中国成年居民在外就餐变化趋势及对营养状况的影响
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摘要
研究背景
在外就餐的流行是全球营养变迁中的一个重要特征,尤其在目前的发展中国家,在外就餐对营养状况的影响愈加明显。在外就餐的食物特点通常表现为高能量、高脂肪、低碳水化合物和低微量营养素,经常在外就餐会降低居民的膳食质量和增加超重、肥胖的危险性。目前,关于在外就餐对中国成年居民营养状况的影响及其时间变化趋势的研究甚少。
研究目的
本研究旨在了解我国成年居民在外就餐的变化趋势,分析在外就餐食物的营养特点及对成年居民膳食能量和主要营养素摄入的影响,探讨在外就餐对成年居民超重肥胖的影响,以及研究我国成年居民在外就餐的影响因素。
研究内容与方法
研究数据来源于“中国健康与营养调查”项目1991-2011年九省区和2011年三个直辖市调查的18-80岁成年居民,剔除孕妇和慢性病患者,以及关键分析变量记录不完整者。定义家庭以外地点烹调制作的食物为“在外就餐食物”,计算在外就餐食物供能比。分析在外就餐食物供能比的变化趋势,在外就餐食物的营养特点,以及在外就餐食物供能比对膳食能量及主要营养素摄入的影响。选取2004-2009年至少参加过两轮调查,并有完整数据的研究对象,作为纵向追踪研究的分析对象,采用随机截距发展模型和多水平Logistic回归模型探讨在外就餐食物供能比与超重肥胖及中心性肥胖的关系,以及我国成年居民在外就餐食物供能比的影响因素。
研究结果
1.1991-2011年间,我国九省区成年居民营养相关慢性病患病率显著增加。超重率从19.6%增加到32.0%,肥胖率从3.1%增加到11.6%,中心性肥胖率从12.1%增加到37.1%。
2.1991-2011年九省区成年居民在外就餐食物供能比从8.6%升至16.5%,其中城市居民从12.1%升至20.3%,农村居民从6.9%升至14.7%。2011年加入调查的三个直辖市成年居民在外就餐食物供能比为25.4%,其中城市地区为27.2%,农村地区为21.3%,远高于其他省区的水平。二十年间,城乡居民在外就餐食物供能比的相对差距呈现缩小的趋势,尤其是女性居民变化更为明显。
3.在外就餐食物与在家就餐食物相比,营养特点呈现出地区和年龄差异,不同餐次(早、中、晚)也有不同的特点。总体来说,在外就餐食物的能量、脂肪和蛋白质(早餐除外)密度较高,而碳水化合物、膳食纤维、维生素A、维生素C和钙的密度较低。在外就餐时,成年居民会更常消费面粉及其制品、油炸食品、高脂肪红肉、奶类、酒类和快餐食品等,而相对较少消费米类、豆类、蛋类、蔬菜类、根茎类、粗粮及其制品和鱼类等。
4.在外就餐食物供能比与较高的脂肪和蛋白质摄入,以及较低的碳水化合物和维生素C摄入有关,农村居民在外就餐食物供能比还与膳食高能量摄入有关。
5.控制其他相关变量后,男性在外就餐食物供能比高者,发生超重肥胖和中心性肥胖的危险性增加；女性在外就餐食物供能比与超重肥胖和中心性肥胖的关系均不显著。
6.我国成年居民在外就餐的影响因素存在地区及性别差异。城市居民在外就餐食物供能比2009年已趋于稳定,而农村居民在外就餐食物供能比仍处于上升趋势。年龄、教育程度、收入、饮酒、社区食物环境等是我国成年居民在外就餐的影响因素。
结论
1991-2011年的二十年间,我国成年居民在外就餐食物供能比显著增加,但城乡及地区间差异逐渐缩小。在外就餐食物的营养特点和食物选择偏好与在家就餐存在明显不同。在外就餐更多选择高能量和高脂肪食物,较少选择高碳水化合物、高膳食纤维和高维生素C的食物。在外就餐食物供能比与男性成年居民超重肥胖和中心性肥胖危险性增加有关。我国成年居民在外就餐与年龄、教育程度、收入、饮酒和社区食物环境等因素有关。
Background
Increasing prevalence of eating away from home has been one of the most primary characteristics in global nutrition transition, especially for developing countries. Away from home foods are generally high in energy and fat, while low in carbohydrate and micronutrients. Frequent eating away from home will decrease dietary quality and increase risks of overweight and obesity. However, little has been known on dynamics of eating away from home and its association with nutritional outcomes among Chinese adults.
Objectives
To understand the dynamics of eating away from home, as well as away from home foods'nutritional characteristics among Chinese adults and to examine the association of eating away from home and dietary intake; To investigate relations between eating away from home and overweight/obesity; To explore risk factors of eating away from home in China.
Methods
We used the data of adults aged18to80years from China Health and Nutrition Survey (1991-2011), excluding pregnant women and patients with chronic diseases, as well as those with incomplete data on key variables. We defined foods prepared away from home as "away from home foods"(AFHF) to examine trends of energy contribution from AFHF, and nutritional characteristics of AFHF, and effects of energy contribution from AFHF on dietary energy and nutrients intake. Random intercept growth model and multilevel logistic regression model were performed, using longitudinal data from individuals who were envolved in at least two waves of survey between2004and2009with complete data, to explore association between energy contribution from AFHF and overweight/obesity, as well as potential risk factors of eating away from home.
