title: Environmental, Dietary, and Behavioral Factors Distinguish Chinese Adults with High Waist-to-Height Ratio with and without Inflammation.
abstract: BACKGROUND
  The environmental and behavioral risk factors associated with central obesity and/or inflammation in populations exposed to both obesogenic and pathogenic environments remain unclear.
  
  
  OBJECTIVE
  We tested which of the characteristics distinguished 3 risk groups--high waist-to-height ratio (WHtR; >0.5) without inflammation [high-sensitivity C-reactive protein (hs-CRP) <3 mg/L], normal WHtR (≤ 0.5) with inflammation (hs-CRP: 3-10 mg/L), and high WHtR with inflammation--from the referent group with normal WHtR without inflammation and, secondarily, which factors differed between the groups with high WHtR with and without inflammation.
  
  
  METHODS
  The analytic sample included 8068 adults participating in the China Health and Nutrition Survey in 2009. Adjusted multinomial and logistic regression models were used to assess the risk of being in one of the "unhealthy" groups compared with the referent group.
  
  
  RESULTS
  Men with high WHtR with and without inflammation were more likely to live at higher urbanicity (57-63%) and have higher incomes (26-42%) and household sanitation (26-67%) and were >40% less likely to have high physical activity than the healthy referent group. Men with high WHtR with inflammation had higher odds of infectious symptoms than those with high WHtR without inflammation (OR: 1.73; 95% CI: 1.15, 2.61). Women with high WHtR without inflammation were less likely to have high household sanitation (44%) or perform high levels of physical activity (24%) and were 34% more likely to consume more fiber than the healthy referent group. Women with high WHtR and inflammation were more likely than those with high WHtR without inflammation to have infectious symptoms (OR: 1.45; 95% CI: 1.01, 2.07) and less likely to have higher fiber intake (OR: 0.77; 95% CI: 0.60,1.00) or physical activity (OR: 0.55; 95% CI: 0.41, 0.73).
  
  
  CONCLUSIONS
  These results document different underlying pathogenic and obesogenic risk factors for visceral adiposity with and without inflammation in Chinese adults, suggesting that context-specific approaches may be needed to prevent and treat inflammation.
authors.affiliation: Department of Anthropology, Carolina Population Center, and althomps@email.unc.edu.
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Thompson
authors.affiliation: Carolina Population Center, and Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; and.
authors.forename: Linda
authors.initials: L
authors.lastname: Adair
authors.affiliation: Carolina Population Center, and Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; and.
authors.forename: Penny
authors.initials: P
authors.lastname: Gordon-Larsen
authors.affiliation: Institute of Nutrition and Foods Safety, Chinese Centers for Disease Control, Beijing, China.
authors.forename: Bing
authors.initials: B
authors.lastname: Zhang
authors.affiliation: Carolina Population Center, and Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; and.
authors.forename: Barry
authors.initials: B
authors.lastname: Popkin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism; D002681:China / Q000453:epidemiology; D004032:Diet; D004041:Dietary Fats / Q000008:administration & dosage; D004043:Dietary Fiber / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007249:Inflammation / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009749:Nutrition Surveys; D056128:Obesity, Abdominal / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012959:Socioeconomic Factors; D055105:Waist Circumference; D065927:Waist-Height Ratio; D055815:Young Adult
chemical_list: D004041:Dietary Fats; D004043:Dietary Fiber; D002097:C-Reactive Protein
keywords: C-reactive protein; China; central obesity; inflammation; waist-to-height ratio