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. 2016 Apr 28;19(15):2708–2711. doi: 10.1017/S1368980016000963

Changes in the nutritional status of children and adolescents in Shandong, China

Ying-Xiu Zhang 1,*
PMCID: PMC10271074  PMID: 27121096

Abstract

Objective

Nutritional status during childhood plays an important role in the human life cycle. The present study examined the prevalence trends in different grades of nutritional status (thinness, normal weight, overweight and obesity) among children and adolescents in Shandong, China.

Design

Data for the study were obtained from six cross-sectional surveys of schoolchildren carried out in 1985, 1995, 2000, 2005, 2010 and 2014. Height and weight of all children were measured; BMI was calculated from their height and weight. International BMI cut-offs were used to define thinness, overweight and obesity.

Setting

Shandong Province, China.

Subjects

A total of 56 045 students aged 7–18 years were included in the current analysis.

Results

In the past 29 years, the prevalence of thinness decreased from 18·22 % and 23·45 % in 1985 to 7·18 % and 9·49 % in 2014 for boys and girls, respectively. Conversely, the prevalence of combined overweight and obesity increased from 1·79 % and 1·66 % in 1985 to 31·12 % and 20·11 % in 2014 for boys and girls, respectively.

Conclusions

The nutritional profile of Shandong children and adolescents had an obvious change over the past 29 years. Special attention should be paid to controlling the rapid rise of childhood overweight and obesity.

Keywords: Thinness, Overweight, Obesity, Prevalence, Child and adolescent


Nutritional status during childhood plays an important role in the human life cycle. The importance of child growth as an indicator for tracking the nutritional and health status of populations is well recognized( 1 ). Obesity and thinness are two of the most common nutritional disorders and both are associated with health consequences. Childhood obesity increases the risk of obesity in adulthood and is associated with CVD risk factors such as hypertension, diabetes and dyslipidaemia( 2 4 ). Thinness can also result in problems such as osteoporosis, pubertal delay, menstrual irregularity, increased susceptibility to infections, hypothermia, thinning hair and premature mortality( 5 , 6 ).

The worldwide prevalence of childhood overweight and obesity has increased dramatically during the past decades, both in developing and developed countries( 7 9 ). Recent reports indicate that the increase in childhood obesity is much more rapid in developing countries than in developed countries( 10 ). As a populous country, China has now joined the worldwide epidemic of obesity owing to its rapid economic growth and urbanization( 11 , 12 ). In the present paper, based on provincial data in 1985, 1995, 2000, 2005, 2010 and 2014, we report the prevalence trends in different grades of nutritional status (thinness, normal weight, overweight and obesity) among children and adolescents in Shandong, China.

Participants and methods

The study was approved by the Ethical Committee of the Shandong Center for Disease Control and Prevention, Shandong, China.

Study population

Data for the present study were obtained from six national surveys on students’ constitution and health carried out by the government in 1985, 1995, 2000, 2005, 2010 and 2014 in Shandong Province, China. A total of 56 045 students in Shandong Province of Han nationality, aged 7–18 years, were included in the current analysis (14 458 in 1985, 7198 in 1995, 8498 in 2000, 8568 in 2005, 7577 in 2010 and 9746 in 2014). The sample size of age groups in each survey is given in Table 1. The sampling method was stratified multistage sampling based on economic status, drawn from Jinan (the capital and the political, economic and cultural centre of Shandong Province), Yantai (an eastern coastal and developed city) and Jining (a western inland developing city) as survey areas, and using randomly selected primary and secondary schools; the sample proportions in these three areas in each survey were equal. Six public schools (two primary schools, two junior high schools and two senior high schools) from each of the three districts in Shandong were randomly selected and invited to participate in the study. From the selected schools, two classes in each grade were selected and all students of the selected classes were invited to join the study. Most importantly, the schools from which the students were sampled were selected by a leading group in Shandong Province and in general have not allowed change since 1985, and the method and quality control of measurements in the six surveys were the same( 13 ).

Table 1.

The sample size in each survey of children and adolescents (n 56 045) aged 7–18 years, Shandong Province, China, 1985–2014

Boys Girls
Age/years 1985 1995 2000 2005 2010 2014 1985 1995 2000 2005 2010 2014
7 612 300 318 344 316 419 612 300 357 343 302 427
8 612 300 361 371 318 406 612 300 364 362 323 381
9 612 300 331 357 305 422 612 300 334 359 315 412
10 612 300 395 377 320 413 612 300 376 388 325 405
11 612 300 376 354 301 416 612 299 379 366 317 407
12 611 300 337 362 340 397 612 300 326 343 303 386
13 611 300 363 355 305 410 612 300 361 365 308 411
14 612 300 325 350 305 398 612 300 323 324 320 388
15 612 300 368 363 314 420 612 300 370 340 328 401
16 612 300 372 371 306 423 612 300 353 359 305 415
17 612 300 363 386 310 412 612 300 324 352 306 403
18 612 300 358 343 343 396 384 299 364 334 342 378
Total 7342 3600 4267 4333 3783 4932 7116 3598 4231 4235 3794 4814

Anthropometric measurements and definitions

All measurements were performed by well-trained health professionals in each of the three districts using the same type of apparatus and following the same procedures( 13 ). Each professional is required to pass a training course for anthropometric measurement organized by the investigation team in Shandong. Height without shoes was measured using metal column height-measuring stands to the nearest 0·1 cm. Weight was measured using lever scales to the nearest 0·1 kg while the students wore light clothes. BMI was calculated from their height and weight (kg/m2). The BMI cut-off points recommended by the International Obesity Task Force were used to define overweight and obesity( 14 ). Thinness was also defined by the international BMI cut-offs( 15 ).

