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Background: This article evaluates the evolution of physical activity and health research in China through a bibliometric analysis focused on number of publications, study areas, and sex balance in authorship. Methods: A systematic review was conducted by the Global Observatory for Physical Activity for "physical activity and health" publications between 1950 and 2019. Here, we focus on the 610 Chinese publications identified, defined as those in which data collection took place in China. We assessed the number of publications, classified them into 5 areas (1) surveillance, (2) correlates and determinants, (3) health consequences, (4) interventions, and (5) policy, and analyzed female participation in authorship. Results: The first Chinese publication identified in the review was in 1990. Since, the average number of physical activity and health publications increased from one per year in the 1990s to 7.6 per year in the 2000s, and to 47 per year in the 2010s. Most publications focused on the correlates and determinants (38.7%) and the health consequences of physical activity (35.9%). Physical activity policy accounted for 2.3% of the publications. In the 1990s, 64% of the publications included at least one female author; this proportion increased to 90% in the 2010s. Conclusion: Despite a slow start, China's research on physical activity and health has grown rapidly since 2000. The distribution of publications by study areas and female participation in authorship is similar to that observed globally, with fewer publications focused on interventions and policy as compared with other topics. [ABSTRACT FROM AUTHOR]

In this article, a comprehensive analysis is conducted on the influencing factors of carbon emissions in the transportation sector during the evolution of electrification in Beijing. We also considered the impact of indirect carbon emissions caused by carbon emissions from public and private cars and electricity consumption on overall carbon emissions. Based on the LMDI decomposition theory, nine influencing factors are separated, including development level, energy intensity, vehicle structure, number of private cars, and private transportation energy consumption. The analysis results show that, from 2010 to 2021, the carbon emissions from transportation in Beijing increased from 922.98 x 104t to 1490.6 x 104t. The private road carbon emission accounts for about 77.97%, and has become a decisive factor affecting road carbon emissions. In the public domain the contribution values of the development level and energy intensity are 25.20% and -38.71%, respectively. And they are the two most critical factors affecting carbon emissions on public road carbon emissions. In the private domain, the contribution values of the number of private cars, energy consumption of private transportation, and vehicle structure are 60.17%, 47.86%, and -12.99%, respectively. They are the three key factors affecting the private road carbon emissions. There is a significant difference in the proportion of indirect carbon emissions from electricity in the public and private domain. Indirect carbon emissions from electricity account for about 13.6% of road carbon emissions in the public sector, and about 0.9% in the private sector. The results in this paper provide useful references for decisionmaking in the adjustment of transportation energy structure and the promotion of electrified transportation in Beijing and other cities. [ABSTRACT FROM AUTHOR]

Summary: Background: There is limited evidence on the associations of dietary factors and patterns with risk of later‐onset ulcerative colitis (UC) in Chinese adults. Aims: To investigate the associations of dietary factors and patterns with risk of later‐onset UC in Chinese. Methods: The prospective China Kadoorie Biobank cohort study recruited 512,726 participants aged 30–79. Dietary habits were assessed using food frequency questionnaires. Dietary patterns were derived by factor analysis with a principal component method. Cox regression analysis was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results: During a median follow‐up of 12.1 years, 312 cases of newly diagnosed UC were documented (median age of diagnosis 60.1 years). Egg consumption was associated with higher risk of UC (HR for daily vs. never or rarely: 2.29 [95% CI: 1.26–4.16]), while spicy food consumption was inversely associated with risk of UC (HR: 0.63 [0.45–0.88]). The traditional northern dietary pattern, characterised by high intake of wheat and low intake of rice, was associated with higher risk of UC (HR for highest vs. lowest quartile of score: 2.79 [1.93–4.05]). The modern dietary pattern, characterised by high intake of animal‐origin foods and fruits, was associated with higher risk of UC (HR: 2.48 [1.63–3.78]). Population attributable fraction was 13.04% (7.71%–19.11%) for daily/almost daily consumption of eggs and 9.87% (1.94%–18.22%) for never/rarely consumption of spicy food. Conclusions: The findings highlight the importance of evaluating dietary factors and patterns in the primary prevention of later‐onset UC in Chinese adults. [ABSTRACT FROM AUTHOR]

