Association between dietary patterns and prediabetes risk in a middle-aged Chinese population

Dietary mineral patterns are associated with the pre-diabetes regression and progression: the Tehran lipid and glucose study (TLGS)

AIM

We investigated the potential association between dietary mineral patterns and longitudinal change of glycemic status among individuals with prediabetes (Pre-DM).

METHODS

This study included 1456 individuals with Pre-DM (mean age of 47.2 ± 12.8, and 52.5% men) who participated in the third (2006-2008) and fourth (2009-2011) examinations of the Tehran Lipid and Glucose Study (TLGS) that followed up until 2015-2017. The participants' habitual dietary intakes of minerals were assessed using a semi-quantitative food frequency questionnaire (FFQ) at baseline. Principle factor analysis (PCA) identified three major mineral patterns (with a total variance of 92.3%), including multi-mineral (MM) (characterized by higher loads of phosphorous, zinc, calcium, magnesium, and copper), chromium-selenium (Cr-Se), and iron-manganese (Fe-Mn) patterns. Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of developing type 2 diabetes (T2D) and regression to normal glucose regulation (NGR) across tertile categories of mineral patterns score.

RESULTS

After a median follow-up of 5.8 years, the incidence rates of T2D and NGR was 23.8% and 46.8%, respectively. After adjustment of T2D risk score (i.e., composed of age, sex, family history of diabetes, history of gestational diabetes, body mass index, and physical activity level) and dietary confounders, Cr-Se and Fe-Mn patterns were associated with an increased chance of returning to NGR by 26% (HR = 1.26, 95% CI = 1.02-1.55) and 42% (HR = 1.42, 95% CI = 1.14-1.76), respectively. Fe-Mn pattern was also associated with a reduced risk of developing T2D (HR = 0.67, 95% CI = 0.49-0.92).

CONCLUSION

Our findings emphasize the potential benefits of dietary Fe-Mn and Cr-Se intakes in pre-diabetic individuals.

Exploring the traditional Chinese diet and its association with health status-a systematic review

CONTEXT

Increased adherence to a traditional Chinese diet (TCD) could reduce the increasing prevalence of noncommunicable diseases. Currently, there is no consistent definition of the TCD in the literature, and its associations with health outcomes have not yet been identified.

OBJECTIVE

This systematic review aimed to assess the definition of the TCD, in the literature, and to evaluate whether the TCD, as described, is associated with health outcomes.

DATA SOURCES

Fourteen databases were searched up to April 25, 2022.

DATA EXTRACTION

Three reviewers (in pairs) independently screened and extracted data. A modified risk-of-bias tool was used to assess the quality of the studies assessing the TCD definition; the Newcastle-Ottawa Scale and the Cochrane Risk-of-Bias tool were used to assess the quality of the observational studies and randomized controlled trials assessing associations between the TCD and health outcomes.

DATA ANALYSIS

Ninety-nine studies were identified that assessed the TCD definition. In at least 75% of the studies, rice and leafy vegetables were consistently reported as food groups that characterize the TCD; the most frequently cited food items were white rice, spinach, bokchoy, and cabbage. Fish and seafood, pork, and pork products were consistently reported in studies exclusively referring to the TCD consumed in southern China (n = 21 studies), whereas wheat and wheat products were commonly reported in studies focusing on northern China (n = 14 studies). Fifteen studies reported on the quantities of food groups that are characteristic of the TCD, but their findings were inconsistent. Of the 99 studies, 54 assessed associations with health outcomes. The TCD was overall inversely associated with obesity risk and weight gain, while relationships between the TCD and other health outcomes were inconsistent.

CONCLUSION

Further studies are needed to determine the quantities of foods consumed in the TCD and to establish a consistent definition for further exploration of the TCD's potential role in preventing non-communicable diseases.

Uncovering a New Concept of Foodnality in Diet Recommendations for Chinese Aging Populations Based on Systematic and Bibliometric Review

China is grappling with significant aging challenge, and food patterns play an important role in the health of aging populations. A comprehensive bibliometric analysis with regard to systematically examined population-based studies published between 1 June 2014 and 31 May 2024, and 83 eligible studies, including 43 cross-sectional, 34 longitudinal, and 6 case-control studies, was conducted to investigate the correlations among foods, dietary patterns, and healthy aging concepts. An interesting conclusion from cohort studies was that foods recommended for intake in certain diets might not be recommended in other diets, i.e., food items in various diets showed different contributions. This dual character of foods exhibited in the diet is termed foodnality, a new concept proposed in this study. Foodnality was partially related to the origins, quality, and processing of foods, as well as individual physical status. Therefore, recommended foods with positive foodnality and unrecommended foods with negative foodnality were summarized, and four-dimensional diet recommendations were further proposed, including choosing a suitable dietary pattern, evaluating positive foodnality, upgrading foodnality to a premium diet, and cultivating healthier dietary concepts. This review plays a pivotal role in evaluating the guidelines on food intake and dietary patterns among elderly residents in China.

