Increased Prevalence of Thyroid Nodules Across Nearly 10 Years in Shanghai, China.

OBJECTIVE: This study aimed to determine whether the prevalence of thyroid nodules (TNs) increased due to modern lifestyles or other factors, despite the advances in screening and diagnostic tools. METHODS: This study included 3474 pairs of participants, who were matched by gender and age (±3 years) from two cross-sectional sampling surveys: (1) the program on the iodine nutritional status and related health status of residents in Shanghai in 2009; (2) the thyroid disease screening program for adults in Shanghai between 2017 and 2018. The prevalence of TNs and thyroid diseases in 2009 and 2017-2018 were compared, and the potential risk factors of TNs were detected. RESULTS: The prevalence of TNs in 2009 was 28.9%: 22.5% in males and 34.5% in females. In 2017, this increased to 43.8%: 37.9% in males and 49.1% in females. The prevalence of TNs significantly increased from 2009 to 2017 (odds ratio, 1.486; 95% confidence interval, 1.238-1.786). In addition, female gender, thyroid disease history, and age were the main risk factors for TNs after adjusting for confounders in the logistic regression across the time period. CONCLUSION: The prevalence of TNs significantly increased across nearly 10 years in Shanghai.

Diagnosis of Nonperitonealized Colorectal Cancer with Computerized Tomography Image Features under Deep Learning.

This study aimed to explore the value of abdominal computerized tomography (CT) three-dimensional reconstruction using the dense residual single-axis super-resolution algorithm in the diagnosis of nonperitonealized colorectal cancer (CC). 103 patients with nonperitonealized CC (the lesion was located in the ascending colon or descending colon) were taken as the research subjects. The imagological tumor (T) staging, the extramural depth (EMD) of the cancer tissues, and the extramural vascular invasion (EMVI) grading were analyzed. A dense residual single-axis super-resolution network model was also constructed for enhancing CT images. It was found that the CT images processed using the algorithm were clear, and the peak signal-to-noise ratio (PSNR) and structural similarity (SSIM) were 33.828 dB and 0.856, respectively. In the imagological T staging of CC patients, there were 17 cases in the T3 stage and 68 cases in the T4 stage. With the EMD increasing, the preoperative carcinoembryonic antigen (CEA) highly increased, and the difference was statistically significant (P < 0.05). The postoperative hospital stays of patients were also different with different grades of EMVI. The hospital stay of grade 1 patients (19.45 days) was much longer than that of grade 2 patients (13.19 days), grade 3 patients (15.36 days), and grade 4 patients (14.36 days); the differences were of statistical significance (P < 0.05). It was suggested that CT images under the deep learning algorithm had a high clinical value in the evaluation of T staging, EMD, and EMVI for the diagnosis of CC.

No Association Was Found Between Mild Iodine Deficiency During Pregnancy and Pregnancy Outcomes: a Follow-up Study Based on a Birth Registry.

BACKGROUND: Severe iodine deficiency during gestation is associated with adverse pregnancy outcomes; however, the impact of mild-to-moderate iodine deficiency, though prevalent in pregnancy, remains unclear. METHODS: We extracted follow-up data for 7435 pregnant women from a national iodine deficiency disorders monitoring program from 2016 to 2018 and a mother-child cohort study in 2017 based on a birth registry in Shanghai. Birth outcomes were collected from the registry. Spot urine and household salt samples were collected for iodine testing. Single-factor analysis and logistic regression were used to evaluate the association between maternal iodine status and pregnancy outcomes. RESULTS: The median urine iodine level in pregnant women was 137.5 µg/L (interquartile range 82.4-211.5), suggesting mild deficiency according to WHO standards. The incidence of pregnancy termination, preterm birth, congenital malformations, low birth weight, and cesarean section was 3.2%, 4.3%, 1.4%, 2.7%, and 45.2% in the mildly iodine-deficient group and 3.4%, 4.5%, 1.4%, 2.7%, and 44.5% in the normal group, respectively. After adjusting for maternal age and education, trimesters, and preterm birth rate in the general population, the odds ratios for any outcome did not differ significantly between the two groups. CONCLUSION: The present study suggests that mild maternal iodine deficiency is not associated with adverse pregnancy outcomes.

