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BackgroundMultimorbidity imposes a heavy burden on individuals, families, and society. There are relatively few studies exploring patterns of multimorbidity among middle-aged adults in China. ObjectiveTo explore the current status of multimorbidity, associated risk factors, and multimorbidity patterns among adults aged 45-64 years in China, so as to provide a scientific basis to prevent and control multimorbidity in China. MethodsA total of 5494 adults aged 45-64 years from the Chinese Health and Nutrition Survey (CHNS) in 2018 were selected. Of these, 2494 (45.39%) were men and 3000 (54.61%) were women. The nine diseases included were hypertension, diabetes, dyslipidaemia, obesity, mild cognitive impairment (MCI), myocardial infarction, stroke, asthma, and tumor. The prevalence of each disease or multimorbidity was expressed as N (%). Comparisons of multimorbidity prevalence between different groups were performed using the χ2 test or Cochran-Armitage trend test. Association rule with the Apriori algorithm was used to explore the pattern of multimorbidity, with parameters set at a minimum conditional support of 3.00%, a minimum rule confidence of 50.00%, and a lift of >1.20. Logistic regression was used to evaluate the associations between selected risk factors and multimorbidity. ResultsIn 2018, 37.44% of participants reported multimorbidity in 15 provinces of China. The prevalence of diseases in descending order was dyslipidaemia (39.99%), hypertension (39.48%), obesity (16.42%), MCI (14.47%), diabetes (14.16%), tumor (1.09%), stroke (1.04%), myocardial infarction (0.71%), and asthma (0.64%). A total of seven multimorbidity patterns were identified in this group. Obesity paired with hypertension, and diabetes paired with dyslipidemia were the two major patterns of multimorbidity in the general population and age or sex subgroups. The multimorbidity patterns of different populations were concentrated in the combination of obesity, hypertension, diabetes, and dyslipidemia. The risk of multimorbidity was lower in females than in males (OR=0.85, 95%CI: 0.75, 0.97). The multimorbidity risk was 1.56 times higher in the 55-64 years group than in the 45-54 years group (OR=1.56, 95%CI: 1.40, 1.75). Drinking in the past year increased the risk of multimorbidity by 25% (OR=1.25, 95%CI: 1.08, 1.45) compared to no alcohol comsumption in the past year. High and medium levels of physical activity were associated with a decreased OR (high: OR=0.74, 95%CI: 0.65, 0.85; medium: OR=0.81, 95%CI: 0.70, 0.93) with low level of physical activity as reference. ConclusionIn 2018, there was a high prevalence rate of multimorbidity among middle-aged adults in China. The main multimorbidity patterns were obesity-hypertension and diabetes-dyslipidemia. Surveillance and interventions should be strengthened particularly for men, individuals with alcohol consumption or insufficient physical activity, and those with major multimorbidity patterns.

Abstract The impact of external factors on the human gut microbiota and how gut microbes contribute to human health is an intriguing question. Here, the gut microbiome of 3,224 individuals (496 with serum metabolome) with 109 variables is studied. Multiple analyses reveal that geographic factors explain the greatest variance of the gut microbiome and the similarity of individuals’ gut microbiome is negatively correlated with their geographic distance. Main food components are the most important factors that mediate the impact of host habitats on the gut microbiome. Diet and gut microbes collaboratively contribute to the variation of serum metabolites, and correlate to the increase or decrease of certain clinical indexes. Specifically, systolic blood pressure is lowered by vegetable oil through increasing the abundance of Blautia and reducing the serum level of 1‐palmitoyl‐2‐palmitoleoyl‐GPC (16:0/16:1), but it is reduced by fruit intake through increasing the serum level of Blautia improved threonate. Besides, aging‐related clinical indexes are also closely correlated with the variation of gut microbes and serum metabolites. In this study, the linkages of geographic locations, diet, the gut microbiome, serum metabolites, and physiological indexes in a Chinese population are characterized. It is proved again that gut microbes and their metabolites are important media for external factors to affect human health.

