Does the Dietary Pattern of Shanghai Residents Change across Seasons and Area of Residence: Assessing Dietary Quality Using the Chinese Diet Balance Index (DBI)

Higher consumption of animal organ meat is associated with a lower prevalence of nonalcoholic steatohepatitis

Background

Animal organ meat (offal) is a food with high nutrient density that is popular in different parts of the world, but its relationship with nonalcoholic steatohepatitis (NASH) is unclear. We aimed to examine whether daily animal organ meat consumption is associated with the presence of NASH in individuals with nonalcoholic fatty liver disease (NAFLD).

Methods

A total of 136 Chinese adults with biopsy-proven NAFLD were included. Definite NASH was defined as NAFLD activity score ≥4 and at least one point for steatosis, ballooning, and lobular inflammation. Daily animal organ meat consumption was estimated using a self-administered validated food frequency questionnaire. Logistic regression analysis was performed to assess the association between animal organ meat intake and liver disease severity.

Results

The 136 participants (80.9% men) of the study had a mean ± standard deviation (SD) age of 39.0±12.5 years and body mass index of 27.4±3.6 kg/m2. Prevalence of definite NASH was 65.4%. Daily median organ meat consumption was 1.30 g/1,000 kcal. Animal organ meat consumption was inversely associated with the presence of NASH even after adjustment of demographics, lifestyle variables, metabolic and dietary factors, as well as liver fibrosis stage; adjusted-odds ratios (95% confidence intervals) for NASH were 0.15 (0.03, 0.69) for the highest tertile and 0.18 (0.05, 0.70) for the medium tertile, compared to the lowest (reference) tertile of animal organ meat intake (P value for trend =0.024).

Conclusions

Our results suggest for the first time that higher animal organ meat consumption is associated with a lower prevalence of NASH in Chinese individuals with biopsy-proven NAFLD.

Trends in sperm quality by computer-assisted sperm analysis of 49,189 men during 2015-2021 in a fertility center from China

Background

Sperm quality, including semen volume, sperm count, concentration, and total and progressive motility (collectively, "semen parameters"), has declined in the recent decades. Computer-assisted sperm analysis (CASA) provides sperm kinematic parameters, and the temporal trends of which remain unclear. Our objective is to examine the temporal trend of both semen parameters and kinematic parameters in Shanghai, China, in the recent years.

Methods

This retrospective study analyzed semen parameters and kinematic parameters of 49,819 men attending our reproductive center by using CASA during 2015-2021. The total sample was divided into two groups: samples that surpassed the WHO guideline (2010) low reference limits ("above reference limit" group, ARL; n = 24,575) and samples that did not ("below reference limit" group, BRL; n = 24,614). One-way analysis of variance, Kruskal-Wallis test, independent samples t-test, and covariance analysis were used to assess the differences among groups. Year, age, and abstinence time were included in the multiple linear regression model of the ARL group to adjust the confounders and depict the trends in sperm quality.

Results

Among all the total sample and the ARL and BRL groups, the age of subjects increased in recent years. Semen volume and sperm count showed declined tendency with years in the total sample, the ARL and BRL groups, and the subgroup of age or abstinence time, whereas sperm velocities showed increased tendency with years on the contrary. The multiple linear regression model of the ARL group, adjusting for age and abstinence time, confirmed these trends. Semen volume (β1= -0.162; CI: -0.172, -0.152), sperm count (β1= -9.97; CI: -10.813, -9.128), sperm concentration (β1 = -0.535; CI: -0.772, -0.299), motility (β1 = -1.751; CI: -1.830, -1.672), and progressive motility (β1 = -1.12; CI: -0.201, -0.145) decreased with year, whereas curvilinear line velocity (VCL) (β1 = 3.058; CI: 2.912, 3.203), straight line velocity (VSL) (β1 = 2.075; CI: 1.990, 2.161), and average path velocity (VAP) (β1 = 2.305; CI: 2.224, 2.386) increased over time (all p < 0.001). In addition, VCL, VSL, and VAP significantly declined with age and abstinence time.

Conclusion

The semen parameters declined, whereas the kinematic parameters increased over the recent years. We propose that, although sperm count and motility declined over time, sperm motion velocity increased, suggesting a possible compensatory mechanism of male fertility.

Association Between Dietary Quality and Serum Cystatin C in Kidney Transplant Recipients Based on Chinese Diet Balance Index 2016 (DBI-16)

BACKGROUND Cystatin C (Cys) is considered to be a better marker than serum creatinine in assessing kidney function, predicting cardiovascular events, and all-cause mortality. It seems to be associated with nutritional status in the general population, but little is known about kidney transplant recipients (KTRs). This study aimed to explore the relationship between dietary balance index and serum Cys in KTRs. MATERIAL AND METHODS In a cross-sectional study, 215 KTRs completed an FFQ questionnaire and information on serum Cys. Dietary intake was assessed using the Food Frequency Questionnaire (FFQ). Dietary Balance Index 2016 (DBI-16) edition scores were calculated as an indicator of dietary quality. Data on the patient's serum Cys were obtained through the hospital information system. RESULTS The majority of KTRs were male (75.34%), 76.74% were aged 18-44 years, and 79.53% were abnormal serum Cys. Dairy (z=-2.161, P<0.05), meat (z=-2.578, P<0.05), and dietary diversity (z=-3.393, P<0.05) in the normal group were higher than those in the abnormal group, and the dietary quality distance (DQD) score (t=-2.264, P<0.05) was lower than that in the abnormal group. After adjusting for confounders, a low-quality diet was a risk factor for maintaining the normal level of serum Cys (OR 3.022, 95% CI 1.263-7.231, P<0.05). CONCLUSIONS The present study suggested that KTRs with a high dietary quality might be associated with normal serum Cys levels. Dairy, meat, and varied diet seems to impact the serum Cys levels of KTRs. Dietary imbalances were prevalent among KTRs.

