Characteristics of casein phosphopeptides in Chinese human milk and its correlation with infant growth: A cross-sectional study.

This research aimed to investigate the characteristics of casein phosphopeptides in Chinese human milk, and their potential relationship to infant growth. Using the liquid chromatography-Orbitrap-mass spectrometry technique, a total of 15 casein phosphopeptides were identified from 200 human milk samples. Also, our results indicate that casein phosphopeptides were phosphorylated with only one phosphate. The relative concentrations of casein phosphopeptides at 6 months postpartum were increased compared with milk at 2 months (FDR < 0.05). Significantly positive correlations were observed between casein phosphopeptides and infant growth, as shown by four casein phosphopeptides were positively correlated with the infants' weight-for-age Z-scores (rs range from 0.20 to 0.29), and three casein phosphopeptides were positively correlated with the infants' length-for-age Z-scores (rs range from 0.19 to 0.27). This study is the first to reveal the phosphorylated level and composition of casein phosphopeptides in Chinese human milk, and their potential relationship with infant growth.

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).

Socioeconomic inequalities in dementia burden related to high body mass index, 2005-2018: findings from 1.25 million Chinese adults.

Background: Dementia has become a major public health concern worldwide, but comprehensive assessments of dementia burden attributable to high body mass index (BMI) in China have not been done. Methods: We used a temporal-spatial Bayesian hierarchical model to estimated BMI levels based on 1.25 million Chinese. We estimated dementia burden attributable to high BMI by age, sex, year, and socioeconomic development in terms of deaths and years of life lost (YLLs) and assessed the effect of population ageing. Findings: The average age-standardised BMI was 24.58 kg/m2 and 24.15 kg/m2 for men and women in 2018, respectively. 12,901 (95% UI, 10,617-15,420) dementia deaths were attributable to high BMI in China in 2018, with 5417 deaths from man and 7421 deaths from woman. The attributable age-standardised YLL rates for dementia increased 27% from 2005 to 2018. The attributable age-standardised mortality rates increased with human development index. People aged 80 years and older had the highest attributable mortality rate, and the rate decreased with decreasing age. Population ageing was an important component of the increase in dementia death. Interpretation: The rapid increase and large inequality highlighted the urgent need for evidence-based policies and interventions. We therefore call for establishing stronger anti-dementia strategies to promote the healthy ageing. Funding: China National Key Research and Development Program, China National Science & Technology Pillar Program, and National Health Commission of the People's Republic of China.

Rapid increasing burden of diabetes and cardiovascular disease caused by high body mass index in 1.25 million Chinese adults, 2005-2018.

BACKGROUND: Temporal trends and geographical variations in disease burden for diabetes mellitus (DM) and cardiovascular disease (CVD) attributable to high body mass index (BMI) in China have not been fully elucidated. METHODS: We estimated deaths and years of life lost (YLLs) for DM and CVD attributable to high BMI by age, sex, year, and region from 2005 to 2018 based on pooled data of 1.25 million adults. FINDINGS: Approximately 497,430 (95% uncertainty interval [UI], 470,520-525,720) deaths for DM and CVD were attributable to high BMI in China in 2018, with 453,750 deaths from CVD and 43,700 deaths from DM. Between 2005 and 2018, there was a 17.35% increase in age-standardized mortality rate for DM and CVD attributable to high BMI. The high BMI-related DM and CVD YLL rates increased from 127.46 (95% UI 108.70-148.62) per 100,000 people aged 20-24 years to 5,735.54 (95% UI 4,844.16-6,713.53) per 100,000 people aged ≥80 years, respectively. The highest age-standardized mortality rate for high BMI-related DM and CVD in northeast, northwest, and circum-Bohai Sea regions of China. CONCLUSION: The disease burden for DM and CVD attributable to high BMI increased substantially between 2005 and 2018. Urgent measures are required at both national and regional levels for resource mobilization to slow the growing burden. FUNDING: The work was supported by the National Key Research and Development Program of China, China National Science & Technology Pillar Program, and National Health Commission of the People's Republic of China.

[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.

The burden of cardiovascular disease attributable to high systolic blood pressure across China, 2005-18: a population-based study.

