Cardiovascular diseases in mega-countries: the challenges of the nutrition, physical activity and epidemiologic transitions, and the double burden of disease

Abstract

Purpose of review: There are today 11 mega-countries with more than 100 million inhabitants. Together these countries represent more than 60% of the world's population. All are facing noncommunicable chronic disease (NCD) epidemic where high cholesterol, obesity, diabetes, and cardiovascular diseases are becoming the main public health concerns. Most of these countries are facing the double burden of malnutrition where undernutrition and obesity coexist, increasing the complexity for policy design and implementation. The purpose of this study is to describe diverse sociodemographic characteristics of these countries and the challenges for prevention and control in the context of the nutrition transition.

Recent findings: Mega-countries are mostly low or middle-income and are facing important epidemiologic, nutrition, and physical activity transitions because of changes in food systems and unhealthy lifestyles. NCDs are responsible of two-thirds of the 57 million global deaths annually. Approximately, 80% of these are in low and middle-income countries. Only developed countries have been able to reduce mortality rates attributable to recognized risk factors for NCDs, in particular high cholesterol and blood pressure.

Summary: Mega-countries share common characteristics such as complex bureaucracies, internal ethnic, cultural and socioeconomic heterogeneity, and complexities to implement effective health promotion and education policies across population. Priorities for action must be identified and successful lessons and experiences should be carefully analyzed and replicated.

Box 1

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FIGURE 1

Double burden of malnutrition in mega-countries: coexistence of stunting^a and overweight/obesity^b. ^aStunting prevalence: height-for-age z scores less than 2 SD, obtained by the Global Health Observatory of the WHO, 2010-2011, except for India (2005–2006) and Brazil (2006–2007). ^bOverweight and Obesity prevalence: BMI at least 25 hg/m², obtained by the Global Health Observatory of the WHO, 2010. ^cRussia prevalence of stunting is not national representative of the under 5-year population.

FIGURE 2

Prevalence of cardiometabolic risk factors in mega countries by HDI category. HDI, human development index. Data obtained by the Global Health Observatory of the WHO.

FIGURE 3

Annual percentage of change of cardiovascular disease, ischemic heart disease, ischemic stroke and diabetes mortality per 100 000 inhabitants (1990–2013) by human development index (2014). Data obtained by Institute for Health Metrics and Evaluation. GBD Compare. Seattle, WA: IHME, University of Washington, 2016. r, correlation coefficient.

FIGURE 4

Percentage of deaths attributable to cardiovascular disease and diabetes in mega-countries (2013). Data obtained by Institute for Health Metrics and Evaluation (IHME). GBD Compare. Seattle, WA: IHME, University of Washington, 2016.