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Huang JS, Lu MS, Ramakrishnan R, Gao C, Zheng SY, Yang K, Guo YX, Lu JH, Qiu X, He JR. Weight status changes from childhood to adulthood were associated with cardiometabolic outcomes in adulthood. Acta Paediatr 2024; 113:2126-2133. [PMID: 38714365 DOI: 10.1111/apa.17255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 04/05/2024] [Accepted: 04/17/2024] [Indexed: 05/09/2024]
Abstract
AIM Few studies have assessed the association between weight changes from childhood to adulthood and cardiometabolic factors in adulthood. The aim of this study was to explore the relationships between weight changes from childhood to adulthood and cardiometabolic factors in adulthood using national Chinese data. METHODS We included 649 participants from the China Health and Nutrition Survey from 1989 to 2009 and divided them into four groups by their body mass index from 6 to 37 years of age. They were selected using multistage random cluster sampling from 15 areas with large variations in economic and social development. Poisson regression models assessed associations between weight status changes and cardiometabolic outcomes in adulthood. RESULTS The risk of multiple abnormal cardiometabolic outcomes in adulthood was increased in the 126 subjects with normal weight in childhood but overweight or obesity in adulthood and the 28 with obesity at both ages, compared to the 462 with normal weight at both ages. There was insufficient evidence to demonstrate that the 33 who had weight issues as children, but not as adults, had an increased risk. CONCLUSION Being overweight or obese in both childhood and adulthood or during adulthood only increased the risk of abnormal cardiometabolic outcomes in adulthood. Larger studies need to investigate whether weight problems in childhood, but not adulthood, increase the risk.
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Affiliation(s)
- Jia-Shuan Huang
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- The First Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, Guangzhou, China
- Paediatrics School, Guangzhou Medical University, Guangzhou, China
| | - Min-Shan Lu
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Rema Ramakrishnan
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Chang Gao
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Si-Yu Zheng
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- Paediatrics School, Guangzhou Medical University, Guangzhou, China
- Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Kun Yang
- Paediatrics School, Guangzhou Medical University, Guangzhou, China
| | - Yi-Xin Guo
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jin-Hua Lu
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xiu Qiu
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jian-Rong He
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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Zhang S, Li C, Taerken AY. Trend in physical growth among Chinese urban students: Results from five national successive cross-sectional surveys within the past two decades. Am J Hum Biol 2024:e24132. [PMID: 38984613 DOI: 10.1002/ajhb.24132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 06/20/2024] [Accepted: 06/28/2024] [Indexed: 07/11/2024] Open
Abstract
OBJECTIVES To examine the orientation, magnitude, and pace of secular trends in body height, weight, and body mass index (BMI) among Chinese urban students aged 7-18 years from 2000 to 2019. METHODS Data were extracted from Chinese urban students aged 7-18 years from the Chinese National Surveillance on Students' Constitution and Health in 2000, 2005, 2010, 2014, and 2019. The height, weight, and BMI of 548 419, 548 408, and 548 365 urban students aged 7-18 years, respectively, were tested. The mean differences across survey years were tested by one-way analysis of variance (ANOVA). The pace of secular trends is expressed as the change every 5 years between every two adjacent survey years. RESULTS Height increments between 1.9 and 6.2 cm, weight increments between 2.7 and 8.6 kg, and BMI increments between 0.9 and 1.9 kg/m2 were observed in boys. For girls, height increments between 1.5 and 4.9 cm, weight increments between 2.2 and 6.0 kg, and BMI increments between 0.7 and 1.7 kg/m2 were observed. The pace of secular trends in height decreased in the last 5 years, and the secular trends in weight and BMI have accelerated in the last 9 years compared with the previous 10 years. CONCLUSIONS Although the secular trend in height among Chinese urban students has slowed, it has not yet reached its genetic potential and continues to increase. The rapid increase in weight and BMI was a cause for concern. Our findings provide a basis for the future formulation of public health interventions in China.
