Effects of Smartphone-Based Remote Interventions on Dietary Intake, Physical Activity, Weight Control, and Related Health Benefits Among the Older Population With Overweight and Obesity in China: Randomized Controlled Trial.

BACKGROUND: Traditional health management requires many human and material resources and cannot meet the growing needs. Remote medical technology provides an opportunity for health management; however, the research on it is insufficient. OBJECTIVE: The objective of this study was to assess the effects of remote interventions on weight management. METHODS: In this randomized controlled study, 750 participants were randomly assigned to a remote dietary and physical activity intervention group (group DPI), remote physical activity intervention group (group PI), or control group (group C). At baseline (time 1), day 45 (time 2), and day 90 (time 3), data were collected, including data on dietary intake, physical activity, indexes related to weight control, and health benefits. RESULTS: A total of 85.6% (642/750) of participants completed the follow-up. Compared with group C, group DPI showed a significant decrease in energy intake (-581 vs -82 kcal; P<.05), protein intake (-17 vs -3 g; P<.05), fat intake (-8 vs 3 g; P<.05), and carbohydrate intake (-106.5 vs -4.7 g; P<.05) at time 3. Compared with time 1, groups DPI and PI showed a significant decrease in cereal and potato intake (P<.05). Compared with time 1, the physical activity levels related to transportation (group PI: 693 vs 597 metabolic equivalent [MET]-min/week, group C: 693 vs 594 MET-min/week; P<.05) and housework and gardening (group PI: 11 vs 0 MET-min/week, group C: 11 vs 4 MET-min/week; P<.05) in groups PI and C were improved at time 3. Compared with groups PI and C, group DPI showed a significant decrease in weight (-1.56 vs -0.86 kg and -1.56 vs -0.66 kg, respectively; P<.05) and BMI (-0.61 vs -0.33 kg/m2 and -0.61 vs -0.27 kg/m2, respectively; P<.05) at time 2. Compared with groups PI and C, group DPI showed a significant decrease in body weight (-4.11 vs -1.01 kg and -4.11 vs -0.83 kg, respectively; P<.05) and BMI (-1.61 vs -0.40 kg/m2 and -1.61 vs -0.33 kg/m2, respectively; P<.05) at time 3. Compared with group C, group DPI showed a significant decrease in triglyceride (-0.06 vs 0.32 mmol/L; P<.05) at time 2. Compared with groups PI and C, group DPI showed a significant decrease in systolic blood pressure (-8.15 vs -3.04 mmHg and -8.15 vs -3.80 mmHg, respectively; P<.05), triglyceride (-0.48 vs 0.11 mmol/L and -0.48 vs 0.18 mmol/L, respectively; P<.05), and fasting blood glucose (-0.77 vs 0.43 mmol/L and -0.77 vs 0.14 mmol/L, respectively; P<.05). There were significant differences in high-density lipoprotein cholesterol (-0.00 vs -0.07 mmol/L; P<.05) and hemoglobin A1c (-0.19% vs -0.07%; P<.05) between groups DPI and C. CONCLUSIONS: Remote dietary and physical activity interventions can improve dietary intake among participants with overweight and obesity, are beneficial for weight control, and have potential health benefits. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR1900023355; https://www.chictr.org.cn/showproj.html?proj=38976.

The relationship between water intake, hydration biomarkers and physical activity of young male athletes in Beijing, China: A cross-sectional study.

BACKGROUND AND OBJECTIVES: To explore the relationship between water intake, hydration biomarkers and physical activity of young male athletes. METHODS AND STUDY DESIGN: A 7-day cross-sectional study was conducted among 45 male athletes aged 18-25 years in Beijing, China. Total drinking fluids (TDF) was obtained using 7-day 24-h fluid intake questionnaire. Water from food (WFF) was assessed using the methods of food weighing, duplicate portion method and laboratory analysis. Physical activity was evaluated using physical activity energy expenditure (PAEE) and metabolic equivalent of task (MET). RESULTS: Totally, 42 participants completed the study. The medians of total water intake (TWI), TDF and WFF of participants were 2771 mL, 1653 mL and 1088 mL respectively. Jonckheere-Terpstra test showed a significant increase trend toward higher TWI and TDF with higher PAEE level (Z=2.414, p=0.016; Z=2.425, p=0.015). Spearman's rank correlation showed that TWI was positively correlated with PAEE (rs=0.397, p=0.009). TDF showed a positive correlation with PAEE and MET (rs=0.392, p=0.010; rs=0.315, p=0.042). The median urine volume was 840 mL, urine specific gravity was 1.020, and 24-h urine osmolality was 809 mOsm/kg. Significant differences were found in plasma cortisol among the four MET groups (χ2=8.180; p=0.042). CONCLUSIONS: Young male athletes with higher physical activity level had higher amounts of TWI and TDF than their counterparts but had similar hydration biomarkers. There was a high incidence of dehydration in athletes, and attentions need to be paid on the intake of TDF among them to maintain the optimal hydration status.