Statistical analyses

The prevalence of thinness, overweight and obesity in different survey years was determined. The χ 2 test was used to show significant differences between different years. All analyses were performed with the statistical software package SPSS version 11.5. Significance was defined at the 0·05 level.

Results

The prevalence of thinness, overweight and obesity among children and adolescents aged 7–18 years old in different years is shown in Table 2. A decreasing trend was observed in the prevalence of thinness, from 18·22 % and 23·45 % in 1985 to 7·18 % and 9·49 % in 2014 for boys and girls, respectively (P<0·01). This represents a decrease of 11·04 % in boys and 13·96 % in girls. On the contrary, an increasing trend was observed in the prevalence of overweight and obesity. The prevalence of combined overweight and obesity increased from 1·79 % and 1·66 % in 1985 to 31·12 % and 20·11 % in 2014 for boys and girls, respectively (P<0·01). This represents an increase of 29·32 % in boys and 18·45 % in girls. During the 29-year period, the nutritional profile of children and adolescents had an obvious change (Fig. 1). A decreasing trend was observed in the proportion of normal weight, from 79·98 % and 74·89 % in 1985 to 61·70 % and 70·40 % in 2014 for boys and girls, respectively. This represents a decrease of 18·28 % in boys and 4·49 % in girls.

Table 2.

Prevalence of thinness, overweight and obesity, according to gender, among children and adolescents (n 56 045) aged 7–18 years, Shandong Province, China, 1985–2014

Thinness Overweight Obesity
Gender Year n % 95 % CI % 95 % CI % 95 % CI
Boys 1985 7342 18·22 17·34, 19·10 1·74 1·44, 2·04 0·05 0·00, 0·10
1995 3600 15·19 14·02, 16·36 6·50 5·69, 7·31 1·64 1·23, 2·05
2000 4267 11·13 10·19, 12·07 14·41 13·36, 15·46 5·41 4·73, 6·09
2005 4333 10·85 9·92, 11·78 15·79 14·70, 16·88 5·42 4·75, 6·09
2010 3783 9·25 8·33, 10·17 19·06 17·81, 20·31 9·33 8·40, 10·26
2014 4932 7·18 6·46, 7·90 20·76 19·63, 21·89 10·36 9·51, 11·21
χ 2 = 425·98, P = 0·0000 χ 2 = 1448·30, P = 0·0000 χ 2 = 926·70, P = 0·0000
Girls 1985 7116 23·45 22·47, 24·43 1·62 1·33, 1·91 0·04 0·00, 0·09
1995 3598 21·12 19·79, 22·45 4·28 3·62, 4·94 0·53 0·29, 0·77
2000 4231 16·17 15·06, 17·28 9·00 8·14, 9·86 2·25 1·80, 2·70
2005 4235 17·02 15·89, 18·15 9·66 8·77, 10·55 1·96 1·54, 2·38
2010 3794 16·00 14·83, 17·17 13·42 12·34, 14·50 2·42 1·93, 2·91
2014 4814 9·49 8·66, 10·32 15·77 14·74, 16·80 4·34 3·76, 4·92
χ 2 = 430·26, P = 0·0000 χ 2 = 982·00, P = 0·0000 χ 2 = 346·43, P = 0·0000

Fig. 1.

Fig. 1

Changes in nutritional status (Inline graphic, normal weight; Inline graphic, thinness; Inline graphic, overweight and obesity) of children and adolescents (n 56 045) aged 7–18 years, Shandong Province, China, 1985–2014: (a) boys, 1985; (b) boys, 2014; (c) girls, 1985; (d) girls, 2014

Discussion

During the past decades, China has experienced rapid socio-economic and nutritional transitions, which have led to a more obesogenic environment (e.g. increase in energy intake and decrease in physical activity)( 16 ). The traditional Chinese diet is shifting towards a diet with high fat, high energy density and low dietary fibre( 17 , 18 ). To the best of our knowledge, the present study is the first examining the shifts in nutritional profile among children and adolescents in Shandong, China, spanning 29 years and using internationally agreed standards. Our results show a rapid increase of overweight and obesity and a decrease of thinness in both boys and girls between 1985 and 2014.

