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Non-communicable diseases (NCDs) are increasingly viewed as a global health crisis, demonstrated by an escalating prevalence of diseases such as heart disease, stroke, diabetes, cancer, and respiratory disease. The four key modifiable risk factors identified for NCDs are smoking, alcohol, inadequate physical activity, and unhealthy diet. In 2008, 36 million of 57 million deaths worldwide were attributable to NCDs. Of these, 14 million were attributable to unhealthy diet, 3 million to insufficient physical activity, and 3 million to obesity.

While NCDs affect people of all nationalities, ages, and classes, unambiguous inequalities exist in the burden of these diseases between and within countries, affecting especially those in vulnerable situations (eg, in prisons or detention). Within countries a clear link exists between socioeconomic disadvantage and NCDs. Most of the 9·8 million people imprisoned worldwide are from the poorest and most marginalised sections of society and are therefore likely be at greater risk for NCDs. Contact with the criminal justice system is a public-health opportunity to promote health in this high-risk population. In particular, the prison regime and ethos is important in mediating an individual's exposure to risk factors for NCDs. Prisons, therefore, have a responsibility to create a healthy environment as well as engaging in individual health promotion.

Although prevalence of tobacco and alcohol used by prisoners has been assessed, no systematic review has been done of the other two key modifiable risk factors in prisoners: diet and physical activity. Our systematic review, therefore, aims to address this gap, focusing on diet (including dietary salt), physical activity, and obesity in prison populations worldwide. The review also highlights areas that require further research to provide an objective picture of the risk-factor profiles of prisoners, so that resources can be better directed to improve health promotion and prevention in this vulnerable population.

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Herbert K, Plugge E, Foster C, Doll H. Lancet. 2012 May 26;379(9830):1975-82.