Prevalence and Influencing Factors of Central Obesity among Adults in China: China Nutrition and Health Surveillance (2015-2017).

The purpose of this study was to describe the prevalence of central obesity and its influencing factors among Chinese adults aged 18 or older. The data were from China Nutrition and Health Surveillance (2015-2017), which used a stratified, multistage, random sampling method. A total of 145,298 adults aged 18 years or older from 31 provinces were included in this study. The Criteria of Weight for Adults promulgated by China in 2013 were used to determine central obesity. Out of all the adults investigated, 48,342 were identified with central obesity, with a prevalence rate of 33.3%. A logistic analysis suggested that the following factors were associated with central obesity: female sex [odds ratio (OR) = 1.329, 95%CI = 1.277~1.384]; increasing age [OR (95%CI): 1.146 (1.061~1.238), 1.254 (1.167~1.348), 1.774 (1.651~1.907), 2.041 (1.894~2.198), 2.434 (2.239~2.647)]; being married [OR = 1.184, 95%CI = 1.077~1.302]; being divorced or widowed [OR = 1.132, 95%CI = 1.006~1.273]; an urban setting [OR = 1.096, 95%CI = 1.061~1.132]; BMI [OR (95%CI): 0.159 (0.095~0.266), 12.645 (11.388~14.042), 180.989 (153.025~214.064)]; drinking [OR = 1.069, 95%CI = 1.031~1.109]; and screen time > 5 h [OR = 1.088, 95%CI = 1.036~1.141] were risk factors for central obesity; while education above primary school [OR (95%CI): 0.905 (0.875~0.936), 0.857 (0.802~0.915)] and sufficient physical activity [OR = 0.819, 95%CI = 0.782~0.858] were protective factors for central obesity. This study revealed that the prevalence of central obesity, which differed by gender and age, is still high. Large differences between different groups and geographic regions exist persistently. Effective, sustainable, and culturally targeted interventions are needed.

Hypertension-Related Status and Influencing Factors among Chinese Children and Adolescents Aged 6~17 Years: Data from China Nutrition and Health Surveillance (2015-2017).

Hypertension is currently highly prevalent worldwide and serves as one of the significant risk factors for chronic diseases and mortality. Adult hypertension can be traced back to, as well as prevented starting in, childhood and adolescence. However, due to the lack of surveillance among children and adolescents, the prevalence and influencing factors of hypertension-related conditions have not been well described. Hence, a total of 67,947 children and adolescents aged 6 to 17 from China Nutrition and Health Surveillance (2015-2017) were enrolled to describe the weighted average blood pressure level and the weighted prevalence of hypertension, pre-hypertension, and their distribution and to analyze the risk factors for hypertension and pre-hypertension among Chinese children and adolescents at a nationwide level. In summary, the weighted mean values of systolic blood pressure and diastolic blood pressure were 111.8 (95% CI, 111.2-112.5) mmHg and 66.5 (95% CI, 66.0-67.0) mmHg, respectively. The weighted prevalence of hypertension and pre-hypertension was 24.9% and 17.1%, respectively. Moreover, general obesity, overweight, and central obesity served as risk factors for hypertension and pre-hypertension among Chinese children and adolescents. The current study indicated that the prevalence of hypertension and pre-hypertension in Chinese children and adolescents was at a high level. Moreover, blood pressure screening should be further intensified for children and adolescents at a high risk of being overweight or obese.

[Status of elevated blood pressure among Chinese children and adolescents aged 7-17 from 2016 to 2017 according to 4 different references].

