Iodine status of 8 to 10 years old children within 20 years following compulsory salt iodization policy in Shanghai, China.

BACKGROUND: In 1996, Shanghai implemented universal salt iodization and has became the last provincial unit in China to carry out this intervention. In this study, we summarized achievements in past 20 years, to provide suggestions and evidence for the next stage of iodine supplementation. METHODS: This study summarized and analyzed monitoring data of children from 1997, 1999, 2005, 2011, 2014, and 2017 in Shanghai. In each monitoring year, 30 streets or towns were selected using the probability-proportional-to-size sampling technique. One primary school was selected from each street or town by a simple random sampling technique. From each school, 40 children aged 8 to 10 years were randomly selected. The number of children was divided equally by sex and age. RESULTS: In 1997, 1999, 2005, 2011, 2014, and 2017, median urinary iodine (MUI) was 227.5 µg/L, 214.3 µg/L, 198.1 µg/L, 181.6 µg/L, 171.4 µg/L, and 183.0 µg/L, goiter rate was 3.07, 0.40, 0.08, 0.08, 0.86, and 1.90%, and median thyroid volume (MTvol) was 2.9 mL, 1.2 mL, 2.4 mL, 1.0 mL, 1.8 mL, and 2.8 mL, respectively. There was a linear correlation between goiter rate and median thyroid volume (MTvol) (r = 0.95, P = 0.014). Household salt iodine concentration (SIC) was dropping every monitoring (P < 0.05). There was a significant difference among different household SIC groups in MUI in 1999 and 2017, and in MTvol in 1999 (P < 0.05). No significant differences were detected in the other years. CONCLUSIONS: In Shanghai, the iodine status of 8 to 10 years old children is adequate. Household SIC have little effect on iodine status of children. Future studies should analyze the dietary sources of iodine, especially from pre-packaged and prepared-away-from-home foods or meals. The regular monitoring of iodine status is important to human health.

Validity and reliability of a food frequency questionnaire for assessing dietary intake among Shanghai residents.

BACKGROUND: Few localized food frequency questionnaires (FFQ) have been developed and used in Chinese nutrition surveys despite China's large population and diverse dietary habits. METHOD: We analyzed data collected in two waves (six months apart) of the Shanghai Diet and Health Study in 2012-2013, from 1623 Shanghai residents (798 men and 825 women) older than 18 years. The results of 3-day 24-h dietary recalls (HDR) plus condiment weighing were used to evaluate the validity and reliability of the SDHS FFQ. RESULTS: The median and first and third quartiles for energy intake (in kcal) derived from the FFQ1 and FFQ2 were 1566.5 (1310.1-1869.6) and 1561.9 (1280.2-1838.4), respectively, of which protein (in g) was 54.3 (42.5-65.8) and 52.9 (42.4-64.5), fat (in g) was 49.8 (37.2-64.7) and 47.9 (34.9-61.9), and carbohydrates (in g) was 227.3 (180.8-277.9) and 228.1 (182.2-275.2) in the reliability analysis. The median and first and third quartiles for energy-intake differences between the FFQ1 and the 3-day 24-HDR with condiment weighing was 59.3 (- 255.5-341.6), of which protein was - 5.2 (- 18.7-7.8) and fat was - 11.2 (- 30.8-5.3). The adjusted Spearman's correlations were 0.33-0.77 for validity and 0.46-0.79 for reliability. The intra-class correlation coefficients exceeded 0.46 (validity) and 0.47 (reliability) for macronutrient intake. The consistency between the same and adjacent quartiles was approximately 80% for various nutrients. CONCLUSION: The reliability and comparative validity of the SDHS FFQ is similar to FFQs that are used worldwide.

Age, period and cohort effects and the predictors of physical activity and sedentary behaviour among Chinese children, from 2004 to 2011.

