Bayesian linear mixed model with multiple random effects for prediction analysis on high-dimensional multi-omics data.

MOTIVATION: Accurate disease risk prediction is an essential step in the modern quest for precision medicine. While high-dimensional multi-omics data have provided unprecedented data resources for prediction studies, their high-dimensionality and complex inter/intra-relationships have posed significant analytical challenges. RESULTS: We proposed a two-step Bayesian linear mixed model framework (TBLMM) for risk prediction analysis on multi-omics data. TBLMM models the predictive effects from multi-omics data using a hybrid of the sparsity regression and linear mixed model with multiple random effects. It can resemble the shape of the true effect size distributions and accounts for non-linear, including interaction effects, among multi-omics data via kernel fusion. It infers its parameters via a computationally efficient variational Bayes algorithm. Through extensive simulation studies and the prediction analyses on the positron emission tomography imaging outcomes using data obtained from the Alzheimer's Disease Neuroimaging Initiative, we have demonstrated that TBLMM can consistently outperform the existing method in predicting the risk of complex traits. AVAILABILITY AND IMPLEMENTATION: The corresponding R package is available on GitHub (https://github.com/YaluWen/TBLMM).

Estimating future PM2.5-attributed acute myocardial infarction incident cases under climate mitigation and population change scenarios in Shandong Province, China.

BACKGROUND: The effects of fine particulate matter (PM2.5) on acute myocardial infarction (AMI) have been widely recognized. However, no studies have comprehensively evaluated future PM2.5-attributed AMI burdens under different climate mitigation and population change scenarios. We aimed to quantify the PM2.5-AMI association and estimate the future change in PM2.5-attributed AMI incident cases under six integrated scenarios in 2030 and 2060 in Shandong Province, China. METHODS: Daily AMI incident cases and air pollutant data were collected from 136 districts/counties in Shandong Province from 2017 - 2019. A two-stage analysis with a distributed lag nonlinear model was conducted to quantify the baseline PM2.5-AMI association. The future change in PM2.5-attributed AMI incident cases was estimated by combining the fitted PM2.5-AMI association with the projected daily PM2.5 concentrations under six integrated scenarios. We further analyzed the factors driving changes in PM2.5-related AMI incidence using a decomposition method. RESULTS: Each 10 µg/m3 increase in PM2.5 exposure at lag05 was related to an excess risk of 1.3 % (95 % confidence intervals: 0.9 %, 1.7 %) for AMI incidence from 2017 - 2019 in Shandong Province. The estimated total PM2.5-attributed AMI incident cases would increase by 10.9-125.9 % and 6.4-244.6 % under Scenarios 1 - 3 in 2030 and 2060, whereas they would decrease by 0.9-5.2 % and 33.0-46.2 % under Scenarios 5 - 6 in 2030 and 2060, respectively. Furthermore, the percentage increases in PM2.5-attributed female cases (2030: -0.3 % to 135.1 %; 2060: -33.2 % to 321.5 %) and aging cases (2030: 15.2-171.8 %; 2060: -21.5 % to 394.2 %) would wholly exceed those in male cases (2030: -1.8 % to 133.2 %; 2060: -41.1 % to 264.3 %) and non-aging cases (2030: -41.0 % to 45.7 %; 2060: -89.5 % to -17.0 %) under six scenarios in 2030 and 2060. Population aging is the main driver of increased PM2.5-related AMI incidence under Scenarios 1 - 3 in 2030 and 2060, while improved air quality can offset these negative effects of population aging under the implementation of the carbon neutrality and 1.5 °C targets. CONCLUSION: The combination of ambitious climate policies (i.e., 1.5 °C warming limits and carbon neutrality targets) with stringent clean air policies is necessary to reduce the health impacts of air pollution in Shandong Province, China, regardless of population aging.

Weekly green space visit duration is positively associated with favorable health outcomes in people with hypertension: Evidence from Shenzhen, China.

BACKGROUND: Studies from high income 'western' countries indicate that green space visit duration is associated with better health. However, scant comparable research has been done in developing countries with rapid urbanization and on the potential health impacts of specific green infrastructure. OBJECTIVE: Associations between green space visit duration, green infrastructure and various health outcomes were assessed in hypertensive patients. METHODS: A stratified multi-stage cluster random sampling method was applied to select 1116 patients with hypertension aged 35 years or older in Shenzhen, China. Face-to-face survey, physical examination and laboratory biochemical tests were applied to obtain information. Binary logistic regressions with restricted cubic splines were used to explore the degree of linearity in associations between green space visit duration and the following health outcomes: central obesity; diabetes; blood pressure; dyslipidemia; poor physical health; poor mental health. Models were adjusted for age, sex, education, marital status, occupation, and socioeconomic status. Further analysis was made for presence of the following health promoting green infrastructure: health knowledge promotion areas; walking trails; fitness areas; group exercise venues. RESULTS: Each additional 30 min green space visitation was linearly associated with lower odds of self-reported poor mental health [OR (95%CI): 0.937 (0.891-0.985)], self-reported poor physical health [OR (95%CI): 0.918 (0.872-0.966)], and central obesity [OR (95%CI): 0.951 (0.907-0.997)]. Odds of poor mental health [OR (95%CI): 0.886 (0.788-0.997)], poor physical health [OR (95%CI): 0.882 (0.782-0.996)] and central obesity [OR (95%CI): 0.855 (0.765-0.955)] were founded to decrease with a greater number of health promoting green infrastructure. CONCLUSION: More time spent in green space and with more types of green infrastructure were favourably associated with central obesity, and physical and mental health in people with hypertension.

