Pooled Analysis and Writing (*equal contribution; listed alphabetically)— Goodarz Danaei (Harvard T H Chan School of Public Health, USA)*; Saman Fahimi (Harvard T H Chan School of Public Health, USA)*; Yuan Lu (Harvard T H Chan School of Public Health, USA)*; Bin Zhou (Imperial College London, UK)*; Kaveh Hajifathalian (Harvard T H Chan School of Public Health, USA); Mariachiara Di Cesare (Imperial College London, UK); Wei-Cheng Lo (National Taiwan University, Taiwan); Barbara Reis-Santos (Universidade Federal de Pelotas, Brazil); Melanie J Cowan (World Health Organization, Switzerland); Jonathan E Shaw (Baker IDI Heart and Diabetes Institute, Australia); James Bentham (Imperial College London, UK); John K Lin (University of California San Francisco, USA); Honor Bixby (Imperial College London, UK); Dianna Magliano (Baker IDI Heart and Diabetes Institute, Australia); Pascal Bovet (University of Lausanne, Switzerland; Ministry of Health, Seychelles); J Jaime Miranda (Universidad Peruana Cayetano Heredia, Peru); Young-Ho Khang (Seoul National University, South Korea); Gretchen A Stevens (World Health Organization, Switzerland); Leanne M Riley (World Health Organization, Switzerland); Mohammed K Ali (Emory University, USA); Majid Ezzati (Imperial College London, UK). Country and Regional Data (*equal contribution; listed alphabetically)— Ziad A Abdeen (Al-Quds University, Palestine)*; Khalid Abdul Kadir (Monash University Malaysia, Malaysia)*; Niveen M Abu-Rmeileh (Birzeit University, Palestine)*; Benjamin Acosta-Cazares (Instituto Mexicano del Seguro Social, Mexico)*; Wichai Aekplakorn (Mahidol University, Thailand)*; Carlos A Aguilar-Salinas (Instituto Nacional de Ciencias Médicas y Nutricion, Mexico)*; Alireza Ahmadvand (Tehran University of Medical Sciences, Iran)*; Mohannad Al Nsour (Eastern Mediterranean Public Health Network, Jordan)*; Ala’a Alkerwi (Luxembourg Health Institute, Luxembourg)*; Philippe Amouyel (Lille University and Hospital, France)*; Lars Bo Andersen (University of Southern Denmark, Denmark)*; Sigmund A Anderssen (Norwegian School of Sport Sciences, Norway)*; Dolores S Andrade (Universidad de Cuenca, Ecuador)*; Ranjit Mohan Anjana (Madras Diabetes Research Foundation, India)*; Hajer Aounallah-Skhiri (National Institute of Public Health, Tunisia)*; Tahir Aris (Ministry of Health Malaysia, Malaysia)*; Nimmathota Arlappa (Indian Council of Medical Research, India)*; Dominique Arveiler (Strasbourg University and Hospital, France)*; Fel ix K Assah (Health of Populations in Transition Research Group, Cameroon)*; Mária Avdicová (Regional Authority of Public Health, Banska Bystrica, Slovakia)*; Nagalla Balakrishna (Indian Council of Medical Research, India)*; Piotr Bandosz (Medical University of Gdansk, Poland)*; Carlo M Barbagallo (University of Palermo, Italy)*; Alberto Barceló (Pan American Health Organization, USA)*; Anwar M Batieha (Jordan University of Science and Technology, Jordan)*; Louise A Baur (University of Sydney, Australia)*; Habiba Ben Romdhane (University Tunis El Manar, Tunisia)*; Antonio Bernabe-Ortiz (Universidad Peruana Cayetano Heredia, Peru)*; Santosh K Bhargava (Sunder Lal Jain Hospital, India)*; Yufang Bi (Shanghai Jiao-Tong University School of Medicine, China)*; Peter Bjerregaard (University of Southern Denmark, Denmark; University of Greenland, Greenland)*; Cecilia Björkelund (University of Gothenburg, Sweden)*; Margaret Blake (NatCen Social Research, UK)*; Anneke Blokstra (National Institute for Public Health and the Environment, Netherlands)*; Simona Bo (University of Turin, Italy)*; Bernhard O Boehm (Nanyang Technological University, Singapore)*; Carlos P Boissonnet (Centro de Educación Médica e Investigaciones Clínicas, Argentina)*; Pascal Bovet (University