The Performance Comparison of Socioeconomic and Behavioural Factors as Predictors of Higher Blood Lead Levels of 0-6-Year-Old Chinese Children between 2004 and 2014.

Childhood lead exposure is a commonly known risk factor affecting children's health, and 10 governments have taken actions to reduce children's lead exposure sources. Because lab testing for children's blood lead levels (BLLs) was not popularized easily, socioeconomic and behavioural factors have been usually used as predictors of screening methods. Along with the overall decreasing trend of children's BLLs, the lead-exposure-potential-predicting ability of such factors might be limited or changed over time. Our study aims to compare the predicting ability of multiple factors, including the living environment, economic disparity and personal behaviour differences between 2004 and 2014. With potential predicting factors identified, it could provide direction in identifying individual children facing high-risk lead exposure in the unit of clinics or communities of China. The study was first conducted in 12 cities in China in 2004 and then repeated in 2014 in the same 12 cities with the same method. In total, 27,972 children aged under 7 years were included in this study. With confounding factors adjusted, the child's age, the family's socioeconomic status and the child's personal hygiene habit, especially biting toys, continued to be important predictors of higher blood lead levels among Chinese children. The sex of the child was no longer a predictor. Factors such as the father's occupational contact with lead, residence near the main road and taking traditional Chinese medicine had the potential to be new predictors.

MFGM components promote gut Bifidobacterium growth in infant and in vitro.

PURPOSE: Infant gut microbiota which plays an important role in long-term health is mainly shaped by early life nutrition. However, the effect of nutrients on infants gut microbiota is less researched. Here, we present a study aiming to investigate in vitro a modified formula that is supplemented with milk fat globule membrane (MFGM) that were missing in common formulas when compared with human milk and to assess the impact of feeding scheme on microbiota and metabolism. METHODS: A total of 44 infants including 16 from breast milk feeding, 13 from common formula feeding and 15 from modified formula feeding were analyzed, and A cross-sectional sampling of fecal and urine was done at 1 month-of-age. Stool microbiota composition was characterized using high-throughput DNA sequencing, and urinary metabolome was profiled by nuclear magnetic resonance (NMR). In vitro growth experiment of Bifidobacterium with key components from MFGM was performed and analyzed by both DNA and RNA. RESULTS: Stool samples from the infants who were breastfed had a higher relative abundance of Bifidobacterium and a lower relative abundance of Escherichia than the formula-fed infants. The stool microbiome shifts were associated with urine metabolites changes. Three substances including lactadherin, sialic acid and phospholipid, key components of MFGM were significantly positively correlated to Bifidobacterium of stool samples from infants, and stimulated the growth rate of Bifidobacterium significantly by provided energy in vitro growth experiment with RNA analysis. CONCLUSIONS: These findings suggest that the key components from MFGM could improve infants' health by modulating the gut microbiome, and possibly supporting the growth of Bifidobacterium. REGISTRATION: Clinicaltrials.gov NCT02658500 (registered on January 20, 2016).

The contribution of milks and formulae to micronutrient intake in 1-3 years old children in urban China: a simulation study.

BACKGROUND AND OBJECTIVES: A recent dietary survey in 5 big cities in China provided information on various milk options consumed by 1-3 years old children. To investigate the nutritional role of these milks (young-child formula (YCF), cow's milk, others), simulation analyses based on this survey were performed. METHODS AND STUDY DESIGN: We studied daily intakes of calcium, iron, zinc, vitamins A, B-1, B-2, C and E and compared these to the Chinese DRIs. In Scenario 1, consumption of cow's milk, kid's milk and/or soy milk was replaced with matching amounts of YCF (n=66 children). In Scenario 2, where 348 children exclusively consumed YCF, YCF was replaced with matching amounts of cow's milk. RESULTS: Scenario 1 revealed significant increases in total dietary intakes of iron, vitamins A, B-1, C and E upon substitution of the various milks with YCF. The proportions of children not meeting the Estimated Average Requirement (EAR) for these nutrients dropped from 29, 26, 61, 53 and 54 % to 12, 11, 50, 27 and 24%, respectively. In Scenario 2, the hypothetical substitution of YCF by cow's milk increased the proportions of children not meeting the EAR for these nutrients, calcium and zinc from 11, 6, 49, 15, 28, 42, and 8 to 45, 24, 78, 69, 59, 44, and 20, respectively. Execution of Scenario 2 in subgroups of 1-2- and 2-3 years old children revealed similar results. CONCLUSIONS: YCF may help to reduce the risk of insufficient intake of several key micronutrients for toddlers, independent of age.

