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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Variable iodine intake persists in the context of universal salt iodization in China.

Iodine deficiency disorders were prevalent in China until the introduction of universal salt iodization in 1995. Concerns have recently arisen about possible excess iodine intake in this context. To document iodine intake and the contribution from iodized salt in China, we surveyed dietary iodine intake during China's nationally representative 2007 total diet study (TDS) and during an additional TDS in 4 coastal provinces and Beijing in 2009. Iodine intake was broken down by age and sex in 2009. Mean daily iodine and salt intake and the contribution from different food and beverage groups (and in 2009, individual items) was measured. The iodine in food cooked with iodized and noniodized salt was also assessed. The mean calculated iodine intake of a standard male in China was 425 µg/d in 2007 and 325 µg/d in coastal areas in 2009, well below the upper limit (UL) in all provinces. In 2009, iodine intake was above the UL in only 1-7% of age-sex groups, except among children (18-19%). A concerning number of individuals consumed less than the WHO-recommended daily allowance, including 31.5% of adult women. Salt contributed 63.5% of food iodine, and 24.6% of salt iodine was lost in cooking. Overall salt consumption declined between the surveys. Salt iodization assures iodine nutrition in China where environmental iodine is widely lacking. The risk of iodine excess is low, but planned decreases in salt iodization levels may increase the existing risk of inadequate intake. Regular monitoring of urinary iodine and more research on the impact of excess iodine intake is recommended.

[Study on effects of eating behaviors intervention for 3-5 years old children in Beijing and Shanghai].

OBJECTIVE: To improve the unhealthy eating behaviors in 3-5 years old children and enrich the nutrition knowledge of their parents by the multi-channel health education intervention, and evaluate the effects of intervention. METHODS: By random multi-stage cluster sampling, 810 children (3-5 years old) and their parents were selected from Beijing and Shanghai respectively. The period of intervention was 6 months. Questionnaire surveys about children's eating behavior and the knowledge of their parents were conducted before and after the intervention. RESULTS: After the intervention, the proportion of partial eclipse and drinking beverage declined from 44.5% and 70.4% to 35.5% and 31.7% respectively. The proportion of having regular meal time, fixed dining place, eating by oneself, fix quantify diet and concentrating on food elevate from 80.0%, 87.3%, 73.4%, 32.1% and 27.1% to 92.1%, 90.2%, 83.7%, 44.3% and 40.1%. The awareness about nutrition in parents increased and the attitude to the children's eating behaviors improved after the intervention. CONCLUSION: The intervention has some effects on the improvement of the children' s unhealthy eating behaviors and their parents' nutrition knowledge and attitude.

[Water intake of adults in four cities of China in summer].

OBJECTIVES: To investigate total drinking water intake of adults in the four cities of China in summer. METHODS: A total of 1483 adults aged 18 - 60 yrs from Beijing, Shanghai, Chengdu and Guangzhou were selected using multiple-stage random sampling method. The information of amounts and types of daily drinking water was recorded by subjects for seven consecutive days using a quantitative measurement. The amounts and types of daily drinking water among different cities and between men and women or urban and rural was analyzed. RESULTS: The median of daily total drinking water of subjects was 1488 ml, with significant difference among the four cities (1579, 1793, 1150, 1467 ml in Beijing, Shanghai, Chengdu and Guangzhou city, respectively, χ(2) = 154.31, P = 0.000). The median of daily drinking water was significantly higher in men (1679 ml) than women (1370 ml) (Z = 8.34, P = 0.000), but no significant difference was found between urban (1514 ml) and rural (1466 ml) daily drinking water median (Z = -0.81, P = 0.420). The median of daily consumption of plain water, tea and beverages were 786, 109, 186 ml, respectively. Among four cities, the highest consumption of plain water was in subjects of Guangzhou (917 ml), while the highest tea consumption in Shanghai (257 ml) and the highest beverages consumption in Shanghai (323 ml) and Beijing (264 ml). Consumption of tea in men (229 ml) was significantly higher than that in women (57 ml) (Z = 7.52, P = 0.000). Subjects in urban (693 ml) had lower consumption of plain water than those in rural (914 ml). The proportion was 32.4% (480/1483) for subjects with water drinking less than 1200 ml per day. CONCLUSION: The daily consumption of total drinking water, including plain water, tea and beverages is different in adults among different cities and is different in gender and regions. It is nearly 1/3 of subjects with daily total drinking water less than current Chinese recommended water intake (1200 ml).

