Age, period and cohort effects on adult physical activity levels from 1991 to 2011 in China

Is 70 the new 60? A longitudinal analysis of cohort trends inintrinsic capacity in England and China

To understand how the health of older adults today compares to that of previous generations, we estimated intrinsic capacity and subdomains of cognitive, locomotor, sensory, psychological and vitality capacities in participants of the English Longitudinal Study on Ageing (ELSA) and the China Health and Retirement Longitudinal Study (CHARLS). We applied multilevel growth curve models to examine change over time and cohort trends. We found that more recent cohorts entered older ages with higher levels of capacity, and their subsequent age-related declines were somewhat compressed compared to earlier cohorts. These improvements in capacity were large, with the greatest gains being in the most recent cohorts. For example, a 68-year-old ELSA participant born in 1950 had higher capacity than a 62-year-old born just 10 years earlier. Trends were similar for men and women, and findings were generally consistent across English and Chinese cohorts.

Cancer profiles in China and comparisons with the USA: a comprehensive analysis in the incidence, mortality, survival, staging, and attribution to risk factors

China faces a disproportionate cancer burden to the population size and is undergoing a transition in the cancer spectrum. We extracted data in five aspects of cancer incidence, mortality, survival, staging distributions, and attribution to risk factors in China, the USA and worldwide from open-source databases. We conducted a comprehensive secondary analysis of cancer profiles in China in the above aspects, and compared cancer statistics between China and the USA. A total of 4,546,400 new cancer cases and 2,992,600 deaths occurred in China in 2020, accounting for 25.1% and 30.2% of global cases, respectively. Lifestyle-related cancers including lung cancer, colorectal cancer, and breast cancer showed an upward trend and have been the leading cancer types in China. 41.6% of new cancer cases and 49.3% of cancer deaths occurred in digestive-system cancers in China, and the cancers of esophagus, nasopharynx, liver, and stomach in China accounted for over 40% of global cases. Infection-related cancers showed the highest population-attributable fractions among Chinese adults, and most cancers could be attributed to behavioral and metabolic factors. The proportions of stage I for most cancer types were much higher in the USA than in China, except for esophageal cancer (78.2% vs. 41.1%). The 5-year relative survival rates in China have improved substantially during 2000-2014, whereas survival for most cancer types in the USA was significantly higher than in China, except for upper gastrointestinal cancers. Our findings suggest that although substantial progress has been made in cancer control, especially in digestive system cancers in China, there was still a considerable disparity in cancer burden between China and the USA. More robust policies on risk factors and standardized screening practices are urgently warranted to curb the cancer growth and improve the prognosis for cancer patients.

Maternal Prenatal Depressive Symptoms and Fetal Growth During the Critical Rapid Growth Stage

Importance

Fetal growth in the critical rapid growth stage (CRGS) before delivery, approximately between 30 to 37 gestational weeks, carries significant implications for subsequent overweight, obesity, and arterial health. Previous evidence has demonstrated the association between maternal depressive symptoms and fetal growth trajectories from early to late pregnancy, but there remains limited understanding of the association of these symptoms with the longitudinal fetal growth change within the CRGS.

Objective

To investigate the association between maternal depressive symptoms and fetal growth during the CRGS before delivery.

Design, Setting, and Participants

This prospective birth cohort study was conducted from January 2018 to December 2020. Volunteer pregnant women were enrolled in their first trimester of prenatal visits. Women with severe disease before pregnancy and multiple births, fetuses with congenital anomalies, and preterm or postterm births were excluded. This multicenter study was based in 13 hospitals covering 81 counties across 12 cities in Sichuan Province, China. Follow-up visits were performed at the second trimester, the third trimester, and 24 hours after delivery. The analysis was conducted from January to May 2023.

Exposures

Maternal depressive symptoms, as a continuous variable, measured by the Edinburgh Postpartum Depression Scale (EPDS) at a median gestational week of 24 (range, 14 to 27) weeks of gestation. A higher score on the EPDS indicates worse depressive symptoms.

Main Outcomes and Measures

The main outcomes included ultrasonography-measured biparietal diameter (BPD), femur length (FL), and abdominal circumference (AC), along with calculated estimated fetal weight (EFW). These parameters were evaluated longitudinally at a median gestational week of 30 (range, 28 to 32) and 37 (range, 35 to 39) weeks. Linear mixed models were used to estimate the associations between maternal depressive symptoms and fetal growth parameters.

Results

A total of 2676 mother-offspring dyads were included, in which the mean (SD) age of mothers was 28.0 (4.4) years, and 1294 (48.4%) of the offspring were female. The median (IQR) maternal EPDS score was 5.0 (4.0 to 9.0). After adjustment for confounders, a significant correlation was found between a higher score of depressive symptoms in mothers and a slower rate of fetal growth across FL (β = -0.40; 95% CI, -0.58 to -0.22), AC (β = -1.97; 95% CI, -2.90 to -1.03), and EFW (β = -50.11; 95% CI, -68.46 to -31.75). These associations were stronger in female fetuses or those with better family socioeconomic conditions.

Conclusions and Relevance

In this prospective cohort study, maternal depressive symptoms were associated with slower fetal growth rate in the CRGS before delivery. Early screening for depressive disorders in pregnant women appears to be essential for fetal growth and later health.

