Keyou Ge

Is China facing an obesity epidemic and the consequences? The trends in obesity and chronic disease in China

Background:Over the past two decades, China has enjoyed impressive economic development, and her citizens have experienced many remarked changes in their lifestyle. These changes are often associated with an increase in obesity and chronic disease.Methods:In this meta-analysis, based on nationally representative data, we studied the current prevalence of obesity and the trends in obesity, mortality and morbidity in China.Results:Between 1992 and 2002, the prevalence of overweight and obesity increased in all gender and age groups and in all geographic areas. Using the World Health Organization body mass index cut points, the combined prevalence of overweight and obesity increased from 14.6 to 21.8%. The Chinese obesity standard shows an increase from 20.0 to 29.9%. The annual increase rate was highest in men aged 18–44 years and women aged 45–59 years (approximately 1.6 and 1.0% points, respectively). In general, male subjects, urban residents, and high-income groups had a greater increase. With the increase in overweight and obesity, obesity-, and diet-related chronic diseases (e.g., hypertension, cardiovascular disease (CVD), and type 2 diabetes) also increased over the past decade and became a more important preventable cause of death. Hypertension increased from 14.4% in 1991 to 18.8% in 2002 in adults; in older adults aged 35–74 years, it increased from 19.7 to 28.6%. Between 1993 and 2003, the prevalence of CVD increased from 31.4 to 50.0%; diabetes increased from 1.9 to 5.6%. During 1990–2003, although total mortality rate (per 100 000) decreased, overall the mortality rate and contribution (as percentages) to total death of obesity-related chronic disease increased, in particular, in rural areas. Mortality rate (per 100 000) of CVD increased from 128 to 145 and its contribution to total death, 27 to 32%, in rural areas; the figures decreased slightly in urban areas. The mortality rate of ‘nutrition, endocrinology and metabolism-related disease’ (NEMD) increased in both rural and urban areas between 1990 and 2000, 8.0 to 10.6 and 4.9 to 5.3, respectively. The current prevalence of hypertension, dyslipidaemia, metabolic syndrome, and diabetes among Chinese adults is approximately 20, 20, 15, and 3%, respectively.Conclusion:The prevalence of overweight and obesity and obesity-related chronic diseases have increased in China in the past decade. Our findings provide useful information for the projection of future trends and the formulation of national strategies and programmes that can address the challenges of the growing obesity and chronic disease epidemic.

Weight gain and its predictors in Chinese adults.

OBJECTIVE: To describe 8 y weight change in Chinese adults and to determine the baseline characteristics of those who gained weight.DESIGN: A population-based cohort study of weight change and its predictors from 1989 to 1997.PARTICIPANTS: A cohort of 2488 adults aged 20–45 in 1989 drawn from seven provinces in China using multistage, random cluster sampling.MEASUREMENTS: Weight change over 8 y was the outcome variable. The key exposures were baseline energy intake, physical activity at work, alcohol consumption and smoking status. Baseline weight, weight status, height, age, residence, income and educational attainment were control variables.RESULTS: Overweight (body mass index, BMI≥25 kg/m2) doubled in females (10.4–20.8%) and almost tripled in males (5.0–14.1%). Low physical activity was a strong predictor of weight gain. Compared to those whose weight remained stable (±2 kg/8 y), males and females who experienced large weight gain (>5 kg/8 y) were 3 and 1.8 times more likely to engage in light rather than heavy work-related physical activity.CONCLUSION: The prevalence of overweight increased dramatically in this cohort. Light work-related physical activity was the strongest predictor of this weight gain.

Prospective study on nutrition transition in China.

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.

Body weight patterns among the Chinese: results from the 1989 and 1991 China Health and Nutrition Surveys.

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.

What is China doing in policy-making to push back the negative aspects of the nutrition transition?

OBJECTIVE To review the nutrition policies and efforts related to nutrition transition in China. DESIGN AND SETTING This paper reviews the nutrition policy and activities of China to prevent and control diet-related non-communicable diseases (DR-NCDs). Data came from the Ministry of Health, the Ministry of Agriculture, the State Council and some cross-sectional surveys. RESULTS China is undergoing a remarkable, but undesirable, rapid transition towards a stage of the nutrition transition characterised by high rates of DR-NCDs in a very short time. Some public sector Chinese organisations have combined their efforts to create the initial stages of systematic attempts to reduce these problems. These efforts, which focus on both under- and overnutrition, include the new Dietary Guidelines for Chinese Residents and the Chinese Pagoda and The National Plan of Action for Nutrition in China, issued by the highest body of the government, the State Council. There are selected agricultural sector activities that are laudable and few other systematic efforts that are impacting behaviour yet. In the health sector, efforts related to reducing hypertension and diabetes are becoming more widespread, but there is limited work in the nutrition sector. This paper points to some unique strengths from past Chinese efforts and to an agenda for the next several decades. CONCLUSIONS China is trying in its efforts to prevent and control the development of DR-NCDs but effects are limited. Systematic multi-sector co-operation is needed to effectively prevent and control DR-NCDs inside and outside the health sector.

