城市成年人肥胖

on g Z blic H jin, h In SA Keywords: Chinese Rural the prevalence of overweight and obesity among Chinese rural adults based on tion and Chinese standards. Methods. A cross-sectional whole-population health survey of 1250062 men and 1372026 women aged Overweight and obesity are important lifestyle-related public health (Zhou, 2002; Wang et al., 2004; Wang et al., 2007b; Chen, 2008), Preventive Medicine 48 (2009) 59–63 Contents lists available at ScienceDirect Preventive e ls problems in the world (Willett et al., 1999; World Health Organization, 2000). Two in three adults in the United States are currently classified as overweight (body mass index [BMI] 25.0–29.9 kg/m2) or obese (BMI≥30 kg/m2) (Ogden et al., 2006). More than one half of the adults in most European and other developed countries are overweight or obese, and the prevalence of obesity is becoming a problem also in developing countries (World Health Organization, 2000). Overweight and obesity increase the risks of hypertension, type 2 diabetes, dyslipidemia, coronary heart disease, gout, osteoarthritis, gallbladder disease, cancers of the breast, endometrium and colon, psychosocial problems, sleep apnea, disability andprematuremortality (WorldHealth coronary heart disease (Wang et al., 2007b), and mortality (Wen et al., 2008) have been found among overweight or obese subjects based on both the Asian (BMI 23–24.9 kg/m2 for overweight, and ≥25 kg/m2 for obesity) (WHO/IASO/IOTF, 2000) and Chinese (BMI 24–27.9 kg/m2 for overweight, and ≥28 kg/m2 for obesity) standards (Zhou et al., 2002; Wang et al., 2007c; Chen, 2008). China is currently going through transitions from a traditional lifestyle to a westernized lifestyle, from traditional manufacturing to modernization and industrialization (Popkin et al., 1995). With moder- nization and industrialization physical activities including occupational and commuting physical activities are reduced substantially (Du et al., Organization, 2000; Hu et al., 2004a; Hu et al. Hu et al., 2004d; Hu et al., 2005b; Hu et al., 20 et al., 2006; Bogers et al., 2007; Hu et al., 2007 ⁎ Corresponding author. Department of Health Pro Prevention, National Public Health Institute, Mannerheim Finland. Fax: +358 9 19127313. E-mail address: hu.gang@ktl.fi (G. Hu). 0091-7435/$ – see front matter © 2008 Elsevier Inc. Al doi:10.1016/j.ypmed.2008.10.020 et al., 2008). The increased risks of hypertension (Zhou, 2002; Pang et al., 2008; Chen, 2008), dyslipidemia (Zhou, 2002; Chen, 2008), diabetes Introduction Conclusions. The prevalence of overweight or overweight/obesity is relatively high in this Chinese rural population and might be an important lifestyle-related public health problem in China. © 2008 Elsevier Inc. All rights reserved. weight were measured using a standardized protocol. Results. Using the World Health Organization standard, the age-standardized prevalence of overweight (body mass index [BMI] 25–29.9 kg/m2) and obesity (BMI≥30 kg/m2) was 21.8% and 3.1% in men, 23.1% and 4.7% in women, and 22.5% and 3.9% in men and women combined, respectively. Using the Chinese standard, the age-standardized prevalence of overweight (BMI 24–27.9 kg/m2) and obesity (BMI≥28 kg/m2) was 31.3% and 7.0% in men, 28.7% and 9.7% in women, and 30.0% and 8.4% in men and women combined, respectively. The prevalence of overweight and obesity was higher among Tianjin rural adults than in the whole Chinese rural population based on the 2002 Fourth National Nutritional Survey. Overweight Obesity 15 years and over was undertaken in Tianjin true rural areas in 2004 (response rate, 85.6%). Height and Objective. To investigate the World Health Organiza Prevalence of overweight and obesity am Huiguang Tian a, Hongxiang Xie b, Guide Song c, Hon a Tianjin Public Health Bureau, Tianjin, China b Department of Food Safety Control, Tianjin Public Health Inspection Institute, Tianjin Pu c Department of Chronic Diseases, Tianjin Centers for Disease Control and