Trends in dietary cholesterol intake among Chinese adults: a longitudinal study from the China Health and Nutrition Survey, 1991-2011

Objectives: Dietary cholesterol is the leading risk factor for cardiovascular disease and other chronic diseases. Changes in dietary patterns in China recently might have an impact on the trends of diet-related risk factors of chronic diseases. This study aims to monitor the changes in daily cholesterol intake and its food sources in Chinese adults. Design: A longitudinal study using demographic and dietary data of adults younger than 60 years from eight waves (1991-2011) of the China Health and Nutrition Surveys was conducted. Mixed-effect models were used in this study. Setting: The data were derived from urban and rural communities in nine provinces (autonomous regions) in China. Participants: There were 21 273 participants (10 091 males and 11 182 females) in this study. Outcomes: The major outcome is daily cholesterol intake amount, which was calculated by using the Chinese Food Composition Table, based on dietary data. Results: The mean daily cholesterol intake in Chinese adults increased from 165.8 mg/day in 1991 to 266.3 mg/day in 2011. Cholesterol consumed by participants in different age (18-39 and 40-59 years), sex and urbanisation groups steadily elevated over time (p<0.0001), as did the proportions of participants with greater than 300 mg/day cholesterol consumption. In each subgroup, cholesterol originating from most of the food groups showed increasing trends over time (p<0.0001), except for animal fat and organ meats. Eggs, pork, fish and shellfish in that order remained the top three sources in 1991, 2000 and 2011, whereas milks were a negligible contributor. Cholesterol from animal fat declined and was insignificant in 2011 in most of the subgroups, while cholesterol being of poultry origin increased and became considerable in 2011. Conclusions: Adults in China consumed increasingly high cholesterol and deviated from the recommended intake level over the past two decades. Adults need to pay more attention to intakes of eggs, pork, fish and shellfish.