1998年中国食物营养监测总报告摘要与政策建议(英文)
作者：陈春明
单位：
关键词：
卫生研究000515文章编号：1000-8020(2000)05-0308-06Executive summary of food and nutrition surveillance
in 1998 and policy recommendation
Chinese Academy of Preventive Medicine, State Statistic Bureau of China, Working Group on Chinese
Food and Nutrition Surveillance
, 百拇医药
Written by
Chen Chunming
(Chinese Academy of Preventive medicine, Beijing 100050, China)
Based on the experiences of the pilot study in 1990 to 199 5, a National Food and Nutrition Surveillance System was established in 1997. U nder the collaboration of the Food and Nutrition Surveillance System(FNSS) Worki ng Group of the Chinese Academy of Preventive Medicine, the Urban Household Surv ey Team and the Rural Household Survey Team of the State Statistic Bureau of Chi na, the national surveillance network is formulated by stratified random samplin g. It consists 40 sites, 26 rural sites and 14 urban sites in 26 provinces.
, 百拇医药
In 1998, data on food consumption, anthropometric measurements of children under 6 were collected, basic information of households and feeding practice were recorded by questionnaire. In 1998 surveillance, 1857 rural households and 869 urban household were sampled and whole year food consumption of the households collected by Household Survey Teams was used. Height and weight of 16436 children under 6 were measured, around 400 sampled at each site. Hemoglobin of children in 9 sites was tested. Household salt samples were collected in all sites.
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Following is the report on food and nutrition status in 1998.
1 Nutrition status of children
16436 children under 6 were sampled, number of children under 5 in urban is 4859, and 8862 in the rural sites. WHO/NCHS standard is used for evaluation.
1.1 Prevalence of underweight
The national average prevalence of underweight of children under 5 was 9.6%, 12.6% in the rural and 2.7% in the urban areas. The average prevalence of underweight of children at age 0～3 month was 0.2% and 0.8% for urban and rural respectively. But after 6 month, the prevalence of rural children went up rapidly, reached 9.3% at age of 6 month, the peak at 12 month was 17.9% and leveled off until 5 year of age, which was 12%～15%(P271).
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The prevalence of underweight of urban children of all age group under 5 was between 1.2% to 3.5%(P271). But the prevalence of Z Score wt/ht>2 was 5.4%, w hich was higher than 3.9% in 1992(P273).
1.2 Prevalence of stunting
The national average prevalence of stunting of children under 5 was 16.7%, 22.6% for rural and 4.1% for urban. Comparing with the NCHS standard, the median of height of urban children aged 0～3 month had no difference, but the prevalence of rural children aged 0～3 month was 11.6% stunted. It went up to 23.7% at 12 month of age and peaked to 28.9% at 18 month. Then leveled off after 24 month of age to 20%～25%. In urban, peak of stunting was 5.2% at 18 month of age, then to 3 %～4% later on(P271).
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Comparison of 1998 figure with that in 1990 and 1995 pilot surveillance showed the growth of children have been improving along with the rapid economic development in the country. The continuous reduction of prevalence of underweight demonstrated the immediate effect of economic progress, 42.5% reduction in urban and 21.2% in rural were achieved during 1990～1995. But prevalence of stunting was not improved in parallel, it reduced very little, almost no change during 1990～1995 and it exerted dramatic reduction during the period of 1995～1998. Such pattern of growth improvement illustrated that the favorable factors for weight catch-up was not adequate enough for parallel linear growth, which means more approaches should be considered.
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Linear growth of child requires more animal food, especially for children aged 2～5. It has been proven that height during early childhood is highly correlated wi th mental development and health of their later life, hence the productivity and diseases of their adult life[1～3]. Nutrition as an essential component for economic development should be recognized, and consequent better developmen t in the future could be predicted if more concern is given to the nutrition of children under 5 in rural China where one fourth of them are stunted.
, http://www.100md.com
2 Food consumption and nutrition of urban residents
1875 rural household and 869 urban households were involved, food consumption records have been collected at these households under the supervision of the local reviewers of the State Statistic Bureau. Data of 1997 was transferred to the FNSS Working Group for further cleaning and analysis.
