Diminishing benefits of urban living for children and adolescents’ growth and development

doi:10.1038/s41586-023-05772-8

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Published: 29 March 2023

Diminishing benefits of urban living for children and adolescents’ growth and development

NCD Risk Factor Collaboration (NCD-RisC)

Nature volume 615, pages 874–883 (2023)Cite this article

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Abstract

Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being^1,2,3,4,5,6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5–19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m^–2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified.

Main

The growth and development of school-aged children and adolescents (ages 5–19 years) are influenced by their nutrition and environment at home, in the community and at school. Healthy growth and development at these ages help consolidate gains and mitigate inadequacies from early childhood and vice versa¹, with lifelong implications for health and well-being^2,3,4,5,6. Until recently, the growth and development of older children and adolescents received substantially less attention than in early childhood and adulthood⁷. Increasing attention on the importance of health and nutrition during school years has been accompanied by a presumption that differences in nutrition and the environment lead to distinct, and generally less healthy, patterns of growth and development at these ages in cities compared to rural areas^{8,9,10,11,12,13,14,15,16,17}. This presumption is despite some empirical studies showing that food quality and nutrition are better in cities^18,19.

Data on growth and developmental outcomes during school ages are needed, alongside data on the efficacy of specific interventions and policies, to select and prioritize policies and programmes that promote health and health equity, both for the increasing urban population and for children who continue to grow up in rural areas. Consistent and comparable global data also help benchmark across countries and territories and draw lessons on good practice. Yet, globally, there are fewer data on growth trajectories in rural and urban areas in these formative ages than for children under 5 years of age²⁰ or for adults²¹. The available studies have been in one country, at one point in time and/or in one sex and narrow age groups. The few studies that covered more than one country^22,23,24 mostly focused on older girls and used at most a few dozen data sources and hence could not systematically measure long-term trends. Consequently, many policies and programmes that aim to enhance healthy growth and development in school ages focus narrowly and generically on specific features of nutrition or the environment in either cities or rural areas^{10,13,25,26,27,28}. Little attention has been paid to the similarities and differences between relevant outcomes in these settings or to the heterogeneity of the urban–rural differences across countries.

Here we report on the mean height and BMI of school-aged children and adolescents residing in rural and urban areas of 200 countries and territories (referred to as countries hereafter) from 1990 to 2020. Height and BMI are anthropometric measures of growth and development that are influenced by the quality of nutrition and healthiness of the living environment and are highly predictive of health and well-being throughout life in observational and Mendelian randomization studies^2,3,4,5,6. These studies have shown that having low height and excessively low BMI increases the risk of morbidity and mortality, and low height impairs cognitive development and reduces educational performance and work productivity in later life^2,3,4. A high BMI in these ages increases the lifelong risk of overweight and obesity and several non-communicable diseases, and might contribute to poor educational outcomes^5,6.

We used 2,325 population-based studies that measured height and weight in 71 million participants in 194 countries (Extended Data Fig. 1 and Supplementary Table 2). We used these data in a Bayesian hierarchical meta-regression model to estimate mean height and BMI of children and adolescents aged 5–19 years by rural and urban place of residence, year and age for 200 countries. Details of data sources and statistical methods are provided in the Methods. Our results represent the height and BMI for children and adolescents of the same age over time (that is, successive cohorts) in rural and urban areas of each country, and the difference between the two. For presentation, we summarize the 15 age-specific estimates, for single years of age from 5 to 19, through age standardization, which puts each country-year’s child and adolescent population on the same age distribution and enables comparisons to be made over time and across countries. We also show results, graphically and numerically, for index ages of 5, 10, 15 and 19 years in the Supplementary Information.

In 1990, school-aged boys and girls who lived in cities had a height advantage (that is, were taller) compared with their rural counterparts. The exception was in high-income countries, where the urban height advantage was either negligible (<1.2 cm for age-standardized mean height; posterior probability (PP) for children living in urban areas being taller ranging from 0.51 to >0.99) or there was a small rural advantage (for example, Belgium, the Netherlands and the United Kingdom) (PP for children in rural areas being taller ranging from 0.53 to >0.95 where there was a rural height advantage) (Fig. 1 and Extended Data Fig. 2). The largest height differences between children and adolescents in cities and rural areas in 1990 occurred in some countries in Latin America (for example, Mexico, Guatemala, Panama and Peru), east and southeast Asia (China, Indonesia and Vietnam), central and eastern Europe (Bulgaria, Hungary and Romania) and sub-Saharan Africa (Democratic Republic of Congo (DR Congo) and Rwanda). The urban height advantage in boys and girls in the named countries ranged from 2.4 to 5.0 cm, and the PP of children living in urban areas being taller than children living in rural areas was >0.99 (see Supplementary Table 3 for country-specific numerical values of height in children living in rural versus urban areas, their difference and the corresponding credible intervals (CrIs)).

**Fig. 1: Change in the urban–rural height difference from 1990 to 2020.**

The urban–rural height gap in the late twentieth century among low-income and middle-income countries was determined by how much children and adolescents in cities and rural areas had approached as opposed to fallen behind their peers in high-income countries, where there was little difference between urban and rural height. In countries such as Bulgaria, Hungary and Romania, the height of children and adolescents living in urban areas approached that of high-income countries, whereas children and adolescents in rural areas lagged behind, leading to a relatively large gap. In much of sub-Saharan Africa and south Asia, the height of children and adolescents lagged behind their peers in high-income countries regardless of where they lived, such that the urban–rural gap was relatively small. In a third group of low-income or middle-income countries that included Indonesia, Vietnam, Panama, Peru, DR Congo and Rwanda, children living in urban areas remained shorter than in high-income countries, but children from rural areas lagged even further behind, such that the urban–rural gap became large.

By 2020, the urban height advantage in school ages became smaller in much of the world. In many high-income western countries and some central European countries, it disappeared or reversed into a small (typically <1 cm) urban disadvantage (Fig. 1 and Extended Data Figs. 2 and 8). Countries with substantial convergence over these three decades were in central and eastern Europe (for example, Croatia), Latin America and the Caribbean (for example, Argentina, Brazil, Chile and Paraguay), east and southeast Asia (for example, Taiwan) and for girls in central Asia (for example, Kazakhstan and Uzbekistan). The urban height advantage in the named countries declined by around 1–2.5 cm from 1990 to 2020 (the PP of urban–rural height difference having declined ≥0.90 for the named countries). In many other middle-income countries (for example, China, Romania and Vietnam), the urban–rural height gaps declined, but children and adolescents living in cities remained taller than their rural counterparts (by 1.7–2.5 cm in the named countries for boys and girls; the PP of children in cities being taller than children in rural areas in 2020 >0.99). The exception to this convergence was for boys in most countries in sub-Saharan Africa and some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa, where the urban height advantage slightly increased over these three decades. The largest increase in the urban height advantage for boys occurred in countries in east Africa such as Ethiopia (0.9 cm larger height gap in 2020 than 1990; 95% CrI −0.9 to 2.9, and PP of an increase of 0.86), Rwanda (1.0 cm larger gap, 95% CrI −0.7 to 3.0, and PP 0.88) and Uganda (1.1 cm larger gap, 95% CrI of −0.6 to 3.1, and PP 0.89). For girls, the urban–rural gap remained largely unchanged in many countries in sub-Saharan Africa and south Asia.

In middle-income countries and emerging economies (newly high-income and industrialized countries) where the height of children and adolescents residing in rural areas converged to those in cities, successive cohorts of children and adolescents living in rural areas outpaced their urban counterparts in becoming taller and attained heights that urban children in the same countries had done decades earlier: growing to heights closer to those seen in high-income countries (Figs. 2 and 3). Successive cohorts of children and adolescents residing in rural areas in sub-Saharan Africa did not experience the accelerated height gain seen in cohorts in rural areas of middle-income countries. Notably, in the case of boys living in sub-Saharan Africa, there was no gain, or possibly a decrease, in height, which in turn led to a persistence or even widening of the urban–rural gap. As a result of these global trends, by 2020, the largest urban–rural gaps in height were seen in Andean and central Latin America (for example, Bolivia, Panama and Peru, by up to 4.7 cm (95% CrI 4.0–5.5 cm) for boys and 3.8 cm (95% CrI 3.3–4.3 cm) for girls) and, especially for boys, in sub-Saharan Africa (for example, DR Congo, Ethiopia, Mozambique and Rwanda, by up to 4.2 cm (95% CrI 2.7–5.7 cm)).

**Fig. 2: Urban and rural height in 2020 and the change from 1990 to 2020 for girls.**

**Fig. 3: Urban and rural height in 2020 and change from 1990 to 2020 for boys.**

The urban–rural BMI difference was relatively small throughout these three decades, <1.4 kg m^–2 in all countries and years and <1.1 kg m^–2 in all but nine countries, for age-standardized mean BMI (Fig. 4 and Extended Data Figs. 3 and 9). In 1990, the urban–rural BMI gap was largest in sub-Saharan Africa (for example, Ethiopia, Kenya, Malawi, South Africa and Zimbabwe) and south Asia (for example, Bangladesh and India), followed by parts of Latin America (for example, Mexico and Peru). The urban–rural BMI gap in the two sexes in the named countries ranged from 0.4 to 1.2 kg m^–2, and the PP of children and adolescents living in urban areas having a higher BMI than those in rural areas was ≥0.89. At that time, girls and/or boys in rural areas of some of these countries had mean BMI levels that were close to, and in some ages below, the thresholds of being underweight (>1 s.d. below the median of the World Health Organization (WHO) reference population).

**Fig. 4: Change in the urban–rural BMI difference from 1990 to 2020.**

From 1990 to 2020, the BMI of successive cohorts of children and adolescents in both urban and rural areas increased in all but a few mostly high-income countries (for example, Denmark, Italy and Spain) (Figs. 5 and 6). There was heterogeneity in low-income and middle-income countries in how much the BMI increased in cities compared with rural areas. In the majority of countries in sub-Saharan Africa and south Asia, the BMI of successive cohorts of children and adolescents increased more in rural areas than in cities, leading to a closing of the urban–rural difference. The urban–rural BMI gap declined by up to 0.65 kg m^–2 for both girls and boys, and the PP that the urban–rural BMI difference declined from 1990 to 2020 ranged from 0.52 to 0.95. In both sub-Saharan Africa and south Asia, these changes shifted the mean BMI of boys and girls in rural areas out of the range for being underweight. Moreover, in many countries in sub-Saharan Africa, this shift continued beyond the median of the WHO reference population and in some cases approached the threshold for being overweight (>1 s.d. above the median of the WHO reference population). The opposite, a larger increase in urban BMI, happened in most other low-income and middle-income countries, leading to a slightly larger urban BMI excess in 2020 than in 1990. High-income countries and those in central and eastern Europe experienced a mix of increasing and decreasing urban BMI excess, but remained within a small range (−0.3 to 0.6 kg m^–2 for almost all countries) over the entire period of analysis. At the regional level, the urban–rural BMI difference changed by <0.25 kg m^–2 in these regions.

**Fig. 5: Urban and rural BMI in 2020 and change from 1990 to 2020 for girls.**

**Fig. 6: Urban and rural BMI in 2020 and change from 1990 to 2020 for boys.**

The urban height advantage was larger in boys than girls in most countries (Supplementary Fig. 3). Urban excess BMI was larger in boys than girls in only about one-half of the countries. For the other half, mostly in high-income western countries and those in sub-Saharan Africa, urban excess BMI was larger in girls than boys. The urban height advantage was slightly larger at 5 years of age than at 19 years of age in most low-income and middle-income countries, especially for girls, but there was little difference across ages in high-income regions and in central and eastern Europe (Supplementary Fig. 4).

Since the introduction of modern sanitation in the nineteenth century, cities provided substantial nutritional and health advantages in high-income and subsequently low-income and middle-income countries¹⁹. Our results show that in the twenty-first century, during school ages, these advantages have disappeared in high-income countries and diminished in middle-income countries and emerging economies in Asia, Latin America and the Caribbean, and parts of Middle East and north Africa. Specifically, in these settings, successive cohorts of school-aged children and adolescents living in cities were outpaced by those in rural areas in terms of height gain but gained slightly more weight by 2020, typically in the unhealthy range (Fig. 7). This contrasted with the poorest region in the world: sub-Saharan Africa. In this region, the urban height advantage persisted or even expanded, whereas rural mean BMI went beyond remedying underweight and surpassed the median of the WHO reference population in 2020, hence consolidating the urban advantage. South Asia had a mixed pattern of urban versus rural trends from 1990 to 2020, with children and adolescents in rural areas gaining both more height and more weight for their height than those in cities. Notably, our results also show that differences in height and BMI between urban and rural populations within most countries are smaller than the differences across countries, even those in the same region.

**Fig. 7: Change in the urban–rural height and BMI difference from 1990 to 2020.**

We also found that the urban–rural BMI gap, although dynamic, changed much less than the BMI of either subgroup of the population and less than commonly assumed when discussing the role of cities in the obesity epidemic^{8,10,12,13,15,16}. Urban–rural BMI differences were especially small in high-income countries, which is consistent with evidence from a few countries that show diets and behaviours are affected more by household socioeconomic status than whether children and adolescents live in cities or rural areas^29,30. Urban BMI excess increased slightly more in middle-income countries in east and southeast Asia, Latin America and the Caribbean, and Middle East and north Africa, a trend that was the opposite of the convergence in BMI of adults in these same regions²¹. Additional analyses of data collected by the NCD Risk Factor Collaboration (NCD-RisC) for young adults (20–29 and 30–39 years) showed that the shift from a small divergent trend to convergence of BMI between urban and rural areas happens in young adulthood (Extended Data Figs. 6 and 7), a period during which there is substantial, but variable, weight gain among population subgroups³¹. These shifts in trends from adolescence to young adulthood might be a result of changes in diet and energy expenditure that accompany changes in household structure, social and economic roles and the living environment^32,33,34.

Long-term follow-up studies have shown that children and adolescents do not achieve their height potential if they do not consume sufficient and diverse nutritious foods or if they are exposed to repeated or persistent infections, which result in loss of nutrients². Studies that use data on household socioeconomic and environmental factors have indicated that these physiological determinants of height are themselves affected by income, education, quality of the living environment and access to healthcare in rural as well as urban areas³⁵. This evidence indicates that the relatively small urban–rural height differentials in high-income countries may be because of a greater abundance of nutritious foods, including some fortified foods, better education and healthcare and greater ability to finance programmes that promote healthy growth in countries with greater per-capita income and better infrastructure. Variations across these countries in the urban–rural height gap within this small range may be due to the extent of socioeconomic inequalities and poverty, differences in the availability and cost of nutritious foods between cities and rural areas and whether there are specific programmes (for example, food assistance or school food programmes) that improve nutrition in disadvantaged groups^30,36,37. The more marked changes in height in urban versus rural areas took place in middle-income countries and emerging economies. Case studies in some countries where the heights of children and adolescents living in rural and urban areas converged show that the convergence was partly due to using the growth in national income towards programmes and services that helped close gaps in nutrition, sanitation and healthcare between different areas and social groups^38,39,40. In countries in central and eastern Europe, transition to a market economy and increases in trade may have reduced the disparity in access to, and seasonality of, healthy foods between urban and rural areas⁴¹, and partly underlie the convergence of height seen in our results. By contrast, case studies in some countries have shown that where economic growth was accompanied by large inequalities in income, nutrition and/or services, the urban advantage persisted^42,43,44.

The notable exception in the global trends was sub-Saharan Africa, where a stagnation or reversal of height gain in rural areas led to the persistence or widening of urban–rural height differences, whereas the opposite happened for BMI (Fig. 7). Case studies of specific countries have indicated that unfavourable trends in nutrition in rural Africa, where the majority of the poorest people in the world live, started from macroeconomic shocks in the late twentieth century⁴⁵ and subsequent agriculture, trade and development policies that limited improvements in income and services, and emphasized agricultural exports over local food security and diversity⁴⁵. These macroeconomic factors in turn led to less diverse diets, with higher caloric intake rather than a shift to protein-rich and nutrient-rich foods (for example, animal products, seafood, fruits and vegetables)^46,47,48. Moreover, the slow expansion of infrastructure and services in rural areas restricted improvements in other determinants of healthy growth, such as clean water, sanitation and health care⁴⁹.

Several other factors may have had a secondary role in the observed trends in height and BMI and their difference in rural and urban areas. First, weight gain during childhood may reduce the age of puberty onset, which in turn may limit height gain during adolescence^50,51. No comparable global data currently exist on age at menarche and timing of pubertal growth, even at the national level. Second, rural-to-urban migration and reclassification of previously rural areas to urban as they grow and industrialize may account for some of the observed population-level trends. However, migration tends to be less common in childhood and adolescence than in adulthood in most countries. Finally, improvements in survival among children aged under 5 years in rural areas, particularly low-birthweight children, may have influenced the height and weight of those who survive beyond 5 years of age. However, current data on changes in child survival in rural and urban areas in sub-Saharan Africa are limited and inconclusive in terms of whether mortality declined faster in rural or urban areas^52,53.

As attention in global health turns to children and adolescents, there is a need to consider and evaluate how growth and development in these formative ages may be affected both by social and economic policies that influence household income and poverty and by programmes that affect nutrition, health services, infrastructure and living environments in rural and urban areas. The need to identify, implement and evaluate policies and programmes that improve growth and development outcomes is particularly relevant as the increase in poverty and the cost of food, especially of nutrient-rich foods, as a result of the macroeconomic changes resulting from the COVID-19 pandemic and the war in Ukraine, may hinder further gains or even set back healthy growth and development in children and adolescents.

Methods

We estimated trends in mean height and BMI for children and adolescents aged 5–19 years from 1990 to 2020 by rural and urban place of residence for the 200 countries and territories listed in Supplementary Table 1. We pooled, in a Bayesian meta-regression, repeated cross-sectional population-based data on height and BMI. Our results represent estimates of height and BMI for children and adolescents of the same age over time (that is, for successive cohorts) in rural and urban settings for each country.

Data sources

We used a database on cardiometabolic risk factors collated by NCD-RisC. Data were obtained from publicly available multi-country and national measurement surveys, for example, Demographic and Health Surveys (DHS), WHO-STEPwise approach to Surveillance (STEPS) surveys, and those identified through the Inter-University Consortium for Political and Social Research, UK Data Service and European Health Interview & Health Examination Surveys Database. With the help of the WHO and its regional and country offices as well as the World Heart Federation, we identified and accessed population-based survey data from national health and statistical agencies. We searched and reviewed published studies as previously detailed⁵⁴ and invited eligible studies to join NCD-RisC, as we did with data holders from earlier pooled analyses of cardiometabolic risk factors^55,56,57,58. The NCD-RisC database is continuously updated through all the above routes and through periodic requests to NCD-RisC members to ask them to suggest additional sources in their countries.

