Effect of multidimensional lifestyle interventions on metabolic risk reduction in children: a cluster randomised controlled trial.

Few clinical trials have investigated lifestyle intervention effect on metabolic health in children. The study aimed to examine the effect of diet and physical activity intervention on the reduction of clustered metabolic risk score (CMRS) in children and moderators and mediators of the intervention effect. A multicentre, clustered randomised controlled trial was conducted with examination conducted at baseline and after intervention over one year. 7110 children (49.7% girls) with a mean of 9.06 (95% CI: 9.03, 9.09) years were included in the analysis. In Beijing, each three schools were randomly assigned to diet-only, physical activity-only intervention and control groups. In five other urban cities, each 15 schools were randomly assigned to comprehensive intervention and control groups. CMRS was computed by summing the Z scores of % fat mass, systolic blood pressure, fasting glucose, ratio of cholesterol to high-density lipoprotein, and triglyceride. Compared with controls (n = 2808), children in the comprehensive intervention group (n = 2848) had more reduction in CMRS (multivariate-adjusted mean difference (95% CI): -0.49 (-0.85, -0.14)). The body mass index (BMI) reduction explained 7.3% (95% CI 2.8%-18.1%) of the total intervention effect. The intervention was more effective in children with higher birthweight, lower parental BMI, or complete parental data. Diet-only or physical activity-only intervention had non-significant effects on CMRS reduction. Our multidimensional comprehensive intervention resulted in significant reduction in CMRS in primary school children and this effect was modified by birthweight, parental BMI, and parental involvement. A minority of metabolic risk reduction was mediated through BMI. Clinical Trial Registry number and website: ChiCTR-PRC-09000402, URL: http://www.chictr.org.cn.

Leading dietary determinants identified using machine learning techniques and a healthy diet score for changes in cardiometabolic risk factors in children: a longitudinal analysis.

BACKGROUND: Identifying leading dietary determinants for cardiometabolic risk (CMR) factors is urgent for prioritizing interventions in children. We aimed to identify leading dietary determinants for the change in CMR and create a healthy diet score (HDS) to predict CMR in children. METHODS: We included 5676 children aged 6-13 years in the final analysis with physical examinations, blood tests, and diets assessed at baseline and one year later. CMR score (CMRS) was computed by summing Z-scores of waist circumference, an average of systolic and diastolic blood pressure (SBP and DBP), fasting glucose, high-density lipoprotein cholesterol (HDL-C, multiplying by - 1), and triglycerides. Machine learning was used to identify leading dietary determinants for CMR and an HDS was then computed. RESULTS: The nine leading predictors for CMRS were refined grains, seafood, fried foods, sugar-sweetened beverages, wheat, red meat other than pork, rice, fungi and algae, and roots and tubers with the contribution ranging from 3.9 to 19.6% of the total variance. Diets high in seafood, rice, and red meat other than pork but low in other six food groups were associated with a favorable change in CMRS. The HDS was computed based on these nine dietary factors. Children with HDS ≥8 had a higher decrease in CMRS (ß (95% CI): - 1.02 (- 1.31, - 0.73)), BMI (- 0.08 (- 0.16, - 0.00)), SBP (- 0.46 (- 0.58, - 0.34)), DBP (- 0.46 (- 0.58, - 0.34)), mean arterial pressure (- 0.50 (- 0.62, - 0.38)), fasting glucose (- 0.22 (- 0.32, - 0.11)), insulin (- 0.52 (- 0.71, - 0.32)), and HOMA-IR (- 0.55 (- 0.73, - 0.36)) compared to those with HDS ≦3. Improved HDS during follow-up was associated with favorable changes in CMRS, BMI, percent body fat, SBP, DBP, mean arterial pressure, HDL-C, fasting glucose, insulin, and HOMA-IR. CONCLUSION: Diets high in seafood, rice, and red meat other than pork and low in refined grains, fried foods, sugar-sweetened beverages, and wheat are leading healthy dietary factors for metabolic health in children. HDS is strongly predictive of CMR factors.

The Influence of Fluid Intake Behavior on Cognition and Mood among College Students in Baoding, China.

