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Purpose: The available evidence regarding the role of fruit and vegetable consumption in the development of colorectal polyps remains inconclusive, and there is a lack of data on different histopathologic features of polyps. We aimed to evaluate the associations of fruit and vegetable consumption with the prevalence of colorectal polyps and its subtypes in a high-risk population in China. Methods: We included 6783 Chinese participants aged 40–80 years who were at high risk of colorectal cancer (CRC) in the Lanxi Pre-colorectal Cancer Cohort (LP3C). Dietary information was obtained through a validated food-frequency questionnaire (FFQ), and colonoscopy screening was used to detect colorectal polyps. Dose–response associations of fruit and vegetable intake with the prevalence of polyps were calculated using multivariate-adjusted regression models, which was reported as odds ratios (ORs) with 95% confidence intervals (CIs). Results: 2064 cases of colorectal polyps were ascertained in the LP3C during 2018–2019. Upon multivariable adjustments, including the diet quality, fruit consumption was inversely associated with the prevalence of polyps (P trend = 0.02). Participants in the highest tertile of fruit intake had a 25% lower risk (OR: 0.75; 95% CI 0.62‒0.92) compared to non-consumers, while vegetable consumption had no significant association with polyp prevalence (P trend = 0.86). In terms of colorectal histopathology and multiplicity, higher fruit intake was correlated with 24, 23, and 33% lower prevalence of small polyps (OR: 0.76; 95% CI 0.62‒0.94; P trend = 0.05), single polyp (OR: 0.77; 95% CI 0.62‒0.96; P trend = 0.04), and distal colon polyps (OR: 0.67; 95% CI 0.51‒0.87; P trend = 0.003), respectively. Conclusions: Fresh fruit is suggested as a protective factor to prevent colorectal polyps in individuals at high risk of CRC, and should be underscored in dietary recommendations, particularly for high-risk populations. [ABSTRACT FROM AUTHOR]

Background & aims: Obesity has been linked to various detrimental health consequences. While there is established evidence of a negative correlation between seafood consumption and obesity in adults, the current research on the association between seafood intake in childhood/adolescence and the risk of obesity is lacking. Our aim was to evaluate the association between seafood intake in childhood/adolescence and the risk of obesity in a Chinese nationwide cohort. Methods: We utilized data from the China Health and Nutrition Survey (CHNS) from the year of 1997 to 2015. Seafood consumption was evaluated through 3-day 24-hour recalls. In our study, overweight/obesity status was determined based on the Chinese Criteria of Overweight and Obesity in School-age Children and Adolescents (WS/T 586–2018), while abdominal obesity status was determined according to the Chinese Criteria of Waist Circumference Screening Threshold among Children and Adolescents (WS/T 611–2018). Results: During an average follow-up of 7.9 years, 404 cases developed overweight/obesity among 2206 participants in the seafood-overweight/obesity analysis, while 381 cases developed abdominal obesity among 2256 participants in the seafood-abdominal-obesity analysis. The high-consumer group was associated with 35% lower risk of overweight/obesity risk and 26% lower risk of abdominal obesity after fully adjusting for sociodemographic and lifestyle factors, compared with the non-consumer group. Considering different cooking methods, boiled seafood consumption was associated with 43% lower risk of overweight/obesity and 23% lower risk of abdominal obesity in the fully adjusted model, while stir-fried seafood did not demonstrate a statistical significance. Conclusion: Higher intake of seafood in childhood/adolescents, particularly in a boiled way, was associated with lower obesity risk. [ABSTRACT FROM AUTHOR]

Background: Urinary incontinence is an increasingly common problem, especially among older people in nursing homes. Nursing assistants are the leading workforce in nursing homes, and their knowledge and attitudes regarding urinary incontinence have garnered considerable attention in the context of aging in China. However, most previous studies on this issue have focused on registered nurses. This study aimed to explore nursing assistants' knowledge, attitudes and training needs with regard to urinary incontinence. Methods: We conducted a two-part mixed-methods study. After institutional manager approval, we surveyed the knowledge and attitudes of 509 nursing assistants regarding urinary incontinence. We carried out semi-structured interviews with 40 nursing assistants to elicit detailed information on training needs. Results: In general, knowledge about urinary incontinence was poor (14.00 ± 4.18), although attitudes were primarily positive (35.51 ± 3.19). Most nursing assistants were very willing to learn more about urinary incontinence (93.9%, 478/509), but time constraints and low educational background may be barriers to learning motivation. The three preferred training styles among nursing assistants were face-to-face guidance from a mentor, training combining theory with practice, and online video training. Conclusions: Chinese nursing assistants had poor knowledge but positive attitudes toward urinary incontinence. Facility managers should focus on developing training and learning mechanisms regarding urinary incontinence. It is important to adopt diverse training styles according to the actual situation of nursing homes. [ABSTRACT FROM AUTHOR]

