Potential dietary factors for reducing lead burden of Chinese preschool children.

Dietary approaches to treat children's low lead exposure are implemented routinely in China, while evidence for the effect could not be provided until now. The aim of this study was to examine the relationship between diets including nutrition supplementation and blood lead level of preschool children of China. In total, 17,859 preschool children from 14 cities were recruited, and their social-demography, living environment, and dietary intakes were collected, and capillary blood sample was tested for lead concentration. The average blood lead concentration was 34.5 µg/L, and after adjusting children's social-demography factors, the consumption of milk or dairy production, fruits, and calcium supplementation had negative dose-response relationships with blood lead level. Conversely, intake of iron-rich food and supplementation was not associated. Further studies are needed to prove the causal relationships.

Differences in prevalence of prehypertension and hypertension in children and adolescents in the eastern, central and western regions of China from 1991-2011 and the associated risk factors.

The present study aimed to estimate the differences in rates of prehypertension and hypertension in children and adolescents among three regions with different socioeconomic status in China, and explore the corresponding risk factors associated with prehypertension and hypertension to guide the prevention. Blood pressure measurements of 13 762 children and adolescents aged 6-17 years were obtained from a prospective national survey (the China Health and Nutrition Survey, 1991-2011). Prehypertension and hypertension were defined by age and gender, according to China's standard criteria. Chi-square tests were used to compare the differences in the prevalence of prehypertension and hypertension among three regions. Trend chi-square tests were used to detect the trends in rates of prehypertension and hypertension over survey years. Logistic regression models were used to detect the potential risk factors of prehypertension and hypertension in children and adolescents. During the survey years, the overall prevalence of prehypertension and hypertension were 6.0% and 10.6%. The corresponding rates in the western region were lowest, but increased rapidly over the two decades (84.0% and 122.6% increases respectively, P<0.001). The overall hypertension rate remained high in the eastern region, despite the slower increase (24.2% increase). In the central region, although the prehypertension rate remained stable, the rate of hypertension had a 94.8% increase these years (P<0.0001). According to the results of logistic regression, age, body mass index (BMI) and waist/height ratio (WHtR) were associated with prehypertension and hypertension. Children and adolescents in the eastern region had the highest level of prehypertension and hypertension, while the rapid increase of blood pressure in the western and central regions were also supposed to concern. Improvement of the healthy lifestyle is urgent for prehypertension and hypertension prevention in children and adolescents.

A dietary and nutritional status survey among young children in five big cities of China.

BACKGROUND AND OBJECTIVES: To investigate the dietary patterns and nutritional status of young children living in urban environments in China. METHODS AND STUDY DESIGN: A cross-sectional study was conducted of 750 children aged 6 - 35 months living in 5 large cities in China. The survey methodology included a physical exami-nation, blood hemoglobin measurements and a 24 hour dietary recall questionnaire Results: The educational lev-el of participant mothers was high (79% had attended college or university or higher), which may not be fully representative across all areas of urban China. Overall anthropometric nutritional status indicators were within acceptable ranges based on national recommendations, and there was no evidence of severe micronutrient defi-ciencies. However, we identified three significant nutritional issues that warrant attention: 1.) Later than optimal introduction and low-intake of animal-based iron-containing foods into the diet, and a need for greater inclusion of vitamin B-1 rich foods among 12-35 month old children. 2.) Presence of significant rates of anemia in 6-11 and 12-23 month old children. 3.) An increased risk of overweight/obesity. CONCLUSIONS: Since food availability and affordability are no longer major issues in the well developed parts of urban China, achieving further im-provements in the diet and nutrition of young children in these environments is likely require more specific edu-cation to parents and other significant carers such as grandparents. The relatively high educational level and so-cio-economic status of the population group is likely to facilitate the uptake of such measures in this population group.

The breast milk lead levels among Chinese population.

Breast milk is a potential source of infant and young children lead exposure, but national-level data on breast milk lead (BML) is unknown in China. To fill up this gap, we conducted a review by analyzing the articles enrolled through searching Wanfang MedOnline, CNKI, SinoMed, Pubmed, and Embase databases and relevant articles from 2000 through 2017. After screening and assessing process, 17 articles were included. The average concentrations of BML in these studies varied with regions (1.54-171.84 µg/L), and the BML level was dropping down in general. In conclusion, breast milk should still be encouraged to infant and young children in normal areas of China, and stopping breastfeeding should be considered prudently. Education for health workers and families on BML should be strengthened, and more surveys on BML should be conducted.

Trend of childhood blood lead levels in cities of China in recent 10 years.

