[Energy and nutrients intake from complementary foods of children aged 6-23 months in China in 2019-2021].

OBJECTIVE: To describe the energy and nutrients intake from complementary foods of children aged 6-23 months in different areas of China. METHODS: The data was from the National Special Program for Science & Technology Basic Resources Investigation-China Children's Nutrition and Health System Survey and Application of 0-18 Years Old Children. Children aged 6-23 months(n=546) were included in the current study. Demographic characteristics, socioeconomic status and birth status were collected through questionnaire survey. We used 24-hour weighted dietary record method to collect the intake of complementary foods. Energy, protein, fat, carbohydrate, calcium, iron, zinc, selenium, potassium, vitamin A, vitamin B_1, vitamin B_2 and vitamin C intakes were calculated by using Chinese Food Composition Database. RESULTS: For children aged 6-8 months, 9-11 months, 12-17 months and 18-23 months, the energy intake from complementary foods was 156.1, 258.0, 388.7 and 581.1 kcal, respectively. The protein intake was 5.1, 10.1, 15.0 and 21.7 g, respectively. The fat intake was 3.3, 6.7, 9.5 and 15.9 g, respectively. The calcium intake was 38.7, 54.8, 78.6 and 106.9 mg, respectively. The iron intake was 1.3, 2.2, 3.5 and 5.3 mg, respectively. The zinc intake was 0.7, 1.4, 2.0 and 2.9 mg, respectively. The vitamin A intake was 83.7, 100.3, 157.4 and 180.4 µgRAE, respectively. The vitamin B_1 intake was 0.1, 0.2, 0.2 and 0.3 mg, respectively. The vitamin B_2 intake was 0.1, 0.1, 0.2 and 0.3 mg, respectively. The vitamin C intake was 1.8, 6.3, 9.5 and 19.2 mg, respectively. Compared with the World Health Organization recommended value of nutrients density, the density of protein from complementary foods for children aged 6-23 months was higher(2.6-3.8 mg/100 kcal vs.0.9-1.0 mg/100 kcal). The density of iron(1.0, 0.9 mg/100 kcal vs.4.5, 3.0 mg/100 kcal) and zinc(0.5, 0.5 mg/100 kcal vs.1.6, 1.1 mg/100 kcal) was lower for children aged 6-8 months and 9-11 months, respectively. CONCLUSION: The main issues of complementary food for children in China were high protein for children aged 6-23 months and low iron and zinc for infants aged 6-11 months.

[Association between dietary patterns and abdominal obesity among the adult women in Zhejiang Province].

OBJECTIVE: To explore the dietary patterns and its relationship with abdominal obesity among the adult women in Zhejiang Province. METHODS: We recruited 2915 female residents aged 18 and older by using multi-stage stratified cluster sampling method; We conducted questionnaires survey and physical examinations to understand the basic information and nutritional status of the residents. Dietary patterns were extracted with factor analysis, and the multivariate Logistic regression model was used to analyze the association between dietary patterns and abdominal obesity among the participants. RESULTS: The prevalence rate of abdominal obesity and general obesity among the subjects were 33.07% and 9.23%, respectively. The highest rate of abdominal obesity was among the female who were above 65 years old, living in rural areas with low education. On the other hand, the lowest rate of abdominal obesity was among females with higher education(P<0.0001). Four dietary patterns identified with factor analysis were grain pattern, nut-legume pattern, milk-eggs pattern and modern pattern, accounting for 38.5% of total variance. After adjusting confounding factors as age, education level, occupation, marital status, urban/rural and exercise status, the participants with the fourth quartile(Q4) score of nut-legume dietary pattern had a low risk of abdominal obesity(OR=0.720, 95% CI 0.571-0.908, P=0.0012) compared to those with the quartile(Q1) first score. CONCLUSION: The nut-legume dietary pattern is negatively associated with abdominal obesity in female adults.

[Association between the diet balance index-based dietary quality and cognitive function among Zhejiang population aged 40 years and older].

