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Monday, June 17, 2013 C7



PRESSURE Increasing wealth and urbanisation on the mainland have led to a dramatic change in eating habits – and a matching shift in the causes of premature death, writes Jeanette Wang


A billboard in Shanghai advertises the opening of the latest fast food restaurant. Photo: AFP

hina’s rapid economic growth and emergence as a global power has been accompanied by other speedy developments, two of which made headlines on the same day a fortnight ago: McDonald’s expansion plans, and a new study on the mainland’s shifting disease patterns from infectious to chronic illnesses. It’s a timely coincidence. Diet is the leading risk factor for premature death on the mainland, accounting for one in three deaths in 2010, according to the study published in The Lancet. Comparing data from the World Health Organisation’s Global Burden of Disease (GBD) studies of 1990 and 2010, researchers found a rapid change in the nation’s health profile. Infectious, maternal, neonatal and nutritional disorders declined sharply in prevalence as noncommunicable diseases rose. About 85 per cent of China’s 8.3 million deaths in 2010 were due to non-communicable diseases, with stroke, ischaemic heart disease, cancers and chronic obstructive pulmonary disease the top causes of premature death. “The burden of diseases attributable to individual behaviours and practices is steadily rising,” writes Dr Yang Gonghuan, professor at Peking Union Medical College and co-lead author of the paper. These include diet, smoking, drinking alcohol and physical inactivity. The research team – from the Chinese Centre for Disease Control and Prevention, Peking Union Medical College and the Seattle-based Institute for Health Metrics and Evaluation – say the key dietary problems are the high consumption of sodium and inadequate intake of fruit, whole grains, nuts and seeds. On the same day the study was released, McDonald’s announced plans to boost its number of outlets on the mainland from 1,700 to more than 2,000 by next year. It entered the Chinese market in

HITS AND MYTHS ................................... Sasha Gonzales Q: Can a three-day juice fast really detox your body? The straight answer: No The facts: Fans of juice fasting claim that drinking fresh fruit and vegetable juices for three days is the trick to giving the body a good spring clean. As fresh juices contain high amounts of vitamins and minerals, they help detoxify the body from the inside, encouraging the organs to expel toxins and remove waste products from the bloodstream. During the “cleanse”, nothing but fresh-pressed, organic juices and water can be consumed. Green vegetables are said to be especially purifying, because they are rich in chlorophyll. The juices have to be drunk very slowly to maximise the absorption of nutrients, and chewing is recommended to help stimulate the production of saliva, which contains digestive enzymes. As poisons are purged from the body, juicing devotees rave about the other supposed benefits of the detox: improved stamina, since the energy that would otherwise have been used

to digest food is conserved, a clearer complexion, thanks to the increased vitamin and mineral intake, and weight loss. The human body produces, ingests or inhales toxins every day, in the form of environmental pollutants, like second-hand smoke and car exhaust, pesticides, food additives, toxic metals (that is, mercury from fish), and bisphenol A from plastic drink containers. The thing is a juice cleanse is not necessary because our systems are already equipped to remove these poisons naturally. Dr David Tjiu, specialist in general surgery at Matilda International Hospital, says our respiratory system ensures that excess carbon dioxide is expelled through the breathing process.

Our liver and kidneys, which make up our renal and hepatobiliary systems, excrete toxins, such as alcohol, through the urine and faeces. Our gastrointestinal system prevents toxins from accumulating in the body. Diarrhoea is a natural process by which these negative presences are flushed from our system. Sally Poon Shi-Po, a registered dietitian at Personal Dietitian, says there is little scientific evidence to support the cleansing or detoxifying powers of juice. “Our digestive system is already very good at eliminating toxins, and a good way to boost the efficacy of the gastrointestinal tract is to increase your fibre and water intake and consume yogurt or probiotics.” A three-day juice fast will likely not cause serious harm. In fact, says Poon, it may even motivate a person to make positive dietary changes, such as eating more fruits and vegetables. However, it is important to note that such cleanses should not last for prolonged periods, as it can lead to nutrient deficiencies.

Some juices can actually have detrimental side effects. Raymond Chung Tsz-man, a nutritionist at Albert Place Practice/Mineralysis, says grapefruit and hawthorn berry juices can induce a state of low blood pressure and should not be taken by those who already suffer from the condition. Another concern is the interaction between certain juices and drugs. Cleansing concoctions containing grapefruit juice, for example, can be very dangerous if consumed with some Western medicines and Chinese herbs, because grapefruit can alter their action or absorption. As juices contain high amounts of potassium, they are also not recommended for people suffering from kidney failure or renal insufficiency. People with diabetes or low blood sugar, growing children, teens, pregnant women, and older adults should avoid the juice cleansing diet. “If you want to go on a cleanse or a diet for a specific therapeutic purpose, it is best to consult a health care professional first,” Chung says. “And it’s important to remember that detoxification takes time – usually longer than three days – because most chemicals are accumulated in our fat cells or bind to protein in our organs.”

