Multiple factor assessment for determining resting metabolic rate in young adults.

Existing formulas cannot fully explain the variation of resting metabolic rate (RMR). This study aims to examine potential influencing factors beyond anthropometric measurements and develop more accurate equations using accessible parameters. 324 healthy adults (230 females; 18-32 years old) participated in the study. Height, fat-free mass (FFM), fat mass (FM) and RMR were measured. Menstrual cycle, stress levels, living habits, and frequency of consuming caffeinated foods were collected. Measured RMR were compared with predictive values of the new equations and previous 11 equations. Mean RMR for men and women was 1825.2 ± 248.8 and 1345.1 ± 178.7 kcal/day, respectively. RMR adjusted for FFM0.66FM0.066 was positively correlated with BMI. The multiple regression model showed that RMR can be predicted in this population with model 1 (with FFM, FM, age, sex and daily sun exposure duration) or model 2 (with weight and height replacing FFM and FM). The accuracy was 75.31% in the population for predictive model 1 and 70.68% for predictive model 2. The new equations had overall improved performance when compared with existing equations. The predictive formula that consider daily sun exposure duration improve RMR prediction in young adults. Additional investigation is required among individuals in the middle-aged and elderly demographic.

Effects of decreasing the out-of-pocket expenses for outpatient care on health-seeking behaviors, health outcomes and medical expenses of people with diabetes: evidence from China.

BACKGROUND: To improve access to outpatient services and provide financial support in outpatient expenses for the insured, China has been establishing its scheme of decreasing the out-of-pocket expenses for outpatient care in recent years. There are 156 million diabetes patients in China which almost accounts for a quarter of diabetes population worldwide. Outpatient services plays an important role in diabetes treatment. The study aims to clarify the effects of decreasing the out-of-pocket expenses for outpatient care on health-seeking behaviors, health outcomes and medical expenses of people with diabetes. METHODS: This study constructed a two-way fixed effect model, utilized 5,996 diabetes patients' medical visits records from 2019 to 2021, to ascertain the influence of decreasing the out-of-pocket expenses for outpatient care on diabetes patients. The dependent variables were diabetes patients' health-seeking behaviors, health outcomes, medical expenses and expenditure of the basic medical insurance funds for them; the core explanatory variable was the out-of-pocket expenses for outpatient care expressed by the annual outpatient reimbursement ratio. RESULTS: With each increase of 1% in the annual outpatient reimbursement ratio: (1) for health-seeking behaviors, a diabetes patient's annual number of outpatient visits and annual number of medical visits increased by 0.021 and 0.014, while the annual number of hospitalizations decreased by 0.006; (2) for health outcomes, a diabetes patient's annual length of hospital stays and average length of a hospital stay decreased by 1.2% and 1.1% respectively, and the number of diabetes complications and Diabetes Complications Severity Index (DCSI) score both decreased by 0.001; (3) for medical expenses, a diabetes patient's annual outpatient expenses, annual inpatient expenses, annual medical expenses and annual out-of-pocket expenses decreased by 2.2%, 4.6%, 2.6% and 4.0%; (4) for expenditure of the basic medical insurance funds for a diabetes patient, the annual expenditure on outpatient services increased by 1.1%, and on inpatient services decreased by 4.4%, but on healthcare services didn't change. CONCLUSION: Decreasing the out-of-pocket expenses for outpatient care appropriately among people with diabetes could make patients have a more rational health-seeking behaviors, a better health status and a more reasonable medical expenses while the expenditure of the basic medical insurance funds is stable totally.

Disparities in fresh fruit and vegetable intake by sociodemographic and behavioural factors among adults in China.

OBJECTIVE: To measure the associations of sociodemographic and behavioural factors with fruit and vegetable consumption among adults in China. DESIGN: A cross-sectional study. SETTING: A 2015 wave of the China Health and Nutrition Survey. PARTICIPANTS: Totally, 11 910 adults aged 18 to 64 years. RESULTS: Adjusted log binomial regression analyses showed that adults with higher income levels had higher fruit intake than those with low income levels (medium income group, risk ratio (RR): 1·28; 95 % CI: 1·16, 1·41; high income group, RR: 1·58; 95 % CI: 1·43, 1·74). Current smokers had lower fruit intake than non-smokers (RR: 0·86; 95 % CI: 0·77, 0·96). Adults living in southern China had higher vegetable intake (RR: 1·88; 95 % CI: 1·76, 2·01) but lower fruit intake (RR: 0·85; 95 % CI: 0·79, 0·91) than adults in northern China. With increasing age, adults had higher fruit intake (50-64 years, RR: 1·20; 95 % CI: 1·09, 1·33; reference category 18-34 years) and higher vegetable intake (35-49 years, RR: 1·13; 95 % CI: 1·05, 1·22; 50-64 years, RR: 1·22; 95 % CI: 1·13, 1·31). CONCLUSIONS: Our findings identify a range of sociodemographic and behavioural factors associated with fruit and vegetable consumption among Chinese adults. They also point to the need for public health nutrition interventions for socially disadvantaged populations in China.

