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1.
SSM Popul Health ; 16: 100943, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34703875

RESUMO

Introduction: In low-middle income countries, urbanization leads to changes from traditional to Western diet, which are often accompanied by reductions in cardiometabolic health. Whether socioeconomic status buffers these urbanization-related diet changes over time is unknown. Objective: To examine whether the association between urbanization and a key indicator of Western diet, percent of calories from animal-source foods (1) varies depending on income and (2) whether this association changes over time. Materials and methods: We used data from nine waves of the longitudinal, population-based China Health and Nutrition Survey [n = 22,360 Chinese adults (1991-2015)], followed across 24 years, including diet data from 3 repeated 24-h dietary recalls. We used simultaneous year-stratified linear regression models to examine whether changes in the association between urbanization level and percent of calories from animal-source foods differed by income. Models allowed for variation in associations across the 24 years of urbanization, accounting for within-individual correlation over time and controlling for age, sex, region, physical activity, and caloric intake. Results: In 1991, on average 15% of calories for Chinese adults came from animal source foods and by 2015, this percentage rose to approximately one quarter of total calories. Over the 24 years of follow-up, urbanization and income were each strongly related to percent of calories from animal-source foods with differential association across income levels (p < 0.0001). We also found evidence that this association changed over time (p < 0.0001). Income gradients in animal source food consumption were smallest in the most urban areas in early years with some temporal variation, but over time income gradients narrowed in some later years in low and moderately urbanized areas. However, by 2015 there were few income differences in animal source food consumption across urbanization levels. Conclusions: Throughout 24-years of urbanization, income seemed to buffer the transition from traditional to Western diet. However, the degree to which income buffered these urbanization-related changes depended on the level and history of community urbanization. At later stages of urbanization when Western diet behaviors were more widespread, urban-rural differences in Western diet behaviors varied little by income.

2.
Br J Nutr ; : 1-11, 2021 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-34470677

RESUMO

Little is known about the impact of modifiable risk factors on blood pressure (BP) trajectories and their associations with hypertension (HTN). We aimed to identify BP trajectories in normotensive Chinese adults and explore their influencing factors and associations with HTN. We used data from 3436 adults with at least four BP measurements between 1989 and 2018 in the China Health and Nutrition Survey, an ongoing cohort study. We measured BP using mercury sphygmomanometers with appropriate cuff sizes in all surveys. We used group-based trajectory modelling to identify BP trajectories between 1989 and 2009 and multiple logistic and Cox regression models to analyse their influencing factors and associations with HTN in 2011-2018. We identified five systolic blood pressure (SBP) trajectories, 'Low-increasing (LI)', 'Low-stable (LS)', 'Moderate-increasing (MI)', 'High-stable (HS)' and 'Moderate-decreasing (MD)', and four diastolic blood pressure (DBP) trajectories classified as 'Low-increasing (LI)', 'Moderate-stable (MS)', 'Low-stable (LS)' and 'High-increasing (HI)'. People with higher physical activity (PA) levels and lower waist circumferences (WC) were less likely to be in the SBP LI, MI, HS and MD groups (P < 0·05). People with higher fruit and vegetable intakes, lower WCs and salt intakes and higher PA levels were less likely to be in the DBP LI, MS and HI groups (P < 0·05). Participants in the SBP HS group (hazard ratio (HR) 2·01) or the DBP LI, MS and HI groups (HR 1·38, 1·40, 1·71, respectively) had higher risks of HTN (P < 0·05). This study suggests that BP monitoring is necessary to prevent HTN in the Chinese population.

3.
Nutrients ; 13(8)2021 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-34444995

RESUMO

It is essential to understand the impact of different dietary pattern trajectories on health over time. Therefore, we aimed to explore the long-term trajectories of dietary patterns among Chinese adults and examine the prospective association between different trajectory groups and the risk of overweight/obesity. The sample was 9299 adults aged 18 years or older from the China Health and Nutrition Survey (CHNS) between 1991 and 2018. We used factor analysis to identify dietary patterns and group-based trajectory modeling to identify dietary pattern trajectories. Three trajectories of a southern pattern and a modern pattern and four trajectories of a meat pattern were identified. Participants who followed the highest initial score and a slight decrease trajectory (OR = 1.63; 95% CI: 1.04, 2.54) of the meat dietary pattern were positively associated with risk of overweight/obesity when compared with the lowest initial score trajectory. The southern dietary pattern and the modern dietary pattern trajectories of participants in Group 2 (OR = 0.64; 95% CI: 0.51, 0.81; OR = 0.76; 95% CI: 0.63, 0.91) and Group 3 (OR = 0.71; 95% CI: 0.54, 0.91; OR = 0.64; 95% CI: 0.44, 0.90) were associated with lower risk of overweight/obesity when compared with Group 1. We observed that dietary pattern trajectories have different associations with overweight/obesity among Chinese adults.