1990, three years after KFC opened the mainland’s first fast food restaurant in Beijing. KFC now has more than 4,200 outlets in 850 cities. In the five years to 2012, revenue for the fast food restaurant industry on the mainland grew at about 17 per cent annually to US$89.6 billion, according to research company IBISWorld. “Ten to 20 years ago in China, not many people could afford to eat at McDonald’s and KFC. But today, they’re everywhere and always overflowing with customers,” says Ma Yu-quan, a researcher with Zhuhai People’s Hospital. Increasing affluence and urbanisation have led to a dramatic change in Chinese eating habits, not only to a preference for fast food, but also from a semi-vegetarian diet to one dominated by meat, milk and eggs. This change is matched by a rapid increase in the overweight population, especially in urban areas. It’s contributing to a growing hypertensive population in China, Ma says. A diet high in salt, fat and sugar, as well as physical inactivity and alcohol and tobacco consumption are all risk factors for high blood pressure. In his recent study published in the journal PLOS One, Ma reviewed 27 studies on hypertension in China that were published between January 2002 and June 2012. He found that the prevalence of hypertension among Chinese above 15 years of age increased from 5.1 per cent in 1958 to 17.6 per cent in 2002. Another new study, the China Health and Retirement

Ten to 20 years ago, not many people could afford to eat at McDonald’s MA YU-QUAN, RESEARCHER


system lags Longitudinal behind the change Study of more in disease than 17,000 patterns.” Chinese aged The estimated number of Public health 45 and above, mainlanders aged 60 and programmes to showed that above who have high reduce tobacco more than one blood pressure consumption, sodium in two elderly intake and other dietary people, or risks are clearly important potentially about strategies to tackle 100 million people aged 60 and cardiovascular diseases, the above, have high blood pressure. researchers say. It’s no surprise, then, that Because of China’s hospitalhypertension is the second centred health system, primary leading risk factor identified in care also needs to be the China GBD study. It accounted strengthened to be a platform for for 12 per cent of total years of delivery of interventions such as life lost (due to ill health, screening, early detection and disability or early death) and 24.6 disease management. per cent of deaths. Education is also important. High blood pressure is the Awareness of hypertension, for most common risk factor for example, has remained low for cardiovascular disease, the past 20 to 30 years, at about contributing to nearly 9.4 million 30 per cent of the total deaths worldwide due to heart hypertensive population, disease and stroke every year according to Dr Wang Jiguang, a according to the WHO. professor of medicine and Tobacco is the third major director of the Shanghai Institute risk. The fraction of deaths of Hypertension. The China attributable to tobacco increased Health and Retirement from 12.8 per cent in 1990 to 16.4 Longitudinal Study found that 40 per cent in 2010, and the per cent of respondents had researchers say this will increase undiagnosed hypertension prior because of the lag between to the survey. consumption and death rates. Demographic shifts spurred Smoking prevalence in China by the one-child policy and a is rising, mainly among men. rapidly ageing population, and Fifty-three per cent of Chinese increasing urbanisation, will only men smoke (one of the intensify the health risks and highest rates in the world) challenges to China’s health care and 2.4 per cent of women (one of system. Rising incomes mean the the lowest). burden attributable to lifestyle The double whammy of poor factors is likely to increase. diet and tobacco is also having In response to these changing dire consequences on China’s dynamics, the Chinese cancer burden. The GBD study government launched the China found the mainland has five White Paper on Healthcare in cancers in the top 15 causes of December last year, outlining a premature mortality: lung, liver, plan for tackling nonstomach, oesophageal and communicable diseases by colorectal. Of these, the burden integrating prevention, early of lung, liver and colorectal diagnosis and appropriate cancers increased between 1990 treatment, along with improved and 2010. monitoring, surveillance and “Tobacco and diet account for electronic record-keeping. important shares of stomach, The researchers say the colorectal and lung cancers,” say government needs to take the researchers. “Aggressive responsibility for expansion of tobacco control and national prevention strategies. “Even efforts to encourage changes in small reductions in these risks diet will be important.” could generate substantial health China’s health care system benefits,” Yang writes. also needs to do some catching up, Yang says. “The health care

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