of Lausanne, Switzerland; Ministry of Health, Seychelles)*; Imperia Brajkovich (Universidad Central de Venezuela, Venezuela)*; Juergen Breckenkamp (Bielefeld University, Germany)*; Lizzy M Brewster (University of Amsterdam, Netherlands)*; Garry R Brian (The Fred Hollows Foundation New Zealand, New Zealand)*; Graziella Bruno (University of Turin, Italy)*; Anna Bugge (University of Southern Denmark, Denmark)*; Antonio Cabrera de León (Canarian Health Service, Spain)*; Gunay Can (Istanbul University, Turkey)*; Ana Paula C Cândido (Universidade Federal de Juiz de Fora, Brazil)*; Vincenzo Capuano (Reparto di Cardiologia ed UTIC di Mercato S., Italy)*; Maria J Carvalho (University of Porto, Portugal)*; Felipe F Casanueva (Santiago de Compostela University, Spain)*; Carmelo A Caserta (Associazione Calabrese di Epatologia, Italy)*; Katia Castetbon (French Institute for Health Surveillance, France)*; Snehalatha Chamukuttan (India Diabetes Research Foundation, India)*; Nishi Chaturvedi (University College London, UK)*; Chien-Jen Chen (Academia Sinica, Taiwan)*; Fangfang Chen (Capital Institute of Pediatrics, China)*; Shuohua Chen (Kailuan General Hospital, China)*; Ching-Yu Cheng (Duke-NUS Graduate Medical School, Singapore)*; Angela Chetrit (The Gertner Institute for Epidemiology and Health Policy Research, Israel)*; Shu-Ti Chiou (Ministry of Health and Welfare, Taiwan)*; Yumi Cho (Korea Centers for Disease Control and Prevention, South Korea)*; Jerzy Chudek (Medical University of Silesia, Poland)*; Renata Cifkova (Charles University in Prague, Czech Republic)*; Frank Claessens (Katholieke Universiteit Leuven, Belgium)*; Hans Concin (Agency for Preventive and Social Medicine, Austria)*; Cyrus Cooper (University of Southampton, UK)*; Rachel Cooper (University College London, UK)*; Simona Costanzo (IRCCS Istituto Neurologico Mediterraneo Neuromed, Italy)*; Dominique Cottel (Institut Pasteur de Lille, France)*; Chris Cowell (Westmead University of Sydney, Australia)*; Ana B Crujeiras (CIBERobn, Spain)*; Graziella D’Arrigo (National Research Council, Italy)*; Jean Dallongeville (Institut Pasteur de Lille, France)*; Rachel Dankner (The Gertner Institute for Epidemiology and Health Policy Research, Israel)*; Luc Dauchet (Lille University Hospital, France)*; Giovanni de Gaetano (IRCCS Istituto Neurologico Mediterraneo Neuromed, Italy)*; Stefaan De Henauw (Ghent University, Belgium)*; Mohan Deepa (Madras Diabetes Research Foundation, India)*; Abbas Dehghan (University Medical Center Rotterdam, Netherlands)*; Klodian Dhana (University Medical Center Rotterdam, Netherlands)*; Augusto F Di Castelnuovo (IRCCS Istituto Neurologico Mediterraneo Neuromed, Italy)*; Shirin Djalalinia (Tehran University of Medical Sciences, Iran)*; Kouamelan Doua (Ministère de la Santé et de la Lutte contre le Sida, Côte d’Ivoire)*; Wojciech Drygas (The Cardinal Wyszynski Institute of Cardiology, Poland)*; Yong Du (Robert Koch Institute, Germany)*; Eruke E Egbagbe (University of Benin College of Medical Sciences, Nigeria)*; Robert Eggertsen (University of Gothenburg, Sweden)*; Jalila El Ati (National Institute of Nutrition and Food Technology, Tunisia)*; Roberto Elosua (Institut Hospital del Mar d’Investigacions Mèdiques, Spain)*; Rajiv T Erasmus (University of Stellenbosch, South Africa)*; Cihangir Erem (Karadeniz Technical University, Turkey)*; Gul Ergor (Dokuz Eylul University, Turkey)*; Louise Eriksen (University of Southern Denmark, Denmark)*; Jorge Escobedo-de la Peña (Instituto Mexicano del Seguro Social, Mexico)*; Caroline H Fall (MRC Lifecourse Epidemiology Unit, UK)*; Farshad Farzadfar (Tehran University of Medical Sciences, Iran)*; Francisco J Felix-Redondo (Centro de Salud Villanueva Norte, Spain)*; Trevor S Ferguson (The University