Behaviors of Water Intake, Hydration Status, and Related Hydration Biomarkers among Physically Active Male Young Adults in Beijing, China: A Cross-Sectional Study.

Studies on the water intake of athletes in daily life are insufficient. The objective was to determine the water intake and hydration status among physically active male young adults. In this cross-sectional studies study, 111 physically active male young adults were recruited. The amount of daily total drinking fluid intake (TDF) among participants was recorded and evaluated in real time over 7 days using the "7-day 24-hour fluid intake questionnaire" (liq. In 7). The daily water intake from food (WFF) was calculated using the weighing, duplicate portion, and direct-drying method over 3 days. All urine samples over 3 days were collected, and urine biomarkers were determined. According to 24 h urine osmolality, the participants were divided into three groups with euhydration status, middle hydration, and hypo hydration statuses. Finally, 109 participants completed the study. The median daily total water intake (TWI), TDF, and WFF were 2701, ik1789, and 955 mL, respectively. Among participants, 17 participants (16%) were in euhydration status, 47 participants (43%) were in hypohydration, and 45 participants (41%) were in middle hydration. There were statistical significances in the 24 h urine volume, osmolality, urine specific gravity, and concentrations of K, Na, and Cl in different hydration statuses (χ 2 = 28.212, P < 0.01; χ 2 = 91.341, P < 0.01; χ 2 = 47.721, P < 0.01; χ 2 = 41.548, P < 0.01; χ 2 = 46.863, P < 0.01; and χ 2 = 40.839, P < 0.01). Moderate-intensity correlations were found between the TDF and 24 h urine volume, 24 h urine osmolality, 24 h urine Na concentration, morning urine osmolality, and morning urine Na concentration (r = 0.408, P < 0.01; r = -0.378, P < 0.01; r = -0.325, P < 0.01; r = -0.344, P < 0.01; and r = -0.329, P < 0.01). There were also moderate-intensity correlations between the TDF and 24 h urine osmolality, morning urine osmolality, and morning urine Na concentration (r = -0.365, P < 0.01; r = -0.371, P < 0.01; and r = -0.322, P = 0.01). Increased and higher moderate-intensity correlations were found between plain water and 24 h urine volume, 24 h urine osmolality, 24 h urine K and Na concentration, morning urine osmolality, and morning urine Na concentration (r = 0.374, P < 0.01; r = -0.520, P < 0.01; r = -0.312,P < 0.01; r = -0.355, P < 0.01; r = -0.446, P < 0.01; and r = -0.378, P < 0.01). Insufficient water intake and hypohydration were common among physically active male young adults. The amount and type of water intake were correlated with hydration status and urine biomarkers. The results could provide scientific and accurate references for the development of recommendations on water intake for athletes.

Speed of Movement, Fatness, and the Change in Cardiometabolic Risk Factors in Children.

We aimed to examine speed of movement and its interactive association with fatness to changes in cardiometabolic risk factors over one year in children. The analysis included 8345 children aged 6-13 years. Cardiometabolic risk score was computed by summing Z-scores of waist circumference, the average of systolic and diastolic blood pressure, fasting glucose, high-density lipoprotein cholesterol (multiplied by -1), and triglycerides. Both high baseline and improvement in speed of movement were associated with favourable changes in percent body fat, lipids, and cardiometabolic risk score. Percentages of the association between baseline speed of movement and changes in cardiometabolic risk score, triglycerides, and high-density lipoprotein cholesterol explained by baseline BMI were 24.6% (19.6-29.1%), 26.2% (19.7-31.1%), and 12.5% (9.6-15.4%), respectively. The corresponding number for percent body fat was 47.0% (40.4-54.1%), 43.3% (36.7-51.7%), and 29.8% (25.0-34.6%), respectively. Speed of movement mediated the association between fatness and cardiometabolic risk factors. Improved speed of movement was associated with a lower increase in blood pressure in obese children only. Speed of movement is a strong predictor of changes in cardiometabolic risk factors. Fatness and speed of movement are interactively associated with cardiometabolic risk factors. Speed of movement may attenuate the positive association between fatness and blood pressure.

Urination behaviours of senior citizens in five Chinese cities: Results of a cross-sectional survey.

