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Purpose: This study aimed to evaluate the relationships of separate and mixed exposure of neonicotinoids on cardiometabolic risk at baseline and follow-up and its change over 3 years, and further explore whether inflammatory markers levels and platelet traits (PLT) mediate these relationships., Methods: In this prospective cohort study from the Henan Rural Cohort Study, 2315 participants were involved at baseline, and 1841 participants completed cardiometabolic risk predictors determinations during the 3-year follow-up. Each neonicotinoid pesticide was normalized to imidacloprid (IMI eq ) using the relative potency factor approach. Quantile-based g-computation (Qgcomp) regression was used to evaluate the effect of the mixtures of neonicotinoids mediation analysis was employed to explore whether inflammatory markers levels and platelet traits mediated these relationships. A two-sample mendelian randomization (MR) study was further used to causal association., Results: Qgcomp regression revealed a statistically positive relationship between neonicotinoids mixture exposure and cardiometabolic risk score at baseline and follow-up over 3 years. Both neutrophils/monocytes and PLT were mediators in the relationship between IMI eq and cardiometabolic risk score at baseline and follow-up over 3 years. The causal risk effect of pesticide exposure were 2.50 (0.05, 4.95) and 5.24 (1.28, 9.19) for cardiometabolic risk indicators including insulin resistance and triglyceride, respectively. Nevertheless, there was no correlation discovered between pesticide exposure and other markers of cardiometabolic risk., Conclusion: Neonicotinoid insecticides exposure was connected to an increased cardiometabolic risk, especially in individuals with T2DM. Furthermore, inflammatory markers and PLT seem to be two vital mediators of these associations. Additionally, genetic evidence on pesticide exposure and cardiometabolic risk still needs to be validated by multiregional and multiethnic GWAS studies., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: The relationship between glucocorticoids and hypertension has shown inconsistent findings in previous studies. To address this, our study employed a nested case-control design in rural areas to further investigate the association between serum glucocorticoid levels and hypertension, and blood pressure-related indicators., Methods: This study employed a nested case-control design, involving 560 pairs of hypertensive cases and matched controls. The concentrations of serum cortisol (F), cortisone (E) and 11-deoxycortisol (S) were determined using liquid chromatography-tandem mass spectrometry. We employed various methods, including generalized linear model (GLM), conditional logistic regression model, restricted cubic spline regression, subgroup analysis, interaction, and joint effects, with adjustments for multiple covariates to analyze the relationships between glucocorticoids, hypertension, and blood pressure-related indicators., Results: After multivariable adjustments, ln-F, ln-F/E, and ln-S were positively associated with SBP, DBP, pulse pressure (PP), and mean arterial pressure (MAP), while ln-E was negatively associated with DBP and MAP ( P  < 0.05). Interestingly, ln-S showed no statistically significant association with hypertension prevalence ( P  > 0.05), whereas ln-F and ln-F/E were positively associated with it ( P  < 0.05). The adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were 1.153 (1.011-1.315) for ln-F and 2.072 (1.622-2.645) for ln-F/E, respectively. In contrast, ln-E exhibited a negative association with hypertension prevalence (adjusted OR = 0.837, 95% CI 0.714-0.982). Moreover, a significant association was observed between the combined use of high-dose F/E and high-dose S with hypertension prevalence (adjusted OR = 3.273, 95% CI 2.013-5.321). Blood pressure indicators and hypertension prevalence significantly increased with elevated serum F and F/E concentrations ( P  < 0.05). Interaction analysis further revealed that among women, the positive association between F/E and hypertension prevalence was more pronounced than in men ( P  < 0.05), and S exhibited a more significant positive association with hypertension prevalence in the overweight population ( P  < 0.05)., Conclusion: Serum F/E and S levels demonstrated positive associations with hypertension and blood pressure-related indicators, and their combined influence exhibited a synergistic effect on hypertension. Notably, F, F/E, and S were associated with heightened hypertension risk, warranting particular attention in women and overweight populations., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

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.)

Objective: This study aimed to evaluate the recent prevalence and the distributions of morphological subtypes of anaemia in the rural population., Design: Anaemia was defined according to the WHO and the Chinese criteria, and the morphological subtypes of anaemia were classified based on the erythrocyte parameters. The age-standardised prevalence was calculated according to the data of the Population Census 2010 in China., Setting: A cross-sectional study in Henan Province., Participants: 33 585 subjects aged 18-79 years old., Results: The standardised prevalence of anaemia across the WHO and the Chinese definitions was 13·63 % and 5·45 %, respectively. Regardless of which criteria was used, the standardised prevalence of anaemia was higher among women than among men and that increased with age in men, while markedly decreased after menopause in women. There were shifts in morphological patterns of anaemia using the WHO and the Chinese criteria that the standardised prevalence of microcytic anaemia was 3·74 % and 2·97 %, normocytic anaemia was 9·20 % and 2·34 %, and macrocytic anaemia was 0·75 % and 0·14 %, respectively. Besides, there were differences in the influencing factors of anaemia according to different criteria or gender. However, age, education level and renal damage were consistently significantly associated with anaemia in all participants., Conclusions: Anaemia may still be a serious health problem in rural China. It is necessary to reformulate prevention and management strategies to reduce the disease burden of anaemia.

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.)