of the West Indies, Jamaica)*; Daniel Fernández-Bergés (Hospital Don Benito-Villanueva de la Serena, Spain)*; Marika Ferrari (National Research Institute on Food and Nutrition, Italy)*; Catterina Ferreccio (Pontifi cia Universidad Católica de Chile, Chile)*; Joseph D Finn (University of Manchester, UK)*; Bernhard Föger (Agency for Preventive and Social Medicine, Austria)*; Leng Huat Foo (Universiti Sains Malaysia, Malaysia)*; Heba M Fouad (World Health Organization Regional Offi ce for the Eastern Mediterranean, Egypt)*; Damian K Francis (The University of the West Indies, Jamaica)*; Maria do Carmo Franco (Federal University of São Paulo, Brazil)*; Oscar H Franco (University Medical Center Rotterdam, Netherlands)*; Guillermo Frontera (Hospital Universitario Son Espases, Spain)*; Takuro Furusawa (Kyoto University, Japan)*; Zbigniew Gaciong (Medical University of Warsaw, Poland)*; Andrzej Galbarczyk (Jagiellonian University Medical College, Poland)*; Sarah P Garnett (University of Sydney, Australia)*; Jean-Michel Gaspoz (Geneva University Hospitals, Switzerland)*; Magda Gasull (CIBER en Epidemiología y Salud Pública, Spain)*; Louise Gates (Australian Bureau of Statistics, Australia)*; Johanna M Geleijnse (Wageningen University, Netherlands)*; Anoosheh Ghasemain (Tehran University of Medical Sciences, Iran)*; Simona Giampaoli (Istituto Superiore di Sanita, Italy)*; Francesco Gianfagna (University of Insubria, Italy)*; Jonathan Giovannelli (Lille University Hospital, France)*; Marcela Gonzalez Gross (Universidad Politécnica de Madrid, Spain)*; Juan P González Rivas (The Andes Clinic of Cardio-Metabolic Studies, Venezuela)*; Mariano Bonet Gorbea (National Institute of Hygiene, Epidemiology and Microbiology, Cuba)*; Frederic Gottrand (Université de Lille 2, France)*; Janet F Grant (The University of Adelaide, Australia)*; Tomasz Grodzicki (Jagiellonian University Medical College, Poland)*; Anders Grøntved (University of Southern Denmark, Denmark)*; Grabriella Gruden (University of Turin, Italy)*; Dongfeng Gu (National Center of Cardiovascular Diseases, China)*; Ong Peng Guan (Singapore Eye Research Institute, Singapore)*; Ramiro Guerrero (Universidad Icesi, Colombia)*; Idris Guessous (Geneva University Hospitals, Switzerland)*; Andre L Guimaraes (State University of Montes Claros, Brazil)*; Laura Gutierrez (Institute for Clinical Eff ectiveness and Health Policy, Argentina)*; Rebecca Hardy (University College London, UK)*; Rachakulla Hari Kumar (Indian Council of Medical Research, India)*; Jiang He (Tulane University, USA)*; Christin Heidemann (Robert Koch Institute, Germany)*; Ilpo Tapani Hihtaniemi (Imperial College London, UK)*; Sai Yin Ho (University of Hong Kong, China)*; Suzanne C Ho (The Chinese University of Hong Kong, China)*; Albert Hofman (University Medical Center Rotterdam, Netherlands)*; Andrea R V Russo Horimoto (Heart Institute, Brazil)*; Claudia M Hormiga (Fundación Oftalmológica de Santander, Colombia)*; Bernardo L Horta (Universidade Federal de Pelotas, Brazil)*; Leila Houti (University of Oran 1, Algeria)*; Abdullatif S Hussieni (Birzeit University, Palestine)*; Inge Huybrechts (International Agency for Research on Cancer, France)*; Nahla Hwalla (American University of Beirut, Lebanon)*; Licia Iacoviello (IRCCS Istituto Neurologico Mediterraneo Neuromed, Italy)*; Anna G Iannone (Reparto di Cardiologia ed UTIC di Mercato S., Italy)*; Mohsen M Ibrahim (Cairo University, Egypt)*; Nayu Ikeda (National Institute of Health and Nutrition, Japan)*; M Arfan Ikram (University Medical Center Rotterdam, Netherlands)*; Vilma E Irazola (Institute for Clinical Eff ectiveness and Health Policy, Argentina)*; Muhammad Islam (Aga Khan University, Pakistan)*; Masanori Iwasaki (Niigata University, Japan)*; Jeremy