BACKGROUND: Very few studies have explored the effects of age, time period, and cohort in association with biological, behavioral, economic, and environmental factors predictors on physical activity (PA) and sedentary behaviour (SB) among Chinese children. METHODS: We used data from a cohort study of the China Health and Nutrition Survey (CHNS) between 2004 and 2011 (2004, 2006, 2009 and 2011). The outcomes of interest were metabolic equivalent of task (MET) hours per week from both active and sedentary activities. Age, gender, individual characteristics, household size, asset ownership, and urbanisation were included as covariates. Age, period and cohort effects analyses for PA and SB of children (6-17 y, n = 3528) was conducted to explicitly assess differences in PA and SB due to age vs. period effects, and implicitly assess differences by cohorts due to the period-specific experiences across individuals of varying ages. RESULTS: The mean age of the sample in each time point fluctuated from 12.6 to 11.3 years and PA slightly decreased from 50.0 ± 63.2 MET hours per week (MET-hr./wk) in 2004 to 47.1 ± 54.9 MET-hr./wk. in 2011. However, SB increased from 31.8 ± 22.0 MET-hr./wk. to 37.6 ± 22.2 MET-hr./wk. Girls had lower PA and higher SB levels than boys. Controlling for age effects, marginal period effects on PA were observed in some survey years. Higher levels of urbanisation and number of household computers served as negative and positive predictors for PA and SB, respectively. Higher household income was a positive predictor of SB. Surprisingly, bigger household size was the only negative predictor of SB (P < 0.05). CONCLUSIONS: This longitudinal study followed a large cohort of children over a significant period of their childhood. We observed potential age and secular trends in PA levels. Higher community urbanisation and number of home computers were associated with both PA and SB levels. Larger household size was the only factor that was negatively associated with SB. These findings shed light on health policy and preventative health strategies for China and other countries that are now facing similar public health challenges.

[Effects of nutrition intervention among students in primary school for children of migrant workers in Shanghai].

OBJECTIVE: To evaluate effects of nutrition intervention on nutrition knowledge, attitude and practice and lunch nutrition situation of students in primary school for children of migrant workers in Shanghai, to provide evidence for promoting children 's growth and development and health education. METHODS: A total of 4 primary schools for children of migrant workers in Shanghai were selected by stratified cluster sampling in 2014- 2015, and then were randomly assigned to intervention or control group. All students of 4and 5 grades were selected as subject. Nutrition intervention included the school canteen and students. Survey was implemented before and after intervention, and included demographic questionnaire, physical test and nutrition survey using dietary recall. RESULTS: The average rise in quantity of weight, BMI, the power of gripping, nutrition attitude accuracy and paper folding test score in intervention group were significantly higher than control group. Intervention was helpful to improve the awareness rates of dietary guidelines and the favor rate of school lunch. Except fat, the average rise in intake of energy and main nutrients in intervention group were significantly higher than control group. The average rise in intake of food grains, soybeans and soy products and vegetables and the average falling in intake of animal food in intervention group were significantly higher than control group. All of the differences were statistically significant( P < 0. 05). The average intake of energy, main nutrients and some kinds of food in intervention group were more close to the standard. CONCLUSION: Nutrition intervention has a positive impact on students ' growth and development, nutrition knowledge and attitude, cognitive ability and dietary intake, and should be put into widespread application.

[Relative validity of food frequency questionnaire for estimating dietary nutrients intake].

OBJECTIVE: To assess the relative validity of food frequency questionnaire( FFQ) for estimating dietary nutrients and food intakes. METHODS: Using random sampling methods to select 200 people from Minhang District and Jinshan District. Dietary intakes were estimated by weighed dietary records combining with 24 h dietary recalls( as reference method) and food frequency questionnaire. Relative validity were examined by T-test, Wilcoxon rank test and correlation analysis. RESULTS: The foods groups were the same in FFQ and 24 h dietary recalls. Correlated with daily intake of grains, beans and products, vegetables, cruciferous vegetables, fruits, meat and poultry, aquatic product, milk and products in two methods( Correlation coefficients: 0. 248- 1. 000). The daily food of energy, protein, fat, carbohydrate, cholesterol had significantly positive correlation in FFQ and 24 h dietary recalls( Correlation coefficients: 0. 209- 0. 340). No statistical difference in energy and fat. The daily food of Mg, K, P, Mn, I, Ca, Se had significantly positive correlation in two methods( Correlation coefficients: 0. 204-0. 419). No statistical difference in Mg, K, P, Mn, I. The daily food of vitamin B1、B2、C、niacin had significantly positive correlation in two methods( Correlation coefficients:0. 170- 0. 305). No statistical difference in vitamin B1、B2. CONCLUSION: Food frequency questionnaire can be used to evaluate dietary intakes of I, cruciferous vegetables, soy isoflavones, energy, fat, Mg, K, P, Mn, vitamin B1 and vitamin B2.

