Establish a noninvasive model to screen metabolic dysfunction-associated steatotic liver disease in children aged 6-14 years in China and its applications in high-obesity-risk countries and regions.

Background: The prevalence of metabolic-associated steatotic liver disease (MASLD) is rising precipitously among children, particularly in regions or countries burdened with high prevalence of obesity. However, identifying those at high risk remains a significant challenge, as the majority do not exhibit distinct symptoms of MASLD. There is an urgent need for a widely accepted non-invasive predictor to facilitate early disease diagnosis and management of the disease. Our study aims to 1) evaluate and compare existing predictors of MASLD, and 2) develop a practical screening strategy for children, tailored to local prevalence of obesity. Methods: We utilized a school-based cross-sectional survey in Beijing as the training dataset to establish predictive models for screening MASLD in children. An independent school-based study in Ningbo was used to validate the models. We selected the optimal non-invasive MASLD predictor by comparing logistic regression model, random forest model, decision tree model, and support vector machine model using both the Beijing and Ningbo datasets. This was followed by serial testing using the best performance index we identified and indices from previous studies. Finally, we calculated the potential MASLD screening recommendation categories and corresponding profits based on national and subnational obesity prevalence, and applied those three categories to 200 countries according to their obesity prevalence from 1990 to 2022. Findings: A total of 1018 children were included (NBeijing = 596, NNingbo = 422). The logistic regression model demonstrated the best performance, identifying the waist-to-height ratio (WHtR, cutoff value ≥0.48) as the optimal noninvasive index for predicting MASLD, with strong performance in both training and validation set. Additionally, the combination of WHtR and lipid accumulation product (LAP) was selected as an optimal serial test to improve the positive predictive value, with a LAP cutoff value of ≥668.22 cm × mg/dL. Based on the obesity prevalence among 30 provinces, three MASLD screening recommendations were proposed: 1) "Population-screening-recommended": For regions with an obesity prevalence ≥12.0%, where MASLD prevalence ranged from 5.0% to 21.5%; 2) "Resources-permitted": For regions with an obesity prevalence between 8.4% and 12.0%, where MASLD prevalence ranged from 2.3% to 4.4%; 3) "Population-screening-not-recommended": For regions with an obesity prevalence <8.4%, where MASLD prevalence is difficult to detect using our tool. Using our proposed cutoff for screening MASLD, the number of countries classified into the "Population-screening-recommended" and "Resources-permitted" categories increased from one and 11 in 1990 to 95 and 28 in 2022, respectively. Interpretation: WHtR might serve as a practical and accessible index for predicting pediatric MASLD. A WHtR value ≥0.48 could facilitate early identification and management of MASLD in areas with obesity prevalence ≥12.0%. Furthermore, combining WHtR ≥0.48 with LAP ≥668.22 cm × mg/dL is recommended for individual MASLD screening. Moreover, linking these measures with population obesity prevalence not only helps estimate MASLD prevalence but also indicates potential screening profits in regions at varying levels of obesity risk. Funding: This study was supported by grants from Capital's Funds for Health Improvement and Research (Grant No. 2022-1G-4251), National Natural Science Foundation of China (Grant No. 82273654), Major Science and Technology Projects for Health of Zhejiang Province (Grant No. WKJ-ZJ-2216), Cyrus Tang Foundation for Young Scholar 2022 (2022-B126) and Sino-German Mobility Programme (M-0015).

Mapping Adolescent Mental Well-Being - 30 PLADs, China, 2019.

What is already known about this topic?: High levels of mental well-being are linked to favorable life outcomes. Nonetheless, compared to the research on psychiatric disorders, the understanding of mental well-being among Chinese adolescents is still relatively underexplored. What is added by this report?: This report fills a significant void in the literature concerning the mental well-being of Chinese adolescents by providing updated data. This information is critical for developing evidence-based interventions and strategies aimed at improving mental well-being and addressing mental health issues among adolescents. What are the implications for public health practice?: Enhancing psychological support for vulnerable populations is essential to improve mental well-being among adolescents, reduce health disparities, and achieve global Sustainable Development Goals.

Matching actions to needs: shifting policy responses to the changing health needs of Chinese children and adolescents.

China is home to the second largest population of children and adolescents in the world. Yet demographic shifts mean that the government must manage the challenge of fewer children with the needs of an ageing population, while considering the delicate tension between economic growth and environmental sustainability. We mapped the health problems and risks of contemporary school-aged children and adolescents in China against current national health policies. We involved multidisciplinary experts, including young people, with the aim of identifying actionable strategies and specific recommendations to promote child and adolescent health and wellbeing. Notwithstanding major improvements in their health over the past few decades, contemporary Chinese children and adolescents face distinct social challenges, including high academic pressures and youth unemployment, and new health concerns including obesity, mental health issues, and sexually transmitted infections. Inequality by gender, geography, and ethnicity remains a feature of health risks and outcomes. We identified a mismatch between current health determinants, risks and outcomes, and government policies. To promote the health of children and adolescents in China, we recommend a set of strategies that target government-led initiatives across the health, education, and community sectors, which aim to build supportive and responsive families, safe communities, and engaging and respectful learning environments. TRANSLATION: For the Chinese translation of the abstract see Supplementary Materials section.

