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Yuan Y, Gao C, Yin X, Zhang X, Ji Y, Zheng X, Zhou Q, Wu Y. The Guidelines for use and promotion of low sodium salt in China. J Evid Based Med 2024; 17:454-467. [PMID: 38923391 DOI: 10.1111/jebm.12621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024]
Abstract
AIM Both excessive intake of sodium and inadequate intake of potassium are associated with blood pressure elevation and subsequent increase in the risk of cardiovascular disease, which accounts for the largest number of deaths in China and worldwide. Low sodium salt, a mixture of mainly sodium chloride and potassium chloride, has shown its great potential as a promising population strategy for sodium intake reduction through multiple large-scale, multicenter, randomized controlled trials among populations including patients with cardiovascular disease, individuals with and without hypertension, older and younger adults, and men and women in China and other countries. This Guidelines aims to provide expert recommendations for promotion and use of low sodium salt in China, based on the current available scientific evidence regarding the effectiveness, safety, cost-effectiveness, and acceptability of low sodium salts in various population groups and different application scenarios. The suggestions to key stakeholders are also made. METHODS A working group, an expert review committee and an advisory committee were established to be responsible for formulating the guidelines' scope and key questions to be addressed, for searching, synthesizing, and evaluating research evidence, proposing and reviewing the recommendations. The consensus on the final recommendations was reached using the GRADE grid method. RESULTS The working group summarized current available evidence of salt substitution regarding its effectiveness, safety, cost-effectiveness, acceptability, availability, suitability, etc. The Guidelines provided six recommendations advising different populations how to use low sodium salt, four recommendations on the application of low sodium salts in different scenarios, and five suggestions for key stakeholders to promote salt substitution. CONCLUSION The first evidence-based guidelines on promotion and use of low sodium salts covers all key questions in relevance and would play a critical role in prevention and control of hypertension and cardiovascular disease in China and worldwide.
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Affiliation(s)
- Yifang Yuan
- Clinical Research Institute, Institute of Advanced Clinical Medicine, Peking University, Beijing, China
- State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, Beijing, China
| | - Chao Gao
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xuejun Yin
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xianghui Zhang
- Clinical Research Institute, Institute of Advanced Clinical Medicine, Peking University, Beijing, China
- Department of Preventive Medicine, Shihezi University School of Medicine, Shihezi, China
| | - Yufei Ji
- Hypertension Center, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Fuwai Hospital, Beijing, China
| | - Xizi Zheng
- Renal Division, Peking University First Hospital, Institute of Nephrology, Peking University, Beijing, China
| | - Qi Zhou
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Yangfeng Wu
- Clinical Research Institute, Institute of Advanced Clinical Medicine, Peking University, Beijing, China
- State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
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Ray JL, Srinath R, Mechanick JI. The Negative Impact of Routine, Dietary Pattern, and Physical Activity on Obesity and Dysglycemia During the COVID-19 Pandemic. Am J Lifestyle Med 2023; 17:219-230. [PMID: 36883128 PMCID: PMC9024091 DOI: 10.1177/15598276221084923] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The global coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak, has disrupted routines in education, work, exercise, and dining habits. To prevent viral spread, communal spaces including offices, schools, restaurants, and gyms have closed or drastically limited their capacity. Additionally, government-mandated lockdown orders have forced people to spend more time at home. Studies have shown that these COVID-19 restrictions have led to unhealthier eating patterns, increased sedentary behaviors, and decreased physical activity, leading to weight gain, dysglycemia, and increased metabolic risk. While strict social distancing measures have been necessary to curb the spread of the SARS-CoV-2 virus, people have been forced to adapt by altering their daily routines. Based on existing literature, a model is proposed for intentionally creating daily routines to ensure healthy habits, minimize weight gain, and prevent worsening dysglycemia.
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Affiliation(s)
- Justina L Ray
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Reshmi Srinath
- Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jeffrey I Mechanick
- Kravis Center for Clinical Cardiovascular Health at Mount Sinai Heart, Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Du W, Zhang P, Zhang J, Li Y, He FJ, Zhang X, Su C, Jia X, Li L, Song J, Zhang B, Wang H. Sodium Reduction in Restaurant Food: A Randomized Controlled Trial in China. Nutrients 2022; 14:nu14245313. [PMID: 36558472 PMCID: PMC9781955 DOI: 10.3390/nu14245313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/02/2022] [Accepted: 12/13/2022] [Indexed: 12/15/2022] Open
Abstract
Restaurant food is one of the important sources of sodium intake in China. We aimed to determine whether a restaurant-based comprehensive intervention program may induce lower sodium content in restaurant food. A randomized controlled trial was implemented between 2019 and 2020 in 192 restaurants in China. After baseline assessment, the restaurants were randomly assigned to either an intervention or a control group (1:1). Comprehensive activities designed for intervention restaurants were conducted for one year. The primary outcome was the difference in change of sodium content estimated by the mean values of five best-selling dishes for each restaurant, from baseline to the end of the trial between groups. In total, 66 control restaurants and 80 intervention restaurants completed the follow-up assessment. The average sodium content of dishes at baseline was 540.9 ± 176.8 mg/100 g in control and 551.9 ± 149.0 mg/100 g in intervention restaurants. The mean effect of intervention after adjusting for confounding factors was -43.63 mg/100 g (95% CI: from -92.94 to 5.66, p = 0.08), representing an 8% reduction in sodium content. The restaurant-based intervention led to a modest but not significant reduction in the sodium content of restaurant food. There is great urgency for implementing effective and sustainable salt reduction programs, due to the rapid increase in the consumption of restaurant food in China.
