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Abstract Background The aim of the study was to investigate the relationship between sedentary behavior, screen time and MetS among Chinese children and adolescents aged 7–17 years. Data was obtained from the China National Nutrition and Health Surveillance of Children and Lactating Mothers in 2016–2017. Methods Data on sedentary time, screen time, and MetS indicators were obtained through physical and health questionnaires, anthropometric measurements, and clinical examinations. MetS was defined according to the Cook’s criteria. Wilcoxon rank sum test and chi-square test were applied for comparisons of measurement data and counting data, respectively. The relationship between sedentary time, screen time, and MetS and its components was analyzed using a multivariate logistic regression model. Results The prevalence of MetS among 7-17-year-old students in 2016–2017 was 5.45%. Compared to those with low sedentary behavior, in high sedentary behavior groups, the prevalence of abdominal obesity, high TG, low HDL-C, and MetS was high in boys, and the prevalence of abdominal obesity, high TG, hyperglycemia, and MetS was high in girls. Moreover, for those who reported ≥ 3 h/day of screen time, the prevalence of abdominal obesity, low HDL-C, and MetS was higher in boys, and the prevalence of abdominal obesity and MetS was higher in girls. After adjusting for confounding variables, the risks of abdominal obesity, high TG, low HDL-C, and MetS were higher in high-level sedentary time group, and the risks of abdominal obesity and MetS were 1.15 and 1.14 times higher for those who spent ≥ 3 h/day on screen time, respectively. Conclusions This study shows that high levels of sedentary time and screen time were associated with an increased likelihood of MetS among Chinese children and adolescents aged 7–17 years. Reducing sedentary behavior and screen time may contribute to the prevention of metabolic diseases.

Abstract Beijing is undergoing multiple challenges including urbanization, warming and aging. The Beijing megalopolis of 20 million people now suffers more cold‐related than heat‐related deaths. Stratospheric aerosol injection (SAI) geoengineering is designed to lower surface temperatures, so if SAI were ever done, it may reduce future heat‐related mortality, while also increasing cold‐related mortality. Here we use four Earth System Models (ESM) downscaled to 10 km resolution with the Weather Research and Forecasting (WRF) system to capture urban temperature, humidity and wind speeds. Temperature‐related mortality risk were calculated using a distributed lag nonlinear model (DLNM) of the elderly (over 65s) under the dynamically downscaled moderate (RCP4.5) and extreme (RCP8.5) greenhouse gas, and the G4 SAI scenarios. We used population demographics for all five shared socioeconomic pathways (SSP) and various adaptation measures. Heat‐related excess deaths under G4 are 630∼3,160 per year fewer than RCP4.5, while cold‐related deaths are 370∼1,990 more than RCP4.5 during 2060–2069, with a marginally significant net reduction. G4 significantly reduces the excess deaths relative to RCP8.5. Both heat‐related and cold‐related mortality will increase by 240∼490% when the aging population is accounted for, and decrease by 11%, 23% and 44% under low, medium and high adaptation relative to a no adaptation scenario. Dynamical downscaling produces better quality climate simulations than commonly used statistical approaches, and in the case of Beijing, significantly fewer heat‐related deaths. The marginal health benefits of modest future SAI in Beijing may be representative of the population impacts in the extra‐tropics where deaths due to cold are more than those caused by heat.

Abstract Heat transported in Circumpolar Deep Water is driving the break‐up of ice shelves in the Amundsen Sea sector of Antarctica, that has been simulated to be unavoidable under all plausible greenhouse gas scenarios. However, Solar geoengineering scenarios remain largely unexplored. Solar geoengineering changes global thermal radiative balance, and atmospheric and oceanic transportation pathways. We simulate stratospheric aerosol injection (SAI) designed to reduce global mean temperatures from those under the unmitigated SSP5‐8.5 scenario to those under the SSP2‐4.5 scenario with six CMIP6‐class Earth System Models. These consistently show intensified Antarctic polar vortex and sub‐polar westerlies, which mitigates changes to easterly winds along the Amundsen Sea continental shelf compared with greenhouse gas scenarios. The models show significantly cooler Amundsen Sea waters and lower heat content at 300–600 m under SAI than with either solar dimming or the SSP5‐8.5 unmitigated greenhouse gas scenarios. However, the heat content increases under all scenarios compared with present day suggesting that although vulnerable ice shelves would continue to thin, the rate would be lower for SAI even with SSP5‐8.5 specified greenhouse gases, than for the moderate (SSP2‐4.5) scenario. The simulations here use solar geoengineering designed to meet global temperature targets; interventions targeted at preserving the frozen high latitudes have also been proposed that might be expected to produce bigger local effects, but potentially deleterious impacts elsewhere. Considering the huge disruptions to society of ice sheet collapse, more research on avoiding them by intervention technology is a moral imperative.

Introduction: The risk of diabetes begins at a lower BMI among Asian adults. This study compares the prevalence of diabetes between the U.S. and China by BMI. Methods: Data from the 2015–2017 China Nutrition and Health Surveillance (n=176,223) and the 2015–2018 U.S. National Health and Nutrition Examination Survey (n=4,464) were used. Diagnosed diabetes was self-reported. Undiagnosed diabetes was no report of diagnosed diabetes and fasting plasma glucose ≥126 mg/dL or HbA1c ≥6.5%. Predicted age-adjusted prevalence estimates by BMI were produced using sex- and country-specific logistic regression models. Results: In China, the age-adjusted prevalence of total diabetes was 7.8% (95% CI=7.4%, 8.3%), lower than the 14.6% (95% CI=13.1%, 16.3%) in the U.S. The prevalence of diagnosed diabetes was also lower in China than in the U.S. There were no statistically significant differences in the prevalence of undiagnosed diabetes between China and the U.S. The distribution of BMI in China was lower than in the U.S., and the predicted prevalence of total diabetes was similar between China and the U.S. when comparing adults with the same BMI. The predicted prevalence of undiagnosed diabetes was higher in China than in the U.S. for both men and women, and this disparity increased with BMI. When comparing adults at the same BMI, there was little difference in the prevalence of total diabetes, but diagnosed diabetes was lower in China than in the U.S., and undiagnosed was higher. Conclusions: Although differences in BMI appear to explain nearly all of the differences in total diabetes prevalence in the 2 countries, not all factors that are associated with diabetes risk have been investigated.

Background: Remnant cholesterol (RC) is highly associated with several chronic diseases. However, the relationship between RC and Metabolic syndrome (MetS) remains unclear. The study’s objective is to illustrate the relationship of RC to MetS. Methods: The data were collected from the Chinese Nutrition and Health Surveillance (2015–2017), which included personal, household and dietary information. A total of 65,618 residents aged 20 years or older from 31 provinces in mainland China were included in this study. RC was calculated by the equation RC = TC − (LDL-C + HDL-C). The criteria for MetS were based on the 2020 Chinese Type 2 Diabetes Prevention and Treatment Guidelines. Logistic regression models were used to analyse the relationship between RC and MetS and every MetS component. The receiver operating characteristic (ROC) curve was established to evaluate the accuracy of RC in identifying MetS, and the area under the curve (AUC) and the best threshold were calculated. Results: The weighted RC level of Chinese residents aged 20 years or older was 0.48 mmol/L. Participants with high RC levels were likely to be elderly, have a higher prevalence of MetS, higher total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), fasting blood glucose (FBG), hba1c, and lower high-density lipoprotein cholesterol (HDL-C). Sex, body mass index (BMI), education status, household yearly income per capita, marital status, area of the country, residence location, smoking status, fruit intake and sleep time had statistical differences in the RC group (p < 0.05). The OR of MetS gradually increased with an increase in the RC quartile (p < 0.01), and higher quartiles of RC (Q4) suggested the highest MetS risk. The prevalence of each MetS component gradually increased with an increase in the RC quartile. The ROC curve found that to identify MetS, the AUC and best threshold of RC were 0.71 and 0.52 mmol/L, respectively. Conclusions: RC had a positive association with MetS and each MetS component. The accuracy in identifying MetS was higher in RC than in other indexes. The current study could provide new scientific evidence for the early prevention and control of MetS.