Heterogeneity in diet-related non-communicable disease risks in a Chinese population

PURPOSE

Sub-optimal food choices contribute to the risk of multiple non-communicable diseases (NCDs) which can be mitigated by improving diet quality. Food consumption patterns may partly account for variation of NCD risks in population subgroups in China. This study aimed to evaluate the risk of diet-related NCDs of observed Chinese diets, and to assess the potential reduction in NCD risks by adhering to certain diet recommendations.

METHODS

Dose-response meta-analyses were used to derive relative risks between three diet-related NCDs and consumption of 15 food groups. 24-h dietary recall data of 12,809 adults from the 2011 China Health and Nutrition Survey were used to estimate the diet-related summed risks (SRs) of NCDs. Twelve Chinese provinces were aggregated into five regions, and stratified by age, gender, overweight status, education, income, and urbanicity. The Chinese Dietary Guideline-2016 (CDG-2016) and the EAT-Lancet diet were used as recommended diets.

RESULTS

Associations between SRs and gender, age, educational level, income level, and urbanicity were observed. No association was found between SRs and overweight status. Both diet recommendations have lower SRs compared to observed diets among all regions. The food groups that contributed most to the variation of the SRs of diet-related NCDs in China were high consumption of red meat and refined grains, and low consumption of whole grains, fruits, and legumes.

CONCLUSION

To address the heterogeneity in diet-related NCD risks, focusing on region-specific dietary practical is imperative for Chinese population, in order to propose tailored guidance to adhere to diet recommendations.

Investigating the Effects of Gossypetin on Cardiovascular Function in Diet-Induced Pre-Diabetic Male Sprague Dawley Rats

Gossypetin (GTIN) is a naturally occurring flavonoid recognised for its pharmacological properties. This study examined the effects of GTIN on cardiovascular function in a diet-induced pre-diabetic rat model, which has not been previously studied. Pre-diabetes was induced using a high-fat high-carbohydrate (HFHC) diet supplemented with 15% fructose water for 20 weeks. Thereafter, the pre-diabetic animals were sub-divided into five groups (n = 6), where they were either orally treated with GTIN (15 mg/kg) or metformin (MET) (500 mg/kg), both in the presence and absence of dietary intervention for 12 weeks. The results demonstrated that the pre-diabetic (PD) control group exhibited significantly higher plasma triglyceride, total cholesterol, low-density lipoprotein and very low-density lipoprotein levels, along with decreased high-density lipoprotein (HDL) levels in comparison to the non-pre-diabetic (NPD) group. This was accompanied by significantly higher mean arterial pressure (MAP), body mass index (BMI), waist circumference (WC) and plasma endothelial nitric oxide (eNOS) levels in PD control. Additionally, there were increased heart malondialdehyde levels, reduced heart superoxide dismutase and glutathione peroxidase activity as well as increased plasma interleukin-6, tumour necrosis factor alpha and c-reactive protein levels present in the PD control group. Notably, both GTIN-treated groups showed significantly reduced plasma lipid levels and increased HDL, as well as decreases in MAP, BMI, WC and eNOS levels in comparison to PD control. Additionally, GTIN significantly decreased heart lipid peroxidation, enhanced antioxidant activity and decreased plasma inflammation markers. These findings may suggest that GTIN administration in both the presence and absence of dietary intervention may offer therapeutic potential in ameliorating cardiovascular disturbances associated with the PD state. However, future studies are needed to determine the physiological mechanisms by which GTIN improves cardiovascular function in the PD state.