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Affiliation(s)
- Wenwen Du
- National Institute for Nutrition and Health, Chinese Centre for Disease Control and Prevention, Beijing 100050, China
- Key Laboratory of Trace Element Nutrition, National Health Commission, Beijing 100050, China
| | - Puhong Zhang
- George Institute for Global Health, Peking University Health Science Center, Beijing 100600, China
- Faculty of Medicine, University of New South Wales, Sydney, NSW 1466, Australia
| | - Jiguo Zhang
- National Institute for Nutrition and Health, Chinese Centre for Disease Control and Prevention, Beijing 100050, China
- Key Laboratory of Trace Element Nutrition, National Health Commission, Beijing 100050, China
| | - Yuan Li
- George Institute for Global Health, Peking University Health Science Center, Beijing 100600, China
- Faculty of Medicine, University of New South Wales, Sydney, NSW 1466, Australia
| | - Feng J. He
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK
| | - Xiaofan Zhang
- National Institute for Nutrition and Health, Chinese Centre for Disease Control and Prevention, Beijing 100050, China
- Key Laboratory of Trace Element Nutrition, National Health Commission, Beijing 100050, China
| | - Chang Su
- National Institute for Nutrition and Health, Chinese Centre for Disease Control and Prevention, Beijing 100050, China
- Key Laboratory of Trace Element Nutrition, National Health Commission, Beijing 100050, China
| | - Xiaofang Jia
- National Institute for Nutrition and Health, Chinese Centre for Disease Control and Prevention, Beijing 100050, China
- Key Laboratory of Trace Element Nutrition, National Health Commission, Beijing 100050, China
| | - Li Li
- National Institute for Nutrition and Health, Chinese Centre for Disease Control and Prevention, Beijing 100050, China
- Key Laboratory of Trace Element Nutrition, National Health Commission, Beijing 100050, China
| | - Jing Song
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK
| | - Bing Zhang
- National Institute for Nutrition and Health, Chinese Centre for Disease Control and Prevention, Beijing 100050, China
- Key Laboratory of Trace Element Nutrition, National Health Commission, Beijing 100050, China
| | - Huijun Wang
- National Institute for Nutrition and Health, Chinese Centre for Disease Control and Prevention, Beijing 100050, China
- Key Laboratory of Trace Element Nutrition, National Health Commission, Beijing 100050, China
- Correspondence: ; Tel.: +86-10-66237089
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Lozada-Urbano M, Huamán F, Xirinachs Y, Rivera-Lozada O, Alvarez-Risco A, Yáñez JA. Poverty, Household Structure and Consumption of Foods Away from Home in Peru in 2019: A Cross-Sectional Study. Foods 2022; 11:2547. [PMID: 36076733 PMCID: PMC9455660 DOI: 10.3390/foods11172547] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/15/2022] [Accepted: 08/18/2022] [Indexed: 02/01/2023] Open
Abstract
The aim of this study was to evaluate the probability of buying food away from home according to the type of household using the logit model, as well as the sociodemographic characteristics of the heads of household, and how much income expenditure represents. A cross-sectional study was carried out using the National Household Survey (ENAHO) 2019 database. After joining the database, the household type variables were created. To calculate the probability with the “logit” model of purchase, the variables—family size, income, types of household, and total expenditure—were selected as a measure of the purchasing power of the family. A statistically significant association (p < 0.05) was found between the probability of consumption and the variables: age of household members, predominance, nuclear without children−married, nuclear with children−cohabitant, nuclear with children−widowed, nuclear with children−separated, extended, compounded, poor not extreme, and not poor. The bulk of families was represented by nuclear families (61.97%). The highest expenditure in the CFAH was for families defined as composite with a yearly average of USD 1652.89 (equivalent to PEN 5520.67). Observing the expenditure on food consumed outside the home through the composition of households can allow a better approach to offer educational measures. This information can be helpful to developers of educational issues.
