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Previous studies exploring the relationship between dietary potassium and magnesium intake and the risk of type 2 diabetes mellitus (T2DM) have yielded inconsistent results and the lack evidence from rural China. Therefore, we aimed to investigate the association between dietary potassium and magnesium intake and the risk of T2DM in rural China. Data was collected from the Henan Rural Cohort Study in 2017. A validated semi-quantitative food frequency questionnaire assessed dietary potassium and magnesium intake. Logistic regression models were used to calculate odds ratio (ORs) and 95% confidence intervals (CIs) to evaluate the effect of dietary potassium, magnesium and the potassium-magnesium ratio on the risk of T2DM. A total of 38384 individuals were included in the study, and 3616 participants developed T2DM. Logistic regression analysis revealed that the OR (95% CI) of the highest versus dietary potassium and magnesium and potassium-magnesium ratio intakes were 0.67 (0.59, 0.75), 0.76 (0.67, 0.88), and 0.57 (0.50, 0.66), respectively, compared to the subjects with the lowest quartile of intakes. In addition, gender partially influences the relationship between dietary magnesium and T2DM prevalence (P- interaction = 0.042). The group with the highest dietary potassium and dietary magnesium intake had the lowest risk of T2DM, with an OR (95% CI) of 0.63 (0.51-0.77). Dietary potassium and magnesium intake are important modifiable risk factors for T2DM in rural China. Dietary potassium intake > 1.8g/day, dietary magnesium intake > 358.6mg/day and < 414.7mg/day and potassium-magnesium ratio >5.1 should be encouraged to prevent better and manage T2DM., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Evidence of the relationship between fecal short-chain fatty acids (SCFA) levels, dietary quality and type 2 diabetes mellitus (T2DM) in rural populations is limited. Here, we aimed to investigate the association between fecal SCFA levels and T2DM and the combined effects of dietar quality on T2DM in rural China. In total, 100 adults were included in the case-control study. Dietary quality was assessed by the Alternate Healthy Eating Index 2010 (AHEI-2010), and SCFA levels were analysed using the GC-MS system. Generalised linear regression was conducted to calculate the OR and 95 % CI to evaluate the effect of SCFA level and dietary quality on the risk of T2DM. Finally, an interaction was used to study the combined effect of SCFA levels and AHEI-2010 scores on T2DM. T2DM participants had lower levels of acetic and butyric acid. Generalised linear regression analysis revealed that the OR (95 % CI) of the highest acetic and butyric acid levels were 0·099 (0·022, 0·441) and 0·210 (0·057, 0·774), respectively, compared with the subjects with the lowest tertile of level. We also observed a significantly lower risk of T2DM with acetic acid levels > 1330·106 μg/g or butyric acid levels > 585·031 μg/g. Moreover, the risks of higher acetic and butyric acid levels of T2DM were 0·007 (95 % CI: 0·001, 0·148), 0·005 (95 % CI: 0·001, 0·120) compared with participants with lower AHEI-2010 scores (all P < 0·05). Acetate and butyrate levels may be important modifiable beneficial factors affecting T2DM in rural China. Improving dietary quality for body metabolism balance should be encouraged to promote good health.

Purpose: To investigate the association between low-carbohydrate diet scores (LCDs) and the risk of type 2 diabetes in rural China., Methods: A total of 38,100 adults were included in the Henan Rural Cohort Study. Macronutrient intake was assessed via a validated food-frequency questionnaire to create low-carbohydrate diet (LCD) scores. Multivariate logistic regression models and subgroup analysis were performed to estimate the odds ratio (OR) and 95% confidence interval (95% CI)., Results: After multivariable adjustment, participants with a high total low-carbohydrate diet score have a high risk of T2D (extreme-quartile OR = 1.23, 95% CI: 1.04-1.41; P = 0.007), whereas plant-based LCD score is not related to T2D risk. Among individuals with a BMI < 24 (extreme-quartile OR = 1.22, 95% CI: 1.01-1.47; P < 0.001) or high levels of physical activity (extreme-quartile OR = 1.42, 95% CI: 1.17-1.72; P < 0.001), the animal-based LCD score is positively correlated with the risk of T2D., Conclusion: Among Chinese rural populations, high-fat-low carbohydrate diet is associated with an increased risk of type 2 diabetes. High intake of animal protein and fat also increases T2D risk in those who are overweight or have high physical activity., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Sitting time may affect health by altering the methylation of certain genes. This research aimed to estimate the association of sitting time with abdominal obesity and the role of Janus kinase 2 (JAK2) methylation in the association among rural adults., Methods: A total of 1062 rural adults from the Henan Rural Cohort Study were included. Whole blood was used to extract genomic DNA. JAK2 DNA methylation level was assessed by MethylTarget TM . The logistic regression model was utilized to assess the association of sitting time with abdominal obesity, and the possible effect of JAK2 DNA methylation on the association were conducted by using mediation analyses., Results: Average time of sitting of participants was 7.28 ± 3.37 h/d. For per 1 h increment in sitting time, the odd ratio (OR) and 95% confidence interval (CI) of abdominal obesity was 1.153 (1.095, 1.214) after controlling potential risk factors. Simultaneously, the methylation levels of Chr9: 4985407 site and Chr9: 4985238-4985455 region were negatively correlated with abdominal obesity (OR: 0.549, 95% CI: 0.394, 0.765; OR: 0.189, 95% CI: 0.056, 0.640, respectively). Moreover, Chr9: 4985407 site and Chr9: 4985238-4985455 region methylation levels mediated the association of sitting time with abdominal obesity, and the indirect effects account for 6.78% and 4.24%, respectively., Conclusions: Longer sitting time was positively correlated with abdominal obesity in the rural population, and methylation level of JAK2 may be an underlying mediation of the effect., (© 2023. The Author(s), under exclusive licence to Springer Nature Limited.)

