Background: It is commonly assumed that cardiovascular disease risk factors are associated with affluence and Westernization. We investigated the associations of body mass index (BMI), fasting plasma glucose, systolic blood pressure, and serum total cholesterol with national income, Western diet, and, for BMI, urbanization in 1980 and 2008. Methods and results: Country-level risk factor estimates for 199 countries between 1980 and 2008 were from a previous systematic analysis of population-based data. We analyzed the associations between risk factors and per capita national income, a measure of Western diet, and, for BMI, the percentage of the population living in urban areas. In 1980, there was a positive association between national income and population mean BMI, systolic blood pressure, and total cholesterol. By 2008, the slope of the association between national income and systolic blood pressure became negative for women and zero for men. Total cholesterol was associated with national income and Western diet in both 1980 and 2008. In 1980, BMI rose with national income and then flattened at ≈Int$7000; by 2008, the relationship resembled an inverted U for women, peaking at middle-income levels. BMI had a positive relationship with the percentage of urban population in both 1980 and 2008. Fasting plasma glucose had weaker associations with these country macro characteristics, but it was positively associated with BMI. Conclusions: The changing associations of metabolic risk factors with macroeconomic variables indicate that there will be a global pandemic of hyperglycemia and diabetes mellitus, together with high blood pressure in low-income countries, unless effective lifestyle and pharmacological interventions are implemented.

The Global Cardiovascular Risk Transition: Associations of Four Metabolic Risk Factors with National Income, Urbanization, and Western Diet in 1980 and 2008

Roberto Miccoli;Francesco Pistelli;
2013-01-01

Abstract

Background: It is commonly assumed that cardiovascular disease risk factors are associated with affluence and Westernization. We investigated the associations of body mass index (BMI), fasting plasma glucose, systolic blood pressure, and serum total cholesterol with national income, Western diet, and, for BMI, urbanization in 1980 and 2008. Methods and results: Country-level risk factor estimates for 199 countries between 1980 and 2008 were from a previous systematic analysis of population-based data. We analyzed the associations between risk factors and per capita national income, a measure of Western diet, and, for BMI, the percentage of the population living in urban areas. In 1980, there was a positive association between national income and population mean BMI, systolic blood pressure, and total cholesterol. By 2008, the slope of the association between national income and systolic blood pressure became negative for women and zero for men. Total cholesterol was associated with national income and Western diet in both 1980 and 2008. In 1980, BMI rose with national income and then flattened at ≈Int$7000; by 2008, the relationship resembled an inverted U for women, peaking at middle-income levels. BMI had a positive relationship with the percentage of urban population in both 1980 and 2008. Fasting plasma glucose had weaker associations with these country macro characteristics, but it was positively associated with BMI. Conclusions: The changing associations of metabolic risk factors with macroeconomic variables indicate that there will be a global pandemic of hyperglycemia and diabetes mellitus, together with high blood pressure in low-income countries, unless effective lifestyle and pharmacological interventions are implemented.