Elevated blood pressure (BP) is major risk factor for cardiovascular diseases (CVD). Genome-wide association studies (GWAS) conducted predominantly in populations of European ancestry have identified >2,000 BP-associated loci, but other ancestries have been less well-studied. We conducted GWAS of systolic, diastolic, pulse, and mean arterial BP in 100,453 Chinese adults. We identified 128 non-overlapping loci associated with one or more BP traits, including 74 newly-reported associations. Despite strong genetic correlations between populations, we identified appreciably higher heritability and larger variant effect sizes in Chinese compared with European or Japanese ancestry populations. Using instruments derived from these GWAS, multivariable Mendelian randomisation demonstrated that BP traits contribute differently to the causal associations of BP with CVD. In particular, only pulse pressure was independently causally associated with carotid plaque. These findings reinforce the need for studies in diverse populations to understand the genetic determinants of BP traits and their roles in disease risk.Here the authors identify 128 regions of the genome associated with blood pressure traits in 100,000 Chinese adults. Blood pressure traits contributed differently to CVD risk, with only pulse pressure independently causally associated with carotid plaque. [ABSTRACT FROM AUTHOR]

Despite the high prevalence of snoring in Asia, little is known about the genetic etiology of snoring and its causal relationships with cardiometabolic traits. Based on 100,626 Chinese individuals, a genome-wide association study on snoring was conducted. Four novel loci were identified for snoring traits mapped on SLC25A21, the intergenic region of WDR11 and FGFR, NAA25, ALDH2, and VTI1A, respectively. The novel loci highlighted the roles of structural abnormality of the upper airway and craniofacial region and dysfunction of metabolic and transport systems in the development of snoring. In the two-sample bi-directional Mendelian randomization analysis, higher body mass index, weight, and elevated blood pressure were causal for snoring, and a reverse causal effect was observed between snoring and diastolic blood pressure. Altogether, our results revealed the possible etiology of snoring in China and indicated that managing cardiometabolic health was essential to snoring prevention, and hypertension should be considered among snorers. A genome-wide association study in the China Kadoorie Biobank identified four novel loci related to snoring, and highlights the relevance of cardiometabolic health to snoring prevention. [ABSTRACT FROM AUTHOR]

The effects of various energy conservation and carbon reduction (ECCR) strategies can differ significantly despite equal investment. Given limited amount of capital expenditure, managers and planners of industrial parks must carefully select from different ECCR strategies and implementation technologies to maximize investment returns. This study establishes mathematical models for four ECCR strategies: forestry carbon sequestration (FCS), carbon capture and utilization (CCU), waste heat recovery (WHR), and photovoltaic (PV). A universal ECCR planning optimization model is constructed to maximize annual economic benefits or carbon emission reduction. Using an industrial park in southern China as a case study, genetic algorithms are utilized to solve the model and validate its feasibility. The study analyzes three key parameters: capital expenditure caps, carbon trading price in the Emission Trading Scheme, and transportation distance of captured CO2 products for sensitivity. The results demonstrate considerable economic benefits of the CCU strategy when demand matches appropriately. However, in cases with limited capital expenditure, implementing small-scale FCS strategies in industrial parks is not advisable from both an economic and environmental perspective. [ABSTRACT FROM AUTHOR]

A correction is presented to the article "Device-measured Movement Behaviours in Over 20,000 China Kadoorie Biobank Participants," which appeared in the 2023 issue of the magazine.