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Affiliation(s)
- Shuai Zhang
- Institute of Physical Education, Xinjiang Normal University, Urumqi, China
| | - Chengyue Li
- Institute of Physical Education, Xinjiang Normal University, Urumqi, China
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Zhang Y, Li C, Zhu Y, Contento IR, Koch PA, Yang Q, Dang Q, Hu Z, Wei Y, Chen Z, Yu H. Reliability and Validity of a Theory-Based Determinants of Eating and Physical Activity Behaviors Questionnaire for Chinese Elementary School Children. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2024; 56:466-477. [PMID: 38647517 DOI: 10.1016/j.jneb.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 03/07/2024] [Accepted: 03/10/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE The primary objective of this study was to develop and validate a Social Cognitive Theory-based instrument to identify psychosocial factors that influence diet and physical activity among Chinese children aged 10-12 years. DESIGN This is a cross-sectional study, with data collected from questionnaires. SETTING Two elementary schools in Beijing, China. PARTICIPANTS Fourth to sixth-grade students (N = 1,486) aged 10-12 years were recruited. VARIABLES MEASURED Gender, height, weight, nation, and grade were collected. Energy-balanced eating behaviors and their related sociopsychological factors were surveyed. ANALYSIS Confirmatory factor analysis, Pearson correlations, Cronbach α index, and mediation analysis were used. RESULTS (1) Confirmatory factor analysis revealed a 6-factor solution (51 items) and all factor loadings > 0.32, indicating that the model fitness was acceptable. (2) All correlation coefficients are statistically significant. All of the Cronbach α indexes were > 0.65, indicating acceptable reliability. (3) The mediating effect of goal intention and outcome expectations between self-efficacy and habit strength was statistically significant (P < 0.01), verifying the theory structure. CONCLUSIONS AND IMPLICATIONS This questionnaire exhibits good internal consistency, reliability, and structural validity. It can be effectively employed to investigate energy-balanced eating behaviors related to the Social Cognitive Theory in Chinese children.
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Affiliation(s)
- Yadi Zhang
- School of Public Health, Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, China
| | - Cheng Li
- Beijing Academy of Science and Technology, Beijing, China
| | - Yandi Zhu
- School of Public Health, Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, China
| | - Isobel R Contento
- Program in Nutrition, Department of Health Studies & Applied Educational Psychology, Teachers College, Columbia University, New York, NY
| | - Pamela Ann Koch
- Program in Nutrition, Department of Health Studies & Applied Educational Psychology, Teachers College, Columbia University, New York, NY
| | - Qian Yang
- School of Public Health, Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, China
| | - Qinyu Dang
- School of Public Health, Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, China
| | - Zhuo Hu
- School of Public Health, Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, China
| | - Yuchen Wei
- School of Public Health, Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, China
| | - Zhaoyang Chen
- School of Public Health, Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, China
| | - Huanling Yu
- School of Public Health, Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, China..
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Du M, Shi J, Shi S, Wang F. Enhancing children's nutrition: the influence of rural household technology under China's home appliances going to the countryside policy. Front Nutr 2024; 11:1335200. [PMID: 38577159 PMCID: PMC10993694 DOI: 10.3389/fnut.2024.1335200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/28/2024] [Indexed: 04/06/2024] Open
Abstract
This study explores the influence of household technological advancements on children's nutritional intake, specifically within the context of the Chinese government's "Home Appliances Going to the Countryside" (HAGC) initiative. Utilizing data from the China Health and Nutrition Surveys of 2006, 2009, and 2011, we employed a Propensity Score Matching Difference-in-Differences (PSM-DID) framework to ascertain the repercussions of enhanced household technology on the dynamics of children's nutritional consumption patterns. Our analysis reveals that the HAGC-inspired integration of household appliances, including color televisions, washing machines, and refrigerators, has beneficially reshaped the nutritional consumption patterns of children, with a pronounced effect among female children. This finding remains consistent even when employing alternate methodological robustness tests. A deeper examination of the HAGC policy's mechanisms underscores the pivotal roles of parental time allocation, improved food storage capabilities, and augmented information accessibility as significant drivers bolstering children's nutritional intake. These insights bear considerable significance for strategizing interventions aimed at elevating the nutritional wellbeing of children in rural settings, offering valuable input for shaping public health policies tailored for such demographies.
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Affiliation(s)
| | | | | | - Fang Wang
- College of Management, Sichuan Agricultural University, Chengdu, China
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Zhang Y, Gao X, Zhu H, Sun S, Contento IR, Koch PA, Yu H. Lipid-focused dietary education intervention in pregnant women: study protocol for an open-label, parallel, randomised, intervention study addressing adverse pregnancy outcomes in China. BMJ Open 2024; 14:e076911. [PMID: 38176858 PMCID: PMC10773410 DOI: 10.1136/bmjopen-2023-076911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024] Open
Abstract
INTRODUCTION The incidence of infants who are large-for-gestational-age (LGA) is on the rise in China, and its detrimental effects on health have received increasing attention. Diet-based interventions have the potential to reduce adverse birth outcomes, particularly in decreasing the occurrence of LGA infants. We aim to evaluate the effect of lipid-focused diet education based on the theories of behaviour change in pregnant women on maternal and offspring outcomes through a randomised controlled trial. METHODS AND ANALYSIS We have designed an open-label, parallel, multicentre randomised controlled trial in collaboration with three hospitals in Beijing, China.Pregnant women will be recruited before reaching 12 weeks of gestation and will be randomised in a 1:1:1 ratio into three arms: (1) online education arm, (2) pregnancy nutrition checklist and 'one-page flyer' arm and (3) routine antenatal education. The primary outcome LGA will be recorded at birth. Demographic information, physical activity, sleep and medical history will be collected through questionnaires and case cards prior to enrolment. Questionnaires will also be used to collect dietary behaviours and psychosocial factors of pregnant women at enrolment, at 24-28 weeks and 34-36 weeks of gestation. Additionally, information on breastfeeding and complementary food supplementation for infants and young children will be obtained through questionnaires. Physical development indicators of children and taste tests will be assessed 3 years after delivery. ETHICS AND DISSEMINATION The study has received ethical approval from the Capital Medical University Ethics Committee and other collaborating study centres. Informed consent will be introduced to pregnant women, and their consent will be obtained. The findings will be reported in relevant national and international academic conferences and peer-reviewed publications. TRIAL REGISTRATION NUMBER ChiCTR2300071126.