INTRODUCTION: Water is a critical nutrient, and it is important for the maintenance of the physiological function of the human body [1-3]. In addition to fluid amounts, fluid intake frequency is also important for hydration status [4, 5]. At present, only few guidelines mention fluid intake behavior that recommend drinking water frequently while in small quantities, however, there is no scientific evidence to support it. Therefore, it is necessary to explore the appropriate fluid intake behavior. OBJECTIVE: The objective of this study is to evaluate the influence of different fluid intake behavior on cognition and mood, to provide scientific basis for proposing the appropriate fluid intake behavior. METHODS: A double-blinded randomized controlled trial was designed and implemented among college students aged 18-23 years in Baoding, China. Subjects were randomly assigned into each of 3 groups using a random number generated by computer software: the subjects consuming plain water 200 mL/2 h, that is, 1,600 mL during whole day (group 1), 100 mL/2 h, that is, 800 mL during whole day (group 2), and 110 mL/1 h, that is, 1,650 mL during whole day (group 3), respectively. Subjects were asked to fast from 11:00 p.m., without consuming any foods or drinks the day before the intervention. From 8:00 a.m. to 10:00 p.m. of the first study day, subjects consumed water according to the instructions and repeated it from 8:00 a.m. to 4:00 p.m. of the second study day. Cognition, mood, and urine osmolality were collected twice at 10:00 a.m. (time 1) and 4:00 p.m. (time 2) of the second study day (shown in Fig. 1). RESULTS: A total of 92 subjects (46 males, 46 females) completed this study. It was found that the increasing fluid intake amounts lead to an increase in urine output and a decrease in urine osmolality (p < 0.05). Use the mixed models to compare measurements for groups 1 and 2, which showed that when compared with those drinking 800 mL per day, people who drank 1,600 mL per day scored higher in vigor (11.8 vs. 9.1, p < 0.05) and portrait memory test (22.6 vs. 20.8, p < 0.05) but lower in total mood disturbance (90.8 vs. 97.8, p < 0.05). By comparing groups 1 and 3, the results indicated that compared with drinking 8 times per day, people who drank 15 times per day scored lower in portrait memory test (21.8 vs. 22.6, p < 0.05) and hunger (3.3 vs. 3.6, p < 0.05). CONCLUSIONS: Reasonable fluid intake behavior may be beneficial to improve the cognition and mood of college students. The fluid intake behavior, which is consuming water 200 mL each time and 8 times per day, is recommended. More studies are needed to advise people to have health-beneficial fluid intake behavior.

Cost-utility and cost-benefit analyses of school-based obesity prevention program.

BACKGROUND: Economic evaluation of school-based obesity interventions could provide support for public health decision of obesity prevention. This study is to perform cost-utility and cost-benefit assessment of three school-based childhood obesity interventions including nutrition education intervention (NE), physical activity intervention (PA) and comprehensive intervention (both NE and PA, CNP) with secondary data analysis of one randomized controlled trial. METHODS: The standard cost-effectiveness analysis methods were employed from a societal perspective to the health outcome and costs that are attributable to the intervention. NE, PA and CNP were carried out separately for 2 semesters for childhood obesity interventions in primary schools. The additional quality-adjusted life years (QALYs) resulting from the interventions were measured as the health outcome. A cost-utility ratio (CUR) and A cost-benefit ratio (CBR) was calculated as the ratio of implementation costs to the total medical and productivity loss costs averted by the interventions. RESULTS: The CUR and CBR were ¥11,505.9 ($1646.0) per QALY and ¥1.2 benefit per ¥1 cost respectively, and the net saving was ¥73,659.6 ($10,537.9). The CUR and CBR for nutrition education and physical activity interventions were ¥21,316.4 ($3049.6) per QALY and ¥0.7 benefit per ¥1 cost, ¥28,417.1 ($4065.4) per QALY and ¥0.4 benefit per ¥1 cost, respectively (in 2019 RMB). Compared with PA intervention, the ICERs were ¥10,335.2 ($1478.6) and 4626.3 ($661.8) for CNP and NE respectively. The CBR was ¥1.2, 0.7, and 0.4 benefits per ¥1 cost for CNP, NE, and PA interventions, respectively. Net estimated savings were achieved only through CNP intervention, amounting to ¥73,659.6 ($10,537.9). CONCLUSIONS: Comprehensive school-based obesity intervention is a beneficial investment that is both cost-effective and cost saving. Compared with PA intervention, both CNP and NE intervention were more cost-effective.

