Fighting micronutrient deficiencies in China

According to the World Health Organization (WHO), malnutrition comes in three forms. One is undernutrition or hunger, caused by an insufficient intake of energy and protein. But other types of malnutrition — micronutrient deficiency and obesity — are the greatest malnutrition challenges faced by fast-developing societies such as China, says Junshi Chen from the China National Centre for Food Safety Risk Assessment, a government research institution based in Beijing.

Micronutrient deficiency and obesity typically take their toll slowly, with associated health risks increasing over time. For those with micronutrient deficiencies, multivitamins may improve their nutritional status.

While hunger as a widespread problem in China has greatly decreased, micronutrient deficiency, known as hidden hunger, is still prevalent and obesity is on the rise, explains Chen. “More than 97% of people in China suffer from inadequate calcium intake from their daily diet, which is a major risk factor for osteoporosis,” says Chen, who also highlights the prevalence of vitamin D deficiency among the population.

According to the China State Council Information Office, in 2020, more than half of the Chinese adult population is obese or overweight, and the incidence of diet-related chronic diseases, such as hypertension, cancer and type two diabetes, has also increased rapidly in recent years.

“Many people in China live a fast-paced lifestyle and have inadequate knowledge or awareness of what makes up a balanced diet,” says Chen. He adds that some are consuming energy-dense, but nutrient-poor, diets that are lacking in multiple micronutrients. Micronutrient deficiencies can lead to problems such as poor cognitive function and bad oral health¹.

Brain aging

To explore the possible uses of multivitamin supplements, and potentially beneficial cocoa extracts, for reducing memory loss and improving the cognitive function of older adults in the United States, researchers at institutions, including Harvard Medical School in Boston and Columbia University in New York, set out on a major longitudinal study in 2015.

For the Cocoa Supplement and Multivitamin Outcomes Study (COSMOS), more than 6000 participants aged 60 and over were recruited for randomized, placebo-controlled trials. The studies were supported by a number of entities, including Haleon, a consumer healthcare company that is headquartered in Weybridge, United Kingdom. Haleon provided a Centrum-branded multivitamin for the trial, which contains a range of micronutrients, including B-complex vitamins, as well as vitamins C, D and E, iron, zinc, and folic acid.

The results of the COSMOS study were published in a series of papers^2,3,4. These types of large-scale studies are helping to tease out the effects of daily multivitamin supplementation on memory and cognitive health in older adults, says Henglong Hu, head of research and development at Haleon China, based in Shanghai.

“Because the outcomes of multivitamin use may be subtle over short periods of time, this type of research often requires long-term follow-up research involving large sample sizes covering a diverse population,” Hu explains. More long-term collaborations such as the COSMOS study are needed to better inform public health policy makers on how to tackle nutrition-related public health issues, says Hu.

Long-running studies

Haleon has also provided vitamins for a number of other longitudinal studies. In 1986, as part of an interventional study on oesophageal dysplasia — a pre-cancerous condition in the cells of the throat — a multivitamin was provided to participants of a remote county in Henan Province in China’s east. The researchers hypothesized that malnutrition here may be linked to the area’s high risk of oesophageal dysplasia.

A total of 29,584 people aged 40–69 participated in the double blind, randomized, placebo-controlled trial across the course of six-years, during which the effects of daily supplement intake on progression and mortality rates were evaluated. A follow-up of the study has been ongoing for 35 years⁵.

And in another collaboration with Harvard Medical School, published in 2012⁶, multivitamins were provided daily for 11.2 years to 14,641 male physicians aged 50 and older in the US. The study investigated whether long-term multivitamin intake impacted the risk of cancer in this group.

Nonetheless, Haleon’s 1,400 researchers are actively collaborating on additional studies with leading research universities in the United States, the United Kingdom, China, Singapore and other countries. In the future, Hu says the company “hopes to be able to help provide more solution and scientific data on public health areas of concern, particularly those linked to aging populations”.

Beyond supplements

Haleon has also been working to expand its research to areas beyond nutritional supplements. “We hope to provide innovative healthcare solutions for unmet consumer needs,” explains Hu.

One of the health issues it is researching is dentin hypersensitivity. The condition is caused by loss of enamel associated with tooth wear or gum recession, which exposes dentin, the tissue underneath the enamel that makes up the majority of the tooth. As a follow up to a 2008 survey, Haleon researchers based in Shanghai are collaborating with the China Oral Health Foundation, a public body based in Beijing, on a national survey on the prevalence and the risk factors of dentin hypersensitivity and tooth wear in the Chinese population.

Other research areas that Haleon continues to investigate include pain management, immunity and mobility in older adults, as these areas address the needs of China’s rapidly growing ageing population.

In 2023, Haleon launched a platform in China that creates personalized nutrition and healthcare platform aided by Haleon scientists and artificial intelligence. These platforms are based on health data from questionnaires, physical examinations, wearable tracking devices, genetic tests, etc.

Since 2010, Haleon has also launched a number of health literacy campaigns, including ‘Healthy Bone China’, ‘Pain Free China’ and ‘Healthy Teeth China’, to raise awareness about issues such as bone health, pain management and oral health. Their campaign on bone health, for example, has provided a free bone mineral density test to more than one million Chinese residents across 100 cities.

“We have gained Chinese consumers’ trust over the last 30 years by providing reliable research-based healthcare products and solutions,” Hu says. “It is our social responsibility to inform consumers of impartial information that could potentially improve public health.”