A comparison of the Mini-Mental State Examination (MMSE) with the Montreal Cognitive Assessment (MoCA) for mild cognitive impairment screening in Chinese middle-aged and older population: a cross-sectional study.

BACKGROUND: The Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) are the most commonly used scales to detect mild cognitive impairment (MCI) in population-based epidemiologic studies. However, their comparison on which is best suited to assess cognition is scarce in samples from multiple regions of China. METHODS: We conducted a cross-sectional analysis of 4923 adults aged ≥55 years from the Community-based Cohort Study on Nervous System Diseases. Objective cognition was assessed by Chinese versions of MMSE and MoCA, and total score and subscores of cognitive domains were calculated for each. Education-specific cutoffs of total score were used to diagnose MCI. Demographic and health-related characteristics were collected by questionnaires. Correlation and agreement for MCI between MMSE and MoCA were analyzed; group differences in cognition were evaluated; and multiple logistic regression model was used to clarify risk factors for MCI. RESULTS: The overall MCI prevalence was 28.6% for MMSE and 36.2% for MoCA. MMSE had good correlation with MoCA (Spearman correlation coefficient = 0.8374, p < 0.0001) and moderate agreement for detecting MCI with Kappa value of 0.5973 (p < 0.0001). Ceiling effect for MCI was less frequent using MoCA versus MMSE according to the distribution of total score. Percentage of relative standard deviation, the measure of inter-individual variance, for MoCA (26.9%) was greater than for MMSE (19.0%) overall (p < 0.0001). Increasing age (MMSE: OR = 2.073 for ≥75 years; MoCA: OR = 1.869 for≥75 years), female (OR = 1.280 for MMSE; OR = 1.163 for MoCA), living in county town (OR = 1.386 and 1.862 for MMSE and MoCA, respectively) or village (OR = 2.579 and 2.721 for MMSE and MoCA, respectively), smoking (OR = 1.373 and 1.288 for MMSE and MoCA, respectively), hypertension (MMSE: OR = 1.278; MoCA: OR = 1.208) and depression (MMSE: OR = 1.465; MoCA: OR = 1.350) were independently associated with greater likelihood of MCI compared to corresponding reference group in both scales (all p < 0.05). CONCLUSIONS: MoCA is a better measure of cognitive function due to lack of ceiling effect and with good detection of cognitive heterogeneity. MCI prevalence is higher using MoCA compared to MMSE. Both tools identify concordantly modifiable factors for MCI, which provide important evidence for establishing intervention measures.

Systematic Review on International Salt Reduction Policy in Restaurants.

As the catering sector has increasingly contributed to population-level salt intake, many countries have begun developing salt-reduction strategies for restaurants. This paper aims to provide an overview of global salt reduction policies in restaurants. Scientific papers and website materials were systematically searched from Web of Science, Science Direct, and PubMed, as well as official websites of government departments and organizations. A total of 78 full-text papers and grey literature works were included. From 58 countries and regions, 62 independent policies were identified, 27 of which were mandatory (3 with fines). The most common strategy was menu labeling, which was a component of 40 policies. Target setting (n = 23) and reformulation (n = 13) of dishes were also widely implemented. Other salt-reduction strategies included education campaign, chef training, toolkits delivery, table salt removal, media campaign, and government assistance such as free nutrition analysis and toolkits distribution. Most policies focused on chain restaurants. Evaluations of these policies were limited and showed inconsistent results, and more time is needed to demonstrate the clear long-term effects. Attention has been paid to salt reduction in restaurants around the world but is still at its early stage. The feasibility and effectiveness of the strategies need to be further explored.

Evaluating adherence to recommended diets in adults 1991-2015: revised China dietary guidelines index.

