Achievement of Guideline-Recommended Targets in Diabetes Care in China : A Nationwide Cross-Sectional Study.

BACKGROUND: Nationwide achievement of guideline-recommended diabetes care targets has not been comprehensively assessed in China. OBJECTIVE: To estimate the proportions of adults with diabetes achieving major clinical risk factor control, body mass index (BMI), lifestyle, and dietary targets specified in the Chinese diabetes guidelines. DESIGN: Nationwide cross-sectional survey. SETTING: China, 2015 to 2017. PARTICIPANTS: A national sample of 8401 adults with self-reported diabetes and a subset of 3531 with dietary data. MEASUREMENTS: The assessed targets included 1) ABC targets (individualized hemoglobin A1c [HbA1c] target; blood pressure [BP] <130/80 mm Hg; and low-density lipoprotein cholesterol [LDL-C] level <2.6 or <1.8 mmol/L [<100 or <70 mg/dL], depending on the presence of atherosclerotic cardiovascular disease), 2) BMI below 24 kg/m2, 3) lifestyle targets (not currently smoking or drinking, guideline-recommended leisure time activity level, and sleep duration of 7 to 8 hours), and 4) dietary targets (50% to 65% of energy from carbohydrate, 15% to 20% from protein, 20% to 30% from fat, ≥14 g of fiber per 1000 kcal, and <2000 mg of sodium per day). RESULTS: The proportion of adults with self-reported diabetes achieving each ABC target was 64.1% (95% CI, 61.4% to 66.8%) for HbA1c, 22.2% (CI, 20.2% to 24.1%) for BP, and 23.9% (CI, 21.9% to 25.9%) for LDL-C. The proportion achieving a BMI below 24 kg/m2 was 32.2% (CI, 30.3% to 34.2%). The proportion achieving each lifestyle target was 75.8% (CI, 73.9% to 77.7%) for smoking, 66.7% (CI, 64.4% to 69.1%) for drinking, 17.9% (CI, 15.8% to 20.1%) for leisure time activity, and 52.0% (CI, 49.6% to 54.3%) for sleep duration. The proportion achieving each dietary target was 39.1% (CI, 36.0% to 42.2%) for carbohydrate, 20.1% (CI, 16.9% to 23.3%) for protein, 20.5% (CI, 17.6% to 23.4%) for fat, 9.0% (CI, 7.0% to 10.9%) for sodium, and 2.5% (CI, 1.3% to 3.6%) for fiber. Only 4.4% (CI, 3.5% to 5.2%) of participants achieved all 3 ABC targets, 5.1% (CI, 4.3% to 6.0%) achieved all 4 lifestyle targets, and 4 participants achieved all 5 dietary targets. LIMITATIONS: Self-reported data and age of the data. CONCLUSION: Achievement of guideline-recommended diabetes care targets in Chinese adults with self-reported diabetes was exceedingly low. The findings highlight the need for immediate national health actions to improve diabetes care. PRIMARY FUNDING SOURCE: Shanghai Municipal Education Commission, National Key R&D Program of the People's Republic of China, and the National Health Commission of the People's Republic of China.

[Children's dietary patterns and dietary networks in five regions in China].

OBJECTIVE: To analyze the dietary patterns and dietary networks of children in China, explore regional differences in dietary habits in each region. METHODS: The subjects of the study were children aged 3-17(n=5824) in North Coast Economic Zone, Northeast, Central China, East Coast Economic Zone and Southwest Economic Zone who participated in the China Health and Nutrition Survey. The dietary pattern was obtained by factor analysis. Using mutual information, a measure to detect both linear and non-linear correlations between food groups constructed the dietary networks. RESULTS: Factor analysis resulted in five dietary patterns. Pattern 1 was related to high intakes of wheat and other cereals, pattern 2 was related to high intakes of fruits, milk, eggs and fast foods, pattern 3 was associated with high intakes of tubers, snacks, cakes, beverages and fast foods. The Northeast, Central China and North Coast Economic Zone regions had higher pattern 1 score. Pattern 2 scored higher for North Coast Economic Zone and East Coast Economic Zone regions. Pattern 3 scores in the Northeast region were higher than North Coast Economic Zone and East Coast Economic Zone regions. North Coast Economic Zone, Central China and Southwest Economic Zone regions had focused networks. The network of Northeast and East Coast Economic Zone regions were multiple. All regions were characterized by vegetables, or cereals as the hub. CONCLUSION: The dietary patterns and networks of children in the five regions of China exhibit regional differences.

[Changes in mild cognitive impairment and sociodemographic disparity among adults aged 55 years and above in 4 provinces of China].