Background: There is limited evidence about the association of muscle mass, strength and quality with respiratory disease, especially in Chinese populations. We aimed to comprehensively examine such associations and identify better metrics with more clinical and public health relevance., Methods: We conducted a prospective cohort study based on data from the second resurvey of the China Kadoorie Biobank (CKB) study in participants with no prevalent respiratory disease or cancer. Arm muscle quality was calculated as the ratio of grip strength to arm muscle mass. Low muscle mass, grip strength and arm muscle quality were defined as the sex-specific lowest quintiles of corresponding variables. Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for respiratory disease., Results: In total, 17 510 participants aged 38-88 (65.4% women; mean age 57.8 ± 9.6) were enrolled in 2013-2014 and followed up until 31 December 2018. During a median follow-up of 4.82 years, 1346 participants developed respiratory disease. After adjustment for sociodemographic characteristics, lifestyle factors and medical histories, the elevated HR of respiratory disease was 1.31 (1.14-1.51) for low grip strength and 1.25 (1.09-1.44) for low arm muscle quality. Grip strength and arm muscle quality exhibited a linearly inverse association between respiratory disease (p = 0.137 and 0.102), with each standard deviation (SD) decrease in grip strength and arm muscle quality associated with a 22% (95% CI: 11%-34%) and 14% (95% CI: 7%-22%) increased risk of respiratory disease. No association was found for low total muscle mass index and low appendicular muscle mass index., Conclusion: Low grip strength and arm muscle quality are associated with increased risks of respiratory disease, and they are better muscle-related metrics for identifying adults at high risk of respiratory disease. Chinese adults may need to maintain normal muscle mass, strength and quality to achieve better respiratory health, but this needs to be validated in appropriately designed clinical trials., (© 2024 The Author(s). Journal of Cachexia, Sarcopenia and Muscle published by Wiley Periodicals LLC.)

Background: This study aimed to assess the associations of two common types of preserved vegetables in China, salted and sour pickled vegetables, with the risk of gastrointestinal tract (GI) cancers, including oesophageal cancer, stomach cancer, and colorectal cancer., Methods: The China Kadoorie Biobank collected intake frequency of preserved vegetables among 510 143 adults without self-reported cancer during 2004-2008, and followed up till 31 December 2018. The second resurvey further collected intake frequencies of salted and sour pickled vegetables, which classified the 10 study areas into three types of regions, including the regions never/rarely consuming preserved vegetables (number of participants at baseline = 201 844), mainly consuming salted vegetables (n = 202 927), and mainly consuming sour pickled vegetables (n = 105 372). Cox proportional models were respectively performed to calculate hazard ratios (HRs) for GI cancers with preserved vegetables in the latter two types of regions among baseline participants., Results: In the regions mainly consuming salted vegetables, preserved vegetable consumption was positively associated with stomach cancer (HR = 1.17; 95% confidence interval = 1.00-1.37; P for trend = 0.039). In the regions mainly consuming sour pickled vegetables, a dose-response positive relationship was observed between preserved vegetable consumption and the risk of oesophageal cancer (P for trend = 0.013), with adjusted HR of 1.35 (95% CI 1.02-1.80) for those who daily consumed compared with never consumed., Conclusions: Our findings suggest that different types of preserved vegetables might have different effects on GI cancers, and limiting preserved vegetable consumption might be protective against developing GI cancers., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests., (Copyright © 2024 by the Journal of Global Health. All rights reserved.)

What Is Already Known About This Topic?: China has the world's most significant public health and economic burden of chronic respiratory disease. However, the association between preserved ratio impaired spirometry (PRISm) and mortality risk is unknown., What Is Added by This Report?: The PRISm group exhibited a 37% higher risk of all-cause mortality than the normal group, and the risks of death from cardiovascular diseases, neoplasms, respiratory diseases, and infectious and parasitic diseases were also increased in PRISm. Moreover, the presence of respiratory symptoms or disease was associated with an increased risk of mortality in PRISm., What Are the Implications for Public Health Practice?: It is imperative to enhance public awareness of PRISm and to implement measures to facilitate the regression of PRISm toward normal lung function., Competing Interests: No conflicts of interest., (Copyright and License information: Editorial Office of CCDCW, Chinese Center for Disease Control and Prevention 2024.)