Obesity related metabolic abnormalities: distribution and geographic differences among middle-aged and older Chinese populations.

OBJECTIVE: To investigate geographic differences in obesity related metabolic abnormalities in middle-aged and older Chinese people with different levels of adiposity. METHOD: Data from 3289 individuals aged 50-70 years who participated in a cross-sectional survey in 2005 (1641 from northern [Beijing] and 1648 from southern [Shanghai] China) were analyzed. Overweight or obesity and abdominal obesity were classified as body mass index > or =24 kg/m2 and waist circumference > or =90 cm for men and > or =80 cm for women. Metabolic abnormalities (metabolic syndrome, dyslipidemia, hypertension and diabetes) were defined using the NCEP/ATPIII criteria. RESULTS: The overall prevalence of overweight and obesity was 53.4%, and the prevalence of abdominal obesity was 48.0%, respectively. The prevalence of the metabolic abnormalities was significantly higher among obese individuals than their normal weight counterparts. The association between obesity and the higher prevalence of the metabolic abnormalities was more pronounced among people who were overweight or obese in the north, especially for those living in rural areas. CONCLUSION: The prevalence of obesity and associated metabolic abnormalities varies substantially among Chinese people in different geographic region. Individuals who were overweight or obese living in rural areas in the north contribute importantly to the north-south differences in obesity-related metabolic abnormalities among Chinese populations.

A Comparative Study of Iodized Salt Programs: Shanghai and Switzerland.

Both Shanghai and Switzerland are developed regions with long-standing salt iodization programs and periodic monitoring. However, the two regions have their own approach to the implementation of the iodized salt policy. In Shanghai, monitoring was carried out every few years, using probability-proportional-to-size sampling technique to select 30 sampling units. Each unit consisted of more than 12 pregnant women and one randomly selected primary school. Urine samples were then taken from the chosen pregnant women and randomly recruited students of that school for iodine test. Data of Switzerland used in this comparative study was extracted from published researches. In Shanghai, the median urinary iodine concentration (UIC) in 2014 was 20% lower than in 1999 (P < 0.05). The median UIC of pregnant women in 2014 was 9.5% lower than that in 2011 (P < 0.05). In terms of iodized salt concentration, opposite to the increasing in Switzerland, it has exhibited a downward trend in Shanghai (P < 0.05). For the years monitored, the iodized salt concentration in Shanghai was significantly (P < 0.05) higher than in Switzerland. Though the UIC of children exhibited a downward trend in Shanghai (P < 0.05), it was still significantly (P < 0.05) higher than in Switzerland over the same monitoring period. However, the UIC in pregnant women was a totally different story, which was significantly (P < 0.05) lower in Shanghai than in Switzerland. Iodized salt is very important for maintaining sufficient iodine level in the population. Appropriate concentration of iodine in fortified salt needs to be decided according to local conditions. Special attention should be paid to the iodine level of pregnant women in Shanghai, and more education about iodine is necessary for the public health.

Insulin resistance and depressive symptoms in middle-aged and elderly Chinese: findings from the Nutrition and Health of Aging Population in China Study.

BACKGROUND: Depression is associated with an increased risk of incident diabetes, and insulin resistance is thought to be the underlying link between them. Nevertheless, only a few studies have explored the association between insulin resistance and depression with contradictory results, and none have been conducted in Chinese populations. METHODS: We aimed to determine the association between insulin resistance and depressive symptoms among middle-aged and elderly Chinese using data from the Nutrition and Health of Aging Population in China Study, a population-based cross-sectional study conducted in 2005 in China. Participants included 3285 community residents aged 50-70 years. Depressive symptoms were defined as a Center for Epidemiological Studies of Depression Scale (CES-D) score of 16 or higher. Insulin resistance was calculated using the updated homeostasis model assessment (HOMA2-IR) methods. RESULTS: Value of HOMA2-IR was significantly higher in participants with depressive symptoms (0.284 vs. 0.261, P=0.008), even after adjustment for various confounding factors in the regression model (0.311 vs. 0.291, P=0.026). Logistical regression analyses showed that participants with depressive symptoms had a higher risk of having insulin resistance (defined as in the top quartile of HOMA2-IR values, odds ratio=1.54, 95% confidence intervals=1.17-2.04). LIMITATIONS: Due to the cross-sectional study design, causal relation remains unknown. CONCLUSIONS: The present study found positive associations between depressive symptoms and insulin resistance among Chinese populations. Further prospective studies are needed to validate the results and find the temporal and causal relation between them.