BACKGROUND: Temporal trends and geographical variations in cardiovascular disease attributable to high systolic blood pressure in China are not yet fully understood. The aim of this study was to quantify the cardiovascular disease burden attributable to high systolic blood pressure at national and provincial levels in China. METHODS: In this population-based study, we evaluated systolic blood pressure and estimated the number of deaths, age-standardised mortality rates, and years of life lost (YLLs) due to cardiovascular disease and its subcategories (including ischaemic heart disease, ischaemic stroke, haemorrhagic stroke, and other cardiovascular diseases) attributable to high systolic blood pressure, at the national level and by 31 provincial levels, in China, from 2005 to 2018. We pooled blood pressure data of 1·30 million adults aged 25 years and older from the China Chronic Disease and Risk Factor Surveillance project, the China National Nutrition Survey, and the China Hypertension Survey. We applied a temporal-spatial Bayesian hierarchical model to estimate age-specific, sex-specific, province-specific, and year-specific average systolic blood pressure, and a comparative risk assessment method to compute the cardiovascular disease burden attributable to high systolic blood pressure by age, sex, year, and province. FINDINGS: Nationally, age-standardised mean systolic blood pressure was 132·5 mm Hg (95% uncertainty interval [UI] 124·6-140·3) in men and 129·4 mm Hg (121·7 to 137·2) in women. 2·67 million (95% UI 2·61 to 2·72) cardiovascular disease deaths in China were attributable to high systolic blood pressure, including 1·12 million deaths (1·07 to 1·16) due to ischaemic heart disease, 0·63 million deaths (0·60 to 0·65) due to ischaemic stroke, 0·58 million deaths (0·57 to 0·60) due to haemorrhagic stroke, and 0·34 million deaths (0·32 to 0·36) due to other cardiovascular disease. The age-standardised cardiovascular disease mortality rates associated with high systolic blood pressure were 268·99 per 100 000 people (95% UI 264·11 to 273·51) in 2005 and 220·84 per 100 000 people (216·30 to 224·76) in 2018, a percentage change of -17·90%; the rate changed by an average of -1·50% (95% UI -1·55% to -1·45%) per year from 2005 to 2018 nationally. YLL rates for total cardiovascular disease caused by high systolic blood pressure varied substantially across provinces, ranging from 3078·33 (95% UI 2807·40 to 3303·57) per 100 000 people in Beijing to 7189·98 (95% UI 6817·18 to 7507·99) per 100 000 people in Heilongjiang in 2018. Age-standardised YLL rates for ischaemic heart disease and ischaemic stroke attributable to high systolic blood pressure were particularly high in northeastern provinces, including Heilongjiang, Liaoning, and Jilin. INTERPRETATION: The deaths and YLLs for cardiovascular disease attributable to high systolic blood pressure in China increased between 2005 and 2018, and age-standardised cardiovascular disease mortality rates decreased in the same timeframe. Our findings could help policy makers in promoting blood pressure control measures and implementing effective and locally adapted preventive interventions to reduce the prevalence of high systolic blood pressure and reduce the burden of systolic blood pressure-related cardiovascular disease in China. FUNDING: China National Key Research and Development Program, China National Science & Technology Pillar Program, and National Health Commission of the People's Republic of China. TRANSLATION: For the Chinese translation of the abstract see Supplementary Materials section.

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 the Global Diet Quality Score in Chinese Adults to Evaluate the Double Burden of Nutrient Inadequacy and Metabolic Syndrome.