What Is Already Known About This Topic?: The prevalence of COPD in Chinese individuals aged 50 years and above was obviously higher than that in younger adults, but the risk factors for this age group were unclear., What Is Added by This Report?: The prevalence was estimated at 12.8% and 5.7% for males and females over 50 in 2020-2021, with confirmed risk factors of cigarette smoking, a family history of respiratory diseases, respiratory symptoms, and a history of cough or respiratory diseases during childhood., What Are the Implications for Public Health Practice?: The findings may help clinicians and the public identify individuals at high risk of COPD and take targeted measures in a timely manner., Competing Interests: No conflicts of interests., (Copyright and License information: Editorial Office of CCDCW, Chinese Center for Disease Control and Prevention 2024.)

Adiposity is an established risk factor for multiple diseases, but the causal relationships of different adiposity types with circulating protein biomarkers have not been systematically investigated. We examine the causal associations of general and central adiposity with 2923 plasma proteins among 3977 Chinese adults (mean BMI = 23.9 kg/m²). Genetically-predicted body mass index (BMI), body fat percentage (BF%), waist circumference (WC), and waist-to-hip ratio (WHR) are significantly (FDR < 0.05) associated with 399, 239, 436, and 283 proteins, respectively, with 80 proteins associated with all four and 275 with only one adiposity trait. WHR is associated with the most proteins (n = 90) after adjusting for other adiposity traits. These associations are largely replicated in Europeans (mean BMI = 27.4 kg/m²). Two-sample Mendelian randomisation (MR) analyses in East Asians using cis-protein quantitative trait locus (cis-pQTLs) identified in GWAS find 30/2 proteins significantly affect levels of BMI/WC, respectively, with 10 showing evidence of colocalisation, and seven (inter-alpha-trypsin inhibitor heavy chain H3, complement factor B, EGF-containing fibulin-like extracellular matrix protein 1, thioredoxin domain-containing protein 15, alpha-2-antiplasmin, fibronectin, mimecan) are replicated in separate MR using different cis-pQTLs identified in Europeans. These findings identified potential novel mechanisms and targets, to our knowledge, for improved treatment and prevention of obesity and associated diseases., (© 2024. The Author(s).)

Background: Alterations in lipid metabolism and DNA methylation are 2 hallmarks of aging. Connecting metabolomic, epigenomic, and aging outcomes help unravel the complex mechanisms underlying aging. We aimed to assess whether DNA methylation clocks mediate the association of circulating metabolites with incident atherosclerotic cardiovascular disease (ASCVD) and frailty., Methods: The China Kadoorie Biobank is a prospective cohort study with a baseline survey from 2004 to 2008 and a follow-up period until December 31, 2018. We used the Infinium Methylation EPIC BeadChip to measure the methylation levels of 988 participants' baseline blood leukocyte DNA. Metabolite profiles, including lipoprotein particles, lipid constituents, and various circulating metabolites, were measured using quantitative nuclear magnetic resonance. The pace of DNA methylation age acceleration (AA) was calculated using 5 widely used epigenetic clocks (the first generation: Horvath, Hannum, and Li; the second generation: Grim and Pheno). Incident ASCVD was ascertained through linkage with local death and disease registries and national health insurance databases, supplemented by active follow-up. The frailty index was constructed using medical conditions, symptoms, signs, and physical measurements collected at baseline., Results: A total of 508 incident cases of ASCVD were documented during a median follow-up of 9.5 years. The first generation of epigenetic clocks was associated with the risk of ASCVD ( P <0.05). For each SD increment in LiAA, HorvathAA, and HannumAA, the corresponding hazard ratios for ASCVD risk were 1.16 (1.05-1.28), 1.10 (1.00-1.22), and 1.17 (1.04-1.31), respectively. Only LiAA mediated the association of various metabolites (lipids, fatty acids, histidine, and inflammatory biomarkers) with ASCVD, with the mediating proportion reaching up to 15% for the diameter of low-density lipoprotein ( P =1.2×10 -2 ). Regarding general aging, a 1-SD increase in GrimAA was associated with an average increase of 0.10 in the frailty index ( P =2.0×10 -3 ), and a 33% and 63% increased risk of prefrailty and frailty at baseline ( P =1.5×10 -2 and 5.8×10 -2 ), respectively; this association was not observed with other clocks. GrimAA mediated the effect of various lipids, fatty acids, glucose, lactate, and inflammatory biomarkers on the frailty index, with the mediating proportion reaching up to 22% for triglycerides in very small-sized very low-density lipoprotein ( P =6.0×10 -3 )., Conclusions: These findings suggest that epigenomic mechanisms may play a role in the associations between circulating metabolites and the aging process. Different mechanisms underlie the first and second generations of DNA methylation age in cardiovascular and general aging., Competing Interests: None.

