Correspondence
Dietary transitions and
cardiometabolic
mortality among
Chinese adults
In their cross-sectional population-
based study, Yuna He and colleagues1
used data from the 1982, 1992,
2002, and 2012 China National
Nutrition Surveys and found
associations of high sodium intake
with the largest estimated number of
cardiometabolic deaths. It should be
noted that these associations might
be modified by China’s universal salt
iodisation programme, which was
implemented in 1995. Too much or
too little iodine intake from table
salt might lead to thyroid disorders,
which can have substantial effects
on cardiometabolic morbidities and
mortalities.2 Moreover, the sources
of food, smoking, population aging,
average life expectancy, urbanisation,
and household expenditure might
also affect the associations between
diets and health outcomes. The four
China National Nutrition Surveys
reveal that the traditional Chinese
plant-based, high-fibre diet has been
replaced with modern animal-based,
www.thelancet.com/diabetes-endocrinology Vol 7 August 2019
high-fat foods. The importance of
plant-based carbohydrates in human
nutrition was emphasised by a series
of studies and meta-analyses. 3,4
Adequate intakes of dietary fibre
and whole grains could decrease all-
cause mortality and protect against
cardiovascular diseases, stroke,
type 2 diabetes, and colorectal and
breast cancer.3 In China, smoking is a
big problem, with 350 million current
smokers and 740 million second-hand
smokers. Dose-response associations
exist between pack-years smoked
and deaths from any cause in both
men and women after adjustment for
multiple risk factors.5 According to the
National Bureau of Statistics of China,
the number of older people (≥65 years
old) increased from 49·9 million
(4·9% of China’s population) in 1982
to 127·1 million (8·9%) in 2012.
The average life expectancy also
increased from 67·8 years in 1982 to
74·8 years in 2012. Over the 30-year
period between 1982 and 2012, a
four times increase in the urban-to-
rural population ratio, a 52 times
increase in household consumption
expenditure, and a ten times increase
in the household consumption index
occurred. These drastic changes might
largely account for the increased
disease burdens in China, which are
largely preventable by adequate
intakes of healthy foods and other
lifestyle modifications.
Wan Li, Wei Ling, Yi Sui, *Hai-Lu Zhao
zhaohailu9@126.com
Center for Diabetic Systems Medicine, Guangxi Key
Laboratory of Excellence, Guilin Medical University,
Guilin 541004, China (WLi, WLing, H-LZ);
Department of Endocrinology, Xiangya Hospital,
Central South University, Changsha, China (WLing);
and Department of Clinical Nutrition, The First
Affiliated Hospital of Sun Yat-sen University,
Guangzhou, China (YS)
We declare no competing interests.
1 He Y, Li Y, Yang X, et al. The dietary transition
and its association with cardiometabolic
mortality among Chinese adults, 1982–2012:
a cross-sectional population-based study.
Lancet Diabetes Endocrinol 2019; 7: 540–48.
2 Teng W, Shan Z, Teng X, et al. Effect of iodine
intake on thyroid diseases in China.
N Engl J Med 2006; 354: 2783–93.
3 Reynolds A, Mann J, Cummings J, Winter N,
Mete E, Te Morenga L. Carbohydrate quality
and human health: a series of systematic
reviews and meta-analyses. Lancet 2019;
393: 434–45.
4 Seidelmann SB, Claggett B, Cheng S, et al.
Dietary carbohydrate intake and mortality:
a prospective cohort study and meta-analysis.
Lancet Public Health 2018; 3: e419–28.
5 Gu D, Kelly TN, Wu X, et al. Mortality
attributable to smoking in China. N Engl J Med
2009; 360: 150–59.
593