Malnutrition in Relation with Dietary, Geographical, and Socioeconomic Factors among Older Chinese.

OBJECTIVE: Nutrition is closely related to the health of the elderly population. This study aimed to provide a comprehensive picture of the nutrition status of elderly Chinese and its related dietary, geographical, and socioeconomic factors. METHODS: A total of 13,987 ≥ 60-year-old persons from the 2010-2013 Chinese National Nutrition and Health Survey were included to evaluate various aspects of malnutrition, including underweight, overweight or obesity, and micronutrient inadequacy. RESULTS: Overall, the prevalence of obesity, overweight, and underweight was 12.4%, 34.8%, and 5.7%, respectively, with disparities both geographically and socioeconomically. The prevalence of underweight was higher among the older old (≥ 75 years), rural residents and those with low income, with low education status, and residing in undeveloped West areas. More than 75% of the elderly do not meet the Dietary Reference Intakes for vitamins A, B 1, B 2, and E, folate, calcium, selenium, potassium, biotin, and choline, with the prevalence of inadequate intake increasing with age for most nutrients. At the population level, the mean intakes of numerous food groups did not meet the recommendations by the Chinese Dietary Guideline. CONCLUSIONS: Obesity epidemic, inadequacy of micronutrient intake, and high prevalence of underweight and anemia in susceptible older people are the major nutrition challenges for the rapidly aging population in China.

Association between Baseline SBP/DBP and All-Cause Mortality in Residents of Shanxi, China: A Population-based Cohort Study from 2002 to 2015.

OBJECTIVE: To investigate the association between blood pressure and all-cause mortality in Shanxi, China. METHODS: The '2002 China Nutrition and Health Survey' baseline data in Shanxi province was used. A retrospective investigation was performed in 2015. The effects of SBP and DBP on the all-cause mortality were analyzed using the Cox regression model. The hazard ratio ( HR) and 95% confidence interval ( CI) were estimated by the sex and age groups. RESULTS: The follow-up rate was 76.52% over 13 years, while the cumulative mortality rate for all participants was 917.12/100,000 person-years. The mortality rose with an increasing SBP ( χ 2 trend = 270.537, P < 0.001) or DBP level ( χ 2 trend = 57.240, P < 0.001). After adjustment for the confounding factors, a significant association between mortality and high SBP (≥ 160 mmHg) and high DBP (≥ 100 mmHg), with adjusted HR ranging from 1.405- to 2.179-fold for SBP and 1.550- to 2.854-fold for DBP, was noted. Significant HRs for most DBP subgroups were found in > 60-year-old participants. Males with DBP ≥ 100 mmHg had a significantly higher mortality, with an HR (95% CI) of 2.715 (1.377-5.351). CONCLUSION: Adults with SBP > 160 mmHg and DBP > 100 mmHg had a higher mortality risk. Sex and age difference was noted in both DBP and mortality risk.

Abdominal Obesity and Its Attribution to All-cause Mortality in the General Population with 14 Years Follow-up: Findings from Shanxi Cohort in China.

OBJECTIVE: This study aimed to assess the association of waist circumference (WC) with all-cause mortality among Chinese adults. METHODS: The baseline data were from Shanxi Province of 2002 China Nutrition and Health Survey. The death investigation and follow-up visit were conducted from December 2015 to March 2016. The visits covered up to 5,360 of 7,007 participants, representing a response rate of 76.5%. The Cox regression model and floating absolute risk were used to estimate hazard ratio and 95% floating CI of death by gender and age groups (≥ 60 and < 60 years old). Sensitivity analysis was performed by excluding current smokers; participants with stroke, hypertension, and diabetes; participants who accidentally died; and participants who died during the first 2 years of follow-up. RESULTS: This study followed 67,129 person-years for 12.5 years on average, including 615 deaths. The mortality density was 916 per 100,000 person-years. Low WC was associated with all-cause mortality among men. Multifactor-adjusted hazard ratios ( HR) were 1.60 (1.35-1.90) for WC < 75.0 cm and 1.40 (1.11-1.76) for WC ranging from 75.0 cm to 79.9 cm. Low WC (< 70.0 cm and 70.0-74.9 cm) and high WC (≥ 95.0 cm) groups had a high risk of mortality among women. The adjusted HRs of death were 1.43 (1.11-1.83), 1.39 (1.05-1.84), and 1.91 (1.13-3.22). CONCLUSION: WC was an important predictor of death independent of body mass index (BMI). WC should be used as a simple rapid screening and predictive indicator of the risk of death.