OBJECTIVE: To investigate the changes in mild cognitive impairment(MCI) and sociodemographic disparity among adults aged 55 years and above in 4 provinces of China. METHODS: A total of 4687 adults aged 55 years and above from Community-based Cohort Study on Nervous System Disease who did not have Alzheimer's disease, participated in both rounds of the survey, and had complete baseline sociodemographic data and two rounds of data on cognitive function were selected. Generalized estimation equations were used to analyse the effect of sociodemographic factors on MCI. RESULTS: The detection rates of MCI in adults aged 55 years and above without Alzheimer's disease in 4 provinces of China in 2018 and 2020 were 48.56% and 42.56% respectively. MCI occurred in 30.11% of those with normal cognition(NC) at baseline, and 44.24% of those with MCI at baseline reverted to NC. The risk of MCI increased and the likelihood of MCI reversion decreased with increasing age and decreasing per capita monthly household income. In the baseline NC population, the risk of MCI in the junior high school and above group was 35% lower than that in the illiterate group(RR=0.65, 95%CI 0.53-0.80), the risk of MCI was lower in those living in rural areas(RR=0.56, 95%CI 0.49-0.65), and the risk of MCI was 1.17 times(95%CI 1.03-1.32) higher in those with a history of chronic diseases than in those without it. In the baseline MCI population, the likelihood of MCI reversion increased with education, the likelihood of MCI reversion was 1.04 times higher for workers than for non-workers(95%CI 1.00-1.08). CONCLUSION: The incidence and reversal rates of MCI were high in adults aged ≥55 years in four provinces of China. Advanced age, low education and low income level are risk factors for cognitive dysfunction.

[Epidemiological characteristics of cardio-metabolic risk factors in women aged 15-49 years in 4 provinces of China in 2018].

OBJECTIVE: To analyze the prevalence of cardio-metabolic(CM) risk in women aged 15-49 years in 4 provinces of China and the influence of socioeconomic factors on them. METHODS: A total of 2851 women aged 15-49 years from Community-based Cohort Study on Nervous System Disease in 2018 were selected. Obesity, central obesity, elevated triglyceride(TG), elevated total cholesterol(TC), decreased high-density lipoprotein cholesterol(HDL-C), elevated low-density lipoprotein cholesterol(LDL-C), elevated blood pressure, elevated blood glucose and risk factor aggregation were analyzed. χ~2 test was used for univariate analysis, multinomial Logit model was used to evaluate the relationship between socioeconomic factors and CM risk factors, and Cochran-Armitage trend test was used for trend analysis. RESULTS: The detection rate of CM risk factors in this study from high to low were central obesity(26.76%), overweight(22.41%), pre central obesity(17.47%), decreased HDL-C(15.36%), elevated TG(11.78%), borderline elevated TC(11.40%), borderline elevated TG(11.12%), elevated blood pressure(9.71%) and hypertension(9.12%). The prevalence rates of CM risk factors were different among different age groups, income groups and education levels(P<0.05). In addition to decreased HDL-C, the prevalence of other metabolic risk factors increased with age(P_(trend)<0.05). With the improvement of educational level, the prevalence rates of overweight, obesity, central obesity, central obesity, elevated TG, decreased HDL-C, elevated blood pressure, hypertension, elevated blood pressure and diabetes showed a downward trend(P_(trend)<0.05). Multinomial Logit model showed that the rick of metabolic risk factors in the age group of 40 to 49 years old was higher than that in the younger age group aged 15-29 years, and was more significant in hypertension, elevated blood pressure and elevated blood glucose, which were 8.51 times(95% CI 5.45-13.27), 3.14 times(95%CI 2.20-4.48)and 2.66(95% CI 1.52-4.66)times of the younger age group, respectively. Women with high-income level have a higher risk of borderline elevated TC, elevated TC and borderline elevated LDL-C(OR=1.85, 95% CI 1.44-2.38;OR=2.01, 95% CI 1.25-3.22;OR=2.16, 95% CI 1.61-2.90), but the lower risk of overweight and elevated blood pressure(OR=0.79, 95% CI 0.64-0.98;OR=0.69, 95% CI 0.50-0.94). The risk of obesity, hypertension and diabetes of people with college degree or above was about 50% lower than those with junior high school education or below(OR=0.52, 95% CI 0.35-0.78;OR=0.43, 95% CI 0.27-0.67; OR=0.52, 95% CI 0.28-0.96). CONCLUSION: Central obesity, overweight, pre central obesity and HDL-C decrease were prominent CM risk factors in women aged 15-49 years in four provinces of China in 2018. The detection rate of CM risk factors is higher in women of high age group or low education level.

Sodium content targets for pre-packaged foods, China: a quantitative study and proposal.