2.1 Food consumption
The household average consumption of foods in kg/capita/year were: cereals 126, vegetable 147, fruits 73, vegetable oil 9.9, pork 24, beef/lamb 4.4, poultry 9.4, fish 17, eggs 16, beans/bean products 5.7. Calculate to kg/reference man/year, the figures were 135, 158, 78, 10.6, 26, 4.7, 10, 18, 17, 6.2 respectively. The consumption of cereals and vegetables increased along with income increase, but the amount of cereals consumed in 1997 was 25kg less than the figure collected in 1992 Nationwide Nutritional Survey. Vegetable oil consumption was stable, the 25% lower income households consumed a little higher. Total animal food consumption was 75.9kg/capita/year. Compare with the amount in 1992, animal food was 12.5kg mo re consumed, poultry consumption was remarkably increased and no change of fish consumption, consumption of eggs was similar across the income groups. Pork consumption of the 10% lowest income households was 7kg less than the urban average, and their consumption of eggs, poultry and vegetables were much lower than the urban average(P291).
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2.2 Nutrition of the diet
The daily energy intake of urban household was 2419kcal/Reference man, which has been stable since 1992. Energy from fat was 28.6%, which was 28.4% in 1992 [4]. Daily protein intake of Reference man was 74.4g, the same as in 1992(75g), 37.6% of protein was animal protein, and protein from beans was only 4.4%. Energy from cereals dropped to 52.9% from 57.4% in 1992 and energy from animal food increased from 15.2% to 18.7%. The trend of dietary change since 1992 was increase of animal food along with reduction of cereal consumption, but before 1992, the dietary change was characterized with swift and continuous increase of vegetable oil.
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Desirable Dietary Pattern (DDP)-China for 2000 was applied for evaluation of dietary pattern[5], the score for diet of urban households wa s 90, the dietary pattern was reasonable. But the score for cereals was 27 points compared with the desirable score 30, and score of animal food got penalty of 9.3 points which was 1.7 points higher than the penalty in 1995, and score for beans/bean products was far beyond desirable with 9.1 points deficit(P292). These indicated that the transitional changes and the hidden danger of the diet. The direction of accomplishing the goal of a balanced diet will be: maintain cereal consumption, keep animal food moderate and encourage bean consumption to replace part of animal food..
, http://www.100md.com
The continuous increase of animal food caused sharp increase of fat and cholesterol intake, and greater risk of obesity, diabetes and cardiovascular diseases appeared. Decrease of cereal consumption will accompany with lowered intake of dietary fiber, a component beneficial to health protection and chronic disease prevention. Additionally, animal food production is cereal consuming. Cereal consumed for pork production is more than double that of poultry meat production, excessive consumption of animal food, especially pork, will cause huge pressure to national overall grain production. Evidently, the current trend of food consumption pattern will be disadvantageous both to health and to the economic development, it calls for attention of policy-makers. Replacing partial meat consumption with beans and bean products can achieve the principles of the and thepromulgated by the Ministry of Health in 1999. As the priority measure for nutrition improvement of urban people, it is not only beneficial to the health of the people, more importantly it is feasible economically as well.
, 百拇医药
3 Food consumption and nutrition of rural residents
3.1 Food consumption
Cereal consumption as raw grains was 267kg/capita/year, it was a 28kg increase per Reference man per year comparing with the cereal consumption in 1992. Vegetable consumption was 130kg/capita/year, which went up along with income increase, the amount consumed in 10% lowest income households was only 93kg. Fruit consumption was 21.4kg, almost doubled the amount in 1992, and the amount consumed in the 10% lowest income households was less than one fourth of the rural average. Vegetable oil consumption was 6.4kg, the same as in 1992, but the poorest 10% household consumed only half of the average. Meat consumption was 15.6kg consisting 12kg of pork which increased 3kg since 1992, the 10% poorest consumed 4kg less comparing with the average. Poultry consumption was 2.8kg, eggs 5.3kg, increased 1.9kg and 3.2kg respectively since 1992(P292). The overall food consumptio n has improved in the rural households.
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3.2 Nutrition of the diet
Daily energy intake reached 2471kcal/Reference man, it was 103% of RDA, it was 2294kcal and 95.4% of RDA in 1992. But in the 10% lowest income households, energy intake was 2020kcal and 84% of RDA. Protein intake was 71.6g, 7.3g higher than that in 1992. Energy from fat was 17.6% in average and 15.2% for the 10% poorest households. Energy contribution by cereals was 72% compared with 75.6% in 1992. Energy from animal food was 8.8%, 2.6% higher than in 1992. Consumption of beans and bean products was 6.5kg. Animal and bean origin protein was only 17.8% of total protein, which was even less than half of the desirable level (40%). DDP score of rural diet was 70.2 points, 20 points lower than the urban score.
