Maternal dietary patterns during pregnancy and birth weight: a prospective cohort study.

BACKGROUND: Existing data on maternal dietary patterns and birth weight remains limited and inconsistent, especially in non-Western populations. We aimed to examine the relationship between maternal dietary patterns and birth weight among a cohort of Chinese. METHODS: In this study, 4,184 mother-child pairs were included from the Iodine Status in Pregnancy and Offspring Health Cohort. Maternal diet during pregnancy was evaluated using a self-administered food frequency questionnaire with 69 food items. Principal component analysis was used to identify dietary patterns. Information on birth weight and gestational age was obtained through medical records. Adverse outcomes of birth weight were defined according to standard clinical cutoffs, including low birth weight, macrosomia, small for gestational age, and large for gestational age. RESULTS: Three maternal dietary patterns were identified: plant-based, animal-based, and processed food and beverage dietary patterns, which explained 23.7% variance in the diet. In the multivariate-adjusted model, women with higher adherence to the plant-based dietary patten had a significantly higher risk of macrosomia (middle tertile vs. low tertile: odds ratio (OR) 1.45, 95% CI 1.00-2.10; high tertile vs. low tertile: OR 1.55, 95% CI 1.03-2.34; P-trend = 0.039). For individual food groups, potato intake showed positive association with macrosomia (high tertile vs. low tertile: OR 1.72, 95% CI 1.20-2.47; P-trend = 0.002). Excluding potatoes from the plant-based dietary pattern attenuated its association with macrosomia risk. No significant associations was observed for the animal-based or processed food and beverage dietary pattern with birth weight outcomes. CONCLUSIONS: Adherence to a plant-based diet high in carbohydrate intake was associated with higher macrosomia risk among Chinese women. Future studies are required to replicate these findings and explore the potential mechanisms involved.

Association between lean mass and adolescent idiopathic scoliosis: a meta-analysis.

OBJECTIVE: The objective of this meta-analysis was to evaluate the association between lean mass and adolescent idiopathic scoliosis (AIS). METHODS: English databases CENTRAL (The Cochrane Library and the Cochrane Back Review Group Trials Register), MEDLINE, EMBASE, PubMed, Web of Science and Chinese databases CBM, CNKI, VIP, WANGFANG DATA were searched for the relevant case control studies and cross-sectional studies. Two authors selected studies and extracted data independently. Data analysis was performed by Stata15.0. RESULTS: Eight studies were included, with a total of 1771 cases of AIS and 6340 controls. AIS group had a lower lean mass compared to control group [MD = - 1.95, 95% CI (- 2.96, - 0.93)]. In the subgroup analysis, female AIS patients had a lower lean mass than the control group [MD = - 1.76, 95% CI (- 2.63, - 0.88)]. The mean difference of lean mass between AIS patients and control group in studies with adults [MD = - 3.96, 95% CI (- 7.26, - 0.67)] is much greater than studies without adults [MD = - 1.04, 95% CI (- 1.59, - 0.49)]. There was not statistically significant in European studies [MD = - 2.10, 95% CI (- 4.35, 0.14)], but in Asian studies lean mass in AIS patients was lower than the control group [MD = - 2.26, 95% CI (- 3.98, - 0.54)]. Study type, gender, age, and geography condition were thought to have no effect on the primary outcome of lean mass by subgroup analysis. CONCLUSION: In the meta-analysis, AIS group had a lower lean mass compared to control group, which indicated that lean mass may be involved in the pathogenesis of AIS. But limited by the number of studies we included; the above conclusions need to be validated by more high-quality studies.

[Survey on the awareness rate of nutrition and health knowledge among residents aged 18-64 in Shanghai in 2021].