OBJECTIVE: To describe and analysis the detection rate of high normal blood pressure and high blood pressure among Chinese children and adolescents aged 7-17 years from 2016 to 2017 according to the clinical practice guideline for screening and management of high blood pressure in Children and Adolescents published by the American Academy of Pediatrics(the AAP reference), the international blood pressure references among Children and Adolescents aged 6 to 17 years(the international reference), health industry standard of the People's Republic of China "Reference of screening for elevated blood pressure among children and adolescents aged 7 to 18 years(WS/T 610-2018)"(the industry reference) and updating blood pressure references for Chinese children aged 3 to 17 years(the guideline reference). METHODS: Data was from the China Nutrition and Health Surveillance of Children and Lactating Women(2016-2017), in which the multistage stratified whole group random sampling method was used to draw participants from 275 surveillance sites in 31 provinces(autonomous regions and municipalities). In total, 67 231 participants were included according to the inclusion and exclusion criteria. Blood pressure was measured three times by trained staff using a validated oscillometric blood pressure monitor at the same point. The average blood pressure was calculated for the three measurements for SBP and DBP. To match the sampling design methodology, all values were weighted to represent the total population of Chinese children and adolescents 7-17 years of age considering sampling weights for each stratification based on the sixth population census data provided by the National Bureau of Statistics. RESULTS: The detection rate varied greatly under different references. The detection rate of high normal blood pressure was ranked from high to low according to the AAP reference(20.15%) > the guideline reference(17.29%) > the industry reference(13.14%) > the international reference(12.66%); the detection rate of high blood pressure in descending order is the guideline reference(24.31%) > the international reference(21.34%) > the AAP reference(20.59%) > the industry reference(19.96%). CONCLUSION: Although the consistency between the AAP references and international references and our national two references were medium to high, the difference in detection rate obtained by analysis was large. Considering the differences of demographic characteristics in the reference population, caution should be taken when applying foreign references to judge the blood pressure status of children and adolescents in China.

Deficiency of Energy and Nutrient and Gender Differences among Chinese Adults: China Nutrition and Health Survey (2015-2017).

Half of Chinese adults face the double burden of overweight/obesity and micronutrient deficiencies, and nearly 40% of them are severely overweight/obese or have micronutrient deficiencies. This study used the data from China Nutrition and Health Survey (CNHS) from 2015 to 2017 to estimate the prevalence of inadequate dietary micronutrient intake (including vitamin A, vitamin B1, vitamin B2, vitamin C, cCalcium, iron and sodium) in Chinese adults and further determine the differences in micronutrient intake by gender, age and BMI. A total of 61,768 subjects were included in this study, of which 33,262 (54%) were female. The intake of energy and all macronutrients decreased with age, and the intake was higher in men than in women. Inadequate energy intake occurs in adults of all ages. In terms of nutrient intake, women had a higher rate of insufficient carbohydrate intake than men in all age groups. Inadequate protein intake was more common in women aged 18-49 years (60.9%) than in men. Compared with women, men had a higher rate of vitamin B2 intake. Insufficient vitamin B3 intake was more common in women aged 18-49 years (35.6%), men aged 65-79 years (39.7%) and men aged 80 years and above (47.9%). In all age groups, insufficient vitamin C intake is higher in women than in men-up to 85.8 percent in women aged 80 years old and above. Compared with men in the same age group, insufficient intake of calcium and iron is more obvious in women. Women have significantly higher rates of inadequate intake of calcium, iron and sodium than men. In the analysis of correlations between BMI or demographic data and micronutrient intakes, the likelihood of micronutrient intakes being insufficient was higher in the central and western regions in all age groups compared to the eastern regions. The risk of insufficient micronutrient intake was higher in obese men and women aged 18-49 years and 50-64 years. Underweight and overweight women in the 65-79 age group were more likely to have inadequate micronutrient intake. Obese women over 80 years of age were less likely to have inadequate micronutrient intake. No significant difference was found between urban and rural areas for each age group.

[Distribution of usual vitamin intake and prevalence of inadequate intake among Chinese adults in 2015].