We carefully checked that each data source met our inclusion criteria, as listed below. Potential duplicate data sources were first identified by comparing studies from the same country and year, followed by checking with NCD-RisC members that had provided data about whether the sources from the same country and year, with similar samples, were the same or distinct. If two sources were confirmed as duplicates, one was discarded. All NCD-RisC members were also periodically asked to review the list of sources from their country to verify that the included data met the inclusion criteria and were not duplicates.

For each data source, we recorded the study population, the sampling approach, the years of measurement and the measurement methods. Only data that were representative of the population were included. All data sources were assessed in terms of whether they covered the entire country, one or more subnational regions (that is one or more provinces or states, more than three cities, or more than five rural communities), or one or a small number of communities (limited geographical scope not meeting above national or subnational criteria), and whether participants in rural, urban or both areas were included. As stated in the sections on the statistical model, these study-level attributes were used in the Bayesian hierarchical model to estimate mean height and BMI by country, year, sex, age and place of residence using all available data while taking into account differences in the populations from which different studies had sampled. All submitted data were checked by at least two independent individuals. Questions and clarifications were discussed with NCD-RisC members and resolved before data were incorporated into the database.

Anonymized individual data from the studies in the NCD-RisC database were re-analysed according to a common protocol. We calculated the mean height and the mean BMI, and the associated standard errors, by sex, single year of age from 5 to 19 years and rural or urban place of residence. Additionally, for analysis of height, participants aged 20–30 years were included, assigned to their corresponding birth cohort, because mean height in these ages would be at least that when they were aged 19 years given that the decline in height with age begins in the third and fourth decades of life⁵⁹. All analyses incorporated sample weights and complex survey design, when applicable, in calculating summary statistics. For studies that had used simple random sampling, we calculated the mean as the average of all individuals within the group and the associated standard error (s.d. divided by the square root of sample size); for studies that had used multistage (stratified) sampling, we accounted for survey design features, including clusters, strata and sample weights, to weight each observation by the inverse sampling probability and estimated standard error through Taylor series linearization, as implemented in the R ‘survey’ package⁶⁰. Computer code was provided to NCD-RisC members who requested assistance. For surveys without information on the place of residence, we calculated summary statistics stratified by age and sex for the entire sample, which represented the population-weighted sum of rural and urban means; data on the share of population in urban and rural areas were from the United Nations Population Division⁶¹.

Additionally, summary statistics for nationally representative data from sources that were identified but not accessed using the above routes were extracted from published reports. Data were also extracted for two STEPS surveys that were not publicly available. We also included data from a previous global-data pooling study⁵⁸, when not accessed through the above routes.

Data inclusion and exclusion

Data sources were included in the NCD-RisC height and weight database if the following criteria were met: measured data on height and weight were available; study participants were 5 years of age or older; data were collected using a probabilistic sampling method with a defined sampling frame; data were from population samples at the national, subnational or community level as defined above; and data were from the countries and territories listed in Supplementary Table 1.

We excluded all data sources that were solely based 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 characteristics^62,63,64. Owing to these variations, approaches to correcting self-reported data may leave residual bias. We also excluded data sources on population subgroups for which anthropometric status may differ systematically from the general population, including the following: studies that had included or excluded people based on their health status or cardiovascular risk; studies in which participants were only ethnic minorities; specific educational, occupational or socioeconomic subgroups (with the exception noted below); those recruited through health facilities (with the exception noted below); and females aged 15–19 years in surveys that sampled only ever-married women or measured height and weight only among mothers.

We used school-based data in countries and age–sex groups with school enrolment of 70% or higher. We used data for which the sampling frame was health insurance schemes in countries where 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.

We excluded participants whose age was <18 years and whose data were not reported by single year of age (<0.01% of all participants) because height and weight may have nonlinear age associations in these ages, especially during growth spurts. We excluded BMI data for females who were pregnant at the time of measurement (<0.01% of all participants). We excluded <0.2% of all participants who had recorded height: <60 cm or >180 cm for ages <10 years; <80 cm or >200 cm for ages 10–14 years; <100 cm or >250 cm for ages ≥15 years, or who had recorded weight: <5 kg or >90 kg for age <10 years; <8 kg or >150 kg for ages 10–14 years; <12 kg or >300 kg for ages ≥15 years, or who had recorded BMI: <6 kg m^–2 or >40 kg m^–2 for ages <10 years; <8 kg m^–2 or >60 kg m^–2 for ages 10–14 years; <10 kg m^–2 or >80 kg m^–2 for ages ≥15 years.

Conversion of BMI prevalence metrics to mean BMI

In 0.5% of our data points, mostly extracted from published reports or from a previous pooling analysis⁵⁸, the 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. To use these data, we used previously validated conversion regressions⁶⁵ to estimate the missing primary outcome from the available BMI prevalence metric or metrics. Additional details on regression model specifications along with the regression coefficients are reported at https://github.com/NCD-RisC/ncdrisc-methods/.

Statistical model overview

We used a Bayesian hierarchical meta-regression model to estimate the mean height and BMI by country, year, sex, age and place of residence using the aforementioned data. For presentation, we summarized the 15 age-specific estimates, for single years of age from 5 to 19 years, through age standardization, which puts the child and adolescent population for each country-year on the same age distribution, and hence enables comparisons to be made over time and across countries. We generated age-standardized estimates by taking weighted means of age-specific estimates using age weights from the WHO standard population⁶⁶. We also show results, graphically and numerically, for index ages of 5, 10, 15 and 19 years in the Supplementary Information.

The statistical model is described in detail in statistical papers^67,68, related substantive papers^{7,20,21,55,56,57,58,65,69} and in the section below on model specification. In summary, the model had a hierarchical structure in which estimates for each country and year were informed by its own data, if available, and by data from other years in the same country and from other countries, especially those in the same region and super-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. For the purpose of hierarchical analysis, countries and territories were organized into 21 regions, mostly based on geography and national income (Supplementary Table 1). Regions were in turn organized into nine super-regions.

We used observation year, that is, the year in which data were collected, as the timescale for the analysis of BMI and birth year as the timescale for the analysis of height, consistent with previous analyses^7,65,70. Time trends were modelled through a combination of a linear term, to capture gradual long-term change, and a second-order random walk, which allows for nonlinear trends⁷¹, both modelled hierarchically. The age associations of height and BMI were modelled, using cubic splines, to allow for nonlinear changes over age, including periods of rapid and slow rise. Periods of rapid rise representing adolescent growth spurts, which occur earlier in girls than boys^72,73,74, were reflected in the placement of spline knots for boys and girls, respectively, as detailed in the section on model specification. Spline coefficients were allowed to vary across countries, informed by their own data as well as data from other countries as specified by a hierarchical structure, as previously described⁶⁹.

The model also accounted for the possibility that height or BMI in subnational and community samples might differ systematically from nationally representative samples and have larger variation than in national studies. These features were accounted for through the inclusion of fixed-effect and random-effect terms for subnational and community data as detailed in the model specification section below. The fixed effects accounted for systematic differences between subnational or community studies and national studies. The inclusion of random effects allowed national data to have greater influence on the estimates than subnational or community data with similar sample sizes because the subnational and community data have additional variance from the random-effect terms. Both were estimated empirically as a part of model fitting.

Following the approach of previous papers^20,21,67, the model included parameters representing the urban–rural height or BMI difference, which is empirically estimated and allowed to vary by country and year. We further expanded the model to allow urban–rural difference in height or BMI to vary by age, as height or weight with age may vary between children residing in rural versus urban areas. If data for a country-year-age group contained a mix of children living in urban and rural areas but were not stratified by place of residence (21% of all data sources), the estimated height or BMI difference was informed by stratified data from other age groups, years and countries, especially those in the same region with data from similar time periods and/or ages.

Statistical model specification

As stated earlier, for each data source, we calculated mean height and BMI, together with corresponding standard errors, stratified by sex, age and rural or urban place of residence. For sources that did not stratify the sample on the place of residence, we obtained age-and-sex-stratified data. Each study contributed up to 30 mean BMI data points or 32 mean height data points for each sex, with the exact number depending on how many age groups were represented in the study and whether the study provided data stratified on urban and rural place of residence. The likelihood for an observation at urbanicity level s (urban-only, rural-only or mixed; referred to as stratum hereafter) and age group h, with age z_h, from study i, carried out in country j at time t is as follows:

$$\begin{array}{c}{y}_{s,h,i}\sim N({a}_{j[i]}+{b}_{j[i]}{t}_{i}+{u}_{j[i],{t}_{i}}+{\gamma }_{i}({z}_{h})+{{\boldsymbol{X}}}_{{\boldsymbol{i}}}\,{\boldsymbol{\beta }}+{e}_{i}\\ \,\,+{I}_{s,i}[{p}_{j[i]}+{q}_{j[i]}{t}_{i}+{r}_{j[i]}{z}_{h}+{d}_{i}],{{\rm{S}}{\rm{D}}}_{s,h,i}^{2}/{n}_{s,h,i}+\,{\tau }^{2}),\end{array}$$

where the country-specific intercept and linear time slope from the jth country (j = 1 … J, where J = 200 which is the total number of countries in our analysis) are denoted ${a}_{j}$ and ${b}_{j}$, respectively. We describe the hierarchical model used for the ${a}^{{\prime} }$s and ${b}^{{\prime} }s$ in the section ‘Linear components of country time trends’. Letting T = 31 be the total number of years from 1990 to 2020, the T-length vector ${u}_{j}$ captures smooth nonlinear change over time in country j, as described in the section ‘Nonlinear change’. The age effects of the hth age group (with age ${z}_{h}$) in study $i$ are denoted by ${\gamma }_{i}$; we describe the age model in the section ‘Age model’. The matrix ${\boldsymbol{X}}$ contains terms describing whether studies were representative at the national, subnational or community level. In addition, a random effect, ${e}_{i}$, is estimated for each study, described in the section ‘Study-level term and study-specific random effects’.

Linear components of country time trends

The model had a hierarchical structure, whereby studies were nested in countries, which were nested in regions (indexed by k), which were nested in super-regions (indexed by l), which were all nested in the globe (see Supplementary Table 1 for a list of countries and territories in each region, and regions in each super-region). This structure allowed the model to share information across units to a greater degree when data were non-existent or weakly informative (for example, had a small sample size or were not nationally representative) and, to a lesser extent, in data-rich countries and regions⁷⁵.

The $a$ and $b$ terms are country-specific linear intercepts and time slopes with terms at each level of the hierarchy, denoted by the superscripts c, r, s and g, respectively:

$$\begin{array}{l}\,{a}_{j}={a}_{j}^{c}+{a}_{k[\,j]}^{r}+{a}_{l[k]}^{s}+{a}^{{\rm{g}}},\\ \,{b}_{j}={b}_{j}^{c}+{b}_{k[\,j]}^{r}+{b}_{l[k]}^{s}+{b}^{{\rm{g}}},\\ {a}_{j}^{x}\sim N(0,{\kappa }_{a}^{x}),\\ {b}_{j}^{x}\sim N(0,{\kappa }_{b}^{x}),\end{array}$$

where x = {c, r, s}.

The $\kappa $ terms were each assigned a flat prior on the s.d. scale⁷⁶. We also assigned flat priors to ${a}^{{\rm{g}}}$ and ${b}^{{\rm{g}}}$.

Nonlinear change

Mean BMI or height may change nonlinearly over time^{7,54,58,65,70}. We captured smooth nonlinear change in time in urban and rural strata of country j using the vector ${u}_{j}$. Just as ${a}_{j}$ and ${b}_{j}$ are each defined as the sum of country, region, super-region and global components, we defined

$${u}_{j}={u}_{j}^{c}+{u}_{k[\,j]}^{r}+{u}_{l[k]}^{s}+{u}^{{\rm{g}}}.$$

To allow the model to differentiate between the degrees of nonlinearity that exist at the country, region, super-region and global levels, we assigned the four components of each $u$ a Gaussian autoregressive prior^71,77. In particular, the $T$ vectors ${u}_{j}^{c}$ (j = 1 … J), ${u}_{k}^{r}$ (k = 1 … K), ${u}_{l}^{s}$ (l = 1 … L) and ${u}^{{\rm{g}}}$ each have a normal prior with mean zero and precision ${\lambda }_{{\rm{c}}}P$, ${\lambda }_{{\rm{r}}}P$, ${\lambda }_{{\rm{s}}}P$ and ${\lambda }_{{\rm{g}}}P$, respectively, where the scaled precision matrix $P$ in the Gaussian autoregressive prior penalizes first and second differences as follows:

$$\begin{array}{c}P\,=\,[\begin{array}{ccccc}\,1 & \,0 & \,0 & \,\cdots & \,0\\ -2 & \,1 & \,0 & \,\cdots & \,0\\ \,1 & -2 & \,1 & \,\cdots & \,0\\ \,0 & \,1 & -2 & \,\cdots & \,0\\ \,0 & \,0 & \,1 & \,\cdots & \,0\\ \,\vdots & \,\vdots & \,\vdots & \,\ddots & \,\vdots \\ \,0 & \,0 & \,0 & \,\cdots & \,1\end{array}]\,[\begin{array}{ccccccc}\,1 & -2 & \,1 & \,0 & \,0 & \,\cdots & \,0\\ \,0 & \,1 & -2 & \,1 & \,0 & \,\cdots & \,0\\ \,0 & \,0 & \,1 & -2 & \,1 & \,\cdots & \,0\\ \,\vdots & \,\vdots & \,\vdots & \,\vdots & \,\vdots & \,\ddots & \,\vdots \\ \,0 & \,0 & \,0 & \,0 & \,0 & \,\cdots & \,1\end{array}]\\ \,=\,[\begin{array}{ccccccc}\,1 & -2 & \,1 & \,0 & \,0 & \,\cdots & \,0\\ -2 & \,5 & -4 & \,1 & \,0 & \,\cdots & \,0\\ \,1 & -4 & \,6 & -4 & \,1 & \,\cdots & \,0\\ \,0 & \,1 & -4 & \,6 & -4 & \,\cdots & \,0\\ \,0 & \,0 & \,1 & -4 & \,6 & \,\cdots & \,0\\ \,\vdots & \,\vdots & \,\vdots & \,\vdots & \,\vdots & \,\ddots & \,\vdots \\ \,0 & \,0 & \,0 & \,0 & \,0 & \,\cdots & \,1\end{array}].\end{array}$$

P is multiplied by the estimated precision parameters ${\lambda }_{{\rm{c}}}$, ${\lambda }_{{\rm{r}}}$, ${\lambda }_{{\rm{s}}}$ and ${\lambda }_{{\rm{g}}}$, thus upweighting or downweighting the strength of its penalties and ultimately determining the degree of smoothing at each level. For each of the four precision parameters, we used a truncated flat prior on the s.d. scale ($1/\surd \lambda $)⁷⁶. We truncated these priors such that log$\lambda $ ≤ 20 for each of the four ${\lambda }^{{\prime} }s$. This upper bound is enforced as a computational convenience, whereby models with log$\lambda $ > 20 are treated as equivalent to a model with log$\lambda $ = 20 as they essentially have no extralinear variability in time. In practice, this upper bound had little effect on the parameter estimates. Furthermore, we ordered the ${\lambda }^{{\prime} }s$ a priori as follows: ${\lambda }_{{\rm{c}}}$ < ${\lambda }_{{\rm{r}}}$ < ${\lambda }_{{\rm{s}}}$ < ${\lambda }_{{\rm{g}}}$. This prior constraint conveys the natural expectation that, for example, the global height or BMI trend has less extralinear variability than the trend of any given region, which in turn has less variability than those of constituent countries.

The matrix $P$ has rank $T$ − 2, corresponding to a flat, improper prior on the mean and the slope of the ${u}_{j}^{{\rm{c}}}$’s, the ${u}_{k}^{{\rm{r}}}$’s and the ${u}_{l}^{{\rm{s}}}$’s and ${u}^{{\rm{g}}}$, and is not invertible⁷⁸. Thus, we had a proper prior in a reduced-dimension space⁷¹, with the prior expressed as follows:

$$P({u}_{j}^{{\rm{c}}}| {\lambda }_{{\rm{c}}})\propto {\lambda }_{{\rm{c}}}^{\frac{T-2}{2}}\exp \left\{-\frac{{\lambda }_{{\rm{c}}}}{2}{u}_{j}^{{\rm{c}}{\prime} }P{u}_{j}^{{\rm{c}}}\right\}.$$

Note that if ${u}_{j}^{{\rm{c}}}$ had a non-zero mean, this would introduce non-identifiability with respect to ${a}_{j}^{{\rm{c}}}$. By the same token, ${b}_{j}^{{\rm{c}}}$ would not be identifiable if ${u}_{j}$ had a non-zero time slope, and similarly for the other means and slopes. Thus, to achieve identifiability of the ${a}^{{\prime} }s$, ${b}^{{\prime} }s$, and ${u}^{{\prime} }{\rm{s}}$, we constrained the mean and slope of ${u}^{{\rm{g}}}$ and of each ${u}^{{\rm{s}}}$, ${u}^{{\rm{r}}}$ and ${u}^{{\rm{c}}}$ to be zero. Enforcing orthogonality between the linear and nonlinear portions of the time trends meant that each can be interpreted independently.

For the cases in which we have observations for at least two different time points, this improper prior will not lead to an improper posterior because the data will provide information about the mean and slope. In order to enforce the desired orthogonality between the linear and nonlinear portions of the model, we constrained the mean and slope of the ${u}_{j}^{{\rm{c}}}$’s, ${u}_{k}^{{\rm{r}}}$’s and ${u}_{l}^{{\rm{s}}}$’s and of ${u}^{{\rm{g}}}$ to be zero⁷¹.

For the six countries with no height data, and seven countries with no BMI data, we took the Moore–Penrose pseudoinverse of P ⁷⁹, setting to infinity those eigenvalues that correspond to the non-identifiability. This effectively constrained the non-identified portions of the model to zero, as the corresponding variances are set to zero⁷⁷; in this case the Rue and Held correction⁷¹ is not needed. An intermediate case occurs when data are observed for only one time point in a country. In this case, the full conditional precision has rank $T-1$ because the mean but not the linear trend of ${u}_{j}^{{\rm{c}}}$ is identified by the data. We therefore constrained the linear trend of ${u}_{j}^{{\rm{c}}}$ to zero by taking the generalized inverse of the full conditional precision. We then constrained the mean of ${u}_{j}^{{\rm{c}}}$ to zero using the one-dimensional version of the Rue and Held correction⁷¹.

