Gluten-free diet on video platforms: Retrospective infodemiology study.

Background: Video platform is an important approach for individuals to access and adopt health information. Online information on gluten-free diet (GFD) videos remains underinvestigated. Methods: GFD videos were identified by hashtag-based searching strategy. Videos' basic information, engagement metrics, and content were recorded. Mann-Kendall test was performed to examine time trends of submitting videos and engagement metrics. Video quality was evaluated by the DISCERN instrument and the HONcode. Results: A total of 822 videos were included in the analysis, with the majority focusing on gluten-free food recipes. The number of videos related to GFD was showing an upward trend. Engagement metrics varied between platforms and video types, with non-recipe videos receiving higher user engagement. The average DISCERN score was 50.20 out of 80 and the average HONcode score was 1.93 out of 8. Videos submitted by health professionals demonstrated better quality compared to those submitted by patients or general users. Conclusion: There was a rise in the number of videos related to GFD on Chinese video platforms. The overall quality of these videos was poor, most of them were not rigorous enough. Highlighting using social media as a health information source has the potential risk of disseminating one-sided messages and misleading. Efforts should be made to enhance the transparency of advertisements and establish clear guidelines for information sharing on social media platforms.

The burden of cardiovascular disease attributable to dietary risk factors in the provinces of China, 2002-2018: a nationwide population-based study.

Background: The burden of cardiovascular diseases (CVDs) is on the rise in China, yet a comprehensive and systematic understanding of the temporal trends and distribution of CVD burden attributable to dietary factors across the provinces remains elusive. This study endeavors to provide a comprehensive depiction of the burden of CVDs attributable to dietary risk factors across China's geographical regions from 2002 to 2018. Methods: Data from the China National Nutrition Surveys, the China Chronic Disease and Risk Factor Surveillance, the Hypertension Survey, and the Chinese Centre for Disease Control and Prevention cause-of-death reporting system were used to estimate the intake of dietary factor, the number of deaths, and disability-adjusted life years (DALYs), mortality rate, for ischemic heart disease (IHD), ischemic stroke (IS), hemorrhage and other stroke (HOS) attributable to dietary factors at national and provincial levels in China from 2002 to 2018. Using a comparative risk assessment approach, we estimated the proportion of CVDs burden attributable to suboptimal intake of seven dietary factors, both individually and collectively, among Chinese citizens aged 20 years or older. Finding: The mean consumption of whole grains, soybeans, nuts, vegetables, fruits, red meat, and sugar-sweetened beverages (SSBs) exhibited an upward trend from 2002 to 2018. However, with the exception of red meat and SSBs, the average intake remained below the levels recommended levels outlined in the Chinese national dietary guidelines. Inadequate fruit, whole grain, and vegetables intake were the leading dietary risk factors for IHD, IS and HOS in China, while nuts, soybean and SSB were only associated with IHD mortality. From 2002 to 2018, the number of deaths and mortality rate for CVDs attributable to suboptimal diet among Chinese males were greater than that of females. With increasing age, the diet-related mortality rate for CVDs increased substantially. In 2018, the nationwide mortality rate attributable to diet was found to be 77.9 (95% UI, 77.5-78.1) per 100,000 population for IHD, 34.1 (95% UI, 33.8-34.2) for IS, and 32.8 (95% UI, 32.4-32.8) for HOS. Suboptimal diet was responsible for 16.0 million (95% UI, 13.8-18.4) DALYs and 1137.1 (95% UI, 980.4-1312.3) DALYs per 100,000 population for stroke, and 13.9 million (95% UI, 11.8-16.3) DALYs and 990.2 (95% UI, 841.2-1158.6) DALYs for IHD. Across the provinces of China, in 2018, the highest age-standardized mortality rates of all diet-related deaths were observed in Shandong (92.8 [95% UI, 89.9-93.3]) for IHD, Heilongjiang (38.1 [95% UI, 36.2-38.8]) for IS, and Tibet (68.3 [95% UI, 65.0-70.1]) for HOS. The highest diet related DALYs were observed in Henan (1.4 million [95% UI, 1.2-1.6] for IS, and 1.3 million [95% UI, 1.1-1.5] for IHD). Interpretation: This study provides a comprehensive picture of the geographic variation and temporal trends of the burden of CVDs attributable to dietary risk factors at the national and provincial levels from 2002 to 2018 in China, highlighting the need for geographically targeted intervention strategies to improve the quality of diet and reduce the diet-related burden of CVDs. Funding: National Key Research and Development Program of China (2018YFC1315303), National Natural Science Foundation of China (82103966).

