Data Resource Profile: China National Nutrition Surveys

The China National Nutrition Surveys (CNNSs) are a series of nationally representative cross-sectional studies conducted by the Chinese Center for Disease Control and Prevention, to assess the health and nutrition status of children and adults in China. The routine national surveys started in 1959 (first) and were then conducted in 1982 (second), 1992 (third), 2002 (fourth), 2010–13 (fifth) and 2015–ongoing (sixth). The CNNS was originally initiated by the Chinese government 10 years after the founding of the People’s Republic of China, to investigate the nutritional status of the Chinese population undergoing food shortages. Thus, malnutrition evaluation was one key point of the CNNS 1959, as it also was in the second and third CNNSs. With the improvement of nutritional status and emergence of chronic diseases in China, the evaluation of chronic diseases was added from the fourth CNNS onwards. The CNNSs had provided important health information and played an important role in the prevention of nutritional disorders, especially nutrition deficiencies, in China. However, no electronic data were recorded and saved for the 1959 CNNS, other than a summary report. The CNNSs are a series of surveys focusing on nutrition and a variety of health measurements, including interviews and physical examinations. Each survey has included a randomly selected, nationally representative sample of residents living in mainland China. The 1982 and 1992 CNNSs were mainly focused on dietary intake and nutritional status, including interviews involving demographic, socioeconomic, dietary and health-related questions, physical examination for anthropometric and blood pressure measurements and laboratory tests for anaemia and other malnutrition indicators. In considering the rapid transition of dietary and disease patterns, from 2002 the nutrition survey also included interview questions regarding chronic disease-related factors and laboratory tests for diabetes and dyslipidaemia. In 2002, the survey was renamed as the 2002 China National Nutrition and Health Survey, to highlight the newly added health-related factors. In 2010, the survey became an ongoing continuous surveillance programme by conducting the survey in a subgroup sample each year and finishing a whole round of the national survey every 3–5 years. It was renamed again in 2010 as China National Nutrition and Health Surveillance (CNNHS). The fifth CNNS was conducted in 2010–13 as the CNNHS, and the sixth CNNS started in 2015 and is still ongoing. Currently, data are available for four national nutrition surveys: the China National Nutrition Survey 1982 (1982 CNNS), China National Nutrition Survey 1992 (1992 CNNS), China National Nutrition and Health Survey 2002 (2002 CNNHS) and Chinese National Nutrition and Health Surveillance 2010–2013 (2010–2013 CNNHS). All four were nationally representative cross-sectional surveys, without intentional overlap of the study participants. All samples were recruited using a stratified and multistage cluster random sampling method. The 1982 CNNS, 1992 CNNS and 2002 CNNHS were conducted in the autumn of the survey years, and the 2010–2013 CNNHS was conducted in the autumn of 2010, 2011, 2012 and 2013. The 1982 CNNS, 1992 CNNS, 2002 CNNHS and 2010–2013 CNNHS covered 27, 30, 31 and 31 provinces in China (including autonomous regions and centrally administered municipalities), respectively (Table 1). Sampling frame and sample size for the four national nutrition surveys 2010–2013 included two surveys without overlap of the samples: the 2010–2012 CNNHS for persons aged 6 years and above, and 2013 CNNHS for children aged 0–5 years and women who had children aged 0–2 years during the survey period. Sampling frame and sample size for the four national nutrition surveys 2010–2013 included two surveys without overlap of the samples: the 2010–2012 CNNHS for persons aged 6 years and above, and 2013 CNNHS for children aged 0–5 years and women who had children aged 0–2 years during the survey period. The samples for the surveys were selected to represent the Chinese population of all ages. To produce reliable statistics, the national nutrition surveys oversampled specific groups of people. In the 1982 CNNS, in order to develop the dietary recommendation levels for the Chinese population with different physical activity levels at all ages, each province further included participants from selected factories, institutes, schools and daycare centres with cafeterias. All national nutrition surveys collected identical data from household and dietary interviews and body measurements, as well as laboratory tests for anaemia (Table 2). CNNHS 2002 and 2010–2013 further included interview questions regarding health-related individual behaviours, self-reported physician