Background: Epidemiological studies on the association of residential greenness with sleep quality are limited in China., Objective: This study aims to investigate the association of long-term exposure to residential greenness with sleep quality in rural China., Methods: In our study, 27,654 rural residents were selected from 4 counties of Henan Province by a multi-stage stratified cluster sampling method. Participants' sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). The Normalized Difference Vegetation Index (NDVI) and Enhanced Vegetation Index (EVI), two satellite-derived vegetation indexes, were used to assess the level of residential greenness. Long-term greenness exposure was defined as the averages of NDVI and EVI during the three years prior to the baseline survey. The relationship between sleep quality and greenness was assessed using the mixed-effect linear regression models., Results: Among 27,654 rural residents, the mean age was 55.89 years (standard deviation, SD = 12.22) and 60.18% of them were female. In the crude model, the PSQI score decreased with per interquartile range (IQR) increase in EVI and NDVI [ΔPSQI score (95% confidence interval, 95%CI): -0.073 (-0.115, -0.030) and -0.047 (-0.089, -0.002)]. After controlling potential confounders, ΔPSQI scores and 95%CIs were -0.055 (-0.095, -0.012) and -0.090 (-0.151, -0.025) associated with per IQR increment in EVI and NDVI. The results of stratified analyses showed the effect of residential greenness on sleep was stronger among males and individuals with higher household income and educational attainment than females and those with lower household income and educational attainment. Moreover, the modification effect of air pollution was observed in the greenness-sleep association., Conclusions: Our study indicated that higher residential greenness was significantly associated with better sleep quality in Chinese rural population, which highlights the significant effect of green space on human health., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: The aim of this study was to explore the latest prevalence of hyperuricemia and influencing factors in Chinese rural population. Methods: A survey was conducted from July 2015 to September 2017. A total of 38,855 (15,371 men and 23,484 women) subjects were recruited from the Henan Rural Cohort Study. Hyperuricemia was defined as a serum urate level of >7.0 mg/dL for men and >6.0 mg/dL for women. A meta-analysis of 19 studies that focused on hyperuricemia prevalence was performed to validate the result of the cross-sectional survey. Results: The crude and age-standardized prevalence of hyperuricemia was 10.24% and 12.60%, respectively. The prevalence of hyperuricemia decreased in men with increasing age, but the opposite trend was observed in women. The results of meta-analysis demonstrated that hyperuricemia prevalence in Chinese rural areas was 11.7%, consistent with the result of current survey. Multivariate logistic regression revealed that overweight or obesity, hypercholesterolemia, hypertriglyceridemia, hypoalphalipoproteinemia and high serum creatinine level could increase the risk of hyperuricemia, while high physical activity and fasting plasma glucose were associated with a lower risk of hyperuricemia in all participants. Conclusion: The latest prevalence of hyperuricemia is high in rural China and is associated with multiple factors, indicating that prevention and control strategies for hyperuricemia are needed urgently.

Objectives: The associations of long-term exposure to air pollution with osteoporosis are rarely reported, especially in rural China. This study aimed to explore the association among rural Chinese population., Methods: A total of 8033 participants (18-79 years) derived from the Henan Rural Cohort Study (n = 39,259) were included in this cross-sectional study. Exposure to air pollutants was estimated using machine learning algorithms with satellite remote sensing, land use information, and meteorological data [including particulate matter with aerodynamic diameters ≤1.0 μm (PM 1 ), ≤2.5 μm (PM 2.5 ), and ≤10 μm (PM 10 ), and nitrogen dioxide (NO 2 )]. The bone mineral density of each individual was measured by using ultrasonic bone density apparatus and osteoporosis was defined based on the T-score ≤ -2.5. Multiple logistic regression models were used to examine the association of air pollution and osteoporosis prevalence., Results: We observed that per 1 μg/m 3 increase in PM 1 , PM 2.5 , PM 10 and NO 2 were associated with a 14.9%, 14.6%, 7.3%, and 16.5% elevated risk of osteoporosis. Compared with individuals in the first quartile, individuals in the fourth quartile had higher odds ratio (OR) of osteoporosis (P-trend < 0.001), the ORs (95% confidence interval) were 2.08 (1.72, 2.50) for PM 1 , 2.28 (1.90, 2.74) for PM 2.5 , 1.93 (1.60, 2.32) for PM 10 , and 2.02 (1.68, 2.41) for NO 2 . It was estimated that 20.29%-24.36% of osteoporosis cases could be attributable to air pollution in the rural population from China., Conclusions: Long-term exposure to air pollutants were positively associated with high-risk of osteoporosis, indicated that improving air quality may be beneficial to improve rural residents health., Competing Interests: Declaration of competing interest All authors have read and approved this version of the article, and declared that they had no competing or financial interests to disclosure., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Obesity is an important risk factor for hypertension. Previous studies have explored the association between body fat percentage (BFP) and hypertension, but evidence on the consistency of the association remains uncertain and limited. The aim of this study was to explore the relationship between BFP and hypertension in a Chinese rural population. Methods: The present cross-sectional study including 38,913 eligible individuals was conducted in rural areas of Henan province. BFP was measured by bioelectrical impedance methods using Omron body fat and weight measurement device. Logistic regression models and restricted cubic spline regression models were performed to investigate the relationship between BFP and hypertension. Receiver operating characteristic (ROC) analyses were used to compare the discriminating power of adiposity indices. Results: The age-standard prevalence of hypertension was 23.74 and 17.87% in males and females, respectively. Compared with the first quartile of BFP, the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for hypertension in the highest BFP quartile were 3.30 (95% CI: 2.85, 3.83) in males and 2.66 (95% CI: 2.36, 2.99) in females, and the adjusted ORs increased along with increasing BFP levels. The areas under ROC and 95% CIs of BFP were 0.673 (0.665, 0.682) in males and 0.696 (0.689, 0.703) in females, respectively. Conclusions: BFP was significantly positively associated with the prevalence of hypertension in both males and females in the Chinese rural population. Controlling of body fat should be emphasized in rural areas of China. Clinical Trial Registration: Registration number: ChiCTR-OOC-15006699. http://www.chictr.org.cn/showproj.aspx?proj=11375., (Copyright © 2020 Li, Tian, Wang, Liu, Tu, Wang, Dong, Wang, Wei, Tian, Mao, Li, Huo, Wang and Bie.)

