[A cross-sectional study on the prevalence rate and influencing factors of non-alcoholic fatty liver disease in overweight/obese children]. / è¶ é‡/è‚¥èƒ–å„¿ç«¥éžé ’ç²¾æ€§è„‚è‚ªè‚ç— æ‚£ç— çŽ‡åŠå ¶å½±å“å› ç´ çš„æ¨ªæ–­é¢ç ”ç©¶.

OBJECTIVES: To investigate the prevalence rate of non-alcoholic fatty liver disease (NAFLD) in overweight/obese children who visit a hospital, and to explore the influencing factors of NAFLD, in order to provide a basis for the prevention of NAFLD in overweight/obese children. METHODS: Overweight/obese children who visited Hunan Children's Hospital from June 2019 to September 2021 were recruited. The prevalence rate of NAFLD was examined. Logistic regression analysis was used to explore the factors influencing the development of NAFLD [non-alcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH)]. Receiver operating characteristic curve analysis was used to evaluate the predictive value of the influencing factors for NAFL and NASH. RESULTS: A total of 844 overweight/obese children aged 6-17 years were enrolled. The prevalence rate of NAFLD in overweight/obese children was 38.2% (322/844), among which the prevalence rates of NAFL and NASH were 28.8% (243/844) and 9.4% (79/844), respectively. Multivariate logistic regression analysis showed that the increase of waist-to-hip ratio (WHR) and low high-density lipoprotein cholesterol (HDL-C) were associated with the development of NAFL and NASH (P<0.05). The receiver operating characteristic curve analysis showed that the combined measurement of WHR and HDL-C had a predictive value for NAFL (area under the curve: 0.653, 95%CI: 0.613-0.694), and for NASH (area under the curve: 0.771, 95%CI: 0.723-0.819). CONCLUSIONS: The prevalence rate of NAFLD in overweight/obese children who visit a hospital is high. WHR and HDL-C are associated with the development of NAFLD and the combined measurement of WHR and HDL-C has a certain value for predicating the development of NAFLD.

Predicting Metabolic Syndrome Using Anthropometric Indices among Chinese Adolescents with Different Nutritional Status: A Multicenter Cross-sectional Study.

OBJECTIVE: To evaluate the predictive performance of anthropometric indices for metabolic syndrome (MetS) among Chinese adolescents with different nutritional status. METHODS: We recruited 9,513 adolescents aged 10-18 years from seven provinces in China during September 2014. Anthropometric indices and blood pressure were measured at recruitment, and blood samples were collected for determining fasting plasma glucose and lipid profile. Receiver operating characteristic (ROC) analyses were used to assess the predictive performance of anthropometric indices, including body mass index (BMI) percentile, waist circumference percentile, waist-height ratio, and waist-hip ratio. RESULTS: Overall, the four anthropometric indices showed good accuracy for predicting MetS with areas under ROC curves (AUCs) ranging from 0.86 to 0.94; similar AUCs ranging from 0.73 to 0.99 were observed for participants with normal weight. The performance of all four indices was poor in overweight and obese participants, with AUCs ranging from 0.66 to 0.77 and from 0.60 to 0.67, respectively. Waist circumference showed relatively better performance in all the subgroup analyses. CONCLUSIONS: We suggest using anthropometric indices with the cutoff values presented here for predicting MetS in the overall and normal-weight adolescent population, but not in the overweight and obese adolescent population where more specific screening tests are required.

Long-term exposure to ambient air pollution and metabolic syndrome in children and adolescents: A national cross-sectional study in China.