diagnosis of chronic diseases, a community survey and laboratory tests for diabetes and dyslipidaemia (Table 2). The final sample of participants who had the different examinations is shown in Table 3. Summary of measures included in the China National Nutrition Surveys Physician diagnosis of hypertension, diabetes, dyslipidaemia and stroke, as well as family history of those diseases Detailed behaviours of smoking, drinking, physical activity and child feeding Physician diagnosis of hypertension, diabetes, dyslipidaemia and stroke, as well as family history of those diseases Detailed behaviours of smoking, drinking and physical activity 3 consecutive days of 24-h dietary recalls 3 consecutive days of weight records of all foods (Both methods for the same individual) 3 consecutive days of 24-h dietary recalls plus weight records of cooking oil, salt and condiments 1-year food frequency questionnaire (FFQ) (15+ years). (Both methods for the same individual) 3 consecutive days of 24-h dietary recalls plus weight records of cooking oil, salt and condiments for subgroup (30 of the 75 households in each study site) 1-year FFQ for another subgroup (25 of 75 households) Dietary records of instant and/or processed foods (20 of 75 households) (Overlap of samples for the three methods) Haemoglobin, plasma vitamin A, plasma vitamin D, ferritin, ferritin receptor, CRP, zinc, vitamin B12 Lactating women further measured plasma vitamin B12 and folic acid Physician diagnosis of hypertension, diabetes, dyslipidaemia and stroke, as well as family history of those diseases Detailed behaviours of smoking, drinking, physical activity and child feeding Physician diagnosis of hypertension, diabetes, dyslipidaemia and stroke, as well as family history of those diseases Detailed behaviours of smoking, drinking and physical activity 3 consecutive days of 24-h dietary recalls 3 consecutive days of weight records of all foods (Both methods for the same individual) 3 consecutive days of 24-h dietary recalls plus weight records of cooking oil, salt and condiments 1-year food frequency questionnaire (FFQ) (15+ years). (Both methods for the same individual) 3 consecutive days of 24-h dietary recalls plus weight records of cooking oil, salt and condiments for subgroup (30 of the 75 households in each study site) 1-year FFQ for another subgroup (25 of 75 households) Dietary records of instant and/or processed foods (20 of 75 households) (Overlap of samples for the three methods) Haemoglobin, plasma vitamin A, plasma vitamin D, ferritin, ferritin receptor, CRP, zinc, vitamin B12 Lactating women further measured plasma vitamin B12 and folic acid N-NN, microalbumin mg/l; OGTT, oral glucose tolerance test; FFQ, food frequency questionnaire; CRP, C-reactive protein. Summary of measures included in the China National Nutrition Surveys Physician diagnosis of hypertension, diabetes, dyslipidaemia and stroke, as well as family history of those diseases Detailed behaviours of smoking, drinking, physical activity and child feeding Physician diagnosis of hypertension, diabetes, dyslipidaemia and stroke, as well as family history of those diseases Detailed behaviours of smoking, drinking and physical activity 3 consecutive days of 24-h dietary recalls 3 consecutive days of weight records of all foods (Both methods for the same individual) 3 consecutive days of 24-h dietary recalls plus weight records of cooking oil, salt and condiments 1-year food frequency questionnaire (FFQ) (15+ years). (Both methods for the same individual) 3 consecutive days of 24-h dietary recalls plus weight records of cooking oil, salt and condiments for subgroup (30 of the 75 households in each study site) 1-year FFQ for another subgroup (25 of 75 households) Dietary records of instant and/or processed foods (20 of 75 households) (Overlap of samples for the three methods) Haemoglobin, plasma vitamin A, plasma vitamin D, ferritin, ferritin receptor, CRP, zinc, vitamin B12 Lactating women further measured plasma vitamin B12 and folic acid Physician diagnosis of hypertension, diabetes, dyslipidaemia and stroke, as well as family history of those diseases Detailed behaviours of smoking, drinking, physical activity and child feeding Physician diagnosis of hypertension, diabetes, dyslipidaemia and stroke, as well as family history of those diseases Detailed behaviours of smoking, drinking and physical activity 3 consecutive days of 24-h dietary recalls 3 consecutive days of weight records of all foods (Both methods for the same individual) 3 consecutive days of 24-h dietary recalls plus weight records of cooking oil, salt and condiments 1-year food frequency questionnaire (FFQ) (15+ years). (Both methods for the same individual) 3 consecutive days of 24-h dietary recalls plus weight records of cooking oil, salt and condiments for subgroup (30 of the 75 