Associations of dietary advanced glycation end products with liver steatosis via vibration controlled transient elastography in the United States: a nationwide cross-sectional study.

PURPOSE: Large population-based studies for the associations between dietary advanced glycation end products (dAGEs) intake and liver steatosis remain lacking. It is necessary to clarify the relationship of dAGEsintake with liver steatosis through the National Health and Nutrition Survey (NHANES). METHODS: A total of 5856 participants in the NHANES 2017-2018 were included. The dietary AGEs intake, including ε-(carboxymethyl)lysine(CML), Nε-(1-carboxyethyl)lysine (CEL), and Nδ-(5-hydro-5-methyl-4-imidazolon-2-yl)-ornithine (MG-H1) were estimated using the combination of ultra-performance LC-tandem MS dietary AGEs database and two 24-h dietary recall interviews. Liver steatosis was assessed by controlled attenuation parameter via transient elastography. Logistic regression model was adopted to explore the relationships between dAGEs intake and hepatic steatosis. RESULTS: Compared with individuals of total dAGEs, CML, MG-H1 in the lowest tertile, those in the highest tertile had highest risk of hepatic steatosis, and the corresponding odds radios(ORs) (95% confidence interval(CI)) were 1.37 (1.01, 1.84), 1.36 (1.04,1.78) and 1.40 (1.06, 1.85), respectively. Subgroups analysis found that the positive association between dAGEs, CML, CEL and MG-H1 and hepatic steatosis appeared stronger in subjects with obesity and those with abnormal waist circumference (WC). CONCLUSION: There was a positive correlation between dAGEs, CML, MG-H1, and hepatic steatosis, and this association mainly existed in subjects with obesity and those with abnormal WC. Dietary AGEs restriction might be of high priority for subjects with obesity for the prevention of fatty liver disease. Further longitudinal studies are required to confirm the causal associations and explore the potential mechanisms.

Ultra-processed food consumption in UK adolescents: distribution, trends, and sociodemographic correlates using the National Diet and Nutrition Survey 2008/09 to 2018/19.

PURPOSE: We quantified levels of ultra-processed food (UPF) consumption and investigated consumption patterns in a representative sample of UK adolescents. METHODS: We used data from 4-day food diaries from adolescents in the UK National Diet and Nutrition Survey (NDNS) (2008/09-2018/19). UPF were identified using the NOVA classification. We estimated the percentage of Total Energy Intake (%TEI) and the absolute weight (grams). Linear regression models quantified differences in UPF consumption across survey years and its association with participant's individual characteristics. This was an analysis of the repeated cross-sectional data from the UK NDNS Rolling Programme waves 1-11 (2008/09-2018/19). A total of 2991 adolescents (11-18y) with complete information on dietary intake were included. RESULTS: Mean UPF consumption was 861 (SD 442) g/d and this accounted for 65.9% (SD 13.4%) of TEI. Between 2008 and 2019, mean UPF consumption decreased from 996 to 776 g/d [ - 211 (95%CI - 302; - 120)] and from 67.7% to 62.8% of TEI [ - 4.8% (95%CI - 8.1; - 1.5)]. Higher %TEI was consumed by adolescents with lower socioeconomic status; white ethnicity and living in England North. A higher weight of UPF consumption (g/d) was associated with being male, white, age 18y, having parents with routine or manual occupation, living in England North, and living with obesity. CONCLUSION: Average energy intake from UPF has decreased over a decade in UK adolescents. We observed a social and regional patterning of UPF consumption, with higher consumption among adolescents from lower socioeconomic backgrounds, from a white ethnicity and living in England North. Our findings suggest inequalities associated with UPF intake and factors that might lie beyond individual choice.

Association between inflammatory burden index and all-cause mortality in the general population aged over 45 years: Data from NHANES 2005-2017.

