{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T13:03:20Z","timestamp":1790687000646,"version":"4.1.0"},"reference-count":37,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2020,9,14]],"date-time":"2020-09-14T00:00:00Z","timestamp":1600041600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute for Nutrition and Health, China Center for Disease Control and Prevention; Carolina Population Center","award":["5 R24 HD050924"],"award-info":[{"award-number":["5 R24 HD050924"]}]},{"name":"the University of North Carolina at Chapel Hill; the National Institutes of Health","award":["R01-HD30880, DK056350, R24 HD050924, R01-HD38700"],"award-info":[{"award-number":["R01-HD30880, DK056350, R24 HD050924, R01-HD38700"]}]},{"name":"Fogarty International Center, National Institutes of Health","award":["5D43TW007709, 5D43TW009077"],"award-info":[{"award-number":["5D43TW007709, 5D43TW009077"]}]},{"name":"the Ministry of Finance of the People\u2019s Republic of China","award":["13103110700015005"],"award-info":[{"award-number":["13103110700015005"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Few studies have focused on quantifying the double burden of malnutrition (DBM) phenomenon in China. We aimed to clarify the prevalence of DBM among Chinese adults as well as to examine whether usual daily dietary micronutrient status varies by body mass index (BMI) categories. In this study, a sample of 6602 adults aged 18\u201359 years from the China Health and Nutrition Survey (CHNS) was analyzed. Information was obtained on dietary intake and anthropometric measurements. Dietary intakes of 11 micronutrients were estimated based on the data collected by three consecutive days of 24 h recalls combined with the weighing of household seasonings. Dietary micronutrient deficiency was defined according to the cutoff of the Chinese estimated average requirement (EARs). 44% of Chinese adults faced the problem of DBM, of which nearly 40% experienced overweight\/obesity and micronutrient deficiency simultaneously. Comparable percentages (&gt;50%) of Chinese adults had dietary intake less than the Chinese EARs for key micronutrients including retinol, thiamin, riboflavin, vitamin C, calcium, selenium, zinc, and magnesium, and the percentages varied by body weight status. More than 80% participants had at least two selected vitamin or mineral deficiencies in all BMI categories. These findings indicate that Chinese adults have a high DBM and micronutrient inadequacies prevail among and within gender and all BMI categories. All body weight groups need advice on the changing needs for dietary variety to ensure optimal health.<\/jats:p>","DOI":"10.3390\/nu12092811","type":"journal-article","created":{"date-parts":[[2020,9,13]],"date-time":"2020-09-13T22:01:01Z","timestamp":1600034461000},"page":"2811","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Intra-Individual Double Burden of Malnutrition among Adults in China: Evidence from the China Health and Nutrition Survey 2015"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5431-9178","authenticated-orcid":false,"given":"Qiumin","family":"Huang","sequence":"first","affiliation":[{"name":"National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 29 Nanwei Road, Beijing 100050, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liusen","family":"Wang","sequence":"additional","affiliation":[{"name":"National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 29 Nanwei Road, Beijing 100050, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongru","family":"Jiang","sequence":"additional","affiliation":[{"name":"National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 29 Nanwei Road, Beijing 100050, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huijun","family":"Wang","sequence":"additional","affiliation":[{"name":"National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 29 Nanwei Road, Beijing 100050, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bing","family":"Zhang","sequence":"additional","affiliation":[{"name":"National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 29 Nanwei Road, Beijing 100050, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3266-8999","authenticated-orcid":false,"given":"Jiguo","family":"Zhang","sequence":"additional","affiliation":[{"name":"National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 29 Nanwei Road, Beijing 100050, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaofang","family":"Jia","sequence":"additional","affiliation":[{"name":"National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 29 Nanwei Road, Beijing 100050, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhihong","family":"Wang","sequence":"additional","affiliation":[{"name":"National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 29 Nanwei