Background: The reliability and validity of recalled body shape were unknown in China. This study was conducted to examine the reliability and validity of recalled body shape as well as the responsiveness of obesity classification by recalled body shape among the Chinese rural population., Methods: A total of 166 people from the Henan rural cohort were enrolled. The Spearman's correlation coefficient (SCC), intraclass correlation coefficient (ICC), and Cronbach's α were calculated to assess the reliability and validity of recalled body shape. Additionally, the receiver operator characteristic curve (ROC) was performed to assess the responsiveness., Results: The SCC between the twice recalled body shape ranged from 0.383 to 0.578, and the ICC ranged from 0.357 to 0.615. Besides, the Cronbach's α of the recalled body shape questionnaire was 0.845. At the age of 20-70, the SCC between recalled body shape and actual body mass index (BMI) and waist circumference (WC) ranged from 0.563 to 0.699 and 0.409 to 0.661, respectively. Furthermore, above the age of 20, the area under the curve (AUC) of classifying general obesity and abdominal obesity by recalled body shape ranged from 0.833 to 0.960 and 0.686 to 0.870, respectively., Conclusion: The results indicated that recalled body shape had moderate reliability, validity, and discriminative degree for earlier obesity among the Chinese rural population., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Liao, Liu, Kang, Niu, Song, Wang, Wei, Liu, Sun, Mao, Hou, Wang and Li.)

Objective: The purpose of the current study was to investigate associations between spicy food intake and serum lipids levels in Chinese rural population., Design: Information on spicy food flavour and intake frequency was obtained using a two-item questionnaire survey. Dietary data were collected using a validated thirteen-item FFQ. Fasting blood samples were collected and measured for total cholesterol (TC), TAG, HDL-cholesterol and LDL-cholesterol. Multivariate linear and logistic regression models were employed to examine the relationship between spicy food and serum lipids levels according to the spicy food flavour and intake frequency, respectively., Setting: A cross-sectional study in Henan Province., Participants: 38 238 participants aged 18-79 years old., Results: Spicy flavour and intake frequency were consistently associated with decreased TC and non-HDL-cholesterol levels but mildly associated with elevated TAG levels. Each level increment in spicy flavour was inversely associated with high TC (OR: 0·91; 95 % CI 0·88, 0·93) and high non-HDL-cholesterol (OR: 0·88; 95 % CI 0·85, 0·91) but positively associated with high TAG (OR: 1·04; 95 % CI 1·01, 1·07). Similarly, 1-d increment in spicy food intake frequency was also inversely associated with high TC (OR: 0·92; 95 % CI 0·91, 0·94) and high non-HDL-cholesterol (OR: 0·91; 95 % CI 0·89, 0·93) but positively associated with high TAG (OR: 1·04; 95 % CI 1·02, 1·06)., Conclusions: Spicy food intake was mildly associated with increased risk of abnormal TAG level, significantly associated with decreased risk of abnormal TC and non-HDL levels. Spicy food intake may be contribute to the management of lipid levels.

Introduction: We aimed to explore the association between night sleep duration and ideal cardiovascular health (ICH) among Chinese rural population. Methods: In all, 35,094 participants were included from the Henan Rural Cohort study. Information on sleep was collected using the Pittsburgh Sleep Quality Index. The ICH scores were evaluated. The associations between night sleep duration and ICH were examined using both linear regression and logistic regression models. Results: The mean night sleep duration for all participants was 7.75 ± 1.28 h. Compared with those with night sleep duration of 7 to <9 h by using linear regression model, a significant decrease in ICH scores was observed for participants with shorter [-0.077 (-0.131, -0.024)] and longer [-0.079 (-0.121, -0.036)] night sleep duration. Compared with 7 to <9 h, longer sleep duration [0.919 (0.851, 0.992)] were associated with decreased odds of ideal CVH. Conclusions: Shorter and longer night sleep duration are negatively associated with ICH among rural population. This suggests that it may be beneficial to include night sleep duration assessment in cardiovascular risk screening., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Wu, Liu, Liao, Kang, Sang, Abdulai, Zhai, Wang, Wang and Li.)

Background: The study was conducted to evaluate the independent dose-response of the night sleep duration and sleep initiation time on hypertension, and to explore their combined effect with hypertension., Methods: Participants from the Henan Rural Cohort were enrolled in this study. Information on sleep was collected using the Pittsburgh Sleep Quality Index. Hypertension was defined as systolic blood pressure/diastolic blood pressure ≥140/90 mmHg or self-reported hypertension and current use of anti-hypertensive medicines. Logistic regression and restricted cubic spline were conducted to evaluate the association of night sleep duration and sleep initiation time with hypertension., Results: Of the 37 317 included participants, 12 333 suffered from hypertension. 14 474 (38.79%) were men and 22 843 (61.21%) were women, the mean age were 57.18 ± 12.10 and 55.24 ± 11.98 in men and women. Compared to reference (7-h), fully adjusted odd ratios (ORs) and 95% confidence interval (CI) of hypertension were 0.91 (0.66-1.25) in <5 h group and 1.74 (1.41-2.16) in ≥10 h among men, respectively. Fully adjusted ORs (95% CIs) for hypertension compared with reference (21:00-22:00) were 1.05 (95% CI 0.78-1.41) in the <20:00 group, 1.52 (1.25-1.85) in ≥24:00 in men. The combined effect of sleep duration and sleep initiation time on hypertension were statistically significant in the category of (≥8 h)/night and ≥24:00 (OR 1.87, 95% CI 1.07-3.25) compared to reference in fully adjusted model among men., Conclusions: Long night sleep duration and late sleep initiation time were associated with the higher odds of hypertension, and the sleep duration and sleep initiation time might cumulatively increase the prevalence of hypertension in men., Clinical Trial Registration: The Henan Rural Cohort Study has been registered at the Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699). http://www.chictr.org.cn/showproj.aspx? proj=11375., (© The Author(s) 2019. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