A nomogram model for predicting 5-year risk of prediabetes in Chinese adults

Early identification is crucial to effectively intervene in individuals at high risk of developing pre-diabetes. This study aimed to create a personalized nomogram to determine the 5-year risk of pre-diabetes among Chinese adults. This retrospective cohort study included 184,188 participants without prediabetes at baseline. Training cohorts (92,177) and validation cohorts (92,011) were randomly assigned (92,011). We compared five prediction models on the training cohorts: full cox proportional hazards model, stepwise cox proportional hazards model, multivariable fractional polynomials (MFP), machine learning, and least absolute shrinkage and selection operator (LASSO) models. At the same time, we validated the above five models on the validation set. And we chose the LASSO model as the final risk prediction model for prediabetes. We presented the model with a nomogram. The model's performance was evaluated in terms of its discriminative ability, clinical utility, and calibration using the area under the receiver operating characteristic (ROC) curve, decision curve analysis, and calibration analysis on the training cohorts. Simultaneously, we also evaluated the above nomogram on the validation set. The 5-year incidence of prediabetes was 10.70% and 10.69% in the training and validation cohort, respectively. We developed a simple nomogram that predicted the risk of prediabetes by using the parameters of age, body mass index (BMI), fasting plasma glucose (FBG), triglycerides (TG), systolic blood pressure (SBP), and serum creatinine (Scr). The nomogram's area under the receiver operating characteristic curve (AUC) was 0.7341 (95% CI 0.7290-0.7392) for the training cohort and 0.7336 (95% CI 0.7285-0.7387) for the validation cohort, indicating good discriminative ability. The calibration curve showed a perfect fit between the predicted prediabetes risk and the observed prediabetes risk. An analysis of the decision curve presented the clinical application of the nomogram, with alternative threshold probability spectrums being presented as well. A personalized prediabetes prediction nomogram was developed and validated among Chinese adults, identifying high-risk individuals. Doctors and others can easily and efficiently use our prediabetes prediction model when assessing prediabetes risk.

The Associations of Vitamin D Level with Metabolic Syndrome and Its Components Among Adult Population: Evidence from National Health and Nutrition Examination Survey 2017-2018

Background and Purpose: Vitamin D can both stimulate and inhibit adipogenesis, indicating that associations of the vitamin D level with some metabolic disorders may be nonlinear. This cross-sectional study aims to explore potential nonlinear associations of the 25-hydroxy vitamin D [25(OH)D] level with metabolic syndrome (MetS) and its components. Methods: Adults without previously diagnosed specific noncommunicable disease were selected from the National Health and Nutrition Examination Survey 2017-2018 (n = 870). Their demographic, physical, and laboratory data were obtained. The associations of serum 25(OH)D with MetS and its components were analyzed using logistic regression. Restricted cubic spline was applied to flexibly model the nonlinear association if the nonlinearity test was statistically significant. Results: The 25(OH)D level was inversely associated with risk of MetS [adjusted odds ratio (OR) = 0.986; 95% confidence interval (CI) = 0.978-0.993] and most MetS components, but not with the risk of raised triglycerides (adjusted OR = 0.996; 95% CI = 0.988-1.005). The association of serum 25(OH)D with central obesity risk was significantly nonlinear (P for the nonlinearity test: 0.037). The OR for risk of central obesity decreased rapidly with increase in serum 25(OH)D concentration until the concentration reached 50 nmol/L, and then, the intensity of decrease in OR slowed down. Conclusions: Vitamin D is inversely associated with MetS, but not all MetS components. A nonlinear association between the vitamin D level and risk of central obesity has been found for the first time among the adult population, which reflects the complex roles of vitamin D in lipid metabolism. Although vitamin D deficiency (<50 nmol/L) was defined to avoid abnormal calcium and phosphorus metabolism, preventing its deficiency may also be beneficial for reduction of central obesity risk.

Promoting healthy cooking patterns in China: Analysis of consumer clusters and the evolution of cooking pattern trends

