More and more nutrition health issues occurred in China recent years as economy develops. The Fourth National Nutrition and Health Survey showed that China is facing the dual challenges of nutritional deficiencies and overnutrition [
As a new pattern of public health nutrition service, the nutrition outpatient clinics in China were supported by nutrition physicians, not only physicians but also nutritionists [
In our nutrition outpatient clinical center, thousands of patients have been attended in the past more than two years. The aim of this study was to review and analyze demographics and consultation spectrum in a single nutrition outpatient clinical center in China.
All consecutive new patients seen in a comprehensive teaching hospital (The Fourth Affiliated Hospital of Zhejiang University School of Medicine) nutrition clinical center from August 2015 to February 2018 were included in this retrospective study. The clinical records were reviewed and the demographics of the patients, their height, weight, Body Mass Index (BMI), and the cause of attending were analyzed. According to the types of nutrition-related issues, nutrition services included healthy dietary services, malnutrition, diabetes, neoplasms, digestive system diseases, hypertension, and so on.
Ethical approval for publication of this data was obtained from the Ethics Committee of The Fourth Affiliated Hospital of Zhejiang University School of Medicine.
All patients used the same devices, which were calibrated at the time of measurement. The height and weight of adolescents were measured with thin clothes (shorts and T-shirts) and without shoes. Height was measured to the nearest 0.1 cm with a free-standing stadiometer mounted on a rigid tripod (GMCS-I, Xindong Huateng Sports Equipment Co. Ltd., Beijing, China). Fasting body weight was measured to the nearest 0.1 kg on a digital scale (RGT-140, Weighing Apparatus Co. Ltd, Changzhou Wujin, China). Body mass index (BMI) was calculated by body weight (kg) / [body height (m)]2. Thinness, overweight, and obesity were defined according to the special cutoffs of BMI<18.5 kg/m2, BMI≥24 kg/m2, and BMI≥28 kg/m2, respectively, for the Chinese adult population [
All categorical variables are expressed as proportions. Chi-square tests were used for intergroup comparisons of categorical variables. A p value <0.05 was considered significant, and all p values are 2-sided. Statistical analyses were performed with SPSS software version 19 (IBM/SPSS, Armonk, NY USA 2012).
From August 2015 to February 2018, 1014 patients had been seen in the nutrition clinical center as new cases. The age ranged from 4 months to 92 years old. Proportion of female patients was a little bit more than male. A large proportion of adult patients (18-64 years old) came to our clinic for nutrition services, and minor patients (0- <18 years old) accounted for less than one-third, while the number of elderly patients (≥65 years old) was quite small. About a half of the patients were normal weight; underweight and obesity patients accounted for about one-fifth which was about a double of the overweight patients. Most of them were Han Chinese came from urban area and received education for 7-12 years. The demographics of the patients are shown in Table
Demographics of the patients attending the nutrition clinical center (n=1014).
Demographics | No. (%) of patients |
---|---|
Sex | |
Male | 483(47.6) |
Female | 531(52.4) |
Age (years) | |
0- <18 | 281(27.7 ) |
18-64 | 669(66.0) |
≥65 | 64(6.3) |
BMI categories | |
Underweight | 222(21.9) |
Normal weight | 455(44.9) |
Overweight | 114(11.2) |
Obesity | 223(22.0) |
Region | |
Urban | 947(93.4) |
Rural | 67(6.6) |
Education (years) | |
0 | 119(11.7) |
0-6 | 121(11.9) |
7-12 | 609(60.1) |
>12 | 165(16.3) |
Ethnic group (nationalities) | |
Han | 989(97.5) |
Others | 25(2.5) |
BMI, body mass index.
Majority of the patients (41.9%) came to our clinical center for nutrition consultation of healthy dietary services, 32.1% for malnutrition, 6.7% for diabetes, 6.3% for neoplasms, 5.3% for digestive system diseases, and the last 7.6% for hypertension, hematologic diseases, thyroid diseases, and so on.
Healthy dietary services consisted of nutrition consultation of common diet (34.7%), growth and development (3.4%), maternal nutrition (1.8%), preparation of pregnant (0.7%), and others (1.3%) such as preparation of college entrance examination and breastfeeding.
Malnutrition patients were divided into two groups: undernutrition (11.4%) and overnutrition (20.7%). The undernutrition group included thinness (9.5%), child nutrition disorders (1.5%), and deficiency diseases (0.5%). The overnutrition group consisted of overweight (6.9%) and obesity (13.8%).
More minor patients came for healthy dietary services compared with the population (P<0.001), and, on the contrary, more adult patients came for malnutrition service, especially obesity (P<0.05), while more elderly patients came for consultation services of diabetes, neoplasms, digestive system diseases, and hypertension (P<0.05). The consultation spectrum of the patients is shown in Table
Nutrition services in patients attending the nutrition clinical center.