The relationship between SFA consumption and the risk of overweight/obesity remains unclear. Epidemiological evidence is lacking among Chinese population. This study aimed to investigate the association between individual dietary SFA intake and the risk of overweight/obesity in Chinese adults. Data from 8465 adults with BMI < 24 kg/m2 at entry in the China Health and Nutrition Survey (1989–2011) were analysed. Three-day 24-h dietary records were used to collect dietary data. Cox proportional hazards regression models were constructed to estimate hazard ratios (HR) and 95 % CI for the risk of developing overweight or obesity. A total of 3171 incident cases of overweight/obesity were identified (1649 for women and 1522 for men) during a median of 11 years of follow-up. Compared with the lowest category, the intake of total SFA (TSFA) showed no significant association with the risk of overweight/obesity. However, an increased risk of overweight/obesity was observed with a higher intake of medium chain SFA (MCSFA) (Ptrend = 0·004), especially decanoic acid (10:0) (HR was 1·25 (95 % CI 1·10, 1·42) comparing the highest category with the reference group; Ptrend < 0·001), whereas an inverse relationship was observed for hexanoic acid (6:0) consumption; compared with non-consumers, 6:0 intake was associated with 32 % lower risk of overweight/obesity (HR: 0·68 (95 % CI 0·56, 0·84); Ptrend < 0·001). Overall, the intake of subtypes of MCSFA but not TSFA was associated with the risk of overweight/obesity. Increasing hexanoic acid (6:0) and limiting decanoic acid (10:0) consumption may be protective for overweight/obesity among Chinese population. [ABSTRACT FROM AUTHOR]

Purpose: Monounsaturated fatty acids (MUFAs) are typical components of various plant-sourced and animal-sourced foods. However, the associations of MUFA consumption from different sources with mortality remain unclear. This study aimed to investigate the relationships between MUFA intakes from plant and animal sources and mortality. Methods: A total of 14,305 participants from China Health and Nutrition Survey were prospectively followed up for 14 years. Dietary intake of MUFAs was assessed by 3-day 24-h dietary records in each round. Cox proportional hazards regression models were used to compute hazard ratios (HRs) and 95% confidence intervals (CIs). Results: A total of 1006 deaths occurred during 199,091 person-years of follow-up. Intake of total MUFAs was not associated with mortality (P-trend = 0.17). The plant-sourced MUFA intake was strongly associated with lower mortality [HRQ4vsQ1 (95% CI) 0.72 (0.58–0.89); P-trend = 0.008], whereas animal-sourced MUFA intake showed no significant association. Likewise, oleic acid (OA) and palmitoleic acid (PA) intakes from plant sources were also inversely associated with mortality [HRQ4vsQ1 (95% CI) 0.66 (0.52–0.84) for OA and 0.73 (0.59–0.91) for PA], while animal-sourced OA and PA were not related to mortality. Theoretically replacing saturated fatty acids (SFAs) (5% of total energy) with isocaloric plant-sourced MUFAs was associated with 15% (95% CI 5–25%) lower mortality. In addition, 18% (95% CI 10–26%) lower mortality was observed when theoretically replacing the sum of SFAs and animal-sourced MUFAs with isocaloric plant-sourced MUFAs. Conclusions: Intakes of MUFAs, including OA and PA, from plant but not animal sources were associated with lower total mortality. These findings suggested the importance of consuming MUFAs from plant-based foods for overall health. [ABSTRACT FROM AUTHOR]

Background: Evidence suggests that the relations between intakes of individual fatty acids and risk of type 2 diabetes (T2D) vary. However, associations between intakes of different cooking oils as sources of fatty acids and incident T2D remain largely unknown.Objectives: We aimed to evaluate relations between intakes of individual cooking oils and incident T2D in a nationwide Chinese cohort.Methods: Overall 15,022 Chinese adults aged ≥20 y from the China Health and Nutrition Survey (CHNS) without self-reported T2D at entry in the 1997, 2000, 2004, 2006, or 2009 rounds were followed up until 2011. Consumption of various cooking oils/fats including lard, peanut oil, soybean oil, canola oil, sesame oil, and refined blended plant oil was assessed using 3-d 24-h records in each survey and the cumulative mean intake was calculated. Multivariable-adjusted Cox proportional hazards regression models were constructed to