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Affiliation(s)
- Yadi Zhang
- School of Public Health, Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, China
| | - Xiaoge Gao
- Program in Nutrition, Department of Health Studies & Applied Educational Psychology, Teachers College, Columbia University, New York city, New York, USA
| | - Haiyan Zhu
- Department of Obstetrics and Gynecology, Capital Medical University, Beijing, China
| | - Shengzhi Sun
- School of Public Health, Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, China
| | - Isobel R Contento
- Program in Nutrition, Department of Health Studies & Applied Educational Psychology, Teachers College, Columbia University, New York city, New York, USA
| | - Pamela Ann Koch
- Program in Nutrition, Department of Health Studies & Applied Educational Psychology, Teachers College, Columbia University, New York city, New York, USA
| | - Huanling Yu
- School of Public Health, Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, China
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Li C, Maimaiti S, Zhou Z, Zang L. Secular trends and urban-rural disparities in height of Chinese adolescents aged 18 years from 1985 to 2019. Am J Hum Biol 2024; 36:e23988. [PMID: 38214463 DOI: 10.1002/ajhb.23988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 01/13/2024] Open
Abstract
OBJECTIVES To examine the secular trends and urban-rural disparities in height of Chinese adolescents aged 18 years from 1985 to 2019. METHODS Data were extracted from the Chinese National Surveys on Students' Constitution and Health from 1985 to 2019, and the heights of a total of 76 554 boys and 75 908 girls aged 18 years were measured. The Mann-Kendall trend test was used to analyze the secular trends in height. Changes in different periods and urban-rural disparities were tested by z-tests and calculating the ratios of the coefficient of variation (CV) of height. RESULTS The height of Chinese boys and girls aged 18 years increased from 168.21 and 157.10 cm in 1985 to 172.15 cm and 160.11 cm in 2019, respectively, with a larger increase in rural areas. The secular trends in height were the largest for boys from 1995 to 2005 and for girls from 2014 to 2019, and the same results were observed in urban and rural areas. The urban-rural disparities for boys and girls decreased by 1.79 and 0.91 cm, respectively, with significant decreases for boys in all regions and for girls in the eastern region. The overall CVs of height increased by 0.13% and 0.25% for boys and girls, respectively, with the largest increase among rural girls. CONCLUSIONS The height of Chinese adolescents aged 18 years continued to increase between 1985 and 2019. The urban-rural disparities narrowed, and inequalities within rural areas for girls increased.
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Affiliation(s)
- Chengyue Li
- Institute of Physical Education, Xinjiang Normal University, Urumqi, China
| | - Sigandan Maimaiti
- School of Physical Education and Health, Changji University, Urumqi, China
| | - Zhidong Zhou
- Institute of Physical Education, Xinjiang Normal University, Urumqi, China
| | - Liuhong Zang
- Institute of Physical Education, Xinjiang Normal University, Urumqi, China
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Luo D, Ma N, Liu Y, Yan X, Ma J, Song Y, Patton GC, Sawyer SM. Long-term trends and urban-rural disparities in the physical growth of children and adolescents in China: an analysis of five national school surveys over three decades. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:762-772. [PMID: 37714171 DOI: 10.1016/s2352-4642(23)00175-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/21/2023] [Accepted: 07/04/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND China's rapid economic growth has brought opportunities for improved health and growth of children and adolescents. We sought to explore the long-term trends and urban-rural inequalities in physical growth (specifically height and BMI) among school-aged children and adolescents in China to identify policy priorities for a healthier generation. METHODS We used the 1985, 1995, 2005, 2014, and 2019 cycles of the Chinese National Survey on Students' Constitution and Health from primary and secondary schools in 30 mainland provinces, autonomous regions, and municipalities. We analysed height and BMI data for 7, 12, and 18 year old children and adolescents of Han ethnicity. Children and adolescents who had complete data on age, sex, location, weight, and height were included. All surveys used a multi-stage stratified random cluster sampling method and were nationally representative. A univariate kernel density estimation was used to plot the distribution of height and BMI. Quantile regression was used to examine associations between urban and rural locations and the primary outcomes of height and BMI at specific quantiles of distribution (5th, 25th, 50th, 75th, and 95th). FINDINGS Across the five surveys (in 1985, 1995, 2005, 2014, and 2019), 313 973 children and adolescents were included. From 1985 to 2019, the height and BMI distribution curves shifted to the right for each age group and sex, with the BMI curve becoming more dispersed. Median height in adolescents aged 18 years increased by 3·8 cm (95% CI 3·4-4·1) in boys in urban areas and 5·7 cm (5·3-6·1) in boys in rural areas, and 2·7 cm (2·4-3·0) in girls in urban areas and 3·7 cm (3·4-4·0) in girls in rural areas. Children in urban areas were taller than those in rural areas at every quantile, but the magnitude of this disparity narrowed by 2019. In 2019, the median height of boys in urban areas were 1·4 cm (1·0-1·8) greater in those aged 7 years, 2·5 cm (1·9-3·1) greater in those aged 12 years, and 1·1 cm (0·6-1·5) greater in those aged 18 years than their rural counterparts, whereas the median height of girls in urban areas were 