Letter | Open | Published:

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Naturevolume 569pages260264 (2019) | Download Citation

Abstract

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities1,2. This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity3,4,5,6. Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017—and more than 80% in some low- and middle-income regions—was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing—and in some countries reversal—of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.

Main

Being underweight or overweight can lead to adverse health outcomes. BMI—a measure of underweight and overweight—is rising in most countries2. It is commonly stated that urbanization is one of the most important drivers of the worldwide rise in BMI because diet and lifestyle in cities lead to adiposity3,4,5,6. However, such statements are typically based on cross-sectional comparisons in one or a small number of countries. Only a few studies have analysed how BMI is changing over time in rural and urban areas. The majority have been in one country, over short durations, and/or in one sex and narrow age groups. The few studies that covered more than one country7,8,9,10,11,12 used at most a few dozen data sources and hence could not systematically estimate trends, and focused primarily on women of child-bearing age.

Data on how BMI in rural and urban populations is changing are needed to plan interventions that address underweight and overweight. Here, we report on mean BMI in rural and urban areas of 200 countries and territories from 1985 to 2017. We used 2,009 population-based studies of human anthropometry conducted in 190 countries (Extended Data Fig. 1), with measurements of height and weight in more than 112 million adults aged 18 years and older. We excluded data based on self-reported height and weight because they are subject to bias. For each sex, we used a Bayesian hierarchical model to estimate mean BMI by year, country and rural or urban place of residence. As described in the Methods, the estimated trends in population mean BMI represent a combination of (1) the change in the health of individuals due to change in their economic status and environment, and (2) the change in the composition of individuals that make up the population (and their economic status and environment).

From 1985 to 2017, the proportion of the world’s population who lived in urban areas1 increased from 41% to 55%. Over the same period, global age-standardized mean BMI increased from 22.6 kg m−2 (95% credible interval 22.4–22.9) to 24.7 kg m−2 (24.5–24.9) in women, and from 22.2 kg m−2 (22.0–22.4) to 24.4 kg m−2 (24.2–24.5) in men. The increase in mean BMI was 2.09 kg m−2 (1.73–2.44) and 2.10 kg m−2 (1.79–2.41) among rural women and men, respectively, compared to 1.35 kg m−2 (1.05–1.65) and 1.59 kg m−2 (1.33–1.84) in urban women and men. Nationally, change in mean BMI ranged from small decreases among women in 12 countries in Europe and Asia Pacific, to a rise of >5 kg m−2 among women in Egypt and Honduras. The lowest observed sex-specific mean BMI over these 33 years was that of rural women in Bangladesh of 17.7 kg m−2 (16.3–19.2) and rural men in Ethiopia of 18.4 kg m−2 (17.0–19.9), both in 1985; the highest were 35.4 kg m−2 (33.7–37.1) for urban women and 34.6 kg m−2 (33.1–35.9) for rural men in American Samoa in 2017 (Extended Data Figs. 2, 3), representing a twofold difference.

In 1985, urban men and women in every country in east, south and southeast Asia, Oceania, Latin America and the Caribbean and a region that comprises central Asia, the Middle East and north Africa had a higher mean BMI than their rural peers (Figs. 1, 2). The urban–rural gap was as large as 3.25 kg m−2 (2.57–3.96) in women and 3.05 kg m−2 (2.44–3.68) in men in India. Over time, the BMI gap between rural and urban women shrank in all of these regions by at least 40%, as BMI rose faster in rural areas than in cities (Fig. 3). In 14 countries in these regions, including Armenia, Chile, Jamaica, Jordan, Malaysia, Taiwan and Turkey, the ordering of rural and urban female BMI reversed over time and rural women had higher BMI than their urban peers in 2017 (Fig. 1 and Extended Data Fig. 4).

Fig. 1: The difference between rural and urban age-standardized mean BMI in women.
Fig. 1

a, Difference in age-standardized mean BMI in 1985. b, Difference in age-standardized mean BMI in 2017. We did not estimate the difference between rural and urban areas for countries and territories in which the entire population live in areas classified as urban (Singapore, Hong Kong, Bermuda and Nauru) or rural (Tokelau)—shown in grey. See Extended Data Fig. 2 for mean BMI at the national level and in rural and urban populations in 1985 and 2017. See Extended Data Fig. 6 for comparisons of the results between women and men.

Fig. 2: The difference between rural and urban age-standardized mean BMI in men.
Fig. 2

a, Difference in age-standardized mean BMI in 1985. b, Difference in age-standardized mean BMI in 2017. We did not estimate the difference between rural and urban areas for countries and territories in which the entire population live in areas classified as urban (Singapore, Hong Kong, Bermuda and Nauru) or rural (Tokelau)—shown in grey. See Extended Data Fig. 3 for mean BMI at the national level and in rural and urban populations in 1985 and 2017. See Extended Data Fig. 6 for comparison of results between women and men.

Fig. 3: Trends in age-standardized mean BMI by rural and urban place of residence.
Fig. 3

a, Trends are shown for women in each region. b, Trends are shown for men in each region. The lines show the posterior mean estimates and the shaded areas show the 95% credible intervals.

The mean BMI of rural men also increased more than the mean BMI of urban men in south Asia and Oceania, shrinking the urban–rural BMI gap by more than half (Figs. 2, 3). In east and southeast Asia, Latin America and the Caribbean, and central Asia, the Middle East and north Africa, men in both rural and urban areas experienced a similar BMI increase and, therefore, the urban excess BMI did not change substantially over time.

In contrast to emerging economies, excess BMI among urban women became larger in sub-Saharan Africa (Fig. 3): from 2.59 kg m−2 (2.21–2.98) in 1985 to 3.17 kg m−2 (2.93–3.42) in 2017 (posterior probability of the observed increase being a true increase >0.999). This occurred because female BMI rose faster in cities than in rural areas in sub-Saharan Africa. This led to women in sub-Saharan African countries, especially those in west Africa, having the largest urban excess BMI of any country in 2017—for example, more than 3.35 kg m−2 in Niger, Burkina Faso, Togo and Ghana (Fig. 1 and Extended Data Fig. 4). BMI increased at a similar rate in rural and urban men in sub-Saharan Africa, with the difference in 2017 (1.66 kg m−2; 1.37–1.94) being similar to 1985 (1.60 kg m−2; 1.13–2.07) (Fig. 2 and Extended Data Fig. 4).

BMI was previously lower in rural areas of low- and middle-income countries than in cities, both because rural residents had higher energy expenditure in their daily work—especially agriculture—and domestic activities, such as fuelwood and water collection13,14, and because lower incomes in rural areas restricted food consumption15. In middle-income countries, agriculture is increasingly mechanized, cars are used for rural transport as income increases and road infrastructure improves, service and administrative jobs have become more common in rural areas, and some household tasks are no longer needed—for example, because homes have a water connection and use commercial fuels16. Furthermore, higher incomes as a result of economic growth allow more spending on food and hence higher caloric intake, disproportionately more in rural areas, where a substantial share of income was previously spent on food. Additionally, the consumption of processed carbohydrates may have increased disproportionately in rural areas where such foods have become more readily available through national and transnational companies9,17,18,19,20,21. These changes, referred to as ‘urbanization of rural life’ by some researchers6, have contributed to a larger increase in rural BMI22,23.

In contrast to other regions, urbanization in sub-Saharan Africa preceded significant economic growth24. Subsistence farming remains common in Africa, and agriculture remains mostly manual; fuelwood—usually collected by women—is still the dominant fuel in rural Africa; and the use of cars for transportation is limited by poor infrastructure and poverty. In African cities, many people have service and office jobs, and mobility has become less energy-intensive owing to shorter travel distances and the use of cars and buses. Furthermore, urban markets where fresh produce is sold are increasingly replaced by commercially prepared and processed foods from transnational and local industries and street vendors25,26,27. These effects are exacerbated by limited time and space for cooking healthy meals and possibly perceptions of large weight as a sign of affluence28,29.

In contrast to low- and middle-income regions, urban women in high-income western and Asia Pacific regions, and in central and eastern Europe, had slightly lower mean BMI than their rural peers in 2017 (Fig. 3). The rural excess BMI for women in these regions changed little from 1985 to 2017. Nationally, the excess BMI of rural women was largest in central and eastern European countries (for example, around 1 kg m−2 or more in Belarus, Latvia and Czech Republic; Fig. 1 and Extended Data Fig. 4). Rural men in high-income western countries also had an excess BMI compared to urban men throughout the analysis period. The largest rural excess BMI for men in 2017 was seen in Sweden, Czech Republic, Ireland, Australia, Austria and the United States, which all had an excess BMI of 0.35 kg m−2 or larger. In the high-income Asia Pacific region and in central and eastern Europe, rural and urban men had almost identical BMI throughout these three decades (Fig. 2 and Extended Data Fig. 4).

The lower urban BMI in high-income and industrialized countries reflects a growing rural economic and social disadvantage, including lower education and income, lower availability and higher price of healthy and fresh foods30,31, less access to, and use of, public transport and walking than in cities32,33, and limited availability of facilities for sports and recreational activity34, which account for a significant share of overall physical activity in high-income and industrialized countries.

We also estimated how much of the overall rise in mean BMI since 1985 has been due to increases in BMI of rural and urban populations versus those attributable to urbanization (defined as an increase in the proportion of the population who live in urban areas), in each region and in the world as a whole. At the global level, 60% (56–64) of the rise in mean BMI from 1985 to 2017 in women and 57% (53–60) in men was due to increases in the BMI of rural populations; 28% (24–31) in women and 30% (27–32) in men due to the rise in BMI in urban populations; and 13% (11–15) and 14% (12–16) due to urbanization (Table 1). The contribution of the rise in rural BMI ranged from around 60% to 90% in the mostly rural regions of sub-Saharan Africa, east, south and southeast Asia and Oceania. The contribution of urbanization was small in all regions of the world, with maximum values of 19% (15–25) among women and 14% (10–21) among men in sub-Saharan Africa.

Table 1 Contributors to the rise in mean BMI from 1985 to 2017

Our results show that, contrary to the prevailing view3,4,5,6, BMI is rising at the same rate or faster in rural areas compared to cities, particularly in low- and middle-income countries except among women in sub-Saharan Africa. These trends have resulted in a rural–urban convergence in BMI in most low- and middle-income countries, especially for women. This convergence mirrors the experience of high-income and industrialized countries, where we found a persistently higher BMI in rural areas. The rising rural BMI is the largest contributor to the BMI rise in low- and middle-income regions and in the world as a whole over the last 33 years, which challenges the current paradigm of urban living and urbanization as the key driver of the global epidemic of obesity.

In poor societies, urban areas historically had lower levels of undernutrition35,36, possibly because infrastructure such as roads and electricity facilitate food trade, transport and storage in cities, which can in turn reduce the impacts of agricultural shocks and seasonality. As economic growth and rural nutrition programmes reduce rural caloric deficiency, the rural undernutrition disadvantage may be replaced with a more general and complex malnutrition that entails excessive consumption of low-quality calories. To avoid such an unhealthy transition, the fragmented national and international responses to undernutrition and obesity should be integrated, and the narrow focus of international aid on undernutrition should be broadened, to enhance access to healthier foods in poor rural and urban communities.

Reporting summary

Further information on research design is available in the Nature Research Reporting Summary linked to this paper.

Methods

Our aim was to estimate trends in mean BMI from 1985 to 2017 by rural and urban place of residence for 200 countries and territories (Supplementary Table 2). To achieve this aim, we pooled cross-sectional population-based data on height and weight in adults aged 18 years and older. Therefore, by design, our results measure total change in BMI in each country’s rural and urban populations, which consists of (1) change in the BMI of individuals due to change in their economic status and environment, and (2) change in the composition of individuals that make up the population (and their economic status and environment). Change in population composition occurs naturally owing to fertility and mortality, as well as owing to migration. Therefore, our results should not be interpreted as solely a change in the BMI of individuals. Both components of change are relevant for policy formulation because policies should address the environment and nutrition of the contemporary population.

We used mean BMI as the primary outcome, rather than prevalence of overweight or obesity, because the relationship between BMI and disease risk is continuous, with each unit lower BMI being associated with a constant proportional reduction in disease risk until a BMI of around 21–23 kg m−2, which is below the cut-offs used to define overweight and obesity37,38,39. Therefore, the largest health benefits of weight management are achieved by lowering the population distribution of BMI. Mean BMI is the simplest summary statistic of the population distribution. Nonetheless, mean BMI and prevalence of overweight and obesity are closely associated (Extended Data Fig. 5).


Data sources

We used a database on cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration (NCD-RisC). NCD-RisC is a worldwide network of health researchers and practitioners, that systematically documents the worldwide trends and variations in risk factors for non-communicable diseases. The database was collated through multiple routes for identifying and accessing data. We accessed publicly available population-based measurement surveys—for example, Demographic and Health Surveys, Global School-based Student Health Surveys, the European Health Interview and Health Examination Surveys and those available via the Inter-University Consortium for Political and Social Research. We requested, through the World Health Organization (WHO) and its regional and country offices, help with identification and access to population-based surveys from ministries of health and other national health and statistical agencies. Requests were also sent by the World Heart Federation to its national partners. We made similar requests to the co-authors of an earlier pooled analysis of cardiometabolic risk factors40,41,42,43 and invited them to reanalyse data from their studies and join NCD-RisC. Finally, to identify major sources not accessed through the above routes, we searched and reviewed published studies as described previously44 and invited all eligible studies to join NCD-RisC.

