Prevalence of multiple non-communicable diseases risk factors among adolescents in 140 countries: A population-based study

Tuhin Biswas; Nick Townsend; M Mamun Huda; Joemer Maravilla; Tahmina Begum; Sonia Pervin; Arpita Ghosh; Rashidul Alam Mahumud; Shariful Islam; Novera Anwar; Rukaiya Rifhat; Kerim Munir; Rajat Das Gupta; Andre M N Renzaho; Helda Khusun; Luh Ade Ari Wiradnyani; Tim Radel; Janeen Baxter; Lal B Rawal; David McIntyre; Kjersti Mørkrid; Abdullah Mamun

doi:10.1016/j.eclinm.2022.101591

Prevalence of multiple non-communicable diseases risk factors among adolescents in 140 countries: A population-based study

EClinicalMedicine. 2022 Aug 12:52:101591. doi: 10.1016/j.eclinm.2022.101591. eCollection 2022 Oct.

Authors

Tuhin Biswas^{1

2

3}, Nick Townsend⁴, M Mamun Huda^{1

2

3}, Joemer Maravilla^{1

2

5}, Tahmina Begum^{1

2

3}, Sonia Pervin^{1

2}, Arpita Ghosh⁶, Rashidul Alam Mahumud⁷, Shariful Islam⁸, Novera Anwar⁹, Rukaiya Rifhat¹⁰, Kerim Munir¹¹, Rajat Das Gupta¹², Andre M N Renzaho^{13

14}, Helda Khusun¹⁵, Luh Ade Ari Wiradnyani¹⁵, Tim Radel^{1

2}, Janeen Baxter^{1

2}, Lal B Rawal¹⁶, David McIntyre¹⁶, Kjersti Mørkrid^{17

18}, Abdullah Mamun^{1

2

3}

Affiliations

¹ Institute for Social Science Research, The University of Queensland, Queensland, Australia.
² ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Queensland, Australia.
³ UQ Poche Centre, University of Queensland, Queensland, Australia.
⁴ Department for Health, University of Bath, Bath BA2 7AY, UK.
⁵ Institute of Nursing, Far Eastern University, Manila, Philippines.
⁶ The George Institute for Global Health, UNSW Sydney, New Delhi, India.
⁷ NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Australia.
⁸ Institute for Physical Activity and Nutrition, Faculty of Health, Deakin University, Melbourne, Victoria, Australia.
⁹ Institute of Health Economics, University of Dhaka, Dhaka, Bangladesh.
¹⁰ Department of Soil, Water and Environment, University of Dhaka, Dhaka-1, Bangladesh.
¹¹ Developmental Medicine Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
¹² Department of Epidemiology and Biostatistics, University of South Carolina, USA.
¹³ Translational Health Research Institute, Western Sydney University, Penrith, Australia.
¹⁴ Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia.
¹⁵ SEAMEO Regional Center for Food and Nutrition (RECFON) - Pusat Kajian Gizi Regional Universitas Indonesia (PKGR UI), Jakarta, Indonesia.
¹⁶ School of Health, Medical and Applied Sciences, College of Science and Sustainability, Central Queensland University, Sydney Campus, Australia.
¹⁷ Mater Clinical Unit, The University of Queensland Brisbane, Australia.
¹⁸ Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway.

Abstract

Background: Modifiable non-communicable disease (NCD) risk factors are becoming increasingly common among adolescents, with clustering of these risk factors in individuals of particular concern. The aim of this study was to assess global status of clustering of common modifiable NCD risk factors among adolescents.

Methods: We used latest available data from nationally representative survey for 140 countries, namely the Global School-based Student Health Survey, the Health Behaviour in School-Aged Children and the longitudinal study of Australian Children. Weighted mean estimates of prevalence with corresponding 95% confidence intervals of nine NCD risk factors - physical inactivity, sedentary behaviour, insufficient fruits and vegetable consumption, carbonated soft drink consumption, fast food consumption, tobacco use, alcohol consumption and overweight/obesity - were calculated by country, region and sex.

Findings: Over 487,565 adolescents, aged 11-17 years, were included in this study. According to trend analysis, prevalence of four or more NCD risk factors increased gradually over time. Prevalence of four or more NCD risk factors was 14.8% in 2003-2007 and increased to 44% in 2013-2017, an approximately three-fold increase (44.0%). Similar trends were also observed for three and two risk factors. Large variation between countries in the prevalence of adolescents with four or more risk factors was found in all regions. The country level range was higher in the South-East Asia Region (minimum Sri Lanka = 8%, maximum Myanmar = 84%) than Western Pacific Region (minimum China = 3%, maximum Niue = 72%), European Region (minimum Sweden = 13.9%, maximum Ireland = 66.0%), African Region (minimum Senegal = 0.8%, maximum Uganda = 82.1%) and Eastern Mediterranean Region (minimum Libya = 0.2%, maximum Lebanon = 80.2%). Insufficient vegetable consumption, insufficient fruit consumption and physically inactivity were three of the four most prevalent risk factors in all regions.

Interpretation: Our results suggest a high prevalence of four or more NCD risk factors in adolescents globally, although variation was found between countries. Results from our study indicate that efforts to reduce adolescent NCD risk factors and the associated health burden need to be improved. These findings can assist policy makers to target the rollout of country- specific interventions.

Funding: None.

Keywords: Adolescents; Burden; Non-communicable disease; Risk factors.