Rethinking the “Diseases of Affluence” Paradigm: Global Patterns of Nutritional Risks in Relation to Economic Development

Majid Ezzati,W Philip T James,Alan D Lopez,Anthony Rodgers,Carlene M M Lawes,Rachel Leach,Christopher J L Murray,Stephen Vander Hoorn,Thomas Novotny

doi:10.1371/journal.pmed.0020133

Majid Ezzati, W Philip T James + Show 7 more

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https://doi.org/10.1371/journal.pmed.0020133

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Abstract

BackgroundCardiovascular diseases and their nutritional risk factors—including overweight and obesity, elevated blood pressure, and cholesterol—are among the leading causes of global mortality and morbidity, and have been predicted to rise with economic development.Methods and FindingsWe examined age-standardized mean population levels of body mass index (BMI), systolic blood pressure, and total cholesterol in relation to national income, food share of household expenditure, and urbanization in a cross-country analysis. Data were from a total of over 100 countries and were obtained from systematic reviews of published literature, and from national and international health agencies.BMI and cholesterol increased rapidly in relation to national income, then flattened, and eventually declined. BMI increased most rapidly until an income of about I$5,000 (international dollars) and peaked at about I$12,500 for females and I$17,000 for males. Cholesterol's point of inflection and peak were at higher income levels than those of BMI (about I$8,000 and I$18,000, respectively). There was an inverse relationship between BMI/cholesterol and the food share of household expenditure, and a positive relationship with proportion of population in urban areas. Mean population blood pressure was not correlated or only weakly correlated with the economic factors considered, or with cholesterol and BMI.ConclusionsWhen considered together with evidence on shifts in income–risk relationships within developed countries, the results indicate that cardiovascular disease risks are expected to systematically shift to low-income and middle-income countries and, together with the persistent burden of infectious diseases, further increase global health inequalities. Preventing obesity should be a priority from early stages of economic development, accompanied by population-level and personal interventions for blood pressure and cholesterol.

Highlights

Cardiovascular diseases and their nutritional risk factors are among the leading causes of mortality and morbidity globally (Figure 1), and have been predicted to rise over the few decades [1,2,3]
We examined age-standardized mean population levels of body mass index (BMI), systolic blood pressure, and total cholesterol in relation to national income, food share of household expenditure, and urbanization in a cross-country analysis
Preventing obesity should be a priority from early stages of economic development, accompanied by population-level and personal interventions for blood pressure and cholesterol

Summary

Introduction

Cardiovascular diseases and their nutritional risk factors are among the leading causes of mortality and morbidity globally (Figure 1), and have been predicted to rise over the few decades [1,2,3]. It has been documented that within upper-middle-income and high-income countries, cardiovascular diseases and risk factors are increasingly concentrated among the lowest socioeconomic groups [8,9,10,11] Cardiovascular diseases and their nutritional risk factors—including overweight and obesity, elevated blood pressure, and cholesterol—are among the leading causes of global mortality and morbidity, and have been predicted to rise with economic development. The pattern of cardiovascular diseases is influenced by many lifestyle factors such as diet, physical activity, work and leisure, and smoking The effects of these factors are partly mediated through intermediate risk factors like overweight and obesity, blood pressure, and cholesterol. As more people lived in cities, the population’s BMI went up

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