Lancet. 2017 Dec 16;390(10113):2627-2642. doi: 10.1016/S0140-6736(17)32129-3. Epub 2017 Oct 10.
Underweight, overweight, and obesity in childhood and adolescence are associated with adverse health consequences throughout the life-course. Our aim was to estimate worldwide trends in mean body-mass index (BMI) and a comprehensive set of BMI categories that cover underweight to obesity in children and adolescents, and to compare trends with those of adults.
We pooled 2416 population-based studies with measurements of height and weight on 128·9 million participants aged 5 years and older, including 31·5 million aged 5-19 years. We used a Bayesian hierarchical model to estimate trends from 1975 to 2016 in 200 countries for mean BMI and for prevalence of BMI in the following categories for children and adolescents aged 5-19 years: more than 2 SD below the median of the WHO growth reference for children and adolescents (referred to as moderate and severe underweight hereafter), 2 SD to more than 1 SD below the median (mild underweight), 1 SD below the median to 1 SD above the median (healthy weight), more than 1 SD to 2 SD above the median (overweight but not obese), and more than 2 SD above the median (obesity).
Regional change in age-standardised mean BMI in girls from 1975 to 2016 ranged from virtually no change (-0·01 kg/m per decade; 95% credible interval -0·42 to 0·39, posterior probability [PP] of the observed decrease being a true decrease=0·5098) in eastern Europe to an increase of 1·00 kg/m per decade (0·69-1·35, PP>0·9999) in central Latin America and an increase of 0·95 kg/m per decade (0·64-1·25, PP>0·9999) in Polynesia and Micronesia. The range for boys was from a non-significant increase of 0·09 kg/m per decade (-0·33 to 0·49, PP=0·6926) in eastern Europe to an increase of 0·77 kg/m per decade (0·50-1·06, PP>0·9999) in Polynesia and Micronesia. Trends in mean BMI have recently flattened in northwestern Europe and the high-income English-speaking and Asia-Pacific regions for both sexes, southwestern Europe for boys, and central and Andean Latin America for girls. By contrast, the rise in BMI has accelerated in east and south Asia for both sexes, and southeast Asia for boys. Global age-standardised prevalence of obesity increased from 0·7% (0·4-1·2) in 1975 to 5·6% (4·8-6·5) in 2016 in girls, and from 0·9% (0·5-1·3) in 1975 to 7·8% (6·7-9·1) in 2016 in boys; the prevalence of moderate and severe underweight decreased from 9·2% (6·0-12·9) in 1975 to 8·4% (6·8-10·1) in 2016 in girls and from 14·8% (10·4-19·5) in 1975 to 12·4% (10·3-14·5) in 2016 in boys. Prevalence of moderate and severe underweight was highest in India, at 22·7% (16·7-29·6) among girls and 30·7% (23·5-38·0) among boys. Prevalence of obesity was more than 30% in girls in Nauru, the Cook Islands, and Palau; and boys in the Cook Islands, Nauru, Palau, Niue, and American Samoa in 2016. Prevalence of obesity was about 20% or more in several countries in Polynesia and Micronesia, the Middle East and north Africa, the Caribbean, and the USA. In 2016, 75 (44-117) million girls and 117 (70-178) million boys worldwide were moderately or severely underweight. In the same year, 50 (24-89) million girls and 74 (39-125) million boys worldwide were obese.
The rising trends in children's and adolescents' BMI have plateaued in many high-income countries, albeit at high levels, but have accelerated in parts of Asia, with trends no longer correlated with those of adults.
Wellcome Trust, AstraZeneca Young Health Programme.
儿童和青少年时期的体重过轻、超重和肥胖与整个生命过程中的不良健康后果有关。我们的目的是估计全世界儿童和青少年的平均体重指数（BMI）以及涵盖从体重过轻到肥胖的一系列 BMI 类别呈上升趋势的情况，并将这些趋势与成年人的趋势进行比较。
我们汇集了 2416 项基于人群的研究，这些研究对 1.289 亿 5 岁及以上参与者的身高和体重进行了测量，其中包括 5-19 岁的 3150 万参与者。我们使用贝叶斯分层模型来估计 200 个国家 1975 年至 2016 年期间的平均 BMI 以及 5-19 岁儿童和青少年的 BMI 分类的流行率：世界卫生组织儿童和青少年生长参考标准中位数以下 2 SD 以上（称为中度和重度体重过轻，以下简称“中度和重度体重过轻”），2 SD 至中位数以上 1 SD（轻度体重过轻），中位数以下 1 SD 至中位数以上 1 SD（健康体重），中位数以上 1 SD 至 2 SD（超重但不肥胖），以及中位数以上 2 SD（肥胖）。
1975 年至 2016 年，女孩的年龄标准化平均 BMI 变化幅度从东欧的几乎没有变化（每十年减少 0.01 kg/m；95%可信区间 -0.42 至 0.39，观察到的减少的后验概率[PP]为真实减少的 0.5098）到中拉丁美洲的每十年增加 1.00 kg/m（0.69-1.35，PP>0.9999）和波利尼西亚和密克罗尼西亚的每十年增加 0.95 kg/m（0.64-1.25，PP>0.9999）。男孩的范围从东欧的非显著增加 0.09 kg/m（-0.33 至 0.49，PP=0.6926）到中拉丁美洲的每十年增加 0.77 kg/m（0.50-1.06，PP>0.9999）。最近，西北欧和高收入英语国家和亚太地区的男女平均 BMI 增长趋势已经趋于平稳，西欧男孩的 BMI 增长趋势趋于平稳，中美洲和安第斯山脉地区的女孩 BMI 增长趋势也趋于平稳。相比之下，东亚和南亚的男女 BMI 增长速度加快，东南亚的男孩 BMI 增长速度也加快。全球年龄标准化肥胖率从 1975 年的 0.7%（0.4-1.2）上升到 2016 年的 5.6%（4.8-6.5），女孩的肥胖率从 1975 年的 0.9%（0.5-1.3）上升到 2016 年的 7.8%（6.7-9.1），男孩的肥胖率从 1975 年的 9.2%（6.0-12.9）下降到 2016 年的 8.4%（6.8-10.1），男孩的肥胖率从 14.8%（10.4-19.5）下降到 2016 年的 12.4%（10.3-14.5）。在印度，女孩的中度和重度体重过轻患病率最高，为 22.7%（16.7-29.6），男孩为 30.7%（23.5-38.0）。2016 年，在瑙鲁、库克群岛和帕劳，女孩的肥胖率超过 30%；在库克群岛、瑙鲁、帕劳、纽埃和美属萨摩亚，男孩的肥胖率也超过 30%。在波利尼西亚和密克罗尼西亚、中东和北非、加勒比地区以及美国，几个国家的肥胖率约为 20%或更高。2016 年，全世界有 7500 万（4400 万-1.17 亿）名女孩和 1.17 亿（7000 万-1.78 亿）名男孩体重过轻。同年，全世界有 5000 万（2400 万-8900 万）名女孩和 7400 万（3900 万-1.25 亿）名男孩肥胖。
尽管许多高收入国家的儿童和青少年 BMI 上升趋势已经趋于平稳，但其水平仍然很高，但亚洲部分地区的趋势却在加速，与成年人的趋势不再相关。
威康信托基金会、阿斯利康青年健康计划。