Assuntos
Dieta/estatística & dados numéricos , Obesidade/epidemiologia , Adulto , China , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Sobrepeso/epidemiologia , Fatores de Risco , Adulto Jovem
5.
Int J Eat Disord ; 54(1): 24-35, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33191528

RESUMO

OBJECTIVE: We describe the prevalence and sociodemographic factors associated with screen-detected disordered eating and related traits in a population-based sample of women in China. We also explored prevalence trends over time. METHOD: A total of 4,218 females aged 12-50 were sampled from 15 provinces as part of the China Health and Nutrition Survey (CHNS) in 2015. The SCOFF questionnaire screened for disordered eating and the selected questions from the Eating Disorders Examination-Questionnaire measured dietary restraint, shape concerns, and weight concerns. Body mass index (BMI) was measured and sociodemographic factors captured urban/rural residence, age, ethnicity, income, education, marital status, and occupational status. We calculated the prevalence of screen-detected disordered eating and related traits broadly and across several dimensions and compared prevalence estimates to 2009 and 2011 reports. RESULTS: We detected 296 individuals who screened positive for disordered eating on the SCOFF (prevalence = 7.04%). Positive screens were associated with urban residence (p = .002) and higher education levels (p < .001). Scores on restraint, shape concerns, and weight concerns were all higher for individuals in urban versus village locations (all p's < .001), and with higher BMI (p < .001) for shape and weight concerns. The prevalence of screen-detected disordered eating increased numerically across 2009, 2011, and 2015. DISCUSSION: The prevalence of screen-detected disordered eating in mainland China was comparable to other populations worldwide obtained from a recent meta-analysis. The distribution of disordered eating and related traits varied by several sociodemographic factors, which include age, BMI, urban/rural residence, education, and income, suggesting important directions for case detection and intervention in China.


Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos , Programas de Rastreamento , Adolescente , Adulto , Criança , China/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Pessoa de Meia-Idade , Fatores de Risco , Adulto Jovem
6.
Nutrients ; 12(11)2020 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-33114561

RESUMO

Studies on fat intake and obesity have been inconclusive. This study examined the associations between dietary fat intake and body weight and the risk of overweight and obesity in China. We used data from 23,859 adults aged 20-60 years who participated in the China Health and Nutrition Survey, an ongoing open-cohort study, from 1991 to 2015. We collected detailed dietary data by conducting three 24-h dietary recalls and weighing foods and condiments in household inventories. We examined the associations between fat intake and body weight, body mass index (BMI), and the risk of overweight and obesity with random-effects linear or logistic regression models for panel data. The Chinese population's fat intake, percentage of energy intake from fat, and prevalence of high-fat diets (energy intake from fat > 30%) increased from 68.5 g per day (g/d), 23.1%, and 22.4%, respectively, in 1991 to 79.3 g/d, 35.6%, and 67.2%, respectively, in 2015. The prevalence of overweight and obesity increased from 12.3% to 37.3% during the same period. Fat intake, percentage of energy intake from fat, and a high-fat diet were positively associated with body weight, BMI, and the risk of overweight and obesity in both sexes (p < 0.001) after adjustment for nonfat energy intake, physical activity, and socioeconomic status. Increased fat intake and high-fat diets were associated with increased body weight, BMI, and risk of overweight and obesity. These findings could have a significant impact on Chinese policies and interventions to control overweight and obesity.