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

Abstract Objective: Dietary transitions in China have undergone rapid changes in over the last three decades. The purpose of this study is to describe trends in the macronutrient consumption, the sources of those nutrients and the diet quality among Chinese adults. Design: Longitudinal China Health and Nutrition Survey (CHNS) cohort analysis. Main outcomes are dietary energy intake from total carbohydrate, protein and fat and their subtypes, as well as food sources of carbohydrates, protein, and fat, and the China Dietary Guidelines Index 2018 (CDGI-2018). Setting: CHNS (1991, 2000, 2009 and 2015). Participants: Data from the longitudinal 1991, 2000, 2009 and 2015 CHNS of adults aged 18 years or older who had complete demographic information. Results: The estimated mean energy intake from total carbohydrate decreased from 62·6 % to 50·6 % between 1991 and 2015, while the mean energy intake from total protein increased from 12·6 % to just 13·1 % and the mean energy intake from total fat significantly increased from 24·0 % to 35·8 % (P < 0·001 for trend). Decreases were observed in evaluated mean energy from low-quality carbohydrates (from 53·6 % to 41·7 %) and incomplete protein (from 9·3 % to 7·5 %), while increases were seen in estimated mean energy from high-quality protein (from 3·3 % to 5·5 %), high-quality fat (from 9·1 % to 16·7 %) and low-quality fat (from 14·9 % to 19·0 %). Low-quality carbohydrates, primarily those derived from refined grains, decreased from 52·2 % to 36·2 %. The diet quality as measured by CDGI-2018 improved, with the estimated mean increasing from 41·7 to 52·4 (P < 0·01 for trend). Conclusion: For Chinese adults, there was a significant change in the macronutrient composition over the previous few decades. The percentage of energy consumed from carbohydrates significantly decreased; however, the percentage of energy consumed from total fat significantly increased. Additionally, the diet quality remains suboptimal.

BackgroundChina is witnessing an accelerated aging process and an increasingly serious situation of Parkinson's disease. Research on the pre-disease stage and its related influencing factors has gained more and more attention.ObjectiveTo analyze the current situation of prodromal Parkinson's disease (pPD) of people aged 55 years and above in four provinces of China, and to explore its influencing demographic and socio-economic characteristics.MethodsUsing the data of Community-based Cohort Study on Nervous System Disease in 2020, a total of 10724 participants with complete data on demographic and socio-economic factors and risk factors on Parkinson's disease were selected. Based on the criteria recommended by the International Parkinson and Movement Disorder Society (MDS), we evaluated risk level (i.e., post-test probability) of pPd, prevalence of possible or probable pPD, and number of pPD-related risk/prodromal markers in the participants. Multiple linear regression and multiple logistic regression models were used to analyze the influencing socio-demographic factors of risk level of pPd and prevalence of possible or probable pPD, and Poisson regression and multinomial logit regression models were used to analyze the influencing socio-demographic factors of the number of pPD-related risk/prodromal markers in the total sample, men, and women, respectively.ResultsThe median (P25, P75) of post-test probability of pPD in 2020 was 0.78% (0.42%, 1.66%), the prevalence rate of possible or probable pPD was 0.34%, and 69.03% of the participants reported 3-5 pPD-related risk/prodromal markers. The post-test probabilities of men, those with older age, lower education level, per capita monthly household income < 1000 yuan, urban residency, or without active employment were higher (P

BackgroundChanges in cognitive function exist before the onset of clinical Parkinson's disease. However, studies on association between cognitive function and prodromal Parkinson's disease (pPD) are limited.ObjectiveTo estimate probability of pPD and assess its association with global and domain cognitive function in Chinese elders.MethodsData were drawn from the Community-based Cohort Study on Nervous System Disease 2018 (baseline) and 2020 (follow-up). We selected 3911 residents aged 55 and above who participated the two waves, without Alzheimer's disease and Parkinson's disease, and with completed information on demographics, disease history, cognitive function test, and risk factors of Parkinson's disease. Cognitive function was assessed using the Chinese version of Montreal Cognitive Assessment Scale. Calculation of probability of pPD and assessment of possible (probability between 30% and