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Affiliation(s)
- Michelle Lozada-Urbano
- South American Center for Education and Research in Public Health, Universidad Norbert Wiener, Lima 15046, Peru
| | - Franklin Huamán
- Facultad de Ingeniería Económica, Estadística y Ciencias Sociales, Universidad Nacional de Ingeniería, Lima 15333, Peru
| | - Yanira Xirinachs
- Escuela de Economía, Universidad de Costa Rica-UCR, Ciudad Universitaria Rodrigo Facio Brenes, San José 02060, Costa Rica
| | - Oriana Rivera-Lozada
- South American Center for Education and Research in Public Health, Universidad Norbert Wiener, Lima 15046, Peru
| | - Aldo Alvarez-Risco
- Carrera de Negocios Internacionales, Facultad de Ciencias Administrativas y Económicas, Universidad de Lima, Lima 15023, Peru
| | - Jaime A. Yáñez
- Facultad de Educación, Carrera de Educación y Gestión del Aprendizaje, Universidad Peruana de Ciencias Aplicadas, Lima 15023, Peru
- Gerencia Corporativa de Asuntos Científicos y Regulatorios, Teoma Global, Lima 15073, Peru
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Hallit S, Brytek-Matera A, Malaeb D, Obeid S. Validation of the Arabic version of the modified Yale Food Addiction Scale in the general population in Lebanon. J Eat Disord 2022; 10:112. [PMID: 35927764 PMCID: PMC9354308 DOI: 10.1186/s40337-022-00638-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/31/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Although the definition of food addiction is not agreed upon, it is characterized by eating more than expected without being hungry, not being able to visit certain places associated with overeating or unsuccessfully trying to cut down on the consumption of certain foods. The modified YFAS (mYFAS 2.0) version, instrument available to evaluate food addiction, was shown to have good psychometric properties. Our objective was to assess the psychometric properties of the Arabic version of the mYFAS (mYFAS-Ar-Leb) in the Lebanese population. METHODS This cross-sectional study enrolled 1268 persons residing in Lebanon (September-November 2020). The mean age of the participants was 26.18 years (SD = 11.17; min: 18; max: 85), with 65.1% females. The percentage of participants with food addiction was 226 (17.8%) in the total sample. A confirmatory factor analysis was run on the one-factor structure among the total sample. RESULTS The fit indices of the confirmatory factor analysis of the scale were excellent. The Cronbach's alpha value was good for the total scale. The mYFAS-Ar-Leb score was positively and strongly associated with stress, anxiety and depression. CONCLUSION Our study findings highlighted that the use of the mYFAS-Ar-Leb in Lebanese population might help estimate food addiction prevalence and stress on the need for effective treatment and preventive measures to craving for addictive foods.
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Affiliation(s)
- Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon. .,Psychology Department, College of Humanities, Effat University, Jeddah, 21478, Saudi Arabia. .,Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
| | - Anna Brytek-Matera
- Institute of Psychology, University of Wroclaw, Dawida 1, 50-527, Wrocław, Poland
| | - Diana Malaeb
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates.,School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Sahar Obeid
- School of Arts and Sciences, Social and Education Sciences Department, Lebanese American University, Jbeil, Lebanon
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Du W, Wang H, Zhang J, Zhang X, Wei N, Li Y, Tan M, Zhang P, He FJ. Sodium content of restaurant dishes in China: a cross-sectional survey. Nutr J 2022; 21:10. [PMID: 35177072 PMCID: PMC8851779 DOI: 10.1186/s12937-022-00762-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 02/08/2022] [Indexed: 11/15/2022] Open
Abstract
Background Sodium intake in China is extremely high and eating in restaurants is increasingly popular. Little research has explored the sodium level of restaurant dishes. The present study aims to assess the content and sources of sodium in Chinese restaurants. Methods Cross-sectional data were obtained from the baseline survey of the Restaurant-based Intervention Study (RIS) in 2019. A total of 8131 best-selling restaurant dishes with detailed recipes from 192 restaurants in China were included. Sodium content per 100 g and per serving were calculated according to the Chinese Food Composition Table. The proportion of restaurant dishes exceeding the daily sodium reference intake level in a single serving and the major sources of sodium were determined. Results Median sodium content in restaurant dishes were 487.3 mg per 100 g, 3.4 mg per kcal, and 2543.7 mg per serving. For a single serving, 74.9% of the dishes exceeded the Chinese adults’ daily adequate intake for sodium (AI, 1500 mg per day), and 62.6% of dishes exceeded the proposed intake for preventing non-communicable chronic diseases (PI, 2000 mg per day). Cooking salt was the leading source of sodium in Chinese restaurant dishes (45.8%), followed by monosodium glutamate (17.5%), food ingredients (17.1%), soy sauce (9.4%), and other condiments/seasonings (10.2%). More types of salted condiments/seasonings use were related to higher sodium level. Conclusions The sodium levels in Chinese restaurant dishes are extremely high and variable. In addition to cooking salt, other salted condiments/seasonings also contribute a large proportion of sodium. Coordinated sodium reduction initiatives targeting the main sources of sodium in restaurant dishes are urgently needed.
