Environmental, Dietary, and Behavioral Factors Distinguish Chinese Adults with High Waist-to-Height Ratio with and without Inflammation

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. Objectives: We tested which of the characteristics distinguished 3 risk groups-high waist-to-height ratio (WHtR; >0.5) without inflammation thigh-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). Conclusion: 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.