Cooking methods can change the composition of foods and have important effects on human health. The Chinese people have developed many distinct and unique cooking methods. However, the daily cooking patterns of Chinese people and the characteristics and evolution of trends in cooking patterns commonly used by Chinese consumers remain unclear. The objective of this study was to identify the major cooking patterns and discuss their effects on human health, as well as to identify the cooking pattern consumer clusters and the evolution of trends in Chinese consumer cooking patterns. From March to June 2021, this study interviewed 4,710 residents in Eastern China regarding the consumption frequency of each cooking method when food is prepared at home or when eating out. Exploratory factor analysis, K-Means cluster analysis, Chi-square test, pairwise comparisons of multiple sample rates, and multivariate linear regression were used to identify the cooking patterns and cooking pattern consumer clusters, to assess differences in consumption preferences between consumer clusters, and to examine the relationship between demographic characteristic variables and different cooking patterns. Results revealed three major cooking patterns, namely traditional Chinese (cooking methods with native Chinese characteristics), bland, and high-temperature cooking patterns, as well as seven cooking pattern consumer clusters and their demographic characteristics in the Eastern Chinese population. With increases in age, education level, and income, consumers tended to choose the healthy "Bland" cooking pattern. Further, there was a higher proportion of people aged 36-65 years in the C3 cluster, which is characterized by the "Bland" cooking pattern. However, participants who were male and younger made fewer healthy choices in their cooking patterns. Specifically, a higher proportion of participants aged 21-35 years were found in the C5 cluster, which is characterized by the unhealthy "High-temperature" cooking pattern. Therefore, culinary health education should focus on individuals who are male and young. Specifically, the shift in cooking patterns among people aged 21-35 years should receive special attention.

The association of prediabetes with dietary patterns, life behavior and cardiovascular risk factors among adult population without previously diagnosed non-communicable diseases

BACKGROUND AND AIMS

Prediabetes and its risk factors are difficult to recognize because there may be no clear symptoms in that stage of diabetes mellitus (DM) progression. This cross-sectional study aims to examine associations between prediabetes and potential risk factors among adult population without previously diagnosed non-communicable diseases.

METHODS AND RESULTS

Study participants (n = 30823) were selected all over China. Their dietary, life behavior and laboratory data were obtained through questionnaires, physical examination or biochemical measurement. Factor analysis was applied to identify dietary patterns. Non-proportional odds model was applied to analyze associations between those data and stages of DM progression. The prevalence of prediabetes and DM was 20.6% and 4.5%, respectively. Two dietary patterns were identified: the first pattern was characterized by high consumption of diverse plant- and animal-based food items, and the second pattern was characterized by high consumption of starchy food items. The risk of prediabetes was inversely associated with sufficient sleep duration (OR: 0.939, 95% CI: 0.888-0.993) and the second pattern (OR: 0.882, 95% CI: 0.850-0.914), but not significantly associated with the first pattern (OR: 1.030, 95% CI: 0.995-1.067). High density lipoprotein cholesterol was inversely associated with DM risk (OR: 0.811, 95% CI: 0.667-0.986) but not prediabetes (OR: 1.035, 95% CI: 0.942-1.137).

CONCLUSIONS

The prevalence of undetected prediabetes was high among adult population, and some factors may exert different effects on different stages of DM progression. Dietary diversity, which was reflected by the first pattern to a certain extent, may be not significantly associated with risk of prediabetes.

Dietary patterns and diabetes mellitus among people living with and without HIV: a cross-sectional study in Tanzania

Background

Due to the complexity of human diets, it is difficult to relate single foods to health outcomes. We aimed to identify the dietary patterns and associated factors and to assess the association of dietary patterns with prediabetes/diabetes among adults living with and without HIV in Tanzania.

Methods

Diet data were collected by a food frequency questionnaire (FFQ) and dietary patterns were derived by principal component analysis (PCA) and reduced rank regression (RRR). The associations between dietary patterns and associated factors as well as with prediabetes/diabetes were assessed using multinomial logistic regression and presented by marginal plots.

Results

Of 572 recruited, 63% were people living with HIV. The mean (±SD) age was 42.6 (±11.7) years and 60% were females. The PCA identified two major dietary patterns, i.e., vegetable-rich pattern (VRP) and vegetable-poor pattern (VPP) whereas RRR identified one dietary pattern, i.e., carbohydrate-dense pattern (CDP). In comparison to females, males had higher adherence to VPP and CDP, but less to VRP. Higher socioeconomic status was associated with higher adherence to VRP and VPP but low adherence to CDP. Compared to HIV-negative participants, people living with HIV had higher adherence to VRP but less adherence to CDP. Compared to younger people, older people had lower adherence to VPP. High adherence to CDP or VRP was positively associated with prediabetes. Higher adherence to VRP was associated with a borderline decrease in diabetes. No association was observed between VPP with either prediabetes or diabetes.

Conclusion

Our findings suggest that dietary patterns may impact the risk of prediabetes and diabetes differently. Awareness of the health benefits of VRP should be encouraged in the community, especially for men who seem to consume fewer vegetables. Longitudinal studies are needed to explore the contribution of dietary patterns to prediabetes/diabetes development in sub-Saharan Africa.