BACKGROUND: The double burdens of under- and overnutrition are changing the health of individuals and the economic and disease burdens in China. Poor diet plays an important role; however, a valid and easily operationalized metric that could capture the full range of characteristics of the diet that are relevant to both under- and overnutrition is lacking in China. OBJECTIVES: We aimed to examine the application of the Global Diet Quality Score (GDQS) to evaluate nutrient inadequacy and metabolic syndrome in different demographic groups of Chinese adults. METHODS: A total of 35,146 individuals (men 14,978, women 20,168) aged >18 y from the 2010-2012 China National Nutrition and Health Survey were included. We scored the GDQS using average intakes of 25 food groups from 3 d of 24-h dietary recalls. Double burden was defined as coexisting metabolic syndrome and nutrient inadequacy. RESULTS: Diet quality assessed by GDQS was significantly higher in urban than in rural residents (20.8 compared with 18.7), and increased with both educational level and household income (P-trends < 0.0001). A higher GDQS score was inversely associated with metabolic syndrome and nutrient inadequacy, or both (P-trends < 0.0001): multivariate adjusted ORs comparing extreme quintiles of GDQS were 0.79 (95% CI: 0.69, 0.91) for metabolic syndrome, 0.17 (95% CI: 0.14, 0.20) for nutrient inadequacy, and 0.59 (95% CI: 0.50, 0.69) for the double burden. These associations were consistent across different household income levels (P-interaction = 0.26), suggestively stronger in younger (<50 y), females, urban residents, and the more highly educated (P-interaction < 0.05) compared with their counterparts. CONCLUSIONS: A higher GDQS was inversely associated with a double burden of nutrient inadequacy and metabolic syndrome across various subgroups of Chinese adults. The finding supports the use of the GDQS in different demographic groups of Chinese adults to assess diet quality and nutritional status.

Development and Validation of a Novel Food-Based Global Diet Quality Score (GDQS).

BACKGROUND: Poor diet quality is a major driver of both classical malnutrition and noncommunicable disease (NCD) and was responsible for 22% of adult deaths in 2017. Most countries face dual burdens of undernutrition and NCDs, yet no simple global standard metric exists for monitoring diet quality in populations and population subgroups. OBJECTIVES: We aimed to develop an easy-to-use metric for nutrient adequacy and diet related NCD risk in diverse settings. METHODS: Using cross-sectional and cohort data from nonpregnant, nonlactating women of reproductive age in 10 African countries as well as China, India, Mexico, and the United States, we undertook secondary analyses to develop novel metrics of diet quality and to evaluate associations between metrics and nutrient intakes and adequacy, anthropometry, biomarkers, type 2 diabetes, and iteratively modified metric design to improve performance and to compare novel metric performance to that of existing metrics. RESULTS: We developed the Global Diet Quality Score (GDQS), a food-based metric incorporating a more comprehensive list of food groups than most existing diet metrics, and a simple means of scoring consumed amounts. In secondary analyses, the GDQS performed comparably with the Minimum Dietary Diversity - Women indicator in predicting an energy-adjusted aggregate measure of dietary protein, fiber, calcium, iron, zinc, vitamin A, folate, and vitamin B12 adequacy and with anthropometric and biochemical indicators of undernutrition (including underweight, anemia, and serum folate deficiency), and the GDQS also performed comparably or better than the Alternative Healthy Eating Index - 2010 in capturing NCD-related outcomes (including metabolic syndrome, change in weight and waist circumference, and incident type 2 diabetes). CONCLUSIONS: The simplicity of the GDQS and its ability to capture both nutrient adequacy and diet-related NCD risk render it a promising candidate for global monitoring platforms. Research is warranted to validate methods to operationalize GDQS assessment in population surveys, including a novel application-based 24-h recall system developed as part of this project.

[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.

[Status of parents' feeding behavior and influencing factors in 3-5 years old children in 5 provinces (autonomous regions and municipalities) of China in 2018].

OBJECTIVE: To understand the status of preschool children's feeding behavior, to analyse the feeding behavior of parents and its main influencing factors of children aged 3-5 years old. METHODS: From August to December 2018, 10 kindergartens in Liaoning Province, Shanghai City, Inner Mongolia Autonomous Region, Guangdong Province and Sichuan Province were selected by means of convenient sampling. A survey of 1057 preschool children's caregivers was conducted using the caregiver feeding style questionnaire. Chi-square test and binary Logistic regression were used to analyze the demographic characteristics of families with different feeding behaviors. RESULTS: It was found that among the four feeding style, the authoritative type accounted for only 10. 3%, and the authoritarian type accounted for 36. 1%, followed by the indulgent type(35. 8%) and the uninvolved type(17. 8%). Parents of 5-year-old were more likely to adopt indulgent type(OR=2. 60, 95%CI 1. 60-4. 22);fathers with a college degree or above were more likely to adopt authoritarian type(OR=2. 77, 95%CI 1. 39-5. 52) and indulgent type(OR=3. 79, 95%CI 1. 86-7. 72); mothers as primary caregivers were more likely to adopt authoritarian feeding method(OR=2. 48, 95%CI 1. 06-5. 83) and grandparents as primary caregivers were more likely to adopt indulgent feeding method(OR=3. 49, 95%CI 1. 54-7. 91). CONCLUSION: The proportion of children aged 3-5 whose parents adopt authoritarian, indulgent feeding method is higher. Among them, mothers are more likely to adopt authoritarian feeding behaviors, grandparents are more likely to adopt permissive feeding behaviors, and fathers with higher education are more likely to adopt authoritarian and permissive feeding behaviors.