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.

Longitudinal study of breastfeeding and growth in 0-6 month infants.

BACKGROUND AND OBJECTIVES: To explore advantages and challenges for exclusive breastfeeding (EBF), compared to non-exclusive breastfeeding (nEBF). METHODS AND STUDY DESIGN: Mothers from 7 cities in China were visited at 3, 10, 60, 120, and 180 days postpartum. Data about feeding practices, infant growth, and the macronutrient contents of human milk (HM) were collected. RESULTS: 130 lactating mothers attended 5 visits. 59 mothers (45.4%) exclusively breastfed infants for 0-4 month. Frequencies of breastfeeding per day were higher in the EBF group than the nEBF group at day 3, 10, 120 and 180, and were less than 8 times per day in the nEBF group. For Weight-for-age z scores, there were no differences between the two groups. Length-for-age z score was greater in the nEBF group at day 180 (0.74±1.05 vs 0.33±1.28). Weight-for-length z scores were greater in the EBF group at day 120 and 180 (day 120: 0.88±1.08 vs 0.36±1.1, day 180: 1.1±0.94 vs 0.54±1.07). The average protein and lactose contents of HM in the nEBF group were higher than in the EBF group at day 10. CONCLUSIONS: For nEBF infants, intake of formula replaced intake of breastmilk, due to lack of breastfeeding frequency, which did not bring weight gain for nEBF infants. During the introduction of complementary foods, EBF infants needed complementary nutrients to support growth. Therefore, lactating mothers may need to provide appropriate complementary feeding and maternal leave extension to attend to their infant's nutritional requirements. The criteria for linear growth may also need to be more commensurate with breastfeeding and relevant to later health outcomes.

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.

Association between sn-2 fatty acid profiles of breast milk and development of the infant intestinal microbiome.

Increasing evidence shows that host diet and gut microbes are related. Previous studies have shown the effects of specific dietary fatty acids (FAs) on intestinal microbiota, but little is known about the effect of the stereospecifically numbered sn-2 position in triglycerides (TG) of human milk on the gut microbiome of infants. This study aimed at examining possible effects of sn-2 FAs of human milk on the gut microbial development of breastfeeding babies. Sn-2 FAs and intestinal microbiota were assessed by GC-MS and high-throughput 16S rRNA sequencing, respectively. The results showed that breast milk from mothers in China contained ten major sn-2 FAs dominated by palmitic acid (C16:0, 54.42%), oleic acid (C18:1 n-9, 14.95%), linoleic acid (LA, C18:2 n-6, 12.81%), myristic acid (C14:0, 4.50%) and C12:0 (3.17%). Total long chain unsaturated fatty acids (LCUFA) decreased from colostrum to mature milk, while total saturated fatty acids (SFA) showed no significant difference during lactation. A significant association between sn-2 FAs in milk and infant gut microbiota was found between decanoic acid (C10:0), myristic acid (C14:0), stearic acid (C18:0), C16:0, arachidonic acid (AA, C20:4 n-6), docosahexaenoic acid (DHA, C22:6 n-3) with Bacteroides, Enterobacteriaceae, Veillonella, Streptococcus, and Clostridium. These microbes were involved in short-chain fatty acid (SCFA) production and other functions, and significantly increased at 13-15 d after breastfeeding was initiated. C16:0 and DHA were relevant to most of the microbes. This study demonstrated the relatively steady profiles of sn-2 FAs in breast milk and gut microbiota of infants, together with their correlation during the breastfeeding period. The above results provided important information for designing the configuration of FAs in next-generation formulas for Chinese infants.