Anonymized individual record data from sources included in NCD-RisC were reanalysed according to a common protocol. Within each survey, we included participants aged 18 years and older who were not pregnant. We dropped participants with implausible BMI levels (defined as BMI < 10 kg m−2 or BMI > 80 kg m−2) or with implausible height or weight values (defined as height < 100 cm, height > 250 cm, weight < 12 kg or weight > 300 kg; <0.2% of all subjects). We also dropped participants whose urban and rural status was unknown in surveys that had recorded place of residence (0.05% of all participants). We calculated mean BMI and its standard error by sex, age group (18 years, 19 years, 10-year age groups from 20–29 years to 70–79 years and 80+ years) and rural or urban place of residence. All analyses incorporated appropriate sample weights and complex survey design, when applicable, in calculating summary statistics. Countries typically use the rural and urban classification of communities designated by their statistical offices at any given time both for survey design and for reporting of population to the United Nations Population Division. The classification can change, for example as previously rural areas grow and industrialize and hence become, and are (re)designated as, de novo cities. To the extent that the reclassifications keep up with changes in the real status of each community, survey and population data reflect the status of each community at the time of measurement. For surveys without information on place of residence, we calculated age- and sex-stratified summary statistics for the entire sample, which represented the population-weighted sum of rural and urban means.

To ensure summaries were prepared according to the study protocol, computer code was provided to NCD-RisC members who requested assistance. All submitted data were checked by at least two independent reviewers. Questions and clarifications were discussed with NCD-RisC members and resolved before data were incorporated into the database.

Finally, we incorporated all nationally representative data from sources that were identified but not accessed through the above routes, by extracting summary statistics from published reports. Data were also extracted for nine WHO STEPwise approach to Surveillance (STEPS) surveys, one Countrywide Integrated Non-communicable Diseases Intervention (CINDI) survey, and five sites of the WHO Multinational MONItoring of trends and determinants in CArdiovascular disease (MONICA) project that were not deposited in the MONICA Data Centre. Data were extracted from published reports only when reported by sex and in age groups no wider than 20 years. We also used data from a previous global data pooling study43 when such data had not been accessed through the routes described.

All NCD-RisC members are asked periodically to review the list of sources from their country, to suggest additional sources not in the database, and to verify that the included data meet the inclusion criteria listed below and are not duplicates. The NCD-RisC database is continuously updated through this contact with NCD-RisC members. For this paper, we used data from the NCD-RisC database for years 1985 to 2017 and ages 18 years and older. A list of the data sources that we used in this analysis and their characteristics is provided in Supplementary Table 1.


Data inclusion and exclusion

Data sources were included in the NCD-RisC database if: (1) measured data on height, weight, waist circumference or hip circumference were available; (2) study participants were 5 years of age and older; (3) data were collected using a probabilistic sampling method with a defined sampling frame; (4) data were from population samples at the national, sub-national (that is, covering one or more sub-national regions, more than three urban communities or more than five rural communities) or community level; and (5) data were from the countries and territories listed in Supplementary Table 2.

We excluded all data sources that were based solely on self-reported weight and height without a measurement component, because these data are subject to biases that vary by geography, time, age, sex and socioeconomic characteristics45,46,47. Owing to these variations, approaches to correcting self-reported data leave residual bias. We also excluded data sources on population subgroups whose anthropometric status may differ systematically from the general population, including: (1) studies that included or excluded people based on their health status or cardiovascular risk; (2) studies whose participants were only ethnic minorities; (3) specific educational, occupational, or socioeconomic subgroups, with the exception noted below; (4) those recruited through health facilities, with the exception noted below; and (5) women aged 15–19 years in surveys which sampled only ever-married women or measured height and weight only among mothers.

We used school-based data in countries, and in age–sex groups, with school enrolment of 70% or higher. We used data for which the sampling frame was health insurance schemes in countries in which at least 80% of the population were insured. Finally, we used data collected through general practice and primary care systems in high-income and central European countries with universal insurance, because contact with the primary care systems tends to be as good as or better than response rates for population-based surveys.


Conversion of BMI prevalence metrics to mean BMI

In 2% of our data points—mostly extracted from published reports or from a previous pooling analysis43—mean BMI was not reported, but data were available for the prevalence of one or more BMI categories, for example, BMI ≥ 30 kg m−2. In order to use these data, we used previously validated conversion regressions2 to estimate the missing primary outcome from the available BMI prevalence metric(s). All sources of uncertainty in the conversion—including the sampling uncertainty of the original data, the uncertainty of the regression coefficients and random effects, and the regression residuals—were carried forward by using repeated draws from their joint posterior distribution, accounting for the correlations among the uncertainties of regression coefficients and random effects.


Statistical analysis of BMI trends by rural and urban place of residence

We used a Bayesian hierarchical model to estimate mean BMI by country, year, sex, age and place of residence. The statistical model is described in detail in a statistical paper and related substantive papers2,35,40,41,42,43,44,48,49,50,51, and in the Supplementary Information. In summary, we organized countries into 21 regions (Supplementary Table 2), mostly based on geography and national income. The exception was high-income English-speaking countries (Australia, Canada, Ireland, New Zealand, the United Kingdom and the United States), grouped together in one region because BMI and other cardiometabolic risk factors have similar trends in these countries, which can be distinct from other countries in their geographical regions2,49,50,52. Regions were in turn organized into nine super-regions.

The model had a hierarchical structure in which estimates for each country and year were informed by their own data, if available, and by data from other years in the same country and from other countries, especially those in the same region with data for similar time periods. The extent to which estimates for each country-year were influenced by data from other years and other countries depended on whether the country had data, the sample size of the data, whether they were national, and the within-country and within-region variability of the available data. The model incorporated nonlinear time trends comprising linear terms and a second-order random walk, all modelled hierarchically. The age association of BMI was modelled using a cubic spline to allow nonlinear age patterns, which could vary across countries. The model accounted for the possibility that BMI in sub-national and community samples might differ systematically from nationally representative ones and have larger variation than in national studies. These features were implemented by including data-driven fixed-effect and random-effect terms for sub-national and community data. The fixed effects adjusted for systematic differences between sub-national or community studies and national studies. The random effects allowed national data to have larger influence on the estimates than sub-national or community data with similar sample sizes.

Here, we extended the model to make estimates for rural and urban populations following a previously published approach35,51. This model includes a parameter representing the urban–rural BMI difference, which is estimated empirically and allowed to vary by country and year. The model uses all of the data—those stratified by rural and urban place of residence as well as those reported for the entire population. If data for a country-year were not stratified by place of residence, the estimated urban–rural BMI difference was informed by stratified data from other years and countries, especially those in the same region with data from similar time periods.

We fitted the statistical model with the Markov chain Monte Carlo (MCMC) algorithm and following burn-in obtained 5,000 samples (or draws) from the posterior distribution of model parameters, which were in turn used to obtain the posterior distributions of our primary outcomes—mean urban BMI, mean rural BMI and mean urban–rural BMI difference. Posterior estimates were made in 1-year age groups for ages 18 and 19 and 5-year age groups for those aged 20 years and older. We generated age-standardized estimates by taking weighted means of age-specific estimates, using age weights from the WHO standard population. Regional and global rural and urban mean BMI estimates were calculated as population-weighted averages of rural and urban mean for the constituent country estimates by age group and sex. National mean BMI was calculated as population-weighted averages of the rural and urban means. All analyses were done separately by sex because geographical and temporal patterns of BMI differ between men and women2.

The reported credible intervals represent the 2.5th and the 97.5th percentiles of the posterior distributions. We report the posterior probability that the estimated urban–rural BMI difference is a true difference in the same direction as the posterior mean estimate. We also report the posterior probability that the estimated change in the rural–urban BMI difference over time represents a true increase or decrease.


Validation of statistical model

We calculated the difference between the posterior estimates from the model and data from national studies. Median errors were very close to zero (0.03 kg m−2 for women and −0.02 kg m−2 for men) and median absolute errors were 0.32 kg m−2 for women and 0.26 kg m−2 for men, indicating that the estimates were unbiased and had small deviations relative to national studies. The differences were indistinguishable from zero at the 5% level of statistical significance.

We also tested how well our statistical model predicts missing data, known as external predictive validity or cross-validation, in two different tests. In the first test, we held out all data from 10% of countries with data (that is, created the appearance of countries with no data for which we actually had data). The countries for which the data were withheld were selected randomly from the following three groups: data rich (8 or more data sources for women and 7 or more data sources for men), data poor (1–3 data sources for women and 1–2 for men) and average data availability (4–7 data sources for women and 3–6 for men). All data-rich countries had at least one data source after 2000 and at least one source with data stratified on rural and urban place of residence. We fitted the model to the data from the remaining 90% of countries and made estimates of the held-out observations. In the second test, we assessed other patterns of missing data by holding out 10% of our data sources, again from a mix of data-rich, data-poor and average-data countries, as defined above. For a given country, we either held out a random one third of the country’s data or all of the country’s 2000–2017 data to determine, respectively, how well we filled in the gaps for countries with intermittent data and how well we estimated in countries without recent data. We fitted the model to the remaining 90% of the dataset and made estimates of the held-out observations. We repeated each test five times, holding out a different subset of data in each repetition. In both tests, we calculated the differences between the held-out data and the estimates. We also calculated the 95% credible intervals of the estimates; in a model with good external predictive validity, 95% of held-out values would be included in the 95% credible intervals.

Our statistical model performed very well in the external validation tests, that is, in estimating mean BMI when data were missing. The estimates of mean BMI were unbiased, as evidenced with median errors that were zero or close to zero globally (0.03 and −0.03 kg m−2 for women and –0.15 and 0.00 kg m−2 for men in the first and second tests, respectively), and less than ±0.20 kg m−2 in every subset of withheld data except 1985–1999 data in the first test for men, for which the median error was −0.24 kg m−2 (Extended Data Table 2). Most of the median errors were indistinguishable from zero at the 5% level of statistical significance. The 95% credible intervals of estimated mean BMI covered 94–98% of true data globally; coverage was >93% in all but one subset of withheld data. Median absolute errors ranged from 0.52 to 1.09 kg m−2 globally and were at most 1.29 kg m−2 in all subsets of withheld data. Median absolute errors were smaller in the second test, in which subsets of data sources from some countries were withheld, than in the first test, in which all data from some countries were withheld. Given that we had data for 190 out of 200 countries for women and 183 out of 200 countries for men, the second test is a better reflection of data availability in our analysis. For comparison, median absolute differences for mean BMI between pairs of nationally representative surveys done in the same country and in the same year was 0.46 kg m−2, indicating that our estimates perform almost as well as running two parallel surveys in the same country and year.


Contributions of urbanization and rural and urban BMI change to changes in population mean BMI

We calculated the contributions of the following components to change in population mean BMI from 1985 to 2017: the contribution of change in BMI in rural areas, the contribution of change in BMI in urban areas, and the contribution of urbanization (that is, increase in the proportion of people living in urban areas). The first two parts were calculated by fixing the proportion of people living in rural and urban areas to 1985 levels and allowing BMI to change as it did in the respective population. The contribution of urbanization was calculated by fixing BMI in rural and urban areas to 2017 levels and allowing the proportion of people living in cities to change as it did. Percentage contributions were calculated using posterior draws, with reported credible intervals representing the 2.5th and the 97.5th percentiles of their posterior distributions. The change in mean BMI from 1985 to 2017 was then calculated as (contribution of change in rural BMI + contribution of change in urban BMI + contribution of change in the proportion of the population living in urban areas) = ((change in BMIrural1985–2017)(percentage living in rural areas1985) + (change in BMIurban1985–2017)(percentage living in urban areas1985) +(change in percentage living in urban areas1985–2017)(BMIurban2017 − BMIrural2017)).


Strengths and limitations

Urbanization is regarded as one of the most important contributors to the global obesity epidemic, but this perspective is based on limited data. We present the first comparable estimates of mean BMI for rural and urban populations worldwide over three decades using, to our knowledge, the largest and most comprehensive global database of human anthropometry with information on urban or rural place of residence. We used population-based measurement data from almost all countries, with information on participants’ urban or rural place of residence for the majority of data sources. We maintained a high level of data quality through repeated checks of study characteristics against our inclusion and exclusion criteria, which were verified by NCD-RisC members, and did not use any self-reported data to avoid bias in height and weight. Data were analysed according to a common protocol to obtain mean BMI by age, sex and place of residence. We used a statistical model that used all available data, while giving more weight to national data than sub-national and community studies and took into account the epidemiological features of BMI by using nonlinear time trends and age associations. The model used information on the urban–rural difference in BMI where available and estimated this difference hierarchically and temporally in the absence of stratified data.