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.

[Status of dietary energy and macronutrients intake among Chinese older adults from 2010 to 2012].

OBJECTIVE: To analyze dietary energy and macronutrients intake among Chinese older adults from 2010 to 2012. METHODS: Data was from Chinese Nutrition and Health Surveillance in 2010-2012. Dietary intake information was collected by three days food recall and weighed record of edible oil and condiments among 16 612 older adults. Daily energy and three macronutrients intake were calculated according to Chinese Food Composition 2004 and 2009 edition, and then evaluated by 2013 Chinese dietary reference intake. RESULTS: The daily average energy, carbohydrate, protein and fat intake of Chinese older adults was(1840. 9 ± 636. 7) kcal/d, (255. 9 ± 106. 8) g/d, (55. 6±22. 7) g/d and(66. 8±35. 0) g/d, respectively. The mean proportion of energy supplied from carbohydrate, protein and fat was(55. 7% ± 12. 1%), (12. 3% ± 3. 4%)and(32. 5% ± 11. 7%), respectively. Total energy intake, carbohydrate intake and proportion of energy from carbohydrate among urban elderly were lower than that in rural, whereas protein and fat intake as well as their contribute rate for energy were higher in urban than those in rural. Regardless of urban and rural areas, four regions and genders, there was a decreasing trend of energy and macronutrient intake with the increase of age(P<0. 01). There 57. 0% of male and 53. 8% of female had lower protein intake than the recommended value, while 56. 7% of male and 56. 8% of female had higher fat contribution for energy upper than 30%. The rate of protein intake deficiency among participants aged 60-69 years old, 70-79 years old, 80 years old and above was 51. 0%, 61. 2% and 68. 6% respectively, and the proportion of energy from fat that exceeded 30%was 56. 9%, 56. 3% and 57. 1%, respectively. CONCLUSION: The daily average macronutrients intake model was unreasonable with higher fat but lower protein among Chinese older adults.

Prevalence of metabolic syndrome and individual metabolic abnormalities in China, 2002-2012.

BACKGROUND AND OBJECTIVES: The purpose of our study was to estimate the national prevalence of metabolic syndrome, its individual components and its changes in the past decade. METHODS AND STUDY DESIGN: Two national-representative cross-sectional surveys: the China National Nutrition and Health Survey 2002 (CNNHS 2002) and the Chinese National Nutrition and Health Surveillance 2010-2012 (CNNHS 2010-2012). A total of 48,235 and 104,098 participants aged 18 years or older who had completed data on physical examination, blood lipids, and fasting glucose tests from CNNHS 2002 and CNNHS 2010-2012, respectively, were included in current study. RESULTS: The prevalence of metabolic syndrome in Chinese adults increased from 9.5% (95% confident interval [CI]: 9.2%-9.7%) in 2002 to 18.7% (18.3%-19.1%) in 2010-2012, corresponding to an estimated 83.6 million adults in 2002 and 189 million adults in 2010-2012 living with metabolic syndrome in China. The increment was more than doubled among young, rural residents and those from poor households. Abdominal obesity, hyperglycemia, high triglycerides, low HDL-C, and elevated blood pressure were found in 18.9% (18.5%-19.3%), 6.4% (6.2%-6.7%), 13.8% (13.5%-14.2%), 19.3% (18.9%-19.7%), and 34.0% (33.5%-34.5%) of adults in 2002, respectively, which was 25.8% (25.3%-26.2%), 16.2% (15.8%-16.5%), 23.7% (23.3%-24.2%), 32.6% (32.0%-33.1%), and 34.4% (33.9%-34.9%), respectively, in 2010-2012. CONCLUSIONS: Based on two nationally representative surveys, our results indicated that the prevalence of metabolic syndrome is widespread and increasing in China.