BackgroundIt has been reported that a high intake of dairy products might be associated with an increased risk of Parkinson's disease (PD) in foreign studies, but no such study has yet been conducted on prodromal Parkinson's disease (pPD) and the Chinese population. ObjectiveTo investigate the prospective relationship between the intake of dairy products and pPD among people aged 55 and above in four provinces of China. MethodsThe research data were obtained from the baseline 2018 and follow-up 2020 surveys of Community-based Cohort Study on Nervous System Disease. A total of 9984 residents were selected who participated in both waves of surveys and had complete data on demographics, dietary products intake, and risk factors for PD. We evaluated the risk level and the numbers of related risk/prodromal markers of pPD in the participants based on a criteria recommended by the International Parkinson and Movement Disorder Society (MDS). Food Frequency Questionnaire was used to obtain food consumption data in the past 12 months, and the intake of dairy products was calculated and divided into non-consumption and tertiles of consumption (T1, T2, and T3 from low to high). Multiple linear regression was used to analyze the association between baseline dairy intake and risk level of follow-up pPD. Poisson regression and multinomial logit regression models were used to analyze the relationship of baseline dairy products and the number of risk/prodromal markers of follow-up pPD in the population, and multiple logistic regression was used to analyze each risk/prodromal marker of follow-up pPD according to baseline levels of dairy products intake. ResultsThe percentage of residents without dairy products consumption was 58.02% in 2018, and the dairy products intakes were relatively high among residents being female, aged 55 to 74 years, with an education level of middle school and above, with a per capita monthly household income ≥ 1000 yuan, living in urban areas, and without active employment (P

BackgroundGastrointestinal microbiota plays an important role in the development of Parkinson's disease (PD), and dietary factors have a great impact on intestinal micro ecology. At present, few studies focus on red meat and PD, especially prodromal PD (pPD). ObjectiveTo understand the relationships of the intake of red meat and processed meat products with pPD and the number of risk/prodromal markers, and to explore the association of dietary factors with pPD. MethodsBased on the data of Community-based Cohort Study on Nervous System Disease in 2018 and 2020, adults aged 55 years and older with complete demographic information, dietary survey information, and information on risk factors related to PD were selected from four provinces of China. After excluding those reporting abnormal total energy intake or those reporting alcohol drinking or abused drugs for a long period of time, and confirmed mental diseases with prescribed drugs, a total of 10003 subjects were included. Food frequency questionnaire was used to calculate the intake of red meat and processed meat products. The pPD-related risk/prodromal markers were selected following the International Parkinson and Movement Disorder Society criteria for pPD, and the risk level and the number of markers of pPD were then calculated. The relationship between the intake of red meat and processed meat and the risk level of pPD was analyzed by multiple linear regression. The relationship between the intake of red meat and processed meat and the pPD marker number groups was analyzed by multinomial logit regression model. ResultsIn 2018, the intake of red meat and processed meat was 28.57 g·d−1 in the target population. In 2020, the median of the number of risk/prodromal markers was 3, and the median M (P25, P75) of the posterior probability of pPD was 0.74% (0.42%, 1.49%). The multiple linear regression analysis showed that the higher the intake of red meat and processed meat, the higher the risk level of pPD in follow-up (b=0.021, P

