Prevalence and distribution of acute gastrointestinal illness in the community of China: a population-based face-to-face survey, 2014-2015.

BACKGROUND: The true incidence of acute gastrointestinal illness in China is underrecognized by surveillance systems. The aims of this study were to estimate the incidence and prevalence of self-reported AGI in the community of China, and to investigate sociodemographic and epidemiological determinants of AGI. METHODS: We conducted a 12-months cross-sectional population-based survey in eight provinces of China during 2014-2015. The survey determined the prevalence and incidence of acute gastrointestinal illness (AGI) in the total permanent resident population in China according to the census of the population in 2010. The random multilevel population sample was stratified by geographic, population, and socioeconomic status. We used a recommended case definition of AGI, with diarrhea (three loose or watery stools) and/or any vomiting in a four-week recall. A face-to-face survey was conducted by selecting the member in the household with the most recent birthday. RESULTS: Among 56,704 sampled individuals, 948 (1,134 person-time) fulfilled the case definition; 98.5% reported diarrhea. This corresponds to 2.3% (95% CI:1.9%-2.8%) of an overall standardized four-week prevalence and 0.3 (95% CI: 0.23-0.34) episodes per person-year of annual adjusted incidence rate. There was no significant difference between males and females. The incidence rates were higher among urban residents, and in the spring and summer. In the whole study period, 50% of the cases sought medical care, of which 3.9% were hospitalized and 14.3% provided a biological sample for laboratory identification of the causative agent. Children aged 0-4 and young adults aged 15-24, people living in rural areas and people who traveled frequently had higher prevalence of AGI. CONCLUSION: Results showed that AGI represents a substantial burden in China, and will contribute to the estimation of the global burden of AGI. Complemented with data on the etiologies of AGI, these estimates will form the basis to estimate the burden of foodborne diseases in China.

Risk-benefit assessment of methylmercury and n-3 polyunsaturated fatty acids through fish intake by pregnant women in Shanghai, China: Findings from the Shanghai Diet and Health Survey.

BACKGROUND: Fish and shellfish contain nutrients essential for fetal health, especially docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). The concern of mercury (Hg) pollution limits fish consumption among women in pregnancy, which could adversely affect child development. This study aimed to conduct risk-benefit assessment and provide recommendations for fish intake by pregnant women in Shanghai, China. METHODS: Secondary analysis was conducted using cross-sectional data from a representative sample of the Shanghai Diet and Health Survey (SDHS) (2016-2017), China. Dietary intakes of Hg and DHA + EPA were calculated from the food frequency questionnaire (FFQ) on fish items and 24hr recall record. Raw fish samples (59 common species of fish in Shanghai) were purchased in local markets and their concentrations of DHA, EPA and Hg were measured. Net IQ points gain was used to evaluate the health risk and benefit at a population level by FAO/WHO model. Recommended fish (i.e., high- DHA + EPA and low-level MeHg) were defined, and then the proportion of those hit 5.8 IQ points were simulated with their consumption frequency for 1, 2 and 3 times per week. RESULTS: The average consumption of fish and shellfish was 66.24 g/d among pregnant women in Shanghai. The mean concentrations of Hg and EPA + DHA in fish species most commonly consumed in Shanghai were 0.179 mg/kg and 0.374 g/100 g, respectively. Only 1.4% of the population exceeded the MeHg reference dose of 0.1 µg/kg·bw/d, whereas 81.3% of those who did not meet the recommended daily intakes of 250 mg EPA + DHA. In FAO/WHO model, the proportion of 28.4% reached the maximum IQ points gain. Along with the increase of "recommended fish" consumed, the simulated values of the proportion raised to 74.5, 87.3 and 91.9%, respectively. CONCLUSION: The pregnant women in Shanghai, China had an adequate fish consumption with low-level Hg exposure, but balancing the benefits of fish intake and risk of potential Hg exposure was still a challenge. It is necessary to define a local level of "recommended fish" consumption for developing dietary recommendations for pregnant women.

Neonicotinoids residues in the honey circulating in Chinese market and health risk on honey bees and human.