OBJECTIVE: To analyze the nutrition and health knowledge of residents aged 18-64 in Shanghai, and to understand the level of nutrition and health knowledge and its influencing factors. METHODS: The total of 6518 residents aged 18-64 years old in Shanghai were selected by stratified random sampling in 2021. The subjects were grouped by gender, age, education levels, occupations, and regions. The awareness rate of nutrition and health knowledge and its influencing factors were investigated using the questionnaire and scoring standard designed by National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention. Household survey, face-to-face questioning by surveyors and help to fill in the options. RESULTS: The score of nutrition and health knowledge of residents aged 18-64 in Shanghai was 68.43±12.82, and the awareness rate was 35.78%. The average score(t=-5.04, P<0.01) and awareness rate(χ~2=14.06, P<0.01) of women were significantly higher than men. Significant differences in average scores and awareness rates were found among different groups of ages(F=15.02, P<0.01;χ~2=23.46, P<0.01), education levels(F=191.45, P<0.01;χ~2=210.29, P<0.01), occupations(F=99.17, P<0.01;χ~2=224.12, P<0.01) and regions(F=22.11, P<0.01;χ~2=44.61, P<0.01). The female(OR=1.13, 95%CI 1.02-1.25), high school education and above(OR=1.68-2.85) had better knowledge of nutrition and health. While 18-34 years(OR=0.69-0.74), people engaged in non-medical health institutions(OR=0.46-0.70) and living in non-urban central areas(OR=0.74-0.81) had poorer awareness of nutrition and health knowledge. CONCLUSION: The awareness rate of nutrition and health knowledge among residents aged 18-64 in Shanghai is still upside potential.

Thyroid cancer and Its Associations with Dietary Quality in A 1:1 matched Case-Control Study.

Thyroid cancer (TC) incidence has increased greatly during the past decades with a few established risk factors, while no study is available that has assessed the association of the Chinese Health Dietary Index (CHDI) with TC. We conducted a 1:1 matched case-control study in two hospitals in Shanghai, China. Diet quality scores were calculated according to CHDI using a validated and reliable food-frequency questionnaire. Conditional logistic regression analysis and Restricted cubic spline (RCS) analysis was used to reveal potential associations between CHDI score and thyroid cancer risk. A total of 414 pairs of historically confirmed TC patients and healthy controls were recruited from November 2012 to December 2015. The total score of cases and controls were 67.5 and 72.8, respectively (p < 0.001). The median score of total vegetables, fruit, diary, dark green and orange vegetables, fish, shellfish and mollusk, soybean, and whole grains, dry bean and tuber in cases was significantly lower than those in controls. Compared to the reference group (≤60 points), the average (60∼80 points) and high (≥80 points) levels of the CHDI score were associated with a reduced risk of TC (OR: 0.40, 95% Cl: 0.26∼0.63 for 60∼80 points; OR: 0.22, 95% Cl: 0.12∼0.38 for ≥80 points). In age-stratified analyses, the favorable association remained significant among participants who younger than 50 years old. Our data suggested that high diet quality as determined by CHDI was associated with lower risk of TC.

Iodine nutrition status and thyroid autoimmunity during pregnancy: a cross-sectional study of 4635 pregnant women.