BackgroundMagnesium plays an important physiological role in human, but the association between dietary magnesium intake and the risk of hypertension is unclear. Few studies have reported the dose-response relationship in Chinese population. ObjectiveTo analyze the relationship between dietary magnesium intake and the risk of hypertension in Chinese adults aged 18-64 years, and to explore the dose-response relationship. MethodsA total of 13082 adults aged 18-64 years who participated in at least two rounds of the China Health and Nutrition Survey (CHNS) from 2000 to 2018 were selected. Dietary data were obtained by consecutive 3-day 24-hour dietary recall and weighting & bookkeeping method. Blood pressure was measured with a standard mercury sphygmomanometer. Hypertension was diagnosed when systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg, or self-reported hypertension history or using antihypertensive drugs. The mean of dietary magnesium intake in all survey years (excluding the last survey) was used as the dietary magnesium intake of the subject, and the mean of dietary magnesium intake was divided into 5 equal groups. Cox proportional risk model with adjustments for socio-demographic factors, body mass index (BMI), smoking and drinking, sleep time, physical activity, and dietary factors, was used to analyze the association between dietary magnesium intake and the risk of hypertension. A sensitivity analysis was conducted by excluding baseline diabetes patients and adjusting for baseline blood pressure. In addition, a restricted cubic spline model was used to analyze the dose-response relationship between them. ResultsIn this study, male participants accounted for 47.70%, and those aged 18-44 years accounted for 72.47%. The mean follow-up time was 12.56 years and the prevalence of hypertension was 13.86%. Dietary magnesium intake was inversely associated with the risk of hypertension at the 4th quintile (median 333.56 mg·d−1) and the 5th quintile (median 420.07 mg·d−1) compared with the 1st quintile (median 189.06 mg·d–1), and the hazard risk (HR) values and associated 95%CIs were 0.81 (0.67-0.97) and 0.81 (0.66-0.99) respectively. After eliminating baseline diabetes and adjusting baseline blood pressure, dietary magnesium intake remained negatively associated with the risk of hypertension, which was consistent with the population-wide HR. The association between dietary magnesium intake and the risk of hypertension was non-linear (χ2=11.07, P=0.01). When dietary magnesium intake was higher than 339 mg·d−1, the risk of hypertension decreased, and the HR value was the lowest in 375-418 mg·d−1 (HR=0.65, 95%CI: 0.45-0.94), and then gradually tended to 1. There was no statistically significant association at 467 mg·d−1 and above.ConclusionMagnesium intake in the range of 339-467 mg·d−1 is negatively associated with the risk of hypertension in Chinese adults, presenting a U-shaped dose-response relationship.

BackgroundDiabetes is a major contributor to global burden of disease. The role of magnesium in the prevention of diabetes has aroused concern. However, the research results on the impact of dietary magnesium on the risk of diabetes are hitherto inconsistent. ObjectiveTo evaluate the association between dietary magnesium intake and the risk of diabetes through a systematic review. MethodsPubMed, Web of Science, China National Knowledge Infrastructure, Wanfang databases were searched for prospective studies that contained risk estimates for magnesium intake-associated diabetes and were published from January 1, 2000 to December 31, 2021. Two researchers independently screened the literature according to a set of pre-prepared inclusion and exclusion criteria, extracted the data according to an unified data extraction table, and evaluated the quality of included articles with Newcastle-Ottawa Scale (NOS). R 4.0.3 software and Stata SE16.0 software were used for meta-analysis and subgroup meta-analysis, and Higgins I2 statistics were used to test the heterogeneity of the included studies. The sources of heterogeneity were analyzed by univariate meta regression. ResultsA total of 14 articles involving 17 prospective cohort studies (1065267 participants and 40506 patients with diabetes) were included in the study. The NOS scores ranged from 8 to 9, with an average of 8.6, indicating that the included studies were classified as being high quality. The highest quintile of magnesium intake group reduced the risk of diabetes by 22% (RR=0.78, 95%CI: 0.73-0.82) compared with the lowest quintile group. This association was not substantially modified by geographic region, sex, or follow-up length. The highest quintile of dietary magnesium intake in the Americas and Asia were associated with 22% and 26% reductions in the risk of type 2 diabetes respectively compared with the lowest quintile group (the Americas, RR=0.78, 95%CI: 0.73-0.84; Asia, RR=0.74, 95%CI: 0.63-0.88); The highest quintile of dietary magnesium intake in female, male and without gender stratified were associated with 22%, 19% and 46% reductions in the risk of type 2 diabetes respectively compared with the lowest quintile group (Female RR=0.78, 95%CI: 0.73-0.84; Male RR=0.81, 95%CI: 0.74-0.89; Both RR=0.54, 95%CI: 0.42-0.68); Compared with the lowest quintile groups, the groups with the highest quintile of dietary magnesium intake with a follow-up time of less than 10 years and more than 10 years reduced the risk of type 2 diabetes by 26% and 20% respectively (≤10 years, RR=0.74, 95%CI: 0.65-0.83; ＞10 years, RR=0.80, 95%CI: 0.75-0.85). After adjusting for hypertension, the highest quintile of dietary magnesium intake group reduced the risk of type 2 diabetes by 20% compared with the lowest quintile group (RR=0.80, 95%CI: 0.74-0.85). The year of publication (P

