Elsevier

Preventive Medicine

Volume 39, Issue 1, July 2004, Pages 197-206
Preventive Medicine

Abdominal adiposity in U.S. adults: prevalence and trends, 1960–2000

https://doi.org/10.1016/j.ypmed.2004.01.023Get rights and content

Abstract

Background. There is a large body of epidemiologic evidence linking abdominal obesity to cardiovascular diseases. Abdominal adiposity is an important component of insulin resistance syndrome.

Objective. To investigate prevalence and trends in abdominal obesity in U.S. adult population.

Design, setting/participants. Nationally representative cross-sectional surveys with an in-person interview and measurement of waist circumference; 23,654 adults aged 20–79 years were examined using data from U.S. National Surveys of 1960–1962 [the first National Health Examination Survey (NHES I)], 1988–1994 [the third National Health and Nutrition Examination Survey (NHANES III)] and 1999–2000 [National Health and Nutrition Examination Survey (NHANES 1999–2000)]. Abdominal obesity was defined as waist circumference ≥102 cm (>40 in.) in men and ≥88 cm (>35 in.) in women.

Results. There was a gradient of increasing waist circumference over the three periods of 1960–1962, 1988–1994 and 1999–2000 in both men and women. In men, the mean waist circumferences were 89, 95 and 99 cm for 1960–1962, 1988–1994 and 1999–2000, respectively. The corresponding values in women were 77, 92 and 94 cm, respectively. A gradient of increasing prevalence of abdominal obesity from 1960 to 2000 was also observed in men and women. In men, the overall age-adjusted prevalences of abdominal obesity were 12.7%, 29% and 38.3% in 1960–1962, 1988–1994 and 1999–2000, respectively. In women, the analogous values were 19.4%, 38.8% and 59.9%, respectively. Similar trends of increasing waist circumference and abdominal obesity were observed in normal weight, underweight and obese subjects defined using body mass index (BMI). Trends of increasing abdominal obesity with increasing BMI over the three time periods were also observed.

Conclusions. The increase in the prevalence of abdominal obesity in the United States between 1960–1962 and 1999–2000 has ominous public health implications across entire population, particularly among normal weight subjects. There is an urgent need to describe a public health strategy for early identification of abdominal obesity. Primary prevention of obesity, including abdominal obesity, should be a major public health priority in the United States.

Introduction

There is a wealth of epidemiologic evidence linking obesity with an increased risk of cardiovascular diseases and all cause mortality [1], [2], [3], [4], [5]. In 1999, Allison et al. [6] estimated that between 280,000 and 325,000 deaths could be attributed to obesity annually in the United States. The majority of the literature associating adiposity with cardiovascular diseases is based on generalized form [body mass index (BMI)] of obesity. However, it is now being recognized that other aberrant regional fat distributions as seen in centrally or abdominally obese subjects might be more strongly linked to cardiovascular diseases than overall heaviness as determined from BMI [7]. Abdominal adiposity is an important component of the insulin resistance syndrome [8], [9], [10], [11], [12], [13]. Other components of insulin resistance syndrome include hypertension, hyperinsulinemia, impaired glucose tolerance, hypertriglyceridemia, elevated levels of low-density lipoprotein (LDL-C) and low levels of high-density lipoprotein (HDL-C) cholesterol. Abdominal adiposity is also linked with increased risks of breast, colorectal and renal cell cancers [14], [15], [16].

The gold standard for measuring abdominal adiposity is assessment by imaging techniques such as magnetic resonance and computed tomography. Because these methods are laborious and expensive, they are often not suitable for a large-scale epidemiologic study. Hence, an anthropometric surrogate (waist circumference) of abdominal adiposity is often employed. Waist circumference is an aggregate measurement of the actual amount of total and abdominal fat accumulation and is a crucial correlate of visceral adiposity among obese and overweight subjects. Waist circumference is highly correlated with BMI and thus reflects general and abdominal obesity [17], [18], [19], [20].

The US National Institute of Health (NIH) Clinical Guideline recommends the measurement of waist as a screening tool for health risk [21]. The NIH guideline advocates risk stratification based on waist circumference. The most commonly cited waist circumference cut-points for abdominal adiposity are: (a) waist circumference ≥94 cm for men and ≥80 cm for women (action level I), and (b) waist circumference ≥102 cm for men and ≥88 cm for women (action level II). Proposed originally by Lean et al. [22], and subsequently by Han et al. [23], level I was recommended for lifestyle modifications, whereas level II necessitated the use of professional help. These recommended waist circumference cut-points based on measured waist mid-way between the lower rib and the iliac crest [21], [22], [23], [24] are generally used in studies [21], [22], [23], [24]. The World Health Organization's (WHO) consultation group on obesity [24] and the NIH expert panel on the identification, evaluation and treatment of overweight and obesity have been endorsed these waist circumference cut-points [21].

Despite the fact that aberrant regional fat distributions as seen in abdominally obese subjects may be more potent in cardiovascular diseases than other obesity phenotypes, studies describing prevalence and trends in obesity are often restricted to generalized obesity [25], [26], [27]. To our knowledge, no data exist describing trends in waist circumference and prevalence of abdominal obesity spanning 40 years in U.S. adults. Hence, in this study, we took advantage of U.S. cross-sectional surveys to describe the changes in the distribution of waist circumference in adult men and women from 1960 through 2000. We also sought to determine the prevalence and trends in abdominal obesity using the NIH expert panel and WHO consultation group recommended waist circumference cut-points [21], [22]. Due to the voluminous data regarding the negative effects of obesity in recent years, we hypothesized a decrease in the prevalence of abdominal obesity in the 1999–2000 compared to the prevalence of abdominal obesity that was recorded in the 1996–1962 and 1988–1994 periods.

Section snippets

Data source

The US National Center for Health Statistics (NCHS) provided data sets that were used in this study. Data sets representing three time periods (1960–1962, 1988–1994 and 1999–2000) came from cross-sectional surveys with similar designs and were carried out among non-institutionalized U.S. civilian populations. Descriptions of the plan and operation of these surveys have been previously described [28], [29]. Briefly, these surveys have the same structure and design and are national in scope. In

Results

Descriptive characteristics of the studied populations stratified by survey periods are presented in Table 1. A total of 23,654 adult men and women were eligible for this investigation. Participants tended to be older in NHANES 1999–2000 compared to NHIS I and NHANES III (P < 0.01). Overall, there was a significant difference in mean values of height, weight and BMI between the study periods in both men and women (P < 0.001). There was a gradient of increasing weight and BMI from 1960–1962 to

Discussion

Although literature describing prevalence and trends of obesity is voluminous, we are unaware of any such studies spanning 4 years with respect to abdominal obesity. This is the first investigation to use the new proposed waist circumference cut-off point for abdominal obesity recommended by the NIH expert panel on the identification, evaluation, and the treatment of overweight and obesity in adults [21]. This is also the first investigation utilizing U.S. national health surveys covering a

Conclusion

This study suggests that abdominal obesity is a growing problem in the United States. There was a much lower prevalence of abdominal obesity in 1960–1962 than in 1988–1994 and 1999–2000. The shift in abdominal obesity in the United States between 1960–1962 and 1999–2000 has ominous public health implications across the entire population, including those with normal BMI. The higher increase in the prevalence of abdominal obesity than generalized obesity between 1960 and 2000 makes for a greater

Acknowledgements

We thank the US National Center for Health Statistics for providing data that were used in this study.

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