The Role of Dietary Patterns and Dietary Quality on Body Composition of Adolescents in Chinese College

There is limited evidence regarding the effects of dietary pattern and dietary quality on the risk of unhealthy weight status and related body composition in Chinese adolescence. In particular, studies using bioelectrical impedance analyzer (BIA) in these subjects are rare. The aim of this study was to evaluate the role of diet in body composition, to find a healthy dietary pattern for Chinese youth, and to promote the application of BIA among this population. A total of 498 participants aged from 18 to 22 years old were included. Dietary patterns were identified by principal components analysis. Energy-adjusted dietary inflammatory index (DII) and diet balance index (DBI) were calculated based on semi-quantitative food frequency questionnaire. Multivariate linear regression and logistic regression analysis were used to examine the relationship of dietary patterns, dietary quality with body mass index (BMI), fat mass index (FMI), fat-free mass index (FFMI), and the effect of dietary factors on BMI levels. The majority of participants with overweight and obesity had abdominal obesity, and there was 3.7% abdominal obesity in normal BMI individuals. Four dietary patterns were detected in the subjects. The pattern with the higher energy intake, which was close to the Western diet, was positively correlated with BMI (β = 0.326, p = 0.018) and FMI (β = 0.201, p = 0.043), while being negatively correlated with FFMI (β = −0.183, p = 0.021). Individuals who followed the pattern similar to the Mediterranean diet had a higher basal metabolic rate (BMR), and the highest fat free mass, soft lean mass, and skeletal muscle mass (p < 0.05) but the lowest FMI, visceral fat area (VFA), waist−hip ratio, and FMI/FFMI ratio (p < 0.05). Higher energy-adjusted DII was associated with high BMI. Higher bound score (HBS) (β = −0.018, p = 0.010) and diet quality distance (DQD) (β = −0.012, p = 0.015) were both negatively correlated with FFMI. In conclusion, fat or muscle indexes, such as BMR, FMI, and FFMI, had an important role in predicting overweight and obesity, which suggested the importance of applying BIA among Chinese college students. Students who followed healthful dietary patterns or the high-quality diet that is similar to the Mediterranean diet but not close to the Western diet were more likely to have a healthy BMI and normal body composition.

The high sodium condiments and pre-packaged food should be the focus of dietary sodium control in the adult Shanghai population

BACKGROUND

Long-term, excessively high sodium consumption can lead to increased blood pressure, which is a major risk factor for cardiovascular disease. Therefore, we aimed to analyze the dietary sodium intake and food sources to understand the epidemiological characteristics associated with potentially influencing variables in adults from Shanghai.

METHODS

Residents aged 15 years and above were randomly selected using multi-stage stratified random sampling in Shanghai. Over 3 days, family condiments were weighed for each 24-h day, and recall surveys were conducted for the same timeframe regarding sodium intake during the spring, summer, autumn, and winter seasons.

RESULTS

The median sodium intake for residents aged 15 years and above was 4.3 g/d in Shanghai, where 55.1% was obtained from cooking salt, 13.2% from sodium condiments, and 22.2% from pre-packaged food. There were no significant differences in total sodium intake or main sources of sodium intake between different seasons. The sodium intake of rural residents > suburban residents > urban residents (P < 0.05). The logistic regression demonstrated that compared to the rural, the people living in urban and suburban consumed less sodium. Compared to the 18-44, the people aged 45-59 and ≥ 60 consumed more sodium (P < 0.05).

CONCLUSIONS

Sodium intake is high in Shanghai. The absolute amount of cooking salt is low in Shanghai, and the possibility of further reduction is very little under the existing dietary habit. Limiting high sodium condiments and pre-packaged food is the new key to controlling salt intake in the future.

Food Intake and Diet Quality of Pregnant Women in China During the COVID-19 Pandemic: A National Cross-Sectional Study

Background:

Between January and April 2020, China implemented differentiated prevention and control strategies across the country, based on the severity of the COVID-19 epidemic/pandemic in different regions. These strategies included lockdowns, social distancing, and the closure of public places. These measures may have affected dietary intake to varying degrees. This study aimed to assess variations in food intake and diet quality among pregnant women according to regional severity and related control measures during the most severe period of COVID-19 restrictions in 2020.

Methods

A total of 3,678 pregnant women from 19 provinces/municipalities in mainland China were analyzed in this nationwide, multi-center study. Food intake data were obtained and assessed using a validated food frequency questionnaire (FFQ). Diet quality was quantified using the Diet Balance Index for Pregnancy (DBI-P), which included high bound score (HBS, excessive dietary intake), low bound score (LBS, insufficient dietary intake), and diet quality distance (DQD, dietary imbalance). Linear trend tests and multivariable regression analyses were performed to examine the association between food intake, DBI-P and the severity of pandemic.

Results

The median daily intake of vegetables, fruit, livestock/poultry meat, dairy, and nuts decreased (p < 0.05) according to low, moderate, and high severity of the pandemic, while no significant differences in cereals/potatoes, eggs, and fish/shrimp intake. The median daily intake of cereals/potatoes exceeded the recommended ranges, and the daily intake of eggs and fish/shrimp was below recommended ranges regardless of the pandemic severity (p < 0.05). Regarding diet quality, HBS decreased (lower excessive consumption) (p = 0.047) and LBS increased (greater insufficient consumption) (p = 0.046) with increased severity of the pandemic. On multivariable analyses, moderate and high pandemic severity were related to lower HBS risk (OR = 0.687, OR = 0.537) and higher LBS risk (β = 1.517, β = 3.020) when compared to low pandemic severity.