Combined consideration of body mass index and waist circumference identifies obesity patterns associated with risk of stroke in a Chinese prospective cohort study.

BACKGROUND: In China, few studies have examined the relationship between the combination of body mass index and waist circumference and the risk of stroke. Moreover, the relationship may also be different in different genders. Thus, we investigated the association between the combination of body mass index and waist circumference and the risk of stroke in Chinese. METHODS: This prospective cohort study included 36 632 participants aged 18 to 90 years. Participants were recruited from 60 surveillance sites (25 urban sites and 35 rural sites) across China in 2010 China Chronic Disease Risk Factor Surveillance, and followed up in 2016-2017. Incident cases of stroke were identified through questionnaires (including the basis of clinical diagnosis, imaging tests, time of diagnosis, diagnosis unit) and Cardiovascular Event Report System. Risk factors for stroke were collected at baseline using questionnaire, physical measurements and laboratory tests. Cox proportional hazards regression models were used to generate adjusted hazard ratios and 95%CI. All analyses were duplicated by gender stratification. RESULTS: During 6.42 ± 0.50 years of follow-up, 1 333 (597 males, 736 females) stroke events were observed among the 27 112 participants who did not have cardiovascular diseases at baseline. Compared with the general population who have normal weight or underweight with normal WC, those who have normal weight or underweight with abdominal obesity (adjusted hazard ratios 1.45, 95%CI 1.07-1.97 in males; 0.98, 95%CI 0.78-1.24 in females), overweight with abdominal obesity (1.41, 95%CI 1.14-1.75 in males; 1.33, 95%CI 1.10-1.61 in females), obesity with abdominal obesity (1.46, 95%CI 1.11-1.91 in males; 1.46, 95%CI 1.17-1.81 in females). Overweight with normal WC was found to be not statistically significant for both males and females (all P>0.05). Subgroup analysis found a multiplicative interaction between age and anthropometric group in females (P for interaction <0.05). Sensitivity analysis results did not change. In the subjects with CVD risk factors, we found a similar relationship as in the general population . CONCLUSIONS: Combined assessment of body mass index and waist circumference identifies obesity patterns associated with stroke risk.

Assessing the routine-practice gap for home blood pressure monitoring among Chinese adults with hypertension.

BACKGROUND: Home blood pressure monitoring (HBPM) is recommended for diagnosis, treatment adjustment and management of most hypertension cases in hypertension guidelines from multiple countries. This study aimed to evaluate HBPM behaviour and explore the routine-practice gap in HBPM among Chinese adults with hypertension. METHODS: Data were collected from 20 communities across three cities and six townships in three provinces (Beijing, Shandong and Jiangsu) in China between October 2014 and November 2014. In total, 2272 patients with hypertension aged ≥35 years that were registered with a primary health station in their local communities were selected by simple random sampling. RESULTS: Among the 2272 participants, 45.3% owned a home blood pressure (BP) monitor. In addition, 27.5% (625/2272) engaged in HBPM weekly or more frequently. Healthcare providers' advice was the strongest factor contributing to home BP monitor ownership and weekly HBPM behaviour, with odds ratios of 13.50 and 8.97, respectively. Approximately 4.4% of participants had achieved optimal HBPM regimens (duplicate measurements in the morning and evening for 7 days). Patients with uncontrolled office-measured BP were more likely to conduct HBPM regularly in the morning and evening, measure their BP two or three times in each session and maintain 7 consecutive days of HBPM than patients with controlled office BP (8.8% vs. 5.8%, P = 0.042; 14.3% vs. 8.1%, P = 0.002; and 19.9% vs. 12.4%, P = 0.005, respectively). Only 16.0% (165/1030) of participants actively reported their HBPM readings to doctors. CONCLUSION: The HBPM strategies specified in hypertension guidelines are seldom achieved in actual practice in China. Only a small proportion of patients actively participate in using HBPM to enhance their hypertension care. HBPM may be improved by healthcare providers offering specific advice and training.

[Evaluation of effects of salt reducing intervention among catering units in Shandong Province].