Prevention, Tian d Department of Health Promotion and Chronic Diseases Prevention, National Public Healt e Department of Public Health, University of Helsinki, Helsinki, Finland f Population Science Programs, Pennington Biomedical Research Center, Baton Rouge, LA, U a b s t r a c ta r t i c l e i n f o Available online 5 November 2008 j ourna l homepage: www. , 2004b; Hu et al., 2004c; 05a; Gu et al., 2006; Hu ; Zhang et al., 2007; Pang motion and Chronic Diseases intie 166, FIN-00300 Helsinki, l rights reserved. g 2.6 million rural Chinese adults hang b, Gang Hu d,e,f,⁎ ealth Bureau, Tianjin, China China stitute, Mannerheimintie 166, FIN-00300 Helsinki, Finland Medicine ev ie r.com/ locate /ypmed 2002). At the same time, Chinese people have gradually changed their food habits from traditional high-carbohydrate diets to high-fat diets (Popkin et al., 2001). Lifestyle changes in this population have increased the prevalence of overweight and obesity (Ministry of Public Health, 2004). One recent study from the longitudinal China Health and Nutrition Surveys (CHNS) has found a significant increase in the pre- valence of overweight and obesity from 1989 to 2000 among both Chinese urban and rural adults aged 20–45 years (Wang et al., 2007a). However, few studies in the English literatures have examined over- weight andobesity status in rural areaswith the data of one local whole- population, especially from the rural areas with better economic conditions, like Tianjin, Beijing and Shanghai, etc. The data from above areas are very important because lifestyle-related noncommunicable diseases (mainly including cardiovascular disease and cancer) have quickly become the main causes of deaths in these areas (Wang et al., 2007c). Theaimof this study is to investigate theprevalenceofoverweight and obesity among the rural whole-population inTianjin, China, based on the World Health Organization (WHO) and Chinese standards. 60 H. Tian et al. / Preventive Medicine 48 (2009) 59–63 Methods Subjects A cross-sectional whole-population health survey was carried out from 1st April to 15th July, 2004 in rural areas of Tianjin, China. This survey serves as the baseline for an intervention program that was funded by Tianjin Government. The aims of this program are to investigate Tianjin rural population's health status and its related factors, and then approach the rural population intervention strategy. The city of Tianjin, located in the central north China, is the fourth largest city and a municipality of provincial status in China. The directly-controlled municipality is the highest level of classification for cities used by the Chinese government, with status equal to that of provinces. Four current municipalities are Beijing, Tianjin, Shanghai, and Chongqing. At the end of 2004, the population of Tianjin Municipality was 10.24 million, of whom 9.33 million were holders of Tianjin permanent residence. Among these permanent residents, 5.58 million were urban or suburban, and 3.74 million were rural. All 3744000 true rural subjects who lived in villages, which belong to 153 rural communities of 12 districts or counties, were selected and invited to participate in the survey. A total of 3202962 people completed the study. The participation rate was 85.6%. This relatively high participation ratewas due to a free of charge clinical examination and the effective organization by health workers. The present analysis comprised 1250062 men and 1372026 women aged 15 years ormore after excluding the participantswith incomplete data on height orweight (n=16632), and the participantswith a height b110 cm or N210 cm, a weight b30 kg or N165 kg, or a BMIb14 or N60 kg/m2 (n=5139). The sample sizes by age group and gender are shown in Table 1. The study was approved by the Tianjin Public Health Bureau, and informed consent was obtained from each participant. Baseline measurements The survey included a questionnaire, an anthropometric measure- ment and