Despite our large-scale data collation effort, some countries and regions had fewer data sources, particularly the Caribbean, and Polynesia and Micronesia. There were also fewer data sources before 2000. This temporal and geographical sparsity of data led to wider uncertainty intervals for these countries, regions and years. Although health surveys commonly use the rural and urban classification of national statistical offices, cities and rural areas in different countries vary in their demographic characteristics (for example, population size or density), economic activity, administrative structures, infrastructure and environment. These differences appropriately exist because countries themselves differ in terms of their demography, geography and economy. For example, a country with a smaller population may use a lower threshold for urban designation than one with a larger population, because its cities are naturally smaller even if they serve the same functions. Official rural and urban classifications are used for resource allocation and planning for nutrition and health53,54,55,56,57,58, which makes them the appropriate unit for tracking outcomes. Nonetheless, understanding the causes of change in rural and urban areas can be enriched with use of more complex and multi-dimensional measures of urbanicity involving size, density, economic and commercial activities and infrastructures59,60. Finally, urbanization could arise from a variety of mechanisms: (1) natural increase due to excess births over deaths in cities compared to rural areas, (2) rural to urban migration (often related to opportunities for work and education) and (3) reclassification of previously rural areas as they grow and industrialize and hence become, and are (re)designated as, de novo cities. The contributions of these mechanisms to urbanization vary across countries. The use of time-varying rural versus urban classification of communities ensures that in any year, the rural and urban strata represent the actual status of each community. However, each of these mechanisms may have different implications for changes in nutrition and physical activity and, therefore, BMI.

Data availability

Estimates of mean BMI by country, year, sex and urban and rural place of residence are available from http://www.ncdrisc.org/. Input data from publicly available sources can also be downloaded from http://www.ncdrisc.org/. For other data sources, contact information for data providers can be obtained from http://www.ncdrisc.org/.

Code availability

The computer code for the Bayesian hierarchical model used in this work is available at http://www.ncdrisc.org/.

Additional information

Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Acknowledgements

This study was funded by the Wellcome Trust. H.B. was supported by a Medical Research Council Doctoral Training Partnership Studentship, J.B. by a Royal Society Research Grant, and M.D.C. by an Academy of Medical Sciences Springboard Award. We thank L. Jaacks, B. Popkin, S. Sundberg and W. Willett for recommendations of relevant citations. The authors are responsible for the views expressed in this Letter and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated.

Reviewer information

Nature thanks Miguel A. Martinez Beneito, Barry M. Popkin and the other anonymous reviewer(s) for their contribution to the peer review of this work.

Author information

Author notes

  1. A list of authors and their affiliations appears in the online version of the paper.

  2. Deceased: Deepak N. Amarapurkar, Konrad Jamrozik, Dimitrios Trichopoulos.

Affiliations

  1. Imperial College London, London, UK

    • Honor Bixby
    • , Bin Zhou
    • , James E. Bennett
    • , Cristina Taddei
    • , Andrea Rodriguez-Martinez
    • , Rodrigo M. Carrillo-Larco
    • , Marisa K. Sophiea
    • , Maria L. C. Iurilli
    • , Bethlehem D. Solomon
    • , Queenie Chan
    • , Paul Elliott
    • , Ilpo Tapani Huhtaniemi
    • , Marjo-Riitta Jarvelin
    • , Teresa Norat
    • , Elio Riboli
    • , Paolo Vineis
    •  & Majid Ezzati
  2. University of Kent, Canterbury, UK

    • James Bentham
  3. Middlesex University, London, UK

    • Mariachiara Di Cesare
  4. University of California Berkeley, Berkeley, CA, USA

    • Christopher J. Paciorek
  5. World Health Organization, Geneva, Switzerland

    • Gretchen A. Stevens
    • , Stefan Savin
    • , Melanie J. Cowan
    • , Leanne M. Riley
    • , Mohamed M. Ali
    •  & Francesco Branca
  6. Seoul National University, Seoul, South Korea

    • Young-Ho Khang
  7. University of Zagreb, Zagreb, Croatia

    • Maroje Sorić
    • , Zivka Dika
    • , Vesna Juresa
    • , Marjeta Majer
    • , Marjeta Misigoj-Durakovic
    • , Sanja Music Milanovic
    •  & Vera Musil
  8. US Centers for Disease Control and Prevention, Atlanta, GA, USA

    • Edward W. Gregg
    •  & Yiling J. Cheng
  9. Universidad Peruana Cayetano Heredia, Lima, Peru

    • J. Jaime Miranda
    • , Antonio Bernabe-Ortiz
    • , Maria Lazo-Porras
    • , Salim Mohanna
    • , Pedro J. Ortiz
    •  & Tania Tello
  10. Aga Khan University, Karachi, Pakistan

    • Zulfiqar A. Bhutta
    •  & Muhammad Islam
  11. The Hospital for Sick Children, Toronto, Ontario, Canada

    • Zulfiqar A. Bhutta
  12. Harvard T. H. Chan School of Public Health, Boston, MA, USA

    • Goodarz Danaei
    • , Yanping Li
    • , Dimitrios Trichopoulos
    • , Peter Ueda
    •  & Damaskini Valvi
  13. Ministry of Health, Victoria, Seychelles

    • Pascal Bovet
  14. University of Lausanne, Lausanne, Switzerland

    • Pascal Bovet
  15. Victor Babeş University of Medicine and Pharmacy Timisoara, Timisoara, Romania

    • Adela Chirita-Emandi
    • , Mihai Gafencu
    •  & Maria Puiu
  16. The University of the West Indies, Cave Hill, Barbados

    • Ian R. Hambleton
    •  & Christina Howitt
  17. University of Sydney, Sydney, New South Wales, Australia

    • Alison J. Hayes
    • , Louise A. Baur
    • , Chris Cowell
    • , Sarah P. Garnett
    •  & Eng Joo Tan
  18. National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan

    • Nayu Ikeda
  19. South African Medical Research Council, Cape Town, South Africa

    • Andre P. Kengne
    •  & Aletta E. Schutte
  20. ICMR-National Institute of Nutrition, Hyderabad, India

    • Avula Laxmaiah
  21. Brown University, Providence, RI, USA

    • Stephen T. McGarvey
  22. Ain Shams University, Cairo, Egypt

    • Aya Mostafa
    •  & Mostafa K. Mohamed
  23. Karolinska Institutet, Stockholm, Sweden

    • Martin Neovius
    • , Michael Sjöström
    •  & Per Tynelius
  24. University of Ljubljana, Ljubljana, Slovenia

    • Gregor Starc
    • , Gregor Jurak
    •  & Vedrana Sember
  25. Ministry of Health Malaysia, Kuala Lumpur, Malaysia

    • Ahmad A. Zainuddin
    • , Suhaila Abdul Ghaffar
    • , Mohamad Hasnan Ahmad
    • , Noor Ani Ahmad
    • , Tahir Aris
    • , Azli Baharudin
    • , Norsyamlina Che Abdul Rahim
    • , Norazizah Ibrahim Wong
    • , Muhammad Fadhli Mohd Yusoff
    • , Balkish M. Naidu
    • , Mohd Azahadi Omar
    • , Rusidah Selamat
    •  & Ahmad Faudzi Yusoff
  26. Caja Costarricense de Seguro Social, San José, Costa Rica

    • Leandra Abarca-Gómez
    •  & Roy A. Wong-McClure
  27. Al-Quds University, East Jerusalem, Palestine

    • Ziad A. Abdeen
    •  & Radwan F. Qasrawi
  28. National Center of Public Healthcare, Nur-Sultan, Kazakhstan

    • Shynar Abdrakhmanova
    •  & Zhamilya Battakova
  29. Center for Diabetes and Endocrine Care, Srinagar, India

    • Zargar Abdul Hamid
  30. Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria

    • Jamila Abubakar Garba
  31. Birzeit University, Birzeit, Palestine

    • Niveen M. Abu-Rmeileh
    •  & Abdullatif Husseini
  32. Instituto Mexicano del Seguro Social, Mexico City, Mexico

    • Benjamin Acosta-Cazares
    • , Jorge Escobedo-de la Peña
    • , Margot González-Leon
    • , Ramon A. Rascon-Pacheco
    •  & Blanca Sandra Ruiz-Betancourt
  33. Flinders University, Adelaide, South Australia, Australia

    • Robert J. Adams
  34. Mahidol University, Nakhon Pathom, Thailand

    • Wichai Aekplakorn
    • , Nipa Rojroongwasinkul
    • , Paibul Suriyawongpaisal
    •  & Uruwan Yamborisut
  35. BRAC University, Dhaka, Bangladesh

    • Kaosar Afsana
  36. Food and Nutrition Research Institute, Taguig, The Philippines

    • Imelda A. Agdeppa
    • , Mario V. Capanzana
    • , Charmaine A. Duante
    • , Eldridge Ferrer
    • , Glen Gironella
    •  & Lynell V. Maniego
  37. Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico

    • Carlos A. Aguilar-Salinas
  38. University of Amsterdam, Amsterdam, The Netherlands

    • Charles Agyemang
    • , Lizzy M. Brewster
    • , Marieke B. Snijder
    • , Karien Stronks
    •  & Irene G. M. van Valkengoed
  39. Tehran University of Medical Sciences, Tehran, Iran

    • Naser Ahmadi
    • , Ahmad Reza Dorosty
    • , Farshad Farzadfar
    • , Ali Ghanbari
    • , Erfan Ghasemi
    • , Amir Kasaeian
    • , Parinaz Mehdipour
    • , Sahar Saeeidi Moghaddam
    • , Bahram Mohajer
    • , Kazem Mohammad
    • , Farnam Mohebi
    • , Shohreh Naderimagham
    • , Afshin Ostovar
    • , Mahboubeh Parsaeian
    • , Hamed Pouraram
    • , Sadaf G. Sepanlou
    •  & Moein Yoosefi
  40. Non-Communicable Diseases Research Center, Tehran, Iran

    • Alireza Ahmadvand
    • , Mehrdad Azmin
    • , Anoosheh Ghasemian
    •  & Rosa Haghshenas
  41. University of Bremen, Bremen, Germany

    • Wolfgang Ahrens
  42. The National Center for Diabetes, Endocrinology and Genetics, Amman, Jordan

    • Kamel Ajlouni
    •  & Mohammad Khateeb
  43. Aldara Hospital and Medical Center, Riyadh, Saudi Arabia

    • Fadia AlBuhairan
  44. King Abdullah International Medical Research Center, Riyadh, Saudi Arabia

    • Shahla AlDhukair
  45. King Saud University, Riyadh, Saudi Arabia

    • Hazzaa M. Al-Hazzaa
  46. Universiti Malaysia Sabah, Kota Kinabalu, Malaysia

    • Osman Ali
  47. Luxembourg Institute of Health, Strassen, Luxembourg

    • Ala’a Alkerwi
  48. Kuwait Institute for Scientific Research, Safat, Kuwait

    • Amani Rashed Al-Othman
    •  & Kazi M. Jamil
  49. King Abdulaziz University, Jeddah, Saudi Arabia

    • Rajaa Al-Raddadi
    •  & Suhad Bahijri
  50. ISGlobal Centre for Research in Environmental Epidemiology, Barcelona, Spain

    • Mar Alvarez-Pedrerol
    • , Jordi Sunyer
    •  & Martine Vrijheid
  51. World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt

    • Eman Aly
    •  & Heba M. Fouad
  52. Bombay Hospital and Medical Research Centre, Mumbai, India

    • Deepak N. Amarapurkar
  53. University of Lille, Lille, France

    • Philippe Amouyel
    •  & Frederic Gottrand
  54. Lille University Hospital, Lille, France

    • Philippe Amouyel
    • , Luc Dauchet
    •  & Jonathan Giovannelli
  55. London School of Hygiene & Tropical Medicine, London, UK

    • Antoinette Amuzu
    • , Martin McKee
    • , Moffat Nyirenda
    • , Alison J. Price
    •  & Liam Smeeth
  56. Western Norway University of Applied Sciences, Sogndal, Norway

    • Lars Bo Andersen
  57. Norwegian School of Sport Sciences, Oslo, Norway

    • Sigmund A. Anderssen
    • , Ulf Ekelund
    • , Elin Kolle
    • , Jostein Steene-Johannessen
    •  & Jakob Tarp
  58. University of Copenhagen, Copenhagen, Denmark

    • Lars H. Ängquist
    • , Camilla T. Damsgaard
    • , Kim F. Michaelsen
    • , Drude Molbo
    • , Erik Lykke Mortensen
    •  & Thorkild I. A. Sørensen
  59. Madras Diabetes Research Foundation, Chennai, India

    • Ranjit Mohan Anjana
    • , Mohan Deepa
    • , Viswanathan Mohan
    •  & Rajendra Pradeepa
  60. Zahedan University of Medical Sciences, Zahedan, Iran

    • Alireza Ansari-Moghaddam
  61. National Institute of Public Health, Tunis, Tunisia

    • Hajer Aounallah-Skhiri
  62. Institute of Public Health of the University of Porto, Porto, Portugal

    • Joana Araújo
    •  & Ana Henriques
  63. Norwegian Institute of Public Health, Oslo, Norway

    • Inger Ariansen
    • , Anna Biehl
    • , Sidsel Graff-Iversen
    •  & Jørgen Meisfjord
  64. University of Massachusetts, Amherst, MA, USA