OBJECTIVE: To evaluate the effects of comprehensive intervention measures mainly consisting of salt reduction health education and labeling less salt foods among catering units. METHODS: The total of 36 catering units were selected randomly and divided into intervention group A, B and control group in August of 2015. Health education was initiated in the intervention group A, including the training of knowledge on salt reduction for managers, cooks and service personnel of catering units every month; distribution of special salt control spoon for cooks; the arrangement of environment of salt reduction in catering units. And health education and labeling less salt foods was provided to the intervention group B, The control group C did not actively provide any intervention. The cook records the quantity of low-salt dishes sold, salt collection and the number of persons per meal in according to the requirements. Questionnaire survey and physical examination were performed to evaluate the effects of comprehensive intervention measures among catering units in the three groups of staffs in the catering units in a baseline study and an evaluation survey six months after the intervention. RESULTS: Compared with group C, the knowledge, attitude and behavior of salt reduction was significantly improved in intervention group A and B(P<0. 05). The behavior towards salt reduction improved much better in group B than in group A(P<0. 05), and using salt spoon when cooking and recommending less salt food to customer improved 32. 1%(χ~2=51. 72, P<0. 05)and 24. 2%(χ~2=30. 01, P<0. 05)separately. The proportion of sales of low salt dishes in the unit canteen has increased steadily, reaching 16. 8% while the proportion of sales has dropped to 9. 2% in the hotel by the end of the intervention period(χ~2=44. 66, P<0. 05). CONCLUSION: The level of knowledge of reducing salt was improved by health education, and labeling less salt foods can promote reducing salt related behavior. The effect of comprehensive intervention measures for salt reduction in unit canteen is better than in the hotel. It was suggested that comprehensive intervention measures mainly consisting of salt reduction health education and labeling less salt foods should be used together in the catering units.

Analysis of factors influencing the frequency of primary care visits among diabetic patients in two provinces in China.

BACKGROUND: Community health services have played an important role in the prevention and control of diabetes in China. The aims of this study were to examine the frequency of visits to community clinics for diabetic care services, to assess factors correlated with infrequent primary care visits and to identify barriers to regular follow-up visits for urban and rural patients. METHODS: Between October 2014 and November 2014, data were collected from 17 communities in two cities and four townships located in Shandong and Jiangsu Provinces in China. A total of 1598 diabetic patients aged 18 years or older who were registered with a primary health station in local communities were selected by simple random sampling. Each participant was required to complete an interviewer-led questionnaire. Univariate and multivariate analyses were used to identify significant factors for infrequent visitor status using multivariable logistic regression analysis. RESULTS: After being clearly informed of the study protocol, 1508/1598 (94.4%) patients agreed to participate in this survey. Among the 1508 subjects (mean age 64.4 ± 10.6), 683 (45.3%) were classified as infrequent visitors. The following were significant factors determining infrequent visitor status: urban residence, lack of health insurance, per-capita household income< 20,000 (yuan), lack of telephone follow-up and lack of household visit. From the patients' perspectives, the reasons for infrequent visits among urban patients included drug scarcity and longer travel time to clinics. For rural patients, worries about medical expenses and drug scarcity were the most common barriers to clinic visits. CONCLUSION: Determinants of infrequent community visits in diabetes patients include urban residence, lower household income, lack of health insurance, lack of telephone follow-up and lack of household visit services. Strategies aimed at enhancing the utilization of community health care should be implemented in China.

[Knowledge, attitude and practice of salt reduction among residents in four counties of Shandong and Jiangsu Provinces in 2013].

OBJECTIVE: To explore current status of knowledge, attitude and practice of salt reduction among adults in four counties of Shandong and Jiangsu Provinces, and analyze the relevant influencing factors. METHODS: In 2013, multi-stage cluster sampling was used to select the adults(aged 18-69) in Gaomi City of Weifang City and Fushan Distract of Yantai City, Shandong Province, and Xinyi City of Xuzhou City and Ganyu County of Lianyungang City, Jiangsu Province. A total of 9573 subjects were included. Knowledge, attitude and practice of anti-hypertension by low salt was collected using questionnaire and physical examination was conducted. Then the level of knowledge, attitude and practice of salt reduction was calculated, and multivariate Logistic regression model was used to analyze the influencing factors. RESULTS: A total of 3214 people had hypertension(33.57%), and the proportion of overweight and obesity was 36.20% and 19.48%, respectively. The awareness rate of salt reduction knowledge was between 22.50% and 51.35%; the attitude of salt reduction was between 82.24% and 93.01%, and the rate of salt reduction was between 10.86% and 46.16%. According to Logistic analysis, the degree of education had the greatest impact on knowledge(junior high school vs. elementary school and below: OR=2.30, 95%CI 2.06-2.57, high school and above vs. elementary school and below: OR=5.00, 95%CI 4.35-5.76). The knowledge level had the greatest impact on attitude(OR=3.10, 95%CI 2.80-3.43) and practice(OR=4.66, 95%CI 4.29-5.07). Those aged 45-69 years old had lower knowledge level(OR=0.64, 95%CI 0.58-0.71) but higher practice(OR=1.18, 95%CI 1.09-1.29). The knowledge(OR=3.66, 95%CI 3.34-4.01) and attitude(OR=1.84, 95%CI 1.69-2.02) of salt reduction among residents in Shandong were higher than those in Jiangsu. CONCLUSION: The awareness rate of knowledge is lower, the attitude support rate is higher, and the practice rate is lower among residents in Shandong and Jiangsu Provinces. More attention should be paid to the practical application of salt reduction.