BACKGROUND: Pregnant women in Shanghai have long been at risk for mild iodine deficiency. Because thyroid autoimmunity in pregnant women can lead to premature birth and miscarriage as well as neurodevelopmental deficits in the fetus, the aim of this study was to explore the association of iodine nutrition status with thyroid antibodies during pregnancy. METHODS: A pregnancy-birth cohort was conducted including 4635 pregnant women in Shanghai, China. The eligible participants underwent a face-to-face interview and completed questionnaire surveys to collect baseline information and diet intake. Spot urine samples were collected to test urine iodine. Thyroid antibodies including thyroid peroxidase antibodies (TPOAb), thyroglobulin antibodies (TgAb) and thyrotrophic antibodies (TRAb) were tested. Single-factor analysis and logistic regression were used to evaluate the association between iodine status and thyroid autoimmunity during pregnancy. RESULTS: The median urinary iodine excretion level in the sample was 138.14 µg/L (interquartile range [IQR] 80.90-219.00 µg/L). Among all the subjects, 25.9% consumed non-iodized salt, 54.5% had iodine deficiency, and 31.0% had thyroid autoimmunity. The proportion of patients with iodine deficiency was significantly higher among those who consumed non-iodized salt (36.9% vs. 33.1%; p = 0.04). After adjusting for age, educational status, former smoker status, former drinker status, first pregnancy, and previous thyroid disease, non-iodized salt (odds ratio [OR] = 1.394 [confidence interval, CI, 1.165-1.562]; p = 0.003), iodine-rich food (OR = 0.681 [CI 0.585-0.793]; p = 0.003), iodized nutritional supplements (OR = 0.427 [CI 0.347-0.526]; p = 0.003), were found to be individually associated with thyroid autoimmunity in all participants. The results of the multivariable restricted cubic spline regression analysis showed a non-linear relationship between the continuous change in iodine intake and thyroid autoimmunity (p = 0.019). Participants with iodine deficiency (urinary iodine concentration, UIC,< 100 µg/L) had an increased risk of testing positive for thyroid antibodies (TPOAb/TgAb/TRAb[+]; OR = 1.324 [CI 1.125-1.559]; p < 0.001). Moreover, this associated existed even after removing participants with previous thyroid disease. CONCLUSION: Inadequate iodine nutrition in pregnant women is an independent risk factor for thyroid autoimmunity in Shanghai. It's important to maintain the adequate iodine status in pregnant women.

Effects of animal protein intake during pregnancy on autoimmune thyroiditis in pregnant women with mild iodine deficiency.

BACKGROUND: Iodine and animal protein may affect thyroid function. In the present study, we explored the association between animal protein intake and thyroid antibody status in pregnant women following universal salt iodisation. METHODS: Pregnant women were enrolled using a multistage, stratified random sampling method in Shanghai. In total, 4646 eligible women were interviewed in person. We used a validated food frequency questionnaire and food composition tables to calculate the daily intakes of protein and iodine. We collected urine samples and performed thyroid antibody tests. RESULTS: Positive thyrotropin receptor antibody (TR-Ab) rates were different among animal protein intake groups (p < 0.05). Median urinary iodine concentration (UIC) was higher in the thyroid peroxidase antibody (TPO-Ab) positive group than in the negative group (p < 0.05). The median of total protein intake, animal protein intake and UIC was higher in the TR-Ab positive group than in the negative group (p < 0.05). The median of total protein intake and UIC was higher in the TPO-Ab/TG-Ab/TR-Ab positive group than in the negative group (p < 0.05). Multivariable logistic regression results showed that insufficient iodine had a negative correlation with positive TPO-Ab and positive TR-Ab (p < 0.05). The middle third and top third animal protein intakes served as protective factors for TR-Ab (coefficient = 0.559, 95% confidence interval [CI] = 0.415-0.752, p < 0.001; coefficient = 0.0.406, 95% CI = 0.266-0.621, p < 0.001) and positive TPO-Ab/TR-Ab/TG-Ab (coefficient = 0.817, 95% CI = 0.687-0.971, p = 0.022; coefficient = 0.805, 95% CI = 0.672-0.964, p = 0.018). CONCLUSIONS: Adequate animal protein intake protects against elevated anti-thyroid antibody levels in pregnant women with mild iodine deficiency.

Jiangnan dietary pattern actively prevents muscle mass loss: Based on a cohort study.

BACKGROUND: The proportion of sarcopenia in the elderly is very high, although muscle mass loss before sarcopenia covers a wider population. The present study aimed to analyse the effects of different dietary patterns on muscle mass. METHODS: In both 2015 and 2018, using multilayer random sampling, the same participants were selected, and the same questionnaires and machines were used. RESULTS: In total, 502 participants were selected. The >65-year-old group showed maximum muscle mass loss in males and females (-1.53 kg ± 4.42 and -1.14 kg ± 2.6 on average, respectively). The cumulative variance of four dietary patterns reached 52.28%. Logistical regression revealed significant differences between 'Jiangnan Dietary' groups: Q2 vs. Q1 [odds ratio (OR) = 0.356, 95% confidence interval (CI) = 0.202-0.629]; Q3 vs. Q1 (OR = 0.457, 95% CI = 0.262-0.797). Relative influence factors for muscle mass loss were age (>65 vs. <45, OR = 2.027, 95% CI = 1.117-3.680), physical activity (OR = 0.550, 95% CI = 0.315-0.960), income (high vs. low, OR = 0.413, 95% CI = 0.210 -0.810), sex (female vs. male, OR = 0.379, 95% CI = 0.235-0.519). CONCLUSIONS: After 3 years of follow-up, participants' muscle mass declined significantly. The 'Jiangnan Dietary' pattern prevented muscle mass loss and is recommended to the wider population.