1·1 cm (0·7-1·4) greater in those aged 7 years, 1·6 cm (1·1-2·1) greater in those aged 12 years, and 1·1 cm (0·7-1·5) greater in those aged 18 years than rural girls. Over this period, urban-rural differences in BMI disappeared at the lowest quantile, but persisted at higher quantiles. In 2019, the urban-rural differences in BMI for boys aged 12 years were 0·6 kg/m2 (95% CI 0·3-0·8) at the median, 1·0 kg/m2 (0·6-1·4) at the 75th quantile, and 0·7 kg/m2 (0·1-1·3) at the 95th quantile; for girls aged 12 years, 0·3 kg/m2 (0·1-0·5) at the median, 0·5 kg/m2 (0·2-0·8) at the 75th quantile, and 0·9 kg/m2 (0·3-1·5) at the 95th quantile; for boys aged 18 years, 0·6 kg/m2 (0·4-0·8) at the median, 0·8 kg/m2 (0·5-1·2) at the 75th quantile, and 0.7 kg/m2 (0·0-1·5) at the 95th quantile; and for girls aged 18 years, 0·2 kg/m2 (0·1-0·4) at the median, 0·5 kg/m2 (0·3-0·8) at the 75th quantile, and 1·0 kg/m2 (0·5-1·5) at the 95th quantile. INTERPRETATION Across three decades, school-aged children and adolescents in China have increased in height and BMI, with less disparity between urban and rural locations. Investments are needed to improve the affordability of healthy foods to help children and adolescents in rural areas reach their potential maximum height. Meanwhile, these changes in BMI necessitate tailored strategies according to urban-rural settings to contain the increase in overweight and obesity and promote optimal growth for children and adolescents. FUNDING Capital's Funds for Health Improvement and Research, and National Natural Science Foundation of China.
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Affiliation(s)
- Dongmei Luo
- Institute of Child and Adolescent Health & School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China; Department of Paediatrics, The University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Parkville, VIC, Australia; Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Ning Ma
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Yunfei Liu
- Institute of Child and Adolescent Health & School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Xiaojin Yan
- Institute of Population Research, Peking University, Beijing, China
| | - Jun Ma
- Institute of Child and Adolescent Health & School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China.
| | - Yi Song
- Institute of Child and Adolescent Health & School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China.
| | - George C Patton
- Department of Paediatrics, The University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Parkville, VIC, Australia; Murdoch Children's Research Institute, Parkville, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, VIC, Australia
| | - Susan M Sawyer
- Department of Paediatrics, The University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Parkville, VIC, Australia; Murdoch Children's Research Institute, Parkville, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, VIC, Australia
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Wu M, Li S, Lv Y, Liu K, Wang Y, Cui Z, Wang X, Meng H. Associations between the inflammatory potential of diets with adherence to plant-based dietary patterns and the risk of new-onset cardiometabolic diseases in Chinese adults: findings from a nation-wide prospective cohort study. Food Funct 2023; 14:9018-9034. [PMID: 37740363 DOI: 10.1039/d3fo02579a] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
Aims: convincing evidence is still limited for the validation of associations between the inflammatory potential of diets, based on the dietary inflammatory index (DII), and cardiometabolic outcomes. We aimed to investigate the associations between the DII with adherence to plant-based dietary patterns and the risk of new-onset cardiometabolic diseases (CMDs), including stroke, type 2 diabetes mellitus (T2DM) and myocardial infarction (MI). Methods: adults (N = 14 652) from the China Health and Nutrition Survey (1997-2015) were included in the current analysis. Dietary intake data were collected using a combination of 3 day consecutive 24 h dietary recalls and the food weighing method. The DII was calculated with established and validated methods. CMDs were identified using validated self-reported questionnaires. The Cox proportional hazard regression model was used for statistical analysis. Results: during a mean follow-up of 10 years, a total of 404 new-onset stroke, 1051 new-onset T2DM and 280 new-onset MI cases were identified. Lower PDI, hPDI, ERD, WISH and PHDI scores and higher uPDI scores were associated with higher DII scores (all P-trend < 0. 0001). A pro-inflammatory diet, as reflected by relatively higher DII scores, was positively associated with an increased risk of stroke (Q5 vs. Q1: HR = 1.90; 95% CI: 1.26-2.88; P-trend = 0.0006), T2DM (Q5 vs. Q1: HR = 2.08; 95% CI: 1.61-2.69; P-trend < 0.0001) and MI (Q5 vs. Q1: HR = 1.70; 95% CI: 1.04-2.76; P-trend = 0.0114) in the entire cohort. Sex and BMI significantly modified the association between the DII and the risk of T2DM, and sex significantly modified the association between the DII and the risk of MI. Conclusions: lower adherence to healthy and sustainable plant-based dietary patterns and higher adherence to unhealthy plant-based dietary patterns were associated with higher DII scores. With the use of the DII, we reported long-term positive associations between a pro-inflammatory diet and an increased risk of new-onset stroke, T2DM and MI in Chinese adults who were free from CMDs and cancer at the baseline. These findings provided evidence for the validation of associations between the DII and cardiometabolic health, and contributed to the current literature suggesting careful evaluations of whether the DII should be incorporated into dietary guidelines and utilized as an effective tool for improving the diet quality and CMD prevention in the Chinese population.