    • Raphael E. Arku
  65. Abt Associates, Kathmandu, Nepal

    • Krishna K. Aryal
  66. University of Iceland, Reykjavik, Iceland

    • Thor Aspelund
    •  & Vilmundur Gudnason
  67. University of Yaoundé 1, Yaoundé, Cameroon

    • Felix K. Assah
    • , Jean Claude N. Mbanya
    •  & Eugène Sobngwi
  68. Federal University of Pelotas, Pelotas, Brazil

    • Maria Cecília F. Assunção
    • , Aluisio J. D. Barros
    • , Paula Duarte de Oliveira
    • , Helen Gonçalves
    • , Bernardo L. Horta
    • , Ana Maria B. Menezes
    • , Isabel O. Oliveira
    • , Ina S. Santos
    •  & Cesar G. Victora
  69. University of Medicine 1, Yangon, Myanmar

    • May Soe Aung
  70. University of Oulu, Oulu, Finland

    • Juha Auvinen
    • , Marjo-Riitta Jarvelin
    • , Raija Korpelainen
    • , Soile E. Puhakka
    •  & Sylvain Sebert
  71. Regional Authority of Public Health, Banska Bystrica, Slovakia

    • Mária Avdicová
    •  & Jana Námešná
  72. University of Porto Medical School, Porto, Portugal

    • Ana Azevedo
    •  & Elisabete Ramos
  73. Shahid Beheshti University of Medical Sciences, Tehran, Iran

    • Fereidoun Azizi
    • , Farzad Hadaegh
    • , Davood Khalili
    • , Bahareh Kheiri
    • , Amirabbas Momenan
    •  & Mehdi Yaseri
  74. Indian Council of Medical Research, New Delhi, India

    • Bontha V. Babu
    •  & Geetha R. Menon
  75. Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark

    • Jennifer L. Baker
    • , Thomas M. Dantoft
    • , Marie Eliasen
    • , Torben Jørgensen
    • , Allan Linneberg
    • , Line T. Møllehave
    • , Betina H. Thuesen
    •  & Esther Zimmermann
  76. University of Science and Technology, Sana’a, Yemen

    • Mohamed Bamoshmoosh
  77. Medical University of Lodz, Lodz, Poland

    • Maciej Banach
    • , Elzbieta Dziankowska-Zaborszczyk
    •  & Jolanta Slowikowska-Hilczer
  78. Medical University of Gdansk, Gdansk, Poland

    • Piotr Bandosz
    • , Marcin Rutkowski
    •  & Tomasz Zdrojewski
  79. Universidad Autónoma de Madrid, Madrid, Spain

    • José R. Banegas
    • , Juan J. Cruz
    • , Esther López-García
    •  & Fernando Rodríguez-Artalejo
  80. University of Palermo, Palermo, Italy

    • Carlo M. Barbagallo
    •  & Davide Noto
  81. Pan American Health Organization, Washington, DC, USA

    • Alberto Barceló
    •  & Pedro Ordunez
  82. Mohammed V University de Rabat, Rabat, Morocco

    • Amina Barkat
  83. University of Pernambuco, Recife, Brazil

    • Mauro V. G. Barros
    •  & Rildo S. Wanderley Jr
  84. Dalhousie University, Halifax, Nova Scotia, Canada

    • Iqbal Bata
    •  & Ronald D. Gregor
  85. Jordan University of Science and Technology, Irbid, Jordan

    • Anwar M. Batieha
    • , Hashem Jaddou
    •  & Yousef Saleh Khader
  86. Federal University of Maranhao, Sao Luis, Brazil

    • Rosangela L. Batista
    •  & Antonio M. Silva
  87. Kazakh National Medical University, Almaty, Kazakhstan

    • Assembekov Batyrbek
    • , Salim Berkinbayev
    • , Kairat Davletov
    • , Alibek Mereke
    •  & Baurzhan Zhussupov
  88. University of Auckland, Auckland, New Zealand

    • Robert Beaglehole
    • , Rod T. Jackson
    • , Jacqueline Ramke
    •  & Boyd A. Swinburn
  89. University College Dublin, Dublin, Ireland

    • Silvia Bel-Serrat
    • , Mirjam Heinen
    • , Cecily Kelleher
    •  & Breige A. McNulty
  90. University Tunis El Manar, Tunis, Tunisia

    • Habiba Ben Romdhane
    •  & Olfa Saidi
  91. Federal Ministry of Labour, Social Affairs, Health and Consumer Protection, Vienna, Austria

    • Judith Benedics
    •  & Adelheid Weber
  92. Cafam University Foundation, Bogota, Colombia

    • Mikhail Benet
  93. Lithuanian University of Health Sciences, Kaunas, Lithuania

    • Gailute Bernotiene
    • , Virginija Dulskiene
    • , Jurate Klumbiene
    • , Renata Kuciene
    • , Dalia Luksiene
    • , Jurate Medzioniene
    • , Janina Petkeviciene
    • , Ausra Petrauskiene
    • , Ricardas Radisauskas
    • , Abdonas Tamosiunas
    •  & Justina Vaitkeviciute
  94. University of São Paulo, São Paulo, Brazil

    • Heloisa Bettiol
    • , Viviane C. Cardoso
    • , Paulo A. Lotufo
    •  & Alicia Matijasevich
  95. B. J. Medical College, Ahmedabad, India

    • Aroor Bhagyalaxmi
  96. Chirayu Medical College, New Delhi, India

    • Sumit Bharadwaj
  97. Sunder Lal Jain Hospital, Delhi, India

    • Santosh K. Bhargava
  98. Shandong University of Traditional Chinese Medicine, Shandong, China

    • Hongsheng Bi
    •  & Jianfeng Wu
  99. Shanghai Jiao-Tong University School of Medicine, Shanghai, China

    • Yufang Bi
    •  & Guang Ning
  100. Institute of Medical Research and Medicinal Plant Studies, Yaoundé, Cameroon

    • Elysée Claude Bika Lele
  101. Ufa Eye Research Institute, Ufa, Russia

    • Mukharram Bikbov
    •  & Gyulli Kazakbaeva
  102. Nepal Health Research Council, Kathmandu, Nepal

    • Bihungum Bista
    •  & Meghnath Dhimal
  103. University of Montenegro, Niksic, Montenegro

    • Dusko J. Bjelica
    •  & Stevo R. Popovic
  104. University of Greenland, Nuuk, Greenland

    • Peter Bjerregaard
  105. University of Southern Denmark, Odense, Denmark

    • Peter Bjerregaard
    • , Kaare Christensen
    • , Louise Eriksen
    • , Anders Grøntved
    • , Peter Lund Kristensen
    • , Niels C. Møller
    •  & Janne S. Tolstrup
  106. University of Oslo, Oslo, Norway

    • Espen Bjertness
    • , Marius B. Bjertness
    •  & Haakon E. Meyer
  107. University of Gothenburg, Gothenburg, Sweden

    • Cecilia Björkelund
    • , Robert Eggertsen
    • , Lauren Lissner
    • , Annika Rosengren
    •  & Agneta Sjöberg
  108. National Institute for Public Health and the Environment, Bilthoven, The Netherlands

    • Anneke Blokstra
    • , H. Bas Bueno-de-Mesquita
    • , W. M. Monique Verschuren
    • , Lucie Viet
    •  & Alet H. Wijga
  109. University of Turin, Turin, Italy

    • Simona Bo
    • , Graziella Bruno
    •  & Gabriella Gruden
  110. University College London, London, UK

    • Martin Bobak
    • , Juan-Pablo Casas
    • , Nishi Chaturvedi
    • , Rebecca Hardy
    • , Diana Kuh
    • , Hynek Pikhart
    •  & S. Goya Wannamethee
  111. Liverpool John Moores University, Liverpool, UK

    • Lynne M. Boddy
  112. Nanyang Technological University, Singapore, Singapore

    • Bernhard O. Boehm
  113. German Institute of Human Nutrition, Potsdam, Germany

    • Heiner Boeing
  114. Universidad de la República, Montevideo, Uruguay

    • Jose G. Boggia
    •  & Oscar A. Noboa
  115. CEMIC, Buenos Aires, Argentina

    • Carlos P. Boissonnet
  116. IRCCS Neuromed, Pozzilli, Italy

    • Marialaura Bonaccio
    • , Simona Costanzo
    • , Amalia De Curtis
    • , Giovanni de Gaetano
    • , Maria Benedetta Donati
    •  & Licia Iacoviello
  117. Toulouse University School of Medicine, Toulouse, France

    • Vanina Bongard
    • , Jean Ferrieres
    •  & Jean-Bernard Ruidavets
  118. University of Zurich, Zurich, Switzerland

    • Matthias Bopp
    • , David Faeh
    • , Felix Gutzwiller
    • , Susi Kriemler
    • , Frank J. Rühli
    •  & Kaspar Staub
  119. University Hospital of Varese, Varese, Italy

    • Rossana Borchini
  120. University Hospital KU Leuven, Leuven, Belgium

    • Herman Borghs
  121. Flemish Agency for Care and Health, Brussels, Belgium

    • Lien Braeckevelt
  122. Ghent University, Ghent, Belgium

    • Lutgart Braeckman
    • , Els Clays
    • , Guy De Backer
    • , Dirk De Bacquer
    • , Stefaan De Henauw
    • , Delphine De Smedt
    • , Patrick Kolsteren
    • , Carl Lachat
    • , Nathalie Michels
    •  & Koen Van Herck
  123. FrieslandCampina, Amersfoort, The Netherlands

    • Marjolijn C. E. Bragt
    •  & Ilse M. S. L. Khouw
  124. Universidad Central de Venezuela, Caracas, Venezuela

    • Imperia Brajkovich
  125. Bielefeld University, Bielefeld, Germany

    • Juergen Breckenkamp
  126. World Health Organization Regional Office for Europe, Copenhagen, Denmark

    • João Breda
    •  & Marta Buoncristiano
  127. German Cancer Research Center, Heidelberg, Germany

    • Hermann Brenner
    • , Rudolf Kaaks
    • , Kai-Uwe Saum
    •  & Ben Schöttker
  128. The Fred Hollows Foundation, Auckland, New Zealand

    • Garry R. Brian
  129. University of Medicine and Pharmacy Bucharest, Bucharest, Romania

    • Lacramioara Brinduse
  130. University College Copenhagen, Copenhagen, Denmark

    • Anna Bugge
  131. Institute of Public Health, Tirana, Albania

    • Genc Burazeri
    •  & Jolanda Hyska
  132. Cork Institute of Technology, Cork, Ireland

    • Con Burns
    • , Tara C. Coppinger
    •  & Janette Walton
  133. Universidad de La Laguna, Tenerife, Spain

    • Antonio Cabrera de León
  134. University of Malta, Pietà, Malta

    • Joseph Cacciottolo
  135. Vanderbilt University, Nashville, TN, USA

    • Hui Cai
    •  & Wei Zheng
  136. Ministry of Health, Tongatapu, Tonga

    • Tilema Cama
  137. Canadian Fitness and Lifestyle Research Institute, Ottawa, Ontario, Canada

    • Christine Cameron
    •  & Cora L. Craig
  138. Hospital Santa Maria, Lisbon, Portugal

    • José Camolas
  139. Karadeniz Technical University, Trabzon, Turkey

    • Gamze Can
    • , Cihangir Erem
    •  & Murat Topbas
  140. Istanbul University, Istanbul, Turkey

    • Günay Can
    •  & Altan Onat
  141. Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil

    • Ana Paula C. Cândido
  142. Ministry of Public Health, Asunción, Paraguay

    • Felicia Cañete
    •  & Victor Sequera
  143. Cardiologia di Mercato S. Severino Hospital, Mercato San Severino, Italy

    • Eduardo Capuano
    •  & Vincenzo Capuano
  144. Karolinska Institutet, Huddinge, Sweden

    • Axel C. Carlsson
    •  & Holger Theobald
  145. Centro de Estudios sobre Nutrición Infantil, Buenos Aires, Argentina

    • Esteban Carmuega
    •  & Maria Elisa Zapata
  146. University of Porto, Porto, Portugal

    • Maria J. Carvalho
    • , Luis Lopes
    • , Nuno Lunet
    • , Jorge Mota
    •  & Rute Santos
  147. Santiago de Compostela University, Santiago de Compostela, Spain

    • Felipe F. Casanueva
  148. Associazione Calabrese di Epatologia, Reggio Calabria, Italy

    • Carmelo A. Caserta
  149. Ministry of Health, Ankara, Turkey

    • Ertugrul Celikcan
    • , Sibel Gogen
    •  & Nazan Yardim
  150. Food and Agriculture Organization of the United Nations, Rome, Italy

    • Laura Censi
  151. Federal University of Rio Grande, Rio Grande, Brazil

    • Juraci A. Cesar
    •  & Samuel C. Dumith
  152. India Diabetes Research Foundation, Chennai, India

    • Snehalatha Chamukuttan
    • , Ambady Ramachandran
    •  & Mary Simon
  153. Duke-NUS Medical School, Singapore, Singapore

