我国青少年儿童的营养状况(Regional Case Study-China)

Kalhan SC, Prentice AM, Yajnik CS (eds): Emerging Societies – Coexistence of Childhood Malnutrition and Obesity.Nestlé Nutr Inst Workshop Ser Pediatr Program, vol 63, pp 25–32,Nestec Ltd., Vevey/S. Karger AG, Basel, © 2009.Regional Case Studies – ChinaS hi-an YinNational Institute for Nutrition and Food Safety, Chinese Center for Disease Control and Prevention, Beijing, ChinaA bstractOver the last 30 years, the nutritional status of Chinese children has greatly improved due to economic development and improved incomes. In this review, the sta-tus of childhood malnutrition and obesity in China is evaluated based on the National Nutrition and Health Survey of 2002 (NNHS2002) and the survey on National Student Health and Physical Fitness in China of 2005. Compared with the NNHS1992 survey, the body weights and heights of preschool children in urban and rural areas have significantly improved, and the prevalence of malnutrition (underweight and stunt-ing) has been significantly reduced. However, micronutrient deficiencies, including calcium, zinc, vitamin A, vitamins B1 and B2, are still common in preschool and school children. These data show that the growth and development of Chinese children are under our expectations. On the other hand, the national averaged prevalences of over-weight and obesity in the children under 6 years of age are 3.4 or 2.0% as estimated by the Chinese or WHO standards, respectively. We are now facing double challenges: to prevent malnutrition and the increase in overweight and obesity in children.Copyright © 2009 Nestec Ltd., Vevey/S. Karger AG, Basel O ver the last 30 years (1979–2008), the nutritional status of Chinese children has greatly improved due to economic development and income increases. At present, typical malnutrition (for example, severe protein-energy malnutrition, vitamin A or thiamine deficiencies) is not common. However, marginal micronutrient deficiencies (iron, vitamin A, iodine, cal-cium, zinc and vitamin B1 deficiencies) are common in children in urban cit-ies and rural areas [1–3]. Nutritional deficiencies, including anemia, rickets, vitamin A and zinc, are still serious problems affected the growth and devel-opment of children in poor areas. At the same time, the prevalence of over-weight and obesity in children is significantly increased year by year in the cities, especially in large cities. Reviewing the results of the National Student Health and Physical Fitness of China survey in 2005, the rates of overweightYinand obesity were 13.2 and 11.4%, respectively, for boys aged 7–12 years in cities, indicating increases of 1.4 and 2.7%, respectively, compared to the sur-vey conducted in 2000. That is, there has been a significant increase in over-weight and obesity in children and adolescents within 5 years [4].Economic Development and Chronic Non-CommunicableDiseasesEconomic Development Change from 1979 to 2008 in ChinaFor three decades since 1979, following the reform and opening-up of China, the Chinese have gone through a stage of transition from adequate food and clothing to a well-off society. The goal of quadrupling China’s gross national product by 2000 was reached at the end of 1997. Per capita dispos-able income achieved the breakthrough goal of 10,000 Chinese yuan (= USD 1,220) in 2005. Personal income per capita has significant increased in urban and rural areas and reached USD 1,740 in 2006. The increase in China’s econ-omy was 11.4% in 2007 (the fastest pace in 13 years).Prevalence of Chronic Non-Communica b le Diseases Significantly Increases with the Change in Living Pattern at the National LevelIt has been reported that the ratio of the number of chronic disease deaths to the total number of deaths has risen from 73.8% in 1991 to 80.9% at the national level in 2000; deaths were 85.3 and 76.5% in urban and rural areas of China, respectively. Over the last 10 years, mortality rates for cancers, cerebrovascular diseases, diabetes and coronary heart disease have shown an upward trend. For example, in China, hypertension has been the number one killer. The prevalence of hypertension in people over the age of 18 is 18.8%. It is estimated that about 160 million people have hypertension; an increase of more than 70 million patients from 1991 to 2002. Another serious threat to health and survival is the increased incidence of diabetes. Based on the data of 2002, the prevalence of diabetes in people over 18 years of age in China was 6.1, 3.7 and 1.8% in large cities, small- and medium-sized cities, and rural areas, respectively. Compared with the rate in 1996, the prevalence in the large cities