households in each study site) 1-year FFQ for another subgroup (25 of 75 households) Dietary records of instant and/or processed foods (20 of 75 households) (Overlap of samples for the three methods) Haemoglobin, plasma vitamin A, plasma vitamin D, ferritin, ferritin receptor, CRP, zinc, vitamin B12 Lactating women further measured plasma vitamin B12 and folic acid N-NN, microalbumin mg/l; OGTT, oral glucose tolerance test; FFQ, food frequency questionnaire; CRP, C-reactive protein. Study population with data for major measurements Study population with data for major measurements In the 1982 CNNS, in each study site, we randomly selected 50 households for weighted dietary surveys. The dietary survey included 5 days of food weight measurement. Investigators went to the participants’ homes for 5 days to weigh all consumed foods. All members of the selected family were invited to attend the physical examination (minimum of 100 subjects per study site). Among those subjects from the households that completed food weighing, half were randomly selected to provide blood samples for laboratory measurements (Table 2). The final sample sizes for the dietary survey, physical examination and haemoglobin measurements were 67 334, 47 102 and 15 945, respectively (Table 3). For the 1992 CNNS, we randomly selected 30 households per survey site for dietary surveys. Dietary intake for all family members in the selected households was collected using dietary recall for 3 days. Whole food consumed at home during the 3 dietary survey days in 1992 were also weighed. All family members of the 50 households in each study site were also invited to attend the physical examination and blood sample collection. In 1992, 91 175, 80 043 and 73 394 participants finished the dietary surveys, physical examination and haemoglobin measurements, respectively (Table 3). For CNNHS 2002, 90 households were randomly selected in each study site, and all family members of the selected households were invited for physical examination and sample collection for laboratory tests (Table 2). The sample size for physical examination was 209 849. Haemoglobin level was measured for 207 077 participants. The sample sizes for glucose and lipid measurements were 98 772 and 94 996, respectively (Table 3). Family members from one-third of the selected households participated in the 3-day dietary record survey plus recording of cooking oil, salt and condiment weights. Besides the participants from the randomly selected households, the 2002 CNNHS oversampled infants, children, pregnant women and lactating women at each study site. In 2002, 68 962 participants finished the 3 days of dietary records; among those participants who finished the dietary records, 55 211 aged 15 years or older were also interviewed for the 1-year food frequency questionnaire. The 2010–2013 CNNHS included two surveys: the 2010–2012 CNNHS for persons aged 6 years and above, and the 2013 CNNHS for children aged 0–5 years and women who had children aged 0–2 years during the survey period. In 2010–12, 75 households were selected at each study site (Table 1). Of those 75, family members in 30 households were selected to complete the 3-day dietary recall survey, 25 households were selected to complete a 1-year food frequency questionnaire and the remaining households undertook the dietary survey of instant and/or processed foods (Table 2). All family members aged 6 years or older were invited for the dietary surveys: 62 857 for dietary records and 78 497 for the 1-year food frequency questionnaire (Table 3). All participants were invited for the physical examination and blood sample collection. In 2010–12, there were 194 128 participants who completed physical examination, 157 214 had haemoglobin levels measured, 151 938 had glucose levels measured and 136 779 completed lipid measurements (Table 3). The 2013 CNNHS included 55 study sites. In each study site, the 2013 CNNHS sampled 630 children aged 0–5 years and 200 women with children aged 0–2 years. Data collected in the national nutrition surveys were used to assess nutritional status, its related risk factors and disease prevalence and determinants, which provided scientific support for the development of evidence-based public health policy and health promotion programmes and services in China. Findings from the national nutrition surveys were also applied to the development of national standards, such as obesity criteria for Chinese adults and children. The rich resources of the CNNSs have been used, and will continue to be used, for nutritional and epidemiological life science research.1–7 Based on data from the CNNSs, more than 100 papers and books have been published in Chinese and English in the fields of malnutrition, eating behaviours, nutritional epidemiology, public health and chronic diseases (Supplementary