Preplanned Studies: Frequency of Food Consumption Among Students Aged 8–15 Years — China, 2019 and 2021

Diverse dietary intakes featuring a balanced combination of various food groups are essential due to the unique nutritional characteristics of different foods. This study’s findings indicate that in 2021, the frequency of daily consumption of meat, eggs, milk, legumes, and fruits in rural areas of central and western regions significantly increased compared to 2019, yet remained relatively low (1). Urban students, in contrast to their rural counterparts, exhibited higher weekly frequencies of meat, egg, milk, and fruit consumption in 2021.

Previous research has suggested that inadequate consumption frequency of various food categories may be associated with lower economic levels, limited access to healthy foods, and insufficient nutritional knowledge among students and parents in remote rural areas (6-7). This study contributes to the understanding of the two-year changes in consumption frequencies for diverse food groups among Chinese students and offers valuable insights to inform the development of policies and strategies aimed at controlling and preventing malnutrition.

Adequate consumption of foods rich in high-quality protein is a crucial strategy for addressing child malnutrition (8). The dietary guidelines for Chinese school-aged children advise moderate consumption of fish, poultry, and lean meat, one egg, and 300 g of milk daily, as well as legumes 4–7 times per week to ensure sufficient protein intake (1). Nonetheless, our study in 2021 found that only 36.5%, 24.0%, 30.1%, and 10.6% of rural students consumed meat, eggs, milk, and legumes once a day or more, respectively. A similar study conducted between 2015 and 2016 involving 2,107 students aged 6–13 years from impoverished rural areas in China reported that a mere 11.3%, 28.8%, and 24.5% of students consumed meat, eggs, and milk daily. This finding suggests that the low frequency of protein food consumption might be associated with regional economic status (9).

Fresh vegetables and fruits are abundant in essential vitamins, minerals, and dietary fiber. For Chinese school-aged children, dietary guidelines recommend the consumption of at least three or more varieties of fresh vegetables and one serving of fresh fruit daily (1). However, our study revealed that only approximately one-third of students in rural areas consumed fruits once a day or more, and vegetables in more than three types per day. Numerous studies have indicated that children in various countries exhibit low intakes of fruits and vegetables (10–11). Heinen et al. carried out a cross-sectional study with 123,100 children aged 6–9 years across 19 European countries, demonstrating that approximately 30%–80% and 30%–90% of children did not consume fruits or vegetables daily, respectively (10).

The frequency of consumption of various types of food among students may have increased following the COVID-19 outbreak. This study observed a rise in the weekly consumption frequency of meat, eggs, milk, legumes, fresh vegetables, and fruits in 2021 compared to 2019. Several studies suggested that this increase may be attributed to parents providing their children with diverse and balanced diets aimed at improving and maintaining their health after the COVID-19 outbreak (3,12–13). Nicholas et al. conducted an online survey among 254 Canadian households and found that more than half of the families reported a healthier diet, while 42% of children increased their intake of various foods since the onset of COVID-19 (12). It is important to note that although enhancing food intake to combat the virus during the COVID-19 pandemic may decrease undernutrition among students, it could also potentially increase the risk of overweight and obesity.

This study was subject to several limitations. First, the quantity of food intake was not assessed. Some students followed the suggested frequency of consumption but ingested smaller portions each time, leading to inadequate nutritional intake, which in turn may have influenced the accuracy of the study's findings. Second, the potential varying effects of different meat types were not considered separately; for instance, excessive consumption of red or processed meat may have negative health implications. Finally, factors associated with the frequency of food consumption will be examined more thoroughly in future research.

In summary, the weekly consumption frequencies of meat, eggs, milk, legumes, fruits, and vegetables in 2021 were higher compared to those in 2019. However, students in urban areas demonstrated a higher frequency of consuming meat, eggs, and milk, but a lower frequency of legumes and vegetables consumption in 2021, compared to their rural counterparts. It is recommended that the government and health education departments gradually increase financial investment and strengthen nutrition education, while fully considering regional differences, economic conditions, and pandemic factors. This approach aims to enhance food supply, availability, and accessibility in economically underdeveloped areas of China, potentially improving the nutritional status of students. Additionally, schools and parents should work collaboratively to guide children towards adequate intake of protein-rich foods, fresh vegetables, and fruits, thereby promoting their healthy growth.

No conflicts of interest.

Project teams from China CDC, provincial, city, and county level CDCs and Departments of Education, local school staff, and all participants.