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.)

Objective: The present study aimed to evaluate the validity and reproducibility of a thirteen-item FFQ regarding identification of dietary conditions in a rural population in China., Design: A reproducibility study repeated the first FFQ (FFQ1) approximately 4 weeks later (FFQ2). A validity study evaluated the mean of three consecutive 24 h diet recalls as the reference measure., Setting: Cross-sectional study., Participants: Residents of a rural area in Henan Province, which is located in the central region of China., Results: A total of 295 individuals participated in the reproducibility study. In addition, 123 people agreed to participate in the validity study. Spearman's correlation coefficients between the two FFQ ranged from 0·06 (vegetables) to 0·58 (eggs). Spearman's correlation coefficients between the two methods of collection ranged from 0·01 for cereal to 0·49 for staple foods. The mean of the intraclass correlation coefficients of the two FFQ (FFQ1 v. FFQ2) was 0·19. Bland-Altman analysis indicated good agreement for most food groups across the range of intake for the two studies., Conclusions: The study demonstrated that our FFQ design could be used as a representative tool to conduct a dietary evaluation of a rural population.

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: 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.)

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.

Parabens and alkylphenols pose serious hazards to human health, yet there are few studies on their exposure profiles and health risks in rural Chinese populations. In this study, 804 participants were selected from the Henan Rural Cohort in mid-eastern China. The plasma levels of parabens (methylparaben, ethylparaben, propylparaben, butylparaben (BuP)) and alkylphenols (4-tert-butylphenol (4-t-BP), 4-tert-octylphenol (4-t-OP)) were analyzed via liquid chromatography–tandem mass spectrometry. Linear regression models were used to investigate factors that may influence pollutant exposure levels. The correlation between contaminants was assessed using Spearman's correlation. The human contaminant intake was estimated using the estimated daily intake (EDI). The health risk was assessed using the hazard quotient (HQ). The detection frequency of four parabens and two alkylphenols exceeded 75%, with median concentrations of 0.444, 0.067, 0.078, 0.053, 8.810, and 6.401 ng/mL, respectively. Significant correlations were observed between parabens, as well as between 4-t-BP and 4-t-OP. Regarding gender, paraben concentrations were higher in women than in men, except for BuP. The EDI for pollutants except 4-t-OP was lower than their respective tolerable/acceptable daily intake. In total, 85.70% of participants had 4-t-OP HQ > 1. A widespread exposure to parabens and alkylphenols among the rural population was found. The high health risks of alkylphenol exposure indicate that alkylphenols should be used with caution. [ABSTRACT FROM AUTHOR]

Evidence on the effect of long-term exposure to fine particulate matter (PM2.5) on erythrocytosis and thrombocytosis prevalence was limited. We aimed to investigate the association of PM2.5 and its constituents with the risks of erythrocytosis and thrombocytosis. The present study included a total of 33,585 participants from the Henan Rural Cohort at baseline between 2015 and 2017. A hybrid satellite-based model was employed to estimate the concentrations of PM2.5 mass and its constituents (including black carbon [BC], nitrate [NO3−], ammonium [NH4+], inorganic sulfate [SO42−], organic matter [OM], and soil particles [SOIL]). The logistic regression model was used to assess the associations of single exposure to PM2.5 and its constituents with the risks of erythrocytosis and thrombocytosis, and the quantile G-computation method was applied to evaluate their joint exposure risk. For the independent association, the odds ratios for erythrocytosis/thrombocytosis with 1 μg/m3 increase was 1.049/1.043 for PM2.5 mass, 1.596/1.610 for BC, 1.410/1.231 for NH4+, 1.205/1.139 for NO3−, 1.221/1.359 for OM, 1.300/1.143 for SO42−, and 1.197/1.313 for SOIL. Joint exposure to PM2.5 and its components was also positively associated with erythrocytosis and thrombocytosis. The estimated weight of NH4+ was found to be the largest for erythrocytosis, while OM had the largest weight for thrombocytosis. PM2.5 mass and its constituents were positively linked to prevalent erythrocytosis and thrombocytosis, both in single-exposure and joint-exposure models. Additionally, NH4+/OM was identified as a potentially responsible component for the association between PM2.5 and erythrocytosis/thrombocytosis. [ABSTRACT FROM AUTHOR]

