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Villar M, García MCY, Ocampo MB, Gómez G. Intake and food sources of sodium in the population residing in urban areas of Ecuador: results from ELANS study. Glob Health Action 2023; 16:2156110. [PMID: 36601889 PMCID: PMC9828780 DOI: 10.1080/16549716.2022.2156110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND In 2021, WHO notes that globally, 32% of annual deaths worldwide are due to cardiovascular causes, which have been attributed to excessive sodium intake, and therefore recommends a reduction in salt intake to less than 5 g/day. Ecuador does not have data on sodium consumption in the population. Hence, this study sought to determine the association between sodium consumption and sociodemographic variables in subjects living in urban areas of Ecuador. OBJECTIVES Determine the main dietary sources of sodium in subjects living in urban areas of the Coast and Highlands of Ecuador, and the association between sodium intake and sociodemographic variables such as: sex, region, marital status, socio-economic and educational level of this population. METHODS Sodium intake was studied in 800 subjects of both sexes aged 15 to 65 years living in urban areas in Ecuador, originating from the Latin American Nutrition and Health Study (ELANS) between 2014 and 2015. Data were obtained through two 24-hour recalls, and were accessed according to sex, region, age, marital status, socio-economic and educational levels. RESULTS The mean sodium intake was 4900 mg/day (SD ± 1188.32 mg/day), and both sexes exceeded the recommendations. Adjusting for energy intake, sodium consumption is higher in participants aged 50-65 years, from low socio-economic status and with basic education level. A positive relationship was found between sodium and energy intake. Around 48% of the sodium sources included the spices, condiments and herbs group. Within this group, salt itself constitutes 99% of sodium sources. CONCLUSIONS The Ecuadorian population consumes more than double the sodium recommendations, which vary according to gender and age. The first source of sodium is salt itself, which is part of spices and condiments food group. This data is important to formulate public health policies and interventions in Ecuador, especially in the population at risk.
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Affiliation(s)
- Mónica Villar
- Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, Ecuador,CONTACT Mónica Villar Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito17-1200-841, Ecuador
| | | | - María Belén Ocampo
- Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, Ecuador
| | - Georgina Gómez
- Department of Biochemistry, School of Medicine, Universidad de Costa Rica, San José, Costa Rica
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Petermann-Rocha F, Diaz-Toro F, Troncoso-Pantoja C, Martínez-Sanguinetti MA, Leiva-Ordoñez AM, Nazar G, Concha-Cisternas Y, Díaz Martínez X, Lanuza F, Carrasco-Marín F, Martorell M, Ramírez-Alarcón K, Labraña AM, Parra-Soto S, Villagran M, Lasserre-Laso N, Cigarroa I, Mardones L, Vásquez-Gómez J, Celis-Morales CA. Association between a lifestyle score and all-cause mortality: a prospective analysis of the Chilean National Health Survey 2009-2010. Public Health Nutr 2023; 27:e9. [PMID: 38053402 PMCID: PMC10830369 DOI: 10.1017/s1368980023002598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 10/16/2023] [Accepted: 11/23/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVE To investigate the association between a lifestyle score and all-cause mortality in the Chilean population. DESIGN Prospective study. SETTINGS The score was based on seven modifiable behaviours: salt intake, fruit and vegetable intake, alcohol consumption, sleep duration, smoking, physical activity and sedentary behaviours. 1-point was assigned for each healthy recommendation. Points were summed to create an unweighted score from 0 (less healthy) to 7 (healthiest). According to their score, participants were then classified into: less healthy (0-2 points), moderately healthy (3-4 points) and the healthiest (5-7 points). Associations between the categories of lifestyle score and all-cause mortality were investigated using Cox proportional hazard models adjusted for confounders. Nonlinear associations were also investigated. PARTICIPANTS 2706 participants from the Chilean National Health Survey 2009-2010. RESULTS After a median follow-up of 10·9 years, 286 (10·6 %) participants died. In the maximally adjusted model, and compared with the healthiest participants, those less healthy had 2·55 (95 % CI 1·75, 3·71) times higher mortality risk due to any cause. Similar trends were identified for the moderately healthy group. Moreover, there was a significant trend towards increasing the mortality risk when increasing unhealthy behaviours (hazard ratio model 3: 1·61 (95 % CI 1·34, 1·94)). There was no evidence of nonlinearity between the lifestyle score and all-cause mortality. CONCLUSION Individuals in the less healthy lifestyle category had higher mortality risk than the healthiest group. Therefore, public health strategies should be implemented to promote adherence to a healthy lifestyle across the Chilean population.