Background: This study aims to investigate the prevalence and associated factors of major depressive disorder (MDD) and generalized anxiety disorder (GAD) by gender in Chinese rural adults., Methods: A total of 29,993 participants aged from 18 to 79 years from the Henan Rural Cohort Study were included in this study. The Patient Health Questionnaire-2 (PHQ-2) and Generalized Anxiety Disorder-2 (GAD-2) were used to assess MDD and GAD through a face-to-face interview. Multivariate logistic regression model was conducted to analyze the associated factors for MDD and GAD., Results: The age-standardized prevalence of MDD and GAD (and 95%CI) in the total sample were 5.41% (5.17-5.66%) and 4.94% (4.71-5.18%), respectively. Besides, the crude prevalence in women were significantly higher than men for both MDD (6.81% vs. 4.77%) and GAD (6.63% vs. 3.93%) (both P < 0.001). Tetrachoric correlation test showed high comorbidity between MDD and GAD (r = 0.88, P = 0.01). Further analysis revealed that age, sex, marital status, educational level, per capita monthly income, drinking, physical activity, and body mass index were associated with MDD and GAD in the overall sample. Gender difference was found among age groups for MDD (P interaction  < 0.001)., Conclusions: These findings showed that Chinese rural adults were at low risk for prevalence of MDD and GAD. Women had higher prevalence and risks for MDD and GAD compared with men, indicating that women deserved more attention. Gender-specific interventions on the modifiable associated factors are urgently needed to improve the mental conditions for Chinese rural population., Clinical Trial Registration: The Henan Rural Cohort Study has been registered in the Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699). Date of registration: 2015-07-06.

Objectives: To estimate the prevalence and influencing factors of physical activity (PA) and sedentary behaviour (SB) in rural areas of China., Design: Cross-sectional study., Setting: A multistage, stratified cluster sampling method was used to obtain samples in the general population of Henan province in China., Participants: 38 515 participants aged 18-79 years were enrolled from the Henan Rural Cohort Study for the cross-sectional study., Main Outcome Measures: The International Physical Activity Questionnaire was used to assess the levels of PA and SB. Multiple logistic regression analysis was used to calculate ORs and 95% CIs of potential influencing factors with physical inactivity., Results: The age-standardised prevalence of light PA and sitting >7.5 hours per day were 32.74% and 26.88% in the general Chinese rural adults, respectively. Gender differences were: 34.91%, 29.76% for men and 31.75%, 25.16% for women, respectively. The prevalence of participants with both light PA and sitting >7.5 hours per day was 13.95%. Education at least junior middle school, divorced/widowed/unmarried, RMB1000> per capita monthly income ≥RMB500, sitting >7.5 hours per day were negatively associated with light PA. For sitting >7.5 hours per day, the negative factors were being men, divorced/widowed/unmarried, heavy smoking, Fishery products, vegetable and fruits intake ., Conclusion: Physical inactivity and SB were high in rural China. There is an increased need to promote a healthy lifestyle to the rural population., Clinical Trial Registration: The Henan Rural Cohort Study has been registered with the Chinese Clinical Trial Register.Registration number: ChiCTR-OOC-15006699. http://www.chictr.org.cn/showproj.aspx?proj=11375., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: The two-item generalized anxiety disorder scale (GAD-2) has been investigated in different populations, but with limited evaluation in the Chinese population. This study aimed to validate the diagnostic accuracy of GAD-2 for identifying GAD through a validation study along with an updated meta-analysis., Methods: We recruited 694 adults in 2015 from "the Henan Rural Cohort study" where the GAD-7 questionnaire was adopted as the gold standard diagnosis. Receiver operating characteristics (ROC) curve and Cronbach's α were determined. Furthermore, a meta-analysis was conducted to evaluate the effectiveness of the GAD-2., Results: In this study, 37 patients [5.33%; 95% confidence interval (CI): 3.78-7.27%] met the criteria for current GAD. The GAD-2 showed a Cronbach's alpha of 0.806 and an area under the ROC curve (AUC) of 0.954 (95% CI: 0.936-0.968). At a cutoff of 3, GAD-2 had highest Youden's index of 0.845, with a sensitivity of 0.865 and a specificity of 0.980. A total of 13 studies were included in the meta-analysis. The pooled sensitivity, specificity and diagnostic odds ratio (DOR) were 0.80, 0.82 and 17.81, respectively, at the optimal cutoff of 3., Conclusion: GAD-2 has acceptable properties for identifying GAD at a cutoff of 3 in the Chinese rural population., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: This study estimated the burden and characterised the risk factors associated with diabetes and impaired fasting glucose (IFG) in an undiagnosed rural population., Design: Data for 36 960 participants from the Henan Rural Cohort baseline with undiagnosed diabetes were analysed. X 2 test and multivariate logistic regression analyses were performed to test for association between risk factors and diabetes and IFG., Results: Women constituted 60.30% of the study participants, mean age of participants was 55.32±12.18 years, risk factors for diabetes and IFG were prevalent (75% dyslipidaemia, 57% overweight/obese, 50% central obesity and 18% metabolic syndrome). The prevalence of diabetes and IFG was 4.19% and 7.22%, respectively. Having a metabolic syndrome (adjusted OR (aOR) 4.7, 95% CI 4.27 to 5.33), dyslipidaemia (aOR 2.76, 95% CI 2.31 to 3.21), centrally obese (aOR 2.38, 95% CI 2.11 to 2.70), being overweight/obese (aOR 1.66, 95% CI 1.45 to 1.79) and a family history of diabetes (aOR 1.50, 95% CI 1.15 to 1.92) were associated with diabetes. These factors were also associated with IFG. Intake of high salt diet (aOR 1.16, 95% CI 1.02 to 1.32) and smoking (aOR 1.22, 95% CI 1.02 to 1.47; significant in men) were also associated with diabetes. Engaging in moderate physical activity (aOR 0.94, 95% CI 0.89 to 0.98) was noted to be negatively associated with diabetes., Conclusion: Diabetes and IFG remain prevalent in Chinese population with obesity and dyslipidaemia being some of the most significant predictors. Regular physical activity and consumption of fruits and vegetables may be beneficial in keeping blood glucose level low., Trial Registration Number: ChiCTR-OOC-15006699., Competing Interests: Competing interests: None to declare., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Familial hypercholesterolemia (FH) is a common monogenic disease, while studies about the epidemiology for the general population in China was scarce. Aim of the study was to estimate the prevalence of FH and explore related factors by the Chinese modified Dutch Lipid Clinic Network (DLCN) definition., Methods: A total of 39,205 participants (15,463 males and 23,742 females) aged 18-79 years old were enrolled from the Henan Rural Cohort Study. FH was defined by the Chinese modified DLCN definition, and score > 5 was classified as FH. Logistic regression analysis was used to calculate the odds ratio and 95% confidence interval., Results: Crude prevalence of probable/definite FH was 0.35% (0.29-0.41%), estimated by the Chinese modified DLCN definition. Prevalence in female was 0.38%, and in male, it was 0.32%. Age-standardized prevalence in female increased significantly around the age of 50 years. Moreover, there were no FH patients getting low-density lipoprotein cholesterol controlled to the recommended level. Multivariate logistic regression identified that older, overweight/obesity were positively associated with FH., Conclusions: The current study indicated that FH was not rare in rural area of China (1 in 286). Effective early detection and timely control of FH must be strengthened to reduce disease burden.

