The Development of a Chinese Healthy Eating Index and Its Application in the General Population
Abstract
:1. Introduction
2. Materials and Methods
2.1. The DGC-2016 and the Standard Portion (SP) Size
2.2. Participants and Dietary Assessment
2.3. Relevant Variables and Statistical Analysis
3. Results
3.1. Development of the Chinese Healthy Eating Index
3.1.1. Components
3.1.2. Weighting
3.1.3. Scoring
3.2. Application of the Chinese Healthy Eating Index
4. Discussion
5. Conclusions
Supplementary Materials
Acknowledgments
Author Contributions
Conflicts of Interest
References
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Components | Weighting | Key Recommendations | Comments | Key Evidence |
---|---|---|---|---|
Total Grains Whole Grains and Mixed Beans Tubers | 5 5 5 | Eat a variety of foods, cereal-based. Consume cereal at every meal. Increase intake of whole grains and mixed beans. Cook tubers in various forms to increase consumption. | Whole grains prevalent in China are coarse rice, whole wheat, corn, millet, buckwheat and oats. Mixed beans are rich in carbohydrates, including mung bean, red bean and kidney bean, etc. Tubers, such as potatoes, sweet potatoes and cassava, are also recommended as staple food for their high content of carbohydrates. | Consumption of whole grain reduces the risk of colorectal cancer, type 2 diabetes, cardiovascular disease and weight gain (B). Increased tuber intake reduces the risk of constipation (C). |
Total Vegetables Dark Vegetables Fruits Dairy Soybeans | 5 5 10 5 5 | Eat plenty of vegetables, fruits, dairy products, and soybeans. Eat vegetables every meal, and half should be dark vegetables. Every day consume fresh fruits rather than processed forms. Consume a variety of dairy. Consume soybeans regularly. Seeds and nuts are beneficial, but should not be consumed excessively. | Dark vegetables include deep green, orange, red and fuchsia vegetables, such as spinach, tomatoes, carrots, and purple cabbage. Cooked, canned, frozen, and dried fruits cannot replace fresh fruits. Yogurt or low-lactose dairy products should be the first choice for individuals with lactose intolerance. Although seeds and nuts are beneficial for health, excessive intake can lead to an excess of energy. | Total vegetable consumption reduces all causes of mortality and the risk of cardiovascular diseases (CVDs) and cancers of the digestive tract; intake of dark green vegetables lowers risks of type 2 diabetes and lung cancer (B). Increased fruit intake lowers the risk of CVDs, cancers of the digestive tract and adult weight gain (B). Low-fat milk consumption decreases the risk of breast cancer, and higher dairy intake is linked to higher bone mineral density (B). Soybean intake lowers the risks of breast cancer, osteoporosis, type 2 diabetes, hyperlipidemia and hypertension (B). Moderate intake of seeds and nuts decreases all causes of mortality and the risk of CVDs, hypertension, and colorectal cancer in women (B). |
