Asia Pacific J Clin Nutr (1995) 4: 294-297

Studies on the relationship between changes in dietary patterns and health status

Zhao Faji, MD, Guo Junsheng, MD and Chen Hongchang, MD

Department of Public Health, Second Military Medical University, Shanghai, China

Presented at: The conference on healthy eating, aspartame and chronic non-communicable disease. In Beijing and Shanghai, 1994

---

In order to study the relationship between dietary composition and health and disease, we investigated retrospectively the changes in diet composition, health status and disease specific mortality of the Shanghai population from 1950 to 1985. The results showed that remarkable changes occurred in dietary composition, health status and disease mortality. The energy from grain products decreased from 80-83% in the 1950s to 68-72% in the 1980s, and the energy from animal foods increased from 6.5-8.5% in the 1950s to 17.5-18.0% in the 1980s. With the changes in dietary composition, notable changes also occurred in the nutritional composition of the diet. From the 1950s to the 1980s, energy from fat was increased from 16.3-20.1% to 24.0-28.0%, and the energy from carbohydrates decreased from 72.0-73.5% to 62.2-65.8%. Almost certainly as a result of the changes in diet, health status and disease mortality also changed. For example, the average height in males of 18-20 years old increased from 164.89 cm in 1955 to 167.33 cm in 1974, and the average life span of males and females increased from 42.0 years and 45.6 years in 1950 to 72.1 years and 76.4 years in 1985, respectively. At the same time, the rank order of mortality causes also changed. Before 1950, the first three causes of death were measles, tuberculosis and senility, but in 1985 they were malignant tumours, cerebrovascular disease, and ischaemic heart disease. In particular, the mortality from ischaemic heart disease is now higher than in Japan. The causes of these changes may be the changes of dietary composition and nutritional composition of diet, although there are other factors. Therefore, changes in dietary composition which maintain or improve life expectancy, yet decrease the burden of chronic non-communicable disease is required.

---

Introduction

The dietary patterns in today's world may be divided into three types:

(1) Food consumption from both plant and animal origin is fairly optimal, and intakes of energy, protein and fat meet nutritional needs. A typical example is Japan. This type of dietary pattern not only includes some good points of the Western dietary style, but preserves many characteristics of the Eastern diet as well.

(2) The diet in the developed countries of Europe and America which consist of low intakes of plant food and high intakes of animal food, so that the intakes of energy, protein, and fat are all high. It may result in a r 1000 ange of chronic conditions such as obesity and cardiovascular diseases.

(3) The type of diet, which mainly consists of plant foods and is low in protein and fat, and which may result in nutritional deficiencies. It can be found in most developing countries including India, Indonesia, and Pakistan.

In order to study the relationship between dietary patterns and health status, we retrospectively investigated the change in dietary patterns of the Shanghai population.

Materials and methods

The data about changes in the dietary patterns were taken from "The Yearbook of Shanghai Statistics"¹. The eight categories of commonly consumed foods include: grain, edible vegetable oil, pork, poultry, fresh egg, seafood, fresh vegetable and sugar. Twenty-six kinds of foods were assigned to them, according to the dietary habits of Shanghai inhabitants. These foods were identified in a recent survey.

The standard population was derived from population surveys in 1953, 1964, and 1982, inclusive of a projected 10 % itenerant population. This standard population was based on age, gender and stature of adult males with low physical activity^2,3. Such a person’s daily average food consumption, energy and nutrient intake, the composition of the food and its proportion of energy sources, as well as the intake of protein from vegetable or animal sources, were calculated. These calculations were based on the food consumption survey each year for that standard population. All statistical data about health and disease have been published by the Shanghai Statistics Bureau and Shanghai Public Health Bureau. To ascertain its accuracy, our data was compared with the results of an investigation in 1982. The two data sets were in close agreement.