Drinking patterns and hydration biomarkers among young adults with different levels of habitual total drinking fluids intake in Baoding, Hebei Province, China: a cross-sectional study.

BACKGROUND: The purposes were to investigate the drinking patterns and hydration biomarkers among young adults with different levels of habitual total drinking fluids intake. METHODS: A cross-sectional study was conducted among 159 young adults aged 18-23 years in Baoding, China. Total drinking fluids and water from food were assessed by 7-day 24-h fluid intake questionnaire and duplicate portion method, respectively. The osmolality and electrolyte concentrations of the 24 h urine and fasting blood samples were tested. Differences in LD1 (low drinker), LD2, LD3 and HD (high drinker) groups, stratified according to the quartiles of total drinking fluids, were compared using one-way ANOVA, Kruskal-Wallis H test and chi-square test. RESULTS: A total of 156 participants (80 males and 76 females) completed the study. HD group had greater amounts of TWI (Total Water Intake), water from food, higher and lower contributions of total drinking fluids and water from food to TWI, respectively, than LD1, LD2 and LD3 groups (p < 0.05). Participants in HD group had higher amounts of water and water from dishes than participants in LD1, LD2 and LD3 groups (p < 0.05). No significant differences were found in the contributions of different fluids to total drinking fluids within the four groups (p > 0.05). The osmolality of urine was 59-143 mOsm/kg higher in LD1 than that in LD2, LD3 and HD group (p < 0.05). The percentage of participants in optimal hydration status increased from 12.8% in LD1 group to 56.4% in HD group (p < 0.05). HD and LD3 groups had 386~793 higher volumes of urine than that of LD1 and LD2 groups (p < 0.05). Differences were found in the concentrations of electrolytes among the four groups (p < 0.05). No significant differences were found in the plasma biomarkers (p > 0.05), with the exception of higher concentration of Mg in LD3 and HD groups than that in LD1 and LD2 groups (p < 0.05). CONCLUSIONS: Participants with higher total drinking fluids had better drinking pattern and hydration status. Interventions should be undertaken to advise adults to have adequate total drinking fluids, in order to keep in optimal hydration status. TRIAL REGISTRATION: The registration number was ChiCTR-ROC-17010320, which was registered on the Chinese clinical trial registry.

The amounts and contributions of total drinking fluids and water from food to total water intake of young adults in Baoding, China.

PURPOSE: To investigate the amounts and contributions of total drinking fluids and water from food to total water intake (TWI), to explore the drinking pattern, and to compare the amount of TWI with the recommendations of China and EFSA among young adults. METHODS: A cross-sectional study was implemented with 159 young adults aged 18-23 years from Hebei, China. Total drinking fluids and water from food were assessed by 7-day 24-h fluid intake questionnaire and the duplicate portion method, respectively. Differences between groups stratified according to the distribution of TWI were compared using one-way ANOVA and Kruskal-Wallis H test. General linear models were used to identify the variations in TWI due to total drinking fluids and water from food. RESULTS: In total, 156 subjects (80 males and 76 females) completed the study. Approximately 80.1% of them did not meet the TWI recommended by China, while 50.0% did not meet that recommended by the EFSA. Participants with higher TWI had greater amounts of total drinking fluids, water rom food and water than their counterparts with lower TWI. The regression between total drinking fluids and TWI was R2 = 0.8526 (P < 0.05) and that between water from food and TWI was R2 = 0.4650 (P < 0.05). CONCLUSIONS: A large proportion of young adults have insufficient TWI. Participants with lower TWI would not compensate with water from food. The variances in TWI among participants were mainly due to differences in total drinking fluids. There is an urgent need to improve the fluids intake behaviors of young adults.

Advances and gaps in recommendations for adequate water intake in China.