Results
1. Prevalence of nutrition related chronic diseases increased dramatically during the period from1991to2011. Prevalence rate of overweight, general obesity and central obesity increased from19.6%,3.1%and12.1%to32.0%,11.6%and37.1%, respectively.
2. The energy contribution from AFHF among adults in nine provinces from1991to2011increased from8.6%to16.5%, with urban adults increased from12.1%and20.3%, and rural adults increased from6.9%to14.7%, while that among adults in2011three municipalities was25.4%, with27.2%in urban area and21.3%in rural area, both higher than nine provinces. In the past two decades, urban-rural disparities of the energy contribution from AFHF decreased, especially among females.
3. Compared to foods at home (FAH), nutritional characteristics of AFHF demonstrated disparities in area, age and meal time (breakfast, lunch, supper). In general, AFHF were higher in energy, fat and protein (except breakfast), while lower in carbohydrate, fiber, vitamin A, vitamin C and calcium. When eating away from home, adults preferred to choose more wheat and products, fried foods, fatty meat, milk, alcohol and fast foods, while less rice, legumes, eggs, vegetables, starchy roots and tubers, coarse grains and fish.
4. The energy contribution from AFHF was related to higher fat and protein intake, while lower carbohydrate and vitamin C intake. In addition, the energy contribution from AFHF among rural adults was also related to higher dietary energy intake.
5. After controlling for other relevant variables, the higher energy contribution from AFHF was positively associated with increased risk of overweight, general obesity and central obesity among males, while no significant association was found among females.
6. Potentially influencing factors of eating away from home for Chinese adults differed on areas and genders. The energy contribution from AFHF tended to be stable in2009among urban adults, while that among rural adults was still increasing. It was found that, age, educational level, income, drinking and neighborhood food environment were all influencing factors of eating away from home among Chinese adults.
Conclusion
During the past two decades, from1991to2011, the energy contribution from AFHF increased dramatically, while urban-rural disparities decreased. AFHF had significant differences with FAH on nutritional characteristics and food preference. Generally, AFHF were high in energy and fat, while lower in carbohydrate, fiber and vitamin C. Higher energy contribution from AFHF would increase risks of overweight, general obesity and central obesity among males. The energy contribution from AFHF was associated with age, education level, income, drinking and neighborhood food environment among Chinese adults.
在外就餐的流行是全球营养变迁中的一个重要特征,尤其在目前的发展中国家,在外就餐对营养状况的影响愈加明显。在外就餐的食物特点通常表现为高能量、高脂肪、低碳水化合物和低微量营养素,经常在外就餐会降低居民的膳食质量和增加超重、肥胖的危险性。目前,关于在外就餐对中国成年居民营养状况的影响及其时间变化趋势的研究甚少。
研究目的
本研究旨在了解我国成年居民在外就餐的变化趋势,分析在外就餐食物的营养特点及对成年居民膳食能量和主要营养素摄入的影响,探讨在外就餐对成年居民超重肥胖的影响,以及研究我国成年居民在外就餐的影响因素。
研究内容与方法
研究数据来源于“中国健康与营养调查”项目1991-2011年九省区和2011年三个直辖市调查的18-80岁成年居民,剔除孕妇和慢性病患者,以及关键分析变量记录不完整者。定义家庭以外地点烹调制作的食物为“在外就餐食物”,计算在外就餐食物供能比。分析在外就餐食物供能比的变化趋势,在外就餐食物的营养特点,以及在外就餐食物供能比对膳食能量及主要营养素摄入的影响。选取2004-2009年至少参加过两轮调查,并有完整数据的研究对象,作为纵向追踪研究的分析对象,采用随机截距发展模型和多水平Logistic回归模型探讨在外就餐食物供能比与超重肥胖及中心性肥胖的关系,以及我国成年居民在外就餐食物供能比的影响因素。
研究结果
1.1991-2011年间,我国九省区成年居民营养相关慢性病患病率显著增加。超重率从19.6%增加到32.0%,肥胖率从3.1%增加到11.6%,中心性肥胖率从12.1%增加到37.1%。
2.1991-2011年九省区成年居民在外就餐食物供能比从8.6%升至16.5%,其中城市居民从12.1%升至20.3%,农村居民从6.9%升至14.7%。2011年加入调查的三个直辖市成年居民在外就餐食物供能比为25.4%,其中城市地区为27.2%,农村地区为21.3%,远高于其他省区的水平。二十年间,城乡居民在外就餐食物供能比的相对差距呈现缩小的趋势,尤其是女性居民变化更为明显。
3.在外就餐食物与在家就餐食物相比,营养特点呈现出地区和年龄差异,不同餐次(早、中、晚)也有不同的特点。总体来说,在外就餐食物的能量、脂肪和蛋白质(早餐除外)密度较高,而碳水化合物、膳食纤维、维生素A、维生素C和钙的密度较低。在外就餐时,成年居民会更常消费面粉及其制品、油炸食品、高脂肪红肉、奶类、酒类和快餐食品等,而相对较少消费米类、豆类、蛋类、蔬菜类、根茎类、粗粮及其制品和鱼类等。
4.在外就餐食物供能比与较高的脂肪和蛋白质摄入,以及较低的碳水化合物和维生素C摄入有关,农村居民在外就餐食物供能比还与膳食高能量摄入有关。
5.控制其他相关变量后,男性在外就餐食物供能比高者,发生超重肥胖和中心性肥胖的危险性增加；女性在外就餐食物供能比与超重肥胖和中心性肥胖的关系均不显著。
6.我国成年居民在外就餐的影响因素存在地区及性别差异。城市居民在外就餐食物供能比2009年已趋于稳定,而农村居民在外就餐食物供能比仍处于上升趋势。年龄、教育程度、收入、饮酒、社区食物环境等是我国成年居民在外就餐的影响因素。
结论
1991-2011年的二十年间,我国成年居民在外就餐食物供能比显著增加,但城乡及地区间差异逐渐缩小。在外就餐食物的营养特点和食物选择偏好与在家就餐存在明显不同。在外就餐更多选择高能量和高脂肪食物,较少选择高碳水化合物、高膳食纤维和高维生素C的食物。在外就餐食物供能比与男性成年居民超重肥胖和中心性肥胖危险性增加有关。我国成年居民在外就餐与年龄、教育程度、收入、饮酒和社区食物环境等因素有关。
Background