Trends in insufficient physical activity among adults in China 2010-18: a population-based study

BACKGROUND

The global prevalence of insufficient physical activity (PA) was reported to be 27.5% in 2016, and there were stable levels of insufficient PA worldwide between 2001 and 2016. The global target of a 10% reduction in insufficient PA by 2025 will not be met if the trends remain. The relevant data for trends in China were still scarce. This study aimed to determine nationwide temporal trends in insufficient PA among adults in China from 2010 to 2018.

METHODS

645 903 adults aged 18 years or older were randomly selected from four nationally representative cross-sectional surveys of the China Chronic Disease and Risk Factor Surveillance conducted in 2010, 2013, 2015, and 2018. PA was measured using the Global Physical Activity Questionnaire. Temporal changes in insufficient PA prevalence and participation of domain-specific moderate- to vigorous-intensity PA (MVPA) were analyzed using logistic regression.

RESULTS

From 2010 to 2018, the age-adjusted prevalence of insufficient PA in China increased from 17.9% (95% confidence interval 16.3% to 19.5%) in 2010 to 22.3% (20.9% to 23.8%) in 2018 (P for trend < 0.001). By age group, with a significant increase in insufficient PA in adults aged 18-34 years (P for trend < 0.001), which rose more rapidly than in adults aged ≥ 35 years (P for interaction < 0.001). Insufficient PA has increased significantly among adults engaged in agriculture-related work, non-manual work, and other manual work (all P for trend < 0.05). And among the occupational groups, those engaged in agriculture-related work had the fastest increase (P for interaction = 0.01). The percentage of adults participating in work-related MVPA decreased from 79.6% (77.8% to 81.5%) to 66.8% (64.9% to 68.7%) along with a decrease in time spent on work-related MVPA, while percentages of adults participating in recreation-related MVPA increased from 14.2% (12.5% to 15.9%) to 17.2% (16.0% to 18.4%) (all P for trend < 0.05).

CONCLUSIONS

Among Chinese adults, an increasing trend was found in insufficient PA from 2010 to 2018, with more than one-fifth of adults failing to achieve the recommendation of adequate PA. More targeted PA promotion strategies should be developed to improve population health.

Environmental correlates of sedentary behaviors and physical activity in Chinese preschool children: A cross-sectional study

OBJECTIVE

This cross-sectional study examined environmental correlates of sedentary behavior (SB) and physical activity (PA) in preschool children in the urban area of Tianjin, China.

METHODS

Data were collected from the Physical Activity and Health in Tianjin Chinese Children study, involving healthy children 3-6 years old and their families. In all children (n = 980), leisure-time SB (LTSB) and leisure-time PA (LTPA) were reported in min/day by parents. In a subgroup (n = 134), overall sedentary time, light PA, and moderate-to-vigorous PA (MVPA) were objectively measured using ActiGraph accelerometry (≥3 days, ≥10 h/day). Environmental correlates were collected using a questionnaire that included home and neighborhood characteristics (e.g., traffic safety, presence of physical activity facilities) and children's behaviors. Potential correlates were identified using linear regression analysis.

RESULTS

Multiple linear regression analysis showed that "having grandparents as primary caregivers" (βs and 95% confidence intervals (95%CIs) for overall sedentary time: 29.7 (2.1-57.2); LTSB (ln): 0.19 (0.11-0.28)) and "having a television (for LTSB (ln): 0.13 (0.00-0.25)) or computer (for LTSB (ln): 0.13 (0.03-0.23)) in the child's bedroom" were both associated with higher SB. Furthermore, "having grandparents as primary caregivers" was associated with less MVPA (β (95%CI): -7.6 (-14.1 to -1.2)), and "active commuting to school by walking" correlated with more MVPA (β (95%CI): 9.8 (2.2-17.4)). The path model showed that "more neighborhood PA facilities close to home" was indirectly related to higher LTPA (ln), which was partly mediated by "outdoor play" (path coefficients (95%CI): 0.005 (0.002-0.008)) and "going to these facilities more often" (path coefficients (95%CI): 0.013 (0.008-0.018)). Traffic safety was not a correlate.

CONCLUSION

Family structure and media exposure in the home maybe important factors in shaping preschoolers' PA patterns. Built environmental correlates could indirectly influence preschoolers' LTPA through parental help with engaging in active behaviors.

The effect of temperature on physical activity: an aggregated timeseries analysis of smartphone users in five major Chinese cities

Background

Physical activity is an important factor in premature mortality reduction, non-communicable disease prevention, and well-being protection. Climate change will alter temperatures globally, with impacts already found on mortality and morbidity. While uncomfortable temperature is often perceived as a barrier to physical activity, the actual impact of temperature on physical activity has been less well studied, particularly in China. This study examined the associations between temperature and objectively measured physical activity among adult populations in five major Chinese cities.

Methods

Aggregated anonymized step count data was obtained between December 2017-2018 for five major Chinese cities: Beijing, Shanghai, Chongqing, Shenzhen, and Hong Kong. The associations of temperature with daily aggregated mean step count were assessed using Generalized Additive Models (GAMs), adjusted for meteorological, air pollution, and time-related variables.