Associations of Usual 24-Hour Sodium and Potassium Intakes with Blood Pressure and Risk of Hypertension among Adults in China's Shandong and Jiangsu Provinces.

BACKGROUND/AIMS: High sodium intake and low intake of potassium can increase blood pressure (BP) and risk of developing hypertension. Few studies have examined the association between 24-h urinary sodium and potassium excretion and BP or risk of hypertension in China, and most used only a single 24-h urinary sample. METHODS: We analyzed data on 2281 participants aged 18-69 years by using two 24-h urinary sodium and potassium excretions from the supplemental baseline survey of the Shandong-Ministry of Health Action on Salt Reduction and Hypertension (SMASH) project. We used measurement error models to estimate usual intakes, multivariable linear regression to assess their association with B P, and logistic regression to estimate the risk of hypertension. RESULTS: The average usual intakes of sodium and potassium, and the mean sodium-potassium ratio, were 166.9 mmol/day, 25.3 mmol/day, and 6.8, respectively. All three measures were significantly associated with systolic BP (SBP) and diastolic BP (DBP), with an increase of 1.39 mmHg (95% confidence interval [CI] 0.44─2.34) in SBP and 0.94 mmHg (95% CI 0.34─1.55) in DBP for a 1-standard deviation (SD) (25.6mmol/day) increase in sodium intake, a decrease of 1.42 mmHg (95% CI -2.37─ -0.47) in SBP and 0.91 mmHg (95% CI -1.52─ -0.30) in DBP for a 1-SD (3.4 mmol/day) increase in potassium intake, and an increase of 0.97 mmHg (95% CI 0.36─1.58) in SBP and of 0.65 mmHg (95% CI 0.26─1.04) in DBP per unit increase in the sodium-to-potassium ratio. The adjusted odds ratios comparing the risk of hypertension among adults in the highest with those in the lowest quintile differ significantly for potassium (0.51; 95% CI 0.29─0.88) and sodium-to-potassium ratio (1.40; 95% CI 1.01─1.94). CONCLUSIONS: Our results suggested that higher sodium and lower potassium intakes are associated with increased BP and risk of hypertension in the Shandong and Jiangsu adults.

Are 24 h urinary sodium excretion and sodium:potassium independently associated with obesity in Chinese adults?

OBJECTIVE: To examine the association of 24 h urinary Na excretion and Na:K with obesity in Chinese adults. DESIGN: Population-based cross-sectional study using a four-stage stratified sampling strategy. SETTING: Shandong Province, China. SUBJECTS: Chinese adults (n 1906) aged 18-69 years who provided complete 24 h urine samples. RESULTS: Odds of obesity increased significantly across increasing quartiles of urinary Na excretion (1·00, 1·54, 1·69 and 2·52, respectively, for overweight; 1·00, 1·20, 1·50, and 2·03, respectively, for obesity; 1·00, 1·44, 1·85 and 2·53, respectively, for abdominal obesity (assessed by waist circumference); and 1·00, 1·28, 1·44 and 1·75, respectively, for abdominal obesity (assessed by waist-to-height ratio); P for linear trend <0·001 for all). In addition, odds of abdominal obesity, but not odds of overweight and obesity, increased significantly with successive Na:K quartiles. Additionally, for each increment in urinary Na excretion of 100 mmol, odds of overweight, obesity, abdominal obesity (by waist circumference) and abdominal obesity (by waist-to-height ratio) increased significantly by 46 %, 39 %, 55 % and 33 %, respectively. Similarly, with a 1 sd increase in Na:K, odds of abdominal obesity (by waist circumference) and abdominal obesity (by waist-to-height ratio) increased significantly by 12 % and 15 %, respectively. CONCLUSIONS: These findings suggest that 24 h urinary Na excretion and Na:K might be important risk factors for obesity in Chinese adults.

Association between 24 h urinary sodium and potassium excretion and the metabolic syndrome in Chinese adults: the Shandong and Ministry of Health Action on Salt and Hypertension (SMASH) study.

The association of 24 h urinary Na and potassium excretion with the risk of the metabolic syndrome (MetS) has not been studied in China. The aim of the present study was to examine this association by analysing the data from 1906 study participants living in north China. To this end, 24 h urine samples were collected. Of the 1906 participants, 471 (24·7 %) had the MetS. The mean urinary Na and K excretion was 228·7 and 40·8 mmol/d, respectively. After multivariate adjustment, the odds of the MetS significantly increased across the increasing tertiles of urinary Na excretion (1·00, 1·40 and 1·54, respectively). For the components of the MetS, the odds of central obesity, elevated blood pressure and elevated TAG, but not the odds of low HDL-cholesterol and elevated fasting glucose, significantly increased with the successive tertiles of urinary Na excretion. Furthermore, for every 100 mmol/d increase in urinary Na excretion, the odds of the MetS, central obesity, elevated blood pressure and elevated TAG was significantly increased by 29, 63, 22 and 21 %, respectively. However, urinary K excretion was not significantly associated with the risk of the MetS. These findings suggest that high Na intake might be an important risk factor for the MetS in Chinese adults.