    • Angelique W. Chan
    • , Ching-Yu Cheng
    • , Tazeen Jafar
    • , Rahul Malhotra
    •  & Tien Yin Wong
  154. National Institute of Medical Statistics, New Delhi, India

    • Himanshu K. Chaturvedi
    •  & Arvind Pandey
  155. Academia Sinica, Taipei, Taiwan

    • Chien-Jen Chen
    •  & Wen-Harn Pan
  156. Capital Institute of Pediatrics, Beijing, China

    • Fangfang Chen
    •  & Jie Mi
  157. Duke University, Durham, NC, USA

    • Huashuai Chen
    •  & Yi Zeng
  158. Kailuan General Hospital, Tangshan, China

    • Shuohua Chen
    • , Liufu Cui
    • , Jingli Gao
    •  & Shouling Wu
  159. University of Oxford, Oxford, UK

    • Zhengming Chen
    • , Timothy Key
    • , Mark Woodward
    •  & Ling Yang
  160. The Gertner Institute for Epidemiology and Health Policy Research, Ramat Gan, Israel

    • Angela Chetrit
    • , Rachel Dankner
    •  & Ofra Kalter-Leibovici
  161. National Centre of Public Health and Analyses, Sofia, Bulgaria

    • Ekaterina Chikova-Iscener
    •  & Vesselka Duleva
  162. University of Bern, Lausanne, Switzerland

    • Arnaud Chiolero
  163. Ministry of Health and Welfare, Taipei, Taiwan

    • Shu-Ti Chiou
    •  & Ying-Wei Wang
  164. Murcia Health Council, Murcia, Spain

    • María-Dolores Chirlaque
  165. Seoul National University College of Medicine, Seoul, South Korea

    • Belong Cho
  166. Korea Centers for Disease Control and Prevention, Cheongju-si, South Korea

    • Yumi Cho
    •  & Kyungwon Oh
  167. Universidade Estadual Paulista, Presidente Prudente, Brazil

    • Diego G. Christofaro
    • , Romulo A. Fernandes
    •  & William R. Tebar
  168. Medical University of Silesia, Katowice, Poland

    • Jerzy Chudek
    •  & Andrzej Wiecek
  169. Charles University in Prague, Prague, Czech Republic

    • Renata Cifkova
  170. Thomayer Hospital, Prague, Czech Republic

    • Renata Cifkova
  171. Primary Health Care, Floriana, Malta

    • Michelle Cilia
    •  & Victoria Farrugia Sant’Angelo
  172. Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

    • Eliza Cinteza
    • , Maria Dorobantu
    •  & Oana-Florentina Gheorghe-Fronea
  173. Katholieke Universiteit Leuven, Leuven, Belgium

    • Frank Claessens
    •  & Dirk Vanderschueren
  174. Statistics Canada, Ottawa, Ontario, Canada

    • Janine Clarke
    • , Scott B. McLean
    • , Joel G. R. Roy
    •  & Jennifer Servais
  175. Agency for Preventive and Social Medicine, Bregenz, Austria

    • Hans Concin
    • , Bernhard Föger
    • , Harald Geiger
    •  & Georg Posch
  176. Universidade Federal de Santa Catarina, Florianópolis, Brazil

    • Susana C. Confortin
    • , Eleonora d’Orsi
    • , Larissa Pruner Marques
    • , Lariane M. Ono
    •  & Diego Augusto Santos Silva
  177. University of Southampton, Southampton, UK

    • Cyrus Cooper
    • , Elaine Dennison
    • , Caroline H. Fall
    •  & Allan G. Hill
  178. Institut Pasteur de Lille, Lille, France

    • Dominique Cottel
    •  & Jean Dallongeville
  179. Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi

    • Amelia C. Crampin
  180. CIBEROBN, Madrid, Spain

    • Ana B. Crujeiras
    •  & Dora Romaguera
  181. National Institute of Public Health, Bucharest, Romania

    • Alexandra Cucu
    •  & Constanta Huidumac Petrescu
  182. Eduardo Mondlane University, Maputo, Mozambique

    • Albertino Damasceno
  183. National Council of Research, Reggio Calabria, Italy

    • Graziella D’Arrigo
  184. Indian Statistical Institute, Kolkata, India

    • Parasmani Dasgupta
  185. Tabriz Health Services Management Centre, Tabriz, Iran

    • Saeed Dastgiri
  186. Sciensano, Brussels, Belgium

    • Karin De Ridder
  187. Academic Medical Center of University of Amsterdam, Amsterdam, The Netherlands

    • Susanne R. de Rooij
    •  & Constance Schultsz
  188. National Research Centre for Preventive Medicine, Moscow, Russia

    • Alexander D. Deev
    •  & Svetlana A. Shalnova
  189. Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands

    • Abbas Dehghan
    • , Klodian Dhana
    • , Oscar H. Franco
    • , Albert Hofman
    • , M. Arfan Ikram
    • , Maryam Kavousi
    •  & Marileen L. P. Portegies
  190. University of Montreal, Montreal, Québec, Canada

    • Hélène Delisle
  191. Institut de Recherche pour le Développement, Montpellier, France

    • Francis Delpeuch
    • , Yves Kameli
    • , Bernard Maire
    • , Yves Martin-Prevel
    • , Mathilde Savy
    •  & Pierre Traissac
  192. French Public Health Agency, St Maurice, France

    • Valérie Deschamps
    •  & Benoit Salanave
  193. Mediterranea Cardiocentro, Naples, Italy

    • Augusto F. Di Castelnuovo
    •  & Francesco Gianfagna
  194. Universidade do Vale do Rio dos Sinos, São Leopoldo, Brazil

    • Juvenal Soares Dias-da-Costa
  195. National Council of Scientific and Technical Research, Tandil, Argentina

    • Alejandro Diaz
  196. Ministry of Health and Medical Education, Tehran, Iran

    • Shirin Djalalinia
    •  & Niloofar Peykari
  197. National Institute of Nutrition, Hanoi, Vietnam

    • Ha T. P. Do
    • , Chinh Nguyen Huu
    • , Khanh Le Nguyen Bao
    •  & Tuyen D. Le
  198. University of Queensland, Brisbane, Queensland, Australia

    • Annette J. Dobson
  199. Istituto Superiore di Sanità, Rome, Italy

    • Chiara Donfrancesco
    • , Simona Giampaoli
    • , Laura Lauria
    • , Paola Nardone
    • , Luigi Palmieri
    • , Daniela Pierannunzio
    •  & Angela Spinelli
  200. Universidad de Cuenca, Cuenca, Ecuador

    • Silvana P. Donoso
    •  & Angélica M. Ochoa-Avilés
  201. Helmholtz Zentrum München, Munich, Germany

    • Angela Döring
    • , Christa Meisinger
    • , Martina Müller-Nurasyid
    • , Annette Peters
    •  & Doris Stöckl
  202. Ministère de la Santé et de la Lutte Contre le Sida, Abidjan, Côte d’Ivoire

    • Kouamelan Doua
  203. The Cardinal Wyszynski Institute of Cardiology, Warsaw, Poland

    • Wojciech Drygas
    • , Pawel Kurjata
    •  & Aleksandra Piwonska
  204. Beijing Center for Disease Prevention and Control, Beijing, China

    • Jia Li Duan
  205. BIDMC, Boston, MA, USA

    • Rosemary B. Duda
  206. University of Latvia, Riga, Latvia

    • Vilnis Dzerve
    •  & Elena Pahomova
  207. Ministry of Health and Medical Services, Gizo, Solomon Islands

    • Ricky Eddie
  208. University of Benin, Benin City, Nigeria

    • Eruke E. Egbagbe
  209. University of Skövde, Skövde, Sweden

    • Gabriele Eiben
  210. National Institute of Nutrition and Food Technology, Tunis, Tunisia

    • Jalila El Ati
  211. The University of the West Indies, Kingston, Jamaica

    • Denise Eldemire-Shearer
    • , Trevor S. Ferguson
    • , Kenneth James
    • , Shelly R. McFarlane
    • , Marshall K. Tulloch-Reid
    • , Rainford J. Wilks
    •  & Novie O. Younger-Coleman
  212. University of California Davis, Davis, CA, USA

    • Reina Engle-Stone
  213. University of Stellenbosch, Cape Town, South Africa

    • Rajiv T. Erasmus
  214. National Institute for Health and Welfare, Helsinki, Finland

    • Johan G. Eriksson
    • , Tuija Jääskeläinen
    • , Anne Juolevi
    • , Eero O. Kajantie
    • , Seppo Koskinen
    • , Kari Kuulasmaa
    • , Tiina Laatikainen
    • , Annamari Lundqvist
    • , Markku Peltonen
    • , Veikko Salomaa
    •  & Hanna K. Tolonen
  215. Queen’s University of Belfast, Belfast, UK

    • Alun Evans
    •  & Dermot O’Reilly
  216. Shiraz University of Medical Sciences, Shiraz, Iran

    • Mohammad R. Fattahi
    • , Fatemeh Malekzadeh
    •  & Reza Malekzadeh
  217. Centro de Salud Villanueva Norte, Badajoz, Spain

    • Francisco J. Felix-Redondo
  218. Hospital Don Benito-Villanueva de la Serena, Badajoz, Spain

    • Daniel Fernández-Bergés
  219. Ministry of Health, Buenos Aires, Argentina

    • Daniel Ferrante
  220. Council for Agricultural Research and Economics, Rome, Italy

    • Marika Ferrari
  221. Pontificia Universidad Católica de Chile, Santiago, Chile

    • Catterina Ferreccio
    • , Paula Margozzini
    • , Juan Francisco Miquel
    • , Flavio Nervi
    •  & Gonzalo Valdivia
  222. Institute of Mother and Child, Warsaw, Poland

    • Anna Fijalkowska
    •  & Magdalena Korzycka
  223. University of Basel, Basel, Switzerland

    • Günther Fink
  224. Swiss TPH, Basel, Switzerland

    • Günther Fink
  225. University of Tartu, Tartu, Estonia

    • Krista Fischer
    • , Andres Metspalu
    • , Kairit Mikkel
    •  & Mari-Liis Tammesoo
  226. Instituto Nacional de Salud Pública, Cuernavaca, Mexico

    • Eric Monterubio Flores
    • , Leticia Hernandez Cadena
    • , Juan A. Rivera
    •  & Eduardo Salazar-Martinez
  227. Universiti Sains Malaysia, Kelantan, Malaysia

    • Leng Huat Foo
    • , Aziz al-Safi Ismail
    •  & Wan Mohamad Wan Bebakar
  228. Umeå University, Umeå, Sweden

    • Ann-Sofie Forslund
    • , Maria Forsner
    •  & Stefan Söderberg
  229. Georgia College and State University, Milledgeville, GA, USA

    • Damian K. Francis
  230. Federal University of São Paulo, São Paulo, Brazil

    • Maria do Carmo Franco
    •  & Maria Wany Strufaldi
  231. Hospital Universitario Son Espases, Palma, Spain

    • Guillermo Frontera
  232. Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil

    • Flavio D. Fuchs
  233. Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil

    • Sandra C. Fuchs
    •  & Leila B. Moreira
  234. Kindai University, Osaka-Sayama, Japan

    • Yuki Fujita
    •  & Kumiko Ohara
  235. Kyoto University, Kyoto, Japan

    • Takuro Furusawa
  236. Medical University of Warsaw, Warsaw, Poland

    • Zbigniew Gaciong
  237. Ministry of Health, Rome, Italy

    • Daniela Galeone
  238. University of Catania, Catania, Italy

    • Fabio Galvano
    • , Justyna Godos
    • , Giuseppe Grosso
    • , Stefano Marventano
    •  & Antonio Mistretta
  239. CIBER en Epidemiología y Salud Pública, Alicante, Spain

    • Manoli Garcia-de-la-Hera
    •  & Eva Maria Navarrete-Muñoz
  240. Africa Health Research Institute, Mtubatuba, South Africa

    • Dickman Gareta
  241. Geneva University Hospitals, Geneva, Switzerland

    • Jean-Michel Gaspoz
    •  & Idris Guessous
  242. CIBER en Epidemiología y Salud Pública, Barcelona, Spain

    • Magda Gasull
  243. Australian Bureau of Statistics, Canberra, Australian Capital Territory, Australia

    • Louise Gates
  244. Universidade Federal de Minas Gerais, Belo Horizonte, Brazil

    • Andrea Gazzinelli
    •  & Gustavo Velasquez-Melendez
  245. Wageningen University, Wageningen, The Netherlands

    • Johanna M. Geleijnse
  246. University of Insubria, Varese, Italy

    • Francesco Gianfagna
    • , Licia Iacoviello
    •  & Giovanni Veronesi
  247. University of Adelaide, Adelaide, South Australia, Australia

    • Tiffany K. Gill
    • , David A. Gonzalez-Chica
    • , Konrad Jamrozik
    •  & Anne Taylor
  248. Lund University, Lund, Sweden

    • Aleksander Giwercman
    • , Emily Sonestedt
    •  & Tanja Stocks
  249. Ministry of Health, Jerusalem, Israel

    • Rebecca A. Goldsmith
    •  & Lital Keinan-Boker
  250. McGill University, Montreal, Québec, Canada

