Food Consumption, Nutrient Intake, and Prevalence of Malnutrition in Relation with Geographical and Socio-Economic Factors Among Older Chinese: Findings from Chinese National Nutrition and Healthy Survey 2010-2013

Abstract

Background: China has been undergoing tremendous demographic transitions towards an aging society. Although suboptimal diets and malnutrition are the leading risk factors for disease burden, capturing nutrition challenges faced by the aging population is challenging due to the limited national representative information available. This study aimed to provide a comprehensive picture of the nutrition status of mid-aged and elderly Chinese and its relation to geographical and socioeconomic factors. Methods: A total of 75,758 non-institutionalized adults aged 45-80 years from the 2010-2013 Chinese National Nutrition and Health Survey were included in this study to evaluate their nutritional status and prevalence of malnutrition problems including anemia, underweight, overweight and obesity. Dietary data from 33,418 participants in this sample were obtained through 24 hour-recall over three consecutive days combined with weighted food inventory. Nutrient intakes were estimated based on dietary records and comparison with Chinese Dietary Reference Intakes 2013 (DRIs). Malnutrition problems were reported with stratification for demographic, geographic, and socioeconomic variables. Odd ratios of risks factors for malnutrition were estimated through multilevel multiple logistic regression analysis. Findings: Chinese population mean intakes of nutrient-dense food groups including fruits, dairy, soy and nuts, eggs, fish and seafood, as well as vegetables were lower than recommendations. Conversely, consumption of fat- and sodium- contributing groups such as meat and poultry, cooking oil, salt and condiments were higher than recommendations.The low adherence to dietary recommendations led to inadequate micronutrient intakes compared to DRIs, especially for eight micronutrients (calcium, folate, magnesium, selenium, vitamin A, vitamin B1, vitamin B2, and vitamin C), with more than 50% of participants have intakes lower than Estimated Average Requirements (EAR). Older age groups showed lower percentages of nutrient adequacy. The overall prevalences of anemia, underweight, overweight and obesity were 10.9%, 3.7%, 36% and 14%, respectively. The combined prevalence of overweight and obesity was 51.3% for the middle-aged group (45-59 years) and 45.2% for the elderly group (60-80 years). After adjusting for confounders at both individual and province levels, being older, female, a rural resident and having lower education were factors associated with higher risk for anemia and underweight, while younger age, female, urban residency and higher income were factors associated with greater risk for being overweight and obese. Interpretation: The results provide reference data for the development of policy and interventions to substantiate the China National Nutrition Plan 2017-2030. Within Chinese adults, older people have the highest prevalence of malnutrition. We suggest three priorities which require attention and solution: addressing anemia and underweight in high risk groups, curbing overweight and obesity, and supporting healthy eating and balanced diets. Funding Statement: The China National Nutrition and Healthy Survey (CNNHS), the Chinese Center for Disease Control and Prevention (CDC). This secondary data analysis received financial support from the Nestle Research Center. Declaration of Interests: This secondary data analysis received financial support from Nestle Research Center. Co-author Kai Yu, Jing Yin, and Fabrizio Arigoni are employed by Nestle Research Center. These authors contributed to the development of the manuscript, with no roles in the survey design and data analysis. Ethics Approval Statement: The study protocol was approved by the ethical review committee of the Chinese CDC. Written informed consent was obtained from all participants.