The Nutrition Knowledge Level and Influencing Factors among Chinese Women Aged 18-49 Years in 2021: Data from a Nationally Representative Survey.

Women aged 18-49 years are women of childbearing age. Their nutrition knowledge (NK) is not only related to their physical health but also affects the diet quality of the entire family and the health status of the next generation. Studies that assess the NK level of women of childbearing age using representative data in China are lacking. This study aimed to evaluate the NK level of Chinese women aged 18-49 years and explore influencing factors at both the individual and provincial levels. Data were from the Chinese Nutrition and Health Knowledge Survey 2021. A total of 38,065 females aged 18-49 years were included in the analysis. A face-to-face validated standard questionnaire was used to collect NK from respondents. The full score of the questionnaire was 100. Respondents who scored higher than 75 were considered to have NK. The Rao-Scott chi-square test was used to compare the differences in the NK awareness rate between or among the subgroups. A multilevel logistic regression model was used to explore influencing factors at the individual and provincial levels. All analyses accounted for complex sample design including clustering, stratification, and sample weights. The mean score of NK among Chinese women aged 18-49 years was 65.1 ± 11.8, and the awareness rate was 20.9% (95% CI: 19.6-22.3%). Among the five dimensions, the awareness rate of food safety was the highest (74.0%, 95% CI: 72.8-75.3%), and the dietary recommendation was the lowest (16.4%, 95% CI: 15.3-17.5%). The two-level logistic regression model analysis revealed that at the individual level, age, education level, occupation, chronic disease status and residence were the main influencing factors of the NK level. At the provincial level, the region and the female illiteracy rate were associated with the NK level. Dependent children ratio, per capita income, and health expenditure were not significantly associated with the NK level. The model accounted for 58.8% of the variance in the NK level. The NK level of Chinese women aged 18-49 years was low. Knowledge of dietary recommendations was weakest. Both individual and provincial-level factors were associated with the NK level. There is an urgent need to strengthen nutrition education actions for enhancing the NK of reproductive-age women effectively to improve their dietary behaviors.

Evaluation of the effectiveness of healthy school canteen intervention on nutritional literacy and dietary behavior among primary school students / 中国学校卫生

Objective@#To explore the effectiveness of healthy school canteen intervention on nutritional literacy, food consumption, as well as attitude towards school canteen.@*Methods@#A primary school in Taizhou City was selected as the intervention school, and another comparable primary school was selected as the control one. A total of 320 students (163 in the intervention group and 157 in the control group) received a comprehensive intervention based on the construction of a healthy school canteen in the school,incluling healthy dining environment,food impravement,chef training,nutrition and health education, while the control group did not receive any intervention. Questionnaires survey was administered to both groups before and after the intervention.@*Results@#Before the intervention, no significant differences were found in the total scores of skills and nutrition literacy, frequency of food intake, behaviors and attitudes related to canteen construction between the two groups( P >0.05). Daily intake of vegetables, dairy products, fish/poultry/eggs/lean meat increased by 19.63, 15.95 and 19.63 percentage point respectively ( χ 2=15.25，9.14，13.93， P <0.01). The proportion of students reporting have read related intervention materials in the intervention group(95.71%) was higher than the control group(84.71%) ( χ 2= 11.04, P < 0.01 ). The students in favor of low salt, low oil and low sugar dishes in the intervention group (74.85%) was higher than in the control group(48.41%) ( χ 2=23.73, P <0.01).@*Conclusion@#Based on the comprehensive intervention of nutrition and health canteens can improve students nutrition literacy and dietary structure. It is recommended to adopt the form of "home school linkage" to carry out the construction of large sample, multi regional and long term nutrition and health canteens.

[Expert consistency evaluation on nutrition and health knowledge questionnaire items for Chinese adults].

OBJECTIVE: To establish nutrition knowledge questionnaire items for Chinese adults by Delphi consensus study. METHODS: The framework system and preliminary items of nutrition knowledge questionnaire were established through literature review and experts consultation, considering the nutrition status and problems of Chinese people. Delphi method was used to conduct consensus analysis with 11 experts in related field involved to determine the nutrition knowledge questionnaire items. RESULTS: The active coefficients of consultation in two rounds were both 100%(11/11), and the authority coefficients of experts were 0.900. The average scores of all items were(4.67±0.28) and(4.80±0.21), the variation coefficients were 0.06 and 0.04, and the Kendall harmony coefficients were 0.261(χ~2=39.645, P=0.004) and 0.324(χ~2=43.122, P=0.001), respectively. After the second round of consultation, all selected items met the inclusion criteria. Finally, 20-item nutrition knowledge questionnaire were determined, including five dimensions of dietary recommendations, food characteristics, nutrition and health, food choices and food safety. CONCLUSION: The Delphi consensus of nutrition knowledge questionnaire items for Chinese adults were basically achieved.

