Association between sedentary behavior, screen time and metabolic syndrome among Chinese children and adolescents.

BACKGROUND: The aim of the study was to investigate the relationship between sedentary behavior, screen time and MetS among Chinese children and adolescents aged 7-17 years. Data was obtained from the China National Nutrition and Health Surveillance of Children and Lactating Mothers in 2016-2017. METHODS: Data on sedentary time, screen time, and MetS indicators were obtained through physical and health questionnaires, anthropometric measurements, and clinical examinations. MetS was defined according to the Cook's criteria. Wilcoxon rank sum test and chi-square test were applied for comparisons of measurement data and counting data, respectively. The relationship between sedentary time, screen time, and MetS and its components was analyzed using a multivariate logistic regression model. RESULTS: The prevalence of MetS among 7-17-year-old students in 2016-2017 was 5.45%. Compared to those with low sedentary behavior, in high sedentary behavior groups, the prevalence of abdominal obesity, high TG, low HDL-C, and MetS was high in boys, and the prevalence of abdominal obesity, high TG, hyperglycemia, and MetS was high in girls. Moreover, for those who reported ≥ 3 h/day of screen time, the prevalence of abdominal obesity, low HDL-C, and MetS was higher in boys, and the prevalence of abdominal obesity and MetS was higher in girls. After adjusting for confounding variables, the risks of abdominal obesity, high TG, low HDL-C, and MetS were higher in high-level sedentary time group, and the risks of abdominal obesity and MetS were 1.15 and 1.14 times higher for those who spent ≥ 3 h/day on screen time, respectively. CONCLUSIONS: This study shows that high levels of sedentary time and screen time were associated with an increased likelihood of MetS among Chinese children and adolescents aged 7-17 years. Reducing sedentary behavior and screen time may contribute to the prevention of metabolic diseases.

[Comparison study of food, energy and nutrient intake by 24-hour dietary recall method on two consecutive days versus three consecutive days].

OBJECTIVE: To compare the differences in estimated food, energy, and nutrient intakes between the consecutive 3 days 24-hour dietary recall(24HR)(referred to as the 3-day method) and consecutive 2 days 24HR(referred to as the 2-day method) to provide a basis for the use of consecutive 2 days 24HR in China nutrition surveillance. METHODS: Using objective sampling to select participants in northern and southern provinces, dietary data were obtained through consecutive 3 days 24HR, and the average intakes of food, energy and nutrients were calculated for three days from Thursday to Saturday and two days on Friday and Saturday, respectively. The 3-day method was considered as the reference standard method to evaluate the performance of the 2-day method for estimating food, energy and nutrient intakes. RESULTS: Among 778 participants aged 18-60 years in urban and rural areas of two provinces, the errors of the mean and median of 2-day method for estimating the intake of four major food categories less than 6% compared with the 3-day method, and there were significant equivalencies(P<0.025) and no significant differences in four major food categories group(P>0.05). Of the 24 food groups estimated by the 2-day method, 17 had mean errors within 5%, the largest error was in animal offal(13.45%) and the smallest in fruit(0.15%), and there were significant equivalencies(P<0.025) and no significant differences in seven food groups(P>0.05). For energy and nutrients, the mean and median errors of energy were less than 0.5% and there were significant equivalencies(P<0.025) and no significant differences for energy(P>0.05). Among the 25 nutrients, except sodium, iodine and vitamin E, the mean and median errors of the other 22 nutrients were less than 5%, and there were significant equivalencies(P<0.025) and no significant differences in 16 nutrients(P>0.05). CONCLUSION: There was little difference between the two survey method in assessing the intake of high consumption frequency foods, energy and most nutrients at group level, the 2-day method can be used as an alternative to the 3-day method to collect dietary intake data with high consumption rates in the population.

[Prevalence and trends of low body weight among elderly population aged 60 years and above in China in 2002-2015].

OBJECTIVE: Understand the current situation and changing trends of low body weight in elderly population aged 60 years and above. METHODS: Data was collected from 2002 Chinese Nutrition and Health Survey, 2010-2013 Chinese Nutrition and Health Surveillance and 2015 Chinese Adult Chronic Disease and Nutrition Surveillance. Multi-stage stratified cluster random sampling was used for all surveys or surveillance. In 2002, 27 778 samples of people aged 60 and over were taken from 132 monitoring sites in mainland China. In 2010-2013, 34 581 subjects were selected from 150 monitoring points in mainland China. In 2015, 59 576 subjects were selected from 302 monitoring points in mainland China. Questionnaires collected basic information such as gender, and date of birth, and information such as height and weight were collected through physical examination. RESULTS: The prevalence of low body weight in the elderly aged 60 years and above showed a downward trend from 2002 to 2015 in China(P<0.01). The prevalence of low body weight decreased from 11.67% in 2002 to 5.19% in 2015. The prevalence of low body weight among males decreased from 11.51% in 2002 to 5.21% in 2015. The prevalence of low body weight among females decreased from 11.83% in 2002 to 5.17% in 2015. The prevalence of low body weight in the elderly aged 60 years and above showed an upward trend with age. The prevalence of low body weight in urban areas decreased from 5.85% in 2002 to 3.31% in 2015. The prevalence of low body weight in rural areas decreased from 16.25% in 2002 to 6.67% in 2015. The prevalence of low body weight in seven geographic regions of China decreased from 2002 to 2015. The prevalence of low body weight was highest in the elderly population aged 60 years and above in South China(9.49%(95%CI 8.61%-10.38%)) and lowest in North China(2.55%(95%CI 2.15%-2.95%)) in 2015. CONCLUSION: The prevalence of low body weight among the elderly aged 60 years and above in China decreased from 2002 to 2015. The prevalence of low body weight increased with age. The prevalence was higher in rural areas than in urban areas, and the prevalence in South China was higher than in other geographic regions.

