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The relationship between distinct dietary selenium intake and type 2 diabetes (T2D) is still a topic of uncertainty. This study examined the relationship between dietary selenium intake and T2D risk among middle-aged and older Chinese adults. Dietary selenium intake was assessed through three 24 h recalls, using data from the China Health and Nutrition Survey. To investigate the relationship and the potential dose–response pattern between selenium intake and the likelihood of developing T2D, we employed both the restricted cubic spline analysis and the Cox proportional hazards model as our analytical tools. A cohort of 5970 participants aged ≥ 50 years was followed for an average of 5.44 years. The results revealed a V-shaped correlation between selenium intake and T2D risk, with the lowest risk observed at approximately 45 µg/day. Below this level, the risk decreased with an increasing selenium intake, while the risk increased between 45 and 100 µg/day. No significant association was found beyond 100 µg/day. These findings suggest that both low and high selenium consumption may increase T2D risk, highlighting the importance of maintaining a balanced selenium intake for T2D prevention. [ABSTRACT FROM AUTHOR]

Appropriate dietary patterns for preserving cognitive function in China remains unknown. This study explored the association between dietary pattern and cognitive function in the Chinese population. A total of 6308 adults aged 55 and above who participated in the China Health and Nutrition Survey at least two waves from 1997 to 2018 were selected. The dietary pattern was determined using the reduced rank regression method with responses regarding vitamin C, vitamin E, zinc, iron, copper, and selenium intakes. We used a three-level random coefficient model to evaluate the association. A "vegetable-pork" dietary pattern characterized by high intakes of Legume products, vegetables, fruits, nuts, pork, fish, and plant oil was identified. Compared to the first quartile (Q1) of dietary scores, the regression coefficients (p value) for the global cognitive score across Q2, Q3, and Q4 were 0.27 (p = 0.030), 0.45 (p < 0.001), and 0.50 (p < 0.001), respectively. The adjusted odds ratios (ORs) and the 95% confidence intervals (CIs) for poor cognition across Q2, Q3, and Q4 were 0.82 (0.73 to 0.93), 0.79 (0.69 to 0.91), and 0.74 (0.63 to 0.86), respectively. The relationship appeared to be stronger among people who were 65 years and older, women, people from the south, and smokers. Higher adherence to the "vegetable-pork" diet is associated with better cognitive function among Chinese elders. [ABSTRACT FROM AUTHOR]

The warning label is identified as a simple front-of-package labeling format that assists consumers in making healthier food choices at the point of purchase. The color and/or shape of the design elements of the packaging labels can influence the understanding and purchase intention outcomes. This study aimed to explore the perceptions of consumers regarding differently designed warning labels (WLs) to identify a possibly suitable warning label design in the Chinese context. Using a qualitative approach, we collected data through 12 focus group discussions consisting of 116 participants residing in 6 provinces. Participants were selected by purposive sampling. Data were coded following inductive thematic analysis and summarized into three themes: (1) perceived preference for the appearance of the WLs, (2) perceived benefits of the WLs, and (3) suggestions for promoting the WLs. Participants preferred the black shield label showing a high content of the nutrients of concern (e.g., sodium, added sugar, and saturated fat) in both Chinese and English. Consumers generally agreed that the WLs were easy to understand and offered a simple method for choosing healthier foods. They anticipated that WLs could encourage the food industry to reformulate their products. Our study results will support the design and facilitate the use of WLs in China. [ABSTRACT FROM AUTHOR]

Restaurant food is one of the important sources of sodium intake in China. We aimed to determine whether a restaurant-based comprehensive intervention program may induce lower sodium content in restaurant food. A randomized controlled trial was implemented between 2019 and 2020 in 192 restaurants in China. After baseline assessment, the restaurants were randomly assigned to either an intervention or a control group (1:1). Comprehensive activities designed for intervention restaurants were conducted for one year. The primary outcome was the difference in change of sodium content estimated by the mean values of five best-selling dishes for each restaurant, from baseline to the end of the trial between groups. In total, 66 control restaurants and 80 intervention restaurants completed the follow-up assessment. The average sodium content of dishes at baseline was 540.9 ± 176.8 mg/100 g in control and 551.9 ± 149.0 mg/100 g in intervention restaurants. The mean effect of intervention after adjusting for confounding factors was −43.63 mg/100 g (95% CI: from −92.94 to 5.66, p = 0.08), representing an 8% reduction in sodium content. The restaurant-based intervention led to a modest but not significant reduction in the sodium content of restaurant food. There is great urgency for implementing effective and sustainable salt reduction programs, due to the rapid increase in the consumption of restaurant food in China. [ABSTRACT FROM AUTHOR]

