Understanding the Knowledge, Attitudes, and Practices of Healthy Eating among Adolescents in Chongqing, China: An Empirical Study Utilizing Structural Equation Modeling.

Healthy eating is crucial for optimal growth, development, and the prevention of chronic diseases in adolescents. Our study aimed to develop a comprehensive structural equation model (SEM) to analyze the relationships between knowledge, attitudes, practices (KAP), and healthy eating among adolescents in Chongqing. An online questionnaire was administered to middle school students in 39 districts and counties of Chongqing, China from 2 December to 15 December 2021 to collect sociodemographic and KAP information. SEM models were constructed to examine the relationships between educational environment and healthy eating knowledge, attitudes, and practices. The Monte Carlo test was employed to assess the significance of the mediating effect of relevant variables. The study included 139,832 adolescents aged 14.8 ± 0.7 years, with a 14% rate of overweight and obesity. Health and nutrition knowledge averaged a score of 3.60 ± 1.50 (correct rate: 60%). Participants had positive attitudes (average score: 13.61 ± 2.29) and engaged in healthy eating practices (average score: 12.06 ± 3.08). The results of the SEM revealed a significant influence of the educational environment on adolescents' knowledge (ß = 0.235, p < 0.001) and attitude towards healthy eating (ß = 0.143, p < 0.001). Knowledge exhibited positive effects on both attitude (ß = 0.225, p < 0.001) and practice (ß = 0.054, p < 0.001), while attitude exhibited positive effects on practice behavior (ß = 0.565, p < 0.001). The indirect effect of knowledge on practices through attitude was more substantial than the direct effect (ratio 2.361). Our study highlights the mediating role of attitude between healthy eating knowledge and practices. A significant association exists between a favorable educational environment and improved knowledge and positive attitudes toward healthy eating among adolescents. In the future, nutrition and health education should prioritize exploring effective ways to translate knowledge into practices.

Association between body weight misperception and snacking patterns among adolescents: a population-based cross-sectional study.

BACKGROUND: Unhealthy snacking behaviors and body weight misperception are both significant concerns in adolescent health. Weight misperception are common among youth and may influence their motivation to engage in health-related behaviors, however, the effect on snacking patterns choice remains unclear. Our study aimed to examine the relationship between body weight misperception and snacking pattern choice among school adolescents. METHODS: A cross-sectional study was conducted using an online survey platform. Body weight misperception was defined based on perceived body weight and true weight. Snack intake was measured using a qualitative food-frequency questionnaire. Factor analysis was used to identify snacking patterns, and multiple linear regression was employed to examine the association between body weight misperception and snacking patterns. RESULTS: 190,296 students with the average age of 13.3 ± 1.0 years was included, and 44.5% of students misperceived their weight. Overestimation was more prevalent than underestimation. Two snacking patterns, namely a high-calorie snacking pattern and a healthy snacking pattern, were identified with eigenvalues > 1. Weight underestimation was positively linked to high-calorie snacking pattern scores for both normal weight students (ß: 0.16, 95% CI: 0.11, 0.21) and students with overweight/obesity (ß: 0.44, 95% CI: 0.35, 0.52), and to healthy snacking scores for students with overweight/obesity (ß: 0.28, 95% CI: 0.22, 0.33), but negatively linked to healthy snacking pattern scores for normal weight students (ß: -0.12, 95% CI: -0.15, -0.09). Conversely, weight overestimation was negatively linked to both high-calorie and healthy snacking pattern scores for normal weight students (ß: -0.07, 95% CI: -0.11, -0.04 and ß: -0.13, 95% CI: -0.15, -0.10), but positively linked to healthy snacking scores for underweight students (ß: 0.15, 95% CI: 0.08, 0.21). Interactions were found between sex, grade, accommodation, only child, primary guardians, parental education level and weight misperception to snacking patterns. CONCLUSIONS: Adolescents with normal weight and overweight/obesity who misperceived their weight exhibited less healthy snacking patterns, whereas underweight students who misperceived their weight displayed healthier snacking patterns. Comprehensive programs are crucial to educate and guide adolescents in understanding their weight status and making healthier snack choices, involving families, schools, and society.

Association between Selenium Status and Chronic Kidney Disease in Middle-Aged and Older Chinese Based on CHNS Data.