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Affiliation(s)
- Wenwen Du
- The National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 29 Nanwei Rd, Beijing, China
| | - Huijun Wang
- The National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 29 Nanwei Rd, Beijing, China.
| | - Jiguo Zhang
- The National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 29 Nanwei Rd, Beijing, China
| | - Xiaofan Zhang
- The National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 29 Nanwei Rd, Beijing, China
| | - Nan Wei
- The National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 29 Nanwei Rd, Beijing, China
| | - Yuan Li
- The George Institute for Global Health at Peking University Health Science Center, Room 011, Unit 2, Tayuan Diplomatic Office Building No. 14 Liangmahe Nan Lu, Beijing, China
| | - Monique Tan
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, EC1M-6BQ, London, UK
| | - Puhong Zhang
- The George Institute for Global Health at Peking University Health Science Center, Room 011, Unit 2, Tayuan Diplomatic Office Building No. 14 Liangmahe Nan Lu, Beijing, China
| | - Feng J He
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, EC1M-6BQ, London, UK
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Huang F, Wang H, Wang Z, Du W, Ouyang Y, Zhang B. Stressed females, rather than males, tend to eat away from home. Eur J Clin Nutr 2022; 76:1010-1016. [PMID: 35031768 DOI: 10.1038/s41430-021-01058-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/27/2021] [Accepted: 12/01/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The aim of this study is to examine the association between perceived stress and multifarious eating away from home among Chinese adults in different genders. METHODS We examined cross-sectional data from the China Health and Nutrition Survey conducted in 2018 among Chinese adults aged 18-59 years. A self-reported questionnaire involving the perceived stress scale with 10 items (PSS-10), and the food frequency questionnaire about eating away from home were used. Adjusted two-level zero-inflated Poisson regression models were used to explore the association. RESULTS There were 3161 males and 3599 females in the study. The median PSS-10 score was 16.0 and the frequencies of eating 1) breakfast, 2) lunch or supper, and 3) three main meals away from home were 12, 10, and 49 times per year, respectively. In males, PSS-10 score was not associated with eating away from home. In females, PSS-10 score was significantly positively associated with eating 1) lunch or supper, 2) three main meals, 3) Chinese food away from home, and 4) eating at stalls/restaurants (β1 = 0.016, P1 = 0.006; β2 = 0.014, P2 = 0.002; β3 = 0.015, P3 = 0.013; β4 = 0.014, P4 = 0.015 respectively). But there was not association between PSS-10 score and the frequency of eating breakfast away from home in females (β = 0.006, P = 0.325). CONCLUSIONS Stressed females tend to eat away from home, but the effects are very small.
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Affiliation(s)
- Feifei Huang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Huijun Wang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhihong Wang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wenwen Du
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yifei Ouyang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Bing Zhang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China.
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Chen SW, Wang P, Ji GY, Jiang Q, Hong XM, Ma WJ, Huang R, Chen ZH, Peng JW. Sex Difference in the Association Between Eating Away From Home and the Risk of High Serum Uric Acid in South China. Front Nutr 2021; 8:647287. [PMID: 34733871 PMCID: PMC8558310 DOI: 10.3389/fnut.2021.647287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 09/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The prevalence of high serum uric acid is increasingly rising in recent years, and diet behavior is perceived to be associated with it. This study aimed to explore the relationship between eating away from home (EAFH) and the risk of high serum uric acid in adults in South China. Methods: The data utilized in this study were from Guangdong Nutrition and Health Survey (NHS) 2015. Serum uric acid concentration was detected. EAFH in the past week was investigated. We defined EAFH as food consumption away from home. Dietary data were collected by 24-h recalls on 3 consecutive days. A generalized linear mixed-effects model was applied to compute the odds ratio (OR) and its corresponding 95% CI. Results: A total of 3,489 individuals were included in this study. A 1.27-fold OR (95% CI: 1.05–1.52, P = 0.012) of high serum uric acid was identified in adults with EAFH in comparison with those without EAFH. With respect to men, a 1.66-fold OR (95% CI: 1.3–2.1, P < 0.001) of high serum uric acid was observed. We also observed that men with EAFH had higher intakes of red meat, poultry, vegetable, carbohydrate, protein, fat, and total energy, while a lower grain intake than those without EAFH. However, there was a lack of significant association between EAFH and the odds ratio of high serum uric acid in women. Women with EAFH did not have higher consumptions of red meat, vegetable, fish, fat, and water than those without EAFH. Conclusions: This study found that EAFH was associated with an increased odds ratio of high serum uric acid in men, but not in women.