Fish and Seafood Red Meat Poultry Eggs | 5 5 5 5 | Eat moderate amounts of fish, poultry, eggs, and lean meats. Choose fish, seafood and poultry. Decrease intake of fat meat and smoked meat products. | Adverse effects of excessively consuming red meat have been demonstrated. Eat egg with yolk. | Consumption of fish lowers risk of CVDs, stroke (B), cognitive decline and macular degeneration (C). Excessive intake of meat increases all-cause mortality in men and risk of type 2 diabetes, colorectal cancer (B), and obesity (C). Higher meat intake lowers risk of iron deficiency anemia (C). |
Cooking Oils Sodium Added Sugars Alcohol | 10 10 5 5 | Limit salt, cooking oil, added sugar, and alcohol. Limit cooking oils intake to 25–30g/day. Consume salt less than 6 g/day, and consume sodium less than 1500 mg/day. Limit intake of added sugars to less than 50 g/day. Children, adolescents, pregnant and lactating women should not consume alcohol; men (women) should limit alcohol intake to less than 25 g (15 g). | Cooking oils include plant oil and animal fat. The sodium component of the CHEI also includes sodium in sodium-rich foods (sodium content more than 500 mg/100 g). | Excessive consumption of any kind of fat increases energy intake and the risk of obesity (A). High consumption of sodium increases risk of hypertension (A), CVDs (C), stroke (B), gastric cancer (B). Overconsumption of added sugar increases risk of dental caries (B), weight gain (C), and hyperlipidemia (C). Excessive intake of alcohol rises risk of liver injury (A), gout (A), colorectal cancer (B), breast cancer (B), CVDs (B), and fetal alcohol syndrome (A). |
Food Group | Standard Portion per 1000 kcal | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Calorie Level (kcal) | 1000 | 1200 | 1400 | 1600 | 1800 | 2000 | 2200 | 2400 | 2600 | 2800 | 3000 |
Total Grains | 1.7 | 1.7 | 2.1 | 2.5 | 2.5 | 2.5 | 2.5 | 2.5 | 2.7 | 2.7 | 2.7 |
Whole Grains and Mix Beans | 0.6 | 0.8 | 1.0 | 1.1 | 1.3 | ||||||
Tubers | 0.3 | 0.3 | 0.4 | 0.3 | 0.4 | 0.5 | 0.4 | 0.4 | |||
Total Vegetables | 2.0 | 2.1 | 2.1 | 1.9 | 2.2 | 2.3 | 2.0 | 2.1 | 1.9 | 1.8 | 2.0 |
Dark Vegetables | 1.0 | 1.0 | 1.1 | 0.9 | 1.1 | 1.1 | 1.0 | 1.0 | 1.0 | 0.9 | 1.0 |
Fruits | 1.5 | 1.3 | 1.1 | 1.3 | 1.1 | 1.5 | 1.4 | 1.5 | 1.3 | 1.4 | 1.3 |
Dairy | 2.0 | 1.7 | 1.0 | 0.8 | 0.7 | 0.6 | 0.5 | 0.5 | 0.5 | 0.4 | 0.4 |
Soybeans | 0.3 | 0.6 | 0.5 | 0.5 | 0.4 | 0.4 | 0.6 | 0.5 | 0.5 | 0.4 | 0.4 |
Seeds and Nuts | 0.6 | 0.6 | 0.5 | 0.5 | 0.4 | 0.4 | 0.4 | 0.3 | |||
Fish and Seafood | 0.3 | 0.4 | 0.6 | 0.6 | 0.6 | 0.6 | 0.8 | 0.7 | 0.6 | 0.8 | 0.9 |
Meat and Poultry | 0.3 | 0.5 | 0.6 | 0.6 | 0.6 | 0.6 | 0.8 | 0.7 | 0.6 | 0.8 | 0.7 |