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So, quantitative and qualitative improvement of nutrition among rural residents should be focused on the increase of soybean and animal food consumption resulting the reduction of cereal energy contribution of about 65% of total energy intake. Immediate action on promoting vegetable and soybean intake will achieve in a more balanced diet and better protein and micronutrient nutrition at affordable cost.
4 Analysis on nutrition issues and related policy recommenda tions
, 百拇医药
4.1 The improvement of the nutritional status of children in China is the consequence of socio-economic development
In China, the nutritional status of children has been improving greatly during 1992～1998. The standardized prevalence of underweight of children under 5 reduced 6.9 percentage points(ppt), from 19.3% (95% CI 19.8%～20.5%) to 12.4%(95%CI 11.9%～13.1%), annual reduction was 1.2 ppt. Reduction of of the prevalence of stunting was 17.1 ppt in the same period, from 39.1%(95%CI 39.5～40.1%) to 22.2% (95%CI 21.1%～22.9%), annual reduction was about 3 ppt(P273).
, 百拇医药
Comparison of the increment of height of children of various age groups in 1990～1995 with that in 1995～1998 shows marked linear growth increase of the age groups over 24 month. During 1990～1995, weight increase of age groups were remarkable, but the increment of height of the age groups were very small(P273) The proportion of stunted children among normal weight children was 31.3% in 1995, it dropped to 15% in 1998, such changes proved again the speedup of linear growth of children under 5 during 1995～1998 period and the un-matched height and weight growth has been made up in the later part of eight year time period.(P 273,Fig.5)
, 百拇医药
The jump of prevalence of Wt/Ht Z score>2 from 1.1% in 1990 to 12.6% in 1995 shown in the previous paper can be illustrate by the un-matched process of body development[6].
The apparent improvement of nutrition status of children under 5 in China is the outcome of the speedy socio-economic development. The analysis of the 1992 National Child Survey data ruled out the major attributable factors of stunting of rural children under 5, they are: safe drinking water, breastfeeding, two-week prevalence of diarrhea, education level of mother, income etc[7], and these factors were also identified in 1998 FNSS data. In fact, since 1990, these factors have been changed favorably, such as:
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(1)The two-week prevalence of diarrhea of rural children under 5 was 7.0%, and 4.2% for urban children in 1998, in 1990 it was 13.0% and 9.4% respectively.
(2)Safe drinking water rate in rural households in 1998 was 36% and was 16% in 1990.
(3)The exclusive breastfeeding of children aged 4-6 month was 29.5% in 1992 and 50.4% in 1998 in rural areas.
(4)The Rate of illiteracy in rural areas was 7.4% in 1998 and 22.5% in 1992, 58% of the mothers got more than 9-year education.
, 百拇医药
(5)Due to the rapid agriculture development, the dietary energy from animal food at the rural households increased from 6.2% to 8.8% during 1992～1998. It would certainly improve the quality of complementary food and the diet of children over 2 year of age and explains the catch-up of linear growth during 1995～1998.
(6)The income (Yuan/capita/year) was 3132 in 1998 and 990 in 1990.
In addition, Chinese Government has invested a great deal to social development in 1990s, and by cooperation with UN agencies, many national programs have been implemented, such as the Child Development Program for 1990s, National EPI Program, Water Resource Program, Poverty Alleviation Program, IDD Control Program, Maternal Child Health Program etc. All these favorable factors must have contributed to the nutrition well being of the children.
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The conclusion is the continuous reduction of underweight prevalence and dramatic drop of stunting prevalence in 1990s.was the consequence of the speedy socio-economic development of China since 1978.
4.2 The strategy for child nutrition improvement should focus on rural area and complementary feeding should be a key approach as important as breastfeeding to be stressed on
Even the nutrition status of children has improved in the last decade, the current prevalence of underweight and stunting in rural is still quite high in China. Data in 1998 showed the nutritional status of children aged under 2 is most critical for the development of the first five year of life. So, the recommendation is to take actions well-timed on children under 2 in rural area:
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(1)Exclusive breastfeeding at age under 4～6 month.Data from the questionnaire o f 1998 FNSS showed children breastfed exclusively under 4 month were 0.36kg heavier, and 1.2cm longer in length than the non-exclusive breastfed children; two-week diarrhea prevalence were 13.1 % and 29.0% respectively(P276).