Background: Little is known about the underlying relationship between mosaic loss of chromosome Y (mLOY), the most common chromosomal alterations in older men, and the risk of age-related lung diseases., Methods: We included 217 780 participants from the UK Biobank and 42 859 participants from the China Kadoorie Biobank. The mLOY events were detected using the Mosaic Chromosomal Alterations pipeline. Outcomes included all lung diseases, chronic obstructive pulmonary disease (COPD), lung cancer, and idiopathic pulmonary fibrosis (IPF). Cox proportional hazard models were fitted to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of mLOY with lung diseases in both cohorts. The combined HRs were derived from meta-analysis., Results: Results from two cohorts showed that expanded mLOY was associated with increased risks of all lung diseases [HR (95% CI): 1.19 (1.04, 1.37)], COPD [HR (95% CI): 1.20 (1.13, 1.28)], lung cancer [HR (95% CI): 1.34 (1.21, 1.48)], and IPF [HR (95% CI): 1.34 (1.16, 1.56) in UKB]. There was evidence of positive interactions between mLOY and smoking behavior [relative excess risk due to interaction (97.5%CI)>0]. Additionally, we observed that current smokers with expanded mLOY had the highest risk of incident lung diseases in both cohorts., Conclusion: mLOY may be a novel predictor for age-related lung diseases. For current smokers carrying mLOY, adopting quitting smoking behavior may contribute to substantially reduce their risk of incident lung diseases., (Copyright ©The authors 2024.)

Background: Whether adherence to a healthy lifestyle is associated with a lower risk of developing pneumonia and a better long-term prognosis remains unclear. This study aimed to investigate associations of individual and combined lifestyle factors (LFs) with the incidence risk and long-term prognosis of pneumonia hospitalization., Methods: Using data from the China Kadoorie Biobank study, we used the multistate models to investigate the role of five high-risk LFs, including smoking, excessive alcohol drinking, unhealthy dietary habits, physical inactivity, and unhealthy body shape, alone or in combination in the transitions from a generally healthy state at baseline to pneumonia hospitalization or cardiovascular disease (CVD, regarded as a reference outcome), and subsequently to mortality., Results: Most of the five high-risk LFs were associated with increased risks of transitions from baseline to pneumonia and from pneumonia to death, but with different risk estimates. The greater the number of high-risk LFs, the higher the risk of developing pneumonia and long-term mortality risk after pneumonia, with the strength of associations comparable to that of LFs and CVD. Compared to participants with 0-1 high-risk LF, the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for transitions from baseline to pneumonia and from pneumonia to death in those with five high-risk LFs were 1.43 (1.28-1.60) and 1.98 (1.61-2.42), respectively. Correspondingly, the respective HRs (95% CIs) for transitions from baseline to CVD and from CVD to death were 2.00 (1.89-2.11) and 1.44 (1.30-1.59), respectively. The risk estimates changed slightly when further adjusting for the presence of major chronic diseases., Conclusion: In this Chinese population, unhealthy LFs were associated with an increased incidence and long-term mortality risk of pneumonia., (Copyright © 2024 The Chinese Medical Association, produced by Wolters Kluwer, Inc. under the CC-BY-NC-ND license.)

