Subnational variation of stunting, wasting and malnutrition in Chinese primary-school children between 2010 and 2014: urban–rural disparity

Abstract

ObjectiveTo examine urban–rural disparity in childhood stunting, wasting and malnutrition at national and subnational levels in Chinese primary-school children in 2010 and 2014.DesignData were obtained from two nationwide cross-sectional surveys conducted in 2010 and 2014. Malnutrition was classified using the Chinese national ‘Screening Standard for Malnutrition of Children’.SettingAll twenty-seven mainland provinces and four municipalities of mainland China.ParticipantsChildren aged 7–12 years (n 215 214; 107 741 in 2010 and 107 473 in 2014) from thirty-one provinces.ResultsStunting, wasting and malnutrition prevalence were 1·9, 12·3 and 13·7 % in 2010, but decreased to 1·0, 9·4 and 10·2 % in 2014, respectively. The prevalence of stunting, wasting and malnutrition in both urban and rural children was higher in western provinces, while lower in eastern provinces. Although the prevalence of wasting and malnutrition was higher in rural children than their urban counterparts, the urban–rural disparity in both wasting and malnutrition decreased from 2010 to 2014 (prevalence OR: wasting, 1·35 to 1·16; malnutrition, 1·50 to 1·27). A reversal occurred in 2014 in several eastern provinces where the prevalence of wasting and malnutrition in urban children surpassed their rural peers. The urban–rural disparity was larger in western provinces than eastern provinces.ConclusionsThe shrinking urban–rural disparity and the reversal in wasting and malnutrition suggest that the malnutrition situation has improved during the post-crisis period, especially in the western provinces. Region-specific policies and interventions can be useful to sustainably mitigate malnutrition in Chinese children, especially in rural areas and the western provinces.

Differences in nutritional status between rural and urban Yucatec Maya children: The importance of early life conditions

“…In this study, urban Yucatec Maya 6‐year‐olds have higher values for anthropometry and elevated overweight/obesity relative to rural Yucatec Maya children. This finding conforms to a global pattern of anthropometric differentiation of rural and urban children (Dong et al, 2019; Gutiérrez‐Jiménez et al, 2019; Oyhenart et al, 2008; Paciorek et al, 2013; Van de Poel et al, 2007). The urban Yucatec Maya children overweight/obesity rate is high (46%) and exceeds the overweight/obesity rate of urban children reported in Mexico's 2012 National Nutrition Survey (37%) (Hernández‐Cordero et al, 2017).…”

“…The nutrition transition is here defined as a process by which locally produced and “traditional” (low‐fat and high‐fiber) diets become displaced by “urbanized,” non‐local diets composed of highly refined market foods and beverages that are high in fat, salt and sugar and low in fiber (Moreno‐Altamirano et al, 2014; Popkin et al, 2020; Rivera et al, 2002; Tzioumis et al, 2016; Varela‐Silva et al, 2012; Vega Mejía et al, 2018; WHO, 2021). Upon exposure to the nutritional transition, urban children become taller and more obesity‐prone than rural children, a pattern that persists when comparing rural versus urban children within the same country, region, and ethnic population (Dong et al, 2019; Paciorek et al, 2013; Van de Poel et al, 2007). However, socioeconomic and sex differences can cut across the rural–urban divide and may affect children's growth in more complex ways (Aris et al, 2017; Gatica‐Domínguez et al, 2020; Paciorek et al, 2013).…”

Time trends in socio-economic and geographic-based inequalities in childhood wasting in Guinea over 2 decades: a cross-sectional study

“…Finally, we found significant regional inequality in childhood wasting across all the survey years, consistent with a previous study. 51 The higher proportion of uneducated mothers 45 and the urban–rural nature of the provinces 51 , 52 in the country may explain the variation in childhood wasting prevalence across regions. 13 , 45 , 52 There is evidence that wasting may be caused by a reduced intake of food, 53 therefore the regional difference may be partly due to seasonal food insecurity that is related to natural disasters such as extreme poverty, crop damage by locusts and shifts in the practice of agriculture.…”

Geographical Variation in Physical Fitness Among Chinese Children and Adolescents From 2005 to 2014

“…Apart from those nationwide efforts, reductions in academic pressures, breaking of sedentary time, and engagement in sporting activities should also be encouraged to narrow these regional disparities in children and adolescents' physical fitness (23). For example, since obesity and undernutrition were both important causes of physical fitness deterioration, the background of rapid increase in obesity and persistent undernutrition among children and adolescents suggested that the differentiated improvement measures were needed in different regions of China (24,25). Thus, as suggested in the previous study, the control of over-nutrition should be emphasized among eastern developed provinces with policies that encourage taxation on unhealthy foods and promotion of moderate-to-vigorous PA.…”