The transition of Chinese dietary guidelines and food guide pagoda.

China promulgated her first food based dietary guidelines (FBDGs) in 1989. It was proposed by the standing board of Chinese Nutrition Society. The guidelines consisted of 8 items, each followed by a paragraph of explanation words. The second FBDGs came out in 1997, was expanded to include 3 parts i.e. guide lines for general population, for 7 particular population groups (infants, toddlers and preschool children, school-age children, adolescents, pregnant women, lactating mothers and the aged) and a newly formed food guide pagoda (FGP). The last version of the Chinese FBDGs was compelled by Chinese Nutrition Society in 2007, and proclaimed by the Ministry of Health in early 2008. The new guidelines kept the skeleton of three parts, but expanded remarkably in volume and coverage. The guidelines for the general population consisted of 10 items, each containing: core information, a discussion and reference materials. The guidelines for particular groups contained more subgroups, and more detailed recommendations. The revised pagoda kept the previous food grouping and placement but altered the amount of some food groups. An image of a walker and a cup of water were added to the side of the pagoda. Guidelines-2007 called for more coarse grains and less cooking oil consumption. Physical activity is also strongly recommended.

Prospective study on nutrition transition in China.

The aim of the prospective study reported here was to examine the effects of social and economic transformation on dietary patterns and nutritional status in China. The study began in 1989 and continued with follow-ups in 1991, 1993, 1997, 2000, and 2004. A total of 5000 subjects aged 18-45 years from 4280 households in nine provinces were included. Weighed records and three consecutive 24-h recalls were used. Over the study period, average consumption of all animal foods except milk increased, while cereal intake decreased. The proportion of animal protein and fat as a percentage of energy also increased. However, vitamin A and calcium intake did not increase and remained low. Child height and weight increased while undernutrition decreased and overweight increased. The results indicate that rapid changes in dietary pattern are associated with economic reforms in China.

Nutrition leadership training in North-East Asia: an IUNS initiative in conjunction with nutrition societies in the region.

Food for humans is one of the most important of all global issues. It is a critical determinant of planetary and individual health, of economic development, of how sustainable energy and water supplies are, and its security a powerful determinant of peace or conflict. Those who assume leadership for the integrity of food and health systems have great responsibility. The IUNS (International Union of Nutritional Sciences), regional and national nutrition science and food technology organizations have concern about the leadership capacity available and required in what are rapidly changing and increasingly demanding circumstances. These include persistent poverty and hunger, climate change which threatens the sustainability of food production and fragile financial systems which are making food less affordable for many. North East Asia (NEA) is a major region for its population size, its economic wealth and disparities, its food production, its life expectancies among the best and its global reach. In 2008, for those of Chinese ancestry and of wider Asian origin, Nutrition Leadership training has been conducted in Hangzhou, Shanghai, Seoul and Taiwan (Hsinchu and Zhunan). Ninety prospective young leaders participated in all. Several successful early career Asian nutrition scientists and professionals served as role models. Senior colleagues acted as mentors for groups of 2 or 3. With mentors, the concept of leadership has been examined, careers and roles explored, knowledge and skills honed for a different future, and plans made to network in mutual support. Early feedback indicates that new opportunities have been created and seized.

Lifespan nutrition and changing socio-economic conditions in China.

BACKGROUND: Twenty-five years ago, China introduced sweeping reforms in the structure of its rural economy, family planning program, and financial accountability within enterprises and service sector organizations. A rapid rise in economic productivity has resulted in continuing increases in income and changes to the traditional Chinese diet. OBJECTIVE: The aim of this study is to examine how the social and economic transformation of China affects dietary patterns and nutritional status of people. DESIGN: The data from a prospective study, China Health and Nutrition Survey, begun in 1989 and followed up in 1991, 1993, 1997, 2000 and 2004. The population used in this study included 5000 subjects aged 18-45 from 4280 households in nine provinces. Dietary intakes were measured using a combination of the weighing method and three consecutive 24-h recalls. All other data were directly measured or obtained by in-depth interviews. RESULT: The average consumption of all animal source foods except milk and eggs increased by 34g per capita per day, while the average intake of cereals decreased by 130g per capita per day. The proportion of animal source protein increased greatly and fat contributed an increasing proportion of energy. However, vitamin A and calcium intake did not increase from their low levels of intake during this period. Child height and weight increased and were linked with a decline in under-nutrition. For example, the prevalence of overweight increased from 11.4% to 22.8% in women and from 6.4% to 25.1% in men in the same period, climbing much faster than before. The rapid shift in diet and obesity linked with social and economic changes in China continues unabated. CONCLUSIONS: In association with the economic reform, the dietary pattern changed rapidly in these years.

[Measuring diet quality of chinese 18 - 59 years adult using chinese diet balance index].