China is the largest beekeeping and honey consumption country globally. Neonicotinoids in honey can pose adverse effects on honey bees and human, but data on neonicotinoids residues in honey and its health risk remain limited in China. A total of 94 honey samples were selected from Chinese market based on production region and sale volume in 2020. Eight neonicotinoids and four metabolites were determined by liquid chromatography coupled to mass spectrometry. Health risk of neonicotinoids in honey on honey bees and human was assessed by hazard quotient (HQ) and hazard index (HI). Neonicotinoids and their metabolites were overall detected in 97.9% of honey samples. Acetamiprid, thiamethoxam, and imidacloprid were top three dominant neonicotinoids in honey with the detection frequencies of 92.6%, 90.4%, and 73.4%, respectively. For honey bees, 78.7% of honey samples had a HI larger than one based on the safety threshold value of sublethal effects. Top three neonicotinoids with the highest percent proportion of HQ larger than one for honey bees were acetamiprid (43.6%), imidacloprid (31.9%), and thiamethoxam (24.5%) and their maximum HQs were 420, 210, and 41, respectively. Based on oral median lethal doses for honey bees, both HQ and HI were lower than one in all honey samples. For human, both HQ and HI were lower than one based on acceptable daily intakes in all honey samples. Neonicotinoids concentrations and detection frequencies in honey samples and its health risk varied with production region, commercial value of nectariferous plants, number of nectariferous plants, and sale price. The results suggested extensive residues of neonicotinoids in honey in Chinese market with a variation by the characteristics of honey. The residues were likely to affect the health of honey bees, but showed no detectable effect on human health.

The high sodium condiments and pre-packaged food should be the focus of dietary sodium control in the adult Shanghai population.

BACKGROUND: Long-term, excessively high sodium consumption can lead to increased blood pressure, which is a major risk factor for cardiovascular disease. Therefore, we aimed to analyze the dietary sodium intake and food sources to understand the epidemiological characteristics associated with potentially influencing variables in adults from Shanghai. METHODS: Residents aged 15 years and above were randomly selected using multi-stage stratified random sampling in Shanghai. Over 3 days, family condiments were weighed for each 24-h day, and recall surveys were conducted for the same timeframe regarding sodium intake during the spring, summer, autumn, and winter seasons. RESULTS: The median sodium intake for residents aged 15 years and above was 4.3 g/d in Shanghai, where 55.1% was obtained from cooking salt, 13.2% from sodium condiments, and 22.2% from pre-packaged food. There were no significant differences in total sodium intake or main sources of sodium intake between different seasons. The sodium intake of rural residents > suburban residents > urban residents (P < 0.05). The logistic regression demonstrated that compared to the rural, the people living in urban and suburban consumed less sodium. Compared to the 18-44, the people aged 45-59 and ≥ 60 consumed more sodium (P < 0.05). CONCLUSIONS: Sodium intake is high in Shanghai. The absolute amount of cooking salt is low in Shanghai, and the possibility of further reduction is very little under the existing dietary habit. Limiting high sodium condiments and pre-packaged food is the new key to controlling salt intake in the future.

Appropriate Range of Median Urinary Iodine Concentration in 8- to 10-Year-Old Children Based on Generalized Additive Model.