Acceptability and feasibility of smartphone-assisted 24 h recalls in the Chinese population.

OBJECTIVE: To examine the acceptability and feasibility of using smartphone technology to assess beverage intake and evaluate whether the feasibility of smartphone use is greater among key sub-populations. DESIGN: An acceptability and feasibility study of recording the video dietary record, the acceptability of the ecological momentary assessment (EMA), wearing smartphones and whether the videos helped participants recall intake after a cross-over validation study. SETTING: Rural and urban area in Shanghai, China. SUBJECTS: Healthy adults (n 110) aged 20-40 years old. RESULTS: Most participants reported that the phone was acceptable in most aspects, including that videos were easy to use (70%), helped with recalls (77%), EMA reminders helped them record intake (75%) and apps were easy to understand (85%). However, 49% of the participants reported that they had trouble remembering to take videos of the beverages before consumption or 46% felt embarrassed taking videos in front of others. Moreover, 72% reported that the EMA reminders affected their consumption. When assessing overall acceptability of using smartphones, 72% of the participants were favourable responders. There were no statistically significant differences in overall acceptability for overweight v. normal-weight participants or for rural v. urban residents. However, we did find that the overall acceptability was higher for males (81%) than females (61%, P=0·017). CONCLUSIONS: Our study did not find smartphone technology helped with dietary assessments in a Chinese population. However, simpler approaches, such as using photographs instead of videos, may be more feasible for enhancing 24 h dietary recalls.

[Water intake and its influencing factors of children and adolescents in Shanghai].

OBJECTIVE: To describe the total drinking water intake and its influencing factors among children and adolescents in Shanghai, and to accumulate basis for developing adequate water intakes for children and adolescents in China. METHODS: A total of 1454 children and adolescents aged 8-17 years from two districts of Shanghai was selected by using stratified random sampling method. The information on amounts and types of daily drinking water was recorded by subjects for seven consecutive days using a quantitative measurement. Total drinking water was the sum of plain water and beverages. RESULTS: The median of total drinking water of subjects was 1014 ml/d, and the median of plain water and beverages was 580 and 339 ml/d, respectively. The consumption of total drinking water, plain water, and beverages in boys was significantly higher than that in girls, was increasing with aging and in urban was significantly higher than that in suburbs (P < 0.05). The obese drank more beverages (P < 0.05). CONCLUSION: The total drinking water of children and adolescents in Shanghai was less. To establish adequate intake of water, the comprehensive effect of gender, age, BMI and region when should be considered.

Elevated plasma ferritin is associated with increased incidence of type 2 diabetes in middle-aged and elderly Chinese adults.

