Public Health Nutrition

Biological and behavioural determinants

Lack of dietary diversity and dyslipidaemia among stunted overweight children: the 2002 China National Nutrition and Health Survey

Yanping Lia1a2 c1, Nicole M Wedicka2, Jianqiang Laia1, Yuna Hea1, Xiaoqi Hua1, Ailing Liua1, Songming Dua1, Jian Zhanga1, Xiaoguang Yanga1, Chunming Chena4, Frank B Hua2a3 c1 and Guansheng Maa1 c1

a1 National Institute for Nutrition and Food Safety, Chinese Center for Disease Control and Prevention, Nanwei Road 29 Hao, Beijing 100050, People's Republic of China

a2 Departments of Nutrition and Epidemiology, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA

a3 Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA

a4 Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China


Objective Both stunting and overweight are present in children across China. Seemingly paradoxical, these two conditions can also coexist in the same child. The aim was to examine the associations between dietary food/nutrient intake and plasma lipid profiles related to stunting and overweight status.

Design The 2002 China National Nutrition and Health Survey was a family-based nationally representative cross-sectional study.

Setting Thirty-one provinces, autonomous regions and municipalities.

Subjects The study included 13 770 children aged 2–17 years. The sample size for the four exposure groups was 10 814 for children of normal height and weight, 2128 for stunted, 729 for overweight and 99 for stunted overweight.

Results Compared with children of normal height and weight, stunted and stunted overweight children consumed more high-energy-dense foods with a lower dietary diversity score, less protein, polyunsaturated fat and Fe, and a higher molar ratio of phytate to Ca. On the contrary, overweight children tended to consume significantly less carbohydrates and more protein and fat. Overall, stunted overweight children consumed lower amounts of vegetables, fruit, white meat (poultry and fish) and more milk. The OR for prevalent dyslipidaemia were 1·32 (95 % CI 1·13, 1·53), 1·76 (95 % CI 1·48, 2·09) and 2·59 (95 % CI 1·65, 4·07) among stunted, overweight and stunted overweight children, respectively, compared with children of normal height and weight. In addition, being overweight was significantly associated with high glucose concentrations, whereas stunting was significantly associated with having anaemia.

Conclusions Limited dietary diversity and intake of high-energy-dense foods were notably observed among stunted overweight children. Furthermore, being stunted and/or overweight was associated with an increased likelihood of unhealthy lipid profiles.

(Received March 14 2010)

(Accepted September 28 2010)

(Online publication February 10 2011)


c1 Corresponding author: Email,,