Dietary pattern scores in relation to pre-diabetes regression to normal glycemia or progression to type 2 diabetes: a 9-year follow-up

BACKGROUND

We aimed to assess potential associations of habitual dietary pattern scores in relation to the risk of pre-diabetes (Pre-DM) progression to type 2 diabetes mellitus (T2DM) or the chance of returning to normal glycemia.

METHODS

This cohort study included 334 Pre-DM individuals (mean age of 49.4 years, and 51.5% men) who participated in the third phase of the Tehran Lipid and Glucose Study (2006-2008) and followed up for a median of 9 years. A validated food frequency questionnaire at baseline assessed usual intakes of the participants. Major dietary patterns were identified using principal component analysis. The DASH score and Mediterranean diet score (MDS) were also calculated. Multinomial logistic regression analysis was used to estimate the odds ratios (95% confidence intervals (CIs)) of developing T2DM and returning to normal glycemia in relation to dietary pattern scores.

RESULTS

During the study follow-up, 39.8% progressed to T2DM, and 39.8% returned to normal glycemia. Three following major dietary patterns, including Western-style (with a higher load of red meats, hydrogenated fats, sodium, and total fat intakes), healthy pattern (with a higher load of whole grains, vegetables, and dairy products), and processed-foods pattern (with a higher load of processed-meats, fast-foods, salty snakes, and sweets and candies) were identified. The Western-style dietary pattern increased the risk of progressing to T2DM by 38% (OR = 1.38; 95% CI = 1.00 to 1.89, P = 0.050). Other dietary pattern scores were not related to regression or progression from Pre-DM.

CONCLUSION

The Western-style dietary pattern (characterized by higher load of red meats, hydrogenated fats, sodium intake, and high-GI foods) may accelerate the progression of Pre-DM to T2DM.

The Association between Unhealthy Food Consumption and Impaired Glucose Metabolism among Adults with Overweight or Obesity: A Cross-Sectional Analysis of the Indonesian Population

BACKGROUND

It has been shown that dietary patterns are associated with glucose control. However, the association between the types of food consumed and blood glucose in overweight or obese individuals is still unclear. The present study aimed to determine the association between unhealthy food consumption and impaired glucose metabolism in adults with overweight or obesity.

METHODS

The analysis presented in this study was based on the data from a population-based, cross-sectional, nationally representative survey (Indonesian Basic Health Research 2018/RISKESDAS 2018). The body mass index (BMI) was calculated as weight (kg)/height squared (m²) and was determined based on the World Health Organization (WHO) criteria for the Asian population. A validated questionnaire and food card were used to assess the diet. Fasting plasma glucose and 2-hpost-prandial glucose were employed to determine blood glucose markers.

RESULTS

In total, 8752 adults with overweight or obesity were included in this analysis. We found that consumption of sweet, grilled, and processed foods was associated with impaired fasting plasma glucose (IFG) before and after adjustment (p < 0.05). Consumption of high-fat foods was also associated with impaired glucose tolerance (IGT) for all models tested (p < 0.05). Furthermore, all models showed a link between processed food consumption and combined glucose intolerance (CGI) (p ≤ 0.001).

CONCLUSIONS

Differential food group consumption was associated with IFG, IGT, and CGI in Indonesian adults who were overweight or obese.

Observation on clinical effect of Huoxue-Jiangtang decoction formula granules in treating prediabetes: a randomized prospective placebo-controlled double-blind trial protocol

Background

Prediabetes is a hypermetabolic syndrome with blood sugar levels falling between the normal and diabetes. People with prediabetes have a significantly increased chances of developing diabetes, cardiovascular and cerebrovascular diseases, tumors, dementia, and other diseases in the future when compared to the healthy population. However, prediabetes is mainly treated based on lifestyle intervention, currently without targeted drug treatment plan. Traditional Chinese medicine (TCM), which has a longstanding experience, has been shown in clinical studies to be effective for the treatment of diabetes and its related complications. Furthermore, different dosage forms such as decoction and granule have developed gradually in clinical application. Preliminary studies have found that Huoxue-Jangtang Decoction (HJD), with good hypoglycemic and lipid-regulating effects, is potentially one of the complementary and alternative treatments for prediabetes. Therefore, this project intends to perform a prospective clinical study to observe the clinical effectiveness of HJD on prediabetes and the consistency of the efficacy of formula granules and the elixation.

