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This study uses unique official data to document nutritional changes in the 1949-1992 period. In 1949, widespread famine, high mortality and low life expectancy dominated. Economic progress was uneven; however, the longer term food supply changed greatly, and hunger was conquered. Diet composition shifted greatly over this period. Cereal consumption, already high, increased from 541.2 g d(-1) (70.0% coarse grains) in 1952 to 645.9 g d(-1) (15.9% coarse grains) in 1992. Consumption of animal-source foods, half of which were pork and pork products, tripled from 30.0 to 103.0 g d(-1). The proportion of energy intake from fat tripled from 7.6% to 22.5%, and that from carbohydrates decreased from 83.0% to 65.8% over the same period. Physical activity was high in all domains, but shifts were beginning to occur (e.g. the initial mechanization of work and the expansion of biking). Nutritional improvement was uneven, including increased undernutrition in the 1959-1962 period and a remarkable rebound and continued improvement thereafter. Overweight emerged only after 1982. Shifts in diet, activity and body composition in 1949-1992 set the stage for major shifts in nutrition in the subsequent decades.

By 2002, China’s prevalence of overweight and obesity among adults was 18.9 percent and 2.9 percent, respectively. The Chinese traditional diet has been replaced by the “Western diet” and major declines in all phases of activity and increased sedentary activity as the main reasons explaining the rapid increase in overweight and obesity, bring major economic and health costs. The Nutrition Improvement Work Management Approach was released in 2010. Overweight and obesity prevention-related policies were added to national planning for disease prevention and control. The Guidelines for Prevention and Control of Overweight and Obesity of Chinese Adults and the School-age Children and Teenagers Overweight and Obesity Prevention and Control Guidelines in China were promulgated in 2003 and 2007, respectively. Few education programs have been implemented. Selected academic intervention research projects dominate with a focus on reducing child obesity and promoting healthier diets; increasing physical activity and reducing sedentary time; and facilitating changes in family, school, social, and cultural environments. Intervention samples are small and have not addressed the increasing rates of obesity throughout the entire population. Government provision of effective policy measures, multisectoral cooperation and increasing corporate social responsibility are keys to curb the trend toward overweight and obesity in China.

ObjectiveThe present study aimed to identify dietary patterns and explore their associations with blood lipid profiles among Chinese women.DesignIn a cross-sectional study, we identified dietary patterns using principal component analysis of data from three consecutive 24 h dietary recalls. The China Health and Nutrition Survey (CHNS) collected blood samples in the morning after an overnight fast and measured total cholesterol (TC), HDL cholesterol (HDL-C), LDL cholesterol (LDL-C) and TAG.SettingData were from the 2009 wave of the CHNS.SubjectsWe studied 2468 women aged 18–80 years from the CHNS.ResultsWe identified three dietary patterns: traditional southern (high intakes of rice, pork and vegetables), snack (high intakes of fruits, eggs and cakes) and Western (high intakes of poultry, fast foods and milk). The traditional southern pattern was inversely associated with HDL-C (β=−0·68; 95 % CI −1·22, −0·14; Pβ=4·14; 95 % CI 0·44, 7·84; Pβ=2·52; 95 % CI 1·03, 4·02; Pβ=2·26; 95 % CI 0·86, 3·66; PConclusionsWe identified three dietary patterns that are significantly associated with blood lipid profiles. This information is important for developing interventions and policies addressing dyslipidaemia prevention among Chinese women.

To examine the longitudinal association between dietary cholesterol intake and stroke incidence in Chinese adults.The data were from 5833 non-stroke participants aged 30-98 in 1997 and more than one repeated measurements in the following five waves (2000, 2004, 2006, 2009 and 2011) of the China Health and Nutrition Survey. 5805 participants were included eventually after removing those with abnormal dietary cholesternul intake. Dietary cholesterol and energy intake was assessed with 3 d - 24 h dietary recalls in all the waves. Self-reported hypertension, diabetes mellitus, alcohol drinking, smoking, and standardized measurement of waist circumstance were collected also. Time-dependent Cox proportional hazard regression models were constructed to estimate relative risks (RR) with 95% confidence intervals (CI).During the mean 11. 3 years follow-up, 198 stroke events of 5805 participants were ascertained. The quintiles dietary cholesterol intake were 70.0, 146.9, 218.3, 297.8 and 425.9 mg/d. After adjusted for potential confounders, the time-dependent cholesterol intake, baseline cholesterol intake and the mean cholesterol intake during 1997-2011 were insignificantly associated with stroke. The relative risks and 95% confidence intervals were 1. 000 (0.999 - 1.001), 1.000 (0.999 - 1.001 ) and 0.999 (0.998 - 1.001) respectively. The cholesterol intake quintiles were insignificantly associated with stroke incidence. The relative risks and 95% confidence intervals versus lowest quintile were 0.812 (0.504 - 1.310), 0.644 (0.389 - 1.066) 0.913 (0.576 - 1.446) and 0.692 (0.416 - 1.152) respectively.Effect of dietary cholesterol intake on stroke incidence might was insignificant in Chinese adults.

Consumption is a major driving force in China's economy. The consumer society is particularly emerging in the more urbanized and affluent regions in China. Given the rise of consumerism on the one hand, and the rise of overweight and obesity on the other, this study explored whether the proliferating consumer culture is a threat to the traditional health culture in China. The lifestyle-oriented approach used in this study does not confirm a straightforward relationship between an upward trend in Chinese with (economic) assets to join the consumer society and a downward trend in health interest among urban Chinese. The result that the rise of the consumer society is not directly accompanied by a devaluation of health issues does not imply that lifestyle research is of no use. On the contrary, this paper successfully identified four dimensions of health-related lifestyle for urban China, namely Food-health Belief, Perceived Knowledge, Health Careless and Group Conformity. This result is informative with respect to the complexity of sociocultural factors influencing the increasing prevalence of overweight and obesity.

