Background: China has been undergoing tremendous demographic transitions towards an aging society. Although suboptimal diets and malnutrition are the leading risk factors for disease burden, capturing nutrition challenges faced by the aging population is challenging due to the limited national representative information available. This study aimed to provide a comprehensive picture of the nutrition status of mid-aged and elderly Chinese and its relation to geographical and socioeconomic factors. Methods: A total of 75,758 non-institutionalized adults aged 45-80 years from the 2010-2013 Chinese National Nutrition and Health Survey were included in this study to evaluate their nutritional status and prevalence of malnutrition problems including anemia, underweight, overweight and obesity. Dietary data from 33,418 participants in this sample were obtained through 24 hour-recall over three consecutive days combined with weighted food inventory. Nutrient intakes were estimated based on dietary records and comparison with Chinese Dietary Reference Intakes 2013 (DRIs). Malnutrition problems were reported with stratification for demographic, geographic, and socioeconomic variables. Odd ratios of risks factors for malnutrition were estimated through multilevel multiple logistic regression analysis. Findings: Chinese population mean intakes of nutrient-dense food groups including fruits, dairy, soy and nuts, eggs, fish and seafood, as well as vegetables were lower than recommendations. Conversely, consumption of fat- and sodium- contributing groups such as meat and poultry, cooking oil, salt and condiments were higher than recommendations.The low adherence to dietary recommendations led to inadequate micronutrient intakes compared to DRIs, especially for eight micronutrients (calcium, folate, magnesium, selenium, vitamin A, vitamin B1, vitamin B2, and vitamin C), with more than 50% of participants have intakes lower than Estimated Average Requirements (EAR). Older age groups showed lower percentages of nutrient adequacy. The overall prevalences of anemia, underweight, overweight and obesity were 10.9%, 3.7%, 36% and 14%, respectively. The combined prevalence of overweight and obesity was 51.3% for the middle-aged group (45-59 years) and 45.2% for the elderly group (60-80 years). After adjusting for confounders at both individual and province levels, being older, female, a rural resident and having lower education were factors associated with higher risk for anemia and underweight, while younger age, female, urban residency and higher income were factors associated with greater risk for being overweight and obese. Interpretation: The results provide reference data for the development of policy and interventions to substantiate the China National Nutrition Plan 2017-2030. Within Chinese adults, older people have the highest prevalence of malnutrition. We suggest three priorities which require attention and solution: addressing anemia and underweight in high risk groups, curbing overweight and obesity, and supporting healthy eating and balanced diets. Funding Statement: The China National Nutrition and Healthy Survey (CNNHS), the Chinese Center for Disease Control and Prevention (CDC). This secondary data analysis received financial support from the Nestlé Research Center. Declaration of Interests: This secondary data analysis received financial support from Nestlé Research Center. Co-author Kai Yu, Jing Yin, and Fabrizio Arigoni are employed by Nestlé Research Center. These authors contributed to the development of the manuscript, with no roles in the survey design and data analysis. Ethics Approval Statement: The study protocol was approved by the ethical review committee of the Chinese CDC. Written informed consent was obtained from all participants.
To investigate the intakes of trans fatty acids over the age of 3 in different populations, and to determine the high exposure food and population in two cities.Use food frequency survey to investigate the frequency and the average intake of food containing trans fatty acids among subjects in the past three months.The first ranks high exposure food is vegetable oil, while other food is different in sequence among two cities. The common high exposure populations are 13-17 years old groups and students at school groups.The high exposure food and population are different among two cities, and the reasons are so various that we need further research.
