Publications
2025 |
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Song X, Zhou B, Baird S, Lu C, Song Z, Zhang Y, Wang R, Jiang J, Chen L, Liu J, Yuan W, Liu Y, Dang J, Hu P, Ma J, Dong Y, Song Y, Ezzati M, Sawyer SM. The Lancet child and Adolescent Health, 9 (8), pp. 530-543, 2025. @article{X2025,
title = {Trends and predictions to 2030 in demographic structures and metabolic health for children and adolescents in China: analysis of national school health surveys from 2000 to 2019}, author = {Song X, Zhou B, Baird S, Lu C, Song Z, Zhang Y, Wang R, Jiang J, Chen L, Liu J, Yuan W, Liu Y, Dang J, Hu P, Ma J, Dong Y, Song Y, Ezzati M, Sawyer SM.}, doi = { 10.1016/S2352-4642(25)00140-3}, year = {2025}, date = {2025-06-19}, journal = {The Lancet child and Adolescent Health}, volume = {9}, number = {8}, pages = {530-543}, abstract = {Summary Background Understanding the changing metabolic health burden among children and adolescents is crucial for current and future public health resource allocation in China, particularly given rapid population ageing. We aimed to estimate trends in the metabolic burden in children and adolescents aged 7\textendash18 years from 2000 to 2030, using overweight, obesity, and hypertension as proxy indicators. Methods We extracted age, sex, height, weight, and blood pressure data for Han children and adolescents aged 7\textendash18 years, as recorded in five cycles of the Chinese National Surveys on Students Constitution and Health in the years 2000, 2005, 2010, 2014, and 2019. We used demographic indicators reported by the Seventh National Population Census in 2020 to represent the demographic situation in 2019 and UN population estimates and projections for China to derive the national age structure from 2000 to 2030. We calculated the 2019 age-standardised prevalence rates of overweight and obesity, hypertension, comorbid overweight and obesity with hypertension, severe obesity, and severe hypertension. Direct standardisation was applied to adjust for the effect of changes in population structures and derive age-specific prevalence estimates from 2000 to 2030. A population development index that captures demographic trends while accounting for the influence of age structure was calculated from birth rate, death rate, and proportions of the population aged 0\textendash14 years and older than 65 years. Correlation coefficients (r) and corresponding p values for the association between the population development index and metabolic burden were calculated with general linear regression models. Multinomial regressions were applied to model age-specific and sex-specific prevalence rates as a function of time. We used decomposition analysis to evaluate the individual contributions of age-specific prevalence, age distribution, and population growth to the net change in case numbers. Findings The final analysis of national survey data included 1 106 416 observations. In 2019, the age-standardised prevalence rates were 21·5% (95% CI 21·3\textendash21·7) for overweight and obesity, 16·6% (16·4\textendash16·8) for hypertension, 5·5% (5·4\textendash5·6) for overweight and obesity with hypertension, 1·6% (1·5\textendash1·6) for severe obesity, and 2·1% (2·0\textendash2·2) for severe hypertension. China's population of children and adolescents aged 7\textendash18 years is predicted to decrease from 276 million in 2000 to 181 million in 2030 (\textendash34·4%). Between 2000 and 2030, we estimate increases of 39·0 million (180·6%) cases of overweight and obesity, 7·1 million (131·5%) cases of overweight and obesity with hypertension, 4·3 million (430·0%) cases of severe obesity, and 1·2 million (34·3%) cases of severe hypertension. Between 2000 and 2030, we estimate a slight decrease of 0·3 million (\textendash0·8%) cases of hypertension. A significant negative association between population development index and metabolic