BackgroundGeographic distribution of dietary inflammatory index (DII) in China has not been thoroughly evaluated and evidence on the association between DII and hypertension among Chinese middle-aged and older population was inadequate.ObjectiveTo investigate the geographic disparities of DII and its association with hypertension among Chinese middle-aged and elders.MethodsData was from the China Adults Chronic Diseases and Nutrition Surveillance (CACDNS 2015) for middle-aged and older participants. The DII for each participant was determined through a combination of 3 days 24 h dietary recall interviews and a food frequency questionnaire. Spatial analysis was employed to investigate the geographic distribution of DII in China. Restricted cubic spline models and binary logistic regression analysis were used to assess the relationship between DII and hypertension. The least absolute shrinkage and selection operator (LASSO) regression was applied for identifying key hypertension-related factors, which was then included in the establishment of a risk prediction nomogram model, with the receiver operating characteristic (ROC) curve and decision curve analysis (DCA) being built to evaluate its discriminatory power for hypertension.ResultsA total of 52,087 middle-aged and older participants were included in the study, among whom 36.6% had hypertension. it revealed that a clear spatial correlation in the national distribution of DII scores (Moran I: 0.252, p = 0.001), with higher DII scores concentrated in the northwest region and lower DII scores concentrated in the southeast region. Hypertensive participants had higher DII scores compared to those without hypertension (OR: 1.507 vs. 1.447, p = 0.003). Restricted cubic spline models and binary logistic regression analysis demonstrated a positive association between DII and hypertension after adjusting for potential confounding factors. There was a significant increasing trend in the proportion of hypertensive individuals as DII scores increase (p for trend = 0.004). The nomogram model, constructed using key factors identified through LASSO regression, demonstrated a robust discriminative capacity, with an area under the curve (AUC) of 73.2% (95% CI, 72.4–74.0%). Decision curve analysis confirmed the reliability and effectiveness of the nomogram model. Sensitivity analysis conducted within the subpopulation aged under 45 years yielded results consistent with the primary analysis.ConclusionIn Chinese adults middle-aged and older, geographic disparities in dietary inflammatory potential are notable, with lower levels observed in the southeastern coastal regions of China and higher levels in the northwestern regions. Meanwhile, there is a positive association between the inflammatory potential of the diet and hypertension. Additional research is needed to investigate regional disparities in dietary inflammatory potential and pinpoint specific dietary patterns associated with lower inflammation.

ObjectiveTo examine the intake of cooking oil and salt among day students and boarders aged 12 − 17 years in China in 2016 – 2017 for providing evidence to the development of effective measures on reducing cooking oil and salt intake in the students. MethodsThe data on 3 492 day students and 3 773 boarders aged 12 − 17 years were extracted from China National Nutrition and Health Survey conducted during 2016 – 2017 at 275 surveillance sites selected with multistage stratified random sampling in 31 provincial-level administrative divisions. Three-day consecutive weighing of household or school canteen cooking oil and salt use were adopted to measure the participants′ cooking oil and salt intake. ResultsThe median of cooking oil intake was 31.1 grams/day (g/d) for the day students and 30.6 g/d for the boarders and there was no significant difference between the medians of the two student groups (P > 0.05); but there were significant gender and residential region (urban-rural, north-south, east-middle-west) differences in the median of cooking oil intake for both day students and boarders (P < 0.01 for all). The percentages of the day students and boarders with the intake of cooking oil exceeding 30 g/d (being recommended in the Dietary Guidelines for Chinese Residents – 2022) were 52.4% and 51.9% ,respectively, without significant difference (P > 0.05). The median of table salt intake of the day students and boarders were 6.5 g/d and 6.6 g/d and there was no significant difference between the medians of the two student groups (P > 0.05); but there were significant gender and residential region (north-south, east-middle-west) differences in the median of table salt intake for both day students and boarders（all P < 0.05) and there was urban-rural difference in the median for the boarders (P < 0.01). The percentages of the day students and boarders with the intake of table salt exceeding 5 g/d (being recommended in the Dietary Guidelines for Chinese Residents – 2022) were 65.6% and 67.1% ,respectively, without significant difference (P > 0.05). ConclusionThere were no significant differences in the medians of daily intake of cooking oil and table salt between the day students and boarders aged 12 – 17 years in China and more than 50% of the day students and boarders had the cooking oil and table salt intake exceeding the amount recommended in national dietary guidelines.

Abstract The IPCC sixth assessment report forecasts sea level rise (SLR) of up to 2 m along coasts by 2100 relative to 1995–2014 following business as usual (SSP585) scenarios. Geoengineering may reduce this threat. We use five Earth System Models simulations of two different solar geoengineering methods (solar dimming and stratospheric sulfate aerosol injection), that offset radiative forcing differences between SSP585 “no-mitigation” and the modest mitigation SSP245 greenhouse gas scenarios, to analyze the impact on global mean thermosteric and dynamic regional sea levels. By 2080–2099, both forms of geoengineering reduce global mean thermosteric sea level by 36–41% (11.2–12.6 cm) relative to SSP585, bringing the global mean SLR under SSP585 in line with that under SSP245, but do not perfectly restore regional SLR patterns. Some of the largest reductions (∼18 cm) are on densely populated coasts of eastern Northern America and Japan and along vulnerable Arctic coastal permafrost.

The purpose of this study was to describe the prevalence of central obesity and its influencing factors among Chinese adults aged 18 or older. The data were from China Nutrition and Health Surveillance (2015–2017), which used a stratified, multistage, random sampling method. A total of 145,298 adults aged 18 years or older from 31 provinces were included in this study. The Criteria of Weight for Adults promulgated by China in 2013 were used to determine central obesity. Out of all the adults investigated, 48,342 were identified with central obesity, with a prevalence rate of 33.3%. A logistic analysis suggested that the following factors were associated with central obesity: female sex [odds ratio (OR) = 1.329, 95%CI = 1.277~1.384]; increasing age [OR (95%CI): 1.146 (1.061~1.238), 1.254 (1.167~1.348), 1.774 (1.651~1.907), 2.041 (1.894~2.198), 2.434 (2.239~2.647)]; being married [OR = 1.184, 95%CI = 1.077~1.302]; being divorced or widowed [OR = 1.132, 95%CI = 1.006~1.273]; an urban setting [OR = 1.096, 95%CI = 1.061~1.132]; BMI [OR (95%CI): 0.159 (0.095~0.266), 12.645 (11.388~14.042), 180.989 (153.025~214.064)]; drinking [OR = 1.069, 95%CI = 1.031~1.109]; and screen time > 5 h [OR = 1.088, 95%CI = 1.036~1.141] were risk factors for central obesity; while education above primary school [OR (95%CI): 0.905 (0.875~0.936), 0.857 (0.802~0.915)] and sufficient physical activity [OR = 0.819, 95%CI = 0.782~0.858] were protective factors for central obesity. This study revealed that the prevalence of central obesity, which differed by gender and age, is still high. Large differences between different groups and geographic regions exist persistently. Effective, sustainable, and culturally targeted interventions are needed.

Half of Chinese adults face the double burden of overweight/obesity and micronutrient deficiencies, and nearly 40% of them are severely overweight/obese or have micronutrient deficiencies. This study used the data from China Nutrition and Health Survey (CNHS) from 2015 to 2017 to estimate the prevalence of inadequate dietary micronutrient intake (including vitamin A, vitamin B1, vitamin B2, vitamin C, cCalcium, iron and sodium) in Chinese adults and further determine the differences in micronutrient intake by gender, age and BMI. A total of 61,768 subjects were included in this study, of which 33,262 (54%) were female. The intake of energy and all macronutrients decreased with age, and the intake was higher in men than in women. Inadequate energy intake occurs in adults of all ages. In terms of nutrient intake, women had a higher rate of insufficient carbohydrate intake than men in all age groups. Inadequate protein intake was more common in women aged 18–49 years (60.9%) than in men. Compared with women, men had a higher rate of vitamin B2 intake. Insufficient vitamin B3 intake was more common in women aged 18–49 years (35.6%), men aged 65–79 years (39.7%) and men aged 80 years and above (47.9%). In all age groups, insufficient vitamin C intake is higher in women than in men—up to 85.8 percent in women aged 80 years old and above. Compared with men in the same age group, insufficient intake of calcium and iron is more obvious in women. Women have significantly higher rates of inadequate intake of calcium, iron and sodium than men. In the analysis of correlations between BMI or demographic data and micronutrient intakes, the likelihood of micronutrient intakes being insufficient was higher in the central and western regions in all age groups compared to the eastern regions. The risk of insufficient micronutrient intake was higher in obese men and women aged 18–49 years and 50–64 years. Underweight and overweight women in the 65–79 age group were more likely to have inadequate micronutrient intake. Obese women over 80 years of age were less likely to have inadequate micronutrient intake. No significant difference was found between urban and rural areas for each age group.

Abstract Background Studies have shown that nutritional supplements could reduce the adverse effects induced by air pollution. However, whether dietary patterns can modify the association of long-term exposure to fine particulate matter (PM2.5) and its constituents with hypertension defined by the 2017 ACC/AHA guideline has not been evaluated. Methods We included 47,501 Chinese adults from a nationwide cross-sectional study. PM2.5 and five constituents were estimated by satellite-based random forest models. Dietary approaches to stop hypertension (DASH) and alternative Mediterranean diet (AMED) scores were calculated for each participant. Interactions between dietary patterns and air pollution were examined by adding a multiplicative interaction term to logistic models. Results Long-term exposure to PM2.5 and its constituents was associated with an increased risk of hypertension and stage 1–2 hypertension. The DASH and AMED scores significantly modified these associations, as individuals with higher scores had a significantly lower risk of air pollution-related hypertension and stage 1–2 hypertension (P-interaction

Many traditional Chinese medicines (TCMs) have been confirmed to have antibacterial activities. However, very few substances have been found to be active against Gram-negative bacteria. This study aimed to identify antimicrobial activity substances against Gram-negative bacteria from fourteen TCMs. Fourteen TCMs with antibacterial potential were chosen for quantitative extraction and antibacterial activity assay, and the plant with the highest activity against Escherichia coli was selected to construct the component-target network. The following virtual screening and enzyme inhibition experiments were performed to analyse the antibacterial mechanisms of the compounds from Galla chinensis. The chemical constituents of Galla chinensis were identified by chemical fingerprinting. 1, 2, 3, 4, 6-Penta-O-galloyl-β-D-glucose (PGG) from Galla chinensis exhibited significant inhibition activity against adenylyl transferase (ATase) of E. coli and antibacterial activity against E. coli. Meanwhile, PGG was identified in the Galla chinensis ethanol extract as the abundant ingredient with a high content of 1.95% (w/w). PGG enriched in Galla chinensis is a promising natural antibiotic with the mode of action inhibiting ATase activity. To our knowledge, this is the first study attributing the antibacterial activity of PGG to its affinity with ATase.