BACKGROUND: The association between selenium and chronic kidney disease (CKD) remains controversial. Population studies with large samples facilitate the reliability of conclusions. OBJECTIVE: In this study, we aimed to describe the prevalence of a CKD association with selenium intake in middle-aged and older Chinese. METHODS: Data for this study were obtained from the China Health and Nutrition Survey (CHNS). A total of 5381 participants (aged ≥ 45) with biochemical test data were included in the study. Logistic regression models were used to examine the association between diet selenium intake (quartile) and the prevalence of CKD. RESULTS: A total of 942 (17.01%) participants had CKD. The prevalence of CKD was 23.33%, 20.32%, 14.98%, and 9.25% among participants with average selenium intakes of 21.5 ± 4.82, 33.1 ± 2.79, 43.8 ± 3.70, and 67.0 ± 13.97 µg/day, respectively. In the fully adjusted model (Model 3), across the quartiles of selenium intake, the ORs for the prevalence of CKD were 1.00, 1.09 (95% CI 0.69-1.73), 0.82 (95% CI 0.49-1.38), and 0.43 (95% CI 0.22-0.85). The protein intake had a certain diagnostic significance for the selenium intake. CONCLUSIONS: An adequate selenium intake may have a positive effect on CKD. The influence of individual weight and location on the effect of selenium on CKD needs to be further explored.

Selenium Intake and its Interaction with Iron Intake Are Associated with Cognitive Functions in Chinese Adults: A Longitudinal Study.

Studies on the relation between selenium intake and cognitive function are inconclusive. This study aimed to examine the associations between dietary selenium intake and cognitive function among Chinese adults and tested the interaction effect of selenium intake and iron intake on cognition. Data from 4852 adults aged 55 years and above who attended the 1991-2006 China Health and Nutrition Survey (CHNS) were used. Cognitive function was assessed through face-to-face interviews in 1997, 2000, 2004, and 2006. A 3-day, 24-hour recall was used to collect dietary selenium intake. Multivariable mixed linear regression and logistic regression were used in the analyses. In fully adjusted regression models, the regression coefficients (95% confidence interval) were 0.00, 0.29 (-0.12-0.70), 0.26 (-0.18-0.70), and 0.50 (0.02-0.97) across the quartiles of selenium intake. In the subgroup analysis, the positive association between selenium intake and cognitive function was only observed in the participants who live in the southern region but not those in the northern region. The selenium-intake-to-iron-intake ratio was inversely associated with low global cognition scores. Furthermore, only those with a normal BMI had a positive association between selenium and cognition. In conclusion, high selenium intake was linked to better cognitive function and a lower risk of cognition decline in Chinese adults among those with low iron intake. A substantial interaction was found between selenium intake and BMI or region.

Development of Nutrition Literacy Scale for Middle School Students in Chongqing, China: A Cross-Sectional Study.

Background: Information on nutrition literacy of middle schoolers is limited and tools for measuring nutrition literacy of middle schoolers are inadequate. Nutrition literacy has a positive effect on health. Improving children's nutrition literacy can help them to master the necessary nutritional knowledge, develop a healthy lifestyle, and learn to supplement nutrition according to their own needs for healthy growth. Objectives: To develop the Chongqing Middle school student Nutrition Literacy Scale (CM-NLS). Methods: Three experiments were conducted. A theoretical framework and an initial item pool of CM-NLS were established based on the literature review. And the two-round Delphi method was used to explore the suitable acceptance indicators and items. Item evaluation and reduction were performed using the classical test theory. Then, the items in the final CM-NLS were tested for their validity and reliability amongst 462 middle school students. The construct validity was assessed using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The internal consistency reliability and split-half reliability were evaluated using Cronbach's alpha coefficients. Results: The final CM-NLS consisting of 52 items that were based on three primary items (functional, interactive and critical) and six sub-items (obtain, understand, apply, interact, medial literacy and critical skill) was developed and validated. EFA suggested six factors explaining 69.44% of the total variance (Kaiser-Meyer-Olkin test = 0.916, Bartlett's test χ2 = 5,854.037, P < 0.001). CFA showed that the model fit the data adequately, with χ2/df = 1.911, root mean square error of approximation = 0.063, goodness-of-fit index = 0.822 and adjusted goodness of fit index = 0.790. The total CM-NLS Cronbach's alpha values of internal consistency and split-half reliability were 0.849 and 0.521, respectively, with reasonable reliability. Conclusions: CM-NLS is a valid and reliable instrument for assessing nutrition literacy among middle school students in Chongqing. Specifically, it could be used by practitioners for needs assessment before the implementation of a nutrition education program.