Results

Significant decreases in step counts during periods of high temperatures were found for cold or temperate climate cities (Beijing, Shanghai, and Chongqing), with maximum physical activity occurring between 16 and 19.3 °C. High temperatures were associated with decreases of 800-1500 daily steps compared to optimal temperatures. For cities in subtropical climates (Shenzhen and Hong Kong), non-significant declines were found with high temperatures. Overall, females and the elderly demonstrated lower optimal temperatures for physical activity and larger decreases of step count in warmer temperatures.

Conclusions

As minor reductions in physical activity could consequentially affect health, an increased awareness of temperature’s impact on physical activity is necessary. City-wide adaptations and physical activity interventions should seek ways to sustain physical activity levels in the face of shifting temperatures from climate change.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01285-1.

Effectiveness of a Worksite-Based Lifestyle Intervention on Employees' Obesity Control and Prevention in China: A Group Randomized Experimental Study

Background: This study was to culturally adapt a lifestyle intervention for employees’ obesity control and prevention using a participatory process, and evaluate the effectiveness of the project at worksites. Methods: A group randomized experimental study included four worksites (two intervention, two control) in the Yangtze River Delta in China was conducted. A total of 388 participants (216 in the intervention worksites and 172 in the control worksites) were finally recruited from 955 employees at the four worksites (464 in the intervention worksites and 491 in the control worksites). The final evaluation was completed by two hundred and seventy-eight employees (159 in the intervention worksites and 119 in the control worksites, respectively). Data of demographic information, weight, BMI, waist circumference, hip circumference and weight-related behaviors including diary behaviors and physical activities were collected before and after a 12-month intervention and analyzed using descriptive statistics, t-test, chi-square test, linear mixed regression and logistic mixed regression. Results: Although the intervention worksites had a reduction in body mass index (23.21 to 22.95, p < 0.01), hip circumference (95.97 to 95.28, p = 0.03) and waist-to-height ratio (0.49 to 0.48, p = 0.01), the differential changes compared to those of the control group were not statistically significant. The frequency of sweet beverages (−1.81, 95%CI: −0.52, −3.11), frequency of vegetable intake (5.66, 95%CI: 1.59, 9.74), daily servings of vegetables (0.53, 95%CI: 0.24, 0.82), frequency of fruit intake (3.68, 95%CI: 1.25, 6.12), daily servings of fruit (0.26, 95%CI: 0.44, 0.92), daily servings of vegetables and fruit (0.79, 95%CI: 0.43, 1.16), daily steps (863.19, 95%CI: 161.42, 1564.97) and self-efficacy to change physical activity (OR = 1.91, 95%CI: 1.02,3.60) were more improved in the intervention group than were those measures in the control group. Conclusions: The worksite-based lifestyle intervention project for obesity control and prevention improved several employees’ dietary behaviors and physical activities at worksites in China in a short time. Long-term intervention with larger samples in more worksites should be further examined.

Prevalence, awareness, and associated factors of high blood pressure among female migrant workers in Central South China

BACKGROUND

Although many young Chinese women migrate to urban regions for better opportunities, little is known about the prevalence and awareness of having high blood pressure (HBP) in this population. This study investigated the prevalence, awareness, and factors associated with HBP among young female migrant workers in Central South China.

METHODS

We conducted a cross-sectional study to identify HBP (2017 ACC/AHA guidelines) among female migrant workers aged 18-45 years in Central South China. Demographics, anthropometric measurements, hypertension-related lifestyle, awareness of HBP, and blood pressure were recorded. Logistic regression analysis was used to identify the factors associated with HBP (blood pressure ≥ 130/80 mmHg).

RESULTS

Overall, 232 female migrants participated in the study (mean age 34.4; standard deviation: 6.4 years). The prevalence of HBP was 27.2% (95% CI [21.6-33.2]), and 88.9% of the participants were unaware of their HBP status. Having rural medical insurance (odds ratio [OR] = 20.7; 95% confidence interval 95% CI [2.1-204.8]), awareness of having HBP (OR = 5.1; 95% CI [1.4-18.5]), physical inactivity (OR = 2.9; 95% CI [1.1-7.9]), and being overweight/obese (OR = 2.7; 95% CI [1.3-6.1]) were independently associated with HBP.

CONCLUSIONS

This study revealed a high prevalence of HBP among young Chinese female migrant workers, as well as a high frequency of being unaware of their condition and some associated factors (rural medical insurance, awareness of having HBP, physical inactivity, and overweight/obesity). The uncontrolled HBP among young Chinese female migrant workers suggested that health education needs further promotion in such a population.

Benefits of active commuting on cardiovascular health modified by ambient fine particulate matter in China: A prospective cohort study

BACKGROUND

Active commuting as a contributor to daily physical activity is beneficial for cardiovascular health, but leads to more chances of exposure to ambient air pollution. This study aimed to investigate associations between active commuting to work with cardiovascular disease (CVD), mortality and life expectancy among general Chinese adults, and to further evaluate the modification effect of fine particulate matter (PM2.5) exposure on these associations.

METHODS

We included 76,176 Chinese adults without CVD from three large cohorts of the Prediction for Atherosclerotic Cardiovascular Disease Risk in China project. Information about commuting mode and physical activity were collected by unified questionnaire. Satellite-based PM2.5 concentrations at 1-km spatial resolution was used for estimating PM2.5 exposure of participants. Hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD incidence, mortality and all-cause mortality were estimated using Cox proportional hazards regression models. Multiplicative interaction term of commuting mode and PM2.5 level was tested to investigate potential effect modification.