Increasing prevalence of eating away from home has been one of the most primary characteristics in global nutrition transition, especially for developing countries. Away from home foods are generally high in energy and fat, while low in carbohydrate and micronutrients. Frequent eating away from home will decrease dietary quality and increase risks of overweight and obesity. However, little has been known on dynamics of eating away from home and its association with nutritional outcomes among Chinese adults.
Objectives
To understand the dynamics of eating away from home, as well as away from home foods'nutritional characteristics among Chinese adults and to examine the association of eating away from home and dietary intake; To investigate relations between eating away from home and overweight/obesity; To explore risk factors of eating away from home in China.
Methods
We used the data of adults aged18to80years from China Health and Nutrition Survey (1991-2011), excluding pregnant women and patients with chronic diseases, as well as those with incomplete data on key variables. We defined foods prepared away from home as "away from home foods"(AFHF) to examine trends of energy contribution from AFHF, and nutritional characteristics of AFHF, and effects of energy contribution from AFHF on dietary energy and nutrients intake. Random intercept growth model and multilevel logistic regression model were performed, using longitudinal data from individuals who were envolved in at least two waves of survey between2004and2009with complete data, to explore association between energy contribution from AFHF and overweight/obesity, as well as potential risk factors of eating away from home.
Results
1. Prevalence of nutrition related chronic diseases increased dramatically during the period from1991to2011. Prevalence rate of overweight, general obesity and central obesity increased from19.6%,3.1%and12.1%to32.0%,11.6%and37.1%, respectively.
2. The energy contribution from AFHF among adults in nine provinces from1991to2011increased from8.6%to16.5%, with urban adults increased from12.1%and20.3%, and rural adults increased from6.9%to14.7%, while that among adults in2011three municipalities was25.4%, with27.2%in urban area and21.3%in rural area, both higher than nine provinces. In the past two decades, urban-rural disparities of the energy contribution from AFHF decreased, especially among females.
3. Compared to foods at home (FAH), nutritional characteristics of AFHF demonstrated disparities in area, age and meal time (breakfast, lunch, supper). In general, AFHF were higher in energy, fat and protein (except breakfast), while lower in carbohydrate, fiber, vitamin A, vitamin C and calcium. When eating away from home, adults preferred to choose more wheat and products, fried foods, fatty meat, milk, alcohol and fast foods, while less rice, legumes, eggs, vegetables, starchy roots and tubers, coarse grains and fish.
4. The energy contribution from AFHF was related to higher fat and protein intake, while lower carbohydrate and vitamin C intake. In addition, the energy contribution from AFHF among rural adults was also related to higher dietary energy intake.
5. After controlling for other relevant variables, the higher energy contribution from AFHF was positively associated with increased risk of overweight, general obesity and central obesity among males, while no significant association was found among females.
6. Potentially influencing factors of eating away from home for Chinese adults differed on areas and genders. The energy contribution from AFHF tended to be stable in2009among urban adults, while that among rural adults was still increasing. It was found that, age, educational level, income, drinking and neighborhood food environment were all influencing factors of eating away from home among Chinese adults.
Conclusion
During the past two decades, from1991to2011, the energy contribution from AFHF increased dramatically, while urban-rural disparities decreased. AFHF had significant differences with FAH on nutritional characteristics and food preference. Generally, AFHF were high in energy and fat, while lower in carbohydrate, fiber and vitamin C. Higher energy contribution from AFHF would increase risks of overweight, general obesity and central obesity among males. The energy contribution from AFHF was associated with age, education level, income, drinking and neighborhood food environment among Chinese adults.
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