Conclusions

Under more severe COVID-19 pandemic conditions, pregnant women consumed less quality food, characterized by reduced consumption of vegetables, fruit, livestock/poultry meat, dairy and nuts, while the quality of the foods that pregnant women consumed in excess tended to improve, but the overconsumption of cereals/potatoes was a problem.

Unfavorable Dietary Quality Contributes to Elevated Risk of Ischemic Stroke among Residents in Southwest China: Based on the Chinese Diet Balance Index 2016 (DBI-16)

Background: Little is known about the effects of dietary quality on the risk of ischemic stroke among Southwest Chinese, and evidence from prospective studies is needed. We aimed to evaluate the associations of ischemic stroke with dietary quality assessed by the Chinese Diet Balance Index 2016 (DBI-2016). Methods: The Guizhou Population Health Cohort Study (GPHCS) recruited 9280 residents aged 18 to 95 years from 12 areas in Guizhou Province, Southwest China. Baseline investigations, including information collections of diet and demographic characteristics, and anthropometric measurements were performed from 2010 to 2012. Dietary quality was assessed by using DBI-2016. The primary outcome was incident ischemic stroke diagnosed according to the International Classification of Diseases 10th revision (ICD-10) until December 2020. Data analyzed in the current study was from 7841 participants with complete information of diet assessments and ischemic stroke certification. Cox proportional hazards models were used to estimate the risk of ischemic stroke associated with dietary quality. Results: During a median follow-up of 6.63 years (range 1.11 to 9.53 years), 142 participants were diagnosed with ischemic stroke. Participants with ischemic stroke had a more excessive intake of cooking oils, alcoholic beverages, and salt, and had more inadequacy in meats than those without ischemic stroke. (p < 0.05). Compared with participants in the lowest quartile (Q1), those in the highest quartile (Q4) of the higher bound score (HBS) and of the dietary quality distance (DQD) had an elevated risk for ischemic stroke, with the corresponding hazard ratios (HRs) of 3.31 (95%CI: 1.57−6.97) and 2.26 (95%CI: 1.28−4.00), respectively, after adjustment for age, ethnic group, education level, marriage status, smoking and waist circumference, and the medical history of diabetes and hypertension at baseline. In addition, excessive intake levels (score 1−6) of cooking oils, excessive intake levels (score 1−6) of salt, and inadequate intake levels (score −12 to −7) of dietary variety were positively associated with an increased risk for ischemic stroke, with the multiple HRs of 3.00 (95%CI: 1.77−5.07), 2.03 (95%CI: 1.33−3.10) and 5.40 (95%CI: 1.70−17.20), respectively. Conclusions: Our results suggest that unfavorable dietary quality, including overall excessive consumption, excessive intake of cooking oils and salt, or under adequate dietary diversity, may increase the risk for ischemic stroke.

A China Healthy Diet Index-Based Evaluation of Dietary Quality among Pregnant Women in Shanghai across Trimesters and Residential Areas

Good dietary quality among pregnant women is critical for maternal and fetal health. The primary objective of our study was to analyze the dietary quality of pregnant woman and its influencing factors. Pregnant women were enrolled using a multistage, stratified, random-sampling method in Shanghai. We used a personal food frequency questionnaire and a household condiment weighing method for dietary assessments. Participants' scores on the China Healthy Diet Index (CHDI) were analyzed to evaluate diet quality. Significant differences in the median daily intake of almost all food types were found across all trimesters, and all food types were found across all residential areas (urban, suburban and rural). The median of total CHDI score was 71.6 in all subjects, 71.1 in early pregnancy, 71.5 in middle pregnancy and 72.3 in late pregnancy. The results of uni-variate analysis showed that significant differences in CHDI scores were found across trimesters and residential areas. Eighty one point six percent of participants scored below 80 points, indicating general or poor dietary quality. Logistic regression models showed that participants in early and middle pregnancy had lower scores than those in late pregnancy. Women in urban areas had higher scores than those in suburban and rural areas. Most of pregnant women living in Shanghai suffer from a general or poor dietary quality. Education on balance diet should be strengthened to guide pregnant women in making reasonable food choices and intake, especially those living in suburban and rural areas and those in their first and second trimesters.

A Systematic Review of Diet Quality Index and Obesity among Chinese Adults

Diet quality scores are designed mainly based on Western-style dietary patterns. They were demonstrated to be good indicators of obesity in developed but not developing countries. Several diet quality scores were developed based on the Chinese dietary guidelines, yet no systematic review exists regarding how they were related to obesity. We searched research articles published between 2000 and 2021 in PubMed, CINAHL, and Scopus databases. Both cross-sectional and prospective studies that examined the relationship between a diet quality score and weight, body mass index, obesity, or waist circumference conducted in a Chinese population were selected. From the 602 articles searched, 20 articles were selected (12 are cross-sectional studies and 8 are prospective cohort studies). The relationship between internationally used scores and obesity was inconsistent among studies. Scores tailored to the Chinese diet demonstrated a strong relationship with both being underweight and obesity. The heterogeneity of the populations and the major nutrition transition in China may partially explain the discrepancies among studies. In conclusion, diet quality scores tailored to the Chinese diet may be associated with both undernutrition and overnutrition, as well as being underweight and obesity outcomes.

