Eating-out behaviors, associated factors and associations with obesity in Chinese school children: findings from the childhood obesity study in China mega-cities.

PURPOSE: Eating-out and prevalence of obesity/overweight have been rising rapidly in China in the past two decades due to social economic developments. This study examined Chinese school children's eating-out behaviors and associated factors, including their association with obesity during a 3-year follow. METHODS: Data were collected from 3313 primary and middle school children aged 7-16 years in five mega-cites across China in 2015, 2016 and 2017, in an open cohort study. Eating-out behaviors were assessed using questionnaire survey. The Chinese age-sex-specific body mass index (BMI) cutoffs were used defining child overweight/obesity (combined) and obesity; central obesity was defined as WHtR ≥ 0.48. Mixed effect models examined associations between child eating-out behaviors and BMI, overweight and obesity in this longitudinal data, adjusting for other covariates. RESULTS: About 80.1% of the children reported having eaten out ≥ 1 times/week over the past 3 months; 46.7% and 70.9% chose Western- and Chinese-style food when ate out, respectively. Meanwhile, 29.8% of them were overweight/obese, 12.7% were obese and 20.1% had central obesity. Child eating-out behaviors were positively associated with parents' eating-out behaviors (p < 0.05). Boys were more likely to choose Western-style food than girls (OR 1.27; 95% CI 1.09-1.48) when eating out. Compared to non-overweight/obese children, those being overweight/obese at baseline were less likely to eat out dining on Western-style food during the follow-up. CONCLUSION: Eating-out is common among school children in major cities in China, but with considerable differences across groups. Children's weight status was associated with eating-out behaviors.

Neighborhood sidewalk access and childhood obesity.

The lack of access to sidewalks is a barrier for physical activity (PA) and may be a risk factor for childhood obesity. However, previous studies reported mixed findings and the association between sidewalk accessibility and childhood obesity remains unclear. This study systematically examined the evidence on the association between sidewalk accessibility and childhood obesity. PubMed, Cochrane Library, and Web of Science were searched for relevant articles (published before 1 January 2019) that reported on the association between neighborhood sidewalk access and weight-related behaviors and outcomes in children. Seventeen studies conducted in five countries were included. Ten studies used objective measure of access to sidewalks, seven studies measured children's height and weight, and seven studies objectively measured the PA or sedentary behaviors. Ten studies reported on the association of better access to sidewalks with increased PA (ß ranging from 0.032 to 2.159; p < 0.05), reduced sedentary behaviors (ß ranging from -0.19 to -0.14; p < 0.05), lower body mass index (BMI) (ß ranging from -0.261 to -0.144; p < 0.001), or obesity risks (OR ranging from 1.02 to 1.32; p < 0.05); while the remaining seven studies did not report a desirable obesity-sidewalk association. Our findings support the hypothesis that higher sidewalk accessibility is associated with higher PA levels, lower BMI, and obesity risks. Efforts in building healthy environments, including health-promoting city planning, can help minimize the growing obesity epidemic and promote public health.

Temporal, geographical and demographic trends of stroke prevalence in China: a systematic review and meta-analysis.

BACKGROUND: China has made large efforts to reduce stroke prevalence. We aimed to systematically examine the prevalence of stroke in China over the past two decades. METHODS: Databases, including China National Knowledge Infrastructure, Wanfang, VIP, and PubMed, were systematically searched for studies published in English or Chinese that reported stroke prevalence in China during 2000-2017. Meta-analysis was conducted to estimate the pooled stroke prevalence and the variations in stroke prevalence subgroups stratified by age, gender, time period, and region. RESULTS: In total, 96 papers met the inclusion criteria. Meta-analysis showed that the overall estimated national prevalence was 5.1% (5.0-5.3%) with large variations across regions: 3.1% (2.5-3.6%) in south China, 3.4% (3.0-3.8%) in southwest China, 3.6% (3.3-3.8%) in east China, 5.0% (4.7-5.4%) in central China, 5.8% (4.6-7.1%) in northwest China, 6.0% (5.0-7.0%) in northeast China, and 8.0% (7.4-8.5%) in north China. Men had a higher prevalence than women [7.3% (6.9-7.7%) vs. 5.6% (5.2-6.0%)]. Stroke prevalence increased with age, was 1.2% (1.0-1.3%), 2.9% (2.6-3.2%), 5.9% (5.2-6.5%), and 8.7% (8.0-9.5%) in the 40-49, 50-59, 60-69, and ≥70 years old groups, respectively. CONCLUSIONS: Men, people being older, or living in northern China had higher stroke prevalence. More vigorous efforts are needed in China to prevent stroke.