BackgroundAt present, domestic and foreign studies on the association between dietary magnesium and diabetes risk are not consistent, and there are relatively few prospective studies in China and the study population is relatively limited. ObjectiveTo explore the association between dietary magnesium intake and diabetes risk in Chinese adults in 15 provinces (autonomous regions, municipalities), and to provide a scientific basis for revising dietary magnesium intake reference for Chinese residents. MethodsA total of 8061 adults aged 18-64 who participated in at least two follow-up surveys in the China Health and Nutrition Survey in 2009, 2015, and 2018, had complete survey data, and did not report diabetes at baseline were selected as subjects. Food consumption data were collected from 3-day 24-hour dietary recalls and by weighing household cooking oil and condiments. The average daily dietary magnesium intake was calculated based on the food composition table. Multiple Cox proportional risk regression model and restricted cubic spline (RCS) model were used to analyze the association and dose-response relationship between dietary magnesium intake and diabetes risk. Diabetes was defined according to the Chinese Guidelines for the Prevention and Treatment of Type 2 Diabetes (2020 edition). ResultsA total of 47237.46 person-years were followed up, with an average follow-up of 5.86 years. Among 8061 subjects, the incidence rate was 8.86%. Compared with those in the top quintile of magnesium intake (Q5), those with lower dietary magnesium intake were more likely to be female, have higher income, higher education, live in urban areas, and have lower intakes of energy, dietary fiber, and dietary calcium. After adjusting for demographic characteristics, lifestyle, and dietary factors, compared with adults in the lowest quintile of dietary magnesium intake, the results of Cox proportional risk regression model showed that the second (median: 220.96 mg·d−1), third (median: 263.01 mg·d−1), and fourth (median: 312.33mg·d−1) quintile dietary magnesium intake reduced the risk of diabetes by 45% (HR=0.55, 95%CI: 0.43-0.71), 39% (HR=0.61, 95%CI: 0.47-0.78), and 34% (HR=0.66, 95%CI: 0.51-0.78), respectively. The results of RCS analysis showed that dietary magnesium intake and the risk of diabetes were U-shaped overall. Taking the 5th percentile magnesium intake as reference, when dietary magnesium intake was lower than 240 mg·d−1, the risk of diabetes gradually decreased with the increase of magnesium intake; the risk was the lowest at 240 mg·d−1, followed by a slight increase in risk at 240-400 mg·d−1; and no statistical difference presented in the association between dietary magnesium and diabetes risk after 650 mg·d−1. ConclusionThe study findings suggest an association between dietary magnesium intake and diebetes risk. The association is negative and non-linear when dietary magnesium intake is below 240 mg·d−1.