Methods

This is a prospective, randomized, double-blind, and placebo-controlled clinical trial. A total of 183 participants are randomly assigned to HJD Formula Granules plus lifestyle intervention, HJD Elixation plus lifestyle intervention, and placebo plus lifestyle intervention. All subjects undergo 1 day of screening before participating in the study, followed by 84 days of drug intervention and observation. During and after treatment, the main outcome measures include fasting blood glucose and 2-hour postprandial blood glucose.

Discussion

This research attempts to verify the clinical efficacy and possible mechanism of HJD in the treatment of prediabetes, and prove the consistency of HJD Formula Granules with HJD Elixation. This study also aims to provide a treatment that is both effective and safe for prediabetic patients.

Trial registration

ClinicalTrials.gov Identifier: ChiCTR2200060813, Registered 12 June 2022.

Identifying Glucose Metabolism Status in Nondiabetic Japanese Adults Using Machine Learning Model with Simple Questionnaire

We aimed to identify the glucose metabolism statuses of nondiabetic Japanese adults using a machine learning model with a questionnaire. In this cross-sectional study, Japanese adults (aged 20–64 years) from Tokyo and surrounding areas were recruited. Participants underwent an oral glucose tolerance test (OGTT) and completed a questionnaire regarding lifestyle and physical characteristics. They were classified into four glycometabolic categories based on the OGTT results: category 1: best glucose metabolism, category 2: low insulin sensitivity, category 3: low insulin secretion, and category 4: combined characteristics of categories 2 and 3. A total of 977 individuals were included; the ratios of participants in categories 1, 2, 3, and 4 were 46%, 21%, 14%, and 19%, respectively. Machine learning models (decision tree, support vector machine, random forest, and XGBoost) were developed for identifying the glycometabolic category using questionnaire responses. Then, the top 10 most important variables in the random forest model were selected, and another random forest model was developed using these variables. Its areas under the receiver operating characteristic curve (AUCs) to classify category 1 and the others, category 2 and the others, category 3 and the others, and category 4 and the others were 0.68 (95% confidence intervals: 0.62–0.75), 0.66 (0.58–0.73), 0.61 (0.51–0.70), and 0.70 (0.62–0.77). For external validation of the model, the same dataset of 452 Japanese adults in Hokkaido was obtained. The AUCs to classify categories 1, 2, 3, and 4 and the others were 0.66 (0.61–0.71), 0.57 (0.51–0.62), 0.60 (0.50–0.69), and 0.64 (0.57–0.71). In conclusion, our model could identify the glucose metabolism status using only 10 factors of lifestyle and physical characteristics. This model may help the larger general population without diabetes to understand their glucose metabolism status and encourage lifestyle improvement to prevent diabetes.

Association between dietary patterns and glycaemic control in a middle-aged Chinese population

OBJECTIVE

The present work was performed to analyse the association of dietary patterns with glycaemic control (Hb A1c < 7 %) in a large group of Chinese adults aged between 45 and 59 years.

DESIGN

Habitual dietary intakes in the preceding 12 months were assessed by well-trained interviewers using a validated semi-quantitative FFQ. Factor analysis with principal component method was used to obtain the dietary patterns, and the associations between dietary patterns and glycaemic control were determined using multivariable logistic regression models. Poor glycaemic control was defined as HbA1c ≥ 7·0.

SETTING

Despite decades of research, data on the relationship between dietary patterns and glycaemic control (HbA1c < 7 %) in China are sparse.

PARTICIPANTS

A total of 1739 participants aged 45-59 years from Hangzhou were included in the final analysis.

RESULTS

Three dietary patterns were ascertained and labelled as traditional southern Chinese, Western and grains-vegetables patterns. After controlling of the possible confounders, participants in the highest quartile of Western pattern scores had greater OR for HbA1c ≥ 7·0 (OR = 1·05; (95 % CI 1·000, 1·095); P = 0·048) than did those in the lowest quartile. Compared with those in the lowest quartile of grains-vegetables pattern, participants in the highest quartile had lower OR for HbA1c ≥ 7·0 (OR = 0·82; (95 % CI 0·720, 0·949); P = 0·038). Besides, no significant relationship between the traditional southern Chinese pattern and HbA1c ≥ 7·0 was observed (P > 0·05).

CONCLUSIONS

This study indicated that the Western pattern was associated with a higher risk, and the grains-vegetables pattern was associated with a lower risk for HbA1c ≥ 7·0. Future prospective studies are needed to confirm our findings.

