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Epidemiology and Population Health

Changes in waist circumference relative to body mass index in Chinese adults, 1993–2009

International Journal of Obesity volume 38, pages 1503–1510 (2014)Cite this article

Subjects

Abstract

Background:

Although body mass index (BMI) and waist circumference (WC) are correlated, the relationship between WC and BMI may have changed over time.

Objectives:

 To describe temporal trends in BMI and WC distributions and quantify the increase in WC at a given BMI over time.

Subjects/Methods:

Data on adults aged 20–59 years from two waves (1993 and 2009) of the China Health and Nutrition Survey were used in a pooled cross-sectional analysis. Quantile regression examined age-adjusted temporal trends in the distributions of BMI and WC. Linear regression examined changes in mean WC over time, adjusting for BMI, age at survey and survey year. All models were stratified by gender.

Results:

There was a significant increase in BMI and WC over time, particularly at the 95th quantile: on average, men had 2.8 kg m−2 (95% confidence interval (CI): 2.4, 3.3) and women 1.5 kg m−2 (95% CI: 1.1, 2.0) higher BMI in 2009 compared with their counterparts in 1993. WC increased by 9.0 cm (95% CI: 7.5, 10.1) and 5.0 cm (95% CI: 3.4, 6.6) for men and women, respectively. On average, men and women had a 3.2 cm (95% CI: 2.8, 3.7) and 2.1 cm (95% CI: 1.7, 2.5) higher WC in 2009 compared with their counterparts in 1993, holding BMI and age constant. WC adjusted for BMI increased to a larger extent among obese versus lean individuals and among younger versus older women.

Conclusions:

For both genders, BMI and WC increased significantly over time, with particularly greatest increase in magnitude in the upper tail of the BMI and WC distributions. Furthermore, WC at equivalent BMIs was higher in 2009, compared with their counterparts in 1993. Our findings suggest that even if BMI remained constant from 1993 to 2009, adults in 2009 might be at increased cardiometabolic risk as a result of their higher WC.

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Acknowledgements

We thank the Institute of Nutrition and Food Safety, China Center for Disease Control and Prevention, the Carolina Population Center, the University of North Carolina at Chapel Hill, the NIH (NICHD (R01-HD30880) and NHLBI (R01-HL108427), DK056350, 5 R24 HD050924 and R01-HD38700) and the Fogarty NIH grant 5 D43 TW009077 for financial support for the CHNS data collection and analysis files from 1989 to 2011 and future surveys and the China-Japan Friendship Hospital, Ministry of Health for support for CHNS 2009. We wish to thank Frances L Dancy for administrative assistance, Tom Swasey for graphics support and Phil Bardsley for research assistance. NIH had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review or approval of the manuscript. DS is supported by the Mexican Council Consejo Nacional para la Ciencia y Tecnologia. (CONACyT) Scholarship 309902. LPS thanks the Carolina Population Center for general support (R24 HD050924).

Author contributions

DS, LPS and BMP were responsible for the study concept and design. DS was responsible for the data analysis, interpretation of results and the draft of the manuscript. LPS, PG-L and BMP provided guidance in the interpretation of results and manuscript development. DS, LPS, BZ, PG-L and BMP were responsible for the critical revision of the manuscript.

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Authors and Affiliations

  1. Department of Nutrition, Carolina Population Center, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    D Stern, L P Smith, P Gordon-Larsen & B M Popkin

  2. National Institute of Nutrition and Food Safety, Chinese Center for Disease Control and Prevention, Beijing, China

    B Zhang

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Correspondence to B M Popkin.

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Stern, D., Smith, L., Zhang, B. et al. Changes in waist circumference relative to body mass index in Chinese adults, 1993–2009. Int J Obes 38, 1503–1510 (2014). https://doi.org/10.1038/ijo.2014.74

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