Lack of dietary diversity and dyslipidaemia among stunted overweight children: The 2002 China National Nutrition and Health Survey

National Institute for Nutrition and Food Safety, Chinese Center for Disease Control and Prevention, Nanwei Road 29 Hao, Beijing 100050, People's Republic of China.
Public Health Nutrition (Impact Factor: 2.68). 02/2011; 14(5):896-903. DOI: 10.1017/S1368980010002971
Source: PubMed


Both stunting and overweight are present in children across China. Seemingly paradoxical, these two conditions can also coexist in the same child. The aim was to examine the associations between dietary food/nutrient intake and plasma lipid profiles related to stunting and overweight status.
The 2002 China National Nutrition and Health Survey was a family-based nationally representative cross-sectional study.
Thirty-one provinces, autonomous regions and municipalities.
The study included 13,770 children aged 2-17 years. The sample size for the four exposure groups was 10,814 for children of normal height and weight, 2128 for stunted, 729 for overweight and 99 for stunted overweight.
Compared with children of normal height and weight, stunted and stunted overweight children consumed more high-energy-dense foods with a lower dietary diversity score, less protein, polyunsaturated fat and Fe, and a higher molar ratio of phytate to Ca. On the contrary, overweight children tended to consume significantly less carbohydrates and more protein and fat. Overall, stunted overweight children consumed lower amounts of vegetables, fruit, white meat (poultry and fish) and more milk. The OR for prevalent dyslipidaemia were 1·32 (95% CI 1·13, 1·53), 1·76 (95% CI 1·48, 2·09) and 2·59 (95% CI 1·65, 4·07) among stunted, overweight and stunted overweight children, respectively, compared with children of normal height and weight. In addition, being overweight was significantly associated with high glucose concentrations, whereas stunting was significantly associated with having anaemia.
Limited dietary diversity and intake of high-energy-dense foods were notably observed among stunted overweight children. Furthermore, being stunted and/or overweight was associated with an increased likelihood of unhealthy lipid profiles.