[Evaluate the dietary quality of pregnant women using the adjusted diet balance index for pregnancy].

OBJECTIVE: To update the Chinese diet balance index for pregnancy(DBI＿P), evaluate the dietary quality of pregnant women at different stages of pregnancy and analyze the influencing factors. METHODS: The DBI＿P was adjusted according to the recommended intake of various foods for pregnant women at different stages in the newly released Dietary Guidelines for Chinese Residents(2022) and and the balanced dietary pagoda for pregnant women. A total of 521 pregnant women in Taicang were investigated by questionnaire and 3-day food records method. Their basic information and food intake in the first, second and third trimester were collected. Low bound score(LBS), high bound score(HBS), diet quality distance(DQD) of DBI＿P were used to evaluate the dietary quality of each stage of pregnancy and multiple linear regression method was used to analyze the influencing factors of dietary quality. RESULTS: There was insufficient intake of cereals, vegetables, fruits, dairy products, soy nuts, aquatic products and food categories at all stages of pregnancy. The intake of eggs was sufficient at each stage of pregnancy. The intake of meat and poultry was excessive at all stages of pregnancy. The proportion of pregnant women with insufficient vegetable intake in the first, second and third trimester all exceeded 70%. The proportion with insufficient daily food categories in each term was more than 90%. The proportion with excessive intake of meat and poultry increased from 74.5% in the first trimester to 84.1% in the third trimester. The mean of LBS in each stage of pregnancy were 16.0, 15.5 and 15.1, and the proportion with moderate to severe insufficient intake were 14.2%, 12.2% and 9.2%, respectively. The mean of HBS in each stage of pregnancy were 4.3, 4.8 and 4.9, and the proportion with moderate to severe excessive intake were 4.3%, 5.4% and 4.5%, respectively. The mean of DQD in each stage of pregnancy were 20.3, 20.3 and 20.0, and the proportion with moderate to severe imbalanced intake were 26.9%, 26.1% and 21.7%, respectively. The proportion of pregnant women with low imbalanced intake or balanced diet during the whole pregnancy was 51.1%. Compared with pregnant women under 25 years of age, pregnant women ≥25 years of age had a lower degree of insufficient and unbalanced dietary intake(ß=-0.99, 95%CI-1.94--0.03). With the increase of education level, the degree of insufficient and unbalanced dietary intake of pregnant women showed a downward trend, while the degree of excessive intake increased only in college graduates(ß=0.66, 95%CI 0.11-1.22). Compared with pregnant women living in rural areas, pregnant women living in urban areas had a lower degree of excessive dietary intake(ß=-0.59, 95%CI-0.97--0.21). CONCLUSION: The dietary structure of pregnant women in Taicang is imbalanced, and the dietary quality is affected by sociodemographic characteristics.

Effect of hydrolyzed formulas on gastrointestinal tolerance in preterm infants: a systematic review and meta-analysis.

OBJECTIVE: Hydrolyzed formulas (HFs) have been increasingly used in early enteral feeding in preterm infants. The current study aimed to compare the effect of HFs with standard preterm formula (SPF) on gastrointestinal tolerance in preterm infants by systematically reviewing the randomized controlled trials (RCTs) related. METHODS: Relevant studies published until August 2021 were searched in English and Chinese databases, including PubMed, Embase, Cochrane Library, CNKI, WanFang Data, and VIP. Three outcomes, including the incidence of feed intolerance (FI), necrotizing enterocolitis (NEC), and the time to full enteral feeding, were chosen to evaluate the effect on gastrointestinal tolerance comprehensively. RESULTS: Ten eligible studies with 886 participants were included in the final analysis. Infants who received HFs showed a lower risk of FI (RR = 0.61, 95% CI = 0.42-0.90; p < .05) and shorter time to full enteral feeding (MD = -0.56, 95% CI = -1.03 to -0.10; p < .05) compared with those fed with SPF. There was no significant difference in risk of NEC (RR = 0.48, 95%CI = 0.21 - 1.08; p > .05) between the two groups. CONCLUSIONS: The results showed that HFs may have benefits in improving gastrointestinal tolerance in preterm infants, including reducing the risk of FI and shortening the time to full enteral feeding.