BACKGROUND: The China Dietary Guidelines Index (CDGI) is a diet quality evaluation index that can present the overall diet quality and is comparable between individuals. The aim of this study was to revise CDGI for Chinese adults according to the Chinese Dietary Guidelines 2016 (CDG-2016), evaluate adherence to recommended diets between 1991 and 2015, and analyze the trend, variation, and determinants of diet quality. METHODS: Food, cooking oil, and condiment intakes were estimated based on twenty-four-hour dietary recalls over three consecutive days and the household weighing method. Based on the food and nutrients recommendations for people with different energy requirements in CDG-2016, CDGI was revised as China Dietary Guidelines Index (2019)-Adults (CDGI(2019)-A) by equal weight continuity scoring. Three-level random intercept-slope growth models were applied to analyze the trend, variation, and determinants at both the community and individual levels. RESULTS: CDGI(2019)-A, the sum of fourteen component scores with a range of 0-110 points, increased significantly from 38.2 in 1991 to 47.3 in 2015. Components with a score of less than half were milk (91.6%), fruits (72.0%), nuts (82.5%), other cereals and beans (82.6%), and seafood (77.7%). Between-individual accounted for 25.6% of the total score variation, of which 87.4% derived from the community level. CDGI(2019)-A score displayed a positive association with being female, having higher education, having higher income, living in an urban area, and knowing the CDG-2016 recommendations. The impact of income and awareness of CDG-2016 varied significantly across communities. CONCLUSIONS: Although quality of diet has been improving in China, overall quality remains poor, primarily because of inadequate intake of milk and dairy products, nuts, fruits, other cereals and miscellaneous beans, and seafood. Intervention at the community level may improve diet quality more efficiently than at the individual level, and the most effective intervention should be selected in different communities according to local conditions.

Dietary Zinc Intake and Its Association with Metabolic Syndrome Indicators among Chinese Adults: An Analysis of the China Nutritional Transition Cohort Survey 2015.

The dietary zinc consumed in Chinese households has decreased over the past decade. However, the national dietary zinc intake in the last five years has seldom been investigated. Using data from 12,028 participants 18 to 64 years old (52.9% male) in the China Nutritional Transition Cohort Survey (CNTCS) 2015, we describe the intake of dietary zinc and the contributions of major foods and we examine the relationship between the level of dietary zinc intake and metabolic syndrome indicators, including blood pressure, fasting glucose, and triglycerides (TG), in Chinese adults. We assessed dietary zinc intake using 24 h recalls on three consecutive days. The mean daily dietary zinc intake for all participants was 10.2 milligrams per day (males 11.2 mg/day, females 9.4 mg/day, p < 0.001). The mean daily dietary zinc density for all participants was 5.2 mg/day per 1000 kilocalories. Among all participants, 31.0% were at risk of zinc deficiency, with dietary zinc intakes of less than the Estimated Average Requirement (EAR) (males 49.2%, females 14.8%, p < 0.050), and 49.9% had adequate dietary zinc intakes, equal to or greater than the recommended nutrient intake (RNI) (males 30.7%, females 67.0%, p < 0.050). We found substantial gender differences in dietary zinc intake and zinc deficiency, with nearly half of the men at risk of zinc deficiency. Males of younger age, with higher education and incomes, and who consumed higher levels of meat, had higher zinc intakes, higher zinc intake densities, and higher rates of meeting the EAR. Among all participants, grains, livestock meat, fresh vegetables, legumes, and seafood were the top five food sources of zinc, and their contributions to total dietary zinc intake were 39.5%, 17.3%, 8.9%, 6.4%, and 4.8%, respectively. The groups with relatively better dietary zinc intakes consumed lower proportions of grains and higher proportions of livestock meat. For males with adequate dietary zinc intake (≥RNI), TG levels increased by 0.219 millimoles per liter (mmol/L) compared with males with deficient dietary zinc intake (

Why is there gender disparity in the body mass index trends among adults in the 1997-2011 China health and nutrition surveys?

BACKGROUND AND OBJECTIVE: Over the past three decades, the prevalence of overweight and obesity in China has increased greatly. Chinese body mass index (BMI) dynamics have shown much greater rates of changes among men, aged 18-45 years, than among women. This study examined the gender difference in the BMI trends and related factors. METHODS AND STUDY DESIGN: We used longitudinal data from the China Health and Nutrition Survey collected in 1997, 2000, 2004, 2006, 2009 and 2011. A total of 10,982 participants (N=5339 men and 5643 women) aged 18-45 years were included in the final analysis. Lambda mu sigma method (LMS) was used to describe changes of BMI distribution. Separate sex-stratified multilevel random intercept-slope growth models were applied to examine effects of individual and community variables on BMI trends of Chinese adults. RESULTS: Male BMI increased by 0.21 kg/m2 overtime, which was larger than female BMI at 0.16 kg/m2. Higher income, drinking and away-from-home food consumption were associated with higher BMI, and these variables were only significant among men. Physical activity (PA) had a negative association for both genders. CONCLUSIONS: Since different variables resulted in gender disparity in BMI trends among Chinese adults, separate health policies should be developed for men and for women.