a clinical examination. The average duration for taking above examinations was about 1–2 h based on the clinical examina- tion items. The questionnaire included questions on health status and health behaviors. The participants were invited to the health centers for the determination of height and weight. About 4000 health workers, whowere from the Disease Prevention Centers and hospitals at city, district and subdistrict levels, conducted the survey. All health Table 1 Sample size by gender and age in Tianjin Rural Health Survey in 2004 Age group (years) Men Women Total 15–24 227393 208713 436106 25–34 236160 259783 495943 35–44 285702 332538 618240 45–54 246388 280113 526501 55–64 129753 154481 284234 65–74 86427 90504 176931 75–84 33772 39864 73636 85+ 4467 6030 10497 Total 1250062 1372026 2622088 workers were intensively trained in meeting and in practical sessions. Weight was measured without shoes and light indoor clothing to the nearest 0.1 kg by using a beam balance scale. Height was measured to the nearest 0.1 cm by using a stadiometer. BMI was calculated by dividing weight in kilograms by the square of height in meters. Classifications of overweight and obesity In this study, we used the twomost common BMI classifications for adults in China. According to the WHO standard (World Health Organization, 2000), BMI is classified as normal (BMIb25 kg/m2), overweight (BMI 25–29.9 kg/m2), and obese (BMI≥30 kg/m2). According to the Chinese standard (Zhou et al., 2002; Wang et al., 2007c; Chen, 2008), BMI is classified as normal (BMIb24 kg/m2), overweight (BMI 24–27.9 kg/m2), and obese (BMI≥28 kg/m2). Statistical analyses The age-and gender-prevalence of overweight or obesity was calculated by 10-year age intervals. The age-standardized prevalence to the Chinese 2000 population was calculated (National Bureau of Statistics of China, 2001). A chi-square test was used to compare the prevalence of overweight or obesity between genders. Statistical package SPSS for Windows, version 15.0 (SPSS Inc, Chicago, III), was used for statistical analysis. Results Themean values of height (cm), weight (kg), and BMI (kg/m2) were 170 (SD 6.3), 68.0 (9.8), and 23.6 (SD 3.1) for men, 160 (SD 6.2), 60.6 (9.4), and 23.7 (SD 3.6) for women, and 165 (SD 8.0), 64.1 (10.3), and 23.7 (SD 3.8) for men and women combined, respectively. Using the WHO standard, the age-standardized prevalence of over- weight (BMI 25–29.9 kg/m2) and obesity (BMI≥30 kg/m2) was 21.8% and 3.1% in men, 23.1% and 4.7% in women, and 22.5% and 3.9% in men and women combined, respectively (Table 2). The combined age-standar- dized prevalence of overweight and obesity was 24.9% in men, 27.8% in women, and 26.4% in men and women combined. The prevalence of overweight or obesity, and the combined prevalence of overweight and obesity were higher in women than in men (all p valuesb0.001). Using the Chinese standard, the age-standardized prevalence of overweight (BMI 24–27.9 kg/m2) and obesity (BMI≥28 kg/m2) was 31.3% and 7.0% in men, 28.7% and 9.7% in women, and 30.0% and 8.4% in men and women combined, respectively (Table 3). The combined age-standardized prevalence of overweight and obesity was 38.3% in men, 38.4% in women, and 38.4% in men and women combined. Whereas the prevalence of overweight was higher in men than in women (p valueb0.001), the prevalence of obesity was higher in women than in men (p valueb0.001). The age-specific prevalence of overweight or obesity, and the combined prevalence of overweight and obesity based on either the WHO or Chinese standard first rose with age before reaching middle age (45–64 years), and then decreased with age after 65 years old among both men and women (Tables 2 and 3). Comparing our data with the 2002 Fourth National Nutritional Survey, which included 140022 subjects aged 18 years or more with measured height and weight (Ma et al., 2005), the age-standardized prevalence of overweight or obesity, and the combined age-standar- dized