Abdominal adiposity in U.S. adults: prevalence and trends, 1960–2000

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Background. There is a large body of epidemiologic evidence linking abdominal obesity to cardiovascular diseases. Abdominal adiposity is an important component of insulin resistance syndrome. Objective. To investigate prevalence and trends in abdominal obesity in U.S. adult population. Design, setting/participants. Nationally representative cross-sectional surveys with an in-person interview and measurement of waist circumference; 23,654 adults aged 20–79 years were examined using data from U.S. National Surveys of 1960–1962 [the first National Health Examination Survey (NHES I)], 1988–1994 [the third National Health and Nutrition Examination Survey (NHANES III)] and 1999–2000 [National Health and Nutrition Examination Survey (NHANES 1999–2000)]. Abdominal obesity was defined as waist circumference ≥102 cm (>40 in.) in men and ≥88 cm (>35 in.) in women. Results. There was a gradient of increasing waist circumference over the three periods of 1960–1962, 1988–1994 and 1999–2000 in both men and women. In men, the mean waist circumferences were 89, 95 and 99 cm for 1960–1962, 1988–1994 and 1999–2000, respectively. The corresponding values in women were 77, 92 and 94 cm, respectively. A gradient of increasing prevalence of abdominal obesity from 1960 to 2000 was also observed in men and women. In men, the overall age-adjusted prevalences of abdominal obesity were 12.7%, 29% and 38.3% in 1960–1962, 1988–1994 and 1999–2000, respectively. In women, the analogous values were 19.4%, 38.8% and 59.9%, respectively. Similar trends of increasing waist circumference and abdominal obesity were observed in normal weight, underweight and obese subjects defined using body mass index (BMI). Trends of increasing abdominal obesity with increasing BMI over the three time periods were also observed. Conclusions. The increase in the prevalence of abdominal obesity in the United States between 1960–1962 and 1999–2000 has ominous public health implications across entire population, particularly among normal weight subjects. There is an urgent need to describe a public health strategy for early identification of abdominal obesity. Primary prevention of obesity, including abdominal obesity, should be a major public health priority in the United States.