The double burden of under- and overnutrition and nutrient adequacy among Chinese preschool and school-aged children in 2009–2011

BACKGROUND/OBJECTIVE: Coincident with economic development, China has experienced a dramatic transition from undernutrition to overweight/obesity over the last few decades. We aimed to explore the burden of under- and overnutrition and nutrient adequacy among 2-12 y-old Chinese children. METHODS: We included anthropometry, dietary intake and biomarkers from 2-12-y-olds who participated in the 2009-2011 China Health and Nutrition Survey (n=1,191 in 2009; n=1,648 in 2011). Dietary intakes were compared with the 2013 Chinese Dietary Recommended Intakes. RESULTS: In 2011, approximately 19% of 2-6 y-old children were underweight, 4% were stunted, 10% were overweight and 12% were obese. Among 7-12 y-old children, stunting was almost 0% whereas approximately 21% were underweight, 13% were overweight and 6% were obese in 2011. Overweight and obesity were more prevalent among children from urban areas and higher income households. In particular, 2-6 y-old children from urban areas and higher income households experienced the highest increase in obesity from 2009 to 2011 (P<0.05). Children from urban areas and higher income households had overall higher intakes of total daily energy and most macro- and micronutrients (P<0.05). However, a significant proportion of children did not meet the recommendations for important micronutrients. CONCLUSIONS: Underweight and stunting currently coexist with overweight and obesity among Chinese children <12 y-old. We found critical disparities in the prevalence of under- and overweight/obesity, as well as in nutrient intakes and dietary adequacies between children from different incomes, revealing that the burden of childhood under- and overnutrition may constitute a public health concern in modern China