Rishi Caleyachetty1, Justin B Echouffo-Tcheugui2, Christopher A Tait3, Sam Schilsky4, Terrence Forrester5, Andre P Kengne6. 1. Ministry of Health and Quality of Life, Port Louis, Republic of Mauritius; MRC Unit for Lifelong Health and Ageing, University College London, London, UK; National Collaborating Centre for Women's and Children's Health, Royal College of Obstetricians and Gynaecologists, London, UK. 2. Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA; Department of Medicine, MedStar Health, Baltimore, Maryland, USA. 3. Dalla Lana School of Public Health, University of Toronto, Canada. 4. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA. 5. University of West Indies, Mona, Jamaica; The Liggins Institute, The University of Auckland, New Zealand; Department of Medicine, University of Cape Town, Cape Town, South Africa. 6. Department of Medicine, University of Cape Town, Cape Town, South Africa; Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa; The George Institute for Global Health, Sydney, Australia; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: andre.kengne@mrc.ac.za.
Abstract
BACKGROUND: Although overt manifestations of cardiovascular disease (CVD) rarely emerge before adulthood, CVD risk factors are often present in adolescents. However, the prevalence and magnitude of behavioural CVD risk factors in adolescents in low-income and middle-income countries remains unclear. We estimated the magnitude and co-occurrence of behavioural CVD risk factors in adolescents aged 12-15 years for 65 low-income and middle-income countries between 2003 and 2011. METHODS: We extracted Global School-Based Student Health Surveys (GSHS) datasets from the Centers for Disease Control and Prevention (CDC) website. Pooled prevalence estimates of current tobacco use, alcohol use, low fruit and vegetable intake, low physical activity, obesity and co-occurrence of CVD risk factors for WHO regions and overall, was calculated with random-effects meta-analysis. We explored potential sources of heterogeneity for each CVD risk factor through random-effects meta-regression analysis. FINDINGS: Between 2003 and 2011, of 169 369 adolescents, 12·1% (95% CI 10·2-14·1) used tobacco, 15·7% (12·3-19·5) used alcohol, 74·3% (71·9 -76·5) had low fruit and vegetable intake, 71·4% (69·5-73·3) reported low physical activity and 7·1% (5·6-8·7) were obese. The pooled regional prevalence of exposure to three or more CVD risk factors was lowest in the southeast Asian region (3·8%, 95% CI 1·2-7·5) and highest in the western Pacific region (18·6%, 12·8-25·3). Substantial heterogeneities within and across regions were not fully explained by major study characteristics. INTERPRETATION: In low-income and middle-income countries, adolescents carry a substantial burden of behavioural CVD risk factors, which tend to co-occur. Surveillance, prevention, detection, and control initiatives are a global health priority. FUNDING: None.
BACKGROUND: Although overt manifestations of cardiovascular disease (CVD) rarely emerge before adulthood, CVD risk factors are often present in adolescents. However, the prevalence and magnitude of behavioural CVD risk factors in adolescents in low-income and middle-income countries remains unclear. We estimated the magnitude and co-occurrence of behavioural CVD risk factors in adolescents aged 12-15 years for 65 low-income and middle-income countries between 2003 and 2011. METHODS: We extracted Global School-Based Student Health Surveys (GSHS) datasets from the Centers for Disease Control and Prevention (CDC) website. Pooled prevalence estimates of current tobacco use, alcohol use, low fruit and vegetable intake, low physical activity, obesity and co-occurrence of CVD risk factors for WHO regions and overall, was calculated with random-effects meta-analysis. We explored potential sources of heterogeneity for each CVD risk factor through random-effects meta-regression analysis. FINDINGS: Between 2003 and 2011, of 169 369 adolescents, 12·1% (95% CI 10·2-14·1) used tobacco, 15·7% (12·3-19·5) used alcohol, 74·3% (71·9 -76·5) had low fruit and vegetable intake, 71·4% (69·5-73·3) reported low physical activity and 7·1% (5·6-8·7) were obese. The pooled regional prevalence of exposure to three or more CVD risk factors was lowest in the southeast Asian region (3·8%, 95% CI 1·2-7·5) and highest in the western Pacific region (18·6%, 12·8-25·3). Substantial heterogeneities within and across regions were not fully explained by major study characteristics. INTERPRETATION: In low-income and middle-income countries, adolescents carry a substantial burden of behavioural CVD risk factors, which tend to co-occur. Surveillance, prevention, detection, and control initiatives are a global health priority. FUNDING: None.
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