title: Prevalence of behavioural risk factors for cardiovascular disease in adolescents in low-income and middle-income countries: an individual participant data meta-analysis.
abstract: BACKGROUND
  Although overt manifestations of cardiovascular disease (CVD) rarely emerge before adulthood, CVD risk factors are often present in adolescents. However, the prevalence and magnitude of behavioural CVD risk factors in adolescents in low-income and middle-income countries remains unclear. We estimated the magnitude and co-occurrence of behavioural CVD risk factors in adolescents aged 12-15 years for 65 low-income and middle-income countries between 2003 and 2011.
  
  
  METHODS
  We extracted Global School-Based Student Health Surveys (GSHS) datasets from the Centers for Disease Control and Prevention (CDC) website. Pooled prevalence estimates of current tobacco use, alcohol use, low fruit and vegetable intake, low physical activity, obesity and co-occurrence of CVD risk factors for WHO regions and overall, was calculated with random-effects meta-analysis. We explored potential sources of heterogeneity for each CVD risk factor through random-effects meta-regression analysis.
  
  
  RESULTS
  Between 2003 and 2011, of 169 369 adolescents, 12·1% (95% CI 10·2-14·1) used tobacco, 15·7% (12·3-19·5) used alcohol, 74·3% (71·9 -76·5) had low fruit and vegetable intake, 71·4% (69·5-73·3) reported low physical activity and 7·1% (5·6-8·7) were obese. The pooled regional prevalence of exposure to three or more CVD risk factors was lowest in the southeast Asian region (3·8%, 95% CI 1·2-7·5) and highest in the western Pacific region (18·6%, 12·8-25·3). Substantial heterogeneities within and across regions were not fully explained by major study characteristics.
  
  
  CONCLUSIONS
  In low-income and middle-income countries, adolescents carry a substantial burden of behavioural CVD risk factors, which tend to co-occur. Surveillance, prevention, detection, and control initiatives are a global health priority.
  
  
  BACKGROUND
  None.
authors.affiliation: Ministry of Health and Quality of Life, Port Louis, Republic of Mauritius; MRC Unit for Lifelong Health and Ageing, University College London, London, UK; National Collaborating Centre for Women's and Children's Health, Royal College of Obstetricians and Gynaecologists, London, UK.
authors.forename: Rishi
authors.initials: R
authors.lastname: Caleyachetty
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA; Department of Medicine, MedStar Health, Baltimore, Maryland, USA.
authors.forename: Justin B
authors.initials: JB
authors.lastname: Echouffo-Tcheugui
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Canada.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Tait
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA.
authors.forename: Sam
authors.initials: S
authors.lastname: Schilsky
authors.affiliation: University of West Indies, Mona, Jamaica; The Liggins Institute, The University of Auckland, New Zealand; Department of Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Terrence
authors.initials: T
authors.lastname: Forrester
authors.affiliation: Department of Medicine, University of Cape Town, Cape Town, South Africa; Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa; The George Institute for Global Health, Sydney, Australia; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: andre.kengne@mrc.ac.za.
authors.forename: Andre P
authors.initials: AP
authors.lastname: Kengne
mesh_terms: D000293:Adolescent; D000428:Alcohol Drinking / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002648:Child; D003906:Developing Countries / Q000706:statistics & numerical data; D005247:Feeding Behavior; D005260:Female; D014943:Global Health; D006801:Humans; D008297:Male; D009043:Motor Activity; D009765:Obesity / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D012959:Socioeconomic Factors; D064424:Tobacco Use / Q000453:epidemiology