The nutrition and health of middle-aged and elderly people is crucial to the long-term development of a country. The present study aimed to analyze the dietary consumption status in Chinese adults by using baseline and follow-up data from the community-based Cohort Study on Nervous System Diseases between 2018–2020 and selecting those aged 55 and older (n = 23,296). Dividing 65 food items into 17 subgroups on the basis of a valid semi-quantitative food frequency questionnaire, we analyze the consumption amount and consumption rate of foods in relation to wave and sociodemographic factors by employing the Wilcoxon rank sum test, Kruskal–Wallis analysis, the Chi-squared test, and the Cochran–Armitage trend test and evaluate food intake status using the Chinese Dietary Guidelines Recommendations (2022). Compared to 2018, the median daily intake of livestock meat, poultry, and eggs increased in 2020 (p < 0.05), while the median daily intake of wheat, other cereals, tubers, legumes, fruits, and fish and seafood decreased (p < 0.05). The proportion of subjects with excessive intake of grain, livestock and poultry, and eggs was 46.3%, 36.6%, and 26.6%, respectively, while the proportion of subjects with insufficient intake of whole grains and mixed beans, tubers, legumes, dairy products, fruits, vegetables, and fish and seafood were 98.4%, 80.3%, 74.0%, 94.6%, 94.3%, 75.8%, and 86.5%, respectively, and more than 50% of subjects were non-consumers of dairy products, nuts, and whole grains and mixed beans. In conclusion, the problem of unhealthy dietary structure is prominent among adults aged 55 and older in China; insufficient or excessive intakes of various types of foods are common; and excessive consumption of edible oil and salt remains a serious problem. [ABSTRACT FROM AUTHOR]

How diet as a whole impacts the risk of general overweight and abdominal obesity among the Chinese elderly is unclear. The present study aimed to examine the association of overall diet quality with general overweight and abdominal obesity in the Chinese elderly. Using data from the China Health and Nutrition Survey (CHNS) from 1993 to 2015, an ongoing cohort study, we selected participants aged 60 and older who were not generally overweight, but who had abdominal obesity at baseline and who had participated in at least two waves of the survey as subjects. The China Elderly Dietary Guidelines Index (CDGI-E) was used, based on the critical diet-related recommendations of the 2016 Chinese Dietary Guideline (CDG-2016), to assess overall diet quality. Consecutive 3 d, 24 h recalls and household weighing for seasonings and edible oils were used to collect dietary data and calculate the CDGI-E scores. Three-level (community-individual-wave) random intercept logistic regression models were used to analyze the impact of diet quality on the risk of general overweight and abdominal obesity in the elderly. The results showed that the older women in the top sixtiles of the CDGI-E scores had a 38% reduction —0.62, 95% CI (0.41, 0.92)—in the risk of abdominal obesity, as compared to those in the bottom sixtiles after adjusting for all potential confounders, while the null association was observed in the older men. The relationship between CDGI-E score and the risk of overweight/general obesity in the Chinese elderly has not been found. It was concluded that a high diet quality was associated with a reduced risk of abdominal obesity among elderly women in China. Our findings will help to improve the understanding of the relationship between the overall effect of diet and health. It may provide a new avenue for obesity intervention policy formulation from the aspect of improving overall dietary quality. [ABSTRACT FROM AUTHOR]

There is a lack of studies on the association between whole grain intake and cardiometabolic risk factors in China and the current definition of whole grains is inconsistent. This study defined whole grains in two ways, Western versus traditional, and examined their associations with the risks of major cardiometabolic factors (CMFs) among 4706 Chinese adults aged ≥18 years, who participated in surveys both in 2011 and in 2015. Diet data were collected by consecutive 3 d 24 h recalls, together with household seasoning weighing. Whole grains were defined as grains with a ratio of fiber to carbohydrate of ≥0.1, while coarse grains were defined as grains except for rice and its products, and wheat and its products. Multivariable logistic regressions were modeled to analyze the associations of intakes of whole grains and coarse grains, respectively, with risks of major CMFs including obesity-, blood pressure-, blood glucose- and lipid-related factors, which were defined by International Diabetes Federation and AHA/NHLBI criteria. After adjusting for potential confounders, the odds of elevated LDL-C decreased with the increasing intake levels of whole grains (OR 0.64, 95% CI 0.46–0.88, p-trend < 0.05). Moreover, adults with the whole grain intake of 50.00 to 150.00 g/day had 27% lower odds of overweight and obesity (OR 0.73, 95% CI 0.54–0.99) and 31% lower odds of elevated LDL-C (OR 0.69, 95% CI 0.49–0.96), as compared with non-consumers. In conclusion, given the significant nutrient profiles of whole grains and coarse grains, the adults with higher intakes of whole grains only may have a lower risk of LDL-C and overweight and obesity. [ABSTRACT FROM AUTHOR]

Magnesium is an essential mineral for the human body and a cofactor or activator for more than 300 enzymatic reactions, including blood glucose control and insulin release. Diabetes is a well-known global burden of disease with increasing global prevalence. In China, the prevalence of diabetes in adults is higher than the global average. Evidence shows that magnesium is a predictor of insulin resistance and diabetes. However, the majority of studies focus on dietary magnesium instead of serum magnesium concentration. We study the correlation of serum magnesium levels with insulin resistance and Type 2 diabetes. In this prospective cohort study, we included 5044 participants aged 18 years and older without insulin resistance (IR) and diabetes at the baseline from China Health and Nutrition Survey (CHNS). A fasting blood sample was taken for the measurement of both types of magnesium, fasting blood glucose, hemoglobin A1c (HbA1c), and fasting insulin. The homeostatic model (HOMA-IR) was calculated. Demographic characteristics of participants, and risk factors such as intensity of physical activities, smoking status, drinking habit, and anthropometric information were recorded. IR was defined as HOMA-IR ≥ 2.5, and Type 2 diabetes mellitus was defined as fasting plasma glucose ≥ 7.0 mmol/L or HbA1c ≥ 6.5%, or a self-reported diagnosis or treatment of diabetes. A total of 1331 incident insulin resistance events and 429 incident diabetic events were recorded during an average follow-up of 5.8 years. The serum magnesium concentration was categorized into quintiles. After adjusting for relevant covariates, the third quintile of serum magnesium (0.89–0.93 mmol/L) was correlated with 29% lower risk of incident insulin resistance (hazard ratio = 0.71, 95% CI 0.58, 0.86) and with a lower risk of Type 2 diabetes. Multivariable-adjusted hazard ratios (95% confidence intervals) for insulin resistance were compared with the lowest quintile of serum magnesium (<0.85). We found similar results when evaluating serum magnesium as a continuous measure. Restricted cubic spline (RCS) curves showed a nonlinear dose–response correlation in both serum magnesium levels and insulin resistance, and in serum magnesium levels and Type 2 diabetes. Lower serum magnesium concentration was associated with a higher risk of insulin resistance and diabetes. [ABSTRACT FROM AUTHOR]