AIM: To investigate the urination behaviours of senior citizens in China. METHODS: Stratified random sampling was used to recruit senior citizens who met the inclusion criteria from five cities in China. After training by researchers, participants recorded their urination behaviours in real time by using the validated 7-day 24-hour urination behaviour record, which consisted of frequency of urination, time of urination, urinary urgency and urine colour. RESULTS: Of the 551 recruited participants, 524 (233 male and 291 female) completed the survey, yielding a completion rate of 95.1%. The median frequency of urination was 7.4 times per day. The frequency of urination was highest among participants in Guangzhou, at 8.0 times per day (χ2  = 29.356; P < .001), and participants in the first percentile body mass index group, at 8.0 times per day (χ2  = 10.344; P = .016). The percentage of participants who urinated >7 times during the day was 44.3%. The percentage of participants who urinated ≥1 time at night was 77.5%. The number of times participants reported feeling no urge to urinate, a strong urge to urinate and an uncomfortable urge to urinate accounted for 59.7%, 62.8% and 24.8% of all records of urinary urgency, respectively. Instances of patients having no urge to urinate, a strong urgent to urinate and an uncomfortable urge accounted for 16.1%, 13.3% and 2.9% of all instances of urination, respectively. The number of times participants whose urine was yellow and dark yellow accounted for 69.1% and 18.9% of all records of urine colour, respectively. Urine with yellow and dark yellow colour accounted for 13.0% and 1.5%, respectively. CONCLUSION: Unhealthy urination behaviours, including urinating at night and holding back urine, were common among senior citizens. This result can provide information for the prevention and control of urinary system diseases.

Effect of multidimensional lifestyle interventions on metabolic risk reduction in children: a cluster randomised controlled trial.

Few clinical trials have investigated lifestyle intervention effect on metabolic health in children. The study aimed to examine the effect of diet and physical activity intervention on the reduction of clustered metabolic risk score (CMRS) in children and moderators and mediators of the intervention effect. A multicentre, clustered randomised controlled trial was conducted with examination conducted at baseline and after intervention over one year. 7110 children (49.7% girls) with a mean of 9.06 (95% CI: 9.03, 9.09) years were included in the analysis. In Beijing, each three schools were randomly assigned to diet-only, physical activity-only intervention and control groups. In five other urban cities, each 15 schools were randomly assigned to comprehensive intervention and control groups. CMRS was computed by summing the Z scores of % fat mass, systolic blood pressure, fasting glucose, ratio of cholesterol to high-density lipoprotein, and triglyceride. Compared with controls (n = 2808), children in the comprehensive intervention group (n = 2848) had more reduction in CMRS (multivariate-adjusted mean difference (95% CI): -0.49 (-0.85, -0.14)). The body mass index (BMI) reduction explained 7.3% (95% CI 2.8%-18.1%) of the total intervention effect. The intervention was more effective in children with higher birthweight, lower parental BMI, or complete parental data. Diet-only or physical activity-only intervention had non-significant effects on CMRS reduction. Our multidimensional comprehensive intervention resulted in significant reduction in CMRS in primary school children and this effect was modified by birthweight, parental BMI, and parental involvement. A minority of metabolic risk reduction was mediated through BMI. Clinical Trial Registry number and website: ChiCTR-PRC-09000402, URL: http://www.chictr.org.cn.

Patterns and sociodemographic determinants of water intake by children in China: results from the first national population-based survey.

PURPOSE: Accurate data on water and beverage intakes are essential for assessing hydration adequacy and setting proper guidelines. The objective of this study is to identify the patterns and sociodemographic determinants of water intake and to assess the intake adequacy for children in China. METHODS: The study team recruited 41,439 children aged 6-17 years using a multi-stage cluster random sampling method. Daily water and beverage intakes were investigated with the standard questionnaires and measuring containers in face-to-face interviews. Each participant was assigned an adjustment weight to obtain a nationally representative sample. Sociodemographic factors influencing water intake were identified using multi-variable regressions. Water intake adequacy was evaluated by comparing with the recommended water intake (RWI). RESULTS: The mean ± standard deviation of total water intake (TWI) was 1603 ± 731 mL/day for boys and 1487 ± 661 mL/day for girls. Plain water, food moisture, and other beverages contributed 51%, 20%, and 29% of the TWI. Multi-variable analyses showed that TWI of children increased with age, in urban areas and day schools, and with parents' economic and educational levels. The majority (82%) of children had TWI not meeting the corresponding RWI, and the percentage increased with age except for 14-17-year-old boys. CONCLUSIONS: Plain water is still the major source of daily water intake by children in China. Unfortunately, the majority of children do not have sufficient water intake, which warrants future actions and guidelines targeting adequate hydration.

Leading dietary determinants identified using machine learning techniques and a healthy diet score for changes in cardiometabolic risk factors in children: a longitudinal analysis.