Background and Purpose: Previous studies, mostly focusing on the European population, have reported polygenic risk scores (PRSs) might achieve risk stratification of stroke. We aimed to examine the association strengths of PRSs with risks of stroke and its subtypes in the Chinese population., Methods: Participants with genome-wide genotypic data in China Kadoorie Biobank were split into a potential training set (n=22 191) and a population-based testing set (n=72 150). Four previously developed PRSs were included, and new PRSs for stroke and its subtypes were developed. The PRSs showing the strongest association with risks of stroke or its subtypes in the training set were further evaluated in the testing set. Cox proportional hazards regression models were used to estimate the association strengths of different PRSs with risks of stroke and its subtypes (ischaemic stroke (IS), intracerebral haemorrhage (ICH) and subarachnoid haemorrhage (SAH))., Results: In the testing set, during 872 919 person-years of follow-up, 8514 incident stroke events were documented. The PRSs of any stroke (AS) and IS were both positively associated with risks of AS, IS and ICH (p<0.05). The HR for per SD increment (HR SD ) of PRS AS was 1.10 (95% CI 1.07 to 1.12), 1.10 (95% CI 1.07 to 1.12) and 1.13 (95% CI 1.07 to 1.20) for AS, IS and ICH, respectively. The corresponding HR SD of PRS IS was 1.08 (95% CI 1.06 to 1.11), 1.08 (95% CI 1.06 to 1.11) and 1.09 (95% CI 1.03 to 1.15). PRS ICH was positively associated with the risk of ICH (HR SD =1.07, 95% CI 1.01 to 1.14). PRS SAH was not associated with risks of stroke and its subtypes. The addition of current PRSs offered little to no improvement in stroke risk prediction and risk stratification., Conclusions: In this Chinese population, the association strengths of current PRSs with risks of stroke and its subtypes were moderate, suggesting a limited value for improving risk prediction over traditional risk factors in the context of current genome-wide association study under-representing the East Asian population., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: In non-high-risk individuals, risk-category-based atherosclerotic cardiovascular disease (ASCVD) screening strategies may be more cost-effective than one-size-fits-all approaches. However, current decisions are constrained by a lack of research evidence. We aimed to explore appropriate risk-category-based screening interval strategies for non-high-risk individuals in ASCVD primary prevention in the Chinese population., Methods: We used data from 28,624 participants in the China Kadoorie Biobank (CKB) who had completed at least two field surveys. The risk assessment tools were the 10-year ASCVD risk prediction models developed based on the CKB cohort. We constructed multistate Markov models to model disease progression and estimate transition probabilities between different risk categories. The total person-years spent unidentified in the high-risk state over a 10-year period were calculated for each screening interval protocol. We also estimated the number of ASCVD events prevented, quality-adjusted life years (QALYs) gained, and costs saved when compared to the 3-yearly screening protocol., Findings: When compared to the uniform 3-yearly protocol, most risk-category-based screening interval protocols would identify more high-risk individuals timely, thus preventing more ASCVD events and gaining QALYs. A few of them would reduce total health-care costs. The protocol, which used 6-year, 3-year, and 2-year screening intervals for low-risk, intermediate-low-risk, and intermediate-high risk individuals, was optimal, and would reduce the person-years spent unidentified in the high-risk category by 17.9% (95% CI: 13.1%-21.9%), thus preventing an estimated 113 thousand (95% CI: 83-138) hard ASCVD events for Chinese adults aged 30-79 over a 10-year period. When using a lower cost of statin therapy, more screening protocols would gain QALYs while saving costs., Interpretation: For the primary prevention of ASCVD, risk-category-based screening protocols outperformed the one-size-fits-all approach in the Chinese population., Funding: This work was supported by National Natural Science Foundation of China (82192904, 82388102, 82192900) and grants (2023YFC2509400) from the National Key R&D Program of China. The CKB baseline survey and the first re-survey were supported by a grant from the Kadoorie Charitable Foundation in Hong Kong. The long-term follow-up is supported by grants from the UK Wellcome Trust (212946/Z/18/Z, 202922/Z/16/Z, 104085/Z/14/Z, 088158/Z/09/Z), grants (2016YFC0900500) from the National Key R&D Program of China, National Natural Science Foundation of China (81390540, 91846303, 81941018), and Chinese Ministry of Science and Technology (2011BAI09B01)., Competing Interests: We declare no competing interests., (© 2024 The Author(s).)