Objective: To determine the contribution of pre-packaged foods to population sodium intake in China, and to propose sodium content targets for food subcategories used for the World Health Organization's (WHO's) global sodium benchmarks. Methods: The impact of four different approaches to reducing the sodium content of pre-packaged foods on population sodium intake was estimated using data from national databases covering the nutrient content and ingredients of 51 803 food products and food consumption by 15 670 Chinese adults. We recategorized food products using a food categorization framework developed for WHO's global sodium benchmarks and adapted for China-specific foods. Findings: Pre-packaged foods, including condiments, contributed 1302.5 mg/day of sodium intake per adult in 2021, accounting for 30.1% of population sodium intake in China. Setting maximum sodium content levels using a 90th-percentile target would reduce sodium intake from pre-packaged foods by 96.2 mg/day, corresponding to a 1.9% reduction in population intake. Using the 75th-percentile, a fixed 20% reduction and WHO benchmark targets would further reduce intake by 262.0 mg/day (5.2% population intake), 302.8 mg/day (6.0% population intake) and 701.2 mg/day per person (13.9% population intake), respectively. Maximum sodium content levels based on revised 20% reduction targets were proposed because they should result in substantial and acceptable reductions in sodium content for most food subcategories: overall sodium intake would decline by 305.0 mg/day per person, and population intake by 6.1%. Conclusion: This study provides the scientific rationale for government policy on setting targets for food sodium content in China. Simultaneous action on discretionary salt use should also be taken.

National nutrition surveillance programmes in 18 countries in South-East Asia and Western Pacific Regions: a systematic scoping review.

Objective: To identify and analyse ongoing nutrition-related surveillance programmes led and/or funded by national authorities in countries in South-East Asian and Western Pacific Regions. Methods: We systematically searched for publications in PubMed® and Scopus, manually searched the grey literature and consulted with national health and nutrition officials, with no restrictions on publication type or language. We included low- and middle-income countries in the World Health Organization South-East Asia Region, and the Association of Southeast Asian Nations and China. We analysed the included programmes by adapting the United States Centers for Disease Control and Prevention's public health surveillance evaluation framework. Findings: We identified 82 surveillance programmes in 18 countries that repeatedly collect, analyse and disseminate data on nutrition and/or related indicators. Seventeen countries implemented a national periodic survey that exclusively collects nutrition-outcome indicators, often alongside internationally linked survey programmes. Coverage of different subpopulations and monitoring frequency vary substantially across countries. We found limited integration of food environment and wider food system indicators in these programmes, and no programmes specifically monitor nutrition-sensitive data across the food system. There is also limited nutrition-related surveillance of people living in urban deprived areas. Most surveillance programmes are digitized, use measures to ensure high data quality and report evidence of flexibility; however, many are inconsistently implemented and rely on external agencies' financial support. Conclusion: Efforts to improve the time efficiency, scope and stability of national nutrition surveillance, and integration with other sectoral data, should be encouraged and supported to allow systemic monitoring and evaluation of malnutrition interventions in these countries.

[Cardiovascular health status and related factors among adults aged 20-59 in 15 provinces of China in 2018].

OBJECTIVE: To evaluate the cardiovascular health status of Chinese adults and explore the related influencing factors. METHODS: Adults aged 20-59 from the China Health and Nutrition Survey covering 15 provinces and cities in 2018 were selected as the study subjects. The average score of 8 health factors was calculated using the definition of the "Life's Essential 8" for cardiovascular health released by the American Heart Association in 2022. Cardiovascular health was classified according to the score. Multinomial logit model was used to analyze the impact of demographic characteristics on cardiovascular health. RESULTS: A total of 5977 subjects were included in this study. The total score of cardiovascular health was 73.62. The single factor analysis showed that sleep and physical activity scored higher(91.69 and 87.39, respectively), while blood pressure and diet scored lower(58.88 and 44.16, respectively). Clustering analysis found that only 0.45% of the people with full score of all eight indicators, The average number of full score indicators was 4.22, and the full score indicators were more among 20-44, female, college or above, and urban residents. In addition, the number of people with high, moderate and poor cardiovascular health status were 35.70%, 59.58% and 4.72%, respectively. Multinomial logit analysis showed that compared with low cardiovascular health status, the people with high in 45-59 were 66%(95% CI 0.25-0.45) lower than those in 20-44. Women with moderate and high were 9.93(95%CI 6.44-15.33) and 41.82(95% CI 26.87-65.08) times higher than men, respectively. The moderate cardiovascular health of the people with middle income was 1.47(95% CI 1.07-2.01) times higher than those with low income. People in the south with moderate and high were 31%(95% CI 0.53-0.91) and 38%(95% CI 0.46-0.82) lower than those in the north, respectively. CONCLUSION: Adults in our country were in the moderate cardiovascular health. People aged 20-44, female, people with higher income and living in the north had better cardiovascular health.

[Accuracy verification of diet recording tool based on WeChat applet].

