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Introduction: Physical activity (PA), sedentary behaviors (SB), sleep, and diet are related to adiposity among children and adolescents. However, there may be interactions between PA, SB, sleep, and diet, and these lifestyle behaviors may work together to affect body weight. The purpose of this study was to explore the impact of multiple lifestyle behaviors of PA, SB, sleep, and diet on childhood adiposity (body mass index z-score and overweight/obesity), and to investigate the effect of meeting multiple guidelines on adiposity among children and adolescents in China. Methods: Cross-sectional results were based on 28,048 children aged 6–17 years from the China National Nutrition and Health Surveillance in 2010–2012. Information about PA, SB, and sleep was measured through interview-administered questionnaire. Dietary intake was assessed with food frequency questionnaire. The associations between multiple lifestyle behaviors and BMI z-score and overweight/obese were examined. Results: The prevalence of overweight/obesity in the participants was 19.2%. The average time of moderate-to-vigorous PA (MVPA), leisure SB, and sleep was 76.7 ± 45.5 min, 2.9 ± 1.4 h, and 8.5 ± 1.1 h per day, respectively. The China Dietary Guidelines Index for Youth (CDGI-Y) score was 62.6 ± 11.0. Sleep duration and diet score were negative associated with BMI z-score (both p < 0.001). MVPA and SB time were positive associated with BMI z-score (p = 0.041, 0.004). Meeting the SB, sleep, and diet guidelines had a lower BMI z-score (all p < 0.01) and lower odds of overweight/obesity (all p < 0.05). There were significant interactions between PA and diet. Compared with meeting no guidelines, those who met multiple guidelines had a lower risk of overweight/obesity (all p < 0.01). The more guidelines the participants met, the lower odds of overweight/obesity (p for trend <0.001). Conclusions: PA, SB, sleep, and diet are important behaviors associated with adiposity among children and adolescents. Attaining adequate amounts of appropriate multiple behaviors provided an additional benefit. It is important for children to meet recommended behavioral guidelines or recommendations. Interventions that aim to improve awareness of and compliance with these guidelines are needed in future. [ABSTRACT FROM AUTHOR]

Objective: To analyze the age distribution of nutrition and health knowledge level of Chinese residents aged 18-64., Methods: A total of 102 398 residents aged 18-64 were selected from 302 survey sites in China by multi-stage cluster random sampling method, a total of 98 567 respondents were included in the study. Both mean and rate were calculated by complex sampling weighting., Results: The nutrition and health knowledge score of residents aged 18-24, 25-34, 35-44, 45-54 and 55-64 years old in China were(65.1±11.4) points, (64.6±11.7) points, (64.7±12.0) points, (62.2±12.8) points and(59.5±13.3) points. The nutrition and health knowledge awareness rates were 20.3%, 19.1%, 20.3%, 16.9% and 12.1%, respectively(P&lt;0.001). A decreasing trend in all dimensions and overall nutrition and health knowledge with increasing age was found(β&lt;0, P&#95;(trend)&lt;0.001). This trend was also reflected across gender or regions. While the trend of nutrition and health knowledge level with age varies with different literacy levels. Differences in knowledge points with positive response rates &lt;30% by age groups., Conclusion: The level of nutrition and health knowledge among Chinese adult residents of all ages is relatively low in 2021, but the knowledge shortcomings are different.

Objective: To analyze the knowledge level and related factors related to dietary recommendations for Chinese residents aged 18-64 years in 2021., Methods: A multi-stage cluster random sampling was used to select 302 survey sites across the country, there were 102 398 people surveyed, with 98 567 valid questionnaires, 49.4% male and 41.9% urban, and an average age of(38.5±12.2) years. A standardized questionnaire certified by experts and evaluated for reliability and validity was used to conduct the face-to-face survey. The questionnaire was scored out of 100 points; dietary recommendation-related knowledge was scored out of 30 points, and a score of 22.5 points or above was judged as acquiring relevant knowledge. Descriptive statistics were used to report the values of relevant knowledge level of respondents with different characteristics, and univariate and multi-variate Logistic regression models were used to analyze the factors influencing relevant knowledge level., Results: The average score of dietary recommendation-related knowledge was(17.9±4.2), and the knowledge awareness rate was 14.7%. The five knowledge points with the lowest correct rates were the recommended intakes of soybeans and products(21.1%), added sugars(22.6%), milk(25.5%), food groups(27.6%), and cooking oils(31.4%) and the recommended intakes of fruits and salt were also less correct(56.9% and 58.5%). Multi-variate analysis revealed that the knowledge of dietary recommendations was lower among residents in rural(OR=0.945, 95%CI 0.944-0.945), central(OR=0.863, 95%CI 0.863-0.864) and western(OR=0.983, 95%CI 0.982-0.983) areas, those with chronic diseases(OR=0.784, 95%CI 0.783-0.784) and those who did not know about chronic diseases(OR=0.694, 95%CI 0.694-0.694) compared to the counterparts; female(OR=1.090, 95%CI 1.090-1.091) had a higher knowledge rate compared to male. The awareness rate of residents increased with the level of education, and the trend was statistically significant(P&lt;0.001)., Conclusion: The level of knowledge related to dietary recommendations for the adult population in China in 2021 is low, especially for the recommended intake of dairy, soybeans and products, and cooking oils, and the knowledge level of men, rural, central and western, and less educated populations is even lower.