BACKGROUND AND AIM: The objective of this study was to investigate the association between inflammatory burden index (IBI) and all-cause mortality in the general population aged over 45 years. METHODS AND RESULTS: The study included 8827 participants from the National Health and Examination Nutrition Survey (NHANES) who were aged over 45 years. The IBI was calculated using three markers: C-reaction protein × neutrophil/lymphocyte, and all the participants were classified into four groups (Quartile 1: IBI ≤0.178, N = 2206; Quartile 2: 0.178 1.099, 2207). Cox proportional hazards regression models were used to estimate hazard ratios (HR) and 95 % confidence interval (CI) for the association between IBI and all-cause mortality. During a median follow-up of 129 month, 2431 deaths occurred. The all-cause mortality rate in Quartile 1, Quartile 2, Quartile 3 and Quartile 4 was 14.76 %, 17.67 %, 23.18 % and 29.69 %, respectively (p < 0.001). After adjustment for demographic, and potential clinical factors, higher IBI was significantly associated with an increased risk of all-cause mortality (Quartile 3 vs. Quartile 1: HR = 1.26, 95 % CI: 1.08 to 1.46, p = 0.003; Quartile 4 vs. Quartile 1: HR = 1.59, 95 % CI: 1.40 to 1.80, p < 0.001). Furthermore, the results of the restricted cubic spline analysis suggested that the association between IBI and all-cause mortality was nonlinear and positive, without specific threshold value. CONCLUSIONS: This study supports that higher IBI is associated with an increased risk of all-cause mortality in the general population aged over 45 years.

Long-term relatively high dietary manganese intake could decrease the risk of hyperuricemia: Twelve-year distinct dietary manganese consumption trajectories and the China Health and Nutrition Survey.

BACKGROUND AND AIM: Currently, the relationship between dynamic changes in dietary manganese (Mn) intake and risk of hyperuricemia (HU) is still unclear. This study aimed to identify dietary Mn consumption trajectories in the Chinese adults and assess their relation with the risk of HU. METHODS AND RESULTS: Cohort data from the China Health and Nutrition Survey (CHNS) 1997-2009 were employed in this study. Overall, 6886 adult participants were included. Participants were designated into subgroups based on the trajectories of dietary Mn consumption by sex. Cox proportional hazard models were used to explore the associations between different trajectories and the risk of HU. For men, compared with low stable trajectory group, moderate to high trajectory group was significantly related to reduced risk of HU (HR = 0.61, 95% CI: 0.38 to 0.98) with adjustment for covariates. TC, HDL-C, ApoB, and TG exerted partial regulation function between trajectories and HU. For women, compared with low stable trajectory group, high stable trajectory group was significantly related to reduced risk of HU (HR = 0.76, 95% CI: 0.60 to 0.95) with adjustment for covariates. Similarly, TC, HDL-C, ApoB, and ApoA exerted partial regulation function between trajectories and HU. CONCLUSIONS: Long-term relatively high dietary Mn consumption may have a protective effect against HU in Chinese adults. The differences in HU-related factors among different dietary Mn intake trajectories partially regulated the association between these trajectories and HU.

Seafood intake in childhood/adolescence and the risk of obesity: results from a Nationwide Cohort Study.

BACKGROUND & AIMS: Obesity has been linked to various detrimental health consequences. While there is established evidence of a negative correlation between seafood consumption and obesity in adults, the current research on the association between seafood intake in childhood/adolescence and the risk of obesity is lacking. Our aim was to evaluate the association between seafood intake in childhood/adolescence and the risk of obesity in a Chinese nationwide cohort. METHODS: We utilized data from the China Health and Nutrition Survey (CHNS) from the year of 1997 to 2015. Seafood consumption was evaluated through 3-day 24-hour recalls. In our study, overweight/obesity status was determined based on the Chinese Criteria of Overweight and Obesity in School-age Children and Adolescents (WS/T 586-2018), while abdominal obesity status was determined according to the Chinese Criteria of Waist Circumference Screening Threshold among Children and Adolescents (WS/T 611-2018). RESULTS: During an average follow-up of 7.9 years, 404 cases developed overweight/obesity among 2206 participants in the seafood-overweight/obesity analysis, while 381 cases developed abdominal obesity among 2256 participants in the seafood-abdominal-obesity analysis. The high-consumer group was associated with 35% lower risk of overweight/obesity risk and 26% lower risk of abdominal obesity after fully adjusting for sociodemographic and lifestyle factors, compared with the non-consumer group. Considering different cooking methods, boiled seafood consumption was associated with 43% lower risk of overweight/obesity and 23% lower risk of abdominal obesity in the fully adjusted model, while stir-fried seafood did not demonstrate a statistical significance. CONCLUSION: Higher intake of seafood in childhood/adolescents, particularly in a boiled way, was associated with lower obesity risk.

