Prevalence of Abdominal Obesity in Chinese Middle-Aged and Older Adults with a Normal Body Mass Index and Its Association with Type 2 Diabetes Mellitus: A Nationally Representative Cohort Study from 2011 to 2018

Xuan Chen; Mingrui Duan; Rui Hou; Manqi Zheng; Haibin Li; Manjot Singh; Changwei Li; Kuo Liu; Feng Zhang; Xinghua Yang; Yanxia Luo; Yan He; Lijuan Wu; Deqiang Zheng

doi:10.2147/DMSO.S339066

Prevalence of Abdominal Obesity in Chinese Middle-Aged and Older Adults with a Normal Body Mass Index and Its Association with Type 2 Diabetes Mellitus: A Nationally Representative Cohort Study from 2011 to 2018

Diabetes Metab Syndr Obes. 2021 Dec 20:14:4829-4841. doi: 10.2147/DMSO.S339066. eCollection 2021.

Authors

Xuan Chen^#¹, Mingrui Duan^#^{1

2}, Rui Hou^#^{1

2}, Manqi Zheng^{1

2}, Haibin Li³, Manjot Singh^{4

5}, Changwei Li⁶, Kuo Liu^{1

2}, Feng Zhang^{1

2}, Xinghua Yang^{1

2}, Yanxia Luo^{1

2}, Yan He^{1

2}, Lijuan Wu^{1

2}, Deqiang Zheng^{1

2

7}

Affiliations

¹ Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, People's Republic of China.
² Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, People's Republic of China.
³ Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China.
⁴ Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, University of Western Australia, Crawley, WA, Australia.
⁵ School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.
⁶ Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
⁷ Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden.

^# Contributed equally.

Abstract

Background: Few studies have focused on the prevalence of abdominal obesity in Chinese middle-aged and older adults with a normal body mass index (BMI). Furthermore, it is still unclear whether abdominal obesity is an independent risk factor for type 2 diabetes mellitus (T2DM). Participants with a normal BMI are usually neglected during assessments of abdominal obesity-associated T2DM risk since the current recommendations for medical interventions are mainly focused on overall body mass index rather than fat deposition patterns.

Methods: In this study, 7942 normal-BMI participants aged over 45 years from the China Health and Retirement Longitudinal Study were included to assess the prevalence of abdominal obesity defined by waist circumference (WC) or waist-to-height ratio (WHtR). In addition, 4348 normal-BMI individuals with no diabetes at baseline were included to evaluate the association between abdominal obesity and the risk of T2DM with the Cox proportional hazards model.

Results: The prevalence (95% confidence interval, CI) of increased WC and substantially increased WC among adults with a normal BMI was 22.0% (21.1%-22.9%) and 18.1% (17.3%-19.0%), respectively. The adjusted hazard ratios and 95% CIs for T2DM incidence were 1.39 (1.05-1.85) and 1.89 (1.42-2.53) for those with increased WC and substantially increased WC, respectively, compared to the individuals with a normal WC. Similar HRs were obtained for the association between WHtR and the risk of T2DM. In prediabetic patients, the HRs (95% CIs) for new-onset T2DM for those with increased WC and substantially increased WC were 1.85 (1.27-2.69) and 2.46 (1.67-3.61), respectively, when compared with individuals with normal WC. This positive association was observed in women but not in men or adults with normal glucose tolerance (NGT).

Conclusion: Abdominal obesity is highly prevalent among middle-aged and older Chinese adults with a normal BMI, and maintaining a normal waist circumference may be beneficial in the prevention of T2DM.

Keywords: abdominal obesity; hazard ratio; normal body mass index; prevalence; type 2 diabetes mellitus.

Grants and funding

This work was supported by grants from the Natural Science Foundation of Beijing Municipality [grant number 7202011], the National Natural Science Foundation of China [grants numbers 82073648 and 81703317], and the China Scholarship Council.