Proper intake of energy and macronutrients (including protein, fat, and carbohydrate) are vital factors for human nutrition and health, especially among children aged 6–11 years old. The fact that unhealthy diet is associated with non-communicable diseases (NCDs) and worsened quality of life has been recognized worldwide (1). Childhood is the key stage of growth over the whole lifetime and has higher nutrition requirements. Malnutrition consists of undernutrition and overnutrition. The latest data from the World Health Organization (WHO) showed that the prevalence of obesity among children and adolescents were 11.7%, and about 21.3% of children under the age of 5 were stunted (2). In 2010, the prevalence of malnutrition, including stunting, mild wasting, and moderate severe wasting in children aged 7–12 years were 13.29% and 12.55%, respectively (3). This study aimed to reveal the status of energy and macronutrient intake among children aged 6–11 years old in China using data from the China Nutrition and Health Surveillance conducted between 2016 and 2017.
Compared with Chinese Nutrition and Health Survey in 2002, a declining trend of the average energy intake was observed in 2010–2012, while the average fat intake was slightly increased with a narrowing gap between urban and rural areas. Carbohydrate intake decreased, and protein intake largely remained the same (4). No previous nationwide report about the intakes of energy and macronutrients among 6–11 years old children in China was published, and the intake levels of energy and macronutrients evaluated by dietary reference intakes (DRIs), including estimated average requirement (EAR) and recommended nutrient intake (RNI), were also rarely reported in this age group.
Data were obtained from the China Nutrition and Health Surveillance of Children and Lactating Mothers in 2016–2017. This study was a cross-sectional study, conducted in 31 provincial-level administrative divisions (PLADs). The survey used multistage stratified random sampling method and was nationally and provincially representative. The method of data collection included four parts: interviews to collect demographic information; physical examination to observe the indices of growth; laboratory tests to evaluate the health and dietary status among interviewees; and inquiring into the energy and nutritional intake. The information on energy and macronutrient intakes were drawn and assessed by 3 consecutive days of 24 h dietary recalls and weight records of edible oil, salt, and flavoring (5). The calculation of the energy was conducted by referring to China Food Composition (6-7). The protein intake of participants was evaluated using the criteria of EAR and RNI, and then were divided into <EAR, EAR–RNI, and ≥RNI groups (8). Study populations were allocated into different groups by sex and regions. SAS 9.4 (SAS Institute Inc., Cary, NC, USA) was used to conduct all the analyses. The protocol of this study was evaluated and approved by the ethical committee China CDC (201614).
A total of 8,777 subjects were included for this report, including 4,145 in urban areas and 4,632 in rural areas. The number of males was 4,364, including 2,034 in urban areas and 2,330 in rural areas; the number of females was 4,413, including 2,111 in urban areas and 2,302 in rural areas.
Table 1 presented the data on energy and macronutrient intakes of two regions of the two sexes. The average intake of energy was 1,591.7±560.0 kcal/d, and the average intakes of protein, fat, and carbohydrate were 50.0±20.8 g/d, 69.6±37.5 g/d, and 196.3±81.6 g/d, respectively. All the intake of energy and macronutrients in urban area was higher than in rural area. Overall, the average protein intake in urban areas was approximately 10.0 g/d higher than in rural areas, and similar results were observed when grouped by regions and sexes. Although the carbohydrate intakes were higher in males than in females, which was similar to the results based on region.
Gender Energy & macronutrients Total Urban Rural Male Energy (kcal/d) 1,624.1±567.7 1,672.3±555.2 1,581.9±575.1 Protein (g/d) 50.9±21.2 56.2±21.9 46.3±19.3 Fat (g/d) 71.4±38.1 73.8±36.7 69.4±39.2 Carbohydrate (g/d) 199.5±82.3 201.2±81.2 198±83.3 Female Energy (kcal/d) 1,559.7±550.6 1,600.5±540.9 1,522.2±556.7 Protein (g/d) 49.1±20.4 54.1±21.9 44.5±17.7 Fat (g/d) 67.8±36.8 69.3±34.8 66.4±38.5 Carbohydrate (g/d) 193.2±80.8 195.2±81.1 191.4±80.5 Both Energy (kcal/d) 1,591.7±560.0 1,635.8±549.1 1,552.2±566.8 Protein (g/d) 50.0±20.8 55.2±21.9 45.4±18.6 Fat (g/d) 69.6±37.5 71.5±35.8 67.9±38.9 Carbohydrate (g/d) 196.3±81.6 198.2±81.2 194.7±82.0
Table 1. Energy and macronutrient intake among children aged 6–11 years old in China, 2016–2017.
The results of evaluating protein intake based on the value of EAR and RNI were illustrated in Table 2. Generally, the proportion of children whose protein intake were below the EAR criteria was about 19.5% in urban areas and more than 33.9% in rural areas. Protein intake of more than half of the total children were over the EAR criterion. Similar trends were observed in protein intake evaluated by RNI in the overall group of children aged 6–11 years old. All the proportions of protein intake that were below EAR in urban male and female groups remained around 20% and were higher in rural groups.
Gender DRIs Total (%) Urban (%) Rural (%) Male <EAR 26.9 19.8 33.2 EAR–RNI 19.6 16.3 22.6 ≥RNI 53.4 64.0 44.3 Female <EAR 27.3 19.1 34.7 EAR–RNI 21.4 18.7 23.8 ≥RNI 51.4 62.2 41.5 Both <EAR 27.1 19.5 33.9 EAR–RNI 20.5 17.5 23.2 ≥RNI 52.4 63.0 42.9 Abbreviations: DRTs=dietary reference intakes; EAR=estimated average requirement; RNI=recommended nutrient intake.
Table 2. Distributions of protein intakes among children aged 6–11 years old in China 2016–2017.