Association of fine particulate matter and its constituents with hypertension: the modifying effect of dietary patterns.

BACKGROUND: Studies have shown that nutritional supplements could reduce the adverse effects induced by air pollution. However, whether dietary patterns can modify the association of long-term exposure to fine particulate matter (PM2.5) and its constituents with hypertension defined by the 2017 ACC/AHA guideline has not been evaluated. METHODS: We included 47,501 Chinese adults from a nationwide cross-sectional study. PM2.5 and five constituents were estimated by satellite-based random forest models. Dietary approaches to stop hypertension (DASH) and alternative Mediterranean diet (AMED) scores were calculated for each participant. Interactions between dietary patterns and air pollution were examined by adding a multiplicative interaction term to logistic models. RESULTS: Long-term exposure to PM2.5 and its constituents was associated with an increased risk of hypertension and stage 1-2 hypertension. The DASH and AMED scores significantly modified these associations, as individuals with higher scores had a significantly lower risk of air pollution-related hypertension and stage 1-2 hypertension (P-interaction < 0.05), except for interaction between PM2.5, sulfate, nitrate, ammonium, and AMED score on stage 1 hypertension. For each IQR increase in PM2.5, participants with the lowest DASH and AMED quintiles had hypertension risk with ORs (95%CI) of 1.20 (1.10, 1.30) and 1.19 (1.09, 1.29), whereas those with the highest DASH and AMED quintiles had lower risks with 0.98 (0.91, 1.05) and 1.04 (0.97, 1.11). The stratified analysis found modification effect was more prominent in the < 65 years age group. Consuming more fresh vegetables, fruits, whole grains, and dairy would reduce the risk of hypertension caused by PM2.5 and its constituents. CONCLUSIONS: Dietary patterns rich in antioxidants can reduce long-term exposure to PM2.5 and its constituents-induced hypertension defined by the 2017 ACC/AHA guideline, especially in young and middle-aged individuals. Compared to the Mediterranean diet, the DASH diet offers superior dietary guidance to prevent stage 1 hypertension caused by air pollution.

[Energy and macronutrients intake of the elderly aged 75 years and above in China in 2015].

OBJECTIVE: To analyze the intake of energy and macronutrients in the elderly aged 75 years and above in China. METHODS: The data was sourced from the China National Chronic Non-communicable Disease and Nutrition Surveillance, which adopted a multi-stage stratified clustered random sampling method and selected 298 monitoring points from 31 provinces across the country to carry out chronic non-communicable disease and nutrition surveillance of Chinese adults. The condiments weighting method and 3-day 24-hour dietary review method were used to collect dietary data for residents. Based on the dietary survey result of 3368 elderly people aged 75 years and above in the surveillance, the intake of energy and macro nutrients of elderly people was analyzed. RESULTS: Among the elderly aged 75 years and above included in the analysis, there were 1727 males and 1641 females, 1511 people in urban areas and 1857 people in rural areas, 1956 people aged 75-79, 1412 people aged ≥ 80. The average energy intake of the elderly aged 75 years and above in China was(1601.0±473.4)kcal, and the average intakes of carbohydrate, protein and fat were(219.6±76.6)g, (48.2±18.6)g and(60.2±31.5)g, respectively. The energy supply ratios of carbohydrate, protein and fat were 54.9%, 12.0% and 33.1% respectively. The carbohydrate intake and its energy supply ratio of the urban elderly((200.0±74.0)g and 51.8%) were significantly lower than those of the rural elderly((235.5±75.0) and 57.4%), while the protein intake and its energy supply ratio((50.2±18.9)g and 13.0%), fat intake and its energy supply ratio((61.2±30.2)g and 35.2%)of the urban elderly were significantly higher than those of the rural elderly((46.5±18.2)g and 11.2% for protein, and(59.4±32.5)g and 31.4% for fat). According to Chinese dietary reference intake standard, only 28.1% of the elderly aged 75 and above reached the recommended value of energy, 71.9% of the elderly did not take enough energy, the proportion of insufficient protein intake was 72.2%, 68.5% in urban areas and 75.2% in rural areas, the proportion of people with fat to energy ratio more than 30% was 58.5%, 65.3% in urban areas and 52.9% in rural areas. CONCLUSION: The energy intake of the elderly aged 75 years and above in China was insufficient, the protein intake was low, the fat to energy ratio was too high, and the dietary structure was unreasonable.