Diet frequency may potentially influence metabolic health. However, general population-based evidence on the association between meal frequency and type 2 diabetes mellitus (T2DM) remains limited and inconclusive. Thus, this study aimed to investigate the association between meal frequency and T2DM in resource limited area. A total of 29,405 qualified participants were enrolled from the Henan rural cohort study. Data on meal frequency were collected through a validated face-to-face questionnaire survey. Logistic regression models were utilized to explore the association between meal frequency and T2DM. Compared with 21 times per week meal frequency group, the adjusted odds ratios (ORs) and 95% confidence intervals (95%CIs) were 0.75 (0.58, 0.95) and 0.70 (0.54, 0.90) for 16–20 times/week group and 14–15 times/week group, respectively. For the analysis of the three meals, significant associations were only found between dinner frequency and T2DM. Compared with seven times per week dinner group, the ORs (95%CIs) were 0.66 (0.42, 0.99) and 0.51 (0.29, 0.82) for the group with three to six times/week and zero to two times/week. Reduced meal frequency, especially dinner frequency, was associated with lower prevalence of T2DM, which suggests that an appropriate reduction in meal frequency per week may have a role in decreasing the risk of T2DM. [ABSTRACT FROM AUTHOR]

Evidence on the potential risk factors of normocytic anemia, the most prevalent morphology subtype of anemia, was scarce to date. The purpose of this study is to investigate the association of cooking fuel use or daily cooking duration with normocytic anemia and further explore the modification effect of mechanical ventilation. Participants totaling 29,448 from the Henan Rural Cohort were included in this study. Normocytic anemia was defined by hemoglobin (based on the World Health Organization criteria) and mean corpuscular volume. Cooking-related data was collected by questionnaire, and the average daily cooking duration was calculated by the weekly cooking frequency and the cooking duration of each meal. Logistic regression models were employed to derive the combined and independent associations of cooking fuel type and daily cooking duration with normocytic anemia and the modification effect of ventilation. Compared with people who never cooked, both clean fuel and solid fuel users were significantly associated with increased prevalent normocytic anemia [OR (95% CI) = 1.196 (1.014, 1.411) and 1.335 (1.105, 1.614), respectively], and the effect estimates on normocytic anemia risk were 1.260 (1.043, 1.523), 1.320 (1.104, 1.578), and 1.310 (1.081, 1.587) in participants who daily cooked < 1 h/day, 1–2 h/day, and ≥ 2 h/day, respectively. These relationships were attenuated in subjects with mechanical ventilation (All P < 0.05). Cooking with solid fuel or for a long duration are independently associated with prevalent normocytic anemia in rural population, and mechanical ventilation could attenuate these associations. Future efforts to reduce the burden of anemia could target the universal use of ventilation and solid fuel use or cooking duration reduction. Clinical trial registration: The Henan Rural Cohort Study has been registered at Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699). Date of registration: 06 July, 2015. http://www.chictr.org.cn/showproj.aspx?proj=11375 [ABSTRACT FROM AUTHOR]

Objective: Food-away-from-home (FAFH) is one of the leading dietary patterns in Chinese families. However, the relationship between FAFH and dyslipidemia remains unclear, especially in the rural adult population. This study explored the relationship of FAFH frequency with serum lipid levels and dyslipidemia in rural Chinese adults. Methods: A total of 12,002 men and 17,477 women aged 18–79 were included from the Henan rural cohort. Serum lipid levels were measured by enzyme colorimetry. Information on FAFH frequency was collected using a validated questionnaire. The associations of FAFH frequency and serum lipid levels were assessed through multiple linear regression modeling. Logistic regression was performed to explore the linkages of the FAFH frequency to dyslipidemia and its four parameter types. Mediation analysis examined whether body mass index (BMI) acted as a mediator between the FAFH frequency and dyslipidemia. Results: After adjusting for potential confounders, the adjusted odds ratio (OR) and 95% confidence interval (CI) of the groups with 8–11 FAFH times/week for dyslipidemia were 1.991 (1.569, 2.526) in men compared with 0-frequency subgroup. Participants who consumed 8–11 FAFH times/week had a higher risk of high total cholesterol (TC), high triglycerides (TG), high LDL-cholesterol (LDL-C), and low HDL-cholesterol (HDL-C) with the OR and 95% CI of 1.928 (1.247, 2.980), 1.723 (1.321, 2.247), 1.875 (1.215, 2.893), and 1.513 (1.168, 1.959), respectively. In addition, the interaction effect between FAFH and gender was significantly associated with dyslipidemia and lipid levels (P < 0.001). BMI played a fully mediating effect between FAFH frequency and dyslipidemia in men, and the Sobel test showed the significance of the mediating effect (z = 4.2158, P < 0.001). Conclusion: In rural Chinese adults, FAFH was significantly associated with a higher risk of dyslipidemia, which indicated the importance of FAFH reduction and dietary intervention in patients with dyslipidemia and cardiovascular disease, especially in clinical practice. Trial Registration: The Henan Rural Cohort Study has been registered on the Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15,006,699). [ABSTRACT FROM AUTHOR]