Purpose Television (TV) use has been linked with poor eating behaviors and obesity in young people. This study examines the association between TV watching and paying attention to TV commercials with buying and requesting snacks seen on commercials, and eating snacks while watching TV among youth in China. Methods Data from 1,552 participants (ages 6–17.99) in the 2004 China Health and Nutrition Survey were analyzed cross-sectionally. The 2004 China Health and Nutrition Survey was conducted in nine Chinese provinces. Results Most respondents (92.2%) reported watching TV; on average children (6–11.99 years old) and adolescents (12–17.99 years old) watched TV for 9–10 hours per week. Nearly half (42.9%) of all the respondents said they "sometimes" or "often" paid attention to TV commercials. Respondents who reported paying attention to commercials had higher odds of requesting snacks (odds ratio [OR] = 3.43; 95% confidence interval [CI] = 2.55–4.60) and buying snacks (OR = 2.73; 95% CI=2.17–3.43) seen on TV, and eating snacks while watching TV (OR = 1.60; 95% CI=1.23–2.07) than those who did not pay attention. However, frequency of watching TV was not significantly related to snacking. Conclusion Attention to TV commercials for snack foods may be one of the factors affecting the increase in obesity among children and adolescents in China.

OBJECTIVE To investigate the association of the dietary pattern with the presence of newly diagnosed glucose tolerance abnormalities among Chinese adults. RESEARCH DESIGN AND METHODS A total of 20,210 adults aged 45–69 years from the 2002 China National Nutrition and Health Survey were included. Information on dietary intake was collected using a validated food frequency questionnaire. Factor analysis and cluster analysis were used to identify the food factors and dietary pattern clusters. RESULTS Four dietary pattern clusters were identified (“Green Water,” “Yellow Earth,” “Western Adopter,” and “New Affluence”). The prevalence of glucose tolerance abnormalities ranged from 3.9% in the Green Water to 8.0% in the New Affluence. After adjustment for area, age, sex, current smoking, and physical activity, subjects in the Yellow Earth cluster (prevalence ratio 1.22 [95% CI 1.04–1.43]) and New Affluence cluster (2.05 [1.76–2.37]) had significantly higher prevalence rates compared with those for the Green Water cluster. After further adjustment for BMI and waist-to-height ratio, the elevated risk in the New Affluence remained statistically significant. CONCLUSIONS Dietary patterns and food factors are associated with the presence of glucose tolerance abnormalities in China, even independent of obesity. A New Affluence diet is an important modifiable risk factor, which needs attention from the prevention point of view.

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.

Summary The purpose of the present study was to estimate the association of physical activity level (PAL) with metabolic syndromes among the employed population in China. Using data from the 2002 China National Nutrition and Health Survey, the PAL of 21 834 subjects aged 18–59 years was described, and its relationship with the risk of metabolic syndrome was studied after adjusting for the relative effects of smoking, drinking, diet and socioeconomic status. Information on physical activity was collected by trained investigators using a 1-year physical activity questionnaire. PAL was classified into four categories: sedentary (PAL 1.00–1.39), low active (PAL 1.40–1.59), active (PAL 1.60–1.89) and very active (PAL 1.90–2.50). The definition of metabolic syndrome by the International Diabetes Federation 2005 was applied. The percentage of people being sedentary, low active, active and very active was 12.3%, 13.7%, 20.1% and 53.9% respectively. The crude prevalence of metabolic syndrome in the sedentary, low active, active and very active groups was 9.7%, 6.9%, 5.6% and 4.9% respectively. After adjusting for the effect of other risk factors, the higher the PAL, the lower the relative risk of metabolic syndrome as well as the individual metabolic abnormalities. The risk of overweight/obesity and metabolic syndrome was 50% and 59% less, respectively, in the adults who were very active and whose dietary fat contributed less than 20% to energy intakes when compared with their counterparts who were sedentary and consumed more fat (≥30% energy). PAL was an independent risk factor for obesity and multiple metabolic syndrome abnormalities among the employed population in China. The high-risk population were middle-age males living in large cities with high incomes who drink alcohol.

Analyses of data from the representative 2002 National Nutrition and Health Survey were used to assess the likelihood of metabolic complications of overweight and obesity in Chinese children aged 7-17 years. Chinese criteria for body mass index classification were used for overweight and obesity with the 75th percentile US adolescent values for waist circumferences and all the metabolic criteria for blood pressure, lipids, fasting glucose established for US adolescents. Diabetes in 7-12-year-olds was 0.2% and 0.4% in children aged 12-18 years. Prevalences of dyslipidaemia (61.9%), hypertriglyceridaemia (18.2%) and low high-density lipoprotein cholesterol (56.1%) were high and 16.0% of 15-18 years had hypertension. The overall prevalence of the metabolic syndrome was 3.3% with more than half the children having at least one metabolic abnormality and 19.8% having at least two. All the metabolic parameters were significantly elevated in the overweight and obese children except high-density lipoprotein cholesterol. These data emphasize the marked sensitivity of Chinese children to the metabolic complications of overweight and obesity and amplify the need for early preventive measures.

This paper combines two of today’s most salient phenomena in contemporary China: the remarkable rise of China as a consumer society and the related mounting overweight epidemic, which now includes about 200 million overweight people. Relatively little is understood about the many factors which contribute to the expanding waistlines of the Chinese. Within the nutrition transition framework, this paper concentrates on food consumption with a special focus on the adoption of energy-rich high calorie diets. Four consumer segments have been identified according to consumption of various food products – i.e., the food perspective. These groups are labeled Yellow Earth, Green Water, Newly Affluent, and Western Adopters, and differ significantly with respect to body mass index (BMI) and socio-demographic factors. The consumption of specific food products appears to be related to the extent of overweight among different consumer clusters. By undertaking a consumer segmentation based on food consumption, this study aims to contribute to our understanding of corpulence in a fast-changing China. This paper concludes that the growing impact of the overweight and obesity epidemic in China merits the attention of food policymakers.

