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Prospective Study on Nutrition Transition in China

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Prospective Study on Nutrition Transition in China Prospective study on nutrition transition in China Fengying Zhai, Huijun Wang, Shufa Du, Yuna He, Zhihong Wang, Keyou Ge, and Barry M Popkin The aim of the prospective study reported here was to examine the effects of social and economic transformation on dietary patterns and nutritional status in China. The study began in 1989 and continued with follow-ups in 1991, 1993, 1997, 2000, and 2004. A total of 5000 subjects aged 18–45 years from 4280 households in nine provinces were included. Weighed records and three consecutive 24-h recalls were used. Over the study period, average consumption of all animal foods except milk increased, while cereal intake decreased. The proportion of animal protein and fat as a percentage of energy also increased. However, vitamin A and calcium intake did not increase and remained low. Child height and weight increased while undernutrition decreased and overweight increased. The results indicate that rapid changes in dietary pattern are associated with economic reforms in China. © 2009 International Life Sciences Institute INTRODUCTION development, public resources, and health indicators. A multistage, random cluster sample was used to draw the Twenty-five years ago, China introduced sweeping sample surveyed in each of the provinces. In 1989–1993 reforms in the structure of its rural economy. The there were 190 primary sampling units; a new province economy has experienced exponential growth in the past and its sampling units were added in 1997. Currently, decade, with per-capita GDP rising from 460 yuan in there are about 3800 households in the overall survey, 1980 to 9101 yuan in 2003.1 Since 1990, the annual rate covering 16,000 individuals, including all age groups. The of per-capita GDP growth has been 8.6%.2 A rapid rise surveys collected information on all individuals living in in economic productivity has resulted in continuing the household.A complete household roster was used as a increases in income and changes in the traditional reference for subsequent blocks of questions on indi- Chinese diet. But these changes are occurring at markedly vidual, household, and community infrastructure. The different rates across the country. Following rapid eco- study included adults aged 18–45 years in the survey to nomic and social change, the pace of nutrition transition comprise the study population (Table 1). has accelerated in China.3,4 The study presented here focused on the interplay of demographic and economic changes that affect food demand and nutritional status in RESULTS China’s population. Trends in dietary intake SUBJECT AND METHODS Over the past 10 years, adult intake of cereals and starchy Data and study population roots declined. During the same period, consumption of animal food, especially meat and eggs, increased The data was derived from the China Economic, Popula- (Table 2). The proportion of dietary energy derived from tion, Nutrition and Health Survey, which covers nine fat in the adult diet increased dramatically, from 19% provinces that vary substantially in geography, economic to 28%, mainly due to replacement of calories from Affiliations: F Zhai, H Wang, SDu, YHe, Z Wang, and KGeare with the Institute of Nutrition and Food Safety, China CDC, Beijing, China. BM Popkin is with the Carolina Population Center, University of North Carolina at Chapel Hill, North Carolina, USA. Correspondence: F Zhai, Institute of Nutrition and Food Safety, China CDC, No. 29 Nan Wei Road, Xuan Wu District, Beijing 100050, China. E-mail: [email protected]. Key words: China Health and Nutrition Survey, dietary pattern, nutrition transition, trends doi:10.1111/j.1753-4887.2009.00160.x S56 Nutrition Reviews® Vol. 67(Suppl. 