Trends in Lipids Level and Dyslipidemia among Chinese Adults, 2002-2015.

OBJECTIVE To investigate the trends of lipid profiles and dyslipidemia among Chinese adults from 2002 to 2015. METHODS Data were collected from three nationally representative cross-sectional surveys. Fasting venous blood samples were collected and serum lipids were tested by biochemical analysis and enzymatic determination. Lipid levels and the prevalence of dyslipidemia among adults were analyzed with complex sampling weighting adjustment for age and gender. RESULTS The weighted means of TC, TG, and LDL-c significantly increased linearly from 3.93, 1.12, and 2.12 mmol/L in 2002 to 4.59, 1.41, and 2.78 mmol/L in 2010 and then to 4.63, 1.47, and 2.87 mmol/L in 2015, respectively; by contrast, HDL-c levels decreased significantly from 1.30 mmol/L to 1.26 mmol/L over the same period. Similar trends in mean non-HDL-c and lipid-related ratios were observed. The weighted dyslipidemia prevalence linearly increased; in particular, hypercholesterolemia increased from 1.6% to 5.6% and then to 5.8%, hypertriglyceridemia increased from 5.7% to 13.6% and then to 15.0%, low HDL-c increased from 18.8% to 35.5% and then to 24.9%, and high LDL-c increased from 1.3% to 5.6% and then to 7.2% (P for trend < 0.001). CONCLUSION Dyslipidemia increased among Chinese adults from 2002 to 2015. Development of a comprehensive strategy to decrease lipid levels in this population is urgently required.

Childhood BMI and Adult Obesity in a Chinese Sample: A 13-Year Follow-up Study.

OBJECTIVE: Obesity is recognized as a significant risk factor for diabetes and hypertension. The present study aimed to examine the associations between adults'obesity risk and childhood and parental obesity. METHODS: A total of 204 children aged 6-17 years were recruited in 2002 with an average follow-up period of 13.2 years. Height and body weight were measured by trained staffs. Overweight and obesity were defined based on the Chinese standard for children and adults. T-test, analysis of variance, and Chi-square analysis were used for single factor analysis. Multiple linear and logistic regression analyses were used to perform multifactor analysis. RESULTS: The percentage of non-obese children who grew up to be non-obese adults was 62.6%, and that of obese children who grew up to be obese adults was 80.0%. There was a significant association between childhood body mass index (BMI) and adulthood BMI with a ß regression coefficient of 3.76 [95% confidence interval (CI): 1.36-6.16], and between childhood obesity and adulthood obesity with an odds ratio of 5.76 (95% CI: 1.37-24.34). There was no statistical difference between parental obesity at baseline and children's adulthood obesity, after adjustment of confounders. Male participants and those aged 10.0-13.0 years had a higher risk of adulthood obesity with odds ratios of 2.50 (95% CI: 1.12-5.26) and 3.62 (95% CI: 1.17-11.24), respectively. CONCLUSION: Childhood obesity is an important predictor of adulthood obesity.

Relationships of Insulin Action to Age, Gender, Body Mass Index, and Waist Circumference Present Diversely in Different Glycemic Statuses among Chinese Population.

INTRODUCTION: To study the influence of different glycemic statuses on the relationship of insulin action to age, gender, body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) among Chinese population. METHODS: A total of 35,327 participants (17,456 males and 17,871 females) were included in this nationally representative cross-sectional study. Glycemic status was defined according to the 2010 American Diabetes Association criteria. Fasting insulin was measured by the chemiluminescence method. RESULTS: Insulin and HOMA-IR levels were the highest in newly diagnosed diabetes and were lowest in normal fasting glucose (NFG) (P < 0.001). Insulin and HOMA-IR levels were higher in females (P < 0.001) than in males with previously diagnosed diabetes and impaired fasting glucose (IFG) and NFG, meanwhile decreased with age (P < 0.001) among IFG and NFG participants. As compared with participants with a BMI from 18.5 to 19.9, those in the lowest BMI category (<18.5) had a significantly elevated risk of IR (OR, 1.96; 95% CI, 1.01-3.80), as did those in the higher BMI categories among NFG participants. The risk of IR increased with WC and WHtR, and the response was linear (P < 0.001 for linear trend) for the participants with NFG but not in those with IFG. CONCLUSIONS: Different glycemic statuses significantly affect the relationships of insulin action to age, gender, BMI, WC, and WHtR among Chinese population.