Selenium status in the body and cardiovascular disease: a systematic review and meta-analysis.

Background: Both experimental and observational studies have provided conflicting evidence on the associations of selenium with incidence and mortality of cardiovascular disease (CVD). The aim of this study was to evaluate the association between selenium status in the body and incidence and mortality of CVD by performing a systematic review and meta-analysis of observational studies and randomized controlled trials. Methods: A systematic search for articles in MEDLINE (Ovid), Embase, Web of Science (Thomson Reuters) and Cochrane library (Wiley) was conducted. Thirteen of the 1811 articles obtained from the databases met our inclusion criteria and were considered in the final analysis. The effect sizes were presented as weighted relative risk (RR) and 95% confidence intervals (CIs) using random-effects model. To detect dose-response relationships, we used meta-regression. Results: Overall, there was a reduced risk of CVD incidence (RR = 0.66; 95% CI: 0.40-1.09) and mortality (RR = 0.69; 95% CI: 0.57-0.84) in physiologically high selenium status compared to low selenium status in the body. There was a 15% (RR = 0.85, 95% CI: 0.76-0.94) decreased risk of CVD incidence per 10 µg increment in blood selenium concentration. In addition, a statistically significantly nonlinear dose-response relationship was found between CVD mortality and increased blood selenium concentration with the lowest risk at the 30-35 µg increment in blood selenium. Conclusions: Physiologically high selenium levels in the body are associated with decreased risk for CVD incidence and mortality, however, people should be cautious about the potential harmful effects from excessive intake of selenium.

Differences and Correlation Analysis of Birth Weight and Overweight/Obesity in Shanghai Twin Cohort.

The objective of this study was to analyze differences in birth weight and overweight/obesity in a Shanghai twin cohort. We also wanted to study their association and explore possible risk factors for the discordance of overweight/obesity within twins. This was an internal case-control study designed for twins. The 2012 Shanghai Twin Registration System baseline survey data of a total of 3417 twin pairs were statistically analyzed using SPSS22 software. Results show that the body mass index (BMI) of the Shanghai twin population increased with age. Twins with a high birth weight had a higher BMI and a higher rate of overweight and obesity; 0- to 6-year-old twins, male twins and dizygotic (DZ) twins had higher rates of overweight/obesity than other groups. The greater the discordant birth weight rate of twins, the more obvious the difference in BMI (p < .05). There was a significant difference in overweight/obesity between twins with a relative difference of birth weight ≥15% in DZ twins (p < .05). DZ twins, male twins and 0- to 6-year-old twins were more likely to be discordant in overweight/obese than others. The discordant birth weight within twins was not a risk factor for discordant overweight/obesity. However, attention should be paid to childhood obesity, and appropriate interventions should be made at the appropriate time. Genetics may play an important role in the occurrence and development of overweight/obesity. In conclusion, discordant growth and development in the uterus early in life may not lead to discordant weight development in the future.

Higher poultry consumption was associated with an earlier age at menarche.