1):S56–S61 Table 1 Composition of the study population in China by year. Population group 1989 1991 1993 1997 2000 2004 n % n % n % n % n % n % Sex Male 2400 47.3 2692 47.1 2460 47.3 2464 48.8 2486 48.2 2160 48.3 Female 2672 52.7 3018 52.9 2742 52.7 2584 51.2 2674 51.8 2314 51.7 Total 5072 100.0 5710 100.0 5202 100.0 5048 100.0 5160 100.0 4474 100.0 Age 18–24 1132 22.3 1429 25.0 1252 24.1 1047 20.7 905 17.5 626 14.0 25–29 1052 20.7 1159 20.3 906 17.4 916 18.1 817 15.8 648 14.5 30–34 1028 20.3 884 15.5 867 16.7 1014 20.1 964 18.7 893 20.0 35–39 1015 20.0 1150 20.1 1066 20.5 832 16.5 1177 22.8 1032 23.1 40–45 845 16.7 1088 19.1 1111 21.4 1239 24.5 1297 25.1 1275 28.5 Total 5072 100.0 5710 100.0 5202 100.0 5048 100.0 5160 100.0 4474 100.0 Community Urban 806 15.9 851 14.9 671 12.9 717 14.2 630 12.3 599 13.4 Suburb 779 15.4 934 16.4 897 17.2 1005 19.9 997 19.4 914 20.5 Town 756 14.9 910 15.9 805 15.5 761 15.1 867 16.9 686 15.3 Rural 2731 53.8 3015 52.8 2829 54.4 2565 50.8 2645 51.5 2272 50.8 Total 5072 100.0 5710 100.0 5202 100.0 5048 100.0 5160 100.0 4474 100.0 carbohydrate (Figure 1).About one-half of dietary fat was both children and adults. Moreover, the rate of over- derived from edible oil, while the consumption of refined weight increase is becoming increasingly rapid (Figure 2). animal fat decreased. The distribution of BMI estimated from this survey Comparing the surveys from 1989 and 2004 revealed in 1989, 1997, 2000, and 2004 is shown in Figures 3 and 4 that energy and protein intake had decreased over time, and the line of BMI shifted to the right in both males and but the quantity of protein had increased as a percentage females. Thus, the proportion to the right of the distribu- of total calories. The average calcium intake among the tion has increased with time. If action is not taken, the city and suburban populations was only about 430 mg per prevalence of overweight and obesity will increase more day, while among the town and village populations, the rapidly than before. average calcium intake was about 380 mg per day. Intake of vitamins and other minerals remained steady (Table 3). DISCUSSION Trends in nutritional status Over the past 20 years, the status of diet and nutrition among the urban and rural populations in China has Trends in the nutritional status of the Chinese population undergone significant improvement, and the prevalence clearly demonstrate that undernutrition is declining of malnutrition and nutrition deficiencies has been rapidly, while overweight and obesity are increasing in decreasing continuously.5–7 However, China is also 2004 12.5 27.5 60 2000 11.9 28.9 58.8 protein Year 1997 11.9 25.8 61.9 fat 1993 12.2 22.2 65 carbonhydrates 1991 11.9 21.8 65.6 1989 11.5 19.3 68.8 0% 20% 40% 60% 80% 100% Figure 1 Trends in percent of macronutrients as proportion of total dietary energy intake in the Chinese population. Nutrition Reviews® Vol. 67(Suppl. 1):S56–S61 S57 S58 Table 2 Trends in intake (g/day) of food groups for adults in China by residence and year. Food Total Rural Urban 1989 1991 1993 1997 2000 2004 1989 1991 1993 1997 2000 2004 1989 1991 1993 1997 2000 2004 Rice 348 337 320 297 274 280 362 338 335 312 290 295 316 336 284 262 237 243 Wheat 190 196 199 181 152 167 193 196 211 193 154 173 183 194 169 153 146 152 Other cereals 53 35 32 28 20 16 86 37 39 34 22 18 15 29 12 12 14 13 Tubers 139 94 89 83 73 42 174 95 98 91 78 47 88 91 66 67 70 29 Legumes and products 23 21 20 19 19 50 23 21 21 19 19 43 22 21 19 19 19 68 Vegetables* 296 278 284 280 267 359 314 302 303 292 277 377 242 238 234 239 262 313 Fresh fruit 14 9 12 10 12 29 14 8 11 6 8 25 14 12 16 20 22 38 Pork 52 59 62 60 69 62 44 59 52 49 60 54 71 59 89 86 91 80 Other meats§ 557991545666117612161525 Poultry 7 7 9 12 14 1547610121312714171919 Milk and products† 243361212112655791725 Eggs and products‡ 11141524262691312202323161522333233 Fish 24 21 22 28 26 30 22 21 20 25 25 28 27 22 28 35 30 35 Vegetable oil 32 22 22 31 30 33 30 22 21 30 30 32 37 22 26 34 30 36 Animal fat 18 13 10 10 12 6 19 14 11 10 12 7 15 12 9 9 12 4 Cakes 122326131216214558 Sugar 855665854665847864 Salt 19 16 14 13 13 10 21 16 14 13 13 10 23 16 13 14 14 9 Pastes and soy sauce 26 14 12 16 15 9 22 13 12 17 15 10 32 16 13 14 14 8 Nutrition Reviews® Vol. 67(Suppl. 1):S56–S61 Other foods 13 12 12 14 14 36 13 12 11 12 13 36 14 12 15 19 16 36 * Total vegetables; excludes potatoes. † Products containing milk. ‡ Products in which egg is the key ingredient. § All processed meats. Nutrition Reviews® Vol. 67(Suppl. 1):S56–S61 Table 3 Nutrient intake by community and year in China.
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