RESULTS

During 448,499 person-years of follow-up, 2230 CVD events and 2777 all-cause deaths were recorded. Compared with the non-active commuters, the multivariable-adjusted HRs (95% CIs) of CVD incidence and all-cause mortality were 0.95(0.85-1.05) and 0.79(0.72-0.87) for walking commuters, respectively. Corresponding HRs (95% CIs) for cycling commuters were 0.71(0.62-0.82) and 0.67(0.59-0.76). Active commuters over 45 years old were estimated to have more CVD-free years and life expectancy than non-active commuters under lower PM2.5 concentration. However, these beneficial effects of active commuting were alleviated or counteracted by long-term exposure to high PM2.5 concentration. Significant multiplicative interaction of commuting mode and PM2.5 level was showed in all-cause mortality, with the lowest risk observed in cycling participants exposed to lower level of PM2.5.

CONCLUSIONS

Active commuting was associated with lower risk of CVD, all-cause mortality, and longer life expectancy among Chinese adults under ambient settings with lower PM2.5 level. It will be valuable to encourage active commuting among adults and develop stringent strategies on ambient PM2.5 pollution control for prevention of CVD and prolongation of life expectancy.

Epidemiology and determinants of obesity in China

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

A Qualitative Exploration of Patients' Experiences with Lifestyle Changes After Sleeve Gastrectomy in China

PURPOSE

Sleeve gastrectomy (SG) is the most widely used surgical treatment for severe obesity worldwide. Individuals who have undergone SG usually need to change lifestyle behaviors as a response to the anatomical changes imposed by SG, and patients need to sustain lifestyle changes for long-term surgical success. Little is known about how patients experience and manage lifestyle changes following SG. In China, where SG comprises over 70% of bariatric surgical procedures, there have been no reports addressing this issue. This study aimed to describe individuals' experiences related to lifestyle changes after SG in China.

MATERIALS AND METHODS

Semi-structured interviews were conducted at the Shanghai Huashan Hospital in China with adults who had undergone SG between 2012 and 2018. Two independent researchers used an interpretive thematic approach to analyze transcripts for themes and sub-themes.

RESULTS

Interviews (N = 15) revealed three major themes of participants' experiences with postoperative lifestyle changes: advantages outweigh disadvantages; developing self-management strategies (i.e., adopting new behaviors and developing habits, continuing self-monitoring, focusing on health over weight, staying determined); and experiencing culture-specific difficulties in adherence to follow-up visits and lifestyle recommendations.

CONCLUSION

The data from this study provided a rich description of the postoperative experiences of patients in China. Participants reported that surgical benefits supersede the surgery-related side effects, and participants were able to develop self-management strategies in order to achieve success. However, personal and social barriers, such as the challenges of applying postoperative dietary guidelines into daily practice, may impede patients making and sustaining recommended behavioral changes.

Trends in hypertension prevalence, awareness, treatment and control rates among Chinese adults, 1991-2015

OBJECTIVE

The upward trends in the prevalence and control of hypertension in Chinese adults have been described, but recent trends based on the most recent guidelines are unavailable. We examined recent trends in the prevalence, awareness, treatment and control of hypertension among Chinese adults from 1991 to 2015 based on the 2018 Chinese Guideline.

METHODS

A total of 72 452 adults aged 20-79 years from the China Health and Nutrition Survey conducted between 1991 and 2015 were included in the study. Hypertension status and control rate were defined according to the 2018 Chinese Guideline. Age-standardized estimates were calculated based on the age distribution of the WHO standard population.

RESULTS

From 1991 to 2015, the crude/age-standardized hypertension prevalence (14.0/15.3 to 34.1/25.6%), awareness (29.4/24.2 to 43.8/27.2%), treatment (19.2/15.1 to 39.2/23.6%) and control rates (3.5/3.6 to 13.8/8.4%) increased (all P for trend <0.001). The prevalence of hypertension increased at a greater rate in rural regions compared with that in urban regions, whereas the control rate was higher in urban regions than that in rural regions. Compared with middle-aged and older adults aged 40-79 years, young adults aged 20-39 years had a larger increase in the prevalence of hypertension, but the awareness, treatment and control rates in the young adults did not increase.

CONCLUSION

The prevalence of hypertension has increased markedly over the past two decades among Chinese adults, and the awareness, treatment and control rates have increased slightly or moderately and they have remained very low. These data underscore the need for effective measures to prevent hypertension and to increase the control of hypertension in Chinese adults.

Effects of the total physical activity and its changes on incidence, progression, and remission of hypertension

OBJECTIVES

Moderate to vigorous physical activity is recommended to prevent hypertension according to the current guidelines. However, the degree to which the total physical activity (TPA) and its changes benefit normotensives and hypertensives is uncertain. We aimed to examine the effects of TPA and its changes on the incidence, progression, and remission of hypertension in the large-scale prospective cohorts.

METHODS

A total of 73,077 participants (55,101 normotensives and 17,976 hypertensives) were eligible for TPA analyses. During a mean follow-up of 7.16 years (394,038 person-years), 12,211 hypertension cases were identified. TPA was estimated as metabolic equivalents and categorized into quartiles. Cox proportional hazards regression and multivariable logistic regression were used to estimate associations of TPA and changes in TPA with incident hypertension and progression/remission of hypertension.

