Feng Jing is working on improving her mum’s diet. “My home town is in the western part of China,” she says. “In that area, people eat a lot of meat: around 80% of their diet is meat and wheat. So when people get to 60, they often get many diseases like diabetes.”
Jing, who is a freelance journalist and runs a nutrition podcast from her home in Shanghai in eastern China, says the diet books she gave her mother didn’t hit home at first. But change did happen, if slowly: after Jing’s mother visited Shanghai and stayed for a few months, she started eating more vegetables.
In Shanghai, Jing says, “she visits the wet market and can buy all kinds of vegetables. She’s a bit worried that when she gets back to her home town, she might not find so many”.
Jing’s mother is an exception. In general, people in China are failing to finish the greens on their plates. The country’s middle class is enjoying a rapid rise, with more access to junk-food suppliers and less focus on healthy eating. These changes in diet are making themselves known in the country’s health demographics.
Since China’s economic reform in the late 1970s, people’s disposable income — the amount of money left to spend and save after taxes — has increased by more than 130 times for both rural and urban households (not taking inflation into account). In 1978, an urban household had an average of 343 yuan (US$202 at the time) in disposable income. By 2021, it was more than 47,000 yuan ($7,288 at 2021 rates; see ‘Money to spend’). The growth in income led to a richer middle class and a dietary shift in both rural and urban China.
“Over the past 40–50 years, the population’s overall nutritional intake has increased,” says Lijing Yan, a global-health researcher at Duke Kunshan University near Suzhou, China. “The consumption of meat, oil and sugar increased, and the trend is similar for both urban and rural residents,” she says.
Chinese people are consuming significantly more meat than they did 30 years ago. It is estimated that the average rural person ate about 12 kilograms of meat in 1990, a figure that had more than tripled by 2021. Over the past 30 years, both urban and rural households saw a reduction in overall grain consumption — of 35% in rural communities and 4.5% in urban ones — as other foods became more prominent (see ‘A changing plate’).
National nutrition surveys have estimated that the average energy intake from carbohydrates declined from 62.6% in 1991 to 50.6% in 2015, and during the same period, the average proportion of energy intake from fat grew from 24.0% to 35.8% — a figure similar to that in Western countries such as the United States.
China has one of the highest proportions worldwide of overweight and obesity among children under five. About 8.3% of people of this age group in China — roughly 5 million children — were overweight or obese in 2020, and the proportion is still rising. The figure is greater than in countries such as Brazil (7.3%) but slightly smaller than in the United States, where the proportion is 8.8%. The global figure is 5.7% (see ‘Growing pains’).
According to the World Health Organization, childhood obesity is associated with a higher risk of breathing problems and fractures, and a greater chance of disability and premature death in adulthood.
People in China have one of the world’s highest salt intakes. On average, adults consume almost 11 grams per day (see ‘A pinch or a pound’). The World Health Organization recommends that adults limit salt intake to less than 5 grams a day. Increased levels can lead to high blood pressure, which is associated with many cardiovascular diseases, including heart attack and stroke.
Monique Tan, a public-health researcher at the Queen Mary University of London, says China’s high intake is partly a result of its tradition of consuming vegetables preserved in salt. Moreover, she says, the increase in consumption of processed and restaurant foods is a concern.
In China, cardiovascular disease (CVD) affects more than 300 million people. CVD is the leading cause of death, accounting for 40% of mortality in the country. Between 1990 and 2015, case rates of CVD almost doubled in China (see ‘On the pulse’). Acknowledging the severity of the challenge, the Chinese government has made CVD control a priority in its national health-care blueprint, known as Healthy China 2030, which it announced in 2016.
The government has pledged to reduce the mortality rate of CVD by more than half by 2030 — to less than 190.7 deaths per 100,000 people.