A China Healthy Diet Index-Based Evaluation of Dietary Quality among Pregnant Women in Shanghai across Trimesters and Residential Areas.

Good dietary quality among pregnant women is critical for maternal and fetal health. The primary objective of our study was to analyze the dietary quality of pregnant woman and its influencing factors. Pregnant women were enrolled using a multistage, stratified, random-sampling method in Shanghai. We used a personal food frequency questionnaire and a household condiment weighing method for dietary assessments. Participants' scores on the China Healthy Diet Index (CHDI) were analyzed to evaluate diet quality. Significant differences in the median daily intake of almost all food types were found across all trimesters, and all food types were found across all residential areas (urban, suburban and rural). The median of total CHDI score was 71.6 in all subjects, 71.1 in early pregnancy, 71.5 in middle pregnancy and 72.3 in late pregnancy. The results of uni-variate analysis showed that significant differences in CHDI scores were found across trimesters and residential areas. Eighty one point six percent of participants scored below 80 points, indicating general or poor dietary quality. Logistic regression models showed that participants in early and middle pregnancy had lower scores than those in late pregnancy. Women in urban areas had higher scores than those in suburban and rural areas. Most of pregnant women living in Shanghai suffer from a general or poor dietary quality. Education on balance diet should be strengthened to guide pregnant women in making reasonable food choices and intake, especially those living in suburban and rural areas and those in their first and second trimesters.

Reducing contrast medium dose with low photon energy images in renal dual-energy spectral CT angiography and adaptive statistical iterative reconstruction (ASIR).

OBJECTIVE: To evaluate the value of using low energy (keV) images in renal dual-energy spectral CT angiography (CTA) and adaptive statistical iterative reconstruction (ASIR) to reduce contrast medium dose. METHODS: 40 patients with renal CTA on a Discovery CT750HD were randomly divided into two groups: 20 cases (Group A) with 600 mgI kg-1 and 20 cases (Group B) with 300 mgI kg-1. The scan protocol for both groups was: dual-energy mode with mA selection for noise index of 10 HU, pitch 1.375:1, rotating speed 0.6 s/r. Images were reconstructed at 0.625 mm thickness with 40%ASIR, Group A used the conventional 70keV monochromatic images, and Group B used monochromatic images from 40 to 70 keV at 5 keV interval for analysis. The CT values and standard deviation (SD) values of the renal artery and erector spine in the plain and arterial phases were measured with the erector spine SD value representing image noise. The enhancement degree of the renal artery (ΔCT = CT(arterial) -CT(plain)), signal-to-noise ratio (SNR=CTrenal-artery/SDrenal-artery) and contrast-to-noise ratio (CNR=(CTrenal-artery-CTerector spine)/SDerector-spine) were calculated. The single factor analysis of variance was used to analyze the difference of ΔCT, SNR and CNR among image groups with p < 0.05 being statistically significant. The subjective image scores of the groups were assessed blindly by two experienced physicians using a 5-point system and the score consistency was compared by the κ test. RESULTS: Contrast medium dose in the 300 mgI kg-1 group was reduced by 50% compared with the 600 mgI kg-1 group, while radiation dose was similar between the two groups. The subjective scores were 4.00 ± 0.65, 4.50 ± 0.60 and 3.70 ± 0.80 for images at 70 keV (600 mgI kg-1 group), 40 keV (300 mgI kg-1 group) and 45 keV (300 mgI kg-1 group), respectively with good consistency between the two reviewers (p > 0.05). The 40 keV images in the 300 mgI kg-1 group had similar ΔCT (469.77 ± 86.95 HU vs 398.54 ± 73.68 HU) and CNR (15.52 ± 3.32 vs 18.78 ± 6.71) values as the 70 keV images in the 600 mgI kg-1) group but higher SNR values (30.19 ± 4.41 vs 16.91 ± 11.12, p < 0,05). CONCLUSION: Contrast dose may be reduced by 50% while maintaining image quality by using lower energy images combined with ASIR in renal dual-energy CTA. ADVANCES IN KNOWLEDGE: Combined with ASIR and energy spectrum, can reduce the amount of contrast dose in renal CTA.