Water is essential for life survival and development. It plays a pivotal role in metabolic function, modulates normal osmotic pressure, maintains the electrolyte balance, and regulates body temperature. Adequate water intake is necessary for optimal hydration-both excessive and insufficient water consumption can have adverse effects on health. Water requirements among people vary based on various factors such as gender, age, physical activity, dietary factors, ambient temperature, and renal concentrating capacity. In recent years, water intake guidelines have been developed in some countries and by some organisations. Even in China, it is important to develop such guidelines considering specific dietary habits, height of people, and environmental factors. In 2013, guidelines for adequate water intake were developed in China, but the scope was somewhat limited; there are still specific challenges in formulating such recommendations. Future water-related studies should focus on surveying water intake among infants and toddlers, older adults, and pregnant and lactating women. Moreover, additional studies should be conducted to elucidate water intake among adults and adolescents in different regions and seasons, and the association between water intake and related diseases should also be investigated. It is imperative to transform the results of scientific research into action plans for water-related health education so as to inform and evaluate pertinent public health programmes.

[Study on the psychological health condition among junior and senior high school students in Beijing, Shanghai and Guangzhou].

OBJECTIVE: To describe the status and difference of students' mental health in junior high school, ordinary high school and vocational high school in Beijing, Shanghai and Guangzhou. METHODS: 135 schools and 14 473 students were randomly selected and stratified to draw the sample. Mental Health Test (MHT) was used to measure the status of students' mental health. RESULTS: Among 13 286 valid questionnaire, 2.1% students were mentally disabled, more females reported their mental problems (2.1%) than males (1.9%). Students from Shanghai (2.5%) and Beijing (2.3%) were more likely to report their mental problems than students from Guangzhou (1.6%), which were statistically significant. The top three mental problems includes anxiety (42.6%), physical condition (11.1%) and self - blame tendency (9.7%), etc. CONCLUSION: Students from Beijing, Shanghai and Guangzhou got different extend of mental problems.

[Knowledge, attitude and practice on drinking water of primary and secondary students in Shenzhen].

OBJECTIVE: To investigate the status on drinking water related knowledge, attitude and practice of primary and secondary students in Shenzhen. METHODS: All 832 primary and secondary students from three schools in Shenzhen were selected by using multi-stage random sampling method. The information of drinking water related knowledge, time of drinking water and the type of drink chose in different situations were collected by questionnaires. RESULTS: 87.3% of students considered plain water being the healthiest drink in daily life, and the percent in girls (90.6%) was significantly higher than that in boys (84.4% ) (chi2 = 7.13, P = 0.0089). The awareness percent of the harm of dehydration was 84.5%. The percent in high school students (96.4%) was significantly higher than that in primary (73.9%) and middle school students (94.2%) (chi2 = 73.77, P < 0.0001). 63.7% of students considered that the healthiest time of drinking water was in the morning with an empty stomach, and 46.3% chose when they felt thirsty. However, 63.7% drank water when they felt thirsty, and 50.6% drank water in the morning with an empty stomach. The percent of drinking plain water at school was the highest (83.4%), followed by at home (64.1%) and in public (26.2%). There were 45.2% and 53.3% of students, respectively, choosing sugary drinks as their favorite drink and most frequently drinking in public places. CONCLUSION: Primary and secondary students in Shenzhen have a good awareness of drinking water, which is inconsistent with their practice. Meanwhile, a considerable proportion of students towards choosing drinks have many misconceptions. The education of healthy drinking water should be strengthened.

[The relationship between within-day drinking occasion and intake amount of water of primary and middle school students in four cities of China].