Background: The appropriate range of median urinary iodine concentration (MUI) in children has always been controversial. To prevent the occurrence of a goiter epidemic in Shanghai, we explored the appropriate range of MUI by integrating multiple monitoring results. Methods: This study summarized and analyzed the monitoring data from 1997, 1999, 2011, 2014, and 2017 of children living in Shanghai. In each monitoring year, the probability-proportional-to-size sampling technique was used to select 30 sampling units. In each sampling unit, one primary school was randomly selected. From each selected school, 40 children 8- to 10-year-old were randomly recruited to measure thyroid volume (Tvol) and their household salt iodine intake. Results: In 1997, 1999, 2011, 2014, and 2017, MUI of 8- to 10-year-old children was 228, 214, 182, 171, and 183 µg/L, and median Tvol (MTvol) was 2.9, 1.2, 1.0, 1.8, and 2.8 mL, respectively. There was a linear correlation between goiter rate and MTvol (r = 0.95, p = 0.014; 100 × goiter rate = 1.314 × MTvol -1.287). Generalized additive model (GAM) was used to predict MTvol as follows, MTvol = 0.60689 + 0.00302 MUI +0.999928 s (MUI) -0.05172 mean salt iodized concentrations (MSIs) +0.03481 × 100 × iodized salt coverage rate +0.00000969 per capita disposable income +0.271422 s (per capita disposable income) -0.38772 × monitoring year gap. The results revealed that the average relative error between predicted and actual value was 15.2%. GAM results showed that at 27-277 µg/L MUI, the goiter rate was <5%. Conclusions: Iodine status is appropriate in Shanghai. Under the existing economy and MSI, the optimal range of MUI should be 70-277 µg/L in 8- to 10-year-old children living in Shanghai.

Validity and reliability of a food frequency questionnaire for assessing dietary intake among Shanghai residents.

BACKGROUND: Few localized food frequency questionnaires (FFQ) have been developed and used in Chinese nutrition surveys despite China's large population and diverse dietary habits. METHOD: We analyzed data collected in two waves (six months apart) of the Shanghai Diet and Health Study in 2012-2013, from 1623 Shanghai residents (798 men and 825 women) older than 18 years. The results of 3-day 24-h dietary recalls (HDR) plus condiment weighing were used to evaluate the validity and reliability of the SDHS FFQ. RESULTS: The median and first and third quartiles for energy intake (in kcal) derived from the FFQ1 and FFQ2 were 1566.5 (1310.1-1869.6) and 1561.9 (1280.2-1838.4), respectively, of which protein (in g) was 54.3 (42.5-65.8) and 52.9 (42.4-64.5), fat (in g) was 49.8 (37.2-64.7) and 47.9 (34.9-61.9), and carbohydrates (in g) was 227.3 (180.8-277.9) and 228.1 (182.2-275.2) in the reliability analysis. The median and first and third quartiles for energy-intake differences between the FFQ1 and the 3-day 24-HDR with condiment weighing was 59.3 (- 255.5-341.6), of which protein was - 5.2 (- 18.7-7.8) and fat was - 11.2 (- 30.8-5.3). The adjusted Spearman's correlations were 0.33-0.77 for validity and 0.46-0.79 for reliability. The intra-class correlation coefficients exceeded 0.46 (validity) and 0.47 (reliability) for macronutrient intake. The consistency between the same and adjacent quartiles was approximately 80% for various nutrients. CONCLUSION: The reliability and comparative validity of the SDHS FFQ is similar to FFQs that are used worldwide.

The Dietary Intake and Its Features across Four Seasons in the Metropolis of China.

Chinese diet pattern known as plant-based is more linked with seasonal supply, but it is lack of study on seasonal difference in dietary intakes in China. Our study was to assess seasonal variation in the absolute dietary intake among general population in a metropolis, Shanghai, China. A representative sample of general population aged 15 and older (n=1,704) were randomly stratified-sampled from communities in Shanghai. Dietary survey included consecutive 3-day-24-hour diet record recall and household condiments weighing. Data was collected across four seasons during 2012-2014. Most of food and condiments consumption differed across seasons in Shanghai. Intakes of grains, legumes and cooking oil were highest in spring; vegetables, fruit and non-alcoholic beverage highest, but cooking oil and cooking salt lowest in summer; red meat, nuts and cooking salt highest in winter. Seasonality existed in the intakes of energy and energy contributed from macronutrients that fat contributed more in winter but less in summer. Seasonal variations were also found in beta-carotene, vitamin E, vitamin K, thiamin, folate and sodium intakes. Seasonal changes of dietary intake were extensively observed in Shanghai, a highly-developed metropolis in China. Given the seasonal differences and their features described in current article, the estimation methods of the average dietary intake across whole year by just conducting dietary survey in one single season warrants further study.

Eating Out-of-Home in Adult Residents in Shanghai and the Nutritional Differences among Dining Places.