Perceived risk, behavior changes and Health-related outcomes during COVID-19 pandemic: Findingsamong adults with and without diabetesin China.

AIMS: To examine perceived infection risk of COVID-19 and the health and related behavior changes among people with diabetes, compared with people without diabetes, and to examine factors associated with self-reported health during the national quarantine period in China. METHODS: The 2020 China COVID-19 Survey is an anonymous 74-item survey administered via social media across China. A national sample of 10,545 adults in all 31 provinces in mainland China provided data on sociodemographic characteristics, awareness, attitudes towards COVID-19, lifestyle factors, and health outcomes during the quarantine. Regression models tested associations among study variables adjusting for covariates. RESULTS: Among the 9,016 total participants (42.6% men and 57.4% women), 585 reported having diagnosed diabetes and 8,431 had no diabetes. Participants with diabetes perceived themselves to be at higher risk and were more worried about being infected with COVID-19 when compared to non-diabetic individuals (p < 0.001). During the COVID-19 pandemic, participants with diabetes were more likely to experience food and drug shortages and to increase their physical activity, compared to their counterparts. Among diabetic respondents, a high proportion of current smokers (74.1%) and drinkers (68.5%) reported increased amounts of smoking and drinking. People with diabetes were 11% less likely to report excellent or very good health. Having 150 min/week physical activity was positively associated with excellent or very good health (prevalence ratio, PR = 1.14, 95%CI 1.11-1.16). CONCLUSIONS: A high proportion of people with diabetes perceived risk of COVID-19 infection and increased their smoking and drinking during the pandemic.

Associations between iron status and insulin resistance in Chinese children and adolescents: findings from the China Health and Nutrition Survey.

BACKGROUND AND OBJECTIVES: Iron homeostasis abnormalities are associated with insulin resistance (IR), but studies on such associations in children and adolescents are limited and have contrasting results. The purpose of this study was to determine the associations between indicators of iron status and IR, and assesse if there are sex disparities in these associations. METHODS AND STUDY DESIGN: We selected data of 689 children and adolescents (367 boys and 322 girls) aged 6-18 years in the analysis. Serum ferritin, transferrin, and soluble transferrin receptor (sTfR) levels were determined. The level of glycated hemoglobin (HbA1c) was assessed using highperformance liquid chromatography. Homeostasis model assessment of insulin resistance (HOMA-IR) was used to indicate the status of insulin resistance. Stepwise and multivariate logistic regression analyses were computed to evaluate associations between iron status and glucose parameters. RESULTS: The prevalence of IR (HOMAIR >3.16) and high HbA1c (HbA1c ≥5.7%) were 29.8% and 16.4%, respectively. Serum transferrin and sTfR were significant associated with HbA1c (p<0.001), while serum transferrin was associated with HOMA-IR (p<0.001). Furthermore, the highest transferrin concentrations were associated with higher risks of both HOMAIR and high HbA1c, while decreased sTfR concentrations were associated with a risk of higher HbA1c in both children and adolescents. CONCLUSIONS: Serum transferrin and sTfR were statistically significantly associated with glucose parameters, which may suggest that transferrin and sTfR levels should be taken into consideration when studying IR in both boys and girls.

Changes in patterns of the double burden of undernutrition and overnutrition in Nepal over time.

Knowledge regarding nutrition transition in Nepal remains limited. This systematic review examined the shifts in undernutrition and overnutrition in Nepal during the past two decades. We searched PubMed for studies and reports published between January 1, 2000, and June 30, 2018. Publications with a sample size greater than or equal to 500 that reported prevalence of nutritional status were included. Six large national reports and 36 studies met study inclusion criteria and were included. Overall, available nationally representative data remained limited. The Nepal Demographic and Health Survey 2001 to 2016 showed that underweight prevalence decreased from 26.7% to 17.2% and prevalence of overweight/obesity increased from 6.5% to 22.1% among women of reproductive age (15-49 years). In preschool children, prevalence of stunting, wasting, and underweight decreased from 57.2% to 35.8%, 11.2% to 9.7%, and 42.7% to 27.0%, respectively. Prevalence of overweight/obesity was low among children and was higher in higher socio-economic status (SES) groups. The overweight-obesity/underweight ratios indicate a shift from undernutrition to overnutrition problem; it was more evident in urban areas and higher SES groups. In conclusion, Nepal is experiencing a nutrition transition. More research is warranted to address this shift, and well-tailored public health efforts need to combat the double burden of overweight/obesity and undernutrition.