Urinary albumin excretion and prevalence of microalbuminuria in a general Chinese population: a cross-sectional study.

BACKGROUND: Microalbuminuria has been shown to be a risk factor for cardiovascular and renal disease in patients with hypertension and diabetes as well as in the general population. Urinary albumin excretion over 24 h is considered a 'gold standard' to detect microalbuminuria. Few studies have used 24-h urinary albumin excretion to analyze the prevalence of and related factors for microalbuminuira in a general Chinese population. METHODS: This study included 1980 adults aged 18-69 years from the Shandong-Ministry of Health Action on Salt and Hypertension (SMASH) Project 2011 survey. Blood pressure, height, weight and waist circumference were measured, and a venous blood and timed 24-h urine samples were collected from each participant. Linear and logistic regression analyses were used to test associations between established cardiovascular risk factors and microalbuminuria. RESULTS: The median (25th-75th percentile) of 24-h urinary albumin excretion was 6.1 mg/d (4.5-8.7 mg/d) for all adults, 6.0 mg/d (4.4-8.5 mg/d) for men and 6.2 mg/d (4.6-8.9 mg/d) for women. The overall prevalence of microalbuminuria was 4.1% (95% confidence interval [CI]: 3.2-5.0%), 3.7% (95% CI: 2.9-4.5%) for men and 4.6% (95% CI: 3.7-5.5%) for women. Microalbuminuria was present in 8.1% (95% CI: 6.9-9.3%) of individuals with hypertension, 11.4% (95% CI: 10.0-12.8%) of those with diabetes and 15.6% (95% CI: 14.0-17.2%) of those with both. Multiple logistic regression analysis indicated that systolic blood pressure (odds ratio [OR] 1.02; 95% CI: 1.01-1.03) and fasting blood glucose (OR 1.19; 95% CI: 1.05-1.35) were the independent risk factors for microalbuminuria. CONCLUSIONS: Adults in the general population of Shandong Province have a moderate prevalence of microalbuminuria. Those with hypertension and diabetes are at high risk of having microalbuminuria, suggesting the need for screening and early intervention for microalbuminuria among these individuals.

Estimation of salt intake by 24-hour urinary sodium excretion: a cross-sectional study in Yantai, China.

BACKGROUND: High levels of dietary sodium are associated with raised blood pressure and adverse cardiovascular health. To determine baseline salt intake, we investigated the average dietary salt intake from 24-hour urinary sodium excretion with a small sample of Yantai adults in the Shandong province of China. METHODS: One hundred ninety one adults aged 18-69 years were randomly selected from the Yantai adult population. Blood pressure, anthropometric indices and sodium excretion in a 24-hour urine collection were measured. Consumption of condiments was derived from 3-day weighted records. Completeness of urine collections was verified using creatinine excretion in relation to weight. RESULTS: The mean Na and K outputs over 24 hours were 201.5 ± 77.7 mmol/day and 46.8 ± 23.2 mmol/day, respectively (corresponding to 11.8 g NaCl and 1.8 g K). Overall, 92.1% of the subjects (96.9% of men and 87.1% of women) had intakes of over 6 g salt (NaCl)/d. The main sources of salt intake from weighed condiments records were from home cooking salt (74.7%) followed by soy sauce (15.0%). Salt intake from condiments and salt excretion were weakly correlated((r = 0.20, p = 0.005).A positive linear correlation between salt intake was associated with systolic blood pressure in all adjusted and unadjusted model (r = 0.16, p = 0.01). Each 100 mmol/day increase in sodium intake was associated with a 4.0 mmHg increase in systolic blood pressure. CONCLUSION: Dietary salt intake in Yantai adults was high. Reducing the intake of table salt and soy sauce used in cooking will be an important strategy to reduce sodium intake among Yantai adults.

Hypertension prevalence, awareness, treatment, and control and sodium intake in Shandong Province, China: baseline results from Shandong-Ministry of Health Action on Salt Reduction and Hypertension (SMASH), 2011.