The adverse effects of lead on human especially childhood have been well established. Largely due to the phase out of lead in gasoline, blood lead levels (BLLs) had declined substantially all over the world including China. In 2004, 2007, 2010, and 2013, we conducted a continuous project including 47,346 children aged 0-6 years old from 11 cities all over China to show how the decline happened and to explore what to do next to improve the BLLs of children of China. Our data shown the BLLs of Chinese children decreased from 46.38, 43.58, 38.95 to 37.17 µg/L, but the decline was not enough. These decline was mainly because of the number decrease of children with high BLLs. Integrated strategy should be used to promote the BLLs of Chinese children, like striving to improve the environment, setting new cutoff for high BLLs, and establishing routine blood lead screening.

Dietary survey of anaemic infants and young children in urban areas of China: a cross-sectional study.

BACKGROUND AND OBJECTIVES: To explore the diet characteristics of anaemic infants and young children of China, blood tests and diets surveys were conducted in five cities. METHODS AND STUDY DESIGN: About 150 children aged 6-36 mo were selected in a typical community health center of each city, and the total sample was 750. Nutritional status was measured through 24h dietary recall method and HEMO Cue was used for Haemoglobin concentration testing. RESULTS: The average prevalence of anaemia was 17.2% in 6-12 mo children, which was higher than in other age groups. Median intakes of 8 nutrients (protein, vitamin A, B-1 and C, calcium, iron, zinc and copper) in anaemic children were less than non-anaemic children (p<0.05) in 6-12 mo olds; at age 12-24 mo the intake of vitamin A in anaemic children was less than in non-anaemic children (p<0.05). Market complementary food was the main source of iron in both anaemic and non-anaemic children (6-12 mo olds: 2.28 and 3.69 mg; 12-24 mo olds: 2.06 and 2.09 mg, respectively). Iron intake from formula was lower in anaemic children than in nonanaemic children (6-12 mo olds: 0.88 vs 2.54 mg; 12-24 mo olds: 1.59 vs 2.87 mg). The proportion of children obtaining continued breastfeeding in anaemic children was significantly higher than in non-anaemic children aged 6-12 mo (65% vs 37%, p<0.05). CONCLUSIONS: Appropriate practices around continuing breastfeeding and complementary feeding particularly targeted to breast fed older infants and young children are needed to reduce anaemia in infants and young children.

Surveillance of childhood blood lead levels in 11 cities of China.

BACKGROUND: Exposure to lead can be deleterious to children's health. Surveillance for blood lead levels (BLLs) is reported every year in the USA and some other countries. However, such reports are lacking in China which has the world's largest population of children. In this study, we provided the latest nationally representative data on BLLs among Chinese children living in cities, described the change in BLLs since 2004, and explored the risk factors for elevated BLLs (EBLLs) among children. METHODS: We studied 12 693 children aged 0-6 years in 2004 and 11 255 children aged 0-6 years in 2010. We evaluated the average BLLs and the prevalence of EBLLs, and a multivariate logistic regression model was used to estimate predictors of EBLLs. RESULTS: The geometric mean BLLs of children aged 0-6 years dropped by 16% (from 46.38 ± 2.10 µg/L in 2004 to 38.95 ± 1.83 µg/L in 2010), while the prevalence of EBLLs dropped by 87% (from 9.78% in 2004 to 1.32% in 2010). In a multivariate analysis, the following factors were associated with EBLLs: (1) children being cared for at home or at a boarding nursery (compared to children being cared for in a day nursery), (2) children having fathers with a lower education level, and (3) children often eating popcorn and chewing fingernails or sucking fingers were associated with EBLLs. CONCLUSIONS: The results of this study demonstrated a substantial decline in BLLs from 2004 to 2010 among Chinese children 0-6 years living in cities. However, these levels were higher than levels in countries, such as the USA, Canada, Japan and Sweden. These data demonstrate that Chinese children's lead exposure remains a public health problem that requires additional effort and resources.

Blood lead levels among children aged 0 to 6 years in 16 cities of China, 2004-2008.