[Screen time among Chinese primary and middle school students from 2016 to 2017].

OBJECTIVE: To get a better knowledge of the current situation of screen time among primary and secondary school students in all provinces of China from 2016 to 2017. METHODS: Data was from the China National Nutrition and Health Surveillance of Children and Lactating Women(2016-2017).275 monitoring points were selected from 31 provinces of China by multi-stage stratified cluster random sampling. A total of 280 primary and secondary school students from 2 primary schools, 2 junior middle schools and 1 senior high school were randomly selected from each monitoring point to complete the survey.73629 primary and secondary school students(except grade 9 and grade 12) were included in this study. RESULTS: From 2016 to 2017, the average daily screen time of Chinese primary and secondary school students was(1.65±1.54) hours, M(P25, P75) was 1.29(0.58, 2.21) h. In terms of provinces, the average daily electronic screen time of primary and secondary school students in Beijing, Tianjin, Jilin, Fujian, Guangdong and Hainan is more than 2 hours. In terms of rural and urban areas, the screen time of students in Beijing's rural and urban areas, Tianjin's rural areas, Hebei's urban areas, Liaoning's rural areas, Jilin's rural areas, Fujian's urban areas, Guangdong's urban areas, Guangxi's urban areas, Hainan's rural and urban areas, and Xinjiang's urban areas all exceeds 2 hours/day. Besides, screen times of rural primary and secondary school students in Beijing(Z=2.62, P<0.01), Tianjin(Z=5.94, P<0.01), Liaoning(Z=11.56, P<0.01), Jilin(Z=-7.59, P<0.01), Shanghai(Z=3.19, P<0.01), Jiangsu(Z=12.00, P<0.01), Zhejiang(Z=-4.80, P<0.01), Anhui(Z=-4.67, P<0.01), Jiangxi(Z=-3.29, P=0.01), and Sichuan(Z=-4.53, P<0.01) are longer than that of urban students. CONCLUSION: There are urban-rural differences in the average daily electronic screen time and different types of electronic screen time of primary and secondary school students in China's provinces from 2016 to 2017.

[Intake of main food among the children aged 6-17 years in different regions of China in 2019-2021].

OBJECTIVE: To analyze the intakes of main food among the children of 6-17 years in different regions of China from 2019 to 2021, and to provide a scientific basis for evaluation and guiding Chinese children to make reasonable diet. METHODS: Multistage stratified random sampling method was used to collect data in east China, north China, central China, south China, southwest, northwest and northeast seven areas of each random two provinces, randomly selected from each province one urban survey site and one rural survey site, 28 sites of the 13th Five Year National Science and Technology Basic Resources Survey Project-Chinese children aged 0-18 investigation and application of nutrition and health system in 14 provinces of China. The study included 6413 children aged 6 to 17. Three consecutive 24-hour recalls method combined with weighing were used to collect the information of food intake. According to the food classification in the standard version of the food composition list, the food was divided into cereals, tubers, fresh vegetables, fresh fruits, meat and poultry, fish and shrimp, eggs, milk, etc. , and the intake of various foods was calculated for boys and girls aged 6-8, 9-11, 12-14 and 15-17 in different regions. RESULTS: Compared with the average daily food intake of children of the same sex and age in the urban and rural, The average daily intake of cereals and tubers for boys aged 9-17, cereals for girls aged 9-17, tubers for girls aged 12-17, and fish and shrimp for boys of edible population aged 15-17 were higher in rural areas than in urban areas. There were differences in the average daily food intake and consumption rate of fresh vegetables, fresh fruits, meat and poultry, eggs and milk of the same sex and age, which were higher in urban than in rural areas(P<0.05). Compared with the average daily food intake of children of the same sex and age in the south and the north, the average daily intake of cereals and eggs for boys aged 9-14, cereals for girls aged 6-8, and fresh fruits for boys and girls of edible population aged 6-17 were higher in the north than in the south. There were differences in average daily intake and consumption rates of tubers, fresh vegetables, meat and poultry, milk and fish and shrimp of the same sex and age, which were higher in the south than in the north(P<0.05). Compared with the average daily food intake of children of the same sex and age in the eastern, central and western regions, the average daily intake of cereals for boys aged 6-14, cereals for girls aged 6-17, fresh fruits for boys and girls of edible population aged 6-17, and fish and shrimp for boys and girls of edible population aged 15-17 were lower in the eastern region than in the central and western regions. The average daily intake of tubers for boys aged 9-11 and 15-17, for girls aged 9-17 were higher in the western regions than the eastern and central regions. The average daily intake of eggs for boys and girls aged 12-17 was lower in western regions than the eastern and central regions. There were differences in average daily intake and consumption rates of fresh vegetables, meat and poultry and milk of the same sex and age, which were higher in the eastern region than in the central and western regions. (P<0.05). The proportion of coarse grains to cereals was low, between 3.7% and 10.1%. The proportion of pork to meat and poultry was high, between 56.1% and 71.4%. CONCLUSION: In China, there are differences in daily intake of main food for children aged 6 to 17 years old in urban and rural areas, north and south areas, east, central and west areas.

