Q&A ｜ Is the dining table of Shanghainese healthy enough？ How to eat scientifically？

Q:What are the nutrition and health problems of Shanghai residents?

A:It is not eating too much, but the dietary structure is unreasonable, mainly because there are less plant foods (cereals/vegetables/fruits) and more animal foods (livestock and poultry meat); The proportion of fat in diet is high, and the energy provided by fat is 38.0%, which exceeds the recommended upper limit of 30%.

First, the problem of overweight and obesity is prominent. As far as diet is concerned, the problem is unreasonable dietary structure (more animal food/less plant food, high fat ratio).

The overweight and obesity rate of Shanghai residents is 44.1%, which is close to the average level of cities in the national nutrition monitoring results from 2010 to 2013 (the overweight and obesity rate of big cities in China is 47.8%). Shanghai residents don’t eat too much. The energy intake of Shanghai residents is lower than that of 10 years ago, which may be related to the change of lifestyle, people no longer engaged in manual labor, and the decrease of energy demand, as well as the trend of energy intake of people found in international and our country’s nutrition monitoring.

There are many factors that cause obesity. As far as dietary factors are concerned, the main problem of Shanghai residents is the unreasonable dietary structure. The traditional Chinese diet mainly takes plant food (cereal is the staple food), which is rich in dietary fiber, which is beneficial to prevent chronic diseases. However, current monitoring shows that the intake of animal food in residents’ diet greatly exceeds the recommended level, while the intake of cereal has dropped significantly in the past 10 years, and the intake of vegetables and fruits is insufficient. Such a dietary structure contains less dietary fiber, which is not conducive to the prevention of chronic diseases. At the same time, the absorption rate of different foods in the human body is different. The current dietary structure may increase the absorption rate of food, which may lead to the increase in the overweight and obesity rate of residents.

On the other hand, the monitoring also found that the percentage of energy provided by residents’ fat was 38.0%, which was close to the average level of big cities (37.2%) in the national nutrition monitoring results from 2010 to 2013. In the recommendation of Dietary Guidelines for China Residents, the percentage of energy provided by dietary fat does not exceed 30%, which has now exceeded the upper limit by a lot. Animal foods, especially livestock and poultry meat, contain more saturated fat. The monitoring results show that the intake of livestock and poultry meat in Shanghai residents’ animal foods exceeds the recommended 61%.

Second, suggestions on unreasonable dietary structure: increase plant food, reduce animal food, and replace some livestock and poultry meat with aquatic products.

1. Increase the intake of plant foods such as cereals, vegetables and fruits.

In view of the dietary nutrition problems found by monitoring, it is suggested that residents gradually improve their dietary structure and increase the intake of plant foods such as coarse grains, vegetables and fruits. Usually, people’s food intake in a day is relatively stable. If the intake of plant food increases, the intake of animal food will decrease accordingly.

It is worth noting that in the past 10 years, the grain intake has dropped significantly. At present, the grain intake of residents is 189.6g, which only reaches 69% of the recommended intake (the recommended intake is 200-300g, compared with 275g/2200kcal). It is suggested that residents should increase the intake of cereals, and at the same time, they should match the thickness, and pay attention to increasing whole grains and miscellaneous beans, because cereals with high processing precision will cause high blood sugar response. Rice can be eaten with whole grains (brown rice), miscellaneous grains (oats, millet, buckwheat, corn, etc.) and miscellaneous beans (red beans, mung beans, kidney beans, flower beans, etc.).

2. Reduce animal food, you can choose aquatic products to replace some livestock and poultry meat.

At the same time, it advocates food diversification. In view of the problem of excessive intake of livestock and poultry meat by Shanghai residents, it is recommended that residents can choose aquatic products to replace some livestock and poultry meat. Livestock and poultry meat contains saturated fat, which is a risk factor for cardiovascular diseases and tumors. Aquatic products contain unsaturated fat, which is beneficial to health.

Finally, it is recommended to choose at least 12 different foods every day to prevent the risk of chronic diseases caused by possible nutritional deficiency or excess.

Third, the rising trend of overweight and obesity among students has not been curbed, and sugary drinks are widely consumed. Excessive drinking of sugary drinks is one of the risk factors of overweight and obesity, so it is suggested that students should be controlled to drink sugary drinks.

There are many factors that cause overweight and obesity, except the unreasonable dietary structure mentioned just now. In addition, there are differences between primary and secondary school students and adults. This monitoring found that it is common for primary and secondary school students to drink sugary drinks. 74.6% primary and middle school students drink sugary drinks more than once a week, and 36.5% primary and middle school students often drink them. It is more common for high school students to drink sugary drinks, and 62.5% of them often drink them. There are also a few students who drink sugary drinks every day. 20.9% of primary and secondary school students drink sugary drinks more than once a day, and the proportion of high school students is even higher. There are 41.5% of high school students who drink sugary drinks more than once a day.

The Dietary Guidelines for China Residents (2016 Edition) recommends that children and adolescents prefer boiled water to sugary drinks every day. Drinking sugary drinks does not produce satiety, resulting in excessive intake of sugar and energy. According to literature reports, excessive intake of sugary drinks can easily lead to various diseases such as obesity, diabetes, metabolic syndrome and blood lipid problems.

It is suggested that primary and secondary school students should be restricted from drinking sugary drinks, students should be encouraged not to drink sugary drinks, and extra sugar and energy intake should be reduced. Parents and school teachers should be aware of the influence of sugary drinks on children’s overweight and obesity. It is suggested that schools should encourage students not to bring sugary drinks into school, schools should not provide sugary drinks for sale, and widely carry out health knowledge propaganda on restricting sugary drinks in schools.