RESULTS

Compared with the lowest quartile of TPA, normotensives at the third and the highest quartile had a decreased risk of incident hypertension, with hazard ratios (HRs) of 0.86 [95% confidence interval (CI): 0.81-0.91] and 0.81 (95% CI: 0.77-0.86), respectively. Hypertensives at the highest quartile of TPA demonstrated a decreased risk of progression of hypertension [odds ratio (OR) = 0.87, 95% CI: 0.79-0.95], and an increased probability of hypertension remission (OR = 1.17, 95% CI: 1.05-1.29). Moreover, getting active from a sedentary lifestyle during the follow-up period could reduce 25% (HR = 0.75, 95% CI: 0.58-0.96) risk of incident hypertension, whereas those becoming sedentary did not achieve benefit from initially being active.

CONCLUSIONS

Our findings indicated that increasing and maintaining TPA levels could benefit normotensives, whereas higher TPA levels were needed to effectively control progression and improve remission of hypertension. Physical activity played undoubtedly an essential role in both primary and secondary prevention of hypertension.

Are the factors associated with overweight/general obesity and abdominal obesity different depending on menopausal status?

Rapid modernization in China has impacted the daily lives and health of women, including a rise in obesity. However, little is known about the impact of menopausal status, behavior, and psychosocial factors on the risk of obesity for rural women in China. The aim of this study is to identify risk factors, including demographic information (education, family history of T2DM, menopausal status), obesity-related behavior, and psychosocial factors associated with overweight/general obesity and abdominal obesity. In a cross-sectional study design, participants had their weight, height, and waist circumference measured and completed questionnaires regarding family demographics, obesity-related health behaviors (physical activity, diet, sleep), and psychosocial information (stress, social support, and self-efficacy related to physical activity and healthy diet). A total of 646 women were included in this study; 46.6% were overweight/generally obese, and 48% had abdominal obesity. Postmenopausal women had a higher prevalence of general and central obesity. Regular physical activity decreased the risk for overweight/general obesity and abdominal obesity (OR = .41 and .31, respectively, p = .04) in premenopausal women. Postmenopausal women who had not breastfed their infants and reported moderate/high-stress had a higher risk for overweight/general obesity (OR = 3.93, and 2, respectively) and those who reported less than 6 hours of sleep per day increased their risk for abdominal obesity (OR = 2.08). Different factors associated with obesity were found in Chinese women, depending on menopausal status. Future studies should examine the impact of menopause on a woman’s risk for obesity, as well as develop tailored interventions to improve health, well-being and reduce the risk of obesity.

Cancer burden in China: trends, risk factors and prevention

As the most populous country in the world, China has made strides in health promotion in the past few decades. With the aging population, the burden of cancer in China continues to grow. Changes in risk factors for cancer, especially diet, obesity, diabetes, and air pollution, continue to fuel the shift of cancer transition in China. The burden of upper gastrointestinal cancer in China is decreasing, but still heavy. The rising burden of colorectal, prostate, and breast cancers is also significant. Lung cancer became the top cause of cancer-related deaths, together with smoking as the most important contributor to cancer deaths. The Chinese government has taken several approaches to control cancer and cancer-related risk factors. Many achievements have been made, but some challenges remain. Health China 2030 is ambitious and depicts a bright vision of the future for cancer control in China. The decrease in the cancer burden in China will require cross-sector collaboration and coordinated efforts on primary and secondary preventions by governments, public health organizations, and individuals. In this review, we describe the trends of cancer burden and discuss cancer-related risk factors in China, identifying strategies to reduce the burden of cancer in China.

Physical activity and posttraumatic growth in patients receiving maintenance hemodialysis: A prospective study

This study used a prospective design to examine the association between self-reported physical activity and posttraumatic growth (PTG) over a 1-year period among 150 patients receiving maintenance hemodialysis. Transport-related, household, and leisure-time physical activity were positively associated with PTG at baseline and follow-up. Total physical activity could predict higher levels of PTG at follow-up, after controlling for baseline PTG and other covariates. The findings indicate that daily physical activity could be a modifiable behavioral factor associated with PTG among patients receiving maintenance hemodialysis. Further study is needed using a randomized controlled design and objective measures of physical activity.

Prevalence of overweight and obesity in China: Results from a cross-sectional study of 441 thousand adults, 2012-2015

OBJECTIVES

Obesity has become a global health public problem. The study aims to examine the latest prevalence of overweight and obesity in China.

METHODS

Data came from the China Hypertension Survey (CHS), a nationally representative cross-sectional study among residents aged ≥18 years from October 2012 to December 2015. Overweight and obesity were defined as 25≤BMI<30kg/m² and BMI≥30kg/m² according to the WHO classifications, respectively.

RESULTS

The data of 441 306 participants were analyzed. The prevalence of overweight and obesity was 28.1% and 5.2% respectively. The prevalence of overweight and obesity varied considerably across provinces. The prevalence of overweight was the highest in Beijing, which was 2.8 fold of the lowest in Guangxi (40.9% vs. 14.6%). The prevalence of obesity was the highest in Tianjin, which was 9.4 fold of the lowest in Hainan (12.2% vs. 1.3%). There was a striking north-south gradient with the prevalence higher in Northeast and Northwest China and lower in Southeast China. Multivariate logistic regression analysis indicated that sex, age, education, smoking, marital status and family history of cardiovascular disease were significantly associated with overweight and obesity.