[Dietary recommendation-related knowledge level of Chinese adults in 2021].

OBJECTIVE: To analyze the knowledge level and related factors related to dietary recommendations for Chinese residents aged 18-64 years in 2021. METHODS: A multi-stage cluster random sampling was used to select 302 survey sites across the country, there were 102 398 people surveyed, with 98 567 valid questionnaires, 49.4% male and 41.9% urban, and an average age of(38.5±12.2) years. A standardized questionnaire certified by experts and evaluated for reliability and validity was used to conduct the face-to-face survey. The questionnaire was scored out of 100 points; dietary recommendation-related knowledge was scored out of 30 points, and a score of 22.5 points or above was judged as acquiring relevant knowledge. Descriptive statistics were used to report the values of relevant knowledge level of respondents with different characteristics, and univariate and multi-variate Logistic regression models were used to analyze the factors influencing relevant knowledge level. RESULTS: The average score of dietary recommendation-related knowledge was(17.9±4.2), and the knowledge awareness rate was 14.7%. The five knowledge points with the lowest correct rates were the recommended intakes of soybeans and products(21.1%), added sugars(22.6%), milk(25.5%), food groups(27.6%), and cooking oils(31.4%) and the recommended intakes of fruits and salt were also less correct(56.9% and 58.5%). Multi-variate analysis revealed that the knowledge of dietary recommendations was lower among residents in rural(OR=0.945, 95%CI 0.944-0.945), central(OR=0.863, 95%CI 0.863-0.864) and western(OR=0.983, 95%CI 0.982-0.983) areas, those with chronic diseases(OR=0.784, 95%CI 0.783-0.784) and those who did not know about chronic diseases(OR=0.694, 95%CI 0.694-0.694) compared to the counterparts; female(OR=1.090, 95%CI 1.090-1.091) had a higher knowledge rate compared to male. The awareness rate of residents increased with the level of education, and the trend was statistically significant(P<0.001). CONCLUSION: The level of knowledge related to dietary recommendations for the adult population in China in 2021 is low, especially for the recommended intake of dairy, soybeans and products, and cooking oils, and the knowledge level of men, rural, central and western, and less educated populations is even lower.

[Age distribution of nutrition and health knowledge among Chinese adults in 2021].

OBJECTIVE: To analyze the age distribution of nutrition and health knowledge level of Chinese residents aged 18-64. METHODS: A total of 102 398 residents aged 18-64 were selected from 302 survey sites in China by multi-stage cluster random sampling method, a total of 98 567 respondents were included in the study. Both mean and rate were calculated by complex sampling weighting. RESULTS: The nutrition and health knowledge score of residents aged 18-24, 25-34, 35-44, 45-54 and 55-64 years old in China were(65.1±11.4) points, (64.6±11.7) points, (64.7±12.0) points, (62.2±12.8) points and(59.5±13.3) points. The nutrition and health knowledge awareness rates were 20.3%, 19.1%, 20.3%, 16.9% and 12.1%, respectively(P<0.001). A decreasing trend in all dimensions and overall nutrition and health knowledge with increasing age was found(ß<0, P_(trend)<0.001). This trend was also reflected across gender or regions. While the trend of nutrition and health knowledge level with age varies with different literacy levels. Differences in knowledge points with positive response rates <30% by age groups. CONCLUSION: The level of nutrition and health knowledge among Chinese adult residents of all ages is relatively low in 2021, but the knowledge shortcomings are different.

[Access channels on nutrition and health knowledge of Chinese adults in 2021].

OBJECTIVE: To analyze the access channels on nutritional health knowledge of Chinese residents aged 18-64 years in 2021. METHODS: A multi-stage cluster random sampling was used to select 302 survey sites across the country, there were 102 398 people surveyed, with 98 424 valid questionnaires, 49.4% male and 42.0% urban, with an average age of(38.5±12.2) years old. A standardized questionnaire certified by experts and evaluated for reliability and validity was used to conduct the face-to-face survey. Descriptive statistics were used to report the access channels on nutrition and health knowledge of respondents, and the proportion of access channels of respondents with different characteristics was compared by chi-square test. RESULTS: The access channels on nutrition and health knowledge of Chinese residents aged 18-64 in 2021 were, in descending order, WeChat/Microblog/Tik Tok/Kuaishou and other software(77.0%), TV/radio(55.7%), family/relatives/friends(41.8%), books/newspapers/journals/magazines(32.5%), website search(30.7%), promotional lectures(29.3%) and other(1.9%). A high proportion of people who access nutrition and health knowledge through software, website searches and books/newspapers were mostly from the lower age groups, higher education groups, urban and eastern regions. People with a high proportion of access through TV/radio, family/relatives/friends and promotional lectures were mostly from the higher age groups, lower education groups, rural and western areas(P<0.001). Women are more likely than men to obtain nutrition and health information from all channels except website search. The higher the level of education, the higher the level of concern for nutrition and health knowledge(P<0.001). CONCLUSION: In 2021, the top access channel for Chinese residents aged 18-64 to obtain nutrition and health knowledge is WeChat/Microblog/Tik Tok/Kuaishou and other software. There are differences in access channels for different groups of people.