OBJECTIVE: To estimate the usual vitamin intake and the prevalence of inadequate intakes among Chinese adults in 2015, and to provide a scientific basis for developing nutrition intervention strategies and measures for target populations. METHODS: Data was drawn from the Chinese Nutrition and Health Surveillance 2015-2017, a nationally representative cross-sectional study. The multistage stratified whole-group random sampling method was used to draw participants from 298 surveillance sites in 31 provinces(autonomous regions and municipalities). Participants with no available information or abnormal energy intake were excluded, and finally, a total of 72 231 participants aged 18 years and older were included in the current study. The dietary data of the participants were collected by the 24-hour dietary recall method combined with the condiment weighing method for three consecutive days. The National Cancer Institute method was used to estimate the distribution of the usual intake of vitamin B_1(thiamine), vitamin B_2(riboflavin), niacin, vitamin C(ascorbic acid), and vitamin E(tocopherol), and the prevalence of inadequate intake was evaluated based on estimated average requirement or adequate intake from the Chinese Dietary Reference Intakes 2023. RESULTS: The usual intake of vitamin E, vitamin C, vitamin B_1, vitamin B_2 and niacin were 27.93 mg/d, 77.67 mg/d, 0.78 mg/d, 0.62 mg/d and 13.15 mg/d, respectively. The prevalence of inadequate intake was, in descending order, vitamin B_2(95.98%), vitamin B_1(86.73%), vitamin C(63.70%), niacin(39.81%), and vitamin E(21.17%). The prevalence of inadequate vitamin E, vitamin C, vitamin B_1 and niacin intake among females was higher than among males(P<0.01). Overall, the prevalence of inadequate vitamin intake increased with age. Rural residents had a higher prevalence of inadequate intake of vitamin C, vitamin B_2 and niacin than urban residents(P<0.01). Except for vitamin E, the prevalence of inadequate intake of vitamins decreased with increasing education levels. The prevalence of inadequate intake of these five vitamins was higher among participants with lower income levels than those with middle or high income(P<0.01). Participants with normal weight had a higher prevalence of inadequate intake of vitamin E than those with overweight or obesity and had a higher prevalence of inadequate intake of vitamin C than those with obesity. However, participants with normal weight had a higher prevalence of inadequate intake of vitamin E than those with overweight or obesity, with the differences being statistically significant(P<0.01). Except for vitamin E, the prevalence of inadequate intake of vitamins decreased with increasing physical activity intensity. CONCLUSION: In 2015, the usual intake of dietary vitamins of Chinese adults was low. There are differences in usual intakes of vitamins and prevalence of inadequate vitamin intake for adults aged 18 years and above in males and females, different age groups, urban and rural areas, education levels, household income levels, body mass index and physical activity intensity.

[Association between habitual tea consumption and 10-year cardiovascular risk among Chinese mid-aged and elderly].

OBJECTIVE: To explore the association between habitual tea consumption and 10-year cardiovascular disease risk among middle-aged and elderly Chinese. METHODS: China Nutrition and Health Surveillance 2015 applied a stratified, multistage, and random sampling method. The current study selected middle-aged and elderly participants aged 45 and older, and they were investigated by basic information survey, dietary survey based on the food frequency questionnaire, physical measurements including height, weight, and blood pressure, and a laboratory examination with fasting blood samples. Habitual tea consumption was defined by asking about the number of cups of tea usually consumed per day in the past 12 months, and the risk of cardiovascular disease incidence was calculated using the Framingham risk score over a 10-year period. The association between tea consumption and 10-year risk of cardiovascular disease in this population was analyzed using multiple logistic regression, and further analyzed using gender as a stratification factor. RESULTS: A total of 42 704 Chinese middle-aged and elderly were included in this study, with an average age of(59.4±9.4) years, 20 104 males and 22 600 females, 17 194 in urban areas and 25 510 in rural areas. For tea drinking, there were 12 519(29.32%) tea drinkers in the included sample, of which 4153(9.73%) consumed 1-2 cups/d, 3336(7.81%) 3-4 cups/d, and 5030(11.78%) ≥5 cups/d. For 10-year cardiovascular risk, 28 267 participants(66.19%) were estimated to be low risk, while 14 437(33.81%) were in the high risk. After adjusting for age, sex, body mass index, place of residence, education, income, marital status, smoking, excessive alcohol consumption, physical activity, sedentary behavior, sleep, participation in medical examination within one year, DASH dietary score, energy intake and chronic disease status, the result showed a reduced risk of cardiovascular disease over a 10-year period among those who consumed 3-4 cups/d compared with those who did not consume tea(OR=0.820, 95%CI 0.719-0.934, P_(trend)=0.03). When stratified by gender, both gender showed participants who consumed 3-4 cups/d had a lower risk for cardiovascular disease than those who did not consume tea(males: OR=0.849, 95%CI 0.722-0.997; females: OR=0.697, 95%CI 0.527-0.922). And the result was more pronounced among females. CONCLUSION: Moderate habitual tea consumption could reduce the risk of cardiovascular disease among middle-aged and elderly Chinese people, and its protective effect is more pronounced among females.

A community-based cross-sectional study of dietary composition and associated factors among tuberculosis patients in China.