OBJECTIVE: To evaluation the dietary quality of Zhejiang population aged 40 years and older using the Dietary Balance Index(DBI) and to analyze the association between dietary quality and cognitive function. METHODS: The dietary information was collected with the help of questionnaire survey, a 3-day dietary recall and household condiment weighing method from Zhejiang participants of the 2018 wave of the China Health and Nutrition Survey aged 40 years and older, and the food and energy intakes were calculated. The cognitive function was assessed by the Mini Mental Status Examination. Dietary quality was evaluated using the DBI method. A multivariate Logistic regression model was used to examine the association between dietary quality and the risk of cognitive impairment. RESULTS: Among 640 participants aged 40 years and older, 14.2% had cognitive impairment. Univariate analysis showed that those with cognitive impairment had higher cereal(P=0.001), particularly, higher rice and products intake(P<0.001), as well as higher egg intake(P=0.008) than those with normal cognitive function; while the intake of soybean and its product(P=0.025) was lower. Those with cognitive impairment had higher DBI score of cereal(P=0.006) and high bound score(HBS)(P=0.028)than those with normal cognitive function. After adjustment for possible confounding factors, Logistic regression showed that moderated and severe over-consumption was positively associated with cognitive impairment(OR=2.486, 95% CI 1.130-5.470, P=0.024). CONCLUSION: Over-consumption may increase the risk of cognitive impairment among aged Zhejiang population, and should be used to prevent or reduce cognitive decline by improving the quality of the diet through a reasonable dietary mix.

The Current Status of Insufficient Sleep Duration and Its Influencing Factors Among Children and Adolescents: A Household Based Cross-Sectional Study in Zhejiang Province, China.

PURPOSE: Insufficient sleep duration is common among children and adolescents worldwide, and the decline of sleep duration during the recent years is troubling. This study aimed to learn the status of insufficient sleep duration and to explore its influencing factors among children and adolescents in Zhejiang Province, China. DESIGN AND METHODS: A stratified sampling technique was employed in the present cross-sectional study. Demographic characteristics, sports time as well as sedentary behavior were investigated. RESULTS: A greater proportion of children than adolescents reported insufficient sleep duration (36.4% versus 19.2%, p = 0.001). For children, insufficient sleep duration was associated with age (OR = 1.290, 95%CI: 1.069-1.557), watching movies or TV shows with smartphones after school (OR = 3.098, 95%CI: 1.293-7.420), surf the internet after school (OR = 0.113, 95%CI: 0.013-0.969), walk to school (OR = 0.289, 95%CI: 0.105-0.793). For adolescents, insufficient sleep duration was associated with watch TV after school (OR = 0.379, 95%CI: 0.148-0.970), watching movies or TV shows with smartphones after school (OR = 4.744, 95%CI: 1.799-12.507), do homework after school (OR = 0.265, 95%CI: 0.086-0.813). CONCLUSIONS: An unhealthy sedentary screen lifestyle profile may have influence on insufficient sleep duration. Urgent actions are needed to improve sleep duration among children and adolescents.

Adult breakfast habits and nutritional status: A household based cross-sectional study in Zhejiang Province, China.

BACKGROUND AND OBJECTIVES: Although Dietary Guidelines for Chinese Residents offers advice for breakfast in China, current breakfast consumption habits are unclear. The aim of this study was to describe the frequency of breakfast consumption among adults and explore its associations with daily food consumption and daily nutrient intake. METHODS AND STUDY DESIGN: A stratified cluster sampling technique was employed in this cross-sectional study. Demographic characteristics, breakfast consumption, and daily food and nutrient intake were investigated. RESULTS: Dietary data were collected for 3251 adult residents through interviews. We determined that residents with an annual income of

[Dietary microelements intakes status of elderly people from different areas in Zhejiang Province in 2010-2012].

OBJECTIVE: To assess the situations of dietary microelements intakes among elderly people in different areas of Zhejiang Province, and analyze the food sources of microelements. METHODS: Data were obtained from the 2010-2012 Chinese National Nutrition and Health Survey in Zhejiang Province. 832 elderly people( 434 male, 398 female, age was( 68. 02±6. 68) years) were from large cities, small-medium cities and rural counties. The 24-hour dietary recall method for 3 consecutive days was used to collect food intake information to analyze dietary intakes among elderly people of Fe, Mn, Cu, Zn, Se and their sources in different areas. RESULTS: The elderly people'intakes of Mn was 4. 86( 3. 44, 6. 45) mg/d, Cu was 1. 69( 1. 13, 2. 27) mg/d, and Se was36. 85( 21. 32, 54. 21) µg/d, those were generally low. The intake of Zn was 10. 15( 7. 94, 12. 62) mg/d in males, was low as well. Intakes of Mn, Cu, Se were significantly different in different areas, small-medium cities had highest intakes of Mn( 5. 87 mg/d)and Cu( 1. 88 mg/d), large cities had a highest intake of Se( 45. 47 µg/d). The food sources of microelements were slightly variant. Rural counties had less fungi and algae sources of Fe and Mn than large cities and small-medium cities. The Cu from vegetables were higher than dried legumes and the Se from poultry and poultry products were higher than eggs in rural counties. The Zn from fish, shellfish and mollusk were higher than dried legumes in large cities. CONCLUSION: The insufficient status of microelements intakes among elderly people in Zhejiang Province was serious, and there were differences among elderly people from different areas in intakes and food sources of microelements.