[Eating out behavior of residents aged 6 and above in China from 2015 to 2017].

OBJECTIVE: To analyze the eating out behavior of Chinese residents aged 6 and above from 2015 to 2017. METHODS: Using the data of eating out behavior in the past week from China Nutrition and Health Surveillance(2015-2017), after data cleaning, a total of 150 682 subjects were included in this study, including 80 703 in 2015 and 69 979 in 2016-2017. The percentage of cases were used to describe the eating behaviors of different characteristics of the population, Chi-square test was used to comparative analysis. RESULTS: From 2015 to 2017, proportions of eating out for all the three meals was 46.3% of Chinese residents aged 6 and above in the past week, that of were 69.7%, 84.6%, 33.2%, 19.8% and 9.1% of Chinese residents aged 6 to 11, 12 to 17, 18 to 44, 45 to 59 and 60 and above, respectively. The proportion of urban and rural residents eating out in the past week were 52.8% and 41.2%, respectively, the difference was statistically significant(P<0.05). The proportion of male and female residents eating out in the past week were 49.6% and 43.1%, respectively, the difference was statistically significant(P<0.05). Proportions of eating out for breakfast, lunch and dinner were 31.4%, 37.2% and 21.4% respectively of Chinese residents, that of were 17.3%, 29.1% and 15.1% of Chinese residents eating breakfast, lunch and dinner in work/school canteens. CONCLUSION: Children aged 6 to 17 years old are the key groups for eating out. Among adults aged 18 and above, residents aged 18 to 44 have the highest proportion of eating out. Proportions of eating out for lunch is the highest and the main eating-out place is the canteen for Chinese residents.

[Status of dietary micronutrient intakes among the children of 12-17 years old in China from 2016 to 2017].

OBJECTIVE: To analyze the status of dietary micronutrient in takes among the children of 12-17 years old in China from 2016 to 2017. METHODS: Multistage stratified random sampling method was used to collect data in 275 monitoring sites of the China National Nutrition and Health Survey of Chinese children and lactating mothers in 31 provinces of China from 2016 to 2017. Three consecutive 24-hour recalls method wasused to collect the information of food intake, and household or school canteen edible oil and condiments weighing were adopted. The dietary micronutrient were analyzed based on theChina Food Composition table. RESULTS: The average daily intakes of vitamin A(retinol activity equivalents), vitamin B_1(thiamine), vitamin B_2(riboflavin), vitamin C(ascorbic acid), calcium, iron, zinc and sodium were 356.8 µ g, 0.8 mg, 0.8 mg, 60.5 mg, 342.8 mg, 19.2 mg, 9.8 mg and 5 230.4 mg, respectively. The proportion ofdaily average intakes of vitamin A, vitamin B_1, vitamin B_2, vitamin C and calcium lower than 60% of the recommended value were 74.3%, 59.4%, 57.7%, 62.6% and 93.0%, respectively. The proportion of daily intake of iron and zinc reaching 80% of the recommended value were 73.8% and 64.8%, respectively. The proportion of daily average intake of sodium exceeded the appropriate intake by 94.4%. The average daily intakes of micronutrients increased with age among the children of 12-17 years old. There were differences of daily intake of vitamin A in gender, urban and rural areas(P<0.05), there was difference of vitamin C in urban and rural areas(P<0.01), there were differences of daily intake of vitamin B_1, vitamin B_2, calcium, iron and zinc in age, gender, urban and rural areas(P<0.01), there were differences in the average daily intake of sodium in age, gender(P<0.01). CONCLUSION: The average daily dietary of iron and zinc intakes in the diet were basically enough in most children of 12-17 years old in China, that of sodium was too much, and that of some micronutrients was insufficient.

[Current situation of screen time among Chinese primary and middle school students from 2016 to 2017].

OBJECTIVE: To analyze and describe the status and characteristics of using electronic screens of primary and middle school students in China from 2016 to 2017. METHODS: From 2016 to 2017, 275 monitoring points were selected from 31 provinces in China, and 280 primary and middle school students were selected from each monitoring point to complete the survey. Using the suggestion from "Healthy China Initiative(2019-2030)"of which the screen time of primary and middle school students should be less than one hour per day as the standard. RESULTS: A total of 74 314 primary and secondary school students(except grade 9 and grade 12) were included in this study. Among them, there were 37 147 boys(50.0%) and 37 167 girls(50.0%); 44 612 pupils(60.0%), 14 858 junior school students(20.0%), and 14 844 senior high school students(20.0%); 38 995(52.5%) rural students and 35 319(47.5%) urban students; 53 287 boarding students(71.7%) and 20 537 day students(27.6%). From 2016 to 2017, the average daily screen time of Chinese primary school students was 1.45 hours, M(P25, P75) was 1.14(0.57, 1.93) h. That of junior high school students was 1.92 hours, M(P25, P75) was 1.43(0.71, 2.48) h. That of senior high school students was 2.37 hours, M(P25, P75) was 1.71(0.90, 3.02) h. The average daily screen time qualified rates of primary school, junior high and senior high school students were 46.1%, 37.1% and 27.7%, respectively. From 2016 to 2017, the most used electronic screen products of primary school students in China were TV/videos(62%), followed by mobile phones(21%). Junior high school students spent 38% and 37% of the total time watching TV/videos and playing mobile phones, respectively. High school students spend the longest time using mobile phones(49%) of the total time, followed by watching TV/videos(26%). CONCLUSION: With the increasing of grade, screen time became longer, and screen time qualified rate dropped. Moreover, the most used electronic screens were mobile phones and TV/videos.

