Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Authors: Andrea Rodriguez‐Martinez, Bin Zhou, Marisa K. Sophiea, James Bentham, Christopher Paciorek, Maria LC Iurilli, Rodrigo M. Carrillo‐Larco, James E Bennett, Mariachiara Di Cesare, Cristina Taddei, Honor Bixby, Gretchen A Stevens, Leanne M Riley, Melanie Cowan, Stefan Savin, Goodarz Danaei, Adela Chiriță-Emandi, André Pascal Kengne, Young‐Ho Khang, Avula Laxmaiah, Reza Malekzadeh, J Jaime Miranda, Jin Soo Moon, Stevo Popovic, Thorkild IA Sørensen, Maroje Sorić, Gregor Starc, Ahmad Ali Zainuddin, Edward W. Gregg, Zulfiqar A Bhutta, Robert E. Black, Leandra Abarca-Gómez, Ziad Abdeen, Shynar Abdrakhmanova, Suhaila Abdul Ghaffar, Hanan F Abdul Rahim, Niveen Abu-Rmeileh, Jamila Abubakar Garba, Benjamín Acosta-Cázares, Robert J Adams, Wichai Aekplakorn, Kaosar Afsana, Shoaib Afzal, Imelda Angeles‐Agdeppa, Javad Aghazadeh-Attari, Carlos A Aguilar-Salinas, Charles Agyemang, Mohamad Hasnan Ahmad, Noor Ani Ahmad, Ali Ahmadi, Naser Ahmadi, Soheir H. Ahmed, Wolfgang Ahrens, Gulmira Aitmurzaeva, Kamel Ajlouni, Hazzaa M Al-Hazzaa, Amani Al‐Othman, Rajaa Al‐Raddadi, Monira Alarouj, Fadia AlBuhairan, Shahla AlDhukair, Mohamed M Ali, Abdullah Alkandari, Ala'a Alkerwi, Kristine H. Allin, Mar Álvarez‐Pedrerol, Eman Aly, Deepak Amarapurkar, Parisa Amiri, Norbert Amougou, Philippe Amouyel, Lars Bo Andersen, Sigmund A. Anderssen, Lars Ängquist, Ranjit Mohan Anjana, Alireza Ansari‐Moghaddam, Hajer Aounallah-Skhiri, Joana Araújo, Inger Ariansen, Tahir Aris, Raphael E. Arku, Nimmathota Arlappa, Krishna K Aryal, Thor Aspelund, Félix Assah, Maria Cecília F Assunção, May Soe Aung, Juha Auvinen, Mária Avdičová, Ana Azevedo, Mohsen Azimi-Nezhad, Fereidoun Azizi, Mehrdad Azmin, Bontha V. Babu, Maja Bæksgaard Jørgensen, Azli Baharudin, Suhad Bahijri, Jennifer L. Baker, Nagalla Balakrishna, Mohamed Bamoshmoosh, Maciej Banach, Piotr Bandosz, José R Banegas, Joanna Baran, Carlo M Barbagallo, Alberto Barceló, Amina Barkat, Aluisio JD Barros, Mauro Virgílio Gomes de Barros, Abdul Basit, Joao Luiz D Bastos, Iqbal Bata, Anwar Batieha, Rosângela Fernandes Lucena Batista, Zhamilya Battakova, Batyrbek Assembekov, Louise A. Baur, R Beaglehole, Silvia Bel‐Serrat, Belavendra Antonisamy, Habiba Ben Romdhane, Judith Benedics, Mikhail Benet Rodríguez, James E Bennett, Salim Berkinbayev, Antonio Bernabé‐Ortiz, Gailutė Bernotienė, Heloísa Bettiol, Jorge Bezerra, Aroor Bhagyalaxmi, Sumit Bharadwaj, Santosh K. Bhargava, Zulfiqar A Bhutta, Hongsheng Bi, Yufang Bi, Daniel Bia, Elysée Claude Bika Lele, Mukharram M Bikbov, Bihungum Bista, Duško Bjelica, Peter Bjerregaard, Espen Bjertness, Marius B Bjertness, Cecilia Björkelund, Kátia Vergetti Bloch, Anneke Blokstra, Simona Bo, Martin Bobák, Lynne M. Boddy, Bernhard O Boehm, Heiner Boeing, Jose G Boggia, Elena Bogova, Carlos P Boissonnet, Stig E. Bojesen, Marialaura Bonaccio, Vanina Bongard, Alice Bonilla-Vargas, Matthias Bopp, Herman Borghs, Pascal Bovet, Lien Braeckevelt, Lutgart Braeckman, Marjolijn CE Bragt, Imperia Brajkovich, Francesco Branca, Juergen Breckenkamp, João Breda, Hermann Brenner, Lizzy M. Brewster, Garry Brian, Lăcrămioara Aurelia Brîndușe, Sinéad Brophy, Graziella Bruno, H. Bas Bueno-de-Mesquita, Anna Bugge, Marta Buoncristiano, Genc