Understanding the rise of cardiometabolic diseases in low- and middle-income countries

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Increases in the prevalence of noncommunicable diseases (NCDs), particularly cardiometabolic diseases such as cardiovascular disease, stroke and diabetes, and their major risk factors have not been uniform across settings: for example, cardiovascular disease mortality has declined over recent decades in high-income countries but increased in low- and middle-income countries (LMICs). The factors contributing to this rise are varied and are influenced by environmental, social, political and commercial determinants of health, among other factors. This Review focuses on understanding the rise of cardiometabolic diseases in LMICs, with particular emphasis on obesity and its drivers, together with broader environmental and macro determinants of health, as well as LMIC-based responses to counteract cardiometabolic diseases.

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Fig. 1: The capacity-load model.


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J.J.M. conceived the idea of linking child survival and adult population handicaps that will affect responses to NCDs and climate change while supported through an Erasmus Mundus Scholar at KIT Royal Tropical Institute, Amsterdam, in 2013. This idea was further elaborated through interactions with W. Pan, D. Beran, and F. Maldonado, among others. J.J.M. acknowledges having received support from the Alliance for Health Policy and Systems Research (HQHSR1206660), the Bernard Lown Scholars in Cardiovascular Health Program at Harvard T.H. Chan School of Public Health (BLSCHP-1902), Bloomberg Philanthropies, FONDECYT via CIENCIACTIVA/CONCYTEC, British Council, British Embassy and Newton-Paulet Fund (223-2018, 224-2018), DFID/MRC/Wellcome Global Health Trials (MR/M007405/1), Fogarty International Center (R21TW009982, D71TW010877), Grand Challenges Canada (0335-04), International Development Research Center Canada (IDRC 106887, 108167), Inter-American Institute for Global Change Research (IAI CRN3036), Medical Research Council (MR/P008984/1, MR/P024408/1, MR/P02386X/1), US National Cancer Institute (1P20CA217231), National Heart, Lung and Blood Institute (HHSN268200900033C, 5U01HL114180, 1UM1HL134590), National Institute of Mental Health (1U19MH098780), Swiss National Science Foundation (40P740-160366), Wellcome (074833/Z/04/Z, 093541/Z/10/Z, 107435/Z/15/Z, 103994/Z/14/Z, 205177/Z/16/Z, 214185/Z/18/Z) and the World Diabetes Foundation (WDF15-1224). T.B.-G. was supported by Bloomberg Philanthropies, the Bernard Lown Scholars in Cardiovascular Health Program at Harvard T.H. Chan School of Public Health, the “Fondo Sectorial en Investigación en Salud y Seguridad Social” from the National Council for Science and Technology of Mexico (CONACYT-FOSSIS-202671) and Wellcome (205177/Z/16/Z). C.C. receives a salary as assistant professor at INTA, University of Chile. A.A.H. did not receive external funding for this work but has internal support as director of the Center on Commercial Determinants of Health, Milken Institute School of Public Health, George Washington University. He has received support from numerous agencies including current funding from the US National Institutes of Health’s Fogarty International Center. M.L.-P. receives funding from the Swiss Excellence Government Scholarship (2018.0698). T.O. is supported by the US National Institute for Health Research (NIHR) Global Health Research Group and Network on Diet and Activity. The views expressed in this publication are those of the author and not necessarily those of the National Health Service, the NIHR or the Department of Health. Funding from NIHR (16/137/34) is gratefully acknowledged. T.O. is also supported by the Stellenbosch Institute for Advanced Study Iso Lomso Fellowship and LIRA 2030 Africa Programme (LIRA2030-GR06/18), implemented by the International Science Council (ISC) in partnership with the Network of African Science Academies (NASAC) with support from the Swedish International Development Cooperation Agency (Sida). J.C.K.W. receives a salary as a professor at University College London’s Great Ormond Street Institute of Child Health. The authors acknowledge N. Paichadze and I. Bari from the Milken Institute School of Public Health, George Washington University, for their support with the case study on alcohol.

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Miranda, J.J., Barrientos-Gutiérrez, T., Corvalan, C. et al. Understanding the rise of cardiometabolic diseases in low- and middle-income countries. Nat Med 25, 1667–1679 (2019) doi:10.1038/s41591-019-0644-7

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