AIM: To examine the association between meat consumption and earlier age of menarche among schoolgirls in Shanghai. METHODS: The study randomly selected 1981 schoolgirls aged 6-18 years in Shanghai using a two-stage random sampling design. Information on meat intake was collected using a semi-quantitative food frequency questionnaire. Menarche age, household income, physical activity and other covariates were obtained by standardised questionnaires. Logistic regression was used to analyse the association between intake of meat and earlier age of menarche. Earlier age of menarche was defined as first menstruation before 12 years of age. RESULTS: Among the 986 girls who had experienced menarche, 518/986 (52.5%) had earlier age of menarche. After adjusting for body mass index, age, physical activity, sleep, household income and parental education, consumption of poultry was positively associated with risk of earlier age of menarche (P-trend = .03). Girls who never consumed poultry had a lower risk of earlier age of menarche (odds ratio [OR]: 0.61, 95% confidence interval [CI]: 0.39-0.96). Neither the consumption of pork, beef, lamb, processed meat nor total meat consumption was associated with menarche age. CONCLUSION: Higher consumption of poultry was associated with an earlier age at menarche.

The development of a Chinese Healthy Eating Index for School-age Children and its Application in children from China Health and Nutrition Survey.

This study aimed to develop a Chinese Healthy Eating Index for School-age Children (CHEI-SC), apply it in the 2011 China Health and Nutrition Survey (CHNS) to assess dietary quality, and compared it with our former developed index named CHEI. Data of 3-day 24-hour diet recalls and household food inventory survey from 1600 school-age children in CHNS-2011 were used to develop the CHEI-SC, using the methods of standard portion size, energy-density-based approach, and least restrictive approach. The CHEI-SC included 19 components with a total score (T-score) ranging from 0 to 100. The investigated children had a median score of 49.6. Children with a higher T-score were more likely to have higher social economic status (SES), higher level of urbanisation, fewer family size, and regularly attending school. The CHEI-SC was able to assess dietary quality of Chinese school-age children, was sensitive to demographics, and more comprehensive and accurate than the CHEI.

Relationship of household cooking salt and eating out on iodine status of pregnant women in environmental iodine-deficient coastal areas of China.

As city residents eat out more frequently, it is unknown that if iodised salt is still required in home cooking. We analysed the relationship of household salt and eating out on urinary iodine concentration (UIC) in pregnant women. A household condiment weighing method was implemented to collect salt data for a week. A household salt sample was collected. A urine sample was taken at the end of the week. Totally, 4640 participants were investigated. The median UIC was 139·1 µg/l in pregnant women and 148·7, 140·0 and 122·9 µg/l in the first, second and third trimesters. Median UIC in the third trimester was lower than in the other trimesters (P < 0·001). The usage rates of iodised (an iodine content ≥ 5·0 mg/kg) and qualified-iodised (an iodine content ≥ 21·0 mg/kg) salt were 73·9 and 59·3 %. The median UIC in the qualified-iodised salt group was higher than in the non-iodised group (P = 0·037). The median UIC in the non-iodised group who did not eat out was lower than in qualified-salt groups who both did and did not eat out (P = 0·007, <0·001). The proportion of qualified-iodised salt used in home cooking is low, but foods eaten out have universal salt iodisation according to the national compulsory policy. Household iodised salt did not play a decisive role in the iodine status of pregnant women. Pregnant women in their third trimester who are not eating out and using non-iodised salt at home require extra iodine.

[Effect evaluation of health education intervention on nutrition label for community residents in Shanghai].

OBJECTIVE: To understand the knowledge, attitude and practice(KAP) of nutrition label for community residents in Shanghai and the effects of health education interventions, and to explore the factors affecting the knowledge, attitude and practice(KAP), and to provide theoretical bases for relevant policies. METHODS: Using stratified random sampling to randomly select at least 20 residents before and after the intervention in each community in Shanghai. A baseline survey was carried out in early March 2016. The survey included basic information and the knowledge、attitude and practice of nutrition label. Using a combination of online and offline method such as issuing posters, folding pages, conducting lectures on knowledge, tweeting on WeChat public accounts, etc. , for a 4-month intervention, and an assessment survey was conducted in June. The same questionnaire was used before and after the intervention. RESULTS: The awareness rate of nutrition labels among community residents in Shanghai increased from 63. 0% before the intervention to 87. 4% after the intervention. The proportion of those who felt it necessary to label nutrition labels increased from 77. 7% before the intervention to 88. 3%. When purchasing prepackaged food, the proportion of people who often read nutrition labels increased from 32. 2% before intervention to 51. 8%, and the above differences were statistically significant(P<0. 05). After the intervention, the mastery of nutrition labeling knowledge, attitudes and behaviors of men were positively changed(P<0. 05). After the intervention, residents in the suburban areas have significantly improved their knowledge, attitudes and behaviors related to nutrition labeling(P<0. 05). The improvement effects of residents in the suburbs was lower than that in the other two types of areas(P<0. 05). Logistic regression analysis showed that intervention, female, high education, living in the central city, knowing the nutrition label, and thinking that it is necessary to label the nutrition label are the protective factors of looking at the nutrition label when buying foods. CONCLUSION: Health education can effectively improve the awareness rate of prepackaged food nutrition labels, relevant attitudes and behavior changes of residents in Shanghai communities. After intervention, the knowledge and behavior of nutrition labels in Shanghai communities are at a high level. Men, low-education low-income and residents in remote areas are the key population for future health education related to nutrition labels.