Dietary Cholesterol in the Elderly Chinese Population: An Analysis of CNHS 2010-2012.

Dietary cholesterol intake increased dramatically over the past two decades in the elderly Chinese population. However, the nationwide dietary cholesterol intake and its related factors seldom been investigated. Based on data from 16,594 participants aged 60 years or older (49.0% male, 54.8% urban residents) from the China National Nutrition and Health Survey (CNHS) 2010-2012, we aimed to describe the intake of cholesterol and major food contributions, as well as its association with serum cholesterol level and relationship with protein intake. Mean daily cholesterol intake for all participants was 217.4 mg, the mean cholesterol intakes in urban and rural areas were 264.0 mg and 168.8 mg, respectively. Cholesterol intake levels varied by age, gender, BMI and region (p < 0.001). In addition, the proportion of all participants who consumed greater than 300 mg of cholesterol per day was 26.6%. Eggs, red meats, and seafood were the top three food sources and their contributions to total daily cholesterol intake were 57.7%, 24.0% and 10.9% respectively. Serum total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) were related to dietary cholesterol intake, with each 100 mg increase in dietary cholesterol intake apparently leading to a 0.035 mmol/L (p = 0.001) increase in serum TC and a 0.038 mmol/L (p < 0.001) increase in LDL-C. The partial correlation coefficients between dietary cholesterol and total protein, high-quality protein, intake of protein per kilogram body weight (BW), and high-quality protein percentage were 0.538, 0.580, 0.426, and 0.548, respectively, after adjusting for age, gender, and energy, fat and carbohydrate intakes (p < 0.001). In conclusion, there was a substantial urban-rural difference in cholesterol intake. Eggs and red meat were the main sources of dietary cholesterol intake. Serum TC and LDL-C were associated with dietary cholesterol and the response was linear. Dietary cholesterol intake was closely related to the intake of high-quality protein.

Trends in Determinants of Hypercholesterolemia among Chinese Adults between 2002 and 2012: Results from theNational Nutrition Survey.

Hypercholesterolemia is a known risk factor for cardiovascular diseases and affects a high proportion of the population. This study aimed to assess and compare the determinants of hypercholesterolemia among Chinese adults aged 18 years and above, from 2002 to 2012. The study used a stratified multistage cluster sampling method to select participants. Sociodemographic and lifestyle information was collected during face-to-face interviews. Dietary intake was calculated by 3-day, 24-h dietary records in combination with weighted edible oil and condiments. Hypercholesterolemia was defined as total cholesterol above 6.22 mmol/L (240 mg/dL) from fasting blood samples. The study included 47,701 (mean age 43.0 years) and 39,870 (mean age 51.0 years) participants in 2002 and 2010-2012 surveys respectively. The weighted prevalence of hypercholesterolemia increased from 1.6% (2.1% urban, 1.0% rural) in 2002 to 6.0% (6.4% urban, 5.1% rural) in 2012. The intake of plant-based food decreased but the intake of pork increased over the 10 years. A high intake of protein and pork, alcohol drinking and overweight/obesity were positively associated with hypercholesterolemia. Neither education nor fruit and vegetable intake were associated with hypercholesterolemia. In conclusion, the burden of hypercholesterolemia increased substantially between 2002 and 2012 in China. Unhealthy lifestyle factors and change in traditional dietary pattern were positively associated with hypercholesterolemia. Further research on the role of diet in the development and prevention of hypercholesterolemia is needed.

[Risk factors on anemia among rural elderly women aged 50-75 y in Xinning county, Anhui province, China].