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Affiliation(s)
- Fanny Petermann-Rocha
- Centro de Investigación Biomédica, Facultad de Medicina, Universidad Diego Portales, Santiago, Chile
| | - Felipe Diaz-Toro
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- Facultad de Enfermería, Universidad Andres Bello, Santiago7550196, Chile
| | - Claudia Troncoso-Pantoja
- Centro de Investigación en Educación y Desarrollo (CIEDE-UCSC), Departamento de Salud Pública, Facultad de Medicina, Universidad Católica de la Santísima Concepción, Concepción, Chile
| | | | - Ana María Leiva-Ordoñez
- Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - Gabriela Nazar
- Departamento de Psicología, Facultad de Ciencias Sociales, Universidad de Concepción, Concepción, Chile
- Centro de Vida Saludable, Universidad de Concepción, Concepción, Chile
| | - Yeny Concha-Cisternas
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Talca, Chile
- Pedagogía en Educación Física, Facultad de Educación, Universidad Autónoma de Chile, Talca, Chile
| | - Ximena Díaz Martínez
- Departamento de Ciencias de la Educación, Grupo calidad de Vida en diferentes Poblaciones, Universidad del Biobio, Chillán, Chile
| | - Fabian Lanuza
- Departamento de Procesos Diagnósticos y Evaluación, Facultad de Ciencias de la Salud, Universidad Católica de Temuco, Temuco4813302, Chile
| | - Fernanda Carrasco-Marín
- Centro de Vida Saludable, Universidad de Concepción, Concepción, Chile
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Departamento de Enfermería, Farmacología y Fisioterapia, Facultad de Medicina y Enfermería, Universidad de Córdoba, Córdoba, España
| | - Miquel Martorell
- Centro de Vida Saludable, Universidad de Concepción, Concepción, Chile
- Departamento de Nutrición y Dietética, Facultad de Farmacia, Universidad de Concepción, Concepción, Chile
| | - Karina Ramírez-Alarcón
- Centro de Investigación Biomédica, Facultad de Medicina, Universidad Diego Portales, Santiago, Chile
- Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - Ana María Labraña
- Departamento de Nutrición y Dietética, Facultad de Farmacia, Universidad de Concepción, Concepción, Chile
| | - Solange Parra-Soto
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Departamento de Nutrición y Salud Pública, Facultad Ciencias de la Salud y de los Alimentos, Universidad del Bío-Bío, Chillán3780000, Chile
| | - Marcelo Villagran
- Laboratorio de Ciencias Biomédicas, Facultad de Medicina, Universidad Católica de la Santísima Concepción, Concepción, Chile
| | - Nicole Lasserre-Laso
- Escuela de Nutrición y Dietética, Facultad de Salud, Universidad Santo Tomás, Los Ángeles, Chile
| | - Igor Cigarroa
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Los Ángeles 4440000, Chile
| | - Lorena Mardones
- Laboratorio de Ciencias Biomédicas, Facultad de Medicina, Universidad Católica de la Santísima Concepción, Concepción, Chile
- Centro de Biodiversidad y Ambientes Sustentables (CIBAS) Universidad Católica de la Santísima Concepción, Concepción, Chile
| | - Jaime Vásquez-Gómez
- Centro de Investigación de Estudios Avanzados del Maule (CIEAM), Laboratorio de Rendimiento Humano, Universidad Católica del Maule, Talca, Chile
| | - Carlos A Celis-Morales
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Human Performance Lab, Education, Physical Activity and Health Research Unit, Universidad Católica del Maule, Talca, 3466706, Chile
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Lee J, Sohn C, Kim OY, Lee YM, Yoon MO, Lee M. The association between dietary sodium intake and obesity in adults by sodium intake assessment methods: a review of systematic reviews and re-meta-analysis. Nutr Res Pract 2023; 17:175-191. [PMID: 37009133 PMCID: PMC10042719 DOI: 10.4162/nrp.2023.17.2.