OBJECTIVE: To examine the relationship between diet, particularly dietary fat intake, and body mass index (BMI). DESIGN: Prospective study of adults who participated in the 1989 and 1991 China Health and Nutrition Survey. SUBJECTS: 3484 adults aged 20±45 at baseline (1989) survey. MEASUREMENTS: Measurement of dietary intake with replicated 24 h dietary recalls. Anthropometric measurements. Measurements of physical activity, smoking habit and socio-economic factors. RESULTS: Change in fat intake was positively associated with change in BMI in men (b b 0.00036, P 0.0001), and change in physical activity level was inversely associated with change in BMI in women (b b 70.12, P 0.02). Energy intake, physical activity and major socio-economic factors were related to BMI in cross-sectional analysis. CONCLUSIONS: Diet is becoming an increasingly important determinant of body weight in this population, where fat and energy consumption has been increasing steadily during the past decade.

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Recent US work identifies “metabolically healthy overweight” and “metabolically at risk normal weight” individuals. Less is known for modernizing countries with recent increased obesity. Fasting blood samples, anthropometry and blood pressure from 8,233 adults aged 18–98 in the 2009 nationwide China Health and Nutrition Survey, were used to determine prevalence of overweight (Asian cut point, BMI≥23 kg/m2) and five risk factors [pre-diabetes/diabetes (HbA1c≥5.7%) inflammation (hsCRP ≥3 mg/L), pre-hypertension/hypertension (SBP/DBP≥130/85 mmHg), high triglycerides (≥150 mg/dL), low high-density lipoprotein cholesterol (<40 (men)/<50 mg/dL (women)]. Sex-stratified, logistic and multinomial logistic regression models estimated concurrent obesity and cardiometabolic risk, with and without abdominal obesity, adjusting for age, smoking, alcohol consumption, physical activity, urbanicity, and income. Irrespective of urbanicity, 78.3% of the sample had ≥1 elevated cardiometabolic risk factor (normal weight: 33.2% had ≥1 elevated risk factor; overweight: 5.7% had none). At age 18–30, 47.4% had no elevated risk factors, which dropped to 6% by age 70, largely due to age-related increase in hypertension risk (18–30 years: 11%, >70 years: 73%). Abdominal obesity was highly predictive of metabolic risk, irrespective of overweight (e.g., “metabolically at risk overweight” relative to “metabolically healthy normal weight” [men: Relative Risk Ratio (RRR) =39.06; 95% Confidence Interval (CI): 23.47, 65.00; women: RRR=22.26; 95% CI: 17.49, 28.33]). To conclude, a large proportion of Chinese adults have metabolic abnormalities. High hypertension risk with age, irrespective of obesity underlies the low prevalence of metabolically healthy overweight. Screening for cardiometabolic-related outcomes dependent upon overweight will likely miss a large portion of the Chinese at-risk population.

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