Association between breakfast patterns and executive function among adolescents in Shanghai, China.

Introduction: The aim of this cross-sectional study was to investigate the association between breakfast patterns and executive function among adolescents in Shanghai, China. Methods: In 2022, we randomly recruited 3,012 adolescents aged 12-13 years from all administrative districts in Shanghai. Breakfast information was collected by parents using a one-day recall method. Executive function was measured using the Behavior Rating Inventory of Executive Function-Parent Version. Latent Class Analysis was performed to identify breakfast patterns based on the food groups in the Diet Quality Questionnaire for China. Results: Breakfast patterns were classified into three categories: "Egg and milk foods", "Grain foods", and "Abundant foods", except for adolescents who skipped breakfast. Logistic regression was used to estimate the multivariate odds ratio (ORs) and 95% confidence intervals (95% CI) for the association between breakfast patterns and potential executive dysfunction. Adolescents in the "Abundant foods" class had a lower risk of executive dysfunction in terms of initiate (OR: 0.36; 95% CI: 0.17-0.76), and organization of materials (OR: 0.18; 95% CI: 0.04-0.94), compared to those who skipped breakfast. Similarly, the breakfast patterns of "Grain foods" and "Egg and milk foods" were associated with a lower risk of executive dysfunction, including initiate and working memory. Discussion: Our findings suggest that breakfast patterns were associated with executive function. The improvement of breakfast patterns among adolescents should be a significant public health intervention.

Changes in obesity and lifestyle behaviours during the COVID-19 pandemic in Chinese adolescents: A longitudinal analysis from 2019 to 2020.

BACKGROUND: Since December 2019, the coronavirus disease 2019 (COVID-19) has become a global pandemic. Currently, the COVID-19 pandemic is still ongoing. What changes have taken place in the obesity and obesity-related lifestyle behaviours of adolescents during the first year of the COVID-19 pandemic? OBJECTIVE: This study aims at analysing the changes in obesity and lifestyle behaviours of Chinese adolescents before and 1 year after the outbreak of the COVID-19 pandemic, providing evidence for the global strategies to respond to the impact of the COVID-19 pandemic on adolescent obesity. METHODS: Physical examinations and student health and influencing factors questionnaires were conducted among 6047 adolescents aged 11-16 years by health professionals in Shanghai, China, before the COVID-19 pandemic (September-November of 2019) and 1 year after the outbreak of the COVID-19 pandemic (September-November of 2020). Paired χ2 tests, paired t-tests or Wilcoxon signed-rank test was used to evaluate the changes in the obesity prevalence, BMI and lifestyle behaviours from 2019 to 2020. RESULTS: 1 year after the outbreak of the COVID-19 pandemic, the obesity prevalence of Chinese adolescents rose from 14.2% to 15.4% (p < 0.01), mainly because of the increase in boys. And the average BMI increased from 20.3 to 21.2 kg/m2 (p < 0.01). Their lifestyle behaviours have also significantly changed. The mobile screen time increased from 0.25-1.50 h/day to 0.33-2.00 h/day (p < 0.01). The proportion of adolescents who participated in MVPA for ≥60 min/day on all 7 days during the past week dropped from 14.4% to 11.7% (p < 0.01). The generalized estimation equation analysis indicated that adolescents who participated in MVPA for ≥60 min/day on all 7 days had a lower likelihood of having obesity. Boys with computer time ≥2 h/day and girls with mobile screen time ≥2 h/day or TV time ≥2 h/day had a higher likelihood of having obesity. CONCLUSION: This study found that 1 year after the outbreak of the COVID-19 pandemic, the BMI and obesity prevalence of Chinese adolescents increased and obesity-related lifestyle behaviours have also changed.

Relationship between myopia and nutritional status among upper elementary students in Shanghai / 中国学校卫生

Objective@#To explore the relationship between myopia and nutritional status among upper elementary students in Shanghai.@*Methods@#A stratified cluster sampling method was used to select 5 576 fourth and fifth grade students from 16 districts in Shanghai, vision test, physical examination and questionnaire survey were administered. Two level multivariate Logistic regression and mixed linear models were used to analyze the relationship between myopia, spherical equivalent (SE) and nutritional status.@*Results@#The detection rates of overweight and obesity were 17.0%(949) and 18.7%(1 042), respectively. There was a statistical difference in the proportion of the nutritional status in boys and girls( χ 2=210.94, P <0.01), with overweight and obesity in boys higher than those of girls. The overweight boys were more likely to have myopia (univariate analysis: OR=1.23, P =0.04; multivariate analysis: OR=1.21, P =0.06) than the normal weight boy. Overweight students tended to had more negative refractive than those with normal weight in both boys and girls(multivariate analysis, boys: β =-0.19, girls: β=-0.24, P <0.05). Myopia risk and refractive power in obese students showed no statistical difference with normal weight students( P >0.05).@*Conclusion@#Overweight students have lower SE than the normal weight among upper elementary students of Shanghai, more researches are needed to confirm this finding and to provide theoretical bases for myopia prevention and control.