There is no evidence on the longitudinal and causal associations between multiple pesticides and the incidence of type 2 diabetes mellitus (T2DM) in the Chinese rural population, and whether physical activity (PA) modified these associations remains unclear. Here, we aimed to investigate the longitudinal and causal associations between pesticides mixture and T2DM, and determine whether PA modified these associations. A total of 925 subjects with normal glucose and 925 subjects with impaired fasting glucose (IFG) were enrolled in this case-cohort study. A total of 51 targeted pesticides were quantified at baseline. Logistic regression, quantile g-computation, and Bayesian kernel machine regression (BKMR) were used to assess the individual and combined effects of pesticides on IFG and T2DM. Mendelian randomization (MR) analysis was employed to obtain the causal association between pesticides and T2DM. After 3-year follow-up, one-unit increment in ln-isofenphos, ln-malathion, and ln-deltamethrin were associated with an increase conversion of IFG to T2DM (FDR- P <0.05). One quartile increment in organochlorine pesticides (OCPs), organophosphorus pesticides (OPs), herbicides and pyrethroids mixtures were related to a higher incidence of T2DM among IFG patients (P <0.05). The BKMR results showed a positive trend between exposure to pesticides mixture and T2DM. The MR analysis indicated a positive association between exposure to pesticides and T2DM risk (P<0.05). No any significant association was found between pesticides and IFG. In addition, compared to subjects with high levels of PA, those with low levels of PA were related to increased risk of T2DM with the increased levels of pesticides among IFG patients. Individual and combined exposure to pesticides increased the incidence of T2DM among IFG patients. MR analysis further supported the causal association of pesticides exposure with T2DM risk. Our study furtherly indicated that high levels of PA attenuated the diabetogenic effect of pesticides exposure. [Display omitted] • Individual and combined exposure to various pesticides increased T2DM incidence. • MR analysis supported the causal association of pesticides with T2DM risk. • High levels of PA attenuate the diabetogenic effect of pesticides. [ABSTRACT FROM AUTHOR]

Background: Long‐term exposure to ambient ozone links to aging biomarkers and increased risk for atherosclerotic cardiovascular diseases (ASCVD). However, the roles of aging biomarkers in the association of long‐term exposure to ambient ozone with ASCVD are unclear. Methods: A total of 5298 participants completed the questionnaire and physical examination and provided biological specimens. Aging biomarkers (telomere length [TL] and mitochondrial copy number [mtDNA‐CN]) were measured by using a real‐time polymerase chain reaction method. The concentration of ambient ozone was assessed using a random forest model. Associations of ambient ozone or aging biomarkers with 10‐year ASCVD risk were analyzed using logistic regression models. The roles of aging biomarkers in the association of ambient ozone exposure with 10‐year ASCVD risk were explored by mediation analysis. Results: The adjusted odds ratios and 95% confidence interval of high 10‐year ASCVD risk were 1.16 (1.08, 1.25), 0.71 (0.60, 0.85), and 0.78 (0.64, 0.96) in association with each 1‐unit increment in ambient ozone (1 μg/m3) concentration, relative TL, and mtDNA‐CN, respectively. The mediated proportion of the association between ambient ozone exposure and high 10‐year ASCVD risk by TL or mtDNA‐CN was 21.13% or 7.75%, respectively. The total proportion of association between ambient ozone exposure and high 10‐year ASCVD risk mediated by TL plus mtDNA‐CN was 21.02%. Conclusions: Long‐term exposure to ambient ozone was associated with increased 10‐year ASCVD risk, and the association was partially mediated by aging biomarkers (shortened TL and decreased mtDNA‐CN). This study indicated that ambient ozone pollution–related ASCVD risk might be partially explained by the telomere–mitochondrial axis of aging. [ABSTRACT FROM AUTHOR]

There is little research on how long-term exposure to independent and multiple air pollutants changes cardiometabolic risk in adults. In addition, previous studies focused on only the effect of one or two lifestyles on cardiometabolic risk. The evidence on the interactive effects of the lifestyle score and exposure to independent and mixtures of air pollutants on cardiometabolic risk is lacking. A total of 33,638 rural residents were included in the cross-sectional study. The three-year average concentrations of air pollutants for participants were predicted by using a satellite-based prediction. The air pollution score was created to assess the combined exposure of four air pollutants (PM1, PM2.5, PM10, and NO2). A gender−age-specific cardiometabolic risk score was calculated. Multivariable-adjusted linear regression and quantile g-computation were used to investigate the associations between air pollutants and cardiometabolic risk. Interaction plots were applied to describe the interactive effects of air pollution and the healthy lifestyle score on cardiometabolic risk. Per interquartile range (IQR) unit increases in PM1, PM2.5, PM10, or NO2 were associated with 0.162 (95% CI: 0.091, 0.233), 0.473 (95% CI: 0.388, 0.559), 0.718 (95% CI: 0.627, 0.810), and 0.795 (95% CI: 0.691, 0.898) unit increases in cardiometabolic risk score (all p < 0.05), respectively. A 0.854 (95% CI: 0.768, 0.940) unit increase in cardiometabolic risk was associated with each IQR increase in air pollution score. Furthermore, the strengths of associations of PM1, PM2.5, PM10, NO2, and the air pollution score on cardiometabolic risk score were attenuated with the healthy lifestyle score increase. In addition, there was no statistical significance after the lifestyle score equal to four scores for the effect of PM1 on the cardiometabolic risk score. In conclusions, individual or joint air pollutants were associated with an increased cardiometabolic risk. Improving the healthy lifestyle may be an effective method to improve cardiometabolic health in highly polluted rural regions. [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]