[Status of fresh vegetables and fruit consumption among Chinese aged 60 years old and above in 2015].

OBJECTIVE: To analysis the fresh vegetables and fresh fruit consumption among the elders aged 60 and above of China in 2015. METHODS: The consumption of fresh vegetables and fresh fruits in the past 12 months was calculated by using the food frequency questionnaire data of 58 335 elderly people aged 60 and above from "China National Chronic Diseases and Nutrition Surveillance of Adults(2015)", and the intake status was evaluated according to the recommended intake of Dietary Guidelines for Chinese Residents(2016). RESULTS: The consumption rate of fresh vegetables among the elderly in China was 98. 7%, the median intake of the whole population was 270. 0 g, the median intake of the consumer population was 300. 0 g, and the proportion of under-intake was 49. 6%. The fresh fruit consumption rate was 84. 2%, the median intake of the whole population was 30. 0 g, and the median intake of the consumer population was 50. 0 g. The proportion of insufficient intake of fresh fruits reached 85. 2%. The frequency of intake of fresh vegetables was mainly 2 times/day, accounting for 45. 9%; fresh vegetables intake 1-3 times/week and ≥2 times/day were 38. 7% and 35. 6%, respectively. The consumption rate and intake of fresh vegetables and fruits were both higher in urban areas than in rural areas, and decrease significantly with increasing age, lower educational background and lower income. In addition, the consumption rate and intake were lower in elderly living alone. CONCLUSION: China& apos; s elderly people aged 60 and above have insufficient intake of vegetables and fruits. Health education and dietary guidance should be carried out, and intervention measures should be taken for key populations to effectively promote a reasonable diet for the elderly.

[Relevant effects of pathoglycemia in Chinese children and adolescents aged 6-17 in 2016-2017].

OBJECTIVE: To analyze the effects of diabetes mellitus(DM) and pathoglycemia in Chinese children and adolescents in 2016-2017. METHODS: The data originated from Nutrition and Health Survey of Chinese Children and Adolescents in 2016-2017.The multi-stage stratified cluster random sampling method in proportion was used. The subjects were selected from 275 surveillance sites, which were from 31 provinces in nationwide. Dietary survey, medical physical examination and laboratory tests were carried out in 51 902 subjects. Among them, 25 946 subjects were male and 25 956 were female, 26 340 subjects were from urban and 25 596 from rural, there were 23 637, 17 884 and 10 381 subjects in aged 6-10, 11-14 and 15-17, respectively. Factor analysis method was used to obtain the dietary patterns of children and adolescents and two-level Logistic regression model was used to analyze the association of pathoglycemia with dietary patterns, overweight and obesity. RESULTS: The prevalence of pathoglycemia and DM in Chinese children and adolescents were 2.40% and 0.26%, respectively. The prevalence of pathoglycemia(2.83%)and DM(0.32%)in urban areas was higher than that in rural(1.79% and 0.17%)(χ~2=6.90, P<0.01 and χ~2=6.88, P<0.01). The prevalence of pathoglycemia in male(3.00%) higher than that in female(1.71%)(χ~2=78.34, P<0.01). The prevalence of pathoglycemia in 11-14 years old group was the highest(3.35%)while that in 6-10 years old group was the lowest(1.86%)(χ~2=40.85, P<0.01). Two-level Logistic regression model result showed that overweight and obesity, hypertension and dyslipidemia were all associated with pathoglycemia in children and adolescents, with OR values of overweight and obesity were 1.42(95%CI 1.20-1.68) and 1.80(95%CI 1.53-2.13) respectively. The OR values of hypertension and dyslipidemia were 1.74(95%CI 1.53-1.97) and 1.38(95%CI 1.20-1.59), respectively. CONCLUSION: The prevalence of pathoglycemia and DM in Chinese children and adolescents is different in urban and rural, gender and age. Overweight and obesity, hypertension, dyslipidemia is the effects of pathoglycemia in children and adolescents.

[Status of undernutrition of left-behind children under 6 years old in rural China in 2013].