Objective: To explore the geographical distribution of nutrition and health knowledge among 18-64 years old adults in China., Methods: A total of 102 398 residents aged 18-64 from 302 survey sites were selected by multi-stage cluster random sampling method, a total of 98 567 respondents were included in the study. Both mean and rate were calculated by complex sampling weighting., Results: The nutrition and health knowledge score in eastern region(65.5±12.0) was higher than that in central(62.4±11.9) and western(61.4±12.9), and the score in northern region(63.9±11.8) was higher than that in southern(63.1±12.8). In the seven geographical regions, the highest score was in north(65.8±11.4), and the lowest score was in northwest(61.6±12.2). The awareness rate of nutrition and health in eastern region(22.4%) was higher than that in central(14.7%) and western(14.9%), the highest awareness rate among the seven geographic regions was in east(23.2%), followed by north(22.5%) and the lowest was in northwest(13.2%). There were also differences in nutritional health knowledge levels of residents in different regions in the five dimensions(P&lt;0.001). Northwest China had the lowest awareness of food characteristics and nutrition and disease dimensions, South China had the lowest awareness of dietary recommendations and food choices dimensions, and Southwest China had the lowest awareness of food safety dimensions., Conclusion: The level of nutrition and health knowledge of Chinese adults have large geographical differences.

Objective: To establish nutrition knowledge questionnaire items for Chinese adults by Delphi consensus study., Methods: The framework system and preliminary items of nutrition knowledge questionnaire were established through literature review and experts consultation, considering the nutrition status and problems of Chinese people. Delphi method was used to conduct consensus analysis with 11 experts in related field involved to determine the nutrition knowledge questionnaire items., Results: The active coefficients of consultation in two rounds were both 100%(11/11), and the authority coefficients of experts were 0.900. The average scores of all items were(4.67±0.28) and(4.80±0.21), the variation coefficients were 0.06 and 0.04, and the Kendall harmony coefficients were 0.261(χ~2=39.645, P=0.004) and 0.324(χ~2=43.122, P=0.001), respectively. After the second round of consultation, all selected items met the inclusion criteria. Finally, 20-item nutrition knowledge questionnaire were determined, including five dimensions of dietary recommendations, food characteristics, nutrition and health, food choices and food safety., Conclusion: The Delphi consensus of nutrition knowledge questionnaire items for Chinese adults were basically achieved.

Objective: To analyze the access channels on nutritional health knowledge of Chinese residents aged 18-64 years in 2021., Methods: A multi-stage cluster random sampling was used to select 302 survey sites across the country, there were 102 398 people surveyed, with 98 424 valid questionnaires, 49.4% male and 42.0% urban, with an average age of(38.5±12.2) years old. A standardized questionnaire certified by experts and evaluated for reliability and validity was used to conduct the face-to-face survey. Descriptive statistics were used to report the access channels on nutrition and health knowledge of respondents, and the proportion of access channels of respondents with different characteristics was compared by chi-square test., Results: The access channels on nutrition and health knowledge of Chinese residents aged 18-64 in 2021 were, in descending order, WeChat/Microblog/Tik Tok/Kuaishou and other software(77.0%), TV/radio(55.7%), family/relatives/friends(41.8%), books/newspapers/journals/magazines(32.5%), website search(30.7%), promotional lectures(29.3%) and other(1.9%). A high proportion of people who access nutrition and health knowledge through software, website searches and books/newspapers were mostly from the lower age groups, higher education groups, urban and eastern regions. People with a high proportion of access through TV/radio, family/relatives/friends and promotional lectures were mostly from the higher age groups, lower education groups, rural and western areas(P&lt;0.001). Women are more likely than men to obtain nutrition and health information from all channels except website search. The higher the level of education, the higher the level of concern for nutrition and health knowledge(P&lt;0.001)., Conclusion: In 2021, the top access channel for Chinese residents aged 18-64 to obtain nutrition and health knowledge is WeChat/Microblog/Tik Tok/Kuaishou and other software. There are differences in access channels for different groups of people.

