Kids Nutrition and Health Study in China

Dantong Wang

KNHS (the Kids Nutrition and Health Study) is a global research project focusing on the assessment of children’s dietary intakes and eating behaviors, including nutrient intakes, food patterns, and physical activities. China is one of the countries involved in the study. KNHS China is a collaboration between the China National Institute of Nutrition and Health (NINH; Beijing, China), the University of North Carolina (UNC; Chapel Hill, NC, USA), and the Nestlé Research Center (NRC; Lausanne, Switzerland). Data used in this study were from the 2011 China Health and Nutrition Survey (CHNS). 

In the 2011 CHNS, a multistage randomized cluster sampling method was used to recruit participants from 9 provinces and 3 mega cities (Beijing, Shanghai, and Chongqing) representing different geographies and economic development stages, with communities from both urban and rural areas. The KNHS China project focused on children 4–13 years old. In total, dietary intake data from 1,481 children in the age range were analyzed. In some publications, the age range was extended from 4–13 to 4–17 years (1,905 subjects) to provide information on a broader age spectrum. Individual dietary data were collected using 24-h recalls on 3 consecutive days (2 weekdays and 1 weekend day). For children younger than 12 years, the mother or a caregiver who handled food preparation and feeding in the household was interviewed. The interviews were conducted by trained field interviewers with the assistance of food models and pictures. Household edible oils, sugar, and salt consumption were determined on a daily basis by calculating the changes in the home food inventory by weighing [1]. Food recalls were coded and analyzed to calculate nutrient intakes using the Chinese Food Composition Tables published in 2009 [2]. 

We found that, compared to dietary intake recommendations, Chinese children had low intakes of micronutrients such as calcium and vitamin D. The intake of dietary fiber was low in 97% of children, whereas the intakes of saturated fat and sodium were excessive in 57 and 85% of children, respectively (Fig. 1). Geographic location and socioeconomic status have an impact on food quality and nutrient intakes. Children from urban areas and from higher-income households were more likely to have higher micronutrient intakes and consume more animal source foods, especially dairy products, than those from rural areas and from lower-income households [3]. We observed the double burden of malnutrition in Chinese children: the prevalence of overweight or obesity in children was higher in urban areas and higher-income families than in rural settings and those from lower-income households [4]. The disparity found in this study suggests that specific strategies are needed to improve diet quality and address nutrient shortfalls in different community types. 

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Fig. 1. Percent of Chinese children 4–13 years old with a nutrient intake below or above the recommendation.

We also reported that almost all children had 3 main meals, breakfast, lunch, and dinner, and over 70% of them reported having snacks, which contributed 10% of total daily energy. Children 9–13 years old consumed more salty snacks and less fruits and dairy products than children 4–8 years old did, which deserves attention [5]. Promoting healthy food choices in snacking could contribute to the improvement in nutritional quality of the total diet. 

In conclusion, the KNHS China results suggest that a comprehensive approach that includes nutrition education, nutrition intervention programs targeting vulnerable populations, and promotion of physical activity inside and outside of school is needed to improve the nutrition and health status of Chinese children.

References

  1. Zhang B, Zhai FY, Du SF, Popkin BM: The China Health and Nutrition Survey, 1989– 2011. Obes Rev 2014;15(suppl 1):2–7.
  2. Chinese Nutrition Society: Chinese Dietary Reference Intakes (Edition 2013) (in Chinese). Beijing, Science Press, 2014.
  3. Zhang J, Wang D, Eldridge AL, et al: Urban-rural disparities in energy intake and contribution of fat and animal source foods in Chinese children aged 4–17 years. Nutrients 2017;9:526.
  4. Piernas C, Wang D, Du S, et al: The double burden of under- and overnutrition and nutrient adequacy among Chinese preschool and school-aged children in 2009–2011. Eur J Clin Nutr 2015;69:1323–1329.
  5. Wang D, van der Horst K, Jacquier EF, et al: Snacking patterns in children: a comparison between Australia, China, Mexico, and the US. Nutrients 2018;10:198.