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Published in: BMC Public Health 1/2013

Open Access 01-12-2013 | Research article

Increasing trends in central obesity among Chinese adults with normal body mass index, 1993–2009

Authors: Tingting Du, Xingxing Sun, Ping Yin, Rui Huo, Chaochao Ni, Xuefeng Yu

Published in: BMC Public Health | Issue 1/2013

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Abstract

Background

Central obesity is thought to be more pathogenic than overall obesity and studies have shown that the association between waist circumference (WC) and mortality was strongest in those with a normal body mass index (BMI). The objective of our study was to determine secular trends in the prevalence of central obesity (WC ≥ 90 cm for men and ≥ 80 cm for women) among Chinese adults with normal BMI from 1993 to 2009 and to examine the impact of performance of combined BMI and WC on the prevalence of obesity in Chinese adults.

Methods

We used data from the China Health and Nutrition Survey (CHNS) conducted from 1993 to 2009. From which we included a total of 52023 participants aged ≥ 18 years.

Results

The age-standardized prevalence of central obesity among Chinese adults with BMI < 25 kg/m2 increased from 11.9% in 1993 to 21.1% in 2009 (P for linear trend <0.001). The upward trends were noted in both genders, all ages, rural/urban settings, and education groups (all P for linear trend <0.001), with greater increments in men, participants aged 18–64 years, and rural residents (P for interaction terms survey × sex, survey × age, and survey × rural/urban settings were 0.042, 0.003, and < 0.001, respectively). Trends in the prevalence of central obesity were similar when a more stringent BMI < 23 kg/m2 cut point (Asian cut point) was applied. Central obesity is associated with a higher risk of incident hypertension within normal BMI category. More than 65% individuals with obesity would be missed if solely BMI was measured.