Iodine status of 8 to 10 years old children within 20 years following compulsory salt iodization policy in Shanghai, China.

BACKGROUND: In 1996, Shanghai implemented universal salt iodization and has became the last provincial unit in China to carry out this intervention. In this study, we summarized achievements in past 20 years, to provide suggestions and evidence for the next stage of iodine supplementation. METHODS: This study summarized and analyzed monitoring data of children from 1997, 1999, 2005, 2011, 2014, and 2017 in Shanghai. In each monitoring year, 30 streets or towns were selected using the probability-proportional-to-size sampling technique. One primary school was selected from each street or town by a simple random sampling technique. From each school, 40 children aged 8 to 10 years were randomly selected. The number of children was divided equally by sex and age. RESULTS: In 1997, 1999, 2005, 2011, 2014, and 2017, median urinary iodine (MUI) was 227.5 µg/L, 214.3 µg/L, 198.1 µg/L, 181.6 µg/L, 171.4 µg/L, and 183.0 µg/L, goiter rate was 3.07, 0.40, 0.08, 0.08, 0.86, and 1.90%, and median thyroid volume (MTvol) was 2.9 mL, 1.2 mL, 2.4 mL, 1.0 mL, 1.8 mL, and 2.8 mL, respectively. There was a linear correlation between goiter rate and median thyroid volume (MTvol) (r = 0.95, P = 0.014). Household salt iodine concentration (SIC) was dropping every monitoring (P < 0.05). There was a significant difference among different household SIC groups in MUI in 1999 and 2017, and in MTvol in 1999 (P < 0.05). No significant differences were detected in the other years. CONCLUSIONS: In Shanghai, the iodine status of 8 to 10 years old children is adequate. Household SIC have little effect on iodine status of children. Future studies should analyze the dietary sources of iodine, especially from pre-packaged and prepared-away-from-home foods or meals. The regular monitoring of iodine status is important to human health.

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.

[Evaluation of dietary intake quantity and quality of high school students in Shanghai City].

OBJECTIVE: To understand the dietary intake quantity and quality of high school students in Shanghai education. METHODS: From 2015 to 2016, Shanghai center for Disease Control and Prevention, divided the school into three levels(urban area, suburban area and rural area) according to the economic level and population composition of the street where the school was located. The probability-proportional-to-size sampling technique was used to select 19 high schools, from which 9 boys and 9 girls from same class were randomly recruited for each grade. A total of 1026 students were recruited. The survey included general situation questionnaire and dietary inquiry. Participants were required to complete the standardized questionnaire form through face-to-face interviews with trained interviewers. Chinese Dietary Guidelines(2016) was used to evaluate dietary quantity while China healthy diet index(CHDI) was used to evaluate dietary quality. RESULTS: The medians of intake of grain, vegetables, fruits, meat/livestock, fish/shrimp, eggs, milk and milk products, bean and bean products, cooking oil, cooking salt were 313. 8, 189. 7, 66. 3, 179. 2, 34. 7, 48. 9, 133. 3, 33. 3, 27. 1 and 6. 0 g/d within high school students, respectively. In both boys and girls, the medians of intake of vegetables, fruits, fish/shrimp, dairy products were lower than reference standard and meat/livestock was higher(P<0. 05). The intake differences among different area's high school students upon grain, vegetables, fruits, poultry/livestock, fish/shrimp, dairy products, beans/nuts, cooking oil, cooking salt were statistically significant(P<0. 05). The CHDI median total score of high school students was 68. 5 in Shanghai. 75. 2% of the CHDI total scores were between 60 and 80. The vegetable score, dark vegetable score, fruit score and total CHDI score in boys were significantly lower than those in girls(P<0. 05). The urban area CHDI score was significantly higher than suburban's and countryside's(P<0. 05). CONCLUSION: Both dietary structure and dietary quality are inappropriate and unfit within high school students in Shanghai, the urban area's condition is better than another two. We suggest to increase intake of vegetables, fruits, fish/shrimp, dairy products while decrease poultry/livestock's consumption.

