General and abdominal adiposity and hypertension in eight world regions: a pooled analysis of 837 population-based studies with 7·5 million participants
Issued Date
2024-08-31
Resource Type
ISSN
01406736
eISSN
1474547X
Scopus ID
2-s2.0-85202151977
Pubmed ID
39216975
Journal Title
The Lancet
Volume
404
Issue
10455
Start Page
851
End Page
863
Rights Holder(s)
SCOPUS
Bibliographic Citation
The Lancet Vol.404 No.10455 (2024) , 851-863
Suggested Citation
Zhou B., Bennett J.E., Wickham A.P., Singleton R.K., Mishra A., Carrillo-Larco R.M., Ikeda N., Jain L., Barradas-Pires A., Heap R.A., Lhoste V.P.F., Sheffer K.E., Phelps N.H., Rayner A.W., Gregg E.W., Woodward M., Stevens G.A., Iurilli M.L.C., Danaei G., Cesare M.D., Aguilar-Salinas C.A., Ahmad N.A., Bovet P., Chen Z., Damasceno A., Filippi S.L., Janszky I., Kengne A.P., Khang Y.H., Khunti K., Laxmaiah A., Lim L.L., Lissner L., Margozzini P., Mbanya J.C., McGarvey S., Shaw J.E., Söderberg S., Soto-Mota L.A., Wang J., Zaccardi F., Ezzati M., Abarca-Gómez L., AbbasiKangevari M., Abdrakhmanova S., Abdul Ghaffar S.A., Abdul Rahim H.F., Abdurrahmonova Z., Abu-Rmeileh N.M., Acosta-Cazares B., Adam I., Adamczyk M., Aekplakorn W., Agdeppa I.A., Aghazadeh-Attari J., Agyemang C., Ahmad M.H., Ahmadi A., Ahmadi N., Ahmadi N., Ahmed S.H., Ahrens W., Aitmurzaeva G., Ajlouni K., Al-Hazzaa H.M., Al-Hinai H., Al-Lawati J.A., Al-Raddadi R., Asfoor D.A., Al Hourani H.M., Alarouj M., AlBuhairan F., AlDhukair S., Ali M.M., Alieva A.V., Alkandari A., Alkhatib B.M., Aly E., Amarapurkar D.N., Amiano Etxezarreta P., Amougou N., Andersen L.B., Anderssen S.A., Androutsos O., Anjana R.M., Ansari-Moghaddam A., Anufrieva E., Aounallah-Skhiri H., Aris T., Arku R.E., Arlappa N., Aryal K.K., Assah F.K., Assembekov B., Assunção M.C.F., Auvinen J., Avdicová M., Azad K., Azevedo A., Azimi-Nezhad M. General and abdominal adiposity and hypertension in eight world regions: a pooled analysis of 837 population-based studies with 7·5 million participants. The Lancet Vol.404 No.10455 (2024) , 851-863. 863. doi:10.1016/S0140-6736(24)01405-3 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/106687
Title
General and abdominal adiposity and hypertension in eight world regions: a pooled analysis of 837 population-based studies with 7·5 million participants
Author(s)
Zhou B.
Bennett J.E.
Wickham A.P.
Singleton R.K.
Mishra A.
Carrillo-Larco R.M.
Ikeda N.
Jain L.
Barradas-Pires A.
Heap R.A.
Lhoste V.P.F.
Sheffer K.E.
Phelps N.H.
Rayner A.W.
Gregg E.W.
Woodward M.
Stevens G.A.
Iurilli M.L.C.
Danaei G.
Cesare M.D.
Aguilar-Salinas C.A.
Ahmad N.A.
Bovet P.
Chen Z.
Damasceno A.
Filippi S.L.
Janszky I.
Kengne A.P.
Khang Y.H.
Khunti K.
Laxmaiah A.
Lim L.L.
Lissner L.
Margozzini P.
Mbanya J.C.
McGarvey S.
Shaw J.E.
Söderberg S.
Soto-Mota L.A.
Wang J.
Zaccardi F.
Ezzati M.
Abarca-Gómez L.
AbbasiKangevari M.
Abdrakhmanova S.
Abdul Ghaffar S.A.
Abdul Rahim H.F.
Abdurrahmonova Z.
Abu-Rmeileh N.M.
Acosta-Cazares B.
Adam I.
Adamczyk M.
Aekplakorn W.
Agdeppa I.A.
Aghazadeh-Attari J.
Agyemang C.
Ahmad M.H.
Ahmadi A.
Ahmadi N.
Ahmadi N.
Ahmed S.H.
Ahrens W.
Aitmurzaeva G.
Ajlouni K.
Al-Hazzaa H.M.
Al-Hinai H.
Al-Lawati J.A.
Al-Raddadi R.
Asfoor D.A.
Al Hourani H.M.
Alarouj M.
AlBuhairan F.
AlDhukair S.
Ali M.M.
Alieva A.V.
Alkandari A.
Alkhatib B.M.
Aly E.
Amarapurkar D.N.
Amiano Etxezarreta P.
Amougou N.