[Comparative study on burden of diet-related chronic diseases in China between 1990 and 2016].

OBJECTIVE: To compare the disease burden of diet-related chronic diseases in China between 1990 and 2016. METHODS: Based on the Global Burden of Disease 2016, we extracted the absolute number of deaths and disability-adjusted life years( DALYs) of diet-related chronic diseases and the corresponding age-standardized rates in China in 1990 and 2016. Subgroup analyses were conducted in various gender, dietary risk factors and categories of diseases. RESULTS: In 2016, the total number and rate of diet-related NCDs deaths was 2493 thousand and 182. 4/100000. The corresponding number and rate of DALYs was 54995 thousand person-year and 4023. 0/100000. Compared with those in 1990, the rates of death and DALYs in 2016 increased by19. 5% and 9. 3%, respectively. Both death rate and DALYs rate increased with the age. Death rate( 214. 6/100000) and DALYs rate( 4961. 1/100000) in males were 1. 4-fold and 1. 6-fold as that in females( 148. 2/100000 and 3028. 2/100000, respectively). High intake in sodium, low intake in whole grains and low intake in fruits were the three leading dietary risk factors and cardiovascular diseases accounted for 88. 1% DALYs in all chronic diseases. CONCLUSION: The burden of diet-related chronic diseases in China is severe and it continues increasing over years.

[Analysis on the dietary survey results of 60 years old and over population in different economic area of Zhejiang Province in 2010-2012].

OBJECTIVE: To analyze the dietary energy and pattern of the elderly in different economic area of Zhejiang Province. METHODS: Data was from Chinese National Nutrition and Health Survey from 2010 to 2012 in Zhejiang Province. The 24 h dietary recall method for 3 consecutive days was used in dietary survey and weighing method was used for condiment intake. RESULTS: There were 793 elderly( age≥60 years) attended in the survey. The intake of beans and nuts, fish and shrimps, eggs, cereals and vegetables respectively were 30. 26, 54. 07, 20. 56, 300. 27 and 277. 78 g. The livestock and poultry meat( 92. 69 g), salt( 9. 14 g), and cooking oil( 33. 60 g) intake was higher than that recommended. Dietary pattern of the urban was better than that of the rural areas. The proportion of energy providing in protein and fat was 14. 17% and 34. 46%, respectively. The proportion of protein from grain and animal food was 31. 51% and 37. 48%. The proportion of fat from plant food was 66. 44%. CONCLUSION: The major problems areirregular diet, imbalanced diet, and unreasonable food sources of protein in Zhejiang province. Because the level of each localities economic development is different, each region's dietary problems are different. We need to research in different areas to analyze specific issues of nutrition interventions, and improving the elders' life quality.

Dietary intake of manganese and the risk of the metabolic syndrome in a Chinese population.

Animal studies have suggested that Mn might be associated with some components of the metabolic syndrome (MetS). A few epidemiological studies have assessed dietary Mn intake and its association with the risk of the MetS and its components among Chinese adults. In this study, we assessed daily dietary Mn intake and its relationship with MetS risk among Chinese adults in Zhejiang Province using data from the 5th Chinese National Nutrition and Health Survey (2010-2012). A total of 2111 adults were included. Dietary Mn intake was assessed using 3-d 24-h dietary recalls; health-related data were obtained by questionnaire surveys, physical examinations and laboratory assessments. The mean intake of Mn was 6·07 (sd 2·94) mg/d for men (n 998) and 5·13 (sd 2·65) mg/d for women (n 1113). Rice (>42 %) was the main food source of Mn. The prevalence of the MetS was 28·0 % (590/2111). Higher Mn intake was associated with a decreased risk of the MetS in men (Q4 v. Q1 OR 0·62; 95 % CI 0·42, 0·92; P trend=0·043) but an increased risk in women (Q4 v. Q1 OR 1·56; 95 % CI 1·02, 2·45; P trend=0·078). In addition, Mn intake was inversely associated with abdominal obesity (P trend=0·016) and hypertriacylglycerolaemia (P trend=0·029) in men, but positively associated with low HDL-cholesterol in both men (P trend=0·003) and women (P trend<0·001). Our results suggest that higher Mn intakes may be protective against the MetS in men. The inverse association between Mn intake and the MetS in women might be due to the increased risk for low HDL-cholesterol.