Relationship of household cooking salt and eating out on iodine status of pregnant women in environmental iodine-deficient coastal areas of China.

As city residents eat out more frequently, it is unknown that if iodised salt is still required in home cooking. We analysed the relationship of household salt and eating out on urinary iodine concentration (UIC) in pregnant women. A household condiment weighing method was implemented to collect salt data for a week. A household salt sample was collected. A urine sample was taken at the end of the week. Totally, 4640 participants were investigated. The median UIC was 139·1 µg/l in pregnant women and 148·7, 140·0 and 122·9 µg/l in the first, second and third trimesters. Median UIC in the third trimester was lower than in the other trimesters (P < 0·001). The usage rates of iodised (an iodine content ≥ 5·0 mg/kg) and qualified-iodised (an iodine content ≥ 21·0 mg/kg) salt were 73·9 and 59·3 %. The median UIC in the qualified-iodised salt group was higher than in the non-iodised group (P = 0·037). The median UIC in the non-iodised group who did not eat out was lower than in qualified-salt groups who both did and did not eat out (P = 0·007, <0·001). The proportion of qualified-iodised salt used in home cooking is low, but foods eaten out have universal salt iodisation according to the national compulsory policy. Household iodised salt did not play a decisive role in the iodine status of pregnant women. Pregnant women in their third trimester who are not eating out and using non-iodised salt at home require extra iodine.

Appropriate Range of Median Urinary Iodine Concentration in 8- to 10-Year-Old Children Based on Generalized Additive Model.

Background: The appropriate range of median urinary iodine concentration (MUI) in children has always been controversial. To prevent the occurrence of a goiter epidemic in Shanghai, we explored the appropriate range of MUI by integrating multiple monitoring results. Methods: This study summarized and analyzed the monitoring data from 1997, 1999, 2011, 2014, and 2017 of children living in Shanghai. In each monitoring year, the probability-proportional-to-size sampling technique was used to select 30 sampling units. In each sampling unit, one primary school was randomly selected. From each selected school, 40 children 8- to 10-year-old were randomly recruited to measure thyroid volume (Tvol) and their household salt iodine intake. Results: In 1997, 1999, 2011, 2014, and 2017, MUI of 8- to 10-year-old children was 228, 214, 182, 171, and 183 µg/L, and median Tvol (MTvol) was 2.9, 1.2, 1.0, 1.8, and 2.8 mL, respectively. There was a linear correlation between goiter rate and MTvol (r = 0.95, p = 0.014; 100 × goiter rate = 1.314 × MTvol -1.287). Generalized additive model (GAM) was used to predict MTvol as follows, MTvol = 0.60689 + 0.00302 MUI +0.999928 s (MUI) -0.05172 mean salt iodized concentrations (MSIs) +0.03481 × 100 × iodized salt coverage rate +0.00000969 per capita disposable income +0.271422 s (per capita disposable income) -0.38772 × monitoring year gap. The results revealed that the average relative error between predicted and actual value was 15.2%. GAM results showed that at 27-277 µg/L MUI, the goiter rate was <5%. Conclusions: Iodine status is appropriate in Shanghai. Under the existing economy and MSI, the optimal range of MUI should be 70-277 µg/L in 8- to 10-year-old children living in Shanghai.

The associations between sugar-sweetened beverage intake and cardiometabolic risks in Chinese children and adolescents.