Quantitative Measurement of PARD3 Copy Number Variations in Human Neural Tube Defects.

Although more than 200 genes are known to be related to neural tube defects (NTDs), the exact molecular basis is still unclear. Evaluating the contribution of copy number variation (CNV) might be a priority because CNV involves changes in the copy number of large segments of DNA, leading to phenotypic traits and disease susceptibility. Recent studies have documented that the polarity protein partitioning defective 3 homolog (Pard3) plays an essential role in the process of neural tube closure. The aim of this study was to assess the role of PARD3 CNVs in the etiology of human NTDs. Relative quantitative PCR and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry were used to quantitative measurement of CNVs in 25 PARD3 exons in 202 NTD cases and 231 controls from a region of China with a high prevalence of NTDs. The results showed that microduplications ranging from 3 to 4 were evident in coding Exon 21 and Exon 25 in both case and control groups. A novel heterozygous microdeletion spanning 444 bp of Exon 14 was identified in two cases of anencephaly and is absent from all controls analyzed. Expression analyses indicated that this heterozygotic microdeletion showed no tissue specificity and led to defective expression of PARD3. Our study provides further evidence implicating PARD3 in the etiology of NTDs.

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.

Implementation of international code of marketing breast-milk substitutes in China.

BACKGROUND: Breastmilk is the best source of nourishment for infants and young children, and breastfeeding is one of the most effective ways to ensure child health and survival. In May 1981, the World Health Assembly adopted the International Code of Marketing Breast-Milk Substitutes. Since then several subsequent resolutions have been adopted by the World Health Assembly, which both update and clarify the articles within the International Code (herein after the term "Code" refers to both the International Code and all subsequent resolutions). The Code is designed to regulate "inappropriate sales promotion" of breastmilk substitutes and instructs signatory governments to ensure the implementation of its aims through legislation. The Chinese Regulations of the Code were adopted by six government sectors in 1995. However, challenges in promotion, protection, and support of breastfeeding remain. This study aimed to monitor the implementation of the Code in China. SUBJECTS AND METHODS: Six cities were selected with considerable geographic coverage. In each city three hospitals and six stores were surveyed. The International Baby Food Action Network Interview Form was adapted, and direct observations were made. Research assistants administered the questionnaires to a random sample of mothers of infants under 6 months old who were in the outpatient department of the hospitals. In total, 291 mothers of infants, 35 stores, 17 hospitals, and 26 companies were surveyed. RESULTS: From the whole sample of 291 mothers, the proportion who reported exclusively breastfeeding their infant was 30.9%; 69.1% of mothers reported feeding their infant with commercially available formula. Regarding violations of the Code, 40.2% of the mothers reported receiving free formula samples. Of these, 76.1% received the free samples in or near hospitals. Among the stores surveyed, 45.7% were found promoting products in a way that violates the Code. Also, 69.0% of the labeling on the formula products did not comply with the regulations set out in the Code. CONCLUSIONS: As the social and economic developments continue, the interactions of more and more factors curb further success in breastfeeding. Support from all sectors of the society is needed in order to create a social environment to enable the promotion of breastfeeding, in addition to the efforts already made by the healthcare system.

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.

A comparison between antenatal care quality in public and private sector in rural Hebei, China.

AIM: To evaluate the quality of antenatal care (ANC) in Hebei Province and compare it between the public and private sector and within the public sector. METHODS: We conducted a Maternal, Newborn and Child Health Household Survey in 2010 using a two-stage sampling procedure and included 1079 mothers. The quality of ANC was assessed on the basis of the number of ANC visits, the time of the first ANC visit, 16 different ANC procedures, owning a maternal health care booklet, and the type of service provider. RESULTS: Almost all women (98%) received ANC services at least once, 80% at least four times, and 54% at least five times. About half of the women (46%) visited ANC facility within their first trimester. Neither public nor private sector provided all 16 standardized services, but significantly more women in public sector received ANC procedures. Most women received ANC in county or higher-level hospitals (75%) and very few in township hospitals (8%). Significantly fewer women were weighed and tested for HIV/AIDS in township than in county or higher-level hospitals. CONCLUSION: The quality of ANC in Hebei was poorer than required by China's national and World Health Organization norms. Although the public sector performed better than the private sector, the utilization and quality of care of ANC services in this sector varied and women generally visited county or higher-level health facilities.

