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. 2019 Jul;7(7):540-548.
doi: 10.1016/S2213-8587(19)30152-4. Epub 2019 May 10.

The dietary transition and its association with cardiometabolic mortality among Chinese adults, 1982-2012: a cross-sectional population-based study

Yuna He  1 , Yanping Li  2 , Xiaoguang Yang  1 , Elena C Hemler  2 , Yuehui Fang  1 , Liyun Zhao  1 , Jian Zhang  1 , Zhenyu Yang  1 , Zhu Wang  1 , Li He  1 , Jing Sun  1 , Dong D Wang  2 , Jingzhong Wang  1 , Jianhua Piao  1 , Xiaofeng Liang  3 , Gangqiang Ding  4 , Frank B Hu  5
Affiliations

The dietary transition and its association with cardiometabolic mortality among Chinese adults, 1982-2012: a cross-sectional population-based study

Yuna He et al. Lancet Diabetes Endocrinol. 2019 Jul.

Abstract

Background: Few studies have used nationally representative data to describe dietary trends and the related cardiometabolic mortality burden in China. Thus, we aimed to characterise the trends in disease-related dietary factors as well as their associated disease burden among Chinese adults from 1982 to 2012.

Methods: For this cross-sectional population-based study, we analysed a nationally representative sample of 204 802 adults aged 20 years or older, using data from the 1982, 1992, 2002, and 2010-12 China National Nutrition Surveys (CNNS). We did a comparative risk assessment, in which the effects of suboptimal intakes of 12 dietary factors, individually and collectively, on cardiometabolic mortality were estimated by calculating the population attributable fraction (PAF) to estimate the proportional reduction in cardiometabolic deaths that would occur if exposure to each dietary risk factor was reduced to an alternative optimal level.

Findings: The overall PAF of mortality from cardiovascular disease and type 2 diabetes that was associated with suboptimal dietary quality was 62·2% in 1982, 57·9% in 1992, 56·2% in 2002, and 51·0% in 2010-12, which accounted for 21·6% of total mortality in China in 1982, 16·6% in 1992, 17·6% in 2002, and 20·8% in 2010-12. The estimated number of cardiometabolic deaths associated with suboptimal dietary intakes was 1·07 million in 1982, 0·93 million in 1992, 1·18 million in 2002, and 1·51 million in 2010-12. Of all 12 dietary factors examined, high sodium intake (17·3%), low fruit consumption (11·5%), and low marine omega-3 fatty acids (9·7%) were associated with the largest numbers of estimated cardiometabolic deaths in 2010-12.

Interpretation: We observed an improvement in several dietary factors in China in the past few decades. However, current intakes of these dietary factors remain suboptimal. Poor diet quality is estimated to be associated with a substantial proportion of deaths from heart disease, stroke, and type 2 diabetes in China.

Funding: Ministry of Health, China, and Ministry of Science and Technology, China.

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Conflict of interest statement

Declaration of Conflict Interest

Dr. Hu reported receiving research support from the California Walnut Commission and honoraria for lectures from Metagenics and Standard Process and honoraria from Diet Quality Photo Navigation, outside the submitted work. Dr. Li reported receiving research support from the California Walnut Commission.

Figures

Figure 1:
Figure 1:. Proportion of Chinese adults meeting (A) or exceeding (B) Chinese National dietary recommendations* in the China National Nutrition Surveys 1982–2012
*Standards according to Chinese national dietary recommendations: Whole grain and dry bean: ≥20g/1000kcal; Total vegetable : ≥180g/1000kcal; Soybean: ≥ 10g/1000kcal; Dark color vegetable: ≥90g/1000kcal; Fish and seafoods: ≥25g/1000kcal; Fruit: ≥110g/1000kcal; Dairy products: ≥100g/1000kcal; Saturated fatty acid: <10%E; Refined grain:≤100g/1000kcal; Meat: ≤25g/1000kcal; Sodium: ≤1g/1000kcal
Figure 2
Figure 2
Absolute and proportional cardiometabolic disease mortality associated with suboptimal dietary intake of individual foods and nutrients among Chinese adults 1982–2012
Figure 3
Figure 3
Absolute and proportional cardiometabolic disease mortality associated with overall suboptimal dietary habits among Chinese adults 1982–2012
Figure 4
Figure 4
Prevalence of overweight/obesity and hypertension and the associated cardiometabolic mortality burden in the Chinese population 1982–2012
See this image and copyright information in PMC

Comment in

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