OBJECTIVE: To evaluate the overall diet quality of Chinese adults using Chinese Diet Balance Index and the validity of DBI. METHODS: 28320 adult aged 18 - 59 years who had completed 3 day dietary information and basic information were selected from 2002 National Nutrition and Health Survey. Diet quality were evaluated by using DBI scoring and evaluating system. RESULTS: The major problems of Chinese residents are adequate food intake and excessive food intake co-exist. dietary quality are different between urban and rural populations, the extent of lower intake and excessive intake both is higher in rural areas than in urban areas. It shows that the extent of dietary imbalance is worse and severe among rural residents. The diet quality is effected by individual education level and family income. CONCLUSIONS: Comparing with the other measurements, DBI can describe the overall dietary quality more comprehensive, be easier to find out the major problem of the dietary pattern, and describe the extend of the problem numerically.

[Approaching Chinese diet balance index].

OBJECTIVE: To establish Chinese Diet Balance Index (DBI).; To evaluate the overall diet quality; To provide an effective measurement instrument for researchers, food and nutrition policy makers and the public. METHODS: The Dietary Guidelines for Chinese Residents motivated the selection of food-based components. The components were weighted and assigned cut-offs and point schemes based on the Chinese Food Guide Pagoda. Five scoring method are used to combine the component scores. RESULTS: 8 food-based components were selected, these are the intake of cereals, vegetable and fruit, bean and dairy, animal food, alcohol, salt, oil as well as the food variety. The scoring system including total score, lower bound score, higher bound scores, and diet quality distance can reflect both under and over intake. DBI can be used as a measurement to evaluate the dietary quality of the individual or the population.

Lysine-fortified wheat flour improves the nutritional and immunological status of wheat-eating families in northern China.

The purpose of this study was to determine the impact of the fortification of wheat flour with lysine on selected health indicators among farm families obtaining 58% to 67% of their dietary protein from wheat. A man, a woman, and a child aged 5 to 12 years were studied from each of 88 families in a village near Huixian City, Henan Province, China. Half of the families received wheat flour fortified with 3 g of lysine per kilogram for three months, and the other half received wheat flour without fortification. The results showed a significantly greater gain in the height and weight of children receiving lysine-fortified wheat flour. Hemoglobin values were not affected. The mean prealbumin values of adult men and women were higher in those receiving lysine. The numbers of CD3 T cells increased significantly in women and children, as did the complement fraction C3 and IgG in men, IgA in women, and IgG, IgA, IgM, and C3 in children. These results indicate that lysine fortification of wheat flour can significantly improve some indicators of the nutritional status and immune function of family members consuming a wheat-based diet.

Why do some overweight children remain overweight, whereas others do not?

OBJECTIVE: To study the dynamics of childhood overweight and the influence of dietary intake on tracking of overweight. DESIGN AND SETTING: A follow-up study conducted in China. SUBJECTS: Ninety-five overweight children, 6-13 years old, identified from 1455 children at baseline, were followed over a 2-year period. METHODS: Data on anthropometry and 3-day dietary intake were collected at baseline and during follow-up. Overweight was defined using the International Obesity Task Force reference of body mass index (BMI)-for-age. Differences between groups were tested using analysis of variance and Cochran-Mantel-Haenszel tests. RESULTS: Of the 95 overweight children, 36.8% remained overweight 2 years later ('tracking group'). Urban boys were three times more likely than rural boys to remain overweight (63.2% vs. 21.9%). At baseline, the tracking group had higher BMI, body weight and fat intake (% of energy), and lower carbohydrate intake (% of energy), than the non-tracking group (who shifted from overweight to not overweight); they were more likely to have a high-fat or high-meat diet, but less likely to have a diet high in carbohydrate or vegetables and fruit. During the follow-up, the tracking group increased fat intake and reduced carbohydrate intake while the non-tracking group did not; and they also grew slower in height but faster in weight. Tracking of overweight seemed to be related to tracking of high-meat (relative risk (RR) 2.4, 95% confidence interval (CI) 1.0-5.6, P < 0.05) and high-fat (RR 1.5, 95% CI 0.9-2.5, P < 0.1) diets. CONCLUSION: Considerable changes in children's overweight status during childhood and adolescence were observed in China, a transitional society. Dietary patterns, particularly dietary composition, seemed to influence the tracking patterns of overweight.

[Effects of calcium and vitamin D-fortified milk on physical development in school girls aged 10 to 12 years].