M Jacobs (Hadassah University Medical Center, Israel)*; Tazeen Jafar (Duke-NUS Graduate Medical School, Singapore)*; Grazyna Jasienska (Jagiellonian University Medical College, Poland)*; Chao Qiang Jiang (University of Hong Kong, China)*; Jost B Jonas (Ruprecht-Karls-University of Heidelberg, Germany)*; Pradeep Joshi (World Health Organization Country Offi ce, India)*; Anthony Kafatos (University of Crete, Greece)*; Ofra Kalter-Leibovici (The Gertner Institute for Epidemiology and Health Policy Research, Israel)*; Amir Kasaeian (Tehran University of Medical Sciences, Iran)*; Joanne Katz (Johns Hopkins Bloomberg School of Public Health, USA)*; Prabhdeep Kaur (National Institute of Epidemiology, India)*; Maryam Kavousi (University Medical Center Rotterdam, Netherlands)*; Roya Kelishadi (Isfahan University of Medical Sciences, Iran)*; Andre P Kengne (South African Medical Research Council, South Africa)*; Mathilde Kersting (Research Institute of Child Nutrition, Germany)*; Yousef Saleh Khader (Jordan University of Science and Technology, Jordan)*; Young-Ho Khang (Seoul National University, South Korea)*; Stefan Kiechl (Medical University Innsbruck, Austria)*; Jeongseon Kim (National Cancer Center, South Korea)*; Yutaka Kiyohara (Kyushu University, Japan)*; Patrick Kolsteren (Institute of Tropical Medicine, Belgium)*; Paul Korrovits (Tartu University Clinics, Estonia)*; Seppo Koskinen (National Institute for Health and Welfare, Finland)*; Wolfgang Kratzer (University Hospital Ulm, Germany)*; Daan Kromhout (Wageningen University, Netherlands)*; Krzysztof Kula (Medical University of Łodz, Poland)*; Pawel Kurjata (The Cardinal Wyszynski Institute of Cardiology, Poland)*; Catherine Kyobutungi (African Population and Health Research Center, Kenya)*; Carl Lachat (Ghent University, Belgium)*; Youcef Laid (National Institute of Public Health, Algeria)*; Tai Hing Lam (University of Hong Kong, China)*; Orlando Landrove (Ministerio de Salud Pública, Cuba)*; Vera Lanska (Institute for Clinical and Experimental Medicine Prague, Czech Republic)*; Georg Lappas (Sahlgrenska Academy, Sweden)*; Avula Laxmaiah (Indian Council of Medical Research, India)*; Catherine Leclercq (Food and Agriculture Organization, Italy)*; Jeannette Lee (National University of Singapore, Singapore)*; Jeonghee Lee (National Cancer Center, South Korea)*; Terho Lehtimäki (Tampere University Hospital, Finland)*; Rampal Lekhraj (Universiti Putra Malaysia, Malaysia)*; Luz M León-Muñoz (Universidad Autónoma de Madrid, Spain)*; Yanping Li (Harvard T H Chan School of Public Health, USA)*; Wei-Yen Lim (National University of Singapore, Singapore)*; M Fernanda Lima-Costa (Oswaldo Cruz Foundation Rene Rachou Research Institute, Brazil)*; Hsien-Ho Lin (National Taiwan University, Taiwan)*; Xu Lin (University of Chinese Academy of Sciences, China)*; Lauren Lissner (University of Gothenburg, Sweden)*; Roberto Lorbeer (University Medicine Greifswald, Germany)*; José Eugenio Lozano (Consejería de Sanidad Junta de Castilla y León, Spain)*; Annamari Lundqvist (National Institute for Health and Welfare, Finland)*; Per Lytsy (University of Uppsala, Sweden)*; Guansheng Ma (Peking University, China)*; George L L Machado-Coelho (Universidade Federal de Ouro Preto, Brazil)*; Suka Machi (The Jikei University School of Medicine, Japan)*; Stefania Maggi (National Research Council, Italy)*; Dianna Magliano (Baker IDI Heart and Diabetes Institute, Australia)*; Marcia Makdisse (Hospital Israelita Albert Einstein, Brazil)*; Kodavanti Mallikharjuna Rao (Indian Council of Medical Research, India)*; Yannis Manios (Harokopio University of Athens, Greece)*; Enzo Manzato (University of Padova, Italy)*; Paula Margozzini (Pontifi cia Universidad Católica de Chile, Chile)*; Pedro