美国 1993-2012 年 BMI 中群体不平等和个体间不平等的趋势。
Trends in group inequalities and interindividual inequalities in BMI in the United States, 1993-2012.
机构信息
From the Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (AK and SVS); the Department of Medicine, University of Toronto, Toronto, Canada (FR); the Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Canada (FR); the Harvard Center for Population and Development Studies. Boston, MA (FR); Laval University, Quebec, Canada (AL); the Quebec Heart and Lung Institute Research Center, Quebec, Canada (AL); and the School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom (GDS).
出版信息
Am J Clin Nutr. 2015 Mar;101(3):598-605. doi: 10.3945/ajcn.114.100073. Epub 2015 Jan 14.
BACKGROUND
Marked increases in mean body mass index (BMI) and prevalence of obesity and overweight in the United States are well known. However, whether these average increases were accompanied by changing dispersion (or SD) remains understudied.
OBJECTIVE
We investigated population-level changes in the BMI distribution over time to understand how changes in dispersion reflect between-group compared with within-group inequalities in weight gain in the United States.
DESIGN
Using data from the Behavioral Risk Factor Surveillance System survey (1993-2012), we analyzed associations between mean, SD, and median BMI and BMI at the 5th and 95th percentiles for 3,050,992 non-Hispanic white, non-Hispanic black, and Hispanic men and women aged 25-64 y.
RESULTS
Overall, an increase of 1.0 in mean BMI (in kg/m²) was associated with an increase of 0.70 (95% CI: 0.67, 0.73) in the SD of BMI. A change of 1.0 in median BMI was associated with a change of 0.18 (95% CI: 0.14, 0.21) in the BMI value at the 5th percentile compared with a change of 2.94 (95% CI: 2.81, 3.07) at the 95th percentile. Quantile-quantile plots showed unequal changes in the BMI distribution, with pronounced changes at higher percentiles. Similar patterns were observed in subgroups stratified by sex, race-ethnicity, and education with non-Hispanic black women and women with less than a high school education having highest mean BMI, SD of BMI, and BMI values at the 5th and 95th percentiles.
CONCLUSIONS
Mean BMI and the percentage of overweight and obese individuals do not fully describe population changes in BMI. Increases in within-group inequality in BMI represent an underrecognized characteristic of population-level weight gain. Crucially, similar increases in dispersion within groups suggest that growing inequalities in BMI at the population level are not driven by these socioeconomic and demographic factors. Future research should focus on understanding factors driving inequalities in weight gain between individuals.
背景
美国的平均体重指数（BMI）显著增加，肥胖和超重的患病率也显著增加，这是众所周知的。然而，这些平均增长是否伴随着分布（或标准差）的变化仍有待研究。
目的
我们研究了 BMI 分布随时间的人群水平变化，以了解体重增加的组间和组内不平等如何反映在 BMI 分布的变化中。
设计
使用来自行为风险因素监测系统调查（1993-2012 年）的数据，我们分析了非西班牙裔白种人、非西班牙裔黑人和西班牙裔男性和女性 25-64 岁人群中 BMI 的平均值、标准差和中位数与 BMI 的第 5 百分位和第 95 百分位之间的关联。
结果
总体而言，BMI 平均值增加 1.0kg/m²与 BMI 的标准差增加 0.70（95%CI：0.67，0.73）相关。中位数 BMI 增加 1.0kg/m²与第 5 百分位 BMI 值的变化相关，变化为 0.18（95%CI：0.14，0.21），而第 95 百分位 BMI 值的变化为 2.94（95%CI：2.81，3.07）。分位数-分位数图显示 BMI 分布的变化不均等，在较高百分位有明显的变化。在按性别、种族-民族和教育程度划分的亚组中观察到类似的模式，非西班牙裔黑人和受教育程度较低的女性具有最高的平均 BMI、BMI 的标准差和第 5 百分位和第 95 百分位的 BMI 值。
结论
平均 BMI 和超重及肥胖人群的百分比不能完全描述 BMI 的人群变化。BMI 组内不平等的增加代表了人群体重增加的一个未被充分认识的特征。重要的是，组内离散度的相似增加表明，人群层面 BMI 不平等的增长并非由这些社会经济和人口因素驱动。未来的研究应集中于了解个体间体重增加不平等的驱动因素。
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