Age model

To capture sex-specific patterns of growth, especially adolescent growth spurts, we modelled age using cubic splines. The number and position of the knots of the splines were selected on the basis of a combination of physiological and statistical considerations, as described in a national level analysis⁷. For age group h with age z_h, in study i, the age effect for height and BMI is given, respectively, as follows:

$$\begin{array}{l}{\gamma }_{i}({z}_{h})={\gamma }_{1i}\,{z}_{h}+{\gamma }_{2i}{z}_{h}^{2}+{\gamma }_{3i}{z}_{h}^{3}+{\gamma }_{4i}{({z}_{h}-{k}_{1})}_{+}^{3}+{\gamma }_{5i}{({z}_{h}-{k}_{2})}_{+}^{3}+{\gamma }_{6i}{({z}_{h}-{k}_{3})}_{+}^{3}+{\gamma }_{7i}{({z}_{h}-{k}_{4})}_{+}^{3},\end{array}$$

(height)

(BMI)

For height, four spline knots were placed at ages {${k}_{1},{k}_{2},{k}_{3},{k}_{4}\}\,=$$\{\,8,\,10,\,12,14\}$ for girls and at ages {${k}_{1}$,${k}_{2},{k}_{3},{k}_{4}\}=\{10,12,14,16\}$ for boys. For BMI, we used two spline knots (at ages 10 and 15 years) because, at the population level, changes in BMI with age are smoother than those in height^7,72,73. Each of the spline coefficients was allowed to vary across countries, with a hierarchical structure as described in a previous paper⁶⁹, using the equation below, where $\psi $ is the global intercept, and $c,r\,{\rm{and}}\,s$ are the country, region and super-region random intercepts, respectively. The kth age effect coefficients for study i (${\gamma }_{k,i}$) for each age group h, with age z_h, are given as follows:

$$\begin{array}{l}{\gamma }_{k,i}={\psi }_{k}+{c}_{k,j[i]}+{r}_{k,l[i]}+{s}_{k,m[i]},\\ {c}_{k,j} \sim N(0,{\sigma }_{k,c}^{2}),\\ {r}_{k,l} \sim N(0,{\sigma }_{k,r}^{2}),\\ {s}_{k,l} \sim N(0,{\sigma }_{k,s}^{2}).\end{array}$$

A flat improper prior was placed on each of the ${{\sigma }}_{k}$’s .

Study-level term and study-specific random effects

Mean height or BMI from individual studies may deviate from the true country-year mean owing to factors associated with sampling, response or measurement. We used a study-level term to help account for potential systematic differences associated with data sources that are representative of subnational and community populations. Our model therefore included time-varying offsets (referred to as fixed effects above) for subnational and community data in the term ${{\boldsymbol{X}}}_{{\boldsymbol{i}}}{\boldsymbol{\beta }}$:

$$\begin{array}{l}{{\boldsymbol{X}}}_{{\boldsymbol{i}}}{\boldsymbol{\beta }}={\beta }_{1}I\{{X}_{j[i],t[i]}^{{\rm{cvrg}}}={\rm{subnational}}\}+{\beta }_{2}I\{{X}_{j[i],t[i]}^{{\rm{cvrg}}}={\rm{subnational}}\}{t}_{i}\\ \,+\,{\beta }_{3}I\{{X}_{j[i],t[i]}^{{\rm{cvrg}}}={\rm{community}}\}+{\beta }_{4}I\{{X}_{j[i],t[i]}^{{\rm{cvrg}}}={\rm{community}}\}{t}_{i},\end{array}$$

where ${X}_{j\left[i\right],t\left[i\right]}^{{\rm{cvrg}}}$ is the indicator for whether the coverage of study i, in country j and year t, is subnational or community.

Even after accounting for sampling variability, national studies may still not reflect the true mean height or BMI level of a country with perfect accuracy, and subnational and community studies have even larger variability. In study i, the study-specific random effect ${e}_{i}$ allows all age groups from the same study to have an unusually high or an unusually low mean after conditioning on the other terms in the model. Each ${e}_{i}$ is assigned a normal prior with variance depending on whether study i is representative at the national, subnational or community level. Random effects from national studies were constrained to have smaller variance (${v}_{{\rm{n}}}$) than random effects of subnational studies (${v}_{{\rm{s}}}$), which were in turn constrained to have smaller variance than community studies (${v}_{{\rm{c}}}$). To make country-level predictions, we set ${e}_{i}=0$, thus not including random effects arising from imperfections and variations in study design and implementation and from within-country variability of height or BMI means.

Urban and rural strata

To model mean height and BMI by urban and rural places of residence, the model included offsets for the two strata. The offsets were captured by country-specific intercept, linear time and age effects, using a centred indicator term (${I}_{s,i}$):

$${I}_{s,i}[{p}_{j[i]}+{q}_{j[i]}{t}_{i}+{r}_{j[i]}{z}_{h}+{d}_{i}],$$

where ${I}_{s,i}=-1+2{X}_{s,i}^{{\rm{u}}{\rm{r}}{\rm{b}}}$, with

$${X}_{s,i}^{{\rm{urb}}}=\left\{\begin{array}{ll}1, & {\rm{if}}\,{\rm{stratum}}\,s\,{\rm{contains}}\,{\rm{only}}\,{\rm{urban}}\,{\rm{individuals}},\\ 0, & {\rm{if}}\,{\rm{stratum}}\,s\,{\rm{contains}}\,{\rm{only}}\,{\rm{rural}}\,{\rm{individuals}},\\ {X}_{j[i],t[i]}^{{\rm{urb}}}, & {\rm{if\; stratum}}\,s\,{\rm{contains\; a\; mixture\; of\; urban}}\,{\rm{and}}\,{\rm{rural}}\,{\rm{individuals}}.\end{array}\right.$$

In other words, for data not stratified by place of residence, the model treated the unstratified mean height or BMI as equivalent to the weighted sum of the (unobserved) urban sample mean height or BMI and rural sample mean height or BMI, with the weights based on the proportion of the population of that country living in urban areas in the year of the survey (${X}_{j\left[i\right],t[i]}^{{\rm{urb}}}$).

The intercept ($p$) and slope ($q$) terms capture the country-to-country variation in the magnitude of the height or BMI difference between urban and rural populations and how the difference changes over time. The slope ($r$) captures the country-to-country variation in the BMI or height difference between urban and rural populations across age groups. These were specified with the same geographical hierarchy as the country-specific intercepts ($a$) and slopes ($b$) as follows:

$$\begin{array}{l}\,{p}_{j}={p}_{j}^{c}+{p}_{k[\,j]}^{r}+{p}_{l[k]}^{s}+{p}^{{\rm{g}}},\\ \,{q}_{j}={q}_{j}^{c}+{q}_{k[\,j]}^{r}+{q}_{l[k]}^{s}+{q}^{{\rm{g}}},\\ \,{{\rm{r}}}_{j}={r}_{j}^{c}+{r}_{k[\,j]}^{r}+{r}_{l[k]}^{s}+{r}^{{\rm{g}}},\\ {p}_{j}^{x}\sim N(0,{\kappa }_{p}^{x}),\\ {q}_{j}^{x}\sim N(0,{\kappa }_{q}^{x}),\\ {r}_{j}^{x}\sim N(0,{\kappa }_{r}^{x}),\end{array}$$

where $x=\{c,r,s\}$. The study random effect term ${d}_{i}$ incorporates deviations from the country-level urban–rural difference in each study and is analogous to ${e}_{i}$.

Residual age-by-study variability

The age patterns across communities within a given country may differ from the overall age pattern of that country. This within-study variability cannot be captured by the $e$ terms, which are equal across age-specific observations in each study, so we included an additional variance component for each study, ${\tau }^{2}$.

Model implementation

All analyses were done separately by sex because age, geographical and temporal patterns of height and BMI differ between girls and boys^7,65. We fitted the statistical model using Markov chain Monte Carlo (MCMC). We started 35 parallel MCMC runs from randomly generated overdispersed starting values. For computational efficiency, each chain was run for a total of 75,000 iterations. All chains converged to the same target distribution within this number, but due to the overdispersed initial values, the length of burn-in required to converge to the target distribution varied. After the runs were completed, we used trace plots to monitor convergence and to select chains that had completed burn-in within 35,000 iterations. This resulted in 16 chains for boys and 17 for girls for BMI, and 14 chains for boys and 16 for girls for height. Within each of these chains, post-burn-in iterations were thinned by keeping every 10th iteration, which were then combined for all chains and further thinned to a final set of 5,000 draws of the model parameter estimates. We used the posterior distribution of the model parameters to obtain the posterior distributions of our outcomes: mean urban and rural height and BMI, and the urban–rural difference in mean height and BMI. Posterior estimates were made for one-year age groups from 5 to 19 years, as well as for age-standardized outcomes, by year. The reported Crls represent the 2.5th and the 97.5th percentiles of the posterior distributions. We also report the posterior s.d. of estimates, and PP that the estimated change in height or BMI in rural or urban areas, and in the urban–rural height or BMI difference over time, represents a true increase or decrease.

Convergence was confirmed for the country-sex specific posterior outcomes—namely mean urban height and BMI, mean rural height and BMI and the urban–rural difference in mean height and BMI—for reporting ages (5, 10, 15, 19 years and age-standardized) and years (1990 and 2020) using the R-hat diagnostic^80,81. For height, the 2.5th to 97.5th percentiles of the R-hats for the reporting ages and years were 0.999–1.010 for girls and 0.999–1.004 for boys. For BMI, the 2.5th to 97.5th percentiles of the R-hats were 0.999–1.004 for girls and 0.999–1.005 for boys.

We applied the pool-adjacent-violators algorithm, a monotonic regression that uses an iterative algorithm based on least squares to fit a free-form line to a sequence of observations such that the fitted line is non-decreasing^82,83, on the posterior height estimates to ensure that the height for each birth cohort increased monotonically with age. In practice, this had little effect on the results, with height at age 19 years adjusted by an average of 0.26 cm or less for both boys and girls. All analyses were conducting using the statistical software R (v.4.1.2)⁸⁴.

Strengths and limitations

An important strength of our study is its novel scope of presenting consistent and comparable estimates of urban and rural height and BMI among school-aged children and adolescents, which is essential to formulate and evaluate policies that aim to improve health in these formative ages. We used a large number of population-based studies from 194 countries and territories covering around 99% of the population of the world. We maintained a high level of data quality and representativeness through repeated checks of study characteristics against our inclusion and exclusion criteria, and did not use any self-reported data to avoid bias in height and weight. Data were analysed according to a consistent protocol, and the characteristics and quality of data from each country were rigorously verified through repeated checks by NCD-RisC members. We used a statistical model that used all available data and took into account the epidemiological features of height and BMI during childhood and adolescence by using nonlinear time trends and age associations. The model used the available information on the urban–rural difference in height and BMI and estimated the age-varying and time-varying urban–rural difference for all countries and territories hierarchically.

Despite our extensive efforts to identify and access data, some countries had fewer data, especially those in the Caribbean, Polynesia, Micronesia and sub-Saharan Africa. Of the studies used, fewer than half had data for children aged 5–9 years compared to nearly 90% with data for children and adolescents aged 10–19 years. The scarcity of data is reflected in the larger uncertainty of our estimates for these countries and regions, and younger age groups. This reflects the need to systematically include school-aged children in both health and nutrition surveys, and, especially in countries where school enrolment is high, to use schools as a platform for monitoring growth and developmental outcomes for entire national populations and key subgroups such as those in rural and urban areas. Although urban and rural classifications are commonly based on definitions by national statistical offices, classification of cities and rural areas may, appropriately, vary by country according to their demographic characteristics (for example, population size or density), economic activities, administrative structures, infrastructure and environment. Similarly, urbanization takes place through a variety of mechanisms such as changes in fertility in rural and urban areas, migration and reclassification of previously rural areas to urban as they grow and industrialize. Each of these mechanisms may have different implications for nutrition and physical activity, and hence height and/or BMI, and should be a subject of studies that follow individual participants and changes in their place of residence. Finally, there is variation in growth and development of children within rural or urban areas based on household socioeconomic status and community characteristics that affect access to and the quality of nutrition, the living environment and healthcare^35,85,86. Among these, in some cities, a large number of families live in slums^19,87. School-aged children and adolescents living in slums have nutrition, environment and healthcare access that is typically worse than other residents of the city, although often better than those in rural areas^{19,87,88,89,90}.

Reporting summary

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

Data availability

Estimates of mean BMI and height by country, year, sex, single year of age as well as age-standardized, and place of residence (urban and rural) will be available from https://www.ncdrisc.org in machine-readable numerical format and as visualizations upon publication of the paper. Input data from publicly available sources and contact information for data providers can be downloaded from https://www.ncdrisc.org and Zenodo (https://doi.org/10.5281/zenodo.7355601).

Code availability

The computer code for the Bayesian hierarchical model and the code used to generate figures in this work will be available at https://www.ncdrisc.org and Zenodo (https://doi.org/10.5281/zenodo.7355601).

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Acknowledgements

This study was funded by the UK Medical Research Council (grant number MR/V034057/1), the Wellcome Trust (Pathways to Equitable Healthy Cities grant 209376/Z/17/Z), the AstraZeneca Young Health Programme and the European Commission (STOP project through EU Horizon 2020 research and innovation programme under Grant Agreement 774548). For the purpose of open access, the author has applied a Creative Commons Attribution (CC BY) licence to the Author Accepted Manuscript version arising from this submission. We thank W. Dietz, L. Jaacks and W. Johnson for recommendations of relevant citations. The authors alone are responsible for the views expressed in this Article and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated.

Author information

These authors contributed equally: Anu Mishra, Bin Zhou, Andrea Rodriguez-Martinez, Honor Bixby
Deceased: Konrad Jamrozik, Altan Onat, Robespierre Ribeiro, Michael Sjöström, Agustinus Soemantri, Jutta Stieber, Dimitrios Trichopoulos