CONCLUSIONS

Overweight and obesity are highly prevalent among Chinese adults, and their prevalence varies greatly among different population subgroups and provinces. National and provincial obesity control and prevention strategies should be public health priorities in China.

Decomposing adult obesity trends in China (1991-2011)

Using data from the China Health and Nutrition Survey, this study analyses two decades (1991-2011) of change in adult obesity in China with a focus on whether rising obesity rates result from all population cohorts becoming more obese across time (intra-cohort change) or recent cohorts being more obese than their earlier counterparts (inter-cohort change or cohort replacement). To do so, we decompose changes in the body mass index (BMI), waist circumference (WC), general obesity and abdominal obesity of adults aged 20+ using both Firebaugh's linear decomposition and Das Gupta's non-linear technique. Our analysis not only reveals significant increases in both general and abdominal obesity (8.1 and 32 percentage points, respectively) in the two decades studied but shows that the rising means in all four measures are mostly attributable to intra-cohort change. In fact, contrary to findings for the U.S., inter-cohort change for the Chinese sample is actually negative, implying that cohort replacement attenuates intra-cohort change over time. Given that intra-cohort change is the central force for the increase in BMI, WC and obesity with individual increases in obesity widely distributed across all cohorts and age groups over time, policy interventions should focus more broadly on all age groups and birth cohorts.

Generational differences in longitudinal blood pressure trajectories by geographic region during socioeconomic transitions in China

OBJECTIVES

To examine generational differences in longitudinal blood pressure trajectories by region following socioeconomic transitions, which is important for establishing the population risk of cardiovascular diseases (CVDs).

METHODS

With data from the China Health and Nutrition Survey (1991-2011), we used multilevel growth-curve models to estimate systolic/diastolic blood pressure (SBP/DBP) levels at the mean age and rates of change by cohort (born between 1931 and 1980), region, and sex.

RESULTS

Younger cohorts generally had higher SBP/DBP levels at 44.5 years but lower growth rates in SBP/DBP than older cohorts. They became prehypertensive (SBP ≥ 120 mm Hg or DBP ≥ 80 mm Hg) at an earlier age. The upward shift of SBP/DBP trajectories across cohorts was more pronounced in the Coastal and Southern Mountainous Regions than the Northeastern and Inland Regions, and for males versus females.

CONCLUSIONS

Younger cohorts have a longer lifetime duration of being susceptible to CVDs, posing warnings for an increased burden of CVDs. Generational differences in BP trajectories and geographic and sex variations in the cohort trends highlight the need for tailored interventions to tackle the generation, region, and sex-based risk of CVDs.

Higher Numbers of Pregnancies Associated With an Increased Prevalence of Gestational Diabetes Mellitus: Results From the Healthy Baby Cohort Study

Background

Pregnancy leads to substantial maternal metabolic and lifestyle alterations. However, it is still unclear whether repeated exposure to these changes will influence the development of gestational diabetes mellitus (GDM). In the present study, we aimed to investigate the association between the number of pregnancies and GDM among Chinese women.

Methods

A total of 7,008 subjects from the Healthy Baby Cohort study were included in this study. The number of pregnancies was classified into three categories: 1, 2, or ≥3 pregnancies. GDM was diagnosed using International Association of Diabetes and Pregnancy Study Groups criteria. Multivariate logistic regression models were used.

Results

In the fully adjusted model, women with ≥3 pregnancies had a 1.27-fold (95% confidence interval [CI], 1.05–1.54) higher risk of GDM. Among women ≥30 years old, 2 and ≥3 pregnancies were associated with a higher risk of GDM (odds ratio [OR] 1.32; 95% CI, 1.01–1.73 and OR 1.54; 95% CI, 1.17–2.01, respectively). Among women with a pre-pregnancy BMI <24 kg/m², ≥3 pregnancies were associated with a 1.35-fold (95% CI, 1.09–1.67) higher risk of GDM.

Conclusions

Our findings suggested that higher numbers of pregnancies is an independent risk factor of GDM. The association between number of pregnancies and GDM was more prominent among women who were ≥30 years old or with a pre-pregnancy BMI <24 kg/m².

Community readiness assessment for disseminating evidence-based physical activity programs to older adults in Changsha, China: a case for Enhance®Fitness

Physical activity (PA) has declined in China due to urbanization in the past two decades. Evidence-based programs are good approaches to promote PA, but are limited in China. Adopting existing programs can be a viable option. Prior to that, readiness assessment is needed. This study aimed to assess community readiness levels for disseminating evidence-based PA programs to older adults in Changsha, China. In-person interviews were conducted with 33 participants of five districts in Changsha to assess the community readiness level in five dimensions: community knowledge of efforts, community climate, community knowledge about the issue, leadership and resources. Data was transcribed, reviewed and compared with an anchored rating scale to provide a stage of readiness score ranging from 1 (no awareness) to 9 (high level of community ownership). Participants included 14 community staff, 13 older adults, four community leaders and three health professionals. The top three barriers to disseminating PA programs were lack of appropriate locations, funding and instructors. The top three resources were availability of indoor space, chairs and loudspeakers. Community leadership was the highest-rated readiness dimension (3.3 out of 9) followed by community climate (3.2), community knowledge of efforts (3.1) and resources (2.8); knowledge about the issue scored the lowest (2.7). The overall community stage readiness score of Changsha was 3.0 out of 9. The stage of readiness for communities in Changsha, China is 'vague awareness'. Developing strategies to improve community readiness levels may increase evidence-based PA program dissemination in Changsha, China.