BACKGROUND: The prevalence of metabolic syndrome (MetS) rapidly increased over the past decades. However, little evidence exists about the effects of long-term exposure to ambient air pollution on MetS in children and adolescents. OBJECTIVE: This study aims to assess the association between long-term ambient air pollution and the prevalence of MetS in a large population of Chinese children and adolescents. METHODS: In 2013, a total of 9,897 children and adolescents aged 10 to 18 years were recruited from seven provinces/municipalities in China. MetS was defined based on the recommendation by the International Diabetes Federation (IDF). Satellite based spatio-temporal models were used to estimate exposure to ambient air pollution (including particles with diameters ≤1.0 µm (PM1), ≤2.5 µm (PM2.5), and ≤10 µm (PM10), and nitrogen dioxide (NO2)). Individual exposure was calculated according to 94 schools addresses. After adjustment for a range of covariates, generalized linear mixed-effects models were utilized to evaluate the associations between air pollutants and the prevalence of MetS and its components. In addition, several stratified analyses were examined according to sex, weight status, outdoor physical activity time, and sugar-sweetened beverages (SSBs) intake. RESULTS: The prevalence of MetS was 2.8%. The odds ratio of MetS associated with a 10 µg/m3 increase in PM1, PM2.5, PM10 and NO2 was 1.20 (95%CI: 0.99, 1.46), 1.31 (95%CI: 1.05, 1.64), 1.32 (95%CI: 1.08, 1.62), and 1.33 (95%CI: 1.03, 1.72), respectively. Regarding the MetS components, we observed associations between all pollutants and abdominal obesity. In addition, long-term PM1 and NO2 exposures were associated with the prevalence of elevated fasting blood glucose. Stratified analyses detected that the associations between air pollutants and the prevalence of MetS were stronger in boys (Pinteraction < 0.05). CONCLUSIONS: We found that long-term exposure to PM2.5, PM10, and NO2 were positively associated with the prevalence of MetS in children and adolescents. Our findings may have certain public health implications for some comprehensive strategy of environment improvement and lifestyles changes in order to reduce the burden of non-communicable disease.

Greenness surrounding schools and adiposity in children and adolescents: Findings from a national population-based study in China.

BACKGROUND: Previous studies have indicated that exposure to green space may benefit human health. However, the available evidence concerning the effects of greenness, especially school-based greenness, on pediatric obesity is scarce. OBJECTIVE: To explore the association between school-based greenness and adiposity in children and adolescents in China. METHOD: We conducted a nationwide cross-sectional study of 56,620 children and adolescents (aged 6-18 years) in seven provinces/municipalities across China. School-based greenness was assessed using satellite-derived Normalized Difference Vegetation Index (NDVI) and Soil Adjusted Vegetation Index (SAVI) within 100-, 500-, and 1000-m circular buffers around each school's address. Generalized linear mixed regression models were used to estimate associations of greenness with BMI z-scores (zBMI), waist circumference, and prevalent overweight/obesity. We also explored the potential mediating role of ambient air pollution and physical activity in the greenness-adiposity associations. RESULT: In the adjusted model, an IQR increase in NDVI-1000m was associated with lower zBMI (ß: -0.11, 95% confidence interval[CI]: -0.13,-0.09) and waist circumference (ß: -0.64, 95%CI: -0.78,-0.50). Consistently, an IQR increase in NDVI-100m, NDVI-500m, NDVI-1000m was associated with 7-20% lower odds of overweight/obesity in the adjusted models. Air pollutants mediated 6.5-29.1% of the association between greenness and zBMI. No significant mediation effect was observed for physical activity. CONCLUSION: Higher school-based greenness levels were associated with lower zBMI, waist circumference, and lower odds of overweight and obesity in children and adolescents. Ambient air pollutants may partially mediate the greenness-adiposity associations.

Associations of MGMT promoter hypermethylation with squamous intraepithelial lesion and cervical carcinoma: A meta-analysis.

