Background Little attention has been paid to how the association between urbanisation and abdominal adiposity changes over the course of economic development in low-income and middle-income countries.
Methods Data came from the China Health and Nutrition Survey waves 1993–2011 (seven waves). A mixed linear model was used to investigate the association between community-level urbanisation with waist-to-height ratio (WHtR; an indicator of abdominal adiposity). We incorporated interaction terms between urbanisation and study waves to understand how the association changed over time. The analyses were stratified by age (children vs adults).
Results Adult WHtR was positively associated with urbanisation in earlier waves but became inversely associated over time. More specifically, a 1 SD increase in the urbanisation index was associated with higher WHtR by 0.002 and 0.005 in waves 1993 and 1997, while it was associated with lower WHtR by 0.001 in 2011. Among child participants, the increase in WHtR over time was predominantly observed in more urbanised communities.
Conclusion Our study suggests a shift in adult abdominal adiposity from more urbanised communities to less urbanised communities over a time of rapid economic development in China. Children living in more urbanised communities had higher increase in abdominal obesity with urbanisation over time relative to children living in less urbanised communities.
- epidemiology of chronic non communicable diseases
- longitudinal studies
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Contributors All authors contributed to the conception, design and interpretation of data. YI was responsible for data analysis and drafted the manuscript. PGL contributed to the acquisition of data. AGH, ALT and PGL contributed to critical revision of the manuscript. YI and PGL had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors have read and approved the final manuscript.
Funding This work was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (R01- DK104371), the National Heart, Lung, and Blood Institute (R01-HL108427) and uses data from China Health and Nutrition Survey (CHNS), funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01-HD30880), although no direct support was received from grant for this analysis. We thank the National Institute of Nutrition and Health, China Center for Disease Control and Prevention, the NIH (DK056350 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. We also are thankful to general support from the Carolina Population Center (P2C HD050924), the University of North Carolina at Chapel Hill. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.
Competing interests None declared.
Patient consent Guardian consent obtained.
Ethics approval Institutional Review Board at the University of North Carolina at Chapel Hill, the China-Japan Friendship Hospital, Ministry of Health, and the National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Data available at: http://www.cpc.unc.edu/projects/china/