BACKGROUND: The intake of sugar-sweetened beverages (SSBs) has been linked to an increased risk of cardiometabolic diseases. OBJECTIVES: This study aims to examine associations between SSB intake and cardiometabolic risks among Chinese children and adolescences. METHODS: Data from 3958 participants aged 6-17 years old were obtained in Shanghai, China, from September to October 2015. A 3-day dietary record and a food-frequency questionnaire (FFQ) were applied to assess SSB consumption and frequency. Anthropometric and laboratory measurements were conducted to measure cardiometabolic indicators. RESULTS: After adjusting for age, sex, daily energy intake, pubertal stage, sedentary time, maternal education, and household income, SSB consumption was positively associated with serum total cholesterol and low-density lipoprotein-cholesterol (LDL-C), while it was inversely associated with systolic blood pressure (P < .05). The participants in the highest intake category (≥201.7 mL/day) of SSB consumption had 0.10 (95%CI, 0.02-0.18) mmol/L higher total cholesterol and 0.09 (95%CI, 0.03-0.16) mmol/L higher LDL-C levels than the nonconsumption group (0 mL/day). There was a quasi-U-shaped trend in LDL-C across the categories of >0 mL/day SSB consumption. SSB frequency was positively associated with BMI (P = .04). CONCLUSIONS: SSB intake was positively associated with serum cholesterol and was weakly associated with BMI in Chinese children and adolescents, independent of energy intake.

The Associations of Dietary Iron, Zinc and Magnesium with Metabolic Syndrome in China's Mega Cities.

BACKGROUND: Iron, zinc and magnesium perform differently in body metabolism but exist in similar food. This study was to evaluate the associations of dietary iron, zinc and magnesium with metabolic syndrome (MetS). METHODS: A sample of a total of 5323 participants from four of China's mega cities was included in the current study. Both a 3-day 24-h dietary recall and household condiment weighing were applied to assess dietary intake, respectively. Hierarchical logistic regression models were used to evaluate the associations of dietary iron, zinc and magnesium with MetS. RESULTS: After adjusting for age, sex, region, years of education, physical activity level, intended physical exercises, smoking status, alcohol use, daily energy intake and mutual adjustment for dietary iron, zinc and magnesium, significant positive trends were found across quartiles of total dietary iron and the risk of MetS, as well as for magnesium and MetS (p value for trends = 0.01 and 0.02, respectively); dietary zinc was inversely associated with MetS risk (p value for trend < 0.01). Magnesium from grains and potato was positively associated with MetS (p value for trend < 0.01). CONCLUSIONS: Dietary iron and magnesium were positively associated with the risk of MetS, while zinc was inversely associated with the risk of MetS, in China's mega cities. The positive association of magnesium with MetS could be a result confounding by other factors correlated with magnesium in grains and potato, which warrants further study.

Reducing Radiation Dose and Improving Image Quality in CT Portal Venography Using 80 kV and Adaptive Statistical Iterative Reconstruction-V in Slender Patients.

OBJECTIVE: To explore the feasibility of reducing radiation dose and improving image quality in CT portal venography (CTPV) using 80 kV and adaptive statistical iterative reconstruction-V(ASIR-V) in slender patients in comparison with conventional protocol using 120 kV and ASIR. METHODS: Sixty slender patients for enhanced abdominal CT scanning were randomly divided into group A and group B. Group A used the conventional 120 kV tube voltage, 600 mgI/kg contrast dose and reconstructed with the recommended 40% ASIR. Group B used 80 kV tube voltage, 350 mgI/kg contrast dose and reconstructed with ASIR-V from 40% to 100% with 10% interval. The CT values and standard deviation (SD) values of the main portal vein, left branch, and right branch of portal vein, liver, and erector spinae at the same level were measured to calculate the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). The image quality was subjectively scored by two experienced radiologists blindly using a 5-point criterion. The contrast dose, volumetric CT dose index, and dose length product were recorded in both groups and the effective dose was calculated. RESULTS: There was no significant difference in general data between the two groups (p > 0.05), the effective dose and contrast dose in group B were reduced by 63.3% (p < 0.001) and 39.7% (p < 0.001), respectively compared with group A. With the percentage of ASIR-V increased in group B, the CT values showed no significant difference, while the SD values gradually decreased and SNR values and CNR values increased accordingly. Compared with group A, group B demonstrated similar CT values (p > 0.05), while the SD values with 80% ASIR-V to 100% ASIR-V were significantly lower than those of 40% ASIR (p < 0.001), and the SNR values and CNR values with 70% ASIR-V to 100% ASIR-V were significantly higher than those of 40% ASIR (p < 0.001). The subjective image quality scores by the two radiologists had excellent consistency (kappa value>0.75, p < 0.001), and the final subjective image quality scores and the subjective scores in each of the 5 scoring categories with 60% ASIR-V to 100% ASIR-V were all significantly higher than those of 40% ASIR, and 80% ASIR-V obtained the highest subjective score among different reconstructions. CONCLUSION: In CTPV, the application of 80 kV and ASIR-V reconstruction in slender patients can significantly reduce radiation dose (by 63.3%) and contrast agent dose (by 39.7%). Compared with the recommended 40% ASIR using 120 kV, ASIR-V with 80% to 100% percentages can further improve image quality and with 80% ASIR-V being the best reconstruction algorithm. ADVANCES IN KNOWLEDGE: CTPV with 80 kV and ASIR-V algorithm in slender patients can significantly reduce radiation dose and contrast agent dose as well as improve image quality, compared with the conventional 120 kV protocol using 40% ASIR.