    • David Goltzman
    •  & Suzanne Morin
  251. Universidad Autonoma de Santo Domingo, Santo Domingo, Dominican Republic

    • Angel R. Gonzalez
  252. Universidad Politécnica de Madrid, Madrid, Spain

    • Marcela Gonzalez-Gross
  253. The Andes Clinic of Cardio-Metabolic Studies, Merida, Venezuela

    • Juan P. González-Rivas
  254. Instituto Nacional de Higiene, Epidemiología y Microbiología, Havana, Cuba

    • María-Elena González-Villalpando
    • , Ramón Suárez-Medina
    •  & Patricia Varona-Pérez
  255. Ministry of Health, Lisbon, Portugal

    • Antonio Pedro Graça
  256. Institute for Clinical and Experimental Medicine, Prague, Czech Republic

    • Dušan Grafnetter
    •  & Vera Lanska
  257. Children’s Memorial Health Institute, Warsaw, Poland

    • Aneta Grajda
    • , Beata Gurzkowska
    • , Zbigniew Kulaga
    •  & Mieczyslaw Litwin
  258. Aristotle University of Thessaloniki, Thessaloniki, Greece

    • Maria G. Grammatikopoulou
    •  & Xenophon Theodoridis
  259. Jagiellonian University Medical College, Kraków, Poland

    • Tomasz Grodzicki
    • , Grazyna Jasienska
    • , Ilona Nenko
    • , Andrzej Pająk
    •  & Roman Topór-Madry
  260. National Center of Cardiovascular Diseases, Beijing, China

    • Dongfeng Gu
  261. University of Ferrara, Ferrara, Italy

    • Emanuela Gualdi-Russo
    • , Natascia Rinaldo
    •  & Luciana Zaccagni
  262. Icelandic Heart Association, Kopavogur, Iceland

    • Elias F. Gudmundsson
    • , Johanna Gunnlaugsdottir
    •  & Örn Olafsson
  263. Universidad Icesi, Cali, Colombia

    • Ramiro Guerrero
  264. State University of Montes Claros, Montes Claros, Brazil

    • Andre L. Guimaraes
  265. King’s College London, London, UK

    • Martin C. Gulliford
  266. International Agency for Research on Cancer, Lyon, France

    • Marc Gunter
    • , Inge Huybrechts
    • , Mattias Johansson
    •  & Neil Murphy
  267. Capital Medical University, Beijing, China

    • Xiuhua Guo
    • , Yin Guo
    • , Ya Xing Wang
    • , Wenbin Wei
    • , Liang Xu
    •  & Qi Sheng You
  268. Healis-Sekhsaria Institute for Public Health, Navi Mumbai, India

    • Prakash C. Gupta
    • , Sameer Narake
    •  & Mangesh S. Pednekar
  269. Eternal Heart Care Centre and Research Institute, Jaipur, India

    • Rajeev Gupta
  270. University of Ibadan, Ibadan, Nigeria

    • Oye Gureje
  271. Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina

    • Laura Gutierrez
    • , Vilma E. Irazola
    •  & Adolfo Rubinstein
  272. Research and Education Institute of Child Health, Nicosia, Cyprus

    • Charalambos A. Hadjigeorgiou
    • , Savvas Savva
    •  & Michael J. Tornaritis
  273. Danish Cancer Society Research Centre, Copenhagen, Denmark

    • Jytte Halkjær
    •  & Anne Tjonneland
  274. Alexander Technological Educational Institute, Thessaloniki, Greece

    • Maria Hassapidou
    • , Ioannis Pagkalos
    • , Dimitrios Poulimeneas
    •  & Maria Tsigga
  275. Kyushu University, Fukuoka, Japan

    • Jun Hata
    •  & Toshiharu Ninomiya
  276. University of Bergen, Bergen, Norway

    • Teresa Haugsgjerd
    •  & Grethe Tell
  277. Tulane University, New Orleans, LA, USA

    • Jiang He
  278. Chinese Center for Disease Control and Prevention, Beijing, China

    • Yuna He
    • , Xiaoguang Yang
    • , Wenhua Zhao
    •  & Maigeng Zhou
  279. University of Pécs, Pécs, Hungary

    • Regina Heidinger-Felso
    •  & Dénes Molnár
  280. Danish Health Authority, Copenhagen, Denmark

    • Tatjana Hejgaard
  281. Joep Lange Institute, Amsterdam, The Netherlands

    • Marleen Elisabeth Hendriks
  282. Oulu University Hospital, Oulu, Finland

    • Sauli Herrala
    • , Jari J. Jokelainen
    •  & Sirkka Keinänen-Kiukaanniemi
  283. Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia

    • Victor M. Herrera
  284. ETH Zurich, Zurich, Switzerland

    • Isabelle Herter-Aeberli
  285. Chronic Diseases Research Center, Tehran, Iran

    • Ramin Heshmat
  286. University of Hong Kong, Hong Kong, China

    • Sai Yin Ho
    • , Tai Hing Lam
    •  & Hung-Kwan So
  287. The Chinese University of Hong Kong, Hong Kong, China

    • Suzanne C. Ho
    • , Yn-Tz Sung
    •  & Jean Woo
  288. University of Western Australia, Perth, Western Australia, Australia

    • Michael Hobbs
  289. Kingston Health Sciences Centre, Kingston, Ontario, Canada

    • Wilma M. Hopman
  290. Heart Institute, São Paulo, Brazil

    • Andrea R. V. R. Horimoto
    •  & Alexandre C. Pereira
  291. Fundación Oftalmológica de Santander, Santander, Colombia

    • Claudia M. Hormiga
    •  & Johanna A. Otero
  292. University Oran 1, Oran, Algeria

    • Leila Houti
    •  & Sounnia Mediene-Benchekor
  293. Independent Public Health Specialist, Nay Pyi Taw, Myanmar

    • Thein Thein Htay
  294. Ministry of Health and Sports, Nay Pyi Taw, Myanmar

    • Aung Soe Htet
    • , Maung Maung Than Htike
    •  & Aye Aye Sein
  295. Peking University, Beijing, China

    • Yonghua Hu
    • , Guansheng Ma
    • , Jun Ma
    • , Yi Song
    • , Xun Tang
    • , Yong Tao
    •  & Yi Zeng
  296. CIBER en Epidemiología y Salud Pública, Murcia, Spain

    • José María Huerta
    •  & Diego Salmerón
  297. Amsterdam UMC of University of Amsterdam, Amsterdam, The Netherlands

    • Martijn Huisman
    •  & Tanja G. M. Vrijkotte
  298. Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

    • Martijn Huisman
    •  & Marjolein Visser
  299. American University of Beirut, Beirut, Lebanon

    • Nahla Hwalla
    •  & Abla M. Sibai
  300. CIBER en Epidemiología y Salud Pública, San Sebastian, Spain

    • Jesús M. Ibarluzea
  301. Cairo University, Cairo, Egypt

    • Mohsen M. Ibrahim
  302. The University of Tokyo, Tokyo, Japan

    • Takafumi Ishida
    •  & Kenji Shibuya
  303. University Hospital Centre Zagreb, Zagreb, Croatia

    • Vanja Ivkovic
    • , Ana Jelakovic
    • , Ivan Pecin
    •  & Tajana Zeljkovic Vrkic
  304. Niigata University, Niigata, Japan

    • Masanori Iwasaki
    •  & Akihiro Yoshihara
  305. Hadassah University Medical Center, Jerusalem, Israel

    • Jeremy M. Jacobs
    •  & Jochanan Stessman
  306. Norwegian University of Science and Technology, Trondheim, Norway

    • Imre Janszky
    • , Steinar Krokstad
    • , Lars E. Laugsand
    • , Abhijit Sen
    •  & Lars Vatten
  307. The University of Melbourne, Melbourne, Victoria, Australia

    • Edward Janus
  308. Sports University of Tirana, Tirana, Albania

    • Juel Jarani
  309. University of Zagreb School of Medicine, Zagreb, Croatia

    • Bojan Jelakovic
    •  & Ivan Pecin
  310. Heart Foundation, Melbourne, Victoria, Australia

    • Garry Jennings
    •  & Bill Stavreski
  311. National Health Insurance Service, Wonju, South Korea

    • Seung-lyeal Jeong
    •  & Yeon-Yong Kim
  312. Guangzhou 12th Hospital, Guangzhou, China

    • Chao Qiang Jiang
  313. Universidad Eugenio Maria de Hostos, Santo Domingo, Dominican Republic

    • Ramon O. Jimenez
  314. Simon Fraser University, Burnaby, British Columbia, Canada

    • Michel Joffres
  315. Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany

    • Jost B. Jonas
    •  & Songhomitra Panda-Jonas
  316. World Health Organization Country Office, Delhi, India

    • Pradeep Joshi
  317. Institute of Public Health of Serbia, Belgrade, Serbia

    • Dragana P. Jovic
  318. University of Opole, Opole, Poland

    • Jacek Józwiak
  319. University of Crete, Heraklion, Greece

    • Anthony Kafatos
  320. Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia

    • Nor Azmi Kamaruddin
    • , Bee Koon Poh
    •  & Jyh Eiin Wong
  321. Hellenic Medical Association for Obesity, Athens, Greece

    • Efthymios Kapantais
    •  & Themistoklis Tzotzas
  322. Maharajgunj Medical Campus, Kathmandu, Nepal

    • Khem B. Karki
  323. Aarhus University, Aarhus, Denmark

    • Marzieh Katibeh
    •  & Kim Overvad
  324. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    • Joanne Katz
  325. Pennington Biomedical Research Center, Baton Rouge, LA, USA

    • Peter T. Katzmarzyk
  326. University of Eastern Finland, Kuopio, Finland

    • Jussi Kauhanen
    • , Jaakko Mursu
    • , Tomi-Pekka Tuomainen
    • , Jyrki K. Virtanen
    • , Ari Voutilainen
    •  & Sari Voutilainen
  327. National Institute of Epidemiology, Chennai, India

    • Prabhdeep Kaur
    •  & Sudha Ramachandra Rao
  328. University of Münster, Münster, Germany

    • Ulrich Keil
  329. Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan, Iran

    • Roya Kelishadi
  330. Amsterdam Public Health Research Institute, Amsterdam, The Netherlands

    • Han C. G. Kemper
    • , Erik J. Timmermans
    •  & Natasja M. Van Schoor
  331. Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan

    • Alina Kerimkulova
    •  & Erkin Mirrakhimov
  332. Research Institute of Child Nutrition, Dortmund, Germany

    • Mathilde Kersting
  333. University of Cambridge, Cambridge, UK

    • Kay-Tee Khaw
    •  & Nicholas Wareham
  334. Hypertension Research Center, Isfahan, Iran

    • Alireza Khosravi
  335. Medical University of Innsbruck, Innsbruck, Austria

    • Stefan Kiechl
    • , Ursula Kiechl-Kohlendorfer
    • , Michael Knoflach
    • , Hanno Ulmer
    • , Johann Willeit
    •  & Peter Willeit
  336. Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

    • Japhet Killewo
  337. National Cancer Center, Goyang-si, South Korea

    • Jeongseon Kim
    •  & Jeonghee Lee
  338. Statistics Austria, Vienna, Austria

    • Jeannette Klimont
  339. B. P. Koirala Institute of Health Sciences, Dharan, Nepal

    • Bhawesh Koirala
    •  & Sanjib K. Sharma
  340. University of Vienna, Vienna, Austria

    • Jürgen König
    •  & Petra Rust
  341. Oulu Deaconess Institute Foundation, Oulu, Finland

    • Raija Korpelainen
    •  & Soile E. Puhakka
  342. Tartu University Clinics, Tartu, Estonia

    • Paul Korrovits
    •  & Margus Punab
  343. Kansai Medical University, Osaka-Sayama, Japan

    • Katsuyasu Kouda
  344. National Institute of Pharmacy and Nutrition, Budapest, Hungary

    • Viktoria A. Kovacs
  345. Ministry of Health and Quality of Life, Port Louis, Mauritius

    • Sudhir Kowlessur
  346. Polish Academy of Sciences Anthropology Unit, Wroclaw, Poland

    • Slawomir Koziel
  347. University Hospital Ulm, Ulm, Germany

    • Wolfgang Kratzer
  348. University of Groningen, Groningen, The Netherlands

    • Daan Kromhout
  349. North-West University, Potchefstroom, South Africa

    • Herculina S. Kruger
    •  & Aletta E. Schutte
  350. National Institute of Public Health, Prague, Czech Republic

    • Ruzena Kubinova
  351. University of Jyväskylä, Jyväskylä, Finland

    • Urho M. Kujala
  352. Institute of Public Health of Montenegro, Podgorica, Montenegro

    • Enisa Kujundzic
    •  & Boban Mugoša
  353. Amrita Institute of Medical Sciences, Cochin, India

    • R. Krishna Kumar
    •  & Manu Raj
  354. Institute of Endocrinology, Prague, Czech Republic

    • Marie Kunešová
    • , Radka Taxová Braunerová
    •  & Hana Zamrazilová
  355. All India Institute of Medical Sciences, New Delhi, India

