聂鹏教授作为NCD Risk Factor Collaboration (NCD-RisC)成员之一，其参与的合作研究于在2024年8月30日在The Lancet发表题为“Worldwide trends in the burden of underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million school-aged children, adolescents and adults”。

Summary

Background: Adiposity can be measured using body mass index (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 persons with and without hypertension.

Methods: We used data from studies carried out from 1990 to 2023 on BMI, WHtR and hypertension from 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 level. We graphically examined the prevalence of hypertension, as well as the distribution of people who have hypertension in relation to BMI and WHtR, and assessed how closely BMI and WHtR discriminate between participants with and without hypertension using C-statistic and net reclassification improvement (NRI).

Results: The correlation between BMI and WHtR ranged from 0.76 to 0.89 within different regions. After accounting 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; it was lower 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 these two adiposity metrics had virtually identical C-statistics and NRI for every region and sex, with C-statistics ranging 0.72-0.81 and NRI ranging 0.34-0.57 in different region and sex combinations. When both BMI and WHtR were used, performance improved only slightly compared to using either adiposity measure alone.

Interpretation: BMI can distinguish young and middle-aged adults with higher versus lower levels of abdominal adiposity with moderate-to-high success, and both BMI and WHtR distinguish persons 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.

Zhou, B., et al. (2024). 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, 404(10455): 851 - 863. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01405-3/fulltext