NCD Risk Factors Research Articles

Obesity Prevalence in the Long-Term Future in 18 European Countries and in the USA

Introduction: Obesity constitutes a major public health problem in Europe, but how the obesity epidemic in European countries will evolve remains unknown. Most previous obesity projections considered the short-term future only, focused on single non-European countries, and projected ongoing increases foremost. We comparatively project obesity prevalence into the long-term future for 18 European countries and the USA. Data: We used national age-specific (20–84 years) and sex-specific obesity prevalence estimates (1975–2016) from the NCD Risk Factor Collaboration (NCD-RisC) 2017 study, which are based on available measured height and weight data, supplemented with estimates from a Bayesian hierarchical model. Methods: We projected age- and sex-specific obesity prevalence up to the year 2100 by integrating the notion of a wave-shaped obesity epidemic into conventional age-period projections. Results: In 1990–2016, the increasing trends in obesity prevalence were decelerating. Obesity is expected to reach maximum levels between 2030 and 2052 among men, and between 2026 and 2054 among women. The maximum levels will likely be reached first in The Netherlands, USA, and UK, and last in Switzerland; and are expected to be highest in the USA and UK, and lowest in The Netherlands for men and Denmark for women. In 2060, obesity prevalence is expected to be lowest among Dutch men and highest among Swiss men. The projected age-specific obesity prevalence levels have an inverse U-shape, peaking at around the age of 60–69 years. Discussion: Applying our novel approach to the NCD-RisC 2017 data, obesity prevalence is expected to reach maximum levels between 2026 and 2054, with the USA and UK reaching the highest maximum levels first, followed by other European countries.

Health disparity toward noncommunicable diseases among residents in rural Cambodia: a descriptive study.

Objective: Regional disparities in health services is a crucial problem in Cambodia. Particularly, a number of NCD risk factors are more common among the rural poor. Fortunately, 80% of NCDs are preventable and cost-effective interventions exist. Therefore, health care needs assessments regarding NCDs in poor rural areas are vital. The object of this pilot study was to identify health care needs regarding NCDs among residents in poor rural areas in Cambodia.Materials and Methods: A medical health check-up and questionnaire survey were conducted with 208 rural residents who participated in a free health check-up and doctor consultation in Kaoh Peam Reang.Results: One hundred sixteen (55.8%) females were included in the total sample size of 208 participants; the majority (52.9%) were between 35 and 65 years of age. Twenty-five participants (12%) were current smokers, and 44 (21%) were current alcohol drinkers. Eighty (38.5%) participants had hypertension and 44 participants (21.2%) had a body mass index over 25. Alcohol drinking and smoking habits were more common among men. The five most frequent medical complaints were headache (18.3%), lower back pain (14.4%), foot and hand pain (13.9%), joint pain (10.1%), and difficulty breathing (10.1%).Conclusions: The medical need for doctor consultations regarding chronic disease and chronic pain might be higher in poor rural areas in Cambodia.

Socio-economic and demographic determinants of non-communicable diseases in Kenya: a secondary analysis of the Kenya stepwise survey.