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 12/22/2022] [Accepted: 01/17/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND/OBJECTIVES The scientific evidence of a sodium-obesity association is limited by sodium intake assessments. Our specific aim is to synthesize the association between dietary sodium intake and obesity across the sodium intake assessments as evidenced by systematic reviews in adults. SUBJECTS/METHODS A systematic search identified systematic reviews comparing the association of dietary sodium intakes with obesity-related outcomes such as body mass index (BMI), body weight, waist circumference, and risk of (abdominal) obesity. We searched PubMed on October 24, 2022. To assess the Risk of Bias in Systematic Reviews (ROBIS), we employed the ROBIS tool. RESULTS This review included 3 systematic reviews, consisting of 39 unique observational studies (35 cross-sectional studies and 4 longitudinal studies) and 15 randomized controlled trials (RCTs). We found consistently positive associations between dietary sodium intake and obesity-related outcomes in cross-sectional studies. Studies that used 24-h urine collection indicated a greater BMI for those with higher sodium intake (mean difference = 2.27 kg/m2; 95% confidence interval [CI], 1.59-2.51; P < 0.001; I2 = 77%) compared to studies that used spot urine (mean difference = 1.34 kg/m2; 95% CI, 1.13-1.55; P < 0.001; I2 = 95%) and dietary methods (mean difference = 0.85 kg/m2; 95% CI, 0.1-1.51; P < 0.05; I2 = 95%). CONCLUSIONS Quantitative synthesis of the systematic reviews has shown that cross-sectional associations between dietary sodium intake and obesity outcomes were substantially different across the sodium intake assessments. We need more high-quality prospective cohort studies and RCTs using 24-h urine collection to examine the causal effects of sodium intake on obesity.
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Affiliation(s)
- Jounghee Lee
- Department of Food and Nutrition, Kunsan National University, Gunsan 54150, Korea
| | - Cheongmin Sohn
- Department of Food and Nutrition, Wonkwang University, Iksan 54538, Korea
| | - Oh-Yoen Kim
- Department of Food Science and Nutrition, Dong-A University, Busan 49315, Korea
| | - Young-Min Lee
- Department of Practical Science Education, Gyeongin National University of Education, Incheon 21044, Korea
| | - Mi Ock Yoon
- Nutrition Information Center, Korean Nutrition Society, Seoul 04376, Korea
| | - Myoungsook Lee
- Department of Food and Nutrition, School of Bio-Health Convergence, Health & Wellness College, Sungshin Women’s University, Seoul 01133, Korea
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Wang NX, Arcand J, Campbell NRC, Johnson C, Malta D, Petersen K, Rae S, Santos JA, Sivakumar B, Thout SR, McLean R. The World Hypertension League Science of Salt: a regularly updated systematic review of salt and health outcomes studies (Sept 2019 to Dec 2020). J Hum Hypertens 2022; 36:1048-1058. [PMID: 35688876 PMCID: PMC9734047 DOI: 10.1038/s41371-022-00710-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/05/2022] [Accepted: 05/27/2022] [Indexed: 02/07/2023]
Abstract
The World Hypertension League Science of Salt health outcomes review series highlights high-quality publications relating to salt intake and health outcomes. This review uses a standardised method, outlined in previous reviews and based on methods developed by WHO, to identify and critically appraise published articles on dietary salt intake and health outcomes. We identified 41 articles published between September 2019 to December 2020. Amongst these, two studies met the pre-specified methodological quality criteria for critical appraisal. They were prospective cohort studies and examined physical performance and composite renal outcomes as health outcomes. Both found an association between increased/higher sodium intake and poorer health outcomes. Few studies meet criteria for high-quality methods. This review adds further evidence that dietary salt reduction has health benefits and strengthens evidence relating to health outcomes other than blood pressure and cardiovascular disease. We observe that most studies on dietary sodium do not have adequate methodology to reliably assess sodium intake and its association with health outcomes.