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Affiliation(s)
- Man Wu
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Sun Yat-Sen University, Shenzhen, Guangdong 518107, China.
| | - Shun Li
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Sun Yat-Sen University, Shenzhen, Guangdong 518107, China.
| | - Yiqian Lv
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Sun Yat-Sen University, Shenzhen, Guangdong 518107, China.
| | - Ke Liu
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Sun Yat-Sen University, Shenzhen, Guangdong 518107, China.
| | - Yin Wang
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Sun Yat-Sen University, Shenzhen, Guangdong 518107, China.
| | - Zhixin Cui
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Sun Yat-Sen University, Shenzhen, Guangdong 518107, China.
| | - Xiaoling Wang
- The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518033, China
| | - Huicui Meng
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Sun Yat-Sen University, Shenzhen, Guangdong 518107, China.
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Guangzhou, Guangdong 510080, China
- Guangdong Province Engineering Laboratory for Nutrition Translation, Guangzhou, Guangdong 510080, China
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Zhao J, Zuo L, Sun J, Su C, Wang H. Geographic and urban-rural disparities in dietary energy and macronutrient composition among women of childbearing age: findings from the China health and nutrition survey,1991-2015. Nutr J 2023; 22:23. [PMID: 37158933 PMCID: PMC10169383 DOI: 10.1186/s12937-023-00851-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 04/24/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Understanding nutritional status among women of childbearing age (WCA) is of increasing concern, as nutrient intakes may affect the health of WCA and well-being of their offspring. This study aimed to investigate secular trends of dietary energy and macronutrients intakes and access longitudinally the urban-rural and geographic disparities among Chinese WCA. METHODS A total of 10,219 participants were involved in three rounds of the Chinese Health and Nutrition Survey (CHNS:1991, 2004, and 2015). Average macronutrients intakes were compared against the Chinese Dietary Reference Intakes Standard (DRIs) to better assess adequacy. Mixed effect models were used to estimate the secular trends of dietary intake. RESULTS A total of 10,219 participants were involved. Dietary fat, the percentage of energy (%E) from fat, and the proportion with more than 30% of energy from fat and less than 50% from carbohydrates increased notably over time (p < 0.001). In 2015, urban western WCA had the most dietary fat (89.5 g/d), %E from fat (41.4%), with the highest proportion of energy from fat (81.7%) and carbohydrate (72.1%) out the range of DRIs. From 1991 to 2015, the average urban-rural differences in dietary fat decreased from 15.7 g/d to 3.2 g/d among eastern WCA. However, it increased to 16.4 g/d and 6.3 g/d among central and western WCA, respectively. CONCLUSION WCA was experiencing a rapid transformation to a high-fat diet. Temporal variation with obvious urban-rural and geographic disparities in dietary. energy and macronutrient composition persistently existed among Chinese WCA.These findings have implications of future public strategies to strengthen the nutrition propaganda and education of balanced diet for WCA to help them to improve their nutritional status, especially for those living in western China.
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Affiliation(s)
- Jian Zhao
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, School of Basic Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100005, China
| | - Lijun Zuo
- Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing, 100101, China
| | - Jian Sun
- School of Public Health and Management, Ningxia Medical University, Yinchuan, 750004, China
| | - Chang Su
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, 100050, China.
| | - Huijun Wang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, 100050, China.