South East Asian Nutrition Surveys (SEANUTS) II - a multi-country evaluation of nutrition and lifestyle indicators in children aged 12 years and below: Rationale and Design.

OBJECTIVE: To assess the nutritional status, growth parameters and lifestyle behaviours of children between 0.5-12 years in nationally representative samples in Malaysia, Indonesia, Thailand, and Vietnam. DESIGN: A cross-sectional study was conducted in the four countries, between May 2019 and April 2021. Data collected can be categorized into four categories: (1) Growth - anthropometry, body composition, development disorder, (2) Nutrient intake and dietary habits - 24-hour dietary recall, child food habits, breast feeding and complementary feeding, (3) Socio-economic status - food insecurity and child health status/environmental, and (4) Lifestyle behaviours - physical activity patterns, fitness, sunlight exposure, sleep patterns, body image and behavioural problems. Blood samples were also collected for biochemical and metabolomic analyses. With the pandemic emerging during the study, a COVID-19 questionnaire was developed and implemented. SETTING: Both rural and urban areas in Malaysia, Indonesia, Thailand, and Vietnam. PARTICIPANTS: Children who were well, with no physical disability or serious infections/injuries and between the age of 0.5-12 years old were recruited. RESULTS: The South East Asian Nutrition Surveys II recruited 13,933 children. Depending on the country, data collection from children were conducted in schools and commune health centres, or temples, or sub-district administrative organizations. CONCLUSIONS: The results will provide up-to-date insights into nutritional status and lifestyle behaviours of children in the four countries. Subsequently, these data will facilitate exploration of potential gaps in dietary intake among Southeast Asian children and enable local authorities to plan future nutrition and lifestyle intervention strategies.

The relationship between proportions of carbohydrate and fat intake and hyperglycemia risk in Chinese adults.

OBJECTIVE: To address the relationship between the proportions of carbohydrates and fat and hyperglycemia in the Chinese population. DESIGN: A cross-section research involving data from the China Health and Nutrition Survey in 2009, and nutritional status and health indicators were mainly focused. SETTING: China. PARTICIPANTS: 8197 Chinese individuals aged over 16 years, including 1345 subjects had a low carbohydrate and high fat diet (LCHF), 3951 individuals had a medium proportion of carbohydrate and fat (MPCF) diet, 2660 participants had a high carbohydrate and low fat (HCLF) diet and 241 people had the very high carbohydrate and low fat (VHCLF) diet. RESULTS: Subjects with the HCLF diet were significantly associated with an increased risk of hyperglycemia (OR:1.142, 95%CI:1.022-1.276) when compared with the individuals with the MPCF diet. Meanwhile, people with a VHCLF diet had a higher risk of hyperglycemia (OR:1.829, 95%CI:1.377-2.429). In contrast, the association between participants with an LCHF diet and hyperglycemia was not significant (OR:1.082, 95%CI:0.942-1.243) with adjusting a series of confounding factors. Furthermore, people with a VHCLF diet were significantly associated with a higher risk of hyperglycemia in the major energy levels and social characteristics subgroup. CONCLUSION: We found the HCLF and VHCLF diets were significantly associated with a high risk of hyperglycemia. And, the association between LCHF diets and the risk of hyperglycemia was not significant.

Dietary calcium intake at breakfast is associated with a lower risk of cognitive impairment than at dinner in Chinese adults: the CHNS cohort study.

BACKGROUND AND OBJECTIVES: If the proportion of calcium intake over a whole day is related to the risk of cognitive impairment in adults is still largely unknown. This research aimed to examine the relation of dietary calcium intake at dinner versus breakfast with the risk of cognitive impairment by using data from the China Health and Nutrition Survey (CHNS). METHODS AND STUDY DESIGN: A total of 2,099 participants (including 668 cognitive impairment) in the CHNS (1997-2006) were included. The participants were categorized into 5 groups in accordance with the ratio of dietary calcium intake at dinner and breakfast (Δ = dinner/breakfast). After adjustment was conducted for a series of confounding factors, Cox hazard regression modelling was performed to discuss the relation of Δ with cognitive impairment. Dietary substitution models were used to explore the changes in cognitive impairment risk when a 5% dietary calcium intake at dinner was replaced with dietary calcium intake at breakfast. RESULTS: Participants in the highest distribution of Δ showed a greater susceptibility to cognitive impairment than those in the lowest quintile, with an adjusted hazard ratio of cognitive impairment of 1.38 (95% CI: 1.08-1.76). When maintaining total calcium intake, substituting 5% of dietary calcium intake at dinner with calcium intake at breakfast was related to an 8% decrease in the risk of cognitive impairment. CONCLUSIONS: Higher dietary calcium intake at dinner was associated with an increased risk of cognitive impairment, emphasizing the importance of appropriately distributing dietary calcium intake between breakfast and dinner.