[The association between socioeconomic status and blood pressure control in diagnosed hypertension patients].

OBJECTIVE: To explore the association between socioeconomic status (SES) and blood pressure control in diagnosed hypertension patients. METHODS: The database of Zhejiang provincial survey on metabolic syndrome which implemented in 2010 in which prior hypoertensive patients were brought into this sutdy. Descriptive statistics were applied to test the distributive differences of relevant factors (age, sex, marital status, hypertension duration, BMI, education level, per capita household yearly income, smoking, alcohol drinking, fruit and vegetable intake) between patients with optimally-controlled blood pressure and those without. The SES of diagnosed hypertension patients was measured separately by two common indicators: education level and the per capita household yearly income. Univariate and multivariate logistic regression models were used to differentiate the association between those two SES indicators and blood pressure control, and the trend of the association was also tested. RESULTS: Totally, 2 394 hypertension patients were diagnosed and identified. Of the patients analysed, the overall mean was (61.53 ± 10.64) years, and 55.7% (1 334 cases) had ≤ 5 years' disease duration. 1 090 achieved optimal blood pressure control, which accounted for a proportion of 45.5%. 1 676 had elementary school education and below, accounting for 70.1%. The patients with per capita household yearly income of < 5 000 Yuan and 5 000-14 999 Yuan groups were 401 (29.4%) and 690 (50.5%) respectively. 416 (17.4%) were smokers and 541 (22.6%) were alcohol drinkers. Based on the statistical tests, we found that the distributions of age, marital status, hypertension duration, body mass index, smoking and alcohol drinking were different between two groups (t or χ² values were 4.57, 5.44, 6.40, 6.21, 5.99, 3.98, respectively, all P values were < 0.05). Optical blood pressure control in higer education level group was significantly better than that of in lower education level (χ² = 12.65, P < 0.001), and there was no statistical significance association between per capita household yearly income and optimal blood pressure control (χ² = 2.78, P = 0.249). Multivariate logistic regression models revealed that, of those two SES indicators, a positive association was shown between education level and optimal blood pressure control: compared with patients in the category of 'elementary school and below, those of 'junior high school and above observed an OR of 1.40 (95% CI: 1.09-1.81). And in further trend χ² test, we identified a trend of such association (χ² trend = 12.74, P = 0.002). However, no significant association has been recognized between per capita household yearly income and optimal blood pressure control: compared with patients in the category of < 5 000 Yuan group, those of 5 000-14 999 Yuan and ≥ 15 000 Yuan groups had OR of 0.93 (95% CI: 0.72-1.20) and 1.04 (95% CI: 0.83-1.31) respectively. CONCLUSION: Among all diagnosed hypertension patients, those with lower education level have poorer blood pressure control and should be labelled as the key population for intense health education and standardized management to improve their blood pressure control status.

Associations of cigarette smoking and alcohol consumption with metabolic syndrome in a male Chinese population: a cross-sectional study.

BACKGROUND: Whether cigarette smoking and alcohol consumption are associated with the risk of metabolic syndrome (MetS) remains controversial. This study investigated the associations of cigarette smoking and alcohol consumption with MetS in a male population in China. METHODS: We conducted a cross-sectional study. A questionnaire was used to collect data on cigarette smoking, alcohol consumption, MetS status, and other related information from 8169 men aged 19-97 years. Logistic regression was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between smoking and alcohol consumption and the risk of MetS. RESULTS: The prevalence of MetS was 15.2% in the study population. Proportions of current smokers and drinkers were 48.2% and 46.5%, respectively. Adjusted OR of MetS was 1.34 (95% CI, 1.01-1.79) among smokers who smoked ≥40 cigarettes/day compared with nonsmokers and 1.22 (95% CI 1.03-1.46) for those who consumed 0.1-99 grams of alcohol/day compared with nondrinkers. Adjusted OR was 2.32 (95% CI 1.45-3.73) among ex-drinkers who never smoked, 1.98 (95% CI 1.35-2.91) among ex-drinkers who were current smokers, and 1.34 (95% CI 1.08-1.68) among current drinkers who never smoked compared with those who neither smoked nor drank. There was a significant interaction between smoking and drinking alcohol on MetS (P for interaction is 0.001). CONCLUSIONS: Our study indicated that smoking and drinking is associated with higher prevalence of MetS. Interactions between smoking and drinking on the risk of MetS in men in China may also exist. Our findings need to be confirmed in future case-control or cohort studies.