Objective To analyze and evaluate the status of main food intakes among 6 – 17 years old children in China from 2016 to 2017，and to provide evidence for guiding the children's food intake. Methods The data of the study were extracted from the National Nutrition and Health Survey among children and lactating mothers conducted during 2016 – 2017 at 275 surveillance sites selected with stratified multistage random sampling in 31 provincial-level administrative divisions across China. The information on food intake of 16 042 children aged 6 – 17 years were collected using three consecutive 24-hour recalls. Based on the classification of the China Food Composition Table, the food were divided into grains and cereals, tubers, whole grains and miscellaneous beans, fresh vegetables, fresh fruits, meat and poultry, fish and shrimp, eggs, milk, nuts and beans, and the children's intake of each food were calculated. The percentage of the average daily intake of main foods (< 60%, 60% – 79%, 80% – 99%, and > 100%) relative to the recommended amount among the children were analyzed according to the food guide pagoda for Chinese school-age children. Results The estimated average daily intakes (grams) of the children were 236.20 ± 118.45 for grains and cereals, 33.32 ± 51.86 for tubers, 12.12 ± 24.67 for whole grains and miscellaneous beans, 164.03 ± 127.08 for fresh vegetables, 47.85 ± 75.76 for fresh fruits, 2.16 ± 8.68 for nuts, 103.39 ± 78.99 for meat and poultry, 15.45 ± 32.45 for fish and shrimp, 33.25 ± 32.51 for eggs, 72.83 ± 113.66 for milk and milk products, and 9.29 ± 18.41 for beans, respectively. In comparison to recommendations of the food guide pagoda, the children's average daily intakes of grains and cereals were 58.43% higher and those of meat and poultry were 76.06% higher; while, the average daily intakes were 80.55% lower for whole grains and miscellaneous beans, 76.21% for fresh vegetables, 85.21% for fresh fruits, 88.99% for nuts, 79.67% for fish and shrimp, 86.93% for milk and milk products, and 70.81% for beans. There were significant age differences in daily intakes of main foods (P < 0.05 for all), except for nuts; there were also significant gender differences in daily intake of grains and cereals, whole grains and miscellaneous beans, fresh fruits, meat and poultry, eggs, and nuts (all P < 0.05) and regional differences between urban and rural areas and among eastern, central and western regions in daily intakes of main foods (both P < 0.05). ConclusionThe average daily intakes of grains and cereals, meat and poultry were adequate, even too much in most children of 6 – 17 years old in China, but those of whole grains and miscellaneous beans, fresh vegetables, fresh fruits, meat and poultry, fish and shrimp, eggs, milk, nuts and beans were insufficient. There were significant differences in the children′s daily intakes of main foods between urban and rural areas and among eastern, central and western regions.

Abstract Background Venetoclax (Ven) combined with intensive chemotherapy was proven effective in the management of acute myeloid leukemia (AML). However, the severe and prolonged myelosuppression remains a concern to worry about. To explore more appropriate combination regimens, we designed Ven combining daunorubicin and cytarabine (DA 2 + 6) regimen as induction therapy, aimed to evaluate the effectiveness and safety in adults de novo AML. Methods A phase 2 clinical trial was performed in 10 Chinese hospitals to investigate Ven combined with daunorubicin and cytarabine (DA 2 + 6) in patients with AML. The primary endpoints were overall response rate (ORR), comprising of complete remission (CR), complete remission with incomplete blood cell count recovery (CRi), and partial response (PR). Secondary endpoints included measurable residual disease (MRD) of bone marrow assessed by flow cytometry, overall survival (OS), event-free survival (EFS), disease-free survival (DFS), and the safety of regimens. This study is a currently ongoing trial listed on the Chinese Clinical Trial Registry as ChiCTR2200061524. Results Overall, 42 patients were enrolled from January 2022 to November 2022; 54.8% (23/42) were male, and the median age was 40 (range, 16–60) years. The ORR after one cycle of induction was 92.9% (95% confidence interval [CI], 91.6–94.1; 39/42) with a composite complete response rate (CR + CRi) 90.5% (95% CI, 89.3–91.6, CR 37/42, CRi 1/42). Moreover, 87.9% (29/33) of the CR patients with undetectable MRD (95% CI, 84.9–90.8). Grade 3 or worse adverse effects included neutropenia (100%), thrombocytopenia (100%), febrile neutropenia (90.5%), and one mortality. The median neutrophil and platelet recovery times were 13 (5–26) and 12 (8–26) days, respectively. Until Jan 30, 2023, the estimated 12-month OS, EFS, and DFS rates were 83.1% (95% CI, 78.8–87.4), 82.7% (95% CI, 79.4–86.1), and 92.0% (95% CI, 89.8–94.3), respectively. Conclusion Ven with DA (2 + 6) is a highly effective and safe induction therapy for adults with newly diagnosed AML. To the best of our knowledge, this induction therapy has the shortest myelosuppressive period but has similar efficacy to previous studies.

Obesity is a major public health issue in children and adolescents. Our study aimed to examine the impacts of birth weight on overweight and obesity among Chinese children and adolescents. Using data from the China National Nutrition and Health Surveillance of Children and Lactating Mothers in 2016–2017, we included 10,041 participants aged 7–17 years. According to birth weight, participants were categorized into six groups, and the birth weight category of 3000 to 3499 g was chosen as the reference group, containing the largest number of children. Logistic regression analyses were used to investigate the association of birth weight with the risk of being obese at 7 to 17 years of age in multivariable-adjusted models. A restricted cubic spline was utilized to show the odds ratios (ORs) of obesity at different birth weight levels. The adjusted ORs for overweight were 0.98 (95%CI 0.63, 1.53), 1.02 (95%CI 0.84, 1.25), 1.34 (95%CI 1.16, 1.55), 1.72 (95%CI 1.35, 2.18), and 1.17 (95%CI 0.71, 1.96) in several birth weight groups, compared with group C (3000–3499 g). The adjusted ORs for obesity were 0.82 (95%CI 0.48, 1.40), 0.77 (95%CI 0.60, 0.98), 1.33 (95%CI 1.13, 1.57), 1.97 (95%CI 1.53, 2.53), and 2.01 (95%CI 1.27, 3.19). Furthermore, children in the post-pubertal stage had a slightly higher risk of overweight and obesity than those in the pre-pubertal and pubertal stage. Moreover, these associations were stronger among boys. The lower part of normal birth weight range is associated with a lower risk of overweight and obesity in children and adolescents. However, higher levels of birth weight increase risk.

The K-feldspar mineral is an insoluble potassium resource with a high potassium content and the most extensive and abundant reserves. To address the insufficient supply of soluble potassium fertilizers in China, the application of appropriate processing methods to extract potassium from K-feldspar and transform it into a soluble potassium fertilizer is of great significance. To date, various techniques have been developed to extract potassium from K-feldspar and produce a soluble potassium fertilizer. This review summarizes the main methods, i.e., the hydrothermal, high-temperature pyrolysis, microbial decomposition, and low-temperature methods, for potassium extraction from K-feldspar. The mechanisms, efficiencies, impact parameters, and research progress of each potassium extraction method are comprehensively discussed. This study also compares the merits and drawbacks of the individual methods in terms of potassium extraction efficiency and practical operating conditions. The species of additives, reaction temperature, reaction time, particle size of K-feldspar, and dosage of additives significantly affected the potassium extraction efficiency. Moreover, the combination of different methods was very effective in improving the potassium extraction efficiency. This review elaborates the research prospects and potential strategies for the efficient utilization of the K-feldspar mineral as a fertilizer resource.

This study aimed to describe the prevalence of comorbid hypertension and hyperuricemia (HH) and detected the dietary factors for HH in Chinese adults aged 18 to 64 years. All of the data were collected from the China Nutrition and Health Surveillance 2015–2017, with a stratified, multistage, random sampling method on a national scale. A total of 52,627 adult participants aged 18~64 years from the CNHS 2015–2017 were included in this study. HH was identified as SUA level cut-offs for males and females of 420 μmol/L and 360 μmol/L, respectively, with mean systolic blood pressure ≥140 mmHg and/or mean diastolic blood pressure ≥ 90 mmHg and/or received antihypertensive treatment within two weeks. The differences in HH prevalence between or among the subgroups were compared by the Rao–Scott chi-square test. The correlations between HH and covariates or metabolic factors were detected by a weighted two-level multivariate survey logistic regression. The total weighted sufficient intake ratios of beans and nuts, vegetables, and red meat were 59.1%, 46.6%, and 64.8%, respectively. The weighted prevalence of HH in the total participants was 4.7% (95% CI: 4.3–5.0%). The positive effects of bean and nut on HH were observed. The participants who had sufficient bean and nut intake showed lower risk for HH (for the total participants: OR = 0.734, 95% CI = 0.611–0.881). The prevalence of HH might have been a public health problem, and bean and nut intake might be a protective factor for HH in the Chinese population.