    • Yadlapalli S. Kusuma
  356. African Population and Health Research Center, Nairobi, Kenya

    • Catherine Kyobutungi
  357. Hanoi University of Public Health, Hanoi, Vietnam

    • Quang Ngoc La
    •  & Hoang Van Minh
  358. Higher Institute of Nursing Professions and Technical Health, Rabat, Morocco

    • Fatima Zahra Laamiri
  359. National Institute of Public Health of Algeria, Algiers, Algeria

    • Youcef Laid
  360. Croatian National Institute of Public Health, Zagreb, Croatia

    • Maja Lang Morovic
    •  & Sanja Music Milanovic
  361. Sahlgrenska Academy, Gothenburg, Sweden

    • Georg Lappas
  362. Endocrinology and Metabolism Research Center, Tehran, Iran

    • Bagher Larijani
  363. University of Public Health, Yangon, Myanmar

    • Tint Swe Latt
    •  & Ko Ko Zaw
  364. International Food Policy Research Institute, Dakar, Senegal

    • Agnès Le Port
  365. National University of Singapore, Singapore, Singapore

    • Jeannette Lee
    • , Wei-Yen Lim
    • , Ei Ei K. Nang
    •  & E. Shyong Tai
  366. Hong Kong Polytechnic University, Hong Kong, China

    • Paul H. Lee
  367. Tampere University Hospital, Tampere, Finland

    • Terho Lehtimäki
  368. University of Douala, Douala, Cameroon

    • Daniel Lemogoum
  369. University of Cape Town, Cape Town, South Africa

    • Naomi S. Levitt
  370. West Virginia University, Morgantown, WV, USA

    • Christa L. Lilly
    •  & William A. Neal
  371. Oswaldo Cruz Foundation Rene Rachou Research Institute, Belo Horizonte, Brazil

    • M. Fernanda Lima-Costa
    •  & Sergio Viana Peixoto
  372. National Taiwan University, Taipei, Taiwan

    • Hsien-Ho Lin
    •  & Yu-Hsiang Tsao
  373. University of Chinese Academy of Sciences, Shanghai, China

    • Xu Lin
    •  & Xingwang Ye
  374. Uppsala University, Uppsala, Sweden

    • Lars Lind
    • , Johan Sundström
    •  & Agneta Yngve
  375. Capital Medical University Beijing An Zhen Hospital, Beijing, China

    • Jing Liu
    •  & Dong Zhao
  376. National Institute for Health Development, Tallinn, Estonia

    • Helle-Mai Loit
    • , Keiu Nelis
    • , Liis Nelis
    • , Eha Nurk
    •  & Toomas Veidebaum
  377. Universidad San Martín de Porres, Lima, Peru

    • Tania Lopez
    •  & Luis Revilla
  378. University Medicine of Greifswald, Greifswald, Germany

    • Roberto Lorbeer
    • , Matthias Nauck
    • , Astrid Petersmann
    • , Sabine Schipf
    • , Carsten O. Schmidt
    •  & Henry Völzke
  379. Consejería de Sanidad Junta de Castilla y León, Valladolid, Spain

    • José Eugenio Lozano
    •  & Tomas Vega
  380. Norrbotten County Council, Luleå, Sweden

    • Robert Lundqvist
  381. University of Uppsala, Uppsala, Sweden

    • Per Lytsy
  382. Universidade Federal de Ouro Preto, Ouro Preto, Brazil

    • George L. L. Machado-Coelho
  383. University of Coimbra, Coimbra, Portugal

    • Aristides M. Machado-Rodrigues
    • , Anabela Mota-Pinto
    • , Magdalena Muc
    • , Cristina Padez
    •  & Daniela Rodrigues
  384. The Jikei University School of Medicine, Tokyo, Japan

    • Suka Machi
  385. National Research Council, Padua, Italy

    • Stefania Maggi
    •  & Marianna Noale
  386. Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia

    • Dianna J. Magliano
    •  & Jonathan E. Shaw
  387. Agricultural University of Athens, Athens, Greece

    • Emmanuella Magriplis
    •  & Antonis Zampelas
  388. Hospital Israelita Albert Einstein, São Paulo, Brazil

    • Marcia Makdisse
  389. Institute of Internal and Preventive Medicine, Novosibirsk, Russia

    • Sofia Malyutina
  390. Harokopio University, Athens, Greece

    • Yannis Manios
  391. University of Otago, Dunedin, New Zealand

    • Jim I. Mann
    • , Rachael M. McLean
    • , Jody C. Miller
    •  & Winsome R. Parnell
  392. University of Padua, Padua, Italy

    • Enzo Manzato
    •  & Sabina Zambon
  393. Technological Educational Institute of Crete, Heraklion, Greece

    • Anastasia Markaki
    •  & Vassilis Zafiropulos
  394. Loughborough University, Loughborough, UK

    • Oonagh Markey
  395. Ministry of Health, Nicosia, Cyprus

    • Eliza Markidou Ioannidou
  396. Lausanne University Hospital, Lausanne, Switzerland

    • Pedro Marques-Vidal
    • , Jardena J. Puder
    •  & Peter Vollenweider
  397. CIBERCV, Barcelona, Spain

    • Jaume Marrugat
  398. Mary Immaculate College, Limerick, Ireland

    • Rosemarie Martin
    •  & Elaine M. Murtagh
  399. Emory University, Atlanta, GA, USA

    • Reynaldo Martorell
    •  & Aryeh D. Stein
  400. Hungarian Society of Sports Medicine, Budapest, Hungary

    • Eva Martos
  401. Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India

    • Shariq R. Masoodi
  402. UiT The Arctic University of Norway, Tromsø, Norway

    • Ellisiv B. Mathiesen
    •  & Tom Wilsgaard
  403. National Centre for Disease Informatics and Research, New Delhi, India

    • Prashant Mathur
  404. Cape Peninsula University of Technology, Cape Town, South Africa

    • Tandi E. Matsha
  405. University of Rzeszow, Rzeszow, Poland

    • Artur Mazur
  406. University of Edinburgh, Edinburgh, UK

    • Stela McLachlan
    •  & Jacqueline F. Price
  407. International Medical University, Shah Alam, Malaysia

    • Safiah Md Yusof
  408. Institut National de la Santé et de la Recherche Médicale, Lille, France

    • Aline Meirhaeghe
  409. Robert Koch Institute, Berlin, Germany

    • Gert B. M. Mensink
    • , Angelika Schaffrath Rosario
    •  & Anja Schienkiewitz
  410. Lusófona University, Lisbon, Portugal

    • Cláudia S. Minderico
  411. Democritus University, Alexandroupolis, Greece

    • Daphne Mirkopoulou
  412. Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania

    • Veronica Mocanu
  413. Università degli Studi di Firenze, Florence, Italy

    • Pietro A. Modesti
  414. Isfahan Cardiovascular Research Center, Isfahan, Iran

    • Noushin Mohammadifard
  415. Strasbourg University Hospital, Strasbourg, France

    • Marie Moitry
  416. University of Strasbourg, Strasbourg, France

    • Marie Moitry
    •  & Aline Wagner
  417. Mulago Hospital, Kampala, Uganda

    • Charles K. Mondo
  418. Instituto Nacional de Salud Pública, Mexico City, Mexico

    • Eric A. Monterrubio
    •  & Rosalba Rojas-Martinez
  419. University of Limpopo, Sovenga, South Africa

    • Kotsedi Daniel K. Monyeki
  420. Seoul National University Children’s Hospital, Seoul, South Korea

    • Jin Soo Moon
  421. University Medical Science, Havana, Cuba

    • Alain Morejon
  422. Universidad de Zaragoza, Zaragoza, Spain

    • Luis A. Moreno
  423. RCSI, Dublin, Ireland

    • Karen Morgan
  424. La Trobe University, Melbourne, Victoria, Australia

    • George Moschonis
  425. International Institute of Molecular and Cell Biology, Warsaw, Poland

    • Malgorzata Mossakowska
    •  & Przemyslaw Slusarczyk
  426. Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

    • Mohammad Esmaeel Motlagh
  427. Gorgas Memorial Institute of Public Health, Panama City, Panama

    • Jorge Motta
    •  & Julio Zuñiga Cisneros
  428. World Health Organization Country Office, Lilongwe, Malawi

    • Kelias P. Msyamboza
  429. Department of Public Health, Nay Pyi Taw, Myanmar

    • Thet Thet Mu
  430. University of Brescia, Brescia, Italy

    • Maria Lorenza Muiesan
    •  & Massimo Salvetti
  431. Ministry of Health and Social Protection, Dushanbe, Tajikistan

    • Parvina Mukhtorova
    •  & Sherali Rakhmatulloev
  432. Bushehr University of Medical Sciences, Bushehr, Iran

    • Iraj Nabipour
  433. Ulm University, Ulm, Germany

    • Gabriele Nagel
  434. Kobe University, Kobe, Japan

    • Harunobu Nakamura
  435. Suraj Eye Institute, Nagpur, India

    • Vinay B. Nangia
  436. UNICEF, Yaoundé, Cameroon

    • Martin Nankap
    •  & Félicité Tchibindat
  437. National Institute of Hygiene and Epidemiology, Hanoi, Vietnam

    • Chung T. Nguyen
  438. University of Pharmacy and Medicine, Ho Chi Minh City, Vietnam

    • Nguyen D. Nguyen
    •  & Oanh T. H. Trinh
  439. Hanoi Medical University, Hanoi, Vietnam

    • Quang Ngoc Nguyen
  440. Miami Veterans Affairs Healthcare System, Miami, FL, USA

    • Ramfis E. Nieto-Martínez
  441. Heartfile, Islamabad, Pakistan

    • Sania Nishtar
  442. National Cancer Center, Tokyo, Japan

    • Sawada Norie
    •  & Shoichiro Tsugane
  443. Eastern Mediterranean Public Health Network, Amman, Jordan

    • Mohannad Al Nsour
  444. State University of Medicine and Pharmacy, Chisinau, Moldova

    • Galina Obreja
  445. Tachikawa General Hospital, Nagaoka, Japan

    • Eiji Oda
  446. Japan Wildlife Research Center, Tokyo, Japan

    • Ryutaro Ohtsuka
  447. University of Vale do Rio dos Sinos, São Leopoldo, Brazil

    • Maria Teresa Anselmo Olinto
  448. National Food and Nutrition Institute, Warsaw, Poland

    • Maciej Oltarzewski
    •  & Lucjan Szponar
  449. University of Manchester, Manchester, UK

    • Terence W. O’Neill
    •  & Frederick C. Wu
  450. Ministry of Health, Bandar Seri Begawan, Brunei Darussalam

    • Sok King Ong
    •  & Khairil Si-Ramlee
  451. University of Madeira, Funchal, Portugal

    • Rui Ornelas
  452. University of Puerto Rico, San Juan, Puerto Rico

    • Ana P. Ortiz
    •  & Cynthia M. Pérez
  453. Research Center for Prevention and Health, Glostrup, Denmark

    • Merete Osler
  454. MRC Lifecourse Epidemiology Unit, Southampton, UK

    • Clive Osmond
  455. University of Novi Sad, Novi Sad, Serbia

    • Sergej M. Ostojic
    •  & Ivana Radic
  456. Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

    • Ellis Owusu-Dabo
  457. Institute for Social and Preventive Medicine, Lausanne, Switzerland

    • Fred Michel Paccaud
  458. Cancer Prevention and Research Institute, Florence, Italy

    • Domenico Palli
  459. University of Wisconsin-Madison, Madison, WI, USA

    • Alberto Palloni
  460. IRCCS Casa Sollievo della Sofferenza, Bari, Italy

    • Francesco Panza
  461. Zayed University, Abu Dhabi, United Arab Emirates

    • Dimitrios Papandreou
  462. Catholic University of Daegu, Daegu, South Korea

    • Soon-Woo Park
  463. University of Medicine, Pharmacy, Science and Technology of Târgu Mureş, Târgu Mureş, Romania

    • Ionela M. Pascanu
    •  & Raluca M. Pop
  464. Jivandeep Hospital, Anand, India

    • Nikhil D. Patel
  465. South African Medical Research Council, Durban, South Africa

    • Nasheeta Peer
  466. Spanish Food Safety and Nutrition Agency, Madrid, Spain

    • Napoleon Perez-Farinos
    •  & Sara Santos Sanz
  467. Vietnam National Heart Institute, Hanoi, Vietnam

    • Son Thai Pham
  468. Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany

    • Iris Pigeot
    •  & Hermann Pohlabeln
  469. University of Sarajevo, Sarajevo, Bosnia and Herzegovina

    • Aida Pilav
  470. Cardiovascular Prevention Centre Udine, Udine, Italy

    • Lorenza Pilotto
    •  & Diego Vanuzzo
  471. University Hospital of Pisa, Pisa, Italy

    • Francesco Pistelli
  472. Ministry of Health and Medical Services, Honiara, Solomon Islands

    • Freda Pitakaka
  473. Public Health Agency of Catalonia, Barcelona, Spain

    • Pedro Plans-Rubió
  474. Institut Hospital del Mar d’Investigacions Mèdiques, Barcelona, Spain