Dietary Iodine Intake and Sources among Residents in Zhejiang Province 10 Years after Reducing Iodine Concentration in Iodized Salt.

We aimed to assess dietary iodine intake and sources in Zhejiang Province a decade after a reduction in iodine concentration in iodized salt. Three-day 24 h dietary recall and household weighing were used, complemented by "Chinese Food Composition" data. Household water and salt samples were collected from 5890 residents and analyzed. Differences in iodized salt consumption rates were observed across the following regions: inland (84.20%), subcoastal (67.80%), and coastal (37.00%) areas. The median (P25, P75) iodine concentration in water and diet were 2.2 (0.9, 4.0) µg/L and 142.05 (58.94, 237.11) µg/d, respectively, with significant regional differences in dietary concentration (inland [185.61 µg/d], subcoastal [153.42 µg/d], and coastal [75.66 µg/d]). Males (149.99 µg/d) and iodized salt consumers (191.98 µg/d) had a significantly higher dietary iodine intake than their counterparts. Regions were ranked as follows based on the proportions of individuals meeting the recommended dietary iodine intake: inland (69.40%), subcoastal (56.50%), and coastal (34.10%) areas. Dietary sources included salt (48.54%), other foods (32.06%), drinking water (8.84%), laver (4.82%), kelp (3.02%), and other seafood (2.32%). The qualified iodized salt consumption rate was significantly lower than the national standard. Zhejiang Province should continue implementing measures to control iodine deficiency through salt iodization, education efforts, and increasing the qualified iodized salt consumption rate.

Association between socioeconomic status and obesity in a Chinese adult population.

BACKGROUND: Existing studies which regarding to the association between individual socioeconomic status (SES) and obesity are still scarce in developing countries. The major aim of this study is to estimate such association in an adult population which was drawn from an economically prosperous province of China. METHODS: Study population was determined by multilevel randomized sampling. Education and income were chosen as indicators of individual SES, general obesity and abdominal obesity were measured by body mass index (BMI) and waist circumference (WC). Descriptive statistical methods were used to depict overall and factor-specific distributions of general and abdominal obesity among 16,013 respondents. Two-step logistic regression models were fitted on gender basis. RESULTS: The age-and-sex adjusted rates of general overweight, general obesity, abdominal overweight and abdominal obesity in study population were 28.9% (95%CI: 27.9%-29.9%), 7.5% (95%CI: 7.0%-8.1%), 32.2% (95%CI: 31.2%-33.3%) and 12.3% (95%CI: 11.6%-13.1%), respectively. Based on model fitting results, a significant inverse association between education and obesity only existed in women, while in men, income rather than education was positively related to obesity. CONCLUSIONS: The atypical SES-obesity relationship we found reflected the on-going social economy transformation in affluent regions of China. High-income men and poorly-educated women were at higher risk of obesity in Zhejiang province, thus merit intense focuses.

[Association between dyslipidemia and different subtypes of hypertension among Zhejiang population in 2010].