Introductionnon-communicable diseases (NCDs) are projected to become the leading cause of death in Africa by 2030. Gender and socio-economic differences influence the prevalence of NCDs and their risk factors.Methodswe performed a secondary analysis of the STEPS 2015 data to determine prevalence and correlation between diabetes, hypertension, harmful alcohol use, smoking, obesity and injuries across age, gender, residence and socio-economic strata.Resultstobacco use prevalence was 13.5% (males 19.9%, females 0.9%, p<0.001); harmful alcohol use was 12.6% (males 18.1%, females 2.2%, p<0.001); central obesity was 27.9% (females 49.5%, males 32.9%, p=0.017); type 2 diabetes prevalence 3.1% (males 2.0%, females 2.8%, p=0.048); elevated blood pressure prevalence was 23.8% (males 25.1%, females 22.6%, p<0.001), non-use of helmets 72.8% (males 89.5%, females 56.0%, p=0.031) and seat belts non-use 67.9% (males 79.8%, females 56.0%, p=0.027). Respondents with <12 years of formal education had higher prevalence of non-use of helmets (81.7% versus 54.1%, p=0.03) and seat belts (73.0% versus 53.9%, p=0.039). Respondents in the highest wealth quintile had higher prevalence of type II diabetes compared with those in the lowest (5.2% versus 1.6%,p=0.008). Rural dwellers had 35% less odds of tobacco use (aOR 0.65, 95% CI 0.49, 0.86) compared with urban dwellers, those with ≥12 years of formal education had 89% less odds of tobacco use (aOR 0.11, 95% CI 0.07, 0.17) compared with <12 years, and those belonging to the wealthiest quintile had 64% higher odds of unhealthy diets (aOR 1.64, 95% CI 1.26, 2.14). Only 44% of respondents with type II diabetes and 16% with hypertension were aware of their diagnosis.Conclusionprevalence of NCD risk factors is high in Kenya and varies across socio-demographic attributes. Socio-demographic considerations should form part of multi-sectoral, integrated approach to reduce the NCD burden in Kenya.

Association of body mass index and gross national income with caries experience in children in 117 countries

Objective: To evaluate the association of body mass index (BMI) and gross national income (GNI) per capita with dental caries experience in children at population levels.Methods: This ecological study used global data of decay, missing, and filled teeth (DMFT), BMI, and GNI. DMFT data of 12 years old children from 117 countries were obtained from the World Health Organization. BMI data of children and adolescents from the same 117 countries were retrieved from the NCD Risk Factor Collaboration and GNI per capita from the World Bank. ANOVA test, Pearson’s correlation coefficient (r), and multivariable linear regression were performed.Results: Globally mean BMI ranged from 16.1 to 22.2 in children. Low-income countries had the lowest BMI (17.41 ± 0.57) and high-income countries had the highest BMI (20.14 ± 0.87) (p < .001). The highest mean DMFT was observed in upper-middle-income countries (2.48 ± 1.16) and the lowest in low-income countries (1.22 ± 0.83) (p = .001). There was no significant correlation between BMI and dental caries (DMFT) (r = .063; p = .498). However, there were significant correlations between GNI per capita and BMI (r = 0.366; p < .001) and GNI per capita and DMFT (r= −0.252; p = .007). In multivariable linear regression, GNI per capita was negatively associated with caries experience in children (B= −1.83; p < .001).Conclusion: The study found that BMI was associated with income levels of the countries. GNI per capita significantly and negatively correlated with DMFT in children. Further investigation into the association between BMI and dental caries is warranted.

Clustering of lifestyle risk factors for non-communicable diseases in 304,779 adolescents from 89 countries: A global perspective

The precursors of non-communicable diseases (NCDs) are often manifested during childhood and adolescence with little knowledge about co-occurrence of their related lifestyle risk factors. To address this deficit, we estimated the prevalence and clustering of six major NCD-risk factors in adolescents around the world. Data from the Global School-based Student Health Survey, collected between 2007 and 2016, were analysed in 304,779 adolescents aged 11–17 years (52.2% females) from 89 countries. We compared the observed (O) to expected (E) prevalence ratios of 64 possible combinations of six risk factors to determine their clustering patterns. Overall, 82.4% (95% CI 82.1–82.7) of adolescents had ≥2 risk factors, while 34.9% (34.6–35.3) had ≥3. Adolescents aged 16–17 years, compared to those aged 11–13 years, had higher odds (OR 1.33; 95% CI 1.31–1.36) of reporting ≥3 risk factors. Risk factors clustered in multiple combinations and differed by sex. The clustering of physical inactivity and low fruit and vegetable intake was evident in both males (O/E 1.10; 95% CI 1.07–1.12) and females (1.08; 1.06–1.10). The co-occurrence of cigarette smoking, alcohol drinking, physical inactivity, and low fruit and vegetable intake was 165% greater in females (2.65; 2.28–3.07) and 110% greater in males (2.10; 1.90–2.32) than expected. Globally, adolescents exhibit multiple modifiable risk factors for future development of NCDs. Early gender-specific prevention strategies targeting clusters of lifestyle risk factors should be prioritised to help mitigate future burden of NCDs globally. Periodical collection of behavioural risk factor data should be encouraged to facilitate a sustainable global surveillance.