BACKGROUND: Identifying leading dietary determinants for cardiometabolic risk (CMR) factors is urgent for prioritizing interventions in children. We aimed to identify leading dietary determinants for the change in CMR and create a healthy diet score (HDS) to predict CMR in children. METHODS: We included 5676 children aged 6-13 years in the final analysis with physical examinations, blood tests, and diets assessed at baseline and one year later. CMR score (CMRS) was computed by summing Z-scores of waist circumference, an average of systolic and diastolic blood pressure (SBP and DBP), fasting glucose, high-density lipoprotein cholesterol (HDL-C, multiplying by - 1), and triglycerides. Machine learning was used to identify leading dietary determinants for CMR and an HDS was then computed. RESULTS: The nine leading predictors for CMRS were refined grains, seafood, fried foods, sugar-sweetened beverages, wheat, red meat other than pork, rice, fungi and algae, and roots and tubers with the contribution ranging from 3.9 to 19.6% of the total variance. Diets high in seafood, rice, and red meat other than pork but low in other six food groups were associated with a favorable change in CMRS. The HDS was computed based on these nine dietary factors. Children with HDS ≥8 had a higher decrease in CMRS (ß (95% CI): - 1.02 (- 1.31, - 0.73)), BMI (- 0.08 (- 0.16, - 0.00)), SBP (- 0.46 (- 0.58, - 0.34)), DBP (- 0.46 (- 0.58, - 0.34)), mean arterial pressure (- 0.50 (- 0.62, - 0.38)), fasting glucose (- 0.22 (- 0.32, - 0.11)), insulin (- 0.52 (- 0.71, - 0.32)), and HOMA-IR (- 0.55 (- 0.73, - 0.36)) compared to those with HDS ≦3. Improved HDS during follow-up was associated with favorable changes in CMRS, BMI, percent body fat, SBP, DBP, mean arterial pressure, HDL-C, fasting glucose, insulin, and HOMA-IR. CONCLUSION: Diets high in seafood, rice, and red meat other than pork and low in refined grains, fried foods, sugar-sweetened beverages, and wheat are leading healthy dietary factors for metabolic health in children. HDS is strongly predictive of CMR factors.

Associations between hydration state and pregnancy complications, maternal-infant outcomes: protocol of a prospective observational cohort study.

BACKGROUND: Water requirements increases with gestational age. Insufficient water intake causes dehydration, which may adversely affect maternal health and birth outcomes. However, few related studies have been conducted. The purposes are to assess the water intake and hydration state among pregnant women, and to investigate the associations with pregnancy complications and maternal and infant outcomes. METHODS: A prospective observational cohort study will be applied. A total of 380 pregnant women will be recruited from the First Affiliated Hospital of Hainan Medical University. Hydration biomarkers and health outcomes will be tested during 15~17 weeks' gestation, 20~22 weeks' gestation, 30~32 weeks' gestation, during childbirth and 42 days after childbirth. Daily fluid intake will be collected using a 24-h fluid intake record for 7 consecutive days. A semi-quantified food frequency method will be used to assess food intake and water intake from food. Anthropometric measurement will be taken following standardized processes. Intracellular fluid (ICF) and extracellular fluid (ECF) will be measured using a body composition analyzer. Morning fasting urine and blood osmolality will be tested by laboratory physicians using an osmotic pressure molar concentration meter. Pregnancy complications will be assessed and diagnosed throughout pregnancy and childbirth. Maternal-infant outcomes will be monitored using related indicators and technologies. In order to explore the internal mechanism and interactions from the perspective of endocrine, pregnancy related hormones (estradiol, prolactin, progesterone) and the hydration-related hormones (copeptin) will be tested during pregnancy. A mixed model of repeated measures ANOVA will be analyzed using SAS 9.2. RESULTS: The results may provide basic data on water intake among pregnant women. The association between hydration state and maternal-infant outcomes will also be explored. CONCLUSIONS: This preliminary exploratory study findings will fill the gaps in the research on water intake, hydration and maternal health, birth outcomes, provide scientific reference data for updating recommendation on water adequate intake among pregnant women, and provide suggestion for developing water intake interventions. TRIAL REGISTRATION: The protocol has been registered on the website of Chinese Clinical Trial Registry. The Identifier code is ChiCTR1800019284. The Registry date is 3 November, 2018. Registry name is "Study for the correlation between hydration state and pregnancy complications, maternal and infant outcomes during pregnancy".

The Influence of Fluid Intake Behavior on Cognition and Mood among College Students in Baoding, China.