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Affiliation(s)
- Shao-Wei Chen
- Guangdong Provincial Center for Disease Control and Prevention, Guangdong Provincial Institute of Public Health, Guangzhou, China
| | - Ping Wang
- Guangdong Provincial Center for Disease Control and Prevention, Guangdong Provincial Institute of Public Health, Guangzhou, China
| | - Gui-Yuan Ji
- Guangdong Provincial Center for Disease Control and Prevention, Guangdong Provincial Institute of Public Health, Guangzhou, China
| | - Qi Jiang
- Guangdong Provincial Center for Disease Control and Prevention, Guangdong Provincial Institute of Public Health, Guangzhou, China
| | - Xiao-Min Hong
- Guangdong Provincial Center for Disease Control and Prevention, Guangdong Provincial Institute of Public Health, Guangzhou, China
| | - Wen-Jun Ma
- Guangdong Provincial Center for Disease Control and Prevention, Guangdong Provincial Institute of Public Health, Guangzhou, China
| | - Rui Huang
- Guangdong Provincial Center for Disease Control and Prevention, Guangdong Provincial Institute of Public Health, Guangzhou, China
| | - Zi-Hui Chen
- Guangdong Provincial Center for Disease Control and Prevention, Guangdong Provincial Institute of Public Health, Guangzhou, China
| | - Jie-Wen Peng
- Guangdong Provincial Center for Disease Control and Prevention, Guangdong Provincial Institute of Public Health, Guangzhou, China
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Takimoto H, Okada E, Takebayashi J, Tada Y, Yoshizaki T, Yokoyama Y, Ishimi Y. Nutrient Profiles of Dishes Consumed by the Adequate and High-Salt Groups in the 2014-2018 National Health and Nutrition Survey, Japan. Nutrients 2021; 13:nu13082591. [PMID: 34444751 PMCID: PMC8398318 DOI: 10.3390/nu13082591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 12/27/2022] Open
Abstract
Dish-based nutrient profile analyses are essential for setting goals to achieve a balanced diet. In 2014, the Japanese government proposed the “Healthy Meal” criteria, which requires a salt content of 3 g/650 kcal per meal. To examine the current intake status of a nationally representative sample, we conducted a series of secondary analyses of the 2014–2018 National Health and Nutrition Survey data. Participants (aged 18–74 years) were grouped as “high-salt” consumers if their salt intake was 3 g/650 kcal or higher and “adequate” consumers if they consumed less than 3 g/650 kcal. A total of 13,615 participants were identified as “adequate” consumers and 22,300 as “high-salt” consumers. The median salt intake in the “high-salt” group was 11.3 g/day, while that in the “adequate” group was 7.5 g/day. Almost all dishes consumed by the “adequate” group had significantly high energy and fat content but low salt content, compared with those consumed by the “high-salt” group. For example, the median energy, fat, and salt contents in the main dishes consumed by the “adequate” group were 173 kcal, 10.4 g, and 0.9 g/dish, respectively, while those in the main dishes consumed by the “high-salt” group were 159 kcal, 8.9 g, and 1.1 g/dish, respectively. Examples of balanced dishes that are low in both salt and fat content can be proposed to help improve the Japanese consumers’ dietary behavior.
