Table 11_Burden, trends, and projections of nutritional deficiencies in China from 1990 to 2030.docx

BackgroundNutritional deficiencies remain a pressing public health concern, especially in countries undergoing rapid demographic and epidemiologic transitions. In China, understanding the long-term trends and sex- and age-specific burden of nutritional deficiencies is crucial for designing targeted prevention and intervention strategies.
MethodsWe used data from the Global Burden of Disease Study 2021 to estimate the burden of nutritional deficiencies in China from 1990 to 2021. Indicators included incidence, prevalence, mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs), stratified by age, sex, and type of malnutrition. We applied Joinpoint regression to examine temporal trends and conducted age-period-cohort (APC) and decomposition analyses to explore underlying drivers. Projections through 2030 were generated using Bayesian APC modeling.
ResultsIn 2021, nutritional deficiencies led to 46.0 million incident and 146.1 million prevalent cases in China, with a significantly higher burden among women. While males had higher mortality and YLL rates, females showed higher prevalence, YLDs, and DALYs. The age-standardized burden declined substantially from 1990 to 2021, particularly for protein-energy malnutrition. DALYs declined by 92.8% for protein-energy malnutrition, and vitamin A deficiency incidence dropped by 81.2%. APC analysis revealed that younger cohorts experienced dramatically lower burdens, especially among children under 5, although older adults continued to carry a growing burden due to aging. Decomposition analysis identified epidemiologic improvements as the primary driver of reduced burden, but demographic factors like population aging mitigated these gains. Forecasts indicate further declines in disease burden through 2030, with consistently higher prevalence and DALY rates projected among females.
ConclusionDespite substantial progress in reducing the burden of nutritional deficiencies in China over the past three decades, disparities persist by sex and age. Continued surveillance, alongside interventions targeting women and older adults, is essential to sustain progress and address residual gaps.

背景 营养缺陷仍是亟待破解的重大公共卫生关切问题，尤其在经历快速人口结构与流行病学转型的国家中。在中国，明晰营养缺陷的长期流行趋势、分性别与分年龄组的疾病负担，对于制定精准化的预防与干预策略至关重要。
方法 本研究采用2021年全球疾病负担研究（Global Burden of Disease Study 2021）的数据，估算1990至2021年中国营养缺陷相关疾病负担。研究指标涵盖发病率、患病率、死亡率、伤残调整寿命年（disability-adjusted life years, DALYs）、失能损失健康寿命年（years lived with disability, YLDs）以及早死损失寿命年（years of life lost, YLLs），并按年龄、性别与营养不良类型进行分层分析。本研究采用连接点回归分析（Joinpoint regression）探究时间趋势特征，同时开展年龄-时期-队列（age-period-cohort, APC）分析与分解分析以探索潜在驱动因素。此外，通过贝叶斯年龄-时期-队列建模（Bayesian APC modeling）预测至2030年的疾病负担变化。
结果 2021年，中国营养缺陷相关新发病例达4600万例，现患病例达1.461亿例，女性的疾病负担显著更高。尽管男性的死亡率与早死损失寿命年率更高，但女性的患病率、失能损失健康寿命年以及伤残调整寿命年均处于更高水平。1990至2021年，标化疾病负担呈显著下降趋势，尤以蛋白质能量营养不良为甚：蛋白质能量营养不良相关伤残调整寿命年下降92.8%，维生素A缺乏症发病率下降81.2%。年龄-时期-队列分析显示，较年轻的队列人群疾病负担大幅降低，尤其是5岁以下儿童，但老年人群因人口老龄化导致疾病负担持续攀升。分解分析结果表明，流行病学水平的改善是疾病负担降低的主要驱动因素，但人口老龄化等人口结构因素削弱了这一获益。预测结果显示，至2030年疾病负担将进一步下降，且女性的患病率与伤残调整寿命年率将持续处于更高水平。
结论 尽管过去三十年间中国在降低营养缺陷相关疾病负担方面取得了显著进展，但性别与年龄层面的健康差异依然存在。持续开展疾病监测，并针对女性与老年人群制定针对性干预措施，对于维持现有进展、填补剩余健康缺口至关重要。