Correspondence

2 Okorodudu DO, Jumean MF, Montori VM, et al. population vary on the basis of the
Diagnostic performance of body mass index to
identify obesity as defined by body adiposity:
specific adiposity metric used should
a systematic review and meta-analysis. be explored in large, global databases,
Int J Obes (Lond) 2010; 34: 791–99. such as those used by the NCD Risk
3 Reilly JJ, Kelly J, Wilson DC. Accuracy of simple
clinical and epidemiological definitions of Factor Collaboration,3,4 as has been
childhood obesity: systematic review and done for diabetes.5
evidence appraisal. Obes Rev 2010; 11: 645–55.
ME reports a charitable grant from AstraZeneca
4 Javed A, Jumean M, Murad MH, et al.
Diagnostic performance of body mass index to Young Health Programme and personal fees from
identify obesity as defined by body adiposity in Scor and Third Bridge, all outside the submitted work.
children and adolescents: a systematic review All other authors declare no competing interests.
and meta-analysis. Pediatr Obes 2015;
10: 234–44. *Majid Ezzati, Mariachiara Di Cesare,
5 Hruschka DJ, Hadley C. How much do universal James Bentham
anthropometric standards bias the global majid.ezzati@imperial.ac.uk
monitoring of obesity and undernutrition?
Obes Rev 2016; 17: 1030–39. School of Public Health, Imperial College London,
London W2 1PG, UK (ME); Middlesex University
London, London, UK (MDC); and University of Kent,
Authors’ reply Canterbury, UK (JB)
Although different measures of 1 Okorodudu DO, Jumean MF, Montori VM, et al.
adiposity might differentially classify Diagnostic performance of body mass index to
identify obesity as defined by body adiposity:
people as overweight or obese, studies a systematic review and meta-analysis.
that have compared body-mass index Int J Obes (Lond) 2010; 34: 791–99.
(BMI) with other measures of adiposity 2 Huxley R, Mendis S, Zheleznyakov E, Reddy S,
Chan J. Body mass index, waist circumference
have found that, at higher BMIs (eg, and waist:hip ratio as predictors of
30 kg/m² and above), classification cardiovascular risk—a review of the literature.
Eur J Clin Nutr 2010; 64: 16–22.
using BMI gives similar results to 3 NCD Risk Factor Collaboration (NCD-RisC).
other approaches, such as dual-energy Trends in adult body-mass index in 200
x-ray absorptiometry.1 More broadly, countries from 1975 to 2014: a pooled analysis
of 1698 population-based measurement
in selecting risk factor metrics for studies with 19·2 million participants. Lancet
population health reporting, two other 2016; 387: 1377–96.
4 NCD Risk Factor Collaboration (NCD-RisC).
issues should be kept in mind. Worldwide trends in body-mass index,
First, it is important to consider underweight, overweight, and obesity from
how different metrics represent the 1975 to 2016: a pooled analysis of 2416
population-based measurement studies in
health consequences of risk factors. 128·9 million children, adolescents, and
For example, a systematic review2 adults. Lancet 2017; 390: 2627–42.
5 NCD Risk Factor Collaboration (NCD-RisC).
of epidemiological studies reported Effects of diabetes definition on global
that, taken together, studies that surveillance of diabetes prevalence and
Department of Error
assessed BMI and other measures diagnosis: a pooled analysis of
96 population-based studies with 331,288 Stephenson J, Heslehurst N, Hall J, et al. Before the
of adiposity did not show that any participants. Lancet Diabetes Endocrinol 2015; beginning: nutrition and lifestyle in the
of these measures had superior 3: 624–37.
preconception period and its importance for
discriminatory capability for adverse future health. Lancet 2018; 391: 1830–41—
In figure 1 of this Series paper (published
cardiometabolic outcomes; any
online first on April 16, 2018), definitions for
reported difference was “too small to the use of * and † symbols were added to the
be of any clinical relevance”. legend. This correction has been made to the
Second, to be useful for population online version as of May 3, 2018, and the
printed Series paper is correct.
health surveillance, data should be
readily available through population- Global Burden of Disease Health Financing
Collaborator Network. Trends in future health
based surveys. Height and weight financing and coverage: future health spending
can be measured in population- and universal health coverage in 188 countries,
based surveys, whereas methods like 2016–40. Lancet 2018; 391: 1783–98—
In table 2 of this Article, a digit was mistakenly
dual-energy x-ray absorptiometry
omitted from after the decimal point in the
are too complex for use, even in a value for universal health coverage index in
clinical setting. high-income countries in 2030 under the
worse scenario. This correction has been made
Nonetheless, to the extent that data
to the online version as of May 3, 2018, and
are available, how the classification the printed version is correct.
of individuals and prevalence in the

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