burden was observed for 2019 (r=\textendash0·485, p=0·0062) and projected for 2030 (r=\textendash0·417, p=0·020). Decomposition analysis indicated that rising age-specific prevalence is the primary driver of increasing numbers of metabolic cases, partially offset by population decline. Interpretation In the context of China's declining youth populations, increases in the prevalence, clinical severity, and absolute case numbers of overweight and obesity with hypertension signal a worsening metabolic health burden. Beyond public health policies to shape healthier lifestyle patterns, enhanced efforts are needed to prepare China's primary health-care system and optimise the allocation of paediatric health-care resources. Funding National Key R&D Program of China, National Natural Science Foundation of China, Beijing Natural Science Foundation, Peking University Talent Introduction Program Project, Clinical Medicine Plus X-Young Scholars Project of Peking University, UK Medical Research Council, and the Abdul Latif Jameel Institute for Disease and Emergency Analytics at Imperial College London, funded by a donation from Community Jameel.}, keywords = {Child Health}, pubstate = {published}, tppubtype = {article} } Summary
Background Understanding the changing metabolic health burden among children and adolescents is crucial for current and future public health resource allocation in China, particularly given rapid population ageing. We aimed to estimate trends in the metabolic burden in children and adolescents aged 7–18 years from 2000 to 2030, using overweight, obesity, and hypertension as proxy indicators. Methods We extracted age, sex, height, weight, and blood pressure data for Han children and adolescents aged 7–18 years, as recorded in five cycles of the Chinese National Surveys on Students Constitution and Health in the years 2000, 2005, 2010, 2014, and 2019. We used demographic indicators reported by the Seventh National Population Census in 2020 to represent the demographic situation in 2019 and UN population estimates and projections for China to derive the national age structure from 2000 to 2030. We calculated the 2019 age-standardised prevalence rates of overweight and obesity, hypertension, comorbid overweight and obesity with hypertension, severe obesity, and severe hypertension. Direct standardisation was applied to adjust for the effect of changes in population structures and derive age-specific prevalence estimates from 2000 to 2030. A population development index that captures demographic trends while accounting for the influence of age structure was calculated from birth rate, death rate, and proportions of the population aged 0–14 years and older than 65 years. Correlation coefficients (r) and corresponding p values for the association between the population development index and metabolic burden were calculated with general linear regression models. Multinomial regressions were applied to model age-specific and sex-specific prevalence rates as a function of time. We used decomposition analysis to evaluate the individual contributions of age-specific prevalence, age distribution, and population growth to the net change in case numbers. Findings The final analysis of national survey data included 1 106 416 observations. In 2019, the age-standardised prevalence rates were 21·5% (95% CI 21·3–21·7) for overweight and obesity, 16·6% (16·4–16·8) for hypertension, 5·5% (5·4–5·6) for overweight and obesity with hypertension, 1·6% (1·5–1·6) for severe obesity, and 2·1% (2·0–2·2) for severe hypertension. China's population of children and adolescents aged 7–18 years is predicted to decrease from 276 million in 2000 to 181 million in 2030 (–34·4%). Between 2000 and 2030, we estimate increases of 39·0 million (180·6%) cases of overweight and obesity, 7·1 million (131·5%) cases of overweight and obesity with hypertension, 4·3 million (430·0%) cases