OBJECTIVE: To explore the association between dyslipidemia and different subtypes of hypertension among Zhejiang population. METHODS: From June to October in 2010, 19 113 local residents aged ≥ 18 years old were selected among 7571 families from fifteen counties in Zhejiang by four stage stratified-random sampling method. A self-designed questionnaire was adopted to collect information on demographic characteristics, physical activity and life style. At the same time, physical examinations including height, weight, blood pressure and blood lipids were carried out. RESULTS: A total of 19 113 participants completed the interviews, physical examinations and collected the blood samples.Excluding those who did not meet the criteria, 14 731 were finally enrolled in the study. The prevalence rates of isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), systolic and diastolic hypertension (SDH) were 7.16% (1055/14 731, standardized rate:5.46%), 4.60% (677/14 731, standardized rate:4.41%), 7.09% (1045/14 731, standardized rate:5.75%), respectively. Among normal blood pressure group, subjects with normal TC, high TC and abnormal TC were separately 10 571 (88.43%), 1173 (9.81%) and 210 (1.76%); subjects with normal HDL-C and low HDL-C were separately 6885 (57.60%) and 5069 (42.40%); subjects with normal TG, high TG, abnormal TG were separately 9952 (79.91%), 1213 (10.15%) and 1189(9.95%).In ISH group, subjects with normal TC, high TC and abnormal TC were separately 826 (78.29%), 188 (17.82%) and 41 (3.89%); subjects with normal HDL-C and low HDL-C were separately 666(63.13%) and 389 (36.87%); subjects with normal TG, high TG and abnormal TG were separately 737 (69.86%), 150 (14.22%) and 168 (15.92%). Multi factor analysis showed that high TG and abnormal TG were associated with ISH (OR (95%CI):1.43 (1.16-1.76), 1.65 (1.34-2.03) respectively). Among IDH group, subjects with normal TC, high TC, abnormal TC were separately 556(82.13%), 99(14.62%) and 22 (3.25%); subjects with normal HDL-C, low HDL-C were separately 335 (49.48%) and 342 (50.52%); subjects with normal TG, high TG, and abnormal TG separately were 402 (59.38%), 107 (15.81%) and 168 (24.82%). The multi factor analysis showed that high TG and abnormal TG could increase the risk of IDH (OR(95%CI):1.57 (1.24-1.98), 2.18 (1.76-2.70) respectively). Among SDH group, subjects with normal TC, high TC and abnormal TC were 817 (78.18%), 193 (18.47%) and 35 (3.35%); subjects with normal HDL-C and abnormal HDL-C were separately 599 (57.32%) and 446 (42.68%); subjects with normal TG, high TG, abnormal TG were separately 675 (64.59%), 164 (15.69%) and 206 (19.71%). The multi factor analysis showed that high TC, high TG and abnormal TG were also associated with the increased risk of SDH (OR (95%CI):1.38 (1.14-1.67), 1.43(1.18-1.75), 1.73 (1.43-2.10) respectively). CONCLUSION: Dyslipidemia is an important factor of different subtypes of hypertension among Zhejiang population, especially triglycerides. Dyslipidemia screening should be strengthened to reduce the risk of cardiovascular diseases.

Sedentary Activities and Food Intake among Children and Adolescents in the Zhejiang Province of China: A Cross-Sectional Study.

BACKGROUND: Sedentary behavior may affect the types of food consumed in children and adolescents' daily diets. Previous published studies are limited to local surveys. This study aimed to explore the relationship between sedentary behavior and food intake among children and adolescents. METHODS: A stratified sampling technique was employed in the present cross-sectional study. Demographic characteristics, sedentary behavior, transportation modes, and food intake were investigated. RESULTS: We found that children and adolescents who watched movies or TV programs online or on their smartphones on weekends and who chatted online on weekends, including on QQ (an instant messaging software service) and WeChat (an instant messaging software service), increased their intake of instant noodles and fried pasta (Spearman's rho = 0.468, 0.575, 0.465, and 0.323; p < 0.05). Children and adolescents who chatted online on weekends, including on QQ and WeChat, increased their intake of tofu skin (Spearman's rho = 0.461; p < 0.05), and those who browsed online on weekdays increased their intake of whole-fat liquid milk (Spearman's rho = 0.455; p < 0.05). Children and adolescents who browsed and chatted online on weekends, including on QQ and WeChat, and who played computer or smartphone games, increased their intake of fried potato chips (French fries or other fried snacks) (Spearman's rho = 0.568, 0.270, and 0.412; p < 0.05). With respect to modes of transportation used to travel to and from school, children and adolescents who took buses and subways increased their intake of rice, instant noodles, sweet potatoes, soybean milk, tofu skin, processed meat products (sausage, ham sausage, or lunch meat), fish, shrimp, vegetables, nuts, and sweet cookies (buns, cakes, Dim sum, and moon cakes) (Spearman's rho = 0.394, 0.536, 0.630, 0.408, 0.485, 0.441,0.410, 0.424, 0.444, 0.541, and 0.366; p < 0.05). CONCLUSIONS: Sedentary behavior affects the types of food consumed in children and adolescents' daily diets. Children and adolescents who browsed online on weekdays increased their intake of whole-fat liquid milk, but also increased their intake of foods with high fat, high salt, and low nutrient density. Children and adolescents taking buses and subways increased their intake of low-nutrition quality products. Public awareness efforts should focus on reducing the consumption of low-nutrition quality products and nutritional education.

Food and Nutrient Intake in Children and Adolescents with or without Overweight/Obesity.