Assuntos
Peso Corporal/fisiologia , Dieta/estatística & dados numéricos , Gorduras na Dieta/análise , Ingestão de Alimentos/fisiologia , Obesidade/etiologia , Sobrepeso/etiologia , Adulto , Índice de Massa Corporal , China/epidemiologia , Estudos de Coortes , Dieta/efeitos adversos , Registros de Dieta , Exercício Físico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Estado Nutricional , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Prevalência , Fatores de Risco , Adulto Jovem
7.
Artigo em Inglês | MEDLINE | ID: mdl-32751678

RESUMO

Household air pollution (HAP) from solid cooking fuels continues to affect 600 million people in China and has been associated with high blood pressure. The role of diet in HAP-associated high blood pressure has yet to be evaluated in China. The aim of this study was to estimate the impact of cooking fuel on change in blood pressure and evaluate whether intake of antioxidant- and omega-3 fatty acid-rich foods (fruits, vegetables, and seafood) attenuates any adverse effects of solid fuel use on blood pressure. We analyzed longitudinal data collected between 1991 and 2011 from nonpregnant women aged 18 to 80 years living in rural areas of China. We used linear mixed effects models to estimate the association between cooking fuel (coal or wood versus clean [electric or liquid petroleum gas]) and blood pressure. Possible mediation of the fuel effect by diet was assessed by the difference method. A total of 6671 women were included in this study. Women less than 40 years of age cooking with cleaner fuels over time had lower rates of change in systolic blood pressure compared to women cooking with coal (p = 0.004), and this effect was not mediated by dietary intake. Associations between fuel use and change in diastolic blood pressure were not significant. These findings lend further support for there being a direct effect of reducing HAP on improvements in blood pressure, independent of concurrent dietary intake.


Assuntos
Poluição do Ar em Ambientes Fechados , Pressão Sanguínea , Culinária , População Rural , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Poluição do Ar em Ambientes Fechados/análise , China , Carvão Mineral , Feminino , Humanos , Pessoa de Meia-Idade , Adulto Jovem
8.
Obes Rev ; 21(11): e13128, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32845580

RESUMO

The linkage of individuals with obesity and COVID-19 is controversial and lacks systematic reviews. After a systematic search of the Chinese and English language literature on COVID-19, 75 studies were used to conduct a series of meta-analyses on the relationship of individuals with obesity-COVID-19 over the full spectrum from risk to mortality. A systematic review of the mechanistic pathways for COVID-19 and individuals with obesity is presented. Pooled analysis show individuals with obesity were more at risk for COVID-19 positive, >46.0% higher (OR = 1.46; 95% CI, 1.30-1.65; p < 0.0001); for hospitalization, 113% higher (OR = 2.13; 95% CI, 1.74-2.60; p < 0.0001); for ICU admission, 74% higher (OR = 1.74; 95% CI, 1.46-2.08); and for mortality, 48% increase in deaths (OR = 1.48; 95% CI, 1.22-1.80; p < 0.001). Mechanistic pathways for individuals with obesity are presented in depth for factors linked with COVID-19 risk, severity and their potential for diminished therapeutic and prophylactic treatments among these individuals. Individuals with obesity are linked with large significant increases in morbidity and mortality from COVID-19. There are many mechanisms that jointly explain this impact. A major concern is that vaccines will be less effective for the individuals with obesity.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Obesidade/epidemiologia , Obesidade/fisiopatologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , COVID-19 , Comorbidade , Humanos , Internacionalidade , Pandemias , SARS-CoV-2
9.
Nature ; 582(7811): 240-245, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32499647

RESUMO

Meta-analyses of genome-wide association studies (GWAS) have identified more than 240 loci that are associated with type 2 diabetes (T2D)1,2; however, most of these loci have been identified in analyses of individuals with European ancestry. Here, to examine T2D risk in East Asian individuals, we carried out a meta-analysis of GWAS data from 77,418 individuals with T2D and 356,122 healthy control individuals. In the main analysis, we identified 301 distinct association signals at 183 loci, and across T2D association models with and without consideration of body mass index and sex, we identified 61 loci that are newly implicated in predisposition to T2D. Common variants associated with T2D in both East Asian and European populations exhibited strongly correlated effect sizes. Previously undescribed associations include signals in or near GDAP1, PTF1A, SIX3, ALDH2, a microRNA cluster, and genes that affect the differentiation of muscle and adipose cells3. At another locus, expression quantitative trait loci at two overlapping T2D signals affect two genes-NKX6-3 and ANK1-in different tissues4-6. Association studies in diverse populations identify additional loci and elucidate disease-associated genes, biology, and pathways.