Non-communicable diseases risk factors and their determinants: A cross-sectional state-wide STEPS survey, Haryana, North India

BackgroundRecent studies have documented high variation in epidemiologic transition levels among Indian states with noncommunicable disease epidemic rising swiftly. However, the estimates suffer from non-availability of reliable data for NCDs from sub populations. In order to fill the knowledge gap, the distribution and determinants of NCD risk factors were studied along with awareness, treatment and control of NCDs among the adult population in Haryana, India.MethodsNCD risk factors survey was conducted among 5078 residents, aged 18–69 years during 2016–17. Behavioural risk factors were assessed using STEPS instrument, administered through an android software (mSTEPS). This was followed by physical measurements using standard protocols. Finally, biological risk factors were determined through the analysis of serum and urine samples.ResultsMales were found to be consuming tobacco and alcohol at higher rates of 38.9% (95% CI: 35.3–42.4) and 18.8% (95% CI: 15.8–21.8). One- tenth (11%) (95% CI: 8.6–13.4) of the respondents did not meet the specified WHO recommendations for physical activity for health. Around 35.2% (95%CI: 32.6–37.7) were overweight or obese. Hypertension and diabetes were prevalent at 26.2% (95% CI: 24.6–27.8) and 15.5% (95% CI: 11.0–20.0). 91.3% (95% CI: 89.3–93.3) of the population had higher salt intake than recommended 5gms per day.ConclusionThe documentation of strikingly high and uniform distribution of different NCDs and their risk factors in state warrants urgent need for evidence based interventions and advocacy of policy measures.

Prevalence of NCD Risk Factors Among the Adult Family Members of Students of School (Phase – A)

Background: Like other developing countries, in our country major causes of mortality is shifted from communicable to non-communicable diseases. NCD already disproportionately affect low and middle income countries, where nearly three quarters of NCD deaths (28 million) occur annually. Management of the existing NCD and upcoming NCD will be a great challenge for the developing countries like us. Therefore a strategy of prevention of NCD is very important.&#x0D; Materials and methods: This was a community based prospective interventional study, carried out in Mornea high school and Alef Uddin Sarker high school of Rangpur sadar. In the first phase, from each school 100 students from different classes were selected randomly. Then adult family members of these students were surveyed to see the prevalence of NCD risk factors. In second phase (ongoing) school health education will be given in Mornea high school (randomly chosen) monthly basis for 12 months and the students will share these with their family members. On the other hand the other school’s students will not provide any health education. One of the guardian from each family will chosen for confirmation of the sharing of information of school health education acquired by students over phone after each class. After one year prevalence of NCD risk factors will be surveyed again to know whether there are any significant differences of outcome of school health education.&#x0D; Results: In this study we have been able to study of 356 adult people of both sexes. From the Mornea high school 197 (55.3%) and Alef Uddin Sarker high school 159 (44.7%). Mean age of the study population was 47.33 years and female was more than male 66.3%. Awareness of NCD was found in only 10.4% of the study population. Overall 96.63% had NCD risk factors, 30.90% had two risk factors and 50.26% had 3 or more risk factors. Overall prevalence of smoking was 36.8%, among them 20.5% were current smoker. 33.1% of the study population used to take smokeless tobacco. Among the survey population only 14.3% used to take vegetables 7 days/week. 32.6% (116) people were physically inactive and 6.7% (24) had sedentary lifestyle. Only 5.3% of the people were obese and 66.57% had central obesity. Prevalence of hypertension and diabetes among the study population was 28.9% and 4.77% respectively. Among the known hypertensive 72.7% (16) used to take antihypertensive drug regularly and blood pressure was controlled in only 27.3%. Among the known diabetic mean duration were 4.12 years and 62.5% (5) of the patients used to take the antidiabetic drug regularly.&#x0D; Conclusions: In our study, awareness of NCD is very low but high prevalence of NCD risk factors, which are modifiable. So, an appropriate intervention is needed to modify the risk factors and thus prevention of NCDs.&#x0D; J MEDICINE JAN 2020; 21 (1) : 8-13