Comparison of sleep quality among puerperal women before and during the COVID-19 pandemic: a cross-sectional survey in Lanzhou, China.

PURPOSE: Few studies have yet examined sleep quality among puerperal women during the coronavirus disease 2019 (COVID-19) pandemic. This cross-sectional study aimed to compare the sleep quality of puerperal women before and during the COVID-19 pandemic in Lanzhou, China. The study exploreed the factors that affect sleep quality among puerperal women. METHODS: The study population comprised puerperal women who went to the obstetric department of the Gansu Provincial Maternity and Childcare Hospital on the 42nd day after childbirth. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). Data were collected by doctors in the obstetric department before the COVID-19 pandemic (Oct.-Dec. 2019) and during the COVID-19 pandemic (Feb.-Apr. 2020) in China. Multiple linear regressions were used to examine the association between the sleep quality of puerperal women and COVID-19 and to identify factors that affect the total PSQI scores. RESULTS: In 2019, 546 puerperal women were assessed compared with 655 who were assessed in 2020. Compared with before COVID-19, the total PSQI scores of puerperal women improved during the COVID-19 pandemic. In addition, the influencing factors of sleep quality among puerperal women were the pandemic itself, age, conception method, and postpartum depression (PPD). CONCLUSIONS: In contrast with other studies, there was no evidence for worsening sleep quality of puerperal women during the COVID-19 pandemic in Lanzhou, China. Puerperal women who underwent assisted pregnancy or developed PPD were more likely to experience poor sleep quality.

Nutritional literacy and influencing factors among students from Nutrition Improvement Program for Rural Compulsory Education Students in Chongqing / 中国学校卫生

Objective@#To analyze the nutritional literacy and influencing factors among students from Nutrition Improvement Program for Rural Compulsory Education Students (NIPRCES) in Chongqing, and to provide a scientific basis for improving the nutritional literacy of middle school students in the NIPRCES.@*Methods@#Using cross sectional survey, a total of 3 365 students in the grade 7 and 8 were selected from the middle schools in 12 national pilot districts and 2 Chongqing pilot districts by online survey in September 2020. Students filled out a self designed nutritional literacy questionnaire anonymously. The relative evaluation method was used to convert the nutritional literacy of scores into a percentile, and the median score was used as the criterion for qualified nutritional literacy screening.@*Results@#The median score of nutritional literacy of participants was 63.5, and 64.2% achieved the qualified level. The results of multivariate Logistic regression analysis showed that boarding school ( OR =1.28, 95% CI =1.08- 1.51 ) and no parents as the primary caregiver ( OR =1.22，95% CI =1.05-1.42) were associated with poor nutritional literacy. Urban residence ( OR =0.75, 95% CI =0.63-0.90), NIPRCES local pilot ( OR =0.83, 95% CI =0.71-0.97) and high paternal education ( OR =0.70, 95% CI =0.52-0.95) were associated with higher nutritional literacy ( P <0.01). Classroom was the main channel for students to obtain nutrition information at present (65.1%) and in the future (72.8%).@*Conclusion@#The nutritional literacy among students in the NIPRCES in Chongqing needs to be improved. Nutritional literacy level of students can be strengthened by nutritional education in boarding schools, rural areas, national pilot areas, and primary caregivers.

Influence of the request and purchase of television advertised foods on dietary intake and obesity among children in China.