Table 1, available as Supplementary data at IJE online). The data have also contributed to research on the global burdens of undernutrition and overnutrition and worldwide nutritional surveillance of children and women. The work on nutrition status has provided an overall nutritional transition of Chinese children and adults: the energy contribution from carbohydrates decreased from 71% in 1982 to 66% in 1992, then further decreased to 59% in 2002 and 55% in 2010–12; meanwhile, the energy contribution from fat increased from 18% in 1982 to 22% in 1992, 30% in 2002 and 33% in 2010–12.8-11 The malnutrition work has shown a clear trend in the decreasing prevalence of stunting, thinness and underweight among children aged under 5 years and adults.8–11 At the same time, the prevalences of overweight, obesity, hypertension and diabetes have increased rapidly in China.1 However, awareness, treatment and control of hypertension and diabetes are still very low in China, which should call for the attention of both policy makers and public health workers, as well as the individuals affected.10,11 Based on data from the 2002 CNNHS, the fetal programming project indicated that being born during the China famine period in 1959–1961—representing severe in utero stress—was associated with an increased risk of hyperglycaemia, hypertension and metabolic syndrome in adulthood; these associations appear to be exacerbated by a nutritionally rich environment in later life.2,12,13 The CNNSs are a series of nutritional surveys conducted at the national level to obtain information on households, diet, body measurements, health-related individual behaviours, self-reported physician diagnoses of chronic diseases, community surveys and laboratory tests for anaemia, diabetes and dyslipidaemia of the Chinese population. The samples for the CNNSs were selected to represent the Chinese population of all ages. Limitations of the CNNS data include being non-representative of immigrant populations and having no follow-up data for incident chronic diseases and mortality. Open access to the CNNS data is not yet available. However, we welcome ideas and proposals for potential collaborations. Any enquiries should be sent to Dr Yuna He (heyn@ninh.chinacdc.cn). The China National Nutrition Surveys (CNNSs) are a series of nationally representative cross-sectional studies conducted by the Chinese Center for Disease Control and Prevention to assess the health and nutrition status of children and adults in China. The first CNNS began in 1959. Five national nutrition surveys (1959, 1982, 1992, 2002, 2010–13) have been finished and the sixth (2015–) is ongoing. The CNNS surveys avoid intentional overlap of the study participants. All samples have been recruited using a stratified and multistage cluster random sampling method. The 1982 CNNS, 1992 CNNS, 2002 CNNHS and 2010–2013 CNNHS covered 27, 30, 31 and 31 provinces in China and had about 238 134, 100 201, 247 464 and 232 719 participants, respectively. The CNNSs have collected identical data from households, dietary interviews and body measurements, as well as laboratory tests for anaemia. CNNHS 2002 and 2010–2013 also included interview questions regarding health-related individual behaviours, self-reported physician diagnosis of chronic diseases, community surveys and laboratory tests for diabetes and dyslipidaemia. Results have been published in printed versions. All data from the CNNSs are saved at the China National Institute of Nutrition and Health, Chinese Center for Disease Control and Prevention. Summary tables and detailed reports are published by the investigators following each survey, and hard copies can be purchased online or in store. Progress of the CNNS and the most recent reports are available in Chinese from the official website of the Chinese Center for Disease Control and Prevention [http://www.chinanutri.cn/]. The 1982 CNNS was supported by the Major Program of National Medical and Health Research. The Ministry of Health provided special funding support to the 1992 CNNS, which was organized by the Ministry of Health, Ministry of Agriculture, Ministry of Public Security and National Bureau of Statistics. The 2002 CNNHS was supported by the Ministry of Health, Ministry of Science and Technology, National Bureau of Statistics, (2001-DEA30035, 2003-DIA6N008), UNICEF, WHO, Unilever China and Danone Nutrition Institute China. CNNHS 2010–2013 was supported by the Special Fund for Health-Scientific Research in the Public Interest (No. 20120212) from the National Health and Family Planning Commission of the People’s Republic of China. The authors thank all the team members and all participants from all provinces working for the China National Nutrition Surveys. Conflict of interest: None declared.

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.