Marques-Vidal (Lausanne University Hospital, Switzerland)*; Reynaldo Martorell (Emory University, USA)*; Shariq R Masoodi (Sher-i-Kashmir Institute of Medical Sciences, India)*; Tandi E Matsha (Cape Peninsula University of Technology, South Africa)*; Jean Claude N Mbanya (University of Yaoundé 1, Cameroon)*; Shelly R McFarlane (The University of the West Indies, Jamaica)*; Stephen T McGarvey (Brown University, USA)*; Stela McLachlan (University of Edinburgh, UK)*; Breige A McNulty (University College Dublin, Ireland)*; Sounnia Mediene-Benchekor (University of Oran 1, Algeria)*; Aline Meirhaeghe (INSERM, France)*; Ana Maria B Menezes (Universidade Federal de Pelotas, Brazil)*; Shahin Merat (Tehran University of Medical Sciences, Iran)*; Indrapal I Meshram (Indian Council of Medical Research, India)*; Jie Mi (Capital Institute of Pediatrics, China)*; Juan Francisco Miquel (Pontifi cia Universidad Católica de Chile, Chile)*; J Jaime Miranda (Universidad Peruana Cayetano Heredia, Peru)*; Mostafa K Mohamed (Ain Shams University, Egypt)*; Kazem Mohammad (Tehran University of Medical Sciences, Iran)*; Viswanathan Mohan (Madras Diabetes Research Foundation, India)*; Muhammad Fadhli Mohd Yusoff (Ministry of Health Malaysia, Malaysia)*; Niels C Møller (University of Southern Denmark, Denmark)*; Denes Molnar (University of Pécs, Hungary)*; Charles K Mondo (Mulago Hospital, Uganda)*; Luis A Moreno (Universidad de Zaragoza, Spain)*; Karen Morgan (PU-RCSI School of Medicine, Malaysia)*; George Moschonis (Harokopio University of Athens, Greece)*; Malgorzata Mossakowska (International Institute of Molecular and Cell Biology, Poland)*; Aya Mostafa (Ain Shams University, Egypt)*; Jorge Mota (University of Porto, Portugal)*; Maria L Muiesan (University of Brescia, Italy)*; Martina Müller-Nurasyid (Helmholtz Zentrum München, Germany)*; Jaakko Mursu (University of Eastern Finland, Finland)*; Gabriele Nagel (University of Ulm, Germany)*; Jana Námešná (Regional Authority of Public Health, Banska Bystrica, Slovakia)*; Ei Ei K Nang (National University of Singapore, Singapore)*; Vinay B Nangia (Suraj Eye Institute, India)*; Eva Maria Navarrete-Muñoz (CIBER de Epidemiología y Salud Pública, Spain)*; Ndeye Coumba Ndiaye (INSERM, France)*; Flavio Nervi (Pontifi cia Universidad Católica de Chile, Chile)*; Nguyen D Nguyen (University of Pharmacy and Medicine of Ho Chi Minh City, Vietnam)*; Ramfi s E Nieto-Martínez (Universidad Centro-Occidental Lisandro Alvarado, Venezuela)*; Guang Ning (Shanghai Jiao-Tong University School of Medicine, China)*; Toshiharu Ninomiya (Kyushu University, Japan)*; Marianna Noale (National Research Council, Italy)*; Davide Noto (University of Palermo, Italy)*; Angélica M Ochoa-Avilés (Universidad de Cuenca, Ecuador)*; Kyungwon Oh (Korea Centers for Disease Control and Prevention, South Korea)*; Altan Onat (Istanbul University, Turkey)*; Clive Osmond (MRC Lifecourse Epidemiology Unit, UK)*; Johanna A Otero (Fundación Oftalmológica de Santander, Colombia)*; Luigi Palmieri (Istituto Superiore di Sanita, Italy)*; Songhomitra Panda-Jonas (Ruprecht-Karls-University of Heidelberg, Germany)*; Francesco Panza (Unversity of Bari, Italy)*; Mahboubeh Parsaeian (Tehran University of Medical Sciences, Iran)*; Sergio Viana Peixoto (Oswaldo Cruz Foundation Rene Rachou Research Institute, Brazil)*; Alexandre C Pereira (Heart Institute, Brazil)*; Annette Peters (Helmholtz Zentrum München, Germany)*; Niloofar Peykari (Tehran University of Medical Sciences, Iran)*; Aida Pilav (Federal Ministry of Health, Bosnia and Herzegovina)*; Freda Pitakaka (University of New South Wales, Australia)*; Aleksandra Piwonska (The Cardinal Wyszynski Institute of Cardiology, Poland)*; Jerzy Piwonski (The Cardinal Wyszynski Institute