(2)Availability and accessibility of complementary food with adequate nutrition value. Correlation analysis indicated the appearance of animal food and vegetable/fruit in complementary food was negatively correlated with the prevalence of underweight and stunting. To stunting, the Attributable Risk (AR) of vegetable/fruit was 41.2% (p=0.005) for children aged 6～12 month, 57.3% (p=0.10) for 12～18 month children, 48.5% (p=0.07) for children aged 18～24 month. The AR of eggs/meat/fish was 42.2% (p=0.003), 64.4% (p=0.0001), 61.2% (p=0.0001) for the respective age groups. The Odd Ratio of animal food non-existing complementary food to stunting was 1.73 to 2.81. Starchy food was commonly existing in complementary food, but has no correlation with the prevalence of stunting, the OR for children aged 12～18 month was 1.63 and 1.70 for children aged 18～24 month(P282). All the data proved the essential role played by animal food and vegetable/fruits in complementary food of children aged 4 to 24 month.
, 百拇医药
To guarantee the nutrition adequacy of children under 2 in rural China, actions on complementary feeding ought to be taken as a priority strategy parallel with exclusive breastfeeding in 4～6 month after birth. Base on our data, the estimate is that an increase of 10% coverage of animal food-containing complementary feeding, 2.6 ppt reduction of the prevalence of stunting of children aged 18～24 month could be achieved(P281).
4.3 Immediate set priority on approaches promoting consumption, production and processing of soybean
, 百拇医药
It is clearly shown above, even varied in purpose, promotion of soybean consumption is the common key issue for both urban and rural population to accomplish the goal of balanced diet and good nutrition. The recommends daily consumption of 40g of soybean which seems applicable. The Program for school children in 1997～1998 was highly welcome by the community because its effectiveness in health and school performance of the children involved in the Program, the amount of soymilk consumed was equivalent to 25g of soybean per day. Further expansion of e ducation to the general public and elderly, consumption of 40g of soybean could be accomplished. To achieve the goal, relevant enhancement of soybean industry and the policies stimulating the whole process of “agricultural production-processing-distribution-dinning tables” should be in place. Hopefully, a traditionally-based nutrition improvement in China could be achieved with the great role played by soybean.
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4.4 Nutrition problem of the poor should and could be resolved to consolidate the achievement of the National Poverty Alleviation Program
Among 1857 rural household in our sample, there were 2.5% (46 households) with i ncome lower than poverty line in 1997 (630 Yuan/capita/year), which were define d as poor households. In these households, daily energy intake of a Reference man was 1862kcal, equivalent to 78% of RDA. Comparing with data in 1995, the average d aily energy intake of Reference man of 719(4.15%) poor households which was 200 3 kcal and 83% RDA. even the prop ortion of poor household was reduced about one third between 1995 and 1997, but the poor in 1997 was experiencing worse nutrition situation, probably due to their worse living conditions. That indicated the Poverty Alleviation Program is getting into more difficult task while it has succeeded in alleviating 46 million people from poverty.
, 百拇医药
Even the average nutrition status of rural children enhanced remarkably, malnutrition in the sampled poor counties was still serious. The prevalence of underweight was 20%～40%, stunted was 30～60%, both were much higher than the average. Since malnourished children are not only vulnerable to infectious diseases and mental retardation, poor adults faced to higher risk of chronic disease such as stroke, hypertension, coronary heart disease, COPD[8]. Nutrition becomes critical in avoidance of the recurrence to poverty of the poverty-alleviated households, consequently, the economic development will be blocked and the community will run a vicious cycle.
, 百拇医药
To the poor area, further invest to nutrition at low cost to meet the goal of dietary adequacy is an issue of basic needs of people during economic development . It is an important issue with impact on the productivity of the current labor force and the potentials of mental and physical development of th e future labor force.So, it is an issue of the quality of manpower resources. It is the time now to put “invest on nutrition” on the agenda of further implementation of the Poverty Alleviation Program of the country.
, 百拇医药
The rural nutrition programs supported by UNICEF in 1990～1995 provided the evidences that active nutrition education at the grassroots level could mobilize the household initiatives in planning the home gardening,and stimulate good feedin g practice and care of children, etc. which really made a difference[9]. The investme nt was small and affordable, and the immediate outcome was visible and the long-term effectiveness is predictable.