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Affiliation(s)
- Hidemi Takimoto
- Department of Nutritional Epidemiology and Shokuiku, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8636, Japan;
- Correspondence: ; Tel.: +81-3-3203-5721
| | - Emiko Okada
- Department of Nutritional Epidemiology and Shokuiku, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8636, Japan;
| | - Jun Takebayashi
- Department of Food Function and Labeling, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8636, Japan;
| | - Yuki Tada
- Department of Nutritional Science, Faculty of Applied Biosciences, Tokyo University of Agriculture, 1-1-1 Sakuragaoka, Setagaya-ku, Tokyo 156-8502, Japan;
| | - Takahiro Yoshizaki
- Department of Nutrition and Health Sciences, Faculty of Food and Nutritional Sciences, Toyo University, 1-1-1 Izumino, Itakura-cho, Oura-gun, Gunma 374-0193, Japan;
| | - Yuri Yokoyama
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan;
| | - Yoshiko Ishimi
- Research Institute for Agricultural and Life Sciences, Tokyo University of Agriculture, 1-1-1 Sakuragaoka, Setagaya-ku, Tokyo 156-8502, Japan;
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Hoteit M, Zoghbi E, Rady A, Shankiti I, Al-Jawaldeh A. Fatty Acids Quality in Middle Eastern Traditional Dishes, Arabic Sweets and Market Foods Frequently Consumed in Lebanon. Nutrients 2021; 13:2462. [PMID: 34371969 PMCID: PMC8308895 DOI: 10.3390/nu13072462] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/04/2021] [Accepted: 07/09/2021] [Indexed: 01/06/2023] Open
Abstract
The prevalence of diet-related non-communicable diseases is on the rise in the countries of the Eastern Mediterranean, including Lebanon. This study aimed to provide data on fatty acid profiles and ratios of Lebanese composite dishes, Arabic sweets, and market foods. Methods: Thirty types of traditional dishes, collected from five different Lebanese governorates, thirty-seven types of Arabic sweets and forty-six market food products were considered for analysis. Food samples were chemically analyzed for total, unsaturated and saturated fatty acids. The range of total fatty acids in composite dishes, Arabic sweets, and market food products was between 1.2-11.7 g/100 g, 5.3-25.8 g/100 g, and 0.5-100 g/100 g, respectively. Additionally, the range of saturated fatty acids in composite dishes, Arabic sweets, and market food products was between 0.5-4.9 g/100 g, 2.5-23.6 g/100 g and 0.1-56.4 g/100 g, respectively. Furthermore, about 75% of these foods were poor in unsaturated fatty acids. Regarding saturated fatty acid, the polyunsaturated to monounsaturated (P.M.S) ratio was lower than the recommended ratio of 1:1:1 in 96% of samples. To conclude, there is a need to prioritize fat content in foods and consider processing modifications in the food production system with the aim of achieving a higher P:M:S ratio intake among the population.
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Affiliation(s)
- Maha Hoteit
- Faculty of Public Health, Lebanese University, Beirut 6573, Lebanon;
| | - Edwina Zoghbi
- Country Office for Lebanon, World Health Organization, Beirut 5391, Lebanon; (E.Z.); (A.R.); (I.S.)
| | - Alissar Rady
- Country Office for Lebanon, World Health Organization, Beirut 5391, Lebanon; (E.Z.); (A.R.); (I.S.)
| | - Iman Shankiti
- Country Office for Lebanon, World Health Organization, Beirut 5391, Lebanon; (E.Z.); (A.R.); (I.S.)
| | - Ayoub Al-Jawaldeh
- World Health Organization Regional Office for the Eastern Mediterranean, Cairo 11371, Egypt
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Mandracchia F, Tarro L, Llauradó E, Valls RM, Solà R. Interventions to Promote Healthy Meals in Full-Service Restaurants and Canteens: A Systematic Review and Meta-Analysis. Nutrients 2021; 13:1350. [PMID: 33919552 PMCID: PMC8073122 DOI: 10.3390/nu13041350] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/13/2021] [Accepted: 04/16/2021] [Indexed: 11/16/2022] Open
Abstract
Out-of-home eating is increasing, but evidence about its healthiness is limited. The present systematic review and meta-analysis aimed to elucidate the effectiveness of full-service restaurant and canteen-based interventions in increasing the dietary intake, food availability, and food purchase of healthy meals. Studies from 2000-2020 were searched in Medline, Scopus, and Cochrane Library using the PRISMA checklist. A total of 35 randomized controlled trials (RCTs) and 6 non-RCTs were included in the systematic review and analyzed by outcome, intervention strategies, and settings (school, community, workplace). The meta-analysis included 16 RCTs (excluding non-RCTs for higher quality). For dietary intake, the included RCTs increased healthy foods (+0.20 servings/day; 0.12 to 0.29; p < 0.001) and decreased fat intake (-9.90 g/day; -12.61 to -7.19; p < 0.001), favoring the intervention group. For food availability, intervention schools reduced the risk of offering unhealthy menu items by 47% (RR 0.53; 0.34 to 0.85; p = 0.008). For food purchases, a systematic review showed that interventions could be partially effective in improving healthy foods. Lastly, restaurant- and canteen-based interventions improved the dietary intake of healthy foods, reduced fat intake, and increased the availability of healthy menus, mainly in schools. Higher-quality RCTs are needed to strengthen the results. Moreover, from our results, intervention strategy recommendations are provided.
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Affiliation(s)
- Floriana Mandracchia
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (F.M.); (L.T.); (R.M.V.); (R.S.)
| | - Lucia Tarro
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (F.M.); (L.T.); (R.M.V.); (R.S.)
