Trends in abdominal obesity among Chinese children and adolescents, 1993–2015
-
Shujing Ma
Abstract
Objectives
The prevalence of general overweight and obesity defined by body mass index criteria has greatly increased in Chinese children and adolescents in recent decades. However, few studies have considered the trend in abdominal obesity in Chinese children and adolescents. This study aimed to examine the secular trends in waist circumference (WC), waist-to-height ratio (WHtR) and the prevalence of abdominal obesity among Chinese children and adolescents aged 6–17 years from 1993 to 2015.
Methods
A total of 11,985 children and adolescents aged 6–17 years participated in the China Health and Nutrition Survey, a continuous cross-sectional survey, conducted from 1993 to 2015. Abdominal obesity was defined as WC≥age- and sex-specific 90th percentile based on the reference from Chinese children and adolescents or WHtR≥0.50.
Results
After adjustment for age, sex and region, mean WC increased from 60.27 cm in 1993 to 64.31 cm in 2015 (p for trend <0.001), and mean WHtR increased from 0.430 to 0.434 (p for trend <0.05). The prevalence of abdominal obesity defined by WC reference increased from 5.0% in 1993 to 19.3% in 2015 and defined by WHtR reference increased from 6.4% in 1993 to 14.5% in 2015 (p for trend <0.001).
Conclusions
The prevalence of abdominal obesity among Chinese children and adolescents aged 6–17 years has increased between 1993 and 2015.
Funding source: National Natural Science Foundation of China
Award Identifier / Grant number: 81673195
Funding source: National Institutes of Health
Award Identifier / Grant number: R01‐HD30880
Award Identifier / Grant number: DK056350
Award Identifier / Grant number: R01‐HD38700
Acknowledgement
We thank the Chinese Centers for Disease Control and Prevention and the University of North Carolina for sharing their data. We also thank the National Institutes of Health for support of data collection.
Research funding: This work was supported by the National Natural Science Foundation of China (81673195) and the National Institutes of Health (R01‐HD30880, DK056350 and R01‐HD38700).
Author contributions: B.X. conceptualized the study and designed the protocol. L.Y. collated the data. S.M. and D.H. drafted the manuscript. S.M. and L.Y. analyzed the data. C.G.M., B.X., Y.Z., J.S., and M.Z. critically revised the manuscript. All authors reviewed and approved the final manuscript. All authors approved the final version of the manuscript to be published and they are accountable for all aspects of the work.
Competing interests: The authors declare no competing interest.
References
1. Dong, YH, Jan, C, Ma, YH, Dong, B, Zou, ZY, Yang, Y, et al.. Economic development and the nutritional status of Chinese school-aged children and adolescents from 1995 to 2014: an analysis of five successive national surveys. Lancet Diabetes Endocrinol 2019;7:288–99. https://doi.org/10.1016/s2213-8587(19)30075-0.Search in Google Scholar
2. Plesner, JL, Dahl, M, Fonvig, CE, Nielsen, TRH, Kloppenborg, JT, Pedersen, O, et al.. Obesity is associated with vitamin D deficiency in Danish children and adolescents. J Pediatr Endocrinol Metab 2018;31:53–61. https://doi.org/10.1515/jpem-2017-0246.Search in Google Scholar
3. Skinner, AC, Perrin, EM, Moss, LA, Skelton, JA. Cardiometabolic risks and severity of obesity in children and young adults. N Engl J Med 2015;373:1307–17. https://doi.org/10.1056/nejmoa1502821.Search in Google Scholar