estimate the HRs of T2D.Results: A total of 1014 cases were recorded after a median follow-up of 14 y. The intakes of animal and plant cooking oils/fats were both associated with higher T2D risk. Compared with nonconsumers, multivariable-adjusted HRs and 95% CIs for the highest tertiles were 1.31 (1.03, 1.67) for lard, 1.36 (1.10, 1.66) for peanut oil, 1.14 (0.91, 1.43) for soybean oil, 1.11 (0.87, 1.43) for canola oil, 1.02 (0.79, 1.32) for sesame oil, and 1.42 (1.12, 1.82) for refined blended plant oil. Substituting 1 tablespoon/d (8 g · 2000 kcal-1 · d-1) of soybean oil for the sum of lard, peanut oil, refined blended plant oil, and other plant oils was associated with a 3% (HR: 0.97; 95% CI: 0.95, 0.99) lower risk of T2D.Conclusions: Intakes of lard, peanut oil, and refined blended plant oil but not soybean oil, canola oil, and sesame oil are associated with higher T2D risk. Reducing the consumption of cooking oils in general may be protective against T2D among the Chinese population.This trial was registered at clinicaltrials.gov as NCT03259321. [ABSTRACT FROM AUTHOR]

Background and Objectives: To examine the associations of regional body fat distribution with metabolic risk factors among Chinese.Methods and Study Design: Truncal fat (TF) and leg fat (LF) were measured by dualenergy X-ray absorptiometry (DXA) among 947 adults, and abdominal visceral fat (VAT) and subcutaneous fat (SAT), upper leg SAT were measured by magnetic resonance image (MRI) among 103 adults during 2008-2013. Metabolic risk factors included fasting blood glucose, total triglyceride, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and metabolic syndrome (MetS).Results: TF showed adverse effect while LF showed beneficial effect on metabolic risk factors, and all these effects were independent of body mass index (BMI) (mostly p<0.01). Individuals with higher TF and lower LF experienced the highest risk of MetS compared to other subgroups of combination of TF and LF (all p<0.05). Abdominal VAT was positively associated with risk of MetS (men: odds ratio (OR)=4.45, 95% confidence interval (CI): 1.18, 16.8; women: OR=6.54, 95% CI: 1.08, 39.6) and serum triglyceride (men: beta (β)=0.379, 95% CI: 0.090, 0.667; women: β=0.700, 95% CI: 0.327, 1.07). Upper leg SAT showed an opposite association with most metabolic factors compared to abdominal SAT and VAT, however, the association was not statistically significant.Conclusion: TF and LF showed opposite effects on metabolic risk factors among Chinese adults. Abdominal VAT, but not abdominal SAT, was positively associated with serum triglyceride and risk of MetS. Future studies are warranted to examine the potential mechanism of the opposite effects between TF and LF on metabolic risk factors among Chinese. [ABSTRACT FROM AUTHOR]

Whether fish and marine omega-3 polyunsaturated fatty acid (PUFA) intakes are linked to type 2 diabetes (T2D) risk remains unclear in China. We aimed to assess the long-term associations in a nationwide cohort. Overall 15,100 Chinese adults, aged ≥20 years, were included from China Health and Nutrition Survey. The cumulative averages of fish and marine omega-3 PUFA intakes were evaluated based on 3-day 24-h records. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) of T2D risk. Overall 1017 T2D cases were documented over a median of 14 years of follow-up. Compared with non-fish consumers, low and moderate fish consumption were associated with higher T2D risk whereas high fish consumption was not associated. Multivariable-adjusted HRs (95% CIs) for low and moderate fish consumption were 1.43 (1.09, 1.86) and 1.42 (1.07, 1.85) respectively in men, and were 1.58 (1.22, 2.02) and 1.39 (1.08, 1.83) respectively in women. In meat substitution analyses, low and moderate fish consumption was related to 55% and 69% higher T2D risk for men, and was associated with 68% and 54% higher T2D risk for women, respectively. Fried but not non-fried fish intake was associated with higher T2D risk. Intake of marine omega-3 PUFAs was dose-dependently associated with higher T2D risk for both men and women (P-trend<0.001). Overall low and moderate intakes of fish, especially fried fish, and marine omega-3 PUFAs were associated with higher T2D risk. Current level of fish and marine omega-3 PUFA consumption is not protective against T2D incidence among Chinese people. [ABSTRACT FROM AUTHOR]