- Institut d’Investigació Sanitaria Pere Virgili, 43204 Reus, Spain
| | - Elisabet Llauradó
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (F.M.); (L.T.); (R.M.V.); (R.S.)
| | - Rosa Maria Valls
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (F.M.); (L.T.); (R.M.V.); (R.S.)
| | - Rosa Solà
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (F.M.); (L.T.); (R.M.V.); (R.S.)
- Institut d’Investigació Sanitaria Pere Virgili, 43204 Reus, Spain
- Hospital Universitari Sant Joan de Reus, 43204 Reus, Spain
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12
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Eating-out behaviors, associated factors and associations with obesity in Chinese school children: findings from the childhood obesity study in China mega-cities. Eur J Nutr 2021; 60:3003-3012. [PMID: 33439333 DOI: 10.1007/s00394-020-02475-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 12/21/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Eating-out and prevalence of obesity/overweight have been rising rapidly in China in the past two decades due to social economic developments. This study examined Chinese school children's eating-out behaviors and associated factors, including their association with obesity during a 3-year follow. METHODS Data were collected from 3313 primary and middle school children aged 7-16 years in five mega-cites across China in 2015, 2016 and 2017, in an open cohort study. Eating-out behaviors were assessed using questionnaire survey. The Chinese age-sex-specific body mass index (BMI) cutoffs were used defining child overweight/obesity (combined) and obesity; central obesity was defined as WHtR ≥ 0.48. Mixed effect models examined associations between child eating-out behaviors and BMI, overweight and obesity in this longitudinal data, adjusting for other covariates. RESULTS About 80.1% of the children reported having eaten out ≥ 1 times/week over the past 3 months; 46.7% and 70.9% chose Western- and Chinese-style food when ate out, respectively. Meanwhile, 29.8% of them were overweight/obese, 12.7% were obese and 20.1% had central obesity. Child eating-out behaviors were positively associated with parents' eating-out behaviors (p < 0.05). Boys were more likely to choose Western-style food than girls (OR 1.27; 95% CI 1.09-1.48) when eating out. Compared to non-overweight/obese children, those being overweight/obese at baseline were less likely to eat out dining on Western-style food during the follow-up. CONCLUSION Eating-out is common among school children in major cities in China, but with considerable differences across groups. Children's weight status was associated with eating-out behaviors.
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Du W, Zhang J, Li Y, He FJ, Zhou X, Xu Z, Gao Y, Yin L, Chang X, Yan W, Tan M, MacGregor GA, Luo R, Zhang P, Wang H. Restaurant interventions for salt reduction in China: protocol for a randomised controlled trial. BMJ Open 2020; 10:e038744. [PMID: 33268406 PMCID: PMC7713225 DOI: 10.1136/bmjopen-2020-038744] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 09/18/2020] [Accepted: 10/08/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Salt intake in China is high, and most of it comes from that added by consumers. Nevertheless, recent years have seen a rapid increase in the frequency at which people eat out. The aim of this study is to evaluate the effectiveness of interventions designed for salt reduction in restaurants through a randomised controlled trial in China. METHODS AND ANALYSIS As a randomised controlled trial with restaurants as study subjects, we recruited 192 restaurants from 12 counties of 6 provinces in China. After the baseline survey, restaurants were randomly assigned to intervention or control group. Using social cognitive theory, comprehensive intervention activities were designed to encourage salt reduction in all restaurant foods, and at the same time, to encourage consumers to choose lower salt options when eating out. The interventions will be conducted only in restaurants of the intervention group during the first year. The follow-up assessment will be conducted at the end of the trial. The primary outcome is the change in the average salt content of the five best-selling dishes of the restaurant, as measured by laboratory tests. Secondary outcomes include differences in the monthly use of salt and salty condiments between intervention and control restaurants, and the knowledge, attitude and practice on salt among restaurant consumers. ETHICS AND DISSEMINATION The study was reviewed and approved by the Review Board of the National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention and Queen Mary Research Ethics Committee. Results will be disseminated through presentations, publications and social media. TRIAL REGISTRATION NUMBER ChiCTR1800019694; Pre-results.
