The American journal of clinical nutrition · 2026
Mapping transitions and inequalities in the burden of malnutrition among Chinese children and adolescents: a dual-level analysis of 6 nationwide surveys, 1995 to 2019.
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Cai Shan, Li Leah, Huang Tianyu, Liu Yunfei, Dang Jiajia, Li Jiaxin, Yang Ruolan, Chen Qiuyuan, Zhu Kaiheng, Yang Yang, Sun Ziyue, Hu Peijin, Dong Yanhui, Ma Jun, Sawyer Susan M, Song Yi
Аннотация
BACKGROUND: Previous studies have focused on double burden of malnutrition (DBM), involving overweight/obesity (OWOB) and undernutrition, primarily at individual or household levels.
OBJECTIVES: This study aimed to assess evolving patterns and inequalities in DBM and triple burden of malnutrition (TBM) across 1995-2019 at both individual and population levels among Chinese children and adolescents.
METHODS: Data were from the Chinese National Survey on Students' Constitution and Health, including 1,290,214 participants aged 7 to 18 y. OWOB, undernutrition, and anemia were assessed according to World Health Organization criteria. DBM and TBM were categorized into 4 patterns at both levels. Population-level DBM and TBM were defined as the coexistence of malnutrition forms within the same population rather than within individuals. Temporal trends were assessed using annual percent change (APC) estimated by Joinpoint regression for 1995 to 2010, 2010 to 2019, and 1995 to 2019.
RESULTS: During 1995 to 2010, OWOB increased, whereas undernutrition and anemia declined; during 2010 to 2019, OWOB rose rapidly, undernutrition continued to decline, and anemia plateaued. At the individual level, OWOB + undernutrition increased after 2010 [APC = 2.87%, 95% confidence interval (CI): 1.03%, 4.85%], and OWOB + anemia increased steadily across 1995 to 2019 (APC = 4.83%, 95% CI: 3.64%, 6.44%). At the population level, OWOB + undernutrition and OWOB + anemia increased more rapidly during 2010 to 2019 than during 1995 to 2010. Although the prevalence of individual-level TBM remained rare (<0.05%), the combined prevalence of TBM declined from 38.59% (1995) to 34.16% (2005), then increased to 39.91% (2019), with an APC of 1.11% (95% CI: 0.67%, 1.58%) during 2010 to 2019. OWOB-related DBM and TBM were more prevalent among younger and urban boys, whereas rural boys experienced steeper increases after 2010. Northeastern and western provinces bore the heaviest DBM and TBM, linked to lower socioeconomic development.
CONCLUSIONS: The post-2010 period marked a critical nutrition transition in China, characterized by rapidly rising OWOB + anemia at both levels and increasing population-level TBM. Reducing malnutrition burden requires nutrition-sensitive, equity-focused strategies that tackle undernutrition, OWOB, and micronutrient deficiency together.
OBJECTIVES: This study aimed to assess evolving patterns and inequalities in DBM and triple burden of malnutrition (TBM) across 1995-2019 at both individual and population levels among Chinese children and adolescents.
METHODS: Data were from the Chinese National Survey on Students' Constitution and Health, including 1,290,214 participants aged 7 to 18 y. OWOB, undernutrition, and anemia were assessed according to World Health Organization criteria. DBM and TBM were categorized into 4 patterns at both levels. Population-level DBM and TBM were defined as the coexistence of malnutrition forms within the same population rather than within individuals. Temporal trends were assessed using annual percent change (APC) estimated by Joinpoint regression for 1995 to 2010, 2010 to 2019, and 1995 to 2019.
RESULTS: During 1995 to 2010, OWOB increased, whereas undernutrition and anemia declined; during 2010 to 2019, OWOB rose rapidly, undernutrition continued to decline, and anemia plateaued. At the individual level, OWOB + undernutrition increased after 2010 [APC = 2.87%, 95% confidence interval (CI): 1.03%, 4.85%], and OWOB + anemia increased steadily across 1995 to 2019 (APC = 4.83%, 95% CI: 3.64%, 6.44%). At the population level, OWOB + undernutrition and OWOB + anemia increased more rapidly during 2010 to 2019 than during 1995 to 2010. Although the prevalence of individual-level TBM remained rare (<0.05%), the combined prevalence of TBM declined from 38.59% (1995) to 34.16% (2005), then increased to 39.91% (2019), with an APC of 1.11% (95% CI: 0.67%, 1.58%) during 2010 to 2019. OWOB-related DBM and TBM were more prevalent among younger and urban boys, whereas rural boys experienced steeper increases after 2010. Northeastern and western provinces bore the heaviest DBM and TBM, linked to lower socioeconomic development.
CONCLUSIONS: The post-2010 period marked a critical nutrition transition in China, characterized by rapidly rising OWOB + anemia at both levels and increasing population-level TBM. Reducing malnutrition burden requires nutrition-sensitive, equity-focused strategies that tackle undernutrition, OWOB, and micronutrient deficiency together.