of severe obesity, and 1·2 million (34·3%) cases of severe hypertension. Between 2000 and 2030, we estimate a slight decrease of 0·3 million (–0·8%) cases of hypertension. A significant negative association between population development index and metabolic burden was observed for 2019 (r=–0·485, p=0·0062) and projected for 2030 (r=–0·417, p=0·020). Decomposition analysis indicated that rising age-specific prevalence is the primary driver of increasing numbers of metabolic cases, partially offset by population decline. Interpretation In the context of China's declining youth populations, increases in the prevalence, clinical severity, and absolute case numbers of overweight and obesity with hypertension signal a worsening metabolic health burden. Beyond public health policies to shape healthier lifestyle patterns, enhanced efforts are needed to prepare China's primary health-care system and optimise the allocation of paediatric health-care resources. Funding National Key R&D Program of China, National Natural Science Foundation of China, Beijing Natural Science Foundation, Peking University Talent Introduction Program Project, Clinical Medicine Plus X-Young Scholars Project of Peking University, UK Medical Research Council, and the Abdul Latif Jameel Institute for Disease and Emergency Analytics at Imperial College London, funded by a donation from Community Jameel. |
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2024 |
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Xinli Song, Bin Zhou, Sarah Baird, Chunling Lu, Majid Ezzati, Li Chen The Lancet Public Health, 9 (12), pp. E1025-E1036, 2024. (Child Health, Non-Communicable Diseases) Child Health, Non-Communicable Diseases @article{Song2024,
title = {Trends and inequalities in thinness and obesity among Chinese children and adolescents: evidence from seven national school surveys between 1985 and 2019}, author = {Xinli Song and Bin Zhou and Sarah Baird and Chunling Lu and Majid Ezzati and Li Chen }, doi = { 10.1016/S2468-2667(24)00211-1}, year = {2024}, date = {2024-10-28}, journal = {The Lancet Public Health}, volume = {9}, number = {12}, pages = {E1025-E1036}, keywords = {Child Health, Non-Communicable Diseases}, pubstate = {published}, tppubtype = {article} } |
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NCD Risk Factor Collaboration (NCD-RisC) Lancet, 403 (10431), pp. 1027-1050, 2024. (Child Health, Methodology, Non-Communicable Diseases) Child Health, Methodology, Non-Communicable Diseases @article{(NCD-RisC)2024b,
title = {Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults}, author = {NCD Risk Factor Collaboration (NCD-RisC)}, doi = {10.1016/S0140-6736(23)02750-2}, year = {2024}, date = {2024-02-29}, journal = {Lancet}, volume = {403}, number = {10431}, pages = {1027-1050}, keywords = {Child Health, Methodology, Non-Communicable Diseases}, pubstate = {published}, tppubtype = {article} } |
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2023 |
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NCD Risk Factor Collaboration (NCD-RisC) Diminishing benefits of urban living for children and adolescents’ growth and development Nature, (615), pp. 874–883, 2023. (Child Health, Health Inequalities, Methodology, Non-Communicable Diseases, Urban Health) Child Health, Health Inequalities, Methodology, Non-Communicable Diseases, Urban Health @article{(NCD-RisC)2023,
title = {Diminishing benefits of urban living for children and adolescents’ growth and development}, author = {NCD Risk Factor Collaboration (NCD-RisC)}, doi = {https://doi.org/10.1038/s41586-023-05772-8}, year = {2023}, date = {2023-03-29}, journal = {Nature}, number = {615}, pages = {874\textendash883}, keywords = {Child Health, Health Inequalities, Methodology, Non-Communicable Diseases, Urban Health}, pubstate = {published}, tppubtype = {article} } |
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2022 |