In order to prioritise interventions for micronutrient deficiencies in China, the populations affected by iron and zinc deficiencies were assessed based on data from the 2002 China National Nutrition and Health Survey. The costs and cost-effectiveness of supplementation, food diversification and food fortification were estimated using the standard World Health Organization ingredients approach. Results indicated that 30% of children (60 years), pregnant and lactating women, and 20% of women of reproductive age were anaemic, some 245 million people. Approximately 100 million people were affected by zinc deficiency (zinc intake inadequacy and stunting), the majority living in rural areas. Among interventions on iron and zinc deficiency, biofortification showed the lowest costs per capita, I 0.01 (international dollars), while dietary diversification through health education represented the highest costs at I 1148(international dollars). The cost-effectiveness of supplementation, food fortification and dietary diversification for iron deficiency alone was I 179(international dollars) , I 66 and I 103 (international dollars) per disability-adjusted life-year (DALY), respectively. Data for biofortification were not available. For zinc deficiency, the corresponding figures were I 399(international dollars), I 153(international dollars) and I 103(international dollars) per DALY, respectively. In conclusion, iron and zinc deficiencies are of great public health concern in China. Of the two long-term intervention strategies, i.e. dietary diversification and biofortification with improved varieties, the latter is especially feasible and cost-effective for rural populations. Supplementation and fortification can be used as short-term strategies for specific groups.

China’s health profile has shifted to one dominated by obesity and nutrition-related noncommunicable diseases (NR-NCDs) necessitating an examination of how economic policies can improve this situation. Edible oil consumption is responsible for much of the increase in energy density of the Chinese diet and particularly linked with the shifting burden of NR-NCDs toward the poor. Longitudinal analysis among adults in the China Health and Nutrition Survey (CHNS) covering the period 1991 to 2000 revealed that price policy effects on edible oil can influence dietary composition (particularly of the poor) and the results identify a key preventive policy need.

In order to investigate the determinants of childhood overweight and obesity in China, the prevalence of overweight (including obesity) was compared according to different dietary and physical activity patterns and parental body weight status. A total of 6826 children aged 7–17 years from the 2002 China National Nutrition and Health Survey were included in the study. Information for dietary intake was collected using three consecutive 24-h recalls by trained interviewers. The amounts of cooking oil and condiments consumed were weighed. An interview-administered 1-year physical activity questionnaire was used to collect physical activity information. The results showed that the heavier the parental body weight, the higher the overweight prevalence in children. The prevalence ratio increased if parent(s) were overweight and/or obese, up to 12·2 if both parents were obese. Overweight children consumed significantly more dietary energy, protein and fat, but less carbohydrate than their normal weight counterparts. On average, overweight children spent 0·5 h less on moderate/vigorous activities and 2·3 h more on low intensity activities per week. The following prevalence ratios were statistically significant: walking to and from school (0·6); moderate/vigorous activities ≥ 45 min/d (0·8); low intensity physical activities >2 h/d (1·3); the consumption of ≥ 25 g/d cooking oil (1·4); ≥ 200 g/d meat and meat products consumption (1·5); ≥ 100 g/d dairy products (1·8). After adjustment for parental body weight status and socioeconomic status, only cooking oil consumption and walking to and from school remained significantly related to child overweight. In conclusion, parental weight status is an important determinant. Fat intake, low intensity activities and active transport to/from school may be suitable entry points for overweight prevention among Chinese school children.

To analyze the nutritional ingredients of daily consumed pre-packaged foods in Chinese adult residents.From October to December 2013, the nutrition labels of pre-packaged foods consumed in continuous 7 days by 706 adult residents were collected by multi-stage stratified cluster random sampling in 18 communities with 360 households in 9 cities in China including Beijing, Shanghai, Chongqing, Shenyang, Haerbin,Jinan,Zhengzhou, Changsha and Nanning. The contents of energy, protein, fat, carbohydrate, sodium and the percentages of low-fat and low-sodium foods were compared among 7 different kinds of foods including baked foods, convenient foods, leisure foods, puffed foods, milk, beverages and seasonings.871 kinds of pre-packaged foods were collected. The median (min, max) of energy contents of puffed foods, baked foods and leisure foods were 2 155(1 638-2 785) kJ/100 g, 1 980 (582-2 639) kJ/100 g, 1 575 (353-3 015) kJ/100 g respectively. The median (min, max) of fat contents of puffed foods, baked foods and leisure foods were 30.0 (5.0-40.9) g/100 g, 20.5 (0.3-40.5) g/100 g, 15.1 (0-71.4) g/100 g respectively. The contents of carbohydrate of baked foods, convenient foods and puffed foods were high relatively, the medians (min, max) of which were 58.1(19.8-82.5), 56.5(0-90.7), and 56.1(42.6-75.8)g/100 g respectively. The sodium content of seasoning was the highest, which was 2 177 (20-12 000) mg/100 g. The protein content of beverage was the lowest, which was 0.4(0-17.8)g/100 ml.The energy and fat contents of puffed foods, baked foods and leisure foods were high. The carbohydrate contents of baked foods, convenient foods and puffed foods were high relatively. The sodium content of seasonings was high. The protein contents of beverages were low.

Dietary patterns represent the combined effects of foods, and illustrate efficaciously the impact of diet on health outcomes. Some findings of previous studies have limited applicability to Chinese children due to cultural factors. The presnt study was designed to identify dietary patterns and determine their relationships with obesity among Chinese children and adolescents. Data collected from 1282 children and adolescents aged 7–17 years from the 2011 China Health and Nutrition Survey (CHNS) were used. Dietary patterns were identified using factor analysis of data from three consecutive 24-h dietary recalls. Weight and height were measured following standard methods, and BMI was calculated. Three dietary patterns were identified: modern (high intakes of milk, fast foods and eggs), traditional north (high intakes of wheat, tubers and other cereals) and traditional south (high intakes of vegetables, rice and pork). After adjusting for some confounders and total energy intake, subjects in the highest quartiles of the modern and traditional north patterns were found to have significantly greater risk of obesity (OR 3·10, 95 % CI 1·52, 6·32, and OR 2·42, 95 % CI 1·34, 4·39, respectively). In conclusion, the modern dietary pattern and the traditional north dietary pattern were associated with higher risk of obesity. Promoting healthier eating patterns could help prevent obesity in Chinese children.