Assuntos
Grupo com Ancestrais do Continente Asiático/genética , Diabetes Mellitus Tipo 2/genética , Predisposição Genética para Doença , Aldeído-Desidrogenase Mitocondrial/genética , Alelos , Anquirinas/genética , Índice de Massa Corporal , Estudos de Casos e Controles , Europa (Continente)/etnologia , Proteínas do Olho/genética , Extremo Oriente/etnologia , Feminino , Estudo de Associação Genômica Ampla , Proteínas de Homeodomínio/genética , Humanos , Masculino , Proteínas do Tecido Nervoso/genética , RNA Mensageiro/análise , Fatores de Transcrição/genética , Transcrição Genética
10.
J Nutr ; 150(5): 1230-1239, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-31909790

RESUMO

BACKGROUND: Intervention strategies to reduce sodium intake and increase potassium intake may decrease blood pressure; however, most are focused on reducing sodium in processed food globally. OBJECTIVES: We attempt to fill important gaps in understanding the dynamics of these dietary determinants of hypertension in China. METHODS: We used data on 29,926 adults aged ≥20 y between 1991 and 2015 from an ongoing cohort, the China Health and Nutrition Survey. We collected detailed diet data with use of weighing methods with 3 consecutive 24-h recalls. With panel data random-effects models, we analyzed factors associated with sodium and potassium intakes and sodium to potassium (Na/K) ratios. RESULTS: Sodium intake decreased from 6.3 g/d in 1991 to 4.1 g/d in 2015, still twice the tolerable upper intake recommended by the WHO. Potassium intake was 1.7 g/d in 1991 and 1.5 g/d in 2015, below half that recommended by the WHO. The Na/K ratio decreased from 4.1 (ratios in g) in 1991 to 3.1 in 2015, 5 times the recommendation of the WHO. More than two-thirds (67%) of sodium intake was from salt added during food preparation, with 8.8% from processed foods in 2015, up from 5.0% in 1991. The most at-risk populations lived in China's central region and rural areas, were middle aged, had lower educations, or were farmers. CONCLUSIONS: Sodium intake is very high across all regions in China. As part of sodium reduction efforts, China should target people living in the central region and adults aged above 60 whose sodium intakes are much higher. Strategies to decrease sodium intake and increase potassium intake should be different from those applied in the Western world where the major source is processed food. Reduced sodium higher potassium salts should become a major policy initiative in China.


Assuntos
Potássio na Dieta/administração & dosagem , Sódio na Dieta/administração & dosagem , Adulto , Idoso , China , Estudos de Coortes , Culinária/métodos , Ingestão de Energia , Fazendeiros , Feminino , Alimentos , Manipulação de Alimentos/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Recomendações Nutricionais , Reprodutibilidade dos Testes , População Rural , Cloreto de Sódio na Dieta/administração & dosagem , Organização Mundial da Saúde
11.
BMJ Open ; 10(11): e038163, 2020 11 19.
Artigo em Inglês | MEDLINE | ID: mdl-33444181

RESUMO

OBJECTIVE: The human gut microbiota plays important roles in human health but is also known to be highly diverse between populations from different regions. Yet most studies inadequately account for this regional diversity in their analyses. This study examines the extent to which geographical variation can act as a confounding variable for studies that associate the microbiota with human phenotypic variation. DESIGN: Population-based study. SETTING: China. PARTICIPANTS: 2164 participants from 15 province-level divisions in China. PRIMARY AND SECONDARY OUTCOME MEASURES: We analysed the impact of geographic location on associations between the human gut microbiota and 72 host factors representing a wide variety of environmental-level, household-level and individual-level factors. RESULTS: While the gut microbiota varied across a wide range of host factors including urbanisation, occupation and dietary variables, the geographic region (province/megacity) of the participants explained the largest proportion of the variance (17.9%). The estimated effect sizes for other host factors varied substantially by region with little evidence of a reproducible signal across different areas as measured by permutational multivariate analysis of variance and random forest models. CONCLUSIONS: Our results suggest that geographic variation is an essential factor that should be explicitly considered when generalising microbiota-based models to host phenotype across different populations.