BackgroundGlobal dietary magnesium insufficiency is widespread and seriously harmful to human health. There are few studies on dietary magnesium intake in China, and associated dietary intervention lacks scientific support. ObjectiveTo explore the dietary magnesium intake level and food sources of Chinese adults aged 18-64 in 2018, and to identify the problems of dietary magnesium intake. MethodsA total of 9181 residents in the 2018 "China Health and Nutrition Survey" were selected as the study subjects. Types and intake of food collected from consecutive 3-day 24-hour dietary recalls and by household condiment weighing and counting method. The average daily dietary magnesium intake and the composition of main food sources were calculated using the food composition table. Multiple logistic regression was used to analyze the relationship between socioeconomic factors and insufficient dietary magnesium intake. ResultsIn 2018, the daily intake of magnesium in P50 (P25, P75) of adults aged 18-64 in 15 provinces (autonomous regions and municipalities) of China was 252.28 (196.25, 326.27) mg. The proportion of residents with insufficient dietary magnesium intake was 60.9%. The proportions of women, adults aged 18-49, urban residents, southern region residents, and western regions residents with insufficient dietary magnesium intake were 66.4%, 63.4%, 62.4%, 65.2%, and 68.3%, respectively. The results of multiple logistic regression analysis showed that the risks of insufficient dietary magnesium intake were 64.6%, 24.6%, and 43.6% higher in women, urban residents, and southern region residents than those in men, rural residents, and northern region residents, respectively (OR=1.646, 95%CI: 1.509-1.794; OR=1.246, 95%CI: 1.126-1.379; OR=1.436, 95%CI: 1.311-1.573); the risk of insufficient dietary magnesium intake in residents aged 50-64 was 15.7% lower than that in residents aged 18-49 (OR=0.843, 95%CI: 0.771-0.921); the risks of insufficient magnesium intake in residents in middle and western areas were 1.202 times and 1.590 times of that in residents in eastern area (OR=1.202, 95%CI: 1.079-1.340; OR=1.590, 95%CI: 1.424-1.776). The effect of education level and income level on magnesium intake insufficiency was not observed (P>0.05). In addition, 41.4% of dietary magnesium of the subjects came from cereals and products (ranking first in food sources), and only 2.4% from dark vegetables with rich magnesium content (ranking sixth place). The top six dietary magnesium sources of men and women were the same. The proportion of dietary magnesium from cereals and products was 6.3% higher in rural residents than in urban residents, and 9.3% higher in residents living in northern regions than those in southern regions. The proportion of dietary magnesium from livestock meat and products was 1.3% higher in the 18-49 age group than in the 50-64 age group, 0.9% higher in urban residents than in rural residents, and 1.6% higher in western region residents than in eastern region residents. ConclusionThe dietary magnesium intake of Chinese residents is generally insufficient, and the source of dietary magnesium is irrational. Women, residents aged 18-49, residents in southern, middle, and western areas are high-risk populations of dietary magnesium insufficiency. Chinese residents are encouraged to eat more dark vegetables and whole grain food; women should improve their dietary quality and intake diverse magnesium-rich food; southern region residents and urban residents should increase the intake of whole grains and avoid over refining food; residents aged 18-49, urban residents, and those in western regions should adjust their dietary structure and reduce meat intake.

BackgroundMagnesium is an important nutrient, and participates in most metabolic processes. Many studies show an association between dietary magnesium intakes and nutrition-related diseases such as diabetes. However, the data of dietary magnesium intakes and secular trends among the whole life cycle of Chinese residents are not available. ObjectiveTo investigate the dietary magnesium intakes and associated secular trends over the past three decades in residents of all ages and China, to identify the high-risk residents of magnesium deficiency and plan nutritional interventions, and provide basic data support for the revision of dietary magnesium reference intake. MethodThe data came from the 10 rounds of the "China Health and Nutrition Survey" from 1991 to 2018, and the participants with complete sociodemographic and dietary data wereselected. The median intakes, insufficient rates, and secular trends of dietary magnesium intakes were analyzed in different survey years. Analysis of multiple linear regression was used to analyze the annual change characteristics of dietary magnesium intakes controlling gender, age, education, urban-rural stratum, and north-south region. Wilcoxon trend test was used to analyze the secular trends of dietary magnesium intakes in different characteristic groups. The trends of insufficient rate were analyzed by Cochran-Armitage trend test among different characteristic groups. ResultsA total of 127169 residents were included in the present study. The medians of dietary magnesium intakes in 1991, 1993, 1997, 2000, 2004, 2006, 2009, 2011, 2015, and 2018 were 283.70, 283.38, 304.26, 285.50, 283.64, 275.49, 267.92, 242.93, 240.51, and 238.89 mg·d−1, respectively, showing a significant downward trend (F=2931.81, P

