Nutritional determinants, childhood morbidity patterns, and healthcare utilization among Chinese children: a...

Childhood nutrition has a substantial impact on growth, disease susceptibility, and use of health care services. Malnutrition is a double burden in China, characterized by chronic undernutrition and childhood obesity.

The objective of this study was to explore the relationships between nutrition determinants, childhood morbidity patterns and health care utilization in the Chinese population.

This retrospective, institution-based study analyzed routinely collected health records from 720 children aged 3-14 years who received care at a tertiary healthcare center in Nanchong, Sichuan, China, between 2021 and 2025. Nutritional status and dietary quality were determined by using the routine health records. Morbidity burden and service use were assessed using medical records for children. Independent predictors were identified by using multivariable logistic regression.

15.1% of participants were undernourished, and 20.3% were overweight or obese. The childhood morbidity burden was observed in 25.7% of children and was significantly higher in children who were undernourished and obese (p < 0.001). Known-groups validity testing showed that all 9 individual components of the dietary-quality score varied significantly and monotonically across derived tiers (Cochran-Armitage p < 0.001 for all), supporting the internal coherence of the measure. Poor dietary quality, as measured by this study-specific composite index, was an independent risk factor for a high burden of morbidity (Adjusted odds ratio (AOR) = 2.76, 95% CI: 1.89-4.05). High healthcare utilization was observed in 25.8% of participants. It was independently associated with high morbidity burden (AOR = 3.87, 95% CI: 2.71-5.54), undernutrition (AOR = 2.09, 95% CI: 1.37-3.20), obesity (AOR = 2.34, 95% CI: 1.40-3.89), poor dietary quality (AOR = 1.96, 95% CI: 1.32-2.92), low household income (AOR = 1.58, 95% CI: 1.07-2.34), and grandparent caregiving (AOR = 1.45, 95% CI: 1.01-2.11).

Undernutrition and overweight/obesity, in addition to poor diet quality, are associated with higher morbidity rates and utilization of health services in children in China. The findings suggest that nutritional status and dietary quality are significantly associated with childhood morbidity burden and healthcare utilization.