4. Cote, AT, Harris, KC, Panagiotopoulos, C, Sandor, GG, Devlin, AM. Childhood obesity and cardiovascular dysfunction. J Am Coll Cardiol 2013;62:1309–19. https://doi.org/10.1016/j.jacc.2013.07.042.Search in Google Scholar
5. Singh, AS, Mulder, C, Twisk, JWR, van Mechelen, W, Chinapaw, MJ. Tracking of childhood overweight into adulthood: a systematic review of the literature. Obes Rev 2008;9:474–88. https://doi.org/10.1111/j.1467-789x.2008.00475.x.Search in Google Scholar
6. Llewellyn, A, Simmonds, M, Owen, CG, Woolacott, N. Childhood obesity as a predictor of morbidity in adulthood: a systematic review and meta-analysis. Obes Rev 2016;17:56–67. https://doi.org/10.1111/obr.12316.Search in Google Scholar
7. Bjerregaard, LG, Jensen, BW, Ängquist, L, Osler, M, Sørensen, TIA, Baker, JL. Change in overweight from childhood to early adulthood and risk of type 2 diabetes. N Engl J Med 2018;378:1302–12. https://doi.org/10.1056/nejmoa1713231.Search in Google Scholar
8. Park, MH, Falconer, C, Viner, RM, Kinra, S. The impact of childhood obesity on morbidity and mortality in adulthood: a systematic review. Obes Rev 2012;13:985–1000. https://doi.org/10.1111/j.1467-789x.2012.01015.x.Search in Google Scholar
9. Conway, JM, Chanetsa, FF, Wang, P. Intraabdominal adipose tissue and anthropometric surrogates in African American women with upper- and lower-body obesity. Am J Clin Nutr 1997;66:1345–51. https://doi.org/10.1093/ajcn/66.6.1345.Search in Google Scholar
10. Ashwell, M, Gunn, P, Gibson, S. Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis. Obes Rev 2012;13:275–86. https://doi.org/10.1111/j.1467-789x.2011.00952.x.Search in Google Scholar
11. Lo, K, Wong, M, Khalechelvam, P, Tam, W. Waist-to-height ratio, body mass index and waist circumference for screening paediatric cardio-metabolic risk factors: a meta-analysis. Obes Rev 2016;17:1258–75. https://doi.org/10.1111/obr.12456.Search in Google Scholar
12. Wang, H, Xue, H, Du, S, Zhang, J, Wang, Y, Zhang, B. Time trends and factors in body mass index and obesity among children in China: 1997–2011. Int J Obes 2017;41:964–70. https://doi.org/10.1038/ijo.2017.53.Search in Google Scholar
13. Ogden, CL, Fryar, CD, Hales, CM, Carroll, MD, Aoki, Y. Differences in obesity prevalence by demographics and urbanization in US children and adolescents, 2013–2016. JAMA 2018;319:2410–18. https://doi.org/10.1001/jama.2018.5158.Search in Google Scholar
14. NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet 2017;390:2627–42.10.1016/S0140-6736(17)32129-3Search in Google Scholar
15. Hardy, LL, Xu, J, Guo, CZ, Garnett, SP. 30-year cross-sectional trends in waist-to-height ratio in Australian school age children; 1985 to 2015. Acta Paediatr 2019;108:707–11. https://doi.org/10.1111/apa.14565.Search in Google Scholar
16. Xi, B, Mi, J, Zhao, M, Zhang, T, Jia, C, Li, J, et al.. Trends in abdominal obesity among U.S. children and adolescents. Pediatrics 2014;134:e334–9. https://doi.org/10.1542/peds.2014-0970.Search in Google Scholar
17. Zhang, B, Zhai, FY, Du, SF, Popkin, BM. The China health and nutrition survey, 1989–2011. Obes Rev 2014;15:2–7. https://doi.org/10.1111/obr.12119.Search in Google Scholar
18. Ma, GS, Ji, CY, Ma, J, Mi, J, Yt Sung, R, Xiong, F, et al.. Waist circumference reference values for screening cardiovascular risk factors in Chinese children and adolescents. Biomed Environ Sci 2010;23:21–31. https://doi.org/10.1016/s0895-3988(10)60027-x.Search in Google Scholar
19. Meng, LH, Luo, N, Cheng, H, Hong, DQ, Zhao, XY, Mi, J. Waist circumference reference values in Beijing versus the national values in detecting cardiovascular risk factors in 7–18 years old children. Chin J Prev Med 2011;45:717–22.Search in Google Scholar