Eggs | 0.4 | 0.5 | 0.4 | 0.6 | 0.5 | 0.6 | 0.5 | 0.5 | 0.4 | 0.4 | 0.4 |
Cooking Oils (g/1000 kcal) | 15.0 | 16.7 | 14.3 | 15.6 | 13.9 | 12.5 | 11.4 | 12.5 | 11.5 | 10.7 | 11.7 |
Component | Score | ||
---|---|---|---|
0 | 5 | 10 | |
Adequacy | |||
Total Grains | 0 | ≥2.5 SP/1000 kcal | |
Whole Grains and Mixed Beans | 0 | ≥0.6 SP/1000 kcal | |
Tubers | 0 | ≥0.3 SP/1000 kcal | |
Total Vegetables | 0 | ≥1.9 SP/1000 kcal | |
Dark Vegetables | 0 | ≥0.9 SP/1000 kcal | |
Fruits | 0 | ≥1.1 SP/1000 kcal | |
Dairy | 0 | ≥0.5 SP/1000 kcal | |
Soybeans | 0 | ≥0.4 SP/1000 kcal | |
Fish and Seafood | 0 | ≥0.6 SP/1000 kcal | |
Poultry | 0 | ≥0.3 SP/1000 kcal | |
Eggs | 0 | ≥0.5 SP/1000 kcal | |
Seeds and Nuts | 0 | ≥0.4 SP/1000 kcal | |
Limitation | |||
Red Meat | ≥3.5 | ≤0.4 SP//1000 kcal | |
Cooking Oils | ≥32.6 | ≤15.6 g/1000 kcal | |
Sodium | ≥3608 | ≤1000 mg/1000 kcal | |
Added Sugars | ≥20% | ≤10% of energy | |
Alcohol | ≥25 g (men)/15 g (women) | ≤60 g (men)/40 g (women) |
Characteristics | CHEI Tertiles | ||||
---|---|---|---|---|---|
Total (n = 14,584) | Low (n = 4861) | Intermediate (n = 4862) | High (n = 4861) | p for Trend | |
CHEI Score | 52.4 ± 10.9 | 40.6 ± 5.6 | 52.2 ± 2.7 | 64.3 ± 6.0 | |
Age group in years (%) | 0.114 | ||||
2–17 | 14.5 | 17.4 | 13.4 | 12.7 | |
18–59 | 61.0 | 53.9 | 63.8 | 65.3 | |
≥60 | 24.5 | 28.7 | 22.8 | 22.0 | |
Female sex (%) | 52.0 | 52.7 | 49.6 | 53.7 | 0.330 |
Current smoking(%) | 17.9 | 19.2 | 17.5 | 16.9 | 0.029 |
Living alone (%) | 14.1 | 15.9 | 13.6 | 12.9 | <0.001 |
Urbanization (%) | <0.001 | ||||
Urban | 24.3 | 13.6 | 18.5 | 40.7 | |
Suburban | 33.2 | 33.3 | 33.8 | 32.4 | |
Rural | 42.5 | 53.1 | 47.7 | 26.9 | |
Education level (%) | |||||
Low | 42.2 | 55.3 | 42.6 | 28.8 | <0.001 |
Medium | 47.3 | 39.4 | 49.0 | 53.4 | |
High | 10.5 | 5.3 | 8.4 | 17.8 | |
Occupation (employed %) | 49.4 | 45.1 | 52.9 | 50.2 | <0.001 |
BMI | <0.001 | ||||
Under weight | 14.0 | 17.5 | 13.5 | 11.1 | |
Normal | 47.5 | 46.1 | 48.5 | 47.9 | |
Over weight | 28.8 | 26.8 | 28.0 | 31.4 | |
Obesity | 9.7 | 9.6 | 10.0 | 9.6 |
Percentile | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|
CHEI Score | Mean | 1st | 5th | 10th | 25th | 50th | 75th | 90th | 95th | 99th |
Total | 52.4 | 27.6 | 34.6 | 38.7 | 45.0 | 52.2 | 59.6 | 66.5 | 70.9 | 78.3 |
Men | 52.2 | 27.9 | 35.2 | 39.1 | 45.2 | 52.1 | 59.2 | 65.6 | 69.8 | 76.6 |
Women | 52.5 | 27.5 | 34.1 | 38.2 | 44.7 | 52.3 | 60.0 | 67.5 | 71.6 | 78.9 |
2–17 | 50.4 | 22.9 | 31.1 | 35.2 | 42.3 | 50.9 | 58.5 | 65.2 | 69.4 | 76.9 |
18–59 | 53.2 | 29.1 | 36.2 | 39.8 | 46.3 | 53.1 | 60.1 | 67.0 | 70.9 | 77.8 |
60+ | 51.4 | 27.6 | 33.8 | 37.9 | 43.6 | 50.6 | 58.6 | 66.1 | 71.5 | 79.8 |
Variables | CHEI Score | Univariate Model | Final Multivariate Model a | ||
---|---|---|---|---|---|