To describe body mass index (BMI, in kg/m(2)) distribution patterns and trends among Chinese adults, aged 20-45 years (1989-2000).A descriptive, population-based study of BMI change.Chinese provinces (eight in 1989 and 1997; nine in 2000), representative of the household-based surveys (the China Health and Nutrition Survey, 1989-2000) using multistage, random cluster sampling, supplemented with annual household consumption survey data of the State Statistical Bureau (SSB).A total of 4527, 4507 and 4046 adults, aged 20-45 years, in 1989, 1997 and 2000, respectively.BMI (underweight: BMI18.5 kg/m(2) and overweight: BMI/=25 kg/m(2)). Percentile curves for BMI in 1989 and 2000 were constructed by gender and age using the LMS (lambda, mu, sigma) method.Compared with 1989, the 2000 BMI distribution curves flattened at higher levels of BMI (men and women). There was a 13.7% increase in the proportion of men and a 7.9% increase of women who were overweight or obese with a resulting greater change in the annualized prevalence rate for men. This increase in the prevalence of overweight and obesity was far greater than the decrease (2.1% for men; 2.2% for women) in that of underweight. Age-gender-specific percentile curves showed BMI increases mainly among women, aged 35-45 years, and among men at all age groups.Chinese BMI dynamics show much greater rates of change among men, aged 20-45 years, than among women, with the increase among women concentrated between ages 35 and 45 years. These changes portend large shifts in other diet-related non-communicable diseases in China over the following decades. Controlling the increasing trends of BMI, especially in men, is an important public health problem facing China.

To study the impact of income change--specifically rapid income growth--on diet behavior over time and by socioeconomic level, we used data from a prospective study of China begun in 1989 (followed up in 1991, 1993 and 1997). The subpopulation used in this study included 5783 subjects aged 20-45 years old from 3129 households. Dietary intakes were measured using a combination of the weighing method and three consecutive 24-h recalls. Detailed income and price data were collected, and predicted household per capita income was used in multivariate longitudinal random-effects models that described the consumption of several food groups and nutrients. Income elasticity was used to measure the changes for the effects of income over time on (a) the probability of consuming any food and (b) the quantity of food consumed. The structure of the Chinese diet is shifting away from high-carbohydrate foods toward high-fat, high-energy density foods. The variation in the income effects that we uncovered indicated that important changes in income effects took place between 1989 and 1997, with the changes varying considerably by socioeconomic status. These shifts in income effects indicate that increased income might have affected diets and body composition in a detrimental manner to health, with those in low-income groups having the largest increase in detrimental effects due to increased income. Extrapolating from our estimates, higher income levels in the future could lead to the reversal of the health improvements achieved in the last two decades, if diet-related noncommunicable diseases cannot be controlled.

Dietary patterns represent the combined effects of foods and efficaciously illustrate the impact of diet on health outcomes. This study identified the dietary patterns and determined their relationships with obesity among young Chinese women.In 2011, the China Health and Nutrition Survey included 2363 young women aged 18-44 years. Factor analysis of data from three consecutive 24-h dietary recalls identified the dietary patterns. Weight, height and waist circumstance (WC) were measured, and body mass index (BMI) was calculated. General obesity was defined as BMI ⩾28 kg/m(2) and abdominal obesity as WC ⩾85 cm.Four dietary patterns were identified: traditional south; traditional north; snack; and high protein. After adjusting for confounders and energy intake, women in the highest-score quintiles of the traditional south pattern were less likely to have general obesity (odds ratio (OR)=0.48; 95% confidence interval (CI) 0.29-0.78) and abdominal obesity (OR=0.64; 95% CI 0.46-0.90). Subjects in the highest-score quintiles of the traditional north pattern had significantly greater risk of general obesity (OR=2.28; 95% CI 1.38-3.74) and of abdominal obesity (OR=2.32; 95% CI 1.66-3.24).The traditional south pattern of rice as the major staple food with pork and vegetable dishes is associated with lower risk of general and abdominal obesity. The traditional north pattern of high intake of wheat, other cereals and tubers is positively associated with general and abdominal obesity. This provides important information for interventions and policies addressing obesity prevention among young Chinese women.

Cross-sectional data from the 1991 (n = 1657) and 1993 (n = 1773) China Health and Nutrition Surveys were used to describe patterns in the diets, activity levels and body mass index (BMI) of elderly Chinese (aged 60 or older). In 1991 and 1993, the prevalence of low BMI (BMI18.5 or BMI22.0) exceeded 15%, while the prevalence of high BMI (BMI25.0 or BMI27.0) ranged between 4% and 24%. The BMI was consistently, positively and significantly associated with urban residence. Urban residence and income were consistently and positively associated with energy from fat and protein intakes, and decreasing physical activity levels. The results suggest that under- and overnutrition coexist among Chinese elders and are differentially distributed across income and urban/rural strata.

A longitudinal survey of health and nutrition in China was undertaken in eight provinces (Liaoning, Jiangsu, Shandong, Henan, Hubei, Hunan, Guangxi, Guizhou). Data were collected in 1989, 1991, 1993 and 1997. The 1991 and 1993 data were used to investigate factors affecting intrahousehold food distribution. The discrepancy score and the ratio of food share to energy share were used to describe food distribution within households. Findings indicated that, in most cases, males had a higher proportion of nutrient intake than females, particularly in the young adult group where men presented with a higher discrepancy score than women for energy and all nutrients observed. The food and nutrient distribution tends to be more favourable to the middle-aged group, although the youngest group, while accepting relatively smaller amounts of cereals, ate much bigger amounts of meat, dairy products and fruits. Household members with higher incomes are more favoured in terms of food consumption and nutrient intake. Household leaders accepted a higher share of energy and nutrients in comparison with other members of the household across all age and sex groups. Administrators and people working in service or trade industries in rural areas are favoured in terms of food distribution relative to farmers and manual workers. Well-educated people accepted a better food allocation than others and those in employment received more nutrients than the unemployed. The 'contribution rule' (individuals who make a greater contribution to the family receive a larger share of the family's food) is discussed and deemed to be applicable in explaining the discrepancy in food distribution and nutrient intake among household members.

China is undergoing a marked transition in its diet and nutritional status patterns. This study determines the structural change in the impact of income on food consumption in China during 1989-93. Utilizing data from a longitudinal study of 3800 households in China evidence points to a shift in the relationship between income dietary structure and total nutrient intake at the macrolevel. Overall it is noted that the increase in income over time in the country coincided with a shift in the demand for inferior and normal food groups. In addition there was a pronounced increase in the income elasticity for more luxury foods during the specified period while less superior goods became more inferior over this 4-year span. Such an increase in income elasticities for total energy and for energy from fat suggest a worsening of the composition of the diet in ways that are linked to obesity and obesity-related diseases as incomes continue to rise. In view of this several implications for the formulation of future nutrition policies in China are cited.