of Cardiology, Poland)*; Pedro Plans-Rubió (Public Health Agency of Catalonia, Spain)*; Miquel Porta (Hospital del Mar Medical Research Institute-IMIM, Spain)*; Marileen L P Portegies (University Medical Center Rotterdam, Netherlands)*; Hossein Poustchi (Tehran University of Medical Sciences, Iran)*; Rajendra Pradeepa (Madras Diabetes Research Foundation, India)*; Jacqueline F Price (University of Edinburgh, UK)*; Margus Punab (Tartu University Clinics, Estonia)*; Radwan F Qasrawi (Al-Quds University, Palestine)*; Mostafa Qorbani (Alborz University of Medical Sciences, Iran)*; Olli Raitakari (University of Turku, Finland)*; Sudha Ramachandra Rao (National Institute of Epidemiology, India)*; Ambady Ramachandran (India Diabetes Research Foundation, India)*; Rafel Ramos (Institut Universitari d’Investigació en Atenció Primària Jordi Gol, Spain)*; Sanjay Rampal (University of Malaya, Malaysia)*; Wolfgang Rathmann (German Diabetes Center, Germany)*; Josep Redon (University of Valencia, Spain)*; Paul Ferdinand M Reganit (University of the Philippines, Philippines)*; Fernando Rigo (Health Center San Agustin, Spain)*; Sian M Robinson (University of Southampton, UK)*; Cynthia Robitaille (Public Health Agency of Canada, Canada)*; Laura A Rodríguez (Universidad Industrial de Santander, Colombia)*; Fernando Rodríguez-Artalejo (Universidad Autónoma de Madrid, Spain)*; María del Cristo Rodriguez-Perez (Canarian Health Service, Spain)*; Rosalba Rojas-Martinez (Instituto Nacional de Salud Pública, Mexico)*; Dora Romaguera (Centre for Research in Environmental Epidemiology, Spain)*; Annika Rosengren (Sahlgrenska Academy, Sweden)*; Adolfo Rubinstein (Institute for Clinical Eff ectiveness and Health Policy, Argentina)*; Ornelas Rui (University of Madeira, Portugal)*; Blanca Sandra Ruiz-Betancourt (Instituto Mexicano del Seguro Social, Mexico)*; Marcin Rutkowski (Medical University of Gdansk, Poland)*; Charumathi Sabanayagam (Singapore Eye Research Institute, Singapore)*; Harshpal S Sachdev (Sitaram Bhartia Institute of Science and Research, India)*; Olfa Saidi (University Tunis El Manar, Tunisia)*; Sibel Sakarya (Marmara University, Turkey)*; Benoit Salanave (French Institute for Health Surveillance, France)*; Jukka T Salonen (University of Helsinki, Finland)*; Massimo Salvetti (University of Brescia, Italy)*; Jose Sánchez-Abanto (National Institute of Health, Peru)*; Renata Nunes dos Santos (University of São Paulo, Brazil)*; Rute Santos (University of Porto, Portugal)*; Luis B Sardinha (Universidade de Lisboa, Portugal)*; Marcia Scazufca (University of São Paulo, Brazil)*; Herman Schargrodsky (Hospital Italiano de Buenos Aires, Argentina)*; Christa Scheidt-Nave (Robert Koch Institute, Germany)*; Jonathan E Shaw (Baker IDI Heart and Diabetes Institute, Australia)*; Kenji Shibuya (The University of Tokyo, Japan)*; Youchan Shin (Singapore Eye Research Institute, Singapore)*; Rahman Shiri (Finnish Institute of Occupational Health, Finland)*; Rosalynn Siantar (Singapore Eye Research Institute, Singapore)*; Abla M Sibai (American University of Beirut, Lebanon)*; Mary Simon (India Diabetes Research Foundation, India)*; Judith Simons (St Vincent’s Hospital, Australia)*; Leon A Simons (University of New South Wales, Australia)*; Michael Sjostrom (Karolinska Institute, Sweden)*; Jolanta Slowikowska-Hilczer (Medical University of Łodz, Poland)*; Przemyslaw Slusarczyk (International Institute of Molecular and Cell Biology, Poland)*; Liam Smeeth (London School of Hygiene & Tropical Medicine, UK)*; Marieke B Snijder (University of Amsterdam, Netherlands)*; Vincenzo Solfrizzi (University of Bari, Italy)*; Emily Sonestedt (Lund University, Sweden)*; Aicha Soumare (University of Bordeaux, France)*; Jan A Staessen (University of