Mean (SD) | Coefficient (95%CI) | p-Value | Coefficient (95%CI) | p-Value | |
Sex | |||||
Men | 52.2 (10.4) | Reference | Reference | ||
Women | 52.5 (11.3) | 0.27 (−0.08, 0.63) | 0.130 | 0.36 (−0.02, 0.73) | 0.070 |
Age groups | |||||
18–59 | 53.2 (10.5) | Reference | Reference | ||
2–17 | 50.4 (11.6) | −2.88 (−3.40, −2.37) | <0.001 | −0.32 (−2.09, 1.44) | 0.719 |
≥60 | 51.4 (10.9) | −1.86 (−2.28, −1.44) | <0.001 | −0.93 (−1.44, −0.43) | <0.001 |
Education level | |||||
Low | 49.3 (10.3) | Reference | Reference | ||
Medium | 53.8 (10.5) | 4.50 (4.14, 4.86) | <0.001 | 2.66 (2.25,3.06) | <0.001 |
High | 58.4 (11.1) | 9.06 (8.47, 9.65) | <0.001 | 5.13 (4.47, 5.78) | <0.001 |
Smoking | |||||
Non-smoker | 52.5 (10.9) | Reference | Reference | ||
Former smoker | 54.4 (11.1) | 1.96 (0.76, 3.16) | 0.001 | 0.30 (−0.85, 1.44) | 0.609 |
Current smoker | 51.8 (10.5) | −0.72 (−1.19, −0.26) | 0.002 | −1.29(−1.78, −0.80) | <0.001 |
Living alone | |||||
Yes | 51.3 (10.9) | Reference | Reference | ||
No | 52.6 (10.9) | 1.28 (0.78, 1.79) | <0.001 | 1.75 (1.24, 2.24) | <0.001 |
Urbanization | |||||
Rural | 49.3 (9.5) | Reference | Reference | ||
Suburban | 52.1 (10.5) | 2.79 (2.40, 3.18) | <0.001 | 1.95 (1.55,2.35) | <0.001 |
Urban | 58.1 (11.4) | 8.77 (8.34, 9.19) | <0.001 | 6.83 (6.35, 7.31) | <0.001 |
Occupation | |||||
Employed | 52.9 (10.2) | Reference | Reference | ||
Unemployed | 50.1 (10.4) | −2.77 (−3.24, −2.29) | <0.001 | −1.69 (−2.17, −1.22) | <0.001 |
Retired | 55.0 (11.7) | 2.14 (1.65, 2.62) | <0.001 | 0.96 (0.38, 1.55) | 0.001 |
At school | 52.1 (11.1) | −0.72 (−1.30, −0.14) | 0.015 | 0.69 (−1.02, 2.40) | 0.428 |
Dropouts | 46.5 (12.2) | −6.38 (−7.27, −5.48) | <0.001 | −3.73 (−5.67, −1.79) | <0.001 |
BMI | |||||
Normal | 52.6 (10.6) | Reference | Reference | ||
Underweight | 49.9 (11.3) | −2.73 (−3.27, −2.20) | <0.001 | −0.73 (−1.36, −0.09) | 0.024 |
Overweight | 53.2 (10.9) | 0.59 (0.18, 1.01) | 0.005 | 0.27 (−0.12, 0.66) | 0.176 |
Obesity | 52.4 (10.9) | −0.12 (−0.74, 0.49) | 0.693 | 0.05 (−0.53, 0.62) | 0.875 |
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Yuan, Y.-Q.; Li, F.; Dong, R.-H.; Chen, J.-S.; He, G.-S.; Li, S.-G.; Chen, B. The Development of a Chinese Healthy Eating Index and Its Application in the General Population. Nutrients 2017, 9, 977. https://doi.org/10.3390/nu9090977
Yuan Y-Q, Li F, Dong R-H, Chen J-S, He G-S, Li S-G, Chen B. The Development of a Chinese Healthy Eating Index and Its Application in the General Population. Nutrients. 2017; 9(9):977. https://doi.org/10.3390/nu9090977
Chicago/Turabian StyleYuan, Ya-Qun, Fan Li, Rui-Hua Dong, Jing-Si Chen, Geng-Sheng He, Shu-Guang Li, and Bo Chen. 2017. "The Development of a Chinese Healthy Eating Index and Its Application in the General Population" Nutrients 9, no. 9: 977. https://doi.org/10.3390/nu9090977