INTRODUCTION: Water is a critical nutrient, and it is important for the maintenance of the physiological function of the human body [1-3]. In addition to fluid amounts, fluid intake frequency is also important for hydration status [4, 5]. At present, only few guidelines mention fluid intake behavior that recommend drinking water frequently while in small quantities, however, there is no scientific evidence to support it. Therefore, it is necessary to explore the appropriate fluid intake behavior. OBJECTIVE: The objective of this study is to evaluate the influence of different fluid intake behavior on cognition and mood, to provide scientific basis for proposing the appropriate fluid intake behavior. METHODS: A double-blinded randomized controlled trial was designed and implemented among college students aged 18-23 years in Baoding, China. Subjects were randomly assigned into each of 3 groups using a random number generated by computer software: the subjects consuming plain water 200 mL/2 h, that is, 1,600 mL during whole day (group 1), 100 mL/2 h, that is, 800 mL during whole day (group 2), and 110 mL/1 h, that is, 1,650 mL during whole day (group 3), respectively. Subjects were asked to fast from 11:00 p.m., without consuming any foods or drinks the day before the intervention. From 8:00 a.m. to 10:00 p.m. of the first study day, subjects consumed water according to the instructions and repeated it from 8:00 a.m. to 4:00 p.m. of the second study day. Cognition, mood, and urine osmolality were collected twice at 10:00 a.m. (time 1) and 4:00 p.m. (time 2) of the second study day (shown in Fig. 1). RESULTS: A total of 92 subjects (46 males, 46 females) completed this study. It was found that the increasing fluid intake amounts lead to an increase in urine output and a decrease in urine osmolality (p < 0.05). Use the mixed models to compare measurements for groups 1 and 2, which showed that when compared with those drinking 800 mL per day, people who drank 1,600 mL per day scored higher in vigor (11.8 vs. 9.1, p < 0.05) and portrait memory test (22.6 vs. 20.8, p < 0.05) but lower in total mood disturbance (90.8 vs. 97.8, p < 0.05). By comparing groups 1 and 3, the results indicated that compared with drinking 8 times per day, people who drank 15 times per day scored lower in portrait memory test (21.8 vs. 22.6, p < 0.05) and hunger (3.3 vs. 3.6, p < 0.05). CONCLUSIONS: Reasonable fluid intake behavior may be beneficial to improve the cognition and mood of college students. The fluid intake behavior, which is consuming water 200 mL each time and 8 times per day, is recommended. More studies are needed to advise people to have health-beneficial fluid intake behavior.

Cost-utility and cost-benefit analyses of school-based obesity prevention program.

BACKGROUND: Economic evaluation of school-based obesity interventions could provide support for public health decision of obesity prevention. This study is to perform cost-utility and cost-benefit assessment of three school-based childhood obesity interventions including nutrition education intervention (NE), physical activity intervention (PA) and comprehensive intervention (both NE and PA, CNP) with secondary data analysis of one randomized controlled trial. METHODS: The standard cost-effectiveness analysis methods were employed from a societal perspective to the health outcome and costs that are attributable to the intervention. NE, PA and CNP were carried out separately for 2 semesters for childhood obesity interventions in primary schools. The additional quality-adjusted life years (QALYs) resulting from the interventions were measured as the health outcome. A cost-utility ratio (CUR) and A cost-benefit ratio (CBR) was calculated as the ratio of implementation costs to the total medical and productivity loss costs averted by the interventions. RESULTS: The CUR and CBR were ¥11,505.9 ($1646.0) per QALY and ¥1.2 benefit per ¥1 cost respectively, and the net saving was ¥73,659.6 ($10,537.9). The CUR and CBR for nutrition education and physical activity interventions were ¥21,316.4 ($3049.6) per QALY and ¥0.7 benefit per ¥1 cost, ¥28,417.1 ($4065.4) per QALY and ¥0.4 benefit per ¥1 cost, respectively (in 2019 RMB). Compared with PA intervention, the ICERs were ¥10,335.2 ($1478.6) and 4626.3 ($661.8) for CNP and NE respectively. The CBR was ¥1.2, 0.7, and 0.4 benefits per ¥1 cost for CNP, NE, and PA interventions, respectively. Net estimated savings were achieved only through CNP intervention, amounting to ¥73,659.6 ($10,537.9). CONCLUSIONS: Comprehensive school-based obesity intervention is a beneficial investment that is both cost-effective and cost saving. Compared with PA intervention, both CNP and NE intervention were more cost-effective.

Drinking patterns and hydration biomarkers among young adults with different levels of habitual total drinking fluids intake in Baoding, Hebei Province, China: a cross-sectional study.

