Evidence map›Paper›PMID 34274065›Full record

ArticleLancet (London, England)2021

Body-mass index and diabetes risk in 57 low-income and middle-income countries: a cross-sectional study of nationally representative, individual-level data in 685 616 adults.

Felix Teufel, Jacqueline A Seiglie, Pascal Geldsetzer, Michaela Theilmann, Maja E Marcus, Cara Ebert, William Andres Lopez Arboleda, Kokou Agoudavi, Glennis Andall-Brereton, Krishna K Aryal and 35 more

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Lancet (London, England), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 83 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
83citing papers in PubMed, 3 pooled it
23.3field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

83 citing papers in PubMed, 3 syntheses or guidelines pooled it, 154 citations in OpenAlex.

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  15. Association Between Trunk Fat Mass Index and Diabetes in a Multinational Population.Mayo Clinic proceedings. Innovations, quality & outcomes · 2025
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  20. GABAMedComm · 2025
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23 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

45 authors at 20 institutions in 23 countries.

Felix TeufelHeidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany.
Jacqueline A SeiglieDiabetes Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA.
Pascal GeldsetzerHeidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany; Department of Medicine, Division of Primary Care and Population Health, Stanford University, Stanford, CA, USA.
Michaela TheilmannHeidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany.
Maja E MarcusDepartment of Economics and Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany.
Cara EbertRWI-Leibniz Institute for Economic Research, Essen (Berlin Office), Germany.
William Andres Lopez ArboledaHeidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany.
Kokou AgoudaviTogo Ministry of Health, Lome, Togo.
Glennis Andall-BreretonCaribbean Public Health Agency, Port of Spain, Trinidad and Tobago.
Krishna K AryalNepal Health Sector Programme 3, Monitoring Evaluation and Operational Research Project, Abt Associates, Kathmandu, Nepal.
Brice Wilfried BicabaInstitut National de Santé Publique, Ministère de la santé, Ouagadougou, Burkina Faso.
Garry BrianThe Fred Hollows Foundation New Zealand, Auckland, New Zealand.
Pascal BovetMinistry of Health, Victoria, Seychelles; University Center for Primary Care and Public Health, Lausanne, Switzerland.
Maria DorobantuUniversity of Medicine and Pharmacy Carol Davila, Bucharest, Romania.
Mongal Singh GurungHealth Research and Epidemiology Unit, Ministry of Health, Thimphu, Bhutan.
David GuwatuddeDepartment of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda.
Corine HouehanouLaboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin.
Dismand HouinatoLaboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin.
Jutta M Adelin JorgensenDepartment of Public Health, University of Copenhagen, Copenhagen, Denmark.
Gibson B KagarukiNational Institute for Medical Research, Dar es Salaam, Tanzania.
Khem B KarkiDepartment of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
Demetre LabadariosFaculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.
Joao S MartinsFaculty of Medicine and Health Sciences, Universidade Nacional Timor Lorosae, Rua Jacinto Candido, Dili, Timor-Leste.
Mary T MayigeNational Institute for Medical Research, Dar es Salaam, Tanzania.
Roy Wong McClureEpidemiology Office and Surveillance, Caja Costarricense de Seguro Social, San Jose, Costa Rica.
Joseph Kibachio MwangiDivision of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya; Faculté de Médecine, Université de Genève, Geneva, Switzerland.
Omar MwalimZanzibar Ministry of Health, Mnazi Mmoja, Zanzibar, Tanzania.
Bolormaa NorovNational Center for Public Health, Ulaanbaatar, Mongolia.
Sarah CrooksCaribbean Public Health Agency, Port of Spain, Trinidad and Tobago.
Farshad FarzadfarNon-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
Sahar Saeedi MoghaddamEndocrinology and Metabolism Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
Bahendeka K SilverSt Francis Hospital, Nsambya, Kampala, Uganda.
Lela SturuaNon-Communicable Diseases Department, National Center for Disease Control and Public Health, Tbilisi, Georgia; Petre Shotadze Tbilisi Medical Academy, Tbilisi, Georgia.
Chea Stanford WessehLiberia Ministry of Health, Monrovia, Liberia.
Andrew C StokesDepartment of Global Health, Boston University School of Public Health, Boston, MA, USA.
Utibe R EssienDivision of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA.
Jan-Walter De NeveHeidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany.
Rifat AtunDepartment of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA; Department of Global Health and Social Medicine, Harvard University, Boston, MA, USA.
Justine I DaviesDepartment of Global Health, Centre for Global Surgery, Stellenbosch University, Stellenbosch, South Africa; MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of Witwatersrand, Johannesburg, South Africa; Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
Sebastian VollmerDepartment of Economics and Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany.
Till W BärnighausenHeidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany; Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA; Africa Health Research Institute, Somkhele, South Africa.
Mohammed K AliHubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA.
James B MeigsDepartment of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA.
Deborah J WexlerDiabetes Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA.
Jennifer Manne-GoehlerMedical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: jmanne@partners.org.
Harvard University · USHeidelberg University · DECaribbean Public Health Agency · TTNational Institute for Medical Research · TZTehran University of Medical Sciences · IRUniversité d'Abomey-Calavi · BJUniversity of Göttingen · DEAbt Associates (Nepal) · NPBoston University · USBrigham and Women's Hospital · USCarol Davila University of Medicine and Pharmacy · ROCosta Rican Department of Social Security · CREmory University · USFred Hollows Foundation · AUMakerere University · UGMinistère De La Santé · BFMinistry of Health · SCNational Center for Communicable Diseases · MNNational Center for Disease Control and Public Health · GENsambya Hospital · UG