Results

Changes in food consumption

Consumption of sucrose and foods of animal origin were significantly increased yearly except in 1960. However, consumption of grain and vegetables rose slightly. If consumption in 1950 was 100, then for meat, egg, seafood and sucrose in 1985 it was 281, 492, 291 and 282, respectively (Fig. 1). Regarding food composition, energy from grain products in 1950 was 80% and from animal food was 8.5%, whereas in 1985 they were 68% and 17.5%, respectively. This change was similar to the trend of food composition changes in Japan after the Second World War^4,5 but the consumption levels of foods from animal sources including meats, eggs, seafood and milk products were one tenth of that in European and American countries and Australia and one third of that in Japan. It was similar to the dietary pattern found in developing countries (Table 1).

Table 1: Comparison of food consumption between Shanghai population and other world regions (g/daily per person)

Regions	Year	Grain	Vegetable	Meat	Egg	Seafood	Milk 1000	Fat	Sucrose
North America	1978	205	231	298	40	21	738	58	143
South America	1978	295	131	209	15	12	372	31	116
Europe	1978	215	221	216	38	42	879	52	109
Australia	1977-1978	216	256	322	1000 37	15	964	23	122
Asia	1975-1980	442	192	24	14	57	74	18	45
Japan	1980	330	308	61	40	95	170	38	63
China	1982	527	309	39	9	11	8	17	7
Shanghai	1980-1985	486	216	67	16	29	7	20	15

Notes: North America: USA and Canada; South America: Brazil and Argentina; Europe: Britain, France, West Germany, Austria, Denmark, Norway, Sweden, Switzerland and Spain; Australia: Australia and New Zealand; Asia: India, South Korea and Japan

Figure 1. Mean food consumption/ capita/ day

Change in intakes of energy and nutrients

With the change of food consumption, the intake of energy and nutrients change. There is a trend for an annual increase in energy and nutrient intake (Table 2). Compared with the Chinese RDA⁶, the energy intake in 1985 was 104% of the RDA; intakes of protein, calcium and iron were 87%, 49% and 178% of the RDA, respectively; vitamin A, thiamine, riboflavin, niacin and ascorbic acid intakes were 90%, 128%, 58%, 168% and 177%, respectively. It illustrates that the intakes of protein, calcium and riboflavin were below the Chinese RDA, especially for calcium and riboflavin.

Table 2. Energy and nutrition intakes/ capita/ day in Shanghai (1950- 1985)

Year	Energy	Protein	Fat	Carbo	Calcium	Iron	Vit A	Vit B1	Vit B2	Niacin	Vit C
	(kcal)	(g)	(g)	(g)	(mg)	(mg)	(m g***)	(mg)	(mg)	(mg)	(mg)
1950	1780	43.1	39.7	312	227	14	333.9	1.08	0.44	14.83	52.8
1955	1970	50.1	35.7	61	308	17	500.1	1.20	0.52	16.86	80.7
1960	1718	41.9	25.9	268	342 1000	20	733.2	1.18	0.50	17.34	138.4
1965	1737	45.8	38.8	300	376	17	731.0	1.10	0.50	15.19	116.9
1970	1789	47.2	41.7	305	388	18	746.1	1.13	0.56	15.57	121.1
1975	1951	50.0	52.0	320	371	18	687.4	1.26	0.57	16.72	111.5
1980	2268	58.1	61.5	370	396	20	731.5	1.46	0.66	19.24	113.2
1985	2497	61.1	77.6	388	392	21	721.6	1.54	0,70	20.15	106.4
1982*	2337	72.0	63.0	365	610	24	497.0	2.00	1.00	17.00	115.0
RDA**	2400	70.0	--	--	800	12	800.0	1.20	1.20	12.00	60.0

* From data of nutrition survey in Shanghai; ** RDA of China; *** Retinol equivalents

The composition of the macronutrients in foods changed considerably. The energy intake derived from fat increased each year, higher than the average values for other cities in China and for Japan in 1985 (Table 3). Animal fats increased to 55% of total fats, higher than the average values for other cities in China, the world, Asia and developing counties (Table 4). The ratio of P to S (polyunsaturated to saturated fatty acids) changed from 1.644 in 1950 to 1.083 in 1985. During the same period, the quality of dietary proteins improved yearly, which was reflected by increased intakes of animal proteins each year except in 1960. In 1985, it increased to 23.36%, which was higher than the average level for Asian and developing countries.