BACKGROUND: The purposes were to investigate the drinking patterns and hydration biomarkers among young adults with different levels of habitual total drinking fluids intake. METHODS: A cross-sectional study was conducted among 159 young adults aged 18-23 years in Baoding, China. Total drinking fluids and water from food were assessed by 7-day 24-h fluid intake questionnaire and duplicate portion method, respectively. The osmolality and electrolyte concentrations of the 24 h urine and fasting blood samples were tested. Differences in LD1 (low drinker), LD2, LD3 and HD (high drinker) groups, stratified according to the quartiles of total drinking fluids, were compared using one-way ANOVA, Kruskal-Wallis H test and chi-square test. RESULTS: A total of 156 participants (80 males and 76 females) completed the study. HD group had greater amounts of TWI (Total Water Intake), water from food, higher and lower contributions of total drinking fluids and water from food to TWI, respectively, than LD1, LD2 and LD3 groups (p < 0.05). Participants in HD group had higher amounts of water and water from dishes than participants in LD1, LD2 and LD3 groups (p < 0.05). No significant differences were found in the contributions of different fluids to total drinking fluids within the four groups (p > 0.05). The osmolality of urine was 59-143 mOsm/kg higher in LD1 than that in LD2, LD3 and HD group (p < 0.05). The percentage of participants in optimal hydration status increased from 12.8% in LD1 group to 56.4% in HD group (p < 0.05). HD and LD3 groups had 386~793 higher volumes of urine than that of LD1 and LD2 groups (p < 0.05). Differences were found in the concentrations of electrolytes among the four groups (p < 0.05). No significant differences were found in the plasma biomarkers (p > 0.05), with the exception of higher concentration of Mg in LD3 and HD groups than that in LD1 and LD2 groups (p < 0.05). CONCLUSIONS: Participants with higher total drinking fluids had better drinking pattern and hydration status. Interventions should be undertaken to advise adults to have adequate total drinking fluids, in order to keep in optimal hydration status. TRIAL REGISTRATION: The registration number was ChiCTR-ROC-17010320, which was registered on the Chinese clinical trial registry.

The amounts and contributions of total drinking fluids and water from food to total water intake of young adults in Baoding, China.

PURPOSE: To investigate the amounts and contributions of total drinking fluids and water from food to total water intake (TWI), to explore the drinking pattern, and to compare the amount of TWI with the recommendations of China and EFSA among young adults. METHODS: A cross-sectional study was implemented with 159 young adults aged 18-23 years from Hebei, China. Total drinking fluids and water from food were assessed by 7-day 24-h fluid intake questionnaire and the duplicate portion method, respectively. Differences between groups stratified according to the distribution of TWI were compared using one-way ANOVA and Kruskal-Wallis H test. General linear models were used to identify the variations in TWI due to total drinking fluids and water from food. RESULTS: In total, 156 subjects (80 males and 76 females) completed the study. Approximately 80.1% of them did not meet the TWI recommended by China, while 50.0% did not meet that recommended by the EFSA. Participants with higher TWI had greater amounts of total drinking fluids, water rom food and water than their counterparts with lower TWI. The regression between total drinking fluids and TWI was R2 = 0.8526 (P < 0.05) and that between water from food and TWI was R2 = 0.4650 (P < 0.05). CONCLUSIONS: A large proportion of young adults have insufficient TWI. Participants with lower TWI would not compensate with water from food. The variances in TWI among participants were mainly due to differences in total drinking fluids. There is an urgent need to improve the fluids intake behaviors of young adults.

Advances and gaps in recommendations for adequate water intake in China.

Water is essential for life survival and development. It plays a pivotal role in metabolic function, modulates normal osmotic pressure, maintains the electrolyte balance, and regulates body temperature. Adequate water intake is necessary for optimal hydration-both excessive and insufficient water consumption can have adverse effects on health. Water requirements among people vary based on various factors such as gender, age, physical activity, dietary factors, ambient temperature, and renal concentrating capacity. In recent years, water intake guidelines have been developed in some countries and by some organisations. Even in China, it is important to develop such guidelines considering specific dietary habits, height of people, and environmental factors. In 2013, guidelines for adequate water intake were developed in China, but the scope was somewhat limited; there are still specific challenges in formulating such recommendations. Future water-related studies should focus on surveying water intake among infants and toddlers, older adults, and pregnant and lactating women. Moreover, additional studies should be conducted to elucidate water intake among adults and adolescents in different regions and seasons, and the association between water intake and related diseases should also be investigated. It is imperative to transform the results of scientific research into action plans for water-related health education so as to inform and evaluate pertinent public health programmes.

The effects of breakfast on short-term cognitive function among Chinese white-collar workers: protocol for a three-phase crossover study.