Epidemiological studies suggest that elevated circulating ferritin is associated with heightened incident diabetes in mainly Western populations, although the results were not entirely consistent. We aimed to prospectively investigate the ferritin-diabetes association in an Asian population for the first time, to our knowledge, and also to examine this association with an updated meta-analysis. Our prospective study included 2198 community-living Chinese between 50 and 70 y of age in 2005. All individuals participated in a 6-y follow-up survey in 2011. Fasting plasma ferritin, high-sensitivity C-reactive protein (hsCRP), adiponectin, and γ-glutamyltransferase (GGT) were measured at baseline. A total of 538 incident diabetes cases were documented by self-reports and/or fasting glucose ≥7.0 mmol/L at the follow-up survey. After multiple adjustments, the RR of type 2 diabetes was 1.90 (95% CI: 1.37, 2.65) when comparing the highest with the lowest sex-specific ferritin quintile. The association remained significant after further controlling for BMI, hsCRP, adiponectin, and GGT. To update the evidence reported in previous meta-analyses, we searched all prospective studies evaluating the association between blood ferritin and incident diabetes on PubMed prior to October 24, 2012. Besides our prospective study, 9 additional studies were also included. The pooled RR was 1.60 (95% CI: 1.25, 2.04) when comparing the highest with the lowest category of ferritin with a moderate heterogeneity (I(2) = 49.0%; P = 0.03). A significant linear dose-response relationship was detected in this meta-analysis. Overall, our results indicate an independent and significant positive association between higher plasma ferritin, a marker of elevated body iron stores, and increased risk of developing type 2 diabetes in middle-aged and elderly Chinese adults, which is similar to Western populations.

[Water intake of primary and middle school students in four cities of China].

OBJECTIVE: To investigate total intake of drinking water of primary and middle school students in four cities of China, and to provide scientific evidence for developing standard of intake of drinking water for primary and middle school students in China. METHODS: A total of 5914 primary and middle school students were selected from Beijing, Shanghai, Chengdu and Guangzhou using multi-stage random sampling method and 5868 subjects completed the survey. The information on the amounts of daily drinking water was recorded for seven consecutive days using a 24 hour measurement. The amounts of daily drinking water among different cities and ages and between boys and girls or urban and rural were analyzed. RESULTS: The average daily total drinking water of subjects was (1089 ± 540) ml, with significant differences among the four cities ((1165 ± 549), (1126 ± 544), (866 ± 421), (1185 ± 568) ml in Beijing, Shanghai, Chengdu and Guangzhou, respectively; F = 114.28, P < 0.05). The average daily drinking water was significantly higher in boys (1157 ± 575) ml than in girls (1026 ± 498) ml (Z = 8.88, P < 0.05), and in urban (1185 ± 578) ml than in rural (991 ± 480) ml (Z = 13.94, P < 0.05). The difference among different ages was statistically significant (F = 91.53, P < 0.05) with ascending order in 7 - 10, 11 - 13 and 14 - 17 years old ((953 ± 483), (1134 ± 551) and (1170 ± 557) ml respectively). CONCLUSION: The daily consumption of total drinking water is different in primary and middle school students among different cities, regions, genders and ages.

[Drinking behaviors of adults at different time of day in four cities of China in summer].

OBJECTIVE: To investigate the drinking behaviors of adults at different time of day in four cities of China in summer. METHODS: A total of 1483 adults aged 18 - 60 years old from Beijing, Shanghai, Chengdu and Guangzhou were selected using multiple-stage random sampling method. The information of amounts and types of daily drinking water was recorded by subjects for seven consecutive days using a quantitative measurement. RESULTS: The proportion (97% - 99%) and mean (290 - 471 ml) of drinking water of subjects after breakfast, lunch and supper are higher than other time of day (P < 0.01). The distribution of plain water, tea, beverages at different time of day was the same as total drinking water. Among three periods a day, the amount of drinking water in the morning (719 ml/d) was the most, followed by in the afternoon (539 ml/d), and the least in the evening (417 ml/d), the difference was statistically significant (F = 972.55, P < 0.01). The highest consumption of plain water and beverages were in the morning. The consumption of tea in the morning was close to it in the afternoon and higher than that in the evening (t = -52.13, P < 0.01). The average daily drinking water in mealtime was 240 ml, while non-mealtime was 1436 ml, so the difference was statistically significant. Beverages in non-mealtime were higher than mealtime while plain water in non-meal time was higher than meal time (P < 0.05). CONCLUSION: The highest consumption of drinking was plain water among three periods a day, and beverages were higher in mealtime while plain water higher in non-mealtime.