A cross-sectional survey of nutrition labelling use and its associated factors on parents of school students in Shanghai, China.

OBJECTIVE: To understand parents' knowledge and use of nutrition labelling and to explore its associated factors. DESIGN: Cross-sectional survey. SETTING: Two schools providing a nine-year educational programme in Putuo District, Shanghai, China, were selected for the study. Information was included on demographic data and knowledge of the Chinese Food Pagoda. SUBJECTS: Students and their parents (n 1770) participated in a questionnaire survey. RESULTS: Of questionnaires, 1766 were completed (response rate 99·8 %). Utilization rate of nutrition labelling was 19·3 %. Among 624 parents knowing nutrition labelling, 22·1 % understood all the information included, 70·7 % understood it partially and 7·2 % could not understand it at all. Use of nutrition labelling by parents was related to the following factors (OR; 95 % CI): high educational level of parent (1·465; 1·165, 1·841), parent's knowledge of the Chinese Food Pagoda (1·333; 1·053, 1·688), parent's consumption of top three snacks which are unhealthy (1·065; 1·023, 1·109), parent's assumption that nutrition labelling would affect their choice of food (1·522; 1·131, 2·048), student's willingness to learn about labels (1·449; 1·093, 1·920) and student's knowledge and use of labels (2·214; 1·951, 2·513). CONCLUSIONS: Parents' knowledge and use of nutrition labelling are still at a lower level, and some information included in the nutrition labels is not understood by parents. The forms of the existing nutrition labelling need to be continuously improved to facilitate their understanding and usefulness. It is necessary to establish nutrition projects focusing on education and use of nutrition labels which help parents and their children make the right choices in selecting foods.

Age, period and cohort effects and the predictors of physical activity and sedentary behaviour among Chinese children, from 2004 to 2011.

BACKGROUND: Very few studies have explored the effects of age, time period, and cohort in association with biological, behavioral, economic, and environmental factors predictors on physical activity (PA) and sedentary behaviour (SB) among Chinese children. METHODS: We used data from a cohort study of the China Health and Nutrition Survey (CHNS) between 2004 and 2011 (2004, 2006, 2009 and 2011). The outcomes of interest were metabolic equivalent of task (MET) hours per week from both active and sedentary activities. Age, gender, individual characteristics, household size, asset ownership, and urbanisation were included as covariates. Age, period and cohort effects analyses for PA and SB of children (6-17 y, n = 3528) was conducted to explicitly assess differences in PA and SB due to age vs. period effects, and implicitly assess differences by cohorts due to the period-specific experiences across individuals of varying ages. RESULTS: The mean age of the sample in each time point fluctuated from 12.6 to 11.3 years and PA slightly decreased from 50.0 ± 63.2 MET hours per week (MET-hr./wk) in 2004 to 47.1 ± 54.9 MET-hr./wk. in 2011. However, SB increased from 31.8 ± 22.0 MET-hr./wk. to 37.6 ± 22.2 MET-hr./wk. Girls had lower PA and higher SB levels than boys. Controlling for age effects, marginal period effects on PA were observed in some survey years. Higher levels of urbanisation and number of household computers served as negative and positive predictors for PA and SB, respectively. Higher household income was a positive predictor of SB. Surprisingly, bigger household size was the only negative predictor of SB (P < 0.05). CONCLUSIONS: This longitudinal study followed a large cohort of children over a significant period of their childhood. We observed potential age and secular trends in PA levels. Higher community urbanisation and number of home computers were associated with both PA and SB levels. Larger household size was the only factor that was negatively associated with SB. These findings shed light on health policy and preventative health strategies for China and other countries that are now facing similar public health challenges.