OBJECTIVE: To explore the accuracy of a dietary recording tool based on the mobile phone WeChat applet-"Zhishi AI Dietitian" applied to dietary records. METHODS: The research subjects were 109 full-time undergraduates from Zhejiang University. Respondents completed one round of dietary records of "Zhishi AI Dietitian" for three non-consecutive days and one round of non-consecutive three-day 24-hour dietary review method records. The two method must overlap for one day. The energy, nutrients and various food intake data obtained from the Zhishi AI nutritionist survey were sorted and compared with the corresponding survey result of the 24-hour dietary review method. Pearson correlation coefficient or Spearman correlation coefficient was used for correlation analysis, intra-group correlation coefficient was used for reliability analysis, and Bland-Atlman scatter plot was used for consistency analysis. RESULTS: In terms of reliability, the two method had certain reliability in assessing intake of various foods, energy and nutrients. After energy correction, the reliability of nutrient intake was enhanced. In terms of correlation, the correlation coefficients of food groups ranged from 0.34 to 0.79(mean 0.60), and the energy and nutrient correlation coefficients ranged from 0.34 to 0.72(mean 0.55). In terms of consistency, the proportion of research subjects outside the 95% consistency interval is less than 10%, indicating that the two have good consistency. CONCLUSION: Zhishi AI Dietitian applied to college students' dietary records has good accuracy.

[Analysis of differentiated regional dietary structures of adults aged 18-64 years in 15 provinces (autonomous regions, municipalities) of China in 2018].

OBJECTIVE: To analyze the status of energy and macronutrient intake among adults aged 18 to 64 years old in 15 provinces(autonomous regions and municipalities) of China. METHODS: A sample of 9481 adults aged 18-64 years from the data of the China Health and Nutrition Survey in 2018 was analyzed. Three consecutive days of 24 h recalls combined with the weighing of household seasonings were used to collect information on food intake and condiment intake. Food consumption was converted into energy and various nutrient intakes by the China Food Composition Table. RESULTS: The median daily intakes of energy were 1942.28 kcal and 1951.14 kcal in urban and rural areas, 1796.94 kcal, 1972.89 kcal, 1989.61 kcal and 1908.98 kcal in northwest, southwest, southeast and northern regions, respectively. The energy supply ratio of protein and fat were 13.61% and 35.85%, respectively, higher than 12.31% and 34.45% in rural areas, while the energy supply ratio of carbohydrates in urban(49.62%) was lower than that in rural areas(52.18%). The energy supply ratios of fat in the southwest and southeast regions were 38.90% and 36.80%, respectively, while the energy supply ratios of carbohydrates were 47.70% and 47.93%. The main food sources of energy, protein, and fat are different in different regions. The percentage of energy, protein, and fat from animal foods decreased with increasing age groups. The adults with low-income levels had a high intake of carbohydrates but a low intake of protein, and the adults with high-income levels had high proportions of energy, protein and fat from animal food sources. CONCLUSION: The total energy intakes of residents in different regions are relatively ideal, but the dietary structures are still unreasonable, and the energy supply ratios of fat are relatively high, especially in the southwest and southeast regions. The intake and food sources of the three macronutrients are varied in different regions and urban and rural areas. Age and income level affect the food choices of residents.

[Analysis of differentiated regional dietary patterns of adults aged 18-64 years in 15 provinces( autonomous regions, municipalities) in 2018].

OBJECTIVE: To analyze the dietary patterns of Chinese adults in 15 provinces and cities in China. METHODS: A total of 9208 adults aged 18-64 from the "China Health and Nutrition Survey" in 2018 were selected as subjects. Food consumption data were collected through 3 d-24 h dietary recalls and weighing household cooking oil and condiments, and the average daily dietary nutrient intake was calculated by the food composition table. Clustering analysis was used to analyze dietary patterns in different regions, and data from the 2009 China Health and Nutrition Survey were used for comparison. RESULTS: Three dietary patterns were obtained in this study, including northern pattern, coastal pattern and southern pattern. The analysis of demographic characteristics showed that the intake of cereals, vegetables and livestock were statistically different among different age groups, and livestock and poultry intake was higher in the 18-49 years; Fruit and milk were higher in women and other foods were higher in men; The intakes of cereals, tubers, legumes and vegetables were higher in rural areas, people with low income and low education levels, and other foods were higher in urban areas, people with high income and high education levels, especially milk. Compared with the dietary guidelines, it was found that the proportion of insufficient intake of dark vegetables, fruits and nuts in three patterns and milk, eggs in the southern pattern and aquatic products in the northern pattern was up to 80%, the other food intake was in 50%-80%; The proportion of excessive intake of livestock and poultry meat in the southern mode was significantly higher, reaching 78%. Nutrient analysis showed that the intake of carbohydrate, dietary fiber and carbohydrate energy ratio, vitamin E, magnesium and manganese were higher in the northern pattern; The intakes of protein, protein energy ratio, riboflavin, potassium, sodium, calcium, phosphorus, copper and selenium were higher in the coastal pattern; The southernpattern had a higher intake of energy, fat, fat energy ratio, niacin, retinol, zinc and vitamin C. In addition, the comparison between 2009 and 2018 showed that the intake of most foods except milk has decreased to varying degrees in the past decade, while the intake of some foods has increased. CONCLUSION: The 15 provinces in China were divided into three dietary patterns. Unbalanced intake of food and nutrients was common among them, and the intake was influenced by different demographic characteristics. In addition, most food intake has declined over the past decade.