OBJECTIVE: To analyze and describe the status and characteristics of undernutrition among left-behind children under 6 years old in rural China in 2013. METHODS: Data was from the China Nutrition and Health Surveillance among 0-5 Years Old Children and Lactating Women in 2013. Stratified multistage cluster sampling method was used, and 4576 participants under 6 years old from 55 sites of 30 provinces, autonomous region and municipalities were involved. Definition of undernutrition were according to the WHO 2006 growth standard in children less than 5 years old and the WHO 2007 growth reference in children of 5 years old. Results were computed by post stratification weight based on national census from the National Bureau of Statistics in 2010. RESULTS: The prevalence of stunting was 10. 6% among left-behind children under 6 years old in rural China in 2013. It was 11. 6% in boys and 9. 4% in girls. The rate of general rural area and poor rural area were 7. 1% and 16. 6%. The prevalence of stunting showed a significant difference in sex(P=0. 022), general rural and poor rural(P=0. 006), three regions(P=0. 003), parental type of outing(P=0. 005), mother's education(P<0. 001), annual per capita household income(P<0. 001). The prevalence of underweight was 3. 2% among left-behind children under 6 years old in rural China in 2013. It was 3. 4% in boys and 2. 9% in girls. The rate of general rural area and poor rural area were 1. 6% and 2. 0%. The prevalence of stunting showed a significant difference in general rural and poor rural(P<0. 001), three regions(P<0. 001), annual per capita household income(P=0. 0144), mother's education(P<0. 001). The prevalence of wasting was 2. 3% among left-behind children under 6 years old in rural China in 2013. It was 2. 3% in boys and 2. 2% in girls. The rate of general rural area and poor rural area were 1. 5%, 3. 5%. The prevalence of stunting of general rural showed a significant difference in parental type of outing(P=0. 033), the prevalence of stunting of poor rural showed a significant difference in mother's education(P<0. 001), annual per capita household income(P=0. 020). CONCLUSION: The undernutrition rate among left-behind children under the age of 6 in rural China should be paid attention, especially in the higher subgroups of poor rural areas, western regions, low-income families, mothers away from home and mothers with less than junior middle school education.

[Intakes of dietary energy and macronutrients among the elderly aged 65 and above in China in 2015].

OBJECTIVE: To analyze the intakes of dietary energy and macronutrients among the elderly aged 65 and above in China in 2015. METHODS: Data was from the China National Chronic Non-communicable Disease and Nutrition Surveillance of adults in 2015. Stratified multistage cluster sampling method was used. The valid dietary data of 18 161 the elderly aged 65 and above were extracted from 302 surveillance sites in 31 provinces. Consecutive 3-day 24-hour dietary recall method and household cooking oils and condiments weighting method were applied to collect dietary intakes data. The intakes of daily energy and macronutrients were calculated using China Food Composition Tables 2004 and 2009, and the dietary quality were evaluated according to 2013 Chinese Dietary Reference Intakes. RESULTS: The study showed that the average intake of daily energy was 1595. 5 kcal, the average intake of carbohydrates, proteins and fats were 208. 7 g, 47. 9 g and 63. 6 g, respectively. The proportion of energy from carbohydrates, proteins and fats were 52. 7%, 12. 1% and 35. 4%, respectively. The carbohydrates intake and proportion of energy from carbohydrates among urban elderly were 202. 3 g and 51. 4%, all lower than that in rural(213. 6 g and 53. 7%, P<0. 05). While the proteins intake and proportion of energy from proteins among urban elderly were 50. 8 g and 12. 9%, all higher than rural elderly(45. 6 g and 11. 5%, P<0. 001). The fats intake and proportion of energy from fats among urban elderly were 64. 1 g and 35. 9%, rural elderly were 63. 3 g and 35. 0%, there were no significant differences in fats intake and proportion of energy from fats between urban elderly and rural elderly(P>0. 05). The dietary intake of energy and macronutrients among the oldest old were lowest, especially those in rural areas, were 1394. 4 kcal, 182. 4 g, 40. 1 g and 56. 4 g. In 2015, the rate of energy lower than EER among the elderly was 75. 8%, and the rate of percentage of energy from carbohydrates lower than DRIs was 41. 5%. The rate of proteins lower than recommended nutrient intake was 76. 6%. The rate of percentage of energy from fats higher than dietary reference intakes was 64. 5%. CONCLUSION: In China, the unreasonable dietary intake among the elderly aged 65 and above is severe, and the oldest old especially those in rural areas have the most serious deficiency in proteins intake.

[Intakes of energy and macronutrients in 6-11 years old age group in 2016-2017 in China].