prevalence of overweight and obesity based on the Chinese standard were higher among Tianjin rural men and women than in the whole Chinese rural population (Fig. 1). Discussion Our results found that the combined age-standardized prevalence of overweight and obesity was 26.4% and 38.4% based on the WHO and Table 2 Prevalence of overweight and obesity based on WHO standard by gender and age in Tianjin Rural Health Survey in 2004 a Age group (years) Overweight Obesity Overweight or obesity Men Women Total Men Women Total Men Women Total 15–24 9.8 8.7 9.2 1.7 1.5 1.6 11.4 10.2 10.8 25–34 21.9 19.7 20.7 3.1 3.4 3.2 24.9 23.1 24.0 35–44 26.4 29.5 28.1 3.4 5.6 4.6 29.8 35.1 32.6 45–54 27.7 33.2 30.6 3.5 7.3 5.5 31.2 40.5 36.2 55–64 27.9 33.0 30.7 4.1 8.3 6.4 32.0 41.4 37.1 65–74 24.2 26.8 25.6 3.5 6.0 4.8 27.8 32.9 30.4 75–84 19.9 21.0 20.5 2.7 3.4 3.1 22.7 24.4 23.6 85+ 15.4 15.7 15.5 1.6 2.8 2.3 17.0 18.5 17.8 Total 22.6 25.1 23.9 3.1 5.2 4.2 25.7 30.3 28.1 Age-standardized b 21.8 c 23.1c 22.5 3.1 c 4.7 c 3.9 24.9 c 27.8 c 26.4 a Overweight was defined as BMI 25–29.9 kg/m2; obesity was defined as BMI≥30 kg/m2. b Age-adjusted to the 2000 China population (National Bureau of Statistics of China, 2001). c Significant difference between gender, pb0.001. 61H. Tian et al. / Preventive Medicine 48 (2009) 59–63 Chinese standards among Tianjin rural adults aged 15 or older, which was significantly higher than themean values from national representa- tive data with measured height and weight (Ma et al., 2005). Increases in the prevalence of overweight and obesity have been observed in many countries including both developed and developing countries, such as US (Ogden et al., 2006), Spain (Rodriguez Artalejo et al., 2002), Denmark (Bendixen et al., 2004), Great Britain (Rennie et al., 2005), Italy (Gallus et al., 2006), Finland (Hu et al., 2008), Japan (Asia Pacific Cohort Studies Collaboration, 2007), Australia (Asia Pacific Cohort Studies Collaboration, 2007), China (Wildman et al., 2008), etc. Data from the Chinese National Nutritional Survey indicated that the prevalence of overweight and obesity based on measured data of height and weight increased in all gender and age groups and in all geographic areas (both rural and urban) between 1992 and 2002 (Wang et al., 2007c). Using the WHO BMI cut points (≥25 kg/m2), the combined prevalence of overweight and obesity increased from 14.6 to 21.8%. The Chinese overweight standard (≥24 kg/m2) showed an increase from 20.0 to 29.9% (Wang et al., 2007c). The combined prevalence of overweight and obesity based on the Chinese standard (≥24 kg/m2) in the 2002 Fourth National Nutritional Survey was higher in urban areas (34.2% inmen and 29.2% inwomen) than in rural areas (18.5% in men and 21.4% in women) (Wang et al., 2007c), but lower than in Tianjin rural areas (39.0% in men and 38.9% in women) (Fig. 1). This means that rural adults who live in Tianjin are more likely to be overweight or obese than either urban or rural adults in mainland China overall. This higher prevalenceof overweightor obesity in Tianjin rural areas could be due to better economic conditions in this region than in other regions of mainland China (including urban areas). The city of Tianjin is the fourth largest city and the per capita gross domestic product (GDP) is ranked as one of the best places in China. The Table 3 Prevalence of overweight and obesity based on Chinese standard by gender and age in Tian Age group (years) Overweight Obesity Men Women Total Men 15–24 16.5 13.8 15.2 3.3 25–34 32.6 27.1 29.7 6.8 35–44 37.0 35.6 36.3 8.2 45–54 37.8 37.2 37.5 8.6 55–64 36.9 36.3 36.6 9.6 65–74 33.0 31.9 32.4 8.1 75–84 29.1 27.0 28.0 6.1 85+ 24.4 21.9 23.0 3.7 Total 32.1 30.5 31.3 7.2 Age-standardized b 31.3 c 28.7c 30.0 7.0c a Overweight was defined as BMI 24–27.9 kg/m2; obesity was defined as BMI≥28 kg/m2. b Age-adjusted to the 2000 China population (National Bureau of Statistics of China, 200 c Significant