OBJECTIVE: To explore the food and nutrient characteristics of children and adolescents with or without overweight/obesity and to provide scientific basis for the development of prevention strategies on overweight/obesity. METHODS: This study included children and adolescents aged 6-17 years who participated in provincial nutrition surveillance which included 90 counties (cities and districts) in Zhejiang Province with a provincial representative. Food consumption was assessed using three consecutive days of 24 h dietary recall, and nutrient intake was calculated using dietary recall in conjunction with the China Food Composition Table. Overweight/obesity was also investigated. Associations were evaluated using ordinal regression models. RESULTS: The analysis included a total of 1827 children and adolescents. The overweight prevalence was 14.0% and the obesity prevalence was 10.1%. Children and adolescents with overweight/obesity were observed to have a higher intake of carbohydrates, iron, sodium, potassium, and magnesium (F = 3.464, 5.232, 5.619, 3.469, 3.934, p < 0.05), as well as having a higher intake of the food group of cereals, tubers and beans, snacks, and salt (F = 7.348, 6.797, 3.413, p < 0.05) compared to children and adolescents without overweight/obesity. After adjusting for potential confounders via ordinal regression models, children and adolescents with overweight/obesity were observed to have a higher intake of carbohydrates (Wald χ2 = 4.325, p < 0.05). There were significant differences concerning the daily energy provided by snacks, the daily carbohydrate intake provided by snacks, the daily sodium intake provided by snacks, and the proportion of snacks to the food group of cereals, tubers, and beans (F = 8.305 6.316, 13.955, 3.692, p < 0.05). CONCLUSION: Children and adolescents with overweight/obesity have presented a high consumption of carbohydrates, which is associated with the food group of cereals, tubers, and beans. Snacks are the main factor leading to the high intake of the food group of cereals, tubers, and beans among children and adolescents with overweight/obesity.

Combined associations of general obesity and central obesity with hypertension stages and phenotypes among children and adolescents in Zhejiang, China.

General and central obesity are suggested to be associated with elevated blood pressure (BP), whereas few studies have investigated their combined associations with hypertension in children. This study aimed to assess the associations of combinations of general obesity and central obesity with hypertension in Chinese children, including its stages and phenotypes. A total of 5430 children aged 7-17 years in Zhejiang Province were enrolled. General obesity was evaluated by body mass index (BMI), while central obesity was by waist circumference (WC). Then all children were sorted into three mutually exclusive groups: normal weight with or with no central obesity (NW), abnormal weight with no central obesity (AWNCO), and abnormal weight with central obesity (AWCO). Hypertension was defined as either a systolic or diastolic BP ≥ 95th percentile, and further classified into stage 1 hypertension, stage 2 hypertension, isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic diastolic hypertension (SDH). Logistic regression was used. AWNCO and AWCO were associated with stage 1 hypertension (AWNCO, odds ratio [OR] = 1.94, 95% confidence interval [CI]: 1.59-2.37; AWCO, 2.67, 2.20-3.25), stage 2 hypertension (AWNCO, 2.35, 1.33-4.13; AWCO, 4.53, 2.79-7.37), ISH (AWNCO, 2.50, 1.96-3.18; AWCO, 3.95, 3.15-4.95), and SDH (AWNCO, 2.48, 1.75-3.52; AWCO, 2.78, 1.94-3.99). Children with AWCO were more likely to have stage 1 and stage 2 hypertension, as well as ISH and SDH. The combined measurement of general and central obesity is suggested as an appropriate screening tool for hypertension among children and adolescents.

Serum levels of vitamin D, retinol, zinc, and CRP in relation to obesity among children and adolescents.

BACKGROUND: The aim of this study was to examine the possible association between serum micronutrients (vitamin D, retinol, zinc), C-reactive protein (CRP), and obesity among children and adolescents. METHODS: Weight and height were measured and serum 25-hydroxy vitamin D, serum retinol, serum zinc, and CRP were measured in 2818 children and adolescents (6-17 years of age), and the data of 10 investigation sites in Zhejiang Province were used. The difference of micronutrients (vitamin D, retinol, zinc) and CRP among different nutritional status were explored by ANOVA and Chi-square test. The associated factors of micronutrients and CRP of overweight and obesity were explored by multifactor analysis. RESULTS: There were significant differences between male students and female students on BMI, 25(OH)D3, and CRP, and there were significant differences between children and adolescents and between students living in urban area and rural area on BMI, 25(OH)D3, retinol, and zinc(t > 1.96, p < 0.05). There were significant differences on 25(OH)D3 and CRP level among children and adolescents with different nutritional conditions (F = 2.612, 15.022, p < 0.05). In multifactor analysis, we found that female [odds ratio (OR) = 0.68, 95% CI 0.49-0.81], living in rural area (OR = 0.68, 95% CI 0.56-0.82), age (OR = 0.95, 95% CI 0.92-0.98), high CRP concentration (OR = 1.08, 95% CI 1.04-1.12) and appropriate retinol level (OR = 1.32, 95% CI 1.09-1.59) were associated with obesity compared to low/normal BMI. CONCLUSION: Gender, living area, age, CRP concentration, and vitamin A status were associated with children and adolescents with overweight and obesity compared to low/normal BMI. More attention in the intervention of overweight and obesity should be paid to boys living in urban areas, and high serum concentration of CRP should also be concerned.