Burazeri, Con Burns, Antonio Cabrera de León, Joseph Cacciottolo, Hui Cai, Tilema Cama, Christine Cameron, José Camolas, Günay Can, Ana Paula Carlos Cândido, Felicia Cañete, Mario V. Capanzana, Naděžda Čapková, Eduardo Capuano, Vincenzo Capuano, Marloes Cardol, Viviane C Cardoso, Axel C. Carlsson, Estéban Carmuega, Joana Carvalho, José A. Casajús, Felipe F. Casanueva, Ertugrul Celikcan, Laura Censi, Marvin Cervantes–Loaiza, Juraci Almeida César, Snehalatha Chamukuttan, Angelique Chan, Queenie Chan, Himanshu K Chaturvedi, Nish Chaturvedi, Norsyamlina Che Abdul Rahim, Chien‐Jen Chen, Fangfang Chen, Huashuai Chen, Shuohua Chen, Zhengming Chen, Ching-Yu Cheng, Bahman Cheraghian, Angela Chetrit, Ekaterina Chikova‐Iscener, Arnaud Chioléro, Shu-Ti Chiou, Adela Chiriță-Emandi, María-Dolores Chirlaque, Belong Cho, Kaare Christensen, Diego Giulliano Destro Christófaro, Jerzy Chudek, Renata Cifkova, Michelle Cilia, Eliza Cinteza, Frank Claessens, Janine Clarke, Els Clays, Emmanuel Cohen, Hans Concin, Susana C Confortin, Cyrus Cooper, Tara Coppinger, Eva Corpeleijn, Simona Costanzo, Dominique Cottel, Chris Cowell, Cora L. Craig, Amelia C. Crampin, Ana B. Crujeiras, Semánová Csilla, Alexandra M Cucu, Liufu Cui, Felipe Vogt Cureau, Graziella D’Arrigo, Eleonora d’Orsi, Liliana Dacica, María Ángeles Dal Re Saavedra, Jean Dallongeville, Albertino Damasceno, Camilla T. Damsgaard, Goodarz Danaei, Rachel Dankner, Thomas Meinertz Dantoft, Parasmani Dasgupta, Saeed Dastgiri, Luc Dauchet, Kairat Davletov, Guy De Backer, Dirk De Bacquer, Giovanni de Gaetano, Stefaan De Henauw, Paula Duarte de Oliveira, David De Ridder, Karin De Ridder, Susanne R. de Rooij, Delphine De Smedt, Mohan Deepa, А. Д. Деев, Vincent Jr DeGennaro, Abbas Dehghan, Hélène Delisle, Francis Delpeuch, Stefaan Demarest, Elaine Dennison, Katarzyna Dereń, Valérie Deschamps, Klodian Dhana, Meghnath Dhimal, Augusto Di Castelnuovo, Juvenal Soares Dias da Costa, María Elena Díaz Sánchez, Alejandro Díaz, Živka Dika, Shirin Djalalinia, Visnja Djordjic, Ha TP, Annette J. Dobson, Maria Benedetta Donati, Chiara Donfrancesco, Silvana P Donoso, Angela Döring, Maria Dorobanţu, Ahmad Reza Dorosty, Kouamelan Doua, Wojciech Drygas, Yanping Li, Charmaine A Duante, Priscilla Duboz, Rosemary B. Duda, Vesselka Duleva, Virginija Dulskienė, Samuel Carvalho Dumith, Anar Dushpanova, Vilnis Dzērve, Elżbieta Dziankowska–Zaborszczyk, Ricky Eddie, Ebrahim Eftekhar, Eruke E Egbagbe, Robert Eggertsen, Sareh Eghtesad, Gabriele Eiben, Ulf Ekelund, Mohammad El-Khateeb, Jalila El Ati, Denise Eldemire‐Shearer, Marie Eliasen, Paul Elliott, Reina Engle‐Stone, Enguerran Macia, Rajiv T Erasmus, Raimund Erbel, Cihangir Erem, Louise Eriksen, Johan G Eriksson, Jorge Escobedo-de la Peña, Saeid Eslami, Ali Esmaeili, Alun Evans, David Faeh, Albina A. Fakhretdinova, Caroline H Fall, Elnaz Faramarzi, Mojtaba Farjam, Victoria Farrugia Sant’Angelo, Farshad Farzadfar, Mohammad Reza Fattahi, Asher Fawwad, Francisco Javier Félix-Redondo, Trevor S. Ferguson, Romulo A Fernandes, Daniel Fernández‐Bergés, Daniel Ferrante, Thomas Ferrao, Marika Ferrari, Maurizio Ferrario, Catterina Ferreccio, Eldridge Ferrer, Jean Ferrieres, Thamara Hübler Figueiró, Anna Fijałkowska, Günther Fink, Krista Fischer, Bernhard Föger, Leng