Use of quantile regression to investigate changes in the body mass index distribution of Chinese adults aged 18-60 years: a longitudinal study

Background: Traditional linear regression analyses have detected increasing trends in the incidence of overweight/obesity among both genders in China. However, these previous regression analyses were limited in their ability to capture cross-distribution variations among effects. The objective of our study was to analyze the change in the body mass index (BMI) distribution of adults and investigated the relationships between the key covariates and the BMI distribution. Methods: We used longitudinal data from the China Health and Nutrition Surveys (CHNS) in 1991, 1993, 1997, 2000, 2004, 2006, 2009, and 2011, with at least two waves of data collection. In total, 17,819 participants aged 18-60 years (N = 8587 men and 9232 women) were included in the final analysis with 48,900 observations. The lambda-mu-sigma (LMS) method was used to describe changes in the BMI distribution. Separate sex-stratified longitudinal quantile regression (QR) analyses were used to investigate changes in the BMI distribution over time. Results: The main characteristics of the BMI changes in both genders were that the curves shifted to the right and the distributions became wider. All of the BMI percentile curves tended to increase from 1991 to 2011, where the levels increased more in the higher percentiles. The QR analyses showed that these patterns remain consistent after adjusting for individual and community level factors. Physical activity (PA) had a negative association with BMI for both genders in all percentiles. Income and energy intake were associated with positive changes in male BMI in the upper percentile. Sedentary time had a positive association with female BMI in the middle percentile. Compared with less educated women, women with senior school education at 75th percentile had 0.951 kg/m(2) lower BMIs. Conclusions: This longitudinal quantile regression suggests that effects of different covariates worked differently across the BMI distribution. Since social and economic characteristics in China have underlined the significant disparities in many aspects, national strategies to tackle overweight/obesity should be tailored as appropriate for various segments.