OBJECTIVE: To survey the intakes of energy and macronutrients in 6-11 years old age group in 2016-2017 in China. METHODS: Multi-stage cluster randomization sampling method was used to collect the data from China Nutrition and Health Surveillance of Children and Lactating Mothers in 2016-2017 in 257 surveillance sites of 31 provinces. 24-h dietary recalls for three consecutive days were used to obtain the dietary information. The intakes of energy, protein, fat and carbohydrate were calculated by the China Food Composition, and the intakes of protein were assessing by Chinese Dietary Reference Intakes(DRIs). RESULTS: A total of 8777 children in 6-11(9. 2±1. 6) years old group were recruited in this surveillance, the number of boys and girls were 4364 and 4413, respectively. The general intakes of energy were 1591. 7 kcal and that of boys and girls were 1624. 1 kcal and 1559. 7 kcal, respectively. The energy intakes in urban children were higher than rural children. The energy intakes in the east region were the highest and the middle region were the lowest. The general protein intakes were 50. 0 g, and that of boys and girls were 50. 9 g and 49. 1 g, respectively. The intakes of protein in urban children were higher than in rural. The intakes of protein in east region were higher than that in the middle and west regions. The ratios that above RNI of protein intakes were 52. 4%, and the ratios of urban and rural were 63. 0% and 42. 9%, respectively. The general fat intakes were 69. 6 g and that of boys and girls were 71.4 g and 67.8 g, respectively. The fat intakes in urban children were higher than in rural, but in the rural of the west the fat intakes were higher than in the urban of the east. The general intakes of carbohydrate were 196. 3 g, and that of boys and girls were 199. 5 g and 193. 2 g, respectively. The carbohydrate intakes in urban children were higher than in rural, and in the west region the intakes of carbohydrate were higher than in the east region. But in the rural populations, the carbohydrate intakes in the west region were higher than that in the east region. CONCLUSION: Comparing with 2010-2013, obvious changes of energy and macronutrients intakes in China 6-11 y children were observed in 2016-2017 surveillance. Inadequate intakes of protein were still the problem in rural children populations. The increase of fat intake was larger and more significant in the western region.

[Energy and macronutrient intakes of farmers at different levels of physical activity in China from 2010 to 2012].

OBJECTIVE: To analyze the intake and structure of energy and macronutrients of farmers under three kinds of job types: working, farming and housework in China, and analyzes the intake status under different work intensity. METHODS: Based on the data of China Nutrition and Health Survey in 2010-2012, this paper analyzed the dietary intake of farmers over 18 years old at three job types and different work intensities. RESULTS: The energy intake of farmers in China was 2149. 5 kcal/d, and that of men and women were 2345. 2 kcal/d and 1985. 4 kcal/d, respectively. Farming farmers took in the highest energy and the domestic farmers took in the lowest energy. The average protein intake of farmers was 60. 8 g, 66. 0 g for men and 56. 4 g for women. The protein intake of working, farming and housework farmers, showed a downward trend. The fat intake of farmers was 66. 6 g, including 71. 9 g for men and 62. 1 g for women. With the three main forms of working, farming and housework, the fat intake showed a downward trend. The carbohydrate intake of farmers was 327. 5 g, including 354. 6 g for men and 304. 7 g for women, with farming farmers taking in the highest carbohydrate. Among the working farmers, under the light, medium and heavy work intensity, the intake of carbohydrate increased in turn, but protein and fat had no obvious characteristics; among the farming workers, under the light, medium and heavy work intensity, carbohydrate, protein and fat showed an increasing trend. There were also differences in the dietary structure characteristics among the three job types of working, farming and housework. The proportion of energy from protein and fat was higher in working farmers, the proportion of high-quality protein was close to 35%, the proportion of energy from carbohydrate was the highest in farming farmers, the proportion of high-quality protein was only 27%, the proportion of high-quality protein in household farmers was 30%, and the ratio of fat to energy in both farming and household farmers was less than 30%. Among working farmers, under the light, medium and heavy work intensity, the proportion of energy from carbohydrate increased, while the proportion of protein from animal food decreased; among farming farmers, under the light, medium and heavy work intensity, the proportion of protein from animal food increased slightly. CONCLUSION: There are some differences in the energy and macronutrients intake among the working farmers, farming farmers and household farmers in China. The farming farmers have the most energy intake, and with the increase of work intensity, the proportion of carbohydrate intake increases, and the protein intake is insufficient, especially the heavy work intensity. The nutrition needs of the population should get more attention.

[Eating out behavior and its impact on obesity among Chinese residents aged 18-59 in 2015].

OBJECTIVE: To study the eating out behavior and its impact on obesity among Chinese residents aged 18-59. METHODS: Multistage stratified random sampling method was used to collect data in 302 monitoring sites of the China National Chronic Non-communicable Disease and Nutrition Surveillance of adults in 31 provinces of China from 2015. A total of 53 887 subjects were included in this study by data cleaning. The population data published by the National Bureau of Statistics in 2010 were used as a standard population of the data result for 2015. Complex sampling weighting method was adopted in data analyses. The number and percentage of cases were used to describe the eating behaviors of different characteristics of the population, Statistical analysis was conducted by using SURVEYFREQ process, and Chi-square test was used to comparative analysis. Multi-factor analysis was conducted to the relationship between eating out frequency and different characteristics and obesity by using SURVEYLOGISTIC model regression. RESULTS: In 2015, proportions of eating out for all the three meals was 36. 1% of Chinese residents aged 18-59 in the past week, that of were 41. 3% and 24. 3% of Chinese residents aged 18-44 and 45-59, respectively. Proportions of Chinese residents was 12. 2% for eating out 1-6 times a week, 15. 8% for eating out 7-13 times a week, and 8. 1% for eating out 14-21 times a week. Results from the multivariate Logistic regression analysis showed that 18-44 years old, male, urban, highly educated, family per capita annual income ≥ 20 000 yuan, unmarried, on the job and school students chose to eat out more commonly. No statistical association was noticed between the frequency of eating out and obesity in women, men who ate out 14-21 times a week showed higher risk of obesity than those who not ate out, with OR=1. 8(95%CI 1. 3-2. 5). CONCLUSION: Proportions of eating out increased for Chinese residents aged 18-59, men who ate out 14-21 times a week showed higher risk of obesity.