Objective: To learn the knowledge level on &quot;salt and health&quot;, and analyze the influence on related behavior among school teachers in four Chinese cities., Methods: The data of 2014 salt KAP among urban residents in China was used, with stratified random cluster sampling, a total of 2518(male 708, female 1810) school teachers were selected from four cities of China, including Shenyang, Wuhan, Chengdu and Guangzhou city. Self-filled questionnaire was used to collect the information on the salt intake knowledge and behavior. The statistical software package SAS version 9. 4 was used for data analysis., Results: Among the teachers in four Chinese cities, about 50. 9% of them knew the recommendation of salt intake, about 66. 6% of them knew sodium in the salt may influence health. Approximately 85. 3% of them knew eating long-term salty food may cause hypertension. The proportions of knowing salt intake among female, 40 years and older, below the undergraduate, higher family income teachers were higher than their counterparts(P&lt;0. 05). The proportions of knowing the health influence of sodium among female, higher family income teachers were higher than their counterparts(P&lt;0. 05). The proportions of knowing that eating long-term salty food may cause hypertension among female, undergraduate and above, higher family income teachers were higher than their counterparts(P&lt;0. 05). About 80. 1% of them knew the nutrition labeling on the package food, about 19. 7% of them knew the nutrition labeling contents. Teachers utilized nutrition labeling differently owing to their knowledge on the labeling contents(P&lt;0. 05). In the past three months, about 21. 4% of the teachers always use low-sodium salt when cooking, only 4. 2% of them always control their family's salt intake by using salt control spoon, about 25. 4% of them always choose low-sodium food when purchasing, only 15. 1% of the teachers requested the meals cooked lightly when eating out. The proportions of teachers who used low-sodium salt among female, higher family income, knowing salt intake recommended, knowing the health influence of sodium, knowing that long-term salty food may cause hypertension, active learning related knowledge, family members suffering from hypertension were higher than their counterparts(P&lt;0. 05). The proportions of using salt control spoon among teachers under Bachelor's degree, active learning related knowledge were higher than their counterparts(P&lt;0. 05). The proportions of teachers purchasing low-sodium food among 40 years and older, under Bachelor's degree, higher family income, knowing salt intake recommended, knowing the health influence of sodium, knowing that long-term salty food may cause hypertension, family members not suffering from hypertension, active learning related knowledge were higher than their counterparts(P&lt;0. 05). The proportions of teachers requesting the meals cooked slightly when eating-out among 40 years and older, under Bachelor's degree, not knowing salt intake recommended, not knowing that long-term salty food may cause hypertension, not knowing if their family members suffered from hypertension, active learning related knowledge were higher than their counterparts(P&lt;0. 05). The teachers consumed soy sauce, bean paste, fried bread stick differently owing to their knowledge about this(P&lt;0. 05)., Conclusion: The teachers in the four cities have grasped some knowledge on salt and health, but their related behaviors should be improved to reduce the salt intake.

Nutrient supplements play a key role in managing malnutrition/chronic diseases and are commonly used in the world, but few studies described the prevalence of nutrient supplement use at the national level in China. To our knowledge, this study provides the first detailed investigation of nutrient supplement use in a nationally representative sample of the Chinese population. This study aimed to describe the prevalence of the nutrient supplement use among the Chinese population aged 6 years or older in 2010⁻2012. A stratified multistage cluster sampling method was conducted to recruit participants from 150 surveillance sites. The demographic characteristics and information about nutrient supplement use were collected through an interview-administrative questionnaire. A total of 74,501 children and adults (excluding the pregnant women) were included in the study (mean age, 35.7 years; male, 47.0%, female, 53.5%). Only 0.71% of the participants reported using nutrient supplements in the previous month. Participants aged 6⁻11 years and 60 years and above, female, living in large urban, with higher education level and higher family incomes were more likely to use nutrient supplements than their counterparts ( p < 0.05). The prevalence of nutrient supplement use increased with age in Chinese adults. The highest usage among the nutrient supplements was multi-vitamins and minerals with 0.37%. More females used single vitamin, multi-mineral, multi-vitamins and minerals than males ( p < 0.05). The nutrient supplement use proportion was highest amongst the participants with a health problem, and the participants who had no idea about their health conditions were the least likely to use the nutrient supplements ( p < 0.05). The prevalence of nutrient supplement use was low among the Chinese population in 2010⁻2012. Further research is required to understand the social cognition, usage reasons, dosage and consumption motivation of NS, and the relationships with health effects, to ensure that the nutrient supplements can be appropriately promoted in China.

