Burden of Nutritional Deficiencies among Children and Adolescents Aged 0 to 19 Years in China, 1990 to 2015
Nutritional deficiencies pose a significant public health challenge in low- and middle-income countries. In China, where rapid socioeconomic development has transformed health landscapes, understanding the burden of nutritional deficiencies among children and adolescents remains critical for informed policy-making. This study leverages data from the Global Burden of Disease, Injuries, and Risk Factors Study 2015 (GBD 2015) to analyze trends in the burden of nutritional deficiencies among individuals aged 0–19 years from 1990 to 2015, providing a national perspective on age-, gender-, and region-specific disparities.
Key Definitions and Methodological Framework
The study defines nutritional deficiencies as conditions including protein-energy malnutrition (PEM), iron deficiency anemia (IDA), iodine deficiency, and other micronutrient deficiencies. These were classified using International Classification of Diseases (ICD) codes (ICD-9 and ICD-10). Data were derived from the GBD 2015, which employs standardized analytical methods to estimate prevalence, mortality, and disability metrics across populations. Disability-adjusted life years (DALYs)—a composite measure of years of life lost (YLLs) and years lived with disability (YLDs)—were used to quantify disease burden. Age standardization was performed using the World Health Organization (WHO) world population standard to enable comparisons over time and across regions.
China’s three major regions—eastern, central, and western—were analyzed to assess geographical disparities. Age groups were stratified into <5 years, 5–9 years, 10–14 years, and 15–19 years. Metrics included age-standardized prevalence, mortality rates, YLD rates, YLL rates, and DALY rates. Data were analyzed for 1990, 1995, 2000, 2005, 2010, and 2015 to evaluate temporal trends.
Temporal Trends in Nutritional Deficiency Burden
From 1990 to 2015, China achieved substantial reductions in the burden of nutritional deficiencies among children and adolescents. The age-standardized prevalence declined by 7.03%, from 22.20% to 20.64%, while the mortality rate plummeted by 93.80%, from 6.13 to 0.38 per 100,000. Similarly, the age-standardized DALY rate fell by 38.97%, from 1,448.45 to 884.00 per 100,000. This progress reflects improvements in healthcare access, socioeconomic conditions, and targeted nutrition interventions.
Gender-Specific Disparities
Gender disparities were evident in both prevalence and DALY rates. Males consistently exhibited higher age-standardized prevalence (23.80% vs. 16.99% in 2015), YLD rates (1,016.58 vs. 661.42 per 100,000), and DALY rates (1,039.64 vs. 703.42 per 100,000) compared to females. However, females experienced a greater relative reduction in DALY rates (−51.01% vs. −28.95% for males) over the 25-year period. The higher burden among males may stem from physiological demands during growth spurts, coupled with lower awareness of nutritional needs.
Age-Related Variations
Children under five years old faced the highest mortality and YLL rates due to the acute consequences of conditions like PEM. However, the largest declines in DALY rates occurred in this age group (−71.42%), attributable to national programs addressing child malnutrition. By contrast, adolescents aged 15–19 years exhibited the lowest overall DALY rates, though their progress was slower. Children aged 5–9 years had the highest prevalence (25.59%), YLD rates (1,272.15 per 100,000), and DALY rates (1,278.52 per 100,000), reflecting the persistent impact of deficiencies like IDA on school-aged populations.
Regional Disparities
Geographical analysis revealed uneven progress across regions. The western region, historically disadvantaged, demonstrated the steepest decline in age-standardized DALY rates (−51.42%), surpassing reductions in eastern (−35.81%) and central (−34.46%) regions. By 2015, the western region’s DALY rate (742.18 per 100,000) was lower than those in the east (927.10) and center (946.64). This shift likely reflects targeted poverty alleviation and nutrition programs in western provinces.
Subtype-Specific Burden
Nutritional deficiency subtypes exhibited distinct trajectories. IDA accounted for the highest DALY rate in 2015 (787.21 per 100,000), underscoring its persistent burden despite overall progress. PEM, while showing the steepest decline in DALY rates (−85.06%), remained a concern, particularly among children under five. Compared to high-income Asian nations like Japan and South Korea, China’s DALY rates for IDA and PEM were markedly higher, highlighting unresolved challenges.
Protein-Energy Malnutrition (PEM)
PEM-associated DALY rates fell from 1,068.36 to 159.46 per 100,000 between 1990 and 2015 (−85.06%). This dramatic reduction aligns with nationwide efforts to improve infant and child feeding practices, immunization coverage, and food security. However, residual cases persist in marginalized communities.
Iron Deficiency Anemia (IDA)
IDA remained the dominant subtype, with minimal reduction in YLD rates (−6.70%) compared to PEM. The age-standardized DALY rate for IDA was 787.21 per 100,000 in 2015, reflecting limited awareness and inadequate dietary diversification among adolescents.
Other Deficiencies
Iodine deficiency and other micronutrient deficiencies showed moderate declines, aided by salt iodization programs and supplementation campaigns. However, subclinical deficiencies continue to impair cognitive and physical development.
Drivers of Progress and Persistent Challenges
China’s progress stems from multisectoral strategies, including the National Nutrition Improvement Program, school meal initiatives, and prenatal care enhancements. The introduction of micronutrient-fortified foods, such as Yingyangbao (a nutrient supplement for infants), significantly reduced PEM in poverty-stricken areas.
Despite these gains, challenges persist. Regional disparities, particularly between urban and rural areas, underscore inequities in healthcare access. The stagnation in YLD rates for IDA suggests that interventions must address dietary quality and adolescent-specific needs. Additionally, data gaps—especially for adolescents—hinder targeted policymaking.
Methodological Considerations and Limitations
While GBD 2015 provides a robust framework, its reliance on disability weights derived from Western populations may introduce cultural biases. Furthermore, the underrepresentation of adolescent-specific data in global databases limits precision. Despite these constraints, the study offers valuable insights for prioritizing interventions.
Policy Implications and Future Directions
Sustaining progress requires reinforcing maternal and child health services, expanding school-based nutrition programs, and enhancing monitoring systems for micronutrient deficiencies. Addressing gender- and age-specific vulnerabilities, particularly among adolescent males and rural populations, is critical. Future research should prioritize high-resolution data collection to refine burden estimates and evaluate intervention efficacy.
In conclusion, China has made remarkable strides in reducing the burden of nutritional deficiencies among children and adolescents. However, the lingering effects of IDA, regional inequities, and demographic disparities demand continued vigilance. By building on past successes and addressing emerging challenges, China can further safeguard the health and potential of its youngest generations.
doi.org/10.1097/cm9.0000000000001748
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