Monitoring of obesity in the Italian adult population: preliminary results of 1998-2018 trend

Abstract Background Obesity is a risk factor for the majority of non-communicable diseases-NCDs. In the Italian country profile, the NCD Risk Factor Collaboration estimated the 2010 obesity prevalence at 19.0% (95% confidence interval - C.I. 15.7-22.7) in women aged 18 years and over and 18.5% (95% C.I. 15.1-22.0) in men, with a very low probability (2-9%) of halting the increase of obesity by 2025 (WHO global obesity target). This preliminary analysis aims to assess 20 years trend of BMI and obesity in the Italian general adult population using the data collected within the CUORE Project. Methods Mean of BMI and prevalence of obesity (BMI &amp;gt; =30 kg/m2) in random samples of resident population in 6 Italian Regions, aged 35-74 years, stratified by age and sex, were assessed in an on-going survey started in 2018 (men 612; women 649), and compared to those assessed in the same Regions in 1998-2002 (men 1933, women 1926) and in 2008-2012 (men 1306; women 1318). Weight and height were measured using standardized methodologies. Surveys were partly funded by the Italian Ministry of Health-CCM and approved by the National Institute of Health ethical committee. Results In men, mean values of BMI resulted 26.6 kg/m2 (95% C.I. 26.4-26.8) in 1998 survey, 27.5 (27.2-27.7) in 2008 and 26.5 (26.1-26.8) in 2018; prevalence of obesity was 16.8% (95% C.I. 15.1-18.4) in 1998, 23.5% (21.2-25.8) in 2008 and 17.3% (14.4-20.4) in 2018. In women mean values of BMI were 26.1 kg/m2 (95% C.I.: 25.9-26.4) in 1998, 26.4 (26.1-26.7) in 2008 and 25.5 (25.1-25.9) in 2018; prevalence of obesity was 20.7% (95% C.I.: 18.9-22.5), 21.9% (19.7-24.2) and 19.0% (15.9-22.0) respectively. Conclusions Preliminary data of first 6 Regions (out of 10 to be examined in the on-going survey) suggest that mean BMI and prevalence of obesity in Italian adult population are still very high; if confirmed, in the last ten years a reduction seems to be occurred increasing the probability of meeting the WHO obesity target by 2025. Key messages Mean BMI and prevalence of obesity in Italian adult population are still high. If confirmed, in the last ten years a reduction of mean BMI and prevalence of obesity in Italian adult population seems to be occurred.

An epidemiological evaluation of predictors of overweight and obesity in Garhwal region of Uttarakhand.

SummaryIntroductionNow a day, obesity has become a chronic disorder affecting the larger population than any other disease in the world, which made its presence felt first in the Northern Hemisphere, and has now taken a pandemic look affecting practically almost all the countries of the globe.MethodA cross sectional study with a sample size of 632 was carried out. Multistage stratified random sampling and “Kish” method was applied for selection of study area and selection of study subjects (21-60 years). WHO STEPS for NCD Risk Factor Surveillance, was used to gather the necessary data. Percentage, Chi square, & logistic regression analysis was done and significant level was taken at p < 0.05.ResultsAs per Asia Pacific classification 16.0% & 33.4% of subjects while as per WHO classification 24.5% & 8.9% of subjects were found to be overweight and obese respectively. It was nearly 2 times higher in urban males. Central obesity was more commonly observed in urban subjects as compared to rural. At risk Waist hip ratio was recorded in 55.9% and high Weight height ratio was recorded in 66.8% of total subjects. All the predictors showed higher percentages in females of urban area and increased with the rise in age.ConclusionThe present study reveals that, there is high prevalence of overweight and obesity in the study population. Certainly, there has been a considerable shift in their dietary and lifestyle profile. there appears to be an urgent need to develop suitable health strategies as well as intervention programmes for combating the prevalence of overweight and obesity.