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Available from: Guansheng Ma, Feb 08, 2014
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    • "For example, dietary diversity characteristics may have exerted an additional effect on hsCRP levels, over and above the aforementioned effects of individual nutrients. Previous studies by others showed that dietary diversity was associated with reduced cardiovascular disease risks such as stunting and overweight among Chinese children (Li et al., 2011), Bolivian Amazonian women (Benefice et al., 2007) and Mexican adults (Flores et al., 2010). Similarly, an association between diverse diets and lower risks of mortality from cardiovascular disease and cancer has been reported in a study of cause-specific mortality risks (Kant et al., 1995). "
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    ABSTRACT: Objectives Low-grade elevation of C-reactive protein (CRP) is a non-specific inflammatory marker, used as a predictor for cardiovascular disease development and chronic inflammatory risks. Research investigating dietary influences on inflammation has focused primarily on the relationship between dietary characteristics, CRP elevation and BMI in the populations at greatest risk for cardiovascular disease, namely those in the overweight and obese ranges, often in clinical settings and/or among those middle aged or older, leaving little information about normal to underweight populations of reproductive age in ecological settings. This study evaluates impacts of dietary nutrients on serum CRP levels in a population of predominantly underweight to normal weight adult women experiencing the additional nutritional demands of lactation. Methods Data from non-overweight breastfeeding Ariaal women of Kenya collected in 2006 were used (n = 194). Logistic regression models were applied using low-grade CRP elevation (hsCRP > 3 mg/L) as the outcome variable and dietary nutrients, age, BMI, and serum retinol as predictors. ResultsModels showed that energy intake (Kcal) and age were positive predictors of CRP elevation while folate intake, total vitamin A intake, and serum retinol concentration were protective against CRP elevation. Unlike previous studies among higher BMI populations, this study found no significant effect of dietary lipids/fatty acids or BMI on CRP elevation. Conclusions The effects of specific dietary nutrients on inflammatory status may vary with BMI or, in women, reproductive status. Further research should investigate the role of dietary fats, fatty acids, and antioxidant vitamins across populations with a wide range of BMI, including postpartum women. Am. J. Hum. Biol. 26:796-802, 2014. (c) 2014 Wiley Periodicals, Inc.
    American Journal of Human Biology 11/2014; DOI:10.1002/ajhb.22600 · 1.70 Impact Factor
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    • "The dietary diversity score (DDS), as measured by a quantitative number of food groups, has become a widely used method of determining variety in the diet, and by proxy, nutrient adequacy [1] [2] [3] [4] [5]. A low DDS also has been associated with low weight and stunted growth [6] [7], cardiovascular risk [8] [9], dyslipidemia [10], and higher probability of metabolic syndrome [11]. Numerous classification systems have evolved in determining dietary diversity adequacy with the number of food group indicators ranging from 6 to 21 groups (Table 1). "
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    ABSTRACT: The aim of this study was to determine the best dietary diversity indicator to measure dietary diversity and micronutrient adequacy in children. A national representative cross-sectional survey of children ages 1 to 9 y (N = 2,200) was undertaken in all ethnic groups in South Africa. A 24-h recall was done with the mother or caregiver of each child. A dietary diversity score (DDS), the number of food groups consumed at least once in a period of 24 h, was calculated for each child in accordance with 6-, 9-, 13-, and 21-food group (G) indicators and compared with a mean adequacy ratio (MAR). The nutrient adequacy ratio (NAR) was calculated for 11 micronutrients by comparing the distributions of estimated intakes with the Estimated Average Requirements for that micronutrient. The MAR was the average of all NARs. Correlations were done between MAR and DDS and sensitivity and specificity calculated for each group indicator. Pearson's correlations between food group indicators and MAR indicate that r values were all highly significant (P < 0.0001). There were no consistent or large differences found between the different group indicators although G13 and G21 appeared to be marginally better. Sensitivity and specificity values in the current study lay between DDS of 3 and 5, suggesting one of these as the best indication of (low) micronutrient adequacy. Overall results seem to indicate that any of the four G indicators can be used in dietary assessment studies on children, with G13 and G21 being marginally better. A cut-off DDS of 4 and 5, respectively, appear best.
    Nutrition 01/2014; 30(1):55-60. DOI:10.1016/j.nut.2013.06.002 · 2.93 Impact Factor
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    • "However, the bulk of published studies focus on the implication of DDS on obesity, metabolic disorder and cardiovascular disease risks in developed countries or nutrition transition contexts (e.g. Azadbakht and Esmaillzadeh, 2011; Azadbakht et al., 2006; Flores et al., 2010; Kant and Graubard, 2005; Roberts et al., 2005; Li et al., 2011). The usefulness of DDS to predict micronutrient health outcomes for adults has only recently been explicitly demonstrated using dietary and laboratory data from the National Health and Nutrition Examination Survey with U.S. adults (Kant and Graubard, 2005). "
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    ABSTRACT: Diets consisting of diverse food items provide a wide range of nutrients that can enhance nutritional quality of the diet. Few studies have, however, assessed dietary diversity and its effects on micronutrient health in rural populations in field settings. This study assesses how well Dietary Diversity Score (DDS), an indicator of dietary diversity based on a simple count of food groups consumed, predicts the micronutrient status, focusing on serum vitamin A concentration. We used cross-sectional data from women in food-insecure northern Kenya where dietary diversity is likely critical for micronutrient health yet under-studied. A linear regression model was applied to examine the relationships between DDS and serum retinol concentration. A logistic regression model was used to test DDS as a predictor of vitamin A insufficiency (serum retinol < 1.05 μmol/l). DDS had a significant positive effect on serum retinol concentration (t = 2.01, P = 0.045) after adjusting for age, wealth, acute phase reaction, hemoglobin, vitamin A intake and vitamin A supplementation. A one unit increase in DDS by adding an extra food group in one's diet was significantly less likely to have vitamin A insufficiency (OR = 0.64, P = 0.026) after adjusting for the covariates. Our results indicate that diversified diets enhance vitamin A status relative to narrower diets with equivalent vitamin A content. DDS shows a potential as a low-cost, field-friendly method for exploratory assessments of vitamin A status, and a potential as a research tool for human biologists and anthropologists interested in dietary quality and micronutrient health. Am. J. Hum. Biol., 2012. © 2012 Wiley Periodicals, Inc.
    American Journal of Human Biology 11/2012; 24(6):829-34. DOI:10.1002/ajhb.22327 · 1.70 Impact Factor
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