[Geographical distribution differences of nutrition and health knowledge among Chinese adults in 2021].

OBJECTIVE: To explore the geographical distribution of nutrition and health knowledge among 18-64 years old adults in China. METHODS: A total of 102 398 residents aged 18-64 from 302 survey sites were selected by multi-stage cluster random sampling method, a total of 98 567 respondents were included in the study. Both mean and rate were calculated by complex sampling weighting. RESULTS: The nutrition and health knowledge score in eastern region(65.5±12.0) was higher than that in central(62.4±11.9) and western(61.4±12.9), and the score in northern region(63.9±11.8) was higher than that in southern(63.1±12.8). In the seven geographical regions, the highest score was in north(65.8±11.4), and the lowest score was in northwest(61.6±12.2). The awareness rate of nutrition and health in eastern region(22.4%) was higher than that in central(14.7%) and western(14.9%), the highest awareness rate among the seven geographic regions was in east(23.2%), followed by north(22.5%) and the lowest was in northwest(13.2%). There were also differences in nutritional health knowledge levels of residents in different regions in the five dimensions(P<0.001). Northwest China had the lowest awareness of food characteristics and nutrition and disease dimensions, South China had the lowest awareness of dietary recommendations and food choices dimensions, and Southwest China had the lowest awareness of food safety dimensions. CONCLUSION: The level of nutrition and health knowledge of Chinese adults have large geographical differences.

The Association of Sleep Duration with Breakfast Patterns and Snack Behaviors among Chinese Children Aged 6 to 17 Years: Chinese National Nutrition and Health Surveillance 2010-2012.

A significant increase in the prevalence of short sleep among children has been observed. Short sleep may be associated with unhealthy breakfast and snacking behaviors. The purpose of the current study was to explore the associations of short sleep with breakfast and snacking behaviors among children. Data were obtained from the 2010-2012 China National Nutrition and Health Surveillance (CNNHS). A total of 5254 children aged 6 to 17 years were included. Sleep duration was classified into three categories: moderate sleep, slightly short sleep, and severely short sleep. Breakfast behaviors included skipping breakfast, food diversity, intake of energy and macronutrients, and their proportion of daily total intake. Snack behaviors included snack consumption rate/frequency, types, intake of energy and macronutrients, and proportion of daily total intake. Multiple linear regression and multivariate logistic regression were used for analysis, with models adjusted for the potential effects of gender, age, region, and family income level. The bootstrapping method was used to calculate the 95% confidence intervals of the model statistics. Results showed that slightly short sleep (OR = 1.15, 95%CI: 1.00, 1.33)) and severely short sleep (OR = 1.36, 95%CI: 1.04, 1.77) was related to higher rates of skipping breakfast compared to moderate sleep. Severely short sleep was associated with higher energy (ß = 28.44, 95%CI: 31.97, 44.70), carbohydrate (ß = 6.62, 95%CI: 8.29, 8.84) and protein (ß = 1.17, 95%CI: 1.44, 1.70) intake at breakfast and breakfast accounted for a higher proportion of total daily energy (ß = 1.39, 95%CI: 1.48, 2.52), protein (ß = 2.26, 95%CI: 3.16, 5.84) and carbohydrate (ß = 0.83, 95%CI: 0.07, 3.41). Severely short sleep was associated with higher energy (ß = 27.4, 95%CI: 18.64, 69.41), protein (ß = 0.8, 95%CI: 0.48, 2.40), and fat (ß = 1.40, 95%CI: 1.21, 3.16) intake at snacks and snacks accounted for a higher proportion of total daily protein intake (ß = 1.23, 95%CI: 0.71, 3.58) and fat intake (ß = 2.74, 95%CI: 3.13, 6.09). Slightly short sleep was associated with higher energy (ß = 7.28, 95%CI: 0.15, 28.13) and carbohydrate (ß = 1.67, 95%CI: 0.86, 5.73) intake at snacks and snacks accounted for a higher proportion of total daily carbohydrate intake. Children with severely short sleep were more likely to choose sugar-sweetened beverages (SSBs) as snacks (16.5%) and intake them more frequently, at a daily consumption of 204.7 g and 26.7 g per night. Overall, short sleep was associated with unhealthy breakfast patterns and snack behaviors among children. Children with short sleep had higher intake of energy and macronutrients at breakfast and snacks compared with those with moderate sleep. Promoting adequate sleep among children may have a positive effect on developing healthy eating behaviors.