Assuntos
Microbioma Gastrointestinal , Adulto , China/epidemiologia , Dieta , Feminino , Geografia , Humanos , Masculino , Pessoa de Meia-Idade
12.
PLoS Genet ; 14(4): e1007275, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29621232

RESUMO

To identify genetic contributions to type 2 diabetes (T2D) and related glycemic traits (fasting glucose, fasting insulin, and HbA1c), we conducted genome-wide association analyses (GWAS) in up to 7,178 Chinese subjects from nine provinces in the China Health and Nutrition Survey (CHNS). We examined patterns of population structure within CHNS and found that allele frequencies differed across provinces, consistent with genetic drift and population substructure. We further validated 32 previously described T2D- and glycemic trait-loci, including G6PC2 and SIX3-SIX2 associated with fasting glucose. At G6PC2, we replicated a known fasting glucose-associated variant (rs34177044) and identified a second signal (rs2232326), a low-frequency (4%), probably damaging missense variant (S324P). A variant within the lead fasting glucose-associated signal at SIX3-SIX2 co-localized with pancreatic islet expression quantitative trait loci (eQTL) for SIX3, SIX2, and three noncoding transcripts. To identify variants functionally responsible for the fasting glucose association at SIX3-SIX2, we tested five candidate variants for allelic differences in regulatory function. The rs12712928-C allele, associated with higher fasting glucose and lower transcript expression level, showed lower transcriptional activity in reporter assays and increased binding to GABP compared to the rs12712928-G, suggesting that rs12712928-C contributes to elevated fasting glucose levels by disrupting an islet enhancer, resulting in reduced gene expression. Taken together, these analyses identified multiple loci associated with glycemic traits across China, and suggest a regulatory mechanism at the SIX3-SIX2 fasting glucose GWAS locus.


Assuntos
Glicemia/genética , Diabetes Mellitus Tipo 2/genética , Inquéritos Epidemiológicos , China , Jejum , Feminino , Estudo de Associação Genômica Ampla , Humanos , Ilhotas Pancreáticas/metabolismo , Masculino , Mutação de Sentido Incorreto , Inquéritos Nutricionais , Locos de Características Quantitativas
13.
Public Health Nutr ; 21(11): 2056-2064, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29478427

RESUMO

OBJECTIVE: Previous studies in China showed large sex differences in childhood overweight and obesity (OW/OB) rates. However, limited research has examined the cause of these sex differences. The present study aimed to examine individual and parental/familial factors associated with sex differences in childhood OW/OB rates in China. DESIGN: Variables associated with child weight status, beliefs and behaviours, and obesity-related parenting practices were selected to examine their sex differences and association with a sex difference in child OW/OB outcomes using logistic regression analysis. SETTING: Cross-sectional data analysis using the 2011 China Health and Nutrition Survey. SUBJECTS: Children aged 6-17 years (n 1544) and their parents. RESULTS: Overall child OW/OB prevalence was 16·8 %. Adolescent boys (AB; 12-17 years) were about twice as likely to be overweight/obese as adolescent girls (AG; 15·5 v. 8·4 %, P<0·05). AB more likely had energy intake exceeding recommendations, self-perceived underweight, underestimated their body weight and were satisfied with their physical activity level than AG. AG more likely practised weight-loss management through diet and self-perceived overweight than AB. Mothers more likely identified AG's weight accurately but underestimated AB's weight. Stronger associations with risk of childhood OW/OB were found in boys than girls in dieting to lose weight (OR=6·7 in boys v. 2·6 in girls) and combined maternal and child perception of the child's overweight (OR=35·4 in boys v. 14·2 in girls). CONCLUSIONS: Large sex differences in childhood obesity may be related to the sex disparities in weight-related beliefs and behaviours among children and their parents in China.


Assuntos
Comportamento Infantil/psicologia , Comportamento Alimentar/psicologia , Pais/psicologia , Obesidade Pediátrica/epidemiologia , Fatores Sexuais , Adolescente , Peso Corporal , Criança , China/epidemiologia , Estudos Transversais , Dieta/efeitos adversos , Dieta/psicologia , Feminino , Humanos , Masculino , Inquéritos Nutricionais , Poder Familiar/psicologia , Obesidade Pediátrica/psicologia , Prevalência
14.
Public Health Nutr ; 21(7): 1307-1318, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29306339