Objective: To describe the status of sedentary activities of the Chinese pupils in the leisure time, and to provide basic information for developing intervention strategies., Methods: Utilizing the data of 2010-2012 China National Nutrition and Health Surveillance, using the multi-stage stratified cluster randomization sampling method, a total of 39 242 pupils on sedentary activities including watching TV, using computer, playing computer games, reading and doing homework, was analyzed. Age and sex standardization was performed based on the China 2009 population published by National Statistics Bureau. The sedentary time after weight adjustment for complex sampling was reported to analyze the time distribution of Chinese pupils., Results: The average time of Chinese pupils' sedentary activities was 2. 92 h/d. There was significant difference between the urban and rural area( 3. 04 h vs 2. 81 h), the boys spent more time slightly on the sedentary activities in their spare time. The senior high school students spent more time on the sedentary activities than the junior school students( 3. 45 h vs 3. 06h), who spent more time than the elementary school students( 3. 06 h vs 2. 60 h). The prevalence of engaging sedentary activities longer than 2 hours was 86. 2%, there was significant difference between the urban and rural area( 87. 5% vs 85. 1%) and the ratio of boys and girls was 86. 4% and 86. 0%, respectively. More senior high school students engaged in sedentary activities longer than 2 hours daily than the junior school students, and the proportion of the junior school students engaged in sedentary activities longer than2 hours was higher than the elementary school students. The average daily homework time was 1. 48 h, and boys spent less time on homework than girls slightly( 1. 44 h vs 1. 52 h). Pupils in the senior school engaged more time in their homework than the junior school students( 1. 90 h vs 1. 62 h). and pupils in the junior school engaged more time in their homework than the elementary school students( 1. 62 h vs 1. 20 h)., Conclusion: Chinese pupils engaged too much time in sedentary activities in the leisure time, so it is recommended that schools and families create a supportive environment, encouraging the children to reduce their sedentary activities and to improve their physical activity levels.

Objective: To analyze the leisure time sedentary behavior and related sociodemographic factors among Chinese adults., Methods: The data were collected by the physical activity questionnaire of 2012 Chinese Nutrition and Health Survey, a total of142 369 subjects aged 18 years and over( male 62 563, female 79 806) were investigated about their sedentary behavior in leisure time., Results: The average hour of total sedentary activities was 2. 66 h/d. About 82. 1% of residents aged 18 years and over spent2 h and over on sedentary activities in leisure time. Urban( 83. 0%), male( 83. 8%), higher education level, higher family income( 83. 6%) and never married( 89. 1%) were higher than their counterparts, as age decreasing and educational level increasing, the rateof spending 2 h and over on sedentary activities increased. Logistic regression model showed that the rates varied according to different social determinants., Conclusion: Chinese resident spent much time on sedentary activities and the pattern was varied according to socio-demographic factors.

Objective: To study the effects of parents on primary and secondary school students' breakfast behaviors in four cities in China., Methods: A stratified random cluster sampling method was used to recruit subjects. A total of 10 545 primary and secondary students and their parents were selected from Shenyang, Guangzhou, Wuhan and Chengdu. A questionnaire survey was used to collect information about frequency and nutrition quality of their breakfast., Results: Primary and secondary school students' breakfast behaviors were positively correlated with their parents'. Compared with not eating breakfast, the OR( 95% CI) values of parents eating 1 to 3 times, 4 to 6 times and 7 times breakfast a week were 2. 917( 1. 856-4. 585), 4. 323( 3. 010-6. 208) and 5. 829( 4. 317-7. 870), respectively. Compared with poor nutrition quality, the OR( 95% CI)values of adequate and good nutrition quality of parents' breakfast were 1. 875( 1. 542-2. 280) and 6. 372( 5. 270-7. 704). The higher the educational level of parents, the more likely students did not eat breakfast, but the more adequate nutrition quality of breakfast., Conclusion: Parents' breakfast behaviors greatly influence on the students'. Interventions should be taken against the different educational levels of parents.

Objective: To analyze the status and the influence factors of exercise and sedentary activities in the leisure time among third and fourth grade pupils in Qingdao, Tai' an and Yantai city of Shandong province., Methods: With random cluster sampling, a total of 2283 primary students were selected from three cities of Shandong province. Questionnaires were used to collect the information on their exercise, sedentary activities., Results: In the past week the participation rate of exercise in the leisure time among the pupils was 65.9%. Among the pupils who participated exercise, the average days of moderate and high-intensity exercise was four, and the average daily exercise time was 30 minutes. The average time of sedentary activities in the leisure time was 0.9 h/d, and the rate of 2 hours and over per day of sedentary activities was 13.6%. Pupils participating the exercise was related to their area, gender, their satisfaction of their body image and their parents' exercise. Their sedentary patterns was related to their understanding of their own body weight and their parents' sedentary behavior., Conclusion: Intervention related to physical activity should be strengthened among pupils and their parents to promote their physical activity level.