The Effects of Household Technology on Body Mass Index among Chinese Adults

Assessing the diet quality, environmental impact, and monetary costs of the dietary transition in China (1997–2011): Impact of urbanization

Background

Increased urbanization has been linked to transitions in dietary patterns. However, evidence on the impacts of urbanization on diet quality, and environmental impact, and diet cost is limited. The aim of this study was to investigate the time trends of these three dietary sustainability in China over the period 1997–2011 and to examine their associations with urbanization.

Methods

Food consumption of 8,330 participants (18–64y) of the China Health and Nutrition Survey cohort (1997, 2000, 2004, 2006, 2009, and 2011) were examined and diet quality was assessed using the Chinese Healthy Eating Index 2016 (CHEI2016). Dietary related environmental impacts on Greenhouse Gas Emissions (GHGE), Total Water Use (TWU), and Land Use (LU) were estimated using the Chinese Food Life Cycle Assessment Database. Monetary cost of diet was calculated using the community market prices of food items. Multilevel mixed-effects models were used to estimate associations between the time trend of dietary sustainability indicators and degree of urbanization.

Results

From 1997 to 2011, the CHEI2016 score increased by 10.6%, GHGE by 23.8%, LU by 29.1%, and the inflation-corrected cost of diet by 80%. Urbanization was positively associated with these time trends, which remained after adjustment for sociodemographic and lifestyle factors (all P < 0·05).

Conclusion

The rapid urbanization in China over the past two decades has been followed by an improvement in the overall dietary quality, but this has been accompanied by an increase in the environmental impacts and higher cost of the diet, especially in communities with lower urbanization index.

Changes in the prevalence of obesity and hypertension and demographic risk factor profiles in China over 10 years: two national cross-sectional surveys

Background

Previous studies have shown increases in the prevalence of obesity and hypertension, but nationally representative data on recent changes in prevalence adjusted for population structure changes are lacking. Two nationwide surveys were conducted in 2007 and 2017 to assess the prevalence changes of these conditions in China.

Methods

A multistage stratified random sampling method was used to obtain a nationally representative sample of adults aged 20 years and older in mainland China in 2007 and 2017. Temporal changes in the prevalence of hypertension and obesity were investigated. Changes in blood pressure, body mass index (BMI) and waist circumference were also assessed. Logistic regression models were constructed to assess the changes in prevalence over time.

Findings

The weighted prevalence of hypertension (25.7% vs. 31.5%, P=0.04), high-normal blood pressure (11.7% vs. 14.3%, P<0.0001), general obesity (31.9% vs. 37.2%, P=0.008), and central obesity (25.9% vs. 35.4%, P=0.0002) was significantly higher in 2017 (n=72824) than in 2007 (n=45956) in the overall population. No significant changes in the prevalence of overweight and grade 1 or grade 2 hypertension were observed in the overall population, but a significantly higher prevalence was observed among participants aged 20-29 years for grade 1 hypertension (P=0.002) and among participants aged 70 years and older for grade 2 hypertension (P=0.046) in 2017.

Interpretation

Compared with 2007, the prevalence of hypertension and obesity was significantly higher among adults in mainland China after adjusting for demographic confounding factors in 2017. More targeted interventions and prevention strategies are needed to offset the increasing risk of cardiovascular disease due to increases in the prevalence of hypertension and obesity.

Funding

The Clinical Research Fund of the Chinese Medical Association (Grant No. 15010010589), the National Natural Science Foundation of China (Grant No. 82000753), and the Chinese Medical Association Foundation and Chinese Diabetes Society (Grant No. 07020470055).

Epidemiology and determinants of obesity in China

Obesity has become a major public health issue in China. Overweight and obesity have increased rapidly in the past four decades, and the latest national prevalence estimates for 2015-19, based on Chinese criteria, were 6·8% for overweight and 3·6% for obesity in children younger than 6 years, 11·1% for overweight and 7·9% for obesity in children and adolescents aged 6-17 years, and 34·3% for overweight and 16·4% for obesity in adults (≥18 years). Prevalence differed by sex, age group, and geographical location, but was substantial in all subpopulations. Strong evidence from prospective cohort studies has linked overweight and obesity to increased risks of major non-communicable diseases and premature mortality in Chinese populations. The growing burden of overweight and obesity could be driven by economic developments, sociocultural norms, and policies that have shaped individual-level risk factors for obesity through urbanisation, urban planning and built environments, and food systems and environments. Substantial changes in dietary patterns have occurred in China, with increased consumption of animal-source foods, refined grains, and highly processed, high-sugar, and high-fat foods, while physical activity levels in all major domains have decreased with increasing sedentary behaviours. The effects of dietary factors and physical inactivity intersect with other individual-level risk factors such as genetic susceptibility, psychosocial factors, obesogens, and in-utero and early-life exposures. In view of the scarcity of research around the individual and collective roles of these upstream and downstream factors, multidisciplinary and transdisciplinary studies are urgently needed to identify systemic approaches that target both the population-level determinants and individual-level risk factors for obesity in China.