Funding

TRAINING PROGRAM IN ENDOCRINOLOGY AND DIABETEST32DK007028 · NIDDK · MASSACHUSETTS GENERAL HOSPITAL · PI Karen K Miller · 1986 to 2026
$18.5M
Institutional Career Development Core (KL2)KL2TR003143 · NCATS · STANFORD UNIVERSITY · PI ASCH, STEVEN M. · 2019 to 2023
$8.7M
Institutional Career Development CoreKL2TR002542 · NCATS · HARVARD MEDICAL SCHOOL · PI BREDELLA, MIRIAM ANTOINETTE, RUTKOVE, SEWARD B. · 2018 to 2022
$8.7M
TOPMed Omics of Type 2 Diabetes and Quantitative TraitsUM1DK078616 · NIDDK · MASSACHUSETTS GENERAL HOSPITAL · PI MANNING, ALISA KNODLE · 2021 to 2025
$3.8M
Preventing Weight Gain and Diabetes in People with HIV in South AfricaK23DK125162 · NIDDK · MASSACHUSETTS GENERAL HOSPITAL · PI MANNE-GOEHLER, JENNIFER · 2020 to 2024
$986k
NCATS NIH HHS KL2 TR002542NCATS NIH HHS KL2 TR003143NIDDK NIH HHS K23 DK125162NIDDK NIH HHS T32 DK007028NIDDK NIH HHS UM1 DK078616Wellcome Trust
6 · The paper itself

Abstract

backgroundThe prevalence of overweight, obesity, and diabetes is rising rapidly in low-income and middle-income countries (LMICs), but there are scant empirical data on the association between body-mass index (BMI) and diabetes in these settings.

methodsIn this cross-sectional study, we pooled individual-level data from nationally representative surveys across 57 LMICs. We identified all countries in which a WHO Stepwise Approach to Surveillance (STEPS) survey had been done during a year in which the country fell into an eligible World Bank income group category. For LMICs that did not have a STEPS survey, did not have valid contact information, or declined our request for data, we did a systematic search for survey datasets. Eligible surveys were done during or after 2008; had individual-level data; were done in a low-income, lower-middle-income, or upper-middle-income country; were nationally representative; had a response rate of 50% or higher; contained a diabetes biomarker (either a blood glucose measurement or glycated haemoglobin [HbA

findingsOur pooled dataset from 58 nationally representative surveys in 57 LMICs included 685 616 individuals. The overall prevalence of overweight was 27·2% (95% CI 26·6-27·8), of obesity was 21·0% (19·6-22·5), and of diabetes was 9·3% (8·4-10·2). In the pooled analysis, a higher risk of diabetes was observed at a BMI of 23 kg/m

interpretationThe association between BMI and diabetes risk in LMICs is subject to substantial regional variability. Diabetes risk is greater at lower BMI thresholds and at younger ages than reflected in currently used BMI cutoffs for assessing diabetes risk. These findings offer an important insight to inform context-specific diabetes screening guidelines.

fundingHarvard T H Chan School of Public Health McLennan Fund: Dean's Challenge Grant Program.

Indexed as

Body Mass IndexDiabetes MellitusAdultCross-Sectional StudiesDeveloping CountriesFemaleGlobal HealthGlycated HemoglobinHealth SurveysHumansMaleMiddle AgedObesityPovertyPrevalenceGlycated Hemoglobin

Identifiers

PMID34274065
PMCPMC8336025
OpenAlexW3179285483

What OpenQuestion holds

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LicenceTDM
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.