Authors and Affiliations

Imperial College London, London, UK
Anu Mishra, Bin Zhou, Andrea Rodriguez-Martinez, Rosie K. Singleton, Rodrigo M. Carrillo-Larco, Kate E. Sheffer, James E. Bennett, Victor Lhoste, Maria L. C. Iurilli, Nowell H. Phelps, Marisa K. Sophiea, Edward W. Gregg, Queenie Chan, Amanda J. Cross, Paul Elliott, Ilpo Tapani Huhtaniemi, Marjo-Riitta Jarvelin, Elio Riboli, Evangelia Tzala, Mark Woodward & Majid Ezzati
McGill University, Montreal, Québec, Canada
Honor Bixby, David Goltzman & Suzanne N. Morin
University of Essex, Colchester, UK
Honor Bixby & Mariachiara Di Cesare
University of California Berkeley, Berkeley, CA, USA
Christopher J. Paciorek & Farnam Mohebi
University of Kent, Canterbury, UK
James Bentham
World Health Organization, Geneva, Switzerland
Gretchen A. Stevens, Melanie J. Cowan, Stefan Savin, Leanne M. Riley, Mohamed M. Ali & Francesco Branca
Harvard T. H. Chan School of Public Health, Boston, MA, USA
Goodarz Danaei, Wafaie W. Fawzi, Yanping Li, Caleb Ochimana & Dimitrios Trichopoulos
Mahidol University, Nakhon Pathom, Thailand
Wichai Aekplakorn, Nipa Rojroongwasinkul, Paibul Suriyawongpaisal & Uruwan Yamborisut
Ministry of Health, Kuala Lumpur, Malaysia
Noor Ani Ahmad, Suhaila Abdul Ghaffar, Mohamad Hasnan Ahmad, Tahir Aris, Azli Baharudin, Norsyamlina Che Abdul Rahim, Norazizah Ibrahim Wong, Muhammad Fadhli Mohd Yusoff, Mohd Azahadi Omar, Rusidah Selamat, Ahmad Faudzi Yusoff & Ahmad A. Zainuddin
Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
Jennifer L. Baker, Kristine Allin, Anne A. Bjerregaard, Thomas M. Dantoft, Marie Eliasen, Torben Jørgensen, Freja B. Kampmann, Line L. Kårhus, Katja B. Leth-Møller, Allan Linneberg, Anja L. Madsen, Line T. Møllehave, Merete Osler & Betina H. Thuesen
Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
Adela Chirita-Emandi, Mihai Gafencu, Iulia Jurca Simina & Maria Puiu
Non-Communicable Diseases Research Center, Tehran, Iran
Farshad Farzadfar, Naser Ahmadi, Mehrdad Azmin, Ali Ghanbari, Erfan Ghasemi, Rosa Haghshenas, Parinaz Mehdipour, Sahar Saeedi Moghaddam, Bahram Mohajer, Shohreh Naderimagham & Moein Yoosefi
Swiss Tropical and Public Health Institute, Basel, Switzerland
Günther Fink
University of Basel, Basel, Switzerland
Günther Fink
World Health Organization Regional Office for Europe, Copenhagen, Denmark
Mirjam Heinen, Marta Buoncristiano, Ivo Rakovac, Kremlin Wickramasinghe & Julianne Williams
National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
Nayu Ikeda & Nobuo Nishi
South African Medical Research Council, Cape Town, South Africa
Andre P. Kengne
Seoul National University College of Medicine, Seoul, Republic of Korea
Young-Ho Khang
University of Eastern Finland, Kuopio, Finland
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Finnish Institute for Health and Welfare, Helsinki, Finland
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Peking University, Beijing, China
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Universidad de San Carlos, Guatemala City, Guatemala
Michele Monroy-Valle
BRAC James P. Grant School of Public Health, Dhaka, Bangladesh
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University of Coimbra, Coimbra, Portugal
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University of Otago, Dunedin, New Zealand
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Al-Quds University, East Jerusalem, State of Palestine
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Birzeit University, Birzeit, State of Palestine
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Instituto Mexicano del Seguro Social, Mexico City, Mexico
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Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico
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Luxembourg Institute of Health, Strassen, Luxembourg
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Departamento de Salud del Gobierno Vasco, San Sebastián, Spain
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Ghana Health Service, Kintampo, Ghana
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UMR CNRS-MNHN 7206, Paris, France
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Western Norway University of Applied Sciences, Sogndal, Norway
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Norwegian School of Sport Sciences, Oslo, Norway
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Madras Diabetes Research Foundation, Chennai, India
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University Tunis El Manar, Tunis, Tunisia
Habiba Ben Romdhane & Olfa Saidi
Federal Ministry of Social Affairs, Health, Care and Consumer Protection, Vienna, Austria
Judith Benedics & Adelheid Weber
Cafam University Foundation, Bogotá, Colombia
Mikhail Benet
Ministerio de Salud Pública y Bienestar Social, Asunción, Paraguay
Gilda Estela Benitez Rolandi, Felicia Cañete, Ethel Santacruz & Guillermo Sequera
University of Agder, Kristiansand, Norway
Elling Bere & Frøydis N. Vik
Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
Yemane Berhane
Kazakh National Medical University, Almaty, Kazakhstan
Salim Berkinbayev & Ildar Fakhradiyev
Universidad Peruana Cayetano Heredia, Lima, Peru
Antonio Bernabe-Ortiz, Maria Lazo-Porras, J. Jaime Miranda, Salim Mohanna, Pedro J. Ortiz & Tania Tello
Lithuanian University of Health Sciences, Kaunas, Lithuania
Gailute Bernotiene, Virginija Dulskiene, Jurate Klumbiene, Vilma Kriaucioniene, Renata Kuciene, Dalia Luksiene, Jurate Medzioniene, Janina Petkeviciene, Ausra Petrauskiene, Ricardas Radisauskas, Abdonas Tamosiunas & Justina Vaitkeviciute
Pontificia Universidad Católica de Chile, Santiago, Chile
Ximena Berrios Carrasola, Guadalupe Echeverría, Catterina Ferreccio, Paula Margozzini, Juan Francisco Miquel, Flavio Nervi, Attilio Rigotti & Gonzalo Valdivia
University of São Paulo, São Paulo, Brazil
Heloísa Bettiol, Viviane C. Cardoso, Andrea R. V. R. Horimoto, Paulo A. Lotufo, Alicia Matijasevich & Alexandre C. Pereira
Johannes Gutenberg University, Mainz, Germany
Manfred E. Beutel, Karl J. Lackner, Martina Müller-Nurasyid, Thomas Münzel, Norbert Pfeiffer & Philipp S. Wild
B. J. Medical College, Ahmedabad, India
Aroor Bhagyalaxmi
Chirayu Medical College, New Delhi, India
Sumit Bharadwaj
Sunder Lal Jain Hospital, Delhi, India
Santosh K. Bhargava
Shandong University of Traditional Chinese Medicine, Jinan, China
Hongsheng Bi & Jianfeng Wu
Shanghai Jiao-Tong University School of Medicine, Shanghai, China
Yufang Bi & Guang Ning
Universidad de la República, Montevideo, Uruguay
Daniel Bia, Jose G. Boggia, Oscar A. Noboa & Yanina Zocalo
University of Strasbourg, Strasbourg, France
Katia Biasch & Marie Moitry
Institute of Medical Research and Medicinal Plant Studies, Yaoundé, Cameroon
Elysée Claude Bika Lele
Ufa Eye Research Institute, Ufa, Russia
Mukharram M. Bikbov, Albina A. Fakhretdinova, Ellina M. Iakupova, Gyulli M. Kazakbaeva, Iuliia A. Rusakova & Azaliia M. Tuliakova
Nepal Health Research Council, Kathmandu, Nepal
Bihungum Bista, Meghnath Dhimal & Anil Poudyal
University of Montenegro, Niksic, Montenegro
Dusko J. Bjelica & Stevo R. Popovic
University of Southern Denmark, Copenhagen, Denmark
Peter Bjerregaard, Louise Eriksen & Janne S. Tolstrup
University of Gothenburg, Gothenburg, Sweden
Cecilia Björkelund, Robert Eggertsen, Dominique Hange, Jenny M. Kindblom, Lauren Lissner, Kirsten Mehlig, Claes Ohlsson, Annika Rosengren & Agneta Sjöberg
Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
Katia V. Bloch
National Institute for Public Health and the Environment, Bilthoven, The Netherlands
Anneke Blokstra, Jolanda M. A. Boer, Johannes Brug, W. M. Monique Verschuren & Lucie Viet
University of Haifa, Haifa, Israel
Moran Blychfeld Magnazu & Ronit Endevelt
Ministry of Health, Ramat Gan, Israel
Moran Blychfeld Magnazu
University of Turin, Turin, Italy
Simona Bo, Graziella Bruno & Gabriella Gruden
University College London, London, UK
Martin Bobak, Nish Chaturvedi, Hynek Pikhart, Rui Providencia, Reecha Sofat, Julie Taylor, S. Goya Wannamethee & Andrew Wong
Liverpool John Moores University, Liverpool, UK
Lynne M. Boddy
Nanyang Technological University, Singapore, Singapore
Bernhard O. Boehm
National Medical Research Center for Endocrinology, Moscow, Russia
Elena Bogova & Valentina Peterkova
Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires, Argentina
Carlos P. Boissonnet
IRCCS Neuromed, Pozzilli, Italy
Marialaura Bonaccio, Simona Costanzo, Amalia De Curtis, Giovanni de Gaetano, Maria Benedetta Donati & Licia Iacoviello
Toulouse University School of Medicine, Toulouse, France
Vanina Bongard, Jean Ferrieres & Jean-Bernard Ruidavets
University of Zurich, Zurich, Switzerland
Matthias Bopp, David Faeh, Felix Gutzwiller, Susi Kriemler, Frank J. Rühli & Kaspar Staub
KU Leuven, Leuven, Belgium
Herman Borghs, Frank Buntinx, Frank Claessens, Jesus D. Melgarejo, Jan A. Staessen, Dirk Vanderschueren, Yu-Ling Yu & Zhen-Yu Zhang
Ministry of Health, Victoria, Seychelles
Pascal Bovet & Bharathi Viswanathan
Unisanté, Lausanne, Switzerland
Pascal Bovet & Fred Michel Paccaud
World Health Organization Country Office in Tajikistan, Dushanbe, Tajikistan
Khadichamo Boymatova
Flemish Agency for Care and Health, Brussels, Belgium
Lien Braeckevelt
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, Wendy Van Lippevelde & Maïté Verloigne
FrieslandCampina, Amersfoort, The Netherlands
Marjolijn C. E. Bragt & Ilse M. S. L. Khouw
Universidad Central de Venezuela, Caracas, Venezuela
Imperia Brajkovich, Marianella Herrera-Cuenca & Maritza Landaeta Jimenez
Bielefeld University, Bielefeld, Germany
Juergen Breckenkamp
World Health Organization Athens Quality of Care Office, Athens, Greece
João Breda
German Cancer Research Center, Heidelberg, Germany
Hermann Brenner, Rudolf Kaaks, Kai-Uwe Saum & Ben Schöttker
The Fred Hollows Foundation, Auckland, New Zealand
Garry R. Brian
University of the Andes, Mérida, Venezuela
Yajaira Briceño & Mariela Paoli
Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Lacramioara Brinduse, Eliza Cinteza, Maria Dorobantu & Oana-Florentina Gheorghe-Fronea
Instituto Politécnico de Lisboa, Lisbon, Portugal
Miguel Brito
Swansea University, Swansea, UK
Sinead Brophy & Gareth Stratton
University College Copenhagen, Copenhagen, Denmark
Anna Bugge
Institute of Public Health, Tirana, Albania
Genc Burazeri & Jolanda Hyska
Munster Technological University, Cork, Ireland
Con Burns, Tara C. Coppinger & Janette Walton
Universidad de La Laguna, Santa Cruz de Tenerife, Spain
Antonio Cabrera de León
University of Malta, Msida, Malta
Joseph Cacciottolo & Sarah Cuschieri
Vanderbilt University, Nashville, TN, USA
Hui Cai & Wei Zheng
Pan American Health Organization, Washington, DC, USA
Roberta B. Caixeta & Pedro Ordunez
Ministry of Health, Tongatapu, Tonga
Tilema Cama
Canadian Fitness and Lifestyle Research Institute, Ottawa, Ontario, Canada
Christine Cameron & Cora L. Craig
Hospital Santa Maria, Lisbon, Portugal
José Camolas
Istanbul University–Cerrahpasa, Istanbul, Turkey
Günay Can
Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
Ana Paula C. Cândido
National Institute of Public Health, Prague, Czech Republic
Naděžda Čapková, Jana Kratenova, Ruzena Kubinova, Michala Lustigová & Kristyna Zejglicova
Gaetano Fucito Hospital, Mercato San Severino, Italy
Eduardo Capuano, Rocco Capuano & Vincenzo Capuano
University of Groningen, Groningen, The Netherlands
Marloes Cardol, Eva Corpeleijn & Daan Kromhout
Karolinska Institutet, Huddinge, Sweden
Axel C. Carlsson & Holger Theobald
Centro de Estudios Sobre Nutrición Infantil, Buenos Aires, Argentina
Esteban Carmuega & Maria Elisa Zapata
University of Porto, Porto, Portugal
Joana Carvalho, Luis Lopes, Nuno Lunet, Jorge Mota, Andreia N. Pizarro, Maria Paula Santos & Rute Santos
University of Zaragoza, Zaragoza, Spain
José A. Casajús, Pilar De Miguel-Etayo, Esther M. González-Gil & Luis A. Moreno
Santiago de Compostela University, Santiago de Compostela, Spain
Felipe F. Casanueva
Ministry of Health, Ankara, Turkey
Ertugrul Celikcan, Sibel Gogen & Nazan Yardim
Council for Agricultural Research and Economics, Rome, Italy
Laura Censi, Marika Ferrari, Myriam Galfo & Romana Roccaldo
Federal University of Rio Grande, Rio Grande, Brazil
Juraci A. Cesar & Samuel C. Dumith
India Diabetes Research Foundation, Chennai, India
Snehalatha Chamukuttan, Ambady Ramachandran & Mary Simon
Duke–NUS Medical School, Singapore, Singapore
Angelique Chan, Tazeen Jafar, Rahul Malhotra & Tien Yin Wong
ICMR–National Institute of Medical Statistics, New Delhi, India
Himanshu K. Chaturvedi, Geetha R. Menon & Arvind Pandey
Singapore Eye Research Institute, Singapore, Singapore
Miao Li Chee, Charumathi Sabanayagam, Rosalynn Siantar & Yih Chung Tham
Academia Sinica, Taipei, Taiwan
Chien-Jen Chen & Wen-Harn Pan
Capital Institute of Pediatrics, Beijing, China
Fangfang Chen & Jie Mi
Xiangtan University, Xiangtan, China
Huashuai Chen
Kailuan General Hospital, Tangshan, China
Shuohua Chen, Liufu Cui, Jingli Gao & Shouling Wu
National University of Singapore, Singapore, Singapore
Ching-Yu Cheng, Xinyi Gwee, Jeannette Lee, Charlie Lim, Wei-Yen Lim, Ei Ei K. Nang, Tze Pin Ng, Xueling Sim & E. Shyong Tai
US Centers for Disease Control and Prevention, Atlanta, GA, USA
Yiling J. Cheng
Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Bahman Cheraghian, Mohammad Esmaeel Motlagh, Nader Saki & Ali Akbar Shayesteh
The Gertner Institute for Epidemiology and Health Policy Research, Ramat Gan, Israel
Angela Chetrit, Rachel Dankner, Ofra Kalter-Leibovici & Gilad Twig
National Centre of Public Health and Analyses, Sofia, Bulgaria
Ekaterina Chikova-Iscener, Vesselka L. Duleva & Lalka S. Rangelova
Amsterdam UMC Public Health Research Institute, Amsterdam, The Netherlands
Mai J. M. Chinapaw & Han C. G. Kemper
Universidad de Costa Rica, San José, Costa Rica
Anne Chinnock & Georgina Gómez
University of Fribourg, Fribourg, Switzerland
Arnaud Chiolero
National Taiwan University, Taipei, Taiwan
Shu-Ti Chiou & Hsien-Ho Lin
CIBERESP, Madrid, Spain
María-Dolores Chirlaque, Manoli Garcia-de-la-Hera, Magda Gasull, José María Huerta, Jesús M. Ibarluzea, Diego Salmerón, Helmut Schröder & Laura Torres-Collado
Seoul National University, Seoul, Republic of Korea
Belong Cho & Jin Soo Moon
University of Southern Denmark, Odense, Denmark
Kaare Christensen, Anders Grøntved, Peter Lund Kristensen, Niels C. Møller, Stine Schramm, Morten Sodemann & Niels Wedderkopp
Universidade Estadual Paulista, Presidente Prudente, Brazil
Diego G. Christofaro, Romulo A. Fernandes & William R. Tebar
Medical University of Silesia, Katowice, Poland
Jerzy Chudek & Andrzej Więcek
Charles University, Prague, Czech Republic
Renata Cifkova & Michala Lustigová
Thomayer Hospital, Prague, Czech Republic
Renata Cifkova
Primary Health Care, Floriana, Malta