RESUMO

OBJECTIVE: Eating away from home is associated with poor diet quality, in part due to less healthy food choices and larger portions. However, few studies account for the potential additional contribution of differences in food composition between restaurant- and home-prepared dishes. The present study aimed to investigate differences in nutrients of dishes prepared in restaurants v. at home. DESIGN: Eight commonly consumed dishes were collected in twenty of each of the following types of locations: small and large restaurants, and urban and rural households. In addition, two fast-food items were collected from ten KFC, McDonald's and food stalls. Five samples per dish were randomly pooled from every location. Nutrients were analysed and energy was calculated in composite samples. Differences in nutrients of dishes by preparation location were determined. SETTING: Hunan Province, China. SUBJECTS: Na, K, protein, total fat, fatty acids, carbohydrate and energy in dishes. RESULTS: On average, both the absolute and relative fat contents, SFA and Na:K ratio were higher in dishes prepared in restaurants than households (P < 0·05). Protein was 15 % higher in animal food-based dishes prepared in households than restaurants (P<0·05). Quantile regression models found that, at the 90th quantile, restaurant preparation was consistently negatively associated with protein and positively associated with the percentage of energy from fat in all dishes. Moreover, restaurant preparation also positively influenced the SFA content in dishes, except at the highest quantiles. CONCLUSIONS: These findings suggest that compared with home preparation, dishes prepared in restaurants in China may differ in concentrations of total fat, SFA, protein and Na:K ratio, which may further contribute, beyond food choices, to less healthy nutrient intakes linked to eating away from home.


Assuntos
Dieta/estatística & dados numéricos , Fast Foods/análise , Fast Foods/estatística & dados numéricos , Valor Nutritivo , Restaurantes , China , Culinária/estatística & dados numéricos , Gorduras na Dieta/análise , Proteínas na Dieta/análise , Análise de Alimentos , Humanos , Potássio/análise , Sódio/análise
15.
Am J Hypertens ; 31(1): 63-71, 2017 Dec 08.
Artigo em Inglês | MEDLINE | ID: mdl-29036366

RESUMO

BACKGROUND: It is unknown whether efforts to reduce hypertension burden in countries with very high prevalence, would be more effective if directed at hypertension diagnosis vs. treatment. Most analyses do not address bias and correlation across the sequence from elevated blood pressure (BP) to hypertension diagnosis and treatment, leading to potentially misleading findings. METHODS: Using data spanning 18 years of the China Health and Nutrition Survey (n = 18,926; ages 18-75 years), we used an innovative 3-step, integrated system of equations to predict the sequence from: (i) elevated BP (systolic/diastolic BP ≥ 140/90 mm Hg) to (ii) diagnosed hypertension conditional on elevated BP, and to (iii) treatment (medication use) conditional on diagnosis, accounting for measured and unmeasured individual- and community-level confounders at each of the 3 steps. We compared results to separate traditional logistic regression models without control for unmeasured confounding. RESULTS: Using our 3-step model, elevated BP increased from 12.6% and 8.5% (1991) to 36.8% and 29% (2009) in men and women, respectively, but diagnosis remained under 50%. We found widening disparities in hypertension diagnosis (higher hypertension at lower vs. higher education (difference of 2% in 1991 that widened to 5% in 2009)) and narrowing disparities in education (difference of 6% in 1991 to 4% in 2009) and insurance status (difference of 7% in 1991 to 2% in 2009) for treatment. CONCLUSIONS: Our 3-step model improved model fit over traditionally used models. Our findings highlight serious barriers to hypertension diagnosis in Chinese adults, particularly among men and individuals of low attained education.


Assuntos
Pressão Sanguínea , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Viés de Seleção , Adolescente , Adulto , Idoso , China/epidemiologia , Interpretação Estatística de Dados , Progressão da Doença , Feminino , Humanos , Hipertensão/epidemiologia , Seguro Saúde/estatística & dados numéricos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Prevalência , Reprodutibilidade dos Testes , Fatores Sexuais , Fatores Socioeconômicos , Resultado do Tratamento , Urbanização , Adulto Jovem
16.
Nat Genet ; 49(12): 1722-1730, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29083407

RESUMO

Most genome-wide association studies have been of European individuals, even though most genetic variation in humans is seen only in non-European samples. To search for novel loci associated with blood lipid levels and clarify the mechanism of action at previously identified lipid loci, we used an exome array to examine protein-coding genetic variants in 47,532 East Asian individuals. We identified 255 variants at 41 loci that reached chip-wide significance, including 3 novel loci and 14 East Asian-specific coding variant associations. After a meta-analysis including >300,000 European samples, we identified an additional nine novel loci. Sixteen genes were identified by protein-altering variants in both East Asians and Europeans, and thus are likely to be functional genes. Our data demonstrate that most of the low-frequency or rare coding variants associated with lipids are population specific, and that examining genomic data across diverse ancestries may facilitate the identification of functional genes at associated loci.


