Interviewed expert

Liu Lan, Vice Chairman and Secretary General of Beijing Dietetic Association

In the long river of history, 40 years is very short, but China has changed dramatically with fast development during this period of time. People's needs have changed from having enough food and having delicious food to having nutritious and healthy food, and the improvement of nutrition level is reflected in the growth of residents' life expectancy. Although there are still many food-related problems to be solved for the Chinese people, we have made positive achievements in the past 40 years of reform and opening up.

"Stamps" are the earliest memory for those born in the 1970s

"I was born during the period of reform and opening up, and as a practitioner in the nutrition industry, I can truly feel the tremendous changes brought about by reform and opening up policy to the health of all the Chinese people." Liu said that "stamps" such as food stamps, meat stamps, oil stamps and cloth stamps, are the earliest memories of those born in the 1970s.

Almost all the daily necessities need to be bought with stamps. In her childhood memories, she remembered about meat tickets most vividly. At that time, if any neighborhood cooked meat, the fragrance would make the children in the whole street mouthwatering, and everyone would wonder "the fragrance is from which family".

"Every day after school, me and other children would rush home, expecting to find surprises waiting for us. However, we had merely cornmeal porridge, cornbread, and wild vegetables with light bitter taste and unknown name. Meanwhile, we felt depressed and still wondered who was eating meat." Liu said that it was not only her that desired for meat. The story was an epitome of dietary situation of the Chinese residents in the early 1980s.

Nutrient deficiency is the key word of the life in 1980s

"The Second National Nutrition Survey made in 1982 showed that the dietary structure of Chinese residents featured plant-based diet, and the energy intake of all the Chinese people had reached the RDA standard. The per capita energy intake was 2485kcal and the protein was 67g, reaching the low limit of RDA; The intake of vitamin A and B2 were generally insufficient; The dietary protein and calcium intake of preschool children and primary and middle school students were generally insufficient, and rickets was the main nutrition-related problem among children, which was more serious in the north; The dietary energy intake of middle school students reached the standard of supply, but due to the large proportion of plant food, other nutrients such as protein, calcium, vitamin A and B2 were in short supply." Liu said that nutrient deficiency became the key word of this period.

Vitamin A deficiency: mild in cities, moderate in rural areas and severe in western rural areas. Therefore, the World Summit for Children and the Outline on Development for Chinese Children in the 1990s (2001-2010) take the reduction of vitamin A deficiency as one of the strategic goals in the next decade.

Vitamin D and calcium deficiency: The general survey of 124,901 people in 26 provinces, municipalities and autonomous regions by the National Rickets Prevention and Treatment Cooperation Group from 1977 to 1987 showed that the prevalence rate in the northern part was the highest, with an average of 49.39%, and that of 33.11% and 24.64% in the central and southern part respectively. Among them, the prevalence rates in Inner Mongolia, Gansu, Heilongjiang, Jilin, Shandong and Hebei provinces were all over 50%, with little difference between urban and rural areas.

Overnutrition began to appear in the 1990s

The Third National Nutrition Survey made in 1992 showed that the average daily intake of energy, protein and fat of Chinese residents were 2328kcal, 68g and 58g respectively."

Liu said that the heat energy from animal food accounted for 9.3% of the total dietary amount, with the protein and fat accounting for 18.9% and 40.3% respectively, and the proportion of fat had increased significantly. However, the intake of calcium, vitamin B2 and A of Chinese residents were still low, only reaching 50.5%, 66.6% and 59.5% of the recommended dietary allowance (RDA) standard respectively. The average incidence of growth retardation in children under 5 years old caused by protein-energy malnutrition reached 32.6%. Iron deficiency anemia, rickets in children and other diseases had relatively high prevalence rate.By 1990s, the westernization trend in Chinese urban residents' dietary patterns has become obvious, and the phenomenon of over-nutrition has begun to appear.