Three current equations for estimating iron bioavailability were evaluated, and adjustments were proposed that would allow us to most effectively study iron bioavailability in China. Dietary intake data were obtained from 24-h dietary recalls taken over three consecutive days as part of the third Chinese National Nutrition Survey. Hemoglobin status was measured for 42,606 Chinese adults aged 18-60 y. The mean iron intake was 24.4 mg per capita per day, which was 177% of the Chinese RDA (209% of U.S. RDA). About 18% of the sample was classified as being anemic, indicating a large iron deficiency anemia and iron bioavailability problem in China. A number of methods proposed by World Health Organization and U.S. scholars were examined for adjusting iron bioavailability. Even the methods that consider several iron enhancers and inhibitors did not work adequately for the Chinese diet. The statistical assessment of the fit between iron bioavailability and hemoglobin status provided direction for adjusting the best of these predictive equations. We propose a new predictive approach for iron bioavailability which is more predictive of Chinese iron status. Consideration of additional dietary elements such as rice and bean consumption patterns are important. Our findings provide insight into additional factors which may influence iron bioavailability as well as possible improved methods for estimating the combined effect of multiple dietary factors on iron bioavailability, particularly in a vegetarian diet.

The rapid change in diets, physical activity and body composition in low income countries has led to the coexistence of large pockets of undernutrition and overnutrition. Public health strategies for addressing this situation may be necessary, and price policy options are examined for China. Longitudinal dietary data collected in China in 1989-1993 on a sample of 5625 adults aged 20-45 y were examined. Three-day averages of food group consumption and nutrient intake were used in longitudinal statistical models to examine separately the effects of food prices on the decision to consume each food group and then the amount consumed. The effects of changes in six food prices on the consumption of each of six food groups, not just the food group whose price had changed, and on three macronutrients were estimated. The effects show large and significant price effects. If the joint effects of the nutrition transition are to be considered, then there are clear tradeoffs among which foods to tax and which to subsidize. Most important is the effect of prices in reducing fat intake of the rich but not adversely affecting protein intake for the poor. Increases in the prices of pork, eggs and edible oils are predicted to lower fat intake. Only increases in pork prices led to reduced protein intakes. This raises questions about earlier policy changes being implemented in China and provides insight into an important and controversial area for public health policy.

By 2002, China’s prevalence of overweight and obesity among adults was 18.9 percent and 2.9 percent, respectively. The Chinese traditional diet has been replaced by the “Western diet” and major declines in all phases of activity and increased sedentary activity as the main reasons explaining the rapid increase in overweight and obesity, bring major economic and health costs. The Nutrition Improvement Work Management Approach was released in 2010. Overweight and obesity prevention-related policies were added to national planning for disease prevention and control. The Guidelines for Prevention and Control of Overweight and Obesity of Chinese Adults and the School-age Children and Teenagers Overweight and Obesity Prevention and Control Guidelines in China were promulgated in 2003 and 2007, respectively. Few education programs have been implemented. Selected academic intervention research projects dominate with a focus on reducing child obesity and promoting healthier diets; increasing physical activity and reducing sedentary time; and facilitating changes in family, school, social, and cultural environments. Intervention samples are small and have not addressed the increasing rates of obesity throughout the entire population. Government provision of effective policy measures, multisectoral cooperation and increasing corporate social responsibility are keys to curb the trend toward overweight and obesity in China.

To study the status and trend of fat and cholesterol intake among Chinese middle and old aged residents in 9 provinces from 1991 to 2009, and provide the basic reference material for the revision of Chinese DRIs.The data were collected in 1991, 1993, 1997, 2000, 2004, 2006 and 2009 from China Health and Nutrition Survey. The sample was 50 years old and over of health male and female residents and the intake of fat, cholesterol and mean percentage of energy from fat was calculated and compared with Chinese DRIs.The results showed that, in 1991 - 2009, the dietary fats, mean percentage of energy from total fat and intake of cholesterol had an increasing trend in the surveyed population of 9 provinces, and in 2009, the results was 81.9 g/d, 270.8 mg/d and 31.8% in male, and was 70.4 g/d, 238.5 mg/d and 32.2% in female respectively. The percentage of population whose mean percentage of energy from total fat exceed 30% and intake of cholesterol exceed 300 mg/d increased significantly, and in 2009, the results was 54.7% and 35.8% in male, and was 56.9% and 29.8% in female respectively.The dietary structure of middle and old aged residents in Chinese 9 provinces had changed significantly, and the percentage of energy from total fat and intake of cholesterol had closed or exceeded the Chinese DRIs. So the intake of food that is rich in fat and cholesterol should be controlled.

The purpose of this cross-sectional study was to investigate the joint associations of physical activity level (PAL) and dietary patterns in relation to cardiovascular disease (CVD) risk factors among Chinese men. The study population consisted of 13 511 Chinese males aged 18-59 years from the 2002 China National Nutrition and Health Survey. Based on dietary data collected by a food frequency questionnaire, four dietary patterns were identified and labeled as "Green Water'' (high consumption of rice, vegetables, seafood, pork, and poultry), "Yellow Earth'' (high consumption of wheat flour products and starchy tubers), "New Affluent'' (high consumption of animal sourced foods and soybean products), and "Western Adopter'' (high consumption of animal sourced foods, cakes, and soft drinks). From the information collected by a 1-year physical activity questionnaire, PAL was calculated and classified into 4 categories: sedentary, low active, active, and very active. As compared with their counterparts from the New Affluent pattern, participants who followed the Green Water pattern had a lower likelihood of abdominal obesity (AO; 50.2%), hypertension (HT; 37.9%), hyperglycemia (HG; 41.5%), elevated triglyceride (ETG; 14.5%), low HDL (LHDL; 39.8%), and metabolic syndrome (MS; 51.9%). When compared to sedentary participants, the odds ratio of participants with very active PAL was 0.62 for AO, 0.85 for HT, 0.71 for HG, 0.76 for ETG, 0.74 for LHDL, and 0.58 for MS. Individuals who followed both very active PAL and the Green Water pattern had a lower likelihood of CVD risk factors (AO: 65.8%, HT: 39.1%, HG: 57.4%, ETG: 35.4%, LHDL: 56.1%, and MS: 75.0%), compared to their counterparts who followed both sedentary PAL and the New Affluent pattern. In addition, adherence to both healthy dietary pattern and very active PAL presented a remarkable potential for CVD risk factor prevention.