Objective: To estimate the prevalence of poor sleep quality and identify related factors by gender in the Chinese rural population., Methods: Overall, 27424 subjects (10881 males and 16543 females) aged 18-79 years were enrolled from the Henan Rural Cohort Study. Sleep quality was evaluated by the standard Pittsburgh Sleep Quality Index (PSQI) and global score>5 was classified as poor sleep quality. Logistic regression analysis was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs). A meta-analysis including 14 studies was used to validate the result of the cross-sectional study., Results: The average PSQI score was 3.78 ± 2.72 in total, and the score of females (4.10 ± 2.90) was significantly higher than males (3.29 ± 2.33). The crude and age-standardized prevalences of poor sleep quality were 21.62% and 15.80%, respectively. The crude prevalence in females (25.73%) was significantly higher than males (15.38%). The results of meta-analysis showed that the pooled prevalence of poor sleep quality was 25.0% (18.8%-31.2%) in total sample, 31.7% (24.9%-38.5%) in male, and 38.2% (29.7%-46.7%) in females. Multivariate logistic regression identified that older age, being female, unmarried/divorced/widowed, low education level, low income, drinking, depression and dyslipidemia could increase the odds of poor sleep quality., Conclusions: More than one fifth of the participants in a rural area of China slept poorly and the prevalence in females was significantly higher than males. Effective interventions are urgently needed to improve the sleep quality in resource limited areas., Clinical Trial Registration: The Henan Rural Cohort Study has been registered at Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699). http://www.chictr.org.cn/showproj.aspx?proj=11375., (Copyright © 2018 Elsevier B.V. All rights reserved.)

The study aimed to explore the relationship between visceral fat index (VFI) and dyslipidemia and evaluate the efficiency of VFI as a marker for identifying dyslipidemia in Chinese rural adults. The cross-sectional study recruited 35,832 aged 18-79 years eligible participants from The Henan Rural Cohort Study. VFI was measured by bioelectrical impendence methods and classified into sex-specific quartiles. Fasting blood samples were collected. Logistic regression models with VFI as a categorical variable and restricted cubic spline regression models with VFI as a continuous variable were performed to obtain odds ratios (ORs) and 95% confidence intervals (CIs). Receiver-operating characteristic (ROC) curve was conducted to evaluate the identifying performance of VFI. The age-standardized prevalence of dyslipidemia was 29.80% and 26.01% in male and female, respectively. Increasing VFI quartiles were significantly positively related to the risk of dyslipidemia and its components (P for trend  < 0.01). The adjusted ORs (95% CIs) for per 1-SD increase in VFI were 2.11 (2.02-2.20) and 1.52 (1.47-1.56) in male and female, respectively, and dose-response relationships were observed in both genders (P for nonlinearity  < 0.01). In addition, area under the curves (AUCs) in male (0.697) was larger than in female (0.655) (P < 0.05). VFI was significantly positively related to the risk of dyslipidemia and its components, and the risk was shown to be more prominent in male. Meanwhile, dose-response relationships were observed in both genders. Furthermore, VFI might be a relatively effective marker for identifying dyslipidemia in male, but not in female., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Aim: To assess the relationship between various obesity categories according to body mass index (BMI) and waist circumference (WC) and risk of type 2 diabetes mellitus (T2DM) among Chinese rural adults., Methods: A total of 38,466 eligible participants were derived from The Henan Rural Cohort Study. Structured questionnaires and anthropometric and laboratory measurements were undertaken. Logistic regression was performed by gender., Results: The age-standardized prevalence of T2DM in current study was 3.94% in men and 5.14% in women. Compared with participants with both normal BMI and WC, participants with normal BMI but high WC, high BMI but normal WC, or both high BMI and WC showed elevated risk of T2DM, in addition to being women with high BMI but normal WC. Moreover, when BMI and WC were included in the same multivariate adjusted model, both BMI and WC were significantly associated with increased T2DM risk in men, however, WC but not BMI remained positively associated with T2DM risk in women., Conclusions: In summary, gender-specific differences between obesity measures and T2DM were found. WC was independently associated with increased risk of T2DM regardless of BMI status in women, whereas both BMI and WC showed positive association with T2DM risk in men., (Copyright © 2018 Elsevier Inc. All rights reserved.)

The study aimed to estimate prevalence and influencing factors of overweight, general obesity, and abdominal obesity in rural areas of China. A total of 39034 participants aged 18 to 79 years were enrolled from the Henan Rural Cohort Study for the cross-sectional study. The age-standardized prevalence of overweight, general obesity, and abdominal obesity were 34.97%, 16.82%, and 43.71% in the general Chinese rural adults, respectively. Gender differences were: 36.04%, 18.98%, 35.37% for men, and 34.55%, 15.42%, 49.13% for women, respectively. The subgroup analysis showed the rates of overweight, general obesity, and abdominal obesity existed considerable disparities, but were universally high in all subgroups. Further, the study found that there were statistically significant U-shaped associations between the prevalence of overweight, general obesity, and abdominal obesity and age groups. In addition, the prevalence of participants with both abnormal BMI and WC were even at approximate forty percent. Aging, married/cohabiting, higher per capita monthly income, and unhealthy lifestyle were independent influencing factors of overweight, general obesity and abdominal obesity. In conclusion, overweight and obesity were severe in rural China. There is an increased need for closely monitoring high risk factors and promoting healthy lifestyle to curb the obesity epidemic among rural population.

