title: Changes in prevalence of obesity and high waist circumference over four years across European regions: the European male ageing study (EMAS).
abstract: Diversity in lifestyles and socioeconomic status among European populations, and recent socio-political and economic changes in transitional countries, may affect changes in adiposity. We aimed to determine whether change in the prevalence of obesity varies between the socio-politically transitional North-East European (Łódź, Poland; Szeged, Hungary; Tartu, Estonia), and the non-transitional Mediterranean (Santiago de Compostela, Spain; Florence, Italy) and North-West European (Leuven, Belgium; Malmö, Sweden; Manchester, UK) cities. This prospective observational cohort survey was performed between 2003 and 2005 at baseline and followed up between 2008 and 2010 of 3369 community-dwelling men aged 40-79 years. Main outcome measures in the present paper included waist circumference, body mass index and mid-upper arm muscle area. Baseline prevalence of waist circumference ≥ 102 cm and body mass index ≥ 30 kg/m2, respectively, were 39.0, 29.5 % in North-East European cities, 32.4, 21.9 % in Mediterranean cities, and 30.0, 20.1 % in North-West European cities. After median 4.3 years, men living in cities from transitional countries had mean gains in waist circumference (1.1 cm) and body mass index (0.2 kg/m2), which were greater than men in cities from non-transitional countries (P = 0.005). North-East European cities had greater gains in waist circumference (1.5 cm) than in Mediterranean cities (P < 0.001). Over 4.3 years, the prevalence of waist circumference ≥ 102 cm had increased by 13.1 % in North-East European cities, 5.8 % in the Mediterranean cities, 10.0 % in North-West European cities. Odds ratios (95 % confidence intervals), adjusted for lifestyle factors, for developing waist circumference ≥ 102 cm, compared with men from Mediterranean cities, were 2.3 (1.5-3.5) in North-East European cities and 1.6 (1.1-2.4) in North-West European cities, and 1.6 (1.2-2.1) in men living in cities from transitional, compared with cities from non-transitional countries. These regional differences in increased prevalence of waist circumference ≥ 102 cm were more pronounced in men aged 60-79 years than in those aged 40-59 years. Overall there was an increase in the prevalence of obesity (body mass index  ≥ 30 kg/m2) over 4.3 years (between 5.3 and 6.1 %) with no significant regional differences at any age. Mid-upper arm muscle area declined during follow-up with the greatest decline among men from North-East European cities. In conclusion, increasing waist circumference is dissociated from change in body mass index and most rapid among men living in cities from transitional North-East European countries, presumably driven by economic and socio-political changes. Information on women would also be of value and it would be of interest to relate the changes in adiposity to dietary and other behavioural habits.
authors.affiliation: Institute of Cardiovascular Research, Royal Holloway, Egham & Ashford and St Peter's NHS Foundation Trust, University of London (ICR2UL), Surrey, UK. t.s.han@doctors.org.uk.
authors.forename: Thang S
authors.initials: TS
authors.lastname: Han
authors.affiliation: School of Computing, Science and Engineering, University of Salford, Salford, UK.
authors.forename: Elon
authors.initials: E
authors.lastname: Correa
authors.affiliation: Department of Human Nutrition, University of Glasgow, Glasgow, UK.
authors.forename: Michael E J
authors.initials: ME
authors.lastname: Lean
authors.affiliation: Cathie Marsh Institute for Social Research, School of Social Sciences, The University of Manchester, Manchester, UK.
authors.forename: David M
authors.initials: DM
authors.lastname: Lee
authors.affiliation: Arthritis Research UK Centre for Epidemiology & NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
authors.forename: Terrence W
authors.initials: TW
authors.lastname: O'Neill
authors.affiliation: Department of Obstetrics, Gynaecology and Andrology, Albert Szent-György Medical University, Szeged, Hungary.
authors.forename: György
authors.initials: G
authors.lastname: Bartfai
authors.affiliation: Endocrinology Unit, University of Florence, Florence, Italy.
authors.forename: Gianni
authors.initials: G
authors.lastname: Forti
authors.affiliation: Reproductive Medicine Centre, Skåne University Hospital, University of Lund, Lund, Sweden.
authors.forename: Aleksander
authors.initials: A
authors.lastname: Giwercman
authors.affiliation: Department of Andrology and Reproductive Endocrinology, Medical University of Łódź, Łódź, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Kula
authors.affiliation: Institute of Brain Behaviour and Mental Health, Salford Royal NHS Trust, University of Manchester, Salford, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Pendleton
authors.affiliation: Andrology Unit, United Laboratories of Tartu University Clinics, Tartu, Estonia.
authors.forename: Margus
authors.initials: M
authors.lastname: Punab
authors.affiliation: The Endocrinology and Diabetes Research Group, Institute of Human Development, Department of Medical and Human Sciences, University of Manchester, Manchester, UK.|Manchester Diabetes Centre, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
authors.forename: Martin K
authors.initials: MK
authors.lastname: Rutter
authors.affiliation: Department of Andrology and Endocrinology, Catholic University of Leuven, Leuven, Belgium.
authors.forename: Dirk
authors.initials: D
authors.lastname: Vanderschueren
authors.affiliation: Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, UK.
authors.forename: Ilpo T
authors.initials: IT
authors.lastname: Huhtaniemi
authors.affiliation: Andrology Research Unit, The University of Manchester, Manchester, UK.
authors.forename: Frederick C W
authors.initials: FC
authors.lastname: Wu
authors.affiliation: Department of Medicine, CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS), Santiago de Compostela University, Santiago de Compostela, Spain. felipe.casanueva@usc.es.
authors.forename: Felipe F
authors.initials: FF
authors.lastname: Casanueva
mesh_terms: D050154:Adiposity / Q000502:physiology; D000328:Adult; D000368:Aged; D000375:Aging; D015992:Body Mass Index; D004032:Diet; D005060:Europe / Q000453:epidemiology; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology* / Q000503:physiopathology; D015995:Prevalence; D011446:Prospective Studies; D055105:Waist Circumference / Q000502:physiology*
keywords: Body mass index; Environment; Fat distribution; Health promotion; Obesity; Waist circumference