Nutrition services | Patients | Female | P Value | Age 0- <18 | P value | Age 18-64 | P value | Age ≥65 | P value |
---|---|---|---|---|---|---|---|---|---|
Healthy Dietary Services | 425(41.9) | 229(53.9) | 0.599 | 199(46.8) | <0.001 | 218(51.3) | <0.001 | 8(1.9) | <0.001 |
Common diet consultation | 352(34.7) | 181(51.4) | 0.759 | 159(45.2) | <0.001 | 185(52.6) | <0.001 | 8(2.3) | 0.004 |
Growth and development consultation | 35(3.5) | 13(37.1) | 0.076 | 35(100.0) | <0.001 | 0(0.0) | <0.001 | 0(0.0) | 0.266 |
maternal consultation | 18(1.8) | 18(100.0) | <0.001 | 0(0.0) | 0.006 | 18(100.0) | 0.001 | 0(0.0) | 0.621 |
Preparation of pregnant consultation | 7(0.7) | 7(100.0) | <0.001 | 0(0.0) | 0.200 | 7(100.0) | 0.103 | 0(0.0) | 1.000 |
others | 13(1.3) | 10(76.9) | 0.096 | 5(38.5) | 0.153 | 8(61.5) | 0.772 | 0(0.0) | 1.000 |
Malnutrition | 326(32.1) | 157(48.2) | 0.186 | 70(21.5) | 0.118 | 247(75.8) | 0.001 | 9(2.8) | 0.014 |
Undernutrition | 116(11.4) | 65(56.0) | 0.454 | 33(28.4) | 0.867 | 77(66.4) | 0.931 | 6(5.2) | 0.630 |
Thinness | 96(9.5) | 58(60.4) | 0.131 | 15(15.6) | 0.010 | 75(78.1) | 0.016 | 6(6.3) | 0.981 |
Child nutrition disorders | 15(1.5) | 5(33.3) | 0.193 | 15(100.0) | <0.001 | 0(0.0) | <0.001 | 0(0.0) | 0.617 |
Deficiency diseases | 5(0.5) | 2(40.0) | 0.674 | 3(60.0) | 0.136 | 2(40.0) | 0.345 | 0(0.0) | 1.000 |
Overnutrition | 210(20.7) | 92(43.8) | 0.024 | 37(17.6) | 0.002 | 170(81.0) | <0.001 | 3(1.4) | 0.002 |
Overweight | 70(6.9) | 31(44.3) | 0.191 | 15(21.4) | 0.254 | 54(77.1) | 0.055 | 1(1.4) | 0.118 |
Obesity | 140(13.8) | 61(43.6) | 0.051 | 22(15.7) | 0.002 | 116(82.9) | <0.001 | 2(1.4) | 0.018 |
Diabetes | 68(6.7) | 33(48.5) | 0.621 | 0(0.0) | <0.001 | 53(77.9) | 0.043 | 15(22.1) | <0.001 |
Neoplasms | 64(6.3) | 42(65.6) | 0.039 | 0(0.0) | <0.001 | 52(81.2) | 0.012 | 12(18.8) | <0.001 |
Digestive system diseases | 56(5.3) | 25(44.6) | 0.260 | 4(7.1) | <0.001 | 43(76.8) | 0.095 | 9(16.1) | 0.005 |
Hypertension | 16(1.6) | 11(68.8) | 0.217 | 0(0.0) | 0.009 | 12(75.0) | 0.598 | 4(25.0) | 0.017 |
Hematologic diseases | 12(1.2) | 5(41.7) | 0.566 | 4(33.3) | 0.747 | 6(50.0) | 0.358 | 2(16.7) | 0.178 |
Thyroid diseases | 10(1.0) | 9(90.0) | 0.023 | 2(20.0) | 0.735 | 8(80.0) | 0.509 | 0(0.0) | 1.000 |
Atherosclerosis | 8(0.8) | 4(50.0) | 1.000 | 0(0.0) | 0.116 | 4(50.0) | 0.456 | 4(50.0) | 0.001 |
Respiration disorders | 8(0.8) | 4(50.0) | 1.000 | 2(25.0) | 1.000 | 5(62.5) | 1.000 | 1(12.5) | 0.410 |
Hyperuricemia | 6(0.6) | 0(0.0) | 0.032 | 0(0.0) | 0.196 | 6(100.0) | 0.102 | 0(0.0) | 1.000 |
Hyperlipidemia | 5(0.5) | 4(80.0) | 0.377 | 0(0.0) | 0.331 | 5(100.0) | 0.173 | 0(0.0) | 1.000 |
Kidney diseases | 4(0.4) | 3(75.0) | 0.626 | 0(0.0) | 0.580 | 4(100.0) | 0.306 | 0(0.0) | 1.000 |
Mental disorders | 3(0.3) | 2(66.7) | 1.000 | 0(0.0) | 0.565 | 3(100.0) | 0.555 | 0(0.0) | 1.000 |
Endocrine system diseases | 3(0.3) | 3(100.0) | 0.251 | 0(0.0) | 0.565 | 3(100.0) | 0.555 | 0(0.0) | 1.000 |
Values are presented as number (%). (a) Values for proportion of patients in each group were compared with the population (n=1014) using chi-squared test and Fisher exact test. (b) P-value <0.05.