2013
Danaei, Goodarz; M Singh, Gitanjali; J Paciorek, Christopher; K Lin, John; J Cowan, Melanie; M Finucane, Mariel; Farzadfar, Farshad; A Stevens, Gretchen; M Riley, Leanne; Lu, Yuan; Rao, Mayuree; Ezzati, Majid; Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group: Goodarz Danaei, Global; M Singh, Gitanjali; Paciorek, Christopher J.; Lin, John K.; Cowan, Melanie J.; Finucane, Mariel M.; Farzadfar, Farshad; Stevens, Gretchen A.; Riley, Leanne M.; Lu, Yuan; Rao, Mayuree; Ezzati, Majid; Data Group: Geir Aamodt, Country; Abdeen, Ziad; Abdella, Nabila A.; Abdul Rahim, Hanan F.; Addo, Juliet; Aekplakorn, Wichai; Afifi, Mustafa M.; Agabiti-Rosei, Enrico; Aguilar Salinas, Carlos A.; Agyemang, Charles; Ali, Mohamed M.; Al-Nsour, Mohannad; Al-Nuaim, Abdul R.; Ambady, Ramachandran; Aro, Pertti; Azizi, Fereidoun; Barbagallo, Carlo M.; Barbieri, Marco Antonio M.; Barceló, Alberto; Barreto, Sandhi M.; Barros, Henrique; Bautista, Leonelo E.; Benetos, Athanase; Bjerregaard, Peter; Björkelund, Cecilia; Bo, Simona; Bobak, Martin; Bonora, Enzo; Bontha, Babu V.; Botana, Manuel A.; Bovet, Pascal; Breckenkamp, Juergen; Breteler, Monique M.; Broda, Grazyna; Brown, Ian J.; Bursztyn, Michael; Cabrera de León, Antonio; Campos, Hannia; Cappuccio, Francesco P.; Capuano, Vincenzo; Casiglia, Edoardo; Castellano, Maurizio; Castetbon, Katia; Cea, Luis; Chang, Chihjen; Chaouki, Noureddine; Chatterji, Somnath; Chen, Chien-Jen; Chen, Zhengming; Chen, Chien-Jen; Choi, Jin-Su; Chua, Lily; Cífková, Renata; Cobiac, Linda J.; Cooper, Richard S.; Maria Corsi, Anna; Costanza, Michael C.; Craig, Cora L.; Dankner, Rachel S.; Dastgiri, Saeed; Delgado, Elias; Dinc, Gonul; Doi, Yasufumi; Dong, Guang-Hui; Dorsi, Eleonora; Dragano, Nico; Drewnowski, Adam; Eggertsen, Robert W.; Elliott, Paul; Engeland, Anders; Erem, Cihangir; Esteghamati, Alireza; Fall, Caroline H. D.; Fan, Jian-Gao; Ferreccio, Catterina; Fezeu, Leopold; Firmo, Josélia O.; Florez, Hermes J.; Fornés, Nélida S.; Fowkes, F. Gerry R.; Franceschini, Guido; Frisk, Fredrik; Fuchs, Flávio D.; Fuller, Eva L.; Getz, Linn; Giampaoli, Simona; Gómez, Luis F.; Gomez-Zumaquero, Juan M.; Graff-Iversen, Sidsel; Grant, Janet F.; Guerrero Carvajal, Ramiro; Gulliford, Martin C.; Gupta, Rajeev; Gupta, Prakash C.; Gureje, Oye; Hansen, Tine W.; Hata, Jun; He, Jiang; Heim, Noor; Heinrich, Joachim; Hemmingsson, Tomas; Hennis, Anselm; Herman, William H.; Herrera, Victor M.; Ho, Suzanne; Holdsworth, Michelle; Hollman Frisman, Gunilla; Hopman, Wilma M.; Hussain, Akhtar; Husseini, Abdullatif; Mohsen Ibrahim, M.; Ikeda, Nayu; Jacobsen, Bjarne K.; Jaddou, Hashem Y.; Jafar, Tazeen H.; Janghorbani, Mohsen; Jasienska, Grazyna; Joffres, Michel R.; Jonas, Jost B.; Kadiki, Othman A.; Kalter-Leibovici, Ofra; Kamadjeu, Raoul M.; Karalis, Ioannis; Kastarinen, Mika J.; Katz, Joanne; Keinan-Boker, Lital; Kelly, Paul; Khalilzadeh, Omid; Khang, Young-Ho; Kiechl, Stefan; Woong Kim, Ki; Kiyohara, Yutaka; Kobayashi, Junji; Krause, Maressa