BACKGROUND: As the first meal of the day, breakfast plays an important role in supplying energy and nutrients, which are critical to working and learning activities. A three-phase crossover study was designed to investigate the effects of breakfast on cognitive function among Chinese white-collar workers. The planned study protocol is presented. METHODS: A total of 264 participants aged 25-45 years will be recruited from Shenyang and Chongqing. Self-administered questionnaires will be used to collect information on age, gender, marital status, education level, occupation, smoking habits, drinking habits, and breakfast behaviours. The participants will be randomly assigned to 3 equal-sized groups (Groups A, B, and C) and will be provided with a nutrition-adequate breakfast, a nutrition-inadequate breakfast, or no breakfast, respectively. Each participant will receive the breakfast treatment on the basis of assignment to one of three sequences (ABC/BCA/CAB). Each participant will complete a battery of cognitive tests assessing short-term memory, attention, and working memory 120 minutes after breakfast. Mood will be measured through a self-administered questionnaire assessing the dimensions of positive and negative frames of mind. Additionally, fasting blood glucose and postprandial 2-hour blood glucose levels will be tested with a blood-glucose meter (Roche ACCU-CHEK®-Performa). All the participants will take all the tests in three successive weeks, and the order of presentation will be counter-balanced across groups. DISCUSSION: The present study will be the first investigation of the effect of breakfast food type and quality on cognitive function amongst white-collar workers in China. We predict that a nutrition-adequate breakfast, compared with a nutrition-inadequate breakfast and no breakfast, will significantly improve short-term cognitive function. The results of this study should provide scientific evidence of the effect of breakfast quality on cognitive function and provide scientific data to inform nutrition education strategies and promote a healthy lifestyle. TRIAL REGISTRATION: Chinese clinical trial registry (Primary registry in the WHO registry network) Registration number: ChiCTR-IPR-15007114 . Date of registration: August 25, 2015.

[Consumption of fruits and vegetables in Chinese adults from 2010 to 2012].

OBJECTIVE: To analyze the consumption of fruits and vegetables of Chinese adults. METHODS: Data were collected from 2010-2012 China National Nutrition and Health Surveillance. Information on fruits and vegetables consumption was collected by using the 24 h recall method for 3 consecutive days. Using the multi-stage stratified cluster randomization sampling method. The participants selected were more than 18 years old of 150 counties from 31 provinces in China. Age and sex standardization was performed based on the China 2009 population published by National Statistics Bureau. The average consumption of vegetables or fruits after weight adjustment for complex sampling was reported to analyze the consumption of fruits and vegetables of Chinese adults (x ± Sx). RESULTS: The average daily consumptions of vegetables and fruits for Chinese residents were (255 ± 6) and (36 ± 3)g/d, respectively. The total consumptions of fruits and vegetables were (291 ± 7)g/d, (295 ± 8)g/d for male, (286 ± 7)g/d for female. Rates on intake of vegetables in Chinese adults during the three survey days were 99.0%-99.8%.Rates on intake of fruits of urban and rural residents were 36.9%-51.5% and 21.3%-30.3%,respectively.The proportion of people whose total amount of vegetables and fruits intake reached 400 g/d were 24%-28% and 13%-23% in urban and rural areas, respectively. In urban and rural areas, the proportion of adults whose consumption reached Chinese dietary guidelines recommended level were 22%-26% and 14%-19% in vegetables, 2%-5% and 1%-2% in fruit, respectively. CONCLUSION: The consumptions of vegetables and fruits were inadequate in Chinese adults.

[Salt intake among Chinese adults in 2010-2012].

OBJECTIVE: To analyze the mean population intake of salt in Chinese adults in 2010-2012. METHODS: Data were from the Chinese Nutrition and Health Surveillance in 2010-2012. The samples were selected through the method of probability proportion to size (PPS). The study objects were 55 531 adults aged 18 and over from 150 sites in 31 provinces, autonomous regions or municipalities in China. The information of oil, salt and other condiments for household was from the 3 d food weighed record. The average of salt intake for individuals was calculated based on the energy percentage in one family. The results presented the level of salt intake (x ± Sx) by analyzing the different demography characteristics. The results were calculated using complex weighting by the population data from National Bureau of Statistics in 2009. RESULTS: The intake of salt was (9.6 ± 0.3) g/d and it was higher in men ((10.4 ± 0.4) g/d) than that in women ((8.8 ± 0.3) g/d). The intake in the age group of 40-49, 50-59 and 60-69 was (9.9 ± 0.5) g/d, (10.3 ± 0.4) g/d and (9.9 ± 0.3) g/d, respectively. The adults in rural ((10.2 ± 0.3) g/d) had a higher salt intake than that of urban ((9.0 ± 0.5) g/d). An average of salt intake was increased gradually in big city ((7.9 ± 0.3) g/d), medium /small city ((9.2 ± 0.6) g/d) , general rural ((9.9 ± 0.4) g/d) and poor rural ((10.8 ± 0.7)g/d). CONCLUSION: The mean salt intake among Chinese adults was still in a very high level. Something should be done to reduce the salt intake for the government and policy-makers.

Total fluid intake of children and adolescents: cross-sectional surveys in 13 countries worldwide.