Background: The associations of early adulthood BMI with cardiovascular diseases have yet to be completely delineated. There is little reliable evidence about these associations among east Asian populations, that differ in fat distribution, disease patterns, and lifestyle factors from other populations. We aimed to study the associations between early adulthood BMI and cardiovascular diseases in a Chinese population, and the effect of midlife lifestyle factors on outcomes., Methods: In this prospective analysis, we used data from the China Kadoorie Biobank, a large and long-term cohort from five urban areas and five rural areas, using participants aged 35-70 years. The primary outcome was the incidence of cardiovascular diseases as a group, ischaemic heart disease, haemorrhagic stroke, and ischaemic stroke, which were obtained mainly through linkage to disease registries and the national database for health insurance claims. Early adulthood BMI was assessed through self-report at baseline survey. We used Cox proportional hazards regression models to examine the prospective associations. We also undertook multiplicative and additive interaction analyses to investigate the potential modification effect of midlife healthy lifestyle factors (a combined score covering smoking, drinking, physical activity, and diet)., Findings: Participants were recruited for baseline survey between June, 2004, and July, 2008. During a median follow-up of 12·0 years (IQR 11·3-13·1), we documented 57 203 (15·9%) of incident cardiovascular diseases in 360 855 participants. After adjustment for potential confounders, monotonic dose-response associations were observed between higher early adulthood BMI and increased risks of incident cardiovascular diseases. Compared with an early adulthood BMI of 20·5-22·4 kg/m 2 (the reference group), the hazard ratios for a BMI of less than 18·5 kg/m 2 was 0·97 (95% CI 0·94-1·00), 18·5-20·4 kg/m 2 was 0·97 (0·95-0·99), 22·5-23·9 kg/m 2 was 1·04 (1·02-1·07), 24·0-25·9 kg/m 2 was 1·12 (1·09-1·15), 26·0-27·9 kg/m 2 was 1·19 (1·14-1·24), 28·0-29·9 kg/m 2 was 1·34 (1·25-1·44), and ≥30·0 kg/m 2 was 1·58 (1·42-1·75). Except for haemorrhagic stroke, lower early adulthood BMI (<20·5 kg/m 2 ) was associated with decreased incident cardiovascular disease risks. No significant interaction was found between midlife healthy lifestyle factors and early adulthood BMI on cardiovascular disease risks., Interpretation: Increased risks of cardiovascular disease incidence were found among participants with high early adulthood adiposity, including ischaemic heart disease, haemorrhagic stroke, and ischaemic stroke. Our findings suggest early adulthood as an important time to focus on weight management and obesity prevention for cardiovascular health later in life., Funding: National Natural Science Foundation of China, National Key Research and Development Program of China, Chinese Ministry of Science and Technology, Kadoorie Charitable Foundation, and the Wellcome Trust., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Background: Healthy diet is essential for cardiovascular disease risk management, but its effects among Chinese patients, whose diets differ from Western diets, remain largely unknown., Methods: In this multicenter, patient- and outcome assessor-blind, randomized controlled feeding trial, 265 Chinese adults with baseline systolic blood pressure 130 to 159 mmHg were randomly assigned into Chinese heart-healthy (CHH) diet or usual diet for a 28-d intervention after a 7-d run-in period on usual diet. Blood lipids and glucose were measured from overnight fasting blood samples before and after the intervention. Ten-year cardiovascular disease risk was estimated using models previously developed and validated in Chinese. The changes in secondary outcomes of serum total cholesterol (TC), blood glucose, and 10-y cardiovascular disease risk over the intervention period were compared between intervention groups, adjusting for center, among participants with baseline and follow-up blood samples available. Sensitivity analyses were done with further adjustment for baseline values and covariables; missing data imputed; and among per-protocol population., Results: Among 256 eligible participants (130 on CHH diet, 126 on control diet), 42% had hypercholesterolemia and 15% had diabetes at baseline. In the control group, TC and 10-y cardiovascular disease risk decreased after the intervention by 0.16 mmol/L and 0.91%, respectively, but blood glucose increased by 0.25 mmol/L. Compared with usual diet, the CHH diet lowered TC (-0.14 mmol/L, P = 0.017) and 10-y cardiovascular disease risk (-1.24%, P = 0.001) further. No effect on blood glucose was found. All sensitivity analyses confirmed the results on TC and 10-y cardiovascular disease risk, and analysis with multiple variables adjusted showed a borderline significant effect on blood glucose (-0.17 mmol/L, P = 0.051). The differences in intake of nutrients and food groups between intervention groups explained the results., Conclusions: The CHH diet reduced TC and 10-y cardiovascular disease risk and was likely to reduce blood glucose among Chinese adults with mild hypertension. Further studies with longer terms are warranted. This trial was registered at clinicaltrials.gov as NCT03882645., (Copyright © 2023 American Society for Nutrition. Published by Elsevier Inc. All rights reserved.)