Table 3. Energy distribution in Shanghai (% total energy) 1000 Year Protein Fat Carbohydrate 1950 9.7 20.1 72.0 1955 10.2 16.3 73.5 1960 10.8 12.0 77.2 1965 10.5 20.1 69.4 1970 10.6 21.0 68.4 1975 10.2 24.0 65.8 1980 10.2 24.0 65.8 1985 9.8 28.0 62.2 Mean value of cities other than Shanghai 10.25 20.69 69.29

Table 4. Fats from plants and animals sources

Year	Total	Animal source		Plant source
	(g)	Weight(g)	%	Weight(g)		%
1950	39.68	14.16	35.69	25.52		64.31
1955	35.73	11.27	31.54	24.46		68.46
1960	25.87	3.60	13.92	22.27		86.08
1965	38.79	18.95	48.85	19.84		51.15
1970	41.66	22.27	53.46	19.38		46.54
1975	52.04	33.60	64.57	18.44		35.43
1980	61.53	39.21	63.71	22.31		36.29
1985	77.61	42.70	55.02	34.91		44.98
China 1982	68.20	31.78	46.60	36.42		53.40
World 1979-81	63.40	32.97	52.00	30.43		48.00
Asia 1979-81	38.70	15.79	40.80	22.91		59.20
Countries:
Developed 1979-81	120.40	80.07	66.50	40.33		33.50
Developing 1979-81	40.60	15.87	39.10	24.73		60.90

Changes in health and diet-related diseases

Changes in health and diet-related diseases of the Shanghai population came with changes in their dietary composition and nutrient intake, however, there were other health-influencing factors. All these changes had both beneficial as well as adverse effects on health. The benefits were evidenced mainly by developmental growth and life expectancy. The height and body weight of 18-20 year old males in 1955 were 164.89 cm and 53.45 kg, respectively, and those in 1974 were increased to 167.33 cm and 55.22 kg, respectively. The life expectancies of Shanghai males and females in 1950 was 42.0 and 45.6, respectively, and improved significantly, reaching 75.1 in males and 76.4 in females. The prevalence of changes in mortality from diseases also changed prominently (Figure 2).

Figure 2. Mortality rate in Shanghai

Malignant tumours, cerebrovascular disease, and heart disease have become the three leading causes of death for the Shanghai population. This closely resembles some developed countries and in Japan after the Second World War. The mortality of heart disease is mostly associated with diet and nutrition and was lower than in developed countries, but higher than in Japan. The result 1000 s from stepwise regression analysis about the above three diseases with food categories and dietary composition are shown in Table 5 and Table 6. There was a significant positive correlation (P<0.01) between consumption of meats, eggs, sucrose, and saturated fatty acids and malignant tumours, heart disease and cerebrovascular disease. Discussion Since the founding of the People’s Republic of China, the dietary patterns of the Shanghai population have changed considerably. The consumption of sucrose, foods from animal origin including eggs, meats and seafood increased yearly, but grain consumption declined each year. Although the trend of changes in dietary pattern was similar to that which occurred in Japan after the Second World War, the composition of food from animal sources was still lower than in Japan, especially milk and seafood. For example, the consumption of milk products by the Shanghai population was only 4.1% of that in Japan. As to the proportions of foods from animal sources, the diets of Shanghai inhabitants were mainly meats, especially pork, which was 56% of total foods of animal origin, whereas eggs, milk and seafood were 13.4%, 24.4.% and 6.0%, respectively. However, meats in the diet of Japanese people were only 16.7% of total foods of animal origin; eggs, milk and seafood were 10.9%, 46.4% and 26.0%, respectively. The changes in dietary composition in the Shanghai population mentioned above resulted in nutritional changes. It was noticed that the intake of fats, especially saturated fatty acids, increased markedly; however, the intakes of protein, calcium, vitamin A and riboflavin were still insufficient. Intake of fats was lower than the average value in developed countries, but higher than the average values for cities in China (other than Shanghai), the world, Asia, and developing countries. The energy intake from fats in 1985 increased to 28% of total energy, which was higher than the average values for cities in China (except Shanghai) or in Japan. This situation was clearly associated with dietary changes which contained a large amount of animal foods, especially pork.