Gene-Environment Interaction on Type 2 Diabetes Risk among Chinese Adults Born in Early 1960s.

BACKGROUND: Gene-environment interactions on type 2 diabetes (T2D) risk are studied little among Chinese adults. AIM: This study aimed to explore the interactions among Chinese adults born in early 1960s. METHODS: The interaction of single nucleotide polymorphisms (SNPs) and environmental factors on T2D risk were analyzed by multiple linear or logistic regression models, and in total 2216 subjects were included with the age of 49.7 ± 1.5 years. RESULTS: High dietary intake increased the effects of rs340874 on impaired fasting glucose (IFG), rs5015480, rs7612463 on T2D (OR = 2.27, 2.37, 11.37, respectively), and reduced the effects of rs7172432 on IFG, rs459193 on impaired glucose tolerance (IGT) (OR = 0.08, 0.28, respectively). The associations between rs4607517 and T2D, rs10906115 and IGT, rs4607103, rs5015480 and IFG could be modified by drinking/smoking (OR = 2.28, 0.20, 3.27, 2.58, respectively). Physical activity (PA) interacted with rs12970134, rs2191349, rs4607517 on T2D (OR = 0.39, 3.50, 2.35, respectively), rs2796441 and rs4607517 on IGT (OR = 0.42, 0.33, respectively), and rs4430796, rs5215, and rs972283 on IFG (OR = 0.39, 3.05, 7.96, respectively). Significant interactions were identified between socioeconomic status and rs10830963, rs13266634 on T2D (OR = 0.41, 0.44, respectively), rs1470579 and rs2796441 on IGT (OR = 2.13, 2.37, respectively), and rs7202877 and rs7612463 on IFG (OR = 5.64, 9.18, respectively). CONCLUSION: There indeed existed interactions between environmental factors and genetic variants on T2D risk among Chinese adults.

Association between Physical Activity, Sedentary Behaviors, Sleep, Diet, and Adiposity among Children and Adolescents in China.

INTRODUCTION: Physical activity (PA), sedentary behaviors (SB), sleep, and diet are related to adiposity among children and adolescents. However, there may be interactions between PA, SB, sleep, and diet, and these lifestyle behaviors may work together to affect body weight. The purpose of this study was to explore the impact of multiple lifestyle behaviors of PA, SB, sleep, and diet on childhood adiposity (body mass index z-score and overweight/obesity), and to investigate the effect of meeting multiple guidelines on adiposity among children and adolescents in China. METHODS: Cross-sectional results were based on 28,048 children aged 6-17 years from the China National Nutrition and Health Surveillance in 2010-2012. Information about PA, SB, and sleep was measured through interview-administered questionnaire. Dietary intake was assessed with food frequency questionnaire. The associations between multiple lifestyle behaviors and BMI z-score and overweight/obese were examined. RESULTS: The prevalence of overweight/obesity in the participants was 19.2%. The average time of moderate-to-vigorous PA (MVPA), leisure SB, and sleep was 76.7 ± 45.5 min, 2.9 ± 1.4 h, and 8.5 ± 1.1 h per day, respectively. The China Dietary Guidelines Index for Youth (CDGI-Y) score was 62.6 ± 11.0. Sleep duration and diet score were negative associated with BMI z-score (both p < 0.001). MVPA and SB time were positive associated with BMI z-score (p = 0.041, 0.004). Meeting the SB, sleep, and diet guidelines had a lower BMI z-score (all p < 0.01) and lower odds of overweight/obesity (all p < 0.05). There were significant interactions between PA and diet. Compared with meeting no guidelines, those who met multiple guidelines had a lower risk of overweight/obesity (all p < 0.01). The more guidelines the participants met, the lower odds of overweight/obesity (p for trend <0.001). CONCLUSIONS: PA, SB, sleep, and diet are important behaviors associated with adiposity among children and adolescents. Attaining adequate amounts of appropriate multiple behaviors provided an additional benefit. It is important for children to meet recommended behavioral guidelines or recommendations. Interventions that aim to improve awareness of and compliance with these guidelines are needed in future.