We compared two dietary survey methods using the 1991 nationwide China Health and Nutrition Survey. Data were collected over three consecutive days by 24-hour dietary recall and a household inventory for 3,563 households with 13,606 individuals. We studied the absolute difference between the two methods and the relative differences expressed as dietary in take per capita per day. There was only a 74-kcal difference between the methods for average daily calorie intake; the relative difference was 1%. Ratios were larger for average daily protein (5%) and fat (3%) intakes. Analysis of covariance was used to compare the means of the intakes of nutrients when adjusting for other confounding variables. The largest difference was in households with guests eating at home, where fat intake was significantly higher. Particularly important was an adjustment for household cooking oil consumption used to modify the recall results. Removing this adjustment greatly expanded differences in the two methods.

To analyze feeding status of children under 2 years old in the poor rural areas of western China in 2009.The study subjects were 2933 from the program of 'Study on appropriate technology of children under-nutrition improvement in poor rural areas'.In 2009, the rate of almost exclusive breast-feeding of children under 6 months in poor rural areas of western China was 38.3%, the time of giving complementary food was the 5th month and the weaning time was the 10th month.The study demonstrated that it is unreasonable of feeding status in poor rural areas of western China.

The relationships between dietary and environmental factors and obesity are reviewed. Findings from selected population studies of diet and body weight are presented. In general, the results from population studies of diet and obesity have been inconsistent and marked with methodological weaknesses, especially the use of cross-sectional study design. Apart from the diet, several social and economic factors appear to be important correlates of obesity in the population. However, most studies have focused on the socioeconomic status as a broad, composite measure. The relationships between income, education, occupation, place of residence, and obesity are reviewed here, with emphasis on the developing countries. In many developing countries, the changing dietary pattern, along with rising life expectancy and changing socioeconomic environment, has contributed to the increasing problems of obesity and other diet-related chronic diseases that will have an enormous impact on the health and health care resource of these countries in the near future.

OBJECTIVES. A longitudinal survey assessed the distribution of adult body weight among the Chinese population. METHODS. Data from the 1989 and 1991 China Health and Nutrition Survey were used to study changes in the proportions of adults aged 20-45 years who were classified as underweight, normal weight, overweight, and severely overweight. RESULTS. There was a slight decline in the proportion of men and women classified as underweight, but among lower-income persons an increase occurred. The proportion of adults with normal body weight decreased, and the proportions of those classified as overweight and severely overweight increased during the same period. The observed increases in proportions of adults classified as overweight and severely overweight were largely confined to the urban residents and to those in the middle- and high-income groups. CONCLUSIONS. Results indicate increases in both obesity and undernutrition. Current efforts in China to develop a preventive health care policy emphasize the prevention of excess nutrient intakes and overnutrition and, hence, address the problem of the increase in obesity among well-to-do, mostly urban residents. However, the increase in undernutrition among low-income Chinese adults should not be overlooked and requires further research and serious policy consideration.

To investigate the effect of nutritional status in childhood on health status in adulthood.Data were collected from the China Health and Nutrition Survey in 1991, 1993, 1997, 2001, 2004 and 2006, and the subjects were older than 2 and no more than 18 year-old at the Survey in 1991 and remained in the same cohort with completed records through all six surveys. Mixed effect linear model was used to study the trajectory of BMI. Proportional hazards model was used to study the hazard risk of hypertension in adulthood.Generally, the thinness or overweight-obesity status in childhood followed a same trend till adulthood. Nutritional status in childhood and the educational level of their parents appeared to be related to risk factors of hypertension in adulthood. The hazard ratio of not developing hypertension for additional 1 gram of protein intake per day in male subjects was 0.991, and which for additional 1 kcal of energy intake per day in female subjects was 0.9997.The nutritional health status in childhood keeps the same trajectory till adulthood.

This study investigates the dynamic shifts in snacking behaviors and patterns in China. Using four waves (1991, 2004, 2006, and 2009) from the China Health and Nutrition Survey (CHNS) with full socioeconomic and demographic data and 3-day, 24-hour dietary recall data, 45,402 individuals age two and older were studied. Multiple logistic regressions were performed to examine the association of social-demographic factors on snacking behaviors. Results show that snacking prevalence, frequency of daily snacking occasions, and percentage of total daily energy intake (EI) from snacks increased significantly across all ages between 1991 and 2009, with a dramatic increase after 2004. Snacking was much more prevalent among children and higher-income, urban, and educated populations over time. Evening was the preferred snacking occasion, and the proportion of total daily EI from snacks varied between 4.1% and 12.3% for all snackers by age. Fruits, grains, and beverages were the most popular snacks and the highest contributors to snacking EI over all age groups. A marked transition from a tradition of two or three meals per day toward meals combined with snacks is underway. Further research is needed to develop a better understanding of the nutritional implications of Chinese snacking behaviors.

To explore the relationship between adiposity and blood pressure (BP)of urban and rural residents in China.The data in the China Health and Nutrition survey (CHNS) in 2006 were utilized. Cross-sectional analysis was carried out on the relationship between blood pressure and body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) among 6433 adult inhabitants aged 18-60 from 9 provinces of China. A multiple regression equation was used for the prediction of blood pressure with these indicators.The average SBP and DBP were increased linearly with the increase of BMI, WC, WHR and WHtR. A statistically significant linear association was found between each adiposity indicator and BP level in separate regression models controlled by age. The regression coefficients were higher in women than that in men. A gain of 0.77 in BMI, 2.43 cm in WC, 2.66% in WHR and 1.54% in WHtR for men and a gain of 0.75, 2.12 cm, 2.54% and 1.53% respectively for women would have a corresponding elevation of 1 mmHg in SBP. Multiple stepwise regression analyses showed that DBP was related with WHtR.There was a stable linear relationship between adiposity indicators and BP. WHtR not a good predicator of SBP and DBP in Chinese adults.

