Disparities in economic development in Eastern China: impact on nutritional status of adolescents

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Abstract
To compare the effects of disparities in economic development in urban and rural Eastern China on the nutritional status of adolescents. A cross-sectional survey consisting of self-completion questionnaires, anthropometry and haemoglobin measurement. Twelve middle schools in an urban and a rural area of Zhejiang Province: Hangzhou, the capital, and Chunan, a poor mountainous area. Some 4835 young adolescents (predominant age range 13-16 years). The mean body mass index (BMI) was significantly higher in urban Hangzhou (P = 0.01) Overweight affected 3.6% overall; adjusted odds ratios (ORs) showed male sex (OR 2.1, 95% confidence interval (CI) 1.1-3.4) and urban residence (OR 9.1, 95% CI 3.7-22) to be the most important risk factors. The prevalence of underweight was 18%, with no significant urban-rural difference. Predictors of underweight were male sex (OR 1.5, 95% CI 1.1-2.0) and low household income (OR, 1.3, 95% CI 1.1-1.5). Mean haemoglobin was significantly lower in the rural area. Anaemia was more common in girls, 51% compared with 21% of the boys, but rural residence was not an independent risk factor. Rural students exercised more and had a less varied diet than their urban counterparts. Around one-third of the respondents consumed dietary supplements on a regular basis. These results suggest that in urban areas of Eastern China a dual picture is emerging with the problems of excess (overweight and obesity) coexisting with underweight and anaemia. In rural areas the problems of relative nutritional deprivation predominate, but the long-term consequences of such marginal underweight and anaemia are not clear.