Objective: To measure the associations of sociodemographic and behavioural factors with fruit and vegetable consumption among adults in China.Design: A cross-sectional study.Setting: A 2015 wave of the China Health and Nutrition Survey.Participants: Totally, 11 910 adults aged 18 to 64 years.Results: Adjusted log binomial regression analyses showed that adults with higher income levels had higher fruit intake than those with low income levels (medium income group, risk ratio (RR): 1·28; 95 % CI: 1·16, 1·41; high income group, RR: 1·58; 95 % CI: 1·43, 1·74). Current smokers had lower fruit intake than non-smokers (RR: 0·86; 95 % CI: 0·77, 0·96). Adults living in southern China had higher vegetable intake (RR: 1·88; 95 % CI: 1·76, 2·01) but lower fruit intake (RR: 0·85; 95 % CI: 0·79, 0·91) than adults in northern China. With increasing age, adults had higher fruit intake (50-64 years, RR: 1·20; 95 % CI: 1·09, 1·33; reference category 18-34 years) and higher vegetable intake (35-49 years, RR: 1·13; 95 % CI: 1·05, 1·22; 50-64 years, RR: 1·22; 95 % CI: 1·13, 1·31).Conclusions: Our findings identify a range of sociodemographic and behavioural factors associated with fruit and vegetable consumption among Chinese adults. They also point to the need for public health nutrition interventions for socially disadvantaged populations in China. [ABSTRACT FROM AUTHOR]

Background: Intervention strategies to reduce sodium intake and increase potassium intake may decrease blood pressure; however, most are focused on reducing sodium in processed food globally.Objectives: We attempt to fill important gaps in understanding the dynamics of these dietary determinants of hypertension in China.Methods: We used data on 29,926 adults aged ≥20 y between 1991 and 2015 from an ongoing cohort, the China Health and Nutrition Survey. We collected detailed diet data with use of weighing methods with 3 consecutive 24-h recalls. With panel data random-effects models, we analyzed factors associated with sodium and potassium intakes and sodium to potassium (Na/K) ratios.Results: Sodium intake decreased from 6.3 g/d in 1991 to 4.1 g/d in 2015, still twice the tolerable upper intake recommended by the WHO. Potassium intake was 1.7 g/d in 1991 and 1.5 g/d in 2015, below half that recommended by the WHO. The Na/K ratio decreased from 4.1 (ratios in g) in 1991 to 3.1 in 2015, 5 times the recommendation of the WHO. More than two-thirds (67%) of sodium intake was from salt added during food preparation, with 8.8% from processed foods in 2015, up from 5.0% in 1991. The most at-risk populations lived in China's central region and rural areas, were middle aged, had lower educations, or were farmers.Conclusions: Sodium intake is very high across all regions in China. As part of sodium reduction efforts, China should target people living in the central region and adults aged above 60 whose sodium intakes are much higher. Strategies to decrease sodium intake and increase potassium intake should be different from those applied in the Western world where the major source is processed food. Reduced sodium higher potassium salts should become a major policy initiative in China. [ABSTRACT FROM AUTHOR]

Background: Calcium is one of the essential micronutrients in the human body and is well-known for its important role in keeping bones and teeth healthy. However, calcium deficiency is a very common nutritional problem in the world and especially in China. The aim of this research was to determine the dietary calcium intake of Chinese adults and the corresponding food sources based on data from the 2015 China Nutritional Transition Cohort Study. Methods: We obtained dietary data from Chinese adults ages 18 to 64 years in 15 provinces, autonomous regions, and municipalities using 3 consecutive days combined with the household weighing method. We used the China Food Composition (book 1, 2nd edition) to calculate the calcium intake from each food category. We regarded the percentage of participants with a calcium intake median below the estimated average requirement as the level of calcium inadequacy in the overall population. Results: We divided the participants into 2 age groups, 18–49 years and 50–64 years, which included 6,630 and 5,307 participants, respectively. The groups’ dietary calcium intake medians were 324.8 milligrams per day (mg/d) and 332.7 mg/d, respectively, and the calcium inadequacies were 92.9% and 96.0%, correspondingly. The median calcium intake for the whole study population was 328.3 mg/d, and the inadequacy was 94.3%, which improved with higher education, income, and urbanization levels. The main food sources of dietary calcium among the study population were vegetables, legumes, and cereals, which contributed 30.2%, 16.7%, and 14.6%, respectively. Milk and dairy products contributed 6.7% to the study population but varied with the urbanization level to 15.0%, 6.1%, 6.3%, and 2.0% in urban, suburban, county, and rural areas, respectively. Conclusion: These findings highlight the importance of nutrition education and intervention for Chinese adults to improve their dietary structures and increase milk and dairy products intake to consume adequate calcium. [ABSTRACT FROM AUTHOR]