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Paalanen L, Levälahti E, Mäki P, Tolonen H, Sassi F, Ezzati M, Laatikainen T Association of socioeconomic position and childhood obesity in Finland: a registry-based study BMJ Open , 12 (12), pp. e068748, 2022. (Child Health, Health Inequalities, Non-Communicable Diseases, Nutrition) Child Health, Health Inequalities, Non-Communicable Diseases, Nutrition @article{L2022,
title = {Association of socioeconomic position and childhood obesity in Finland: a registry-based study}, author = {Paalanen L and Lev\"{a}lahti E and M\"{a}ki P and Tolonen H and Sassi F and Ezzati M and Laatikainen T}, doi = {doi:10.1136/bmjopen-2022-068748}, year = {2022}, date = {2022-12-29}, journal = {BMJ Open }, volume = {12}, number = {12}, pages = {e068748}, keywords = {Child Health, Health Inequalities, Non-Communicable Diseases, Nutrition}, pubstate = {published}, tppubtype = {article} } |
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Lelijveld N, Benedict RK, Wrottesley SV, Bhutta ZA, Borghi E, Cole TJ, Croft T, Frongillo EA, Hayashi C, Namaste S, Sharma D, Tumilowicz A, Wells JC, Ezzati M, Patton GC, Mates E The Lancet Child & Adolescent Health, 6 (10), pp. 738-746, 2022. @article{N2022c,
title = {Towards standardised and valid anthropometric indicators of nutritional status in middle childhood and adolescence}, author = {Lelijveld N and Benedict RK and Wrottesley SV and Bhutta ZA and Borghi E and Cole TJ and Croft T and Frongillo EA and Hayashi C and Namaste S and Sharma D and Tumilowicz A and Wells JC and Ezzati M and Patton GC and Mates E }, doi = {https://doi.org/10.1016/S2352-4642(22)00196-1}, year = {2022}, date = {2022-08-23}, journal = {The Lancet Child & Adolescent Health}, volume = {6}, number = {10}, pages = {738-746}, keywords = {Child Health, Nutrition}, pubstate = {published}, tppubtype = {article} } |
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Stevens GA, Paciorek CJ, Flores-Urrutia MC, Borghi E, Namaste S, Wirth JP, Suchdev PS, Ezzati M, Rohner F, Flaxman SR, Rogers LM Lancet Global Health, 10 (5), pp. 627-639, 2022. (Child Health, Non-Communicable Diseases, Nutrition) Child Health, Non-Communicable Diseases, Nutrition @article{GA2022,
title = {National, regional, and global estimates of anaemia by severity in women and children for 2000-19: a pooled analysis of population-representative data}, author = {Stevens GA and Paciorek CJ and Flores-Urrutia MC and Borghi E and Namaste S and Wirth JP and Suchdev PS and Ezzati M and Rohner F and Flaxman SR and Rogers LM}, doi = {https://doi.org/10.1016/S2214-109X(22)00084-5}, year = {2022}, date = {2022-05-01}, journal = {Lancet Global Health}, volume = {10}, number = {5}, pages = {627-639}, keywords = {Child Health, Non-Communicable Diseases, Nutrition}, pubstate = {published}, tppubtype = {article} } |
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Black RE, Liu L, Hartwig FP, Villavicencio F, Rodriguez-Martinez A, Vidaletti LP, Perin J, Black MM, Blencowe H, You D, Hug L, Masquelier B, Cousens S, Gove A, Vaivada T, Yeung D, Behrman J, Martorell R, Osmond C, Stein AD, Adair LS, Fall CHD, Horta B, Menezes AMB, Ramirez-Zea M, Richter LM, Patton GC, Bendavid E, Ezzati M, Bhutta ZA, Lawn JE, Victora CG. Health and development from preconception to 20 years of age and human capital Lancet, 399 (10336), pp. 1730-1740, 2022. @article{RE2022,
title = {Health and development from preconception to 20 years of age and human capital }, author = {Black RE and Liu L and Hartwig FP and Villavicencio F and Rodriguez-Martinez A and Vidaletti LP and Perin J and Black MM and Blencowe H and You D and Hug L and Masquelier B and Cousens S and Gove A and Vaivada T and Yeung D and Behrman J and Martorell R and Osmond C and Stein AD and Adair LS and Fall CHD and Horta B and Menezes AMB and Ramirez-Zea M and Richter LM and Patton GC and Bendavid E and Ezzati M and Bhutta ZA and Lawn JE and Victora CG. }, doi = {https://doi.org/10.1016/S0140-6736(21)02533-2}, year = {2022}, date = {2022-04-30}, journal = {Lancet}, volume = {399}, number = {10336}, pages = {1730-1740}, keywords = {Child Health}, pubstate = {published}, tppubtype = {article} } |