The increasing prevalence of childhood obesity constitutes a serious public health problem in both developed and developing countries. In Shandong Province, the prevalence of obesity was only 0·05 % and 0·04 % for boys and girls, and the prevalence of overweight was less than 2 % in 1985, indicating no obesity epidemic at that time. However, the prevalence rates of obesity plus overweight had reached 31·12 % for boys and 20·11 % for girls in 2014, indicating that childhood overweight and obesity has entered the extensively epidemic stage in this region at present. The reasons include mainly high-energy diet and lifestyle change from being active to sedentary( 9 ). Comprehensive strategies of intervention should include periodic monitoring and education on nutrition, physical exercise and healthy dietary behaviour( 11 ).

The current study examined the shifts in nutritional profile among children and adolescents in Shandong, China spanning 29 years. However, two limitations are noted. First, data for the study were acquired from six independent cross-sectional surveys spanning 29 years rather than from a longitudinal cohort study, thus preventing further assessment of cohort and time effects. Second, the absence of detailed information concerning living environments, dietary patterns and physical activity at the individual level also limited our study.

Acknowledgements

Acknowledgements: The author thanks all of the team members and all participants. Special thanks are extended to Mr B. Yu for providing access to the survey data. Financial support: This study was supported by the Medical and Health Program of Shandong, China (2014WS0376). The surveys on students’ constitution and health were conducted under the auspices of the Department of Education in Shandong Province, China. The funders had no role in the design, analysis or writing of this article. Conflict of interest: None. Authorship: Y.-X.Z. is the sole author. Ethics of human subject participation: The study was approved by the Ethical Committee of the Shandong Center for Disease Control and Prevention, Shandong, China.

References

  • 1. de Onis M, Blössner M, Borghi E et al. (2004) Methodology for estimating regional and global trends of child malnutrition. Int J Epidemiol 33, 1260–1270. [DOI] [PubMed] [Google Scholar]
  • 2. Geiss HC, Parhofer KG & Schwandt P (2001) Parameters of childhood obesity and their relationship to cardiovascular risk factors in healthy prepubescent children. Int J Obes Relat Metab Disord 25, 830–837. [DOI] [PubMed] [Google Scholar]
  • 3. Franks PW, Hanson RL, Knowler WC et al. (2010) Childhood obesity, other cardiovascular risk factors, and premature death. N Engl J Med 362, 485–493. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4. Herouvi D, Karanasios E, Karayianni C et al. (2013) Cardiovascular disease in childhood: the role of obesity. Eur J Pediatr 172, 721–732. [DOI] [PubMed] [Google Scholar]
  • 5. Takimoto H, Yoshiike N, Kaneda F et al. (2004) Thinness among young Japanese women. Am J Public Health 94, 9–16. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6. Misra M, Aggarwal A, Miller KK et al. (2004) Effects of anorexia nervosa on clinical, hematologic, biochemical, and bone density parameters in community-dwelling adolescent girls. Pediatrics 114, 1574–1583. [DOI] [PubMed] [Google Scholar]
  • 7. Lobstein T, Baur L & Uauy R (2004) Obesity in children and young people: a crisis in public health. Obes Rev 5, 4–85. [DOI] [PubMed] [Google Scholar]
  • 8. Wang Y & Lobstein T (2006) Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes 1, 11–25. [DOI] [PubMed] [Google Scholar]
  • 9. Karnik S & Kanekar A (2012) Childhood obesity: a global public health crisis. Int J Prev Med 3, 1–7. [PMC free article] [PubMed] [Google Scholar]
  • 10. de Onis M, Blössner M & Borghi E (2010) Global prevalence and trends of overweight and obesity among preschool children. Am J Clin Nutr 92, 1257–1264. [DOI] [PubMed] [Google Scholar]
  • 11. Ji CY & Cheng TO (2009) Epidemic increase in overweight and obesity in Chinese children from 1985 to 2005. Int J Cardiol 132, 1–10. [DOI] [PubMed] [Google Scholar]
  • 12. Cheng TO (2014) China’s epidemic of child obesity: an ounce of prevention is better than a pound of treatment. Int J Cardiol 172, 1–7. [DOI] [PubMed] [Google Scholar]
  • 13. Research Section of the Constitution and Health of Chinese Students (2012) Report on the Physical Fitness and Health Research of Chinese School Students, pp. 21–50. Beijing: Higher Education Press; (in Chinese). [Google Scholar]
  • 14. Cole TJ, Bellizzi MC, Flegal KM et al. (2000) Establishing a standard definition for child overweight and obesity worldwide: international study. BMJ 320, 1240–1243. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15. Cole TJ, Flegal KM, Nicholls D et al. (2007) Body mass index cut offs to define thinness in children and adolescents: international survey. BMJ 335, 194–197. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16. Washington RL (2006) Evidence-based medicine and the obesogenic environment. J Pediatr 149, 5–6. [DOI] [PubMed] [Google Scholar]
  • 17. Shang X, Li Y, Liu A et al. (2012) Dietary pattern and its association with the prevalence of obesity and related cardiometabolic risk factors among Chinese children. PLoS One 7, e43183. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18. Du S, Mroz TA, Zhai F et al. (2004) Rapid income growth adversely affects diet quality in China – particularly for the poor! Soc Sci Med 59, 1505–1515. [DOI] [PubMed] [Google Scholar]

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