[Main food intake prediction of Chinese residents based on grey model].

OBJECTIVE: To predict the main food intake trend of the China's urban and rural residents from 2022 to 2030. METHODS: Data was collected from the China Health and Nutrition Survey(CHNS), which was carried out on a stratified, multistage, clustered, and random sampling method. And the average daily food intake in the survey was continuously collected by a 24-hour dietary review method for 3 consecutive days. The sample sizes aged 20 years or older of seven rounds survey were 9794, 9425, 9313, 9726, 12 760, 15 446 and 15 051, respectively. Based on the seven rounds of average food intake, the main food intake of urban and rural residents in China from 2022 to 2030 was predicted by the Grey model. RESULTS: (1)The mean absolute percentage error of average food intake prediction in urban and rural ranged from 1.6% to 38.4%. (2)In terms of the trends of food intake from 2022 to 2030, the grain and vegetable average intake of plant food in urban and rural residents showed a decreasing trend, while the average intake of fruits showed an increasing trend. The average intake of animal food, such as poultry and aquatic products in urban, livestock, poultry, eggs in rural areas showed an upward trend. Meanwhile, the average intake of animal food, such as livestock and eggs in urban and aquatic products in rural showed a downward trend. (3)Compared with the 2018, the fruits, poultry and aquatic product intake of urban and rural residents in 2030 will increase by 60.7%, 29.4% and 6.6%, the intake of grain, vegetables, livestock and eggs in urban areas will decrease by 36.9%, 19.4%, 8.7% and 12.4%, respectively. In 2030, the intake of fruits, livestock, poultry and eggs of rural residents will increase by 88.9%, 31.8%, 71.9% and 9.2%, respectively. While the intake of grain, vegetables and aquatic products of rural residents will decrease by 32.5%, 24.8% and 2.2%, respectively. (4)By 2030, the average intake of poultry in urban and rural areas will be within the recommended range of dietary guidelines. But the average intake of grain, vegetables, fruits, eggs and aquatic products in urban and rural areas will remain below dietary recommendations. While the livestock average intake will be far higher than the recommendations. CONCLUSION: The model accuracy is different when applied to different kinds of food. According to the prediction result of the grey model, residents should be guided to maintain the current grain intake level and increase the intake of vegetables, fruits, poultry, eggs and aquatic products in order to get balanced diet, while reducing the intake of livestock.

Associations between Feeding Patterns and Infant Health in China: A Propensity Score Matching Approach.

Breastmilk is the optimal food for infants. Feeding pattern is closely related to physical development and health during infancy. Understanding the associations between feeding patterns and health status can inform related policy interventions and advocacy in China. This study aimed to investigate the relationship between infant feeding patterns and health status in China infants. The China National Nutrition and Health Surveillance 2013 was a national-representative cross-sectional study performed particularly for children aged 0-5 years. A total of 3974 infants aged under 1 year were included in the analysis, of whom 1082 (27.2%) made up the formula feeding group, and 2892 (72.8%) made up the breastfeeding group. The associations between feeding patterns and physical development and health were investigated using propensity score matching and multivariable logistic regression models. Among breastfeeding and formula feeding infants aged 9-11 months old, weight-for-age z score was 1.1 ± 1.1 and 0.9 ± 1.3, respectively, and weight-for-length z score was 1.0 ± 1.3 and 0.7 ± 1.4, respectively. Hemoglobin in 0-2, 3-5, 6-8, and 9-11 months old breastfeeding infants was 121.4 ± 15.2 g/L, 117.1 ± 13.0 g/L, 113. 9 ± 11.9 g/L, and 114.4 ± 14.0 g/L, while in 0-2, 3-5, 6-8, and 9-11 months formula feeding infants was 116.3 ± 14.8 g/L, 120.4 ± 11.3 g/L, 119.8 ± 11.2 g/L, and 120.0 ± 11.5 g/L, respectively. Breastfeeding was associated with lower risk of respiratory disease (OR: 0.79; 95% CI: 0.64, 0.99) and diarrhea (OR: 0.75; 95% CI: 0.57, 0.98). Breastfeeding could slightly improve infant physical development, and had a protective effect on the diarrheal and respiratory diseases. Infants aged 3-11 months who were breastfeeding showed lower hemoglobin than that of formula-fed infants and thus should increase intake of iron rich complementary foods.