Dietary quality is associated with reduced risk of diabetes among adults in Northern China: a cross-sectional study

In this study, we analysed the prevalence of diabetes in Inner Mongolia and explored the relationship between dietary patterns and diabetes using the Chinese Dietary Balance Index-16 (DBI-16). This study was a surveillance survey of Chronic Disease and Nutrition Monitoring among Chinese Adults in Inner Mongolia in 2015. Dietary data were collected using the 24-h dietary recall and weighing method over three consecutive days. Dietary quality was evaluated via the DBI-16. A generalised linear model was used to examine the associations between the DBI-16 and dietary patterns. The relationship between dietary patterns and diabetes was analysed using logistic regression. In Inner Mongolia, the diabetes prevalence was 8·5 % and the estimated standardised prevalence was 6·0 %. Four major dietary patterns were identified: 'meat/dairy products', 'traditional northern', 'high cereal/tuber' and 'high-salt/alcohol'. Generalised linear models showed that the 'meat/dairy product' pattern was relatively balanced (βLBS = -1·993, βHBS = -0·206, βDQD = -2·199; all P < 0·05) and was associated with a lower diabetes risk (OR 0·565; 95 % CI 0·338, 0·945; P < 0·05) after adjusting for potential confounders. The other three dietary patterns (i.e. 'traditional northern', 'high cereal/tuber' and 'high-salt/alcohol') exhibited relatively unbalanced dietary quality and were unassociated with diabetes risk. Diabetes prevalence in Inner Mongolia was moderate. The dietary quality of the 'meat/dairy product' pattern was relatively balanced and was correlated with a decreased risk of diabetes prevalence, suggesting that dietary quality may help decrease diabetes prevalence and provide a suggestion for local dietary guidelines.

Perceived social support and diet quality among ethnic minority groups in Yunnan Province, Southwestern China: a cross-sectional study

Background

Social support is an important health determinant and may affect dietary behaviors. The purpose of this study was to examine the relations between perceived social support and the Chinese Diet Balance Index-16 (DBI-16) among ethnic minority groups in Southwest China.

Methods

This cross-sectional study was conducted between May 2019 and August 2020 among six ethnic minority groups native to Yunnan Province (n = 3564). Perceived social support from family, friends and significant others were measured with the Multi-dimensional Scale of Perceived Social Support (MSPSS). Dietary data were obtained using a 100-item Food Frequency Questionnaire (FFQ) and a lifestyle questionnaire. Lower Bound Score (LBS), Higher Bound Score (HBS) and Diet Quality Distance (DQD) which represent inadequate, excessive and unbalanced food intake respectively were calculated to measure the compliance with the recommendations of the Dietary Guidelines for Chinese 2016.

Results

One thousand four hundred ninety-six men and two thousand sixty-eight women were included. 51.2% of the subjects had moderate or high levels of inadequate intake; 21.3% had moderate or high levels of excessive intake; and 74.0% had moderate or high levels of unbalanced dietary intake. With potential confounders adjusted, support from family was negatively associated with inadequate intake, while support from friends was positively associated with inadequate and excessive intake. No significant associations were found between perceived social support from significant others and diet quality indicators.

Conclusions

An unbalanced diet is common among adults of the ethnic minority groups in Yunnan Province, Southwest China. Social support should be taken into account in designing nutrition interventions rather than focusing solely on individuals.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11787-5.

Risk of dietary intake of organochlorine pesticides among the childbearing-age women: A multiple follow-up study in North China

Exposure to organochlorine pesticides (OCPs) can cause adverse health effects in the female population. We investigated the dietary OCP intake of childbearing-age women living in large agricultural areas of Northern China, as well as their associated health risks. Ten childbearing-age women were recruited during 2015-2016. Their weekly dietary intake diaries and food samples were collected over the course of five visits. The OCP residues of 322 food samples from seven categories (i.e., cereal, vegetable, fruit, fish, meat, egg, and milk) were analyzed by gas chromatography-mass spectrometry. The average concentrations of the total hexachlorocyclohexanes (ΣHCH), dichlorodiphenyltrichloroethanes and their metabolites (ΣDDX), endosulfans (ΣES), and dieldrin and endrin (ΣDrin) in all food categories were, overall, much lower than the maximum residue limits. Relative high mean residues of ΣDrin and ΣES were found in fruits (ΣDrin: 0.687 ng g-1 wet weight (w.w.), ΣES: 2.24 ng g-1 w.w.) and vegetables (ΣDrin: 0.690 ng g-1 w.w., ΣES: 2.11 ng g-1 w.w.). The estimated daily dietary intake (EDI) of these compounds was calculated, with mean levels of 10.6 (ΣES) > 4.37 (ΣDrin) > 1.51 (ΣHCH) > 0.850 (ΣDDX) ng kg-1 day-1. Women during the heating period (from January to March) tended to ingest more ΣHCH, ΣDDX, ΣDrin, and ΣES. Overall, women had no obvious non-carcinogenic and carcinogenic risks due to intake of OCPs, but 83.9% of them has potential carcinogenic risk, with estimated life carcinogenic risk (LCR) exceeding 10-6. Furthermore, women had a higher potential carcinogenic risk during the heating period (mean LCR: 1.33 × 10-5) than during the non-heating period (mean LCR: 8.50 × 10-6). ΣDrin was the dominant OCP responsible for health risks, followed by ΣHCH. We concluded that women in North China still have some dietary OCP intake, especially during the heating period.