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2020 |
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NCD Risk Factor Collaboration (NCD-RisC) The Lancet, 396 (10261), pp. 1511-1524, 2020. (Child Health, Non-Communicable Diseases, Nutrition) Child Health, Non-Communicable Diseases, Nutrition @article{(NCD-RisC)2020b,
title = {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}, author = {NCD Risk Factor Collaboration (NCD-RisC)}, doi = {10.1016/S0140-6736(20)31859-6}, year = {2020}, date = {2020-11-07}, journal = {The Lancet}, volume = {396}, number = {10261}, pages = {1511-1524}, keywords = {Child Health, Non-Communicable Diseases, Nutrition}, pubstate = {published}, tppubtype = {article} } |
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Black RE, Liu L, Hartwig FP, Villavicencio F, Rodriguez-Martinez A, Vidaletti LP, Perin J, Black MM, Blencowe H, You D, Hug L, Masquelier B, Cousens S, Gove A, Vaivada T, Yeung D, Behrman J, Martorell R, Osmond C, Stein AD, Adair LS, Fall CHD, Horta B, Menezes AMB, Ramirez-Zea M, Richter LM, Patton GC, Bendavid E, Ezzati M, Bhutta ZA, Lawn JE, Victora CG Health and development from preconception to 20 years of age and human capital Lancet, 399 (10336), pp. 1730-1740, 2020. (Child Health, Non-Communicable Diseases) Child Health, Non-Communicable Diseases @article{RE2020,
title = {Health and development from preconception to 20 years of age and human capital}, author = {Black RE and Liu L and Hartwig FP and Villavicencio F and Rodriguez-Martinez A and Vidaletti LP and Perin J and Black MM and Blencowe H and You D and Hug L and Masquelier B and Cousens S and Gove A and Vaivada T and Yeung D and Behrman J and Martorell R and Osmond C and Stein AD and Adair LS and Fall CHD and Horta B and Menezes AMB and Ramirez-Zea M and Richter LM and Patton GC and Bendavid E and Ezzati M and Bhutta ZA and Lawn JE and Victora CG}, doi = {https://doi.org/10.1016/S0140-6736(21)02533-2}, year = {2020}, date = {2020-04-27}, journal = {Lancet}, volume = {399}, number = {10336}, pages = {1730-1740}, keywords = {Child Health, Non-Communicable Diseases}, pubstate = {published}, tppubtype = {article} } |
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2019 |
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Smith Fawzi MC, Andrews KG, Fink G, Danaei G, McCoy DC, Sudfeld CR, Peet ED, Cho J, Liu Y, Finlay JE, Ezzati M, Kaaya SF, Fawzi WW BMJ Global Health, 4 (1), pp. e001144, 2019. (Child Health, Health Inequalities, Nutrition) Child Health, Health Inequalities, Nutrition @article{MC2019,
title = {Lifetime economic impact of the burden of childhood stunting attributable to maternal psychosocial risk factors in 137 low/middle-income countries}, author = {Smith Fawzi MC and Andrews KG and Fink G and Danaei G and McCoy DC and Sudfeld CR and Peet ED and Cho J and Liu Y and Finlay JE and Ezzati M and Kaaya SF and Fawzi WW}, doi = {10.1136/bmjgh-2018-001144}, year = {2019}, date = {2019-01-10}, journal = {BMJ Global Health}, volume = {4}, number = {1}, pages = {e001144}, keywords = {Child Health, Health Inequalities, Nutrition}, pubstate = {published}, tppubtype = {article} } |
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2017 |
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Lee AC, Kozuki N, Cousens S, Stevens GA, Blencowe H, Silveira MF, Sania A, Rosen HE, Schmiegelow C, Adair LS, Baqui AH, Barros FC, Bhutta ZA, Caulfield LE, Christian P, Clarke SE, Fawzi W, Gonzalez R, Humphrey J, Huybregts L, Kariuki S, Kolsteren P, Lusingu J, Manandhar D, Mongkolchati A, Mullany LC, Ndyomugyenyi R, Nien JK, Roberfroid D, Saville N, Terlouw DJ, Tielsch JM, Victora CG, Velaphi SC, Watson-Jones D, Willey BA, Ezzati M, Lawn JE, Black RE, Katz J BMJ, 358 , pp. j3677, 2017. @article{AC2017b,