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Ayling K, Li R, Muhardi L, Melse-Boonstra A, Sun Y, Chen W, Kudla U. Systematic Literature Review of the Nutrient Status, Intake, and Diet Quality of Chinese Children across Different Age Groups. Nutrients 2023; 15:1536. [PMID: 36986271 PMCID: PMC10057142 DOI: 10.3390/nu15061536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/23/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
There is a lack of comprehensive reports on nutrient deficiencies and dietary intake among various age groups of children in China. The objective of this review is to provide an overview of the nutrient status, intake, and diet adequacy of Chinese children (0-18 years old). PubMed and Scopus were searched for literature published between January 2010 and July 2022. A systematic review approach with a quality assessment was performed to analyze 2986 identified articles in English and Chinese. Eighty-three articles were included in the analysis. In younger children, anemia and iron and Vitamin A deficiencies remain severe public health problems, despite high Vitamin A and adequate iron intake. In older children, a high prevalence of selenium; Vitamin A and D deficiencies; and inadequate intakes of Vitamins A, D, B, C, selenium, and calcium were reported. Intakes of dairy, soybeans, fruits, and vegetables were below recommended levels. High intakes of iodine, total and saturated fat, and sodium and low dietary diversity scores were also reported. As nutritional concerns vary with age and region, future nutrition interventions should be tailored accordingly.
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Affiliation(s)
- Katie Ayling
- Friesland Campina, 3818 LA Amersfoort, The Netherlands;
| | - Rongrong Li
- Department of Clinical Nutrition, Peking Union Medical College Hospital (PUMCH), Beijing 100730, China
| | | | - Alida Melse-Boonstra
- Division of Human Nutrition and Health, Wageningen University & Research, 6703 HE Wageningen, The Netherlands
| | - Ye Sun
- Friesland Campina Development Centre AMEA, Singapore 118261, Singapore
| | - Wei Chen
- Department of Clinical Nutrition, Peking Union Medical College Hospital (PUMCH), Beijing 100730, China
| | - Urszula Kudla
- Friesland Campina, 3818 LA Amersfoort, The Netherlands;
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11
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Cui Z, Wu M, Liu K, Wang Y, Kang T, Meng S, Meng H. Associations between Conventional and Emerging Indicators of Dietary Carbohydrate Quality and New-Onset Type 2 Diabetes Mellitus in Chinese Adults. Nutrients 2023; 15:647. [PMID: 36771355 PMCID: PMC9919288 DOI: 10.3390/nu15030647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/23/2023] [Accepted: 01/23/2023] [Indexed: 01/31/2023] Open
Abstract
Dietary glycemic index (GI), carbohydrate to fiber ratio (CF) and carbohydrate quality index (CQI) are conventional and emerging indicators for carbohydrate quality. We aimed to investigate the associations between these indicators and new-onset type 2 diabetes mellitus (T2DM) risk among Chinese adults. This prospective cohort study included 14,590 adults from the China Health and Nutrition Survey without cardiometabolic diseases at baseline. The associations between dietary GI, CF and CQI and T2DM risk were assessed using Cox proportional hazard regression analysis and dose-response relationships were explored using restricted cubic spline and threshold analysis. After a mean follow-up duration of 10 years, a total of 1053 new-onset T2DM cases occurred. There were U-shaped associations between dietary GI and CF and T2DM risk (both P-nonlinear < 0.0001), and T2DM risk was lowest when dietary GI was 72.85 (71.40, 74.05) and CF was 20.55 (17.92, 21.91), respectively (both P-log likelihood ratio < 0.0001). Inverse associations between CQI and T2DM risk specifically existed in participants < 60 y or attended middle school or above (both P-trend < 0.05). These findings indicated that moderate dietary GI and CF range and a higher dietary CQI score may be suggested for T2DM prevention in Chinese adults.
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Affiliation(s)
- Zhixin Cui
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Sun Yat-sen University, Shenzhen 518107, China
- Shenzhen Health Development Research and Data Management Center, Shenzhen 518028, China
| | - Man Wu
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Sun Yat-sen University, Shenzhen 518107, China
| | - Ke Liu
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Sun Yat-sen University, Shenzhen 518107, China
| | - Yin Wang
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Sun Yat-sen University, Shenzhen 518107, China
| | - Tong Kang
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Sun Yat-sen University, Shenzhen 518107, China
| | - Shuangli Meng
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Sun Yat-sen University, Shenzhen 518107, China
| | - Huicui Meng
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Sun Yat-sen University, Shenzhen 518107, China
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Guangzhou 510080, China
- Guangdong Province Engineering Laboratory for Nutrition Translation, Guangzhou 510080, China
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12
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Effects of Ambient Particulate Matter (PM 2.5) Exposure on Calorie Intake and Appetite of Outdoor Workers. Nutrients 2022; 14:nu14224858. [PMID: 36432544 PMCID: PMC9699249 DOI: 10.3390/nu14224858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 11/18/2022] Open
Abstract
Malaysia has been experiencing smoke-haze episodes almost annually for the past few decades. PM2.5 is the main component in haze and causes harmful impacts on health due to its small aerodynamic size. This study aimed to explore the implications of PM2.5 exposure on the dietary intake of working individuals. Two phased 13-weeks follow-up study was conducted involving 440 participants, consisting of two cohorts of outdoor and indoor workers. Ambient PM2.5 concentrations were monitored using DustTrakTM DRX Aerosol Monitor. Data on Simplified Nutritional Appetite Questionnaire (SNAQ) and 24 h diet recall were collected weekly. The highest PM2.5 concentration of 122.90 ± 2.07 µg/m3 was recorded in August, and it vastly exceeded the standard value stipulated by US EPA and WHO. SNAQ scores and calorie intake were found to be significantly (p < 0.05) associated with changes in PM2.5 exposure of outdoor workers. Several moderate and positive correlations (R-value ranged from 0.4 to 0.6) were established between SNAQ scores, calorie intake and PM2.5 exposure. Overall findings suggested that long hours of PM2.5 exposure affect personal dietary intake, potentially increasing the risk of metabolic syndromes and other undesired health conditions. The current policy should be strengthened to safeguard the well-being of outdoor workers.
