Sartorius B, Sartorius K, Taylor M, Aagaard-Hansen J, Dukhi N, Day C, Ndlovu N, Slotow R, Hofman K
Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa.
Faculty of Commerce, University of the Witwatersrand, Johannesburg, South Africa.
Int J Epidemiol. 2018 Jun;47(3):942-952. doi: 10.1093/ije/dyx263. Epub 2017 Dec 14.
There is a global epidemic of overweight and obesity; however, this rate of increase is even greater in some low- and middle-income countries (LMIC). South Africa (SA) is undergoing rapid socioeconomic and demographic changes that have triggered a rapid nutrition transition. The paper focuses on the recent rate of change of body mass index (BMI) among children, adolescents and young adults, further stratified by key sociodemographic factors.
We analysed mean BMI of 28 247 individuals (including children) from 7301 households by age and year, from anthropometric data from four national cross-sectional (repeated panel) surveys using non-linear fitted curves and associated 95% confidence intervals.
From 2008 to 2015, there was rapid rise in mean BMI in the 6-25 age band, with the highest risk (3-4+ BMI unit increase) among children aged 8-10 years. The increase was largely among females in urban areas and of middle-high socioeconomic standing. Prominent gains were also observed in certain rural areas, with extensive geographical heterogeneity across the country.
We have demonstrated a major deviation from the current understanding of patterns of BMI increase, with a rate of increase substantially greater in the developing world context compared with the global pattern. This population-wide effect will have major consequences for national development as the epidemic of related non-communicable disease unfolds, and will overtax the national health care budget. Our refined understanding highlights that risks are further compounded for certain groups/places, and emphasizes that urgent geographical and population-targeted interventions are necessary. These interventions could include a sugar tax, clearer food labelling, revised school feeding programmes and mandatory bans on unhealthy food marketing to children.The scenario unfolding in South Africa will likely be followed in other LMICs.
超重和肥胖在全球范围内流行；然而，在一些低收入和中等收入国家（LMIC），这种增长速度甚至更快。南非（SA）正在经历快速的社会经济和人口变化，引发了快速的营养转型。本文重点关注儿童、青少年和年轻人中体重指数（BMI）的近期变化率，并按关键社会人口因素进一步分层。
我们使用非线性拟合曲线和相关的95%置信区间，分析了来自7301户家庭的28247名个体（包括儿童）按年龄和年份的平均BMI，这些数据来自四项全国性横断面（重复面板）调查的人体测量数据。
从2008年到2015年，6 - 25岁年龄组的平均BMI迅速上升，8 - 10岁儿童的风险最高（BMI单位增加3 - 4个以上）。增长主要发生在城市地区社会经济地位中高的女性中。在某些农村地区也观察到显著增长，全国存在广泛的地理差异。
我们已经证明，与当前对BMI增长模式的理解存在重大偏差，与全球模式相比，发展中世界背景下的增长速度要快得多。随着相关非传染性疾病的流行，这种全人群效应将对国家发展产生重大影响，并将使国家医疗保健预算不堪重负。我们更精确的理解突出表明，某些群体/地区的风险进一步加剧，并强调需要采取紧急的针对地理区域和人群的干预措施。这些干预措施可能包括征收糖税、更清晰的食品标签、修订学校供餐计划以及强制禁止向儿童推销不健康食品。南非正在出现的这种情况可能会在其他低收入和中等收入国家出现。