Cooking process for food significantly impacts household air and increases exposure to endocrine disruptors such as acrylamide, consequently affecting human health. In the past 30 years, the transformation of cooking methods to high-temperature thermal processing has occurred widely in China. Yet the transition of cooking methods on the onset of type 2 diabetes (T2D) remains unclear, which may hinder health-based Sustainable Development Goals. We aimed to estimate the associations between dietary intake with different cooking methods and T2D risk. We included 14,745 participants (>20 y) from the China Health and Nutrition Survey (1991-2015). Food consumption was calculated using three consecutive 24-h dietary recalls combined with both individual participant level and household food inventory. Cooking methods, including boiling, steaming, baking, griddling, stir-frying, deep-frying, and raw eating, were also recorded. The consumption of baked/griddled and deep-fried foods was positively associated with 39% and 35% higher of T2D risk by comparing the highest with the lowest category of food consumption, respectively. The use of unhealthy cooking methods for processing foods including baked/griddled and deep-fried foods was attributable for 15 million T2D cases of the total T2D burden in 2011, resulting in a medical cost of $2.7 billion and was expected to be attributable for 39 million T2D cases in 2030, producing a medical cost of $223.8 billion. Replacing one serving of deep-fried foods and baked/griddle foods with boiled/steamed foods was related to 50% and 20% lower risk of T2D, respectively. Our findings recommend healthy driven cooking methods for daily diet for nourishing sustainable T2D prevention in China., 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 Ltd. All rights reserved.)

Background: Cereal grains are rich in carbohydrates and could trigger a hyperglycemic response which is closely linked to blood pressure status. We aim to examine the associations between the consumption of cereals with different cooking methods and hypertension risk., Methods: We conducted a prospective analysis utilizing the nationwide data of 11,080 adult participants who were free of hypertension at baseline. Cereal intake was assessed using 3-day 24 h dietary recalls with a weighing technique. Hypertension incidence was identified in adherence with the Seventh Joint National Commission guidelines during the follow-up. Cox proportional hazards regression models were used to extrapolate hazard ratios associated with hypertension risk., Results: Over an average follow-up span of 7 years (77,560 person-years), we identified 3643 new hypertension cases. The intake of total, fried, and baked cereals was associated with 15%, 20%, and 20% higher risk of hypertension, respectively. Whole grain consumers had an 8% lower risk of hypertension compared with non-consumers, while total refined grain consumers showed no significant association. Replacing one daily serving of fried or baked cereals with an equivalent serving of boiled cereals was related to a 28% or 14% lower risk, respectively., Conclusions: Total, fried, and baked cereal consumption was positively associated with hypertension risk, while consuming whole grains was related to a lower risk. Modifying cooking methods from frying or baking to boiling for cereals may be beneficial to lower risk. The current study underscores the significance of considering both the degree of processing and cooking methods applied to cereals in addressing hypertension prevention and management.

Background: Fresh vegetable consumption has been associated with lower incidence of cardiovascular disease (CVD). However, whether preserved vegetable consumption is linked with CVD and mortality remains unclear. This study aimed to assess the associations of preserved vegetable consumption with all-cause and cause-specific mortality., Methods: A total of 440,415 participants free of major chronic diseases, aged 30-79 years, were enrolled from 10 diverse regions in China between 2004 and 2008 and were followed up for an average of 10 years. Preserved vegetable consumption was assessed using a validated food frequency questionnaire. Cause-specific hazard models with the consideration of competing risk from various deaths were performed to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of mortality., Results: During 4,415,784 person-years of follow-up, we documented 28,625 deaths. After adjustment for major risk factors, preserved vegetable consumption was marginally associated with higher CVD mortality (P = 0.041 for trend and P = 0.025 for non-linearity) but not associated with cancer mortality and total mortality. For specific causes of death, consuming preserved vegetables was associated with higher hemorrhagic stroke mortality. The multivariable-adjusted HRs (95% CIs) of hemorrhagic stroke mortality compared with non-consumers were 1.32 (1.17-1.50) for 1-3 days/week and 1.15 (1.00-1.31) for regular consumers (≥4 days/week) (P = 0.006 for trend and P < 0.001 for non-linearity). In addition, regular preserved vegetable consumption was associated with increased risk of digestive tract cancer mortality [HR (95% CI): 1.13 (1.00-1.28); P = 0.053 for trend] and esophageal cancer mortality [HR (95% CI): 1.45 (1.17-1.81); P = 0.002 for trend]., Conclusions: Frequent consumption of preserved vegetables was associated with higher risk of mortality from hemorrhagic stroke and esophageal cancer in China. Our findings suggest limiting preserved vegetable consumption might be protective for premature death from hemorrhagic stroke and digestive tract cancer., (© 2023. The Author(s).)

