【作者】 苏畅；

【导师】 张兵；

【作者基本信息】 中国疾病预防控制中心 ， 营养与食品卫生学， 2010， 博士

【摘要】 研究背景：经济因素是影响人群膳食结构和营养状况的重要因素之一。有文献报道,当人均GDP由1000美元增至3000美元时是食物结构变化的敏感期,也是进行营养干预促进居民实现平衡膳食合理营养的最佳时期。然而,国内对经济因素与人群膳食结构和营养状况之间关系的研究还较少。研究目的：了解我国九省城乡社会发展水平、居民膳食结构、营养状况、身体活动及营养相关性疾病从1991年到2006年的15年变化趋势；对居民在2010年和2020年时各类食物的消费量进行预测；同时探讨经济因素对居民膳食结构和营养状况的影响程度。研究方法：研究采用“中国居民健康与营养调查”项目1991、1993、1997、2000、2004、2006年的6轮调查数据。研究对象主要包括各轮调查中18～60岁的成年居民。各轮调查的样本量分别为5085、6621、6646、6752、5603和5263人。首先建立社区城市化指数评价各轮调查中各社区的社会发展水平。其次对我国九省城乡居民膳食结构、营养状况、身体活动及营养相关疾病及营养素价格的变化趋势进行描述性分析。再次,运用趋势外推法中的11种不同形式的数学模型分析在无任何干预措施的条件下,对九省城乡居民食物消费量的未来变化趋势进行预测。最后采用计量经济学中的两阶段模型和双对数模型对九省城乡居民的食物消费的影响因素及影响程度进行分析探讨。结果：1、从1991年到2006年,城市、郊区、县城、农村四类地区的谷类食物消费量呈下降的趋势,至2006年分别为324.7克／天、388.2克／天、388.4克／天、469.7克／天；豆类食物的消费量15年间变化不大,至2006年四类地区消费量分别为20.5克／天、21.1克／天、20.1克／天、19.8克／天；蔬菜消费量呈上升趋势,至2006年四类地区消费量分别为325.5克／天、379.5克／天、318.6克／天、377.3克／天；水果消费量呈上升趋势,至2006年四类地区消费量分别为118.7克／天、79.6克／天、49.9克／天、39.7克／天；肉类消费量呈上升趋势,至2006年四类地区消费量分别为113.8克／天、112.4克／天、101.5克／天、76.5克／天；蛋类消费量呈上升趋势,至2006年四类地区消费量分别为40.7克／天、30.1克／天、35.1克／天、27.4克／天；水产品消费量呈上升趋势,至2006年四类地区消费量分别为42.2克／天、53.5克／天、37.4克／天、28.4克／天；奶类消费量呈上升趋势,至2006年四类地区消费量分别为47.9克／天、22.8克／天、18.5克／天、3.7克／天；食用油消费量呈上升趋势,至2006年四类地区消费量分别为47.3克／天、42.8克／天、40.8克／天、43.5克／天。2、优质蛋白质比例不断提高,至2006年四类地区分别为48.6%、42.5%、42.9%和31.3%；碳水化合物供能比持续下降,至2006年四类地区分别为49.3%、53.3%、55.7%和60.6%；脂肪供能比持续上升,至2006年四类地区分别为37.7%、33.0%、31.7%和28.0%；碳水化合物供能比异常人群比例持续上升,至2006年四类地区分别为31.4%、18.6%、12.6%和10.5%；脂肪供能比异常人群比例持续上升,至2006年四类地区分别为31.4%、18.6%、12.6%和10.5%；能量价格从1991年的1.1元／千卡增加到2006年的1.6元／千卡、蛋白质的价格从1991年的3.7元／100克增加到2006年的5.2元／100克、脂肪的价格从1991年的5.5元／100克减少到2006年的5.3元／100克。3、城乡居民身体活动强度明显下降,每周代谢当量时间(MET-hrs／week)从1997年到2006年下降了32%,其中男性下降了28%,女性下降了37%。调查的15年间,职业活动的代谢当量时间平均下降了40%,其中男性下降了36%,女性下降了47%。每日锻炼和交通(骑自行车、走路)时间超过30分钟的人群比例已经从1997年的46-51%下降到2006年的28-33%。4、从1991年到2006年,男性平均体重增加了7.5kg,女性平均体重增加了4.6kg；男性和女性BMI均逐渐增加。15年间男性和女性BMI分别增加2.0kg／m2和1.2kg／m2。2006年男性和女性超重／肥胖率(BMI>24 kg／m2)分别达到38.5%和36.0%,是1991年的2.1倍和1.7倍。2006年男性和女性高血压患病率分别达到23.7%和18.6%,是1991年的1.6倍和1.4倍。2006年男性和女性中心性肥胖率分别达到45.6%和48.6%,是1991年的2.3倍和1.7倍。5、2010年和2020年谷类食物消费量的预测结果,城市居民为311克／天和257克／天、郊区居民为301克／天和255克／天、县城居民362克／天和314克／天、农村居民426克／天和353克／天；2010年和2020年豆类食物消费量的预测结果,城市居民为22克／天和22克／天、郊区居民为21克／天和22克／天、县城居民20克／天和21克／天、农村居民19克／天和18克／天；2010年和2020年水果类食物消费量的预测结果,城市居民为130克／天和310克／天、郊区居民为106克／天和237克／天、县城居民54克／天和139克／天、农村居民39克／天和140克／天；2010年和2020年肉类食物消费量的预测结果,城市居民为99克／天和95克／天、郊区居民为105克／天和90克／天、县城居民107克／天和103克／天、农村居民79克／天和108克／天；2010年和2020年水产品类食物消费量的预测结果,城市居民为47克／天和63克／天、郊区居民为59克／天和87克／天、县城居民45克／天和71克／天、农村居民45克／天和61克／天；2010年和2020年奶类食物消费量的预测结果,城市居民为69克／天和109克／天、郊区居民为44克／天和103克／天、县城居民33克／天和79克／天、农村居民6克／天和18克／天；2010年和2020年食用油消费量的预测结果,城市居民为45克／天和50克／天、郊区居民为45克／天和45克／天、县城居民43克／天和47克／天、农村居民45克／天和55克／天。6、社区城市化指数与居民食物消费量和食物消费选择存在关联。城市化指数越高,居民消费动物性食物和食用油的概率也越大,动物性食物消费量和食用油的消费量也越高。7、收入的增加是谷类食物消费量的负向因素,是动物性食物和食用油消费量的正向因素。在大多数食物组中,收入弹性有所下降。从经济学的角度来看,谷类食物已经成为各收入人群的劣等商品。低收入人群随着收入的增加,脂肪摄入量增加的更快。8、由于价格的影响,各类食物存在补充和替代的关系。低收入人群对价格的变化更敏感。价格对营养素的摄入量有显著影响。9、食物的边际消费倾向不断下降,各类食物中猪肉的边际消费倾向最高。结论：1、从1991年到2006的15年间中国城乡居民的膳食质量明显改善,但与中国居民膳食指南推荐的参考标准相比,居民的膳食结构和营养状况依然存在很多问题。体力活动水平的降低以及脂肪摄入的增加导致居民营养相关性慢性疾病的患病率不断增加。2、对未来城乡居民食物消费量的预测结果表明,食用油、肉类、豆类和奶类消费量不合理的现象仍然比较突出。3、经济因素对居民的食物消费有显著的影响。为了控制营养相关慢性病患病率的不断上升,建议国家制定价格干预政策来控制猪肉和食用油的摄入量。更多还原