20. Ashwell, M, Gibson, S. A proposal for a primary screening tool: ‘Keep your waist circumference to less than half your height’. BMC Med 2014;7:207.10.1186/s12916-014-0207-1Search in Google Scholar PubMed PubMed Central
21. Xi, B, Zong, XN, Kelishad, R, Litwin, M, Hong, YM, Poh, BK, et al.. International waist circumference percentile cut-offs for central obesity in children and adolescents aged 6–18 years. J Clin Endocrinol Metab 2020;105:dgz195.10.1210/clinem/dgaa578Search in Google Scholar PubMed
22. Liang, L, Fu, JF, Du, JB. Exploration and significance of the definition of metabolic syndrome in Chinese children and adolescents. Chin J Pediatr 2012;50:401–4.Search in Google Scholar
23. Cui, Z, Dibley, MJ. Trends in dietary energy, fat, carbohydrate and protein intake in Chinese children and adolescents from 1991 to 2009. Br J Nutr 2012;108:1292–9. https://doi.org/10.1017/s0007114511006891.Search in Google Scholar
24. Dearth-Wesley, T, Howard, AG, Wang, HJ, Zhang, B, Popkin, BM. Trends in domain-specific physical activity and sedentary behaviors among Chinese school children, 2004–2011. Int J Behav Nutr Phys Activ 2017;14:141. https://doi.org/10.1186/s12966-017-0598-4.Search in Google Scholar
25. Wei, X, Zang, Y, Jia, X, He, X, Zou, S, Wang, H, et al.. Age, period and cohort effects and the predictors of physical activity and sedentary behaviour among Chinese children, from 2004 to 2011. BMC Public Health 2017;17:353. https://doi.org/10.1186/s12889-017-4215-x.Search in Google Scholar
26. Min, J, Yan, AF, Wang, VHC, Wang, Y. Obesity, body image, and its impact on children’s eating and exercise behaviors in China: a nationwide longitudinal study. Prev Med 2018;106:101–6. https://doi.org/10.1016/j.ypmed.2017.10.024.Search in Google Scholar
27. Martinson, ML, Chang, YL, Han, WJ, Wen, J. Child overweight and obesity in Shanghai, China: contextualizing Chinese socioeconomic and gender differences. Int J Behav Med 2018;25:141–9. https://doi.org/10.1007/s12529-017-9688-6.Search in Google Scholar
28. Cui, ZH, Huxley, R, Wu, YF, Dibley, MJ. Temporal trends in overweight and obesity of children and adolescents from nine Provinces in China from 1991 to 2006. Int J Pediatr Obes 2010;5:365–74. https://doi.org/10.3109/17477166.2010.490262.Search in Google Scholar
29. Denney-Wilson, E, Crawford, D, Dobbins, T, Hardy, L, Okely, AD. Influences on consumption of soft drinks and fast foods in adolescents. Asia Pac J Clin Nutr 2009;18:447–52.Search in Google Scholar
30. Shi, Z, Lien, N, Kumar, BN, Holmboe-Ottesen, G. Socio-demographic differences in food habits and preferences of school adolescents in Jiangsu Province, China. Eur J Clin Nutr 2005;59:1439–48. https://doi.org/10.1038/sj.ejcn.1602259.Search in Google Scholar
31. Mihrshahi, S, Drayton, BA, Bauman, AE, Hardy, LL. Associations between childhood overweight, obesity, abdominal obesity and obesogenic behaviors and practices in Australian homes. BMC Public Health 2017;18:44. https://doi.org/10.1186/s12889-017-4595-y.Search in Google Scholar
32. Nawarycz, T, So, HK, Choi, KC, Sung, RY, Li, AM, Nelson, EA, et al.. Waist-to-height ratio as a measure of abdominal obesity in southern Chinese and European children and adolescents. Int J Obes 2016;40:1109–18. https://doi.org/10.1038/ijo.2015.251.Search in Google Scholar
Supplementary Material
The online version of this article offers supplementary material (https://doi.org/10.1515/jpem-2020-0461).