[Application of different spatial interpolation methods in sodium intake estimation].

OBJECTIVE: The spatial interpolation method was used to estimate the intake of sodium in the areas without dietary sodium intake data. METHODS: The data of dietary sodium consumption in this study are from the 2010-2012 China National Nutrition and Health Surveillance(CNNHS), the CNNHS was carried out on stratified multistage systematic clustered random sampling method with proportional to the population to form a representative sample of China as a whole, including 150 survey site. Dietary data was collected through face-to-face interview, based on a combination of three consecutive days of 24-h recalls combined with a household food weighting method, a total of 48 826 participants aged 20 years old and more were recruited in this study. The average sodium intake among 150 survey sites were calculated according to data of the CNNHS 2010-2012. The accuracy of spatial analysis techniques, such as Inverse Distance Weight, Ordinary Kriging, Cooperative Kriging method and Regression Kriging Interpolation method, was compared in the estimation of dietary sodium intake. The spatial analysis method with the highest accuracy was used to estimate the daily dietary sodium intake of each district and county in China, and then the dietary sodium intake of each province was calculated according to the population weight. RESULTS: The average sodium intake among Chinese adults was 5. 18 g, among which the average intake of men is 5. 33 g and that of women was 5. 03 g. Comparing the accuracy of four spatial analysis method in estimating dietary sodium intake, it was found that the Regression Kriging Interpolation method was superior to the other three methods, with root mean square error and mean absolute error of 0. 54 and 0. 44. The Regression Kriging Interpolation method was used to estimate the dietary sodium intake in different regions of China, the estimated national dietary sodium intake by population weighted calculation was 5. 17 g/d, the estimated national dietary sodium intake was 5. 33 g/d for men and 5. 01 g/d for women. The difference rate between the measured and estimated dietary sodium intake for all age groups was not more than 10%. Shandong Province, Tianjin City and Hebei Province had the highest sodium intake, which was 5. 98 g/d, 5. 83 g/d and 5. 82 g/d, respectively. Guizhou Province had the lowest sodium intake, with an estimated intake value of 4. 27 g/d. CONCLUSION: The spatial interpolation method can be used to estimate the intake of sodium, and the accuracy of Regression Kriging Interpolation method is higher than other spatial interpolation method.

[China prime diet quality score].

OBJECTIVE: To Develop the China Prime Diet Quality Score(CPDQS) and evaluate the relationship between dietary quality and health-related outcomes in Chinese adults. METHODS: CPDQS was conducted by 22 components, including dark green vegetables, dark red/orange vegetables, other vegetables, dark yellow fruits, citrus fruits, other fruits, whole grains/legumes, sweet potato, other potatoes, soybean, nuts, poultry, fish and shrimp, milk, eggs, red meat, fried food, refined grains, sugar sweetered beverages, salt, cooking oil, and alcohol. CPDQS components were selected based on Chinese Dietary Guidelines, and the values of each CPDQS components were set according to the dietary recommendations of foods and nutrients. According to the recommended amount of all kinds of foods under energy requirements of 2000 kcal in the Balanced Diet Pagoda, the basic score for each kind of food was 0-4, and the total score of the 22 components ranges from 0 to 100. Dietary quality of Chinese residents was evaluated according to CPDQS by analyzing data of adults aged 20-80 from Chinese Nutrition and Health Surveillance in 2010-2012. RESULTS: Mean of CPDQS for Chinese residents aged 20 and above was 40. 28±0. 08. CPDQS was higher in urban areas than in rural areas with median 48 and 39 respectively. CPDQS of female was slightly higher than that of male with median 44 and 43 respectively. CPDQS showed significantly correlation with all kinds of nutrients, in which correlation coefficient with carbohydrate and MPA was-0. 18 and 0. 35. With the increase of CPDQS score, the risk of overweight and obesity, abdominal obesity, hypertension, low high-density lipoprotein cholesterol-emia and metabolic syndrome decreased. After multi-factor adjustment, ORs of the highest quantile-group were 0. 73(95%CI 0. 63-0. 84), 0. 72(95%CI 0. 63-0. 83), 0. 67(95%CI 0. 57-0. 78), 0. 85(95%CI 0. 73-0. 99) and 0. 72(95%CI 0. 61-0. 85), respectively compared with the lowest quantile-group. CONCLUSION: CPDQS is a simplified index for comprehensive evaluation of dietary quality and it can reflect differences in diet quality among people in different regions and different health conditions. CPDQS could be used as an effective tool for evaluation of dietary quality.