5 References
, 百拇医药
1，Waterlow JC. Summary of cause and mechanisms of linear growth ret ardation. Eur J Clin Nutr, 1994,48(suppl 1): S210
2，van Dusseldorp M, Dagnelie PC. Diet and growth in young vege tarian, Feeding from Toddler to Adolescence,by Angel Ballabriga,Nestle Nutritio n Series, Vol.37,Philadelphia:Lippincott-Raven Publishers,1996,211—217
3，Marterell R, Khan LK, Schroeder DG. Reversibility of stunting; epidemiolo gucal findings in children from developing countries. Eur J Clin Nutr, 48(suppl 1):S45—57
4，Ge KY. The dietary and nutritional status of Ch inese, 百拇医药
单位：
关键词：
卫生研究000515文章编号：1000-8020(2000)05-0308-06Executive summary of food and nutrition surveillance
in 1998 and policy recommendation
Chinese Academy of Preventive Medicine, State Statistic Bureau of China, Working Group on Chinese
Food and Nutrition Surveillance
, 百拇医药
Written by
Chen Chunming
(Chinese Academy of Preventive medicine, Beijing 100050, China)
Based on the experiences of the pilot study in 1990 to 199 5, a National Food and Nutrition Surveillance System was established in 1997. U nder the collaboration of the Food and Nutrition Surveillance System(FNSS) Worki ng Group of the Chinese Academy of Preventive Medicine, the Urban Household Surv ey Team and the Rural Household Survey Team of the State Statistic Bureau of Chi na, the national surveillance network is formulated by stratified random samplin g. It consists 40 sites, 26 rural sites and 14 urban sites in 26 provinces.
, 百拇医药
In 1998, data on food consumption, anthropometric measurements of children under 6 were collected, basic information of households and feeding practice were recorded by questionnaire. In 1998 surveillance, 1857 rural households and 869 urban household were sampled and whole year food consumption of the households collected by Household Survey Teams was used. Height and weight of 16436 children under 6 were measured, around 400 sampled at each site. Hemoglobin of children in 9 sites was tested. Household salt samples were collected in all sites.
, http://www.100md.com
Following is the report on food and nutrition status in 1998.
1 Nutrition status of children
16436 children under 6 were sampled, number of children under 5 in urban is 4859, and 8862 in the rural sites. WHO/NCHS standard is used for evaluation.
1.1 Prevalence of underweight
The national average prevalence of underweight of children under 5 was 9.6%, 12.6% in the rural and 2.7% in the urban areas. The average prevalence of underweight of children at age 0～3 month was 0.2% and 0.8% for urban and rural respectively. But after 6 month, the prevalence of rural children went up rapidly, reached 9.3% at age of 6 month, the peak at 12 month was 17.9% and leveled off until 5 year of age, which was 12%～15%(P271).
, http://www.100md.com
The prevalence of underweight of urban children of all age group under 5 was between 1.2% to 3.5%(P271). But the prevalence of Z Score wt/ht>2 was 5.4%, w hich was higher than 3.9% in 1992(P273).
1.2 Prevalence of stunting
The national average prevalence of stunting of children under 5 was 16.7%, 22.6% for rural and 4.1% for urban. Comparing with the NCHS standard, the median of height of urban children aged 0～3 month had no difference, but the prevalence of rural children aged 0～3 month was 11.6% stunted. It went up to 23.7% at 12 month of age and peaked to 28.9% at 18 month. Then leveled off after 24 month of age to 20%～25%. In urban, peak of stunting was 5.2% at 18 month of age, then to 3 %～4% later on(P271).
, 百拇医药
Comparison of 1998 figure with that in 1990 and 1995 pilot surveillance showed the growth of children have been improving along with the rapid economic development in the country. The continuous reduction of prevalence of underweight demonstrated the immediate effect of economic progress, 42.5% reduction in urban and 21.2% in rural were achieved during 1990～1995. But prevalence of stunting was not improved in parallel, it reduced very little, almost no change during 1990～1995 and it exerted dramatic reduction during the period of 1995～1998. Such pattern of growth improvement illustrated that the favorable factors for weight catch-up was not adequate enough for parallel linear growth, which means more approaches should be considered.
, http://www.100md.com
Linear growth of child requires more animal food, especially for children aged 2～5. It has been proven that height during early childhood is highly correlated wi th mental development and health of their later life, hence the productivity and diseases of their adult life[1～3]. Nutrition as an essential component for economic development should be recognized, and consequent better developmen t in the future could be predicted if more concern is given to the nutrition of children under 5 in rural China where one fourth of them are stunted.
, http://www.100md.com
2 Food consumption and nutrition of urban residents
1875 rural household and 869 urban households were involved, food consumption records have been collected at these households under the supervision of the local reviewers of the State Statistic Bureau. Data of 1997 was transferred to the FNSS Working Group for further cleaning and analysis.