BACKGROUND: With the rapid development of Shanghai's economy, diet habits have undergone great changes. The study aimed to examine the situation of out-of-home (OH) eating in Shanghai adults and the nutrition characteristics of eating in different dining places, and to assess the social demographic determinants of eating OH. METHOD: Data was sourced from the Shanghai Diet and Health Survey (SDHS) involving people aged 18 years or older in 2012⁻2013. The food frequency questionnaire (FFQ) and three-day 24-h dietary recall (24-HDR) were used to collect dietary intake data on how people eat out in a cross-sectional study of 1689 adults. OH food refers to the food prepared or consumed away from home. We define that people who eat at least one meal prepared away from home in each survey have a habit of eating outside. The multiple linear and logistic regression methods were used for statistical analysis. RESULTS: The prevalence of eating OH and at restaurants was only 55.1% and 31.8%, respectively. There was an increase in energy, protein, carbohydrate, fat, and iron intake while eating OH. Restaurant and company/school canteen consumption were both associated with an increase in daily total energy intake of 140 kcal and 91 kcal, and fat intake of 6.0 g and 4.3 g, respectively. However, eating at restaurants was associated with higher intake of 548 mg of sodium. However, no significant association was observed between eating at canteens and higher sodium intake. CONCLUSIONS: Eating OH related to a poor diet quality, and the diet quality was different restaurant and canteen food. There may be a need for interventions to target residents' overall dining-out behavior, particularly focusing on the consumption of restaurant food.

A computerized system for detecting signals due to drug-drug interactions in spontaneous reporting systems.

UNLABELLED: WHAT IS ALREADY KNOWN ABOUT THE SUBJECT: * Concomitant use of different drugs may yield excessive risk for adverse drug reactions and it is a challenging task to do surveillance on the safety profile of the interaction between different drugs. * Currently, several methods are used by pharmacoepidemiologists and statisticians to detect possible drug-drug interactions in spontaneous reporting systems. * However, with the increasing number of reports in the system, there is a growing need for a computerized system that could facilitate the process of data arrangement and detection of drug interaction. WHAT THIS STUDY ADDS: * We had already developed a computerized system to detect adverse drug reaction signals due to single drugs. * After the development of this system, interaction between different drugs could also be detected automatically and intelligently. AIMS: In spontaneous reporting systems (SRS), there is a growing need for the automated detection of adverse drug reactions (ADRs) resulting from drug-drug interactions. In addition, special attention is also needed for systems facilitating automated data preprocessing. In our study, we set up a computerized system to signal possible drug-drug interactions by which data acquisition and signal detection could be carried out automatically and the process of data preprocessing could also be facilitated. METHODS: This system was developed with Microsoft Visual Basic 6.0 and Microsoft Access was used as the database. Crude ADR reports submitted to Shanghai SRS from January 2007 to December 2008 were included in this study. The logistic regression method, the Omega shrinkage measure method, an additive model and a multiplicative model were used for automatic detection of drug-drug interactions where two drugs were used concomitantly. RESULTS: A total of 33 897 crude ADR reports were acquired from the SRS automatically. The 10 drug combinations most frequently reported were found and the 10 most suspicious drug-drug ADR combinations for each method were detected automatically after the performance of the system. CONCLUSIONS: Since the detection of drug-drug interaction depends upon the skills and memory of the professionals involved, is time consuming and the number of reports is increasing, this system might be a promising tool for the automated detection of possible drug-drug interactions in SRS.

Pharmacovigilance in Traditional Chinese Medicine safety surveillance.

PURPOSE: To give an overview of the current status including problems and efforts about pharmacovigilance in Traditional Chinese Medicine (TCM) safety surveillance. METHODS: It is based on literature review and publicly available data in China. RESULTS: TCM led to several adverse drug reactions (ADRs) during the past few years and pharmacovigilance about TCM remained as a problem though great effort had been made to improve it. CONCLUSIONS: Pharmacovigilance in TCM is still facing many challenges in playing critical roles in China. More attention should be paid to pharmacovigilance in TCM safety surveillance.