Legume consumption and risk of hypertension in a prospective cohort of Chinese men and women

Prior data on long-term association between legume consumption and hypertension risk are sparse. We aimed to evaluate whether total legume and subtype intakes prospectively associate with hypertension incidence among 8758 participants (≥30 years) from the China Health and Nutrition Survey 2004-2011. Diet was assessed by interviews combining 3-d 24-h food recalls and household food inventory weighing at each survey round. Incident hypertension was identified by self-reports or blood pressure measurements. We applied multivariable Cox regressions to estimate hazard ratios (HR) with corresponding 95 % CI for hypertension across increasing categories of cumulatively averaged legume intakes. For 35 990 person-years (median 6·0 years apiece), we documented 944 hypertension cases. After covariate adjustment, higher total legume intakes were significantly associated with lower hypertension risks, with HR comparing extreme categories being 0·56 (95 % CI 0·43, 0·71; Ptrend < 0·001). Then we found that intakes of dried legumes (HR 0·53 (95 % CI 0·43, 0·65); Ptrend < 0·001) and fresh legumes (HR 0·67 (95 % CI 0·55, 0·81); Ptrend < 0·001) were both related to decreased hypertension hazards. However, further dried legume classification revealed that negative association with hypertension substantially held for soyabean (HR 0·51 (95 % CI 0·41, 0·62); Ptrend < 0·001) but not non-soyabean intakes. In stratified analyses, the association of interest remained similar within strata by sex, BMI, physical activity, smoking and drinking status; rather, significant heterogeneity showed across age strata (Pinteraction = 0·02). Total legume consumption among the over-65s was related to a more markedly reduced hypertension risk (HR 0·47 (95 % CI 0·30, 0·73); Ptrend < 0·001). Our findings suggest an inverse association of all kinds of legume (except non-soyabean) intakes with hypertension risks.

Tackling socioeconomic inequalities and non-communicable diseases in low-income and middle-income countries under the Sustainable Development agenda

Five Sustainable Development Goals (SDGs) set targets that relate to the reduction of health inequalities nationally and worldwide. These targets are poverty reduction, health and wellbeing for all, equitable education, gender equality, and reduction of inequalities within and between countries. The interaction between inequalities and health is complex: better economic and educational outcomes for households enhance health, low socioeconomic status leads to chronic ill health, and non-communicable diseases (NCDs) reduce income status of households. NCDs account for most causes of early death and disability worldwide, so it is alarming that strong scientific evidence suggests an increase in the clustering of non-communicable conditions with low socioeconomic status in low-income and middle-income countries since 2000, as previously seen in high-income settings. These conditions include tobacco use, obesity, hypertension, cancer, and diabetes. Strong evidence from 283 studies overwhelmingly supports a positive association between low-income, low socioeconomic status, or low educational status and NCDs. The associations have been differentiated by sex in only four studies. Health is a key driver in the SDGs, and reduction of health inequalities and NCDs should become key in the promotion of the overall SDG agenda. A sustained reduction of general inequalities in income status, education, and gender within and between countries would enhance worldwide equality in health. To end poverty through elimination of its causes, NCD programmes should be included in the development agenda. National programmes should mitigate social and health shocks to protect the poor from events that worsen their frail socioeconomic condition and health status. Programmes related to universal health coverage of NCDs should specifically target susceptible populations, such as elderly people, who are most at risk. Growing inequalities in access to resources for prevention and treatment need to be addressed through improved international regulations across jurisdictions that eliminate the legal and practical barriers in the implementation of non-communicable disease control.

The longitudinal association between informal caregiving and body mass index in the second half of life: findings of the German Ageing Survey

OBJECTIVE

We aimed to investigate the relation between informal caregiving and body mass index (BMI) longitudinally.

STUDY DESIGN

The data were drawn from wave 2 (2002) to wave 5 (2014) of the German Ageing Survey. This is a representative sample of the community-dwelling population aged 40 years and above in Germany.

METHODS

Self-rated BMI was used. Individuals were asked whether they provide informal care on a regular basis. Adjusting for employment status, age, marital status, morbidity and depressive symptoms, fixed effects regressions were used.

RESULTS

The fixed effects regressions showed that the onset of informal caregiving was not associated with changes in BMI in the total sample and in women, whereas the onset of informal caregiving was associated with increasing BMI in men (β = 0.15, P < 0.05). In addition, an increase in BMI was positively associated with ageing, an increase in morbidity and a decrease in frequency of sports activities in the total sample and in both sexes.

CONCLUSIONS

Our findings stress the longitudinal relation between informal caregiving and BMI in men. Consequently, it might be helpful to generate weight management strategies specifically designed for male informal caregivers.