Objective: The aim of this study was to explore the independent and combined dose-response association of napping and night sleep duration with type 2 diabetes mellitus (T2DM) among different genders in the rural Chinese population., Methods: For this research, a total of 19,257 participants were enrolled in the Rural Diabetes, Obesity and Lifestyle (RuralDiab) study. Napping and night sleep duration were assessed using the Pittsburgh Sleep Quality Index (PSQI). Restricted cubic splines and logistic regression were used to estimate the relationship between napping and night sleep duration with T2DM., Results: A linear dose-response relationship between napping duration and T2DM as well as a U-shaped relationship between night sleep duration and T2DM were found. Compared with those who reported no napping, participants who had a napping duration of ≥91 min were associated with a 19% increase in prevalence of T2DM. Adjusted odds ratios (ORs) (95% confidence intervals (CIs)) for T2DM were 1.48 (1.03, 2.14) and 1.50 (1.22, 1.85) for shorter (≤5 h) and longer (>9 h) night sleep duration compared with the referential group. Additionally, the combination of longer napping duration (≥91 min) and night sleep duration (>9 h) increased 104% (95% CI: 45%, 128%) prevalence for T2DM. These associations were not found in males but were evident in females., Conclusions: Longer napping duration and extreme night sleep duration increased the prevalence of T2DM. Meanwhile, longer napping and night sleep duration might be jointly associated with a higher prevalence of T2DM., (Copyright © 2018 Elsevier B.V. All rights reserved.)

The aim of the present study was to examine the prevalence, awareness, treatment, control, and potentially influencing factors of high blood pressure (HBP) in Chinese rural adults based on a cross-sectional study. Using data from the Rural Diabetes, Obesity and Lifestyle (RuralDiab) study, a total of 30,834 participants aged 18-74 years were enrolled for the epidemiological study. The multivariate logistic regression model including all selected potentially influencing factors was carried out for the adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Overall, a total of 9872 individuals were diagnosed as HBP (32.02%) with substantial imparity between men and women (32.87% vs. 30.58%), and the corresponding age-standardized prevalence of HBP were 19.50% (20.94% in men and 18.85% in women). Among the HBP patients, 6654 were aware of the diagnosis (67.40%), 5391 were taking medication (54.61%), and 2572 had their blood pressure controlled (26.05%).The corresponding age-adjusted awareness, treatment, and control of HBP were 59.35%, 45.91%, and 23.87%, respectively, and the corresponding rates were higher in women than those in men. The age-specific prevalence and management rates of HBP displayed increased trends with aging in both sexes(P trend  < 0.05). Aging, low level of education, unhealthy lifestyle, positive family history of hypertension, overweight, obesity, diabetes, and dyslipidemia were associated with the prevalence, awareness, treatment, and control of HBP. In conclusion, uncontrolled HBP was common with high prevalence in Chinese rural residents. Strengthening the primary prevention through lifestyle modifications is necessary for reducing the disease burden and improving the management rates of HBP.

Objective: To know the prevalence of low body weight among middleaged and elderly people in general rural areas of China and investigate the influence factors., Methods: A total of 25 464 participants who were 45 years old and above from2010-2012 China National Nutrition and Health Surveillance as subjects to investigate the prevalence of low body weight. For 545 low body weight participants, we performed a1∶ 2 case-control study to investigate the influence factors. The content of survey included3-condecutive days-24-hour dietary recall, physical examinations, physical activity and social economic factor., Results: The prevalence of low body weight among middle-aged and elderly people was 5. 27%, 5. 52% for male and 5. 05% for female. The prevalence of low body weight increased with the age( P < 0. 01). The daily intake of energy, total proteins, high quality proteins, fat and fruits were lower in low body weight than normal body weight among middle-aged and elderly people( P < 0. 01), however, the consumption of smoking and alcohol were higher in low body weight than normal body weight( P < 0. 01). Multivariate conditional Logistic regression analysis showed that the daily intake of total proteins, vegetables and fruits were protective factors and unhealthy lifestyle such as smoking were risk factors among low body weight people., Conclusion: The prevalence of low body weight at a higher level among middle-aged and elderly people in general rural areas of China. It is necessary to promote the middle-aged and elderly people to increase the consumption of high-protein foods, vegetables and fruits, quit smoking and control drinking.

