Clustering of unhealthy lifestyle behaviours and associations with perceived and actual weight status among primary school children in China: A nationally representative cross-sectional study

Burden and attributable risk factors of ischemic stroke in China from 1990 to 2019: an analysis from the Global Burden of Disease Study 2019

Background

The epidemiologic characteristics and attributable risk factors of ischemic stroke in China have changed over the past three decades. An up-to-date analysis on deaths, disability-adjusted life-years (DALYs), prevalence, incidence, and attributable risk factors of ischemic stroke for China is needed. This study aims to provide a comprehensive analysis of burden and attributable risk factors of ischemic stroke at national level in China by sex from 1990 to 2019.

Methods

This is a secondary analysis of the Global Burden of Disease (GBD) study 2019. All data used in this study was derived from the 2019 GBD study. Deaths, DALYs, prevalence, incidence, and attributable risk factors of ischemic stroke in China by sex from 1990 to 2019 were analyzed.

Results

From 1990 to 2019, the age-standardized deaths rate decreased by 3.3%, age-standardized DALYs rate decreased by 4%, age-standardized prevalence rate increased by 33.5%, and age-standardized incidence rate of ischemic stroke in China increased by 34.7%. In 2019, ambient particulate matter pollution became an important risk factor, whereas household air pollution from solid fuels was no longer a major risk factor for ischemic stroke in China. Burden of ischemic stroke was higher in China compared to other regions. Ambient particulate matter pollution among men, and diet high in sodium, smoking, household air pollution from solid fuels among women account for the increased deaths/DALYs due to ischemic stroke in China.

Conclusion

Our study revealed that great changes have occurred in burden and attributable risk factors of ischemic stroke in China in the past three decades. Distinct sex-specific differences are observed in burden and attributable risk factors.

Transition patterns of weight status: A cohort study of Chinese school-age children

Background

Childhood overweight and obesity are increasing public concerns. However, little is known about the transition patterns of childhood weight status, especially in developing countries. In this study, we aimed to evaluate patterns of change in weight status and the risk factors among Chinese school-age children.

Methods

This retrospective cohort study included 2,334 children aged 6 years with complete 5-year (2012-2017) physical examination data in Minhang District, Shanghai. A time-homogeneous three-state Markov model was fit to the longitudinal data with dynamic outcomes (normal weight, overweight, and obesity).

Results

According to the Markov model, 42.3% of school-age children who were initially overweight transitioned to another weight status within 1 year, with 24.8% (95% confidence interval [CI]: 23.1, 27.0) transitioning to normal weight and 17.5% (95% CI: 15.9, 19.3) becoming obese. In contrast, children who were initially normal weight (92.9% [95% CI: 92.3, 93.5]) or obese (83.1% [95% CI: 81.1, 84.8]) tended to maintain their initial weight status. Male sex, semi-urban area, absence of late adiposity rebound, lower annual height increments, higher annual weight increments, and higher initial body mass index were significantly associated with a higher risk of developing or maintaining overweight and obesity (p < 0.05).

Conclusions

The weight status of Chinese school-age children is more likely to change among those who are initially overweight than in those who are initially obese. Interventions to promote healthy weight status may be more effective if key groups are targeted, such as overweight and pre-school-age children.

The relationship between weight bias internalization and healthy and unhealthy weight control behaviours

PURPOSE

Weight bias internalization (WBI) is associated with disordered eating symptomology and motivation to control weight. The relationship between WBI and specific weight control behaviours and how these behaviours differ between men and women is not well understood. The objectives of this study are to determine (1) the relationship between WBI and weight control behaviours, (2) whether weight perception is independently associated with weight control behaviours, and (3) whether these relationships differ between men and women.

METHODS

Canadian adults (N = 161; 52.8% women; body mass index [BMI] = 26.5 ± 4.99 kg/m²) completed questionnaires pertaining to WBI, weight control behaviours (healthy, unhealthy, extreme) and weight perception (accurate, under-, or over-estimation compared with objectively measured BMI). The cross-sectional relationship between (1) WBI or (2) weight perception with the total number of healthy and unhealthy or extreme weight control behaviours, and likelihood of performing specific weight control behaviours were assessed with linear, and logistic regression models, respectively. All analyses were conducted adjusting for age, gender, and race. Subsequent analyses were stratified by sex.

RESULTS

WBI was associated with an increased likelihood of performing exercise for weight loss (OR 2.28, p < 0.05); increased likelihood of skipping meals in women (OR 2.57, p < 0.01), and consuming little amounts of food and food substitutes in men (OR 2.28, p < 0.01 and OR 2.17, p < 0.05, respectively). Weight perception was not associated with weight control behaviours.

CONCLUSIONS

WBI was associated with various weight control behaviours. This study highlights the importance of assessing WBI in clinical practice with patients seeking to manage their weight. Future longitudinal research should be conducted to further understand the behavioural and health effects from WBI.

LEVEL V

Cross-sectional descriptive study.