Changes in Hypertension-Related Knowledge and Behavior and Their Associations with Socioeconomic Status among Recently Urbanized Residents in China: 2013⁻2016

The rapid urbanization in China has brought with it some health benefits, but it also brought about a negative influence on the lifestyle of residents. We conducted this study to assess the change in hypertension-related knowledge and behavior from 2013 to 2016 among recently urbanized residents and determine their association with socioeconomic status (SES). This research used data from two cross-sectional studies conducted in Hezuo community in Chengdu, Sichuan province of China. A total of 2268 and 2601 individuals, respectively, participated and completed standard questionnaires. According to the results, the median (IQR) scores of health knowledge was 1 (0,3) and 3 (1,5), respectively, (p < 0.001) and the median (IQR) scores of health behavior was 6 (5,6) and 5 (5,6), respectively, (p < 0.001) in 2013 and 2016. The rate of sufficient knowledge increased from 8.8% to 18.1% (p < 0.001), while the rate of correct behavior decreased from 54.5% to 45.5% (p < 0.001) in three years. Logistic regression analysis showed that higher education was associated with sufficient hypertension-related knowledge (p < 0.05), and those with higher education, unemployment, and retirement were more likely to have sufficient behavior (p < 0.05). The impact of SES on knowledge was stable between 2013 and 2016. The behavior difference between the middle school educated and the illiterate increased from 2013 to 2016 (p < 0.05), and the behavior difference between the unemployed and manual workers decreased from 2013 to 2016 (p < 0.05). Our results revealed that hypertension-related knowledge improved with no corresponding improvement in self-reported behavior among recently urbanized residents from 2013 to 2016. Organizational strategy should be implemented to improve health education on knowledge, and what is more, translate knowledge into behavior. All these measures should be given more attention to the lower educated and manual workers among recently urbanized residents to eliminate the SES disparity.

Generational differences in patterns of physical activities over time in the Canadian population: an age-period-cohort analysis

Background

Using longitudinal panel data, the aim of this study was to examine the contribution of age, period, and cohort effects on changes in physical activity over time in a population-based sample of Canadians. We focused on three domains of physical activities: leisure time, commuting (i.e. walking and cycling), and daily activities (i.e. sedentary behavior). We also examined whether changes in sedentary behavior related to changes in participation in leisure time and commuting activities.

Methods

We used data from the Longitudinal National Population Health Survey (1994–2011): 10050 participants born between 1935 and 1984 grouped in five 10-years birth cohorts. We examined three outcomes: moderate-to-vigorous leisure time physical activity, active commuting, and sedentary behavior. We also included education, income, and body mass index as covariates. We used hierarchical age-period-cohort analysis to examine the contribution of age, period, and cohort effects to changes over time for each outcome.

Results

We found that recent cohorts were more likely to report sedentary behavior and greater participation in leisure time physical activities and active commuting. We also found a significant trend of increasing participation in active leisure time physical activity and active commuting among Canadians from 1994/95 to 2010/11 and, at the same time, an increase in sedentary behavior. The greater participation in leisure time physical activities and active commuting in each succeeding recent cohort was partially related to the secular trend of increasing participation in physical activities over time in the population. Furthermore, those with sedentary behavior were less likely to report participation in physical activities. Overall, obese individuals were less likely to be physically active and more likely to be sedentary, while the effect of socio-economic status varied by outcome.

Conclusions

The greater participation in physical activities (leisure time and commuting) in recent cohorts is encouraging and was substantially explained by period effects, which reflect broad social and environmental factors affecting the whole population. The large cohort effect of increasing sedentary behavior and the inverse relationship between sedentary behavior and physical activity is concerning, and identifies a target group for future interventions.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5189-z) contains supplementary material, which is available to authorized users.

Combined effects of fruit and vegetables intake and physical activity on the risk of metabolic syndrome among Chinese adults

BACKGROUND

Unbalanced dietary intake and insufficient physical activity (PA) have been recognized as risk factors for metabolic syndrome (MetS). We aimed to examine the independent and combined effects of fruit and vegetables (FV) intake and PA on MetS.

METHODS AND FINDINGS

A cross-sectional survey was conducted among residents of China in 2009, with fasting blood samples collected. Participants were divided into sufficient/insufficient FV intake and adequate/ inadequate PA groups according to self-reported questionnaires. MetS was defined using the NCEP-ATPIII criteria. The difference of individual MetS components was compared across different PA or FV groups. Multivariable logistic regression was used to assess association between FV/PA and the risk of MetS. A total of 7424 adults were included in the current study. MetS was prevalent in 28.7% of participants, with 24.7% and 32.9% in male and female, respectively. Compared with those with inadequate PA and insufficient FV intake, participants with the combination of adequate PA and sufficient FV intake had the lowest risk of MetS (OR = 0.69,95%CI: 0.59-0.82), following by the group with adequate PA time but insufficient FV intake (OR = 0.74, 95%CI:0.65-0.83).