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Affiliation(s)
- Wenwen Du
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiguo Zhang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yuan Li
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Feng J He
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Xue Zhou
- Heilongjiang Provincial Center for Disease Control and Prevention, Harbin, China
| | - Zhihua Xu
- Qinghai Provincial Center for Disease Control and Prevention, Xining, China
| | - Yifu Gao
- Hebei Provincial Center for Disease Control and Prevention, Shijiazhuang, China
| | - Lei Yin
- Hunan Provincial Center for Disease Control and Prevention, Changsha, China
| | - Xiaoyu Chang
- Sichuan Provincial Center for Disease Control and Prevention, Chengdu, China
| | - Wei Yan
- Jiangxi Provincial Center for Disease Control and Prevention, Nanchang, China
| | - Monique Tan
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Graham A MacGregor
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Rong Luo
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Puhong Zhang
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Huijun Wang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
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Du S, Wang H, Zhang B, Popkin BM. Dietary Potassium Intake Remains Low and Sodium Intake Remains High, and Most Sodium is Derived from Home Food Preparation for Chinese Adults, 1991-2015 Trends. J Nutr 2020; 150:1230-1239. [PMID: 31909790 PMCID: PMC7198305 DOI: 10.1093/jn/nxz332] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 10/28/2019] [Accepted: 12/11/2019] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Shufa Du
- Department of Nutrition and Carolina Population Center, CB #8120 Carolina Square, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Huijun Wang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Bing Zhang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Barry M Popkin
- Department of Nutrition and Carolina Population Center, CB #8120 Carolina Square, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,Address correspondence to BMP (e-mail: )
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Zhu Y, Chen YP, Ayed C, Li B, Liu Y. An on-line study about consumers’ perception and purchasing behavior toward umami seasonings in China. Food Control 2020. [DOI: 10.1016/j.foodcont.2019.107037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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16
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Does Eating-Away-from-Home Increase the Risk of a Metabolic Syndrome Diagnosis? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16040575. [PMID: 30781483 PMCID: PMC6406498 DOI: 10.3390/ijerph16040575] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/17/2019] [Accepted: 02/13/2019] [Indexed: 12/24/2022]
Abstract
Rising frequency of eating-away-from-home (EAFH) is suspected to be correlated with several non-communicable diseases. This study adopted the Chinese Health and Nutrition Survey (CHNS) 2009 data to investigate the association between being diagnosed with the metabolic syndrome (MetS) and EAFH at different ages. Results showed that the association between EAFH and MetS varied at different ages and differed for males and females. EAFH was positively associated with a higher risk of getting MetS for males, especially for those aged between 45 and 60; while it was negatively associated with the risk of getting MetS for young females (<45) (all p < 0.05). In particular, EAFH was associated with a lower risk of getting high serum triglycerides (TGs), abdominal adiposity, elevated blood pressure, and impaired fasting blood glucose for young females, while higher risk of high serum TGs, abdominal adiposity, elevated blood pressure, and impaired fasting blood glucose for middle-aged males (all p < 0.05). In addition, a higher frequency of EAFH was associated with a higher risk of abdominal adiposity and elevated blood pressure for older women, and a lower risk of elevated blood pressure, and impaired fasting blood glucose for younger men (all p < 0.05). Our study implies that heterogeneous target strategies for preventing MetS in different subpopulation should be considered.
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Yu AYL, López-Olmedo N, Popkin BM. Analysis of dietary trends in Chinese adolescents from 1991 to 2011. Asia Pac J Clin Nutr 2018; 27:1106-1119. [PMID: 30272859 PMCID: PMC6298787 DOI: 10.6133/apjcn.042018.02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVES To examine temporal trends in dietary energy, fat, carbohydrate, protein, sodium and potassium intake of Chinese adolescents aged 12 - 17 years by sex and urbanicity, using data from the China Health and Nutrition Survey. METHODS AND STUDY DESIGN Individual level, consecutive 3 - day 24-hour recalls were analyzed from survey years 1991 (n=504), 2000 (n=665), and 2011 (n=267) from nine provinces representing a range of geography, economic development, and health indicators in China. Linear multivariable regression models were conducted to predict mean intakes of energy, macronutrients, sodium, and potassium. Models were adjusted for age, per capita income, parental education, region, and family size. RESULTS From 1991 to 2011, total energy consumption decreased among both sexes and all urbanicity groups (p<0.05). Sodium intake decreased in all sex and urbanicity groups except the high urbanicity group, which was the only group to show significant change in potassium intake (p<0.05). Sodium-potassium ratios decreased overall and across both sexes (p<0.05). However, the major observed shift was a structural change from carbohydrates to fat and protein. Both sexes showed decrease in carbohydrate-derived energy (p<0.05). Proportion of fat-derived energy increased in female adolescents. Proportion of protein-derived energy increased in male adolescents, as well as in the low and high urbanicity groups (p<0.01). CONCLUSIONS This suggests Chinese adolescents are transitioning to a low carbohydrate diet. Urbanicity appears to play a role in sodium, potassium and protein intake. Improvements of sodiumpotassium ratios are primarily due to decreased sodium intake and require further reduction efforts.
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Affiliation(s)
- Alice Yunzi L Yu
- Department of Nutrition, University of North Carolina at Chapel Hill, USA
| | - Nancy López-Olmedo
- Department of Nutrition, University of North Carolina at Chapel Hill, USA
| | - Barry M Popkin
- Department of Nutrition, University of North Carolina at Chapel Hill, USA.
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