Abstract This paper addresses coordinated problem of uncertain robotic manipulators with matrix-weighted network. Given interconnections between agents are weighted by nonnegative definite matrices, we present a sufficient and necessary condition about zero eigenvalues of matrix-weighted Laplacian and types of coordinated behaviors for multiple agents. Based on the condition, two novel control schemes are proposed for the networked robots by introducing matrix-weighted network. We employ the decomposition approach and Lyapunov-like approach to show coordinated motions of the networked system, and demonstrate that the proposed controls are capable of ensuring the robotic agents reach complete/cluster consensus and complete/cluster synchronization. Finally, some numerical examples and simulations demonstrate the obtained theoretical results.

Studies focused on the association between dietary patterns and elevated blood pressure (BP) and hypertension (HTN) among children and adolescents remain insufficient. This study aimed to explore a dietary pattern that could be helpful for the prevention of abnormal BP and to investigate the association between this dietary pattern and elevated BP and HTN among Chinese children and adolescents. A total of 52,080 Chinese children and adolescents aged 6~17 years old from the China Nutrition and Health Surveillance (CNHS) 2015–2017 were included in the current study. The reduced rank regression (RRR) method was applied to derive a dietary pattern that is associated with BP. Multivariable logistic regression was used to assess the association between dietary pattern (DP) and elevated BP and HTN. The Dietary Approach to Stop Hypertension (DASH) score was also calculated for each participant as a comparative method to validate the dietary pattern derived with the RRR method. A protective dietary pattern (PDP) for BP among Chinese children and adolescents was derived, which was characterized by high intakes of dairy products, mushrooms/edible fungi, fresh vegetables, fresh fruits, fresh eggs, aquatic products, mixed legumes, soybeans and related products, offal, dried fruits, and coarse cereals, with low intakes of refined grains. After multiple adjustments, there were significant inverse associations between PDP scores and the odds of elevated BP and HTN (elevated BP: Q5 vs. Q1, OR = 0.849, 95%CI = 0.755–0.931, P-trend < 0.05; HTN: Q5 vs. Q1, OR = 0.795, 95%CI = 0.694–0.911, P-trend < 0.05). The DASH diet was also observed to have protective effects on elevated BP in model I (Q5 vs. Q1, OR = 0.899, 95%CI = 0.828–0.975, P-trend < 0.05), but was not observed to have protective effects on HTN (HTN: Q5 vs. Q1, OR = 0.958, 95%CI = 0.876–1.048, P-trend > 0.05). The current study suggested that greater adherence to the PDP for BP among Chinese children and adolescents might be associated with lower odds of elevated BP and HTN.

In the era of big data, making full use of remote sensing images to automatically extract surface water bodies (WBs) in complex environments is extremely challenging. Due to the weak capability of existing algorithms in extracting small WBs and WB edge information from remote sensing images, we proposed a new method—Multiscale Fusion SegFormer (MF-SegFormer)—for WB extraction in the Weihe River Basin of China using Landsat 8 OLI images. The MF-SegFormer method adopts a cascading approach to fuse features output by the SegFormer encoder at multiple scales. A feature fusion (FF) module is proposed to enhance the extraction of WB edge information, while an Atrous Spatial Pyramid Pooling (ASPP) module is employed to enhance the extraction of small WBs. Furthermore, we analyzed the impact of four kinds of band combinations on WB extraction by the MF-SegFormer model, including true color composite images, false color images, true color images, and false color images enhanced by Gaussian stretch. We also compared our proposed method with several different approaches. The results suggested that false color composite images enhanced by Gaussian stretching are beneficial for extracting WBs, and the MF-SegFormer model achieves the highest accuracy across the study area with a precision of 77.6%, recall of 84.4%, F1-score of 80.9%, and mean intersection over union (mIoU) of 83.9%. In addition, we used the determination coefficient (R2) and root-mean-square error (RMSE) to evaluate the performance of river width extraction. Our extraction results in an overall R2 of 0.946 and an RMSE of 28.21 m for the mainstream width in the “Xi’an-Xianyang” section of the Weihe River. The proposed MF-SegFormer method used in this study outperformed other methods and was found to be more robust for WB extraction.

Abstract Background Previous cluster-randomized controlled trials evaluating the impact of implementing evidence-based guidelines for nutrition therapy in critical illness do not consistently demonstrate patient benefits. A large-scale, sufficiently powered study is therefore warranted to ascertain the effects of guideline implementation on patient-centered outcomes. Methods We conducted a multicenter, cluster-randomized, parallel-controlled trial in intensive care units (ICUs) across China. We developed an evidence-based feeding guideline. ICUs randomly allocated to the guideline group formed a local "intervention team", which actively implemented the guideline using standardized educational materials, a graphical feeding protocol, and live online education outreach meetings conducted by members of the study management committee. ICUs assigned to the control group remained unaware of the guideline content. All ICUs enrolled patients who were expected to stay in the ICU longer than seven days. The primary outcome was all-cause mortality within 28 days of enrollment. Results Forty-eight ICUs were randomized to the guideline group and 49 to the control group. From March 2018 to July 2019, the guideline ICUs enrolled 1399 patients, and the control ICUs enrolled 1373 patients. Implementation of the guideline resulted in significantly earlier EN initiation (1.20 vs. 1.55 mean days to initiation of EN; difference − 0.40 [95% CI − 0.71 to − 0.09]; P = 0.01) and delayed PN initiation (1.29 vs. 0.80 mean days to start of PN; difference 1.06 [95% CI 0.44 to 1.67]; P = 0.001). There was no significant difference in 28-day mortality (14.2% vs. 15.2%; difference − 1.6% [95% CI − 4.3% to 1.2%]; P = 0.42) between groups. Conclusions In this large-scale, multicenter trial, active implementation of an evidence-based feeding guideline reduced the time to commencement of EN and overall PN use but did not translate to a reduction in mortality from critical illness. Trial registration: ISRCTN, ISRCTN12233792 . Registered November 20th, 2017.

Secreted protein acidic and rich in cysteine (SPARC), also known as osteonectin or BM-40, is a matricellular protein involved in several biological processes including cell adhesion, growth factor availability, extracellular matrix remodeling and immune-regulation. SPARC has also been associated with a variety of diseases including diabetes, colon cancer, and leukemia. The expression of SPARC in different diseases exhibits some degree of ambiguity, especially in hemopathies. Herein, we review the current expression and effects of SPARC in various hematologic disorders with respect to nanoparticle albumin bound innovative therapies and related diagnostic research, providing a clinical perspective on the use of NAB technology in the frontier treatment of hematologic diseases.

Abstract Background Despite significant progress in surgical treatment of hypoplastic left heart syndrome (HLHS), its mortality and morbidity are still high. Little is known about the molecular abnormalities of the syndrome. In this study, we aimed to probe into hub genes and key pathways in the progression of the syndrome. Methods Differentially expressed genes (DEGs) were identified in left ventricle (LV) or right ventricle (RV) tissues between HLHS and controls using the GSE77798 dataset. Then, weighted gene co-expression network analysis (WGCNA) was performed and key modules were constructed for HLHS. Based on the genes in the key modules, protein–protein interaction networks were conducted, and hub genes and key pathways were screened. Finally, the GSE23959 dataset was used to validate hub genes between HLHS and controls. Results We identified 88 and 41 DEGs in LV and RV tissues between HLHS and controls, respectively. DEGs in LV tissues of HLHS were distinctly involved in heart development, apoptotic signaling pathway and ECM receptor interaction. DEGs in RV tissues of HLHS were mainly enriched in BMP signaling pathway, regulation of cell development and regulation of blood pressure. A total of 16 co-expression network were constructed. Among them, black module (r = 0.79 and p value = 2e−04) and pink module (r = 0.84 and p value = 4e−05) had the most significant correlation with HLHS, indicating that the two modules could be the most relevant for HLHS progression. We identified five hub genes in the black module (including Fbn1, Itga8, Itga11, Itgb5 and Thbs2), and five hub genes (including Cblb, Ccl2, Edn1, Itgb3 and Map2k1) in the pink module for HLHS. Their abnormal expression was verified in the GSE23959 dataset. Conclusions Our findings revealed hub genes and key pathways for HLHS through WGCNA, which could play key roles in the molecular mechanism of HLHS.