Objective: Previous studies in China showed large sex differences in childhood overweight and obesity (OW/OB) rates. However, limited research has examined the cause of these sex differences. The present study aimed to examine individual and parental/familial factors associated with sex differences in childhood OW/OB rates in China.Design: Variables associated with child weight status, beliefs and behaviours, and obesity-related parenting practices were selected to examine their sex differences and association with a sex difference in child OW/OB outcomes using logistic regression analysis.Setting: Cross-sectional data analysis using the 2011 China Health and Nutrition Survey.Subjects: Children aged 6-17 years (n 1544) and their parents.Results: Overall child OW/OB prevalence was 16·8 %. Adolescent boys (AB; 12-17 years) were about twice as likely to be overweight/obese as adolescent girls (AG; 15·5 v. 8·4 %, P<0·05). AB more likely had energy intake exceeding recommendations, self-perceived underweight, underestimated their body weight and were satisfied with their physical activity level than AG. AG more likely practised weight-loss management through diet and self-perceived overweight than AB. Mothers more likely identified AG's weight accurately but underestimated AB's weight. Stronger associations with risk of childhood OW/OB were found in boys than girls in dieting to lose weight (OR=6·7 in boys v. 2·6 in girls) and combined maternal and child perception of the child's overweight (OR=35·4 in boys v. 14·2 in girls).Conclusions: Large sex differences in childhood obesity may be related to the sex disparities in weight-related beliefs and behaviours among children and their parents in China. [ABSTRACT FROM AUTHOR]

Background: China has seen rapid increase in obesity and hypertension prevalence and fast food consumption over the past decade. We examined status and risk factors for Western- and Chinese fast food consumption and their associations with health outcomes in Chinese children, and examined how maternal factors were associated with child health outcomes.Methods: Data of 1626 students aged 7-16 (11.6 ± 2.0) years and their parents in four mega-cities across China (Beijing, Shanghai, Nanjing, and Xi'an) were collected in the 2015 baseline survey of the Childhood Obesity Study in China Mega-cities. Weight, height, waist circumference, and blood pressure were measured. Food intake was assessed using questionnaire. Mixed models were used to examine the associations.Results: Among the children, 11.1% were obese, 19.7% were centrally obese, and 9.0% had hypertension. Obesity prevalence was much higher in boys than in girls (15.2% vs. 6.9% and 27.4% vs. 11.7%, respectively, both P < 0.001). About half (51.9% and 43.6%) of children consumed Western and Chinese fast food, respectively, over the past 3 months. Compared to those with college or above maternal education level, those with elementary school or below maternal education level were 49% more likely to consume Western fast food (odds ratio [OR] and 95% confidence interval [CI]: 1.49 [1.10-2.03]). Chinese fast food consumption rate increased by 12% with each year of increase in child's age (OR and 95% CI: 1.12 [1.02-1.23]). No significant associations between fast food consumption and health outcomes were detected. Adjusting for Western fast food consumption, children with lower maternal education were 71% and 43% more likely to have obesity and central obesity (ORs and 95% CIs: 1.71 [1.12-2.61] and 1.43 [1.00-2.03], respectively), and maternal body mass index was positively associated with child obesity, central obesity, and hypertension (ORs and 95% CIs: 1.11 [1.06-1.17], 1.12 [1.07-1.17], and 1.09 [1.03-1.15], respectively). Results were similar when Chinese fast food consumption was adjusted for.Conclusions: The prevalence of fast food consumption, obesity and hypertension is high among children in major cities in China. Maternal factors affect child outcomes. [ABSTRACT FROM AUTHOR]

ObjectiveThe present study aimed to identify dietary patterns and explore their associations with blood lipid profiles among Chinese women.DesignIn a cross-sectional study, we identified dietary patterns using principal component analysis of data from three consecutive 24 h dietary recalls. The China Health and Nutrition Survey (CHNS) collected blood samples in the morning after an overnight fast and measured total cholesterol (TC), HDL cholesterol (HDL-C), LDL cholesterol (LDL-C) and TAG.SettingData were from the 2009 wave of the CHNS.SubjectsWe studied 2468 women aged 18–80 years from the CHNS.ResultsWe identified three dietary patterns: traditional southern (high intakes of rice, pork and vegetables), snack (high intakes of fruits, eggs and cakes) and Western (high intakes of poultry, fast foods and milk). The traditional southern pattern was inversely associated with HDL-C (β=−0·68; 95 % CI −1·22, −0·14; P<0·05). The snack pattern was significantly associated with higher TAG (β=4·14; 95 % CI 0·44, 7·84; P<0·05). The Western pattern was positively associated with TC (β=2·52; 95 % CI 1·03, 4·02; P<0·01) and LDL-C (β=2·26; 95 % CI 0·86, 3·66; P<0·01).ConclusionsWe identified three dietary patterns that are significantly associated with blood lipid profiles. This information is important for developing interventions and policies addressing dyslipidaemia prevention among Chinese women. [ABSTRACT FROM AUTHOR]