"The dietary-fat energy amounted 28.4%, with animal fat accounting for 38.7%. The dietary-fat energy of middle-income group and high-income group reached 31.1% and 32.3%, with animal fat accounting for 40% and 42.3% respectively." Liu said that the World Health Organization suggested that fat energy should account for 15%-30% of the total dietary energy, and saturated fatty acids should account for less than 10%. The results of the above-mentioned group exceeded the upper limit of the recommended standard. The difference between urban and rural areas began to appear, and there were big gaps in food consumption types, nutrient intake levels and nutritional status of people.

At the beginning of this century, people suffered from the harm caused by imbalanced diet

"In 2002, the results of the Fourth National Survey on Diet and Nutrition of Residents made me, a graduate student majoring in nutrition and food hygiene at CCDC, deeply feel that another form of imbalance in diet will also bring harm to people." Liu said that this was the first time that China combined nutrition survey and obesity, hypertension and diabetes survey as a national comprehensive survey project. The results showed that the dietary quality of residents was improved significantly.

With the rapid economic development, the variety of food supply had been constantly enriched, and the need for energy and protein intake of urban and rural residents were basically met. The consumption of animal food such as meat, eggs and poultry products was obviously increased, with the proportion of high-quality protein steadily increased, and the improvement in rural areas was more obvious.

The growth and development level of children and adolescents was steadily improved. The average birth weight of infants was increased by 123g compared with that in 1992, and the low birth weight rate was 3.6%, which had reached the level of developed countries. The average height of children and adolescents aged 2-18 in China increased by 3.3 cm compared with that in 1992. The prevalence of malnutrition among children dropped significantly.

"The dietary structure of residents begins to show unreasonable trend. The urban residents' consumption amount of edible oil and high-fat animal food is relatively high, while the consumption of cereals is low." Liu said that people in rural areas were facing the double challenges of malnutrition and unbalanced nutrition. The deficiency of micronutrients such as iron and vitamin A was still a problem for the Chinese people.

Liu said that noninfectious chronic diseases are important public health problems threatening people's health. The prevalence rates of hypertension, diabetes, dyslipidemia and overweight and obesity in residents aged 18 and above were 18.8%, 2.6%, 18.6% and 23.2%, respectively. The prevalence rate of overweight and obesity in developed cities had reached 35.6%. What's worse, the obesity rate of children had reached 8.1%.

"In order to better reflect the changes in nutrition and health status of Chinese residents during the critical period of changes in dietary patterns and disease spectrum, from 2010 to 2013, the National Health & Family Planning Commission of People’s Republic of China listed the nutrition and health monitoring of Chinese residents as a major medical reform project, and decided to change the survey of nutrition and health status of Chinese residents once every 10 years to routine nutrition monitoring, and complete the national nutrition and health monitoring every 3-4 years." Liu said that the survey results of urban residents showed that, over the past decade from 2002 to 2012, the food demand of Chinese urban residents were met, the nutrition level was further improved, and the prevalence of malnutrition and nutritional deficiency dropped significantly. However, the dietary structure was still unreasonable, unhealthy lifestyles were common, and the prevalence of nutrition-related chronic diseases such as overweight and obesity, hypertension and diabetes was still rising. Chinese urban residents were faced with the main severe challenge of nutritional imbalance.

In recent years, the development of nutrition industry has promoted the health of the Chinese people

In recent years, China's nutrition industry has undergone gratifying changes. General Secretary Xi Jinping noted at the National Health and Fitness Conference that "Prosperity for all is impossible without health for all".

The report of the 19th CPC National Congress clearly put forward the important judgment that "As socialism with Chinese characteristics has entered a new era, the principal contradiction facing Chinese society has evolved. What we now face is the contradiction between unbalanced and inadequate development and the people's ever-growing needs for a better life". This manifested the important role of nutrition industry in people's pursuit of a better life.