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.

[Evaluation of dietary intake quantity and quality of high school students in Shanghai City].

OBJECTIVE: To understand the dietary intake quantity and quality of high school students in Shanghai education. METHODS: From 2015 to 2016, Shanghai center for Disease Control and Prevention, divided the school into three levels(urban area, suburban area and rural area) according to the economic level and population composition of the street where the school was located. The probability-proportional-to-size sampling technique was used to select 19 high schools, from which 9 boys and 9 girls from same class were randomly recruited for each grade. A total of 1026 students were recruited. The survey included general situation questionnaire and dietary inquiry. Participants were required to complete the standardized questionnaire form through face-to-face interviews with trained interviewers. Chinese Dietary Guidelines(2016) was used to evaluate dietary quantity while China healthy diet index(CHDI) was used to evaluate dietary quality. RESULTS: The medians of intake of grain, vegetables, fruits, meat/livestock, fish/shrimp, eggs, milk and milk products, bean and bean products, cooking oil, cooking salt were 313. 8, 189. 7, 66. 3, 179. 2, 34. 7, 48. 9, 133. 3, 33. 3, 27. 1 and 6. 0 g/d within high school students, respectively. In both boys and girls, the medians of intake of vegetables, fruits, fish/shrimp, dairy products were lower than reference standard and meat/livestock was higher(P<0. 05). The intake differences among different area's high school students upon grain, vegetables, fruits, poultry/livestock, fish/shrimp, dairy products, beans/nuts, cooking oil, cooking salt were statistically significant(P<0. 05). The CHDI median total score of high school students was 68. 5 in Shanghai. 75. 2% of the CHDI total scores were between 60 and 80. The vegetable score, dark vegetable score, fruit score and total CHDI score in boys were significantly lower than those in girls(P<0. 05). The urban area CHDI score was significantly higher than suburban's and countryside's(P<0. 05). CONCLUSION: Both dietary structure and dietary quality are inappropriate and unfit within high school students in Shanghai, the urban area's condition is better than another two. We suggest to increase intake of vegetables, fruits, fish/shrimp, dairy products while decrease poultry/livestock's consumption.

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.

The Dietary Intake and Its Features across Four Seasons in the Metropolis of China.

Chinese diet pattern known as plant-based is more linked with seasonal supply, but it is lack of study on seasonal difference in dietary intakes in China. Our study was to assess seasonal variation in the absolute dietary intake among general population in a metropolis, Shanghai, China. A representative sample of general population aged 15 and older (n=1,704) were randomly stratified-sampled from communities in Shanghai. Dietary survey included consecutive 3-day-24-hour diet record recall and household condiments weighing. Data was collected across four seasons during 2012-2014. Most of food and condiments consumption differed across seasons in Shanghai. Intakes of grains, legumes and cooking oil were highest in spring; vegetables, fruit and non-alcoholic beverage highest, but cooking oil and cooking salt lowest in summer; red meat, nuts and cooking salt highest in winter. Seasonality existed in the intakes of energy and energy contributed from macronutrients that fat contributed more in winter but less in summer. Seasonal variations were also found in beta-carotene, vitamin E, vitamin K, thiamin, folate and sodium intakes. Seasonal changes of dietary intake were extensively observed in Shanghai, a highly-developed metropolis in China. Given the seasonal differences and their features described in current article, the estimation methods of the average dietary intake across whole year by just conducting dietary survey in one single season warrants further study.