No significant sex differences were found in the patients who came for nutrition services. About a half of the patients who came for healthy dietary services were minors, while most of the patients who came for malnutrition services were adults (P<0.001). More adult patients came due to overnutrition compared with undernutrition (P<0.01). Differences of demographics between main nutrition services are shown in Table
Differences of demographics between main nutrition services.
Variable | Healthy Dietary Services (n=425) | Malnutrition (n=326) | P Value | Undernutrition (n=116) | Overnutrition (n=210) | P Value |
---|---|---|---|---|---|---|
Sex | ||||||
Female | 229 (53.9) | 157(48.2) | 0.120 | 65(56.0) | 92(43.8) | 0.086 |
Age (years) | ||||||
0- <18 | 199 (46.8) | 70(21.5) | <0.001 | 33(28.4) | 37(17.6) | 0.023 |
18-64 | 218(51.3) | 247(75.8) | <0.001 | 77(66.4) | 170(81.0) | 0.003 |
≥65 | 8(1.9) | 9(2.8) | 0.422 | 6(5.2) | 3(1.4) | 0.073 |
Values are presented as number (%). (a) Values for proportion of patients in each group were compared with each other using chi-squared test and Fisher exact test. (b) P-value <0.05.
Along with the increasing incidence of nutrition-related chronic diseases such as obesity, hyperlipidemia, diabetes, cardio-cerebral vascular disease, cancer, and public awareness, there is a growing demand of public health nutrition service for nutrition-related issues in China in recent years.
A concerted effort was made in the mid-1980s to foster clinical nutrition in major hospitals throughout the country by programs directed at medical graduates and nursing and kitchen staff in China [
Our study showed that thousands of patients had been seen in the nutrition clinic as new cases in the past more than two years which indicated tremendous demand.
The population served by our nutrition outpatient clinic is extensive: age of patients ranged from 4 months to 92 years old. A large proportion of adult patients came to our clinic for nutrition services; on the contrary, minor patients only accounted for less than one-third and the number of elderly patients is quite small. However, population aging is becoming increasingly prominent in developing countries. The need for nutritional assessment and intervention is particularly crucial in elderly people due to the high incidence of chronic illness and malnutrition [
Majority of the patients came to our clinic for healthy dietary services. The healthy dietary services is dietary nutrition consultation for all stages of healthy population without diseases. The main services were nutrition consultation of common diet, growth and development, maternal nutrition, and preparation of pregnancy.
The common diet nutrition consultation accounted for the largest proportion which may due to the unreasonable food consumption patterns. For adult, some studies indicated that Chinese food consumption patterns and eating and cooking behaviors changed dramatically with urbanization, for instance, the increasing consumption of energy from fats, the high level of sodium consumption, and the high sodium-potassium ratios [
Besides healthy dietary services, the second highest ranked nutrition service is about malnutrition. The prevalence of overweight and obesity is increasing worldwide and even developing countries are beginning to experience this trend in the last two decades [
Some other patients came to our clinic for various disease-related nutritional counseling. The main diseases were diabetes, neoplasms, digestive system diseases, and so on. Research has shown that diet is the cornerstone of treatment in diabetes and dietary advice should be tailored to the individual and their circumstances [
The limitation of our research is that it is a retrospective study in a single center. A nonrandom and unrepresentative sample limits the generalizability of our study findings. However, almost all patients in the local area came to our center. So we believe that our conclusions are credible and meaningful.
The present study provided important data of the new public health nutrition service pattern in China which has never been reported yet. It indicated the huge demand of nutrition outpatient clinic, especially nutrition consultation services of healthy diet and malnutrition; further studies about the validity of the new pattern in improving public health nutrition status are expected in the future.
The data used to support the findings of this study are available from the corresponding author upon request.
The funder had no role in the design, analysis, or writing of this article.
The authors declare that there are no conflicts of interest regarding the publication of this paper.
The authors would like to thank the staff of the Division of Nutrition, the Fourth Affiliated Hospital of Zhejiang University School of Medicine, for providing necessary help for this project. This work is financially supported by Zhejiang Medical and Health Science and Technology Plan Project (Yunpeng Jin, Grant no. 2018KY873).