The current study is to explore the association of the Chinese visceral adiposity index (CVAI) with hypertension, and to compare the predictive power of different adiposity indexes regarding hypertension among Chinese adults aged over 45 years. A total of 99,201 participants aged over 45 years from the China Nutrition and Health Surveillance 2015–2017 were included in this study. Multivariate adjusted logistic regression was used to calculate the odds ratio (OR) and 95% confidence interval (CI) of hypertension. Multivariate adjusted restricted cubic spline analyses were applied to explore the association of adiposity indexes with hypertension. Receiver operating characteristic (ROC) analyses were used to compare the predictive powers of different adiposity indexes of hypertension. All eight adiposity indexes included in this study were positively associated with hypertension. Compared with those in the lowest quartile of the CVAI, the participants in the highest quartile showed a significantly higher risk of hypertension (OR = 3.70, 95% CI = 3.54–3.86) after multiple adjustments. The ROC analyses suggested that the CVAI was the strongest predictor of hypertension compared to other adiposity indexes in both genders. The findings supported that the CVAI could serve as a reliable and cost-effective method for early identifying hypertension risk.

Weight control through dietary management is becoming increasingly common worldwide. This study aimed to evaluate and compare the dietary intake and diet quality between Chinese adults with and without weight-control behaviors. Data were collected from the China National Nutrition Survey 2002, 2012, and 2015. Dietary intake was assessed using a combination of 24 h dietary recall of three consecutive days and a weighing method. Diet quality was calculated based on China healthy diet index (CHDI). A total of 167,355 subjects were included, of which 11,906 (8.0%) adults reported attempting to control weight within the past 12 months. Participants with weight control had lower daily total energy intake, as well as lower percentages of energy from carbohydrates, low-quality carbohydrates, and plant protein, but higher percentages of energy from protein, fat, high-quality carbohydrates, animal protein, saturated fatty acids, and monounsaturated fatty acids than those without weight control. Additionally, the CHDI score in the weight-control group was higher than those without (53.40 vs. 48.79, p < 0.001). Fewer than 40% of participants in both groups met the requirement for all specific food groups. Chinese adults who reported weight-control behaviors had an energy-restricted diet characterized by reduced carbohydrate intake and overall higher diet quality compared with those without dietary-control behaviors. However, both groups had significant room for improvement in meeting dietary recommendations.

The purpose of this study was to analyze the fruit and vegetable intake status and examine both potential risk and protective action factors in the Chinese labor force population, while investigating the association between fruit and vegetable intake and malnutrition in this population. Data were derived from a population-based cross-sectional survey, the China Nutrition and Health Surveillance, 2015–2017. Sociodemographic information, physical measurements, and dietary intake data were collected. A total of 45,459 survey respondents aged 18–64 years old were included in the analysis. Fruit and vegetable consumption data were assessed by a food frequency questionnaire (FFQ), and the average daily intake was calculated. In 2015, the daily intake of fresh fruits, fresh vegetables, and combined fruits and vegetables among the Chinese labor force was 64.3 g, 210.0 g, and 330.0 g (median), respectively. Compared with the Dietary Guidelines for Chinese Residents (2022), 79.9% and 53.0% were at risk of inadequate fruit and vegetable intake, while 55.2% were at risk of inadequate intake of combined fruits and vegetables compared with the WHO recommendation. Multivariate logistic regression analysis showed that female gender, higher educational level, and higher income were protective factors for adequate fruit intake, while increasing age and living in the southern region were protective factors for adequate vegetable intake. The results confirmed that increasing vegetable intake helped urban labor force maintain normal BMI and control overweight. Increased fruit consumption may reduce the risk of underweight, but no clear negative association with overweight and obesity was observed. In conclusion, the consumption of fresh fruits and vegetables by the Chinese labor force was inadequate, especially for fruits. Interventions are needed to promote the daily intake of fruits and vegetables in this population. In addition, further in-depth studies in this area are recommended in populations with different health status.

Abstract Ardisia kteniophylla (Primulaceae) is highly valued in traditional medicine due to its production of the pharmacologically active secondary metabolites, especially triterpenoid saponins in its roots. Although A. kteniophylla is very important in traditional medicine, the genetic basis for its production of triterpenoid saponins remains largely unknown. Therefore, we sequenced transcriptomes of A. kteniophylla to identify putative genes involved in production of triterpenoid saponins in both leaves and roots, and we used the transcriptomes to compare expression levels of these genes between the two organ systems. The production of triterpenoid saponins in plants is usually induced through hormonal signaling on account of the presence of pests. Thus, we treated plants with the hormones salicylic acid (SA) and methyl jasmonate (MeJA) and used quantitative real‐time PCR (qRT‐PCR) to investigate expression levels of genes involved in triterpenoid saponin biosynthesis. In total, we obtained transcriptomes for leaf and root tissues representing 52,454 unigenes. Compared with the leaf transcriptome, we found that 6092 unigenes were upregulated in the root, especially enzymes involved in the direct synthesis of triterpenoid saponins, while 6001 genes appeared downregulated, including those involved in precursory steps in the triterpenoid saponin biosynthesis pathway. Our results from qRT‐PCR indicate that genes within the upstream parts of the triterpenoid saponin biosynthesis pathway may be upregulated under exposure to the applied hormones, but downstream genes are downregulated. This suggests possible conflicting effects of SA and MeJA in promoting the production of secondary metabolites on the one hand, and, on the other, limiting plant growth processes to devote energy to combating pests. We also performed an analysis of transcription factors (TFs) and found 997 unique transcripts belonging to 16 TF families. Our data may help to facilitate future work on triterpene saponins biosynthesis in A. kteniophylla with potential pharmacological and molecular breeding applications.

Abstract As an important member of the IVA–VIA group compounds, 2D SnSe2 has emerged as a perfect platform for developing diverse applications, especially in high‐performance optoelectronic devices and data storage, etc. However, the bottom‐up synthesis of large‐area uniform, atomically thin SnSe2 crystals with controlled thicknesses has not yet been realized. Herein, we report the large‐area uniform growth of monolayer (1L), bilayer (2L), and few‐layer (FL) 1T‐SnSe2 single‐crystal flakes on mica substrates via a facile chemical vapor deposition (CVD) route. The feeding amount of Sn precursor and flow rate of hydrogen carrier are found to be the key parameters for the thickness‐controlled growth of uniform SnSe2 flakes. More intriguingly, obvious second harmonic generation (SHG) is revealed in the retained inversion symmetry structure of 1T‐SnSe2, with its intensity showing linear dependence with the thickness from monolayer to multilayers. The new findings reported herein should pave the ways for the thickness‐tunable growth of atomically thin SnSe2 crystals, and their unique optical property explorations and applications in nonlinear optics.

Globally, cervical cancer (CC) is the most common malignant tumor of the female reproductive system and its incidence is only second after breast cancer. Although screening and advanced treatment strategies have improved the rates of survival, some patients with CC still die due to metastasis and drug resistance. It is considered that cancer is driven by somatic mutations, such as single nucleotide, small insertions/deletions, copy number, and structural variations, as well as epigenetic changes. Previous studies have shown that cervical intraepithelial neoplasia is associated with copy number variants (CNVs) and/or mutations in cancer-related genes. Further, CC is also related to genetic mutations. The present study analyzed the data on somatic mutations of cervical squamous cell carcinoma (CESC) in the Cancer Genome Atlas database. It was evident that the Apolipoprotein B mRNA editing enzyme-catalyzed polypeptide-like (APOBEC)-related mutation of the FLG gene can upregulate the expression of the JUN gene and ultimately lead to poor prognosis for patients with CC. Therefore, the findings of the current study provide a new direction for future treatment of CC.

Abstract Immunotherapy (IO) has revolutionized the therapy landscape of non-small cell lung cancer (NSCLC), significantly prolonging the overall survival (OS) of advanced stage patients. Over the recent years IO therapy has been broadly integrated into the first-line setting of non-oncogene driven NSCLC, either in combination with chemotherapy, or in selected patients with PD-L1high expression as monotherapy. Still, a significant proportion of patients suffer from disease progression. A better understanding of resistance mechanisms depicts a central goal to avoid or overcome IO resistance and to improve patient outcome. We here review major cellular and molecular pathways within the tumor microenvironment (TME) that may impact the evolution of IO resistance. We summarize upcoming treatment options after IO resistance including novel IO targets (e.g. RIG-I, STING) as well as interesting combinational approaches such as IO combined with anti-angiogenic agents or metabolic targets (e.g. IDO-1, adenosine signaling, arginase). By discussing the fundamental mode of action of IO within the TME, we aim to understand and manage IO resistance and to seed new ideas for effective therapeutic IO concepts.

Abstract Background Hypoxia is pervasive in cancer and other diseases. Cells sense and adapt to hypoxia by activating hypoxia-inducible transcription factors (HIFs), but it is still an outstanding question why cell types differ in their transcriptional response to hypoxia. Results We report that HIFs fail to bind CpG dinucleotides that are methylated in their consensus binding sequence, both in in vitro biochemical binding assays and in vivo studies of differentially methylated isogenic cell lines. Based on in silico structural modeling, we show that 5-methylcytosine indeed causes steric hindrance in the HIF binding pocket. A model wherein cell-type-specific methylation landscapes, as laid down by the differential expression and binding of other transcription factors under normoxia, control cell-type-specific hypoxia responses is observed. We also discover ectopic HIF binding sites in repeat regions which are normally methylated. Genetic and pharmacological DNA demethylation, but also cancer-associated DNA hypomethylation, expose these binding sites, inducing HIF-dependent expression of cryptic transcripts. In line with such cryptic transcripts being more prone to cause double-stranded RNA and viral mimicry, we observe low DNA methylation and high cryptic transcript expression in tumors with high immune checkpoint expression, but not in tumors with low immune checkpoint expression, where they would compromise tumor immunotolerance. In a low-immunogenic tumor model, DNA demethylation upregulates cryptic transcript expression in a HIF-dependent manner, causing immune activation and reducing tumor growth. Conclusions Our data elucidate the mechanism underlying cell-type-specific responses to hypoxia and suggest DNA methylation and hypoxia to underlie tumor immunotolerance.