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13
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Zeković M, Milešević J, Takić M, Knez M, Šarac I, Kadvan A, Gurinović M, Glibetić M. Evaluation of Dietary Intake and Anthropometric Status in 1–9-Year-old Children Living in Serbia: National Food Consumption Survey According to the EU Menu Methodology. Nutrients 2022; 14:nu14153091. [PMID: 35956268 PMCID: PMC9370416 DOI: 10.3390/nu14153091] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/19/2022] [Accepted: 07/26/2022] [Indexed: 02/01/2023] Open
Abstract
The Serbian Food Consumption Survey among 1–9-year-old-children was conceptualized and conducted in compliance with the principles, established protocols, and guidelines of the EU Menu project between 2017 and 2021. Valid data were collected for 576 individuals (290 1–3-year-old toddlers and 276 3–9-year-old children). Regardless of age and gender category, the majority (68.80%) of children had normal weights according to the Body Mass Index-for-age classification system. The median daily energy intake was 1406.71 kcal with no differences between the settlement types. The overall median contributions of carbohydrates, protein, and fat to the total energy intake were 47.54%, 14.06%, and 37.88%, respectively. The proportions of the macronutrient intake deviated from the dietary reference values with compliance to the recommendations being particularly poor for fat and fiber. The consumption of energy-dense food groups such as meat and meat products, fat and oil, sugar, and confections was more pronounced among older children. The survey results provide a valuable insight into the nutritional status and dietary habits of toddlers and children 1–9 years old living in Serbia. They may serve as an evidence platform for public health programs, a valuable asset for decision-makers, and a reliable reference to guide nutritional policies, diet monitoring, and interventions targeting this population group in the future.
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Affiliation(s)
- Milica Zeković
- Centre of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, National Institute of Republic of Serbia, University of Belgrade, 11000 Belgrade, Serbia; (J.M.); (M.T.); (M.K.); (I.Š.); (M.G.); (M.G.)
- Correspondence:
| | - Jelena Milešević
- Centre of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, National Institute of Republic of Serbia, University of Belgrade, 11000 Belgrade, Serbia; (J.M.); (M.T.); (M.K.); (I.Š.); (M.G.); (M.G.)
| | - Marija Takić
- Centre of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, National Institute of Republic of Serbia, University of Belgrade, 11000 Belgrade, Serbia; (J.M.); (M.T.); (M.K.); (I.Š.); (M.G.); (M.G.)
| | - Marija Knez
- Centre of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, National Institute of Republic of Serbia, University of Belgrade, 11000 Belgrade, Serbia; (J.M.); (M.T.); (M.K.); (I.Š.); (M.G.); (M.G.)
| | - Ivana Šarac
- Centre of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, National Institute of Republic of Serbia, University of Belgrade, 11000 Belgrade, Serbia; (J.M.); (M.T.); (M.K.); (I.Š.); (M.G.); (M.G.)
| | - Agnes Kadvan
- Capacity Development Network in Nutrition in Central and Eastern Europe (CAPNUTRA), 11000 Belgrade, Serbia;
| | - Mirjana Gurinović
- Centre of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, National Institute of Republic of Serbia, University of Belgrade, 11000 Belgrade, Serbia; (J.M.); (M.T.); (M.K.); (I.Š.); (M.G.); (M.G.)
| | - Marija Glibetić
- Centre of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, National Institute of Republic of Serbia, University of Belgrade, 11000 Belgrade, Serbia; (J.M.); (M.T.); (M.K.); (I.Š.); (M.G.); (M.G.)