Application of Adaptive Statistical Iterative Reconstruction-V With Combination of 80 kV for Reducing Radiation Dose and Improving Image Quality in Renal Computed Tomography Angiography for Slim Patients.

OBJECTIVES: To explore the application of adaptive statistical iterative reconstruction-V (ASIR-V) with combination of 80 kV for reducing radiation dose and improving image quality in renal computed tomography angiography (CTA) for slim patients compared with traditional filtered back projection (FBP) reconstruction using 120 kV. METHODS: Eighty patients for renal CTA were prospectively enrolled and randomly divided into group A and group B. Group A used 120 kV and 600 mgI/kg contrast agent and FBP reconstruction, while group B used 80 kV and 350 mgI/kg contrast agent and both FBP and ASIR-V reconstruction from 10%ASIR-V to 100%ASIR-V with 10%ASIR-V interval. The CT values and SD values of the right renal artery and left renal artery were measured to calculate the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). The image quality was subjectively scored by two experienced radiologists blindly using a five-point criterion. The contrast agent, volumetric CT dose index (CTDIvol), and dose length product in both groups were recorded and the effective radiation dose was calculated. RESULTS: There were no significant difference in patient characteristics between two groups (p > 0.05). The CTDIvol, dose length product and effective radiation dose in group B were 59.0%, 65.0%, and 65.1% lower than those in group A, respectively (all p < 0.05), and the contrast agent in group B was 42.2% lower than that in group A (p < 0.05). In group B, with the increase of ASIR-V percentage, CT values showed no significant difference, SD values decreased gradually, SNR values and CNR values increased gradually. The CT values showed no statistically significant difference (p > 0.05) between two groups with different reconstructions. The SD values with 40%ASIR-V to 100%ASIR-V reconstruction in group B was significantly lower(p < 0.5), while the SNR values with 50% ASIR-V to 100% ASIR-V reconstruction and CNR values with 70%ASIR-V to 100%ASIR-V were significantly higher than those of group A with FBP reconstruction (p < 0.5). Two radiologists had excellent consistency in subjective scores of image quality for renal CTA (kappa >0.75, p < 0.05). The subjective scores with 60% ASIR-V to 90% ASIR-V in group B were significantly higher than those of FBP in group A (p < 0.5), of which 70%ASIR-V reconstruction obtained the highest subjective score for renal CTA. CONCLUSION: ASIR-V with combination of 80 kV can significantly reduce effective radiation dose (about 65.1%) and contrast agent (about 42.2%) and improve image quality in renal CTA for slim patients compared with traditional FBP reconstruction using 120 kV, and the 70% ASIR-V was the best reconstruction algorithm in 80 kV renal CTA. ADVANCES IN KNOWLEDGE: Using 80 kV with combination of ASIR-V can significantly reduce radiation dose and contrast agent dose as well as improve image quality in renal CTA for thin patients when compared with FBP using 120 kV.

Improving image quality with model-based iterative reconstruction at quarter of nominal dose in upper abdominal CT.

OBJECTIVE: To evaluate the ability of a model-based iterative reconstruction (MBIR) for improving image quality in upper abdominal CT with quarter of the normal dose, in comparison with adaptive statistical iterative reconstruction (ASiR) at normal dose. METHODS: 40 upper abdominal patients were randomly divided into two groups: normal-dose group (n = 20) with tube current modulation for noise index (NI) of 10 HU and 40% ASiR reconstruction; low-dose group (n = 20) with NI = 20 HU in the delay phase and MBIR and 40%ASiR. Images in the delay phase were compared. The CT values and standard deviation (SD) values of the liver, spleen, pancreas, kidney, erector spine and fat were measured. Contrast-noise-ratio (CNR = (CTtissue-CT fat)/SDfat) of each measured organ were calculated and compared with one-way ANOVA among the three reconstruction groups. The subjective image scores of the three groups were assessed blindly by two experienced physicians using a 5-point system and the score consistency was compared by the κ test. RESULTS: Dose reduction of 75 % was achieved for the low-dose scan. The subjective scores (95 % confidence intervals) of the three groups (NI 10-40 % ASiR, NI 20-40% ASiR and NI 20-MBIR) were 4.00 ± 0.79 (3.62-4.37), 3.35 ± 0.58 (3.07-3.62) and 3.90 ± 0.64 (3.60-4.19), respectively with no difference between the NI 10-40% ASiR and NI20-MBIR groups and good consistency between reviewers (κ = 0.726). MBIR had statistically lower SD values and higher contrast-to-noise ratio values in the liver, spleen, pancreas, kidney and erector spine than NI 10-40% ASiR and NI 20-40% ASiR (all p < 0.05). CONCLUSION: At 75 % dose reduction, MBIR provides similar image quality compared to 40% ASiR at normal-dose. ADVANCES IN KNOWLEDGE: MBIR provides good image quality at 25 % of the normal dose.