Children's exposure to lead is a global health problem, especially in low- and middle-income countries. However, research on the relationship between children's blood lead levels (BLLs) and the development of the lead industry is still limited. This study examined whether children's BLLs were associated with the development of lead industry in different regions. Using survey data on the BLLs of children living in 250 prefectures in China with corresponding data on their economic factors and lead industries, we explored the regional variation of children's BLLs using statistical methods. The results show that the level of economic development in leaded areas was associated with inequity in children's BLLs and met the environmental Kuznets hypothesis. In areas without lead industries, there was little correlation between the level of economic development and the BLLs of children and thus the environmental Kuznets hypothesis was not supported. Lead mines, lead smelting and chemical companies are major sources of blood lead in children living in leaded areas. This study demonstrated the success of control policies for lead-acid battery manufacturers in promoting the prevention and control of childhood lead poisoning in China. China should consciously support the improvement of children's BLLs in undeveloped areas with lead industries through national financing and policies to avoid the continuous effects of the regional inequality problem of high children's BLLs. [Display omitted] • Children's BLLs associated with development of regional lead industry in China. • The leaded areas met the environmental Kuznets hypothesis. • The areas without lead did not meet the environmental Kuznets hypothesis. [ABSTRACT FROM AUTHOR]

Studies on macronutrient intake and obesity have been inconclusive. This study examined the associations between multi-trajectories of macronutrients and the risk of obesity in China. We used data from 7914 adults who participated in the China Health and Nutrition Survey at least three times from 1991 to 2018. We collected detailed dietary data by conducting three 24 h dietary recalls and weighing foods and condiments in household inventories. We identified multi-trajectories using group-based multi-trajectory models and examined their associations with the risk of obesity with multiple Cox regression models. We found four multi-trajectories in rural areas: balanced macronutrient intake (BM), moderate protein, increasing low fat, and decreasing high carbohydrate (MP&ILF&DHC); decreasing moderate protein, decreasing high fat, and increasing moderate carbohydrate (DMP&DHF&IMC); increasing moderate protein, increasing high fat, and decreasing low carbohydrate (IMP&IHF&DLC)—35.1%, 21.3%, 20.1%, and 23.5% of our rural participant population, respectively. Compared with the BM trajectory, the hazard ratios of obesity in the DMP&DHF&IMC and the IMP&IHF&DLC groups were 0.50 (95% confidence interval (CI): 0.27–0.95) and 0.48 (95% CI: 0.28–0.83), respectively, in rural participants. Relatively low carbohydrate and high fat intakes with complementary dynamic trends are associated with a lower risk of obesity in rural Chinese adults. [ABSTRACT FROM AUTHOR]

Studies on the intraindividual double burden of malnutrition (DBM) among Chinese children and adolescents were lacking. This study aimed to analyze the prevalence of intraindividual DBM defined as the coexistence of overweight/obesity and dietary micronutrient intake insufficiency and investigate dietary micronutrient intake in Chinese children and adolescents. Using data from the 2015 China Health and Nutrition Survey (CHNS), 1555 children and adolescents aged 6 to 17 years were selected as the subjects. We referred to China Food Composition to calculate the intakes of 11 selected dietary micronutrients from diet data collected by consecutive three days of 24 h recalls combined with household weighing of seasonings. We used the Chinese estimated average requirement (EARs) as a cutoff to define the dietary micronutrients deficiency, and applied the body-mass-index-for-age Z-scores (BAZ) of World Health Organization (WHO) child growth standards to define the category of body weight. Among the subjects in present study, the prevalence of overweight and obesity was 15.43% and 11.06%, respectively, and 26.24% of the subjects had undergone intraindividual DBM. The results suggest that the prevalence of intraindividual DBM and dietary micronutrients deficiency in Chinese children and adolescents is high. [ABSTRACT FROM AUTHOR]

Cognitive function is not generally associated with diet, and there is debate over that association. Moreover, little is known about such associations with the specific cognitive domains and subtypes of mild cognitive impairment (MCI). We analyzed data of 4309 Chinese adults aged 55 and over from the Community-based Cohort Study on Nervous System Diseases from 2018–2019. Dietary habits were assessed at inclusion using a validated semi-quantitative food frequency questionnaire. Cognitive function of the participants was measured by using the Montreal Cognitive Assessment. Analyses were performed using multiple logistic regression and quantile regression with adjustment for socio-demographic, lifestyle, and health-related factors. Compared with normal cognition participants, those with a worse cognition state were characterized as being an older age and lower economic level. After adjustment for potential factors, participants with higher consumption of rice, legumes, fresh vegetables, fresh fruit, pork, poultry, fish, and nuts tended to have higher scores of global cognitive function and domains, and to have lower odds of MCI, while those with higher consumption levels of wheat and eggs had worse cognition, compared with the corresponding bottom consumption level of each food. Participants with a medium consumption level of beef or mutton had 57% (OR: 1.57, 95%CI: 1.07–2.32) higher odds of aMCI-SD, whereas they had 50% (OR: 0.50, 95%CI: 0.34–0.73) lower odds of naMCI-MD. Similarly, the highest consumption level of dairy was positively associated with the odds of aMCI-SD (OR:1.51, 95%CI:1.00–2.29), but inversely linked to the odds of naMCI-SD (OR: 0.60, 95%CI: 0.38–0.93) and naMCI-MD (OR: 0.49, 95%CI: 0.29–0.82). Most diet global cognitive benefits were observed to be associated with the preexisting higher consumption of rice, legumes, fresh vegetables, fresh fruit, meat, and nuts. In addition, the heterogeneity of associations between the consumption of certain foods and MCI subtypes was observed among Chinese adults aged over 55 years. These cross-sectional observations require validation in prospective studies. [ABSTRACT FROM AUTHOR]