In this paper, combined with the approximation of neural network, a novel direct adaptive alleviating tracking control algorithm is presented for a class of non-strict feedback uncertain nonlinear systems. Here, both nonlinear uncertainties and nonsymmetric dead-zone inputs are considered. First, according to some coordinate transforms and variable separation methods, the non-strict feedback form is converted into the normal form. Second, the relationship of state vector and error functions are established, and the inputs of dead-zone are compensated with adaptive approaches. This novel direct scheme assumes that the approximation error and optimal approximation norms of NN are to be bounded by unknown constants and can alleviate the number of online adjusted parameters so as to improve the robust control performance of the systems. At last, under Lyapunov theorem analysis, the uniformly ultimately boundness of all the signals in the closed-loop systems can be guaranteed and the dead-zone inputs can be compensated, the effectiveness of this algorithm is well demonstrated by simulation results.

Kaolinite clay mineral with a layered silicate structure is an abundant resource in China. Due to its advantages of excellent stability, high specific surface area and environmental friendliness, kaolinite is widely used in environment decontamination. By using kaolinite as a carrier, the photocatalytic technology in pure photocatalysts of poor activities, narrow spectral responses, and limited electron transport can be overcome, and the nano-Ag disinfectant’s limitation of the growth and aggregation of nanoparticles is released. Moreover, pure kaolinite used as an adsorbent shows poor surface hydroxyl activity and low cation exchange, leading to the poor adsorption selectivity and easy desorption of heavy metals. Current modification methods including heat treatment, acid modification, metal modification, inorganic salt modification, and organic modification are carried out to obtain better adsorption performance. This review systematically summarizes the application of kaolinite-based nanomaterials in environmental decontamination, such as photocatalytic pollutant degradation and disinfection, nano silver (Ag) disinfection, and heavy metal adsorption. In addition, applications on gas phase pollutant, such as carbon dioxide (CO2), capture and the removal of volatile organic compounds (VOCs) are also discussed. This study is the first comprehensive summary of the application of kaolinite in the environmental field. The review also illustrates the efficiency and mechanisms of coupling naturally/modified kaolinite with nanomaterials, and the limitation of the current use of kaolinite.

Abstract The Greenland ice sheet is expected lose at least 90% of its current volume if ice sheet summer temperatures warm by around 1.8 °C above pre‐industrial. Geoengineering by stratospheric sulfate aerosol injection might slow Greenland ice sheet melting and sea level rise by reducing summer temperature and insolation; however, such schemes could also reduce precipitation and affect large‐scale climate drivers such as the Atlantic Meridional Over‐turning Circulation (AMOC). Earlier work found that AMOC increased under geoengineering and that might lead to greater mass loss from Greenland than under greenhouse gas forcing alone. We simulated Greenland ice sheet climates using four Earth system models running the stratospheric sulfate aerosol injection experiment GeoMIP G4 and the CMIP RCP4.5 and RCP8.5 greenhouse gas scenarios that were then used to drive the surface energy and mass balance model, SEMIC. Simulated runoff is 20% lower under G4 than RCP4.5, while under RCP8.5 it is 17% higher. The mechanism is through increased Arctic sea ice concentration and reduced humidity leading to surface cooling of the ablation zone. Reduced absorption of outgoing longwave radiation caused by hydrological cycle weakening dominates associated decreases in precipitation under geoengineering and stronger AMOC than under RCP4.5. An ice dynamics model simulates 15% lower ice losses under G4 than RCP4.5. Thus, total sea level rise by 2070 from the Greenland ice sheet under G4 geoengineering is about 15–20% lower than under the RCP4.5 scenario.

Dietary fat intake in the Chinese population has increased. The PURE (prospective urban rural epidemiology) study concluded the potential advantage of total fat and saturated fats (SFA) over carbohydrates on blood lipids with the inaccurate assessment of dietary fats. We investigated the dietary fat profile among 48,315 participants (aged 30–70 years, national representative) from the China Nutrition and Health Surveillance (2015–2017), determined the relationship of various fats with blood lipid biomarkers in the selected 39,115 participants, and compared the results with the PURE study. Dietary fat intake was calculated by using 3 days of 24 h recalls and food inventory. Serum lipid biomarkers were assessed at morning fasting state by health professionals. Plant fats (21.5% of total energy (TE)) dominated in total fat intake (69.5 g/day, 35.6% TE), with monounsaturated fats (MUFA) in the largest (13.8% TE) portion and plant oils as the major source (43.7%). Two thirds of the population consumed more than 30% TE from dietary fats and nearly half more than 35%, while 26.4% of them exceeded 10% TE from SFA. Total fat was positively associated with total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), but also high-density lipoprotein cholesterol (HDL-c), and negatively with triglyceride (TG)-to-HDL-c ratio (TGHDL) (all p-trend < 0.05). Replacing total fat with carbohydrate yielded adverse changes in most biomarkers (higher LDL-c, TG, and TGHDL, lower HDL-c, all p < 0.05) when total fat was low (p < 0.01), while replacing animal fat/SFA with plant fat/PUFA yielded the most favorable changes (lower all biomarkers, all p < 0.01). The results suggested a less harmful effect of carbohydrate on blood lipids when total fat was high, and more beneficial effect of unsaturated fats, than the PURE. In conclusion, dietary fat intake in Chinese adults had reached quite a high level, but with a different profile from Western populations. Replacement of SFA (animal fat) with PUFA (plant fat) could most effectively improve blood lipids, while replacement with carbohydrate could slightly benefit only when total fat was high. The present results may be more applicable to the Chinese population than the PURE study.

This study was designed to explore the associations between nutrient patterns (NPs) and metabolic syndrome (MetS) and its five components among Chinese children and adolescents aged 7–17. The required data of participants were collected from the China National Nutrition and Health Surveillance of Children and Lactating Mothers in 2016–2017. Ultimately, 13,071 participants were included. Nutrient patterns were obtained by means of factor analysis. Multivariate logistic regression analysis was conducted to evaluate the association between nutrient patterns with MetS and its components. After adjusting covariates, the results of logistic regression models revealed that high-carbohydrate patterns were associated with the presence of abdominal obesity. The high-animal protein pattern was negatively associated with high triglyceride (TG) and low high-density lipoprotein cholesterol (HDL-C). The high-sodium-and-fat pattern had a negative relationship with elevated blood pressure (BP) and was positively associated with low HDL-C. The high-Vitamin D-and-Vitamin B12 pattern had protective effects on MetS, high TG, and low HDL-C. Further large-scale longitudinal investigations are necessary in the future.

Few studies have analyzed the implementation of dietary management in Chinese adults with diabetes. Thus, we assessed and compared dietary intake and diet quality between diabetic patients with and without dietary management behaviors (DPDM vs. NDPDM), and evaluated the adherence to dietary guidelines in both groups of patients. The data were obtained from the 2002, 2010–2013, and 2015 China National Nutrition Survey. A total of 69,583, 67,177, and 96,631 subjects participated in the 2002, 2010–2013, and 2015 survey rounds, respectively. The dietary intake data were measured using 3-day 24 h dietary recalls and weighed records of household condiments. The China Healthy Diet Index (CHDI) was used to evaluate diet quality. The study included 6229 patients with diabetes, of which 78% had dietary management behaviors. The diabetic patients with dietary management behaviors showed higher percentages of energy from high-quality carbohydrates, animal protein, saturated fatty acids, and unsaturated fatty acids and lower percentages from low-quality carbohydrates and plant protein than NDPDM. The diabetic patients with dietary management behaviors also had lower intakes of cereals and tubers and higher intakes of vegetables than NDPDM. The total CHDI score of DPDM was higher than NDPDM (56.3 ± 12.7 vs. 54.1 ± 12.3). The proportion of DPDM meeting the recommended intake for different food items ranged from 3.3% to 42.8% and from 3.0% to 39.2% in NDPDM. The diabetic patients with dietary management behaviors showed better adherence to dietary guidelines and higher diet quality scores than NDPDM, while the overall adherence was poor in both groups of patients. Our findings suggested that measures are needed to promote and refine dietary management behaviors, which can help to improve disease management in diabetic patients.