[Cost-benefit analysis on the intervention of application iron-fortified soy sauce for anemia in Deqing 15-54 years women, Zhejiang].

OBJECTIVE: To make a cost-benefit analysis on anemia intervention with iron-fortified soy sauce in 15-54 years old women. METHODS: The study was conducted in Deqing county, Zhejiang province in 2012-2013. A total 585 women as sampling size were estimated with statistical model and randomly selected by probability proportionate to size sampling. Hemoglobin were measured before intervention and after 15 months. The cost of the intervention project were collected with manpower, communication and other invest. The benefit was estimated with profiling model. RESULTS: After the intervention, the anemia prevalence of sampled women decreased from 31.1% to 21.9%(P<0.01). The major cost of the project was 156 400 RMB, and total benefits result ing from projects were 1 448 485 RMB. The cost-benefit ratio of the project is 1∶9.49. If investing one yuan can produce economic benefits of nearly 9.49 yuan, therefore, the intervention projectis worth to be scaling up. Sensitivity analysis showed the result of this study was stable. CONCLUSION: The intervention can significantly reduce the prevalence of anemia in women, and reduce the economic burden of the diseases. .

Body-mass index and obesity in urban and rural China: findings from consecutive nationally representative surveys during 2004-18.

BACKGROUND: In China, mean body-mass index (BMI) and obesity in adults have increased steadily since the early 1980s. However, to our knowledge, there has been no reliable assessment of recent trends, nationally, regionally, or in certain population subgroups. To address this evidence gap, we present detailed analyses of relevant data from six consecutive nationally representative health surveys done between 2004 and 2018. We aimed to examine the long-term and recent trends in mean BMI and prevalence of obesity among Chinese adults, with specific emphasis on changes before and after 2010 (when various national non-communicable disease prevention programmes were initiated), assess how these trends might vary by sex, age, urban-rural locality, and socioeconomic status, and estimate the number of people who were obese in 2018 compared with 2004. METHODS: We used data from the China Chronic Disease and Risk Factors Surveillance programme, which was established in 2004 with the aim to provide periodic nationwide data on the prevalence of major chronic diseases and the associated behavioural and metabolic risk factors in the general population. Between 2004 and 2018 six nationally representative surveys were done. 776 571 individuals were invited and 746 020 (96·1%) participated, including 33 051 in 2004, 51 050 in 2007, 98 174 in 2010, 189 115 in 2013, 189 754 in 2015, and 184 876 in 2018. After exclusions, 645 223 participants aged 18-69 years remained for the present analyses. The mean BMI and prevalence of obesity (BMI ≥30 kg/m2) were calculated and time trends compared by sex, age, urban-rural locality, geographical region, and socioeconomic status. FINDINGS: Standardised mean BMI levels rose from 22·7 kg/m2 (95% CI 22·5-22·9) in 2004 to 24·4 kg/m2 (24·3-24·6) in 2018 and obesity prevalence from 3·1% (2·5-3·7) to 8·1% (7·6-8·7). Between 2010 and 2018, mean BMI rose by 0·09 kg/m2 annually (0·06-0·11), which was half of that reported during 2004-10 (0·17 kg/m2, 95% CI 0·12-0·22). Similarly, the annual increase in obesity prevalence was somewhat smaller after 2010 than before 2010 (6·0% annual relative increase, 95% CI 4·4-7·6 vs 8·7% annual relative increase, 4·9-12·8; p=0·13). Since 2010, the rise in mean BMI and obesity prevalence has slowed down substantially in urban men and women, and moderately in rural men, but continued steadily in rural women. By 2018, mean BMI was higher in rural than urban women (24·3 kg/m2vs 23·9 kg/m2; p=0·0045), but remained lower in rural than urban men (24·5 kg/m2vs 25·1 kg/m2; p=0·0007). Across all six surveys, mean BMI was persistently lower in women with higher levels of education compared with women with lower levels of education, but the inverse was true among men. Overall, an estimated 85 million adults (95% CI 70 million-100 million; 48 million men [95% CI 39 million-57 million] and 37 million women [31 million-43 million]) aged 18-69 years in China were obese in 2018, which was three times as many as in 2004. INTERPRETATION: In China, the rise in mean BMI among the adult population appears to have slowed down over the past decade. However, we found divergent trends by sex, geographical area, and socioeconomic status, highlighting the need for a more targeted approach to prevent further increases in obesity in the Chinese general population. FUNDING: China National Key Research and Development Program, China National Key Project of Public Health Program, and Youth Scientific Research Foundation of the National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention.

The Effects of Physical Activity and Sedentary Behaviors on Overweight and Obesity among Boys may Differ from those among Girls in China: An Open Cohort Study.