title = {Estimates of burden and consequences of infants born small for gestational age in low and middle income countries with INTERGROWTH-21st standard: analysis of CHERG datasets}, author = {Lee AC and Kozuki N and Cousens S and Stevens GA and Blencowe H and Silveira MF and Sania A and Rosen HE and Schmiegelow C and Adair LS and Baqui AH and Barros FC and Bhutta ZA and Caulfield LE and Christian P and Clarke SE and Fawzi W and Gonzalez R and Humphrey J and Huybregts L and Kariuki S and Kolsteren P and Lusingu J and Manandhar D and Mongkolchati A and Mullany LC and Ndyomugyenyi R and Nien JK and Roberfroid D and Saville N and Terlouw DJ and Tielsch JM and Victora CG and Velaphi SC and Watson-Jones D and Willey BA and Ezzati M and Lawn JE and Black RE and Katz J}, url = {http://www.bmj.com/content/358/bmj.j3677}, doi = {10.1136/bmj.j3677}, year = {2017}, date = {2017-08-17}, journal = {BMJ}, volume = {358}, pages = {j3677}, keywords = {Child Health, Nutrition}, pubstate = {published}, tppubtype = {article} } |
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Wylie BJ, Matechi E, Kishashu Y, Fawzi W, Premji Z, Coull BA, Hauser R, Ezzati M, Roberts D Environmental Health Perspectives, 125 (1), pp. 134-140, 2017. (Air Pollution & Climate, Child Health) Air Pollution & Climate, Child Health @article{BJ2017,
title = {Placental pathology associated with household air pollution in a cohort of pregnant women from Dar es Salaam, Tanzania}, author = {Wylie BJ and Matechi E and Kishashu Y and Fawzi W and Premji Z and Coull BA and Hauser R and Ezzati M and Roberts D}, url = {https://ehp.niehs.nih.gov/ehp256/}, doi = {10.1289/EHP256}, year = {2017}, date = {2017-01-01}, journal = {Environmental Health Perspectives}, volume = {125}, number = {1}, pages = {134-140}, keywords = {Air Pollution & Climate, Child Health}, pubstate = {published}, tppubtype = {article} } |
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Wylie BJ, Kishashu Y, Matechi E, Zhou Z, Coull B, Abioye AI, Dionisio KL, Mugusi F, Premji Z, Fawzi W, Hauser R, Ezzati M Indoor Air, 27 (1), pp. 136-146, 2017. (Air Pollution & Climate, Child Health) Air Pollution & Climate, Child Health @article{BJ2017b,
title = {Maternal exposure to carbon monoxide and fine particulate matter during pregnancy in an urban Tanzanian cohort}, author = {Wylie BJ and Kishashu Y and Matechi E and Zhou Z and Coull B and Abioye AI and Dionisio KL and Mugusi F and Premji Z and Fawzi W and Hauser R and Ezzati M}, url = {http://onlinelibrary.wiley.com/doi/10.1111/ina.12289/abstract}, doi = {10.1111/ina.12289}, year = {2017}, date = {2017-01-01}, journal = {Indoor Air}, volume = {27}, number = {1}, pages = {136-146}, keywords = {Air Pollution & Climate, Child Health}, pubstate = {published}, tppubtype = {article} } |
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2016 |
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Danaei G, Andrews KG, Sudfeld CR, Fink G, McCoy DC, Peet E, Sania A, Smith Fawzi MC, Ezzati M, Fawzi WW PLoS Medicine, 13 (11), pp. e1002164, 2016. @article{G2016,
title = {Risk factors for childhood stunting in 137 developing countries: a comparative risk assessment analysis at global, regional, and country levels}, author = {Danaei G and Andrews KG and Sudfeld CR and Fink G and McCoy DC and Peet E and Sania A and Smith Fawzi MC and Ezzati M and Fawzi WW}, url = {http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002164}, doi = {10.1371/journal.pmed.1002164}, year = {2016}, date = {2016-11-01}, journal = {PLoS Medicine}, volume = {13}, number = {11}, pages = {e1002164}, keywords = {Child Health, Nutrition}, pubstate = {published}, tppubtype = {article} } |
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