© 2020 Walter de Gruyter GmbH, Berlin/Boston
Articles in the same Issue
- Frontmatter
- Review Article
- The current review of adolescent obesity: the role of genetic factors
- Original Articles
- Trends in abdominal obesity among Chinese children and adolescents, 1993–2015
- Association of childhood obesity with retinal microvasculature and corneal endothelial cell morphology
- Communication frequency between visits is associated with improved glycemic control in pediatric diabetes
- Increased length of stay and hospital charges in adolescents with type 1 diabetes and psychiatric illness
- Distance from the endocrinology clinic and diabetes control in a rural pediatric population
- Care of children with type 1 diabetes mellitus in school – An interventional study
- Treatment and long-term follow-up of patients diagnosed with type 1 diabetes mellitus before age 5
- Diabetes distress in Indian children with type 1 diabetes mellitus and their mothers
- Impact of lockdown for COVID-19 pandemic in Indian children and youth with type 1 diabetes from different socio-economic classes
- First report on the nationwide prevalence of paediatric type 1 diabetes in Serbia and temporal trends of diabetes ketoacidosis at diagnosis—a multicentre study
- Factors affecting thyroid volume in adolescent students attending a rural middle school in East Hangzhou, China
- Impact of maternal thyroid disease on neonatal thyroid status
- Impact of growth hormone treatment on scoliosis development and progression: analysis of 1128 patients with idiopathic short stature
- Short Communication
- Are we ignoring coexisting rhabdomyolysis as an important aggravating factor for acute kidney injury among childhood diabetic ketoacidosis?
- Case Reports
- Microdeletion in the IGF-1 receptor gene of a patient with short stature and obesity: a case report
- SLC25A19 deficiency and bilateral striatal necrosis with polyneuropathy: a new case and review of the literature
- Familial neonatal nonautoimmune hyperthyroidism due to a gain-of-function (D619G) thyrotropin-receptor mutation
- Transient neonatal diabetes due to a disease causing novel variant in the ATP-binding cassette subfamily C member 8 (ABCC8) gene unmasks maturity-onset diabetes of the young (MODY) diabetes cases within a family
Articles in the same Issue
- Frontmatter
- Review Article
- The current review of adolescent obesity: the role of genetic factors
- Original Articles
- Trends in abdominal obesity among Chinese children and adolescents, 1993–2015
- Association of childhood obesity with retinal microvasculature and corneal endothelial cell morphology
- Communication frequency between visits is associated with improved glycemic control in pediatric diabetes
- Increased length of stay and hospital charges in adolescents with type 1 diabetes and psychiatric illness
- Distance from the endocrinology clinic and diabetes control in a rural pediatric population
- Care of children with type 1 diabetes mellitus in school – An interventional study
- Treatment and long-term follow-up of patients diagnosed with type 1 diabetes mellitus before age 5
- Diabetes distress in Indian children with type 1 diabetes mellitus and their mothers
- Impact of lockdown for COVID-19 pandemic in Indian children and youth with type 1 diabetes from different socio-economic classes
- First report on the nationwide prevalence of paediatric type 1 diabetes in Serbia and temporal trends of diabetes ketoacidosis at diagnosis—a multicentre study
- Factors affecting thyroid volume in adolescent students attending a rural middle school in East Hangzhou, China
- Impact of maternal thyroid disease on neonatal thyroid status
- Impact of growth hormone treatment on scoliosis development and progression: analysis of 1128 patients with idiopathic short stature
- Short Communication
- Are we ignoring coexisting rhabdomyolysis as an important aggravating factor for acute kidney injury among childhood diabetic ketoacidosis?
- Case Reports
- Microdeletion in the IGF-1 receptor gene of a patient with short stature and obesity: a case report
- SLC25A19 deficiency and bilateral striatal necrosis with polyneuropathy: a new case and review of the literature
- Familial neonatal nonautoimmune hyperthyroidism due to a gain-of-function (D619G) thyrotropin-receptor mutation
- Transient neonatal diabetes due to a disease causing novel variant in the ATP-binding cassette subfamily C member 8 (ABCC8) gene unmasks maturity-onset diabetes of the young (MODY) diabetes cases within a family