Conclusions

We observed an upward trend in the prevalence of central obesity among participants with normal BMI irrespective of sex, age, rural/urban settings, and education level. Central obesity is associated with a higher risk of incident hypertension within normal BMI category. Approximately two thirds of the individuals with obesity would be missed if WC was not measured. It is, therefore, urgent to emphasize the importance of WC as a measure to monitor the prevalence of obesity.
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Literature
1.
go back to reference Bouchard C: How much progress have we made over the last few decades?. Int J Obes (Lond). 2008, 32 (Suppl 7): S2-S7.CrossRef Bouchard C: How much progress have we made over the last few decades?. Int J Obes (Lond). 2008, 32 (Suppl 7): S2-S7.CrossRef
2.
go back to reference Rankinen T, Kim SY, Perusse L, Despres JP, Bouchard C: The prediction of abdominal visceral fat level from body composition and anthropometry: ROC analysis. Int J Obes Relat Metab Disord. 1999, 23: 801-809. 10.1038/sj.ijo.0800929.CrossRefPubMed Rankinen T, Kim SY, Perusse L, Despres JP, Bouchard C: The prediction of abdominal visceral fat level from body composition and anthropometry: ROC analysis. Int J Obes Relat Metab Disord. 1999, 23: 801-809. 10.1038/sj.ijo.0800929.CrossRefPubMed
3.
go back to reference Pouliot MC, Despres JP, Lemieux S, Moorjani S, Bouchard C, Tremblay A, Nadeau A, Lupien PJ: Waist circumference and abdominal sagittal diameter: best simple anthropometric indexes of abdominal visceral adipose tissue accumulation and related cardiovascular risk in men and women. Am J Cardiol. 1994, 73: 460-468. 10.1016/0002-9149(94)90676-9.CrossRefPubMed Pouliot MC, Despres JP, Lemieux S, Moorjani S, Bouchard C, Tremblay A, Nadeau A, Lupien PJ: Waist circumference and abdominal sagittal diameter: best simple anthropometric indexes of abdominal visceral adipose tissue accumulation and related cardiovascular risk in men and women. Am J Cardiol. 1994, 73: 460-468. 10.1016/0002-9149(94)90676-9.CrossRefPubMed
4.
go back to reference Yusuf S, Hawken S, Ounpuu S, Bautista L, Franzosi MG, Commerford P, Lang CC, Rumboldt Z, Onen CL, Lisheng L: Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries: a case–control study. Lancet. 2005, 366: 1640-1649. 10.1016/S0140-6736(05)67663-5.CrossRefPubMed Yusuf S, Hawken S, Ounpuu S, Bautista L, Franzosi MG, Commerford P, Lang CC, Rumboldt Z, Onen CL, Lisheng L: Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries: a case–control study. Lancet. 2005, 366: 1640-1649. 10.1016/S0140-6736(05)67663-5.CrossRefPubMed
5.
go back to reference Wang Y, Rimm EB, Stampfer MJ, Willett WC, Hu FB: Comparison of abdominal adiposity and overall obesity in predicting risk of type 2 diabetes among men. Am J Clin Nutr. 2005, 81: 555-563.PubMed Wang Y, Rimm EB, Stampfer MJ, Willett WC, Hu FB: Comparison of abdominal adiposity and overall obesity in predicting risk of type 2 diabetes among men. Am J Clin Nutr. 2005, 81: 555-563.PubMed
6.
go back to reference Reis JP, Macera CA, Araneta MR, Lindsay SP, Marshall SJ, Wingard DL: Comparison of overall obesity and body fat distribution in predicting risk of mortality. Obesity (Silver Spring). 2009, 17: 1232-1239. Reis JP, Macera CA, Araneta MR, Lindsay SP, Marshall SJ, Wingard DL: Comparison of overall obesity and body fat distribution in predicting risk of mortality. Obesity (Silver Spring). 2009, 17: 1232-1239.
7.
go back to reference Flegal KM, Carroll MD, Ogden CL, Curtin LR: Prevalence and trends in obesity among US adults, 1999–2008. JAMA. 2010, 303: 235-241. 10.1001/jama.2009.2014.CrossRefPubMed Flegal KM, Carroll MD, Ogden CL, Curtin LR: Prevalence and trends in obesity among US adults, 1999–2008. JAMA. 2010, 303: 235-241. 10.1001/jama.2009.2014.CrossRefPubMed
8.
go back to reference Gutierrez-Fisac JL, Guallar-Castillon P, Leon-Munoz LM, Graciani A, Banegas JR, Rodriguez-Artalejo F: Prevalence of general and abdominal obesity in the adult population of Spain, 2008–2010: the ENRICA study. Obes Rev. 2012, 13: 388-392. 10.1111/j.1467-789X.2011.00964.x.CrossRefPubMed Gutierrez-Fisac JL, Guallar-Castillon P, Leon-Munoz LM, Graciani A, Banegas JR, Rodriguez-Artalejo F: Prevalence of general and abdominal obesity in the adult population of Spain, 2008–2010: the ENRICA study. Obes Rev. 2012, 13: 388-392. 10.1111/j.1467-789X.2011.00964.x.CrossRefPubMed
9.