Relationship of Sodium Intake with Overweight/Obesity among Chinese Children and Adolescents: Data from the CNNHS 2010-2012.

This study aims to examine association between sodium intake and overweight/obesity among Chinese children and adolescents. Data were obtained from China National Nutrition and Health Surveillance (CNNHS), 2010-2012. All participants recruited in this study aged 7-18 years old and provided complete dietary data on three-day consecutive 24 h dietary recalls combining with the household weighing method. Body Mass Index (BMI) was used to define overweight/obesity, and waist-to-height ratio (WHtR) was used to define abdominal obesity. Sodium intake showed association with risk of overweight/obesity assessed by BMI in the highest tertile group with OR of 1.48 (95%CI 1.13-1.94) and 1.89 (95%CI 1.33-2.67) for WHtR. After adjusted for gender, age, household income, area, energy, carbohydrates, protein, fat, saturated fatty acids, and fiber intake, the relationship between sodium intake and overweight/obesity and abdominal obesity are not changed. The same results were founded in subjects aged 10-18 years old. Our results reveal a positive association between sodium intake and overweight/obesity in Chinese children and adolescents, independent of energy consumption.

Trends and Disparities of Energy Intake and Macronutrient Composition in China: A Series of National Surveys, 1982-2012.

BACKGROUND: China's diet transition might offer guidance to undeveloped countries on the way to prosperity. This report describes the trends and disparities in energy and macronutrient composition among Chinese adults, and between subpopulations. METHODS: Data for the current study were obtained from the 1982, 1992, 2002, and 2010-2012 China National Nutrition Survey (CNNS) rounds, which were nationally representative cross-sectional surveys. We applied 24-h dietary recall and food weighing to assess dietary intake. RESULTS: There were 204,877 participants aged 20 years or older included in the current analysis. From 1982 to 2012, the estimated energy intake declined from 2614.7 kcal to 2063.9 kcal. The trend in the estimated percentage of energy intake from fat showed a spike. It increased from 16.3% to 33.1% (1992 vs. 1982 difference, 7.6%; 95% CI 7.4% to 7.7%; 2002 vs. 1992 difference, 7.7%; 95% CI 7.6% to 7.9%; 2012 vs. 2002 difference, 1.6%; 95% CI 1.4% to 1.7%; p < 0.01 for trend). The trends coincided in all the subgroups (all p < 0.01 for trend) except for the subgroup of those educated over 15 years, whose percentage of energy intake from fat declined from 37.4% to 36.6% (2012 vs. 2002 difference, -0.8%; 95% CI -1.6% to 0.0%). The estimated percentage of energy intake from carbohydrates declined from 74.0% to 55.0%. The ranges of the estimated percentage of energy intake from fat, within population subgroups stratified by education level, area and Gross national product (GNP) level, were narrowed. CONCLUSIONS: Quick improvements in society and the economy effectively curbed undernutrition, but easily triggered overnutrition. Disparities persistently existed between different subpopulations, while the gaps would narrow if comprehensive efforts were made. Education might be a promising way to prevent overnutrition during prosperous progress. The low-social profile populations require specific interventions so as to avoid further disease burdens.

Conceptual Barriers to Palliative Care and Enlightenment From Chuang-tze's Thoughts.

This paper claims that palliative care (PC) is a suitable approach for offering comprehensive support to patients with life-threatening illness and unavoidable asthenia, to enhance their quality of life in aging and chronic illness. There are however some conceptual barriers to accessing that care on the Chinese Mainland: (1) Death-denying culture and society; (2) Misguidance and malpractice derived from the biomedical model; (3) Prejudice against PC and certain deviant understandings of filial piety culture. To counter these obstacles, the study introduces the philosophy of Chinese Taoist Chuang-tze to enlighten the public from ignorance and remove some illusions about death and dying; inspire people to face and accept illness and death calmly, and keep harmony and inner peace of mind to alleviate suffering, with the aim of providing wisdom and a shift of attitude toward life and death. Chuang-tze's thoughts are consistent with the provision of palliative care, and to a certain degree, can promote its acceptability and delivery, and the conception of good death in practice.