Assuntos
Doença da Artéria Coronariana/genética , Exoma/genética , Predisposição Genética para Doença/genética , Variação Genética , Metabolismo dos Lipídeos/genética , Grupo com Ancestrais do Continente Asiático/genética , Doença da Artéria Coronariana/etnologia , Europa (Continente) , Grupo com Ancestrais do Continente Europeu/genética , Extremo Oriente , Frequência do Gene , Predisposição Genética para Doença/etnologia , Estudo de Associação Genômica Ampla , Genótipo , Humanos , Lipídeos/análise
17.
Asia Pac J Clin Nutr ; 26(3): 504-513, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28429917

RESUMO

BACKGROUND AND OBJECTIVES: Research on how urbanization has influenced the food environment in China is limited. The study aimed to examine the impact of urbanization on the food environment in China. METHODS AND STUDY DESIGN: Longitudinal data collected during 1989-2009 from the China Health and Nutrition Survey were used, which covered 9 provinces in China. Urbanicity index (0-10) was assessed using an urbanicity scale. Final analyses included 216 communities. Random-effect models were used in analyses. RESULTS: Urbanization (higher urbanicity index) increased the odds of having fast food restaurants (OR=2.78, 95% CI: 2.18-3.54) and other indoor restaurants (OR=2.93, 95% CI: 2.28-3.76) within the community, the odds of having supermarkets (OR=2.43, 95% CI: 2.04-2.89) and free markets (OR=2.56, 95% CI: 1.77-3.70) within 30 minutes' bus ride from the community. Food prices for apples (ß=0.06, 95% CI: 0.04-0.08) and lean pork (ß =0.02, 95% CI: 0.01-0.03) increased with urbanicity, while prices for other food did not. Urbanicity was positively associated with community norms for fast food consumption (RR=1.28, 95% CI: 1.22-1.33), fast food preferences (RR=1.09, 95% CI: 1.06-1.12) and nutrition knowledge (RR=1.02, 95% CI: 1.01-1.03). CONCLUSIONS: Urbanization is associated with food environment in China. The findings provide insight for future economic development and public health efforts related to urbanization.


Assuntos
Meio Ambiente , Alimentos , Características de Residência , Urbanização , Animais , China , Comércio , Fast Foods , Alimentos/economia , Humanos , Estudos Longitudinais , Carne/economia , Política Nutricional , Restaurantes , Suínos
18.
Hum Mol Genet ; 26(9): 1770-1784, 2017 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-28334899

RESUMO

Large-scale meta-analyses of genome-wide association studies (GWAS) have identified >175 loci associated with fasting cholesterol levels, including total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG). With differences in linkage disequilibrium (LD) structure and allele frequencies between ancestry groups, studies in additional large samples may detect new associations. We conducted staged GWAS meta-analyses in up to 69,414 East Asian individuals from 24 studies with participants from Japan, the Philippines, Korea, China, Singapore, and Taiwan. These meta-analyses identified (P < 5 × 10-8) three novel loci associated with HDL-C near CD163-APOBEC1 (P = 7.4 × 10-9), NCOA2 (P = 1.6 × 10-8), and NID2-PTGDR (P = 4.2 × 10-8), and one novel locus associated with TG near WDR11-FGFR2 (P = 2.7 × 10-10). Conditional analyses identified a second signal near CD163-APOBEC1. We then combined results from the East Asian meta-analysis with association results from up to 187,365 European individuals from the Global Lipids Genetics Consortium in a trans-ancestry meta-analysis. This analysis identified (log10Bayes Factor ≥6.1) eight additional novel lipid loci. Among the twelve total loci identified, the index variants at eight loci have demonstrated at least nominal significance with other metabolic traits in prior studies, and two loci exhibited coincident eQTLs (P < 1 × 10-5) in subcutaneous adipose tissue for BPTF and PDGFC. Taken together, these analyses identified multiple novel lipid loci, providing new potential therapeutic targets.