Road, Beijing 100050, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,9,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/S0140-6736(19)32497-3","article-title":"Dynamics of the double burden of malnutrition and the changing nutrition reality","volume":"395","author":"Popkin","year":"2020","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"483","DOI":"10.3945\/ajcn.111.025056","article-title":"Food and nutrient intakes and their associations with lower BMI in middle-aged US adults: The International Study of Macro-\/Micronutrients and Blood Pressure (INTERMAP)","volume":"96","author":"Shay","year":"2012","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.puhe.2018.10.016","article-title":"Inadequacies of micronutrient intake in normal weight and overweight young adults aged 18-25 years: A cross-sectional study","volume":"167","author":"Farhat","year":"2019","journal-title":"Public Health"},{"key":"ref_4","unstructured":"Chinese Nutrition Society (2014). Chinese DRIs Handbook, Standards Press of China."},{"key":"ref_5","first-page":"410","article-title":"Secular trends in dietary micronutrient intakes and demographic characteristics of adults in nine provinces (autonomous regions) of China from 1991 to 2015","volume":"36","author":"Huang","year":"2019","journal-title":"J. Environ. Occup. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1186\/s12937-018-0369-3","article-title":"Dietary vitamin a intake among Chinese adults: Findings from CNTCS2015","volume":"17","author":"Du","year":"2018","journal-title":"Nutr. J."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Huang, F., Wang, Z., Zhang, J., Du, W., Su, C., Jiang, H., Jia, X., Ouyang, Y., Wang, Y., and Li, L. (2018). Dietary calcium intake and food sources among Chinese adults in CNTCS. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0205045"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.1093\/ije\/dyp322","article-title":"Cohort Profile: The China Health and Nutrition Survey--monitoring and understanding socio-economic and health change in China, 1989\u20132011","volume":"39","author":"Popkin","year":"2010","journal-title":"Int. J. Epidemiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1038\/ejcn.2014.24","article-title":"Trends in dietary fiber intake in Chinese aged 45 years and above, 1991\u20132011","volume":"68","author":"Wang","year":"2014","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1038\/sj.ijo.0801651","article-title":"Weight gain and its predictors in Chinese adults","volume":"25","author":"Bell","year":"2001","journal-title":"Int. J. Obes."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1038\/oby.2002.38","article-title":"The Road to Obesity or the Path to Prevention: Motorized Transportation and Obesity in China","volume":"10","author":"Bell","year":"2002","journal-title":"Obes. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1318","DOI":"10.1038\/sj.ejcn.1602849","article-title":"Longitudinal relationships between occupational and domestic physical activity patterns and body weight in China","volume":"62","author":"Monda","year":"2007","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"S498","DOI":"10.1097\/00005768-200009001-00009","article-title":"Compendium of physical activities: An update of activity codes and MET intensities","volume":"32","author":"Ainsworth","year":"2000","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1436","DOI":"10.1016\/j.socscimed.2010.07.027","article-title":"Understanding community context and adult health changes in China: Development of an urbanicity scale","volume":"71","author":"Popkin","year":"2010","journal-title":"Soc. Sci. Med."},{"key":"ref_15","unstructured":"Institute of Medicine (2006). Dietary Reference Intakes: The Essential Guide to Nutrient Requirements, National Academies Press."},{"key":"ref_16","unstructured":"National Health Commission of People\u2019s Republic of China (2017). Chinese Dietary Reference Intakes\u2014Part 3: Trace Element."},{"key":"ref_17","unstructured":"National Health Commission of People\u2019s Republic of China (2018). Chinese Dietary Reference Intakes\u2014Part 4: Lipid-Soluble Vitamin."},{"key":"ref_18","unstructured":"National Health Commission of People\u2019s Republic of China (2018). Chinese Dietary Reference Intakes\u2014Part 5: Water-Soluble Vitamin."},{"key":"ref_19","unstructured":"National Health Commission of People\u2019s Republic of China (2018). Chinese Dietary Reference Intakes\u2014Part 2: Macroelement."