Dietary shifts and nitrogen losses to water in urban China: the case of Shanghai

China's extraordinary economic development has provided the country's growing population with easier access to animal food products, especially in densely populated urban agglomerations. Increased consumption of such products translates in a higher amount of nitrogen (N) excreted in the form of human manure. Depending on the connection to a sewerage system, or lack thereof, and the N removal efficiency from wastewater treatment plants (WWTPs), a share of the excreted N gets ultimately discharged to water bodies, causing eutrophication. In heavily urbanised areas, N losses from household food consumption account for a dominant portion of total N losses to water. In this study, we firstly estimate dietary N intake, excretion and consequent N losses to water from the residents of Shanghai in 2012. We then explore different scenarios to 2030, in terms of further dietary modifications and different levels of development of the city's sewerage system and WWTPs. In 2012, Shanghai's residents excreted a total of 148.4 Gg N, 54% of which ultimately reached the city's water bodies in diffused N form. The urban population contributed for the majority of the N losses (93%) and showed a higher per capita N load, due to limited N removal efficiency from WWTPs and the significant portion (27%) of residents not connected to the sewerage and directly discharging their excreta to water. The vast majority of the scarce rural population were not connected to the sewerage system and showed a much lower per capita N load, mainly due to the common practice of recycling excreta for agricultural practices. We identify two main approaches to reduce dietary N losses: (1) improving N removal efficiency and sewerage connection rates towards the levels of OECD countries; (2) managing the increase of dietary N intake by promoting healthy and sustainable consumption, as recommended by recent dietary guidelines. According to our scenario analysis, technological improvements can potentially achieve a more significant reduction of total N losses and are easier to implement. Managing demand of animal food and consequent N intake would only stabilise N losses around 2012's levels. On the other hand, a dramatic increase of animal food consumption could have detrimental effects on the city's water bodies, more so if the expected population growth will not be met by an adequate development of a more capillary sewerage system. This study provides valuable insights on dietary N losses in one of China's most developed mega cities, strongly advocating for the necessity of improving N removal efficiency from WWTPs and reducing the percentage of urban residents directly discharging their waste to water bodies.

Associations between Adherence to Four A Priori Dietary Indexes and Cardiometabolic Risk Factors among Hyperlipidemic Patients

Little is known about which currently available a priori dietary indexes provide best guidance for reducing cardiometabolic risk factors (CMRF) among hyperlipidemic patients. This study was designed to compare the associations between four a priori dietary indexes, including Diet Balance Index (DBI-16), Chinese Healthy Eating Index (CHEI), Mediterranean Diet Score (MDS) and Dietary Approaches to Stop Hypertension (DASH) and CMRF among hyperlipidemic patients. A total of 269 participants were enrolled into the cross-sectional study. DBI-16, CHEI, MDS, and DASH scores were calculated using established methods. CMRF was measured using standard methods. DBI-total scores (DBI-TS) were inversely associated with triglyceride concentrations and TC:HDL-C ratio, and positively associated with HDL-C and ApoA1 concentrations (all p < 0.05), while the results for DBI-low bound scores (DBI-LBS) were opposite. DBI-high bound scores (DBI-HBS) and DASH scores were positively and inversely associated with glucose concentrations, respectively (both p < 0.05). Higher diet quality distance (DQD) was positively associated with higher TC, LDL-C and ApoB concentrations, and TC:HDL-C and LDL-C:HDL-C ratios, and lower HDL-C and ApoA1 concentrations and ApoA1:ApoB ratio (all p < 0.05). CHEI scores were inversely associated with triglyceride concentrations (p = 0.036). None of the dietary indexes was associated with blood pressures. DBI-16 provided most comprehensive evaluations of the overall diet quality and balance for optimizing cardiometabolic health among hyperlipidemic individuals.

Appropriate Range of Median Urinary Iodine Concentration in 8- to 10-Year-Old Children Based on Generalized Additive Model

Background: The appropriate range of median urinary iodine concentration (MUI) in children has always been controversial. To prevent the occurrence of a goiter epidemic in Shanghai, we explored the appropriate range of MUI by integrating multiple monitoring results. Methods: This study summarized and analyzed the monitoring data from 1997, 1999, 2011, 2014, and 2017 of children living in Shanghai. In each monitoring year, the probability-proportional-to-size sampling technique was used to select 30 sampling units. In each sampling unit, one primary school was randomly selected. From each selected school, 40 children 8- to 10-year-old were randomly recruited to measure thyroid volume (Tvol) and their household salt iodine intake. Results: In 1997, 1999, 2011, 2014, and 2017, MUI of 8- to 10-year-old children was 228, 214, 182, 171, and 183 μg/L, and median Tvol (MTvol) was 2.9, 1.2, 1.0, 1.8, and 2.8 mL, respectively. There was a linear correlation between goiter rate and MTvol (r = 0.95, p = 0.014; 100 × goiter rate = 1.314 × MTvol -1.287). Generalized additive model (GAM) was used to predict MTvol as follows, MTvol = 0.60689 + 0.00302 MUI +0.999928 s (MUI) -0.05172 mean salt iodized concentrations (MSIs) +0.03481 × 100 × iodized salt coverage rate +0.00000969 per capita disposable income +0.271422 s (per capita disposable income) -0.38772 × monitoring year gap. The results revealed that the average relative error between predicted and actual value was 15.2%. GAM results showed that at 27-277 μg/L MUI, the goiter rate was <5%. Conclusions: Iodine status is appropriate in Shanghai. Under the existing economy and MSI, the optimal range of MUI should be 70-277 μg/L in 8- to 10-year-old children living in Shanghai.

Are the Chinese Moving toward a Healthy Diet? Evidence from Macro Data from 1961 to 2017

The change in diet structure is one of the critical features of social transformation, and diet structure is directly related to human health. In China, with rapid economic development, changes in the diet structure of the population have begun and are proceeding at a fairly rapid rate. In order to reveal how the Chinese diet is approaching or deviating from the nutritional goal, a novel index, NDBI (National Dietary Balance Index), is developed in this study to investigate the Chinese diet from 1961 to 2017 at a national level. The results show that the Chinese diet has transitioned from the under-intake stage to the over-intake stage. Before the 1980s, Chinese people ate all foods inadequately except staple foods; after the 1980s, the issue of under-intake began to fade, and the intake of meats even became excessive. The intake of staple foods is always excessive during this period. Currently, the Chinese diet is still unhealthy because of the inadequate intake of dairy products and the excessive intake of staple foods and meats. By evaluating diet structure on a national level, this study can help people to better understand how the Chinese diet deviated from the nutritional goal and provides information for policymakers intervening in China's food consumption.