[Development and validation of children physical activity questionnaire].

OBJECTIVE: To develop the physical activity questionnaire for Chinese children aged 6-17 years old, in order to evaluate the children's physical activity. METHODS: After systematic review, expert review and preliminary investigation, the "6-to 17-year-old Chinese children physical activity questionnaire(CCPAQ)" was established to measure the weekly physical activity. Based on the sample size estimation and inclusion and exclusion criteria, 120 children aged 6-17 were selected from one survey site in the south and north of China. SAS 9.4 software and Mplus 8.0 software were used for factor analyses to validate the modes and types of physical activity measured by CCPAQ. RESULTS: This study included 119 subjects in total. Exploratory factor analyses were used to assess the 33 modes and 7 types of physical activity time and extract four and one common factor, respectively. Confirmatory factor analysis fitted a second-order 4 factors model and first-order 7 factors model. The evaluation index of the two models were χ~2/df=1.41 and χ~2/df=1.61, respectively, showing that the models fitting were acceptable. CONCLUSION: CCPAQ established in this study can effectively measure the physical activity of Chinese children aged 6-17 years.

[Provincial prevalence of overweight and obesity among 0-5 years old children in China in 2013].

OBJECTIVE: To study the provincial prevalence of overweight and obesity among 0-5 years old children in China in 2013. METHODS: Data was from the China Nutrition and Health Surveillance among 0-5 years Children and Lactating Women in 2013. A stratified multistage cluster sampling was used among 0-5 years children from 31 provinces, autonomous regions, and municipalities and selected 55 districts/counties. The weight and height measurement was conducted using a standard method. The questionnaire was used to collect the information of children. The WHO 2006 growth standard and WHO 2007 growth reference were used to define the overweight and obesity in children. The data was calculated using the post-stratified weight based on provincial census from the National Bureau of Statistics in 2010. RESULTS: The sample participants were 32 861 in 2013. The provincial prevalence of overweight was in 3. 3%-16. 1% and in 0. 6%-9. 7% for obesity. Among the provinces with urban survey sites, the highest prevalence of overweight and obesity was Shandong(14. 3% and 5. 2%), the lowest was Hainan(3. 3% and 0. 6%). Among the provinces with rural survey sites, the highest rate of overweight was Shanxi(16. 1%)and the lowest was Qinghai(3. 3%), while the highest rate of obesity was Shanxi(9. 7%)and the lowest was Qinghai(0. 7%). Among the provinces with both urban and rural survey sites, the highest prevalence of overweight and obesity was in Hebei(14. 3% and 6. 6%), the lowest was in Guizhou(3. 5% and 0. 9%). CONCLUSION: The prevalence of overweight and obesity among 0-5 years old children was higher in central and middle region in China.

[Cognition and control of weight among 15-49 years old women of childbearing age in China during 2010-2013].

OBJECTIVE: To analyze the weight recognition and control among women aged 15-49 in China. METHODS: Data was from the China National Nutrition and Health Surveillance 2010-2013. Stratified multistage cluster sampling method was used. The data of 35 664(16 914 urban women and 18 750 rural women) 15-49 years old women of childbearing age was used. The basic information was collected by questionnaires. Physical measurement indexes such as height and weight were collected. RESULTS: Among overweight and obese women of childbearing age, only 34. 9%(95%CI 34. 2%-35. 6%) of them correctly judged themselves overweight or obese, and 61. 4%(95% CI 60. 6%-62. 1%) of them thought they were normal weight; 10. 8%(95%CI10. 3%-11. 2%) of the normal-weight women thought they were overweight; while 3. 0%(95% CI 2. 6%-3. 4%) of the low-weight women thought they were overweight. Only17. 1%(95% CI 16. 4%-17. 8%) of overweight and obese women of childbearing age take weight control measures. In addition, 3. 6%(95% CI 3. 1%-4. 1%) of low-weight women of childbearing age and 9. 7%(95% CI 9. 3%-10. 1%) of normal-weight women took weight control measures, respectively. The proportion of women aged 15-24 taking weight control measures was higher than that of women aged 25-34 and 35-49, 14. 8%(95% CI 13. 3%-16. 4%), 12. 2%(95% CI 11. 1%-13. 2%) and 10. 0%(95% CI9. 3%-10. 1%), respectively. The proportion of women aged 15-24 taking weight control measures was the highest among normal weight women and overweight and obese women, 13. 9%(95% CI 13. 1%-14. 7%) and 26. 9%(95% CI 26. 4%-27. 4%), respectively. CONCLUSION: At present, there were more women of childbearing age in China who could not correctly assess their own body weight, leading to the inability to take correct weight control measures.