Association between built environments and weight status: evidence from longitudinal data of 9589 Australian children

Background

No studies appear to examine potential associations between changes in built environments across childhood and the developmental trajectories of child weight status.

Objective

Examine the developmental trajectories of child weight status with respect to changes in childhood exposure to the built environments.

Methods

This study used data of 9589 children with biennial follow-up (2004–2016), retrieved from the Longitudinal Study of Australian Children. Changes in objectively-measured child weight status (i.e., body mass index-BMI, waist circumference) were investigated in relation to changes in seven built environments (i.e., neighbourhood safety; green space quality; footpaths and street conditions; public transport; shopping facilities; basic services; and local traffic) subjectively reported by caregivers. Group-based discrete trajectory mixture models were used to classify children according to their developmental trajectories of built environments and weight status. Multilevel multinomial logistic regression was employed to examine associations between built environments and child weight status adjusted for confounding.

Results

Two, four, and six trajectory groups were developed for built environment variables. Three groups namely “moderate”, “high”, and “extreme increase” were generated for each BMI and waist circumference. Findings from multilevel analyses indicated that growing up in neighbourhoods that are considered highly safe, with better quality of green space nearby, and in areas with low local traffic over time are protective against unhealthy weight increase in childhood. Meanwhile, living with better access to shopping facilities and basic services was associated with an unhealthy increase in BMI and/or waist circumference. No clear associations appeared between the quality of footpath and street conditions, access to public transport, and child weight status.

Conclusions

Built environments might act either as a risk or protective factor of an unhealthy increase in child weight status. Enabling health-promoting neighbourhoods (i.e., highly safe, quality green space nearby, low local traffic) is important to support a healthy weight trajectory across childhood.

Sex-Related Difference in the Association Between Child Neglect and the Accuracy of Body Weight Perception Among Chinese Primary Schoolchildren

Introduction: Body weight perception (BWP) directly determines weight management behaviors. Although child neglect is a well-established risk factor for managing body weight, little is known about its association with the accuracy of BWP. This study aimed to assess the cross-sectional and longitudinal associations between child neglect and BWP accuracy in primary schoolchildren, and explore how these differ based on the sex of the child. Methods: The sample included 1,063 primary schoolchildren (557 boys and 506 girls, aged 8-10 years) from a two-wave observational study between 2018 and 2019 in Wuhan, China. Child neglect and BWP were investigated using self-administered questionnaires. The accuracy of BWP was defined by comparing the BWP and actual body weight, and it was categorized into three groups-consistent, underestimated, and overestimated. Multinomial logistic regression analysis was conducted with fitting child neglect as the independent variable and the accuracy of BWP as the dependent variable. Results: The prevalence of weight misperception was ~44% at baseline (underestimation 40%; overestimation 4%) in Chinese primary schoolchildren. In the cross-sectional analysis, children with a higher level of neglect were more likely to misperceive their body weight. Moreover, there was an apparent sex-related difference that boys who experienced a higher level of neglect significantly reported more underestimation, while girls reported more overestimation. There was no significant longitudinal association between child neglect and the change in BWP accuracy. Conclusions: This study revealed that a higher level of neglect was significantly associated with underestimated BWP in boys and overestimated BWP in girls. The mechanisms of sex-related difference and whether child neglect is involved in the change in BWP, merit further investigations.

The association of child neglect with lifestyles, depression, and self-esteem: Cross-lagged analyses in Chinese primary schoolchildren

Child neglect robustly predicts many behavioral problems and adulthood mental disorders, but little is known about its association with daily lifestyles and psychological development during childhood, particularly in the longitudinal study. We aimed to examine the association of child neglect with physical activity (PA), screen time (ST), eating habits (EHs), and depression/self-esteem using a two-wave follow-up study of primary schoolchildren in Wuhan, China. Data of 1085 schoolchildren aged 8-10 years (boys: 53.5%) were analyzed. Child neglect, lifestyles, and depression/self-esteem were collected in 2018 (T1) and 2019 (T2). Autoregressive cross-lagged models (ARCLMs) were fitted to explore the interrelationships among these variables. In ARCLM including child neglect and lifestyles, higher child neglect at T1 was significantly associated with higher ST and more risky EHs at T2, while insignificantly associated with PA. In ARCLM including child neglect and depression/self-esteem, lower T1 child neglect significantly predicted a higher T2 depression, but insignificantly for T2 self-esteem. In ARCLM including all variables, child neglect still significantly predicted later ST and depression, but insignificantly predicted EHs. Our study underscores that child neglect is strongly intertwined with ST, EHs, and depression during childhood. The prevention of child neglect may promote some healthy lifestyles and depression in children.

