| Objective:To analyzetrend in intakes of dietary food and nutrients,and overall diet quality,assessed by China dietary guideline index for the elderly based on the Chinese dietary guidelines,among the elderly in nine provinces(autonomous region)of China.To examine the association between overall diet qualityand abdominalobesity among the elderly in China.Methods:The study was based on the longitudinal cohort study"China Health and Nutrition Survey(CHNS)",a collaboration between National Institute for Nutrition and Health,Chinese Center for Disease Control and Prevention,and the University of North Carolina,CHNS was initiated in 1989 and followed up in 1991,1993,1997,2000.2004,2006,2009.2011 and 2015.The project adopts multi-stage stratified random cluster sampling method to select survey families in each survey province,and all family members participate in the survey.Residents’dietary,economic,physical activity,health indicators and other relevant data were collected through questionnaires,physical measurements and biochemical tests.The dietary survey was conducted by consecutive 3-day 24-hour recall method and household weighing method.A total of 15 provinces(municipalities or autonomous regions)had been included in the study uintil 2015.The presentstudy selected the elderly aged 60 and older from 1991 to 2015 in 9 provinces(autonomous regions)(Liaoning,Jiangsu,Shandong,Henan,Hubei,Hunan,Guangxi,Guizhou,Heilongjiang)as the subjects.The rank sum test,chi-square test and other common statistical methods were used to test trendsin the intakes of dietary food,nutrients and overall diet qualityof the elderly from 1991 to 2015.The China Dietary Guideline Index(2018)-Elderly(CDGI(2018)-E),established based on the 2016 Chinese Dietary Guideline,was used to evaluate the overall diet quality of the elderly.Considering the nested data structure of community-individual-multiple observations,we used multiple-level mixed-effect logistic random intercept regression to examine the relationship between overall diet quality and abdominal obesity in the elderly.Results:1.The average intakes of cereals and tubers and vegetables,among the elderly in nine provinces(autonomous regions)of China were 363.3 g/d and 249.1g/d in 2015,respectively,which decreased by 65.4g/d and17.6g/d as compared tothose in 1991.The intake of meat,egg,and edible oil were 56.7g/d,19.2g/d and 27.5g/d in20159 respectively,which increased by 7.5g/d,19.2g/d and 2.5g/d as compared to those with 1991.In 2015,the proportion of the elderlywho have lower intakes of vegetables,fruits,soybeans,milk and dairy products than the recommended amountwas more than 60%.Nearly 50%of theelderly consumed more edibleoilandsalt intake more than the recommended amounts.The intakes of energy,protein,fat and carbohydrates were1706.8kcal/d,52.2g/d,61.4g/d and 219.3g/d in 2015,respectively.The percentages of energy from dietary protein,fat and carbohydrates were 12.3%,33.3%and 53.0%,respectively.The percentages of energy from dietary fat increased 9.0 points,while the percentage from carbohydrates decreased 8.7points.The main food source of energy is grain,whichhave the decline trend.The main source of fat is edible oil.The average intakes of dietary retinol activity equivalents,thiamin,riboflavin,vitamin C,vitamin E were 344.9μgRAE/d,0.7mg/d,0.6mg/d,57.7mg/d and 23.0mg/d,respectively.The intake ofthiamine showeddecreased trend from 1991 to 2015.The intakes of dietary calcium,phosphorus,sodium,potassium,magnesium,zinc,copperwere291.9mg/d,781.5mg/d,3569.2mg/d,1295.8mg/d,228.7mg/d,8.5mg/d and 1.4mg/d,respectively.The intakes of dietary phosphorus,magnesium,zinc,copper decreased over time.Over 50%of the elderly consumedless retinol,thiamine,riboflavin,vitamin C and calcium less than the corresponding EAR.The proportions of the elderly who had insufficient intakes of thiamine and vitamin C have been rising,and the proportion of the elderly at risk of insufficient calcium intake has been around 95%.2.The CDGI(2018)-E scoresranging from 0 to110 points,consists 13 components from three major categories;"Adequate intake group":First component(the percentage energy from carbohydrate and other grain and miscellaneousbeans),Second component(total vegetables and the rate of dark-color vegetables,fruit,soybean and nuts and dairy products);"Moderate intake group":livestock meat and poultry,eggs and aquatic products;"Limited intake group":oil,salt and wine.In 2015,the median of CDGI(2018)-E scores of the elderly in nine provinces(autonomous regions)of China was 48.8(40.8,57.1),and the variation trend of each component was observed in each year.The component(the percentage energy from carbohydrate and;other grain and miscellaneous beans)showed a decreasing trend,while the other components showed an increasing trend.The female CDGI(2018)-E scores were higher than male,urban areas were higher than rural areas(P<0.05).With the increase of income level,the CDGI(2018)-E scores of the elderly gradually increased.The intakes of dietary protein,dietary fiber,retinol,vitamin C,potassium,calcium,phosphorus,magnesium,zinc,copper and selenium in the elderly with high CDGI(2018)-E scores were higher than those with low diet quality scores(P<0.05).The intake of energy,fat,carbohydrates and sodiumwas relatively low in those with higher CDGI(2018)-E scores(P<0.05).3.The top sextile ofCDGI(2018)-E scores is inversely associated with abdominal obesity only in women,that is,the odds ratio(OR)was 0.61(95%Cl,0.41 to 0.91),after adjusting demographic and economic confounders,OR was 0.60(95%CI,0.40 to 0.89)after additionally adjusting for individuallifestylehabit(smoking and physical activity);OR was 0.62(95%Cl,0.41 to 0.92)after additionally introducing the baseline WC.No significant linear trends were observed(P-trend=0.55).However,null significant association was observed in the older men,OR was 0.93(95%Cl,0.58 to 1.49).Conclusion:1.There are three problems in the dietary patternof the elderly in nine provinces(autonomous region)in China:first,The intakes of cereals and tubers,vegetables and meat was unbalanced,and the intakes of cereals and tubers and vegetables decreased,while the intakes of meat increased over time;second,intakes of the food rich in high quality protein and low fat such as sea food,eggs,dairy products and so on were low,while the intakes of such food illustrated the rising trend;third,the excessive oil and salt consumption was still a problem.However,salt consumption had decreased.The intakes of energy and protein showed a descendingtrend in the elderly of Chinese nine provinces(autonomous region).The elderly need to reduce the fat intake.The water-soluble vitamin and calcium deficiency were relatively serious.Except for retinol,riboflavin,vitamin E,calcium.and selenium,other micronutrients all showed a decreasing trend2.The diet quality of the elderly was relatively low,while showeda growing trend.The foods in the component of"Adequate intake"and "Moderate intake"remains to be improved.The intakes of dairy products,sea food and fruit needed to be increased.In the elderly with high CDGI(2018)-E scores,the intakes of nutrients such as protein,vitamin C,potassium,calcium,zinc and selenium is relatively high,while the intake of fat and sodium is relatively low.Economic condition is one of the most important factors limiting the diet quality of the elderly.The nutritional education and intervention should be mainly targeted at the elderly in rural,low income and education level3.The top sextile of CDGI(2018)-E scoreswas associated with lower abdominal obesity among Chinese older women.The CDGI(2018)-Ebased diet quality method has certain practical application for evaluating overall diet quality as a whole and examining diet quality-diseases relationship. |
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