Background and AimsThis study aimed at comparing the efficacy and safety of severe aplastic anemia (SAA) cases that had met the criteria for SAA at the time of diagnosis (group A) with SAA that had progressed from non-SAA (NSAA) (group B), both undergoing first-line immunosuppressive therapy (IST). Additionally, group B was compared with SAA that had progressed from NSAA and who had been treated by allogeneic hematopoietic stem cell transplantation (allo-HSCT) (group C).MethodsWe retrospectively compared 608 consecutive patients in group A (n = 232), group B (n = 229) and group C (n = 147) between June 2002 and December 2019. Six months after treatment, the rate of overall response and the fraction of patients who had achieved normal blood values, treatment-related mortality (TRM), secondary clonal disease, 5-year overall survival (OS) and failure-free survival (FFS) were indirectly compared between group A and group B, group B and group C.ResultsSix months after treatment, the rate of overall response and the fraction of patients who had achieved normal blood values in group A was higher than in group B (65.24% vs. 40.54%, P < 0.0001; 23.33% vs. 2.25%, P < 0.0001); the same was true for group C (92.50% vs. 2.25%, P < 0.0001). The rate of relapse in group B was higher than in group C (P < 0.0001), but there were no differences in TRM and secondary clonal disease (P > 0.05). There were no differences in estimated 5-year OS between groups A and B (83.8% ± 2.6% vs. 85.8% ± 2.6%, P = 0.837), or between B and C (85.8% ± 2.6% vs. 77.9% ± 3.4%, P = 0.051). The estimated 5-year FFS in groups A and C was higher than for group B (57.1% ± 3.3% vs. 39.7% ± 3.4%, P < 0.001; 76.7% ± 3.5% vs. 39.7% ± 3.4%, P < 0.0001).ConclusionThese results indicate that IST is less effective in SAA progressing from non-SAA but allo-HSCT can improve outcomes.

Abstract The objective of solar geoengineering by stratospheric aerosol injection (SAI) is to lower global temperatures, but it may also have adverse side effects. Iceland is situated close to the overturning regions of the Atlantic Meridional Overturning Circulation (AMOC) that warms the North Atlantic area. Hence, this may be one region where reduced irradiance by SAI may not be successful in reducing impacts from greenhouse gas warming. We examine this proposition by estimating how the Icelandic Vatnajökull ice cap (VIC) surface mass balance (SMB) and surface runoff changes in response to greenhouse gas and solar geoengineering scenarios over the period 1982–2089. We use the surface energy and mass balance model SEMIC driven by Earth System Model output under the GeoMIP G4, and CMIP RCP4.5 and RCP8.5 greenhouse gas scenarios. Geoengineering significantly reduces VIC near‐surface air temperature by 0.4°C, downward longwave radiation by 2.4 Wm−2 and increases snowfall by 4.9 mm yr−1 relative to RCP4.5. During the SAI period 2020–2069, modeled annual mean SMB under G4, RCP4.5 and RCP8.5 are −0.34 ± 0.18 m yr−1, −0.56 ± 0.06 m yr−1 and −0.66 ± 0.04 m yr−1, respectively; surface runoff reduction under G4 is 6 ± 6% and 7 ± 6% (95% confidence interval uncertainties) compared with that under RCP4.5 and RCP8.5, which is far smaller than the 20 ± 2% and 32 ± 2% reductions for the Greenland ice sheet. The differences may be attributed to the reinvigoration of AMOC under G4 relative to RCP4.5 which brings more heat to Iceland than Greenland, leading to around half the cooling and longwave radiation reductions than for Greenland.

Previous studies have used the traditional average-value method to calculate the usual dietary intake of a population, but the results may be biased due to the measurement errors. The aim of this study was to provide an assessment of the usual micronutrient intake and estimate the prevalence of inadequate intake among Chinese adults. Data from the Chinese Nutrition and Health Surveillance 2015–2017 as well as a total of 72,231 subjects aged 18 years and older were included in the analysis. The 24 h recall method combined with the condiment weighing method were used for three consecutive days to collect daily food and condiments intake. The daily intake of 16 micronutrients was calculated based on the Chinese Food Component Tables. The National Cancer Institute (NCI) method was used to estimate the usual intake of micronutrients, and the prevalence of inadequate intake was estimated using the estimated average requirement (EAR) cut-point method. The results showed that, except for sodium, copper, iron (only for males), vitamin E, and phosphorus, the usual intake of micronutrients in Chinese adults was low, and the prevalence of inadequate intake ranged from 38.67 to 97.63%. The prevalence of inadequate calcium and riboflavin intake was more than 90%, and the proportion of individuals with a usual intake of thiamine, vitamin A, potassium, and selenium below EAR also reached 80%. Manganese, magnesium, vitamin C, and zinc were potentially deficient micronutrients, with the prevalence of inadequate intake ranging from 38.67% to 77.09%. However, usual sodium intake was extremely high with an average of 5139.61 mg/day, and only a quarter of Chinese adults were below the World Health Organization (WHO) recommended value. For most micronutrients, the usual dietary intake declined with age and the prevalence of inadequate intake increased with age. Except for zinc, vitamin A, and B-vitamins, the prevalence of micronutrient deficiencies was higher in females than in males in the same age group (p < 0.05). Therefore, Chinese adults do not receive enough micronutrients. Effective nutrition supplementary strategies and measures are needed to address these problems.

Although several studies have shown the relationship between magnesium and diabetes, there are few studies regarding the association between magnesium status and prediabetes. This study aimed to examine the association between dietary magnesium intake and the risk of prediabetes in childbearing Chinese women (18–44 years). A total of 1981 participants without diabetes were randomly selected from China Nutrition and Health Surveillance (CNHS) in 2015 by considering the regional types and monitoring points, including 1420 normal fasting glucose (NFG) people and 561 prediabetes cases. The Food Frequency Questionnaire (FFQ) and inductively coupled plasma mass spectrometry (ICP-MS) measured dietary and plasma magnesium. The results of this study showed that dietary magnesium intake was inversely associated with fasting plasma glucose. For every 100 mg of magnesium intake, there was a 0.052 mmol/L (95% CI 0.019, 0.085) reduction in fasting plasma glucose (p = 0.002). Compared with the lowest intake quartile (p = 0.020) by approximately 37%. The dose-response curves for the association between magnesium intake and prediabetes followed an L shape. The odds ratio of prediabetes decreased significantly with increasing dietary Mg intake at less than 410 mg/day, and then the curve leveled off or slightly increased. This study found a negative association between dietary magnesium intake and prediabetes in childbearing Chinese women. The risk of prediabetes was reduced with increasing dietary magnesium intake, and the threshold value was 410 mg/day. This suggests that childbearing women also need to pay attention to their magnesium status.

This study aimed to investigate the prevalence of hyperuricemia (HUA) and associated risk factors in Chinese adults aged 18 to 59 years. All the data were collected from the China Nutrition and Health Surveillance during the period 2015–2017, which adopted a stratified, multistage, random sampling method on a national scale. A total of 52,627 participants aged 18 years or older were included in this study. The definition of hyperuricemia was 420 μmol/L for male and 360 μmol/L for female. The Rao–Scott chi-square test was used to compare the differences in prevalence between or among the subgroups. A weighted two-level multivariate survey-logistic regression was used to detect the correlations between HUA and demographic, physical, lifestyle and metabolic factors. The total prevalence of HUA was 15.1%, and that was higher in male, current smokers, higher BMI and less physical activities subgroups, and also in noninfectious chronic diseases (NCDs) subgroups. The subgroups of non-vegetarian diet, insufficient vegetable intakes and excessive red meat and alcohol intakes had significantly higher HUA prevalence. After introducing all the variables in the survey-logistic regression, gender, age, BMI, physically active, hypertension, diabetes mellitus, bean and nut intake, vegetable intake, red meat intake, alcohol consumption and vegetarian were associated with HUA. Among the significant variables, age and physical active served as a protective factor, and BMI showed to be a risk factor for HUA. Hypertension and dyslipidemia could increase the risk for HUA, while diabetes mellitus was shown a negative association with it. For dietary factors, vegetarian diet, sufficient beans and nuts and vegetables intake could lower the risk of HUA, but more alcohol could increase the risk of HUA. Dietary factor played a key role in HUA. It suggested that the intervention of dietary factor should receive more attention to ameliorate the high prevalence of HUA in China.