【Abstract】 BACKGROUNDThe economic factor is one of the important part which influence dietary patterns and nutritional status. It was reported that when GDP increases from 1000 dollar to 3000 dollar, it is not only the sensitive period of dietary patterns change, but also the best period of conducting nutritional intervention to achieve dietary balance and reasonable nutrition among residents. However, the domestic study about the relationship of the economic factor to dietary patterns and nutritional status is few.OBJECTIVETo study the level of social development secular trends of dietary patterns, nutritional status, physical activity and nutrition-related non-communicable diseases (NR-NCDs) among Chinese residents. To predict the consumption of different food of Chinese adults in 2010 and 2020. And discuss the extent of economic factor to dietary patterns and nutritional status.METHODSThe study was based on the data of China Health and Nutrition Survey (CHNS), a longitudinal project conducted in 1991,1993,1997,2000,2004 and 2006. The study population was the adult residents aged 18 to 60 years, and the sample size is 5085, 6621,6646,6752,5603 and 5263 respectively.Urbanization index was first built up to evaluate the socioeconomic status of different communities in every wave survey.Secondly, the secular trends of dietary patterns, nutritional status, physical activity, nutrition-related non-communicable diseases and nutrients price were described and analyzed among Chinese nine province’s urban and rural residents. One more, the consumption of different food of Chinese adults in 2010 and 2020 were predicted using the eleven mathematical models or the trend extrapolation (TE) on the condition of no any intervention.Finally, the factors and the extents of the food consumption were analyzed with two-process model (2PM) and Log-Log Models (L-LM) of econometrics.RESULTSFirstly, from 1991 to 2006 the cereals consumption of city, suburbs, country town and rural area has a decreasing trend, it was 324.7g/day、388.2g/day、388.4g/day、469.7g/day respectively to 2006; the beans consumption of city, suburbs, country town and rural area has not large change, it was 20.5g/day、21.1g/day、20.1g/day、19.8g/day respectively to 2006; the vegetable consumption of city, suburbs, country town and rural area has a increasing trend, it was 325.5g/day、379.5g/day、318.6g/day、377.3g/day respectively to 2006; the fruit consumption of city, suburbs, country town and rural area has a increasing trend, it was 118.7g/day、79.6g/day、49.9g/day、39.7g/day respectively to 2006; the meat consumption of city, suburbs, country town and rural area has a increasing trend, it was 113.8g/day、112.4g/day, 101.5g/day、76.5g/day respectively to 2006; the egg consumption of city, suburbs, country town and rural area has a increasing trend, it was 40.7g/day、30.1 g/day、35.1 g/day、27.4g/day respectively to 2006; the