Michelle Cilia, Victoria Farrugia Sant’Angelo & Lorraine Tabone
University of Salerno, Fisciano, Italy
Massimo Cirillo
Statistics Canada, Ottawa, Ontario, Canada
Janine Clarke, Thomas Ferrao, Anie Marcil, Scott B. McLean, Joel G. R. Roy & Jennifer Servais
Alicante Institute for Health and Biomedical Research, Alicante, Spain
Laura-María Compañ-Gabucio
Agency for Preventive and Social Medicine, Bregenz, Austria
Hans Concin, Harald Geiger, Georg Posch & Emanuel Zitt
University of Southampton, Southampton, UK
Cyrus Cooper, Elaine Dennison, Caroline H. Fall, Allan G. Hill, Clive Osmond, Senthil K. Vasan & Leo D. Westbury
Pontificia Universidad Javeriana, Bogotá, Colombia
Lilia Yadira Cortés, Luis F. Gomez & Luz Nayibe Vargas
Institut Pasteur de Lille, Lille, France
Dominique Cottel & Jean Dallongeville
Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
Amelia C. Crampin
CIBEROBN, Madrid, Spain
Ana B. Crujeiras, Pilar De Miguel-Etayo, Luis A. Moreno & Dora Romaguera
Hungarian University of Sports Science, Budapest, Hungary
Tamás Csányi
University of Debrecen, Debrecen, Hungary
Semánová Csilla
National Institute of Public Health, Bucharest, Romania
Alexandra M. Cucu, Constanta Huidumac Petrescu & Rodica Nicolescu
University of Medicine and Pharmacy, Bucharest, Romania
Alexandra M. Cucu
Universidade Federal do Rio Grande do Norte, Natal, Brazil
Felipe V. Cureau
National Research Council, Reggio Calabria, Italy
Graziella D’Arrigo
Eftimie Murgu University Resita, Resita, Romania
Liliana Dacica
Eduardo Mondlane University, Maputo, Mozambique
Albertino Damasceno
Indian Statistical Institute, Kolkata, India
Parasmani Dasgupta
Tabriz Health Services Management Research Center, Tabriz, Iran
Saeed Dastgiri
Geneva University Hospitals, Geneva, Switzerland
David De Ridder & Idris Guessous
Sciensano, Brussels, Belgium
Karin De Ridder, Stefaan Demarest & Johan Van der Heyden
University Medical Centers, Amsterdam, The Netherlands
Susanne R. de Rooij & Tanja G. M. Vrijkotte
National Research Centre for Preventive Medicine, Moscow, Russia
Alexander D. Deev
Innovating Health International, Port-au-Prince, Haiti
Vincent DeGennaro Jr
University of Montreal, Montreal, Quebec, Canada
Hélène Delisle
French National Research Institute for Sustainable Development, Montpellier, France
Francis Delpeuch, Michelle Holdsworth, Yves Kameli, Edwige Landais, Agnès Le Port, Bernard Maire, Yves Martin-Prevel, Mathilde Savy & Pierre Traissac
French Public Health Agency, St Maurice, France
Valérie Deschamps & Benoit Salanave
Mediterranea Cardiocentro, Naples, Italy
Augusto Di Castelnuovo, Francesco Gianfagna & Sara Magnacca
Universidade do Vale do Rio dos Sinos, São Leopoldo, Brazil
Juvenal Soares Dias-da-Costa & Marcos Pattussi
National Institute of Hygiene, Epidemiology and Microbiology, Havana, Cuba
María Elena Díaz-Sánchez, Ramón Suárez-Medina & Patricia Varona-Pérez
National Council of Scientific and Technical Research, Buenos Aires, Argentina
Alejandro Diaz
Servicio Canario de la Salud del Gobierno de Canarias, Santa Cruz de Tenerife, Spain
Pedro Díaz Fernández, María José García Mérida & María del Cristo Rodriguez-Perez
Consejería de Salud del Gobierno de La Rioja, Logroño, Spain
María Pilar Díez Ripollés
Ministry of Health and Medical Education, Tehran, Iran
Shirin Djalalinia & Niloofar Peykari
University of Novi Sad, Novi Sad, Serbia
Visnja Djordjic, Sergej M. Ostojic & Ivana Radic
National Institute of Nutrition, Hanoi, Vietnam
Ha T. P. Do, Chinh Nguyen Huu, Khanh Le Nguyen Bao & Tuyen D. Le
University of Queensland, Brisbane, Queensland, Australia
Annette J. Dobson
Instituto de Investigación Nutricional, Lima, Peru
Liria Dominguez & Rossina G. Pareja
Istituto Superiore di Sanità, Rome, Italy
Chiara Donfrancesco, Simona Giampaoli, Laura Lauria, Paola Nardone, Luigi Palmieri, Daniela Pierannunzio & Angela Spinelli
Sun Yat-sen University, Guangzhou, China
Guanghui Dong & Yingfeng Zheng
Universidad de Cuenca, Cuenca, Ecuador
Silvana P. Donoso & Angélica M. Ochoa-Avilés
Helmholtz Zentrum München, Munich, Germany
Angela Döring, Christian Gieger, Margit Heier, Birgit Linkohr, Christa Meisinger, Annette Peters, Andrea Schneider, Jutta Stieber, Doris Stöckl, Barbara Thorand & Kathrin Wolf
Tehran University of Medical Sciences, Tehran, Iran
Ahmad Reza Dorosty, Sareh Eghtesad, Fatemeh Malekzadeh, Reza Malekzadeh, Kazem Mohammad, Mohammad Reza Mohammadi, Zahra Mohammadi, Seyed-Ali Mostafavi, Mahboubeh Parsaeian, Hamed Pouraram, Akram Pourshams, Hossein Poustchi, Alireza Sadjadi, Sadaf G. Sepanlou, Maryam Sharafkhah & Amaneh Shayanrad
Ministère de la Santé et de l’Hygiène Publique, Abidjan, Côte d’Ivoire
Kouamelan Doua
University Hospital Düsseldorf, Düsseldorf, Germany
Nico Dragano
National Institute of Cardiology, Warsaw, Poland
Wojciech Drygas, Pawel Kurjata & Aleksandra Piwonska
Beijing Center for Disease Prevention and Control, Beijing, China
Jia Li Duan
IRL 3189 ESS, Marseille, France
Priscilla Duboz & Enguerran Macia
Scuola Superiore Sant’Anna, Pisa, Italy
Anar Dushpanova
Al-Farabi Kazakh National University, Almaty, Kazakhstan
Anar Dushpanova, Natalya Glushkova, Zhanna Kalmatayeva & Mukhtar Kulimbet
Semey Medical University, Semey, Kazakhstan
Azhar Dyussupova
University of Latvia, Riga, Latvia
Vilnis Dzerve & Elena Pahomova
Ministry of Health and Medical Services, Gizo, Solomon Islands
Ricky Eddie
Hormozgan University of Medical Sciences, Bandar Abbas, Iran
Ebrahim Eftekhar & Azim Nejatizadeh
University of Benin, Benin City, Nigeria
Eruke E. Egbagbe
University of Skövde, Skövde, Sweden
Gabriele Eiben
Ministry of Health, Rabat, Morocco
Laila El Ammari
National Institute of Nutrition and Food Technology, Tunis, Tunisia
Jalila El Ati
The University of the West Indies, Kingston, Jamaica
Denise Eldemire-Shearer, Trevor S. Ferguson, Damian K. Francis, Kenneth James, Shelly R. McFarlane, Marshall K. Tulloch-Reid, Rainford J. Wilks & Novie O. Younger-Coleman
Ministry of Health, Jerusalem, Israel
Ronit Endevelt
University of California Davis, Davis, CA, USA
Reina Engle-Stone
University of Stellenbosch, Cape Town, South Africa
Rajiv T. Erasmus
University of Duisburg-Essen, Essen, Germany
Raimund Erbel, Karl-Heinz Jöckel, Nils Lehmann, Ulla Roggenbuck & Sara Schramm
Karadeniz Technical University, Trabzon, Turkey
Cihangir Erem, Irfan Nuhoğlu & Murat Topbas
Dokuz Eylul University, Izmir, Turkey
Gul Ergor & Belgin Unal
University of Helsinki, Helsinki, Finland
Johan G. Eriksson & Jukka T. Salonen
Mashhad University of Medical Sciences, Mashhad, Iran
Saeid Eslami, Maryam Keramati, Reza Mohammadpourhodki & Seyed Rasoul Zakavi
Rafsanjan University of Medical Sciences, Rafsanjan, Iran
Ali Esmaeili & Hamid Hakimi
Queen’s University Belfast, Belfast, UK
Alun Evans & Dermot O’Reilly
Tabriz University of Medical Sciences, Tabriz, Iran
Elnaz Faramarzi, Saeid Safiri & Mohammad Hossein Somi
Fasa University of Medical Sciences, Fasa, Iran
Mojtaba Farjam
Shiraz University of Medical Sciences, Shiraz, Iran
Mohammad Reza Fattahi, Reza Malekzadeh, Salar Rahimikazerooni, Abbas Rezaianzadeh & Ali Reza Safarpour
Baqai Medical University, Karachi, Pakistan
Asher Fawwad
Centro de Salud Villanueva Norte, Badajoz, Spain
Francisco J. Felix-Redondo
Hospital Don Benito-Villanueva de la Serena, Badajoz, Spain
Daniel Fernández-Bergés
Ministry of Health, Buenos Aires, Argentina
Daniel Ferrante
Universidad de Santiago de Chile, Santiago, Chile
Gerson Ferrari
University of Insubria, Varese, Italy
Marco M. Ferrario, Alessandro Gialluisi, Francesco Gianfagna, Licia Iacoviello & Giovanni Veronesi
Federal University of Alagoas, Alagoas, Brazil
Haroldo S. Ferreira
Institute of Mother and Child, Warsaw, Poland
Anna Fijalkowska, Magdalena Korzycka & Hanna Nalecz
Hospital Infantil Sabará, São Paulo, Brazil
Mauro Fisberg
University of Tartu, Tartu, Estonia
Krista Fischer, Kairit Mikkel & Mari-Liis Tammesoo
Universiti Sains Malaysia, Kelantan, Malaysia
Leng Huat Foo, Kamarul Imran Musa, Wan Mohamad Wan Bebakar & Nor Azwany Yaacob
Umeå University, Umeå, Sweden
Maria Forsner, Maria Nordendahl & Stefan Söderberg
Federal University of São Paulo, São Paulo, Brazil
Maria do Carmo Franco & Maria Wany Strufaldi
University Clinical Centre Ljubljana, Ljubljana, Slovenia
Zlatko Fras
Hospital Universitario Son Espases, Palma, Spain
Guillermo Frontera
Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
Flavio D. Fuchs
Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
Sandra C. Fuchs, Adroaldo Cesar Araujo Gaya, Anelise Reis Gaya, João Mello, Leila B. Moreira, Maria Teresa A. Olinto, Mariana Sbaraini, Beatriz D. Schaan, Karen Sparrenberger & Daniel G. Vasques
Universitas Sumatera Utara, Medan, Indonesia
Isti I. Fujiati
Kindai University, Osaka-Sayama, Japan
Yuki Fujita
Kyoto University, Kyoto, Japan
Matsuda Fumihiko, Takuro Furusawa & Tabara Yasuharu
I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
Viktoriya Furdela & Halyna Pavlyshyn
Medical University of Warsaw, Warsaw, Poland
Zbigniew Gaciong
Consejería de Sanidad del Gobierno de Cantabria, Santander, Spain
Manuel Galán Cuesta
Jagiellonian University Medical College, Kraków, Poland
Andrzej Galbarczyk, Grazyna Jasienska, Magdalena Klimek, Karolina Miłkowska, Ilona Nenko, Andrzej Pająk & Roman Topór-Mądry
Ministero della Salute DG Prevenzione Sanitaria, Rome, Italy
Daniela Galeone & Maria Teresa Menzano
University of Catania, Catania, Italy
Fabio Galvano, Justyna Godos, Giuseppe Grosso, Stefano Marventano & Antonio Mistretta
Agencia Española de Seguridad Alimentaria y Nutrición, Madrid, Spain
Marta García Solano & Enrique Gutiérrez González
Africa Health Research Institute, Mtubatuba, South Africa
Dickman Gareta
Geneva University Medical School, Geneva, Switzerland
Jean-Michel Gaspoz
Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
Andrea Gazzinelli & Gustavo Velasquez-Melendez
Utrecht University, Utrecht, The Netherlands
Ulrike Gehring, N. Charlotte Onland-Moret & Yvonne T. van der Schouw
Wageningen University, Wageningen, The Netherlands
Johanna M. Geleijnse
Medical Research Foundation, Chennai, India
Ronnie George & Vijaya Lingam
Kurdistan University of Medical Sciences, Sanandaj, Iran
Ebrahim Ghaderi & Farhad Moradpour
University of Adelaide, Adelaide, South Australia, Australia
Tiffany K. Gill, David A. Gonzalez-Chica, Konrad Jamrozik & Anne Taylor
Lund University, Lund, Sweden
Aleksander Giwercman & Emily Sonestedt
Aristotle University of Thessaloniki, Thessaloniki, Greece
Konstantinos Gkiouras, Xenophon Theodoridis & Areti Triantafyllou
National Institute for Health Development, Tallinn, Estonia
Natalja Gluškova, Merike Liivak, Helle-Mai Loit, Keiu Nelis, Eha Nurk, Marge Saamel & Toomas Veidebaum
Central University of Kerala, Kasaragod, India
Ramesh Godara & K. R. Thankappan
Institut National de la Santé et de la Recherche Médicale, Paris, France
Marcel Goldberg & Marie Zins
Paris University, Paris, France
Marcel Goldberg & Marie Zins
Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca, Murcia, Spain
Jesús Humberto Gómez Gómez & Inés Sánchez Rodríguez
Gasol Foundation, Sant Boi de Llobregat, Spain
Santiago F. Gómez
University of Lleida, Sant Boi de Llobregat, Spain
Santiago F. Gómez
PASs Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland
Aleksandra Gomula, Slawomir Koziel & Natalia Nowak-Szczepanska
University Agostinho Neto, Luanda, Angola
Mauer Gonçalves
Kansas State University, Manhattan, KS, USA
Ana D. González-Alvarez
Universidad Politécnica de Madrid, Madrid, Spain
Marcela Gonzalez-Gross
International Clinical Research Center, Brno, Czech Republic
Juan P. González-Rivas
National Institute of Public Health, Cuernavaca, Mexico
Clicerio González-Villalpando, Leticia Hernandez Cadena, Eric Monterrubio-Flores, Juan A. Rivera, Rosalba Rojas-Martinez, Eduardo Salazar Martinez, Teresa Shamah-Levy & Salvador Villalpando
Centro de Estudios en Diabetes A.C., Mexico City, Mexico
María-Elena González-Villalpando
Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
Angel R. Gonzalez
Ministry of Health, Lisbon, Portugal
Antonio Pedro Graça & Maria João Gregório
Institute for Clinical and Experimental Medicine, Prague, Czech Republic
Dušan Grafnetter & Vera Lanska
Children’s Memorial Health Institute, Warsaw, Poland
Aneta Grajda, Zbigniew Kulaga & Mieczyslaw Litwin
University of Thessaly, Larissa, Greece
Maria G. Grammatikopoulou
National Center of Cardiovascular Diseases, Beijing, China
Dongfeng Gu
International Life Science Institute, Buenos Aires, Argentina
Viviana Guajardo
University of Ferrara, Ferrara, Italy
Emanuela Gualdi-Russo, Natascia Rinaldo & Luciana Zaccagni
Authority Sanitaria San Marino, San Marino, San Marino
Andrea Gualtieri & Elena Sacchini
Icelandic Heart Association, Kopavogur, Iceland
Elias F. Gudmundsson, Johanna Gunnlaugsdottir & Örn Olafsson
Universidad Icesi, Cali, Colombia
Ramiro Guerrero & Victoria E. Soto-Rojas
State University of Montes Claros, Montes Claros, Brazil
Andre L. Guimaraes
King’s College London, London, UK
Martin C. Gulliford & Kenji Shibuya
International Agency for Research on Cancer, Lyon, France
Marc J. Gunter & Inge Huybrechts
Capital Medical University, Beijing, China
Xiu-Hua Guo, Ya Xing Wang, Wenbin Wei, Li Juan Wu & Qi Sheng You
Capital Medical University Beijing Tongren Hospital, Beijing, China
Yin Guo, Jie Hao, Lijuan Liu & Ningli Wang
Healis-Sekhsaria Institute for Public Health, Navi Mumbai, India
Prakash C. Gupta, Sameer Narake & Mangesh S. Pednekar
Eternal Heart Care Centre and Research Institute, Jaipur, India
Rajeev Gupta
University of Ibadan, Ibadan, Nigeria
Oye Gureje
Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
Laura Gutierrez, Vilma E. Irazola & Adolfo Rubinstein
National Health Insurance Service, Wonju, Republic of Korea
Seongjun Ha & Yeunsook Rho
Prevention of Metabolic Disorders Research Center, Tehran, Iran
Farzad Hadaegh
Research and Education Institute of Child Health, Nicosia, Cyprus
Charalambos A. Hadjigeorgiou, Savvas Savva & Michael J. Tornaritis
Danish Cancer Society Research Center, Copenhagen, Denmark
Jytte Halkjær & Anne Tjonneland
The University of the West Indies, Cave Hill, Barbados
Ian R. Hambleton & Christina Howitt
Kermanshah University of Medical Sciences, Kermanshah, Iran
Behrooz Hamzeh & Farid Najafi
Africa Health Research Institute, Durban, South Africa
Willem A. Hanekom & Emily B. Wong
Federal University of Pernambuco, Recife, Brazil
Carla Menêses Hardman & Rafael dos Santos Henrique
Yasuj University of Medical Sciences, Yasuj, Iran
Javad Harooni & Moslem Sedaghattalab
International Hellenic University, Thessaloniki, Greece
Maria Hassapidou, Ioannis Pagkalos, Sousana K. Papadopoulou, Dimitrios Poulimeneas, Maria Tsigga & Panagiotis Tsintavis
Kyushu University, Fukuoka, Japan
Jun Hata & Toshiharu Ninomiya
University of Bergen, Bergen, Norway
