Research Article
Prevalence and Secular Trends in Obesity Among Chinese Adults, 1991−2011

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Introduction

The prevalence of obesity in Chinese adults increased from 1991 to 2000; however, recent changes in this trend are unclear. This study aims to estimate the current prevalence of obesity and to assess trends in obesity and BMI distribution in Chinese adults from 1991 through 2011.

Methods

Height and weight measurements of 12,249 Chinese adults from the 2011 China Health and Nutrition Survey were analyzed (in 2013) together with China Health and Nutrition Survey data for 1991−2009. Obesity was defined as BMI≥28.0 kg/m2 based on the Working Group on Obesity in China criteria.

Results

In the 2011 survey, the age-adjusted mean BMI was 23.8 (95% CI=23.7, 23.9) for men and 23.4 (95% CI=23.2, 23.5) for women. The age-adjusted prevalence of obesity was 11.3% (95% CI=10.8%, 11.9%) overall, 11.8% (95% CI=10.8%, 12.6%) among men, and 11.0% (95% CI=10.3%, 11.8%) among women. Estimates of age-adjusted obesity prevalence among the Chinese population were significantly lower than those of the U.S. population (all p<0.05). Over the 20-year period, the prevalence of obesity increased from 2.88% to 11.8% among men (age-adjusted annual change in OR=1.08, 95% CI=1.07, 1.09, p<0.001) and from 4.55% to 11.0% among women (OR=1.05, 95% CI=1.05, 1.06, p<0.001). Similar significant findings were observed for both men and women based on WHO recommendations.

Conclusions

The prevalence of obesity among both Chinese men and women increased significantly from 1991 through 2011, particularly among men.

Introduction

Obesity is a major risk factor for hypertension, diabetes, coronary heart disease, and certain types of cancer.1, 2, 3, 4, 5, 6 Ongoing monitoring of trends in obesity is important for assessing interventions aimed at preventing or reducing the burden of obesity. With the increasing global pandemic of obesity, there has also been a dramatic rise in the number of obese adults in China.7, 8 For example, during 1989−2000, the prevalence of obesity combined with overweight increased by 50% in adults aged 20−45 years.9 Additionally, Gu et al.10 found that the risk of cardiovascular disease increased with increasing BMI. However, most previous estimates of obesity and overweight were either based on limited survey data that only reflected a relatively short period of changes in obesity9, 11, 12 or on clinical data. Recent prevalence and trends in the distribution of BMI among Chinese adults remain unknown. In this study, we provide new estimates of the prevalence of obesity and overweight in adults aged 20 years or older based on measurements of weight and height in 2011; we also provide the long-term trend to determine if it is continuing. We further compare the prevalence of obesity in adults between the Chinese and U.S. populations. In addition, we provide the BMI distribution from 1991 to 2011 of the China Health and Nutrition Survey (CHNS) both for the overall adult population and by sex and age group.

Section snippets

Study Design

The CHNS is an international collaborative project between the National Institute for Nutrition and Food Safety, Chinese Center for Disease Control and Prevention, and University of North Carolina at Chapel Hill, and is also the only large-scale, longitudinal, household-based survey in China to date.13 The first round of the CHNS was conducted in 1989, and subsequently in 1991, 1993, 1997, 2000, 2004, 2006, 2009, and 2011.14 The CHNS began with eight provinces and added a ninth, Heilongjiang in

Results

Pregnant (n=452) or lactating (n=440) women were excluded from data analysis. Additionally, participants with missing data (n=4,027), extreme height (n=75), or extreme BMI values of <15.0 kg/m2 or >40.0 kg/m2 (n=234) were also excluded. The remaining participants aged ≥20 years were 8,142 for 1991; 7,776 for 1993; 8,282 for 1997; 9,184 for 2000; 8,966 for 2004; 8,982 for 2006; 9,297 for 2009; and 12,249 for 2011. Sample sizes for analyses of the eight waves of the CHNS for 1991−2011 are

Discussion

The present data show striking increases in the prevalence of BMI-defined obesity and overweight in adults in China over the 20-year period from 1991 through 2011 for both men and women. Remarkably, both the prevalence of obesity and the combined prevalence of overweight and obesity increased more rapidly among men than women. Meanwhile, there was a significant rising tendency in log-transformed mean BMI from 1991 through 2011 both for men and women. Notably, the changes of BMI in men were

Acknowledgments

This research uses data from China Health and Nutrition Survey (CHNS). We thank the National Institute of Nutrition and Food Safety, China Center for Disease Control and Prevention, Carolina Population Center (5 R24 HD050924), University of North Carolina at Chapel Hill, NIH (R01-HD30880, DK056350, R24 HD050924, and R01-HD38700), and Fogarty International Center, NIH for financial support for the CHNS data collection and analysis files from 1989 to 2011 and future surveys, and the China-Japan

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