Few studies have focused on quantifying the double burden of malnutrition (DBM) phenomenon in China. We aimed to clarify the prevalence of DBM among Chinese adults as well as to examine whether daily dietary micronutrient status varies by body mass index (BMI) categories. In this study, a sample of 6602 adults aged 18–59 years from the China Health and Nutrition Survey (CHNS) was analyzed. Information was obtained on dietary intake and anthropometric measurements. Dietary intakes of 11 micronutrients were estimated based on the data collected by three consecutive days of 24 h recalls combined with the weighing of household seasonings. Dietary micronutrient deficiency was defined according to the cutoff of the Chinese estimated average requirement (EARs). 44% of Chinese adults faced the problem of DBM, of which nearly 40% experienced overweight/obesity and micronutrient deficiency simultaneously. Comparable percentages (>50%) of Chinese adults had dietary intake less than the Chinese EARs for key micronutrients including retinol, thiamin, riboflavin, vitamin C, calcium, selenium, zinc, and magnesium, and the percentages varied by body weight status. More than 80% participants had at least two selected vitamin or mineral deficiencies in all BMI categories. These findings indicate that Chinese adults have a high DBM and micronutrient inadequacies prevail among and within gender and all BMI categories. All body weight groups need advice on the changing needs for dietary variety to ensure optimal health. [ABSTRACT FROM AUTHOR]

Few studies have examined the longitudinal association between urbanicity and dietary fat intake in Chinese adults. A population-based longitudinal observational study was carried out in Chinese adults aged 18–65 from the China Health and Nutrition Survey. Three consecutive 24 h dietary recalls were used to assess dietary fat intake. Multilevel models were used to explore the relationship between urbanicity and dietary fat intake. People in the highest urbanicity quartile had the increments of 7.48 g/d (95% CI:5.42–9.58) and 8.92 g/d (95% CI: 7.03–10.80) in dietary fat intake, 2.86 (95% CI: 2.29–3.44) and 2.69 (95% CI: 2.13–3.25) in proportion of energy from total fat, and odds ratios (ORs) for the risk of excess dietary fat intake of 1.84 (95% CI: 1.65–2.05) and 2.01 (95% CI: 1.78–2.26) for men and women, respectively, compared to the lowest quartile after controlling for potential confounders. These results indicate that urbanicity was an important factor influencing dietary fat intake among Chinese adults. Aggressive nutritional education action coupled with governmental guidelines and programs tailored for the Chinese population are required to promote less dietary fat intake, especially in those adults living in less urbanized areas and whose dietary fat intake is ≥ 30% of their total energy intake per day. [ABSTRACT FROM AUTHOR]

This study aimed to examine longitudinal associations between fatty and lean, fresh red meat intake and blood pressure (BP) in Chinese adults. The data were from nine waves of the China Health and Nutrition Survey (1991–2015), a longitudinal, open cohort study. The surveys were conducted in 303 urban and rural communities of 15 provinces in China. Collected by consecutive three-day 24-h dietary recalls combined with household weighing for foods or only condiments, the diet exposure of interest was daily red meat intake and its subtypes (fatty versus lean) defined by 10-g fat content per 100 g. The main outcome was systolic blood pressure (SBP), diastolic blood pressure (DBP) and risk of elevated BP defined as having a mean of SBP ≥ 135 mmHg, DBP ≥ 85 mmHg, or taking antihypertensive medication. Three-level mixed-effect regressions showed women had SBP increases of 2.19 mmHg (95% CI: 1.07, 4.46) from a higher intake of total fresh red meat, 2.42 mmHg (95% CI: 1.18, 4.94) from a higher intake of fatty, fresh red meat, as well as 0.48 mmHg (95% CI: 0.26, 0.88) from a higher intake of lean, fresh red meat in the top tertile versus bottom one when adjusted for potential confounders. After adjusting for survey years, women with the highest tertile of lean, fresh red meat intake had a 32% lower risk of elevated BP (OR 0.68, 95%CI:0.48, 0.96) as compared with those with the first tertile (non-consumer). Fatty and lean, fresh red meat intakes were differentially associated with BP among Chinese adults. Further research is required to elicit the potential mechanism on gender-specific differential association of fatty versus lean, fresh red meat with BP. [ABSTRACT FROM AUTHOR]