The association between frequency of eating out with overweight and obesity among children aged 6-17 in China: a National Cross-sectional Study.

BACKGROUND: In parallel with the increased prevalence of childhood overweight and obesity, the proportion of eating out in China has increased dramatically in recent years. The purpose of the study was to explore the association between frequency of eating out with overweight and obesity among Chinese children. METHODS: The representative sample was recruited from Chinese National Nutrition and Health Survey (CNNHS) in 2010-2012, which included Chinese children aged 6-17 years (7685 boys and 7576 girls). Frequency of eating out was collected by interview-administered questionnaire and categorized as: 0, 1-2 and ≥ 3 times per week. Height and weight were measured, consequently body mass index was calculated. RESULTS: The prevalence of eating out among Chinese children aged 6-17 years old was 23.2%. Children who ate out 0, 1-2, ≥3 times per week were accounted for 76.8, 10.9 and 12.3% respectively. Findings revealed that eating out three times per week or more was statistically significant associated with higher prevalence of overweight and obesity among boys (OR = 1.20,95CI:1.04-1.38) compared with those ate out less than three times per week. However, no significantly association was observed among girls (OR = 0.91, 95CI:0.78-1.01). In additional, Younger children, rural children, children from low income family, those with leisure exercises (certain physical activities regularly carried out such as swimming, walking, running, equipment fitness), leisure time sedentary behaviors (LTSB)(> 2 h/d) were relatively more likely to eat out. CONCLUSIONS: The results illustrated that eating out three times or more had a significantly positive effect on overweight and obesity among boys in China.

Association of Physical Activity and Sitting Time with Overweight/Obesity in Chinese Occupational Populations.

The aim of this study was to explore association of physical activity and sitting time with overweight/obesity in Chinese occupational populations for the development of intervention and prevention strategies for obesity. METHODS: A total of 23,112 participants were selected from the 2010-2012 China National Nutrition and Health Survey (CNNHS). A logistics regression model was used to examine the associations of physical activity and sitting time with overweight/obesity by gender after adjusting for age, educational level, marital status, and family economic level. RESULTS: The prevalence of overweight/obesity based on the WHO definition and the WGOC definition was 30.8% and 41.3%, respectively. Male employees with moderate and heavy occupation activity intensity had a lower risk for overweight/obesity than those with light occupation activity intensity (moderate: OR 0.90, 95% CI 0.82-0.98; heavy: OR 0.75, 95% CI 0.65-0.86), and the risk of overweight/obesity of male employees with long work-time spent sitting was higher than those with short work-time spent sitting (2-4.9 h/day: OR 1.26, 95% CI 1.14-1.40; ≥5 h/day: OR 1.29, 95% CI 1.15-1.44). The risk of overweight/obesity of male employees with active transportation mode was lower than those with inactive transportation mode (OR 0.91, 95% CI 0.84-0.99), while the risk of overweight/obesity of female employees with active transportation mode was higher (OR 1.14, 95% CI 1.04-1.25). Female employees with leisure-time physical activity (LTPA) for ≥150 min/week had lower risk of overweight/obesity than those with LTPA for <150 min/week (OR 0.69, 95% CI 0.56-0.84). There was no significant association of leisure-time sitting and housework time with overweight/obesity in Chinese occupational populations. CONCLUSION: Occupation activity intensity, LTPA, transportation mode, and work sitting time were associated with overweight/obesity. Reducing work sitting time, moderate and heavy occupation activity intensity, and an active transportation mode could help male employees decrease the risk of overweight/obesity. Increasing leisure-time physical activity could reduce the risk of overweight/obesity in women. Our findings provided insight into the association of physical activity and sitting time with overweight/obesity. It will be necessary to carry out workplace-based interventions, have an active transportation mode, and increase leisure-time physical activity to decrease the risks of overweight/obesity.

Ten SNPs May Affect Type 2 Diabetes Risk in Interaction with Prenatal Exposure to Chinese Famine.