INTRODUCTION: In China, population-based blood pressure levels and prevalence of hypertension are increasing. Meanwhile, sodium intake, a major risk factor for hypertension, is high. In 2011, to develop intervention priorities for a salt reduction and hypertension control project in Shandong Province (population 96 million), a cross-sectional survey was conducted to collect information on sodium intake and hypertension prevalence, awareness, treatment, and control. METHODS: Complex, multistage sampling methods were used to select a provincial-representative adult sample. Blood pressure was measured and a survey conducted among all participants; condiments were weighed in the household, a 24-hour dietary recall was conducted, and urine was collected. Hypertension was determined by blood pressure measured on a single occasion and self-reported use of antihypertension medications. RESULTS: Overall, 23.4% (95% confidence interval [CI], 20.9%-26.0%) of adults in Shandong were estimated to have hypertension. Among those classified as having hypertension, approximately one-third (34.5%) reported having hypertension, approximately one-fourth (27.5%) reported taking medications, and one-seventh (14.9%) had their blood pressure controlled (<140/<90 mm Hg). Estimated total average daily dietary sodium intake was 5,745 mg (95% CI, 5,428 mg-6,063 mg). Most dietary sodium (80.8%) came from salt and high-salt condiments added during cooking: a sodium intake of 4,640 mg (95% CI, 4,360 mg-4,920 mg). The average daily urinary sodium excretion was 5,398 mg (95% CI, 5,112 mg-5,683 mg). CONCLUSION: Hypertension and excessive sodium intake in adults are major public health problems in Shandong Province, China.

[Investigation on knowledge, attitude and behavior of salt reduction in Chinese adults, 2010].

OBJECTIVE: To explore the knowledge, attitude and behavior of salt reduction among Chinese adults aged over 18 years old in 2010. METHODS: A total of 96 916 adults aged over 18 were recruited from 162 surveillance points in 2010, applying multi-stage stratified cluster random sampling method.Information about subjects salt reduction related knowledge, attitude and behavior were collected by face-to-face interview. After performing complex weighted analysis, the awareness, willingness and behavior rates were compared by different genders, age groups, urban, rural and different regions. RESULTS: The unweighted salt reduction rate of the awareness, willingness and behavior among Chinese adults were 63.0%, 84.5% and 44.5%. After being weighted, the awareness rate was 62.9%, the awareness rate difference was not significant between males (62.4%) and females (63.4%) (χ(2) = 1.66, P > 0.05), but the urban areas (77.1%) were significantly higher than the rural areas (56.3%) (χ(2) = 85.11, P < 0.01) . The difference among different ages was significant (χ(2) = 228.68, P < 0.01) with descending order in 18-44, 45-59 and ≥ 60 years old (67.8%, 59.8%, 50.1%, respectively). The difference among different regions was not significant (χ(2) = 9.82, P < 0.01) in eastern, central and western China (68.2%, 61.3%, 57.1%, respectively). After being weighted, the willingness rate was 83.8%, the willingness rate in females (85.8%) was significantly higher than that in males (81.9%) (χ(2) = 61.92, P < 0.01) , and the urban areas (87.1%) were significantly higher than the rural areas (82.3%) (χ(2) = 15.49, P < 0.01) . The difference among different ages was significant (χ(2) = 74.50, P < 0.01) with descending order in 18-44, 45-59 and ≥ 60 years old (85.3%, 83.1%, 79.6%, respectively). The difference was not significant (χ(2) = 0.58, P > 0.05) among eastern, central and western China (84.3%, 84.0%, 82.9%, respectively). After being weighted, the behavior rate of salt reduction was 42.2%, the behavior rate in females (45.6%) was significantly higher than that in males (38.8%) (χ(2) = 107.74, P < 0.01), and urban areas (56.5%) were significantly higher than the rural areas (35.6%) (χ(2) = 74.38, P < 0.01) . The difference was not significant (χ(2) = 4.19, P > 0.05) among 18-44, 45-59 and ≥ 60 years old(41.5%, 43.6%, 42.2%, respectively). The behavior rate of salt reduction difference in eastern China(47.8%) was significantly higher than that in central (38.9%) and western (38.0%) (χ(2) = 7.22, P < 0.05). CONCLUSIONS: The rate of willingness to reduce salt is higher, but the awareness rate and the behavior rate of salt reduction are not high, especially among the population who are from rural area, or who are from central and western China.

[Comparison of dietary survey, frequency and 24 hour urinary Na methods in evaluation of salt intake in the population].