This study aims to characterize future changes in precipitation extremes over China based on regional climate models (RCMs) participating in the Coordinated Regional Climate Downscaling Experiment (CORDEX)-East Asia project. The results of five RCMs involved in CORDEX-East Asia project that driven by HadGEM2-AO are compared with the simulation of CMA-RegCM driven by BCC-CSM1.1. Eleven precipitation extreme indices that developed by the Expert Team on Climate Change Detection and Indices are employed to evaluate precipitation extreme changes over China. Generally, RCMs can reproduce their spatiotemporal characteristics over China in comparison with observations. For future climate projections, RCMs indicate that both the occurrence and intensity of precipitation extremes in most regions of China will increase when the global temperature increases by 1.5/2.0 °C. The yearly maximum five-day precipitation (RX5D) averaged over China is reported to increase by 4.4% via the CMA-RegCM under the 1.5 °C warming in comparison with the baseline period (1986–2005); however, a relatively large increase of 11.1% is reported by the multi-model ensemble median (MME) when using the other five models. Furthermore, the reoccurring risks of precipitation extremes over most regions of China will further increase due to the additional 0.5 °C warming. For example, RX5D will further increase by approximately 8.9% over NWC, 3.8% over NC, 2.3% over SC, and approximately 1.0% over China. Extremes, such as the historical 20-year return period event of yearly maximum one-day precipitation (RX1D) and RX5D, will become more frequent, with occurrences happening once every 8.8 years (RX1D) and 11.5 years (RX5D) under the 1.5 °C warming target, and there will be two fewer years due to the additional 0.5 °C warming. In addition, the intensity of these events will increase by approximately 9.2% (8.5%) under the 1.5 °C warming target and 12.6% (11.0%) under the 2.0 °C warming target for RX1D (RX5D). [ABSTRACT FROM AUTHOR]

Sustainable dietary transition is widely identified essential in addressing the nutrition, environment, and health trilemma. This is particularly important for China, the world's most populous country which is undergoing a rapid dietary structure change. Here, we used a nonlinear optimization algorithm to identify a nutritionally adequate, environmentally friendly, economically affordable, and culturally acceptable diet for each of the 31 provinces in mainland China. We found that province-specific dietary shifts could reduce the carbon, water, land, nitrogen, and phosphorus footprints of China's food consumption by 9.5–25.3%, 10.7–19.1%, 22.4–32.9%, 30.8–40.2%, and 21.4–34.5%, respectively, while meeting the daily recommended intake of essential nutrients and not exceeding current food expenditures. The variation in required food intake was highly province-specific; however, in general, there was a need to reduce the intake of meat, grains, and edible oils and increase the intake of vegetables, fruits, legumes, tubers, and dairy products. Our findings highlight the importance of province-specific diet optimization, which can greatly improve acceptance and feasibility of sustainable dietary transition, guide individuals to change their food consumption behavior, and inform policymakers towards regionally tailored food policies. [Display omitted] [ABSTRACT FROM AUTHOR]

The fast food (FF) industry has expanded rapidly in China during the past two decades, in parallel with an increase in the prevalence of obesity. Using government-reported longitudinal data from 21 provinces and cities in China, this study examined the growth over time and the spatial distribution patterns of the FF industry as well as the key social economic factors involved. We visualized the temporal and geographic distributions of FF industry development and conducted cross-sectional and longitudinal spatial analysis to assess associations between macroeconomic conditions, population dynamics, and the growth and distributional changes of the industry. It grew faster in the southeast coastal (more economically developed) areas since 2005 than in other regions. The industry was: 1) highly correlated with Gross Domestic Product; 2) highly correlated with per capita disposable income for urban residents; 3) moderately correlated with urban population; and 4) not correlated with an increase of population size. The mean center of the FF industry shifted westward as the mean center of the GDP moved in the same direction, while the mean center of the population shifted eastward. The results suggest that the rapid FF industry expansion in China was closely associated with economic growth and that improving the food environment should be a major component in local economic development planning. [ABSTRACT FROM AUTHOR]

Background and Objectives: Research on how urbanization has influenced the food environment in China is limited. The study aimed to examine the impact of urbanization on the food environment in China.Methods and Study Design: Longitudinal data collected during 1989-2009 from the China Health and Nutrition Survey were used, which covered 9 provinces in China. Urbanicity index (0-10) was assessed using an urbanicity scale. Final analyses included 216 communities. Random-effect models were used in analyses.Results: Urbanization (higher urbanicity index) increased the odds of having fast food restaurants (OR=2.78, 95% CI: 2.18-3.54) and other indoor restaurants (OR=2.93, 95% CI: 2.28-3.76) within the community, the odds of having supermarkets (OR=2.43, 95% CI: 2.04-2.89) and free markets (OR=2.56, 95% CI: 1.77-3.70) within 30 minutes' bus ride from the community. Food prices for apples (β=0.06, 95% CI: 0.04-0.08) and lean pork (β =0.02, 95% CI: 0.01-0.03) increased with urbanicity, while prices for other food did not. Urbanicity was positively associated with community norms for fast food consumption (RR=1.28, 95% CI: 1.22-1.33), fast food preferences (RR=1.09, 95% CI: 1.06-1.12) and nutrition knowledge (RR=1.02, 95% CI: 1.01-1.03).Conclusions: Urbanization is associated with food environment in China. The findings provide insight for future economic development and public health efforts related to urbanization. [ABSTRACT FROM AUTHOR]