rose by 40% in only 6 years [1].Growth Status of Chinese ChildrenBased on the National Nutritional and Health Survey in 2002, the body weights and heights of preschool children in urban and rural areas improved significantly compared to the results in 1992 (tables 1, 2) [3]. The heights and weights of preschool children in urban and rural areas improved significantly with the increase in household income [3].Regional Case Studies – ChinaT a b l e 1. C h a n g i n g t r e n d i n h e i g h t (c m ) o f C h i n e s e c h i l d r e n f r o m 1992 t o 2002A g e U r b a n R u r a l y e a r s b o y s g i r l s b o y s g i r l s 19922002g a i n19922002g a i n 19922002g a i n 19922002g a i n2a087.6090.12.5088.2089.00.8085.5087.62.1084.7086.21.53095.4099.74.3094.5098.84.3092.0095.13.1091.0094.23.24102.4106.03.6099.9105.05.1098.5101.83.3097.4101.03.65108.2112.24.0106.6111.54.9104.9108.23.3103.8107.43.66–7113.5118.44.9112.6117.04.4110.2113.12.9109.6112.93.3a M e a s u r e d l e n g t h f o r c h i l d r e n l e s s t h a n 3 y e a r s .T a b l e 2. C h a n g i n g t r e n d i n b o d y w e i g h t (k g ) o f C h i n e s e c h i l d r e n f r o m 1992 t o 2002A g e U r b a n R u r a l y e a r s b o y sg i r l sb o y sg i r l s19922002g a i n19922002g a i n 19922002g a i n19922002g a i n212.813.50.712.712.7012.212.80.611.711.90.2314.716.01.314.515.40.913.814.30.513.213.80.6416.817.81.015.917.01.115.416.00.615.015.50.5518.619.71.117.719.01.317.117.70.616.617.10.56–720.722.21.520.021.11.119.119.40.318.418.70.3YinPrevalence of Malnutrition in Chinese Children under 7 Years of Age in ChinaThe remarkable nutritional improvement of children in the 1990s is the consequence of the rapid socioeconomic development of China [5, 6]. For example, the prevalence of underweight in urban and rural areas was reduced from 10.1 and 20.0% in 1992 to 3.1 and 9.3%, respectively, in 2002, and the prevalence of stunting in urban and rural areas was reduced from 19.1 and 35.0% in 1992 to 4.9 and 17.3%, respectively in 2002 (tables 3, 4) in the same period.Prevalence of Overweight and Obesity in Chinese Children and Adolescents• The national averaged prevalence of overweight and obesity in Chinese children and adolescents is shown in figure 1. The rates of overweight and obesity for the children under 6 years were 3.4 or 2.0% as esti-mated using the Chinese or WHO standards, respectively, and the prevalence of overweight and obesity for 7–17 years was 4.5% (4.2% by WHO) and 2.1% (1.8% by WHO), respectively, in 2002. Using the Chinese standard, the prevalence of overweight and obesity in children and adolescents in cities and rural areas is presented in figure 2 [1, 7].Micronutrient Status of Chinese Children in ChinaThe data from the National Nutrition and Health Survey in 2002 showed that the growth and development of Chinese children is far from ideal. Micronutrient deficiencies, including calcium, zinc, vitamin A, vitamins B1 and B2, are quite common in preschool and school children. Iron deficiency and iron deficiency anemia are still a serous problem based on the National Nutrition and Health Survey in 2002. This survey showed that the preva-lence of anemia in children (6–9 years) was 13–14% in cities [3], indicating that these children are at a high risk of having anemia. The characteristics of anemia in China are that the apparent iron intake is adequate, however, iron deficiency and iron deficiency anemia are the most common nutritional defi-ciency problems, particularly among young children due to the poor absorp-tion of iron from plant food, and thus the amount of absorbable iron is not enough to meet the iron requirements.With regard to vitamin A deficiency, the mean vitamin A level in the serum of 10,784 children in five districts of Shenyang City in China was 1.20 ± 0.44 µmol/l [8], and 33.1 and 10.5% of children have serum retinol levels of 0.7–1.05 and 0.35–0.69 µmol/l, respectively, showing that the vitamin A levels ofRegional Case Studies – ChinaT a b l e 3. C o m p a r i s o n o f u n d e r w e i g h t p r e v a l e n c e o f c h i l d r e n u n d e r 5 y e a r s o f a g e f r o m 1992 t o 2002 (%)A g e , y e a r sN a t i o n a lU r b a nR u r a l19922002c h a n g e19922002c h a n g e 19922002c h a n g e0 9.72.6–73.2 8.71.7–80.510.0 2.9–71.0119.38.4–56.5 9.84.6–53.121.8 9.6–56.0219.29.8–49.010.65.1–51.921.011.2–46.7320.79.4–54.6 8.52.4–71.823.811.7–50.84–518.19.6–47.012.43.4–72.619.511.5–41.0T o t a l 18.07.8–56.710.13.1–69.320.009.3–53.5T a b l e 4. C o m p a r i s o n o f s t u n t i n g p r e v a l e n c e o f c h i l d r e n u n d e r 5 y e a r s o l d f r o m 1992 t o 2002 (%)A g e , y e a r sN a t i o n a lU r b a nR u r a l19922002c h a n g e19922002c h a n g e19922002c h a n g e014.4 8.0–44.410.73.9–63.615.2 9.2–39.5133.818.0–46.719.98.6–56.837.320.9–44.0230.315.1–50.217.28.0–53.533.017.3–47.6336.615.2–58.519.03.3–82.641.019.0–53.74–537.416.1–57.024.84.9–80.240.619.6–51.7T o t a l 31.914.3–55.219.14.9–74.535.017.3–50.6YinFig. 