BACKGROUND: Childhood overweight and obesity are increasing steadily in China, yet few studies have focused on exploring the risk factors associated with sex differences. OBJECTIVES: We tested the hypothesis that the effects of physical activity and sedentary behaviors on overweight and obesity differ between boys and girls. METHODS: We used data collected from 4520 children and adolescents aged 6-18 y from 2004 to 2015 in an ongoing open-cohort study, the China Health and Nutrition Survey, to explore the effects of physical activity and sedentary behaviors on the risk of overweight and obesity in Chinese children and adolescents. We collected detailed information on physical activity and sedentary behavior along with dietary data, and we measured height and weight with standardized methods. We used random-effects logistic regression models to analyze the associations between total physical activity and sedentary behavior and overweight and obesity. RESULTS: The effects of sedentary behaviors and vigorous physical activity were only significant among girls. Vigorous physical activity decreased the risk of overweight and obesity by 63% (OR: 0.37; 95% CI: 0.20, 0.67) among girls ages 6-11 y and by 54% (OR: 0.46; 95% CI: 0.25, 0.85) among girls ages 12-18 y. High sedentary-hour values increased the risk by 96% (OR: 1.96; 95% CI: 1.09, 3.54) among girls ages 12-18 y. None of the effects were significant among boys. CONCLUSION: Low physical activity and high sedentary time increase the risk of overweight and obesity, particularly among adolescent girls. The effects of physical activity and sedentary behaviors on overweight and obesity among boys may differ from those among girls. Sex effects should be taken into consideration when promoting physical activity. Whether this sex difference is a result of high male preferences in China that preclude many activities among boys or other factors requires further study.

Trajectories of energy intake distribution and subsequent risk of hyperglycemia among Chinese adults: findings from the China Health and Nutrition Survey (1997-2018).

AIMS: Few studies have examined the secular trend of the energy intake distribution, and its effect on future risk of hyperglycemia. This study aims to describe trajectories of energy intake distribution over 12 years and relate them to subsequent risk of hyperglycemia over 9 years of follow-up. METHODS: Our study used ten waves of data from the CHNS survey, a population-based longitudinal survey in China, ongoing since 1989. We examined a cohort of adult participants who were free from diabetes but had at least three waves of dietary data from 1997 to 2009. We assessed energy intake using three consecutive 24 h recalls. We used these data to identify trajectory groups of energy intake distribution by multi-trajectory model based on energy intake proportions of breakfast, lunch, and dinner. We followed up participants for hyperglycemia, diabetes, and impaired fasting glucose for 9 years from 2009 to 2018. Outcomes were ascertained with fasting glucose, serum HbA1c, and self-report of diabetes and/or glucose-lowering medication. We estimated relative risk (RR) for hyperglycemia, diabetes, and impaired fasting glucose by identified trajectory groups using multilevel mixed-effects modified Poisson regression with robust (sandwich) estimation of variance. Gender difference was additionally examined. RESULTS: A total of 4417 participants were included. Four trajectory groups were identified, characterized and labeled by "Energy evenly distributed with steady trend group" (Group 1), "Dinner and lunch energy dominant with relatively steady trend group" (Group 2), "Dinner energy dominant with increasing trend and breakfast energy with declining trend group" (Group 3), and "breakfast and dinner energy dominant with increasing trend group" (Group 4). During 48,091 person-years, 1053 cases of incident hyperglycemia occurred, 537 cases of incident diabetes occurred, and 516 cases of impaired fasting glucose occurred. Compared with Group 1, Group 3 was associated with higher subsequent risk of incident hyperglycemia in 9 years of follow-up (RR = 1.28, 95% CI = 1.02, 1.61). No association was found for incident diabetes and impaired fasting glucose. Among males, Group 3 was associated with higher risk of incident hyperglycemia in 9 years of follow-up (RR = 1.44, 95% CI = 1.07, 1.94). No relationship was found in females. CONCLUSIONS: Energy intake distribution characterized by over 40% of energy intake from dinner with a rising trend over years was associated with higher long-term risk of hyperglycemia in Chinese adults.

Ultra-processed food intake is associated with grip strength decline in middle-aged and older adults: a prospective analysis of the TCLSIH study.

PURPOSE: Ultra-processed foods make up more than 50% of daily energy consumed in Western countries and are rapidly increasing in China. However, little is known about the association between ultra-processed food intake and muscle strength, a predictor for physical disability in senior years. We aimed to investigate the association of ultra-processed food intake with longitudinal changes in grip strength among middle-aged and older Chinese adults. METHODS: This prospective cohort study included a total of 5409 adults aged 40 years and over (61.3% men). Ultra-processed food intake was obtained by means of a validated food frequency questionnaire and classified according to the NOVA classification system. Grip strength was measured annually using a handheld digital dynamometer. Multivariable linear regression models were used to examine the association between ultra-processed food intake and annualized change in grip strength and weight-adjusted grip strength. RESULTS: In the fully adjusted models, annualized changes in grip strength and weight-adjusted grip strength per 10% increment in the proportion of ultra-processed foods in the diet were - 0.3708 kg (95% confidence interval - 0.5687, - 0.1730; P < 0.001) and - 0.0057 kg/kg (95% confidence interval - 0.0086, - 0.0029; P < 0.0001), respectively. In analyses stratified by age, sex, body mass index, physical activity, hypertension, hyperlipidemia, diabetes, and healthy diet score, such associations were largely consistent in most subgroups (all P for interaction > 0.05). CONCLUSIONS: Our data indicate that higher ultra-processed food intake was associated with faster grip strength decline in middle-aged and older Chinese adults.