To describe the hypertension awareness, treatment and control among adults in China in 2010-2012.Data was from the China Nutrition and Health Surveillance in 2010-2012. A stratified multistage cluster sampling was used from 31 provinces, autonomous regions, and municipalities and selected 150 districts/counties. The sample was adults aged 18 and over selected through the method of Probability Proportion to Size(PPS). The mercury sphygmomanometer was used to measure the blood pressure. Each person had three measurements. The questionnaire was used to collect the information of hypertension awareness and control.The sample participants were 120 428 in 2010-2012. Among adults with hypertension, 46. 5%were aware of their hypertension, 41. 1% reported taking hypertension medicine in the last two weeks, and 13. 8% controlled the blood pressure. It was higher for hypertension awareness, treatment and control in women(49. 5%, 44. 2% and 14. 6%) than those of men(43. 0%, 37. 4% and 12. 9%). The three rates were increased with age. The prevalence of control was 33. 6% among the treated hypertensive individuals. It was higher for men and the rate was decreased with age. It was higher for hypertension awareness, treatment and control among hypertension and control among treated hypertensive participates in urban area(52. 7%, 47. 9%, 17. 9% and 37. 3%) than those in rural area(39. 5%, 33. 4%, 9. 2% and 27. 6%). The rates of overall, gender, and age groups were decreased in large city, medium and small city, general county, and poor county.The prevalence of hypertension awareness, treatment and control among hypertension and control among treated hypertensive participates among Chinese adults was increased in 2010-2012. But the rates were still keep a low level. The region and age differences need pay attention.
The specific forms of 24 h dietary recall used by national nutrition surveys differ, such as two non-consecutive days and three consecutive days. However, it is unclear which form of 24 h dietary recall is more accurate in the Chinese population. The purpose of this study was to compare the performance of 24 h recalls on two consecutive days (C2), three consecutive days (C3), two non-consecutive days (NC2), and three non-consecutive days (NC3) in estimating Chinese adult dietary intake. A total of 595 participants completed more than twenty-three 24 h recalls. The average of all completed 24 h recalls of each subject was defined as the individual’s true dietary intake. The dietary intake in the four scenarios of 24 h recalls was calculated using the within-person mean (WPM) method and National Cancer Institute (NCI) method and compared with the true values. Equivalent testing was used to evaluate whether scenarios NC2 and C3 were equivalent. Bias and mean bias were used as a measure of precision and accuracy, respectively. For the WPM method, the precision between the four scenarios was similar. For mean, the accuracy between the four scenarios was similar, yielding estimates that were close to the true intakes. However, for percentiles, the accuracy in descending order was scenario NC3, C3, NC2, and C2. Furthermore, the difference between two and three days was greater than that between consecutive and non-consecutive days. In most case, the distribution of dietary intakes calculated from scenarios NC2 and C3 was equivalent with equivalence margins of 5% (p < 0.05). Usually, the NCI method was significantly more accurate than the WPM method. We concluded that three non-consecutive 24 h recalls relative to three consecutive days increases accuracy. Two non-consecutive days can be substituted to some extent for three consecutive days. The new form of 24 h recall needs to be used with caution when applied practically in the China nutrition surveys. Furthermore, using the NCI method to calculate dietary intake from 24 h recall may be a way to reduce costs and increase accuracy.
To describe the change of sweet beverage and unhealthy food consumption among infant and young child aged 6-23 months in 2013, 2016-2017, China.Data was from the China Nutrition and Health Surveillance among Children and Lactating Women in 2013, 2016-2017.9983, 20 423 children aged 6-23 months old were involved respectively. The sweet beverage and unhealthy food consumption was analyzed with WHO and UNICEF 2021 updated infant and young child feeding indicators. Data analyses were conducted using the complex weight based on national census from National Bureau of Statistics in 2010. Rao-Scott Chi-square was used test for statistical difference.The proportions of sweet beverage consumption among children aged 6-23 months was 20.2%(95%CI 16.0%-24.4%) in 2013; it was 29.6% in large cities, and 14.0% in poor rural areas, but there was no significant difference in different areas. Compared with 2013, the proportions of sweet beverage consumption increased significantly in 2016-2017, reaching 51.7%(95%CI 48.9%-54.4%); it was 54.1% in medium and small cities, and 44.3% in large cities. The proportions of unhealthy food consumption among children aged 6-23 months was 31.2%(95%CI 23.2%-39.3%) in 2013; it was 46.3% in medium and small cities, and 16.3% in poor rural areas. Compared with 2013, the proportions of unhealthy food consumption was 35.6%(95%CI 33.6%-39.3%) in 2016-2017, and no significant difference was observed(Rao-Scott χ~2=0.96, P=0.33); It was 38.6% in medium and small cities, and reached 30% in large cities and poor rural areas. For those 2 indicators at the same survey, no consistent differences were observed between boys and girls and there was significant difference in various months of age(P<0.01).In China, the proportion of sweet beverage consumption among children aged 6-23 months has increased significantly, and the intake of unhealthy food is relatively stable. Children aged over 12 months and in rural areas need to be concerned about.