To determine the dietary structure and its associated factors of tuberculosis (TB) patients in the community. This cross-sectional study analysed the dietary intake of 300 TB patients in two impoverished counties in China. Food intake was collected by using food frequency and two consecutive 24-h dietary review (24hdr) methods. The dietary composition and dietary structure of TB patients were compared with China's 2022 Dietary Reference Intake (DRIs) and the average reference value of dietary composition (ARC) in China in 2013. Binary logistic regression models were used to explore the factors associated with inadequate intake of animal food, insufficient protein and fat energy supply in patients with TB. The daily intake of various foods in TB patients was measured and the results were as follows: staple foods-median 372.12 g (interquartile range [IQR] 315.87 g); vegetables-median 200.00 g (IQR 205.55 g); fruits-median 20.22 g (IQR 36.82 g); animal foods-median 100.82 g (IQR 180.74 g); dairy products-median 0.00 g (IQR 0.00 g); nuts-median 17.10 g (IQR 29.75 g). The average daily intakes of vegetables, fruits, animal food, dairy products, soy and nuts were lower than those recommended by the DRIs (P < 0.01). Compared to women, men consumed more whole grains and mixed legumes, but less fruit. The dietary structures, including food and nutrient supply for energy, protein and fat, were significantly different in 300 patients compared with DRIs or ARC values. Inadequate rates of animal food intake were observed in 54.85% of men and 59.57% of women. Protein undersupply rates were 66.02% in men and 56.38% in women, while fat undersupply rates were 52.91% in men and 52.13% in women. The study revealed that being 18-49 years old, being the Han nationality, having less than 2 h of physical activity per day on average, and eating twice a day were risk factors for inadequate animal protein intake, protein energy deficiency and fat energy deficiency. TB patients from impoverished counties in China have inadequate intake of several food categories and insufficient protein and fat energy supply, correlating with multiple factors in socio-demographics, behavioral practices, and TB disease. To improve the nutritional status of TB patients, urgent public health actions, especially carrying out nutritional screening and evaluation once diagnosed, developing individualized nutritional support treatment plans, strengthening dietary nutritional health education and intervention, and advocating for enhanced nutritional support, should be taken.

Bean and Nut Intake Were Protective Factors for Comorbid Hypertension and Hyperuricemia in Chinese Adults: Results from China Nutrition and Health Surveillance (2015-2017).

This study aimed to describe the prevalence of comorbid hypertension and hyperuricemia (HH) and detected the dietary factors for HH in Chinese adults aged 18 to 64 years. All of the data were collected from the China Nutrition and Health Surveillance 2015-2017, with a stratified, multistage, random sampling method on a national scale. A total of 52,627 adult participants aged 18~64 years from the CNHS 2015-2017 were included in this study. HH was identified as SUA level cut-offs for males and females of 420 µmol/L and 360 µmol/L, respectively, with mean systolic blood pressure ≥140 mmHg and/or mean diastolic blood pressure ≥ 90 mmHg and/or received antihypertensive treatment within two weeks. The differences in HH prevalence between or among the subgroups were compared by the Rao-Scott chi-square test. The correlations between HH and covariates or metabolic factors were detected by a weighted two-level multivariate survey logistic regression. The total weighted sufficient intake ratios of beans and nuts, vegetables, and red meat were 59.1%, 46.6%, and 64.8%, respectively. The weighted prevalence of HH in the total participants was 4.7% (95% CI: 4.3-5.0%). The positive effects of bean and nut on HH were observed. The participants who had sufficient bean and nut intake showed lower risk for HH (for the total participants: OR = 0.734, 95% CI = 0.611-0.881). The prevalence of HH might have been a public health problem, and bean and nut intake might be a protective factor for HH in the Chinese population.

Association of the Protective Dietary Pattern for Blood Pressure with Elevated Blood Pressure and Hypertension among Chinese Children and Adolescents Aged 6-17 Years Old: Data from China Nutrition and Health Surveillance (2015-2017).