BACKGROUND: The adverse health effects of lead for children under 6 years are well known. Studies to assess the lead exposure among children in China are small in sample size and lack of national representative data. The aim of this study therefore was to describe blood lead levels and identify risk factors for lead exposure among children aged 0 to 6 years living in 16 cities in China. METHODS: We analyzed data from blood lead levels surveillance in China carried out in 16 large cities between 2004 and 2008. A stratified clustered random sampling strategy was used. A total of 69 968 children aged 0 to 6 years were included. We conducted multiple Logistic regression analyses to explore risk factors to high blood lead level. RESULTS: The geometric mean blood lead level of the children was 4.50 µg/dl (median: 4.90 µg/dl; IQR: 3.20 - 7.00 µg/dl). Overall prevalence of blood lead level ≥ 10.00 µg/dl among 0- to 6-year-old children was 7.57%. But the proportion of blood lead level ≥ 5.00 but < 10.00 µg/dl was 42.12%. Blood lead levels were significantly higher in boys (4.63 µg/dl) than in girls (4.35 µg/dl) (P < 0.0001). The geometric mean blood lead levels and prevalence of blood lead level ≥ 10.00 µg/dl increased with age (P < 0.0001 for the two trends). After controlling for sociodemographic, dietary and behavior factors, multivariable analysis indicated that lower maternal education, male gender, younger age, often biting pencil or/and toys, walking or playing for long time on the street, not washing hands before eating are major risk factors for higher lead levels. CONCLUSIONS: The blood lead levels among Chinese children in urban areas are lower than previous studies but close to those of developed countries. However, children with low lead exposure account for almost half and the sociodemographic factors (age, male sex, and low mother education level) continue to be associated with higher blood lead levels.

Implementation of a programme to market a complementary food supplement (Ying Yang Bao) and impacts on anaemia and feeding practices in Shanxi, China.

In China, a full fat soy powder mixed with multiple micronutrient powders (Ying Yang Bao (YYB)) was developed, and the efficacy of YYB was shown in controlling anaemia and improving child growth and development. However, prior to 2008, there was no sustainable way to provide YYB to vulnerable populations, except through free distribution by the government. This study was to test the concept of public-private partnership (PPP) to deliver YYB and to evaluate the effectiveness of marketing YYB through PPP. Programme activities included development of a complementary food supplement (CFS) national standard, product concept test, product development and marketing, behavior change communication, monitoring and evaluation. Baseline and end-line surveys were used to evaluate product awareness, purchasing and the impacts of the project on anaemia and feeding practices. A Chinese CFS standard was approved. Caregivers and their 6- to-24-month-old children participated in the baseline (n=226) and the end-line survey (n=221). A concept test at the baseline survey showed that 78% of caregivers were willing to buy YYB at 0.1 USD. After developing the product and implementing the intervention for 8 months, 59.6% of surveyed caregivers purchased YYB. While not significant, the prevalence of anaemia was marginally lower at the end line (28.8%) than at the baseline (36.2%). For those purchasing YYB, the risk of anaemia was significantly reduced by 87% of odds (P<0.009). The end-line survey found that feeding practices had improved significantly following the intervention. An enabling policy and regulatory environment in which CFSs are defined and parameters for appropriate marketing are identified as a prerequisite for marketing YYB or other nutritious CFS. Public and private advocacy and marketing could successfully increase awareness of YYB and access and use through market channels. The YYB project may be effective for reducing anaemia and improving feeding practices.

[Blood lead status and influencing factors among preschool children in urban areas of China].

OBJECTIVE: To investigate the blood lead status and influencing factors among preschool children in the sampling city. METHOD: Stratified-clustered-random sampling was used. Standardized questionnaire and peripheral blood samples were obtained from 69 968 children aged 0-6 years in fixed kindergartens and communities of Yinchuan, Xi'an, Chengdu, Wuhan, Hefei, Beijing, Harbin, Zhengzhou, Huhhot, Shijiazhuang, Haikou, Dalian, Qingdao, Guangzhou, Nanning and Changsha from 2004 to 2008, respectively. Tungsten atomic absorbtion spectrophotometry was employed to determine the blood lead level of children. RESULT: The proportion of children with blood lead level ≥ 100 µg/L was 7.57% (among which the proportion of high blood lead level, mild lead poisoning, moderate lead poisoning, severe lead poisoning were 91.0%, 2.76%, 3.32%, 2.93%, respectively) and the blood lead level was lower than those of the past studies. The proportion of high blood lead level has steadily declined from 2004 to 2008 [the proportions were 10.03%, 7.85%, 7.40%, 6.91% and 4.78%, respectively (χ(2) = 297.36, P < 0.0001)]. The proportion of children with blood lead level ≥ 100 µg/L in Haikou, Zhengzhou, Guangzhou, Shijiazhuang, Changsha, Xi'an, Wuhan, Hefei, Chengdu, Yinchuan, Harbin, Beijing, Dalian, Huhhot, Nanning and Qingdao were 12.15%, 10.49%, 10.37%, 9.69%, 9.53%, 9.46%, 9.40%, 8.50%, 7.99%, 7.98%, 7.51%, 6.10%, 3.25%, 2.89%, 2.46% and 2.39%, respectively (χ(2) = 768.21, P < 0.0001). By multiple regression method, the risk factors which influenced blood lead status of children were education status of mother, older children, behavior and dietary habit of children, boy, stay for long time in traffic busy areas, the type of housing, taking traditional Chinese and herbal medicine. The protective factors against lead poisoning in children mainly included scattered living, the nutritional status of calcium, iron, zinc, frequent intake of milk, and older mother. CONCLUSION: The blood lead level of children has decreased, but is still higher than those in developed countries. Lead exposure remains a public health issue which affects children most. The blood lead level of children is affected by multiple factors. Government and the whole society should pay attention to interrupt the lead pollutant and to promote nutritional health education. With all these efforts, it is possible to stop the progress of lead exposure and reduce its hazardous effects on the growth and development of children.

