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

Understanding the nutrition transition: measuring rapid dietary changes in transitional countries

OBJECTIVE: To understand methodological concerns related to dietary intake collection in transitional societies. DESIGN: Three days of household weighing and measurement of all food used and repeated 24-hour recalls. SETTING: Eight Chinese provinces. SUBJECTS: Five thousand nine hundred and fifty-two and 5152 adults aged 20-45 years in 1989 and 1997, respectively. RESULTS: Great variance exists in the types and quantity of animal products used in common recipes. For example, the proportion of pork from lean cuts in 'stir-fried fresh pepper and pork' varies between 14 and 24% in urban and rural areas and the total pork content for 100 g (dish) varies by 15 to 19 g between rural and urban areas in each of eight provinces. Another challenge relates to the variation in the edible vegetable oil content added during food preparation. Reliance on standard recipes for each fried dish would miss the variations in oil use over time, space and socio-economic status. CONCLUSIONS: Dietary change is rapid in transitional countries. Reliance on recipes standardised for animal food and edible oil contents will lead to very large systematic errors in the measurement of energy, fat and protein intakes

Impacts of China's edible oil pricing policy on nutrition

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

Joint Association of Dietary Pattern and Physical Activity Level with Cardiovascular Disease Risk Factors among Chinese Men: A Cross-Sectional Study

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

A new stage of the nutrition transition in China

OBJECTIVE: To fully explore the long-term shifts in the nutrition transition and the full implications of these changes in the Chinese diet. DESIGN: A descriptive, population-based study. SETTING: Data come from nationally representative surveys: the China Health and Nutrition Survey (1989-1997), the China National Nutrition Survey (1982 and 1992), the annual household consumption surveys of the State Statistical Bureau, and the Annual Death Report of China. RESULTS: During the first part of the major economic transformation in China (before 1985), cereal intake increased but decreased thereafter. There was also a long-term reduction of vegetable consumption that has now stabilised. Intake of animal foods increased slowly before 1979 and more quickly after the economic reforms occurred. While the total energy intake of residents has decreased, as has energy expenditure, large changes in the composition of energy have occurred. The overall proportion of energy from fat increased quickly, reaching an overall average of 27.3% and 32.8% for urban residents in 1997. Over a third of all Chinese adults and 60.1% of those in urban areas consumed over 30% of their energy from fat in 1997. Large shifts towards increased inactivity at work and leisure occurred. These changes are linked with rapid increases of overweight, obesity and diet-related non-communicable diseases (DR-NCDs) as well as total mortality for urban residents. CONCLUSIONS: The long-term trend is a shift towards a high-fat, high-energy-density and low-fibre diet. The Chinese have entered a new stage of the nutrition transition

Trends in Chinese Snacking Behaviors and Patterns and the Social-Demographic Role between 1991 and 2009

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

The underweight/overweight household: an exploration of household sociodemographic and dietary factors in China

OBJECTIVE: The goal of this paper is to explore the hypothesis that the nutrition transition is related to households having an underweight and an overweight member simultaneously (under/over households and under/over pairs). DESIGN: The 1993 China Health and Nutrition Survey (CHNS) was used to test the association between being an under/over household and household characteristics related to the nutrition transition. Sociodemographic and diet patterns were tested for the main age combinations of the under/over pairs. SETTING: In China, 8.1% of all households were found to have underweight and overweight members within the same household. SUBJECTS: Results are from the 1993 China Health and Nutrition Survey and are based on a sample of 13814 persons from 3340 households. RESULTS: The under/over household was more urban, had a higher income and was more likely to have assets such as a television, a motor vehicle and a washing machine, even after controlling for sociodemographic confounders. The under/over household had a diet that was higher in fat and protein compared with the underweight and normal weight households. There were no significant differences between the under/over and overweight households, with many of the associations near unity. Comparisons of the under/over subgroups by age of the under/over pairs showed some differences by income and occupation, but not for diet. CONCLUSIONS: It is imperative, as more individuals become exposed to the diet and lifestyle patterns of the nutrition transition, to find effective public health programmes that can simultaneously promote a healthy lifestyle, improve diet quality and address both undernutrition and chronic disease