Background: The consistency and strength of the relationship between napping duration and type 2 diabetes mellitus (T2DM) remained uncertain, especially in the rural population. The purpose of this study was to explore the relationship between napping duration and T2DM in a Chinese rural population., Methods: A total of 12663 participants (4365 males and 8298 females) were derived from the RuralDiab study in China. Napping duration was obtained through a standardized questionnaire, and was divided into five categories: no napping (reference), 1∼, 31∼, 61∼, and ≥91 min. Fasting blood glucose was measured. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). A meta-analysis including seven studies was conducted to validate the result of the RuralDiab study., Results: The crude and age-standardized prevalence of T2DM were 10.31% and 8.14%, respectively. Compared with no napping, the adjusted OR (95%CI) for napping duration ≥91 min was 1.23 (1.05-1.45). A similar relationship was found only in females aged 45-54 years, but not in males and other age group females. In addition, napping duration was associated with T2DM in a positive dose-dependent manner among females aged 45-54 years (P for trend <0.05). The meta-analysis demonstrated this association, and the pooled OR (95%CI) for the longest napping duration compared with no napping was 1.28 (1.22-1.35)., Conclusion: Longer napping duration is associated with higher risk of T2DM in the Chinese rural population, and this association varies across gender and age. Further multi-center prospective researches are needed to confirm the relationship and reveal underlying mechanisms., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Over the past few decades, more studies have suggested that the age at menarche (AAM) has continued to decline. However, the AAM for women in resource-constrained areas is not clear. Moreover, the association between the Chinese famine and AAM is still unclear in rural regions. The study aimed to investigate the secular trends of AAM for women born between 1935 and 2000 and to further explore the effect of famine on AAM in rural China. The study included 23,444 women participants from the baseline study of the Henan Rural Cohort study. Changing AAM over time was analysed using linear regressions. Multinomial logistic regression was conducted to analyse the association between famine exposure and AAM subgroups. The age-standardised mean AAM was 14.74 years. The average AAM declined from 16.98 years for those born in 1935 to 13.87 years for those born in 2000, a decline of 0.077 years per 1 year and 0.729 years per decade. Compared to the reference group, women exposed to famine during foetal, early childhood, middle childhood, and late childhood were 1.376 (95% CI = 1.071–1.769), 1.848 (95% CI = 1.512–2.259), 2.084 (95% CI = 1.725–2.518), and 2.146 (95% CI = 1.788–2.576) times more likely to be ≥18 years AAM than women unexposed to famine, respectively. AAM showed a decreasing trend in rural China. Furthermore, both foetal and childhood famine exposure, especially in late childhood, were positively associated with increased AAM compared to unexposed famine. [ABSTRACT FROM AUTHOR]

Aims/Introduction: Studies have found that a plant‐based diet was associated with a lower risk of type 2 diabetes, but evidence is scarce on such associations in China. The aim of this study was to investigate whether a plant‐based diet is related to a lower risk of type 2 diabetes among Chinese adults. Materials and Methods: A total of 37,985 participants were enrolled from the Henan Rural Cohort Study. An overall plant‐based diet index (PDI) was created by assigning positive and reverse scores to 12 commonly consumed food groups. Multivariate logistic regression models and restricted cubic spline analysis were performed to estimate the odds ratio (OR) and 95% confidence interval (95% CI). Results: After multivariable adjustment, the risk of type 2 diabetes was inversely associated with the PDI (extreme‐quartile OR = 0.88, 95% CI: 0.79–0.98; P = 0.027), the risk associated with a 1 standard deviation (SD) increase in PDI was 4% lower (95% CI, 0.93–1.00; P trend = 0.043) for type 2 diabetes. Moreover, the odds of type 2 diabetes was decreased with an increment of PDI after fitting restricted cubic splines (Ptrend < 0.01). Conclusions: Among Chinese populations, diets higher in plant foods and lower in animal foods were associated with a reduced risk of type 2 diabetes. [ABSTRACT FROM AUTHOR]

Background: Metabolic syndrome (MetS) is significantly associated with the risk of cardiovascular disease and its prevalence is showing a trend of getting younger. Previous studies on the relationship between elements and MetS were mostly reported in adults with single element analysis, while reports in children with combined effects of multiple elements were very limited. The aim of this study is to investigate the association between whole blood Cu, Mg and Zn in both single and combined effects and MetS components in rural Chinese children aged 6–12 years based on the data from 2010–2012 China National Nutrition and Health Survey. Methods: A total of 911 children (51.2% male, 48.7% female) aged 6–12 years were included. Basic characteristics and MetS component parameters were collected and determined by trained stuffs. Elements were detected by Inductively Coupled Plasma Mass Spectrometry (ICP-MS). Multivariate logistic regression analysis was performed to examine the independent relationship between elements and MetS components. Results: In single metal analysis, copper was positively associated with elevated waist (OR = 2.00, 1.18–3.28) and all of the metals were associated with elevated TG. And the comprehensive analysis of multiple elements were mostly consistent with the results of single element analysis (low Cu + high Zn with elevated TG (OR = 2.21, 1.18–4.13), high Cu + low Mg with elevated TG (OR = 0.40, 0.16–0.95), high Cu + high Mg with elevated waist (OR = 2.03, 1.26–3.27)), except the combination of Zn and Mg (high Zn + low Mg with reduced HDL-C (OR = 0.47, 0.28–0.77)). Conclusions: Our study suggested Cu, Zn and Mg in children are indeed associated with metabolic syndrome components, whether in single element or multi-element combined analysis. The results will be confirmed through additional cohort research. [ABSTRACT FROM AUTHOR]

Background Previous reports about health-related quality of life (HRQoL) of type 2 diabetes mellitus (T2DM) concentrated on general patients rather than patients in rural areas with poor infrastructure and limited resources. Thus, the aims of this study were to evaluate the HRQoL of diabetics in the countryside and explore its influencing factors. Methods A total of 23 053 participants aged from 18 to 79 years were drawn from the Henan Rural Cohort Study for this cross-sectional study. The HRQoL of participants were assessed by utility index and VAS-score of European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L) instrument. Binary logistic regression, generalized linear and tobit regression models were used to estimate the potential influencing factors on HRQoL. Results This study (23 053 participants) included 2231 T2DM patients with a crude prevalence of 9.68%. The utility index and VAS-score in health group were 0.96 ± 0.10 and 78.85 ± 14.53, while in T2DM group were 0.93 ± 0.15 and 74.09 ± 16.09, respectively. In total, most diabetics reported problem about pain/discomfort dimension. Being old, poverty, low physical activity, and with comorbidities was negatively related to HRQoL of diabetics, while high educational level was positively related to HRQoL. Conclusion HRQoL of rural T2DM patients depended on several sociodemographic factors. More attention should be paid to diabetics with poor socioeconomic status in rural areas. Clinical trial registration The Henan Rural Cohort Study has been registered at Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699) http://www.chictr.org.cn/showproj.aspx?proj=11375. [ABSTRACT FROM AUTHOR]