Teresa Haugsgjerd & Grethe S. Tell
Tulane University, New Orleans, LA, USA
Jiang He
National Research Institute for Health and Family Planning, Beijing, China
Yuan He & Xu Ma
Chinese Center for Disease Control and Prevention, Beijing, China
Yuna He, Xiaoguang Yang, Wenhua Zhao & Maigeng Zhou
University of Pécs, Pécs, Hungary
Regina Heidinger-Felső, Dénes Molnár & Judit A. Repasy
Danish Health Authority, Copenhagen, Denmark
Tatjana Hejgaard
Joep Lange Institute, Amsterdam, The Netherlands
Marleen Elisabeth Hendriks
Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
Victor M. Herrera
ETH Zurich, Zurich, Switzerland
Isabelle Herter-Aeberli
Chronic Diseases Research Center, Tehran, Iran
Ramin Heshmat
University of Hong Kong, Hong Kong, China
Sai Yin Ho, Tai Hing Lam, Gabriel M. Leung, Michael Y. Ni & Hung-Kwan So
The Chinese University of Hong Kong, Hong Kong, China
Suzanne C. Ho, Yn-Tz Sung & Jean Woo
University of Western Australia, Perth, Western Australia, Australia
Michael Hobbs, Debra S. Judge & Phoebe R. Spencer
Universidade Federal do Paraná, Curitiba, Brazil
Doroteia A. Höfelmann & Lariane M. Ono
Shahid Beheshti University of Medical Sciences, Tehran, Iran
Reza Homayounfar, Davood Khalili, Bahareh Kheiri, Amirabbas Momenan, Hamideh Sabbaghi & Sare Safi
Gasol Foundation, Barcelona, Spain
Clara Homs
University Ramon Llull, Sant Boi de Llobregat, Spain
Clara Homs
Kingston Health Sciences Centre, Kingston, Ontario, Canada
Wilma M. Hopman
Fundación Oftalmológica de Santander, Bucaramanga, Colombia
Claudia M. Hormiga
University Oran 1, Oran, Algeria
Leila Houti & Sounnia Mediene Benchekor
Independent Public Health Specialist, Nay Pyi Taw, Myanmar
Thein Thein Htay
Ministry of Health and Sports, Nay Pyi Taw, Myanmar
Maung Maung Than Htike
Santé publique France, Saint-Maurice, France
Laetitia Huiart
VU University Medical Center, Amsterdam, The Netherlands
Martijn Huisman & Natasja M. Van Schoor
American University of Beirut, Beirut, Lebanon
Nahla Hwalla & Abla M. Sibai
Cairo University, Cairo, Egypt
Mohsen M. Ibrahim
Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
M. Arfan Ikram & Maryam Kavousi
University of Valencia, Valencia, Spain
Carmen Iñiguez & Josep Redon
Medical University Varna, Varna, Bulgaria
Violeta Iotova
The University of Tokyo, Tokyo, Japan
Takafumi Ishida
Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
Godsent C. Isiguzo
The Hospital for Sick Children, Toronto, Ontario, Canada
Muhammad Islam & Zulfiqar A. Bhutta
Deakin University, Geelong, Victoria, Australia
Sheikh Mohammed Shariful Islam
Emory University, Atlanta, GA, USA
Duygu Islek, Reynaldo Martorell, Thirunavukkarasu Sathish & Aryeh D. Stein
Bulgarian Academy of Sciences, Sofia, Bulgaria
Ivaila Y. Ivanova-Pandourska & Yanitsa V. Zhecheva
Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
Masanori Iwasaki
Hadassah University Medical Center, Jerusalem, Israel
Jeremy M. Jacobs & Jochanan Stessman
Université Catholique de Louvain, Brussels, Belgium
Michel Jadoul
Gambia National Nutrition Agency, Banjul, The Gambia
Bakary Jallow & Modou Cheyassin Phall
Kuwait Institute for Scientific Research, Safat, Kuwait
Kazi M. Jamil
Public Health Agency of Sweden, Solna, Sweden
Anna Jansson & Kenisha Russell Jonsson
Norwegian University of Science and Technology, Trondheim, Norway
Imre Janszky, Steinar Krokstad & Elin P. Sørgjerd
University of Melbourne, Melbourne, Victoria, Australia
Edward Janus
Sports University of Tirana, Tirana, Albania
Juel Jarani
Heart Foundation, Melbourne, Victoria, Australia
Garry Jennings & Bill Stavreski
Guangzhou 12th Hospital, Guangzhou, China
Chao Qiang Jiang
Universidad Eugenio Maria de Hostos, Santo Domingo, Dominican Republic
Ramon O. Jimenez
Simon Fraser University, Burnaby, British Columbia, Canada
Michel Joffres
Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
Jost B. Jonas
University of New South Wales, Sydney, New South Wales, Australia
Jitendra Jonnagaddala, Chandini Nekkantti, Aletta E. Schutte, Leon A. Simons & Mark Woodward
World Health Organization Country Office, Delhi, India
Pradeep Joshi
Guilan University of Medical Sciences, Rasht, Iran
Farahnaz Joukar & Fariborz Mansour-Ghanaei
University of Opole, Opole, Poland
Jacek J. Jóźwiak
Gulu University, Gulu, Uganda
Felix O. Kaducu
University of Crete, Heraklion, Greece
Anthony Kafatos
Hungarian School Sport Federation, Budapest, Hungary
Mónika Kaj & Viktoria Anna Kovacs
National Center for Disease Control and Public Health, Tbilisi, Georgia
Natia Kakutia, Lela Shengelia & Lela Sturua
Ministry of Health, Bratislava, Slovakia
Daniela Kállayová
Sri Venkateswara University, Tirupati, India
Kodanda R. Kanala
Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
Srinivasan Kannan
Hellenic Medical Association for Obesity, Athens, Greece
Efthymios Kapantais & Themistoklis Tzotzas
Harokopio University, Athens, Greece
Eva Karaglani, Yannis Manios & Christina Mavrogianni
National and Kapodistrian University of Athens, Athens, Greece
Argyro Karakosta, George S. Stergiou, Konstantinos D. Tambalis & Giota Touloumi
Maharajgunj Medical Campus, Kathmandu, Nepal
Khem B. Karki
Université Officielle de Bukavu, Bukavu, Democratic Republic of the Congo
Philippe B. Katchunga
Aarhus University, Aarhus, Denmark
Marzieh Katibeh, Kim Overvad & Jakob Tarp
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
Joanne Katz & Moyses Szklo
Pennington Biomedical Research Center, Baton Rouge, LA, USA
Peter T. Katzmarzyk
National Institute of Epidemiology, Chennai, India
Prabhdeep Kaur & Sudha Ramachandra Rao
University of Toronto, Toronto, Ontario, Canada
Calvin Ke
University of Münster, Münster, Germany
Ulrich Keil
Israel Center for Disease Control, Ramat Gan, Israel
Lital Keinan Boker & Tal Shimony
Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan, Iran
Roya Kelishadi
Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
Alina Kerimkulova & Erkin Mirrakhimov
Research Institute of Child Nutrition, Dortmund, Germany
Mathilde Kersting
Shahrekord University of Medical Sciences, Shahrekord, Iran
Arsalan Khaledifar
University of Cambridge, Cambridge, UK
Kay-Tee Khaw & Nicholas Wareham
Mazandaran University of Medical Sciences, Sari, Iran
Motahareh Kheradmand & Mahmood Moosazadeh
Hypertension Research Center, Isfahan, Iran
Alireza Khosravi
Medical University of Innsbruck, Innsbruck, Austria
Ursula Kiechl-Kohlendorfer, Stefan Kiechl, Michael Knoflach, Raimund Pechlaner, Hanno Ulmer, Johann Willeit & Peter Willeit
VASCage, Innsbruck, Austria
Sophia J. Kiechl & Stefan Kiechl
Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
Japhet Killewo
Yonsei University College of Medicine, Seoul, Republic of Korea
Hyeon Chang Kim
National Cancer Center, Goyang-si, Republic of Korea
Jeongseon Kim & Jeonghee Lee
Sahlgrenska University Hospital, Gothenburg, Sweden
Jenny M. Kindblom, Claes Ohlsson & Annika Rosengren
Newcastle University, Newcastle, UK
Andrew Kingston & Louise Robinson
University College South Denmark, Haderslev, Denmark
Heidi Klakk
Statistics Austria, Vienna, Austria
Jeannette Klimont
B. P. Koirala Institute of Health Sciences, Dharan, Nepal
Bhawesh Koirala & Sanjib K. Sharma
University of Vienna, Vienna, Austria
Jürgen König & Petra Rust
Tartu University Clinics, Tartu, Estonia
Paul Korrovits & Margus Punab
Kansai Medical University, Hirakata, Japan
Katsuyasu Kouda, Harunobu Nakamura & Kumiko Ohara
District Department of State Public Health Service, Hildburghausen, Germany
Éva Kovács
Pontificia Universidad Católica Argentina, Buenos Aires, Argentina
Irina Kovalskys
Ministry of Health and Wellness, Port Louis, Mauritius
Sudhir Kowlessur
University Hospital Ulm, Ulm, Germany
Wolfgang Kratzer
Croatian Institute of Public Health, Zagreb, Croatia
Helena Krizan, Sanja Musić Milanović & Ranko Stevanović
Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
Maria F. Kroker-Lobos
North-West University, Potchefstroom, South Africa
Herculina S. Kruger & Ruan Kruger
South African Medical Research Council, Potchefstroom, South Africa
Herculina S. Kruger & Ruan Kruger
University of Physical Education, Kraków, Poland
Łukasz Kryst
University of Jyväskylä, Jyväskylä, Finland
Urho M. Kujala
Institute of Public Health, Podgorica, Montenegro
Enisa Kujundzic & Boban Mugoša
Amrita Institute of Medical Sciences, Cochin, India
R. Krishna Kumar & Manu Raj
Institute of Endocrinology, Prague, Czech Republic
Marie Kunešová, Radka Taxová Braunerová & Hana Zamrazilová
All India Institute of Medical Sciences, New Delhi, India
Yadlapalli S. Kusuma
African Population and Health Research Center, Nairobi, Kenya
Catherine Kyobutungi, Shukri F. Mohamed & Elvis O. A. Wambiya
Hanoi University of Public Health, Hanoi, Vietnam
Quang Ngoc La, Khuong Quynh Long, Thi Tuyet-Hanh Tran & Hoang Van Minh
Hassan First University of Settat, Settat, Morocco
Fatima Zahra Laamiri
Ministry of Health, Algiers, Algeria
Youcef Laid
Ministry of Health, Georgetown, Guyana
Lachmie Lall
Sahlgrenska Academy, Gothenburg, Sweden
Georg Lappas
Endocrinology and Metabolism Research Center, Tehran, Iran
Bagher Larijani
Clinical Research Education, Networking & Consultancy, Douala, Cameroon
Simo Pone Larissa
University of Public Health, Yangon, Myanmar
Tint Swe Latt & Ko Ko Zaw
Centro Studi Epidemiologici di Gubbio, Gubbio, Italy
Martino Laurenzi
National University Health System, Singapore, Singapore
Jeannette Lee, Charlie Lim, Wei-Yen Lim, Ei Ei K. Nang, Xueling Sim & E. Shyong Tai
University of Leicester, Leicester, UK
Paul H. Lee
Tampere University Hospital, Tampere, Finland
Terho Lehtimäki
Tampere University, Tampere, Finland
Terho Lehtimäki
University of Douala, Douala, Cameroon
Daniel Lemogoum
University of Cape Town, Cape Town, South Africa
Naomi S. Levitt
West Virginia University, Morgantown, WV, USA
Christa L. Lilly & William A. Neal
Oswaldo Cruz Foundation Rene Rachou Research Institute, Belo Horizonte, Brazil
M. Fernanda Lima-Costa & Sergio Viana Peixoto
Shanghai Institute of Nutrition and Health of Chinese Academy of Sciences, Shanghai, China
Xu Lin & Liang Sun
Uppsala University, Uppsala, Sweden
Yi-Ting Lin, Lars Lind, Johan Sundström & Agneta Yngve
Capital Medical University Beijing An Zhen Hospital, Beijing, China
Jing Liu & Dong Zhao
Taipei Medical University, Taipei, Taiwan
Wei-Cheng Lo
Servicio Andaluz de Salud, Sevilla, Spain
Guadalupe Longo Abril
Sports Medical Center of Minho, Braga, Portugal
Oscar Lopes
Universidad San Martín de Porres, Lima, Peru
Tania Lopez & Luis Revilla
Consejería de Sanidad Junta de Castilla y León, Valladolid, Spain
José Eugenio Lozano & Tomas Vega
Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
Janice L. Lukrafka
Ilembula Lutheran Hospital, Ilembula, Tanzania
Charles Lunogelo
University of Kinshasa Hospital, Kinshasa, Democratic Republic of the Congo
Jean-René M’Buyamba-Kabangu
Coimbra University Hospital Center, Coimbra, Portugal
Luisa M. Macieira & Lèlita C. Santos
University of Texas Rio Grande Valley, Harlingen, TX, USA
Gladys E. Maestre
Institute of Neuroscience of the National Research Council, Padua, Italy
Stefania Maggi & Marianna Noale
Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
Dianna J. Magliano & Jonathan E. Shaw
Agricultural University of Athens, Athens, Greece
Emmanuella Magriplis & Antonis Zampelas
Academia VBHC, São Paulo, Brazil
Marcia Makdisse
SB RAS Federal Research Center Institute of Cytology and Genetics, Novosibirsk, Russia
Sofia K. Malyutina & Yury P. Nikitin
Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
Masimango Imani Manix
University of Northern British Columbia, Prince George, British Columbia, Canada
Taru Manyanga
University of Padua, Padua, Italy
Enzo Manzato & Sabina Zambon
University Medicine Greifswald, Greifswald, Germany
Joany Mariño, Matthias Nauck, Astrid Petersmann, Adrian Richter, Sabine Schipf, Carsten O. Schmidt & Henry Völzke
Hellenic Mediterranean University, Siteia, Greece
Anastasia Markaki
Loughborough University, Loughborough, UK
Oonagh Markey
Ministry of Health, Nicosia, Cyprus
Eliza Markidou Ioannidou
Lausanne University Hospital, Lausanne, Switzerland
Pedro Marques-Vidal, Jardena J. Puder & Peter Vollenweider
University of Lausanne, Lausanne, Switzerland
Pedro Marques-Vidal & Peter Vollenweider
Secretaria de Estado da Saúde de Santa Catarina, Florianópolis, Brazil
Larissa Pruner Marques
CIBERCV, Barcelona, Spain
Jaume Marrugat
Institut Hospital del Mar d’Investigacions Mèdiques, Barcelona, Spain
Jaume Marrugat & Miquel Porta
Mary Immaculate College, Limerick, Ireland
Rosemarie Martin
Hungarian Society of Sports Medicine, Budapest, Hungary
Eva Martos
Paracelsus Medical University, Salzburg, Austria
Katharina Maruszczak & Daniel Weghuber
Institute for Cancer Research, Prevention and Clinical Network, Florence, Italy
Giovanna Masala & Calogero Saleva
Universidade Estadual do Centro-Oeste, Guarapuava, Brazil
Luis P. Mascarenhas
Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
Shariq R. Masoodi
UiT The Arctic University of Norway, Tromsø, Norway
Ellisiv B. Mathiesen & Tom Wilsgaard
ICMR–National Centre for Disease Informatics and Research, Bengaluru, India
Prashant Mathur
Sefako Makgatho Health Sciences University, Pretoria, South Africa
Tandi E. Matsha
Centro de Estudos do Laboratório de Aptidão Física de São Caetano do Sul, São Paulo, Brazil
Victor Matsudo
Brown University, Providence, RI, USA
Stephen T. McGarvey
London School of Hygiene & Tropical Medicine, London, UK
Martin McKee, Moffat Nyirenda, Alison J. Price & Liam Smeeth
University of Edinburgh, Edinburgh, UK
Stela McLachlan & Jacqueline F. Price
Weill Cornell Medicine, New York City, NY, USA
Margaret L. McNairy
Institut National de la Santé et de la Recherche Médicale, Lille, France
Aline Meirhaeghe
Arabkir Medical Centre–Institute of Child and Adolescent Health, Yerevan, Armenia
Marina Melkumova & Yeva Movsesyan
Universidad de los Andes, Bogotá, Colombia
Carlos O. Mendivil & Pedro J. Quiroga-Padilla
Robert Koch Institute, Berlin, Germany
Gert B. M. Mensink, Angelika Schaffrath Rosario & Anja Schienkiewitz
University of Abidjan, Abidjan, Côte d’Ivoire
Diane T. Meto
Pirogov Russian National Research Medical University, Moscow, Russia
Olga Milushkina & Natalia A. Skoblina
Universidade de Lisboa, Lisbon, Portugal
Cláudia S. Minderico, Diana A. Santos & Luis B. Sardinha
Saveetha Dental Colleges & Hospitals, Chennai, India
G. K. Mini
Democritus University, Alexandroupolis, Greece
Daphne Mirkopoulou
Grigore T Popa University of Medicine and Pharmacy, Iasi, Romania
Veronica Mocanu
Università degli Studi di Firenze, Florence, Italy
Pietro A. Modesti
Ain Shams University, Cairo, Egypt
Mostafa K. Mohamed & Aya Mostafa
Isfahan Cardiovascular Research Center, Isfahan, Iran
Noushin Mohammadifard & Nizal Sarrafzadegan
Strasbourg University Hospital, Strasbourg, France