CONCLUSION

Findings of the current study show that the combination of sufficient FV intake and adequate PA was significantly associated with reduced MetS risk among adult residents of China.

Age, period and cohort effects and the predictors of physical activity and sedentary behaviour among Chinese children, from 2004 to 2011

BACKGROUND

Very few studies have explored the effects of age, time period, and cohort in association with biological, behavioral, economic, and environmental factors predictors on physical activity (PA) and sedentary behaviour (SB) among Chinese children.

METHODS

We used data from a cohort study of the China Health and Nutrition Survey (CHNS) between 2004 and 2011 (2004, 2006, 2009 and 2011). The outcomes of interest were metabolic equivalent of task (MET) hours per week from both active and sedentary activities. Age, gender, individual characteristics, household size, asset ownership, and urbanisation were included as covariates. Age, period and cohort effects analyses for PA and SB of children (6-17 y, n = 3528) was conducted to explicitly assess differences in PA and SB due to age vs. period effects, and implicitly assess differences by cohorts due to the period-specific experiences across individuals of varying ages.

RESULTS

The mean age of the sample in each time point fluctuated from 12.6 to 11.3 years and PA slightly decreased from 50.0 ± 63.2 MET hours per week (MET-hr./wk) in 2004 to 47.1 ± 54.9 MET-hr./wk. in 2011. However, SB increased from 31.8 ± 22.0 MET-hr./wk. to 37.6 ± 22.2 MET-hr./wk. Girls had lower PA and higher SB levels than boys. Controlling for age effects, marginal period effects on PA were observed in some survey years. Higher levels of urbanisation and number of household computers served as negative and positive predictors for PA and SB, respectively. Higher household income was a positive predictor of SB. Surprisingly, bigger household size was the only negative predictor of SB (P < 0.05).

CONCLUSIONS

This longitudinal study followed a large cohort of children over a significant period of their childhood. We observed potential age and secular trends in PA levels. Higher community urbanisation and number of home computers were associated with both PA and SB levels. Larger household size was the only factor that was negatively associated with SB. These findings shed light on health policy and preventative health strategies for China and other countries that are now facing similar public health challenges.

Incidence of Peripheral Arterial Disease and Its Association with Pulse Pressure: A Prospective Cohort Study

BACKGROUND

The association of pulse pressure and peripheral arterial disease (PAD) has seldom been examined using a prospective design. This study aimed to investigate the association of pulse pressure with PAD incidence in an elderly general population.

METHODS

We utilized data from a cohort conducted in Beijing with additionally 2-year follow-up time. PAD was defined as an ankle brachial index value <0.9 in either leg. Cox proportional hazard regression model was used to quantify the magnitude of pulse pressure on PAD incidence.

RESULTS

During a 2-year follow-up time, 357 of 4,201 (8.5%) participants developed PAD with 105 (6.9%) men and 252 (9.4%) women, respectively. After adjusting for baseline age, sex, body mass index, hypertension, diabetes, total cholesterol, and high-density lipoprotein cholesterol, and smoking, the hazard ratio and 95% confidence interval for people with pulse pressure greater than 60 mmHg was 2.20 (1.53, 3.15) compared with those whose pulse pressure was less than 40 mmHg. A linear trend was observed for the association of pulse pressure with PAD.

CONCLUSION

Higher pulse pressure was associated with higher PAD incidence.

Associations between individual and environmental factors and habitual physical activity among older Chinese adults: A social-ecological perspective

PURPOSE

To examine, within a social-ecological framework, associations between multifaceted individual and environmental factors and habitual physical activity (HPA) among older Chinese adults.

METHODS

Through a mix of qualitative and quantitative methods, a survey instrument assessing various factors underlying 3 social-ecological dimensions of intrapersonal, interpersonal, and community and environmental resources was developed. Using a cross-sectional design, older adults (n = 1580, aged 67 ± 7 years) recruited from 10 communities in Shandong province completed the social-ecological survey of HPA. Data were analyzed using Partial Least Squares Path Modeling.

RESULTS

Factors related to intrapersonal (medical knowledge, motivation, physical function, sport skills, socioeconomic status, and education), interpersonal (social support, social activity, and social norms), and community and physical environmental resources (safety, capacity, availability of and access to physical activity facilities) were found to be significantly associated with older adults' participation in HPA.

CONCLUSION

The findings provide an initial validation of a social-ecological approach to the study of HPA in China, suggesting that strategies aimed at promoting physical activity in older adults should address multiple levels of factors that may contribute to the likelihood of older Chinese adults being physically active.

Physical activity among older Chinese adults living in urban and rural areas: A review

With an increase in rural-to-urban migration, a rapidly aging population, and the rising risk of developing noncommunicable diseases in China, it is important to understand the epidemiology of physical activity (PA) and health in the context of disease prevention and population health. Despite its public health importance, there is a significant lack of knowledge about PA in older Chinese adults that may hamper primary prevention efforts of health promotion in an increasingly aging population. To fill this gap, this article presents a narrative review of PA in the older Chinese adult population with a special focus on residential settings (i.e., urban and rural). Using existing studies, the review examines overall PA patterns and their correlates and discusses public health implications and future research. Although there are some preliminary indications of urban and rural differences in PA in the aging population in China, continued research efforts are needed to facilitate primary prevention efforts aimed at reducing noncommunicable diseases and promoting an active lifestyle among the largest population of older people in the world.