go back to reference Li C, Ford ES, McGuire LC, Mokdad AH: Increasing trends in waist circumference and abdominal obesity among US adults. Obesity (Silver Spring). 2007, 15: 216-224. 10.1038/oby.2007.505.CrossRef Li C, Ford ES, McGuire LC, Mokdad AH: Increasing trends in waist circumference and abdominal obesity among US adults. Obesity (Silver Spring). 2007, 15: 216-224. 10.1038/oby.2007.505.CrossRef
10.
go back to reference Walls HL, Stevenson CE, Mannan HR, Abdullah A, Reid CM, McNeil JJ, Peeters A: Comparing trends in BMI and waist circumference. Obesity (Silver Spring). 2011, 19: 216-219. 10.1038/oby.2010.149.CrossRef Walls HL, Stevenson CE, Mannan HR, Abdullah A, Reid CM, McNeil JJ, Peeters A: Comparing trends in BMI and waist circumference. Obesity (Silver Spring). 2011, 19: 216-219. 10.1038/oby.2010.149.CrossRef
11.
go back to reference Reynolds K, Gu D, Whelton PK, Wu X, Duan X, Mo J, He J: Prevalence and risk factors of overweight and obesity in China. Obesity (Silver Spring). 2007, 15: 10-18. 10.1038/oby.2007.527.CrossRef Reynolds K, Gu D, Whelton PK, Wu X, Duan X, Mo J, He J: Prevalence and risk factors of overweight and obesity in China. Obesity (Silver Spring). 2007, 15: 10-18. 10.1038/oby.2007.527.CrossRef
12.
go back to reference Macia E, Duboz P, Gueye L: Prevalence of obesity in Dakar. Obes Rev. 2010, 11: 691-694. 10.1111/j.1467-789X.2010.00749.x.CrossRefPubMed Macia E, Duboz P, Gueye L: Prevalence of obesity in Dakar. Obes Rev. 2010, 11: 691-694. 10.1111/j.1467-789X.2010.00749.x.CrossRefPubMed
13.
go back to reference Xi B, Liang Y, He T, Reilly KH, Hu Y, Wang Q, Yan Y, Mi J: Secular trends in the prevalence of general and abdominal obesity among Chinese adults, 1993–2009. Obes Rev. 2012, 13: 287-296. 10.1111/j.1467-789X.2011.00944.x.CrossRefPubMed Xi B, Liang Y, He T, Reilly KH, Hu Y, Wang Q, Yan Y, Mi J: Secular trends in the prevalence of general and abdominal obesity among Chinese adults, 1993–2009. Obes Rev. 2012, 13: 287-296. 10.1111/j.1467-789X.2011.00944.x.CrossRefPubMed
14.
go back to reference Wardle J, Boniface D: Changes in the distributions of body mass index and waist circumference in English adults, 1993/1994 to 2002/2003. Int J Obes (Lond). 2008, 32: 527-532. 10.1038/sj.ijo.0803740.CrossRef Wardle J, Boniface D: Changes in the distributions of body mass index and waist circumference in English adults, 1993/1994 to 2002/2003. Int J Obes (Lond). 2008, 32: 527-532. 10.1038/sj.ijo.0803740.CrossRef
15.
go back to reference Booth ML, Hunter C, Gore CJ, Bauman A, Owen N: The relationship between body mass index and waist circumference: implications for estimates of the population prevalence of overweight. Int J Obes Relat Metab Disord. 2000, 24: 1058-1061. 10.1038/sj.ijo.0801359.CrossRefPubMed Booth ML, Hunter C, Gore CJ, Bauman A, Owen N: The relationship between body mass index and waist circumference: implications for estimates of the population prevalence of overweight. Int J Obes Relat Metab Disord. 2000, 24: 1058-1061. 10.1038/sj.ijo.0801359.CrossRefPubMed
16.
go back to reference National Institutes of Health, National Heart Lung and Blood Institute: Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults--The Evidence Report. National Institutes of Health. Obes Res. 1998, 6 (Suppl 2): 51S-209S. National Institutes of Health, National Heart Lung and Blood Institute: Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults--The Evidence Report. National Institutes of Health. Obes Res. 1998, 6 (Suppl 2): 51S-209S.
17.
go back to reference Li G, Chen X, Jang Y, Wang J, Xing X, Yang W, Hu Y: Obesity, coronary heart disease risk factors and diabetes in Chinese: an approach to the criteria of obesity in the Chinese population. Obes Rev. 2002, 3: 167-172. 10.1046/j.1467-789X.2002.00067.x.CrossRefPubMed Li G, Chen X, Jang Y, Wang J, Xing X, Yang W, Hu Y: Obesity, coronary heart disease risk factors and diabetes in Chinese: an approach to the criteria of obesity in the Chinese population. Obes Rev. 2002, 3: 167-172. 10.1046/j.1467-789X.2002.00067.x.CrossRefPubMed
18.
go back to reference Zhang X, Shu XO, Gao YT, Yang G, Li H, Zheng W: General and abdominal adiposity and risk of stroke in Chinese women. Stroke. 2009, 40: 1098-1104. 10.1161/STROKEAHA.108.539692.CrossRefPubMedPubMedCentral Zhang X, Shu XO, Gao YT, Yang G, Li H, Zheng W: General and abdominal adiposity and risk of stroke in Chinese women. Stroke. 2009, 40: 1098-1104. 10.1161/STROKEAHA.108.539692.CrossRefPubMedPubMedCentral