1.The prevalence of overweight and obesity in children and adolescents (%). OW = Overweight; Ob = obesity; C = using Chinese standard; W = using WHO standard.Fig. 2. The prevalence of overweight and obesity in children and adolescents estimated by Chinese standard in different areas (%). OW = Overweight; Ob = obesity. children aged 3 years old are relatively low. The incidence of marginal vita-min A deficiency (about 40% in children aged 3–12 years) is relatively high. The insufficiency of vitamin A in the diet is the direct cause of vitamin A deficiency [3]. It is well known that vitamin A deficiency may affect the physi-cal development of children. Furthermore, a factor contributing to vitamin A deficiency among Chinese children is that their diets contain even smaller quantities of plant carotenoids than those of adults because plant provitamin A carotenoids account for about 70% of dietary vitamin A in the Chinese pop-ulation [2]. Thus, preschool children are at high risk of vitamin A deficiency due to their rapid growth (which further increases their vitamin A require-Regional Case Studies – China ments), their inadequate complementary feeding, and their general aversion to eating green leafy vegetables.In addition, other micronutrient deficiencies have been observed. As the consumption of milk and its products is relatively low, the lack of calcium in the traditional Chinese diet is very common, making the calcium intake of children less than 40% of the Chinese recommended nutritional intake (RNI; equal to US recommended daily allowance) based on the National Nutrition and Health Survey in 2002 [2]. The zinc intake of children reached 80% of the Chinese RNI; vitamin B2 intake reached about 60% of the Chinese RNI, and vitamin B1 was 65–71% of the Chinese RNI [2].ConclusionsFollowing the economic development and increase in household income, the nutritional status of Chinese children has greatly improved in the past 30 years. However, the prevalence of non-communicable diseases has signifi-cantly increased with the change in living pattern at the national level.With the increase in household income, the body weights and heights of preschool children in urban and rural areas have significantly improved in the last 10 years.The prevalence of malnutrition (underweight and stunting) in urban and rural areas has markedly decreased, and can be ascribed to the remarkable nutritional improvement of children in the 1990s as a consequence of the rapid socioeconomic development of China.The rapid increase in overweight and obesity in children and adolescents in relation to the changes in dietary pattern and physical activities should be a warning.With regard to treating and solving the double challenges (malnutrition and overweight and obesity), we should not only make strategies on how to eliminate micronutrient deficiencies but also on how to prevent overweight and obesity in children and adolescents.AcknowledgementsThe author would like to thank Dr. Guangwen Tang for assistance in preparing the manuscript.References1 Wang LD: Gene r al Report on the Nutritional and Health Status of Chinese Population – 2002National Nutrition and Health Survey. Beijing, People’s Medical Publishing House, 2005.2 Zhai FY, Yang XG: The Status of Dietary and Nutrient Intakes of Chinese Population – 2002National Nutrition and Health Survey. Beijing, People’s Medical Publishing House, 2006.Yin3 Yang XG, Zhai FY: The body mass and nutrition status of Chinese population – 2002 NationalNutrition and Health Survey. Beijing, People’s Medical Publishing House, 2006.4 Ji CY, Sun JL: Analyses of the epidemiological status of overweight and obesity in Chinesestudents and the prevalence. J Peking Univ(Health Sci) 2004;36:194–197.5 Chang S, Fu Z, He W, Chen C: Current situation and trend of child growth in China. J Hyg Res2000;29:270–274.6 Chen CM, He W, Fu ZY, et al: Ten-Year Tracking Nutritional Status in China. Beijing, People’sMedical Publishing House, 2004.7 Ma GS, Li YP, Wu YF, et al: The prevalence of body overweight and obesity and its changesamong Chinese people during 1992 to 2002. Chin J Prev Med 2005;39:311–315.8 Yang R, Chen C, Chen L, et al: Investigate the serum vitamin A levels of children aged 0–6years in Zhejiang Province. Chin J Child Health Care 2001;8:160–161.For discussion, see p. 41.。