Purpose: Type 2 diabetes is a complex disease determined by variable genes and environmental factors. The study was designed to investigate the effect of interactions of four polymorphisms of suppressor of cytokine signaling 3 (SOCS3) with fruit and vegetable (F&V) intake on type 2 diabetes in a rural population of China. Methods: A total of 4411 participants from the rural areas of Henan, China were included in the study. Multivariate logistic regression and restricted cubic splines were used to estimate the associations between polymorphisms and risk allele score of SOCS3 and type 2 diabetes in different groups. Haplotype analysis was conducted to examine the effects of linkage inheritance at these four loci on type 2 diabetes. Results: Three of the four polymorphisms showed significant associations with type 2 diabetes in the less F&V intake group after adjusting the covariates, the odds ratios (ORs) and corresponding 95% confidence intervals (95% CIs) were 1.24 (1.08–1.41) for rs4969168, 1.16 (1.02–1.32) for rs9892622, and 1.21 (1.06–1.39) for rs9914220. No significant association was detected in the more F&V intake group. The obvious dose–response relationship between the risk allele score and type 2 diabetes was also noted only in the less F&V intake group. Conclusions: Variants of SOCS3 gene were associated with type 2 diabetes and the associations could be modified by the F&V intake. [ABSTRACT FROM AUTHOR]

Objective: To assess the independent and combined effects of night sleep duration and sleep quality on depressive symptoms.Methods: A total of 28,202 participants (11,236 males and 16,966 females) aged 18-79 years from the Henan Rural Cohort were included in this study. Night sleep duration and sleep quality were defined by the Pittsburgh Sleep Quality Index (PSQI). Logistic regression and restricted cubic splines were applied to evaluate the association of night sleep duration and sleep quality with depressive symptoms.Results: A U-shaped dose-response relationship between night sleep duration and depressive symptoms along with a J-shaped relationship between sleep quality and depressive symptoms were observed. Compared with reference group (7-<8 h), shorter sleep duration (<6 h) and longer sleep duration (≥10 h) were associated with increased risk of depressive symptoms in males (short sleep: Odds Ratio (OR) = 1.84, 95% confidence interval (CI), 1.34-2.52; long sleep: OR = 1.56, 95% CI, 1.01-2.42) and females (short sleep: OR = 2.19, 95% CI, 1.77-2.70; long sleep: OR = 1.51, 95% CI, 1.10-2.10). Compared with good sleepers, poor sleepers had 4.23-fold (95% CI:3.54-5.06) and 3.87-fold (95% CI: 3.41-4.40) increased odds of depressive symptoms in males and females. Furthermore, participants with longer night sleep duration (≥10 h) and poorer sleep quality had the strongest effect on depressive symptoms (males: OR = 6.64, 95% CI, 3.21-13.74; females: OR = 7.76, 95% CI, 5.00-12.02).Conclusions: Extreme night sleep duration and poor sleep quality were independently and combinedly related to elevated depressive symptoms, suggesting that keeping optimal night sleep duration and good sleep quality maybe benefit for maintaining mental health.Trial Registration: Chinese Clinical Trial Register. Registration number: ChiCTR-OOC-15006699. [ABSTRACT FROM AUTHOR]

Introduction: Group-specific component (GC) and cytochrome P450 family 2 subfamily R member 1 (CYP2R1) gene polymorphisms and obesity have been associated with an increased risk for development of type 2 diabetes mellitus (T2DM) in Asian populations. Objective: This study assessed the associations of interactions between GC gene variants and CYP2R1 gene variants and between genes and obesity with T2DM risk. Methods: A study that included 2,271 subjects was performed. Eight single nucleotide polymorphisms in the GC and CYP2R1 genes were genotyped. Interaction analysis was performed using rs7041 in the GC gene and rs1993116 in the CYP2R1 gene. The effects of multiplicative and additive gene-gene and gene-environment interactions on T2DM risk were assessed. Results: The T2DM risk was significantly associated with being overweight/obese, abdominal obesity, rs7041, and rs1993116. A significant additive interaction between rs1993116 and rs7041 was associated with T2DM. In addition, there was a significant multiplicative interaction between rs7041 and body mass index (BMI) associated with elevated blood glucose levels, and at a higher BMI (>28.47), the G allele carrier showed a stronger effect than the TT genotype. Conclusions: The interactions between GC rs7041-CYP2R1 rs1993116 and GC rs7041-BMI may explain the mechanisms by which these factors increase the risk of T2DM development. [ABSTRACT FROM AUTHOR]

Objectives: This study investigated the association between poor sleep quality and hypertension, and evaluated how the Pittsburgh Sleep Quality Index (PSQI) score correlates with blood pressure and prevalent hypertension.Methods: A total of 27, 912 participants aged 18-79 years from the Henan Rural Cohort Study were included into the current study. PSQI score was classified as <3, 3-, 6-, ≥9. Multivariate logistic regression models and restricted cubic spline with hypertension as a dependent variable were conducted. A meta-analysis was conducted to validate the result of the cross-sectional study.Results: Altogether, 6,085 (21.80%) were poor sleepers and 9,056 (32.44%) suffered from hypertension. The odds ratios (ORs) (95% confidence intervals (CIs)) of participants with sleep quality of 3-, 6-, ≥9 were 1.16(1.07-1.26), 1.35(1.21-1.50) and 1.62 (1.39-1.88) compared to the participants with a score of less than 3 among participants excluding undiagnosed hypertension. ORs and 95% CIs per 3 increment score were higher for hypertension (1.16, 1.11-1.21) among total population, (1.18, 1.10-1.27) among men and (1.13, 1.08-1.19) among women. Compared to reference, poor sleep quality was associated with a higher odd of hypertension (OR 1.09, 95% CI 1.01-1.17) for total population, (1.14, 1.00-1.30) for men and (1.04, 0.95-1.13) for women. Moreover, the odds of hypertension were increased with increment of PSQI score after fitting restricted cubic splines (Ptrend <0.01). The meta-analysis showed that pooled OR of hypertension was significantly higher for poor sleepers (1.62, 1.03-2.56, I2 = 97.3%, P < 0.001).Conclusions: Higher PSQI score was associated with increased odds of prevalent hypertension in both genders. In addition, poorer sleepers might suffer from hypertension. [ABSTRACT FROM AUTHOR]