Association of the NCAN-TM6SF2-CILP2-PBX4-SUGP1-MAU2 SNPs and gene-gene and gene-environment interactions with serum lipid levels

This study investigated the association of the NCAN-TM6SF2-CILP2-PBX4-SUGP1-MAU2 SNPs and gene-gene and gene-environment interactions with serum lipid levels in the population of Southwest China. Genotyping of 12 SNPs (i.e., rs2238675, rs2228603, rs58542926, rs735273, rs16996148, rs968525, rs17216525, rs12610185, rs10401969, rs8102280, rs73001065 and rs150268548) was performed in 1248 hyperlipidemia patients and 1248 normal subjects. The allelic and genotypic frequencies of the detected SNPs differed substantially between the normal and hyperlipidemia groups (P < 0.05-0.001), and the association of the 12 SNPs and hyperlipidemia was also observed (P < 0.004-0.0001). Four haplotypes (i.e., NCAN C-C, CILP2 G-T, PBX4-SUGP1 G-C, and MAU2 C-A-G-T) and 5 gene-gene interaction haplotypes (i.e., rs2238675C-rs2228603C, rs16996148G-rs17216525T, rs12610185G-rs10401969C, rs73001065G-rs8102280A-rs150268548G-rs968525C and rs73001065C-rs8102280A-rs150268548G-rs96852）showed a protective effect, whereas four other haplotypes (i.e., TM6SF2 T-A, TM6SF2 C-A, MAU2 G-G-G-C and MAU2 C-G-A-T), as well as 4 gene-gene interaction haplotypes (i.e., rs58542926C-rs735273A, rs58542926T-rs735273A, rs73001065G-rs8102280G-rs150268548G-rs968525C, and rs73001065C-rs8102280G-rs150268548A-rs968525T), exhibited an inverse effect on hyperlipidemia (P < 0.05-0.0001). There were notable three-locus models comprising SNP-SNP, SNP-environment, and haplotype-haplotype interactions (P < 0.05-0.0001). The individuals with some genotypes and haplotypes reduced the prevalence of hyperlipidemia, whereas the individuals with some other genotypes and haplotypes augmented the prevalence of hyperlipidemia. The NCAN-TM6SF2-CILP2-PBX4-SUGP1-MAU2 SNPs and gene-gene and gene-environment interactions on hyperlipidemia were observed in the population of Southwest China.

Association between Dietary Quality and Prediabetes based on the Diet Balance Index

Dietary quality is an important factor influencing prediabetes, but few studies have applied the Chinese Diet Balance Index (DBI-16) to evaluate the dietary quality of individuals with prediabetes and explore the associations between dietary quality and prediabetes. In our study, the lower-bound score, higher-bound score and diet quality distance, were respectively calculated to assess dietary quality based on each food group. Logistic regression was used to calculate the odds ratio (OR) and 95% confidence interval (95%CI) of unfavorable dietary quality leading to prediabetes in every subgroup. The results were shown that individuals with prediabetes had excessive intake in the categories of cereals, salt and inadequate intake in vegetables, fish and diet variety than participants without prediabetes (all P < 0.01). Unfavourable dietary quality was significantly associated with an increased risk of prediabetes (OR: 1.45, 95%CI: 1.29-1.63), especially among the subjects who lived in rural areas (OR: 1.63, 95%CI: 1.25-1.76), those who had abdominal obesity (OR: 1.58, 95%CI: 1.36-1.85), those who smoked (OR: 1.58, 95%CI: 1.30-1.93), those who consumed alcohol (OR: 1.57, 95%CI: 1.28-1.93) and those who did not drink tea (OR: 1.64, 95%CI: 1.42-1.88). In Conclusion, unfavourable dietary quality was significantly associated with an increased risk of prediabetes.

Diet quality is associated with reduced risk of hypertension among Inner Mongolia adults in northern China

OBJECTIVE

The present study investigated the association between dietary patterns and hypertension applying the Chinese Dietary Balance Index-07 (DBI-07).

DESIGN

A cross-sectional study on adult nutrition and chronic disease in Inner Mongolia. Dietary data were collected using 24 h recall over three consecutive days and weighing method. Dietary patterns were identified using principal components analysis. Generalized linear models and multivariate logistic regression models were used to examine the associations between DBI-07 and dietary patterns, and between dietary patterns and hypertension.

SETTING

Inner Mongolia (n 1861).

PARTICIPANTS

A representative sample of adults aged ≥18 years in Inner Mongolia.

RESULTS

Four major dietary patterns were identified: 'high protein', 'traditional northern', 'modern' and 'condiments'. Generalized linear models showed higher factor scores in the 'high protein' pattern were associated with lower DBI-07 (βLBS = -1·993, βHBS = -0·206, βDQD = -2·199; all P < 0·001); the opposite in the 'condiments' pattern (βLBS = 0·967, βHBS = 0·751, βDQD = 1·718; all P < 0·001). OR for hypertension in the highest quartile of the 'high protein' pattern compared with the lowest was 0·374 (95 % CI 0·244, 0·573; Ptrend < 0·001) in males. OR for hypertension in the 'condiments' pattern was 1·663 (95 % CI 1·113, 2·483; Ptrend < 0·001) in males, 1·788 (95 % CI 1·155, 2·766; Ptrend < 0·001) in females.

CONCLUSIONS

Our findings suggested a higher-quality dietary pattern evaluated by DBI-07 was related to decreased risk for hypertension, whereas a lower-quality dietary pattern was related to increased risk for hypertension in Inner Mongolia.

Iodine status of 8 to 10 years old children within 20 years following compulsory salt iodization policy in Shanghai, China

BACKGROUND

In 1996, Shanghai implemented universal salt iodization and has became the last provincial unit in China to carry out this intervention. In this study, we summarized achievements in past 20 years, to provide suggestions and evidence for the next stage of iodine supplementation.

