聂鹏教授于2021年5月26日受邀加入NCD Risk Factor Collaboration (NCD-RisC)，并作为该合作团队成员之一在2024年2月22日在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: Underweight and obesity are associated with adverse health outcomes throughout the life-course. Our aim was to estimate the individual and combined prevalence of underweight/thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories.

Methods: We used data from 3,663 studies with 222 million participants that had measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different body-mass index (BMI) categories, separately for adults and school-aged children and adolescents (5-19 years). For adults, we report the individual and combined prevalence of underweight (BMI <18.5 kg/m²) and obesity (BMI ≥30 kg/m²), and for school-aged children and adolescents thinness (BMI <2SD below the median of the WHO growth reference) and obesity (BMI >2SD above the median).

Results: From 1990 to 2022, the combined prevalence of underweight and obesity in adults declined in 11 countries (6%) for women and 17 (9%) for men with posterior probability (PP) of the observed changes being true decreases ≥0.80; it increased in 162 countries (81%) for women and 140 countries (70%) for men with PP≥0.80. In 2022, the combined prevalence of underweight and obesity was ≥40% in 55 countries (28%) for women and 16 (8%) for men, and was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with PP ≥0.80 in 177 (89%) and 145 countries (73%) respectively for women and men in 2022, whereas the opposite was true in 16 countries (8%) for women, and 39 (20%) for men.

From 1990 to 2022, the combined burden of thinness and obesity declined among girls in five countries (3%) and among boys in 15 countries (8%) with PP ≥0.80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with PP ≥0.80. The countries with highest combined prevalence of thinness and obesity in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and, for boys, Chile and Qatar. Prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite its decline. In 2022, obesity in school ages was more prevalent than thinness with PP ≥0.80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the opposite was true in only 35 (18%) and 42 countries (21%) respectively.

In the vast majority of countries for both adults and school-aged children and adolescents, the increases in the double burden were driven by increases in obesity, and decreases in double burden were driven by declining underweight/thinness. The countries experiencing a decrease in double burden were predominantly in south and southeast Asia for both sexes and age groups, and in sub-Saharan Africa for males.

Interpretation: The combined prevalence of underweight/thinness and obesity has increased in most countries, driven by obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to healthy and nutritious foods is needed to address the remaining burden of underweight/thinness while curbing and reversing the rise in obesity.