RF12 | PSUN117 Sex-Specific Obesity and Cardiometabolic Disease Risks In Low- and Middle-Income Countries: A Meta-Analysis Involving 2,624,289 Individuals
Authors: Rocha Thais , Melson Eka , Zamora Javier , Fernandez-Felix Borja , Arlt Wiebke , Thangaratinam Shakila 
Published: November 2022

Abstract

Background
Obesity is a leading cause of preventable deaths from cardiometabolic diseases worldwide. About two-thirds of all individuals with obesity live in low- and middle-income countries (LMICs), facing an epidemiological transition from predominantly infectious to non-communicable diseases burden. The magnitude of sex-related disparities in the risk of obesity and cardiometabolic diseases in LMICs, and if these vary by region, country's income status, setting, and time is unclear. We undertook a systematic review and meta-analysis to assess the magnitude of sex-specific disparities in the prevalence of obesity and cardiometabolic diseases in LMICs, their burden on women, and variations by region, country's income status, setting, and time.

Methods
We searched MEDLINE and EMBASE (from inception to September 2021). Two independent reviewers selected the studies, assessed their quality, and performed data extraction. We used a random-effects model to obtain pooled estimates of odds ratios and 95% confidence interval (95%CI) for the association between sex and obesity and cardiometabolic diseases and rates of relevant outcomes.

Results
We included 287 studies (2,624,289 individuals). The risk of obesity was 2.72-fold (OR 2.72, 95% CI 2.54-2.91) higher in women than men, independent of age. The sex-specific disparities varied by World Bank region, with the greatest difference in Sub-Saharan Africa (OR 3.70, 95% CI 2.25-6.08), but it did not vary by the country's income status, setting, or overtime. There were no differences between the sexes in the type 2 diabetes or hypertension rates. Amongst women in LMICs, 22% (95% CI 0.20-0.24) had obesity, 27% (95% CI 0.24-0.30) hypertension, and 7% (95% CI 0.06-0.09) type 2 diabetes. The rates of obesity, hypertension and type 2 diabetes in women varied by region and country's income status, with the highest rates in the Middle East and North-Africa, and in upper-middle-income countries; obesity and type 2 diabetes rates were highest in urban settings. The odds of hypertension (OR 2.43, 95% CI 2.9-2.80) and type 2 diabetes (OR 2.84, 95% CI 2.16-3·74) were doubled in women with vs without obesity.

Conclusions
Women are disproportionately affected by obesity compared to men in LMICs, with the greatest disparity observed in the Sub-Saharan region. Obesity rates were consistently higher in women than men irrespective of the country's income status (low, low-middle, upper-middle), setting (rural, urban) or overtime. Amongst women, obesity and cardiometabolic diseases prevalence vary by World Bank region and country's income status. Obesity doubles the risk of hypertension and type 2 diabetes in women in LMICs. Our findings call for urgent sex-specific and region-stratified actions targeting obesity awareness, prevention, treatment, and control in women in LMICs. Implementing cost-effective and sustainable programmes specific to women and addressing obesity's burden should be an urgent public health priority in LMICs.
Presentation: Saturday, June 11, 2022 1:12 p.m. - 1:17 p.m., Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.