OBJECTIVE: To investigate the number of drinking occasions per day and average amount consumed per drinking occasion of primary and middle school students in four cities of China, and understand the relationship among drinking occasion, average amount consumed per drinking occasion and total drinking water. METHODS: A total of 5914 primary and middle school students from Beijing, Shanghai, Guangzhou and Chengdu were selected using multiple-stage random sampling method, and 5868 students completed the study from September to October in 2011. The detailed information of amounts and types of daily drinking water was recorded by subjects using a 24 hours measurement for seven consecutive days. Analysis of the relationship among drinking occasion, average amount consumed per drinking occasion and total drinking water was carried out. RESULTS: The daily total drinking water of subjects was (1089 ± 540) ml; the daily number of drinking occasions was (4.7 ± 1.8) times, with 79.1% (4639/5868) of subjects reporting 6 or less drinking occasions. The amount consumed per drinking occasion was (239 ± 96) ml, plain water (231 ± 112) ml, and beverages (237 ± 112) ml. The number of drinking occasions of subjects was positively correlated with total drinking water (r = 0.614, P < 0.05), and negatively correlated with the average amount consumed per drinking occasion (r = -0.211, P < 0.05). Total drinking water and the average amount consumed per drinking occasion was positively correlated (r = 0.598, P < 0.05). CONCLUSION: The number of drinking occasion of primary and middle school students more than 6 times was fewer in four cities of China, but the average amount of beverages consumed per drinking occasion was relatively more. With the increasing of drinking occasion, the average amount consumed per drinking occasion decreased, but total drinking water increased.

[Daily intake of plain water and beverages of primary and middle school students in four cities of China].

OBJECTIVE: To describe the daily consumption of plain water and beverages of primary and middle school students in four cities of China. METHODS: A total of 5914 students from Beijing, Shanghai, Guangzhou and Chengdu were selected using multiple-stage random sampling method, and 5868 students completed the study from September to October 2011. The information on amounts and types of drinking water was recorded using a 24 hour measurement for seven consecutive days. The amount of plain water and beverages was analyzed for subjects in different gender, grades and cities. RESULTS: The daily consumption of plain water of subjects was (744 ± 484) ml (68.3% of total drinking water) with statistically significant difference among the Guangzhou, Beijing, Shanghai and Chengdu ((869 ± 528), (818 ± 518), (702 ± 471), and (573 ± 333) ml; F = 113.74, P < 0.05). The amount of plain water in boys (809 ± 534) ml was significantly higher than in girls (683 ± 436) ml (Z = 9.58, P < 0.05) while higher in urban (792 ± 531) ml than in rural (695 ± 427) ml (Z = -6.09, P < 0.05). The consumption of plain water in high school students was the highest (829 ± 513) ml, and that in primary students was the lowest (672 ± 426) ml (F = 55.23, P < 0.05). The average daily consumption of beverages was (345 ± 287) ml (31.7% of total drinking water) and the highest in Shanghai (424 ± 304) ml, then in Beijing (347 ± 303) ml and in Guangzhou (316 ± 267) ml, the lowest in Chengdu (293 ± 255) ml (F = 58.94, P < 0.05). The consumption of beverages for students in urban areas (394 ± 301) ml was higher than that in rural areas (296 ± 264) ml (Z = -14.48, P < 0.05), but no significant difference between boys (348 ± 306) ml and girls (342 ± 269) ml (Z = -1.44, P > 0.05). The consumption of beverages of high school students (356 ± 309) ml and middle school students (360 ± 301) ml were higher than primary school students (328 ± 263) ml (F = 8.37, P < 0.05). CONCLUSION: The major drinking water of primary and middle school students in four cities of China was plain water. The amounts of consumption of plain water and beverages varied in different cities, urban and rural and levels of education.

[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 in different periods of a day of primary and middle school students in four cities of China].