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Affiliation(s)
- Nan Xin Wang
- Department of Preventive and Social Medicine, University of Otago, 18 Frederick St, Dunedin, 9016, New Zealand
| | - JoAnne Arcand
- Faculty of Health Science, Ontario Tech University, Oshawa, ON, Canada
| | - Norm R C Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Claire Johnson
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Daniela Malta
- School of Nutrition, Ryerson University, Toronto, ON, Canada
| | - Kristina Petersen
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, USA
| | - Sarah Rae
- Department of Nutritional Sceinces, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Joseph Alvin Santos
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Bridve Sivakumar
- Faculty of Health Science, Ontario Tech University, Oshawa, ON, Canada
| | | | - Rachael McLean
- Department of Preventive and Social Medicine, University of Otago, 18 Frederick St, Dunedin, 9016, New Zealand.
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Kolahdouz-Mohammadi R, Soltani S, Clayton ZS, Salehi-Abargouei A. Sodium status is associated with type 2 diabetes mellitus: a systematic review and meta-analysis of observational studies. Eur J Nutr 2021; 60:3543-3565. [PMID: 34052916 DOI: 10.1007/s00394-021-02595-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 05/21/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The relationship between sodium intake and the risk of developing type 2 diabetes mellitus (T2DM) is inconsistent. We, therefore, aimed to summarize the current evidence by conducting a systematic review and meta-analysis of observational studies. METHODS We retrieved studies which compared any marker of sodium status between individuals with T2DM and those without diabetes published in any language by searching online databases from inception up to June 2019. Summary effects were derived using random-effects model. RESULTS A total of 44 studies with 503,830 participants from 25 countries were included in this study. Sodium status was significantly different between individuals with and without T2DM (Hedges' g = 0.21; 95% CI 0.02, 0.40; P = 0.029). Individuals with T2DM had higher sodium intake compared to non-diabetic controls (WMD = 621.79 mg/day; 95% CI 321.53, 922.06; P < 0.001) and 24-h urinary excretion was associated with likelihood of developing T2DM (OR = 1.27, 95% CI 1.15, 1.41; P < 0.001). Furthermore, salivary, hair, and platelet sodium were higher in patients with T2DM compared to controls (P < 0.05). CONCLUSION The findings of the current meta-analysis suggest that sodium levels are higher in patients with T2DM compared to non-diabetic controls; however, given that these studies are observational, it is not possible to infer causality.
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Affiliation(s)
- Roya Kolahdouz-Mohammadi
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Sepideh Soltani
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Amin Salehi-Abargouei
- Nutrition and Food Security Research Center, Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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The association between dietary sodium intake, adiposity and sugar-sweetened beverages in children and adults: a systematic review and meta-analysis. Br J Nutr 2020; 126:409-427. [PMID: 33054868 DOI: 10.1017/s0007114520004122] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Higher intakes of Na may contribute to weight gain. The primary aim of this systematic review and meta-analysis was to examine the relationship between dietary Na intake and measures of adiposity in children and adults. Given the previous link between Na intake and the consumption of sugar-sweetened beverages (SSB), which are a known risk factor for obesity, a secondary aim examining the relationship between Na intake and SSB consumption was assessed. A systematic literature search identified cross-sectional and longitudinal studies and randomised controlled trials (RCT) which reduced dietary Na (≥3 months). Meta-analysis was performed for outcomes with ≥3 studies. Cross-sectionally higher Na intakes were associated with overweight/obesity in adults (five studies; n 11 067; OR 1·74; 95 % CI 1·43, 2·13) and in children (three studies; n 3625, OR 3·29; 95 % CI 2·25, 4·80), and abdominal obesity (five studies; n 19 744; OR 2·04; 95 % CI 1·72, 2·42) in adults. Overall, associations remained in sensitivity analyses which adjusted for energy. Findings from longitudinal studies were inconsistent. RCT in adults indicated a trend for lower body weight on reduced-Na compared with control diets (fifteen studies; n 5274; -0·29 kg; 95 % CI -0·59, 0·01; P = 0·06); however, it is unclear if energy intakes were also altered on reduced-Na diets. Among children higher Na intakes were associated with higher intake of SSB (four studies, n 10 329, b = 22, 16 and 26 g/d); no studies were retrieved for adults. Overall, there was a lack of high-quality studies retrieved. While cross-sectional evidence indicates Na intake was positively associated with adiposity, these findings have not been clearly confirmed by longitudinal studies or RCT.