Increasing studies have demonstrated that gene and famine may interact on type 2 diabetes risk. The data derived from the cross-sectional 2010-2012 China National Nutrition and Health Survey (CNNHS) was examined to explore whether gene and famine interacted to influence type 2 diabetes risk. In total, 2216 subjects were involved. The subjects born in 1960 and 1961 were selected as the famine-exposed group, whereas subjects born in 1963 were selected as the unexposed group. A Mass Array system was used to detect the genotypes of 50 related single-nucleotide polymorphisms (SNPs). Interactions were found between prenatal exposure to famine and ten SNPs (rs10401969, rs10886471, rs10946398, rs1470579, rs2796441, rs340874, rs3794991, rs5015480, rs7961581, and rs9470794) on type 2 diabetes risk after adjustments. The stratified results showed that famine exposure exacerbated the effect of CILP2-rs10401969 to fasting serum insulin (FINS), GRK5-rs10886471 to fasting plasma glucose (FPG) and FINS, IGF2BP2-rs1470579 to FINS, TLE1-rs2796441 to impaired fasting glucose (IFG), PROX1-rs340874 to impaired glucose tolerance (IGT), GATAD2A-rs3794991 to FINS, TSPAN8/LGR5-rs7961581 to FPG, and ZFAND3-rs9470794 to IGT and FINS. Famine exposure weakened the effect of CDKAL1-rs10946398 to type 2 diabetes. Famine exposure weakened the effect of HHEX-rs5015480 to IFG, but exacerbated the effect of HHEX-rs5015480 to FINS. The present study suggests that ten SNPs may affect type 2 diabetes risk in interaction with prenatal exposure to Chinese famine.

The Relationship between Leisure-Time Sedentary Behaviors and Metabolic Risks in Middle-Aged Chinese Women.

The prevalence of metabolic diseases has increased over the past few decades, and epidemiological studies suggest that metabolic diseases may be associated with lifestyle. The purpose of the present study was to investigate the relationship between leisure-time sedentary behaviors (LTSBs) and metabolic risks in middle-aged women in China. Data came from the China National Nutrition and Health Surveillance (CNNHS) in 2010-2012. A total of 2643 women aged 46 to 53 years were involved. Multiple linear regression was used to examine the association of leisure-time sedentary duration (LTSD) with total cholesterol (TC), triglyceride (TG), waist circumference (WC), and body mass index (BMI). Restrictive cubic splines (RCS) were used to plot the curves between LTSD and the risk of metabolic diseases. Region, education, income, alcohol consumption, exercise, daily energy intake, and fat energy ratio were adjusted for all models. After adjusting for potential influencing factors, the results of multiple linear regression showed that for each additional hour increase in LTSD, TC and TG increased by 0.03 mmol/L and 0.04 mmol/L, respectively. The results of RCS curves showed that the risks of MetS (p for trend = 0.0276), obesity (p for trend = 0.0369), hypertension (p for trend = 0.0062), and hypercholesteremia (p for trend = 0.0033) increased with the increase in LTSD. LTSB was associated with the risks of MetS, obesity, hypertension, and hypercholesteremia in middle-aged women. Reducing LTSD may be an effective way of preventing metabolic diseases in middle-aged women.

[Salt intake knowledge and behavior among school teachers in four Chinese cities in 2014].

OBJECTIVE: To learn the knowledge level on "salt and health", and analyze the influence on related behavior among school teachers in four Chinese cities. METHODS: The data of 2014 salt KAP among urban residents in China was used, with stratified random cluster sampling, a total of 2518(male 708, female 1810) school teachers were selected from four cities of China, including Shenyang, Wuhan, Chengdu and Guangzhou city. Self-filled questionnaire was used to collect the information on the salt intake knowledge and behavior. The statistical software package SAS version 9. 4 was used for data analysis. RESULTS: Among the teachers in four Chinese cities, about 50. 9% of them knew the recommendation of salt intake, about 66. 6% of them knew sodium in the salt may influence health. Approximately 85. 3% of them knew eating long-term salty food may cause hypertension. The proportions of knowing salt intake among female, 40 years and older, below the undergraduate, higher family income teachers were higher than their counterparts(P<0. 05). The proportions of knowing the health influence of sodium among female, higher family income teachers were higher than their counterparts(P<0. 05). The proportions of knowing that eating long-term salty food may cause hypertension among female, undergraduate and above, higher family income teachers were higher than their counterparts(P<0. 05). About 80. 1% of them knew the nutrition labeling on the package food, about 19. 7% of them knew the nutrition labeling contents. Teachers utilized nutrition labeling differently owing to their knowledge on the labeling contents(P<0. 05). In the past three months, about 21. 4% of the teachers always use low-sodium salt when cooking, only 4. 2% of them always control their family's salt intake by using salt control spoon, about 25. 4% of them always choose low-sodium food when purchasing, only 15. 1% of the teachers requested the meals cooked lightly when eating out. The proportions of teachers who used low-sodium salt among female, higher family income, knowing salt intake recommended, knowing the health influence of sodium, knowing that long-term salty food may cause hypertension, active learning related knowledge, family members suffering from hypertension were higher than their counterparts(P<0. 05). The proportions of using salt control spoon among teachers under Bachelor's degree, active learning related knowledge were higher than their counterparts(P<0. 05). The proportions of teachers purchasing low-sodium food among 40 years and older, under Bachelor's degree, higher family income, knowing salt intake recommended, knowing the health influence of sodium, knowing that long-term salty food may cause hypertension, family members not suffering from hypertension, active learning related knowledge were higher than their counterparts(P<0. 05). The proportions of teachers requesting the meals cooked slightly when eating-out among 40 years and older, under Bachelor's degree, not knowing salt intake recommended, not knowing that long-term salty food may cause hypertension, not knowing if their family members suffered from hypertension, active learning related knowledge were higher than their counterparts(P<0. 05). The teachers consumed soy sauce, bean paste, fried bread stick differently owing to their knowledge about this(P<0. 05). CONCLUSION: The teachers in the four cities have grasped some knowledge on salt and health, but their related behaviors should be improved to reduce the salt intake.