Andersen L.B.
Anderssen S.A.
Androutsos O.
Anjana R.M.
Ansari-Moghaddam A.
Anufrieva E.
Aounallah-Skhiri H.
Aris T.
Arku R.E.
Arlappa N.
Aryal K.K.
Assah F.K.
Assembekov B.
Assunção M.C.F.
Auvinen J.
Avdicová M.
Azad K.
Azevedo A.
Azimi-Nezhad M.
Bennett J.E.
Wickham A.P.
Singleton R.K.
Mishra A.
Carrillo-Larco R.M.
Ikeda N.
Jain L.
Barradas-Pires A.
Heap R.A.
Lhoste V.P.F.
Sheffer K.E.
Phelps N.H.
Rayner A.W.
Gregg E.W.
Woodward M.
Stevens G.A.
Iurilli M.L.C.
Danaei G.
Cesare M.D.
Aguilar-Salinas C.A.
Ahmad N.A.
Bovet P.
Chen Z.
Damasceno A.
Filippi S.L.
Janszky I.
Kengne A.P.
Khang Y.H.
Khunti K.
Laxmaiah A.
Lim L.L.
Lissner L.
Margozzini P.
Mbanya J.C.
McGarvey S.
Shaw J.E.
Söderberg S.
Soto-Mota L.A.
Wang J.
Zaccardi F.
Ezzati M.
Abarca-Gómez L.
AbbasiKangevari M.
Abdrakhmanova S.
Abdul Ghaffar S.A.
Abdul Rahim H.F.
Abdurrahmonova Z.
Abu-Rmeileh N.M.
Acosta-Cazares B.
Adam I.
Adamczyk M.
Aekplakorn W.
Agdeppa I.A.
Aghazadeh-Attari J.
Agyemang C.
Ahmad M.H.
Ahmadi A.
Ahmadi N.
Ahmadi N.
Ahmed S.H.
Ahrens W.
Aitmurzaeva G.
Ajlouni K.
Al-Hazzaa H.M.
Al-Hinai H.
Al-Lawati J.A.
Al-Raddadi R.
Asfoor D.A.
Al Hourani H.M.
Alarouj M.
AlBuhairan F.
AlDhukair S.
Ali M.M.
Alieva A.V.
Alkandari A.
Alkhatib B.M.
Aly E.
Amarapurkar D.N.
Amiano Etxezarreta P.
Amougou N.
Andersen L.B.
Anderssen S.A.
Androutsos O.
Anjana R.M.
Ansari-Moghaddam A.
Anufrieva E.
Aounallah-Skhiri H.
Aris T.
Arku R.E.
Arlappa N.
Aryal K.K.
Assah F.K.
Assembekov B.
Assunção M.C.F.
Auvinen J.
Avdicová M.
Azad K.
Azevedo A.
Azimi-Nezhad M.
Author's Affiliation
RSE on REM "National Center of Public Health" of the Ministry of Health of the Republic of Kazakhstan
National Institutes of Biomedical Innovation, Health and Nutrition
Éco-Anthropologie
Dasman Diabetes Institute
Leibniz Institute for Prevention Research and Epidemiology – BIPS GmbH
Western Norway University of Applied Sciences
Asfendiyarov Kazakh National Medical University
Neyshabur University of Medical Sciences
Princess Nourah Bint Abdulrahman University
Caja Costarricense de Seguro Social
King Saud bin Abdulaziz University for Health Sciences
Ministry of Health Seychelles
Qatar University
Birzeit University
Universidade Eduardo Mondlane
Ministry of Health Oman
Food and Nutrition Research Institute
Université de Yaoundé I
Hashemite University
Baker Heart and Diabetes Institute
University of Leicester
Harvard T.H. Chan School of Public Health
Umeå Universitet
Pontificia Universidad Católica de Chile
Universitetet i Bergen
Universiti Malaya
South African Medical Research Council
UNSW Sydney
Organisation Mondiale de la Santé
University of Oxford
University of Thessaly
Qassim University
Shahrekord University of Medical Sciences
Diabetic Association of Bangladesh
Bill & Melinda Gates Foundation
Urmia University of Medical Sciences
University of Ghana
Oulu University Hospital
Göteborgs Universitet
Imperial College London
Universidade Federal de Pelotas
University of Massachusetts Amherst
Norges Teknisk-Naturvitenskapelige Universitet
Oulun Yliopisto
Kementerian Kesihatan Malaysia
Mahidol University
Brown University
Bombay Hospital and Medical Research Centre
Instituto Nacional de la Nutrición Salvador Zubiran
Instituto Mexicano del Seguro Social
Shahid Sadoughi University of Medical Sciences
Universidade do Porto
King Abdulaziz University
Norges Idrettshøgskole
Universiteit van Amsterdam
University of Essex
Emory University
Seoul National University College of Medicine
Madras Diabetes Research Foundation
Royal College of Surgeons in Ireland
University of Hargeisa
ICMR-National Institute of Nutrition
Non-Communicable Diseases Research Center
Unisanté
Yekaterinburg State Medical University
Ministry of Health and Social Protection
RehaKlinika
Aldara Hospital and Medical Center
Departamento de Salud del Gobierno Vasco
Republican Center for Health Promotion
Health Promotion Research Center
National Center for Diabetes
National Institute of Public Health
Ministry of Health
Regional Authority of Public Health
National Institutes of Biomedical Innovation, Health and Nutrition
Éco-Anthropologie
Dasman Diabetes Institute
Leibniz Institute for Prevention Research and Epidemiology – BIPS GmbH
Western Norway University of Applied Sciences
Asfendiyarov Kazakh National Medical University
Neyshabur University of Medical Sciences
Princess Nourah Bint Abdulrahman University
Caja Costarricense de Seguro Social
King Saud bin Abdulaziz University for Health Sciences
Ministry of Health Seychelles
Qatar University
Birzeit University
Universidade Eduardo Mondlane
Ministry of Health Oman