seafood consumption of city, suburbs, country town and rural area has a increasing trend, it was 42.2 g/day、53.5 g/day、37.4 g/day、28.4 g/day respectively to 2006; the milk consumption of city, suburbs, country town and rural area has a increasing trend, it was 47.9 g/day、22.8g/day、18.5 g/day、3.7 g/day respectively to 2006; the cooking oil consumption of city, suburbs, country town and rural area has a increasing trend, it was 47.3 g/day、42.8 g/day、40.8 g/day、43.5 g/day respectively to 2006.Secondly, the high-quality protein proportion of city, suburbs, country town and rural area has a increasing trend, it was 48.6%、42.5%、42.9%、31.3% respectively to 2006; the energy ratio from carbohydrate of city, suburbs, country town and rural area has a decreasing trend, it was 49.3%、53.3%、55.7%、60.6% respectively to 2006, the energy ratio from fat of city, suburbs, country town and rural area has a increasing trend, it was 37.7%、33.0%、31.7%、28.0% respectively to2006; the ratio of population of the abnormal energy ratio from carbohydrate increased continually, which was 31.4%、18.6%、12.6%、10.5% respectively to 2006 in four area; the ratio of population of the abnormal energy ratio from fat increased continually, which was 31.4%、18.6%、12.6%、10.5% respectively to 2006 in four area; price of energy increased from 1.1 yuan/Kcal in 1991 to 1.6 yuan/Kcal in 2006; price of protein increased from 3.7 yuan/100g in 1991 to 5.2 yuan/100g in 2006; price of fat decreased from 5.5 yuan/100g in 1991 to 5.3 yuan/100g in 2006.Thirdly, the physical activity levels have decreased among urban and rural residents significantly, resident’s MET-hrs/week fell by 32% from 1997 to 2006, and male and female fell by 28% and 37% respectively. In the 15 years, people’s MET-hrs of occupational activity fell 40% averagely, and male and female fell by 36% and 47% respectively. The ratio of population who exercises (cycling and walking) over 30 minutes everyday decreased from 46-51% in 1997 to 28-33% in 2006.Fourthly, from 1991 to 2006 male and female average body weight increased 7.5kg and 4.6kg respectively, and male and female BMI all increased continually. In the 15 years, male and female BMI increased 2.0 kg/m2and 1.2 kg/m2 respectively. In 2006, the overweight/obesity rate (BMI>24) between male and female reached 38.5% and 36.0% respectively, it is 2.1 times and 1.7 times in 1991 In 2006, the rate of high blood pressure between male and female reached 23.7% and 18.6% respectively, it is 1.6 times and 1.4 times in 1991 respectively. In 2006, male and female central obesity rate reached 45.6% and 48.6% respectively, it is 2.3 times and 1.7 times in 1991 respectively.Fifthly, the prediction result of cereal food in 2010 and 2020 is that, citizen is 311g/day and 257g/day, suburban is301g/day and 252g/day, county residents is 362 g/day and 314 g/day and Rural residents is 426g/day and 353g/day. The prediction result of fruit food in 2010 and 2020 is that, citizen is 130g/day and 310g/day, suburban is 106g/day and 237g/day, county residents is 54g/day and 