Background: A large number of nurses across China joined the anti-coronavirus disease 2019 (COVID-19) front-line in Hubei province, where the local healthcare system faced unprecedented challenges in the early 2020. Few studies have reported the psychological experiences of nurses from other regions who voluntarily participated in the response to the COVID-19 pandemic in Hubei province., Aim: To describe the psychological experiences of nurses who were involved in the anti-COVID-19 pandemic battle in Hubei province from January to April 2020., Methods: This was a qualitative descriptive study using purposive and snowball sampling strategies for participant recruitment. Twenty-four nurses were approached and twenty-one of them completed telephone interviews in April 2020. The interviews took an average of 75 min (range 34-140 min). Data were analyzed thematically after verbatim transcription of the interviews., Results: Our analysis generated three primary themes: (I) Contexts; (II) Psychological responses; and (III) Coping strategies (most participants identified suitable coping strategies including relaxing activities and seeking social support). Participants' psychological responses varied in four phases of the journey through the experience: (i) initiation phase: obligations and concerns/fears; (ii) transition phase: from overwhelmed to increased confidence; (iii) adaptation phase: a sense of achievement and exhaustion; and (iv) completion phase: professional and personal growth., Conclusion: Nurses had concerns, fears, and faced challenges working on the COVID-19 front-line. However, they were motivated by a strong sense of professional commitment. Most nurses successfully achieved personal and professional growth as they identified a range of coping strategies. Future research is needed to explore the long-term impact of the COVID-19 related working experiences on these nurses., 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 Wang, Zhong, Ding, Chen, Jiao and Huang.)

Background & Aims: Accumulating evidence has linked distinct associations of red/processed and white meat consumption with chronic diseases and longevity among the general population. However, the associations of meat consumption and changes with mortality among hypertensive patients remain unknown. We aimed to assess the associations of red and white meat consumption with all-cause mortality among hypertensive patients in China., Methods: We followed 8095 hypertensive patients from the China Health and Nutrition Survey between 1991 and 2015. In each survey year, 3-day 24-h dietary records were used to collect dietary data. Cumulative averages of dietary meat intake after the diagnosis of hypertension were calculated. Cox proportional hazards regression was used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality., Results: Overall 927 deaths were documented among these hypertensive patients during an average of 11.4 years of follow-up. Red meat consumption was positively associated with all-cause mortality after multivariable adjustment [HR (95% CI) comparing the highest versus lowest quartile: 1.29 (1.05-1.57), P trend = 0.02]. White meat intake was associated with lower all-cause mortality [HR (95% CI) comparing the highest tertile with non-consumers: 0.77 (0.63-0.94), P trend = 0.002]. Increasing red meat consumption from before to after hypertension diagnosis was significantly associated with higher all-cause mortality [HR (95% CI): 1.55 (1.05-2.28), P trend = 0.04]. Theoretically replacing 1 ounce/day of red meat with the equivalent amount of white meat or eggs was associated with 5% and 10% lower all-cause mortality, respectively., Conclusions: High consumption of red meat, especially after hypertension diagnosis, is associated with higher mortality among hypertensive patients. Our findings suggest replacing red meat consumption with healthy alternative foods for long-term survival among hypertensive patients., Competing Interests: Conflicts of interest The authors declare that they have no competing interests., (Copyright © 2020 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Objective: Current levels of potato consumption in relation to mortality in Chinese people remains unknown. The aim of this study was to investigate the intakes of total potatoes, fried potatoes, non-fried potatoes, and sweet potatoes as dietary carbohydrate sources in relation to all-cause mortality in the China Health and Nutrition Survey (CHNS)., Methods: Overall 14 117 participants ≥20 y of age were included, with a median follow-up of 14 y. The cumulative average consumption of potatoes and other foods were calculated and validated using weighing methods in combination with 3-d, 24-h dietary recalls at both household and individual levels. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression models after multivariate adjustment., Results: We documented 1007 deaths among the participants. The low and moderate intakes of total potatoes, fried potatoes, and non-fried potatoes were inversely associated with mortality. Compared with non-consumers, the intakes of total potatoes (HR, 0.48; 95% CI, 0.38-0.59), fried potatoes (HR, 0.44; 95% CI, 0.34-0.56), and non-fried potatoes (HR, 0.47; 95% CI, 0.37-0.61) at low consumption levels were most significantly related to lower mortality. Sweet potato consumption was inversely associated with mortality after full adjustment (HR, 0.82; 95% CI, 0.69-0.96) compared with non-consumers. Substituting grains and mixed beans for potatoes with equal amounts at high consumption levels strengthened the inverse associations., Conclusion: In the CHNS, current low and moderate, but not high levels of total potato and fried/non-fried potato consumption as well as sweet potato consumption were inversely associated with all-cause mortality among Chinese people., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background & Aims: Evidence linking individual cooking oil consumption with total mortality is limited in China. The aim of this study was to examine the associations of intakes of plant-sourced and animal-sourced cooking oils with total mortality in a Chinese nationwide cohort., Methods: We analyzed data from 14,305 adults aged ≥20 y at entry in the China Health and Nutrition Survey (CHNS). The 3-day 24-h dietary records were used to collect dietary information. Cox proportional hazards regression models were established to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of all-cause death., Results: Overall 1006 deaths were documented during a median of 14 years (199,091 person-years) of follow-up. Multivariate-adjusted HRs (95% CIs) of total mortality via comparing the highest tertile of cooking oil consumption with no consumption were 0.86 (0.70-1.06) for lard, 0.59 (0.47-0.74) for peanut oil, 0.71 (0.54-0.93) for soybean oil, 0.76 (0.61-0.94) for canola oil, 0.71 (0.50-0.99) for salad oil, and 0.59 (0.44-0.79) for other plant cooking oils. Replacing animal cooking oils with 1 tablespoon/d of total plant cooking oils or other plant cooking oils was related to 4% or 17% lower total mortality, respectively, while consumption of peanut oil or salad oil in replacement of animal cooking oils had a marginal inverse association with total mortality., Conclusions: Intakes of plant-sourced cooking oils, including peanut oil, soybean oil, canola oil, salad oil, and other plant cooking oils and substituting plant cooking oils for animal cooking oils were associated with lower total mortality among general Chinese population (NCT03259321)., Competing Interests: Conflicts of interest The authors declare that they have no competing interests., (Copyright © 2020 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background & Aims: Evidence linking egg and dietary cholesterol consumption with human health and longevity is highly debated. Data from non-Western populations are sparse. We aim to prospectively assess the egg and cholesterol consumption in relation to mortality in a nationwide Chinese cohort., Methods: We followed 18,914 adults aged ≥20 y from China Health and Nutrition Survey (CHNS) between 1991 and 2015. In each survey year, 3-day 24-hr dietary records were used to collect dietary data. Cumulative averages of egg and cholesterol intakes were calculated. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using the Cox proportional hazards model., Results: Overall 1,429 deaths were reported after a median follow-up of 15 years. Egg consumption was significantly associated with lower total mortality (P-trend<0.001). Multivariable-adjusted HRs (95% CIs) were 0.69 (0.59-0.81) for 1-3 eggs/wk, 0.68 (0.59-0.79) for 3-7 eggs/wk, 0.78 (0.66-0.93) for 1-2 eggs/d, and 0.64 (0.52-0.78) for ≥2 eggs/d compared with ≤1 egg/wk. Although total dietary cholesterol was not related to mortality, intake of cholesterol from eggs was inversely associated with total mortality (P-trend = 0.001) while intake of cholesterol from non-egg sources was positively related to total mortality (P-trend = 0.01). Substituting 50 g/d egg for equivalent amounts of dairy products, nuts/legumes, or red meat was associated with 9%, 7%, or 8% lower total mortality, respectively., Conclusions: Egg consumption is associated with lower total mortality among the Chinese population. Consuming cholesterol from non-egg sources may be detrimental to longevity. Habitual consumption of eggs should continue to be recommended in the Chinese dietary guidelines while excess intake of cholesterol from non-egg sources may be discouraged., Clinical Trial Registry: This trial was registered at clinicaltrials.gov (NCT04104308)., Competing Interests: Conflicts of interest The authors declare that they have no competing interests., (Copyright © 2020 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background & Aims: Government has popularized potatoes as the staple food in China. Potatoes as a potassium-rich food show high glycemic responses after consumption. Whether potato consumption is prospectively linked with the risk of hypertension remains unclear in oriental populations. In this study, we aimed to investigate the association of potato consumption with the risk of hypertension among Chinese people., Methods: A total of 11,763 adults (≥20 years old) who were free of hypertension at baseline were enrolled from China Health and Nutrition Survey (CHNS) Cohort study in 1989-2011. Participants were excluded if they were <20 years old, identified to be pregnant, and previously diagnosed with hypertension, cancers, infarction, apoplexy