BACKGROUND: In this research, an meta-analysis was performed for assessment of the associations between O6-methyguanine-DNA methyltransferase (MGMT) promoter hypermethylation possessing low-grade intraepithelial lesion (LSIL), high-grade intraepithelial lesion (HSIL), cervical cancer (CC), and clinicopathological characters of CC. METHODS: Literature selection were conducted through searching PubMed, Web of science, EMBASE, China National Knowledge Infrastructure and Wanfang databases (up to November 2018). An assessment of associations between MGMT methylation and LSIL, HSIL, CC risk and clinicopathological characteristics was performed through pooled odds ratios (ORs) with relevant 95% confidence intervals (CIs). Subgroup analyses, meta-regressions and Galbraith plots were conducted to conduct an exploration on the possible sources of heterogeneity. The genome-wide DNA methylation array studies were extracted from Gene Expression Omnibus (GEO) databases for validation of these outcomes. RESULTS: In this meta-analysis of 25 published articles, MGMT hypermethylation gradually elevated the rates among control group (12.16%), LSIL (20.92%), HSIL (36.33%) and CC (41.50%) specimens. MGMT promoter methylation was significant associated with the increased risk of LSIL by 1.74-fold (P<0.001), HSIL by 3.71-fold (P<0.001) and CC by 7.08-fold (P<0.001) compared with control. A significant association between MGMT promoter methylation with FIGO stage was also found (OR = 2.81, 95% CI: 1.79-4.41, p<0.001). The results of GEO datasets showed that 5 CpG sites in MGMT with a great diagnostic value for the screening of cervical cancer. CONCLUSION: The meta-analysis indicated the association between MGMT promoter hypermethylation and squamous intraepithelial lesion and cervical cancer. MGMT methylation detection might have a potential value to be an epigenetic marker for the clinical diagnosis of cervical cancer.

[Study on the willingness of care and related influencing factors among caregivers of those stranded children under 7 years in Chinese rural areas].

OBJECTIVE: To explore the willingness of care and related influencing factors among caregivers of those 'left at hometown' children under 7 years in Chinese rural areas. METHODS: Questionnaires were used to survey caregivers (n = 7585) who were identified by multi-stage stratified cluster sampling. Multi-factor ordinal logistic regression analysis was used to screen the influencing factors on the willingness of care among them. RESULTS: The percentage on 'very willing', 'willing', 'unwilling' on those 'left at home' children were 41.1%, 55.4% and 3.5% respectively in the group with single parent while 19.5%, 71.4% and 9.1% respectively in the group of both parents having left home. Data from the multi-factor ordinal logistic regression analysis showed that factors including the age of the caregiver, annual per capita income for caregivers' families, social connections and the length of children's mother being absent, amount of fees for living provided by parent/parents, and the child's age and lifestyle, being the only child or not, and the age of the child when the parent/parents left the residence etc, were related to the willingness of care of the givers. CONCLUSION: Willingness of care calls for attention and urgent improvement. Influencing factors and measures need to be taken when necessary.

[Analysis on influences of guardians on behavior of left-behind children aged 3 to 7 years in countryside].

OBJECTIVE: To explore the influences of guardians on emotion and behavior of rural left-behind children aged 3 to 7 years. METHODS: A self-designed questionnaire of children's condition and Children Strengths and Difficulties Questionnaire (the edition for parents, SDQ) were used to investigate 805 left-behind children aged 3 to 7 years in countryside. RESULTS: The prevalence of difficulty among left-behind children was 3.5%, in male it was 4.1% and in female 2.7%, the difference was not significant (chi(2) = 1.154, P > 0.05) between male and female. The scores of peer communication problems among associate the left-behind children were (2.30 +/- 1.86), which was significantly higher than that (2.09 +/- 1.74) of not left-behind children (P < 0.05). The score of emotion symptom was (2.76 +/- 1.84) and the total score of difficulty was (11.41 +/- 4.77) among left-behind children was significantly higher than those of left-behind children with one parent stayed out (2.29 +/- 1.64) and (10.41 +/- 5.18), were significantly different (t = -2.489 - 2.006, P < 0.05), the score of social behavior (6.39 +/- 2.26) was significantly lower than that of left-behind children with father or mother stayed out (7.34 +/- 2.18, P < 0.001). The score of social behavior of children whose guardians had higher education level (7.02 +/- 2.21) was significantly higher than those with guardians who were illiterate or semiliterate (6.20 +/- 2.44, P < 0.01). CONCLUSIONS: There are evident problems in emotion and behavior among left-behind children with parents staying out. One of parents should stay home to care for children. To improve educational level of guardian will be beneficial to development of physical and mental health among left-behind children.