[An examination of relevant factors attributable to child health, food behavior, and lifestyle concerns of parents with infants aged at least 18 months: With a view to expanding into Shokuiku (food and nutrition education)].

Objectives　This study focused on food after weaning and examined the children's diet and home environmental factors that influence parents' concerns during health checkup for infants (aged 1.6 and 3 years).Methods　In the analysis, 646 participants, excluding invalid responses, who cooperated with the survey during health checkup for 1.6- and 3-year-old in the Tohoku, Chubu, and Chugoku regions from March 2019 to January 2020, were included. The survey included 56 items of dietary, lifestyle, and health concerns (yes/no answers), child attributes, and frequency of food intake (six options, 18 types). Concern factors were extracted by factor analysis. The association between the worry scores and each factor was analyzed.Results　The 1.6- and 3-year-olds were associated with high scores for (health awareness and lifestyle) and low fruit intake, high salty snacks intake, and low subjective economic status, high scores for (diet content and atmosphere) and low intakes of carotene-rich vegetables, other vegetables, seaweed, and fruits, high scores for (interest and motivation in food) and low carotene-rich vegetables intake, high scores for (food experience and behavior) and high cereals (bread) intake, low subjective economic status. The 3-year-olds were associated with high scores and being boys.Conclusion　We extracted four worry factors that parents with children after the weaning period have and clarified the factors related to each factor and group characteristics.

[Change of dietary pattern among young people aged 18-35 in China from 1989 to 2018].

OBJECTIVE: To analyze the dietary patterns changes of young people aged 18-35 in 15 provinces(autonomous regions, municipalities) from 1989 to 2018. METHODS: Using the data of China Health and Nutrition Survey, a total of 25 400 young people aged 18-35 with complete dietary and sociodemographic information from 1989 to 2018 in 15 provinces(autonomous regions, municipalities) were selected as the research objects. Nutrition survey was carried out by using 3 consecutive days of 24-hour review method combined with weighing accounting method. Energy and nutrient intake was calculated based on food composition list. The principal component cluster analysis was used to select food groups and K-mean cluster was uesd to extract dietary patterns. Dwass-Steel-Critchlow-Fligner was used to test the difference of food intake in different dietary patterns. Cochran-Armitage trend test was to analyze the change of dietary patterns with the years. Chi-square test was to analyze the difference of people with different dietary patterns in 2018. RESULTS: The dietary patterns of young people aged 18-35 in 15 provinces(autonomous regions, municipalities) were mainly divided into three categories: "traditional rice", "traditional pasta" and "high-quality protein". In 2018, the proportion of "traditional rice" dietary patterns was higher for men than for women, and the proportion of "high-quality protein" dietary patterns was lower than for women. The proportion of "traditional pasta" dietary pattern in people aged 25-35 was higher than that aged 18-24, and the proportion of "high-quality protein" dietary pattern was lower than that aged 18-24. The proportion of people in urban with "traditional rice" dietary pattern was lower than that in rural areas, and the proportion of "high-quality protein" dietary pattern was higher than that in rural areas. The northern region was dominated by "traditional pasta" dietary pattern, while the southern region was dominated by "traditional rice" dietary pattern, and the proportion of people with "high-quality protein" dietary pattern was higher in the northern region than in the southern region. With the increase of education level and income level, the proportion of people with "high-quality protein" dietary pattern showed an increasing trend. From 1989 to 2018, the "traditional rice" dietary pattern had always maintained a high proportion among young people aged 18-35 in 15 provinces(autonomous regions, municipalities) in China, and the "traditional pasta" dietary pattern had been decreasing since 2009, and the "high-quality protein" dietary pattern had significantly increased since 2011. CONCLUSION: From 1989 to 2018, the proportion of young people aged 18-35 with reasonable dietary pattern has increased in 15 provinces(autonomous regions, municipalities), but the traditional dietary pattern still needs to be improved.