and diabetes at baseline. Cox proportional hazards regression models were used to estimate the associations after adjusting for potential confounders., Results: During average 11.3 years of follow-up, 4033 incident cases of hypertension were ascertained. People who consumed more amounts of total potatoes, stir-fried potatoes, and non stir-fried potatoes had higher risk of hypertension (P for trend = 0.1225, 0.2168 and 0.0456, respectively). Multivariable hazard ratios (HRs) for increased consumption of total potatoes were 1.402 (95% confidence interval [CI], 1.270-1.548), 1.198 (95% CI, 1.014-1.415), and 1.120 (95% CI, 0.929-1.349) compared with non-consumers. However, the participants with higher intake of potato consumption were inclined to have lower risk of hypertension when excluding the non-consumers of total potatoes or stir-fried potatoes (P for trend = 0.0271 and 0.0001). In addition, a positive association of sweet potatoes intake with hypertension risk was only found in urban residents (P for trend = 0.0239)., Conclusions: Our results showed that potato consumption was prospectively associated with hypertension in Chinese population. As the urbanization process continues along with the transition to Western-style diets, more consideration should be taken before the formulation of potato popularization is promoted in China., (Copyright © 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background & Aims: Polyunsaturated fatty acids (PUFA) have been reported to exert pleiotropic protective effects against various chronic diseases. However, epidemiologic evidence linking specific PUFA intake to mortality has been limited and contradictory. We aim to assess the associations between specific dietary PUFA and mortality among adults in China and America, respectively., Methods: Participants from China Health and Nutrition Survey (CHNS, n = 14,117) and National Health and Nutrition Examination Survey [NHANES (n = 36,032)] were prospectively followed up through the year 2011. Cox regression models were used to investigate hypothesized associations., Results: A total of 1007 and 4826 deaths accrued over a median of 14 and 9.1 years of follow-up in CHNS and NHANES, respectively. Dietary marine omega-3 PUFA was robustly associated with a reduced all-cause mortality [Hazard ratio (HR) comparing extreme categories: 0.74, 95% CI: 0.61-0.89; P < 0.001 for trend] in CHNS. Nevertheless, this inverse relationship was not observed in NHANES. The overall mortality was positively associated with the intake of α-linolenic acid (ALA) (HR comparing extreme quartiles: 1.23, 95% CI: 1.01-1.50; P = 0.054 for trend) in CHNS, whereas weak inverse associations of ALA (P = 0.035 for trend) and LA (P = 0.027 for trend) with all-cause mortality were found in NHANES. Increased dietary intake of arachidonic acid was consistently linked with reduced all-cause mortality both in NHANES and CHNS. Importantly, consuming PUFA at an omega-6/omega-3 ratio of 6-10 was associated with a lower risk of death in CHNS., Conclusions: Intakes of different specific PUFA show distinct associations with mortality and these relationships also vary between Chinese and US populations. These findings suggest maintaining an omega-6/omega-3 balance diet for overall health promotion outcomes (NCT03155659)., (Copyright © 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background: Dietary intakes of total and specific types of saturated fatty acids (SFAs) in relation to total mortality remain largely unknown in China., Objective: We assessed the associations of total and individual SFA intakes with total mortality in a Chinese nationwide population., Methods: This prospective analysis included 7888 women and 6495 men, aged >20 y, from the China Health and Nutrition Survey (1989-2011). Cumulative mean of SFA intake was calculated based on 3 d of 24-h records in each round of the survey. Multivariable Cox proportional hazard models were used to estimate HR and 95% CI., Results: There were 1011 deaths during a median of 14 y of follow-up. In isocaloric nutrient density models that replace total carbohydrates, intakes of total SFAs and even-chain SFAs were associated with higher total mortality in women but not in men. Compared with the lowest quartiles, the HRs (95% CIs) in the highest quartiles were 1.65 (1.03, 2.62) for total SFAs (P-trend = 0.042) and 1.83 (1.13, 2.94) for even-chain SFAs (P-trend = 0.016) in women. Intake of odd-chain SFAs was associated with lower total mortality both in men [HR (95% CI): 0.64 (0.47, 0.87); P-trend = 0.01] and in women [HR (95% CI): 0.59 (0.42, 0.84); P-trend = 0.0013]. Moreover, intake of medium-chain SFAs was linked with lower total mortality in men [HR (95% CI): 0.64 (0.44, 0.93); P-trend = 0.013]. However, isocalorically replacing 1% of energy from unsaturated fatty acids with even-chain SFAs was associated with higher total mortality in men [HRs (95% CIs): 1.08 (0.97, 1.20) and 1.39 (1.20, 1.60) for replacing PUFAs and MUFAs, respectively]., Conclusions: Total SFA and even-chain SFA intake was associated with higher total mortality in women, whereas intake of odd-chain SFAs was related to lower total mortality in both sexes. This analysis of cohort was registered at clinicaltrials.gov as NCT03281512.