Table 5. The relationship between the kind of foods and diseases correlation coefficient 1000 Food Heart Disease Cerebrovascular Disease Malignant Disease Cereals -0.2009 -0.4542 -0.6067 Vegetables -0.0920 0.1124 0.1340 Meat and Poultry 0.9008* 0.8036* 0.7461* Eggs 0.7892* 0.4996 0.4929 Sugar 0.9359* 0.8460* 0.7871* Table 6. The relationship between nutrient intake and disease Y = -7.8538 + 4.2654 X1 + 0.2349 X2 Y: Mortality of heart disease (1/ 105) X1: Saturated fat X2: Cholesterol Y = 70.781 + 3.8212 X1 - 21.5971 X2 Y: Mortality of cerebrovascular disease (1/105) X1: Saturated fat X2 Polyunsaturated fat/ saturated fat (P/S) Y = 172.4629 - 0.4605 X1 + 9.3315 X2 Y: Mortality and malignant tumours (1/105) X1: Carbohydrate 1000 X2 : Saturated fat

Although these changes in dietary composition and nutritional intake had an important role in health improvement of the Shanghai population, there were some adverse health effects. Mortality from malignant tumours, heart disease and cerebrovascular disease increased yearly, and they have now become the three major causes of death. There were certainly other factors influencing health. However, the change in dietary composition and nutritional intake must have been important factors. The characteristics of the dietary and nutritional patterns in Shanghai show that either deficient or excess food and nutrient contents may cause disease. There is an urgent need to modify the dietary pattern, and we suggest the following nutritional goals for the population:

1. Adequately increase the intake of foods from animal sources to supply high-quality protein, calcium, vitamin A and riboflavin. The daily average of a person’s animal-derived food intake should not exceed 200 grams (119g in 1985).
2. Reduce the intake of fats, especially saturated fatty acids (for example, reduce the intake of pork, presuming it to be dominantly saturated, and increase the intake of milk and seafood).
3. Increase the intake of soybean and its products to improve the quality of protein and supply calcium. It has been generally accepted that soybean, which contains 40% of protein, is an ideal nutritional source of proteins. Soybean and its products would supply both the good quality and large quantity of proteins.
4. Increase the intake of vegetables, especially green leafy vegetables, to compensate for shortages of carotene, ascorbic acid and folic acid.
5. Keep or slightly lower the present intake of grain (from the present levels in China) to prevent adverse health effects which were produced by the dietary patterns in Europe and America and to preserve the beneficial aspects of the Chinese dietary pattern.

---

Studies on the relationship between changes in dietary patterns and health status

Zhao Faji, Guo Junsheng and Chen Hongchang

Asia Pacific Journal of Clinical Nutrition (1995) Volume 4, Number 3: 294-297

---

References:

1. Shanghai Statistics Bureau. The total retail amounts of the major consumer’s goods. In: The Yearbook of Shanghai Statistics. Shanghai. People’s Publishing House of Shanghai, 1986; 288-289.
2. Shanghai Statistics Bureau. Population. In: The Yearbook of Shanghai Statistics. Shanghai. People’s Publishing House of Shanghai, 1986; 54, 63-65.
3. Chen XC, Zhao FJ. The methods for dietary survey in the whole country or regions. In: Nutritional Survey Beijing People’s Publishing House of Health, 1987; 90-91.
4. The relationship between the changes of Japanese dietary patterns and nutrtional status. Clinical Nutrition (Rinshe Eeyo) 1985; 66: 21.
5. The relationship between dietary pattern and disease distribution in our country. Ibid, 1985; 66: 29.
< 2eb li>Chinese Nutrition Society. Illustration of the recommended Dietary Allowance of Chinese. Acta Nutrimenta Sinica 1990; 12: 1-9.

Copyright © 1995 [Asia Pacific Journal of Clinical Nutrition]. All rights reserved.
Revised: January 19, 1999 .

 

0