Marie Moitry
Mulago Hospital, Kampala, Uganda
Charles K. Mondo
Instituto Conmemorativo Gorgas de Estudios de la Salud, Panama City, Panama
Roger A. Montenegro Mendoza, Jorge Motta, Hedley K. Quintana & Julio Zuñiga Cisneros
University of Limpopo, Sovenga, South Africa
Kotsedi Daniel K. Monyeki
University of Medical Sciences of Cienfuegos, Cienfuegos, Cuba
Alain Morejon
Ministry of Health and Wellness, Belmopan, Belize
Francis Morey
Royal College of Surgeons in Ireland, Dublin, Ireland
Karen Morgan
La Trobe University, Melbourne, Victoria, Australia
George Moschonis
Sabzevar University of Medical Sciences, Sabzevar, Iran
Alireza Moslem & Mohammad Hossien Saghi
International Institute of Molecular and Cell Biology, Warsaw, Poland
Malgorzata Mossakowska & Przemysław Slusarczyk
World Health Organization Country Office, Lilongwe, Malawi
Kelias P. Msyamboza
Department of Public Health, Nay Pyi Taw, Myanmar
Thet Thet Mu
Albanian Sports Science Association, Tirana, Albania
Florian Muca
University of Brescia, Brescia, Italy
Maria L. Muiesan & Massimo Salvetti
University of Limerick, Limerick, Ireland
Elaine M. Murtagh
Makerere University School of Public Health, Kampala, Uganda
Geofrey Musinguzi & Fred Nuwaha
University de Kinshasa, Kinshasa, Democratic Republic of the Congo
Muel Telo M. C. Muyer
Bushehr University of Medical Sciences, Bushehr, Iran
Iraj Nabipour
Ulm University, Ulm, Germany
Gabriele Nagel
Suraj Eye Institute, Nagpur, India
Vinay B. Nangia
UNICEF, Yaoundé, Cameroon
Martin Nankap
Ministry of Health, Apia, Samoa
Take Naseri
Karolinska Institutet, Stockholm, Sweden
Martin Neovius, Michael Sjöström, Per Tynelius & Peter Ueda
National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
Chung T. Nguyen
University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
Nguyen D. Nguyen & Oanh T. H. Trinh
Hanoi Medical University, Hanoi, Vietnam
Quang Ngoc Nguyen
Xi’an Jiaotong University, Xi’an, China
Peng Nie
LifeDoc Health, Memphis, TN, USA
Ramfis E. Nieto-Martínez
Heartfile, Islamabad, Pakistan
Sania Nishtar
Eastern Mediterranean Public Health Network, Amman, Jordan
Mohannad Al Nsour
University of Manchester, Manchester, UK
Terence W. O’Neill & Frederick C. Wu
State University of Medicine and Pharmacy, Chisinau, Moldova
Galina Obreja
Tachikawa General Hospital, Nagaoka, Japan
Eiji Oda
University of Abuja College of Health Sciences, Abuja, Nigeria
Augustine N. Odili
Korea Centers for Disease Control and Prevention, Cheongju-si, Republic of Korea
Kyungwon Oh & Suyeon Park
Japan Wildlife Research Center, Tokyo, Japan
Ryutaro Ohtsuka
Gadarif University, Gadarif, Sudan
Saeed M. Omar
Istanbul University, Istanbul, Turkey
Altan Onat
Ministry of Health, Bandar Seri Begawan, Brunei
Sok King Ong & Khairil Si-Ramlee
University of Madeira, Funchal, Portugal
Rui Ornelas
University of Puerto Rico, San Juan, Puerto Rico
Ana P. Ortiz & Cynthia M. Pérez
Osteoporosis Research Center, Tehran, Iran
Afshin Ostovar
Universidad de Santander, Bucaramanga, Colombia
Johanna A. Otero
Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
Ellis Owusu-Dabo
University of Wisconsin-Madison, Madison, WI, USA
Alberto Palloni
Privatpraxis Prof Jonas und Dr Panda-Jonas, Heidelberg, Germany
Songhomitra Panda-Jonas
IRCCS Ente Ospedaliero Specializzato in Gastroenterologia S. de Bellis, Bari, Italy
Francesco Panza
Zayed University, Abu Dhabi, United Arab Emirates
Dimitrios Papandreou
Catholic University of Daegu, Daegu, Republic of Korea
Soon-Woo Park
University of Medicine, Pharmacy, Science and Technology of Târgu Mures, Târgu Mures, Romania
Ionela M. Pascanu & Raluca M. Pop
Jivandeep Hospital, Anand, India
Nikhil D. Patel
Centro de Investigação em Saúde de Angola, Caxito, Angola
João M. Pedro
South African Medical Research Council, Durban, South Africa
Nasheeta Peer
National Dental Care Centre Singapore, Singapore, Singapore
Marco A. Peres
University Hospital of Varese, Varese, Italy
Emanuela Pettenuzzo
Vietnam National Heart Institute, Hanoi, Vietnam
Son Thai Pham
Clínica de Medicina Avanzada Dr. Abel González, Santo Domingo, Dominican Republic
Rafael N. Pichardo
University of Sarajevo, Sarajevo, Bosnia and Herzegovina
Aida Pilav
Cardiovascular Prevention Centre Udine, Udine, Italy
Lorenza Pilotto & Diego Vanuzzo
University of Pisa, Pisa, Italy
Francesco Pistelli
Ministry of Health and Medical Services, Honiara, Solomon Islands
Freda Pitakaka
Public Health Agency of Catalonia, Barcelona, Spain
Pedro Plans-Rubió
O. M. Marzeyev Institute for Public Health of the National Academy of the Medical Sciences of Ukraine, Kyiv, Ukraine
Alina G. Platonova & Nadija S. Polka
Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
Bee Koon Poh & Jyh Eiin Wong
Ardabil University of Medical Sciences, Ardabil, Iran
Farhad Pourfarzi
Universidade Pedagógica, Maputo, Mozambique
Antonio Prista
Centre for Disease Prevention and Control, Riga, Latvia
Iveta Pudule & Biruta Velika
Sulaimani Polytechnic University, Sulaymaniyah, Iraq
Muhammed S. Qadir
Alborz University of Medical Sciences, Karaj, Iran
Mostafa Qorbani
Ministry of Health, Hanoi, Vietnam
Tran Quoc Bao
Pure Earth, Dhaka, Bangladesh
Mahfuzar Rahman
Institute of Epidemiology Disease Control and Research, Dhaka, Bangladesh
Mahmudur Rahman
University of Turku, Turku, Finland
Olli Raitakari
UNICEF, Baku, Azerbaijan
Tamerlan Rajabov
World Health Organization Country Office, Juba, South Sudan
Otim P. C. Ramadan
Instituto Federal Riograndense, Rio Grande, Brazil
Virgílio V. Ramires
Institut Universitari d’Investigació en Atenció Primària Jordi Gol, Girona, Spain
Rafel Ramos
Universiti Putra Malaysia, Serdang, Malaysia
Lekhraj Rampal
University of Malaya, Kuala Lumpur, Malaysia
Sanjay Rampal
Sotiria Hospital, Athens, Greece
Vayia Rarra
University of the Philippines, Manila, The Philippines
Paul Ferdinand M. Reganit & Rody G. Sy
Slovak Academy of Sciences, Bratislava, Slovakia
Valéria Regecová
University of Santa Cruz do Sul, Santa Cruz do Sul, Brazil
Jane D. P. Renner & Cézane P. Reuter
Nutrition Research Foundation, Barcelona, Spain
Lourdes Ribas-Barba
Minas Gerais State Secretariat for Health, Belo Horizonte, Brazil
Robespierre Ribeiro
CS S. Agustín Ibsalut, Palma, Spain
Fernando Rigo
Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
Tobias F. Rinke de Wit
Universidade Nove de Julho, São Paulo, Brazil
Raphael M. Ritti-Dias
Ministerio de Salud, Panama City, Panama
Reina G. Roa
Public Health Agency of Canada, Ottawa, Ontario, Canada
Cynthia Robitaille & Ming-Dong Wang
Universidad Industrial de Santander, Bucaramanga, Colombia
Laura A. Rodríguez-Villamizar
Ministry of Health and Social Protection, Bogotá, Colombia
Andrea Y. Rodríguez
Wuqu’ Kawoq, Tecpan, Guatemala
Peter Rohloff
GroundWork, Fläsch, Switzerland
Fabian Rohner
Associazione Calabrese di Epatologia, Reggio Calabria, Italy
Elisabetta L. Romeo
University of Minho, Braga, Portugal
Rafaela V. Rosario
Fiji National University, Suva, Fiji
Ian Rouse
GHESKIO Clinics, Port-au-Prince, Haiti
Vanessa Rouzier
Universidad de San Carlos, Quetzaltenango, Guatemala
Maira H. Ruano
National Center for Epidemiology CIBERESP, Madrid, Spain
Emma Ruiz Moreno
Institute of Food Sciences of the National Research Council, Avellino, Italy
Paola Russo & Alfonso Siani
Medical University of Gdansk, Gdansk, Poland
Marcin Rutkowski & Tomasz Zdrojewski
Sitaram Bhartia Institute of Science and Research, New Delhi, India
Harshpal S. Sachdev
Kindergarten of Avlonari, Evia, Greece
Margarita Samoutian
National Institute of Health, Lima, Peru
Jose Sánchez-Abanto & Carolina B. Tarqui-Mamani
Ministry of Health, Jakarta, Indonesia
Sandjaja
Catalan Department of Health, Barcelona, Spain
Susana Sans
Biodonostia Health Research Institute, San Sebastián, Spain
Loreto Santa Marina
Instituto de Saúde Ambiental, Lisbon, Portugal
Osvaldo Santos
Federal University of Alagoas, Maceió, Brazil
Tamara R. Santos
South Karelia Social and Health Care District, Lappeenranta, Finland
Jouko L. Saramies
National Cancer Center, Tokyo, Japan
Norie Sawada & Shoichiro Tsugane
University of São Paulo Clinics Hospital, São Paulo, Brazil
Marcia Scazufca
Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
Herman Schargrodsky
Medical University of Vienna, Vienna, Austria
Karin Schindler, Thomas Waldhör & Kurt Widhalm
Rigshospitalet, Copenhagen, Denmark
Ida Maria Schmidt
Academic Medical Center of University of Amsterdam, Amsterdam, The Netherlands
Constance Schultsz
German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
Matthias B. Schulze
The George Institute for Global Health, Sydney, New South Wales, Australia
Aletta E. Schutte
Center for Oral Health Services and Research Mid-Norway, Trondheim, Norway
Abhijit Sen
Lagos State University College of Medicine, Lagos, Nigeria
Idowu O. Senbanjo
University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
Luis Serra-Majem
Comenius University, Bratislava, Slovakia
Ľudmila Ševčíková & Ľubica Tichá
Teikyo University, Tokyo, Japan
Hana Shimizu-Furusawa
Finnish Institute of Occupational Health, Helsinki, Finland
Rahman Shiri
Rutgers University, New Brunswick, NJ, USA
Labros S. Sidossis
National Agency for Public Health, Chisinau, Moldova
Natalia Silitrari
St Vincent’s Hospital, Sydney, New South Wales, Australia
Judith Simons
Nes Municipality, Årnes, Norway
Gry Skodje
Health Polytechnic Jakarta II Institute, Jakarta, Indonesia
Moesijanti Y. E. Soekatri
Diponegoro University, Semarang, Indonesia
Agustinus Soemantri
University of Bari, Bari, Italy
Vincenzo Solfrizzi
Institut Régional de Santé Publique, Ouidah, Benin
Charles Sossa Jérome
University of Bordeaux, Bordeaux, France
Aïcha Soumaré & Christophe Tzourio
University of Hohenheim, Stuttgart, Germany
Alfonso Sousa-Poza
Oslo Metropolitan University, Oslo, Norway
Bente Sparboe-Nilsen & Liv Elin Torheim
Institute of Public Health, Skopje, North Macedonia
Igor Spiroski
Ss. Cyril and Methodius University, Skopje, North Macedonia
Igor Spiroski
Lamprecht und Stamm Sozialforschung und Beratung AG, Zurich, Switzerland
Hanspeter Stamm
Bonn University, Bonn, Germany
Peter Stehle
National Institute of Public Health–National Institute of Hygiene, Warsaw, Poland
Jakub Stokwiszewski, Lucjan Szponar & Bogdan Wojtyniak
Kalina Malina Kindergarten, Pazardjik, Bulgaria
Ekaterina Stoyanova
The Jikei University School of Medicine, Tokyo, Japan
Machi Suka
Fu Jen Catholic University, Taipei, Taiwan
Chien-An Sun & San-Lin You
University of Jordan, Amman, Jordan
Nabil William G. Sweis & Ayman A. Zayed
National Statistical Office, Praia, Cabo Verde
René Charles Sylva
Monash University, Melbourne, Victoria, Australia
Eng Joo Tan
Scientific Research Institute of Maternal and Child Health, Ashgabat, Turkmenistan
Maya Tanrygulyyeva
University of Lincoln, Lincoln, UK
Frank Tanser
Ministry of Health, Amman, Jordan
Mohammed Rasoul Tarawneh
UNICEF, Niamey, Niger
Félicité Tchibindat
University of Applied Sciences Utrecht, Utrecht, The Netherlands
Saskia Te Velde
University Medical Center Utrecht, Utrecht, The Netherlands
Erik J. Timmermans
National Research and Innovation Agency, Jakarta, Indonesia
Dwi H. Tjandrarini
Health Service, Murcia, Spain
María José Tormo
Institut d’Investigacio Sanitaria Illes Balears, Menorca, Spain
Maties Torrent
University of Bologna, Bologna, Italy
Stefania Toselli
Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
Mark S. Tremblay
Hellenic Health Foundation, Athens, Greece
Antonia Trichopoulou
Government Medical College, Bhavnagar, India
Atul Trivedi
Institute of Epidemiology and Preventive Medicine, Taipei, Taiwan
Yu-Hsiang Tsao
Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
Lechaba Tshepo
Department of Health, Faga’alu, American Samoa
John Tuitele
LBJ Hospital, Faga’alu, American Samoa
John Tuitele
Addis Ababa University, Addis Ababa, Ethiopia
Fikru Tullu
Ministry of Health, Wellington, New Zealand
Maria L. Turley
Israel Defense Forces Medical Corps, Tel HaShomer, Israel
Gilad Twig
Universidad Centro–Occidental Lisandro Alvarado, Barquisimeto, Venezuela
Eunice Ugel
Meharry Medical College, Nashville, TN, USA
Flora A. M. Ukoli
University of Tampere Tays Eye Center, Tampere, Finland
Hannu M. T. Uusitalo
Sabiha Gokcen Ilkokulu, Ankara, Turkey
Nalan Uysal
Polytechnic Institute of Porto, Porto, Portugal
Susana Vale
Icahn School of Medicine at Mount Sinai, New York City, NY, USA
Damaskini Valvi
George Washington University, Washington, DC, USA
Rob M. van Dam
Universidad CEU San Pablo, Madrid, Spain
Gregorio Varela-Moreiras
Institute of Clinical Physiology of National Research Council, Pisa, Italy
Giovanni Viegi
Universidad San Francisco de Quito, Quito, Ecuador
Monica Vilar & Martha Yépez García
University Miguel Hernandez, Alicante, Spain
Jesus Vioque
Université de Lorraine, Nancy, France
Sophie Visvikis-Siest
Sunflower Nursery School, Craiova, Romania
Mihaela Vladulescu
North Karelia Center for Public Health, Joensuu, Finland
Tiina Vlasoff
University of the Witwatersrand, Johannesburg, South Africa
Alisha N. Wade
Institute for Medical Research, Kuala Lumpur, Malaysia
Wan Nazaimoon Wan Mohamud
Xinjiang Medical University, Urumqi, China
Qian Wang
Shanghai Educational Development Co. Ltd, Shanghai, China
Xiangjun Wang & Yang Yang
Ministry of Health and Welfare, Taipei, Taiwan
Ying-Wei Wang
Ministry of Health and Wellness, Kingston, Jamaica
Karen Webster-Kerr
Örebro University, Örebro, Sweden
Bo Werner
St George’s, University of London, London, UK
Peter H. Whincup
Universitas Indonesia, Jakarta, Indonesia
Indah S. Widyahening
Rehamed-Center, Tajęcina, Poland
Rusek Wojciech
National Yang Ming Chiao Tung University, Taipei, Taiwan
Hon-Yen Wu
Institute of Food and Nutrition Development of Ministry of Agriculture and Rural Affairs, Beijing, China
Haiquan Xu
Beijing Institute of Ophthalmology, Beijing, China
Liang Xu
Children’s Hospital of Fudan University, Shanghai, China
Weili Yan
University of Cyprus, Nicosia, Cyprus
Panayiotis K. Yiallouros
Niigata University, Niigata, Japan
Akihiro Yoshihara
South China Institute of Environmental Sciences, Guangzhou, China
Yunjiang Yu
International Medical University, Shah Alam, Malaysia
Safiah Md Yusof
Hellenic Mediterranean University, Heraklion, Greece
Vassilis Zafiropulos
Iran University of Medical Sciences, Tehran, Iran
Farhad Zamani
Center for Diabetes and Endocrine Care, Srinagar, India
Abdul Hamid Zargar
Jagiellonian University, Kraków, Poland
Magdalena Żegleń
Duke University, Durham, NC, USA
Yi Zeng
Peking University First Hospital, Beijing, China
Luxia Zhang & Ming-Hui Zhao
Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
Shiqi Zhen
West Kazakhstan Medical University, Aktobe, Kazakhstan
Bekbolat Zholdin
Inner Mongolia Medical University, Hohhot, China
Dan Zhu
Przedszkole No. 81, Warsaw, Poland
Monika Zuziak
Johns Hopkins University, Baltimore, MD, USA
Robert E. Black