Association between Serum Klotho and Kidney Stones in US Middle-Aged and Older Individuals with Diabetes Mellitus: Results from 2007 to 2016 National Health and Nutrition Survey.

INTRODUCTION: Kidney stones (KSs) are associated with hematuria and renal failure and pose a significant clinical and public health concern. Diabetes is associated with a higher risk of KSs. In addition, α-Klotho (Klotho), as a novel antiaging protein, is associated with kidney disease, diabetes, and complications and may participate in the pathological mechanism of KSs. However, studies that used large population-based database research are limited. Therefore, this study aimed to investigate whether or not KS prevalence is associated with serum Klotho levels in diabetic adults in the USA. METHODS: This nationally representative cross-sectional study used data on diabetic adults in the USA aged 40-79 years from the National Health and Nutrition Examination Survey 2007-2016 cycles. Multivariate logistic regression models were used to calculate the association between Klotho and KS. Restricted cubic splines were used to further test for linearity and explore the shape of the dose-response association. Moreover, we performed stratified and interaction analyses to see if the relationship was stable in different subgroups. RESULTS: Among the 3,537 diabetic patients included in this study (mean age of 61.4 years, consisting of 51.3% males), 543 participants (15.4%) suffered from KS. In the fully adjusted model, Klotho was negatively associated with KS (OR = 0.72; 95% CI: 0.54-0.96; p = 0.027). A negative relationship was observed between the occurrence of KS and Klotho (nonlinear: p = 0.560). Some differences in the association between Klotho and KS were found in stratified analyses; however, these differences lacked statistical significance. CONCLUSIONS: Serum Klotho was negatively associated with the incidence of KS; when ln-transformed Klotho concentration increased by 1 unit, the risk of KS was 28% lower.

Sodium, added sugar and saturated fat intake in relation to mortality and CVD events in adults: Canadian National Nutrition Survey linked with vital statistics and health administrative databases.

This study aimed to determine whether higher intakes of Na, added sugars and saturated fat are prospectively associated with all-cause mortality and CVD incidence and mortality in a diverse population. The nationally representative Canadian Community Health Survey-Nutrition 2004 was linked with the Canadian Vital Statistics - Death Database and the Discharge Abstract Database (2004-2011). Outcomes were all-cause mortality and CVD incidence and mortality. There were 1722 mortality cases within 115 566 person-years of follow-up (median (interquartile range) of 7·48 (7·22-7·70) years). There was no statistically significant association between Na density or energy from saturated fat and all-cause mortality or CVD events for all models investigated. The association of usual percentage of energy from added sugars and all-cause mortality was significant in the base model with participants consuming 11·47 % of energy from added sugars having 1·34 (95 % CI 1·01, 1·77) times higher risk of all-cause mortality compared with those consuming 4·17 % of energy from added sugars. Overall, our results did not find statistically significant associations between the three nutrients and risk of all-cause mortality or CVD events at the population level in Canada. Large-scale linked national nutrition datasets may not have the discrimination to identify prospective impacts of nutrients on health measures.

Trends in food consumption according to the degree of food processing among the UK population over 11 years.

Although ultra-processed foods represent more than half of the total energy consumed by the UK population, little is known about the trend in food consumption considering the degree of food processing. We evaluated the trends of the dietary share of foods categorised according to the NOVA classification in a historical series (2018-2019) among the UK population. Data were acquired from the NDNS, a survey that collects diet information through a 4-d food record. We used adjusted linear regression to estimate the dietary participation of NOVA groups and evaluated the linear trends over the years. From 2008 to 2019, we observed a significant increase in the energy share of culinary ingredients (from 3·7 to 4·9 % of the total energy consumed; P-trend = 0·001), especially for butter and oils; and reduction of processed foods (from 9·6 to 8·6 %; P-trend = 0·002), especially for beer and wine. Unprocessed or minimally processed foods (≅30 %, P-trend = 0·505) and ultra-processed foods (≅56 %, P-trend = 0·580) presented no significant change. However, changes in the consumption of some subgroups are noteworthy, such as the reduction in the energy share of red meat, sausages and other reconstituted meat products as well as the increase of fruits, ready meals, breakfast cereals, cookies, pastries, buns and cakes. Regarding the socio-demographic characteristics, no interaction was observed with the trend of the four NOVA groups. From 2008 to 2019 was observed a significant increase in culinary ingredients and a reduction in processed food. Furthermore, it sheds light on the high share of ultra-processed foods in the contemporary British diet.