Although obesity reflected by BMI can enhance the association of air pollution with increase blood pressures (BP) and prevalent hypertension in susceptible population, there remains lack evidence on interactive effects of different obesity indices and air pollutants on BP and prevalent hypertension in rural adults. 39,259 individuals were recruited from the Henan Rural Cohort. Concentrations of air pollutants (PM 1 , PM 2.5 , PM 10 and NO 2) were evaluated by a spatio-temporal model based on satellites data. Independent associations of air pollutants and obesity reflected by BMI, WC, WHR, WHtR, BFP and VFI on BP indicators (SBP, DBP, MAP and PP) and prevalent hypertension were analyzed by linear regression and logistic regression models, respectively. Furthermore, their additive effects were quantified by RERI, AP and S. Six obesity indices enhanced the associations of four air pollutants and BP indicators. Individuals with high PM 1 concentrations plus obesity classified by BMI, WC, WHR, WHtR, BFP and VFI had a 4.18-fold (95% CI: 3.86, 4.53), 3.58-fold (95% CI: 3.34, 3.84), 3.53-fold (95% CI: 3.28, 3.81), 4.02-fold (95% CI: 3.72, 4.35), 3.89-fold (95% CI: 3.59, 4.23), 3.87-fold (95% CI: 3.62, 4.14) increase in prevalent hypertension, respectively, compared to non-obese individuals with low PM 1 concentrations; similar results were observed for combined effect of PM 2.5 , PM 10 or NO 2 and obesity indices on prevalent hypertension. The significant values of RERI, AP and S indicated additive effects of air pollutants and obesity indices on hypertension. Obesity amplified the effects of exposure to high levels of air pollutants on increased BP values and prevalent hypertension, implying that obese individuals may be susceptible to elevate BP and prevalent hypertension in relation to air pollution exposure. 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). • High levels of air pollution related to increased blood pressure and hypertension. • Obesity related to increased blood pressure and hypertension in rural adults. • Obesity amplified associations of air pollutants with blood pressure and hypertension. [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]

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Although it has been reported that herbicides exposure is related to adverse outcomes, available evidence on the associations of quantitatively measured herbicides with type 2 diabetes mellitus (T2DM) and prediabetes is still scant. Furthermore, the effects of herbicides mixtures on T2DM and prediabetes remain unclear among the Chinese rural population. To assess the associations of plasma herbicides with T2DM and prediabetes among the Chinese rural population. A total of 2626 participants were enrolled from the Henan Rural Cohort Study. Plasma herbicides were measured with gas chromatography coupled to triple quadrupole tandem mass spectrometry. Generalized linear regression analysis was employed to assess the associations of a single herbicide with T2DM, prediabetes, as well as indicators of glucose metabolism. In addition, the quantile g-computation and environmental risk score (ERS) structured by adaptive elastic net (AENET), and Bayesian kernel machine regression (BKMR) were used to estimate the effects of herbicides mixtures on T2DM and prediabetes. After adjusting for covariates, positive associations of atrazine, ametryn, and oxadiazon with the increased odds of T2DM were obtained. As for prediabetes, each 1-fold increase in ln-transformed oxadiazon was related to 8.4% (95% confidence interval (CI): 1.033, 1.138) higher odds of prediabetes. In addition, several herbicides were significantly related to fasting plasma glucose, fasting insulin, and HOMA2-IR (false discovery rates adjusted P value < 0.05). Furthermore, the quantile g-computation analysis showed that one quartile increase in multiple herbicides was associated with T2DM (OR (odds ratio): 1.099, 95% CI : 1.043, 1.158), and oxadiazon was assigned the largest positive weight, followed by atrazine. In addition, the ERS calculated by the selected herbicides from AENET were found to be associated with T2DM and prediabetes, and the corresponding ORs and 95% CIs were 1.133 (1.108, 1.159) and 1.065 (1.016, 1.116), respectively. The BKMR analysis indicated a positive association between mixtures of herbicides exposure and the risk of T2DM. Exposure to mixtures of herbicides was associated with an increased risk of T2DM among Chinese rural population, indicating that the impact of herbicides exposure on diabetes should be paid attention to and measures should be taken to avoid herbicides mixtures exposure. [Display omitted] • Several herbicides were associated with increased risk of T2DM and prediabetes. • Exposure to the mixture of herbicides was related to the increased risk of T2DM. • The impact of herbicides exposure on T2DM should be paid attention in rural adults. [ABSTRACT FROM AUTHOR]

Socioeconomic status (SES) was a crucial influencing factor of household air pollution (HAP). However, few studies have explored the potential effect modification of SES on the associations of HAP with type 2 diabetes mellitus (T2DM) and glucose homeostasis. A total of 20900 participants were obtained from the Henan Rural Cohort. HAP reflected by cooking fuel type and cooking duration was assessed via questionnaire. SES was evaluated by two dimensions: educational level and average monthly income. Associations of cooking fuel type, cooking duration with T2DM and glucose homeostasis indices (insulin, fasting plasma glucose (FPG), and HOMA- β) were assessed by the generalized linear model. Analyses were also conducted in different SES groups to explore the potential effect modification. Significant negative association of cooking fuel type and cooking duration with T2DM, FPG, and HOMA- β was not observed. However, cooking with solid fuel and long-duration cooking were associated with decreased insulin level in women, and the adjusted coefficients were − 0.35 (95% confidence interval (95% CI): − 0.53, − 0.17) and − 0.36 (95% CI: −0.50, −0.21), respectively. Results from stratified analyses showed that these associations were more prominent in women with low average monthly income, with corresponding coefficient of − 0.57 (95% CI: −0.77, −0.37) for cooking with solid fuel and − 0.34 (95% CI: −0.52, −0.16) for long-duration cooking. Among women with low average monthly income, the largest decreased insulin level was observed in those who cooked with solid fuel, long-duration and poor kitchen ventilation, while the negative association of cooking fuel type and cooking duration with insulin level was slightly alleviated in the good kitchen ventilation group. Low average monthly income aggravated the negative association of HAP and insulin level among rural women, while improving kitchen ventilation may be a practical intervention. The Henan Rural Cohort Study has been registered at Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699). Date of registration: 06 July, 2015. http://www.chictr.org.cn/showproj.aspx?proj= 11375. [Display omitted] • Cooking with solid fuel and long-duration was associated with insulin level. • Low average monthly income aggravated the association of HAP and decreased insulin. • Kitchen ventilation slightly offset the association of HAP and decreased insulin. [ABSTRACT FROM AUTHOR]