Differential burden of peripheral artery disease

Differential burden of peripheral artery disease

The prevalence of selected risk factors for non-communicable diseases in Hargeisa, Somaliland: a cross-sectional study

BackgroundNon-communicable diseases (NCDs), particularly cardiovascular diseases, diabetes, respiratory conditions and cancers, are the most common causes of morbidity and mortality globally. Information on the prevalence estimates of NCD risk factors such as smoking, low fruit & vegetable intake, physical inactivity, raised blood pressure, overweight, obesity and abnormal blood lipid are scarce in Somaliland. The aim of this study was to determine the prevalence of these selected risk factors for NCDs among 20–69 year old women and men in Hargeisa, Somaliland.MethodsA cross-sectional study was conducted in five districts of Hargeisa (Somaliland), using the STEPwise approach to noncommunicable disease risk factor surveillance (STEPS) to collect data on demographic and behavioral characteristics and physical measurements (n = 1100). The STEPS approach is a standardized method for collecting, analysing and disseminating data on NCD risk factor burden. Fasting blood sugar, serum lipids (total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides) were collected in half of the participants.ResultsThe vast majority of participants had ≤1 serving of fruits daily (97.7%) and ≤ 1 serving of vegetables daily (98.2%). The proportion of participants with low physical activity levels was 78.4%. The overall prevalence of high salt intake was 18.5%. The prevalence of smoking and khat chewing among men was 27 and 37% respectively, and negligible among women. In women, the prevalence of hypertension increased from 15% in the age group 20–34 years to 67% in the age group 50–69 years, the prevalence of overweight and obesity (BMI ≥ 25 kg/m2) from 51 to 73%, and the prevalence of diabetes from 3 to 22%. Similar age-trends were seen in men.ConclusionMost of the selected risk factors for noncommunicable diseases were high and increased by age in both women and men. Overweight and obesity and low physical activity needs intervention in women, while hypertension and low fruit and vegetable consumption needs intervention in both men and women. Somaliland health authorities should develop and/or strengthen health services that can help in treating persons with hypertension and hyperlipidaemia, and prevent a future burden of NCDs resulting from a high prevalence of NCD risk factors.

A study on prevalence of risk factors of non-communicable diseases among undergraduate medical student

Background: Non communicable diseases (NCDS) also referred to as “lifestyle diseases” are the leading cause of death globally. Most of the NCD risk factors are behaviorally acquired which are due to change in lifestyle during adolescent age groups With this in mind the present study was conducted with the following objective to determine the prevalence of risk factors of NCDS among medical undergraduates of a district of West Bengal.Methods: Cross-sectional observational study among 96 medical students of a medical college in a district of West Bengal using WHO STEPS questionnaire. Analysis of results was done by percentage and proportion.Results: A total of 96 students were interviewed and examined. Mean age was 19.3 years.12.5% were current smokers, 8.3% were alcohol users. 53.1% did no exercise. 46.5% female and 37.7% male had mild to moderate risk of high BMI, 51.2% female had abnormal waist circumference. 46.5% girls had abnormal waist hip ratio. 34.8% female and 35.8% males were pre hypertensive while 4% boys were hypertensive. Out of 22 students who had undergone blood test, 4.5% were early diabetic. 13.6% had borderline risk and 4.5% high risk for blood cholesterol.Conclusions: A high prevalence of risk factors for non-communicable diseases was found in the present study which emphasizes the need of interventions to reduce these risk factors among these future doctors.