2.1 Food consumption
The household average consumption of foods in kg/capita/year were: cereals 126, vegetable 147, fruits 73, vegetable oil 9.9, pork 24, beef/lamb 4.4, poultry 9.4, fish 17, eggs 16, beans/bean products 5.7. Calculate to kg/reference man/year, the figures were 135, 158, 78, 10.6, 26, 4.7, 10, 18, 17, 6.2 respectively. The consumption of cereals and vegetables increased along with income increase, but the amount of cereals consumed in 1997 was 25kg less than the figure collected in 1992 Nationwide Nutritional Survey. Vegetable oil consumption was stable, the 25% lower income households consumed a little higher. Total animal food consumption was 75.9kg/capita/year. Compare with the amount in 1992, animal food was 12.5kg mo re consumed, poultry consumption was remarkably increased and no change of fish consumption, consumption of eggs was similar across the income groups. Pork consumption of the 10% lowest income households was 7kg less than the urban average, and their consumption of eggs, poultry and vegetables were much lower than the urban average(P291).
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2.2 Nutrition of the diet
The daily energy intake of urban household was 2419kcal/Reference man, which has been stable since 1992. Energy from fat was 28.6%, which was 28.4% in 1992 [4]. Daily protein intake of Reference man was 74.4g, the same as in 1992(75g), 37.6% of protein was animal protein, and protein from beans was only 4.4%. Energy from cereals dropped to 52.9% from 57.4% in 1992 and energy from animal food increased from 15.2% to 18.7%. The trend of dietary change since 1992 was increase of animal food along with reduction of cereal consumption, but before 1992, the dietary change was characterized with swift and continuous increase of vegetable oil.
, 百拇医药
Desirable Dietary Pattern (DDP)-China for 2000 was applied for evaluation of dietary pattern[5], the score for diet of urban households wa s 90, the dietary pattern was reasonable. But the score for cereals was 27 points compared with the desirable score 30, and score of animal food got penalty of 9.3 points which was 1.7 points higher than the penalty in 1995, and score for beans/bean products was far beyond desirable with 9.1 points deficit(P292). These indicated that the transitional changes and the hidden danger of the diet. The direction of accomplishing the goal of a balanced diet will be: maintain cereal consumption, keep animal food moderate and encourage bean consumption to replace part of animal food..
, http://www.100md.com
The continuous increase of animal food caused sharp increase of fat and cholesterol intake, and greater risk of obesity, diabetes and cardiovascular diseases appeared. Decrease of cereal consumption will accompany with lowered intake of dietary fiber, a component beneficial to health protection and chronic disease prevention. Additionally, animal food production is cereal consuming. Cereal consumed for pork production is more than double that of poultry meat production, excessive consumption of animal food, especially pork, will cause huge pressure to national overall grain production. Evidently, the current trend of food consumption pattern will be disadvantageous both to health and to the economic development, it calls for attention of policy-makers. Replacing partial meat consumption with beans and bean products can achieve the principles of the
, 百拇医药
3 Food consumption and nutrition of rural residents
3.1 Food consumption
Cereal consumption as raw grains was 267kg/capita/year, it was a 28kg increase per Reference man per year comparing with the cereal consumption in 1992. Vegetable consumption was 130kg/capita/year, which went up along with income increase, the amount consumed in 10% lowest income households was only 93kg. Fruit consumption was 21.4kg, almost doubled the amount in 1992, and the amount consumed in the 10% lowest income households was less than one fourth of the rural average. Vegetable oil consumption was 6.4kg, the same as in 1992, but the poorest 10% household consumed only half of the average. Meat consumption was 15.6kg consisting 12kg of pork which increased 3kg since 1992, the 10% poorest consumed 4kg less comparing with the average. Poultry consumption was 2.8kg, eggs 5.3kg, increased 1.9kg and 3.2kg respectively since 1992(P292). The overall food consumptio n has improved in the rural households.
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3.2 Nutrition of the diet
Daily energy intake reached 2471kcal/Reference man, it was 103% of RDA, it was 2294kcal and 95.4% of RDA in 1992. But in the 10% lowest income households, energy intake was 2020kcal and 84% of RDA. Protein intake was 71.6g, 7.3g higher than that in 1992. Energy from fat was 17.6% in average and 15.2% for the 10% poorest households. Energy contribution by cereals was 72% compared with 75.6% in 1992. Energy from animal food was 8.8%, 2.6% higher than in 1992. Consumption of beans and bean products was 6.5kg. Animal and bean origin protein was only 17.8% of total protein, which was even less than half of the desirable level (40%). DDP score of rural diet was 70.2 points, 20 points lower than the urban score.