"On January 18, 2014, the State Council issued the Outline of the Program for Food and Nutrition Development in China (2014-2020) (hereinafter referred to as the "Outline"), which set China's food output and nutrition development goals, and put forward the guiding ideology of China's food and nutrition development work in the next seven years." Liu said that the "Outline" proposed to give priority to the development of "three key products": high-quality edible agricultural products, convenient processed nutrition food and milk and soybean products; Give priority to "three key areas": poverty-stricken areas, rural areas and floating population concentration areas and new urbanization areas; Give priority to improving the health of "three major groups": pregnant women and infants, children and adolescents, and the elderly.

Chinese Dietary Reference Intakes (2013 edition) published in 2014 is the theoretical basis of all nutrition-related teaching and scientific research, as well as that of relevant national policies, standards, regulations and nutrition intervention projects. Based on nutrition research results, this set of documents included the research results on the function, evaluation, demand and safety of nutrients and prevention of chronic diseases according to the principles of evidence-based nutrition and risk assessment, and put forward the reasonable intake of dietary nutrients for human body, with the main purpose of preventing nutritional deficiency caused by inadequate intake of some nutrients as well as harmful effects caused by excessive intake.

On June 30, 2015, CCDC, National Center for Cardiovascular Diseases and National Cancer Center published the Report on the Nutrition and Chronic Disease Status of Chinese Residents (2015) (hereinafter referred to as the "Report"), which investigated and analyzed the dietary nutrition and physical development as well as the chronic diseases of Chinese residents. The Report showed that:

(1) The dietary energy supply was sufficient, and the physical development and nutritional status of Chinese residents were generally improved;

(2) The dietary structure changed, and the problems of overweight and obesity were prominent; The overweight and obesity rates of adults aged 18 and above in China were 30.1% and 11.9%, which were 7.3% and 4.8% higher than those in 2002, and the overweight and obesity rates of children and adolescents aged 6-17 were also increasing;

The status of major chronic diseases of Chinese residents was not optimistic; In 2012, the prevalence rates of hypertension and diabetes among adults aged 18 and above in China showed an upward trend. Lung and breast cancer ranked first among men and women respectively, and the incidence of cancer in China showed an upward trend in the past decade;

(4) About the risk factors of chronic diseases. Smoking, excessive drinking, lack of physical activity and unhealthy diet with excessive salt and fat were the main behavioral risk factors for the occurrence and development of chronic diseases.

On May 16, 2015, China launched the first "National Nutrition Week". Previously, the Outline of the Program for Food and Nutrition Development in China 2014-2020 issued by the State Council put forward the suggestions of "improving the nutrition awareness and healthy lifestyle of the whole people, sorting out the scientific diet concept, studying and establishing the public nutrition day, carrying out activities promoting food-nutrition knowledge in villages and households, and strengthening nutrition and health education". The establishment of National Nutrition Week kicked off the national nutrition education.

From August 19 to 20, 2016, the National Health and Fitness Conference was held. "Providing nutrition meals or packages for students in poverty-stricken areas to ensure their growth and development" became an important issue. General Secretary of the CPC Central Committee, President of PRC and Chairman of the Central Military Commission, Xi Jinping attended the meeting and delivered an important speech.

In the speech, Xi pointed out that it was necessary to strengthen the propaganda of health knowledge, improve students' awareness of active disease prevention, and implement targeted activities to distribute nutrition meals or packages for students in poverty-stricken areas to ensure their growth and development. Providing nutrition meals was the basis of ensuring the health of school-age children and adolescents, the important part of life-cycle nutrition, and the major field of basic application of nutrition, which related to the health level of the whole people and national development. Optimizing students' nutrition meals and promoting their health were the foundation of developing people's health and the necessary condition for establishing a well-off society in an all-round way.