Stakeholder Network Analysis for Front-of-Pack Labeling in China

Background

Front-of-pack (FoP) labeling on packaged foods is recommended by the World Health Organization (WHO) to reduce diet-related non-communicable diseases, but it has not yet been implemented in China. The introduction of FoP labeling is driven by multiple institutions and stakeholders. This study aimed to identify key institutional actors involved in FoP labeling and describe links between actors to support future FoP labeling policies and programmes in China.

Methods

The Net-Map method was adopted. We conducted Net-map activities with eight participants using face-to-face interviews between November 2020 and May 2021. Participants were asked to identify actors involved in the development and implementation of FoP labeling in China, describe networks among actors according to pre-defined link types (command, dissemination, funding, and technical assistance), and estimate influence of each actor within the FoP labeling landscape. Social network analysis measures of cohesion and centrality were used to describe each network. Gephi software was used for social network analysis and network visualization.

Results

Forty-one unique actors were identified across seven actor categories including government agencies (n = 14), technical support agencies (n = 7), professional associations (n = 10), food industry groups (n = 2), media groups (n = 4), international organizations (n = 3), and a consumer group (n = 1). Weighted influence scores among actors ranged from 0.13 to 3.13. The Department of Food Safety Standards, Risk Surveillance and Assessment of the National Health Commission (DFSSRSA of NHC) was the actor with the highest weighted influence score, followed by the Bureau of Disease Prevention and Control of National Health Commission, Chinese Nutrition Society, and the National Institute for Nutrition and Health of Chinese Center for Disease Control and Prevention. DFSSRSA of NHC played a central role in both command and technical assistance networks. State-owned media had the greatest betweenness and outdegree centrality in the dissemination network. The Chinese Nutrition Society was in the central position and provided funding to diverse actors in the funding network.

Conclusions

A variety of multisectoral actors have an interest in the introduction of FoP labeling policies and programmes. Effectively engaging key actors identified in this study can generate a multisectoral commitment to advance FoP labeling policies and programmes in China.

Associations of Dietary Patterns and Incident Type 2 Diabetes in a Community Population Cohort From Southwest China

Background

The prevalence of type 2 diabetes (T2D) is rising rapidly worldwide, but there are scant empirical data on the association between diet and diabetes in Southwest China.

Methods

In this prospective community-population cohort study from Guizhou Province, China since 2010, 7,023 eligible adults were included. Dietary information was obtained by face-to-face interviews with a semi-quantitative food frequency questionnaire, and dietary patterns were derived by factor analysis. The hazard ratios (HR) and 95% confidence intervals (95% CI) were estimated for the associations between various dietary patterns and incident T2D risk by cox proportional hazard model.

Results

Until 2020, a total of 749 new T2D cases were identified during the average follow-up of 7.05 years and the incidence was 14.75/1,000 person-years. Two main dietary patterns from the food frequency questionnaire were identified by factor analysis, i.e., vegetable-grain pattern and junk food pattern. In the multivariate analysis, 28 and 20% lower risks of T2D were observed at the low intake of junk food pattern (HR: 0.72, 95% CI: 0.61, 0.87) and the high intake of vegetable-grain pattern (HR: 0.80, 95% CI: 0.67, 0.95) after adjustment for potential confounding factors, compared with the medium intake of such patterns, respectively. Positive linear relationships were found between fasting plasma glucose (FPG) at follow-up and its change with junk food pattern, while there were inverse linear associations with vegetable-grain pattern.

Conclusion

Higher adherence to vegetable-grain patterns and lower adherence to junk food patterns significantly lowered T2D incidence among the population in Southwest China. Moving toward a healthier dietary model deserves more attention to develop interventions for the prevention of T2D.

The Prevalence of Diabetes, Prediabetes and Associated Risk Factors in Hangzhou, Zhejiang Province: A Community-Based Cross-Sectional Study

OBJECTIVE

Little information is available on the prevalence and associated risk factors of diabetes and prediabetes in the community located in Hangzhou city, Zhejiang Province, southeast China. This study aims to investigate the prevalence of adult diabetes and prediabetes and their associated risk factors among a community population in Hangzhou.