Global Inequality in National Food Supplies and Diet-related Health Outcomes, 1970–2010 (P04-094-19)

ObjectivesThe global food system has changed rapidly over recent decades, with large shifts in agricultural supply conditions, international trade, food manufacturing and nutrient availability. These shifts have contributed to both positive and negative impacts on health and wellbeing with some countries catching up while others have fallen further below international norms. We aim to quantify long-run changes in the food supply and diet-related health disparities across countries, to illustrate how inequality has changed from the 1970 s to the 2010 s. MethodsData were drawn from publicly available sources, using food supply from the United Nations Food and Agriculture Organization (FAO) and diet-related health outcomes from the NCD Risk Factor Collaboration (NCD-RisC) and the Joint Monitoring Programming, a collaboration of the World Bank, the World Health Organization, and UNICEF. We used techniques from economics (Lorenz curves, Gini coefficients, and Pen’s Parade) to generate novel visualizations and metrics for global inequality and disparities in national food supply and diet-related health outcomes across countries. ResultsWe computed global inequality in food supplies as available dietary energy from all fruits and vegetables, all animal source foods, and all foods other than starchy staples, and inequality in diet-related outcomes such as overweight and obesity, underweight, stunting, raised blood pressure, and diabetes. Results showed greater equality in food supplies and diet-related health outcomes converging at higher prevalence levels, while stunting and underweight became more unequal and more highly concentrated in a few high-burden countries. For example, the Gini coefficient for energy from fruit and vegetables (0.36 to 0.27), energy from animal source foods (0.51 to 0.33), and overweight and obesity (0.39 to 0.27) decreased indicating greater equality, while the Gini coefficient for underweight increased (0.40 to 0.47) demonstrating greater disparity. ConclusionsConvergence in availability of harmful dietary components and negative health outcomes occurred faster than convergence in beneficial nutrients and positive outcomes. This research can help to inform the design of policies and programs aimed at achieving the UN Sustainable Development Goals and other targets for global food systems. Funding SourcesWellcome Trust.

Prevalence of non communicable disease risk factors among male to female transgenders: a cross sectional study

Background: Non communicable diseases are responsible for a high proportion of deaths and disabilities. The major risk factors attributed to this are smoking, heavy alcohol drinking, inadequate fruit, and vegetable consumptions, and physical inactivity. While there are data available to understand the prevalence of non-communicable risk factors among men and women, there is no data among transgender community. Hence this study was conducted to assess the prevalence of NCD risk factors among the male-to-female transgender community.Methods: This cross sectional study was conducted among 54 transwomen who had been registered with two social welfare organizations for transgender community in Chennai. The risk factor was assessed using WHO STEPS instrument.Results: Among the transwomen, 16.7% were currently smoking tobacco, while 18.5% were using smokeless forms of tobacco. Alcohol consumption was observed in 44.4% of the population. 62.9% of them were not involved in any kind of exerting physical activity for recreation. 25.9% had undergone hormone supplementation for gender affirmation. Prevalence of obesity was 20.4% in the study population. The prevalence of hypertension, diabetes and hypercholesterolemia was 11.1%, 5.6% and 7.4% respectively.Conclusions: High Prevalence of certain risk factors such as smokeless tobacco usage, alcohol consumption and hormone supplementation were seen among the male-to-female transgender community compared to the general population. Targeted interventions must be made so that specific attention is given to the transgender community in various NCD programs by the government. They must also be supported and accepted by every member of this society.