Effects of School-Based Interventions on Reducing Sugar-Sweetened Beverage Consumption among Chinese Children and Adolescents.

We set up a series of school-based interventions on the basis of an ecological model targeting sugar-sweetened beverage (SSB) reduction in Chinese elementary and middle schools and evaluated the effects. A total of 1046 students from Chinese elementary and middle schools were randomly recruited in an intervention group, as were 1156 counterparts in a control group. The interventions were conducted in the intervention schools for one year. The participants were orally instructed to answer all the questionnaires by themselves at baseline and after intervention. The difference in difference statistical approach was used to identify the effects exclusively attributable to the interventions. There were differences in grade composition and no difference in sex distribution between the intervention and control groups. After adjusting for age, sex, and group differences at baseline, a significant reduction in SSB intake was found in the intervention group post intervention, with a decrease of 35.0 mL/day (p = 0.034). Additionally, the frequency of SSB consumption decreased by 0.2 times/day (p = 0.071). The students in the elementary schools with interventions significantly reduced their SSB intake by 61.6 mL/day (p = 0.002) and their frequency of SSB consumption by 0.3 times/day (p = 0.017) after the intervention. The boys in the intervention group had an intervention effect of a 50.2 mL/day reduction in their SSB intake (p = 0.036). School-based interventions were effective in reducing SSB consumption, especially among younger ones. The boys were more responsive to the interventions than the girls. (ChiCTR, ChiCTR1900020781.).

Relationship between body fat percentage and high blood pressure among junior high school students in Shanghai / 中国学校卫生

Objective@#To investigate the relationship between body fat percentage (BF%) and high blood pressure among adolescents in Shanghai, and to provide basis for early prevention and intervention of cardcovascular diseases.@*Methods@#By using stratified cluster sampling method, a total of 5 148 adolescent students in 16 schools from 16 districts of Shanghai were selected. Questionnaire survey and physical examination were performed. The bioelectrical impedance analysis (BIA) was used to measure body fat percentage. National Blood Pressure Reference for Chinese Han Children was used to define high blood pressure. And T test, chi-square test and Logistici regression were used to assess the relation between BF% with high blood pressure.@*Results@#The prevalence of high blood pressure in 5 148 junior middle school students in Shanghai was 10.98%, with girls (13.13%) higher than boys (8.99%)(χ 2=22.48, P<0.01). The average total body fat percentage of male students was (20.90±10.73)%, which decreased with age (linear trend variance is 10.04, P<0.01). The average total body fat percentage of girls was (25.14±8.03)%, which increased with age (linear trend variance is 69.23, P<0.01). After adjusted for age, diet, exercise and other influencing factors, the prevalence of hypertension showed an increasing trend with the increase of body fat percentage for both boys and girls. The risk of high blood pressure in boys with BF%≥P 90 was 12.43 times higher than that in boys with BF%<P 25(95%CI=6.98-22.14), while the risk of high blood pressure in girls with BF% ≥P 90 was 6.12 times higher than that in girls with BF%<P 25(95%CI=3.89-9.63).@*Conclusion@#There was a positive correlation between body fat percentage and high blood pressure in adolescents. The prevalence of high blood pressure increased with the increase of body fat percentage, which was more obvious in boys.

Influence factors and family burden analysis of bicycle injury among middle school students in Shanghai, 2017-2018 / 中国学校卫生

Objective@#To understand the influencing factors and family burden of bicycle injury among middle school students in Shanghai for bicycle injury prevention.@*Methods@#Based on 1∶2 matched case-control design, students who were injured when cycling were selected from Shanghai student injury case reporting system during Sept. 2017 to Dec. 2018 as the case group. The same-sex control was selected from the same grade in the same school with the case. A total of 61 cases and 122 control were selected. Self-reported questionnaires were conducted by parents of children. Univariate and multivariate logistic regression were used to analyze the influencing factors of bicycle injury.@*Results@#Poor eyesight (OR=2.27, 95%CI=1.02-5.07), lots of intersections near the residence (OR=2.00, 95%CI=1.00-3.98), and lots of cyclists near the residence (OR=2.15, 95%CI=1.06-4.36) were positively correlated with bicycle injuries among middle school students. About 34.43% and 8.20% of parents reckon bicycle injuries had a moderate impact on family economic, daily activities and recreational activities. Among the students with bicycle injury, 70.49% of the students were absent from school because of illness, and 36.07% of their parents missed work because of illness. The average absence time for school and working were 10.79 days and 3.03 days respectively. The total economic loss caused by the lack of work was 84 950 yuan, with an average of 1 393 yuan.@*Conclusion@#Bicycle injury of middle school students in Shanghai causes certain family burden. Poor eyesight, lots of intersections near the residence, lots of cyclists near the residence are positively correlated with bicycle injuries among middle school students.