Combined Effect of Outdoor Time and Other Modifiable Factors on Myopia Incidence Among Children and Adolescents - 9 PLADs, China, 2020.

What is already known about this topic?: Myopia has been identified as a significant emerging challenge and policy priority among children and adolescents in China by the Ministry of Education and seven other departments. Limited research has been conducted to investigate the collective impact of outdoor time and other modifiable factors on the incidence of myopia. What is added by this report?: This study provides support for the protective effect of combining increased outdoor time with other prevention strategies in reducing the incidence of myopia. The results indicate the presence of a dose-response relationship. What are the implications for public health practice?: To effectively prevent myopia, it is important to implement comprehensive interventions that encompass various aspects such as outdoor time, eye-use habits, eye-use environments, and lifestyle modifications.

Physical fitness and health status and gender differences of middle school students among five Chinese minorities during 2010 to 2019 / 中国学校卫生

Objective@#To analyze physical fitness and health status and gender differences of middle school students among 5 minorities (Mongolian, Hui, Uyghur, Zhuang and Korean), and to provide the theoretical basis for the strategy formulation.@*Methods@#The present data came from 3 waves of Chinese National Survey on Students Constitution and Health (2010, 2014, and 2019). According to National Standards for Students Physical Health (2014 Revision), excellent, and excellent good physical fitness and health status were defined. Cochran Armitage test was used to examine the trends of physical fitness and health status. Chi square test and Logistic regression were used to analyze the difference of physical fitness and health status by sex and survey year.@*Results@#From 2010 to 2019, the excellent physical fitness and health status rate of Mongolian, Hui, Uyghur, Zhuang and Korean students increased from 1.8%, 0.7%, 0.3%, 0.5% and 1.3% to 4.3%, 2.8%, 1.2%, 1.3% and 3.5%, respectively. The excellent good physical fitness and health status rate of Mongolian, Hui, Uyghur and Zhuang students increased from 12.9%, 8.0%, 7.2 % and 8.4% to 24.7%, 20.1%, 12.6% and 19.8%( Z =6.15，6.71，4.12，3.06，5.26；11.88，13.42，6.70，11.08， P <0.05), respectively. In 2019, students aged 13 to 15 years showed higher proportion of excellent/excellent good physical fitness and health status than that of students aged 16 to 18. Boys were more likely to be in excellent/excellent good physical fitness and health status than girls from 2010 to 2019. The sex difference in excellent/excellent good physical fitness and health status narrowed during 2010 and 2019.@*Conclusion@#Physical fitness and health status of minority students improved while sex difference narrowed during last decade, but there is still a long way to reach the goal proposed by China. Targeted intervention should be proposed to promote physical fitness and health status in accordance with the developmental characteristics, especially for girls and students aged 16 to 18 years.

Relation between physical fitness and frequency of breakfast consumption among Chinese Han college students / 中国学校卫生

Objective@#To examine the relation between physical fitness and frequency of having breakfast among Chinese Han college students so as to provide proper intervention and theoretical basis for improving college students’ physical fitness.@*Methods@#The data from 2014 Chinese National Survey on Students’ Constitution and Health (CNSSCH) was used. The data of 47 172 Han students were calculated, the chi-square test wasused to compare the differences of the physical fitness passing rate in different subgroups of college students. The Log-binomial model was established to assess the relation between physical fitness and breakfast consumption.@*Results@#The unqualified rate of physical fitness was 22.8%. Boys(24.7%), urban students (25.7%), and those who exercised less than one hour per day (23.3%) had lower physical fitness passing rates than girls(20.9%), rural students (19.9%) and those who exercised more than one hour per day (20.3%)respectively(χ2=101.38, 223.33, 32.20,P<0.01). The unqualified rate of physical fitness increased by age. The unqualified rate of physical fitness in eastern, central and western regions was 21.2%, 21.7% and 25.1% respectively. The unqualified rate of physical fitness for those with normal nutritional status (18.2%) was significantly lower than those who were underweight (26.0%) or overweight/obese(42.6%)(χ2=1 660.50, P<0.01). In this study, 53.2% of college students had breakfast every day,unqualified rate of physical fitness was higher among students with less regular consumption of breakfast(χ2=393.50, P<0.01). The Log-binomial model showed that the college students who had 3-5 breakfasts(PR=1.16, 95%CI=1.11-1.20), 1-2 breakfasts(PR=1.34, 95%CI=1.28-1.40), never had breakfast (PR=1.43, 95%CI=1.32-1.53) per week had higher physical fitness failure rates than those who had breakfast every day.@*Conclusion@#There is a significant association between physical fitness and breakfast consumption among college students. Developing the good habit of having breakfast is not only the component of healthy lifestyle but also an indispensable part to the improvement of college students’ physical fitness.