Integrating capacity development during digital health research: a case study from global health

ABSTRACTBackground: The Bloomberg Data for Health Initiative Research and Development Arm at Johns Hopkins University Bloomberg School of Public Health, has thus far collected NCD risk factor data from more than 13,000 citizens of three LMICs (Bangladesh, Tanzania and Uganda), and has actively worked to improve capacity with partners worldwide.Objective: This paper focuses on how a research project, can also act as a capacity building activity through its research into collecting non-communicable disease risk factor data using different mobile phone modalities.Methods: This paper evaluates the activities undertaken by the project using the ESSENCE Planning Monitoring and Evaluation Framework for Research Capacity Strengthening.Results: The project was able to successfully integrate meaningful capacity development activities across all partners. Training, networking, sharing resources, joint data collection, and analysis across individual, organizational and project levels were some of the strategies used. The ESSENCE framework allowed a good assessment strategy for this type of work.Conclusions: This paper highlights the value of making capacity development a high priority for digital health research activities, while also considering the need to monitor and evaluate those activities in order for them to be meaningful and sustainable. It also considers how to utilize the ESSENCE Framework to evaluate capacity development activities through research, and how best to adapt the Framework to different programs.

Dorsopathies: routine checkups as a procedure necessary for early diagnostics, risk factors and comorbidities identification

Early detection of dorsopathies is an urgent task for primary care physicians, since such conditions can combine with other chronic noncommunicable diseases (NСD) and adversely affect the course all comorbidities, consequently disimproving the quality of life of patients and increasing the frequency of their requests for medical assistance. This study aimed to determine the value of routine checkups in the context of detection of dorsopathies, NCD, and identification of risk factors (RF). We have retrospectively analyzed the patient records database of a rural outpatient clinic in the Tver region (years 2015 to 2017). The prevalence of dorsopathies and NCD RF were the subjects investigated. Fisher's exact test and Spearman's rank correlation coefficient (SRCC) were applied for the purposes of statistical processing of the results. We discovered that dorsopathy most often was a comorbidity to arterial hypertension and gastrointestinal tract diseases; it was strongly related to the NCD (SRCC = 0.506), age (SRCC = 0.383), slightly less so — to hypodynamia (SRCC = 0.146), type of the patient's occupation (intellectual or physical labor) (SRCC = 0.07). Routine checkups improve the rate of detection of dorsopathy: the more patients undergo such examinations, the more cases of dorsopathy are diagnosed. Thus, it is necessary to increase the number of working people attending the checkups in order to detect dorsopathies early and prevent them effectively.

Confronting the most challenging risk factor: non-adherence

Despite advances in cardiovascular therapies, coronary heart disease remains the leading cause of death in almost all countries. Two of the most remarkable recent treatments, percutaneous coronary intervention and the availability of proprotein convertase subtilisin/kexin type 9 inhibitor drugs, have revolutionised cardiology practice. Although life-saving and now essential therapies, 1 Benjamin EJ Virani SS Callaway CW et al. Heart Disease and Stroke Statistics—2018 update: a report from the American Heart Association. Circulation. 2018; 137: e67-e492 Crossref PubMed Scopus (4402) Google Scholar whether they will be able to reduce the incidence and associated morbidity and mortality of coronary heart disease remains unlikely since the increase in prevalence of obesity and diabetes is raising the background level of cardiovascular risk. 2 NCD Risk Factor Collaboration (NCD-RisC)Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet. 2017; 390: 2627-2642 Summary Full Text Full Text PDF PubMed Scopus (3822) Google Scholar , 3 NCD Risk Factor Collaboration (NCD-RisC)Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4·4 million participants. Lancet. 2016; 387: 1513-1530 Summary Full Text Full Text PDF PubMed Scopus (2301) Google Scholar , 4 Smith Jr, SC Chen D Collins A et al. Moving from political declaration to action on reducing the global burden of cardiovascular diseases: a statement from the global cardiovascular disease taskforce. Circulation. 2013; 128: 2546-2548 Crossref PubMed Scopus (17) Google Scholar , 5 NCD Countdown 2030 collaboratorsNCD Countdown 2030: worldwide trends in non-communicable disease mortality and progress towards Sustainable Development Goal target 3.4. Lancet. 2018; 392: 1072-1088 Summary Full Text Full Text PDF PubMed Scopus (458) Google Scholar Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA): a pragmatic, open-label, randomised controlled trialThis study provides evidence of the contributory role of pictorial presentation of silent atherosclerosis for prevention of cardiovascular disease. It supports further development of methods to reduce the major problem of low adherence to medication and lifestyle modification. Full-Text PDF

