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Prospective study on nutrition transition in China

Fengying Zhai, Huijun Wang, Shufa Du, Yuna He, Zhihong Wang, Keyou Ge, Barry M Popkin
DOI: http://dx.doi.org/10.1111/j.1753-4887.2009.00160.x S56-S61 First published online: 1 May 2009


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.

  • China Health and Nutrition Survey
  • dietary pattern
  • nutrition transition
  • trends


Twenty-five years ago, China introduced sweeping reforms in the structure of its rural economy. The economy has experienced exponential growth in the past decade, with per-capita GDP rising from 460 yuan in 1980 to 9101 yuan in 2003.1 Since 1990, the annual rate of per-capita GDP growth has been 8.6%.2 A rapid rise in economic productivity has resulted in continuing increases in income and changes in the traditional Chinese diet. But these changes are occurring at markedly different rates across the country. Following rapid economic and social change, the pace of nutrition transition has accelerated in China.3,4 The study presented here focused on the interplay of demographic and economic changes that affect food demand and nutritional status in China's population.


Data and study population

The data was derived from the China Economic, Population, Nutrition and Health Survey, which covers nine provinces that vary substantially in geography, economic development, public resources, and health indicators. A multistage, random cluster sample was used to draw the sample surveyed in each of the provinces. In 1989–1993 there were 190 primary sampling units; a new province and its sampling units were added in 1997. Currently, there are about 3800 households in the overall survey, covering 16,000 individuals, including all age groups. The surveys collected information on all individuals living in the household. A complete household roster was used as a reference for subsequent blocks of questions on individual, household, and community infrastructure. The study included adults aged 18–45 years in the survey to comprise the study population (Table 1).

View this table:
Table 1

Composition of the study population in China by year.


Trends in dietary intake

Over the past 10 years, adult intake of cereals and starchy roots declined. During the same period, consumption of animal food, especially meat and eggs, increased (Table 2). The proportion of dietary energy derived from fat in the adult diet increased dramatically, from 19% to 28%, mainly due to replacement of calories from carbohydrate (Figure 1). About one-half of dietary fat was derived from edible oil, while the consumption of refined animal fat decreased.

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Table 2

Trends in intake (g/day) of food groups for adults in China by residence and year.

Figure 1

Trends in percent of macronutrients as proportion of total dietary energy intake in the Chinese population.

Comparing the surveys from 1989 and 2004 revealed that energy and protein intake had decreased over time, but the quantity of protein had increased as a percentage of total calories. The average calcium intake among the city and suburban populations was only about 430 mg per day, while among the town and village populations, the average calcium intake was about 380 mg per day. Intake of vitamins and other minerals remained steady (Table 3).

View this table:
Table 3

Nutrient intake by community and year in China.

Trends in nutritional status

Trends in the nutritional status of the Chinese population clearly demonstrate that undernutrition is declining rapidly, while overweight and obesity are increasing in both children and adults. Moreover, the rate of overweight increase is becoming increasingly rapid (Figure 2).

Figure 2

Trends in under- and overnutrition in adults in China by urban and rural residence (A) and gender (B).

The distribution of BMI estimated from this survey in 1989, 1997, 2000, and 2004 is shown in Figure 3 and 4 and the line of BMI shifted to the right in both males and females. Thus, the proportion to the right of the distribution has increased with time. If action is not taken, the prevalence of overweight and obesity will increase more rapidly than before.

Figure 3

Changes in distribution of adult male BMI in China.

Figure 4

Changes in distribution of adult female BMI in China.


Over the past 20 years, the status of diet and nutrition among the urban and rural populations in China has undergone significant improvement, and the prevalence of malnutrition and nutrition deficiencies has been decreasing continuously.57 However, China is also undergoing a remarkably fast, but undesirable, shift towards a stage of nutrition transition dominated by a high intake of fat and animal foods, as well as a high prevalence of diet-related non-communicable diseases such as obesity, diabetes mellitus, cardiovascular disease, and cancer.

The classic Chinese diet includes cereals and vegetables with few animal foods.8 It is a diet that many scholars consider as extremely healthy when adequate levels of intake are achieved. With the presently prosperous economy, the quality of the average diet of the Chinese people has improved significantly. The energy and protein intakes among the urban and rural populations have, on the whole, been satisfactory; the consumption of meat, poultry, eggs, and other animal products has increased significantly and the percentage of good-quality protein in the diet has also increased. However, to a certain extent, the dietary pattern among urban residents is not so exemplary. The level of meat and oil consumption is too high, and cereal consumption is at a relatively low level. Low-level consumption of dairy and soy products remains a common problem in China. High dietary energy, high dietary fat, and less physical activity are closely related to the occurrence of overweight, obesity, diabetes, and abnormal blood lipid levels; high salt intake is associated with the risk of hypertension. It should be particularly emphasized that subjects who had higher levels of fat intake and lower levels of physical activity were at highest risk for the above-mentioned chronic diseases.9,10


In conclusion, China is undergoing a remarkable, but undesirable, rapid transition towards a stage of nutrition transition characterized by high rates of diet-related noncommunicable diseases in a very short time. China is facing simultaneous challenges of under- and overnutrition. On the one hand, the government's efforts in the past decades to reduce undernutrition have been very successful and the prevalence of stunted and underweight children has decreased significantly. On the other hand, the prevalence of overweight and obesity and the morbidity associated with noncommunicable diseases have increased significantly in the past 20 years.11,12 In the same time period, the burden of chronic noncommunicable diseases in China has also become greater.


Declaration of interest.  The authors have no relevant interests to declare.


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