Background Several healthful dietary patterns appear to be effective at lowering blood pressure and preventing hypertension. However, the relationship between dietary patterns and hypertension among a representative Chinese population sample is unclear. Methods A nationally representative sample of 23 671 participants aged 18-59 years were recruited by the 2002 China National Nutrition and Health Survey. All participants had their blood pressure measured with standardized mercury sphygmomanometers. Hypertension was defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg. We conducted factor analysis using dietary information from a validated food frequency questionnaire to derive dietary patterns. Information of participants on physical activities, education level, annual household income, smoking status and family history of hypertension was collected by interviewer-administrated questionnaires. Results Three major dietary patterns, defined as 'Western', 'traditional northern', and 'traditional southern', were identified. Participants with the highest quartile for the score of the Western pattern had significantly higher blood pressure comparing with counterparts in the lowest quartile. In contrast, participants in the top quartile for the score of the traditional southern pattern presented significantly lower blood pressure comparing with counterparts in the lowest quartile. In multivariate analyses the traditional northern pattern score was associated with an odds ratio (OR) of 1.30 (95% confidence interval (CI) 1.11-1.53, P for trend = 0.0001) comparing with the lowest quartile. The OR for the top quartile of score for the traditional southern pattern was 0.73 (95% CI, 0.59-0.89, P for trend = 0.0040) compared with the lowest quartile of traditional southern pattern score. However, the significant association between the traditional northern pattern and prevalence of hypertension disappeared after further adjusting for body mass index (BMI) (P for trend = 0.3), whereas the association between the traditional southern pattern and prevalence of hypertension persisted after further adjusting for BMI (P for trend = 0.01). Conclusions We observed a positive relationship between the traditional northern pattern and hypertension that was mediated through differences in BMI. In addition, the traditional southern pattern was significantly associated with lower odds of presenting with hypertension.

Background: It has been hypothesized that monosodium glutamate (MSG), a flavor enhancer, is positively associated with weight gain, which influences energy balance through the disruption of the hypothalamic signaling cascade of leptin action. Objective: The objective was to examine the longitudinal association between MSG consumption and incidence of overweight. Design: Data were collected from the China Health and Nutrition Survey (CHNS), a prospective open-cohort, ongoing nationwide health and nutrition survey, consisting of 10,095 apparently healthy Chinese adults aged 18–65 y at entry from 1991 to 2006. Diet, including MSG and other condiments, was assessed with a weighed food inventory in combination with three 24-h recalls. Incident overweight was defined as a body mass index (BMI; in kg/m2) ≥ 25 or ≥23 based on World Health Organization recommendations for Asian populations. Multilevel mixed-effects models were constructed to estimate change in BMI, and Cox regression models with gamma shared frailty were used to determine the incidence of overweight. Results: The mean follow-up was 5.5 y. The cumulative mean (±SD) MSG intake of 2.2 ± 1.6 g/d was positively associated with BMI after adjustment for potential confounders and cluster effects at different levels (individual, household, and community). The adjusted hazard ratio of overweight was 1.33 (95% CI: 1.01, 1.75; P for trend < 0.01) for participants in the highest quintile of MSG intake compared with those in the lowest quintile after adjustment for age, physical activity, total energy intake, and other major lifestyle factors. Conclusions: MSG consumption was positively, longitudinally associated with overweight development among apparently healthy Chinese adults. Additional studies are needed to elucidate mechanisms of action and to establish causal inference.

To investigate the nutrition literacy status of adults in Jiangxi province and afford support for nutrition education.Two large-scale factories from Nanchang, Jiangxi Province were selected, and then two hundred adults aged 18 to 59 years from each factory were cluster sampled as urban group. Two villages from Nanfeng County, Jiangxi Province were selected, and then two hundred and one adults aged 18 to 59 years from each village were cluster sampled as rural group. A comprehensive evaluation questionnaire on the effectiveness of nutrition education was used to evaluate the nutrition literacy of all subjects.The total scores of the questionnaire, the field of nutrition knowledge and nutrition attitude were higher in urban adults than those in rural adults. The total scores of the questionnaire and the field of dietary behavior and social environment influence were better in females than in males, which indicated that the female put more attention on nutrition. There was no difference among age groups on nutrition literacy. The nutrition literacy increased with educational level. The highest score on nutrition knowledge, nutrition attitude and social environment influence fields were observed in the group with college education.The study showed that the nutritional literacy status of adults in Jiangxi province was at a lower level, which was influenced by the area, gender and educational level. Urban adult, female and higher educational level were positive factors for nutrition literacy, which should be considered in nutrition improvement and nutrition education programs in the future.

To analyze the effect of complex nutrients on growth and development, intelligence and nutrition state of 6-12 years old children in two continuous years.According to the rural school's similar condition, such as social economical statement, education condition and proportion of students entering schools, 6 rural schools were respectively selected in Xishui County of Hubei Province as the experimental group and control group. In the former, middle and later periods (2004, 2005, 2006 ), growth and development, nutrition state and intelligence were analyzed and compared.The increase of height and weight in experimental group were higher than those of the control group. In 2 years, height in experimental group increased 12.9 cm, while the control group increased 11.5 cm. Weights increased in experimental group were 6.6 kg, while the control group increased 5.2 kg. Girl's bone density in experimental group increased from 0.236 g/cm in 2004 to 0.280 g/cm in 2006. The hemoglobin contents of 4 age group's children in experimental group increased significantly (P0.05) . While the anemia prevalence decreased 25 .8% in 2 years, the control group decreased 7.2%. Moreover, other results showed that the complex nutrients also have some effect on the intelligence in experiment group.The complex nutrients supplement could improve the rural school children's growth and development, bone and intelligence.

This research journal article presents a detailed overview of a cohort profile of the China Health and Nutrition Survey (CHNS) which allows for the monitoring and understanding of socio-economic and health change in China from 1989-2011. The author discusses the history and development of the CHNS as a result of the countrys transformations since Chinas reform and open policy. The CHNS was established with the goal to develop a multipurpose longitudinal survey that would allow the research group to examine a series of economic sociological demographic and health questions. The article describes the design of the survey to include in-depth coverage at the individual household and community levels though it was not designed to be representative of China but to be randomly selected and capture a range of economic and demographic circumstances. It provides data randomly from eight different provinces and rounds have been completed nearly every three years since 1989. Though they are very complex to determine with the survey response rates and attrition are assessed along with descriptions of changes in lost-to-follow-up rates. The article describes key finds and publications to be numerous including links to obesity from occupation and transportation; nutrition and chronic disease; and important policy results for agriculture and poverty reduction programs. Lastly the author provides a summary of the CHNSs strengths and weaknesses and recommendations for accessing the data and further information.