OBJECTIVE: To investigate intake of water in different periods of a day of primary and middle school students in Beijing, Shanghai, Guangzhou and Chengdu of China. METHODS: A total of 5914 primary and middle school students from Beijing, Shanghai, Guangzhou and Chengdu were recruited using multiple-stage random sampling method from September to October 2011. Among them, 5868 students completed the survey. The information of amounts and types of drinking in 8 time periods, morning, afternoon, night as well as in meal and non-meal time in 24 hours of a day was recorded by subjects for seven consecutive days using a quantitative measurement. This information was analyzed by different periods. RESULTS: The amount of drinking water among 8 periods of a day was (99 ± 101), (130 ± 106), (191 ± 155), (96 ± 107), (246 ± 172), (90 ± 101), (188 ± 135) and (50 ± 81) ml, respectively for before breakfast, during breakfast, after breakfast, during lunch, after lunch, during dinner, after dinner, and midnight (F = 1679.77, P < 0.01). Based on three periods of a day, the amount of drinking water in the morning (420 ± 242) ml was the statistically significantly most, followed by afternoon (341 ± 199) ml, and the least in the evening (327 ± 195) ml (F = 325.23, P < 0.01). The distribution trend of plain water in three periods was the same as total drinking water, with (270 ± 209), (250 ± 179) and (224 ± 177) ml, respectively (F = 84.89, P < 0.01) ; but beverage consumption was the most in the morning(151 ± 133) ml, then in the evening (103 ± 122) ml, and the least in the afternoon (91 ± 199) ml (F = 373.56, P < 0.01). The daily plain water consumption in meal time was (316 ± 247) ml, while it in non-meal time was (773 ± 445) ml with statistically significant difference (Z = 65.2, P < 0.01). There was no significant difference in meal time between plain water (165 ± 194) ml and beverage (151 ± 152) ml (Z = 0.59, P = 0.56) whilst plain water (579 ± 408) ml in non-meal time was significantly higher than beverages (194 ± 204) ml (Z = 64.5, P < 0.01). CONCLUSION: The amount of drinking water of primary and middle school students in different periods of a day was different in four cities of China.

[Relationships between serum ghrelin and lipid profile and serum leptin, adiponectin, and insulin among children in Beijing, China].

OBJECTIVE: To study the relationship between serum ghrelin and lipid profile and serum leptin, adiponectin, and insulin among children in Beijing. METHODS: A total of 879 pupils aged 8 - 10 years were randomly selected. Height, body weight, waist circumference, body mass index (BMI), body fat percentage (%BF), blood lipid, serum leptin, insulin, adiponectin and ghrelin were measured in all samples. RESULTS: Ghrelin associated negatively with body weight, waist circumference, BMI, %BF, serum leptin level and positively with HDL-C. Factor analysis has shown five factors which were sufficient to explain correlations between variables-body composition and leptin, dyslipidemia, glucose metabolism and adiponectin. CONCLUSION: Serum ghrelin level correlated strongly with body weight, waist circumference, BMI, %BF and leptin, Our finding suggested significantly increased leptin levels following decreased ghrelin levels could mostly disordered adipose metabolism at early obesity in children.

[Total drinking water intake and sources of children and adolescent in one district of Shenzhen].

OBJECTIVE: To describe total drinking water intake among primary and middle school students in one district of Shenzhen and to provide scientific evidence for adequate intakes of drinking water for different people in China. METHOD: A total of 816 students from three primary and middle schools of Shenzhen was selected using three-stage random sampling method. The information on amounts and types of daily drinking water was recorded by subjects for seven consecutive days using a 24 hours measurement. The amounts and types of daily drinking water among different ages and between boys and girls were analyzed. RESULTS: The average total drinking water of subjects was (1225+/-557) ml/d, and the consumption of total drinking water in boys ((1303+/-639) ml/d) was significantly higher than that in girls ((1134+/-478) ml/d, P<0.01). The consumption of total drinking water of secondary school students ((1389+/-541) ml/d) and high school student ((1318+/-641) ml/d) was no statistically difference, but was higher than primary school students ((1097+/-525) ml/d, P<0.01). The average plain water and beverages of the subjects was (818+/-541) ml/d and (407+/-294) ml/d respectively. CONCLUSION: Major of fluid intake comes from drinking water in children and adolescenct of Shenzhen. The knowledge of drinking water of primary school students is need to comprehensive enough.

The Association between the School Environment and Adolescent Alcohol Drinking Behavior in Six Cities in China.

Drinking alcohol during adolescence has short-term and long-term effects on physical and mental health. At this stage, teenagers are greatly influenced by their schoolmates and friends. We conducted a multicenter cross-sectional study to investigate the association between school environment factors and adolescents' drinking behavior in China. Using multistage stratified cluster sampling, the study investigated 27,762 middle school students from six cities in China. The logistic regression model was used to explore the association between the school environment and adolescent alcohol drinking behaviors after adjusting for confounders, including gender, age, city, location, and smoking status. Compared with students with none of their close friends drinking, students with more than half of their close friends drinking were more likely to drink in a year (OR = 20.148, 95% CI: 17.722−22.905, p < 0.001) and in a month (OR = 13.433, 95% CI: 11.779−15.319, p < 0.001). In addition, classmates' drinking behaviors, friends' persuasion, and attending parties were risk factors for adolescents' drinking behavior, while the propaganda and regulations of banning drinking in school were protective factors. The school environment, especially friends drinking, is associated with students' drinking behavior. It is necessary to mobilize the strength of schools and peers to strengthen the prevention and control of adolescent drinking.

