| dc.description.abstract |
<p>Background: Appropriate nutrition during early life is essential for optimal growth
and development. China has seen a drastic improvement in child nutrition over the
past few decades with decreased rates of stunting, wasting and undernutrition. However,
there are wide gaps in the nutritional status of young children and preschoolers in
rural and urban areas, which is a major public health concern. Currently, there is
limited understanding about dietary intake of young children and the rural-urban gap
in China, especially in the years after 2000. Therefore, the aims of this study were
to examine trends in dietary intake of children at 2-6 years of age using data from
the Chinese Health and Nutrition Surveys (CHNS) collected in 2000, 2004, 2006, 2009
and 2011 and to conduct interviews from key stakeholders in China to gather their
perspectives and insights regarding child nutrition improvement in China.</p><p>Methods:
Data obtained from the China National Nutrition and Health Survey (CNNHS) and Global
Burden of Diseases, Injuries, and Risk Factors (GBD) database were used to describe
the trend of child nutritional status in last 20 years from 1992 to 2016. Anthropometric
nutritional indicators including stunting, wasting, underweight, overweight and obesity
were presented in bar graphs and tables.</p><p>In-depth interviews were conducted
with 23 stakeholders whose work involved child nutrition at national levels, as well
as two provinces in Yunnan and Hubei. The interviews addressed topics about the changes
and the current status of child undernutrition, as well as major tasks for child nutrition
improvement. The qualitative analysis for the in-depth-interviews consisted of thematic
analysis. The interviews were conducted in Mandarin. Coding and charting were processed
in Chinese text using MAXQDA version 12. The final thematic framework and insightful
quotations were translated into English.</p><p>The quantitative analysis used the
individual level, consecutive 3-day 24-hour dietary recall data from five waves of
the China Health and Nutrition Surveys (CHNS) in 2000, 2004, 2006, 2009 and 2011.
Energy, macronutrient intakes (carbohydrate, protein, and fat) and food group intakes
of whole grains, vegetables, fruits, meat and other protein sources (i.e., fish and
egg), dairy products and snacks were estimated using data from Chinese Food Composition
Tables (2002)1. These results were presented by survey year, age group, gender, and
region (rural/urban areas). ANOVA, Chi-square test or t-test were used to examine
differences between subgroups. Statistical analyses were performed using SAS version
9.4 (SAS Institute, Cary, NC).</p><p>Results: Impressive declines were reported in
the prevalence of child stunting (35.8% to 8.1%), underweight (19.8% to 3.2%) and
wasting (3.7% to 2.4%) from 1992 to 2012 in China, while an upward trend of overweight
(6.5% to 8.4%) and obesity (2.7% to 3.3%) was observed in children under 6 years
old from 2002 to 2012 in the CNNHS database. Most interview respondents expressed
concerns about the increasing prevalence of childhood obesity, and the urgency of
action for alleviating undernutrition among children living in poverty-stricken areas.
The interview respondents from the child nutrition-related governmental departments
in Hubei and Yunnan province stressed the necessity of enlarging the scale of the
coverage of governmental child nutrition improvement programs in poverty-stricken
rural areas. The average energy and macronutrients intake of children 2-6 years of
age in the CHNS increased from 2000 to 2009 with a slight decrease in 2011. Among
both rural and urban children, the percent energy from fat increased from 2000 to
2011 and exceeded 30% of energy intake. In general, the percentage of these children
who consumed vegetables, meat and protein from fish and eggs, and dairy products increased
from 2004-2011, and significant dietary intake disparities of protein source foods,
such as dairy products were observed between rural and urban areas (p < 0.05) with
lower intakes among children in rural areas.</p><p>Conclusions: From the years 2000
to 2011, the nutritional status and diet quality among urban and rural young children
in China has undergone significant improvement. Also, young children in China are
undergoing a remarkable nutrition transition characterized by a high energy intake
from fat and low energy intake from carbohydrates. Both urban and rural children are
facing the threat brought about by this nutrition transition, and this may lead to
the increasing burden of child overweight. Further, dietary disparities still exist.
Governmental commitment should be devoted to helping vulnerable, marginalized populations
living in poor rural areas in China to further reduce undernutrition, and strategic
action targeted at reducing childhood overweight should be taken to control the increasing
trend in obesity in both rural and urban areas.</p>
|
|