[Study on emotional, behavioral problems and related determinants among stranded children aged 4 to 7 years in the rural areas of China].

OBJECTIVE: To understand emotional, behavioral problems and related determinants among rural stranded children and to provide evidence for further psychological support. METHODS: A total of 3944 caregivers of children in the rural areas and aged 4 to 7 years but without parents around, were randomly selected. Data were collected through Strengths and Difficulties Questionnaires (the edition for parents, SDQ). RESULTS: The overall prevalence of children with behavioral/emotional problems was 43.6% among those stranded children including 8.3% having experienced emotional symptoms, 9.5% reported to be displaying 'conduct' problems, 8.7% exhibited significant hyperactivity/inattention, 18.9% experienced peer relationship problems and 16.8% having prosocial behaviors. The prevalence of behavioral/emotional problems was significantly higher in boys than those in girls and in lower age groups. Significant differences were also found in conduct problems, hyperactivity/inattention and prosocial behaviors (P<0.01). The result from logistic regression analysis showed that factors as education level and motivation of the caregivers as well as financial support from the parents were related to emotional/ behavioral problems among the stranded children. CONCLUSION: The prevalence of emotional and behavioral problems was high among children living the rural areas but without their parents around which should call for psychological intervention.

[Knowledge, attitude, practice and related determinants on nutrition among caregivers of rural stranded children under 7-year-olds in China].

OBJECTIVE: To explore knowledge, attitude, practice (KAP) and related determinants on nutrition among caregivers of those rural stranded children under 7 years of age in China and to provide evidence for setting up relevant health education program. METHODS: 1691 caregivers of the stranded children randomly selected were surveyed by a standard questionnaire. Logistic regression models were used to screen the determinants on KAP regarding nutrition. RESULTS: Rates on awareness, positive attitude and approprite behavior were lower in caregivers of children whose parents both left (47.8%, 55.4%, 41.8%, respectively) the countryside, when compared with those only one parent was away from home (59.9%, 59.5%, 38.0%, respectively). Data from multivariable logistic regression models showed that caregivers' KAP on nutrition was related to age, educational background, average family income, and willingness on the job as well as the age of the child. CONCLUSION: Improving caregivers' KAP on nutrition and setting up appropriate health education program were in urgent need.

[Study on the nutritional status and determinants among rural stranded children in China].

OBJECTIVE: To explore the nutritional status and determinants among rural stranded children under 7 years of age. METHODS: The group of stranded children (n=7585) and the children for control (n=7557) were identified by multi-stage stratified cluster sampling. The ascertainment methods mainly included questionnaire, anthropometric measurements and laboratory examination. RESULTS: In this study, there were three groups, including the group of stranded children whose single parent left home to look for better job somewhere, the group of stranded children whose parent both left home and the third group serving as control. Prevalent rates on the following items were: stunting--14.9%, 17.9% and 16.3%, underweight--7.2%, 8.3% and 7.6%, wasting--3.1%, 3.4% and 3.3% and anemia--18.9%,20.6%, 18.7% respectively. The prevalent rate of stunting in the group of children with both parents away from home was significantly higher than that those with only one parent did. The prevalence rate of anemia in the group with both parents away from home was significantly higher than that in the control group. Based on multivariate non-conditional logistic regression analysis, the determinants of stunting among the stranded children were: age, with low birth weight, living alone, being the only child in the family, mother's education level, frequency of eating breakfast and snacks every week, motives of caretakers and the relationship between children and the caretakers. The determinants of underweight among those stranded children were: age of child, with low birth weight, the frequency of eating snacks every week, motives of the caretakers and having rickets. CONCLUSION: The nutritional status among rural stranded children was relatively poor, especially in those whose parents were both away from home, which calls for urgent improvement.