Background: Neutrophil percentage to albumin ratio (NPAR) has been shown to be correlated with the prognosis of various diseases. This study aimed to explore the effect of NPAR on the prognosis of patients in coronary care units (CCU). Method: All data in this study were extracted from the Medical Information Mart for Intensive Care III (MIMIC-III, version1.4) database. All patients were divided into four groups according to their NPAR quartiles. The primary outcome was in-hospital mortality. Secondary outcomes were 30-day mortality, 365-day mortality, length of CCU stay, length of hospital stay, acute kidney injury (AKI), and continuous renal replacement therapy (CRRT). A multivariate binary logistic regression analysis was performed to confirm the independent effects of NPAR. Cox regression analysis was performed to analyze the association between NPAR and 365-day mortality. The curve in line with overall trend was drawn by local weighted regression (Lowess). Subgroup analysis was used to determine the effect of NPAR on in-hospital mortality in different subgroups. Receiver operating characteristic (ROC) curves were used to evaluate the ability of NPAR to predict in-hospital mortality. Kaplan–Meier curves were constructed to compare the cumulative survival rates among different groups. Result: A total of 2364 patients in CCU were enrolled in this study. The in-hospital mortality rate increased significantly as the NPAR quartiles increased (p < 0.001). In multivariate logistic regression analysis, NPAR was independently associated with in-hospital mortality (quartile 4 versus quartile 1: odds ratio [OR], 95% confidence interval [CI]: 1.83, 1.20–2.79, p = 0.005, p for trend

Regional dietetic cultures were indicated in China, but how dietary patterns geographically varied across China is unknown. Few studies systematically investigated the association of dietary patterns with overweight/obesity and hypertension and the potential mechanism with a national sample. This study included 34,040 adults aged 45 years and older from China Nutrition and Health Surveillance (2015–2017), who had complete outcome data, reliable intakes of calorie and cooking oils, unchanged diet habits, and without diagnosed cancer or cardiovascular disease. Outcomes were overweight/obesity and hypertension. By using the Gaussian finite mixture models, four dietary patterns were identified—common rice-based dietary pattern (CRB), prudent diversified dietary pattern (PD), northern wheat-based dietary pattern (NWB), and southern rice-based dietary pattern (SRB). Geographic variations in dietary patterns were depicted by age–sex standardized proportions of each pattern across 31 provinces in China. We assessed the association of these dietary patterns with outcomes and calculated the proportion mediated (PM) by overweight/obesity in the association of the dietary patterns with hypertension. Evident geographic disparities in dietary patterns across 31 provinces were observed. With CRB as reference group and covariates adjusted, the NWB had higher odds of being overweight/obese (odds ratio (OR) = 1.44, 95% confidence interval (CI): 1.36–1.52, p < 0.001) and hypertension (OR = 1.07, 95%CI: 1.01–1.14, p < 0.001, PM = 43.2%), while the SRB and the PD had lower odds of being overweight/obese (ORs = 0.84 and 0.92, 95%CIs: 0.79–0.89 and 0.85–0.99, p < 0.001 for both) and hypertension (ORs = 0.93 and 0.87, 95%CIs: 0.87–0.98 and 0.80–0.94, p = 0.038 for SRB and p < 0.001 for PD, PMs = 27.8% and 9.9%). The highest risk of overweight/obesity in the NWB presented in relatively higher carbohydrate intake (about 60% of energy) and relatively low fat intake (about 20% of energy). The different trends in the association of protein intake with overweight/obesity among dietary patterns were related to differences in animal food sources. In conclusion, the geographic distribution disparities of dietary patterns illustrate the existence of external environment factors and underscore the need for geographic-targeted dietary actions. Optimization of the overall dietary pattern is the key to the management of overweight/obesity and hypertension in China, with the emphasis on reducing low-quality carbohydrate intake, particularly for people with the typical northern diet, and selection of animal foods, particularly for people with the typical southern diet.

Abstract Background The objectives of this study were to examine nutrient intakes of tuberculosis (TB) patients and to identify their associated factors. Methods In this cross-sectional study, 300 adult TB patients were surveyed in two impoverished counties in China. Nutrient intakes were evaluated through two consecutive 24-h dietary recalls and compared with the Chinese Dietary Reference Intakes (DRIs) 2013. The potential socio-demographic and behavioral factors were analyzed using multivariate logistic model to identify strong influential factors. Results We found that mean daily energy intake was 1655.0 kcal (SD: 619.3 kcal) and 1360.3 kcal (SD: 552.1 kcal) for male and female patients, respectively. The mean daily energy intake was significantly lower than that has been recommended by DRI (i.e., 2250 and 1800 kcal for males and females, respectively), with 87.4% of the male patients and 59.9% of female patients failed to consume adequate energy. The protein intakes were 44.6 g (SD: 18.2 g) and 35.9 g (SD: 12.3 g) for male and female patients, respectively, which were lower than the recommended values by DRI (i.e., 65 and 55 g for males and females, respectively). Most male (90.8%) and female (58.4%) TB patients had insufficient daily protein intake. Further analyses suggested that mean daily intakes of many micronutrients, were insufficient, while for most of patients, intakes of vitamin E and sodium were sufficient. We identified that unemployment was a risk factor for low energy intake (p

Objective: This study aimed to analyze the perinatal changes of plasma estradiol (E2) and angiotensin II (Ang II) in pregnant women with pulmonary arterial hypertension before and after cesarean section. Methods: Depending on pulmonary arterial pressure, the subjects were divided into two groups, moderate group, and severe group. Plasma concentrations of E2 and Ang II were determined at different time points using electrochemiluminescence immunoassay and ELISA, respectively. The correlation between E2 and Ang II concentrations was analyzed. Results: Intragroup comparison indicated that E2 levels at different time points after surgery decreased in the two groups than before, with a greater reduction in the severe group. Besides, both groups showed a reduction in Ang II concentrations after surgery. As indicated by intragroup comparison, there was a significant difference at each time point in the two groups. The reduction in Ang II concentrations was more conspicuous at 48 h and 72 h after surgery (cesarean section) than before for the two groups. Moreover, E2 concentrations were correlated positively with AngII concentrations. Conclusion: Plasma concentrations of E2 and Ang II decreased after delivery. The plasma concentrations of E2 and Ang II were correlated with each other.

This descriptive study aimed to determine the prevalence of metabolic syndrome (MetS) and its components among Chinese children and adolescents aged 7–17 from 2016–2017 according to the Cook’s criteria modified for age on the basis of the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) and to evaluate the associations between the factors of interest (especially vitamin A, vitamin D and hyperuricemia) of MetS and its components, using data from the China National Nutrition and Health Survey of Children and Lactating Mothers from 2016–2017. A total of 54,269 school-aged children and adolescents were ultimately included in this study. Anthropometric measurements and laboratory examinations of the subjects and their relevant information were also collected. A multivariate logistic regression analysis model was applied to analyze the relationships between relevant factors associated with MetS and its components. In the present study, the prevalence of MetS in children and adolescents was 5.98%. Among the five components of MetS, elevated blood pressure (BP) and abdominal obesity were the most prevalent (39.52% and 17.30%), and 58.36% of the subjects had at least one of these components. In the multivariate logistic regression, an overweight condition, obesity and hyperuricemia were positively correlated with the incidence of MetS and all five components. There was also a positive association observed between vitamin A and the risk of MetS and some components of MetS (abdominal obesity and high triglycerides (TG)) and vitamin A was negatively associated with the risk of low high-density lipoprotein cholesterol (HDL-C). Subjects with vitamin D inadequacy had a higher risk of MetS (OR = 1.364, 95%CI: 1.240–1.500) and four of its components, excepting elevated FBG (fast blood glucose). Vitamin D deficiency was positively associated with MetS (OR = 1.646, 95%CI: 1.468–1.845) and all five of its components. Well-designed, large-scale prospective studies are also needed in the future.

Background: Tea consumption is widely reported to have beneficial effects on metabolic functions. The current study is to evaluate the association between habitual tea consumption and risk for metabolic syndrome and its components among Chinese adults aged 18~59 years. Methods: 43,757 participants aged 18~59 years from China Nutrition and Health Surveillance 2015–2017 were included and divided into four groups based on the amount of daily tea consumption in the current study. Using multiple-adjustment logistic regression to explore the relationship between habitual tea consumption and metabolic syndrome-related health outcomes. Results: Compared with those who did not consume tea habitually, participants who drank over 5 cups of tea per day showed a significantly lower risk of metabolic syndrome (OR = 0.836, 95% CI = 0.771–0.905), blood pressure elevated (OR = 0.906, 95% CI = 0.845–0.972), triglyceride elevated (OR = 0.797, 95% CI = 0.741–0.857), and fasting plasma glucose elevated (OR = 0.772, 95% CI = 0.715–0.833), but higher risk for central obesity (OR = 1.354, 95% CI = 1.236–1.484). Regardless of gender, higher tea consumption was related to lower risk of triglyceride and fasting blood glucose elevated but higher risk for central obesity. While for protective effect on metabolic syndrome, blood pressure elevated, and HDL-C reduction only showed in females. Conclusions: Results from current study support that habitual tea consumption would benefit metabolic syndrome and its related components, especially among females.

This study aims to determine the associations of dietary patterns with metabolic syndrome (MetS) and its components in Chinese children and adolescents aged 7–17 in 2016–2017. Using the data from the China National Nutrition and Health Surveillance of Children and Lactating Mothers in 2016–2017, the sociodemographic information, diet, anthropometric measurements and clinical examinations of subjects were obtained, and a total of 13,071 school-aged children and adolescents were included in this study. The Cook criteria were used to define MetS and its components. Dietary intake was derived from 24-h dietary records for three consecutive days, combined with the weighing method. Factor analysis was used to identify major dietary patterns. The associations of dietary patterns with MetS and its components were examined by logistic regression analysis. Consequently, five distinct dietary patterns were identified by factor analysis, and the relationships between dietary patterns with MetS and its components were observed. After adjusting for covariates, the animal product and vegetable patterns may have a positive association with MetS; the condiment pattern was positively associated with low HDL-C; the fruit and junk food patterns had positive relationships with MetS, abdominal obesity and high TG; the cereals and tubers pattern was positively associated with MetS, abdominal obesity, high TG and low HDL-C; the beans pattern was positively associated with high TG.