, http://www.100md.com
So, quantitative and qualitative improvement of nutrition among rural residents should be focused on the increase of soybean and animal food consumption resulting the reduction of cereal energy contribution of about 65% of total energy intake. Immediate action on promoting vegetable and soybean intake will achieve in a more balanced diet and better protein and micronutrient nutrition at affordable cost.
4 Analysis on nutrition issues and related policy recommenda tions
, 百拇医药
4.1 The improvement of the nutritional status of children in China is the consequence of socio-economic development
In China, the nutritional status of children has been improving greatly during 1992～1998. The standardized prevalence of underweight of children under 5 reduced 6.9 percentage points(ppt), from 19.3% (95% CI 19.8%～20.5%) to 12.4%(95%CI 11.9%～13.1%), annual reduction was 1.2 ppt. Reduction of of the prevalence of stunting was 17.1 ppt in the same period, from 39.1%(95%CI 39.5～40.1%) to 22.2% (95%CI 21.1%～22.9%), annual reduction was about 3 ppt(P273).
, 百拇医药
Comparison of the increment of height of children of various age groups in 1990～1995 with that in 1995～1998 shows marked linear growth increase of the age groups over 24 month. During 1990～1995, weight increase of age groups were remarkable, but the increment of height of the age groups were very small(P273) The proportion of stunted children among normal weight children was 31.3% in 1995, it dropped to 15% in 1998, such changes proved again the speedup of linear growth of children under 5 during 1995～1998 period and the un-matched height and weight growth has been made up in the later part of eight year time period.(P 273,Fig.5)
, 百拇医药
The jump of prevalence of Wt/Ht Z score>2 from 1.1% in 1990 to 12.6% in 1995 shown in the previous paper can be illustrate by the un-matched process of body development[6].
The apparent improvement of nutrition status of children under 5 in China is the outcome of the speedy socio-economic development. The analysis of the 1992 National Child Survey data ruled out the major attributable factors of stunting of rural children under 5, they are: safe drinking water, breastfeeding, two-week prevalence of diarrhea, education level of mother, income etc[7], and these factors were also identified in 1998 FNSS data. In fact, since 1990, these factors have been changed favorably, such as:
, http://www.100md.com
(1)The two-week prevalence of diarrhea of rural children under 5 was 7.0%, and 4.2% for urban children in 1998, in 1990 it was 13.0% and 9.4% respectively.
(2)Safe drinking water rate in rural households in 1998 was 36% and was 16% in 1990.
(3)The exclusive breastfeeding of children aged 4-6 month was 29.5% in 1992 and 50.4% in 1998 in rural areas.
(4)The Rate of illiteracy in rural areas was 7.4% in 1998 and 22.5% in 1992, 58% of the mothers got more than 9-year education.
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(5)Due to the rapid agriculture development, the dietary energy from animal food at the rural households increased from 6.2% to 8.8% during 1992～1998. It would certainly improve the quality of complementary food and the diet of children over 2 year of age and explains the catch-up of linear growth during 1995～1998.
(6)The income (Yuan/capita/year) was 3132 in 1998 and 990 in 1990.
In addition, Chinese Government has invested a great deal to social development in 1990s, and by cooperation with UN agencies, many national programs have been implemented, such as the Child Development Program for 1990s, National EPI Program, Water Resource Program, Poverty Alleviation Program, IDD Control Program, Maternal Child Health Program etc. All these favorable factors must have contributed to the nutrition well being of the children.
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The conclusion is the continuous reduction of underweight prevalence and dramatic drop of stunting prevalence in 1990s.was the consequence of the speedy socio-economic development of China since 1978.
4.2 The strategy for child nutrition improvement should focus on rural area and complementary feeding should be a key approach as important as breastfeeding to be stressed on
Even the nutrition status of children has improved in the last decade, the current prevalence of underweight and stunting in rural is still quite high in China. Data in 1998 showed the nutritional status of children aged under 2 is most critical for the development of the first five year of life. So, the recommendation is to take actions well-timed on children under 2 in rural area:
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(1)Exclusive breastfeeding at age under 4～6 month.Data from the questionnaire o f 1998 FNSS showed children breastfed exclusively under 4 month were 0.36kg heavier, and 1.2cm longer in length than the non-exclusive breastfed children; two-week diarrhea prevalence were 13.1 % and 29.0% respectively(P276).