Timing of energy intake and BMI in children: differential impacts by age and sex.

Body weight regulation may be influenced by the timing of food intake. The relationship between children's BMI and their daily pattern of energy consumption was investigated using data from the UK National Diet and Nutrition Survey 2008-2019. The sample included 6281 children aged 4-18 years. Linear and logistic regression models investigated the timing of energy intake (103 kJ) as a predictor of BMI (kg/m2) and healthy weight status. The models showed that children aged 4-10 years who consume more energy content after 20:00, in comparison with less energy content, had a significantly higher BMI (young girls: ß = 0·159; 95 % CI 0·003, 0·315; P = 0·05; young boys: ß = 0·166; 95 % CI 0·028, 0·304; P = 0·02). Similar findings were also present for boys aged 11-18 years (ß = 0·091; 95 % CI 0·003, 0·180; P = 0·04), though logistic regression findings were contradictory (OR = 0·9566; 95 % CI 0·926, 0·989; P = 0·009). However, older girls who consumed more energy content in the morning had a significantly lower BMI (ß = -0·464; 95 % CI -0·655, -0·273; P < 0·001) and a lower probability of non-healthy weight (OR = 0·901; 95 % CI 0·826, 0·982; P = 0·02). Physical activity reduced the likelihood of unhealthy weight status. The data suggest that food consumption later in the day in childhood and into adolescence may increase the risk of a higher BMI, especially for less active children. Developing guidance on appropriate meal timings and recommended energy distribution throughout the day could promote healthier lifestyles. Doing so may help increase parental awareness of timing of food intake and its potential impact on BMI.

J-shaped association between dietary copper intake and all-cause mortality: a prospective cohort study in Chinese adults.

The association between dietary Cu intake and mortality risk remains uncertain. We aimed to investigate the relationship of dietary Cu intake with all-cause mortality among Chinese adults. A total of 17 310 participants from the China Health and Nutrition Survey, a national ongoing open cohort of Chinese participants, were included in the analysis. Dietary intake was measured by three consecutive 24-h dietary recalls in combination with a weighing inventory over the same 3 d. The average intakes of the 3-d dietary macronutrients and micronutrients were calculated. The study outcome was all-cause mortality. During a median follow-up of 9·0 years, 1324 (7·6 %) participants died. After adjusting for sex, age, BMI, ever alcohol drinking, ever smoking, education levels, occupations, urban or rural residents, systolic blood pressure, diastolic blood pressure and the intakes of fat, protein and carbohydrate, the association between dietary Cu intake and all-cause mortality followed a J-shape (Pfor nonlinearity = 0·047). When dietary Cu intake was assessed as quartiles, compared with those in the first quartile (<1·60 mg/d), the adjusted hazard ratios for all-cause mortality were 0·87 (95 % CI (0·71, 1·07)), 0·98 (95 % CI (0·79, 1·21)) and 1·49 (95 % CI (1·19, 1·86)), respectively, in participants in the second (1·60-<1·83 mg/d), third (1·83-<2·09 mg/d) and fourth (≥2·09 mg/d) quartiles. A series of subgroup analyses and sensitivity analyses showed similar results. Overall, our findings emphasised the importance of maintaining optimal dietary Cu intake levels for prevention of premature death.

A U-shaped association between dietary phosphorus intake and new-onset diabetes: A nationwide cohort study in China.