Although short-term exposure to particulate matter (PM) was associated with increased glucocorticoids (GCs) levels, available evidence on associations of long-term exposure to PM and GCs levels is still scant. Previous studies has showed that meat intake is associated with sex hormones levels, but it is unknown whether meat intake is associated with GCs levels. Furthermore, the role of meat intake in the associations between PM and GCs levels remains unclear. The aims of this study were to explore the associations of long-term exposure to PM and GCs levels among Chinese rural adults, and the role of meat intake in these associations. A total of 6223 subjects were recruited from the Henan Rural Cohort Study. Serum GCs levels were measured with liquid chromatography-tandem mass spectrometry. The concentrations of PM (PM 1 and PM 2.5) for each subject were assessed with machine learning algorithms. The food frequency questionnaire (FFQ) was used to obtain each participant' information on meat intake. The effects of PM and meat intake on GCs levels were assessed using generalized linear models. In addition, modification analyses were performed to identify the role of meat intake played in the associations of PM with serum GCs levels. Per 1 μg/m3 increment in PM 1 or PM 2.5 concentration was associated with a 0.364 ng/ml (95% confidence interval (CI): 0.234, 0.494) or 0.227 ng/ml (95%CI: 0.110, 0.343) increase in serum cortisone, respectively. In addition, the moderation effects of total meat intake and red meat intake on the associations of long-term exposure to PM 1 or PM 2.5 with serum cortisone were observed (P < 0.05), indicating that individuals who had high levels of PM 1 or PM 2.5 and meat intake were more susceptible to have a higher state of serum cortisone. Our findings suggested that long-term exposure to PM 1 or PM 2.5 was associated with serum cortisone. Moreover, meat intake was found to be a significant moderator in the association of PM 1 or PM 2.5 with serum cortisone levels. [Display omitted] • Long-term exposure to PM 1 or PM 2.5 was associated with serum cortisone among Chinese rural adults. • Meat intake was found to be a significant moderator in the positive associations of PM 1 or PM 2.5 with serum cortisone. • Our study implied that meat should be consumed reasonably and measures should be taken to control air pollution. [ABSTRACT FROM AUTHOR]

Excessive daytime sleepiness is associated with many adverse consequences, including cardiovascular diseases and mortality. Although exposure to air pollution has been suggested in connection with excessive daytime sleepiness, evidence in China is scarce. The study aimed to explore the association between long-term exposure to air pollution and excessive daytime sleepiness in rural China. A lot of 27935 participants (60% females) from the Henan Rural Cohort Study were included in this analysis. A satellite-based spatiotemporal model estimated a 3-year average air pollution exposure to NO 2 (nitrogen dioxide), PM 1 (particulate matter with aerodynamic diameters not more than 1 μm) and PM 2.5 (particulate matter with aerodynamic diameters not more than 2.5 μm) at the home address of participants before the baseline survey. Logistic regression was used to evaluate the odds ratio and 95% confidence interval between long-term air pollution and excessive daytime sleepiness. The average concentrations of NO 2 , PM 1 and PM 2.5 during three years preceding baseline survey were 38.22 μg/m³, 56.29 μg/m³ and 72.30 μg/m³. Exposure to NO 2 , PM 1 and PM 2.5 were all associated with excessive daytime sleepiness. Each 1 μg/m³ increment of NO 2 , PM 1 and PM 2.5 were related to a 20% (OR: 1.20, 95% CI: 1.13–1.27), 10% (OR: 1.10, 95% CI: 1.05–1.16) and 17% (OR: 1.17, 95% CI: 1.10–1.23) increase of the prevalence of excessive daytime sleepiness. The study demonstrated that long-term exposure to NO 2 , PM 1 and PM 2.5 were all associated with excessive daytime sleepiness. The impact of air pollution should be considered when treating individuals with excessive daytime sleepiness. • The survey studied the effect of air pollution on daytime sleepiness in rural China. • Exposure to ambient NO 2 , PM 1 and PM 2.5 were all associated with daytime sleepiness. • NO 2 showed higher effect on daytime sleepiness than PM 1 and PM 2.5 • Women and those of moderate exercise have higher odds ratios for daytime sleepiness. [ABSTRACT FROM AUTHOR]