OBJECTIVE: To compare the difference and correlation between dietary salt intakes assessed by 24 hours urinary Na method, food weighted record method and food frequency questionnaire method. METHODS: All 2 184 subjects aged 18 to 69 were selected by multi stage stratified cluster random sampling method in Shandong province in June to September, 2011. Dietary salt intakes were measured by 24 hours urinary Na method, food weighted record method and food frequency questionnaire method. The information on gender, age, dining locations and labour intensity of members dining at home for 3 days were recorded. And the dietary habits were surveyed by questionnaire. RESULTS: Salt intakes were 14.0, 12.0 and 10.5 g/d assessed by 24 hours urinary Na method, food weighted record method and food frequency questionnaire, respectively. Comparing with 24 hours urinary Na method, salt intakes assessed by food weighted record method and food frequency questionnaire method were 2.0 g (14.3% undervalued) and 3.4 g (24.3% undervalued) less, respectively. Comparing with 24 hours urinary Na method, the proportion of individuals with salt intake over-reported and under-reported were 42.4% (856/2 020) and 55.3% (1 117/2 020) by food weighted record method, and were 20.7% (418/2 020) and 16.3% (329/2 020) by food frequency questionnaire method, respectively; the proportion of individuals with salt intakes within ± 25% of 24 hours urinary Na method were 36.9% (745/2 020) and 28.4% (574/2 020), respectively. Salt intakes assessed by 24 hours urinary method correlated significantly with both salt intakes assessed by food weighted record method and food frequency questionnaire method; the correlation coefficients were 0.13 and 0.07, respectively. With the increasing of salt intakes by subjects' self-judgment, salt intakes were all rising significantly using three survey methods. Salt intakes of three group population of light, moderate and partial taste salty were 13.6, 13.6 and 14.7 g/d by 24 hours urinary Na method (F = 0.47, P < 0.05); 11.0, 12.0 and 12.7 g/d by food weighted record method (F = 5.83, P < 0.05), and 9.3, 10.2 and 11.9 g/d by food frequency questionnaire method (F = 5.83, P < 0.05), respectively. CONCLUSION: Comparing with 24 hours urinary method, food weighted record method and food frequency questionnaire method would undervalue dietary salt intake. Salt intake status can be more accurately assessed by adjusting the underestimation rate.

[The relationship between salt consumption and blood pressure among residents in Shandong province, China].

OBJECTIVE: To study the relationship between salt consumption and blood pressure among residents in Shandong province, and to provide basic information for guiding people to prevent hypertension by reducing salt intake. METHODS: Using multi-stage stratified cluster random sampling method, 2 184 residents aged 18 to 69 were selected as the research subjects, which were extracted randomly from 20 counties in Shandong province in June, 2011. The blood pressure of the subjects were measured and weighted. Based on 72 h dietary recalls and weighing measurement, and according to the distribution of salt intake, the grouping cut-off points were 10, 14 and 18 g. The difference of subjects with different characteristics and systolic blood pressure, diastolic blood pressure and prevalence of hypertension by grouping salt intake and other characteristics were analyzed, and the relationship between salt intake and prevalence of hypertension were analyzed. RESULTS: The total of 2 133 residents were involved finally, the completion rate was 97.7%. After the complex weighted, the systolic and diastolic blood pressure's means (95%CI value) of the subjects were 121.0 (119.5-122.5) mmHg (1 mmHg = 0.133 kPa) and 78.5(77.4-79.6) mmHg respectively, which were all elevated with increasing of salt consumption. The blood pressure of the subjects with salt intake <10 g was the lowest, which were 119.6 (116.9-122.4) mmHg and 77.5(76.2-78.7) mmHg respectively. The blood pressure of the subjects with salt intake ≥ 18 g was the highest, which were 122.3(120.1-124.5) mmHg and 79.6(78.2-80.9) mmHg respectively. The analysis results showed that, among residents with normal waistline, the prevalence of hypertension of people with salt intake ≥ 18 g was 1.70(95%CI:1.04-2.76) times compared to that of people who consumed less than 10 g salt per day. CONCLUSION: The hypertension prevalence of Shandong province is quite high, and there is a relationship between salt consumption and blood pressure.

[Dietary sodium intakes and resources among residents in Shandong province].

OBJECTIVE: To describe dietary sodium intakes and resources among residents in Shandong province. METHODS: A total of 2184 subjects were selected by multi-stage stratified cluster random sampling method from 18-69 years old people in Shandong province in June, 2011. A total of 2140 subjects completed the study, the completion rate was 98.0%. Three-day (24-hour per day) dietary recalls and weighting methods were conducted to collect information about all the foods and condiments consumed by the subjects. Individual dietary sodium intake was calculated, the differences of dietary sodium intake among subjects with different characteristics were analyzed, and the proportions of different dietary sodium resources were also analyzed. RESULTS: The amount of individual dietary sodium intake was 5745.0 (95%CI:5427.6-6062.5) mg/d in Shandong; 6147.4 (95%CI: 5823.8-6471.0) mg/d for male residents, 5339.3 (95%CI:5005.8-5672.8) mg/d for female residents. There was a significant difference between males and females (F = 75.22, P < 0.01). The amount of individual dietary sodium intake was 5910.1 (95%CI:5449.3-6370.8) mg/d, 5341.6 (95%CI:5007.0-5676.1) mg/d for rural residents and urban residents respectively, and there was also a significant difference (F = 5.53, P < 0.05). The amount of condiment sodium intake was 4640.3 (95%CI:4360.2-4920.4) mg/d, which was the largest contributor to sodium intake, accounting for 80.8% (95%CI:79.9%-81.6%) of total intake. Sodium intake from cereals was 650.7 (95%CI: 590.5-711.0) mg/d, accounting for 11.3% (95%CI:10.3%-12.3%) of total intake. Sodium intake from eggs was 118.9 (95%CI:95.2-142.6) mg/d, accounting for 2.1% (95%CI:1.6%-2.6%) of total intake. The amount of manufactured food sodium intake was 582.1(95%CI: 497.8-666.4) mg/d, accounting for 10.1% (95%CI:8.9%-11.4%) of total intake. CONCLUSION: Sodium intakes remain high among residents of Shandong province, and sodium from condiments was the largest source of dietary sodium intake, sodium of manufactured food only accounting for small part.

