Assessing status of nation's health
By Zhang Feng (China Daily)
Updated: 2004-10-12 08:54

Chinese people are advised that the way to a healthy lifestyle is eating less fat and more cereals, exercising more, smoking less and cutting down on liquor, according to an official survey.

Diners line up to get food at a buffet restaurant in Zhengzhou, Henan Province. The survey indicates that Chinese people's consumption of poultry, meat and oil/fat is too high, and cereals consumption is at a relatively low level. [newsphoto]

A national survey on the status of nutrition and health of the Chinese people shows that China is still facing the dual challenges of nutrition deficiency and nutrition imbalance even though great progress has been made in recent years.

In the 10 years between 1992 and 2002, thanks to the rapid development of China's economy, the status of diet and nutrition among the urban and rural Chinese population has improved significantly.

And the incidences of malnutrition and nutrition deficiency have been in continual decline.

However, the dietary habits of urban residents is still not up to par. Their consumption of poultry, meat and oil/fat is too high, while cereal consumption is at a relatively low level.

Meanwhile, malnutrition among children in China's rural areas is still quite serious.

China also witnessed a rapid increase in the prevalence of chronic non-infectious diseases since 1992, said Kong Lingzhi, director of the Ministry of Health.

Kong's ministry is one of the three departments under the State Council which organized the national survey.

The other two departments are the Ministry of Science and Technology and the National Bureau of Statistics.

About the survey

Previously, three national surveys on nutrition were conducted in 1959, 1982 and 1992.

In the past decade, rapid social and economic development in China has resulted in changes in the dietary patterns, lifestyles and disease patterns of the Chinese population.

To better understand the changes, a new survey was conducted from August to December, 2002.

After on-the-spot investigations in 2002, various tests and database building in 2003, and information analysis in the first seven months of this year, the report of the survey is finally ready for release today.

This was China's first comprehensive survey ever in the field of nutrition and health, Kong said.

The survey covered the Chinese mainland's 31 provinces, autonomous regions and municipalities directly under the central government. Hong Kong, Macao and Taiwan were not included.

A total of 71,971 households, 24,034 urban and 47,937 rural, were chosen as samples from 132 counties.

And a total of 272,023 people are covered by the survey. The survey comprises four parts: questionnaire, health examination, laboratory tests and dietary surveys.

Nutritious progress

Firstly, the survey shows that the quality of the average diet of Chinese people has improved significantly.

The energy and protein intake of the urban and rural population is basically satisfactory as consumption of meat, poultry, eggs and other animal products has increased significantly.

The daily consumption of animal products for the urban and rural residents has increased from 210 grams and 69 grams respectively in 1992 to 248 grams and 126 grams, according to the survey.

Compared with 1992's figures, the dietary pattern of rural residents has become more reasonable, for example, the percentage of good quality protein of total protein intake has increased from 17 to 31 per cent.

Meanwhile, the energy contribution from fat increased from 19 to 28 per cent and energy contribution from carbohydrates decreased from 70 to 61 per cent.

Secondly, the growth of children and teenagers has steadily improved.

The average weight of newborn infants has reached 3,309 grams, and low birth weight (below 2,500 grams) accounted for only 3.6 per cent of total live births, which brings China in line with developed countries.

The average height of three to 18 year-olds in urban and rural areas is 3.3 centimetres higher than the average in 1992.

When compared to urban residents, rural males were on average 4.9 centimetres shorter and females 4.2 centimetres shorter.

Thirdly, the malnutrition rate among children has significantly decreased.

The prevalence of growth retardation in children under the age of five was 14.3 per cent, a 55 per cent decrease from the rate in 1992.

The figure for low body weight in children was 7.8 per cent, 57 per cent lower than that of 1992.

Lastly, the incidence of anemia in urban males and females respectively dropped from 13.4 and 23.3 per cent in 1992 to 10.6 and 17 per cent in 2002.

In rural areas, the percentage has dropped from 15.4 to 12.9 per cent for males and 20.8 to 18.8 per cent for females.

Nutrition imbalance and deficiency

Poor nutrition and health problems remain quite serious, the report of the survey warns.

In 2002, the daily consumption of oils/fats among urban residents increased to 44 grams from 37 grams in 1992.

The energy contribution from fat reached 35 per cent in 2002, exceeding the recommended upper limit of 30 per cent by the World Health Organization.

In contrast, the energy contribution from cereals among urban residents is only 47 per cent, which is significantly lower than the recommended range of 55 to 65 per cent.

Low consumption of dairy and soy products remains a common problem in China.