Dehydration and rehydration affect brain regional density and homogeneity among young male adults, determined via magnetic resonance imaging: A pilot self-control trial.

The effects of dehydration and rehydration on brain regional density and homogeneity are unknown and have been infrequently studied. In this pilot self-control study, twelve participants aged 18-25 years were recruited and the brain was scanned using magnetic resonance imaging for three tests under different hydration statuses. In three tests, urine osmolality was determined to assess hydration status. Test 1 was conducted after 12 h of overnight fasting. Test 2 was conducted in a dehydration state induced by 36 h of water deprivation. Test 3 was conducted in a rehydration state, which was induced by 1.5 L of purified water supplementation. Compared with test 1, participants under the dehydration state in test 2 had higher cerebrospinal fluid density (p < 0.001). Compared with test 2, participants under the rehydration state in test 3 showed an extensive increase in gray matter density in widespread brain regions, mainly involving the left middle temporal gyrus, cuneus, right thalamus, left rolandic opercula, Brodmann area 39, right precentral, left postcentral gyrus, and cingulate gyrus (p < 0.001); a higher white matter density in the temporal lobe, sub-lobar, and sub-gyral areas; and a lower cerebrospinal fluid density (p < 0.001). The multimodal, multiscale neuroimaging marker of the human brain connection-the regional homogeneity (ReHo) index-was used for evaluating the connectivity of nodes in the brain. Compared with test 1, participants in test 2 had a lower ReHo value in the right amygdala, left occiput median, right lingual, opercula part of right inferior frontal gyrus, and right precuneus (p < 0.01). Compared with test 2, participants in test 3 had a higher ReHo value in the right amygdala, right lingual, opercula part of the right inferior frontal gyrus, and right precuneus (p < 0.01). Dehydration state increased cerebrospinal fluid density, decreased brain regional homogeneity. Rehydration state increased brain gray matter and white matter density widespreadly, and increased brain regional homogeneity.

Acute Water Supplementation Improved the Body Composition of Young Female Adults After Water Restriction of 12 h in Baoding, China: A Randomized Controlled Trial (RCT).

Insufficient intake of water may influence the balance of water in the human body. In this study, we explore the impacts of water supplementation on body composition indices among young adults after 12 h of water restriction, with the aim to determine the optimum volume of water for improving body water composition. A randomized controlled trial study was conducted among 64 young men and women in Baoding, China. After fasting overnight for 12 h, anthropometric measurements and urine and blood samples were collected as a baseline test at 8:00 a.m. of Day 2. Body composition was determined by measuring the ECW (extracellular water), ICW (intracellular water), and TBW (total body water) through bioelectrical impedance analysis (BIA). The participants were randomly divided into four groups, including water supplementation (WS) groups 1, 2, and 3, with 500, 200, and 100 mL of water, respectively, and a no water supplementation (NW) group. After 90 min, they were reassessed in a rehydration test (at 10:00 a.m. of Day 2). Repeated measurement ANOVA was used to assess the impact of water supplementation on body composition. Comparing the baseline and rehydration tests, interactions between time and volume were not significant among the men (all p > 0.05). Among women, a significant interaction was only found in ECW (p = 0.043), with TBW tending toward being significant (p = 0.055). Comparing the baseline and rehydration tests, the ECW in WS group 1, WS group 3, and the NW group all decreased (p = 0.028, p = 0.001, and p = 0.029), with reductions of 0.1, 0.3, and 0.2 kg, respectively; however, no significant decrease was observed in WS group 2 (p = 0.329). Furthermore, comparing the WS groups with the NW group in the rehydration test, the differences were not significant (p = 1.000, p = 1.000, and p = 0.288, respectively). Between men and women within groups, all of the body composition indices differed significantly, both at baseline and rehydration tests (all p < 0.05). Water supplementation led to changes in the distribution of the water content in young female adults in this study-but not men-after 12 h of water restriction, with no decrease in ECW. Finally, we found that 200 mL was the minimum volume capable of improving the water content distribution in participants in this study. Trial Registration: [www.chictr.org.cn], identifier [ChiCTR-IOR-17011568].