[Investigation on dietary nutrients among rural stranded children of 2-7 year olds in china].

OBJECTIVE: To understand the dietary nutrients among rural stranded children. METHODS: 2551 children aged 2 to 7, including 1278 stranded children in the rural areas and another 127 children served as controls were selected, using multistage stratified cluster random sampling. Dietary survey was performed with three-day weighing dietary method and questionnaire on food intake. Data on diet were analyzed and evaluated by the Dietary Reference Intakes (DRIs) recommend by Chinese Nutrition Society, to evaluate the levels on energy and nutrient intake among stranded children in the rural areas. RESULTS: The dietary pattern among rural stranded children mainly consisted of grains and vegetables, but the intakes of animal products, fruits, and snacks were significantly less than in the control group. The intakes of three major energy-producing nutrients were below the recommend nutrient intake. Minerals as calcium, zinc, selenium, kalium and vitamins as vitamin A, B1, B2 were insufficient. Most of the rural stranded children took nutrients insufficiently, with 50% lack of adequate energy and 80% of protein, 90% of minerals (calcium, zinc etc.) and vitamins (vitamin BI and vitamin B2 etc.). Sources from high quality protein was insufficient, only consisting 35% of the total protein, but overabundant (over 64%) from the plants. The intake of plant-sources iron was overabundant, accounted for 87%. CONCLUSION: The dietary pattern was unsatisfactory with insufficient intake of energy-sources proteins and some nutrients. The sources of energy, protein, and iron were mostly obtained from underbalanced foods. It is necessary to improve the dietary nutrients status among rural stranded children aged 2-7 years.

[Using multivariate multilevel model in studying the influential factors of violence among rural high school students in Changsha].

OBJECTIVE: To provide evidence for setting up violence intervention programs in rural middle schools, through studying the influential factors. METHODS: Taking variables including emotional, physical and sexual violence in the past year as the multi-dependent variables before multivariate multilevel model logistic regression model was adopted to analyze the correlations among the three kinds of violence and the influential factors. RESULTS: Among 3620 respondents, the incidence rates of emotional, physical and sexual violence weres 21.5%, 24.3% and 2.0% respectively. The correlation coefficients between emotional violence vs. physical violence, emotional violence vs. sexual violence, physical violence vs. sexual violence were 0.337, 0.133, 0.131 respectively when the random effect of class difference was separated by multivariate multilevel model. There was an internal aggregation of the incidence rate on physical violence in different grades (chi2=4.286, P = 0.038) and an internal relevant between emotional violence vs. sexual violence (chi2 = 4.239, P = 0.039), physical violence vs. sexual violence (chi2 = 4.482, P = 0.034). The influential factors on the incidence rates of violence would include: sex, smoking status, family without harmony, tendency of bullying others and the level on self-esteem etc. CONCLUSION: When the random effect of class difference was separated by multivariate multilevel model, the estimated results would be more precise. Other than paying more attention to both individual and family influential factors when taking measures to reduce the incidence rate of violence in high school students, the effect of environment in the class should not be ignored.

[A case-control study on genetic and environmental factors regarding polydactyly and syndactyly].

OBJECTIVE: To explore the genetic and environmental factors related to the development of polydactyly and syndactyly, and to provide evidence for prevention on birth defects. METHODS: A hospital-based case-control study was conducted. 111 cases and 222 controls were interviewed with standardized questionnaires. Logistic regression models were used to select risk factors. RESULTS: Research data through univariate analysis showed that the occurrence of polydactyly and syndactyly were associated with educational level, annual average income per family member, meat and egg intake during early pregnancy, family heredity history, exposure to hazardous substance before pregnancy, serious pregnant reaction etc. of the pregnant women. As shown in multivariable logistic model, some factors, including annual average income of per family member (OR = 0.240), meat and egg intake during early pregnancy (OR = 0.182), could reduce the risk of the development of polydactyly and syndactyly. Other factors including family heredity history (OR = 10.187), exposure to hazardous substance before pregnancy (OR = 3.029), could increase the risk of developing polydactyly and syndactyly. The attributable risks (%) of family heredity history and exposure to hazardous substance before pregnancy were 90.18% and 66.99% respectively. CONCLUSION: Genetic factor was the leading cause on the development of polydactyly and syndactyly. In addition, environmental factors, such as family economic condition, nutritional status during early pregnancy and working condition before pregnancy were associated with the development of polydactyly and syndactyly.