Survey on energy and major nutrients intake of high school students in Shanghai / 中国学校卫生

Objective@#To understand the energy and major nutrients intake of high school students in Shanghai, and to provide basis for formulating target nutritional interventions and health education.@*Methods@#The probability-proportional-to-size sampling technique was used to select 19 high schools, from which 9 boys and 9 girls from same class were randomly recruited for each grade. A total of 900 high school students were surveyed on their energy and major nutrients intake.@*Results@#The medians of intake of energy, protein, fat, carbohydrate, calcium, sodium, iron, vitamin A, vitamin B-1, vitamin B-2, vitamin C and dietary fiber were 2 353 kcal/d, 97.3 g/d, 95.4 g/d, 265.4 g/d, 602.1 mg/d, 4 373 mg/d, 24.3 mg/d, 495.6 μgRE/d, 1.08 mg/d,1.21 mg/d, 83.2 mg/d and 1.01 g/d, respectively. Among of them, the medians of intake of energy, calcium, vitamin A, vitamin B-1, vitamin B-2, vitamin C and dietary fiber for boys and girls were lower than reference standard(P<0.05). The medians of intake of energy and major nutrients in high school students who lived in countryside were less than those lived in suburban and urban(P<0.05), except carbohydrates and iron. The percentages of energy supplied byprotein, fat and carbohydrate were 16.9%, 37.2%and 46.0%, respectively.@*Conclusion@#The energy and calorigenic nutrients intake can meet the demand of daily consumption in high school students in Shanghai, but the intake of dietary fiber, some minerals and vitamins have a various degrees of deficiency. The proportion of energy supplied bycalorigenic nutrients is unbalanced.

Total and Nonheme Dietary Iron Intake Is Associated with Metabolic Syndrome and Its Components in Chinese Men and Women.

The causal relationship between serum ferritin and metabolic syndrome (MetS) remains inconclusive. Dietary iron intake increases serum ferritin. The objective of this study was to evaluate associations of total, heme, and nonheme dietary iron intake with MetS and its components in men and women in metropolitan China. Data from 3099 participants in the Shanghai Diet and Health Survey (SDHS) obtained during 2012⁻2013 were included in this analysis. Dietary intake was assessed by 24-h diet records from 3 consecutive days. Multivariate generalized linear mixed models were used to evaluate the associations of dietary iron intake with MetS and its components. After adjustment for potential confounders as age, sex, income, physical exercise, smoking status, alcohol use, and energy intake, a positive trend was observed across quartiles of total iron intake and risk of MetS (p for trend = 0.022). Compared with the lowest quartile of total iron intake (<12.72 mg/day), the highest quartile (≥21.88 mg/day) had an odds ratio (95% confidence interval), OR (95% CI), of 1.59 (1.15,2.20). In addition, the highest quartile of nonheme iron intake (≥20.10 mg/day) had a 1.44-fold higher risk of MetS compared with the lowest quartile (<11.62 mg/day), and higher risks of MetS components were associated with the third quartiles of total and nonheme iron intake. There was no association between heme iron intake and risk of MetS (p for trend = 0.895). Associations for total and nonheme iron intake with MetS risk were found in men but not in women. Total and nonheme dietary iron intake was found to be positively associated with MetS and its components in the adult population in metropolitan China. This research also revealed a gender difference in the association between dietary iron intake and MetS.

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.