Young Adults with Higher Salt Intake Have Inferior Hydration Status: A Cross-Sectional Study.

The body's water and sodium balances are tightly regulated and monitored by the brain. Few studies have explored the relationship between water and salt intake, and whether sodium intake with different levels of fluid intake leads to changes in hydration status remains unknown. The aim of the present study was to determine the patterns of water intake and hydration status among young adults with different levels of daily salt intakes. Participants' total drinking fluids and water from food were determined by a 7-day 24-h fluid intake questionnaire for 7 days (from Day 1 to Day 7) and duplicate portion method (Day 5, Day 6 and Day 7). Urine of 24 h for 3 days (Day 5, Day 6 and Day 7) was collected and tested for the osmolality, the urine-specific gravity (USG), the concentrations of electrolytes, pH, creatinine, uric acid and the urea. The fasting blood samples for 1 day (Day 6) were collected and measured for the osmolality and the concentrations of electrolytes. The salt intakes of the participants were evaluated from the concentrations of Na of 24 h urine of 3 days (Day 5, Day 6 and Day 7). Participants were divided into four groups according to the quartile of salt intake, including the low salt intake (LS1), LS2, high salt intake (HS1) and HS2 groups. In total, 156 participants (including 80 male and 76 female young adults) completed the study. The salt intakes were 7.6, 10.9, 14.7 and 22.4 g among participants in the four groups (LS1, LS2, HS1 and HS2 groups, respectively), which differed significantly in all groups (F = 252.020; all p < 0.05). Compared to the LS1 and LS2 groups, the HS2 group had 310-381, 250-358 and 382-655 mL more amounts of water from the total water intake (TWI), total drinking fluids and water from food (all p < 0.05), respectively. Participants in the HS2 group had 384-403, 129-228 and 81-114 mL more in the water, water from dishes and staple foods, respectively, than those in the groups of LS1 and LS2 (p < 0.05). The HS2 group excreted 386-793 mL more urine than those in the groups of LS1 and LS2 (p < 0.05). However, regarding urine osmolality, the percentage of participants with optimal hydration status decreased from 41.0% in LS1 and LS2 to 25.6% in the HS2 group (p < 0.05). Participants with higher salt intake had higher TWI, total drinking fluids and water from food. Nevertheless, they had inferior hydration status. A reduction in salt intake should be encouraged among young adults to maintain optimal hydration status.

Low Dietary Diversity for Recommended Food Groups Increases the Risk of Obesity among Children: Evidence from a Chinese Longitudinal Study.

The association between dietary diversity and childhood obesity remains unclear; therefore, this longitudinal study was conducted to analyze the effect of dietary diversity on childhood obesity. One year after the first investigation, a follow-up was completed in 2010. A total of 4538 participants were included for analysis. Dietary diversity scores were calculated based on the consumption of nine recommended food groups which were categorized in accordance with the 2013 United Nations Food and Agriculture Organization guidelines. After a one-year follow-up, the low-score group underwent a significantly more considerable change in weight, body mass index, and body fat percentage than the high-score group (4.62 vs. 4.06 kg, 0.76 vs. 0.51 kg/m2, and 1.99% vs. 1.13%, respectively). Furthermore, in the low-score group, the odds ratios for overweight, obese, and overweight and obese were 1.76 (95% CI: 1.17, 2.65), 0.99 (95% CI: 0.67, 1.46), and 1.35 (95% CI: 1.01, 1.81), and the relative risks were 1.81 (95% CI: 1.03, 3.19), 2.31 (95% CI: 0.81, 6.59), and 1.98 (95% CI: 1.20,3.28), respectively. Low dietary diversity for the recommended food groups was associated with a high weight, high body mass index, and high body fat, which was associated with an increased risk of being overweight or obese in Chinese children.