[Application of capture-mark-recapture method on evaluating the abilities of birth defects surveillance systems].

OBJECTIVE: To evaluate the abilities of population-based birth defects surveillance system (PBBDSS) and hospital-based birth defects surveillance system(HBBDSS). METHODS: We used capture-mark-recapture method(CMR) to analyze the data of the two kinds of birth defects surveillance systems from 1 Oct. 2006 to 31 Dec. 2006 in a county of Hunan province. Data from PBBDSS were defined as the first source and data from HBBDSS were defined as the second source. RESULTS: 49 and 28 birth defect cases were found from PBBDSS and from HBBDSS respectively. Among these cases, 20 were marked. With the method of CMR, the estimated birth defects cases were 68 (95% CI: 56-70). The coincident rates of PBBDSS and HBBDSS were 72.1% and 41.2%, while the total coincident rates was 83.8% and the coincident rates from different sources was 57.1%. The unreported rates of PBBDSS and HBBDSS were 27.9% and 58.8%. CONCLUSION: Not only the HBBDSS but also the PBBDSS appeared to have had high unreported rates, suggesting that we could use CMR to adjust the rate of birth defects from the birth defects surveillance data.

[The status on care and nutrition of 774 children staying in rural areas while parents were in towns].

OBJECTIVE: To understand the status on care and nutrition of children living in the rural areas (so called 'left-behind' children) while their parents were seeking for jobs in the urban areas. METHODS: Cross-sectional study was employed in this investigation. The group of 'left-behind' children (n = 774) and the comparison group (n = 774) were identified. The ascertainment methods mainly included questionnaire, anthropometrics measurements, food-frequency, and laboratory examination. RESULTS: Data from this study revealed that the guardians of the 'left-behind' children had less ability to ensure daily food that the children demanded than the control group and the 'left-behind' children were more likely to be poorly attended (chi2 = 6.671, P = 0.036; xhi2 = 15.053, P = 0.001). Mothers who chose to work outside of their households would tend to choose bottle-feeding or decrease the duration of breastfeeding for their infants (chi2 = 5. 051, P = 0.031; t = -7.201, P = 0.001). The intake of milk and bean products in children younger than 2 years old and cereal intake in children aged 2 to 4 in the group of 'left-behind' children were obviously lower than that seen in the control group (t = -2.150, P = 0.032; t = -2.054, P = 0.040 respectively). The 'left-behind' children were in high prevalence of anemia, and showed significant difference when comparing with the control group (chi2 = 4.560, P = 0.033). CONCLUSION: Children under 'left-behind' situation were in poor nutrition. Recognition of this situation by the communities, parents and extended families would facilitate more attention and effective intervention programs to improve the situation.

[Risk prediction model of perinatal congenital heart disease].

Through analyzing the influencing factors of congenital heart disease (CHD), it is aimed to establish CHD risk prediction model in fetus, and simultaneously provide theoretical foundation for CHD prevention. One-factor logistic regression method was used to screen the significant factors regarding CHD, and to separately adopt multiple-factor non-conditional logistic regression method and decision tree to set up model prediction fetus CHD risk and to analyze the advantages and shortcomings. Correct classification rates turned to be 80.93% and 82.79% respectively among 215 'training samples' by the two methods and the rates were 85.45% and 89.09% respectively among 55 'testing samples'. The alliance of logistic regression and decision tree can overcome influence by co-linearity to guarantee the accuracy and perfection, as well as promoting the predictive accuracy.