Association between long-term exposure to ambient air pollution and obesity remains inconclusive, and the evidence from rural areas was limited. Thus, this study aimed to assess the association between ambient air pollution and obesity based on different anthropometric indices in Chinese rural adults, and further to compare the effect sizes of different air pollution types. A total of 38,824 participants (aged 18–79 years) were recruited from the Henan Rural Cohort Study. Logistic and multivariable linear regression model were used to examine the association between ambient air pollution exposure (including particulate matter with aerodynamic diameters ≤ 1.0 μm (PM 1), ≤2.5 μm (PM 2.5), and ≤10 μm (PM 10), and nitrogen dioxide (NO 2)) and obesity as well as obese anthropometric indices (including body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), body fat percentage (BFP), and visceral fat index (VFI)). The potential effect modifications were also examined. Positive associations were found between long-term exposure to PM 1 , PM 2.5 , PM 10 and NO 2 and obesity regardless of how obesity was defined (false discovery rate (FDR) < 0.05). Moreover, BMI, WC, WHR, WHtR, BFP, and VFI displayed increased trends with PM 1 , PM 2.5 , PM 10 and NO 2 concentrations increasing (all FDR<0.05). PM 10 had the largest effects on obesity among the four types of air pollution. The elderly, women, individuals with low level of education and income, and those who had high fat diet were more vulnerable to the adverse effects of air pollution. In addition, the results of the sensitivity analysis showed that those associations between ambient air pollution and obesity remained robust. These findings suggest that long-term exposure to ambient air pollutant (particularly PM 10) may be positively associated with obesity in Chinese rural adults, especially among the elderly, women, individuals with low education and income, as well as unhealthy lifestyles. Image 1 • Long-term exposure to air pollution (particularly PM 10) were positively associated with obesity. • Different obese anthropometric indices displayed increased trends with increment of air pollution concentrations. • The elderly, women, those who with low socioeconomic status and unhealthy lifestyles might be more vulnerable to the adverse effects of air pollution. [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]

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]

Background: This study aimed to estimate healthy life expectancy (HLE) regarding anxiety, depression and their comorbidity among rural older adults.Methods: A total of 12,851 subjects (5790 men and 7061 women) enrolled from the Henan Rural Cohort Study were used to evaluate healthy status expectancy (HSE), and 10,096 (4475 men and 5621 women) of them were used to estimate health-adjusted life expectancy (HALE). The life expectancy was calculated using period life table, and HSE and HALE indicators were calculated via the Sullivan method.Results: For participants aged 60, the depression-free life expectancy (DFLE), anxiety-free life expectancy (AFLE), and depression- and anxiety-free life expectancy (DAFLE) were 23.0993, 23.3314, and 22.7206 years, respectively. The quality-adjusted life expectancy (QALE) of those with neither anxiety nor depression, with anxiety, with depression, and with comorbidity was 22.0727, 20.8751, 18.1484, and 17.0823 years, respectively. The ratio of DFLE (AFLE) to LE increased with age among both genders, while the DAFLE/LE showed a decreasing trend. Regardless of HSE or HALE indicators, women tended to have higher HLE, while HLE/LE was lower than men. Furthermore, all HLE indicators associated with anxiety were the largest in both genders compared to indicators regarding depression.Limitations: The HLE may be overestimated ignoring institutional population in the study.Conclusion: Anxiety and depression played essential roles in the quality of life among rural older adults, especially depression. Comorbidity would intensify the adverse effect in rural areas, especially for older men. More attention should be paid to the psychological problems among rural older population. [ABSTRACT FROM AUTHOR]

• Long-term exposure to PM 2.5 was associated with poor sleep quality (OR = 1.15). • Long-term exposure to NO 2 was associated with poor sleep quality (OR = 1.14). • Exposure to air pollution showed adverse effects on sleep quality in rural China. • Health effects of air pollution in rural areas should be given more attention. Poor sleep quality is associated with poor quality of life and may even lead to mental illnesses. Several studies have indicated the association between exposure to air pollution and sleep quality. However, the evidence is very limited in China, especially in rural areas. Participants in this study were obtained from the Henan Rural Cohort established during 2015–2017. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI) in the baseline survey. Poor sleep quality was defined by the global score of PSQI > 5. Participants' exposures to PM 2.5 , PM 10 (particulate matter with aerodynamic diameters ≤2.5 μm and 10 μm, respectively) and NO 2 (nitrogen dioxide) during the three years before the baseline survey were estimated using a satellite-based prediction. The associations between long-term exposure to air pollutants and sleep quality were examined using both the linear regression and logistic regression models. The IQRs (interquartile range) of mean levels of participants' exposures to PM 2.5 , PM 10 and NO 2 were 3.3 µg/m3, 8.8 µg/m3, and 4.8 µg/m3, respectively. After adjusted for potential confounders, the global score of PSQI (and 95%CI, 95% confidence intervals) increased by 0.16 (0.04, 0.27), 0.09 (−0.01, 0.19) and 0.14 (0.03, 0.24), associated with per IQR increase in PM 2.5 , PM 10 and NO 2 , respectively. The odds ratios (and 95%CI) of poor sleep quality associated with per IQR increase in PM 2.5 , PM 10 and NO 2 were 1.15 (1.03, 1.29), 1.11 (1.02, 1.21) and 1.14 (1.03, 1.25), respectively. Long-term exposures to PM 2.5 , PM 10 and NO 2 were associated with poor sleep quality in rural China. Improvement of air quality may help to improve sleep quality among rural population of China. [ABSTRACT FROM AUTHOR]