Risk factors for overweight and obesity, and changes in body mass index of Chinese adults in Shanghai

Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai 200233, PR China.
BMC Public Health (Impact Factor: 2.26). 12/2008; 8(1):389. DOI: 10.1186/1471-2458-8-389
Source: PubMed


Over the past two decades, the prevalence of overweight or obesity has increased in China. The aims of this study were to firstly assess the baseline prevelences and the risk factors for overweight and obesity, and secondly to detect the changes of body mass index (BMI) over a follow-up period in Chinese adults in Shanghai.
The data set of a population-based longitudinal study was analyzed. Anthropometric and biochemical data were collected for 5364 subjects (aged 25-95 years) during a period of 1998-2001. Among those individuals, 3032 subjects were interviewed and reexamined at the second survey from 2003 to 2004. Then the standardized prevalences for overweight and obesity were calculated using baseline data; the possible contributing factors of overweight and obesity were detected using binary logistic regression analysis; and the changes of BMI were evaluated after an average of 3.6-year follow-up period.
(1) According to the WHO standard and the Chinese standard, the sex- and age-standardized prevalences were 27.5% and 32.4% for overweight, and 3.7% and 9.1% for obesity, respectively. (2) The risks of overweight and obesity differed among different age groups. Family history of obesity increased the risk of overweight and obesity by about 1.2-fold for both genders. Current male smokers had a lower risk of overweight and obesity (OR = 0.76, p < 0.05) than nonsmokers. In contrast, current male drinkers had a higher risk of overweight and obesity (OR = 1.42, p < 0.05) than nondrinkers. Compared with low-educated women, medium- and high- educated women were at lower risk of overweight and obesity, and the corresponding ORs (95% CIs) were 0.64 (0.52-0.79) and 0.50(0.36-0.68), respectively. (3) The annual changes of BMI means ranged from an increase of 0.1 kg/m2 to a decrease of 0.2 kg/m2 (by genders and age groups). Meanwhile, the BMI increase was statistically significant in the 35-44 years age group, and the BMI decrease was significant above 65 years for both genders.
This study showed high prevalence of overweight and obesity in Shanghai metropolis populations. The risk factors of overweight and obesity were multifactorial and gender specific. After 3.6 years, BMI means changed slightly, BMI increased mainly in middle-aged individuals and decreased in old individuals.

