中国疾病预防控制中心李新华、丁刚强、吴静团队研究了中国城乡居民的体重指数与肥胖趋势。相关论文于2021年7月3日发表在《柳叶刀》杂志上。

在中国，成年人的平均体重指数（BMI）和肥胖率自20世纪80年代初以来稳步上升。然而，据研究人员所知，尚无针对国家、地区或某些人口亚群的最近趋势的可靠评估。为了填补这一证据缺口，研究组对2004-2018年进行的六项具有全国代表性的连续健康调查的相关数据进行了详细分析。旨在研究中国成年人平均BMI和肥胖流行率的长期和近期趋势，特别是2010年前后（当时启动了各种国家非传染性疾病预防规划）的变化，评估这些趋势如何因性别、年龄、城乡地区以及社会经济状况而变化，并估计2018年与2004年相比肥胖的人数。

研究组使用了中国慢性疾病和危险因素监测项目的数据，该项目于2004年建立，目的是定期提供全国普通人群中重大慢性疾病的流行情况以及相关行为和代谢危险因素的数据。2004至2018年，共开展了六项具有全国代表性的调查。邀请了776571人，共746020人（96.1%）参与，包括2004年的33051人，2007年的51050人，2010年的98174人，2013年的189115人，2015年的189754人，以及2018年的184876人。经排除后，仍有645223名年龄在18-69岁之间的受试者参与本次分析。计算平均BMI和肥胖患病率（BMI≥30 kg/m²），比较性别、年龄、城乡地区、地理区域和社会经济地位的时间趋势。

标准化平均BMI水平从2004年的22.7 kg/m²上升至2018年的24.4 kg/m²，肥胖患病率从3.1%上升至8.1%。2010至2018年间，平均BMI每年上升0.09 kg/m²，是2004至2010年报告的一半。同样，2010年后肥胖患病率的年增长率为6.0%，略低于2010年前（8.7%）。自2010年以来，城市男性和女性的平均BMI和肥胖患病率的上升速度显著放缓，农村男性的上升速度适度放缓，但农村女性的上升速度持续稳定。

到2018年，农村女性的平均BMI为24.3 kg/m²，显著高于城市女性（23.9 kg/m²）；但农村男性的平均BMI为24.5 kg/m²，显著低于城市男性（25.1 kg/m²）。在所有六项调查中，与受教育程度较低的女性相比，受教育程度较高的女性平均BMI持续较低，但男性的BMI则相反。总的来说，中国估计有8500万18-69岁的成年人（4800万男性和3700万女性）肥胖，是2004年的三倍。

研究结果表明，在过去的十年里，中国成年人口平均体重指数（BMI）的上升似乎有所放缓。然而，研究组发现了性别、地理区域和社会经济地位的不同趋势，强调需要采取针对性的方法来防止中国普通人群中肥胖的进一步增加。

附：英文原文

Title: Body-mass index and obesity in urban and rural China: findings from consecutive nationally representative surveys during 2004–18

Author: Limin Wang, Bin Zhou, Zhenping Zhao, Ling Yang, Mei Zhang, Yong Jiang, Yichong Li, Maigeng Zhou, Linhong Wang, Zhengjing Huang, Xiao Zhang, Liyun Zhao, Dongmei Yu, Chun Li, Majid Ezzati, Zhengming Chen, Jing Wu, Gangqiang Ding, Xinhua Li

Issue&Volume: 2021/07/03

Abstract:

Background

In China, mean body-mass index (BMI) and obesity in adults have increased steadily since the early 1980s. However, to our knowledge, there has been no reliable assessment of recent trends, nationally, regionally, or in certain population subgroups. To address this evidence gap, we present detailed analyses of relevant data from six consecutive nationally representative health surveys done between 2004 and 2018. We aimed to examine the long-term and recent trends in mean BMI and prevalence of obesity among Chinese adults, with specific emphasis on changes before and after 2010 (when various national non-communicable disease prevention programmes were initiated), assess how these trends might vary by sex, age, urban–rural locality, and socioeconomic status, and estimate the number of people who were obese in 2018 compared with 2004.

Methods

We used data from the China Chronic Disease and Risk Factors Surveillance programme, which was established in 2004 with the aim to provide periodic nationwide data on the prevalence of major chronic diseases and the associated behavioural and metabolic risk factors in the general population. Between 2004 and 2018 six nationally representative surveys were done. 776571 individuals were invited and 746020 (96·1%) participated, including 33051 in 2004, 51050 in 2007, 98174 in 2010, 189115 in 2013, 189754 in 2015, and 184876 in 2018. After exclusions, 645223 participants aged 18–69 years remained for the present analyses. The mean BMI and prevalence of obesity (BMI ≥30 kg/m2) were calculated and time trends compared by sex, age, urban–rural locality, geographical region, and socioeconomic status.

Findings

Standardised mean BMI levels rose from 22·7 kg/m2 (95% CI 22·5–22·9) in 2004 to 24·4 kg/m2 (24·3–24·6) in 2018 and obesity prevalence from 3·1% (2·5–3·7) to 8·1% (7·6–8·7). Between 2010 and 2018, mean BMI rose by 0·09 kg/m2 annually (0·06–0·11), which was half of that reported during 2004–10 (0·17 kg/m2, 95% CI 0·12–0·22). Similarly, the annual increase in obesity prevalence was somewhat smaller after 2010 than before 2010 (6·0% annual relative increase, 95% CI 4·4–7·6 vs 8·7% annual relative increase, 4·9–12·8; p=0·13). Since 2010, the rise in mean BMI and obesity prevalence has slowed down substantially in urban men and women, and moderately in rural men, but continued steadily in rural women. By 2018, mean BMI was higher in rural than urban women (24·3 kg/m2 vs 23·9 kg/m2; p=0·0045), but remained lower in rural than urban men (24·5 kg/m2 vs 25·1 kg/m2; p=0·0007). Across all six surveys, mean BMI was persistently lower in women with higher levels of education compared with women with lower levels of education, but the inverse was true among men. Overall, an estimated 85 million adults (95% CI 70 million–100 million; 48 million men [95% CI 39 million–57 million] and 37 million women [31 million–43 million]) aged 18–69 years in China were obese in 2018, which was three times as many as in 2004.

Interpretation

In China, the rise in mean BMI among the adult population appears to have slowed down over the past decade. However, we found divergent trends by sex, geographical area, and socioeconomic status, highlighting the need for a more targeted approach to prevent further increases in obesity in the Chinese general population.

DOI: 10.1016/S0140-6736(21)00798-4

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00798-4/fulltext