(2)Availability and accessibility of complementary food with adequate nutrition value. Correlation analysis indicated the appearance of animal food and vegetable/fruit in complementary food was negatively correlated with the prevalence of underweight and stunting. To stunting, the Attributable Risk (AR) of vegetable/fruit was 41.2% (p=0.005) for children aged 6～12 month, 57.3% (p=0.10) for 12～18 month children, 48.5% (p=0.07) for children aged 18～24 month. The AR of eggs/meat/fish was 42.2% (p=0.003), 64.4% (p=0.0001), 61.2% (p=0.0001) for the respective age groups. The Odd Ratio of animal food non-existing complementary food to stunting was 1.73 to 2.81. Starchy food was commonly existing in complementary food, but has no correlation with the prevalence of stunting, the OR for children aged 12～18 month was 1.63 and 1.70 for children aged 18～24 month(P282). All the data proved the essential role played by animal food and vegetable/fruits in complementary food of children aged 4 to 24 month.
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To guarantee the nutrition adequacy of children under 2 in rural China, actions on complementary feeding ought to be taken as a priority strategy parallel with exclusive breastfeeding in 4～6 month after birth. Base on our data, the estimate is that an increase of 10% coverage of animal food-containing complementary feeding, 2.6 ppt reduction of the prevalence of stunting of children aged 18～24 month could be achieved(P281).
4.3 Immediate set priority on approaches promoting consumption, production and processing of soybean
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It is clearly shown above, even varied in purpose, promotion of soybean consumption is the common key issue for both urban and rural population to accomplish the goal of balanced diet and good nutrition. The
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4.4 Nutrition problem of the poor should and could be resolved to consolidate the achievement of the National Poverty Alleviation Program
Among 1857 rural household in our sample, there were 2.5% (46 households) with i ncome lower than poverty line in 1997 (630 Yuan/capita/year), which were define d as poor households. In these households, daily energy intake of a Reference man was 1862kcal, equivalent to 78% of RDA. Comparing with data in 1995, the average d aily energy intake of Reference man of 719(4.15%) poor households which was 200 3 kcal and 83% RDA. even the prop ortion of poor household was reduced about one third between 1995 and 1997, but the poor in 1997 was experiencing worse nutrition situation, probably due to their worse living conditions. That indicated the Poverty Alleviation Program is getting into more difficult task while it has succeeded in alleviating 46 million people from poverty.
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Even the average nutrition status of rural children enhanced remarkably, malnutrition in the sampled poor counties was still serious. The prevalence of underweight was 20%～40%, stunted was 30～60%, both were much higher than the average. Since malnourished children are not only vulnerable to infectious diseases and mental retardation, poor adults faced to higher risk of chronic disease such as stroke, hypertension, coronary heart disease, COPD[8]. Nutrition becomes critical in avoidance of the recurrence to poverty of the poverty-alleviated households, consequently, the economic development will be blocked and the community will run a vicious cycle.
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To the poor area, further invest to nutrition at low cost to meet the goal of dietary adequacy is an issue of basic needs of people during economic development . It is an important issue with impact on the productivity of the current labor force and the potentials of mental and physical development of th e future labor force.So, it is an issue of the quality of manpower resources. It is the time now to put “invest on nutrition” on the agenda of further implementation of the Poverty Alleviation Program of the country.
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The rural nutrition programs supported by UNICEF in 1990～1995 provided the evidences that active nutrition education at the grassroots level could mobilize the household initiatives in planning the home gardening,and stimulate good feedin g practice and care of children, etc. which really made a difference[9]. The investme nt was small and affordable, and the immediate outcome was visible and the long-term effectiveness is predictable.
5 References
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1，Waterlow JC. Summary of cause and mechanisms of linear growth ret ardation. Eur J Clin Nutr, 1994,48(suppl 1): S210
2，van Dusseldorp M, Dagnelie PC. Diet and growth in young vege tarian, Feeding from Toddler to Adolescence,by Angel Ballabriga,Nestle Nutritio n Series, Vol.37,Philadelphia:Lippincott-Raven Publishers,1996,211—217
3，Marterell R, Khan LK, Schroeder DG. Reversibility of stunting; epidemiolo gucal findings in children from developing countries. Eur J Clin Nutr, 48(suppl 1):S45—57
4，Ge KY. The dietary and nutritional status of Ch inese, 百拇医药