Studies focused on the association between dietary patterns and elevated blood pressure (BP) and hypertension (HTN) among children and adolescents remain insufficient. This study aimed to explore a dietary pattern that could be helpful for the prevention of abnormal BP and to investigate the association between this dietary pattern and elevated BP and HTN among Chinese children and adolescents. A total of 52,080 Chinese children and adolescents aged 6~17 years old from the China Nutrition and Health Surveillance (CNHS) 2015-2017 were included in the current study. The reduced rank regression (RRR) method was applied to derive a dietary pattern that is associated with BP. Multivariable logistic regression was used to assess the association between dietary pattern (DP) and elevated BP and HTN. The Dietary Approach to Stop Hypertension (DASH) score was also calculated for each participant as a comparative method to validate the dietary pattern derived with the RRR method. A protective dietary pattern (PDP) for BP among Chinese children and adolescents was derived, which was characterized by high intakes of dairy products, mushrooms/edible fungi, fresh vegetables, fresh fruits, fresh eggs, aquatic products, mixed legumes, soybeans and related products, offal, dried fruits, and coarse cereals, with low intakes of refined grains. After multiple adjustments, there were significant inverse associations between PDP scores and the odds of elevated BP and HTN (elevated BP: Q5 vs. Q1, OR = 0.849, 95%CI = 0.755-0.931, P-trend < 0.05; HTN: Q5 vs. Q1, OR = 0.795, 95%CI = 0.694-0.911, P-trend < 0.05). The DASH diet was also observed to have protective effects on elevated BP in model I (Q5 vs. Q1, OR = 0.899, 95%CI = 0.828-0.975, P-trend < 0.05), but was not observed to have protective effects on HTN (HTN: Q5 vs. Q1, OR = 0.958, 95%CI = 0.876-1.048, P-trend > 0.05). The current study suggested that greater adherence to the PDP for BP among Chinese children and adolescents might be associated with lower odds of elevated BP and HTN.

[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.

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.

[Association between cooking fuel and chronic diseases among Chinese housewives from 2015 to 2017].

OBJECTIVE: To analyze the association between the use of different household cooking fuels(including solid fuels and clean fuels) and hypertension, stroke, chronic obstructive pulmonary disease, and asthma among Chinese housewives. METHODS: 15616 housewives aged over 18 years were selected from China Nutrition and Health Surveillance 2015-2017, and their basic information investigation, physical examination and laboratory examination were carried out. Using multiple adjustment logistic regression analysis to compare the risk of using clean fuels and solid fuels in hypertension, stroke, chronic obstructive pulmonary disease and asthma. And living areas(urban or rural) were used as stratified factors for stratified logistic regression analysis. RESULTS: Among 15616 Chinese housewives, 9539(61.08%) used clean cooking fuels and 6077(38.92%) used solid cooking fuels at that time. There were significant differences in the composition of urban and rural areas, age groups, body mass index, education level, household annual income, smoking and drinking, second-hand smoke exposure level and whether to participate in physical examination within one year. After multivariable adjustment, using solid cooking fuels increased the risk of hypertension(OR=1.14, 95% CI 1.05-1.23), stroke(OR=1.44, 95% CI 1.18-1.75), chronic obstructive pulmonary disease(OR=1.20, 95% CI 1.03-1.40) and asthma(OR 1.33, 95% CI 1.09-1.63). After stratified by urban and rural areas, the result showed that using solid cooking fuels among rural housewives significantly increased the risk of the above four diseases(hypertension: OR=1.11, 95% CI 1.01-1.22; stroke: OR=1.49, 95% CI 1.17-1.91; chronic obstructive pulmonary disease: OR=1.20, 95% CI 1.00-1.42; asthma: OR=1.40, 95% CI 1.09-1.79). While in urban housewives, except that using solid cooking fuels might increase the risk of hypertension, the risk of stroke, chronic obstructive pulmonary disease and asthma has not increased significantly, but there was still an increasing tendencies(hypertension: OR=1.18, 95% CI 1.02-1.36; stroke: OR=1.37, 95% CI 0.99-1.90; chronic obstructive pulmonary disease: OR=1.20, 95% CI 0.89-1.60; asthma: OR=1.20, 95% CI 0.82-1.74). CONCLUSION: The use of solid cooking fuels is a risk factor for Chinese housewives in hypertension, stroke, chronic obstructive pulmonary disease, and asthma, and is more significant among rural housewives.

[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.

Comparison of Several Adiposity Indexes in Predicting Hypertension among Chinese Adults: Data from China Nutrition and Health Surveillance (2015-2017).

