title: Trend, projection, and appropriate body mass index cut-off point for diabetes and hypertension in Bangladesh.
abstract: BACKGROUND
  Rapid increasing of high body mass index (BMI) is a global health concern. Population with high BMI predicts an increased risk of diabetes and hypertension. The objective of the present study is to estimate the trend and prediction of diabetes and hypertension in Bangladesh, to examine the association of BMI with risk of diabetes and hypertension, and to ascertain an appropriate BMI cut-off point for screening diabetes.
  
  
  METHODS
  We searched PubMed from inception to August 2016 and identified studies reporting diabetes and hypertension prevalence in Bangladesh. Bangladesh Demographic and Health Survey 2011 data was also included in this study. Bayesian model was used to estimate trend and projection in diabetes and hypertension prevalence by sex and residence. Receiver operating characteristic curves was used to determine the optimal BMI cut-off point for screening diabetes.
  
  
  RESULTS
  Of 535 articles reviewed, 35 studies reported prevalence of diabetes and hypertension. Prevalence of diabetes (95% credible interval) increased between 1992 and 2015 from 3.2% (2.2-4.3) to 12.1% (9.1-15.4) in men, and from 2.5% (1.8-3.5) to 13.4% (9.7-17.6) in women. Diabetes prevalence in 2030 is expected to reach 23.6% (13.6-36.3) for men and 33.5% (19.9-50.9) for women. Hypertension prevalence increased between 1992 and 2015 from 11.0% (8.6-13.7) to 20.4% (18.4-22.4%) in 2015 in men, and from 14.0% (10.3-19.0) to 21.3% (19.0-23.6) in women. Annual average rate of change for diabetes prevalence was higher among women and in rural areas, while for hypertension prevalence it was higher in men and urban areas. Adults with BMI of 22.5kg/m2or above had a higher risk of diabetes and hypertension in this study. The optimal BMI cut-off point for screening diabetes was 23kg/m2for overall population, 22kg/m2for men, and 23kg/m2for women.
  
  
  CONCLUSIONS
  Diabetes is more prevalent among women and rural population groups, while hypertension is more prevalent among men and urban population groups in Bangladesh. A BMI of 22.5kg/m2or more is risk factors for developing diabetes and hypertension. Screening for diabetes may be considered for all Bangladeshi adults with a BMI of ⩾23kg/m2.
authors.affiliation: Department of Global Health Policy, The University of Tokyo, Tokyo, Japan; Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh. Electronic address: mizanur_rub@yahoo.com.
authors.forename: Md Mizanur
authors.initials: MM
authors.lastname: Rahman
authors.affiliation: Department of Epidemiology and Prevention, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Shamima
authors.initials: S
authors.lastname: Akter
authors.affiliation: Department of Global Health Policy, The University of Tokyo, Tokyo, Japan.
authors.forename: Jenny
authors.initials: J
authors.lastname: Jung
authors.affiliation: Department of Global Health Policy, The University of Tokyo, Tokyo, Japan.
authors.forename: Md Shafiur
authors.initials: MS
authors.lastname: Rahman
authors.affiliation: Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh.
authors.forename: Papia
authors.initials: P
authors.lastname: Sultana
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001459:Bangladesh / Q000453:epidemiology; D015992:Body Mass Index; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D003940:Diagnostic Techniques, Endocrine / Q000592:standards* / Q000639:trends*; D005260:Female; D005544:Forecasting; D006306:Health Surveys; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000453:epidemiology; D056865:Ideal Body Weight; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000592:standards / Q000639:trends; D008875:Middle Aged; D009765:Obesity / Q000175:diagnosis* / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D012016:Reference Values; D012307:Risk Factors; D012424:Rural Population; D014505:Urban Population
keywords: BMI cut point; Bangladesh; Bayesian regression model; Diabetes; Hypertension; Projection