Infrastructure and sanitation practice of Chinese primary and middle schools canteens / 中国学校卫生

Objective@#To understand the current situation of infrastructure construction and sanitation practice of school canteens in China and to provide a reference for improving food safety in school canteen and sanitation management level.@*Methods@#Stratified sampling method was adopted to select the surveyed schools. Information regarding school canteen infrastructure and sanitation practice was collected through questionnaires. Chi-square test was used to compare the difference in passing rate on the survey indices among different school types.@*Results@#In environmental sanitation, 91.0% of the school canteen was rated as good and in personal hygiene, 92.8% of the employees were rated as good. The overall health level of urban schools was better than that of township schools, and non-boarding schools was better than that of boarding schools, with statistically significant differences(P<0.01). 67.1% of school canteens provided with independent food outlets while 98.7% of school canteens without independent food stores. The qualified rate of washing facilities in the dining area was 94.7%, and the qualified rate of distance between the canteen and the pollution source was 92.5%. Nearly all the employees held canteen catering service license (99.0%) and the health qualification certificate (99.5%). Most of the school canteens (98.7%) established the safety rules and regulations, including the food retention sample system. Nearly 61.5% schools initiated the principal meal program.@*Conclusion@#Sanitation management in the canteens of primary and secondary schools in China is generally satisfactory, with some canteens still fail to meet the standard requirements. More supervision from schools and relevant government departments (market supervision, health and education departments) is needed to provide students with a clean and heathy campus canteen.

Indoor air quality monitoring and management in primary and secondary schools in China / 中国学校卫生

Objective@#To investigate indoor air quality monitoring and management in primary and secondary schools, so as to provide scientific basis for health protection of students and healthy school environment.@*Methods@#Stratified sampling method was adopted to select schools for investigation. Data of daily ventilation and ventilation was collected from relevant principals of schools through questionnaire survey. Chi-square test was used to analyze the difference of ventilation and ventilation among different types of schools.@*Results@#Daily indoor air quality testing indicators: 317 schools (13.2%) have tested the concentration of CO2 in the air environment. Daily detection of CO2 in urban schools was significantly better than that in township schools, and the difference is statistically significant(χ2=72.06, P<0.01); Non-boarding schools were superior than boarding schools(χ2=21.89, P<0.01). The proportion of schools that routinely tested for carbon monoxide, particulate matter and volatile pollutants was 6.5%, 7.5% and 9.3%, respectively. Of the schools that participated in the survey, 80.8% had a daily ventilation system. Among them, 925 schools (38.5%) had a cumulative daily ventilation time of more than 90 minutes in cold season, and 331 schools (13.8%) had a daily ventilation time of less than 30 minutes.@*Conclusion@#Regulations and standards for school air quality monitoring needs to be improved. The Center for Disease Control and Prevention or other qualified institutions are suggested to lead air quality monitoring in schools testing, creating a healthy learning and living environment for primary and secondary school students.

Subnational disparity of anemia among Chinese Han students aged 7-14 years in 2014 / 中国学校卫生

Objective@#To describe the subnational disparity of anemia among Chinese Han students aged 7-14 years, and to provide a reference for making intervention measures to improve anemia among Chinese children.@*Methods@#A total of 71 115 Chinese Han students aged 7-14 years were selected from the project ‘2014 Chinese National Survey on Students’ Constitution and Health'. Anemia and its severity were defined according to the diagnosis criteria of World Health Organization (WHO). The rank sum test was used to compare anemia distribution of different subgroups. Logistic regression models were established to analyze the influencing factors of anemia and moderate-to-severe anemia.@*Results@#In the 71 115 students with measured hemoglobin concentrations in the 2014 CNSSCH, the overall prevalence rate of anemia was 8.9%, with 5.8% to be mild anemia and 3.1% to be moderate-to-severe anemia. For boys aged 7-14 years, the hemoglobin concentration increased with age; Boys aged 7 years had the highest anemia prevalence (9.8%) and moderate-to-severe anemia prevalence(4.4%). For girls aged 7-12 years, the hemoglobin concentration increased with age, but the concentration decreased a little when girls reached 14 years of age; 14-year-old girls had the highest prevalence of anemia(13.3%), and 7-year-old girls had the highest prevalence of moderate-to-severe anemia(4.8%). The highest prevalence rates of anemia were found in Hainan (24.1%) and Gansu(19.6%), while the lowest was in Beijing(2.0%). Logistic regression models revealed that, for children aged 7 and 9 years, when comparing to those lived in urban areas, living in rural areas appeared to be a risk factor for anemia (OR=1.34) and moderate-to-severe anemia(OR=1.48); when comparing to living in cities of upper socio-economic status, living in cities of intermediate socio-economic status appeared to be a risk factor for anemia (OR=1.43) and moderate-to-severe anemia(OR=1.41), and living in cities of lower socio-economic status also appeared to be a risk factor for anemia (OR=1.26) and moderate-to-severe anemia(OR=1.35). For students aged 12 and 14 years, girls were at higher risks for anemia and moderate-to-severe anemic(OR=2.41，2.20).@*Conclusion@#The overall prevalence of anemia was low in Chinese school-aged children, but substantial subnational disparity and subgroup disparity exists. Our data called for setting up context-specific measures, such as deworming and iron supplementation, to deal with child anemia. Intervention programs need to be implemented among adolescent girls and those with relatively low socioeconomic status.