Consortia

NCD Risk Factor Collaboration (NCD-RisC)

Anu Mishra
, Bin Zhou
, Andrea Rodriguez-Martinez
, Honor Bixby
, Rosie K. Singleton
, Rodrigo M. Carrillo-Larco
, Kate E. Sheffer
, Christopher J. Paciorek
, James E. Bennett
, Victor Lhoste
, Maria L. C. Iurilli
, Mariachiara Di Cesare
, James Bentham
, Nowell H. Phelps
, Marisa K. Sophiea
, Gretchen A. Stevens
, Goodarz Danaei
, Melanie J. Cowan
, Stefan Savin
, Leanne M. Riley
, Edward W. Gregg
, Wichai Aekplakorn
, Noor Ani Ahmad
, Jennifer L. Baker
, Adela Chirita-Emandi
, Farshad Farzadfar
, Günther Fink
, Mirjam Heinen
, Nayu Ikeda
, Andre P. Kengne
, Young-Ho Khang
, Tiina Laatikainen
, Avula Laxmaiah
, Jun Ma
, Michele Monroy-Valle
, Malay K. Mridha
, Cristina P. Padez
, Andrew Reynolds
, Maroje Sorić
, Gregor Starc
, James P. Wirth
, Leandra Abarca-Gómez
, Ziad A. Abdeen
, Shynar Abdrakhmanova
, Suhaila Abdul Ghaffar
, Hanan F. Abdul Rahim
, Zulfiya Abdurrahmonova
, Niveen M. Abu-Rmeileh
, Jamila Abubakar Garba
, Benjamin Acosta-Cazares
, Ishag Adam
, Marzena Adamczyk
, Robert J. Adams
, Seth Adu-Afarwuah
, Kaosar Afsana
, Shoaib Afzal
, Valirie N. Agbor
, Imelda A. Agdeppa
, Javad Aghazadeh-Attari
, Hassan Aguenaou
, Carlos A. Aguilar-Salinas
, Charles Agyemang
, Mohamad Hasnan Ahmad
, Ali Ahmadi
, Naser Ahmadi
, Nastaran Ahmadi
, Imran Ahmed
, Soheir H. Ahmed
, Wolfgang Ahrens
, Gulmira Aitmurzaeva
, Kamel Ajlouni
, Hazzaa M. Al-Hazzaa
, Badreya Al-Lahou
, Rajaa Al-Raddadi
, Huda M. Al Hourani
, Nawal M. Al Qaoud
, Monira Alarouj
, Fadia AlBuhairan
, Shahla AlDhukair
, Maryam A. Aldwairji
, Sylvia Alexius
, Mohamed M. Ali
, Abdullah Alkandari
, Ala’a Alkerwi
, Buthaina M. Alkhatib
, Kristine Allin
, Mar Alvarez-Pedrerol
, Eman Aly
, Deepak N. Amarapurkar
, Pilar Amiano Etxezarreta
, John Amoah
, Norbert Amougou
, Philippe Amouyel
, Lars Bo Andersen
, Sigmund A. Anderssen
, Odysseas Androutsos
, Lars Ängquist
, Ranjit Mohan Anjana
, Alireza Ansari-Moghaddam
, Elena Anufrieva
, Hajer Aounallah-Skhiri
, Joana Araújo
, Inger Ariansen
, Tahir Aris
, Raphael E. Arku
, Nimmathota Arlappa
, Krishna K. Aryal
, Nega Aseffa
, Thor Aspelund
, Felix K. Assah
, Batyrbek Assembekov
, Maria Cecília F. Assunção
, May Soe Aung
, Juha Auvinen
, Mária Avdičová
, Shina Avi
, Ana Azevedo
, Mohsen Azimi-Nezhad
, Fereidoun Azizi
, Mehrdad Azmin
, Bontha V. Babu
, Maja Bæksgaard Jørgensen
, Azli Baharudin
, Suhad Bahijri
, Marta Bakacs
, Nagalla Balakrishna
, Yulia Balanova
, Mohamed Bamoshmoosh
, Maciej Banach
, José R. Banegas
, Joanna Baran
, Rafał Baran
, Carlo M. Barbagallo
, Valter Barbosa Filho
, Alberto Barceló
, Maja Baretić
, Amina Barkat
, Joaquin Barnoya
, Lena Barrera
, Marta Barreto
, Aluisio J. D. Barros
, Mauro Virgílio Gomes Barros
, Anna Bartosiewicz
, Abdul Basit
, Joao Luiz D. Bastos
, Iqbal Bata
, Anwar M. Batieha
, Aline P. Batista
, Rosangela L. Batista
, Zhamilya Battakova
, Louise A. Baur
, Pascal M. Bayauli
, Robert Beaglehole
, Silvia Bel-Serrat
, Antonisamy Belavendra
, Habiba Ben Romdhane
, Judith Benedics
, Mikhail Benet
, Gilda Estela Benitez Rolandi
, Elling Bere
, Ingunn Holden Bergh
, Yemane Berhane
, Salim Berkinbayev
, Antonio Bernabe-Ortiz
, Gailute Bernotiene
, Ximena Berrios Carrasola
, Heloísa Bettiol
, Manfred E. Beutel
, Augustin F. Beybey
, Jorge Bezerra
, Aroor Bhagyalaxmi
, Sumit Bharadwaj
, Santosh K. Bhargava
, Hongsheng Bi
, Yufang Bi
, Daniel Bia
, Katia Biasch
, Elysée Claude Bika Lele
, Mukharram M. Bikbov
, Bihungum Bista
, Dusko J. Bjelica
, Anne A. Bjerregaard
, Peter Bjerregaard
, Espen Bjertness
, Marius B. Bjertness
, Cecilia Björkelund
, Katia V. Bloch
, Anneke Blokstra
, Moran Blychfeld Magnazu
, Simona Bo
, Martin Bobak
, Lynne M. Boddy
, Bernhard O. Boehm
, Jolanda M. A. Boer
, Jose G. Boggia
, Elena Bogova
, Carlos P. Boissonnet
, Stig E. Bojesen
, Marialaura Bonaccio
, Vanina Bongard
, Alice Bonilla-Vargas
, Matthias Bopp
, Herman Borghs
, Pascal Bovet
, Khadichamo Boymatova
, Lien Braeckevelt
, Lutgart Braeckman
, Marjolijn C. E. Bragt
, Imperia Brajkovich
, Francesco Branca
, Juergen Breckenkamp
, João Breda
, Hermann Brenner
, Lizzy M. Brewster
, Garry R. Brian
, Yajaira Briceño
, Lacramioara Brinduse
, Miguel Brito
, Sinead Brophy
, Johannes Brug
, Graziella Bruno
, Anna Bugge
, Frank Buntinx
, Marta Buoncristiano
, Genc Burazeri
, Con Burns
, Antonio Cabrera de León
, Joseph Cacciottolo
, Hui Cai
, Roberta B. Caixeta
, Tilema Cama
, Christine Cameron
, José Camolas
, Günay Can
, Ana Paula C. Cândido
, Felicia Cañete
, Mario V. Capanzana
, Naděžda Čapková
, Eduardo Capuano
, Rocco Capuano
, Vincenzo Capuano
, Marloes Cardol
, Viviane C. Cardoso
, Axel C. Carlsson
, Esteban Carmuega
, Joana Carvalho
, José A. Casajús
, Felipe F. Casanueva
, Maribel Casas
, Ertugrul Celikcan
, Laura Censi
, Marvin Cervantes‐Loaiza
, Juraci A. Cesar
, Snehalatha Chamukuttan
, Angelique Chan
, Queenie Chan
, Himanshu K. Chaturvedi
, Nish Chaturvedi
, Norsyamlina Che Abdul Rahim
, Miao Li Chee
, Chien-Jen Chen
, Fangfang Chen
, Huashuai Chen
, Shuohua Chen
, Zhengming Chen
, Ching-Yu Cheng
, Yiling J. Cheng
, Bahman Cheraghian
, Angela Chetrit
, Ekaterina Chikova-Iscener
, Mai J. M. Chinapaw
, Anne Chinnock
, Arnaud Chiolero
, Shu-Ti Chiou
, María-Dolores Chirlaque
, Belong Cho
, Kaare Christensen
, Diego G. Christofaro
, Jerzy Chudek
, Renata Cifkova
, Michelle Cilia
, Eliza Cinteza
, Massimo Cirillo
, Frank Claessens
, Janine Clarke
, Els Clays
, Emmanuel Cohen
, Laura-María Compañ-Gabucio
, Hans Concin
, Susana C. Confortin
, Cyrus Cooper
, Tara C. Coppinger
, Eva Corpeleijn
, Lilia Yadira Cortés
, Simona Costanzo
, Dominique Cottel
, Chris Cowell
, Cora L. Craig
, Amelia C. Crampin
, Amanda J. Cross
, Ana B. Crujeiras
, Juan J. Cruz
, Tamás Csányi
, Semánová Csilla
, Alexandra M. Cucu
, Liufu Cui
, Felipe V. Cureau
, Sarah Cuschieri
, Ewelina Czenczek-Lewandowska
, Graziella D’Arrigo
, Eleonora d’Orsi
, Liliana Dacica
, Jean Dallongeville
, Albertino Damasceno
, Camilla T. Damsgaard
, Rachel Dankner
, Thomas M. Dantoft
, Parasmani Dasgupta
, Saeed Dastgiri
, Luc Dauchet
, Kairat Davletov
, Maria Alice Altenburg de Assis
, Guy De Backer
, Dirk De Bacquer
, Amalia De Curtis
, Patrícia de Fragas Hinnig
, Giovanni de Gaetano
, Stefaan De Henauw
, Pilar De Miguel-Etayo
, Paula Duarte de Oliveira
, David De Ridder
, Karin De Ridder
, Susanne R. de Rooij
, Delphine De Smedt
, Mohan Deepa
, Alexander D. Deev
, Vincent DeGennaro Jr
, Hélène Delisle
, Francis Delpeuch
, Stefaan Demarest
, Elaine Dennison
, Katarzyna Dereń
, Valérie Deschamps
, Meghnath Dhimal
, Augusto Di Castelnuovo
, Juvenal Soares Dias-da-Costa
, María Elena Díaz-Sánchez
, Alejandro Diaz
, Pedro Díaz Fernández
, María Pilar Díez Ripollés
, Zivka Dika
, Shirin Djalalinia
, Visnja Djordjic
, Ha T. P. Do
, Annette J. Dobson
, Liria Dominguez
, Maria Benedetta Donati
, Chiara Donfrancesco
, Guanghui Dong
, Yanhui Dong
, Silvana P. Donoso
, Angela Döring
, Maria Dorobantu
, Ahmad Reza Dorosty
, Kouamelan Doua
, Nico Dragano
, Wojciech Drygas
, Jia Li Duan
, Charmaine A. Duante
, Priscilla Duboz
, Vesselka L. Duleva
, Virginija Dulskiene
, Samuel C. Dumith
, Anar Dushpanova
, Azhar Dyussupova
, Vilnis Dzerve
, Elzbieta Dziankowska-Zaborszczyk
, Guadalupe Echeverría
, Ricky Eddie
, Ebrahim Eftekhar
, Eruke E. Egbagbe
, Robert Eggertsen
, Sareh Eghtesad
, Gabriele Eiben
, Ulf Ekelund
, Mohammad El-Khateeb
, Laila El Ammari
, Jalila El Ati
, Denise Eldemire-Shearer
, Marie Eliasen
, Paul Elliott
, Ronit Endevelt
, Reina Engle-Stone
, Rajiv T. Erasmus
, Raimund Erbel
, Cihangir Erem
, Gul Ergor
, Louise Eriksen
, Johan G. Eriksson
, Jorge Escobedo-de la Peña
, Saeid Eslami
, Ali Esmaeili
, Alun Evans
, David Faeh
, Ildar Fakhradiyev
, Albina A. Fakhretdinova
, Caroline H. Fall
, Elnaz Faramarzi
, Mojtaba Farjam
, Victoria Farrugia Sant’Angelo
, Mohammad Reza Fattahi
, Asher Fawwad
, Wafaie W. Fawzi
, Edit Feigl
, Francisco J. Felix-Redondo
, Trevor S. Ferguson
, Romulo A. Fernandes
, Daniel Fernández-Bergés
, Daniel Ferrante
, Thomas Ferrao
, Gerson Ferrari
, Marika Ferrari
, Marco M. Ferrario
, Catterina Ferreccio
, Haroldo S. Ferreira
, Eldridge Ferrer
, Jean Ferrieres
, Thamara Hubler Figueiró
, Anna Fijalkowska
, Mauro Fisberg
, Krista Fischer
, Leng Huat Foo
, Maria Forsner
, Heba M. Fouad
, Damian K. Francis
, Maria do Carmo Franco
, Zlatko Fras
, Guillermo Frontera
, Flavio D. Fuchs
, Sandra C. Fuchs
, Isti I. Fujiati
, Yuki Fujita
, Matsuda Fumihiko
, Viktoriya Furdela
, Takuro Furusawa
, Zbigniew Gaciong
, Mihai Gafencu
, Manuel Galán Cuesta
, Andrzej Galbarczyk
, Henrike Galenkamp
, Daniela Galeone
, Myriam Galfo
, Fabio Galvano
, Jingli Gao
, Pei Gao
, Manoli Garcia-de-la-Hera
, María José García Mérida
, Marta García Solano
, Dickman Gareta
, Sarah P. Garnett
, Jean-Michel Gaspoz
, Magda Gasull
, Adroaldo Cesar Araujo Gaya
, Anelise Reis Gaya
, Andrea Gazzinelli
, Ulrike Gehring
, Harald Geiger
, Johanna M. Geleijnse
, Ronnie George
, Ebrahim Ghaderi
, Ali Ghanbari
, Erfan Ghasemi
, Oana-Florentina Gheorghe-Fronea
, Alessandro Gialluisi
, Simona Giampaoli
, Francesco Gianfagna
, Christian Gieger
, Tiffany K. Gill
, Jonathan Giovannelli
, Glen Gironella
, Aleksander Giwercman
, Konstantinos Gkiouras
, Natalya Glushkova
, Natalja Gluškova
, Ramesh Godara
, Justyna Godos
, Sibel Gogen
, Marcel Goldberg
, David Goltzman
, Georgina Gómez
, Jesús Humberto Gómez Gómez
, Luis F. Gomez
, Santiago F. Gómez
, Aleksandra Gomula
, Bruna Gonçalves Cordeiro da Silva
, Helen Gonçalves
, Mauer Gonçalves
, Ana D. González-Alvarez
, David A. Gonzalez-Chica
, Esther M. González-Gil
, Marcela Gonzalez-Gross
, Margot González-Leon
, Juan P. González-Rivas
, Clicerio González-Villalpando
, María-Elena González-Villalpando
, Angel R. Gonzalez
, Frederic Gottrand
, Antonio Pedro Graça
, Sidsel Graff-Iversen
, Dušan Grafnetter
, Aneta Grajda
, Maria G. Grammatikopoulou
, Ronald D. Gregor
, Maria João Gregório
, Else Karin Grøholt
, Anders Grøntved
, Giuseppe Grosso
, Gabriella Gruden
, Dongfeng Gu
, Viviana Guajardo
, Emanuela Gualdi-Russo
, Pilar Guallar-Castillón
, Andrea Gualtieri
, Elias F. Gudmundsson
, Vilmundur Gudnason
, Ramiro Guerrero
, Idris Guessous
, Andre L. Guimaraes
, Martin C. Gulliford
, Johanna Gunnlaugsdottir
, Marc J. Gunter
, Xiu-Hua Guo
, Yin Guo
, Prakash C. Gupta
, Rajeev Gupta
, Oye Gureje
, Enrique Gutiérrez González
, Laura Gutierrez
, Felix Gutzwiller
, Xinyi Gwee
, Seongjun Ha
, Farzad Hadaegh
, Charalambos A. Hadjigeorgiou
, Rosa Haghshenas
, Hamid Hakimi
, Jytte Halkjær
, Ian R. Hambleton
, Behrooz Hamzeh
, Willem A. Hanekom
, Dominique Hange
, Abu A. M. Hanif
, Sari Hantunen
, Jie Hao
, Carla Menêses Hardman
, Rachakulla Hari Kumar
, Tina Harmer Lassen
, Javad Harooni
, Seyed Mohammad Hashemi-Shahri
, Maria Hassapidou
, Jun Hata
, Teresa Haugsgjerd
, Alison J. Hayes
, Jiang He
, Yuan He
, Yuna He
, Regina Heidinger-Felső
, Margit Heier
, Tatjana Hejgaard
, Marleen Elisabeth Hendriks
, Rafael dos Santos Henrique
, Ana Henriques
, Leticia Hernandez Cadena
, Sauli Herrala
, Marianella Herrera-Cuenca
, Victor M. Herrera
, Isabelle Herter-Aeberli
, Karl-Heinz Herzig
, Ramin Heshmat
, Allan G. Hill
, Sai Yin Ho
, Suzanne C. Ho
, Michael Hobbs
, Doroteia A. Höfelmann
, Michelle Holdsworth
, Reza Homayounfar
, Clara Homs
, Wilma M. Hopman
, Andrea R. V. R. Horimoto
, Claudia M. Hormiga
, Bernardo L. Horta
, Leila Houti
, Christina Howitt
, Thein Thein Htay
, Aung Soe Htet
, Maung Maung Than Htike
, Yonghua Hu
, José María Huerta
, Ilpo Tapani Huhtaniemi
, Laetitia Huiart
, Constanta Huidumac Petrescu
, Martijn Huisman
, Abdullatif Husseini
, Chinh Nguyen Huu
, Inge Huybrechts
, Nahla Hwalla
, Jolanda Hyska
, Licia Iacoviello
, Ellina M. Iakupova
, Jesús M. Ibarluzea
, Mohsen M. Ibrahim
, Norazizah Ibrahim Wong
, M. Arfan Ikram
, Carmen Iñiguez
, Violeta Iotova
, Vilma E. Irazola
, Takafumi Ishida
, Godsent C. Isiguzo
, Muhammad Islam
, Sheikh Mohammed Shariful Islam
, Duygu Islek
, Ivaila Y. Ivanova-Pandourska
, Masanori Iwasaki
, Tuija Jääskeläinen
, Rod T. Jackson
, Jeremy M. Jacobs
, Michel Jadoul
, Tazeen Jafar
, Bakary Jallow
, Kenneth James
, Kazi M. Jamil
, Konrad Jamrozik
, Anna Jansson
, Imre Janszky
, Edward Janus
, Juel Jarani
, Marjo-Riitta Jarvelin
, Grazyna Jasienska
, Ana Jelaković
, Bojan Jelaković
, Garry Jennings
, Chao Qiang Jiang
, Ramon O. Jimenez
, Karl-Heinz Jöckel
, Michel Joffres
, Jari J. Jokelainen
, Jost B. Jonas
, Jitendra Jonnagaddala
, Torben Jørgensen
, Pradeep Joshi
, Josipa Josipović
, Farahnaz Joukar
, Jacek J. Jóźwiak
, Debra S. Judge
, Anne Juolevi
, Gregor Jurak
, Iulia Jurca Simina
, Vesna Juresa
, Rudolf Kaaks
, Felix O. Kaducu
, Anthony Kafatos
, Mónika Kaj
, Eero O. Kajantie
, Natia Kakutia
, Daniela Kállayová
, Zhanna Kalmatayeva
, Ofra Kalter-Leibovici
, Yves Kameli
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, Vassilis Zafiropulos
, Ahmad A. Zainuddin
, Seyed Rasoul Zakavi
, Farhad Zamani
, Sabina Zambon
, Antonis Zampelas
, Hana Zamrazilová
, Maria Elisa Zapata
, Abdul Hamid Zargar
, Ko Ko Zaw
, Ayman A. Zayed
, Tomasz Zdrojewski
, Magdalena Żegleń
, Kristyna Zejglicova
, Tajana Zeljkovic Vrkic
, Yi Zeng
, Luxia Zhang
, Zhen-Yu Zhang
, Dong Zhao
, Ming-Hui Zhao
, Wenhua Zhao
, Yanitsa V. Zhecheva
, Shiqi Zhen
, Wei Zheng
, Yingfeng Zheng
, Bekbolat Zholdin
, Maigeng Zhou
, Dan Zhu
, Marie Zins
, Emanuel Zitt
, Yanina Zocalo
, Nada Zoghlami
, Julio Zuñiga Cisneros
, Monika Zuziak
, Zulfiqar A. Bhutta
, Robert E. Black
& Majid Ezzati

Contributions

A.M., B.Z., A.R.M., H.B. and R.K.S. led the data collection and management. A.M., B.Z., A.R.M., H.B., C.J.P., J.E.B. and M.E. developed the statistical method. A.M., B.Z., A.R.M. and H.B. coded the statistical method. A.M. conducted analyses and prepared results. The other authors contributed to study design, and collected, reanalysed, checked and pooled data. M.E., A.M., B.Z., A.R.M. and H.B. wrote the first draft of the report. All other authors commented on the draft report.

Corresponding author

Correspondence to Majid Ezzati.

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Competing interests

M.E. reports a charitable grant from the AstraZeneca Young Health Programme.

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Peer review information

Nature thanks Sam Harper, Jessica Jones-Smith and the other, anonymous, reviewer(s) for their contribution to the peer review of this work. Peer reviewer reports are available.

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Extended data figures and tables

Extended Data Fig. 1 Number of data sources used in the analysis, by country

Extended Data Fig. 2 Urban-rural height difference in 2020 and change from 1990 to 2020.

The top two maps show the urban-rural difference in age-standardised mean height in 2020 for girls and boys resepectively. A positive number shows higher urban mean height and a negative number shows higher rural mean height. The bottom two maps show the change from 1990 to 2020. The density plot below each map shows the distribution of estimates across countries. The top two scatter plots show the urban-rural difference in age-standardised mean height in relation to the uncertainty of the difference measured by posterior s.d. The bottom two scatter plots show the change from 1990 to 2020 in urban-rural difference in mean height in relation to the uncertainty of the change measured by posterior s.d. Each point in the scatter plots shows one country. Shaded areas approximately show the posterior probability (PP) of a true difference (top two scatter plots) and of a true increase or decrease in difference (bottom two scatter plots). See Extended Data Fig. 8 for PPs of the urban-rural difference in age-standardised mean height and its change. See Supplementary Fig. 7 for results at ages 5, 10, 15 and 19 years. We did not estimate the difference between rural and urban height for countries classified as entirely urban (Bermuda, Kuwait, Nauru and Singapore) or entirely rural (Tokelau), as indicated in grey.

Extended Data Fig. 3 Urban-rural body-mass index (BMI) difference in 2020 and change from 1990 to 2020.

See Extended Data Fig. 2 caption for descriptions of the contents of the figure and for definitions. See Extended Data Fig. 9 for PP of the urban-rural difference in age-standardised mean BMI and its change. See Supplementary Fig. 8 for results at ages 5, 10, 15 and 19 years. We did not estimate the difference between rural and urban BMI for countries classified as entirely urban (Bermuda, Kuwait, Nauru and Singapore) or entirely rural (Tokelau), as indicated in grey.

Extended Data Fig. 4 Posterior probability of increase in mean height in urban and rural areas from 1990 to 2020.

The maps show the PP that the age-standardised mean height increased from 1990 to 2020. The PP of a decrease is one minus that of an increase. If an increase in mean height is statistically indistinguishable from a decrease, the PP is 0.50. PPs closer to 0.50 indicate more uncertainty, those towards 1 indicate more certainty of an increase, and those towards 0 indicate more certainty of a decrease. We did not estimate PP for change in mean rural height for countries classified as entirely urban (Bermuda, Kuwait, Nauru and Singapore) or change in mean urban height for countries classified as entirely rural (Tokelau), as indicated in grey.

Extended Data Fig. 5 Posterior probability of increase in mean body-mass index (BMI) in urban and rural areas from 1990 to 2020.

The maps show the posterior probability (PP) that the age-standardised mean BMI increased from 1990 to 2020. The PP of a decrease is one minus that of an increase. We did not estimate PP for change in mean rural BMI in countries classified as entirely urban (Bermuda, Kuwait, Nauru and Singapore) or change in mean urban BMI in countries classified as entirely rural (Tokelau), as indicated in grey.

Extended Data Fig. 6 Trends in body-mass index (BMI) by place of residence for children, adolescents and young adults for females.

The figure shows trends in mean BMI at ages five and 19 years, and in age-standardised mean BMI for young adults (20–29 years and 30–39 years) for females. Shaded areas show the 95% CrIs. Trend for young adults were estimated using a model similar to the one described in Methods, where BMI-age patterns were allowed to vary flexibly via a cubic spline function without knots.

Extended Data Fig. 7 Trends in body-mass index (BMI) by place of residence for children, adolescents and young adults for males.

The figure shows trends in mean BMI at ages five and 19 years, and in age-standardised mean BMI for young adults (20–29 years and 30–39 years) for males. See Extended Data Fig. 6 caption for description of figure contents.

Extended Data Fig. 8 Posterior probability of urban-rural height difference in 2020 and its increase from 1990 to 2020.

The maps show the posterior probability (PP) that age-standardised mean height in 2020 in urban areas was higher than in rural areas (left-hand panels), and the PP that the urban-rural difference in age-standardised mean height increased from 1990 to 2020 (right-hand panels). For 2020, if estimated age-standardised mean urban height is statistically indistinguishable from rural height, the PP is 0.50. PPs closer to 0.50 indicate more uncertainty, those towards 1 indicate more certainty of urban children being taller, and those towards 0 indicate more certainty of rural being taller. For change, if an increase in urban-rural difference in mean height is statistically indistinguishable from a decrease, the PP is 0.50. PPs closer to 0.50 indicate more uncertainty, those towards 1 indicate more certainty of an increase in the urban-rural height difference, and those towards 0 indicate more certainty of a decrease. We did not estimate the PP for differences between rural and urban height for countries classified as entirely urban (Bermuda, Kuwait, Nauru and Singapore) or entirely rural (Tokelau), as indicated in grey.

Extended Data Fig. 9 Posterior probability of urban-rural body-mass index (BMI) difference in 2020 and its increase from 1990 to 2020.

The maps show the posterior probability (PP) that age-standardised mean BMI in 2020 in urban areas was higher than in rural areas (left-hand panels), and the PP that the urban-rural difference in mean BMI increased from 1990 to 2020 (right-hand panels). We did not estimate the PP for differences between rural and urban BMI for countries classified as entirely urban (Bermuda, Kuwait, Nauru and Singapore) or entirely rural (Tokelau), as indicated in grey.

Supplementary information

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Supplementary Tables 1–4, Supplementary Figs. 1–8 and Supplementary References; see contents page for details.

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NCD Risk Factor Collaboration (NCD-RisC). Diminishing benefits of urban living for children and adolescents’ growth and development. Nature 615, 874–883 (2023). https://doi.org/10.1038/s41586-023-05772-8

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Received: 27 May 2022
Accepted: 30 January 2023
Published: 29 March 2023
Issue Date: 30 March 2023
DOI: https://doi.org/10.1038/s41586-023-05772-8

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