Measuring diet quality in China: the INFH-UNC-CH diet quality index.

Objective: This paper describes the development and efficacy of a diet quality index (DQI) for China.Design: The Dietary Guidelines for Chinese Residents motivated the selection of 10 DQI components. These components were weighted and assigned cut-offs and point schemes based on the Chinese Food Guide Pagoda, Chinese and/or international dietary reference values. The efficacy of resulting DQI scores was assessed relative to a priori expectations.Subjects: The Chinese DQI was evaluated using cross-sectional 3 day diet record and anthropometric data on 7450 adults from the 1991 China Health and Nutrition Survey.Methods: For each individual, a DQI total score was calculated as the sum of components, and DQI pattern scores calculated to reflect the underlying composition of diet quality problems. The DQI scores were compared with component scores, food and nutrient intake, weight status and sociodemographic variables.Results: The total DQI score simultaneously represented all component aspects of diet quality as well as micronutrients not explicitly built into the index. The total DQI score was significantly correlated with food and nutrient intakes, BMI, urban residence and income. The DQI pattern scores correlated with DQI components and weight status as expected.Conclusions: The China DQI captures variation along several components of diet quality, appears sensitive to under- and overnutrition, as well as sociodemographic variables. The China DQI may prove useful for monitoring the nutrition transition and epidemiologic trends in China.Sponsorship: National Institutes of Health (HD 38700 and R01-HD30880) and the Chinese Academy of Preventive Medicine. European Journal of Clinical Nutrition (2000) 54, 811–821

Lysine-Fortified wheat Flour Improves the Nutritional and Immunological Status of Wheat-Eating Families in Northern China

The purpose of this study was to determine the impact of the fortification of wheat flour with lysine on selected health indicators among farm families obtaining 58% to 67% of their dietary protein from wheat. A man, a woman, and a child aged 5 to 12 years were studied from each of 88 families in a village near Huixian City, Henan Province, China. Half of the families received wheat flour fortified with 3 g of lysine per kilogram for three months, and the other half received wheat flour without fortification. The results showed a significantly greater gain in the height and weight of children receiving lysine-fortified wheat flour. Hemoglobin values were not affected. The mean prealbumin values of adult men and women were higher in those receiving lysine. The numbers of CD3 T cells increased significantly in women and children, as did the complement fraction C3 and IgG in men, IgA in women, and IgG, IgA, IgM, and C3 in children. These results indicate that lysine fortification of wheat flour can significantly improve some indicators of the nutritional status and immune function of family members consuming a wheat-based diet.

Sex difference in measures of body fatness and the possible difference in the effect of dietary fat on body fatness in men and women.

Objectives: To examine the sex difference in anthropometric measures of body fatness and to explore the possibility that diet may have differential effects on body fatness in men and women.Design: Prospective study design.Setting: The first and second China Health and Nutrition Survey conducted in 1989 and 1991, respectively.Subjects: 1449 men and 1683 women age 20–35 y at the baseline (1989) survey.Methods: Anthropometric measures of body fatness in men and women were compared. Statistical methods were used to explore the potential difference in the effect of dietary fat on body fatness in men and women.Results: Measures of body fatness, especially peripheral fatness, differed markedly between men and women in this study sample. Statistical analysis suggested that the effect of dietary fat on body fatness may be different in men compared to women.Conclusions: Sexual dimorphism in body fatness has important implications for both clinical and epidemiologic research of obesity. The possibility that diet may have differential effect on body fatness in men and women needs to be investigated.Sponsorship: This research was supported by the National Institute of Health, the Carolina Population Center and the Nutrition Institute, University of North Carolina at Chapel Hill.

Effect of nationality on dietary pattern and meal behavior in China.

In 1992 a national nutrition survey was conducted in China in approximately 100,000 people of all ages selected with use of a multistage, stratified, random, clustered procedure. Dietary data were collected with three consecutive 24-h recalls. A total of 9304 members of 20 minority nationality groups were included in the survey, accounting for 9.3% of the total sample. Meal behavior varied greatly according to nationality. Almost all Koreans and Tibetans ate three meals daily but 85% of Lahu people ate only two. Members of many other groups, including the Han, the majority nationality group in China, ate between two and three meals a day. People who ate two meals a day usually ate less than did those consuming three meals. The minority groups consumed amounts of dietary energy and protein comparable to those eaten by the majority group, although cereals accounted for a larger portion and animal food a smaller portion of energy and protein intakes. There were no differences in the dietary patterns of men and women of the same nationalities.