OBJECTIVES: To investigate the effects of calcium and vitamin D supplementation in fortified milk on physical development in Chinese school girls aged 10 - 12 years. METHODS: A non-randomized, double-blind intervention trial was carried out at nine primary schools of Beijing for two years. Seven hundred and fifty-seven girls (with an average age of 10.1 years) were recruited from nine primary schools in Beijing, China. They were divided into three trial groups, a control group (n = 259) having regular diet without milk supplementation, Group 1 (n = 238) having regular diet supplemented with 144 ml/d of calcium-fortified milk, and Group 2 (n = 260) having regular diet supplemented with 144 ml/d of calcium and vitamin D-fortified milk. Data of dietary intake and physical activities were collected by questionnaire, and height, weight, sitting height and knee height were measured before, during and after intervention. RESULTS: Two years after intervention, the percentage increases in height and weight were significantly greater in Groups 1 and 2 than those in control group (9.52%, 9.26% and 8.59% in height, and 34.53%, 35.38% and 30.91% in weight, respectively). The percentage increase of sitting height was greater in Group 1 than those in Group 2, and then than that in control group (9.21%, 8.58% and 7.87%, respectively). The percentage increase of knee height was significantly greater in Group 1 than that in Group 2 and control group (9.00%, 8.37% and 8.44%, respectively). CONCLUSION: Calcium and vitamin D-fortified milk supplementation could promote their physical development in girls aged 10 - 12 years.

Effects of red palm oil on serum lipids and plasma carotenoids level in Chinese male adults.

OBJECTIVE: Effects of red palm oil on major plasma carotenoids, tocopherol, retinol and serum lipids were evaluated when used in Chinese diet. METHODS: Red palm oil group (RPO) composed of 20 male subjects(aged 18-32) and soybean oil group (SBO) composed of 22 male subjects (aged 18-32). Dietary fat provided about 28% of total calories, and the test oil accounted for about 60% of total dietary fat. In the 3 weeks of pretest period, diets were prepared with soybean oil, and then in the next 6 weeks subjects in each group consumed the diet prepared by test oil. RESULTS: Plasma alpha-carotene, beta-carotene and lycopene concentration of RPO group significantly increased at the time of interim (21 days) and of the end (42 days) (P < 0.05), and alpha-tocopherol concentration significantly increased at the time of the end (42 days) in this study. Though Chinese plasma retinol level was relatively low when compared with that of Westerners, red palm oil diet showed no significant effect on adult Chinese plasma retinol level. Serum concentration of total cholesterol, triglyceride, high density lipoprotein cholesterol, apolipoprotein AI and apolipoprotein B of all subjects showed no significant changes in RPO group during the study. CONCLUSIONS: The data in our study suggest that red palm oil is a good source of carotenoids and vitamin E when used in Chinese diet preparation, and it can significantly increase plasma concentration of alpha-carotene, beta-carotene, lycopene and alpha-tocopherol.

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.

The road to obesity or the path to prevention: motorized transportation and obesity in China.

OBJECTIVE: Dependence on motorized forms of transportation may contribute to the worldwide obesity epidemic. Shifts in transportation patterns occurring in China provide an ideal opportunity to study the association between vehicle ownership and obesity. Our objective was to determine whether motorized forms of transportation promote obesity. RESEARCH METHODS AND PROCEDURES: A multistage random-cluster sampling process was used to select households from eight provinces in China. Data were included on household vehicle ownership and individual anthropometric and sociodemographic status. Cross-sectional data (1997) from 4741 Chinese adults aged 20 to 55 years were used to explore the association between vehicle ownership and obesity. Cohort data (1989 to 1997) from 2485 adults aged 20 to 45 years in 1989 (59% follow-up) were used to measure the impact of vehicle acquisition on the odds of becoming obese. RESULTS: Our main outcome measure was current obesity status and the odds of becoming obese over an 8-year period. In 1997, 84% of adults did not own motorized transportation. However, the odds of being obese were 80% higher (p < 0.05) for men and women in households who owned a motorized vehicle compared with those who did not own a vehicle. Fourteen percent of households acquired a motorized vehicle between 1989 and 1997. Compared with those whose vehicle ownership did not change, men who acquired a vehicle experienced a 1.8-kg greater weight gain (p < 0.05) and had 2 to 1 odds of becoming obese. DISCUSSION: Encouraging active forms of transportation may be one way to protect against obesity.

[Study on the relationship between body index and blood pressure in Chinese adult].

The authors use the anthropometry data of the Third National Nutrition Survey in China, and select the adult above 20-year-old as the study subjects in order to study the relationship between BMI and blood pressure value and to provide some reference data for defining the suitable BMI cut-off point of overweight and obesity in Chinese adult. The results show that the distribution of BMI varied with sex, age and areas; mean levels of systolic and diastolic blood pressure both gradually increased as BMI increased, multifactor linear regression analyses indicates there is obvious linear relationship between blood and BMI; The associations of BMI with high blood pressure were statistically significant after controlling for age, sex, area or smoking, logistic regression analyses indicate that odds ratios increased gradually at the different levels of BMI. These data quantify the strong associations of BMI with hypertension.