Assuntos
Colesterol/genética , Triglicerídeos/genética , Adulto , Alelos , Grupo com Ancestrais do Continente Asiático/genética , Colesterol/metabolismo , Grupos Étnicos , Grupo com Ancestrais do Continente Europeu/genética , Feminino , Frequência do Gene/genética , Estudos de Associação Genética/métodos , Estudo de Associação Genômica Ampla , Humanos , Desequilíbrio de Ligação/genética , Lipídeos/genética , Lipoproteínas HDL/genética , Lipoproteínas LDL/genética , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único/genética , Locos de Características Quantitativas , Triglicerídeos/metabolismo
19.
Asia Pac J Clin Nutr ; 25(4): 826-840, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27702726

RESUMO

BACKGROUND AND OBJECTIVES: China's nutrition transition is characterized by dramatic increases in overweight and cardiometabolic (CM) risk. The burden of obesity, CM risk factors and dietary intake among Chinese children were explored. METHODS AND STUDY DESIGN: Children 7-12 y old from the 2009 China Health and Nutrition Survey with available dietary intake data, anthropometry, blood pressure, and fasting blood samples were included (n=663). CM risk prevalence was calculated; logistic regression was used to investigate the association of nutrient intakes with CM risk, adjusting for age, gender, physical activity, area of residence and income. RESULTS: 14% of Chinese school-aged children and ~20% of those from urban areas and higher income households had overweight/obesity (p<0.05). The prevalence of prehypertension was ~20% while hypertension was 14%. Around 20% of all children and >=30% of those from urban areas and higher income households had impaired glucose/ HbA1c (p<0.05). More than half of the studied children had pre-dyslipidemia (i.e. at least one lipid measurement above borderline levels) and 21% of children had dyslipidemia. Approximately 30% of all children had energy intakes above requirements and 38% of them had excessive proportions of dietary fat and saturated fat. Children with higher intakes of total daily energy and total and added sugars had a greater likelihood of having impaired blood pressure and glucose/HbA1c. CONCLUSIONS: Childhood overweight and CM risk is prevalent in urban and rural areas of China and across different socioeconomic groups although disparities between classes still pervade. Several dietary factors such as sugars were significant correlates of CM risk.


Assuntos
Doenças Cardiovasculares/epidemiologia , Dieta , Doenças Metabólicas/epidemiologia , Obesidade Pediátrica/epidemiologia , Glicemia/análise , Criança , China/epidemiologia , Gorduras na Dieta/administração & dosagem , Dislipidemias/epidemiologia , Ingestão de Energia , Feminino , Hemoglobina A Glicada/análise , Humanos , Hipertensão/epidemiologia , Renda , Masculino , Inquéritos Nutricionais , Sobrepeso/epidemiologia , Fatores de Risco , População Urbana
20.
J Am Heart Assoc ; 5(9)2016 09 16.
Artigo em Inglês | MEDLINE | ID: mdl-27638785

RESUMO

BACKGROUND: Recent longitudinal work suggests that weight change is an important risk factor for inflammation across the full range of BMI. However, few studies have examined whether the risk of inflammation differs by patterns of weight gain over time. Using latent class trajectory analysis, we test whether patterns of weight gain are associated with elevated high-sensitivity C-reactive protein (hs-CRP 2-10 mg/L). METHODS AND RESULTS: Data come from China Health and Nutrition Survey (CHNS) participants (n=5536), aged 18 at baseline to 66 years in 2009, with measured weight over 18 years. Latent class trajectory analysis was used to identify weight-change trajectories in 6 age and sex strata. Multivariable general linear mixed-effects models fit with a logit link were used to assess the risk of elevated hs-CRP across weight trajectory classes. Models were fit within age and sex strata, controlling for baseline weight, adult height, and smoking, and included random intercepts to account for community-level correlation. Steeper weight-gain trajectories were associated with greater risk of elevated hs-CRP compared to more moderate weight-gain trajectories in men and women. Initially high weight gain followed by weight loss was associated with lower risk of elevated hs-CRP in women aged 18 to 40. CONCLUSIONS: Latent class trajectory analysis identified heterogeneity in adult weight change associated with differential risk of inflammation independently of baseline weight and smoking. These results suggest that trajectories of weight gain are an important clinical concern and may identify those at risk for inflammation and the development of cardiometabolic disease.


Assuntos
Grupo com Ancestrais do Continente Asiático , Proteína C-Reativa/imunologia , Obesidade/imunologia , Ganho de Peso/imunologia , Adolescente , Adulto , Fatores Etários , Idoso , China , Progressão da Doença , Feminino , Humanos , Modelos Lineares , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Inquéritos Nutricionais , Sobrepeso/imunologia , Fatores Sexuais , Adulto Jovem
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