And the absence of a nutritious diet is still a big problem, especially in rural areas.

The prevalence of growth retardation and low body weight among children under the age of five respectively made up 17.3 and 9.3 per cent.

The figure in poverty-stricken rural areas was 29.3 and 14.4 per cent respectively.

The rate of growth retardation among one-year-old children is the highest of all age groups.

In rural areas, it accounted for 20.9 per cent on average, and in poverty-stricken areas, it reached 34.6 per cent, which demonstrates the significant problems that come with the improper use of complementary foods given to infants in rural areas.

Moreover, the deficiency in micro-nutrients such as iron and vitamin A is a common problem of urban and rural populations.

The prevalence of anemia among the Chinese people averages 15.2 per cent.

Incidences of the disease among infants younger than two years old, people aged over 60 and child-bearing women are respectively 24.2, 21.5 and 20.6 per cent.

And 9.3 per cent of children aged between three to 12 suffer from vitamin A deficiency, and the figure in rural areas reaches 11.2 per cent.

The average calcium intake of urban and the rural populations was only 391 milligrams, equivalent to 41 per cent of the recommended dietary intake.

Non-infectious diseases

China has seen a significant increase in the mortality rate of those suffering from hypertension.

The prevalence of hypertension in people over the age of 18 is 18.8 per cent, and it is estimated that more than 160 million people are suffering from the illness in China.

The rate of hypertension increased by 31 per cent since 1991, with more than 70 million new hypertension cases appearing.

And incidences of the disease in rural areas have also increased rapidly, meaning there is no significant difference between urban and rural areas.

Additionally, the population awareness rate of hypertension is only 30.2 per cent, and only 24.7 per cent of the patients get necessary medical treatment.

The prevalence of diabetes in people over the age of 18 in China is 2.6 per cent.

The report estimates that there are more than 20 million diabetic patients in the country.

The incidence of diabetes in urban areas is much higher than that in rural areas.

Compared with a sampled diabetes survey in 1996, in adults over the age of 20 years old, the diabetic rate in the big cities increased from 4.6 to 6.4 per cent, and the prevalence in small- and medium-sized cities increased from 3.4 to 3.9 per cent.

The problems of being overweight and obesity have significantly increased.

In Chinese adults, the figure of those overweight was 22.8 per cent, and the rate of obesity was 7.1 per cent, with the estimated total numbers respectively 200 million and over 60 million.

The rate of those overweight or obese in big cities among urban adults were 30 and 12.3 per cent respectively, and children's obesity rate has reached 8.1 per cent.

Compared with the nutrition survey data of 1992, the adult rate of being overweight increased by 39 per cent, and the adult prevalence of obesity increased by 97 per cent.

The large number of overweight people means that there will be a rapid growth of obesity rates in the near future, Kong noted.

The problem of abnormal blood lipid levels also requires close attention.

The incidence of abnormal blood lipid levels among adults in China is 18.6 per cent, and it is estimated that 160 million people are suffering from it.

The survey indicates that dietary nutrition and physical activity are closely related to chronic disease.

High dietary energy, high dietary fat and less physical activity are closely related to the occurrence of obesity, diabetes and abnormal blood lipid levels.

And a high salt intake is closely related to the risks of hypertension, while alcohol is closely related to hypertension and abnormal blood lipid levels.

It should be particularly emphasized that those who had higher levels of fat intake and the least physical activity are at the highest risk of various chronic diseases, the report warns.

Proposed actions and measures

"We will consolidate our work to improve people's nutrition status and the control and prevention of chronic diseases through policy support, market guidance and public education," said Kong.

China will promulgate relevant laws and regulations about public nutritional intake, such as carrying out a qualification approval system for nutritionists and food nutrition.

It is necessary for China to integrate the improvement of people's nutrition and health into the 11th Five Year Development Plans (2006-10) at the national and local levels, Kong told China Daily.

A State-level guideline should also be made available to provide authoritative information so the public can choose food and do physical exercise scientifically and properly, Kong added.

China will also enhance scientific guidance in the fields of agriculture, food manufacturing, distribution and marketing to make them play more important roles in improving people's nutrition and health status.

For example, when planning agricultural development, it is vital to greatly develop the soy, milk, aquatic, fruit and vegetable industries.

The governments at various levels are also called to strengthen public education, advocate a balanced diet and a healthy lifestyle, and enhance people's awareness and capabilities for self-health protection.

The white paper on Chinese people's nutrition and health status, as well as a series of monographs and popular scientific books, will be published soon.

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