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/S0140-6736(19)32472-9","article-title":"The double burden of malnutrition: Aetiological pathways and consequences for health","volume":"395","author":"Wells","year":"2020","journal-title":"Lancet"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/S0140-6736(19)32506-1","article-title":"Double-duty actions: Seizing programme and policy opportunities to address malnutrition in all its forms","volume":"395","author":"Hawkes","year":"2020","journal-title":"Lancet"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/S0140-6736(19)32473-0","article-title":"Economic effects of the double burden of malnutrition","volume":"395","author":"Nugent","year":"2020","journal-title":"Lancet"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Fongar, A., G\u00f6decke, T., and Qaim, M. (2019). Various forms of double burden of malnutrition problems exist in rural Kenya. BMC Public Health, 19.","DOI":"10.1186\/s12889-019-7882-y"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e2019050","DOI":"10.4178\/epih.e2019050","article-title":"The double burden of malnutrition among adults in India: Evidence from the National Family Health Survey-4 (2015\u201316)","volume":"41","author":"Dutta","year":"2019","journal-title":"Epidemiol. Health"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Laillou, A., Yakes, E., Le, T.H., Wieringa, F.T., Le, B.M., Moench-Pfanner, R., and Berger, J. (2014). Intra-Individual Double Burden of Overweight and Micronutrient Deficiencies among Vietnamese Women. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0110499"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Heydenreich, J., Melzer, K., Flury, C., and Kayser, B. (2017). Low Energy Turnover of Physically Inactive Participants as a Determinant of Insufficient Mineral and Vitamin Intake in NHANES. Nutrients, 9.","DOI":"10.3390\/nu9070754"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1007\/s12011-016-0785-1","article-title":"Association between Antioxidant Intake\/Status and Obesity: A Systematic Review of Observational Studies","volume":"175","author":"Hosseini","year":"2016","journal-title":"Biol. Trace Element Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1017\/S0007114513000111","article-title":"Dietary calcium intake is associated with adiposity, metabolic profile, inflammatory state and blood pressure, but not with erythrocyte intracellular calcium and endothelial function in healthy pre-menopausal women","volume":"110","author":"Ferreira","year":"2013","journal-title":"Br. J. Nutr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1186\/s12937-015-0057-5","article-title":"Consuming the daily recommended amounts of dairy products would reduce the prevalence of inadequate micronutrient intakes in the United States: Diet modeling study based on NHANES 2007\u20132010","volume":"14","author":"Quann","year":"2015","journal-title":"Nutr. J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1002\/ncp.10376","article-title":"The Role of Vitamin A in Wound Healing","volume":"34","author":"Polcz","year":"2019","journal-title":"Nutr. Clin. Pract."},{"key":"ref_31","first-page":"S99","article-title":"International Zinc Nutrition Consultative Group (IZiNCG) technical document #1. Assessment of the risk of zinc deficiency in populations and options for its control","volume":"25","author":"Brown","year":"2004","journal-title":"Food Nutr. Bull."},{"key":"ref_32","unstructured":"UNICEF (2004). Report on Risk Evaluation of Vitamin and Mineral Deficiency in China."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/S0140-6736(19)32690-X","article-title":"A new nutrition manifesto for a new nutrition reality","volume":"395","author":"Branca","year":"2020","journal-title":"Lancet"},{"key":"ref_34","first-page":"407","article-title":"Promoting balanced dietary structure and preventing micronutrient deficiencies","volume":"36","author":"Ding","year":"2019","journal-title":"J. Environ. Occup. Med."},{"key":"ref_35","first-page":"85","article-title":"Micronutrient consumption and overweight: Is there a relationship?","volume":"15","year":"2012","journal-title":"Rev. Bras. Epidemiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1038\/sj.ejcn.1600633","article-title":"Measurement error in dietary data: Implications for the epidemiologic study of the diet-disease relationship","volume":"52","author":"Paeratakul","year":"1998","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1002\/oby.20995","article-title":"Lower BMI cutoffs to define overweight and obesity in China","volume":"23","author":"He","year":"2015","journal-title":"Obesity"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/12\/9\/2811\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:09:39Z","timestamp":1760177379000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/12\/9\/2811"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,14]]},"references-count":37,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2020,9]]}},"alternative-id":["nu12092811"],"URL":"https:\/\/doi.org\/10.3390\/nu12092811","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9,14]]}}}