19.
go back to reference Jia Z, Zhou Y, Liu X, Wang Y, Zhao X, Liang W, Wu S: Comparison of different anthropometric measures as predictors of diabetes incidence in a Chinese population. Diabetes Res Clin Pract. 2011, 92: 265-271. 10.1016/j.diabres.2011.01.021.CrossRefPubMed Jia Z, Zhou Y, Liu X, Wang Y, Zhao X, Liang W, Wu S: Comparison of different anthropometric measures as predictors of diabetes incidence in a Chinese population. Diabetes Res Clin Pract. 2011, 92: 265-271. 10.1016/j.diabres.2011.01.021.CrossRefPubMed
20.
go back to reference Jacobs EJ, Newton CC, Wang Y, Patel AV, McCullough ML, Campbell PT, Thun MJ, Gapstur SM: Waist circumference and all-cause mortality in a large US cohort. Arch Intern Med. 2010, 170: 1293-1301. 10.1001/archinternmed.2010.201.CrossRefPubMed Jacobs EJ, Newton CC, Wang Y, Patel AV, McCullough ML, Campbell PT, Thun MJ, Gapstur SM: Waist circumference and all-cause mortality in a large US cohort. Arch Intern Med. 2010, 170: 1293-1301. 10.1001/archinternmed.2010.201.CrossRefPubMed
21.
go back to reference Popkin BM, Du S, Zhai F, Zhang B: Cohort Profile: The China Health and Nutrition Survey–monitoring and understanding socio-economic and health change in China, 1989–2011. Int J Epidemiol. 2010, 39: 1435-1440. 10.1093/ije/dyp322.CrossRefPubMed Popkin BM, Du S, Zhai F, Zhang B: Cohort Profile: The China Health and Nutrition Survey–monitoring and understanding socio-economic and health change in China, 1989–2011. Int J Epidemiol. 2010, 39: 1435-1440. 10.1093/ije/dyp322.CrossRefPubMed
22.
go back to reference WHO Expert Committee: Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser. 1995, 854: 1-452. WHO Expert Committee: Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser. 1995, 854: 1-452.
23.
go back to reference Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jones DW, Materson BJ, Oparil S, Wright JT: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003, 289: 2560-2572. 10.1001/jama.289.19.2560.CrossRefPubMed Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jones DW, Materson BJ, Oparil S, Wright JT: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003, 289: 2560-2572. 10.1001/jama.289.19.2560.CrossRefPubMed
24.
go back to reference WHO Expert Consultation: Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004, 363: 157-163.CrossRef WHO Expert Consultation: Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004, 363: 157-163.CrossRef
25.
go back to reference Zhou BF: Predictive values of body mass index and waist circumference for risk factors of certain related diseases in Chinese adults–study on optimal cut-off points of body mass index and waist circumference in Chinese adults. Biomed Environ Sci. 2002, 15: 83-96.PubMed Zhou BF: Predictive values of body mass index and waist circumference for risk factors of certain related diseases in Chinese adults–study on optimal cut-off points of body mass index and waist circumference in Chinese adults. Biomed Environ Sci. 2002, 15: 83-96.PubMed
26.
go back to reference Alberti KG, Zimmet P, Shaw J: The metabolic syndrome–a new worldwide definition. Lancet. 2005, 366: 1059-1062. 10.1016/S0140-6736(05)67402-8.CrossRefPubMed Alberti KG, Zimmet P, Shaw J: The metabolic syndrome–a new worldwide definition. Lancet. 2005, 366: 1059-1062. 10.1016/S0140-6736(05)67402-8.CrossRefPubMed
27.
go back to reference Katzel LI, Bleecker ER, Colman EG, Rogus EM, Sorkin JD, Goldberg AP: Effects of weight loss vs aerobic exercise training on risk factors for coronary disease in healthy, obese, middle-aged and older men. A randomized controlled trial. JAMA. 1995, 274: 1915-1921. 10.1001/jama.1995.03530240025035.CrossRefPubMed Katzel LI, Bleecker ER, Colman EG, Rogus EM, Sorkin JD, Goldberg AP: Effects of weight loss vs aerobic exercise training on risk factors for coronary disease in healthy, obese, middle-aged and older men. A randomized controlled trial. JAMA. 1995, 274: 1915-1921. 10.1001/jama.1995.03530240025035.CrossRefPubMed
28.
go back to reference Klein S, Allison DB, Heymsfield SB, Kelley DE, Leibel RL, Nonas C, Kahn R: Waist circumference and cardiometabolic risk: a consensus statement from shaping America's health: Association for Weight Management and Obesity Prevention; NAASO, the Obesity Society; the American Society for Nutrition; and the American Diabetes Association. Diabetes Care. 2007, 30: 1647-1652. 10.2337/dc07-9921.CrossRefPubMed Klein S, Allison DB, Heymsfield SB, Kelley DE, Leibel RL, Nonas C, Kahn R: Waist circumference and cardiometabolic risk: a consensus statement from shaping America's health: Association for Weight Management and Obesity Prevention; NAASO, the Obesity Society; the American Society for Nutrition; and the American Diabetes Association. Diabetes Care. 2007, 30: 1647-1652. 10.2337/dc07-9921.CrossRefPubMed