P.; Kubínová, Růžena; Kurjata, Pawel; Kusuma, Yadlapalli S.; Hing Lam, Tai; Langhammer, Arnulf; Lawes, Carlene M. M.; Le, Cai; Lee, Jeannette; Lévy-Marchal, Claire; Li, Yanping; Li, Yuqiu; Lim, Stephen; Lim, T. O.; Lin, Xu; Lin, Cheng-Chieh; Lin, Xu; Lin, Hsien-Ho; Lind, Lars; Lissner, Lauren; Liu, Xiaoqing; Lopez-Jaramillo, Patricio; Lorbeer, Roberto; Lorbeer, Roberto; Ma, Guansheng; Ma, Stefan; Macià, Francesc; Maclean, David R.; Maggi, Stefania; Magliano, Dianna J.; Makdisse, Marcia; Mancia, Giuseppe; Mannami, Toshifumi; Marques-Vidal, Pedro; Mbanya, Jean Claude N.; McFarlane-Anderson, Norma; Miccoli, Roberto; Miettola, Juhani; Minh, Hoang V.; Miquel, Juan F.; Jaime Miranda, J.; Mohamed, Mostafa K.; Mohan, V.; Mohanna, Salim; Mokdad, Ali; Mollentze, Willem F.; Morales, Dante D.; Morgan, Karen; Muiesan, Lorenza M.; Muntoni, Sergio; Nabipour, Iraj; Nakagami, Tomoko; Nangia, Vinay; Nemesure, Barbara; Neovius, Martin; Nerhus, Kjersti A.; Nervi, Flavio; Neuhauser, Hannelore; Nguyen, Minh; Ninomiya, Toshiharu; Noale, Marianna; Oh, Sang W.; Ohkubo, Takayoshi; Olivieri, Oliviero; Emel Önal, Ayse; Onat, Altan; Oróstegui, Myriam; Ouedraogo, Hermann; Pan, Wen-Harn; Panagiotakos, Demosthenes B.; Panza, Francesco; Park, Yongsoo; Passos, Valeria M. A.; Pednekar, Mangesh S.; Peres, Marco A.; Pérez, Cynthia; Pérez-Fernández, Román; Pichardo, Rafael; Pin Phua, Hwee; Pistelli, Francesco; Plans, Pedro; Polakowska, Maria; Poulter, Neil; Prabhakaran, Dorairaj; Qiao, Qing; Rafiei, Masoud; Raitakari, Olli T.; Ramos, Luiz R.; Rampal, Sanjay; Rampal, Lekhraj; Rasmussen, Finn; Reddy, Kanala K. R.; Redon, Josep; Revilla, Luis; Reyes-García, Victoria; Roaeid, Ragab B.; Rodriguez-Artalejo, Fernando; Rojas-Martinez, Rosalba; Ronkainen, Kimmo; Rosero-Bixby, Luis; Roth, Gregory A.; Sachdev, Harshpal S.; Sánchez, José R.; Sanisoglu, Selim Y.; Sans, Susana; Sarraf-Zadegan, Nizal; Scazufca, Marcia; Schaan, Beatriz D.; Schapochnik, Norberto; Schelleman, Hedi; Schneider, Ione J. C.; Mary Schooling, C.; Schwarz, Bernhard; Sekuri, Cevad; Sereday, Martha S.; Serra-Majem, Lluís; Shaw, Jonathan; Shera, Abdul S.; Shi, Zumin; Shiri, Rahman; Ou Shu, Xiao; Augusto Santos Silva, Diego; Silva, Eglé; Simons, Leon A.; Smith, Margaret; Söderberg, Stefan; Soebardi, Suharko; Solfrizzi, Vincenzo; Sonestedt, Emily; Soysal, Ahmet; Stattin, Pär; Stein, Aryeh D.; Stergiou, George S.; Stessman, Jochanan; Sudo, Akihiro; Suka, Machi; Sundh, Valter; Sundquist, Kristina; Sundström, Johan; Swai, Andrew B.; Shyong Tai, E.; Tambs, Kristian; Tesfaye, Fikru; Thomas, George N.; Thorogood, Margaret; Tilvis, Reijo S.; Tobias, Martin; Torheim, Liv E.; Trenkwalder, Peter; Tuomilehto, Jaakko O.; Tur, Josep A.; Tzourio, Christophe; Uhernik, Ana I.; Ukoli, Flora A.; Unwin, Nigel; Vander Hoorn, Stephen; Vanderpump, Mark P.; Javier Varo, Jose; Veierød, Marit B.; Velásquez-Meléndez, Gustavo; Verschuren, Monique; Viet, Lucie; Villalpando, Salvador; Vioque, Jesus; Vollenweider, Peter; Volpato, Stefano; Wang, Ningli; Wang, Ya X.; Ward, Mark; Waspadji, Sarwono; Welin, Lennart X.; Wilhelmsen, Lars; Willeit, Johann; Woodward, Mark; Xavier, André J.; Xu, Fei; Xu, Liang; Yamamoto, Akira; Yang, Gonghuan; Yang, Xiaoguang; Yeh, Li-Chia; Yoon, Jin-Sang; You, Qisheng; Yu, Zhijie; Zhang, Jian; Zhang, Lei; Zheng, Wei; Zhou, Maigeng
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