Huat Foo, Maria Forsner, Heba Fouad, Damian Francis, Maria do Carmo Franco, Oscar H Franco, Ruth Frikke‐Schmidt, Guillermo Frontera, Flávio Danni Fuchs, Sandra Cristina Pereira Costa Fuchs, Isti Ilmiati Fujiati, Yuki Fujita, Fumihiko Matsuda, T. Furusawa, Zbigniew Gaciong, Mihai Gafencu, Andrzej Galbarczyk, Henrike Galenkamp, Daniela Galeone, Myriam Galfo, Fabio Galvano, Jingli Gao, Manoli Garcia-de-la-Hera, Marta García‐Solano, Dickman Gareta, Sarah P Garnett, Jean‐Michel Gaspoz, Magda Gasull, Adroaldo César Araújo Gaya, Anelise Reis Gaya, Andréa Gazzinelli, Ulrike Gehring, Harald Geiger, Johanna M. 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Morin, Erik Lykke Mortensen, George Moschonis, Małgorzata Mossakowska, Aya Mostafa, Anabela Mota‐Pinto, Jorge Mota, Mohammad Esmaeel Motlagh, Jorge Motta, Marcos André Moura dos Santos, Malay Kanti Mridha, Kelias P Msyamboza, Thet Thet Mu, Magdalena Muc, Boban Mugoša, Maria L. Muiesan, Parvina Mukhtorova, Martina Müller‐Nurasyid, Neil Murphy, Jaakko Mursu, Elaine Murtagh, Kamarul Imran Musa, Sanja Musić Milanović, Vera Musil, Norlaila Mustafa, Iraj Nabipour, Shohreh Naderimagham, Gabriele Nagel, Balkish M Naidu, Farid Najafi, Harunobu Nakamura, Jana Námešná, Ei Ei K Nang, Vinay Nangia, Martin Nankap, Sameer Narake, Paola Nardone, Matthias Nauck, William A. Neal, Azim Nejatizadeh, Keiu Nelis, Liis Nelis, Ilona Nenko, Martin Neovius, Flavio Nervi, Chung T Nguyen, D Nguyen, Quang Ngoc Nguyen, Ramfis Nieto‐Martínez, Yury P Nikitin, Guang Ning, Toshiharu Ninomiya, Sania Nishtar, Marianna Noale, Óscar Noboa, Helena Nogueira, Teresa Norat, Maria Nordendahl, Børge G. 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Pandey, Francesco Panza, Dimitrios Papandreou, Soon-Woo Park, Suyeon Park, Winsome R Parnell, Mahboubeh Parsaeian, Ionela Pașcanu, Patrick Pasquet, Nikhil D Patel, Mangesh S Pednekar, Nasheeta Peer, Sérgio Viana Peixoto, Markku Peltonen, Alexandre C Pereira, Marco A Peres, Napoleón Pérez‐Farinós, Cynthia M Pérez, Valentina Peterkova, Annette Peters, Astrid Petersmann, Janina Petkeviciene, Ausra Petrauskiene, Emanuela Pettenuzzo, Niloofar Peykari, Son Thai Pham, Rafael Navarro Pichardo, Daniela Pierannunzio, Iris Pigeot, Hynek Pikhart, Aida Pilav, Lorenza Pilotto, Francesco Pistelli, Freda Pitakaka, Aleksandra Piwonska, Andréia Pizarro, Pedro Plans-Rubió, Bee Koon Poh, Hermann Pohlabeln, Raluca-Monica Pop, Stevo R Popovic, Miquel Porta, Georg Posch, Anil Poudyal, Dimitrios Poulimeneas, Hamed Pouraram, Farhad Pourfarzi, Akram Pourshams, Hossein Poustchi, Rajendra Pradeepa, Alison Price, Jacqueline F Price, Rui Providência, Jardena J. 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BACKGROUND: Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. METHODS: For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5-19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. FINDINGS: . In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes-gaining too little height, too much weight for their height compared with children in other countries, or both-occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. INTERPRETATION: The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks. FUNDING: Wellcome Trust, AstraZeneca Young Health Programme, EU.