Association of Sleep Duration and Overweight/Obesity among Children in China.

To investigate the association of sleep duration with overweight and obesity among children aged 6 to 17 years in China, 2010-2012 data from the China National Nutrition and Health Surveillance (CNHHS) were analyzed. A total of 35,414 children were recruited in the survey. Body mass index (BMI) was converted into three categories: normal weight, overweight and obesity. In multinomial logistic regression model, sleep duration was divided into four groups: very short, short, recommended and long. In restricted cubic splines (RCS), sleep duration was examined as a continuous variable in relation to overweight and obesity. In the very short and short groups, sleep duration was a risk factor for obesity after adjusting for the potential impacts of age, gender, residence, family income, leisure sedentary behavior (SB) and leisure exercise, with OR (Odds Ratio) = 3.01 (95% CI (confidence interval): 2.19-4.15) and OR = 1.24 (95% CI: 1.14-1.35), respectively. The adjusted OR of overweight for short sleep duration relative to a recommended sleep duration was 1.17(95% CI: 1.09-1.26). No significant associations of very short sleep with overweight, of long sleep duration with overweight and obesity were found. The RCS curves between sleep duration and overweight and obesity were both inverted J-shaped. To conclude, the shorter the sleep duration, the higher the risk of overweight and obesity in children. Increasing sleep duration would have a positive effect on reducing overweight and obesity rates in Chinese children.

Trends in Transportation Modes and Time among Chinese Population from 2002 to 2012.

Giving the rising trends in obesity and chronic diseases in China, strategies to increase physical activity are important. Transport-related activity is a substantial source of physical activity and can be easily incorporated into the daily lives. It is a key social factor of health, which can help improve people's mental and physical health and decrease environmental pollution. However, little is known about recent trends in transportation modes and time in China. Between 2002 and 2010-2012, information about transportation behaviors of Chinese population aged 15 years or older were collected within two Chinese Nutrition and Health Surveys. A stratified multistage cluster sampling method was conducted to select participants. Sociodemographic information, transportation modes, and time were collected during face-to-face interviews. The study included 82,377 (mean age 41.2 years) and 143,075 (mean age 48.7 years) participants in the 2002 and 2010-2012 surveys respectively. The weighted prevalence of active transportation (including walking and cycling) decreased from 83.8% in 2002 to 54.3% in 2010-2012 (p < 0.001). During the same period, the number of participants using public transportation (including taking the bus, subway, or shuttle bus) has doubled (7.5% and 15.7%, respectively, for 2002 and 2010-2012, (p < 0.001)), and the proportion of inactive transportation (including driving or taking a car, motorcycle, taxi, or electric bicycle) more than tripled. Concurrently, the transportation time almost doubled with an increase of 25.9 min over the 10 years (p < 0.001). The prevalence of active transportation increased with age. Participants with higher family income and education reported a lower prevalence of active transportation. Females were more likely to use active transportation (OR (95% CI): 4.41 (4.14-4.70) and 2.50 (2.44-2.57), respectively, for 2002 and 2010-2012, where males were the reference). Before the prevalence of active transportation and physical activity gets lower, there is a need for the public health sector and the transport and land use sector to work together to develop related policies and initiatives with the aim of promoting active transportation and public transportation to increase the levels of physical activity and to decrease the risks of chronic diseases.

Temporal Trends and Recent Correlates in Sedentary Behaviors among Chinese Adults from 2002 to 2010-2012.