METHODS

This study summarized and analyzed monitoring data of children from 1997, 1999, 2005, 2011, 2014, and 2017 in Shanghai. In each monitoring year, 30 streets or towns were selected using the probability-proportional-to-size sampling technique. One primary school was selected from each street or town by a simple random sampling technique. From each school, 40 children aged 8 to 10 years were randomly selected. The number of children was divided equally by sex and age.

RESULTS

In 1997, 1999, 2005, 2011, 2014, and 2017, median urinary iodine (MUI) was 227.5 μg/L, 214.3 μg/L, 198.1 μg/L, 181.6 μg/L, 171.4 μg/L, and 183.0 μg/L, goiter rate was 3.07, 0.40, 0.08, 0.08, 0.86, and 1.90%, and median thyroid volume (MTvol) was 2.9 mL, 1.2 mL, 2.4 mL, 1.0 mL, 1.8 mL, and 2.8 mL, respectively. There was a linear correlation between goiter rate and median thyroid volume (MTvol) (r = 0.95, P = 0.014). Household salt iodine concentration (SIC) was dropping every monitoring (P < 0.05). There was a significant difference among different household SIC groups in MUI in 1999 and 2017, and in MTvol in 1999 (P < 0.05). No significant differences were detected in the other years.

CONCLUSIONS

In Shanghai, the iodine status of 8 to 10 years old children is adequate. Household SIC have little effect on iodine status of children. Future studies should analyze the dietary sources of iodine, especially from pre-packaged and prepared-away-from-home foods or meals. The regular monitoring of iodine status is important to human health.

Variety, Price, and Consumer Desirability of Fresh Fruits and Vegetables in 7 Cities around the World

Few studies have attempted to quantify the variety, price, and consumer desirability of fruits and vegetables (F&Vs) across a diversity of cities. We implemented a market basket survey of F&Vs from December 2018 to February 2019 in middle-income neighborhoods of the following cities: Visakhapatnam, India; Kathmandu, Nepal; Addis Ababa, Ethiopia; Dar es Salaam, Tanzania; Mexico City, Mexico; Bangkok, Thailand; and Brookline, United States. The total variety of fruits ranged from 4.1 in Visakhapatnam to 17.3 in Brookline, and of vegetables from 6.1 in Dar es Salaam to 20.3 in Brookline. Of the 3 fruits for which price data were collected, apples tended to be the most expensive, and bananas the least expensive. For vegetables, capsicum tended to be the most expensive and eggplants the least expensive. Tablet-based market basket surveys are a useful tool for evaluating food environments. These pilot data provide further evidence of the homogenization of global diets.

The Dietary Intake and Its Features across Four Seasons in the Metropolis of China

Chinese diet pattern known as plant-based is more linked with seasonal supply, but it is lack of study on seasonal difference in dietary intakes in China. Our study was to assess seasonal variation in the absolute dietary intake among general population in a metropolis, Shanghai, China. A representative sample of general population aged 15 and older (n=1,704) were randomly stratified-sampled from communities in Shanghai. Dietary survey included consecutive 3-day-24-hour diet record recall and household condiments weighing. Data was collected across four seasons during 2012-2014. Most of food and condiments consumption differed across seasons in Shanghai. Intakes of grains, legumes and cooking oil were highest in spring; vegetables, fruit and non-alcoholic beverage highest, but cooking oil and cooking salt lowest in summer; red meat, nuts and cooking salt highest in winter. Seasonality existed in the intakes of energy and energy contributed from macronutrients that fat contributed more in winter but less in summer. Seasonal variations were also found in beta-carotene, vitamin E, vitamin K, thiamin, folate and sodium intakes. Seasonal changes of dietary intake were extensively observed in Shanghai, a highly-developed metropolis in China. Given the seasonal differences and their features described in current article, the estimation methods of the average dietary intake across whole year by just conducting dietary survey in one single season warrants further study.

Validity and reliability of a food frequency questionnaire for assessing dietary intake among Shanghai residents

BACKGROUND

Few localized food frequency questionnaires (FFQ) have been developed and used in Chinese nutrition surveys despite China's large population and diverse dietary habits.

METHOD

We analyzed data collected in two waves (six months apart) of the Shanghai Diet and Health Study in 2012-2013, from 1623 Shanghai residents (798 men and 825 women) older than 18 years. The results of 3-day 24-h dietary recalls (HDR) plus condiment weighing were used to evaluate the validity and reliability of the SDHS FFQ.

RESULTS

The median and first and third quartiles for energy intake (in kcal) derived from the FFQ1 and FFQ2 were 1566.5 (1310.1-1869.6) and 1561.9 (1280.2-1838.4), respectively, of which protein (in g) was 54.3 (42.5-65.8) and 52.9 (42.4-64.5), fat (in g) was 49.8 (37.2-64.7) and 47.9 (34.9-61.9), and carbohydrates (in g) was 227.3 (180.8-277.9) and 228.1 (182.2-275.2) in the reliability analysis. The median and first and third quartiles for energy-intake differences between the FFQ1 and the 3-day 24-HDR with condiment weighing was 59.3 (- 255.5-341.6), of which protein was - 5.2 (- 18.7-7.8) and fat was - 11.2 (- 30.8-5.3). The adjusted Spearman's correlations were 0.33-0.77 for validity and 0.46-0.79 for reliability. The intra-class correlation coefficients exceeded 0.46 (validity) and 0.47 (reliability) for macronutrient intake. The consistency between the same and adjacent quartiles was approximately 80% for various nutrients.

CONCLUSION

The reliability and comparative validity of the SDHS FFQ is similar to FFQs that are used worldwide.