PURPOSE: To describe total fluid intake (TFI) according to socio-demographic characteristics in children and adolescents worldwide. METHODS: Data of 3611 children (4-9 years) and 8109 adolescents (10-18 years) were retrieved from 13 cross-sectional surveys (47 % males). In three countries, school classes were randomly recruited with stratified cluster sampling design. In the other countries, participants were randomly recruited based on a quota method. TFI (drinking water and beverages of all kinds) was obtained with a fluid-specific record over 7 consecutive days. Adequacy was assessed by comparing TFI to 80 % of adequate intake (AI) for total water intake set by European Food Safety Authority. Data on height, weight and socio-economic level were collected in most countries. RESULTS: The mean (SD) TFI ranged from [1.32 (0.68)] to [1.35 (0.71)] L/day. Non-adherence to AIs for fluids ranged from 10 % (Uruguay) to >90 % (Belgium). Females were more likely to meet the AIs for fluids than males (4-9 years: 28 %, OR 0.72, p = 0.002; 10-18 years: 20 %, OR 0.80, p = 0.001), while adolescents were less likely to meet the AI than children (OR 1.645, p < 0.001 in males and OR 1.625, p < 0.001 in females). CONCLUSIONS: A high proportion of children and adolescents are at risk of an inadequate fluid intake. This risk is especially high in males and adolescents when compared with females or children categories. This highlights water intake among young populations as an issue of global concern.

Literature research of the Nutrition Improvement Programme for Rural Compulsory Education Students in China.

OBJECTIVE: To describe the Nutrition Improvement Programme for Rural Compulsory Education Students (NIPRCES) in China and to share the experiences of developing and implementing nationwide school meal programmes with other countries. DESIGN: The article is based on a literature review of technical documents and reports of NIPRCES and relevant national legislation, technical reports and studies on school nutrition, minutes of meetings and national conferences, and official documents of the National Office of Student Nutrition and the Chinese Center for Disease Control and Prevention. SETTING: People's Republic of China. SUBJECTS: Published papers, national policies, legislation and unpublished official documents. RESULTS: A total of 23 million rural compulsory education students were covered by NIPRCES. In the development and implementation process of NIPRCES, fifteen ministries and national committees were involved and an efficient collaborative mechanism was established. All NIPRCES-covered schools were required to serve meals on a daily basis. By the end of June 2012, the proportions of students choosing 'school feeding', 'food package' and 'family feeding' modes were respectively 64.0 %, 32.0 % and 4.0 %. The central government subsidized school meals annually by more than $US 2.5 billion and invested $US 4.8 billion on school kitchens to support this programme. CONCLUSIONS: The NIPRCES is a significant movement of governmental nutritional intervention in China. Food safety, financial security, decentralization and other potential concerns should be considered and lessons can be learned from other countries. Further relevant research and a nationwide monitoring and evaluation programme are needed.

Effect of Home-Based Complementary Food Fortification on Prevalence of Anemia Among Infants and Young Children Aged 6 to 23 Months in Poor Rural Regions of China.

Following the 2008 Wenchuan earthquake, the Chinese government instituted an infant and young and child nutrition program that included promotion of in-home fortification of complementary food with ying yang bao (YYB), a soy-based powder containing iron, 2.5 mg as iron-EDTA and 5 mg as ferrous fumarate, and other micronutrients. Ying yang bao was provided to participating families in 8 poor rural counties in Sichuan, Shaanxi, and Gansu provinces by the Ministry of Health. We assessed hemoglobin levels among infants and young children (IYC) aged 6 to 23 months at baseline in May 2010 (n = 1290) and during follow-up in November 2010 (n = 1142), May 2011 (n = 1118), and November 2011 (n = 1040), using the Hemocue method. Interviewers collected basic demographic information and child feeding practices from the children's caretakers. Altitude-adjusted hemoglobin level averaged 10.8 g/dL, and total anemia prevalence was 49.5% at baseline. Average hemoglobin was 11.3 g/dL at 6 months, 11.6 g/dL at 12 months, and 11.7 g/dL at 18 months after introduction of YYB. Moderate anemia (hemoglobin: 70-99 g/dL) decreased from 20.3% at baseline to 7.5%, 5.8%, and 7.3% after 6, 12, and 18 months of home fortification, respectively (P < .001), whereas mild anemia (hemoglobin: 100-110 g/dL) decreased from 29.0% to 16.7%, 18.1%, and 15.4%, respectively (P < .001). Among infants aged 6 to 23 months, 95% had regularly been fed YYB during the observation period. Regression analysis showed that the duration of YYB consumption and number of sachets consumed per week correlated positively with hemoglobin levels and negatively with anemia rates. Home food fortification with YYB is feasible and effective for nutrition promotion among IYC in high-risk regions of China.