Food and Nutrition Research Institute
Université de Yaoundé I
Hashemite University
Baker Heart and Diabetes Institute
University of Leicester
Harvard T.H. Chan School of Public Health
Umeå Universitet
Pontificia Universidad Católica de Chile
Universitetet i Bergen
Universiti Malaya
South African Medical Research Council
UNSW Sydney
Organisation Mondiale de la Santé
University of Oxford
University of Thessaly
Qassim University
Shahrekord University of Medical Sciences
Diabetic Association of Bangladesh
Bill & Melinda Gates Foundation
Urmia University of Medical Sciences
University of Ghana
Oulu University Hospital
Göteborgs Universitet
Imperial College London
Universidade Federal de Pelotas
University of Massachusetts Amherst
Norges Teknisk-Naturvitenskapelige Universitet
Oulun Yliopisto
Kementerian Kesihatan Malaysia
Mahidol University
Brown University
Bombay Hospital and Medical Research Centre
Instituto Nacional de la Nutrición Salvador Zubiran
Instituto Mexicano del Seguro Social
Shahid Sadoughi University of Medical Sciences
Universidade do Porto
King Abdulaziz University
Norges Idrettshøgskole
Universiteit van Amsterdam
University of Essex
Emory University
Seoul National University College of Medicine
Madras Diabetes Research Foundation
Royal College of Surgeons in Ireland
University of Hargeisa
ICMR-National Institute of Nutrition
Non-Communicable Diseases Research Center
Unisanté
Yekaterinburg State Medical University
Ministry of Health and Social Protection
RehaKlinika
Aldara Hospital and Medical Center
Departamento de Salud del Gobierno Vasco
Republican Center for Health Promotion
Health Promotion Research Center
National Center for Diabetes
National Institute of Public Health
Ministry of Health
Regional Authority of Public Health
Corresponding Author(s)
Other Contributor(s)
Abstract
Background: Adiposity can be measured using BMI (which is based on weight and height) as well as indices of abdominal adiposity. We examined the association between BMI and waist-to-height ratio (WHtR) within and across populations of different world regions and quantified how well these two metrics discriminate between people with and without hypertension. Methods: We used data from studies carried out from 1990 to 2023 on BMI, WHtR and hypertension in people aged 20–64 years in representative samples of the general population in eight world regions. We graphically compared the regional distributions of BMI and WHtR, and calculated Pearson's correlation coefficients between BMI and WHtR within each region. We used mixed-effects linear regression to estimate the extent to which WHtR varies across regions at the same BMI. We graphically examined the prevalence of hypertension and the distribution of people who have hypertension both in relation to BMI and WHtR, and we assessed how closely BMI and WHtR discriminate between participants with and without hypertension using C-statistic and net reclassification improvement (NRI). Findings: The correlation between BMI and WHtR ranged from 0·76 to 0·89 within different regions. After adjusting for age and BMI, mean WHtR was highest in south Asia for both sexes, followed by Latin America and the Caribbean and the region of central Asia, Middle East and north Africa. Mean WHtR was lowest in central and eastern Europe for both sexes, in the high-income western region for women, and in Oceania for men. Conversely, to achieve an equivalent WHtR, the BMI of the population of south Asia would need to be, on average, 2·79 kg/m2 (95% CI 2·31–3·28) lower for women and 1·28 kg/m2 (1·02–1·54) lower for men than in the high-income western region. In every region, hypertension prevalence increased with both BMI and WHtR. Models with either of these two adiposity metrics had virtually identical C-statistics and NRIs for every region and sex, with C-statistics ranging from 0·72 to 0·81 and NRIs ranging from 0·34 to 0·57 in different region and sex combinations. When both BMI and WHtR were used, performance improved only slightly compared with using either adiposity measure alone. Interpretation: BMI can distinguish young and middle-aged adults with higher versus lower amounts of abdominal adiposity with moderate-to-high accuracy, and both BMI and WHtR distinguish people with or without hypertension. However, at the same BMI level, people in south Asia, Latin America and the Caribbean, and the region of central Asia, Middle East and north Africa, have higher WHtR than in the other regions. Funding: UK Medical Research Council and UK Research and Innovation (Innovate UK).