China is experiencing a rapid increase in overweight and related conditions. This study describes the geographic variation in BMI levels and the prevalence of overweight and underweight in Chinese adults, and assesses their relations with regional Gross Domestic Product (GDP) per capita levels. BMI values and the prevalence of overweight and underweight in 143 522 adults from the Chinese National Nutrition and Health Survey (2002) were calculated according to geographic regions in China. Their correlations with GDP were assessed. Linear and logistic regressions were used to adjust for age, sex and city–country composition. BMI and the prevalence of overweight were highest in the Bohai coastal regions while lowest in southern provinces such as Guangdong, Guangxi, Yunnan, Hunan and Fujian. Mean BMI values ranged from 20·72 to 25·48 kg/m2, and the prevalence of overweight ranged from 6·6 to 53·9 %. BMI and the prevalence of overweight were positively correlated with economic development, particularly in the northern regions. However, for regions with similar GDP per capita levels, those in the south had substantially lower BMI and lower prevalence of overweight than those in the north. Interestingly, some southern regions with high GDP per capita had low BMI and low prevalence of overweight. The prevalence of underweight was highest in the south. Substantial geographic variations in the prevalence of overweight and underweight exist in China. Such variations cannot be fully explained by the differences in economic status. China is currently facing challenges of both overweight and underweight but priorities vary in different regions.

To analyze the influence of family income on food consumption.The paper used the food information based on 24-hour dietary recall method for 3 consecutive days and weighting method and family income information and analyzed the data with SAS software.Protein intake, fat intake, percentage of energy provided by fat, percentage of energy and protein coming from animal foods and some micro-nutrients intake had increasing trends with the increase of family income for Chinese urban and rural residents.Family income was an important factor to affect dietary nutrients intake and dietary structure of Chinese residents.

The purpose of the study is to examine the dynamic eating behaviors of the Chinese people, focusing on snacking and the choice of cooking methods, and to identify the influences of socioeconomic factors on these eating behaviors. Data for this study were from the China Health and Nutrition Survey (CHNS). There were 11780 subjects, older than two years (y), from the 1991 and 11169 from the 2004 surveys respectively. Logistic regressions of pooled data were performed to evaluate how socioeconomic status (SES) was associated with two eating behaviors: snacking and consuming excessive amounts of fried foods. Simulation techniques were used to clarify the effects of the results that included significant interaction terms. Results showed that the rapid shift in the food and nutrient profile of the Chinese population is accompanied by equally profound changes in meal and cooking patterns. Snacking behavior is beginning to emerge and there are shifts away from the steaming and boiling of food to the, less healthy, frying of food. Income is positively associated with the consumption of both snacks and excessive fried food. Urban residents are also more likely to snack and to consume excessive amounts of fried foods than rural residents. These findings indicate that eating behaviors are beginning to change rapidly toward less healthy options in China. SES plays a vital role in the early stages of the eating behavior transition in China. Future health promotion programs targeting the higher-SES population will exert far-reaching effects on the improvement of health status in this group.

UNLABELLED To estimate the energy gap (i.e. degree of positive energy balance) that is causing weight gain in the population of China in order to provide a quantitative goal for how much behaviour change is required to prevent excess weight gain in the population. This is based on data collected in the China Health and Nutrition Survey. 2288 adults (20-45 years) who took part in both the 1989 and 2000 surveys were selected. RESULTS from 1989 to 2000, the average weight of this population increased from 55.4 kg to 59.1 kg. The medium increasing rate was 0.33 kg year(-1). During this time, the prevalence of overweight in the population increased dramatically from 9.0% to 23.2%. By assuming that each kilogram of body weight gained represents 7700 kcal, the estimated medium energy accumulation in the sample was 7.0 kcal day(-1) and the 90th percentile was 22.5 kcal d(-1). Further, assuming that the energy derived from mixed composition diets is stored with an average efficiency of 50%, the estimated energy gap for the population was 45 kcal day(-1). This is the degree of positive energy balance that is causing weight gain in 90% of the population. The estimate suggests that the behaviour change needed to close the energy gap is small and achievable without dramatically altering current lifestyle in China. For example, reducing energy intake by just 2-3% less each day or walking an extra 10-15 minutes each day could offset weight gain in roughly 90% of the population in China. By providing an estimate of the energy gap it can be predicted that weight gain in most of the population of China could be prevented with small lifestyle changes. It is critical that these lifestyle changes be implemented in order to prevent acceleration of the obesity epidemic in China.

Since national figures on the occurrence of metabolic syndrome among Chinese adolescents are lacking, this study aims to estimate its prevalence and distribution among Chinese youngsters. The 2002 China National Nutrition and Health Survey is a nationally representative cross-sectional study. Applying the criteria for US adolescents, we estimated the prevalence of metabolic syndrome among 2761 adolescents aged 15 to 19 years. The prevalence of metabolic syndrome among Chinese adolescents overall was 3·7 % (10 % in US adolescents). It was 35·2 %, 23·4 % and 2·3 % among adolescents who were overweight (BMI ≥ 95th percentile), at risk of overweight (BMI between 85th and 95th percentile) and normal weight (BMI below the 85th percentile), respectively. Urban boys had the highest rate (5·8 %) compared with girls and rural youngsters. Among adolescents who had a BMI ≥ 85th percentile and one or two parent(s) with metabolic syndrome, the prevalence was 46·4 %. A total of 96 % of overweight adolescents had at least one and 74·1 % overweight adolescents had at least two abnormalities of metabolic syndrome. Based on these figures, it is estimated that more than three million Chinese adolescents have metabolic syndrome. Both overweight and metabolic syndrome prevalence among adolescents are still relatively low in China, but the prevalence of metabolic syndrome among Chinese overweight adolescents is similar to those living in the USA.