9 kg/m2], upper-normal [23·0–24·9 kg/m2], overweight [25·0–29·9 kg/m2], or obese [≥30·0 kg/m2]), sex, and age. Countries were categorised into six geographical regions: Latin America and the Caribbean, Europe and central Asia, east, south, and southeast Asia, sub-Saharan Africa, Middle East and north Africa, and Oceania. We estimated the association between BMI and diabetes risk by multivariable Poisson regression and receiver operating curve analyses, stratified by sex and geographical region.FindingsOur pooled dataset from 58 nationally representative surveys in 57 LMICs included 685 616 individuals. The overall prevalence of overweight was 27·2% (95% CI 26·6–27·8), of obesity was 21·0% (19·6–22·5), and of diabetes was 9·3% (8·4–10·2). In the pooled analysis, a higher risk of diabetes was observed at a BMI of 23 kg/m2 or higher, with a 43% greater risk of diabetes for men and a 41% greater risk for women compared with a BMI of 18·5–22·9 kg/m2. Diabetes risk also increased steeply in individuals aged 35–44 years and in men aged 25–34 years in sub-Saharan Africa. In the stratified analyses, there was considerable regional variability in this association. Optimal BMI thresholds for diabetes screening ranged from 23·8 kg/m2 among men in east, south, and southeast Asia to 28·3 kg/m2 among women in the Middle East and north Africa and in Latin America and the Caribbean.InterpretationThe association between BMI and diabetes risk in LMICs is subject to substantial regional variability. Diabetes risk is greater at lower BMI thresholds and at younger ages than reflected in currently used BMI cutoffs for assessing diabetes risk. These findings offer an important insight to inform context-specific diabetes screening guidelines.FundingHarvard T H Chan School of Public Health McLennan Fund: Dean's Challenge Grant Program.
UR - http://www.thelancet.com/journals/lancet/issue/current
U2 - 10.1016/S0140-6736(21)00844-8
DO - 10.1016/S0140-6736(21)00844-8
M3 - Article
SN - 0140-6736
VL - 398
SP - 238
EP - 248
JO - The Lancet
JF - The Lancet
IS - 10296
ER -