BACKGROUND AND AIMS: The association between dietary phosphorus intake and the risk of diabetes remains uncertain. We aimed to investigate the relation of dietary phosphorus intake with new-onset diabetes among Chinese adults. METHODS AND RESULTS: A total of 16,272 participants who were free of diabetes at baseline from the China Health and Nutrition Survey were included. Dietary intake was measured by 3 consecutive 24-h dietary recalls combined with a household food inventory. Participants with self-reported physician-diagnosed diabetes, or fasting glucose ≥7.0 mmol/L or glycated hemoglobin ≥6.5% during the follow-up were defined as having new-onset diabetes. During a median follow-up of 9.0years, 1101 participants developed new-onset diabetes. Overall, the association between dietary phosphorus intake with new-onset diabetes followed a U-shape (P for nonlinearity<0.001). The risk of new-onset diabetes significantly decreased with the increment of dietary phosphorus intake (per SD increment: HR, 0.64; 95%CI, 0.48-0.84) in participants with phosphorus intake <921.6 mg/day, and increased with the increment of dietary phosphorus intake (per SD increment: HR, 1.33; 95%CI, 1.16-1.53) in participants with phosphorus intake ≥921.6 mg/day. Consistently, when dietary phosphorus intake was assessed as quintiles, compared with those in the 3rd quintile (905.0-<975.4 mg/day), significantly higher risks of new-onset diabetes were found in participants in the 1st-2nd quintiles (<905.0 mg/day: HR, 1.59; 95%CI, 1.30-1.94), and 4th-5th quintiles (≥975.4 mg/day: HR, 1.46; 95%CI, 1.19-1.78). CONCLUSIONS: There was a U-shaped association between dietary phosphorus intake and new-onset diabetes in general Chinese adults, with an inflection point at 921.6 mg/day and a minimal risk at 905.0-975.4 mg/day of dietary phosphorus intake.

U-shaped association of serum uric acid with cardiovascular disease risk scores and the modifying role of sex among Chinese adults.

BACKGROUND AND AIMS: Serum uric acid (SUA) is involved in the development of cardiovascular disease (CVD). However, information on the dose-response relationship between SUA and CVD is limited in the Chinese population. This study aimed to investigate the potential nonlinear dose-response association of SUA with CVD risk in a Chinese population and to explore the effect of sex on these associations. METHODS AND RESULTS: Cross-sectional data, from 6252 Chinese adults aged 30-74 years who participated in the China Health and Nutrition Survey 2009, were stratified by SUA deciles. The 10-year risk of CVD was determined using the Framingham risk score. A restricted cubic spline (RCS) was incorporated into the logistic models to assess the nonlinear relationship between SUA and CVD. Among the participants, 65%, 20%, and 15% had low, moderate, and high 10-year CVD risks, respectively. Compared with the reference SUA strata of 225 to <249 µmol/L, CVD risk was significantly increased at SUA ≥294 µmol/L, with adjusted ORs ranging from 2.39 (1.33-4.33) to 4.25 (2.37-7.65). An increasingly higher nonsignificant CVD risk was found at SUA <225 µmol/L and showed a nonlinear U-shaped association. In the fitted RCS model, an approximate U-shaped association between SUA and CVD risk scores was found in women, but this significant nonlinear relationship was not found in men. CONCLUSION: This study showed that both lower and higher SUA levels were associated with a higher 10-year CVD risk among Chinese adults, forming a U-shaped relationship, and this pattern was particularly pronounced for women.

Association between sleep duration and ideal cardiovascular health in Chinese adults: results from the China health and nutrition survey.

BACKGROUND: Ideal cardiovascular health (CVH) is related to the future risk of cardiovascular disease. Sleep duration is an important factor influencing health outcomes. The association between sleep duration and CVH is unclear. OBJECTIVES: We aimed to explore the associations between sleep duration and CVH among Chinese adults. METHODS: This cross-sectional study was based on nationally representative samples from 2009 China Health and Nutrition Survey (CHNS). Sleep duration was categorized as ≤6, 7, 8, and ≥9 h. The CVH scores were evaluated. Generalized linear regressions and restricted cubic splines were used to determine the association between sleep duration and CVH. RESULTS: A total of 8,103 Chinese adults with a mean age of 50.29 (14.97) years were included. The mean (SD) CVH score was 3.96 (1.43). Only 36.7% of the participants had ideal CVH. Sleep duration was positively associated with ideal CVH (P-trend < 0.05). When comparing the long sleep duration with the short sleep duration, short sleep duration significantly decreased the mean CVH score, ß = -0.24 (95% CI: -0.36, -0.13) and increased the risk of nonideal CVH, OR = 1.38 (95% CI: 1.15, 1.67) by generalized linear regressions. The restricted cubic splines showed CVH did not have a significant nonlinear relationship with sleep duration. The P-value for nonlinear was 0.161. The association of sleep duration with CVH had no obvious threshold. CONCLUSION: Short sleep duration was associated with decreased odds of ideal CVH and lower mean CVH score. Confirmation through longitudinal studies is needed.