Background and Objectives: Over the past two decades, food environment has changed, and the obesity and overweight rates have increased dramatically in China. Previous studies have suggested an association between food environment and obesity, while most studies were based on the data from developed countries, and few were conducted in developing countries.Methods and Study Design: The current study evaluated the influence of food establishments (distance to and types of grocery store, free market, restaurant, and food stall) on body mass index (BMI) in 348 children aged 6-17 years, surveyed in the 2009 and 2011 China Health and Nutrition Survey in nine provinces. Food establishments were assessed using geographic information system (GIS) data. Weight and height of children were directly measured.Results: Our longitudinal analysis suggested boys in the 2nd quartile of the proximity to the nearest grocery store had higher BMI (by 1.6 kg/m2, 95% CI, 0.07 to 3.24) as compared to those in the 1st quartile, while girls in higher quartiles had lower BMI (-1.78 kg/m2, 95% CI: -3.38 to - 0.18, 2nd quartile; -1.62 kg/m2, 95%: -3.22 to -0.01, 3rd quartile) as compared to those in the 1st quartile. Boys and girls in the 2nd quartile of the proximity to the nearest Chinese restaurant had lower BMI (-1.69 kg/m2, 95% CI: - 3.27 to -0.12; -1.76 kg/m2, 95% CI: -3.26, -0.27, respectively) as compared to those in the 1st quartile.Conclusions: Food environment may affect children's BMI in China, while the association is inconsistent with previous studies. Further research is needed. [ABSTRACT FROM AUTHOR]

Background and Objective: Over the past three decades, the prevalence of overweight and obesity in China has increased greatly. Chinese body mass index (BMI) dynamics have shown much greater rates of changes among men, aged 18-45 years, than among women. This study examined the gender difference in the BMI trends and related factors.Methods and Study Design: We used longitudinal data from the China Health and Nutrition Survey collected in 1997, 2000, 2004, 2006, 2009 and 2011. A total of 10,982 participants (N=5339 men and 5643 women) aged 18-45 years were included in the final analysis. Lambda mu sigma method (LMS) was used to describe changes of BMI distribution. Separate sex-stratified multilevel random intercept-slope growth models were applied to examine effects of individual and community variables on BMI trends of Chinese adults.Results: Male BMI increased by 0.21 kg/m2 overtime, which was larger than female BMI at 0.16 kg/m2. Higher income, drinking and away-from-home food consumption were associated with higher BMI, and these variables were only significant among men. Physical activity (PA) had a negative association for both genders.Conclusions: Since different variables resulted in gender disparity in BMI trends among Chinese adults, separate health policies should be developed for men and for women. [ABSTRACT FROM AUTHOR]

The processed food sector in low- and middle-income countries has grown rapidly. Little is understood about its effect on obesity. Using data from 14,976 participants aged two and older in the 2011 China Health and Nutrition Survey, this paper examines patterns of processed food consumption and their impacts on obesity while considering the endogeneity of those who purchase processed foods. A major assumption of our analysis of the impact of processed foods on overweight and obesity was that the consumption of processed foods is endogenous due to their accessibility and urbanicity levels. The results show that 74.5% of participants consumed processed foods, excluding edible oils and other condiments; 28.5% of participants’ total daily energy intake (EI) was from processed foods. Children and teenagers in megacities had the highest proportion of EI (40.2%) from processed foods. People who lived in megacities or highly urbanized neighborhoods with higher incomes and educational achievement consumed more processed foods. When controlling for endogeneity, only the body mass index (BMI) and risk of being overweight of children ages two to eighteen are adversely associated with processed foods (+4.97 BMI units, 95% confidence interval (CI): 1.66–8.28; odds ratio (OR) = 3.63, 95% CI: 1.45–9.13). Processed food purchases represent less than a third of current Chinese food purchases. However, processed food purchases are growing at the rate of 50% per year, and we must begin to understand the implications for the future. [ABSTRACT FROM AUTHOR]

This study examined prevalence of childhood overweight and obesity (ov/ob) and central obesity in five mega-cities across China (Beijing, Shanghai, Xi'an, Nanjing and Chengdu); described parental perceptions of children's ideal body image (IBI); and prospectively examined associations between parental perception of child IBI and child weight changes over 3 years. In this NIH-funded, open cohort study, data were collected from students and their parents in 2015, 2016 and 2017 (n = 3298, in 3 waves). Cross-sectional analysis included all 3298 children; longitudinal data analysis used mixed effects models and included 1691 children aged 6-17 years with ≥two body mass index (BMI) measurements during 2015-2017. Ov/ob prevalence based on Chinese age-sex-specific BMI cut-points was 30.0%. Based on waist-to-height ratio (WHtR), the abdominal obesity rate was 19.8%. Parents reported different preferred IBI for boys vs girls, being about 3 times more likely to select ov/ob as ideal for boys than for girls (4.5% vs 1.5%, respectively, P < .001). In longitudinal analysis, children whose parents selected ov/ob as ideal had higher BMI Z-scores and WHtR increase over time than those whose parents selected an average body image (β [SE] = 0.042 [0.011], and β [SE] = 0.010 [0.004], respectively, all P < .05). Ov/ob rates were high among children in major cities in China. Chinese parents preferred a heavier ideal body image for their boys. Health promotion programs should help empower parents and their children to develop appropriate body images and maintain healthy body weight. [ABSTRACT FROM AUTHOR]