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. 2023 Jun 2:60:102022.
doi: 10.1016/j.eclinm.2023.102022. eCollection 2023 Jun.

The burden of metabolic risk factors in North Africa and the Middle East, 1990-2019: findings from the Global Burden of Disease Study

Mohammad-Reza Malekpour  1 , Mohsen Abbasi-Kangevari  1 , Seyyed-Hadi Ghamari  1 , Javad Khanali  1 , Mahsa Heidari-Foroozan  1 , Sahar Saeedi Moghaddam  1   2 , Mohammadreza Azangou-Khyavy  1 , Sahba Rezazadeh-Khadem  1 , Negar Rezaei  1 , Parnian Shobeiri  1 , Zahra Esfahani  1 , Nazila Rezaei  1 ; GBD 2019 North Africa and the Middle East MRF Collaborators; Ali H Mokdad  3   4 , Mohsen Naghavi  3   4 , Bagher Larijani  5 , Farshad Farzadfar  1   5
Collaborators, Affiliations

The burden of metabolic risk factors in North Africa and the Middle East, 1990-2019: findings from the Global Burden of Disease Study

Mohammad-Reza Malekpour et al. EClinicalMedicine. .

Abstract

Background: The objective of this study is to investigate the trends of exposure and burden attributable to the four main metabolic risk factors, including high systolic blood pressure (SBP), high fasting plasma glucose (FPG), high body-mass index (BMI), and high low-density lipoproteins cholesterol (LDL) in North Africa and the Middle East from 1990 to 2019.

Methods: The data were retrieved from Global Burden of Disease Study 2019. Summary exposure value (SEV) was used for risk factor exposure. Burden attributable to each risk factor was incorporated in the population attributable fraction to estimate the total attributable deaths and disability-adjusted life-years (DALYs).

Findings: While age-standardized death rate (ASDR) attributable to high-LDL and high-SBP decreased by 26.5% (18.6-35.2) and 23.4% (15.9-31.5) over 1990-2019, respectively, high-BMI with 5.1% (-9.0-25.9) and high-FPG with 21.4% (7.0-37.4) change, grew in ASDR. Moreover, age-standardized DALY rate attributed to high-LDL and high-SBP declined by 30.2% (20.9-39.0) and 25.2% (16.8-33.9), respectively. The attributable age-standardized DALY rate of high-BMI with 8.3% (-6.5-28.8) and high-FPG with 27.0% (14.3-40.8) increase, had a growing trend. Age-standardized SEVs of high-FPG, high-BMI, high-SBP, and high-LDL increased by 92.4% (82.8-103.3), 76.0% (58.9-99.3), 10.4% (3.8-18.0), and 5.5% (4.3-7.1), respectively.

Interpretation: The burden attributed to high-SBP and high-LDL decreased during the 1990-2019 period in the region, while the attributable burden of high-FPG and high-BMI increased. Alarmingly, exposure to all four risk factors increased in the past three decades. There has been significant heterogeneity among the countries in the region regarding the trends of exposure and attributable burden. Urgent action is required at the individual, community, and national levels in terms of introducing effective strategies for prevention and treatment that account for local and socioeconomic factors.

Funding: Bill & Melinda Gates Foundation.

Keywords: Global burden of disease; High body-mass index; High fasting plasma glucose; High systolic blood pressure; High-LDL; Metabolic risk factors; North Africa and the Middle East.

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Conflict of interest statement

Z Aryan acknowledges support for attending meetings and/or travel from the American Heart Association Travel Grant. A Hassan acknowledges support from consulting fees from Novartis, Sanofi Genzyme, Biologix, Merck, Hikma Pharma, Janssen, Inspire Pharma, Future Pharma, Elixir pharma; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Novartis, Allergan, Merck, Biologix, Janssen, Roche, Sanofi Genzyme, Bayer, Hikma Pharma, Al Andalus, Chemipharm, Lundbeck, Inspire Pharma, Future Pharma and Habib Scientific Office, and Everpharma; support for attending meetings and/or travel from Novartis, Allergan, Merck, Biologix, Roche, Sanofi Genzyme, Bayer, Hikma Pharma, Chemipharm, and Al Andalus and Clavita pharm; all outside the submitted work. All other authors had no competing interest to declare.

Figures

Fig. 1
Fig. 1
The percentage of DALYs attributable to high-SBP, high-FPG, high-BMI, and high-LDL in 1990 and 2019 by age group.
Fig. 2
Fig. 2
The percentage of DALYs attributable to high-SBP, high-FPG, high-BMI, and high-LDL in genders by age group.
Fig. 3
Fig. 3
The percentage of age-standardized DALY rate of Level 2 causes attributable to high-SBP, high-FPG, high-BMI, and high-LDL in 1990, 2010, and 2019 by gender.
Fig. 4
Fig. 4
Age-standardized DALY rate in 2019 and ARC of age-standardized DALY rate in 2010–2019 period for high-SBP, high-FPG, high-BMI, and high-LDL among countries of the North Africa and the Middle East region.
Fig. 5
Fig. 5
ARC in age-standardized DALY rate compared with age-standardized SEVs during 2010–2019 period for (A) high-SBP, (B) high-FPG, (C) high-BMI, and (D) high-LDL among countries of the North Africa and the Middle East region colored by SDI quintile.
Fig. 6
Fig. 6
Socio-demographic Index (SDI) in 2019 versus ARC of age-standardized DALY rate in 2010–2019 period for high-SBP, high-FPG, high-BMI, and high-LDL among countries of the North Africa and the Middle East region.
Fig. 7
Fig. 7
Age-standardized GDR of attributable death and DALY rates trend from 1990 to 2019 for high-SBP, high-FPG, high-BMI, and high-LDL in the North Africa and the Middle East region.
See this image and copyright information in PMC

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