Exploring the association of dietary patterns with the risk of hypertension using principal balances analysis and principal component analysis.

OBJECTIVE: In the field of nutritional epidemiology, principal component analysis (PCA) has been used extensively in identifying dietary patterns. Recently, compositional data analysis (CoDA) has emerged as an alternative approach for obtaining dietary patterns. We aimed to directly compare and evaluate the ability of PCA and principal balances analysis (PBA), a data-driven method in CoDA, in identifying dietary patterns and their associations with the risk of hypertension. DESIGN: Cohort study. A 24-h dietary recall questionnaire was used to collect dietary data. Multivariate logistic regression analysis was used to analyse the association between dietary patterns and hypertension. SETTING: 2004 and 2009 China Health and Nutrition Survey. PARTICIPANTS: A total of 3892 study participants aged 18-60 years were included as the subjects. RESULTS: PCA and PBA identified five patterns each. PCA patterns comprised a linear combination of all food groups, whereas PBA patterns included several food groups with zero loadings. The coarse cereals pattern identified by PBA was inversely associated with hypertension risk (highest quintile: OR = 0·74 (95 % CI 0·57, 0·95); Pfor trend = 0·037). None of the five PCA patterns was associated with hypertension. Compared with the PCA patterns, the PBA patterns were clearly interpretable and accounted for a higher percentage of variance in food intake. CONCLUSIONS: Findings showed that PBA might be an appropriate and promising approach in dietary pattern analysis. Higher adherence to the coarse cereals dietary pattern was associated with a lower risk of hypertension. Nevertheless, the advantages of PBA over PCA should be confirmed in future studies.

Association between body weight misperception and snacking patterns among adolescents: a population-based cross-sectional study.

BACKGROUND: Unhealthy snacking behaviors and body weight misperception are both significant concerns in adolescent health. Weight misperception are common among youth and may influence their motivation to engage in health-related behaviors, however, the effect on snacking patterns choice remains unclear. Our study aimed to examine the relationship between body weight misperception and snacking pattern choice among school adolescents. METHODS: A cross-sectional study was conducted using an online survey platform. Body weight misperception was defined based on perceived body weight and true weight. Snack intake was measured using a qualitative food-frequency questionnaire. Factor analysis was used to identify snacking patterns, and multiple linear regression was employed to examine the association between body weight misperception and snacking patterns. RESULTS: 190,296 students with the average age of 13.3 ± 1.0 years was included, and 44.5% of students misperceived their weight. Overestimation was more prevalent than underestimation. Two snacking patterns, namely a high-calorie snacking pattern and a healthy snacking pattern, were identified with eigenvalues > 1. Weight underestimation was positively linked to high-calorie snacking pattern scores for both normal weight students (ß: 0.16, 95% CI: 0.11, 0.21) and students with overweight/obesity (ß: 0.44, 95% CI: 0.35, 0.52), and to healthy snacking scores for students with overweight/obesity (ß: 0.28, 95% CI: 0.22, 0.33), but negatively linked to healthy snacking pattern scores for normal weight students (ß: -0.12, 95% CI: -0.15, -0.09). Conversely, weight overestimation was negatively linked to both high-calorie and healthy snacking pattern scores for normal weight students (ß: -0.07, 95% CI: -0.11, -0.04 and ß: -0.13, 95% CI: -0.15, -0.10), but positively linked to healthy snacking scores for underweight students (ß: 0.15, 95% CI: 0.08, 0.21). Interactions were found between sex, grade, accommodation, only child, primary guardians, parental education level and weight misperception to snacking patterns. CONCLUSIONS: Adolescents with normal weight and overweight/obesity who misperceived their weight exhibited less healthy snacking patterns, whereas underweight students who misperceived their weight displayed healthier snacking patterns. Comprehensive programs are crucial to educate and guide adolescents in understanding their weight status and making healthier snack choices, involving families, schools, and society.