difference between gender, pb0.001. present study provides a very important public health message to national and local governments because high prevalence of overweight and obesity and a number of related risk factors may result in the high death rate from cardiovascular disease and cancer in those regions with higher economic conditions in China (Wang et al., 2007c). The worldwide epidemic of excess weight is a consequence of positive energy balance due to both reduced energy expenditure and increased energy intake. Urbanization and automation in recent decades has resulted in a progressive reduction in the level of habitual physical activity associated with work and chores of daily living as well as a growing amount of time spent in very sedentary activities such as watching TV, working on the computer and playing video games (World Health Organization, 2000; Crespo et al., 2001). The same trend is also found in mainland China. For example, data from the 2002 Fourth National Nutritional Survey showed that less than one third of Chinese adults aged 20–69 years participated in leisure- time physical activity three times per week (Ministry of Public Health, 2006). The results from the longitudinal China Health and Nutrition Surveys (CHNS) indicate that a decline in work-related physical activity, as well as the significant increases in motorized forms of transportation (private cars, private motorcycles, public buses and taxies) and TV and computer ownership have been associated with a growing prevalence of overweight or obesity from 1989 to 1997 (Bell et al., 2001; Bell et al., 2002; Wang et al., 2007a). Meanwhile, the commuting time on foot or by bicycle has decreased during the last several years. In one survey on the urban population of Tianjin in 1996, 91% of men and 96% of women walked or cycled to and from work, schools or shops daily with the mean commuting time of 30 min (Hu et al., 2002b; Hu et al., 2002c). However, data from the 2002 Fourth National Nutritional Survey found that 68% of subjects in big cities jin Rural Health Survey in 2004a Overweight or obesity Women Total Men Women Total 2.9 3.1 19.8 16.8 18.3 7.0 6.9 39.4 34.1 36.6 12.0 10.2 45.2 47.5 46.5 15.5 12.3 46.4 52.7 49.7 16.8 13.5 46.6 53.1 50.1 12.3 10.3 41.0 44.2 42.7 7.6 6.9 35.2 34.6 34.9 5.5 4.7 28.1 27.4 27.7 10.8 9.1 39.3 41.3 40.3 9.7 c 8.4 38.3 38.4 38.4 1). subj 4 Ti 62 H. Tian et al. / Preventive Medicine 48 (2009) 59–63 walked or cycled to and fromwork, schools or shops daily (Ministry of Public Health, 2004). The change in dietary habits has also contributed to changes in overweight or obesity in China. Data from the National Nutritional Survey showed that daily consumption of cereals for all the sources of energy intake decreased from 57.4 to 47.4% in urban areas and from 71.7 to 60.7% in rural areas between 1992 and 2002 (Ministry of Public Health, 2004). In contrast, daily mean percentages of calories for total fat increased from 28.4 to 35.4% in urban areas, and from 18.6 to 27.7% in rural areas between 1992 and 2002 (Ministry of Public Health, 2004). The average daily intake of vegetable oil increased from 32 to 40 g in urban areas, and from 17 to 30 g in rural areas between 1992 and 2002 (Ministry of Public Health, 2004). One recent Chinese study indicated that the vegetable-rich food pattern was associated with a higher risk of general obesity/central obesity in adults (Shi et al., 2008). This association can be linked to the high intake of energy due to generous use of oil for stir-frying the vegetables (Shi et al., 2008). We also found that high intakes of energy and carbohydrate among both genders, high intakes of protein and fat among men, and lower levels of occupational and commuting physical activity, were related Fig. 1. Differences in the age-standardized prevalence of overweight and obesity among Fourth National Nutrition Survey (urban and rural areas) (Ma et al., 2005) and the 200 Bureau of Statistics of China, 2001)