METHODS

A multistage sampling method was used in this study. Ten communities located in Shangcheng district of Hangzhou city were selected, and 3096 permanent residents (resident for ≥6 months) aged 18 years and above were enrolled into this study. Finally, a total of 2986 participants were included. A questionnaire interview and physical examination were conducted for all participants by trained investigators in a local medical center. Anthropometric measurements covered height, weight, waist circumference (WC) and blood pressure, while the blood tests included fasting blood glucose, an oral glucose tolerance test and fasting lipid profiles. The American Diabetes Association diabetes diagnosis criteria were used to discriminate among normal blood glucose, diabetes and prediabetes. The Rao-Scott adjusted χ ² test and complex sampling design-based unconditional multivariate logistic regression analysis were used to evaluate factors associated with diabetes and prediabetes. Descriptive and inferential statistics were calculated in Stata version 15. P-values <0.05 indicate statistical significance.

RESULTS

The overall prevalence of diabetes was 13.97%, of which 81.54% had prediagnosed diabetes and 18.46% were newly diagnosed with diabetes in the present study. The prevalence of prediabetes was 18.89%. Multivariable logistic regression analysis showed that age, education, once smoking, family history of diabetes, obesity, central obesity and hypertension were factors associated with diabetes, while age, smoking, drinking, central obesity and hypertension were significant factors related to prediabetes.

CONCLUSION

The prevalence of diabetes and prediabetes in adults in Hangzhou city remains high. Interventions aiming to modify risk factors such as drinking, obesity, central obesity and hypertension are urgently required.

Associations of Dietary Patterns and Risk of Hypertension in Southwest China: A Prospective Cohort Study

Empirical data on the association between diet and incident hypertension in Southwest China is lacking. We examined the associations between various dietary patterns and the risk of incident hypertension in this prospective population cohort of Southwest China. A total of 5442 eligible adults were included from Guizhou Province, China, since 2010. Dietary information was obtained using face-to-face interviews with a semi-quantitative food frequency questionnaire, and dietary patterns were characterized using factor analysis. The hazard ratios (HRs) and 95% confidence intervals (95% CIs) were estimated for the associations between various dietary patterns and incident hypertension risk using a Cox proportional hazard model. Until 2020, a total of 1177 new hypertension cases were identified during an average follow-up of 6.97 years. In the multivariable-adjusted analysis, a low intake of the junk food pattern was significantly associated with the reducing risk of incident hypertension (HR: 0.772, 95% CI: 0.671, 0.887) and a high intake of the vegetable-grain pattern statistically lowered the risk of incident hypertension (HR: 0.774, 95% CI: 0.669, 0.894) compared with the medium intake of such patterns. Higher adherence to the vegetable-grain pattern and lower adherence to the junk food pattern significantly lowered the hypertension incidence among the population in Southwest China. Those findings suggested healthy diet guidelines should be developed for the prevention of hypertension.

A Prediction Model for Prediabetes Risk in Middle-Aged and Elderly Populations: A Prospective Cohort Study in China

BACKGROUND

To investigate indicators for prediabetes risk and construct a prediction model for prediabetes incidences in China.

METHODS

In this study, 551 adults aged 40-70 years had normal glucose tolerance (NGT) and normal hemoglobin A1c (HbA1c) levels at baseline. Baseline data including demographic information, anthropometric measurements, and metabolic profile measurements were collected. The associations between possible indicators and prediabetes were assessed by the Cox proportional-hazards model. The predictive values were evaluated by the area under the receiver operating characteristic (ROC) curve (AUC).

RESULTS

During an average of 3.35 years of follow-up, the incidence of prediabetes was found to be 19.96% (n = 110). In the univariate analyses, fasting plasma glucose (FPG), fasting serum insulin (FINS), 2 h plasma glucose (2hPG), HbA1c, serum uric acid (SUA), waist circumference (WC), smoking, and family history of diabetes (FHD) were found to be significantly correlated with prediabetes. In the multivariable analyses, WC (hazard ratio (HR): 1.032; 95% confidence interval (CI): 1.010, 1.053; p = 0.003), FHD (HR: 1.824; 95% CI: 1.250, 2.661; p = 0.002), HbA1c (HR: 1.825; 95% CI: 1.227, 2.714; p = 0.003), and FPG (HR: 2.284; 95% CI: 1.556, 3.352; p < 0.001) were found to be independent risk factors for prediabetes. A model that encompassed WC, FHD, HbA1c, and FPG for predicting prediabetes exhibited the largest discriminative ability (AUC: 0.702).

CONCLUSIONS

WC, FHD, HbA1c, and FPG are independently correlated with the risk of prediabetes. Furthermore, the combination of these predictors enhances the predictive accuracy of prediabetes.