title: Is waist circumference per body mass index rising differentially across the United States, England, China and Mexico?
abstract: OBJECTIVE
  Little is known about whether waist circumference (WC) has increased disproportionately relative to body mass index (BMI) around the world.
  
  
  METHODS
  Data came from the US National Health and Nutrition Examination Survey (1988-1994 and 2007-2010), Health Survey for England (1992-1993 and 2008-2009); the Mexican Nutrition Survey (1999) and the Mexican National Health and Nutrition Survey (NHNS 2012); and the China Health and Nutrition Survey (1993 and 2011). Country- and sex-stratified (for the United States, also race-/ethnicity-stratified) multivariable linear regressions were used to estimate mean difference in WC over time relative to BMI at specified overweight and obesity cutoff points, adjusting for age and survey year.
  
  
  RESULTS
  Although mean WC and BMI shifted upward over time in all age-sex subpopulations in all four countries, trends in overweight prevalence were less consistent. However, WC relative to BMI increased at varying magnitudes across all countries and subpopulations, except US Black men. The magnitude of increase was largest for women in the youngest age group (20-29 years), particularly for women in Mexico (+6.6 cm, P<0.0001) and China (+4.6 cm, P<0.0001) (holding BMI constant at 25 kg/m(2)). For men, the increase was primarily evident among Chinese men (+4.8 cm, P<0.0001).
  
  
  CONCLUSIONS
  WC has increased disproportionately over time relative to overall body mass across the United States, England, Mexico and China, particularly among young women, with the largest increases occurring in the middle-income countries of Mexico and China. These patterns are potentially a cause for concern especially for countries undergoing rapid economic and nutritional transitions.
authors.affiliation: Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA.|Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: S S
authors.initials: SS
authors.lastname: Albrecht
authors.affiliation: Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA.|Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: P
authors.identifier: http://orcid.org/0000-0001-5322-4188
authors.initials: P
authors.lastname: Gordon-Larsen
authors.affiliation: Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: D
authors.initials: D
authors.lastname: Stern
authors.affiliation: Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA.|Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: B M
authors.initials: BM
authors.lastname: Popkin
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D009749:Nutrition Surveys; D009765:Obesity / Q000453:epidemiology*; D050177:Overweight / Q000453:epidemiology*; D015995:Prevalence; D006113:United Kingdom / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D055105:Waist Circumference; D055815:Young Adult