Leuven, Belgium)*; Jostein Steene-Johannessen (Norwegian School of Sport Sciences, Norway)*; Peter Stehle (Bonn University, Germany)*; Aryeh D Stein (Emory University, USA)*; Jochanan Stessman (Hadassah University Medical Center, Israel)*; Doris Stöckl (Helmholtz Zentrum München, Germany)*; Jakub Stokwiszewski (National Institute of Hygiene, Poland)*; Maria Wany Strufaldi (Federal University of São Paulo, Brazil)*; Chien-An Sun (Fu Jen Catholic University, Taiwan)*; Johan Sundström (Uppsala University, Sweden)*; Paibul Suriyawongpaisal (Mahidol University, Thailand)*; Rody G Sy (University of the Philippines, Philippines)*; E Shyong Tai (National University of Singapore, Singapore)*; Mohammed Tarawneh (Ministry of Health, Jordan)*; Carolina B Tarqui-Mamani (National Institute of Health, Peru)*; Lutgarde Thijs (University of Leuven, Belgium)*; Janne S Tolstrup (University of Southern Denmark, Denmark)*; Murat Topbas (Karadeniz Technical University, Turkey)*; Maties Torrent (Area de Salut de Menorca, Spain)*; Pierre Traissac (Institut de Recherche pour le Développement, France)*; Oanh T H Trinh (University of Pharmacy and Medicine of Ho Chi Minh City, Vietnam)*; Marshall K Tulloch-Reid (The University of the West Indies, Jamaica)*; Tomi-Pekka Tuomainen (University of Eastern Finland, Finland)*; Maria L Turley (Ministry of Health, New Zealand)*; Christophe Tzourio (University of Bordeaux, France)*; Peter Ueda (Harvard T H Chan School of Public Health, USA)*; Flora M Ukoli (Meharry Medical College, USA)*; Hanno Ulmer (Medical University of Innsbruck, Austria)*; Gonzalo Valdivia (Pontifi cia Universidad Católica de Chile, Chile)*; Irene G M van Valkengoed (Academic Medical Center of University of Amsterdam, Netherlands)*; Dirk Vanderschueren (Katholieke Universiteit Leuven, Belgium)*; Diego Vanuzzo (Centro di Prevenzione Cardiovascolare, Italy)*; Tomas Vega (Consejería de Sanidad, Junta de Castilla y León, Spain)*; Gustavo Velasquez-Melendez (Universidade Federal de Minas Gerais, Brazil)*; Giovanni Veronesi (University of Insubria, Italy)*; Monique Verschuren (National Institute for Public Health and the Environment, Netherlands)*; Jesus Vioque (Universidad Miguel Hernandez, Spain)*; Jyrki Virtanen (University of Eastern Finland, Finland)*; Sophie Visvikis-Siest (INSERM, France)*; Bharathi Viswanathan (Ministry of Health, Seychelles)*; Peter Vollenweider (Lausanne University Hospital, Switzerland)*; Sari Voutilainen (University of Eastern Finland, Finland)*; Alisha N Wade (University of the Witwatersrand, South Africa)*; Aline Wagner (University of Strasbourg, France)*; Janette Walton (University College Cork, Ireland)*; Wan Nazaimoon Wan Mohamud (Institute for Medical Research, Malaysia)*; Ming-Dong Wang (Public Health Agency of Canada, Canada)*; Ya Xing Wang (Beijing Tongren Hospital, China)*; S Goya Wannamethee (University College London, UK)*; Deepa Weerasekera (Ministry of Health, New Zealand)*; Peter H Whincup (St George’s, University of London, UK)*; Kurt Widhalm (Medical University of Vienna, Austria)*; Andrzej Wiecek (Medical University of Silesia, Poland)*; Rainford J Wilks (The University of the West Indies, Jamaica)*; Johann Willeit (Medical University Innsbruck, Austria)*; Bogdan Wojtyniak (National Institute of Hygiene, Poland)*; Tien Yin Wong (Duke-NUS Graduate Medical School, Singapore)*; Jean Woo (The Chinese University of Hong Kong, China)*; Mark Woodward (University of Sydney, Australia; University of Oxford, UK)*; Aleksander Giwercman Wu (Lund University, Sweden)*; Frederick C Wu (University of Manchester, UK)*; Shou Ling Wu (Kailuan General Hospital, China)*; Haiquan Xu (Institute of Food and Nutrition Development of Ministry of Agriculture, China)*; Xiaoguang Yang (Chinese Center for