Eating Out-of-Home in Adult Residents in Shanghai and the Nutritional Differences among Dining Places

BACKGROUND

With the rapid development of Shanghai's economy, diet habits have undergone great changes. The study aimed to examine the situation of out-of-home (OH) eating in Shanghai adults and the nutrition characteristics of eating in different dining places, and to assess the social demographic determinants of eating OH.

METHOD

Data was sourced from the Shanghai Diet and Health Survey (SDHS) involving people aged 18 years or older in 2012⁻2013. The food frequency questionnaire (FFQ) and three-day 24-h dietary recall (24-HDR) were used to collect dietary intake data on how people eat out in a cross-sectional study of 1689 adults. OH food refers to the food prepared or consumed away from home. We define that people who eat at least one meal prepared away from home in each survey have a habit of eating outside. The multiple linear and logistic regression methods were used for statistical analysis.

RESULTS

The prevalence of eating OH and at restaurants was only 55.1% and 31.8%, respectively. There was an increase in energy, protein, carbohydrate, fat, and iron intake while eating OH. Restaurant and company/school canteen consumption were both associated with an increase in daily total energy intake of 140 kcal and 91 kcal, and fat intake of 6.0 g and 4.3 g, respectively. However, eating at restaurants was associated with higher intake of 548 mg of sodium. However, no significant association was observed between eating at canteens and higher sodium intake.

CONCLUSIONS

Eating OH related to a poor diet quality, and the diet quality was different restaurant and canteen food. There may be a need for interventions to target residents' overall dining-out behavior, particularly focusing on the consumption of restaurant food.

Diet quality is inversely associated with obesity in Chinese adults with type 2 diabetes

Background

Diet quality has been linked to obesity, but this relationship remains unclear in individuals with type 2 diabetes (T2D). The aim of this study is to examine the association between diet quality and obesity in Chinese adults with T2D.

Methods

Between April and November 2016, a total of 211 Chinese T2D adults who underwent assessment of diabetes-related treatment goals and metabolic control were recruited into two groups based on their body mass index (BMI): obese group (BMI ≥30 kg/m²) and non-obese group (BMI = 18.5–24.9 kg/m²). Diet quality indices including Alternate Healthy Eating Index-2010 (AHEI-2010), Diet Quality Index-International (DQI-I), and Dietary Approach to Stop Hypertension (DASH) score, were derived from a validated food frequency questionnaire.

Results

Obese T2D patients had significantly lower AHEI-2010 (P < 0.001), DQI-I (P < 0.001), and DASH total scores (P = 0.044) than their non-obese counterparts, independent of age and sex. They also had higher total energy (P < 0.001), protein percentage of energy (P = 0.023), and meat, poultry and organ meat (P < 0.001), but lower vegetable (P = 0.014) intakes. Our multivariate logistic regression analyses demonstrated that the AHEI-2010, but not DQI-I and DASH, total score had an inverse association with obesity, independent of sociodemographics, anti-diabetic medication use, physical activity level and total energy intake (odds ratio [OR] per standard deviation (1-SD) increase: 0.95, 95% confidence interval [CI]: 0.91–0.99, P = 0.020). This association remained significant after further adjustment for glycemic control. Inverse associations were also found between obesity and multivariate-adjusted component scores, including AHEI-2010 red/processed meat (OR per 1-SD: 0.71, 95% CI: 0.51–0.99, P = 0.044), DQI-I variety (OR per 1-SD: 0.63, 95% CI: 0.46–0.86, P = 0.004), and DASH red/processed meat (OR per 1-SD: 0.57, 95% CI: 0.38–0.84, P = 0.005).

Conclusions

Better diet quality, as characterized by higher AHEI-2010 scores, was associated with lower odds of obesity in Chinese adults with T2D. Dietary patterns reflecting high consumption of plant-based foods and low consumption of animal-based, high-fat, and processed foods may be imperative to optimize nutritional guidance for obesity management in this population.

Electronic supplementary material

The online version of this article (10.1186/s12937-018-0374-6) contains supplementary material, which is available to authorized users.

Dietary Balance Index-07 and the Risk of Anemia in Middle Aged and Elderly People in Southwest China: A Cross Sectional Study

A balanced diet is essential to achieve and maintain good health. In this study, we assessed diet quality of middle aged and elderly people based on Chinese Diet Balance Index-07 (DBI-07) and explored the associations between DBI-07 and anemia. Data analyzed for this study was from the 2010–2012 National Nutrition and Health Survey in Yunnan province, southwest China (n = 738, aged 50–77 years). Dietary recalls over there consecutive days were done in a face-to-face interview. The scores of DBI-07 for each component and three DBI-07 indicators ((Lower Bound Score (LBS), Higher Bound Score (HBS), Diet Quality Distance (DQD)) were calculated according to compliance with the Dietary Guidelines for Chinese residents. Hemoglobin (Hb) concentration was determined using the cyanmethemoglobin method. Univariate and multivariate linear regression models were used to explore the associations between DBI-07 indicators and anemia, as well as scores of DBI-07 components and Hb level. The sample included 336 men and 402 women. Inadequate intakes of vegetables, fruits, dairy, soybean, eggs, fish and excessive intakes of cereals, meat, cooking oil, salt were both common. 91.3% of the participants had moderate or high levels of inadequate food intake, while 37.7% had moderate or high levels of excessive food intake. The mean Hb was 14.2 ± 1.7 g/dL, with a prevalence of anemia of 13.0%. Subjects with high LBS and DQD were more likely to be anemic (all p < 0.05). After adjustment for potential confounders, there were positive correlations between Hb level and the intakes of vegetables and soybean (β_vegetables = 1.04, p < 0.01; β_soybean = 0.82, p = 0.04). In conclusion, dietary imbalance and anemia are common in middle aged and elderly population in southwest China and inadequate intakes of vegetables and soybean may increase the risk of anemia.