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    • "There are currently no studies in the epidemiological literature investigating the inter-relationship between education and occupation in relation to female obesity in lower income settings to our knowledge, although independent effects of education and wealth on obesity have been reported in single country studies. In Peru, the Philippines, China and Brazil [21,35-38] a positive association has been found between wealth and obesity together with an inverse or protective association between education and obesity (usually among women but not men) when both are taken into account in the analysis. Recent data from China corroborate the emergence of a protective association between education and obesity at least among urban residents [21] and women [22,23]. "
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    ABSTRACT: The prevalence of obesity is increasing rapidly in low- and middle-income countries (LMICs) as their populations become exposed to obesogenic environments. The transition from an agrarian to an industrial and service-based economy results in important lifestyle changes. Yet different socioeconomic groups may experience and respond to these changes differently. Investigating the socioeconomic distribution of obesity in LMICs is key to understanding the causes of obesity but the field is limited by the scarcity of data and a uni-dimensional approach to socioeconomic status (SES). This study splits socioeconomic status into two dimensions to investigate how educated women may have lower levels of obesity in a context where labour market opportunities have shifted away from agriculture to other forms of employment. The Four Provinces Study in China 2008/09 is a household-based community survey of 4,314 people aged >=60 years (2,465 women). It was used to investigate an interaction between education (none/any) and occupation (agricultural/non-agricultural) on high-risk central obesity defined as a waist circumference >=80 cm. An interaction term between education and occupation was incorporated in a multivariate logistic regression model, and the estimates adjusted for age, parity, urban/rural residence and health behaviours (smoking, alcohol, meat and fruit & vegetable consumption). Complete case analyses were undertaken and results confirmed using multiple imputation to impute missing data. An interaction between occupation and education was present (P = 0.02). In the group with no education, the odds of central obesity in the sedentary occupation group were more than double those of the agricultural occupation group even after taking age group and parity into account (OR; 95%CI: 2.21; 1.52, 3.21), while in the group with any education there was no evidence of such a relationship (OR; 95%CI: 1.25; 0.92, 1.70). Health behaviours appeared to account for some of the association. These findings suggest that education may have a protective role in women against the higher odds of obesity associated with occupational shifts in middle-income countries, and that investment in women's education may present an important long term investment in obesity prevention. Further research could elucidate the mechanisms behind this association.
    Full-text · Article · Aug 2013 · BMC Public Health
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    • "There are approximately 937 million and 396 million obese and overweight adults worldwide, respectively [1]. China’s rapid economic growth has led to changes in dietary and physical activity patterns, which in turn have led to an increase in obesity prevalence [2-9]. Based on the analysis of the China Health and Nutrition Survey (CHNS) data, Xi et al. reported an increase of 1.2 kg/m2 in body mass index (BMI) in those aged above 18 years, an increase of 67% in prevalence of overweight from 9.4% in 1993 to 15.7% in 2009 and an increase of 168% in prevalence obesity from 4.0% in 1993 to 10.7% in 2009, respectively [5]. "
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    ABSTRACT: Background Obesity increases the risk of many diseases. However, there has been little literature about the epidemiology of obesity classified by body mass index (BMI) or waist (abdominal obesity) among urban Chinese adults. This study is to fill the gap by assessing the prevalence of obesity and associated risk factors among urban Chinese adults. Methods A representative sample of 25,196 urban adults aged 18 to 74 years in Northeast China was selected and measurements of height, weight and waist circumference (WC) were taken from 2009–2010. Definitions of overweight and obesity by the World Health Organization (WHO) were used. Results The overall prevalence rates of general obesity and overweight classified by BMI were 15.0% (15.7% for men and 14.3% for women, p<0.01) and 19.2% (20.8% for men and 17.7% for women, p<0.01), respectively, and the overall prevalence rate of abdominal obesity was 37.6% (31.1% for men and women 43.9% for women, p<0.01). Multivariable logistic regression showed that the elderly and those who had a history of parental obesity, alcohol drinking, or former cigarette smoking were at high risk of obesity classified by BMI or WC, whereas those with a higher level of education, higher family income, or a healthy and balanced diet were at low risk of obesity. Analysis stratified by gender showed that men with a higher level education level, a white-collar job, a cadre job, or higher family income were the high risk group, and women with a higher level of education or higher family income were the low risk group. Conclusions Obesity and overweight have become epidemic in urban populations in China; associations of risk factors with obesity differ between men and women.
    Full-text · Article · Nov 2012 · BMC Public Health
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    • "Evidence suggests that cigarette smoking is associated with both general and abdominal obesity. The majority of previous studies found that current smokers had smaller BMI (Bamia, et al. 2004; Caks and Kos 2009; Canoy et al. 2005; Hou et al. 2008; Xu et al. 2007) but larger WC and WHR than nonsmokers (Azadbakht and Esmaillzadeh 2008; Bamia, et al. 2004; Caks and Kos 2009; Canoy et al. 2005; Lee et al. 2008), and ex-smokers often gain some weight after smoking cessation (Prentice and Jebb 2001), but the relationship between cigarette smoking and HC was inconsistent (Akbartabartoori et al. 2005; Canoy et al. 2005). In contrast, some other studies revealed that daily cigarette consumption was positively related to BMI (Bamia et al. 2004; Istvan et al. 1994; Liu et al. 1999), which was incompatible with the BMI lowering effect of smoking. "
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    ABSTRACT: Aim The relationship between cigarette smoking and obesity has been extensively studied, but the existing evidence is inconclusive. Moreover, few previous studies had examined the relationships of cigarette smoking with body mass index (BMI), waist circumference (WC), hip circumference (HC) and waist-to-hip ratio (WHR) simultaneously, which could not fully assess the effects of smoking on fat distribution. This study aimed to investigate the associations of cigarette smoking with BMI, WC, HC and WHR in Chinese male adults. Subjects and methods A total of 1,948 Chinese male adults (including 982 non-smokers, 846 current smokers and 210 former smokers) were selected from a community-based chronic disease screening project in Guangzhou and Zhuhai, China. The selected subjects were surveyed about their smoking status and history, and their body fatness indicators (BMI, WC, HC and WHR) were measured. A series of analyses of covariance (ANCOVA) were performed to assess associations between smoking behaviors and the body fatness indicators with adjustment for potential confounders. Results Current smokers had lower BMI (23.3 vs. 23.5 kg/m2) and HC (93.5 vs. 94.1 cm) but higher WHR (0.867 vs. 0.859) than non-smokers. Within current smokers, heavy smokers (>15 cigarettes/day) had higher BMI (23.4 vs. 23.0 kg/m2) than light smokers (1–15 cigarettes/day) without controlling for WC, but this association was reversed after adjusting for WC (23.1 vs. 23.3 cm). Heavy smokers had higher WC and WHR but lower HC than non-smokers. Former smokers who had quit for shorter than 1 year had larger BMI than non-smokers and former smokers who quitted for 1 year or longer. Conclusions Cigarette smoking is associated with both of the reduced total body mass and the increased waist fat deposit, and the weight gain seems to occur and complete itself in a short time after smoking cessation. These findings may improve the understanding on how cigarette smoking is linked to fat distribution and provide scientific evidence regarding intervention in smoking and obesity.
    Full-text · Article · Jun 2012 · Journal of Public Health
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