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Dietary Copper and Selenium Intakes and the Risk of Type 2 Diabetes Mellitus: Findings from the China Health and Nutrition Survey. Nutrients 2022; 14:nu14102055. [PMID: 35631196 PMCID: PMC9142999 DOI: 10.3390/nu14102055] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/08/2022] [Accepted: 05/10/2022] [Indexed: 11/17/2022] Open
Abstract
The long-term associations between dietary copper (Cu) and selenium (Se) intakes and type 2 diabetes mellitus (T2DM) risk are unclear. We aimed to examine the prospective associations between dietary Cu and Se intakes and T2DM risk in Chinese adults. A total of 14,711 adults from the China Health and Nutrition Survey (1997–2015) were included. Nutrient intakes were assessed by 3 consecutive 24 h recalls and food-weighing methods. T2DM was identified by a validated questionnaire and laboratory examination. Cox regression models were used for statistical analysis. A total of 1040 T2DM cases were diagnosed during 147,142 person-years of follow-up. In fully adjusted models, dietary Cu or Se intake was not associated with T2DM risk. Dietary Se intake significantly modified the association between dietary Cu intake and T2DM risk, and dietary Cu intake was positively associated with T2DM risk when Se intake was lower than the median (p-interaction = 0.0292). There were no significant effect modifications on the associations by age, sex, BMI, or region. Although dietary Cu or Se intake was not independently associated with T2DM risk in Chinese adults free from cardiometabolic diseases and cancer at the baseline, there was a significant interaction between dietary Cu and Se intakes on T2DM risk.
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15
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Du W, Wang H, Su C, Jia X, Zhang B. Thirty-Year Urbanization Trajectories and Obesity in Modernizing China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19041943. [PMID: 35206130 PMCID: PMC8871544 DOI: 10.3390/ijerph19041943] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/06/2022] [Accepted: 02/07/2022] [Indexed: 02/02/2023]
Abstract
The effects of long-term urbanization changes in obesity are unclear. Data were obtained from the China Health and Nutrition Survey (CHNS) 1989-2018. A multidimensional urbanicity index was used to define the urbanization level for communities. Group-based trajectory modeling was used to identify distinct urbanization change trajectories. Gender-stratified multilevel models were used to investigate the association between urbanization trajectories and weight/BMI, through the PROC MIXED procedure, as well as the risk of being overweight + obesity (OO)/obesity (OB), through the PROC GLIMMIX procedure. A total of three patterns of the trajectory of change in urbanization were identified in 304 communities (with 1862 measurements). A total of 25.8% of communities had a low initial urbanization level and continuous increase (termed "LU"), 22.2% of communities had a low-middle initial urbanization level and constant increase (termed "LMU"), and 52.0% of communities had a middle-high initial urbanization and significant increase before 2009, followed by a stable platform since then (termed "MHU"). During the 30 follow-up years, a total of 69490 visits, contributed by 16768 adult participants, were included in the analysis. In the period, weight and BMI were observed in an increasing trend in all urbanization trajectory groups, among both men and women. Compared with LU, men living in MHU were related to higher weight, BMI, and an increased risk of OO (OR: 1.46, 95%CI: 1.26 to 1.69). No significant associations were found between urbanization trajectories and OB risk in men. Among women, the associations between urbanization and all obesity indicators became insignificant after controlling the covariates. Obesity indicators increased along with urbanization in the past thirty years in China. However, the differences among urbanization trajectories narrowed over time. More urbanized features were only significantly associated with a higher risk of obesity indicators in Chinese men. The effects of urbanization on obesity among women were buffered.
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Multi-Trajectories of Macronutrient Intake and Their Associations with Obesity among Chinese Adults from 1991 to 2018: A Prospective Study. Nutrients 2021; 14:nu14010013. [PMID: 35010888 PMCID: PMC8746800 DOI: 10.3390/nu14010013] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/16/2021] [Accepted: 12/18/2021] [Indexed: 02/07/2023] Open
Abstract
Studies on macronutrient intake and obesity have been inconclusive. This study examined the associations between multi-trajectories of macronutrients and the risk of obesity in China. We used data from 7914 adults who participated in the China Health and Nutrition Survey at least three times from 1991 to 2018. We collected detailed dietary data by conducting three 24 h dietary recalls and weighing foods and condiments in household inventories. We identified multi-trajectories using group-based multi-trajectory models and examined their associations with the risk of obesity with multiple Cox regression models. We found four multi-trajectories in rural areas: balanced macronutrient intake (BM), moderate protein, increasing low fat, and decreasing high carbohydrate (MP&ILF&DHC); decreasing moderate protein, decreasing high fat, and increasing moderate carbohydrate (DMP&DHF&IMC); increasing moderate protein, increasing high fat, and decreasing low carbohydrate (IMP&IHF&DLC)-35.1%, 21.3%, 20.1%, and 23.5% of our rural participant population, respectively. Compared with the BM trajectory, the hazard ratios of obesity in the DMP&DHF&IMC and the IMP&IHF&DLC groups were 0.50 (95% confidence interval (CI): 0.27-0.95) and 0.48 (95% CI: 0.28-0.83), respectively, in rural participants. Relatively low carbohydrate and high fat intakes with complementary dynamic trends are associated with a lower risk of obesity in rural Chinese adults.
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