Objectives This study aimed to examine the prevalence and risk factors of dyslipidemia in different diabetic progression stages among middle-aged and elderly Chinese populations. Methods The 2010–2012 China National Nutrition and Health Survey (CNNHS) is a nationally representative cross-sectional study. In the present study, a total of 69,974 participants aged ≥ 45 years were included. Dyslipidemia was defined based on the Chinese adult dyslipidemia prevention guide. A multivariable logistic regression model was performed to examine the associations between risk factors and dyslipidemia. Results The prevalence of dyslipidemia was 39.9%, 46.8%, and 59.3% in participants with normal glucose, prediabetes, and type 2 diabetes mellitus (T2DM). Women had a lower dyslipidemia prevalence than men (38.7% vs. 43.3%). Dyslipidemia prevalence was positively associated with the education level and inversely correlated with the physical activity level, and negatively related to age only among prediabetes and T2DM groups (P for trend < 0.05). Obesity, abdominal obesity, and hypertension were associated with dyslipidemia. Conclusions The prevalence of dyslipidemia was relatively high among middle-aged and elderly T2DM person. There are different associations between multiple risk factors and dyslipidemia in different diabetic progression stages.
Objective
To analyze the consumption of fruits and vegetables in Chinese adults between 2010 and 2012.
Methods
Datas were collected from 2010-2012 China National Nutrition and Health Surveillance. Information on fruits and vegetables consumption was collected using the 24 h recall method for 3 consecutive days. Using the multi-stage stratified cluster randomization sampling method, 150 counties' adults from 31 provinces in China were acquired to analyze the consumption and the prevalence of inadequate consumption of fruits and vegetables. Inadequate consumption was defined as daily consumption of fruits and vegetables were less than 400 g. Age and sex standardization was performed based on the China 2009 population published by National Statistics Bureau and they were seen as the standard population. The average consumption of vegetables or fruits and prevalence of inadequate consumption of vegetables and fruits after weight adjustment for complex sampling were reported.
Results
The average daily consumptions of vegetables and fruits for Chinese adults were (252±6)g/d and (43±6)g/d, respectively, and about 70% of the population had no consumption of fruits. The total consumptions of fruits and vegetables were (294±9)g/d(urban: (297±1)g/d,rural:(292±2)g/d,male:(298±9)g/d, and female:(291±9)g/d). Rate on inadequate intake of fruits and vegetables was 78.0% (95%CI:75.2%-80.9%), and the rate in urban and rural areas were 77.3%(95%CI:73.7%-80.9%) and 78.7% (95%CI: 74.3%-83.2%), respectively. The rate was 77.1% (95%CI:74.1%-80.2%) for male and 78.9% (95%CI:76.2%-81.6%) for female.
Conclusion
The consumptions of vegetables and fruits were inadequate in Chinese adults.