OBJECTIVE: To study the risk factors on anemia among elderly women in rural areas of Xiuning county, Anhui province, China. METHODS: Xiuning county was selected as working field and elderly women aged 50-75 y were selected as subjects. Finger hemoglobin (Hb) was measured and basic health survey was face-to-face interviewed. 220 elderly women with anemia entered into the case group; and matched by age, another 220 women with normal Hb concentration entered the control group. Survey on diet, questionnaire regarding health and lifestyle and related blood indexes were studied and tested. RESULTS: When comparing the data from both case and control groups, weight was (49.4 +/- 7.3) kg vs. (52.5 +/- 8.4) kg (t = 3.97, P < 0.01), waist circumference was (75.8 +/- 7.8) cm vs. (79.1 +/- 9.3) cm (t = 3.85, P < 0.01), BMI was (21.8 +/- 2.6) kg/m2 vs. (22.9 +/- 3.2) kg/m2 (t = 3.775, P < 0.01), respectively. The total protein was (76.4 +/- 5.0) g/L vs. (78.4 +/- 5.6)g/L (t = 3.83, P < 0.01), albumin was (45.7 +/- 3.1) g/L vs. (47.3 +/- 2.9)g/L (t = 5.24, P < 0.01), serum iron was ( 10.3 +/- 4.1) micromol/L vs. (12.7 +/- 4.6) micromol/L (t = 5.48, P < 0.01), and saturation of transferrin was (19.0 +/- 7.6)% vs. (23.1 +/- 9.1) % (t = 4.90, P < 0.01), respectively. Results from multifactor conditioned logistic regression analysis showed that the odd ratios (OR) for anemia with staple food, BMI and vitamin A were 1.54, 1.89, 1.69, and the OR for anemia with BMI, staple food, animal food, carbohydrate and vitamin A were 2.0, 1.6, 1.6, 1.4, 1.6, with their confidence intervals (CI) as 1.3-2.9, 1.1-2.3, 1.0-2.3, 1.0-2.1, 1.1-2.4, respectively. CONCLUSION: The quality of diet, health status and related blood indexes on anemia among elderly women were lower than that in control group. Lower BMI, less staple food and animal food, less carbohydrate and vitamin A intake appeared to be risk factors of anemia.

[Risk factors analysis on anemia among rural women aged 50 - 75 years in Huangling county, Shanxi, northwest of China].

OBJECTIVE: To study the related risk factors of anemia of rural elderly women in Huangling county, Shanxi, northwest of China. METHODS: Elderly women aged 50-75 years in Huangling (northwest of China) were selected as study objects. Finger hemoglobin (Hb) was measured and basic health survey was face-to-face questioned. Two-hundred anemia elderly women were entered into the case group; and by age-matching, 200 with normal Hb concentration were entered into the control group. Dietary survey, health and lifestyle questionnaire were undertaken, and related blood indexes were tested. RESULTS: In case and control group, annual income was (446.1 +/- 107.9) vs (903.8 +/- 179.1) yuan (t = 3.06, P < 0.01), daily average physical active time was (9.6 +/- 3.2) vs (10.3 +/- 3.1) hours (t = 1.94, P < 0.05), proportion of experiencing food scarce period was 31.8% vs 22.6% (chi2 = 4.14, P < 0.05), waist circumference was (76.2 +/- 7.3) vs (79.5 +/- 8.9) cm (t = 4.08, P < 0.01), respectively; the total protein was (78.0 +/- 5.8) vs (81.9 +/- 6.0) g/L(t = 5.94, P < 0.01), serum iron was (13.9 +/- 5.7) vs (16.1 +/- 5.0) micromol/L (t = 4.19, P < 0.01), serum ferritin was (94.9 +/- 76.4) vs (116.6 +/- 85.2) microg/L (t = 2.58, P < 0.01), saturation of transferrin was 22.9% +/- 10.0% vs 25.6% +/- 8.7% (t = 3.16, P < 0.01), respectively. Multifactor conditioned logistic regression analysis showed that the odd ratio (OR) for anemia with annual income, whether experiencing food scarce period, daily average physical active time, staple food, soybean products, energy was 0.57, 4.74, 0.06, 0.59, 0.55, 0.65, respectively; their confidence interval (CI) was 0.45 - 0.71, 0.73 - 30.56, 0.01 - 0.52, 0.38 - 0.91, 0.34 - 0.87, 0.44 - 0.98, respectively. CONCLUSION: The quality of diet, health status and related blood indexes in anemia elderly women were lower than those in control group; lower income, less active time, less staple food, soybean products and energy intake should be risk factors of anemia.