In October 2016, the improvement of national nutrition was included in the Outline of "2030 Healthy China". The Outline pointed out that it is necessary to cultivate the self-disciplined healthy behavior, guide rational diet, formulate and implement national nutrition plan, carry out in-depth evaluation and research on the nutritional function of food (agricultural products and food), popularize dietary nutrition knowledge in an all-round way, issue dietary guidelines suitable for different groups of people, guide residents to form scientific dietary habits, and promote the construction of healthy eating culture. Besides, it is also necessary to establish and improve the residents' nutrition monitoring system, implement nutrition intervention for key populations in key areas, focus on solving the problems of micronutrient deficiency and excessive intake of high-calorie food with excessive oil and fat for some populations, and gradually solve the problem of residents' malnutrition and over-nutrition. Other measures including implementing medical nutrition intervention, strengthening the guidance of nutrition and health work in schools, kindergartens and old-age care institutions, and carrying out the construction of demonstration healthy canteens and restaurants. By 2030, residents' nutrition literacy will be significantly improved, the incidence of nutritional deficiency diseases will be significantly reduced, the daily salt intake per capita in China will be reduced by 20%, and the growth rate of overweight and obesity will be significantly slowed down. The Outline is a strategic measure for the health of the whole people, which restates that nutrition is the foundation of health.

On June 21, 2016, "supplementing folic acid for rural women to prevent neural tube defects and improve children's nutrition" was included as a health poverty alleviation task into the Guiding Opinions on Implementing Health Poverty Alleviation Project (hereinafter referred to as "Opinions") released by the State Council.

The Opinions pointed out that it is necessary to strengthen maternal and child health work in poverty-stricken areas, including supplementing folic acid for rural women to prevent neural tube defects and improving children's nutrition. It is also required to strengthen health promotion and education work, widely publicize the basic health knowledge and train residents' skills, and enhance the health awareness of people in poverty-stricken areas, so that they can form good health habits and healthy lifestyles. Nutrition improvement in poverty-stricken areas is a part of health poverty alleviation. The Opinions aim at the specific objectives of nutrition improvement to provide strong support for accurate poverty alleviation and impetus for the development of nutrition industry.

In May 2016, the new edition of The Chinese Dietary Guidelines (2016) was released by National Health and Family Planning Commission of the People's Republic of China as Healthy China becomes a national policy. When it first published in May, this new version of the guidelines was widely used and received several awards. The professional version was listed as one of the 2016 National Outstanding Popular Science Works complied by the Ministry of Science and Technology, and the public version won the "Best Book" among the publications of commissions that is recommended by the themed publicity and incentive project in 2016 and the "2016 Excellent Reading Recommended to the Elderly in China". The new guidelines provides the latest and most authoritative scientific evidence and reference materials for all nutrition and health educators and health communicators, encourages educators to apply their own experience and knowledge to their work, and helps consumers apply such knowledge to their lives, laying a solid foundation for promoting people's health.

On July 13, 2017, the General Office of the State Council issued the National Nutrition Plan (2017-2030), which mapped out the future of national nutrition development in an all-round way, focusing on seven implementation strategies and six major actions. Focusing on "people's health", the plan starts with "national nutrition" in an effort to prevent nutrition-related diseases. It aims to form a new strategy supporting the "Healthy China" by vigorously popularizing nutrition knowledge, optimizing nutrition and health services, improving nutrition system and developing nutrition and health industry.

In 2018, the National Health and Family Planning Commission was reorganized as National Health Commission of the People's Republic of China, with the aim to promote the implementation of the Healthy China initiative and clearly define the concept of comprehensive and general healthcare. The new agency changes its focus from treating diseases to promoting people's health and thus provides all-round and full-cycle health services for the people through preventing and controlling major diseases, actively responding to the aging of the population, and accelerating the development of aging-related undertakings and industries.

In the end, Liu Lan said: "The above remarkable events have directly affected the development of the nutrition industry and played a positive role in promoting China's progress towards the 'Healthy China'."

Author: Chen Zhixiu

Recently, SYRINX joined hands with nutritionist Liu Lan to share the concept of communicating healthy diet and bring dietary fiber to the dining tables of more families. By supplementing the daily nutrition required by human body with meals, we strive to create a high-quality and better life for everyone.

Dietary fiber will be necessary for a healthy diet as people's awareness and expertise in this area increase! Take a SYRINX's Dietary Fiber Collagen Peptide with the meal will help you feel less greasy and live a healthy and beautiful lifestyle!