Poor Health Related Quality of Life and Unhealthy Lifestyle Habits in Weight-Loss Treatment-Seeking Youth

Obesity is associated with unhealthy lifestyle behaviors and poor Health Related Quality of Life (HRQOL). The cumulative effect of lifestyle behaviors on HRQOL has been demonstrated in chronically ill adolescents, but not in adolescents with obesity. The present study aimed to assess the association between HRQOL and adherence to the Mediterranean Diet (MD) and/or low levels of physical activity (PA) in a large sample of outpatient adolescents with overweight or obesity seeking weight loss treatment. Four-hundred-twenty participants were enrolled from 10 Italian outpatient clinics. The demographics and anthropometric features, KIDMED scores, and exercise levels of the participants were collected, together with parental features. The HRQOL was assessed by the Pediatric Quality of Life Inventory (PedsQL™), Adolescents Version 4.0. PedsQL total score and functioning subscales were lower in adolescents who reported one or two unhealthy habits. Compared with the high/intermediate groups, the risk of low HRQOL was twice as high for each unit increase in BMI SDS, while the percentage was reduced by 12.2% for every unit increase in the KIDMED score and by 32.3% for each hour increase of exercise. The clustering of these two unhealthy behaviors conferred a 120% higher risk of low HRQOL. Similarly, adolescents displaying better diet quality and/or a physically more active lifestyle have better physical and psychological functioning. Further studies are needed to disclose whether these characteristics may be predictive of better adherence to weight loss treatment.

Effectiveness of an Internet Dissonance-Based Eating Disorder Prevention Intervention Among Body-Dissatisfied Young Chinese Women

Body image disturbances are widespread in highly populated, rapidly developing Asian nations such as China, but there are severe shortages of practitioners qualified to treat these issues. In such contexts, validated online interventions offer a potentially viable approach for addressing the lack of treatment resources. In this study, we evaluated effects of the eBody Project, an online, dissonance-based eating disorder prevention program, on functioning among body-dissatisfied young Chinese women. Participating women were randomly assigned to the 6-week eBody Project intervention (n = 191) versus an education brochure control condition (n = 181). Self-report assessments of eating disorder risk factors (body dissatisfaction, thin ideal internalization, depressive symptoms, restrained eating), self-esteem, body appreciation, and disordered eating were completed at baseline, posttreatment, and a 6-month follow-up. There were no intervention differences on outcomes before treatment but eBody Project women experienced significantly larger improvements on all outcomes following treatment and/or at follow-up compared to controls; corresponding effect sizes were small to medium. Results indicated the eBody Project program is a promising intervention for young women at risk for eating disorders in China and provide foundations for broad implementation in low- and middle-income countries where resources for in-person therapy and supervision are limited or unavailable altogether.

Associations of health-risk behaviors with mental health among Chinese children

The study aimed to investigate the individual and combined association of health-risk behaviors with mental health among Chinese children. A cross-sectional study was conducted in Wuhan, China, from May to June 2018. Participants self-reported the information on physical activity (PA), screen time (ST), fruit and vegetable (FV) intake, and sleep duration. Mental health, including depression, social anxiety and self-esteem, was assessed using standard questionnaires. A total of 1296 children (704 males and 592 females) aged 9.2 ± 0.4 years were included in the present study. The prevalence of low PA, high ST, low FV intake, and inadequate sleep duration was 45.6%, 18.0%, 69.7%, and 64.7%, respectively. Overall, significant associations were found between individual health-risk behavior and increased risks of mental health. Furthermore, children with three or four health-risk behaviors showed significantly increased risks of anxiety (OR: 3.18, 95%CI: 1.63-6.21), depression (OR: 4.55, 95%CI: 2.28-9.09) and low self-esteem (OR: 3.59, 95%CI: 2.20-5.88) compared with those without health-risk behavior. Results of this study revealed a high prevalence of health-risk behaviors among Chinese children. Furthermore, the clustering of health-risk behavior was associated with significantly increased risks of mental health in this population. Considering these findings, it is important to perform early interventions to reduce children's health-risk behavior and prevent mental health problems.

Transition Patterns of Weight Status and Their Associated Factors among Elementary School Children: A Longitudinal Cohort Study Using Multistate Markov Model

Background: Childhood obesity is a recognized public health concern worldwide. It is essential to study the natural progression of obesity in the interest of prevention. This study aimed to describe the dynamic changes in weight status among elementary school children and identify the significant factors influencing the progression or regression of weight status. Methods: This study involved 928 elementary school children who were followed up annually during their elementary school years. Heights, weights, and vital capacity (VC) were measured each school year. A multistate Markov model containing three weight states was fit to longitudinal weight status data. Results: Children with healthy weight and obesity tended to stay in their preceding weight state. Children with overweight, in contrast, were more likely to move to the other two states. The mean sojourn time in obesity and in overweight states was 5.15 years (95% confidence interval [CI]: 4.22-6.3) and 2 years (95% CI: 1.76-2.28), respectively. Children in lower grades, those with a lower VC index, those with a higher initial BMI, those with a higher annual weight increment, and boys were at increased risk of progression to overweight or obesity, with a decreased probability of regression. Conclusions: Children with obesity were more resistant to recovery than those with overweight. Prevention and intervention measures should be adopted early when abnormal weight onset occurs. The multistate Markov model was an advanced tool to analyze dynamic changes in status and identify significant factors for progression and regression and helped to develop prevention and intervention targeting strategies.