[Trend in vegetable and fruit intake among Chinese children and adolescents aged 6 to 17 years from 1991 to 2009 and related socio-demographic factors].

OBJECTIVE: To analyze the long-term shifts in fruit and vegetable intakes in Chinese children and adolescents between 1991 and 2009 and related impact from socio-economic factors on such dynamics. METHODS: Data was from the seven waves of the China Health and Nutrition Survey. 12 596 children and adolescents aged 6 to 17 years with full data of 3-day-24-hour dietary recall, together with related demographic and socioeconomic factors were chosen as the study subjects. RESULTS: The consumption rates of fruits and vegetables showed an significant increasing trend, from 58.3% in 1991 to 82.4%, on dark-color vegetables(χ(2) = 213.2, P < 0.01), from 94.4% to 96.9% on light-color vegetable(χ(2) = 11.6, P < 0.0001)and from 12.6% to 45.4% for fruits(χ(2) = 571.2, P < 0.0001)in 2009. The median intake of total vegetables decreased from 250.0 g/d in 1991 to 225.8 g/d in 2009(χ(2) = 72.4, P < 0.0001) and the light-color vegetable decreased by 36.6 g/d. However, among the corresponding consumers, the fruit intake increased about 50.0 g/d (χ(2) = 104.2, P < 0.01)and the dark-color vegetable intake decreased about 40.0 g/d (χ(2) = 92.8, P < 0.0001 ). The proportion of children who reached the minimum intake of vegetable(300 g/d)recommended by Dietary Guidelines for Chinese 2007 decreased from 38.9% in 1991 to 26.8% in 2011 and the proportion of children who had met the minimum intake(200 g/d)increased from 2.0% to 13.9% . 25.1% of the children consumed dark-color vegetables more than half of the total vegetable intake. Schooling of the mother and family income had important impact on fruit consumption of the children. CONCLUSION: Rates on fruit and vegetable consumption showed an increasing trend among Chinese children and adolescents over the past 20 years. However, the vegetable intake significantly decreased and the fruit intake increased slightly. Chinese Children posed a greater risk on insufficient intake on both vegetables and fruits. Comprehensive and effective programs should be taken to increase vegetable and fruit intakes in order to improve the nutritional status of children.

[The impact of socioeconomic status on the prevalence of hypertension among adults in 9 provinces of China, 1991-2009].

OBJECTIVE: To investigate the trends of hypertension prevalence among Chinese adults from 1991 to 2009. To analysis the effects of socioeconomic status (SES) on hypertension rate. METHODS: This study was based on the data of China Health and Nutrition Survey which was conducted in 1991, 1993, 1997, 2000, 2004, 2006 and 2009. Adult subjects aged 18 to 74 years old in each round were included. Statistical method of single factor and multi-factor analysis was used. RESULTS: During the eighteen-year follow up, from 1991 to 2009, the crude rate increased from 14.6% to 28.7%, and the adjusted rate by age increased from 14.6% to 32.2% among males. The crude rate increased from 12.0% to 24.6% , and age adjusted rate from 12.0% to 24.9% among females. Hypertension prevalence was highest among the male group with highest SES score at 1991, 1993, 1997, 2000 and 2004. However, the lowest SES score with highest hypertension prevalence was found among the male group at 2006 and 2009. From 1997, the hypertension prevalence of female with highest SES score was lowest, and the group with lowest SES score was highest hypertension prevalence in female group from 1993. Negative association was found between SES score and female hypertension prevalence by the logistic regression analysis. No association was found between SES score and male hypertension prevalence. CONCLUSION: The prevalence of hypertension among Chinese adults had a continual increase with age during the period from 1991 to 2009. Negative association was existed between SES and hypertension prevalence for female. However, further study should be conducted between SES and male hypertension prevalence.

[Status of anemia among children under 5 years of age in the economically less developed rural areas from the 6 western provinces of China, in 2009].

OBJECTIVE: To analyze the status of anemia among children under 5 years of age in the economically less developed rural areas from 6 western provinces of China in 2009. METHODS: 8141 study subjects were from the program- 'Study on Appropriate Technology of Children Under-nutrition Improvement in Poor Rural Areas'. RESULTS: In 2009, the prevalence of anemia among children under 5 years of age in the above said rural areas from 6 western provinces was 24.1%. The prevalence of anemia among male children was much higher than that among female children. The peak of anemia prevalence (38.5%) was among children of 6 - 11 months. The prevalence of anemia decreased along with the increase of age. CONCLUSION: Results from the study demonstrated that anemia among the preschool children was a public health problem in poor rural areas of western China. Improving the knowledge on reasonable feeding seemed a better way for the prevention and control of anemia plus providing complementary nutrients sprinkle to the affected children.