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Carrillo-Larco RM, Bernabe-Ortiz A. Sodium and Salt Consumption in Latin America and the Caribbean: A Systematic-Review and Meta-Analysis of Population-Based Studies and Surveys. Nutrients 2020; 12:nu12020556. [PMID: 32093337 PMCID: PMC7071427 DOI: 10.3390/nu12020556] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/14/2020] [Accepted: 02/18/2020] [Indexed: 02/07/2023] Open
Abstract
Sodium/salt consumption is a risk factor for cardiovascular diseases. Although global targets to reduce salt intake have been established, current levels and trends of sodium consumption in Latin America and the Caribbean (LAC) are unknown. We conducted a systematic review and meta-analysis of population-based studies in which sodium consumption was analyzed based on urine samples (24 h samples or otherwise). The search was conducted in Medline, Embase, Global Health, Scopus and LILACS. From 2350 results, 53 were studied in detail, of which 15 reports were included, providing evidence for 18 studies. Most studies were from Brazil (7/18) and six collected 24 h urine samples. In the random effects meta-analysis, 12 studies (29,875 people) were analyzed since 2010. The pooled mean 24 h estimated sodium consumption was 4.13 g/day (10.49 g/day of salt). When only national surveys were analyzed, the pooled mean was 3.43 g/day (8.71 g/day of salt); when only community studies were analyzed the pooled mean was 4.39 g/day (11.15 g/day of salt). Studies had low risk of bias. The estimated 24 h sodium consumption is more than twice the World Health Organization recommendations since 2010. Regional organizations and governments should strengthen policies and interventions to measure and reduce sodium consumption in LAC.
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Affiliation(s)
- Rodrigo M Carrillo-Larco
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, UK
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Lima 18, Peru
- Centro de Estudios de Población, Universidad Católica los Ángeles de Chimbote (ULADECH-Católica), Chimbote 02804, Peru
- Correspondence:
| | - Antonio Bernabe-Ortiz
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Lima 18, Peru
- Universidad Científica del Sur, Lima 15067, Peru
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Lin Y, Mei Q, Qian X, He T. Salt consumption and the risk of chronic diseases among Chinese adults in Ningbo city. Nutr J 2020; 19:9. [PMID: 31996216 PMCID: PMC6990556 DOI: 10.1186/s12937-020-0521-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 01/07/2020] [Indexed: 12/17/2022] Open
Abstract
Background Chronic diseases have become one of essential public health concerns, leading causes of mortality in China. It is related to the changes in dietary pattern and dietary behavior. The objectives are to assess daily salt intake in Chinese people living in Ningbo and to examine its relationship with health outcomes. Methods Our study used data from health and nutrition survey in 2017. This study included 2811 adults aged 18–79 years (48% males) from urban and rural areas in Ningbo. A food frequency questionnaire together with demographic, physical and medical questionnaires was used to collect dietary intake, demographic, lifestyle and medical information. Ordinal logistic regression was used in the statistical analysis. Results The mean daily salt intake (13.0 g/day) of the participants was higher than the Chinese dietary reference intake (DRI, 6 g/d), which was related to higher risk of pre-hypertension and hypertension. Stratified by gender, education and lifestyle factors, daily salt intake was only significant in the blood pressure category (male: P = 0.048; less education: P = 0.003; urban: P = 0.006; no regular physical activity: P = 0.005, no regular smoking: P = 0.006). Ordinal logistic regression model shows that daily salt intake was significantly associated with higher odds of developing hypertension. Conclusion The daily salt intake of the majority of citizens living in Ningbo exceeded Chinese DRI and may increase the risk of hypertension. Moreover, public health intervention of salt restriction is necessarily needed for the prevention and control the ongoing epidemic of chronic diseases.
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Affiliation(s)
- Yi Lin
- Center for Health Economics, School of Economics, Faculty of Humanities and Social Sciences, University of Nottingham, Ningbo China, 199 Taikang East Road, University Park, Ningbo, 315100, China
| | - Qiuhong Mei
- Department of Health and Education, Ningbo Municipal Center for Disease Control and Prevention, 237 Yongfeng Road, Ningbo, 315010, China
| | - Xujun Qian
- Departmentof Health and Management, Ningbo First Hospital, 59 Liuting Street, Ningbo, 315010, China
| | - Tianfeng He
- Department of Health and Education, Ningbo Municipal Center for Disease Control and Prevention, 237 Yongfeng Road, Ningbo, 315010, China.
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