[Analysis on prevalence states and associated factors of hypertension and prehypertension among adults in Shandong province].

OBJECTIVE: To analyze the prevalence states of hypertension and prehypertension and to explore relevant influencing factors among adult residents in Shandong province. METHODS: 15 600 residents aged between 18 and 69 from 20 counties in Shandong province were selected by multiple stratified and clustered sampling method from July to September, in 2011, to acquire related information by questionnaire survey and physical measurement. The prevalence of hypertension and prehypertension was estimated by special statistic method used to deal with complex sampling data, and the relevant influencing factors were also analyzed. RESULTS: A total of 15 350 subjects were actually completed the survey, with age at (41.4 ± 14.1) years old. The average systolic blood pressure and diastolic blood pressure were 121.1(95%CI: 119.7-122.4) and 78.8(95%CI: 77.8-79.9) mmHg (1 mmHg = 0.133 kPa) respectively. And also 3776 hypertension patients and 5721 subjects with prehypertension were detected, and the weighting prevalence of hypertension and prehypertension were 23.4% (95%CI: 20.9%-26.0%) and 37.1% (95%CI: 34.7%-39.5%) with adjustive prevalence at 20.7% and 36.5% respectively. The multiple SURVEYLOGISTIC analysis showed that age above 40 years old (OR = 3.24, 95%CI: 2.56-4.10), overweight(OR = 2.22, 95%CI: 1.70-2.89) and obesity(OR = 5.84, 95%CI: 3.54-9.66), smoking history(OR = 1.82, 95%CI: 1.03-3.23), constantly drinking (OR = 1.71, 95%CI: 1.08-2.70), diabetes (OR = 1.99, 95%CI: 1.29-3.07), abnormal TC(OR = 1.64, 95%CI: 1.24-2.17), abnormal TG(OR = 1.75, 95%CI: 1.24-2.48) and high 24 h urine Na/K ratio (OR = 1.05, 95%CI: 1.02-1.08) were risk factors of hypertension, while education equal to or above junior middle school (OR = 0.68, 95%CI: 0.52-0.89) was protective factor of hypertension; age above 40 years old (OR = 1.49, 95%CI: 1.15-1.91), overweight(OR = 1.76, 95%CI: 1.25-2.48) and obesity (OR = 3.50, 95%CI: 2.05-5.97), abnormal TC (OR = 1.54, 95%CI: 1.10-2.14), abnormal TG (OR = 1.79, 95%CI:1.25-2.56) and high 24 h urine Na/K ratio (OR = 1.02, 95%CI: 1.01-1.04) were risk factors of prehypertension, while female (OR = 0.41, 95%CI: 0.31-0.56) and education level equal to or above junior middle school (OR = 0.67, 95%CI: 0.52-0.87) were protective factors. CONCLUSION: The hypertension, especially prehypertension tends to be at high prevalence states currently, which may be affected by many factors.

Dietary Fiber-Derived Butyrate Alleviates Piglet Weaning Stress by Modulating the TLR4/MyD88/NF-κB Pathway.

During weaning, piglets are susceptible to intestinal inflammation and impairment in barrier function. Dietary fiber (DF) plays an active role in alleviating weaning stress in piglets. However, the effects of different sources of dietary fiber on the performance of weaned piglets are inconsistent, and the mechanisms through which they affect intestinal health need to be explored. Therefore, in this study, sixty weaned piglets were randomly divided into three treatment groups: basal diet (control, CON), beet pulp (BP), and alfalfa meal (AM) according to the feed formulation for a 28-day trial. The results showed that both AM and BP groups significantly reduced diarrhea rate and serum inflammatory factors (IL-1ß and TNF-α) and increased antioxidant markers (T-AOC and SOD), in addition to decreasing serum MDA and ROS concentrations in the AM group. At the same time, piglets in the AM group showed a significant reduction in serum intestinal permeability indices (LPS and DAO) and a substantial increase in serum immunoglobulin levels (IgA, IgG, and IgM) and expression of intestinal barrier-associated genes (Claudin1, Occludin, ZO-1, and MUC1), which resulted in an improved growth performance. Interestingly, the effect of DF on intestinal inflammation and barrier function can be attributed to its modulation of gut microbes. Fiber-degrading bacteria enriched in the AM group (Christensenellaceae_R-7_group, Pediococcus and Weissella) inhibited the production of TLR4- through the promotion of SCFAs (especially butyrate). MyD88-NF-κB signaling pathway activation reduces intestinal inflammation and repairs intestinal barrier function. In conclusion, it may provide some theoretical support and rationale for AM to alleviate weaning stress and improve early intestinal dysfunction, which may have implications for human infants.