The current study is to explore the association of the Chinese visceral adiposity index (CVAI) with hypertension, and to compare the predictive power of different adiposity indexes regarding hypertension among Chinese adults aged over 45 years. A total of 99,201 participants aged over 45 years from the China Nutrition and Health Surveillance 2015-2017 were included in this study. Multivariate adjusted logistic regression was used to calculate the odds ratio (OR) and 95% confidence interval (CI) of hypertension. Multivariate adjusted restricted cubic spline analyses were applied to explore the association of adiposity indexes with hypertension. Receiver operating characteristic (ROC) analyses were used to compare the predictive powers of different adiposity indexes of hypertension. All eight adiposity indexes included in this study were positively associated with hypertension. Compared with those in the lowest quartile of the CVAI, the participants in the highest quartile showed a significantly higher risk of hypertension (OR = 3.70, 95% CI = 3.54-3.86) after multiple adjustments. The ROC analyses suggested that the CVAI was the strongest predictor of hypertension compared to other adiposity indexes in both genders. The findings supported that the CVAI could serve as a reliable and cost-effective method for early identifying hypertension risk.

Comparison of data-driven identified hypertension-protective dietary patterns among Chinese adults: based on a nationwide study.

PURPOSE: Diet pattern (DP) is a key modifiable and cost-effective factor in hypertension (HTN) management. The current study aimed to identify and compare the hypertension-protective DPs among Chinese adults. METHODS: 52,648 participants aged over 18 years were included from China Nutrition and Health Surveillance (CNHS) 2015-2017. Reduced rank regression (RRR) and partial least square regression (PLS) was applied to identify the DPs. Multivariable-adjusted logistic regression was used to assess the association between the DPs and HTN. RESULTS: DPs derived by RRR and PLS were both featured by higher consumption of fresh vegetables and fruits, mushrooms and edible fungi, seaweeds, soybeans and related products, mixed legumes, dairy products, fresh eggs, and lower of refined grain consumption. Compared to the lowest quintile, participants in the highest quintile had lower odds of HTN (RRR-DP: OR = 0.77, 95% CI = 0.72-0.83; PLS-DP: OR = 0.76, 95% CI = 0.71-0.82; all p < 0.0001). Simplified DP scores were observed the same protective tendencies (Simplified RRR-DP: OR = 0.81, 95% CI = 0.75-0.87; Simplified PLS-DP: OR = 0.79, 95% CI = 0.74-0.85; all p < 0.0001) and showed effective extrapolation in subgroups defined by gender, age, location, lifestyle, and different metabolic conditions. CONCLUSIONS: The identified DPs had high conformity with East Asian dietary habits, and significantly negative associations with HTN among Chinese adults. The simplified DP technique also indicated the potential for improving the extrapolation of the results of DP analysis related to HTN.

Status of Serum Uric Acid and Hyperuricemia among Adults in China: China Nutrition and Health Surveillance (2015).

Objective: The purpose of this study was to determine the serum uric acid levels and the prevalence of hyperuricemia among Chinese adults in 2015 and compare the differences between urban and rural areas, as well as the differences between eastern, central, and western regions. Methods: A national representative sample of 180,208 participants were included using a stratified, multistage, and random sampling method. The demographic characteristics and blood samples were collected to determine the serum uric acid levels and prevalence of hyperuricemia among subgroups using complicated sampling weight. A t-test or ANOVA was used for normally-distributed data. The Kruskal-Wallis rank test was used for skewed-distributed data. The Mantel-Haenszel chi-square test was used to compare the difference in categorical variables. Results: The weighted mean uric acid level in Chinese adults was 310.4 µmol/L (317.5 µmol/L in urban areas and 302.9 µmol/L in rural areas). The weighted average values of uric acid in eastern, central, and western China were 315.5 µmol/L, 303.5 µmol/L, and 310.4 µmol/L, respectively. The weighted prevalence of hyperuricemia in Chinese adults was 14.6%, with a prevalence of 16.5% in urban areas and 12.5% in rural areas. The weighted prevalence of hyperuricemia in eastern, central, and western China was 16.0%, 12.5%, and 14.8%, respectively. Conclusion: The uric acid level in Chinese adults is relatively high. Effective actions are warranted to improve this metabolic abnormality.

The Prevalence of Hyperuricemia and Its Correlates among Adults in China: Results from CNHS 2015-2017.