Assessment of serum Vit A, D and zinc nutritional status and related dietary and exercise behaviors of children and adolescents in rural and urban area.

Vitamin A and vitamin D deficiency in children and adolescents has a negative impact on their growth and development. This study aimed to learn the nutritional status of vitamin A and D among rural children and adolescents and to explore related dietary and exercise behaviors. A total of 10 counties (cities, districts) from 90 counties (cities, districts) in Zhejiang Province were selected by the method of random cluster sampling. Children and adolescents were investigated and their food and nutrient intake were calculated. The concentration of serum vitamin A in urban area was 0.38 ng/ml, which was higher than that in rural area (p < 0.05); while the concentration of serum vitamin D in urban area was 21.25 mg/L, which was lower than that in rural area (p < 0.05). The concentration of serum zinc was 101 µg/dl in urban area and 107 µg/dl in rural area (p < 0.05). The intake of dietary fiber, calcium, vitamin A, vitamin B1, vitamin B2, and vitamin C was lower than the recommended value. In rural area, the intakes of cereals, tubers and beans, livestock, poultry and meat of children and adolescents were higher than the recommended values; while the intake of vegetables, fruits, eggs, milk, fish and shrimp, soybean and nuts was lower than the recommended value. The intake of edible oil and salt is higher than the recommended value. The time of medium and high intensity exercise time in rural area is more than that in urban area in the age group of 12-17 years, while the sitting time is less than that in urban area. Children and adolescents living in rural area should be guided to eat reasonably, and to choose foods with high nutrient density and with low oil, salt and sugar.

Intake of Vitamin B12 and Folate and Biomarkers of Nutrient Status of Women within Two Years Postpartum.

Background: Little is known about variation in vitamin B12 and folate status among Chinese women 2 years postpartum. This study assessed intake of vitamin B12 and folate and biomarkers of nutrient status among Chinese women postpartum. Methods: Demographic information, multi-/single-nutrient supplementation, dietary data, serum vitamin B12 and serum folate were assessed in 982 women within 2 years postpartum, using ten investigation sites in Zhejiang Province from the National Nutritional Study 2016−2017, which is a nationally representative cross-sectional study, to form a representative provincial sample of Zhejiang Province. The dietary diversity score (DDS) was used for assessing the dietary pattern. Results: Vitamin B12 increased slightly at the early stage of postpartum and then dropped over time. Serum folate level elevated with postpartum time. The median serum vitamin B12 concentration was 494.59 (373.21−650.20) pg/mL, and folate was 7.58 (5.02−10.34) ng/mL. Correspondingly, vitamin B12 levels suggesting marginal deficiency (200−300 pg/mL) and deficiency (<200 pg/mL) resulted as 9.27% and 3.26%, respectively, and folate level suggesting deficiency (<3 ng/mL) was 9.16%. Multi-/single-nutrient supplementation during pregnancy was associated with log-transformed serum vitamin B12 and folate level after adjusting for potential confounders (vitamin B12: ß (SE) = 0.124 (0.028), p < 0.001; folate: 0.128 (0.035), <0.001). Additionally, postpartum nutrient supplementation was associated with log-transformed serum folate level, especially for lactating women (ß (SE) = 0.204 (0.062), p = 0.001). Increased DDS was significantly associated with elevated serum vitamin B12 and folate levels (vitamin B12: ß (SE) = 0.028 (0.011), p = 0.011; folate: 0.030 (0.014), 0.031). In addition, age and educational level were influencing factors for serum vitamin B12 and folate concentrations among postpartum women. Conclusion: Serum vitamin B12 level decreased and folate level increased with postpartum age among Chinese women. Nutrient supplementation during pregnancy was related to elevated serum vitamin B12 and folate concentrations. Postpartum nutrient supplementation was associated with the increased serum folate level of lactating women. Dietary diversity was related to increased serum vitamin B12 and folate levels, especially among postpartum women with younger age and lower educational level.