A novel approach for copy number variation analysis by combining multiplex PCR with matrix-assisted laser desorption ionization time-of-flight mass spectrometry.

With the increasing interest in copy number variation as it pertains to human genomic variation, common phenotypes, and disease susceptibility, there is a pressing need for methods to accurately identify copy number. In this study, we developed a simple approach that combines multiplex PCR with matrix-assisted laser desorption ionization time-of-flight mass spectrometry for submicroscopic copy number variation detection. Two pairs of primers were used to simultaneously amplify query and endogenous control regions in the same reaction. Using a base extension reaction, the two amplicons were then distinguished and quantified in a mass spectrometry map. The peak ratio between the test region and the endogenous control region was manually calculated. The relative copy number could be determined by comparing the peak ratio between the test and control samples. This method generated a copy number measurement comparable to those produced by two other commonly used methods - multiplex ligation-dependent probe amplification and quantitative real-time PCR. Furthermore, it can discriminate a wide range of copy numbers. With a typical 384-format SpectroCHIP, at least six loci on 384 samples can be analyzed simultaneously in a hexaplex assay, making this assay adaptable for high throughput, and potentially applicable for large-scale association studies.

Evaluating the efficacy of the AAP "pediatrics in disaster" course: the Chinese experience.

OBJECTIVE: "Pediatrics in Disasters" (PEDS) is a course designed by the American Academy of Pediatrics to provide disaster preparedness and response training to pediatricians worldwide. China has managed to sustain the course and adapt its content for local needs. China has also experienced several natural disasters since the course's inception, providing an opportunity to evaluate the impact of courses that took place in Beijing and Sichuan, in 2008-2010. METHODS: We used pretesting/post-testing, participant surveys, and in-depth interviews to evaluate whether the course imparted cognitive knowledge, was perceived as useful, and fostered participation in relief efforts and disaster preparedness planning. RESULTS: In Beijing and Sichuan, post-test scores were 16 percent higher than pretest scores. On immediate postcourse surveys, 86 percent of Beijing and Sichuan respondents rated the course as very good or excellent. On 6-month surveys, participants identified emotional impact of disasters, planning/triage, and nutrition as the three most useful course modules. Twelve of 75 (16 percent) of Beijing respondents reported direct involvement in disaster response activities following the course; eight of 12 were first-time responders. Participant interviews revealed a need for more training in providing nutritional and psychological support to disaster victims and to train a more diverse group of individuals in disaster response. CONCLUSIONS: PEDS imparts cognitive knowledge and is highly valued by course participants. Emotional impact of disasters, planning/triage, and nutrition modules were perceived as the most relevant modules. Future versions of the course should include additional emphasis on emotional care for disaster victims and should be extended to a broader audience.

Association study of PARD3 gene polymorphisms with neural tube defects in a Chinese Han population.

Partitioning defective 3 homolog (PARD3) is an attractive candidate gene for screening neural tube defect (NTD) risk. To investigate the role of genetic variants in PARD3 on NTD risk, a case-control study was performed in a region of China with a high prevalence of NTDs. Total 53 single-nucleotide polymorphisms (SNPs) in PARD3 were genotyped in 224 fetuses with NTDs and in 253 normal fetuses. We found that 6 SNPs (rs2496720, rs2252655, rs3851068, rs118153230, rs10827337, and rs12218196) were statistically associated with NTDs (P < .05). After stratifying participants by NTD phenotypes, the significant association only existed in cases with anencephaly rather than spina bifida. Further haplotype analysis confirmed the association between PARD3 polymorphisms and NTD risk (global test P = 3.41e-008). Our results suggested that genetic variants in PARD3 were associated with susceptibility to NTDs in a Chinese Han population, and this association was affected by NTD phenotypes.

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.