Surveillance of childhood blood lead levels in 14 cities of China in 2004-2006.

OBJECTIVE: To investigate the blood lead level in children aged 0-6 years in urban areas of China. METHODS: Fourteen cities were selected as sites under surveillance. A total of 44 045 peripheral blood specimens were collected from 2004 to 2006, during which 15 727, 14 737, and 13 584 specimens were tested in 2004, 2005, and 2006, respectively. Tungsten atomizer absorption spectrophotometer was employed to determine blood lead level. RESULTS: The geometric mean blood lead level in the tested children was 47.10 microg/L with 10.10% > or = 100 microg/L, 46.17 microg/L with 7.78% > or = 100 microg/L, and 47.03 microg/L with 7.30% > or = 100 microg/L in 2004, 2005, and 2006, respectively. The blood lead levels seemed to tend to rise in parallel with the increase of age of the children and were higher in boys (48.84 microg/L, 47.56 microg/L, and 47.78 microg/L in the 3 respective years) than in girls (45.00 microg/L, 44.53 microg/L, and 46.13 microg/L). CONCLUSION: The blood lead levels in children in cities of China are lower than those in previous national studies, but higher than those in developed countries. Childhood lead poisoning remains a public health problem in China.

Impact of implementation of Integrated Management of Childhood Illness on improvement of health system in China.

AIM: To explore the impact of implementation of the Integrated Management of Childhood Illness (IMCI) strategy on the Chinese health system. METHODS: Pre- and post-intervention field surveys, based on the adapted World Health Organization protocol of health facility surveys and follow-up assessment tools, respectively. Three hundred and forty-five health facilities were investigated pre intervention and 74 health facilities post intervention. Observation of case management of health workers, interviews with mothers and systematic checking of equipment and drug supplies were conducted in both pre- and post-intervention surveys. RESULTS: There were significant improvements demonstrated with implementation of the IMCI strategy in terms of rational use of drugs, provision of basic equipment and drug supplies of both township and village facilities. The inappropriate use of drugs significantly decreased: injection/IV (from 43.6% to 2.7%), antibiotics (from 59.3% to 6.2%) and hormones (from 4.9% to 0). The availability of basic equipment and supplies of health facilities was improved greatly: children's scales (from 27.8% to 90.5%), timing devices (from 89.3% to 97.3%) and utilities for mixing oral rehydration salts (ORS) (from 36.5% to 100.0%). The supply of all recommended drugs increased, with ORS, vitamin A/D, iron, tetracycline eye ointment, vitamin B complex and diazepam increased greatly. CONCLUSIONS: The IMCI strategy has been shown to contribute to the improvement of the health system, promoting the efficient management of medical care at township and village level, as well as improving the relationship between doctors and patients.

[Study on blood lead level and related risk factors among children aged 0-6 years in 15 cities in China].

OBJECTIVE: To observe blood lead level and related risk factors among children aged 0-6 years old living in cities in China and to provide data for policy development to the prevention on environmental lead pollution. METHODS: A stratified-clustered-random sampling method was used. 17 141 peripheral blood samples of 0-6 years old children from 15 cities in China were tested. Tungsten atomizer absorption spectrophotometer was employed to determined the blood lead level. Related factors were also studied using a standardized questionnaire. Data were analyzed on related risk factors that affecting blood lead levels through multiple regression method. RESULTS: The mean blood lead level of 0-6 years old children from 15 cities in China was 59.52 microg/L including 10.45% of those > or =100 microg/L, and 0.62% > or = 200 microg/L. However, the blood lead levels seemed to have had a trend of increase parallel to age among 0-6 years-old children and were higher for boys (59.50 microg/L) than girls (54.95 microg/L). The risk factors which influenceing children's blood lead levels would include the type of housing, parent's education levels, social status and hobby, children's behavior habit, dieting habit and nutritional condition. CONCLUSION: The blood lead levels of children in China were lower than data gathered from former national studies but higher than those from developed countries, suggesting that the. Government and the whole society should be aware of the problem on lead poisoning among children during their childhood.