Disease Control and Prevention, China)*; Xingwang Ye (University of Chinese Academy of Sciences, China)*; Akihiro Yoshihara (Niigata University, Japan)*; Novie O Younger-Coleman (The University of the West Indies, Jamaica)*; Sabina Zambon (University of Padova, Italy)*; Abdul Hamid Zargar (Center for Diabetes and Endocrine Care, India)*; Tomasz Zdrojewski (Medical University of Gdansk, Poland)*; Wenhua Zhao (Chinese Center for Disease Control and Prevention, China)*; Yingfeng Zheng (Singapore Eye Research Institute, Singapore)*BACKGROUND: Diabetes has been defined on the basis of different biomarkers, including fasting plasma glucose (FPG), 2-h plasma glucose in an oral glucose tolerance test (2hOGTT), and HbA1c. We assessed the effect of different diagnostic definitions on both the population prevalence of diabetes and the classification of previously undiagnosed individuals as having diabetes versus not having diabetes in a pooled analysis of data from population-based health examination surveys in different regions. METHODS: We used data from 96 population-based health examination surveys that had measured at least two of the biomarkers used for defining diabetes. Diabetes was defined using HbA1c (HbA1c ≥6•5% or history of diabetes diagnosis or using insulin or oral hypoglycaemic drugs) compared with either FPG only or FPG-or-2hOGTT definitions (FPG ≥7•0 mmol/L or 2hOGTT ≥11•1 mmol/L or history of diabetes or using insulin or oral hypoglycaemic drugs). We calculated diabetes prevalence, taking into account complex survey design and survey sample weights. We compared the prevalences of diabetes using different definitions graphically and by regression analyses. We calculated sensitivity and specificity of diabetes diagnosis based on HbA1c compared with diagnosis based on glucose among previously undiagnosed individuals (ie, excluding those with history of diabetes or using insulin or oral hypoglycaemic drugs). We calculated sensitivity and specificity in each survey, and then pooled results using a random-effects model. We assessed the sources of heterogeneity of sensitivity by meta-regressions for study characteristics selected a priori. FINDINGS: Population prevalence of diabetes based on FPG-or-2hOGTT was correlated with prevalence based on FPG alone (r=0•98), but was higher by 2-6 percentage points at different prevalence levels. Prevalence based on HbA1c was lower than prevalence based on FPG in 42•8% of age-sex-survey groups and higher in another 41•6%; in the other 15•6%, the two definitions provided similar prevalence estimates. The variation across studies in the relation between glucose-based and HbA1c-based prevalences was partly related to participants' age, followed by natural logarithm of per person gross domestic product, the year of survey, mean BMI, and whether the survey population was national, subnational, or from specific communities. Diabetes defined as HbA1c 6•5% or more had a pooled sensitivity of 52•8% (95% CI 51•3-54•3%) and a pooled specificity of 99•74% (99•71-99•78%) compared with FPG 7•0 mmol/L or more for diagnosing previously undiagnosed participants; sensitivity compared with diabetes defined based on FPG-or-2hOGTT was 30•5% (28•7-32•3%). None of the preselected study-level characteristics explained the heterogeneity in the sensitivity of HbA1c versus FPG. INTERPRETATION: Different biomarkers and definitions for diabetes can provide different estimates of population prevalence of diabetes, and differentially identify people without previous diagnosis as having diabetes. Using an HbA1c-based definition alone in health surveys will not identify a substantial proportion of previously undiagnosed people who would be considered as having diabetes using a glucose-based test.