Public Health Nutrition: 5(1A)

Abstract Objective: The goal of this paper is to explore the hypothesis that the nutrition transition is related to households having an underweight and an overweight member simultaneously (under/over households and under/over pairs). Design: The 1993 China Health and Nutrition Survey (CHNS) was used to test the association between being an under/over household and household characteristics related to the nutrition transition. Sociodemographic and diet patterns were tested for the main age combinations of the under/over pairs. Setting: In China, 8.1% of all households were found to have underweight and overweight members within the same household. Subjects: Results are from the 1993 China Health and Nutrition Survey and are based on a sample of 13 814 persons from 3340 households. Results: The under/over household was more urban, had a higher income and was more likely to have assets such as a television, a motor vehicle and a washing machine, even after controlling for sociodemographic confounders. The under/over household had a diet that was higher in fat and protein compared with the underweight and normal weight households. There were no significant differences between the under/over and overweight households, with many of the associations near unity. Comparisons of the under/over subgroups by age of the under/over pairs showed some differences by income and occupation, but not for diet. Conclusions: It is imperative, as more individuals become exposed to the diet and lifestyle patterns of the nutrition transition, to find effective public health programmes that can simultaneously promote a healthy lifestyle, improve diet quality and address both undernutrition and chronic disease. Keywords China Diet Household food distribution Under/over Underweight Overweight A number of scholars have identified the presence of households with undernutrition and overweight coexisting in the same household. This finding has been regarded as a sign of the shift to the nutrition transition stage linked to diet-related non-communicable disease (NCD). Initial observations in South Africa found low-income, overweight women coexisting in communities with a high prevalence of child undernutrition 1,2 . Subsequent research has shown that this is a common condition in a wide range of countries 3 -5 . Garrett and Ruel 6 have also found obesity and overweight among women clustering with stunting among children. We have hypothesised these findings to be the result of diet and activity changes related to the rapid shift in the stage of the nutrition transition. Here and throughout this paper, the term nutrition transition is used to refer to the shift towards the diet-related NCD phase. Furthermore, emerging and rising obesity in many developing countries 7 indicate that this might be a broader global concern. However, few studies have considered households with underweight and overweight individuals of any age, simultaneously. These households, which are the focus of this paper, will be henceforth referred to as under/over households, and the underweight and overweight individuals within these households will be referred to as under/over pairs. The study by Doak et al. 5 found urban residence to be associated with the under/over households in Brazil, China and Russia. In China, the transitions in diet and activity related to overweight and chronic disease occurred first in the urban areas and among high-income households 8 -10 . These factors, as well as other sociodemographic variables such as household assets, may contribute to the likelihood of underweight and overweight clustering within households. The 1993 China Health and Nutrition Survey is used to test the association between household characteristics. Tests were made related to the nutrition transition and being an under/over household. This survey has in-depth anthropometric, dietary and socio-economic status (SES) data from all household members. It was expected that a common set of factors leads to increased overweight status, which are also related to the q The Authors 200

Transmission dynamics of symptom-dependent HIV/AIDS models

In this study, we proposed two, symptom-dependent, HIV/AIDS models to investigate the dynamical properties of HIV/AIDS in the Fujian Province. The basic reproduction number was obtained, and the local and global stabilities of the disease-free and endemic equilibrium points were verified to the deterministic HIV/AIDS model. Moreover, the indicators Rs0 and Re0 were derived for the stochastic HIV/AIDS model, and the conditions for stationary distribution and stochastic extinction were investigated. By using the surveillance data from the Fujian Provincial Center for Disease Control and Prevention, some numerical simulations and future predictions on the scale of HIV/AIDS infections in the Fujian Province were conducted

TV Use and Snacking Behaviors Among Children and Adolescents in China

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