Scope: To assess the associations of dietary linoleic acid (LA) and α-linolenic acid (ALA) with type 2 diabetes (T2D) risk in a population-based cohort and further explore the mechanism of action in a high-fat-diet (HFD) induced obese (DIO) mouse model., Methods and Results: The occurrence of T2D among 15 100 Chinese adults from China Health and Nutrition Survey (CHNS, 1997-2011) were followed up for a median of 14 years. The relations of ALA and LA intakes with T2D risk were modified by BMI, with significant associations restricted to obese/overweight subjects. Among them, relative risks (95% confidence intervals) comparing extreme quartiles of intakes were 0.55 (0.32-0.93) in men and 0.53 (0.34-0.85) in women for ALA, while 0.71 (0.41-1.16) in men and 0.56 (0.36-0.89) in women for LA. DIO mice were fed with LA- or ALA-enriched HFD (0.2% wt wt -1 ) for 15 weeks and then significant sex-dependent changes of gut microbiota were detected. Endotoxemia, systematic and adipose inflammation were relieved in ALA-fed male and LA-fed female mice., Conclusions: Long-term intake of LA (for women) and ALA may have a protective effect on T2D development for obese/overweight subjects through sex-specific gut microbiota modulation and gut-adipose axis., (© 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Scope: Whether dietary fish consumption is linked to mortality remains unclear. We aim to investigate the association of fish consumption with mortality in Chinese and US nationwide populations., Methods and Results: We utilize data from China Health and Nutrition Survey (CHNS, n = 14 117) and National Health and Nutrition Examination Survey (NHANES, n = 33 221) including NHANES III conducted in 1988-1994 and continuous NHANES 1999-2010. Cox proportional hazards regression is used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). During a median follow-up of 14 and 9.8 years for CHNS and NHANES, 1007 and 5209 deaths are documented, respectively. Among Chinese adults, increased fish intake is significantly associated with decreased total mortality. The multivariable-adjusted HRs (95% CIs) across increasing categories of fish intake are 0.45 (0.36-0.56), 0.72 (0.60-0.86), and 0.70 (0.59-0.85) (p trend < 0.0001). However, fish intake is not associated with total mortality among US adults (p trend = 0.21). We only detected a borderline inverse association between fish intake and stroke mortality (p trend = 0.05), whereas a positive association with diabetes mortality in the third category of fish intake in NHANES., Conclusion: In these two nationwide cohort studies, fish consumption is associated with a reduced risk of total mortality for Chinese but not US populations., (© 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Objective: To investigate ethnic difference in the associations of BMI with comorbidity, mortality, and body composition between mainland Chinese and U.S. whites., Methods: Ethnic-comparison study using data from China Health and Nutrition Survey, U.S. National Health and Nutrition Examination Survey, and data from Zhejiang University (China) and Columbia University (U.S.)., Results: Chinese people experienced greater odds of comorbidities than whites for a given BMI after standardizing for age and sex: 43% for diabetes, 30% for dyslipidemia, 28% for hypertension, 38% for metabolic syndrome, and 48% for hyperuricemia. Comparisons of BMI-mortality associations found that the U-shaped BMI-mortality curve shifted 1-2 kg m(-2) to the left in Chinese compared to whites. Compared to whites at BMIs of 25 and 30 kg m(-2), corresponding cutoffs in Chinese were 22.5 and 25.9 kg m(-2) in men, and 22.8 and 26.6 kg m(-2) in women after both fat and fat distribution were taken into account., Conclusions: Comorbidity, mortality, and body composition data consistently support the use of lower BMI cutoffs in Chinese than those in whites., (© 2015 The Obesity Society.)