BACKGROUND: This study aims to examine the effects of the request and purchase of Television (TV) advertised foods on children's dietary intake, overweight and obesity in China. METHODS: Data from 1417 children (aged 6-17 years) in the 2011 China Health and Nutrition Survey were analysed. The request and purchase of TV advertised foods were assessed through the frequency of children's requests to purchase TV advertised foods and the frequency of parents' purchases of these advertised foods, as well as the frequency of children's purchases of TV advertised foods. The height and weight of children were measured. Logistic regression models were used to identify the associations between the request and purchase of TV advertised foods and overweight/obesity of children. RESULTS: The request and purchase of TV advertised foods were positively associated with children's dietary intake of energy, protein, fat and carbohydrates. After adjusting for potential confounding factors, children's request and purchase of TV advertised foods and parent's purchase of TV advertised foods were positively associated with children's overweight/obesity: odds ratio (OR) and 95% confidence interval (CI) for overweight/obesity were: 1.46 (1.01-2.11) for children purchasing advertised foods ≥1 time/week, 1.59 (1.15-2.18) for parents purchasing advertised foods for their children ≥1 time/week and 1.39 (1.00-1.95) for children requesting advertised foods ≥1 time/week. CONCLUSIONS: The request and purchase of TV advertised foods are associated with children's dietary intake. Moreover, the request and purchase of TV advertised foods can increase the risk of overweight and obesity of children. Health education involving children's request and purchase of TV advertised foods and parents' purchase of TV advertised foods should be considered in China.

Regional Difference in the Association between the Trajectory of Selenium Intake and Hypertension: A 20-Year Cohort Study.

The effect of selenium on hypertension is inconclusive. We aimed to study the relationship between selenium intake and incident hypertension. Adults (age ≥20 years) in the China Health and Nutrition Survey were followed up from 1991 to 2011 (N = 13,668). The latent class modeling method was used to identify trajectory groups of selenium intake. A total of 4039 respondents developed hypertension. The incidence of hypertension was 30.1, 30.5, 30.6, and 31.2 per 1000 person-years among participants with cumulative average selenium intake of 21.0 ± 5.1, 33.2 ± 2.8, 43.8 ± 3.6, and 68.3 ± 25.2 µg/day, respectively. Region and selenium intake interaction in relation to hypertension was significant. In the multivariable model, cumulative intake of selenium was only inversely associated with the incident hypertension in northern participants (low selenium zone), and not in southern participants. Compared to selenium intake trajectory Group 1 (stable low intake), all three trajectory groups had a low hazard ratio for hypertension among the northern participants. However, Group 4 (high intake and decreased) showed an increasing trend of hypertension risk in the south. In conclusion, the association between selenium intake and the incidence of hypertension varied according to regions in China. In the low soil selenium zone, high selenium intake might be beneficial for hypertension prevention.

Biodegradation of alkaline lignin by Bacillus ligniniphilus L1.

BACKGROUND: Lignin is the most abundant aromatic biopolymer in the biosphere and it comprises up to 30% of plant biomass. Although lignin is the most recalcitrant component of the plant cell wall, still there are microorganisms able to decompose it or degrade it. Fungi are recognized as the most widely used microbes for lignin degradation. However, bacteria have also been known to be able to utilize lignin as a carbon or energy source. Bacillus ligniniphilus L1 was selected in this study due to its capability to utilize alkaline lignin as a single carbon or energy source and its excellent ability to survive in extreme environments. RESULTS: To investigate the aromatic metabolites of strain L1 decomposing alkaline lignin, GC-MS analysis was performed and fifteen single phenol ring aromatic compounds were identified. The dominant absorption peak included phenylacetic acid, 4-hydroxy-benzoicacid, and vanillic acid with the highest proportion of metabolites resulting in 42%. Comparison proteomic analysis was carried out for further study showed that approximately 1447 kinds of proteins were produced, 141 of which were at least twofold up-regulated with alkaline lignin as the single carbon source. The up-regulated proteins contents different categories in the biological functions of protein including lignin degradation, ABC transport system, environmental response factors, protein synthesis, assembly, etc. CONCLUSIONS: GC-MS analysis showed that alkaline lignin degradation of strain L1 produced 15 kinds of aromatic compounds. Comparison proteomic data and metabolic analysis showed that to ensure the degradation of lignin and growth of strain L1, multiple aspects of cells metabolism including transporter, environmental response factors, and protein synthesis were enhanced. Based on genome and proteomic analysis, at least four kinds of lignin degradation pathway might be present in strain L1, including a Gentisate pathway, the benzoic acid pathway and the ß-ketoadipate pathway. The study provides an important basis for lignin degradation by bacteria.