29.
go back to reference Flegal KM, Shepherd JA, Looker AC, Graubard BI, Borrud LG, Ogden CL, Harris TB, Everhart JE, Schenker N: Comparisons of percentage body fat, body mass index, waist circumference, and waist-stature ratio in adults. Am J Clin Nutr. 2009, 89: 500-508. 10.3945/ajcn.2008.26847.CrossRefPubMed Flegal KM, Shepherd JA, Looker AC, Graubard BI, Borrud LG, Ogden CL, Harris TB, Everhart JE, Schenker N: Comparisons of percentage body fat, body mass index, waist circumference, and waist-stature ratio in adults. Am J Clin Nutr. 2009, 89: 500-508. 10.3945/ajcn.2008.26847.CrossRefPubMed
30.
go back to reference Aloia JF, Vaswani A, Mikhail M, Flaster ER: Body composition by dual-energy X-ray absorptiometry in black compared with white women. Osteoporos Int. 1999, 10: 114-119. 10.1007/s001980050204.CrossRefPubMed Aloia JF, Vaswani A, Mikhail M, Flaster ER: Body composition by dual-energy X-ray absorptiometry in black compared with white women. Osteoporos Int. 1999, 10: 114-119. 10.1007/s001980050204.CrossRefPubMed
31.
go back to reference Gu D, He J, Duan X, Reynolds K, Wu X, Chen J, Huang G, Chen CS, Whelton PK: Body weight and mortality among men and women in China. JAMA. 2006, 295: 776-783. 10.1001/jama.295.7.776.CrossRefPubMed Gu D, He J, Duan X, Reynolds K, Wu X, Chen J, Huang G, Chen CS, Whelton PK: Body weight and mortality among men and women in China. JAMA. 2006, 295: 776-783. 10.1001/jama.295.7.776.CrossRefPubMed
32.
go back to reference Kragelund C, Omland T: A farewell to body-mass index?. Lancet. 2005, 366: 1589-1591. 10.1016/S0140-6736(05)67642-8.CrossRefPubMed Kragelund C, Omland T: A farewell to body-mass index?. Lancet. 2005, 366: 1589-1591. 10.1016/S0140-6736(05)67642-8.CrossRefPubMed
33.
go back to reference Janssen I, Heymsfield SB, Wang ZM, Ross R: Skeletal muscle mass and distribution in 468 men and women aged 18–88 yr. J Appl Physiol. 2000, 89: 81-88.PubMed Janssen I, Heymsfield SB, Wang ZM, Ross R: Skeletal muscle mass and distribution in 468 men and women aged 18–88 yr. J Appl Physiol. 2000, 89: 81-88.PubMed
34.
go back to reference Kim J, Wang Z, Heymsfield SB, Baumgartner RN, Gallagher D: Total-body skeletal muscle mass: estimation by a new dual-energy X-ray absorptiometry method. Am J Clin Nutr. 2002, 76: 378-383.PubMed Kim J, Wang Z, Heymsfield SB, Baumgartner RN, Gallagher D: Total-body skeletal muscle mass: estimation by a new dual-energy X-ray absorptiometry method. Am J Clin Nutr. 2002, 76: 378-383.PubMed
35.
go back to reference Borkan GA, Norris AH: Fat redistribution and the changing body dimensions of the adult male. Hum Biol. 1977, 49: 495-513.PubMed Borkan GA, Norris AH: Fat redistribution and the changing body dimensions of the adult male. Hum Biol. 1977, 49: 495-513.PubMed
36.
go back to reference Wildman RP, Gu D, Muntner P, Wu X, Reynolds K, Duan X, Chen CS, Huang G, Bazzano LA, He J: Trends in overweight and obesity in Chinese adults: between 1991 and 1999–2000. Obesity (Silver Spring). 2008, 16: 1448-1453. 10.1038/oby.2008.208.CrossRef Wildman RP, Gu D, Muntner P, Wu X, Reynolds K, Duan X, Chen CS, Huang G, Bazzano LA, He J: Trends in overweight and obesity in Chinese adults: between 1991 and 1999–2000. Obesity (Silver Spring). 2008, 16: 1448-1453. 10.1038/oby.2008.208.CrossRef
37.
go back to reference Jones-Smith JC, Gordon-Larsen P, Siddiqi A, Popkin BM: Emerging disparities in overweight by educational attainment in Chinese adults (1989–2006). Int J Obes (Lond). 2012, 36: 866-875. 10.1038/ijo.2011.134.CrossRef Jones-Smith JC, Gordon-Larsen P, Siddiqi A, Popkin BM: Emerging disparities in overweight by educational attainment in Chinese adults (1989–2006). Int J Obes (Lond). 2012, 36: 866-875. 10.1038/ijo.2011.134.CrossRef
Metadata
Title
Increasing trends in central obesity among Chinese adults with normal body mass index, 1993–2009
Authors
Tingting Du
Xingxing Sun
Ping Yin
Rui Huo
Chaochao Ni
Xuefeng Yu
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2013
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-13-327

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