Effect evaluation on physical activity intervention for primary school students in Shanghai / 中国学校卫生

Objective@#To evaluate the effects of physical activity interventions based on social ecology model, and to explore promising approach for increasing physical activity of students in large cities.@*Methods@#A quasi-experimental design with parallel control was implemented. Students from grade 4 in 20 primary schools in 3 districts of Shanghai were recruited. Based on social ecology model, physical activity interventions were carried out in three levels: personal, social-and physical environment. The interventions lasted for 6 months. Questionnaires, physical examinations and physical fitness tests were carried out. Rank sum test, chi-square test and logistic stepwise regression was used to analyze the intervention effects.@*Results@#In the intervention group, the proportion of students who favored physical activity increased from 47.9% to 50.7%. Time spent in moderate to vigorous intensity physical activity (MVPA) increased from 64 min/d to 70 min/d, mainly during the weekend. The interventions showed significant effects, especially for girls. In the intervention group, the proportion of students spent 1 h/d in MVPA increased from 53.7% to 57.7%(χ2=4.95, P<0.05). Multivariate analysis showed that after intervention, the proportion of students spent more than 1 h/d in MVPA in the intervention group was higher than that in the control group (OR=1.22, 95%CI=1.02-1.48, P=0.03).@*Conclusion@#Physical activity interventions based on social ecology model can increase uptake of physical activity among school students.

Intervention effect of hand washing behavior in primary and secondary schools in Shanghai by non-participatory observation / 中国学校卫生

Objective@#To assess the changes of students’ hand washing behaviors after implementing comprehensive interventions, and to provide the reference for hand-washing promotion among students.@*Methods@#The implementation of comprehensive intervention projects had been carried out in three aspects: hardware transformation, system establishment, health management and health education. A randomized controlled trial method was used to select each one primary and secondary school in 2016 from 17 districts in Shanghai, and 17 intervention schools and 17 control schools were taken as object. Non-participant observation was used for students’ hand washing behaviors for 4 times during May, 2016 to May, 2017. Descriptive analysis and chi square test were used to analyze the data.@*Results@#Compared with the control group, the hand washing rate of the intervention group was lower than that of the control group at baseline. The intervention group has got a higher rate than that of the control group in the evaluation of 1, the assessment 2 and the assessment 3 after intervention. The difference was statistically significant(χ2=7.70, 24.23, 38.88, 21.71, P<0.05). Compared with the control group, the hand washing rate of the intervention group after class was lower than that of the control group. After the intervention, the rate of the intervention group was higher than that of the control group in the evaluation 1, the assessment 2 and the assessment 3 after the intervention. The difference was statistically significant (χ2=8.52, 33.79, 54.64, 13.99, P<0.05). Compared with the control group, there was no difference between the baseline intervention group and the control group before meals. The intervention group after intervention was higher than the control group in the evaluation of 1, evaluation 2 and evaluation 3. The difference was statistically significant (χ2=45.01, 42.19, 27.82, P<0.05).@*Conclusion@#After comprehensive intervention, the effect was significant under different temperature conditions, and the effect of intervention lasted for one year.

[Evaluation on the effectiveness of intervention comprehensive program on child obesity, using Generalized Estimating Equation].

OBJECTIVE: To evaluate the effect of child obesity intervention comprehensive program on the improvement of overweight, obese control and knowledge-attitude-practice. METHODS: The study design was under cluster-randomized controlled trial, with 965 children in the intervention and 895 children in the control groups. Repeated measurement data on child obesity was analyzed through Generalized Estimating Equation models. RESULTS: The risk of becoming overweight or obesity in the intervention group was 0.824 times more than children in the control group, showing a reduction of 17.6% the risk of being overweight or obese (P = 0.031). In addition, the possibility of increasing one unit of correct rate on obesity related knowledge, children in the intervention group children was 1.044 times (P = 0.001)than in the control group. On the mean obesity related correct attitude rate, it was 1.023 times (P = 0.001) in the intervention group of the control group. Regarding the possibility of increasing one unit om the mean obesity related behavior score, children in the intervention group was 1.522 times (P = 0.001)than those in the control group (P = 0.046). CONCLUSION: The comprehensive child obesity intervention program could effectively reduce the risk of developing overweight or obesity and improving the obesity related knowledge, attitude and behavior in children.