Background: Previous observational studies established a positive relationship between snoring and stroke. We aimed to investigate the causal effect of snoring on stroke., Methods: Based on 82,339 unrelated individuals with qualified genotyping data of Asian descent from the China Kadoorie Biobank (CKB), we conducted a Mendelian randomization (MR) analysis of snoring and stroke. Genetic variants identified in the genome-wide association analysis (GWAS) of snoring in CKB and UK Biobank (UKB) were selected for constructing genetic risk scores (GRS). A two-stage method was applied to estimate the associations of the genetically predicted snoring with stroke and its subtypes. Besides, MR analysis among the non-obese group (body mass index, BMI <24.0 kg/m 2 ), as well as multivariable MR (MVMR), were performed to control for potential pleiotropy from BMI. In addition, the inverse-variance weighted (IVW) method was applied to estimate the causal association with genetic variants identified in CKB GWAS., Findings: Positive associations were found between snoring and total stroke, hemorrhagic stroke (HS), and ischemic stroke (IS). With GRS of CKB, the corresponding HRs (95% CIs) were 1.56 (1.15, 2.12), 1.50 (0.84, 2.69), 2.02 (1.36, 3.01), and the corresponding HRs (95% CIs) using GRS of UKB were 1.78 (1.30, 2.43), 1.94 (1.07, 3.52), and 1.74 (1.16, 2.61). The associations remained stable in the MR among the non-obese group, MVMR analysis, and MR analysis using the IVW method., Interpretation: This study suggests that, among Chinese adults, genetically predicted snoring could increase the risk of total stroke, IS, and HS, and the causal effect was independent of BMI., Funding: National Natural Science Foundation of China, Kadoorie Charitable Foundation Hong Kong, UK Wellcome Trust, National Key R&D Program of China, Chinese Ministry of Science and Technology., Competing Interests: The authors have no relevant financial or non-financial interests to disclose., (© 2023 The Author(s).)