A Comparison of Iodine Status in Children and Pregnant Women After a Policy Change in the Iodized Salt Standard in Shanghai, China.

In Shanghai, a new iodized salt standard was implemented in 2012. To provide evidence to the government, we compared iodine status before (35 mg/kg) and after (30 mg/kg) adjustment in vulnerable populations living in Shanghai. The probability-proportional-to-size sampling technique was used to select at least 360 pregnant women for urine iodine test and at least 1200 students for thyroid measurement and the household salt test. Of these students, at least 360 performed urine iodine test. The median thyroid volume and the median household salt iodine concentration of children aged 8-10 years were 1.80 ml and 24.8 mg/kg in 2015, and 0.97 ml and 28.3 mg/kg in 2011. The median urine iodine concentration (UIC) of pregnant women was 126.52 and 139.77 µg/L in 2015 and 2011. All differences were statistically significant (P < 0.05). The median UIC of students was 171.40 and 181.63 µg/L in 2015 and 2011, the difference was not statistically significant. Multivariate linear regression analysis showed that thyroid volume in children was associated with sex, age, region, and household salt iodized concentration. The current iodized salt concentration meets the basic needs of the population's iodine requirements except for pregnant women. Periodic monitoring is necessary particularly in vulnerable groups.

Is adherence to the Chinese Dietary Guidelines associated with better self-reported health? The Chinese Dietary Guidelines Adherence Score.

BACKGROUND AND OBJECTIVES: Poor adherence to dietary guidelines is related to physical and mental disorders, as reflected in self-reported health statuses. This study evaluates the association between diet quality and selfreported health within the Shanghai Diet and Health Study. METHODS AND STUDY DESIGN: We used Chinese Dietary Guidelines Adherence scores to assess diet quality in a cross-sectional study of 4487 subjects above 15 years of age, who completed three-day 24h diet recalls and responded to self-reported health questionnaires. A composite health score was calculated based on Item Response Theory, using the Rasch model. Multiple linearregression models were evaluated to assess the relationship between self-reported health status and diet quality. RESULTS: Based on the various adherence scores, we divided our sample into fifths. Based on these divisions and with the exception of a single instance, our results show a significant trend: self-reported health declines with declining adherence to official dietary guidelines. This trend was even significant when controlling for a large number of potential confounders. CONCLUSIONS: This study shows that consumption of a healthy and balanced diet, as reflected in adherence to the Chinese Dietary Guidelines, is related to increased levels of overall health among Shanghai residents.

Eating Out-of-Home in Adult Residents in Shanghai and the Nutritional Differences among Dining Places.

BACKGROUND: With the rapid development of Shanghai's economy, diet habits have undergone great changes. The study aimed to examine the situation of out-of-home (OH) eating in Shanghai adults and the nutrition characteristics of eating in different dining places, and to assess the social demographic determinants of eating OH. METHOD: Data was sourced from the Shanghai Diet and Health Survey (SDHS) involving people aged 18 years or older in 2012⁻2013. The food frequency questionnaire (FFQ) and three-day 24-h dietary recall (24-HDR) were used to collect dietary intake data on how people eat out in a cross-sectional study of 1689 adults. OH food refers to the food prepared or consumed away from home. We define that people who eat at least one meal prepared away from home in each survey have a habit of eating outside. The multiple linear and logistic regression methods were used for statistical analysis. RESULTS: The prevalence of eating OH and at restaurants was only 55.1% and 31.8%, respectively. There was an increase in energy, protein, carbohydrate, fat, and iron intake while eating OH. Restaurant and company/school canteen consumption were both associated with an increase in daily total energy intake of 140 kcal and 91 kcal, and fat intake of 6.0 g and 4.3 g, respectively. However, eating at restaurants was associated with higher intake of 548 mg of sodium. However, no significant association was observed between eating at canteens and higher sodium intake. CONCLUSIONS: Eating OH related to a poor diet quality, and the diet quality was different restaurant and canteen food. There may be a need for interventions to target residents' overall dining-out behavior, particularly focusing on the consumption of restaurant food.