Evidence suggests that more time spent in sedentary behaviors (SB) increases health risk independent of physical activities. Trends in SB among adults have not been fully described in China, and the sociodemographic correlates of SB have not been systematically evaluated either. This study examined the temporal trends of SB among 184,257 adults (2002: n = 52,697, 2010-2012: n = 131,560) using data from the China National Nutrition and Health Survey in 2002 and 2010-2012, and analyzed the recent correlates of SB in Chinese adults. Overall, an increase (+0.29 h/d) was seen in total SB across the survey years, and there was a slight increase (+0.14 h/d) in leisure time SB and a decrease (-0.39 h/d) in occupational SB. From 2002 to 2012, the proportion of Chinese adults whose total SB time over 4 h/d increased from 35.4% to 43.0%, and the proportion of leisure SB time over 3 h/d increased from 42.0% to 48.0%, and the proportion of occupational SB time over 4 h/d decreased from 63.4% to 53.0%. Male, urban areas, employed, unmarried, and with higher educational and family economic level were all positively associated with high sedentary time (HST) in 2010-2012. These trends and correlates are important for health policy in China and other countries that are facing similar challenges.

Physical activity and sedentary behavior among Chinese children aged 6-17 years: a cross-sectional analysis of 2010-2012 China National Nutrition and health survey.

BACKGROUND: Patterns of physical activity (PA) and sedentary behavior have important implications for child health. The purpose of the study was to describe the PA and sedentary behavior among Chinese children. METHODS: The study analyzed the PA and sedentary behavior status of 38,744 Chinese children aged 6-17 years, based on the data from China National Nutrition and Health Survey (CNNHS) in 2010-2012. RESULTS: Chinese children spent 61.6 min/d on school-time PA and the proportion with 60 min and over on school-time PA was 52.5%. The average transportation time was 38.5 min/d and the main mode for children was walking (50.9%), followed by taking private vehicles (19.4%), taking public transportation (16.4%) and cycling (13.3%). Approximately 70% Chinese children did domestic PA and they spent 17.2 min/d on it. Children spent 2.9 h per day on leisure-time sedentary behaviors and 85.8% of them engaged in sedentary behaviors longer than 2 h/d. The proportion of children participating in leisure-time PA was 35.4%and they performed moderate-to-vigorous PA on 3.4 days per week with average 44.9 min per day. Boys were more active in school-time PA, leisure-time PA and transportation, while girls spent more time on domestic PA and homework. More older children took active transportation and spent more time on domestic PA, leisure-time PA and sedentary behaviors compared with younger children. Children in urban area were more likely to take inactive transportation and participate in leisure-time PA, spent less time on domestic PA while more time on sedentary behaviors compared with their counterpart. CONCLUSIONS: Chinese children performed little physical activity and spent long time engaging in sedentary behaviors. Their physical activity and sedentary behaviors varied by gender, age and area.

Effects of variants of 50 genes on diabetes risk among the Chinese population born in the early 1960s.

BACKGROUND: Genome-wide association studies have identified loci that significantly increase diabetes risk. This study explored the genetic susceptibility in relation to diabetes risk in adulthood among a Chinese population born in the early 1960s. METHODS: In all, 2129 subjects (833 males, 1296 females) were selected from the cross-sectional 2010 to 2012 China National Nutrition and Health Survey. Fifty diabetes-related single nucleotide polymorphisms (SNPs) were detected. Two diabetes genetic risk scores (GRSs) based on the 50 diabetes-predisposing variants were developed to examine the association of these SNPs with diabetes risk. RESULTS: Associations were found between diabetes risk and SNPs in the MTNR1B (rs10830963), KLHDC5 (rs10842994), GRK5 (rs10886471), cyclindependentkinase 5 regulatory subunit associated protein 1 (rs10946398), adaptorrelated protein complex 3 subunit sigma 2 (rs2028299), diacylglycerol kinase beta/transmembrane protein 195 (rs2191349), SREBF chaperone (rs4858889), ankyrin1 (rs516946), RAS guanyl releasing protein 1 (rs7403531), and zinc finger AN1-type containing 3 (rs9470794) genes. As a continuous variable, with a 1-point increase in the GRS or weighted (w) GRS, fasting plasma glucose (FPG) increased 0.045 and 0.044 mM, respectively (P < 0.001 for both), after adjusting for confounders. Both GRS and wGRS showed an association with diabetes, with a multivariable-adjusted odds ratio (95% confidence interval) of 1.09 (1.00-1.19) and 1.12 (1.03-1.22), respectively, among all subjects. No significant associations were found between the GRS or wGRS and impaired fasting glucose or impaired glucose tolerance. CONCLUSIONS: The data suggest the association of 10 SNPs and the GRS or wGRS with diabetes risk. Genetic susceptibility to diabetes may synergistically affect the risk of diabetes in adulthood.