Background We examined the independent and cumulative associations of resting heart rate and pulse pressure with metabolic syndrome in Chinese rural population based on epidemiological research. Methods A total of 38,708 participants were derived from the Henan Rural Cohort study. Restricted cubic splines and logistic regression model were used to estimate the odds ratios and 95% confidence intervals of metabolic syndrome risk in relation to resting heart rate and pulse pressure. Results After adjusting for potential confounders, the odds ratio (95% confidence intervals) of resting heart rate and pulse pressure in the highest quartile with the risk of metabolic syndrome were 1.59 (1.48–1.70) and1.81 (1.67–1.95), respectively. Simultaneously, the cumulative effect analysis indicated that the adjusted the odd ratio of resting heart rate and pulse pressure in the highest quartile was 2.89 (2.40–3.47). Furthermore, there was a significantly additive interaction between resting heart rate and pulse pressure on the risk of metabolic syndrome. Conclusion Increased resting heart rate and pulse pressure are associated with the higher risk of metabolic syndrome as well as the influences of resting heart rate with pulse pressure might cumulatively increase the risk of metabolic syndrome. However, the potential clinical application remains to be determined. [ABSTRACT FROM AUTHOR]

Background We explored the association between serum uric acid (SUA) and metabolic syndrome (MetS) in Chinese rural adults. Methods A total of 16,577 subjects (6354 men and 10,223 women) were from the RuralDiab study. SUA concentration was measured by the enzymatic colorimetric method. A meta-analysis including 12 eligible studies focused on SUA and MetS was preformed to confirm the findings of the cross-sectional study. Results After adjustment for age, educational level, and other covariates, the odds ratio (ORs) for MetS increased smoothly with the increasing SUA concentration in both sexes ( P for no-linear trend > 0.05). The adjusted ORs of MetS comparing the fourth and firstly quartiles were 3.11 [95% CI: 2.58–3.74] in men and 3.64 [95% CI: 3.22–4.11] in women ( P trend  < 0.001). In continuous analysis, each 1 mg/dl increment in SUA concentration was significantly associated with a 41% increased risk of MetS in men and 62% in women. The meta-analysis validated the positive association between SUA and MetS (pooled OR: Men, 1.80 [95% CI: 1.57–2.07]; Women, 2.46 [95% CI: 1.95–3.12]). Conclusion SUA concentration was positively with the prevalence of MetS in Chinese rural population, and more studies are needed to explore the mechanisms of the relationship. What is already known on this topic? Previous studies have explored the association between serum uric acid and metabolic syndrome, but evidence on the strength and consistency of the association remains uncertain and limited, especially in rural population. In addition, the epidemiological research and meta-analysis on the association have not been reported. What does this study add? The results of this study showed that serum uric acid was significantly associated with metabolic syndrome and its components in Chinese rural population. Furthermore, the findings demonstrated that the significant associations varied across sex. In addition, the results of epidemiological research were similar with the meta-analysis, which demonstrates the credible of the results of the epidemiology research. [ABSTRACT FROM AUTHOR]

The study aimed to explore the association of visceral fat index (VFI) with untreated hypertension in different genders and evaluate the practicability of VFI as a marker for discriminating untreated hypertension in Chinese rural population. A total of 12,536 eligible participants aged 35 years and older were derived from the RuralDiab study in China. VFI was assessed with bioelectrical impendence methods and divided into sex-specific quartiles. Logistic regression and restricted cubic spline regression were performed. Receiver operating characteristic curve was applied to analyze the discriminating performance of VFI. Meanwhile, a meta-analysis was conducted to validate the result of this study. Compared with the lowest VFI quartile, the adjusted odds ratios (ORs) and 95% confidence interval (95% CI) in the highest VFI quartile were 3.68 (2.91–4.66) in male and 2.63 (2.12–3.25) in female ( P trend < .01). Nonlinear increasing trends about the risk of untreated hypertension were observed with the continuously increasing VFI in both genders ( P linearity < .01). The sensitivity and specificity in the optimal cutoff values for VFI were 58.37% and 62.26% in male, and 49.09% and 66.67% in female. The area under the curves (95% CI) were 0.64 (0.63–0.66) in male and 0.61 (0.60–0.62) in female. Meta-analysis results displayed the pooled odds ratios (95% CI) of 2.65 (1.79–3.93) in male and 2.27 (1.74–2.95) in female. VFI was significantly positively correlated with the risk of untreated hypertension, and dose-response relationships were observed in both genders in Chinese rural population. However, VFI as a marker had limited potential for discriminating untreated hypertension. [ABSTRACT FROM AUTHOR]

Objective: The purposes of the present study were to explore independent and interactive associations between night sleep duration, night sleep quality and coronary heart disease (CHD) based on a rural population in China.Methods: A total of 27,935 participants (11,177 men and 16,758 women) were investigated from the Henan Rural Cohort. Information about sleep was assessed by using the Pittsburgh Sleep Quality Index (PSQI). Restricted cubic splines and logistic regression were used to estimate the relationship between night sleep duration and quality with CHD.Result: Among the 27,935 participants, 1506 participants with CHD were identified. Compared with participants with scores lower than 3, the odds ratios (ORs) and 95% confidence intervals (95% CIs) of participants with score of 3-5, 6-8, ≥9 were respectively 1.42 (1.24-1.63), 1.99 (1.70-2.33), and 2.56 (2.13-3.08) with full adjustment of covariates. Compared with night sleep duration of 7 h, men and women who slept less than 5 h were 1.55 (1.11-2.17), 1.12 (0.59-2.12) and 1.80 (1.20-2.68), after being adjusted ORs (95% CIs) of the total. Moreover, the ORs and 95% CIs of CHD increased with the shortening of sleep duration at PSQI score above the highlighted levels.Conclusion: Poor sleep quality and short night sleep duration were all associated with CHD in Chinese rural areas. Moreover, the association was more obvious in women. In addition, the strongest prevalence of CHD was found in short sleepers with poor sleep quality. [ABSTRACT FROM AUTHOR]