Trends in Dietary Carbohydrates, Protein, and Fat Intake and Diet Quality Among Chinese Adults, 1991-2015: Results from the China Health and Nutrition Survey.

OBJECTIVE: Dietary transitions in China have undergone rapid changes in over the last three decades. The purpose of this study to describe trends in the macronutrient consumption, the sources of those nutrients, and the diet quality among Chinese adults. DESIGN: Longitudinal China Health and Nutrition Survey (CHNS) cohort analysis. Main outcomes are dietary energy intake from total carbohydrate, protein and fat and their subtypes, as well as food sources of carbohydrates, protein, and fat, and the China Dietary Guidelines Index 2018 (CDGI-2018). SETTING: CHNS (1991, 2000, 2009, 2015). PARTICIPANTS: Data from the longitudinal 1991, 2000, 2009, and 2015 China Health and Nutrition Survey (CHNS) of adults aged 18 years or older, who had complete demographic information. RESULTS: The estimated mean energy intake from total carbohydrate decreased from 62.6% to 50.6% between 1991 and 2015, while the mean energy intake from total protein increased from 12.6% to just 13.1% and the mean energy intake from total fat significantly increased from 24.0% to 35.8% (P < 0.001 for trend). Decreases were observed in evaluated mean energy from low-quality carbohydrates (from 53.6% to 41.7%) and incomplete protein (from 9.3% to 7.5%), while increases were seen in estimated mean energy from high-quality protein (from 3.3% to 5.5%), high-quality fat (from 9.1% to 16.7 %), and low-quality fat (from 14.9% to 19.0%). Low-quality carbohydrates, primarily those derived from refined grains, decreased from 52.2% to 36.2%. The diet quality as measured by CDGI-2018 improved, with the estimated mean increasing from 41.7 to 52.4 (P < 0.01 for trend). CONCLUSION: For Chinese adults, there was a significant change in the macronutrient composition over the previous few decades. The percentage of energy consumed from carbohydrates significantly decreased, however the percentage of energy consumed from total fat significantly increased. Additionally, the diet quality remains suboptimal.

[Epidemiological research progress on the relationship between children's dietary patterns and health].

As food preferences and eating habits form early in life, the development of healthy eating habits in early childhood is a way to prevent diet-related diseases. The dietary pattern approach examines the effect of an overall diet on health outcomes, instead of individual foods or nutrients, thereby presenting a comprehensive evaluation of children's dietary intake. This article reviews the current literature to summarize the main methods for assessing dietary patterns and explore relationships between children's dietary patterns and obesity, puberty onset, cardiovascular diseases, and neurodevelopment. The purpose of this review is to provide evidence-based support for reducing the risk of diet-related diseases in children and recommendations for future research directions.

Silenced lncRNA DDX11-AS1 or up-regulated microRNA-34a-3p inhibits malignant phenotypes of hepatocellular carcinoma cells via suppression of TRAF5.

BACKGROUND: Studies have discussed long noncoding RNA DDX11-AS1 (DDX11-AS1)-mediated downstream mechanism in hepatocellular carcinoma (HCC). The goal of this study was to investigate the regulatory mechanism of DDX11-AS1-mediated microRNA-34a-3p (miR-34a-3p)/tumor necrosis factor receptor-associated factor 5 (TRAF5) axis on HCC cells. METHODS: DDX11-AS1, miR-34a-3p and TRAF5 expression levels in HCC were detected. The correlation of DDX11-AS1, miR-34a-3p and TRAF5 in HCC patients was analyzed by Pearson test. HCC cells were transfected with corresponding plasmid/oligonucleotide, and cell proliferation, migration, invasion, apoptosis and tumor formation ability were detected. Bioinformatics software, dual luciferase report experiment and RNA-pull down experiment analysis were applied to verify the targeting relationship between DDX11-AS1, miR-34a-3p and TRAF5. RESULTS: Elevated DDX11-AS1 and TRAF5 and reduced miR-34a-3p exhibited in HCC. Silenced DDX11-AS1 or up-regulated miR-34a-3p inhibited the proliferation, migration, invasion, promoted apoptosis of HCC cells and repressed the tumor growth in nude mice. In addition, DDX11-AS1 bound to miR-34a-3p to target TRAF5. Silencing TRAF5 or elevating miR-34a-3p expression mitigated up-regulated DDX11-AS1-mediated promotion of tumor growth. CONCLUSION: Silenced DDX11-AS1 or up-regulated miR-34a-3p inhibits HCC cell growth via elevation of TRAF5, which could be of great benefit to find early diagnostic markers for HCC patients.