139g/day and rural residents is 39g/day and 140g/day. The prediction result of meat food in 2010 and 2020 is that, citizen is 99g/day and 95g/day, suburban is 105g/day and 90g/day, county residents is 107 g/day and 103 g/day and urban residents is 79g/day and 108g/day. The prediction result of seafood in 2010 and 2020 is that, citizen is 47g/day and 63g/day, suburban is 59g/day and 87g/day, county residents is 45g/day and 71 g/day and rural residents is 45g/day and 61 g/day. The prediction result of milk food in 2010 and 2020 is that, citizen is 69g/day and 109g/day, suburban is 44g/day and 103g/day, county residents is 33 g/day and 79 g/day and rural residents is 6g/day and 18g/day. The prediction result of cooking oil in 2010 and 2020 is that, citizen is 45g/day and 50g/day, suburban is 45g/day and 45g/day, county residents is 43 g/day and 47 g/day and rural residents is 45g/day and 55g/day. The prediction result of beans food in 2010 and 2020 is that, citizen is 22g/day and 22g/day, suburban is 21 g/day and 22g/day, county residents is 20 g/day and 21 g/day and rural residents is 19g/day and 18g/day.Sixthly, There’s an association between community urbanization index and residents’food consumption and food consumption behavior. The higher the community urbanization index is, the larger the probability of consuming animal food and edible oil will be, so the consumption of animal food and edible oil is large.Seventhly, income increased is the negative effect of cereal consumption, the positive effect of animal foods and cooking oil consumption. In most food groups, income elasticity decreased. From an economic point of view, cereal food has already become the inferior goods in different income people. The fat intake will increase more quick in low income groups with the income increased.Eighthly, because of price effect, there is a complementary and substitute relationship in the different foods. Low income people are sensitive to the change of price. The price has affect the nutrients intake significantly.Ninthly, the marginal propensity to consume foods (MPC) decreases continually and the MPC of pork is the highest in the different foods.ConclusionFirstly, from 1991 to 2006, the diet quality among Chinese urban and rural residents has been improved significantly, but it still has many problems in diet structure and nutritional condition compared with recommended reference-standard from the dietary guidelines for Chinese residents. The decrease of physical activity and increase fat intake has reduced the increasing prevalance of NR-NCDs among Chinese residents.Secondly, the prediction results of future urban and rural residents’food consumption show that the unreasonable phenomenon of cooking oil, meat, beans and milk food consumption is still outstanding.Thirdly, economic factors have affect residents’food consumption significantly. In order to controlling the increasing prevalence of NR-NCDs, we suggest that government should make price intervention measures to control the pork and cooking oil intake.更多还原