China Health and Nutrition Survey

Gordon-Larsen and Popkin lead the data collection projects that support the China Health and Nutrition Survey. This is a household-based cohort study that has been conducted by an international team of researchers whose backgrounds include nutrition, public health, economics, sociology, Chinese studies, and demography. The survey takes place over a 7-day period using a multistage, random cluster process to draw a sample of about 7,200 households with over 30,000 individuals in 15 provinces and municipal cities that vary substantially in geography, economic development, public resources, and health indicators. In addition, detailed community data were collected in surveys of food markets, health facilities, family planning officials, and other social services and community leaders. More information can be found here: Link to

Related Research 

Heterogeneity in Cardiometabolic Risk with Obesity: Who Is at Risk? (R21-DK089306). National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Principal Investigator: Penny Gordon-Larsen. 7/15/10 – 4/30/13.

Emergence of Cardiometabolic Risk across the Lifecycle in China (R01-HL108427). National Institutes of Health, National Heart, Lung, and Blood Institute. Principal Investigator: Penny Gordon-Larsen. 3/1/12-2/28/16.

The objective of this research was to investigate the constellation of cardiometabolic risk factors in the context of rapid environmental change seen in China. In this work, we addressed recent increases in cardiometabolic risk in the world’s largest population and the resulting millions of affected individuals at enormous societal and economic cost. Findings extended past China to inform efforts to reduce weight gain and cardiometabolic risk across the globe. We took advantage of extraordinary data from The China Health and Nutrition Survey.

In the Heterogeneity in Cardiometabolic Risk project, we  focused on understanding  how  individuals of similar body mass index can exhibit variability in cardiometabolic risk (i.e., elevated blood pressure, elevated triglycerides, decreased HDL-C, elevated glucose, insulin resistance, and systemic inflammation), resulting in individuals who are metabolically healthy despite being overweight, whereas individuals of normal weight may be at high metabolic risk. While in the US approximately 16.3 million adults are of normal weight but have two or more metabolic abnormalities, we know very little of these phenotypes in the context of rapidly modernizing countries such as China that have experienced a dramatic emergence of obesity, insulin resistance, type 2 diabetes, and cardiovascular disease with urbanization over the past two decades. We used a Latent Class Trajectory Analysis to characterize the patterns of weight change in the sample. We were particularly interested in contrasts across tempo and timing of weight gain and how this tempo and timing influenced cardiometabolic risk.

In the Emergence of Cardiometabolic Risk Project, we identified the multiple pathways through which such changes influence changes in weight and central adiposity and further, development of cardiometabolic risk across the lifecycle. We used complex statistical methodology to develop a full, longitudinal structural model to address complex relationships between diet and activity, weight, and waist circumference with blood pressure over 20 years. There is little understanding of the multiple and complex pathways to cardiometabolic risk. Using innovative strategies and taking advantage of rapid social, economic and environmental changes with urbanization in China, this project informed current understanding of the development of cardiometabolic risk. We aimed to understand how the timing and rapidity of weight gain predict the development of hypertension and high risk of diabetes, dyslipidemia, and inflammation.

Our team is comprised of a well-established team of researchers who have worked together for the past 15 years: Dr. Barry Popkin, the Carla Smith Chamblee Distinguished Professor of Global Nutrition and Dr. Linda Adair, Professor of Nutrition. We are very excited about our collaborative relationships with Dr. Amy Herring, Professor of Biostatistics, Dr. Beth Mayer-Davis, Professor of Nutrition, Dr. Amanda Thompson, Assistant Professor of Anthropology, Dr. Annie Greene Howard, Samantha Attard, all at UNC, as well as Dr. Shengkai Yan of the China-Japan Friendship Hospital, Dr. Bing Zhang of the National Institute of Nutrition and Food Safety, China Center for Disease Control, Beijing China, and Dr. James Meigs of Massachusetts General Hospital and Harvard Medical School.