    • Miquel Porta
  475. Digestive Oncology Research Center, Tehran, Iran

    • Akram Pourshams
  476. Digestive Disease Research Institute, Tehran, Iran

    • Hossein Poustchi
  477. Centre for Disease Prevention and Control, Riga, Latvia

    • Iveta Pudule
    •  & Biruta Velika
  478. Alborz University of Medical Sciences, Karaj, Iran

    • Mostafa Qorbani
  479. Ministry of Health, Hanoi, Vietnam

    • Tran Quoc Bao
  480. BRAC, Dhaka, Bangladesh

    • Mahfuzar Rahman
  481. Institute of Epidemiology Disease Control and Research, Dhaka, Bangladesh

    • Mahmudur Rahman
  482. University of Turku, Turku, Finland

    • Olli Raitakari
  483. Institut Universitari d’Investigació en Atenció Primària Jordi Gol, Girona, Spain

    • Rafel Ramos
  484. Universiti Putra Malaysia, Serdang, Malaysia

    • Lekhraj Rampal
  485. University of Malaya, Kuala Lumpur, Malaysia

    • Sanjay Rampal
  486. National Institute of Public Health, Copenhagen, Denmark

    • Mette Rasmussen
  487. University of Valencia, Valencia, Spain

    • Josep Redon
  488. University of the Philippines, Manila, The Philippines

    • Paul Ferdinand M. Reganit
    •  & Rody G. Sy
  489. Slovak Academy of Sciences, Bratislava, Slovakia

    • Valéria Regecová
  490. Nutrition Research Foundation, Barcelona, Spain

    • Lourdes Ribas-Barba
  491. Minas Gerais State Secretariat for Health, Belo Horizonte, Brazil

    • Robespierre Ribeiro
  492. Health Center San Agustín, Palma, Spain

    • Fernando Rigo
  493. PharmAccess Foundation, Amsterdam, The Netherlands

    • Tobias F. Rinke de Wit
  494. National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal

    • Ana Rito
  495. Universidade Nove de Julho, São Paulo, Brazil

    • Raphael M. Ritti-Dias
  496. Public Health Agency of Canada, Ottawa, Ontario, Canada

    • Cynthia Robitaille
    •  & Ming-Dong Wang
  497. Canarian Health Service, Tenerife, Spain

    • María del Cristo Rodriguez-Perez
  498. Universidad Industrial de Santander, Santander, Colombia

    • Laura A. Rodríguez-Villamizar
  499. Sahlgrenska University Hospital, Gothenburg, Sweden

    • Annika Rosengren
  500. Fiji National University, Suva, Fiji

    • Ian Rouse
  501. Spanish Nutrition Foundation, Madrid, Spain

    • Emma Ruiz Moreno
    •  & Gregorio Varela-Moreiras
  502. Institute of Food Sciences of the National Research Council, Avellino, Italy

    • Paola Russo
    •  & Alfonso Siani
  503. Singapore Eye Research Institute, Singapore, Singapore

    • Charumathi Sabanayagam
    • , Youchan Shin
    • , Rosalynn Siantar
    •  & Yingfeng Zheng
  504. Sitaram Bhartia Institute of Science and Research, New Delhi, India

    • Harshpal S. Sachdev
  505. Maragheh University of Medical Sciences, Maragheh, Iran

    • Saeid Safiri
  506. University of Helsinki, Helsinki, Finland

    • Jukka T. Salonen
  507. National Institute of Health, Lima, Peru

    • Jose Sánchez-Abanto
    •  & Carolina B. Tarqui-Mamani
  508. Ministry of Health, Jakarta, Indonesia

    • Sandjaja
  509. Catalan Department of Health, Barcelona, Spain

    • Susana Sans
  510. Biodonostia Health Research Institute, San Sebastian, Spain

    • Loreto Santa-Marina
  511. Universidade de Lisboa, Lisbon, Portugal

    • Diana A. Santos
    • , Osvaldo Santos
    •  & Luis B. Sardinha
  512. South Karelia Social and Health Care District, Lappeenranta, Finland

    • Jouko L. Saramies
  513. Cardiovascular Research Institute, Isfahan, Iran

    • Nizal Sarrafzadegan
  514. University of São Paulo Clinics Hospital, São Paulo, Brazil

    • Marcia Scazufca
  515. Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    • Herman Schargrodsky
  516. Medical University of Vienna, Vienna, Austria

    • Karin Schindler
    • , Thomas Waldhör
    •  & Kurt Widhalm
  517. Rigshospitalet, Copenhagen, Denmark

    • Ida Maria Schmidt
  518. Lagos State University College of Medicine, Lagos, Nigeria

    • Idowu O. Senbanjo
  519. University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain

    • Luis Serra-Majem
  520. National Center for Disease Control and Public Health, Tbilisi, Georgia

    • Lela Shengelia
    •  & Lela Sturua
  521. National Center for Global Health and Medicine, Tokyo, Japan

    • Hana Shimizu-Furusawa
  522. Samsung Medical Center, Seoul, South Korea

    • Dong Wook Shin
  523. St Vincent’s Hospital, Sydney, New South Wales, Australia

    • Judith Simons
  524. University of New South Wales, Sydney, New South Wales, Australia

    • Leon A. Simons
    •  & Mark Woodward
  525. Health Polytechnic Jakarta II Institute, Jakarta, Indonesia

    • Moesijanti Y. E. Soekatri
  526. Diponegoro University, Semarang, Indonesia

    • Agustinus Soemantri
  527. University of Bari, Bari, Italy

    • Vincenzo Solfrizzi
  528. Institut Régional de Santé Publique, Ouidah, Benin

    • Charles Sossa Jérome
  529. University of Bordeaux, Bordeaux, France

    • Aïcha Soumaré
    •  & Christophe Tzourio
  530. Institute of Public Health, Skopje, Macedonia

    • Igor Spiroski
  531. University of Leuven, Leuven, Belgium

    • Jan A. Staessen
    •  & Lutgarde Thijs
  532. Lamprecht und Stamm Sozialforschung und Beratung AG, Zurich, Switzerland

    • Hanspeter Stamm
  533. INSERM, Nancy, France

    • Maria G. Stathopoulou
    •  & Sophie Visvikis-Siest
  534. Bonn University, Bonn, Germany

    • Peter Stehle
  535. Sotiria Hospital, Sotiria, Greece

    • George S. Stergiou
  536. National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland

    • Jakub Stokwiszewski
    •  & Bogdan Wojtyniak
  537. Swansea University, Swansea, UK

    • Gareth Stratton
  538. Fu Jen Catholic University, Taipei, Taiwan

    • Chien-An Sun
    •  & San-Lin You
  539. National Statistic Office of Cabo Verde, Praia, Cabo Verde

    • René Charles Sylva
  540. University of KwaZulu-Natal, Mtubatuba, South Africa

    • Frank Tanser
  541. Ministry of Health, Amman, Jordan

    • Mohammed Rasoul Tarawneh
  542. Comenius University, Bratislava, Slovakia

    • Lubica Tichá
  543. Health Service of Murcia, Murcia, Spain

    • María José Tormo
  544. IB-SALUT Area de Salut de Menorca, Maó, Spain

    • Maties Torrent
  545. University of Bologna, Bologna, Italy

    • Stefania Toselli
  546. Hellenic Health Foundation, Athens, Greece

    • Antonia Trichopoulou
  547. Government Medical College, Bhavnagar, India

    • Atul Trivedi
  548. Sefako Makgatho Health Science University, Ga-Rankuwa, South Africa

    • Lechaba Tshepo
  549. Addis Ababa University, Addis Ababa, Ethiopia

    • Fikru Tullu
  550. Dasman Diabetes Institute, Kuwait City, Kuwait

    • Jaakko Tuomilehto
  551. Ministry of Health, Wellington, New Zealand

    • Maria L. Turley
    •  & Deepa Weerasekera
  552. Universidad Centro-Occidental Lisandro Alvarado, Barquisimeto, Venezuela

    • Eunice E. Ugel
  553. Meharry Medical College, Nashville, TN, USA

    • Flora A. M. Ukoli
  554. Dokuz Eylul University, Izmir, Turkey

    • Belgin Unal
  555. University of Tampere Tays Eye Center, Tampere, Finland

    • Hannu M. T. Uusitalo
  556. Polytechnic Institute of Porto, Porto, Portugal

    • Susana Vale
  557. Utrecht University, Utrecht, The Netherlands

    • Yvonne T. van der Schouw
  558. University Medical Center Utrecht, Utrecht, The Netherlands

    • Lenie van Rossem
  559. National Research Council, Pisa, Italy

    • Giovanni Viegi
  560. Universidad Miguel Hernandez, Alicante, Spain

    • Jesus Vioque
  561. Ministry of Health, Mont Fleuri, Seychelles

    • Bharathi Viswanathan
  562. North Karelian Center for Public Health, Joensuu, Finland

    • Tiina Vlasoff
  563. University of the Witwatersrand, Johannesburg, South Africa

    • Alisha N. Wade
  564. Institute for Medical Research, Kuala Lumpur, Malaysia

    • Wan Nazaimoon Wan Mohamud
  565. Xinjiang Medical University, Urumqi, China

    • Qian Wang
  566. Shanghai Educational Development Co. Ltd, Shanghai, China

    • Xiangjun Wang
    •  & Yang Yang
  567. Paracelsus Medical University, Salzburg, Austria

    • Daniel Weghuber
  568. St George’s, University of London, London, UK

    • Peter H. Whincup
  569. Universitas Indonesia, Jakarta, Indonesia

    • Indah S. Widyahening
  570. Institute of Food and Nutrition Development of Ministry of Agriculture, Beijing, China

    • Haiquan Xu
  571. Children’s Hospital of Fudan University, Shanghai, China

    • Weili Yan
  572. University of Cyprus, Nicosia, Cyprus

    • Panayiotis K. Yiallouros
  573. Iran University of Medical Sciences, Tehran, Iran

    • Farhad Zamani
  574. West Kazakhstan State Medical University, Aktobe, Kazakhstan

    • Bekbolat Zholdin
  575. Inner Mongolia Medical University, Hohhot, China

    • Dan Zhu

Consortia

  1. NCD Risk Factor Collaboration (NCD-RisC)

Contributions

M.E. designed the study and oversaw research. H.B. led the data collection and statistical analysis, and prepared results. The other authors contributed to study design; collected, reanalysed, pooled and checked data; analysed pooled data; and prepared results. M.E. and H.B. wrote the first draft of the manuscript with input from the other authors.

Competing interests

M.E. reports a charitable grant from the AstraZeneca Young Health Programme, and personal fees from Prudential, Scor and Third Bridge, outside the submitted work. The other authors declare no competing interests.

Corresponding author

Correspondence to Majid Ezzati.

Extended data figures and tables

  1. Extended Data Fig. 1 Number of data sources by country.

    The colour indicates the number of population-based data sources used in the analysis for each country. Countries and territories not included in the analysis are coloured in grey.

  2. Extended Data Fig. 2 Age-standardized national, rural and urban mean BMI in women aged 18 years and older in 1985 and 2017 by country.

    The numerical values are provided in Supplementary Table 3 and can be downloaded from http://www.ncdrisc.org.

  3. Extended Data Fig. 3 Age-standardized national, rural and urban mean BMI in men aged 18 years and older in 1985 and 2017 by country.

    The numerical values are provided in Supplementary Table 3 and can be downloaded from http://www.ncdrisc.org.

  4. Extended Data Fig. 4 The difference between rural and urban age-standardized mean BMI in 1985 compared to 2017.

    Each point shows one country and colours indicate region. A positive number indicates a higher urban mean BMI and a negative number indicates a higher rural mean BMI. Different sections labelled A–F indicate the following categories of countries. A, countries with an urban excess BMI that increased from 1985 to 2017. B, countries with an urban excess BMI that decreased from 1985 to 2017. C, countries with an urban excess BMI in 1985 that changed to a rural excess BMI in 2017. D, countries with a rural excess BMI that increased from 1985 to 2017. E, countries with a rural excess BMI that decreased from 1985 to 2017. F, countries with a rural excess BMI in 1985 that changed to an urban excess BMI in 2017.

  5. Extended Data Fig. 5 The relationship between mean BMI and prevalence of overweight.

    Overweight is defined as BMI ≥ 25 kg m−2. Prevalence is plotted on a probit scale, which changes in an approximately linear manner as the mean changes. Each point represents an age group- and sex-specific mean, stratified by place of residence as described in the Methods and with more than 25 participants, from data sources in the NCD-RisC database.

  6. Extended Data Fig. 6 Comparison of the difference between rural and urban age-standardized mean BMI in women and men aged 18 years and older in 1985 and 2017.

    Each point shows one country and colours indicate region.

  7. Extended Data Table 1 Mean BMI and percentage of the population by urban and rural place of residence
  8. Extended Data Table 2 Results of model validation

Supplementary information

  1. Supplementary Information

    This file contains the statistical model for estimating BMI trends by rural and urban place of residence, Supplementary Tables 1-3 and Supplementary References.

  2. Reporting Summary

About this article

Publication history

Received

Accepted

Published

Issue Date

DOI

https://doi.org/10.1038/s41586-019-1171-x

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