Key words:
Vegetables; Fruit; Adult; Cross-sectional studies
What is already known on this topic? Beverage consumption has become a problematic dietary behavior in children and adolescents. Excessive drinking of beverages, especially sugary beverages, can increase the risk of chronic diseases such as obesity, dental cavities, and diabetes. What is added by this report? This report revealed the beverage consumption rate was higher in males, in urban areas, and adolescents aged 12–17 years. The top three beverages by consumption rate were carbonated beverages (33.2%), milk-containing beverages (25.0%), and non-100% fruit and vegetable beverages (23.5%). Children and adolescents in China consumed beverages at a primary frequency rate of 1–3 times/week. Among children and adolescents aged 6–17 years who consumed beverages, the average amount was 193.8 g/d, and was higher in males (210.6 g/d), those in urban areas (204.7 g/d), and adolescents aged 12–17 years (259.0 g/d). What are the implications for public health practice? Children and adolescents are key periods of life to develop healthy dietary behaviors for individuals. The consumption of beverages by Chinese children and adolescents has shown to increase year over year. Parents, schools, and governments need to prioritize promoting health consumption of beverasges.
The aim of this study was to examine the status of usual dietary micronutrient intakes among Chinese elderly living at home. The data was based on China National Nutrition and Health Survey (CNNHS) 2010-2012. We analyzed data from the participants aged 60-year-old and more (n = 16,612) living at home, who provided dietary data on three days 24 h dietary survey combining with the household weighing method. The means and distribution percentiles for usual intakes of dietary micronutrients were estimated using the Multiple Source Method (MSM). The prevalence of inadequacy for the selected micronutrients was expressed using the proportion of individuals with usual intakes below the Estimated Average Requirement (EAR). For vitamin E, sodium and potassium, the means and the distribution of intakes were compared to the Adequate Intake (AI) level. Usual dietary intakes of most micronutrients were inadequate in the participants, especially folate, calcium, vitamin B6 and vitamin B2, with the prevalence of inadequacy more than 90%. However, dietary sodium intake was extremely high with an average usual intake of 4702 mg/day. The usual dietary intakes of all selected micronutrients in old males were higher than females, and the prevalence of inadequacy of most micronutrients was higher in old women (p < 0.01). The subjects aged 60-74 years tended to have higher usual dietary micronutrient intakes and lower prevalence of inadequate micronutrients than those aged 75 years and over (p < 0.01). Higher usual dietary intakes and lower prevalence of inadequacy of most micronutrients were found in the elderly living in the southern region (p < 0.01). The average usual intakes of most micronutrients declined with socioeconomic status. The prevalence of inadequate vitamin A, B2, C, calcium and selenium below EAR increased with socioeconomic status (p < 0.01, p for trend < 0.01). Thus, essential micronutrients insufficient intake is a public health concern among Chinese community-dwelling old population, especially the females, older people, the elderly in undeveloped areas or living in northern regions. Nutrition education and appropriate approach should be undertaken to address these problems.
Vitamin D deficiency is prevalent globally and there is lack of evidence as to how 25(OH)D2 contributes to vitamin D status. The aim of this study was to describe vitamin D status and to assess the role of vitamin D2, a dietary vitamin D source, against the vitamin D status of children aged 3-5 years in China.Data were extracted from the Chinese National Nutrition and Health Surveillance (CNNHS) in 2013. The concentration of serum 25(OH)D2 and 25(OH)D3 was measured by using LC-MS/MS.A total of 1435 subjects were enrolled and serum 25(OH)D were analyzed. The prevalence of total serum 25(OH)D < 30 nmol/L was 8.9%. Serum 25(OH)D2 was detected in 10.9% of the studied children. After adjusting for confounding factors, total 25(OH)D concentration was 8.48 nmol/L lower and odds ratio of vitamin D deficiency was 4.20 times (OR (95%CI): 4.20 (1.64, 10.77)) in children without 25(OH)D2 than those with 25(OH)D2 detected.Vitamin D deficiency was common among children aged 3-5 years in China. Vitamin D2 may play a role in preventing vitamin D deficiency in Chinese children aged 3-5 years.
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