National Nutritional Transition of Chinese Children from 2005 to 2014: Evidence from Three Successive National Surveys for Han Nationality and 24 Ethnic Minorities

Abstract

Background: Although the rapid nutritional transition has been taking place in China, there are little literatures focused on this transition both in the Han and ethnic minorities' children. This study aimed to assess the nutritional transitions covering a comprehensive set of BMI categories and concomitant characteristics among Chinese children and adolescents from 2005 to 2014 and explore its ethnic differences and association with GDP per capita. Methods: Data were collected from 664 094 Chinese Han and 224 151 ethnic minorities children aged 7-18 years during three cross-sectional surveys (2005, 2010 and 2014) of the Chinese National Survey on Students' Constitution and Health. BMI categories, including thinness, overweight, and obesity were classified according to the International Obesity Task Force (IOTF) definitions. Gross domestic product (GDP) per capita of each nationality was categorized into four stratum to evaluate the socioeconomic development levels. Logistic regression was used to estimate the prevalence odds ratios (POR) of BMI categories for ethnic minorities versus Han in different surveys. Results: Over the 10-year period, the prevalence of thinness decreased from 20*4% in 2005 to 17*1% in 2014 in ethnic minorities' children, and decreased from 18*6% to 13*1% in the Han children. At the same time, the prevalence of overweight and obesity increased from 4*3% to 9*2% in ethnic minorities and increased from 10*4% to 17*7% in the Han children, respectively. The disparity of ethnic minorities versus the Han for thinness widened steadily over time with POR from 1*13 in 2005 to 1*37 in 2014, but shrank for overweight and obesity with POR from 0*39 in 2005 to 0*47 in 2014. Ethnic minorities showed a higher prevalence of thinness and lower prevalence of overweight and obesity than those of the Han children at each survey year. The ethnic minorities with the high prevalence of thinness were more likely to show the low burden of overweight and obesity, vice versa. Those in the two upper economic strata had a higher prevalence of overweight and obesity, whereas those in the two lower economic strata had a higher prevalence of thinness. Conclusions: Both Chinese Han and ethnic minorities are facing the nutritional transition from thinness to overweight and obesity over the 10-year period. Moreover, the transition model shifted with the development of local GDP per capita. Specific nutritional intervention and strategy should consider both the characteristics of each ethnic group currently and its development in the future. The Han nationality at present also needs to develop its policy for obesity control and thus could provide the successful experiences for other ethnic groups and developing countries. Funding: The present study was supported by the National Natural Science Foundation to Jun Ma (81673192) and China Scholarship Council to Yi Song (201606015038). Declaration of Interest: None of the authors have any conflicts of interest to disclose. Ethical Approval: This project was approved by the Medical Research Ethics Committee of Peking University Health Science Center (IR1052-18002).