4. The intake of oil and salt in Shanghai has obviously decreased in recent 10 years, thanks to the measures to control oil and salt in Shanghai, but the current intake of oil and salt is still higher than the recommended level, and it is necessary to continue to strengthen intervention.

Our diet is mainly salty, and frying, frying and frying are common cooking methods. Excessive intake of cooking oil and salt in the diet is one of the important factors causing hyperlipidemia and hypertension. According to the monitoring results, the daily per capita intake of cooking oil and salt is 36.4g and 7.5g, respectively, which are 21% and 24% lower than the survey data 10 years ago, and 11% and 16% lower than the national average of big cities.

We compared the trend of oil and salt intake in Shanghai in recent 10 years, and found that it was obviously decreasing. At the same time, we also looked at the trend of oil and salt intake in urban areas of China in recent 10 years, but there was no obvious downward or upward trend, and it remained basically stable. This difference in trend should be attributed to the health education and intervention on oil and salt control led by the Shanghai Municipal Government in the past 10 years, such as the distribution of "salt control spoons" and "oil control pots" throughout the city in 2008 and 2009, so that the vast number of Shanghai residents can truly experience the quantitative concept of "eating less salt and putting less oil" and turn the traditional propaganda slogan into a reality for residents.

Residents’ intake of cooking oil and salt decreased obviously, thanks to various health education and intervention led by the Shanghai municipal government in the past 10 years, which is a good aspect. On the other hand, we should also see that the intake of oil and salt for eating at home is still higher than the recommended standard. The recommended daily intake of oil and salt is no more than 25 grams per day, and the current intake of cooking oil and salt for residents is still far from the recommended level. Measures to control oil and salt should continue to be strengthened.

5. At present, it is common for residents to eat out (61% residents eat out). In addition to traditional intervention in family cooking, institutions such as restaurants and canteens should be intervened in the future.

From the monitoring data, we also found that the current rate of residents eating out is 61%, which is much higher than the national rate of urban residents eating out of 42%. The people who eat out in Shanghai are mainly young people aged 15-44. People used to eat at home, but now they eat out more and more. We can also see from ourselves that prepackaged foods (that is, packaged food, such as cakes, bread, sausages, etc.) has become a new choice. The development of science and technology has made life more convenient, and the rise of new consumption methods such as take-away and online shopping has affected the traditional family cooking habits. These changes pose new challenges to traditional nutrition intervention strategies.

The monitoring also found that the sodium intake of Shanghai residents was 4927.2mg, which was nearly 1.5 times higher than the recommended level. Excessive intake of sodium is closely related to the increase of blood pressure and the occurrence of hypertension. At present, the sodium intake of residents through salt accounts for 3/5 of the total sodium intake. Besides salt, sodium comes from salty condiments (such as soy sauce, monosodium glutamate, etc.), semi-finished dishes, pickled products, snacks, etc. (common sweet preserves also contain a lot of sodium), and vegetables also contain a certain amount of sodium. In the past, we actively advocated reducing salt intake, which can reduce sodium intake. As mentioned just now, residents’ eating style has changed. More and more people eat out, and they choose more packaged foods. In order to control the intake of sodium, besides controlling the intake of salt, they also reasonably choose condiments, packaged foods and snacks containing sodium.

In the past, our intervention measures to control oil and salt covering the whole city have made great achievements, but the intake of oil and salt for residents to eat at home is still higher than the recommended level. For future intervention and publicity, we will continue to strengthen the implementation of intervention measures to control oil and salt. On the other hand, we will also keep pace with the times, not only to continue to publicize the knowledge of reasonable nutrition for residents, but also with the popularity of residents eating out. Centralized dining halls, restaurants, take-away service providers, and prepackaged foods enterprises will also be the key targets for nutrition promotion in the future, advocating the supply of catering and food with "reducing salt, limiting oil and reducing blood sugar", encouraging dining places to carry out nutrition propaganda, formulating easy-to-understand nutrition labels in prepackaged foods, and guiding residents to choose food reasonably.

In addition, it is recommended that everyone eat at home, adhere to the habit of cooking at home with less oil and salt, and at the same time, eating at home also promotes the emotional exchange and promotion of family members.

6. Insufficient calcium intake is common, and residents drink less milk every day. It is suggested that residents increase the frequency of drinking milk and increase the intake of soybeans and bean products.

Our traditional Chinese diet is mainly based on plant food, which is conducive to the prevention of chronic diseases, but it also has an obvious defect, lacking a good source of calcium. Milk is a good source of calcium, and Chinese diet does not contain milk. A good phenomenon found in this monitoring is that residents have the habit of drinking milk, 41.6% residents consume milk every day, and 71.4% students consume milk every day. However, 86.8% residents still have insufficient calcium intake. Milk supplements the calcium that is insufficient in daily diet. Calcium is an integral part of bones and teeth, and it is an important nutrient for physical growth and bone development. Calcium deficiency will affect normal growth and development and cause osteoporosis. The Dietary Guidelines for China Residents (2016 Edition) recommends that each person should take 800mg of calcium daily, and students in the growth stage need 1000-1200mg. Every 100ml of milk contains about 104mg of calcium. In addition to the calcium in daily diet, 300ml of milk is needed every day. At present, the monitoring results show that the daily milk intake is insufficient. The average daily milk intake of residents is 97ml, and that of primary and secondary school students is 150ml.

Encourage residents to increase the amount of milk they drink. If the single intake is small, they can increase the number of times they drink milk, improve the calcium intake level and ensure the normal demand of the body. People who are lactose intolerant can choose low lactose milk or yogurt. At the same time, soybeans or bean products are also a good source of calcium. The Dietary Guide for Residents in China recommends that they consume 25g soybeans or a considerable amount of bean products every day. At present, residents’ intake of soybeans and bean products is less than half of the recommended amount. It is suggested that residents increase their intake of soybeans or bean products.