[Association between dietary patterns and depressive symptom based on reduced rank regression in people aged 55 and above in 4 provinces of China].

OBJECTIVE: To investigate the dietary patterns related to depressive symptoms based on reduced rank regression in people aged 55 and above in 4 provinces of China and the degree of association between this dietary pattern and depressive symptoms. METHODS: Stratified, multi-stage, cluster and random sampling method was used to collect personal information such as demographic characteristics, behavioral lifestyles, disease history and medicine use in Chinese aged 55 and above who participated in the baseline survey of "Community-based Cohort Study on Nervous System Diseases" project conducted in 2018 and 2019 in Hebei, Zhejiang, Shaanxi and Hunan Provinces. Food frequency questionnaire was used to obtain dietary data. Depressive symptom was assessed by geriatric depression scale with a cut-off of 11. Participants who have incomplete demographic information, dietary data or scores of geriatric depression scale, and those whose intake frequency of each food-group >99. 5% were excluded. A total of 11 497 participants, 43. 1% of whom were male, were involved in this study with average age of(67. 3±7. 6) years. The reduced rank regression method was used to extract depressive symptoms-related dietary patterns by gender, and the degree of association between dietary patterns and depressive symptom was analyzed by logistic regression. RESULTS: Among males, the depressive symptoms-related dietary pattern was characterized by the higher intake frequency of fried flour-made food, meat, processed meat, animal offal, and preserved eggs, and the lower intake frequency of liquid milk/milk power/cheese, fresh eggs(except preserved eggs) and nut. Among females, the depressive symptoms-related dietary pattern was characterized by the higher intake frequency of fried flour-made food, meat, processed meat, animal offal and preserved eggs, and the lower intake frequency of coarse cereals, fruits, liquid milk/milk power/cheese and fresh eggs(except preserved eggs). The highest quartile group of the dietary pattern score had a significantly higher risk of depressive symptom than the lowest quartile group(OR=3. 498, 95% CI 2. 624-4. 663, P<0. 001 for males; OR=3. 853, 95% CI 3. 002-4. 944, P<0. 001 for females). CONCLUSION: The depressive symptoms-related dietary pattern is characterized by the higher intake frequency of fried flour-made food, meat, processed meat, animal offal and preserved eggs, and the lower intake frequency of liquid milk/milk power/cheese and fresh eggs(except preserved eggs) in the Chinese aged 55 and above. The score of this dietary pattern is significantly positively correlated with depressive symptom.

[Current status of nutrition work in Chinese disease control institutions].

OBJECTIVE: To investigate the basic nutrition working status in Chinese CDCs. METHODS: The questionnaire of nutritional working ability of CDC was designed for investigation. The questionnaire was filled in by all disease control institutions of 31 provinces, autonomous regions, municipalities and Xinjiang Production and Construction Corps(excluding Hong Kong, Macao and Taiwan). Data was inputted by each institution through a questionn aire-survey platform called 'wenjuanxing& apos; , and the quality control was carried out by the provincial CDCs according to their jurisdiction. RESULTS: A total of 3150 valid questionnaires were collected. 35.97% of the institutions surveyed had never undertaken nutrition-related work, and only 4.19% of them had set up an independent department for nutrition-related work. The average number of people engaged in nutrition work was 2.5(P50=1.0); The average number of full-time staff was 0.2(P50=0.0). The average number of full-time staff in provincial, municipal and county CDCs was 3.6, 0.4 and 0.2, respectively. In terms of the nutrition work, by 2020 the China Nutrition and Health Surveillance and the National Food Nutrition Surveillance have covered 31 provinces, autonomous regions and municipalities. Besides Shanghai, Zhejiang and Fujian, provincial CDCs implemented the Nutrition Improvemeat Program for Compulsory Education Students in Rural Area. As to the scientific research, only 9.08% of the institutions have carried out nutrition-related projects in the past five years. Particularly, there were little nutrition-related scientific research funds for municipal and county disease control institutions, while 96.57% of the institutions do not have special funds for nutrition work. From 2015 to 2019, the proportion of the institutions that published nutrition-related papers, published nutrition-related books, won nutrition-related awards, and participated in the formulation of nutrition-related standards was 3.81%, 1.27%, 5.65% and 0.70%, respectively. With regard to the implementation of the six major actions of the National Nutrition Plan(2017-2030), only 29.81% of CDCs have organized and carried out related actions. CONCLUSION: Disease control institutions are short of nutrition professional posts, professional personnel, nutrition work funds and scientific research investment, lack of regular nutrition work tasks. Therefore, the nutrition capacity of the CDCs needs to be strengthened, and more efforts will be needed to meet the requirements of the National Nutrition Plan(2017-2030) and the Healthy China Action(2019-2030)-Healthy Diet Campaign.