Dietary Sodium Intake and Food Sources Among Chinese Adults: Data from the CNNHS 2010-2012.

The present study was done to examine the status of dietary sodium intake and dietary sources of sodium among Chinese adults. Data were obtained from China National Nutrition and Health Surveillance (CNNHS) 2010-2012. All adults recruited in this study provided complete dietary data on three-day consecutive 24-h dietary recalls combining with the household weighing method. Sodium intake was adjusted for energy to 2000 kcal/day using the residual method. Average sodium intake was 5013 (95% Confidence Interval, CI: 4858, 5168) mg/day, and 92.6% of adults' sodium intake exceeded the standard in the Chinese proposed intake for preventing non-communicable chronic diseases (PI-NCD). The salt added to food was the main contributor to daily sodium intake, representing 69.2% of the total sodium consumption. The proportion of sodium from salt was different in some subgroups. The contribution ranged from 64.8% for those who came from urban areas aged 18-49 years old to 74.7% for those who came from rural areas with education levels of primary school or less, and sodium from soy sauce was the next highest contributor (8.2%). The proportion of the subjects with sodium intake contributed by flour products was higher in the north with 7.1% than the south with 1.4%. The average consumption of sodium among Chinese was more than the recommended amount, and salt was the main source of sodium.

Epidemiology of Norovirus Outbreaks Reported to the Public Health Emergency Event Surveillance System, China, 2014⁻2017.

We conducted a retrospective analysis of norovirus outbreaks reported to the National Public Health Emergency Event Surveillance System (PHEESS) in China from January 1, 2014 to December 31, 2017. We reviewed all acute gastroenteritis outbreaks (n = 692) submitted to PHEESS to identify the frequency, seasonality, geographic distribution, setting, and transmission mode of outbreaks due to norovirus. A total of 616 norovirus outbreaks resulting in 30,848 cases were reported. Among these outbreaks, 571 (93%) occurred in school settings including 239 (39%) in primary schools, 136 (22%) in childcare facilities, and 121 (20%) in secondary schools. The majority of outbreaks (63%) were due to person-to-person transmission, followed by multiple modes of transmission (11%), foodborne (5%) and waterborne (3%) transmission. These findings highlight the importance of improving hand hygiene and environmental disinfection in high-risk settings. Developing a standard and quantitative outbreak reporting structure could improve the usefulness of PHEESS for monitoring norovirus outbreaks.

Epidemiologic characteristics of Norovirus outbreak in schools and kindergardens in China during 2014-2018 / 中国学校卫生

Objective@#To investigate the epidemiological characteristics of norovirus clustering and outbreaks in schools and kindergartens in China, so as to provide references for prevention and control of outbreaks.@*Methods@#A descriptive epidemiological method was used to analyze outbreaks of Norovirus in schools and kindergartens in China during 2014-2018 , the indicators which was analyzed and compared including attack rate, duration of the outbreak, reporting interval.@*Results@#A total of 832 Norovirus outbreaks were reported by schools and kindergartens in China from 2014 to 2018. The total number of outbreaks showed an upward trend with an average annual growth rate of 58%. The number of reported cases was 40 445 but there was no death. Norovirus outbreaks mainly occurred in primary schools (42%), followed by kindergartens and middle schools (both 24%), university (6%) and 77 outbreaks (4%) were reported in universities and other schools. The peak seasons were March to May, November and December each year. Jiangsu Province and Guangdong Province (both 22%) reported the largest number of outbreaks. The main transmission of norovirus outbreaks was through direct person contact (72%), foodborne (4%) and waterborne (3%) caused fewer outbreaks than direct person contact. The duration of the epidemic was positively correlated with the reporting interval (r=0.63, P<0.05) and the number of cases per outbreak (r=0.51, P<0.05).@*Conclusion@#Disinfection treatment of vomitus should be standardized in schools and kindergartens. Timely detection, reporting, disposal of the epidemic can effectively control the spread of norovirus outbreaks.