[Effects of nutrition intervention among students in primary school for children of migrant workers in Shanghai].

OBJECTIVE: To evaluate effects of nutrition intervention on nutrition knowledge, attitude and practice and lunch nutrition situation of students in primary school for children of migrant workers in Shanghai, to provide evidence for promoting children 's growth and development and health education. METHODS: A total of 4 primary schools for children of migrant workers in Shanghai were selected by stratified cluster sampling in 2014- 2015, and then were randomly assigned to intervention or control group. All students of 4and 5 grades were selected as subject. Nutrition intervention included the school canteen and students. Survey was implemented before and after intervention, and included demographic questionnaire, physical test and nutrition survey using dietary recall. RESULTS: The average rise in quantity of weight, BMI, the power of gripping, nutrition attitude accuracy and paper folding test score in intervention group were significantly higher than control group. Intervention was helpful to improve the awareness rates of dietary guidelines and the favor rate of school lunch. Except fat, the average rise in intake of energy and main nutrients in intervention group were significantly higher than control group. The average rise in intake of food grains, soybeans and soy products and vegetables and the average falling in intake of animal food in intervention group were significantly higher than control group. All of the differences were statistically significant( P < 0. 05). The average intake of energy, main nutrients and some kinds of food in intervention group were more close to the standard. CONCLUSION: Nutrition intervention has a positive impact on students ' growth and development, nutrition knowledge and attitude, cognitive ability and dietary intake, and should be put into widespread application.

Age, period and cohort effects on adult physical activity levels from 1991 to 2011 in China.

BACKGROUND: To date no work has differentiated the effects of age, period, and cohort on physical activity (PA) among Chinese adults, while also considering biological, behavioral, economic, and environmental factors over time. METHODS: We used data from the China Health and Nutrition Survey (CHNS) between 1991 and 2011 (20 years). The outcomes of interest are metabolic equivalent of task (MET) hours per week from work and domestic activities. Age, individual characteristics, household size, asset ownership, urbanization were included as covariates. Analyses for adult (≥20y) males (n = 29,343) and females (n = 31,094) was conducted to explicitly assess differences in PA due to age vs period effects, and implicitly assess differences by cohorts due to the period-specific experiences across individuals of varying ages. RESULTS: The mean age of the sample rose from 41.31 to 50.8 years and PA decreased from 427.75 ± 264.35 MET hours per week (MET-hr/wk) in 1991 to 245.99 ± 206.65 MET-hr/wk in 2011, with much steeper declines for women compared to men. For both genders, we found non-linear decreases in PA with age over time. Controlling for age effects, negative period effects on PA were observed in each survey year, and were substantial from 1993 to 2000 for males and from 1993 to 2011 for females. The interaction between survey year and age (P < 0.05) were observed from 2004 to 2011. Higher community urbanicity, vehicle ownership, TV and computer ownership, overweight and obese, higher education served as negative predictors. Bicycle ownership, bigger household size, non-professional jobs, being married and having more children (for women) were positive predictors of PA (P < 0.05). Furthermore, at any given age, individuals who were younger at baseline had higher mean PA compared with individuals older at baseline. CONCLUSION: This study followed a large cohort of adults over a significant portion of their lives. Strong age and secular trends were observed, resulting in an increasing number of participants who have or are likely to lower their PA levels. These trends suggest that tackling the rapid PA decline among its population is of high priority for China's public health outlook as its population ages and continues to experience significant economic and environmental changes.