This study aimed to investigate the prevalence of hyperuricemia (HUA) and associated risk factors in Chinese adults aged 18 to 59 years. All the data were collected from the China Nutrition and Health Surveillance during the period 2015-2017, which adopted a stratified, multistage, random sampling method on a national scale. A total of 52,627 participants aged 18 years or older were included in this study. The definition of hyperuricemia was 420 µmol/L for male and 360 µmol/L for female. The Rao-Scott chi-square test was used to compare the differences in prevalence between or among the subgroups. A weighted two-level multivariate survey-logistic regression was used to detect the correlations between HUA and demographic, physical, lifestyle and metabolic factors. The total prevalence of HUA was 15.1%, and that was higher in male, current smokers, higher BMI and less physical activities subgroups, and also in noninfectious chronic diseases (NCDs) subgroups. The subgroups of non-vegetarian diet, insufficient vegetable intakes and excessive red meat and alcohol intakes had significantly higher HUA prevalence. After introducing all the variables in the survey-logistic regression, gender, age, BMI, physically active, hypertension, diabetes mellitus, bean and nut intake, vegetable intake, red meat intake, alcohol consumption and vegetarian were associated with HUA. Among the significant variables, age and physical active served as a protective factor, and BMI showed to be a risk factor for HUA. Hypertension and dyslipidemia could increase the risk for HUA, while diabetes mellitus was shown a negative association with it. For dietary factors, vegetarian diet, sufficient beans and nuts and vegetables intake could lower the risk of HUA, but more alcohol could increase the risk of HUA. Dietary factor played a key role in HUA. It suggested that the intervention of dietary factor should receive more attention to ameliorate the high prevalence of HUA in China.

[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.

Association between Habitual Tea Consumption and Metabolic Syndrome and Its Components among Chinese Adults Aged 18~59 Years: Based on China Nutrition and Health Surveillance 2015-2017.

BACKGROUND: Tea consumption is widely reported to have beneficial effects on metabolic functions. The current study is to evaluate the association between habitual tea consumption and risk for metabolic syndrome and its components among Chinese adults aged 18~59 years. METHODS: 43,757 participants aged 18~59 years from China Nutrition and Health Surveillance 2015-2017 were included and divided into four groups based on the amount of daily tea consumption in the current study. Using multiple-adjustment logistic regression to explore the relationship between habitual tea consumption and metabolic syndrome-related health outcomes. RESULTS: Compared with those who did not consume tea habitually, participants who drank over 5 cups of tea per day showed a significantly lower risk of metabolic syndrome (OR = 0.836, 95% CI = 0.771-0.905), blood pressure elevated (OR = 0.906, 95% CI = 0.845-0.972), triglyceride elevated (OR = 0.797, 95% CI = 0.741-0.857), and fasting plasma glucose elevated (OR = 0.772, 95% CI = 0.715-0.833), but higher risk for central obesity (OR = 1.354, 95% CI = 1.236-1.484). Regardless of gender, higher tea consumption was related to lower risk of triglyceride and fasting blood glucose elevated but higher risk for central obesity. While for protective effect on metabolic syndrome, blood pressure elevated, and HDL-C reduction only showed in females. CONCLUSIONS: Results from current study support that habitual tea consumption would benefit metabolic syndrome and its related components, especially among females.

Association of Dietary Patterns with Metabolic Syndrome in Chinese Children and Adolescents Aged 7-17: The China National Nutrition and Health Surveillance of Children and Lactating Mothers in 2016-2017.

This study aims to determine the associations of dietary patterns with metabolic syndrome (MetS) and its components in Chinese children and adolescents aged 7-17 in 2016-2017. Using the data from the China National Nutrition and Health Surveillance of Children and Lactating Mothers in 2016-2017, the sociodemographic information, diet, anthropometric measurements and clinical examinations of subjects were obtained, and a total of 13,071 school-aged children and adolescents were included in this study. The Cook criteria were used to define MetS and its components. Dietary intake was derived from 24-h dietary records for three consecutive days, combined with the weighing method. Factor analysis was used to identify major dietary patterns. The associations of dietary patterns with MetS and its components were examined by logistic regression analysis. Consequently, five distinct dietary patterns were identified by factor analysis, and the relationships between dietary patterns with MetS and its components were observed. After adjusting for covariates, the animal product and vegetable patterns may have a positive association with MetS; the condiment pattern was positively associated with low HDL-C; the fruit and junk food patterns had positive relationships with MetS, abdominal obesity and high TG; the cereals and tubers pattern was positively associated with MetS, abdominal obesity, high TG and low HDL-C; the beans pattern was positively associated with high TG.