Inequality in body mass indices across countries: Evidence from convergence tests

This study examines the long-term inequality in body mass index (BMI) based on convergence tests applied to a database of 172 countries recently published by the NCD Risk Factor Collaboration. First, we find that countries converge in clubs, which indicates that country disparities in BMIs will persist over time. Second, there are three and six convergence clubs in BMIs for female and male individuals, respectively. That is, we would not observe a single convergence pattern in body weights as the nutrition transition theory and the dietary convergence hypothesis seem to suggest. Females have only one healthy club (18.5 ≤ BMI < 25) and two overweight clubs (BMI ≥ 25). Males have three healthy clubs and three overweight clubs. Third, the analysis of club convergence indicates that BMI inequality has increased due to the BMI growth observed in club 1 (the one with the highest average BMI and led by the US) in each gender group. Finally, potential determinants of BMI such as globalization, human capital, income, and urbanization are relevant to understand differences across clubs. We interpret the club convergence as the result of a heterogeneous integration of countries into the global economy, which is probably related to strong domestic preferences, policies designed to manage the impacts of globalization, and shifts in productive structures.

Individual and household level factors associated with presence of multiple non-communicable disease risk factors in Kenyan adults

BackgroundNon-communicable diseases (NCDs), are increasing globally, causing about 60% of disability-adjusted life years and 39.8 million deaths in 2015. Risk factors often cluster and interact multiplicatively in an individual and this is strongly associated with the development and severity of NCDs. We assessed the sociodemographic factors associated with the presence of multiple NCD risk factors among individuals aged 18 years and older in the Kenyan population.MethodsWe used national representative data from 4066 individuals out of 4500 who participated in the WHO STEPs study in 2015. NCD risk factor counts were derived by summing the risk factors present in an individual and categorising into 1–3, 4–6 and 7+ risk factors in any combination of the 12 assessed NCD risk factors (hypertension, diabetes mellitus, cholesterol, insufficient physical activity, excessive alcohol use, tobacco use and obesity, excess sugar intake, insufficient fruit and vegetables intake, high salt consumption, and use of unhealthy cooking fats and oils). Ordered logistic regression was used to investigate the sociodemographic factors associated with an individual possesing multiple NCD risk factors.ResultsMajority (75.8%) of the individuals in the study possesed 4–6 and 10% had ≥7 NCDs risk factors. Nearly everyone (99.8%) had insufficient fruits and vegetable intakes, 89.5% consumed high salt in their diet and 80.3% did not engage in sufficient physical activity. Apart from NCD risk count which increased with age among both men and women, associations with other socio-demographic factors differed between men and women. A woman of Akamba ethinicity had lower odds (0.43) while Meru women had higher odds (3.58) of higher NCD risk factor count, compared to the Kalenjin women. Among men, being a Kisii or Luo was associated with lower odds (0.48 and 0.25 respectively) of higher NCD risk factor count. Women in a marital union had higher odds (1.58) of a higher NCD risk factor count.ConclusionMajority of Kenyan adults possess more than four NCD risk factors; a clear indication of an emerging epidemic of NCDs in this population. Effective and multi-sectoral interventions targeting multiple risk factors in individuals are required to mitigate especially the behavioural and modifiable NCD risk factors in Kenya.

Distribution of diabetes, hypertension and non-communicable disease risk factors among adults in rural Bangladesh: a cross-sectional survey

BackgroundNon-communicable diseases (NCDs) are increasing in low-income settings. We conducted a survey of risk factors, blood pressure and blood glucose in rural Bangladesh and assessed variations by age, sex and...