To investigate the prospective relationship between macronutrient intake and overweight/obesity, data were collected in the China Health and Nutrition Survey (CHNS) from 1991 to 2018. Adults who participated in at least two waves of the survey and were not obese at baseline were selected as the study subjects. A total of 14,531 subjects were finally included with complete data. Overweight/obesity was defined as a body mass index (BMI) ≥ 24.0 kg/m2. The generalized estimating equation (GEE) was used to analyze the relationship between the percentage of energy intake from macronutrients and BMI and overweight/obesity. The percentages of energy intake from protein and fat showed an increasing trend (p < 0.01), and the percentage of energy intake from carbohydrate showed a decreasing trend (p < 0.01) among Chinese adults between 1991 and 2018. Adjusting for covariates, the energy intake from fat was positively correlated with BMI, while the energy intake from carbohydrates was negatively correlated with BMI. The percentage of energy intake from non-high-quality protein and polyunsaturated fatty acids (PUFA) were positively correlated with overweight/obesity. In contrast, monounsaturated fatty acids (MUFA) and high-quality carbohydrates were negatively correlated with overweight/obesity. In short, fat, non-high-quality protein, saturated fatty acids (SFA), and PUFA were positively correlated with the risk of obesity, whereas higher carbohydrate, MUFA, and high-quality carbohydrate intake were associated with a lower risk of obesity. Obesity can be effectively prevented by appropriately adjusting the proportion of intake from the three major macronutrients.

BackgroundOverweight and obesity are on the rise all over the world and are related to a variety of chronic diseases. There is a lack of such research on the population aged 18-35.Objective To explore the trends of overweight and obesity in adults aged 18-35 from 1989 to 2018 and the epidemiological characteristics in 2018.MethodsA total of 22425 adults aged 18-35 enrolled in the China Health and Nutrition Survey in 1989, 1991, 1993, 1997, 2000, 2004, 2006, 2009, 2011, 2015, and 2018 were selected as study subjects. Overweight and obesity were judged in accordance with WST 428-2013 Determination of adult weight. The trend analysis of body mass index (BMI) level adopted a general linear model, and the trend analysis of overweight and obesity rate adopted a chi-square test for trend. A joinpoint regression model was used to calculate the average annual percentage change (AAPC) and annual percentage change (APC). A log-binomial regression model was used to analyze the relationship between socioeconomic factors and overweight/obesity, and a model with sex stratification was also constructed.Results In the period of 1989–2018, the BMI, overweight rate, and obesity rate of adults aged 18-35 all showed an upward trend. The BMI increased from (21.3±2.3) kg·m−2 to (23.3±4.0) kg·m−2, and the rate of overweight and obesity increased from 12.1% to 36.8%. The results of joinpoint regression model showed that 2000 was a joinpoint, and the APCs of overweight rates of 1989–2000 and 2000–2018 were 4.1% and 2.4% respectively (P < 0.05), and the APCs of obesity rates were 15.2% and 7.5% respectively (P < 0.05). From 1989 to 2018, the overweight rate increased at an average annual rate of 3.1% (AAPC=3.1%, 95%CI: 2.4%-3.7%, P

BackgroundIn recent years, Chinese residents have undergone profound changes in dietary habits and lifestyle, and the increasing prevalence rate of central obesity has become one of the major public health problems.ObjectiveTo analyze the changes in waist circumference distribution and central obesity prevalence, and the differences by demographic and socioeconomic factors among Chinese adults aged 18-35 in 15 provinces (autonomous regions and municipalities) from 1993 to 2018, and to provide evidence for further exploration of etiology and control measures.MethodsBased on the data of nine follow-up rounds of the China Health and Nutrition Survey from 1993 to 2018, adults aged 18 to 35 were selected as study subjects. After excluding the records of missing demographic information or abnormal physical measurement data, a total of 16008 subjects were included in this study. Central obesity was diagnosed by WS/T 428—2013 Criteria of weight for adults. Spearman rank test was used to analyze the changes of waist circumference; Cochran-Armitage trend test was used to analyze the trends of central obesity prevalence rate; multiple logistic regression analysis was used to analyze the influencing factors of central obesity in the whole population; subgroup analysis on waist circumference and central obesity prevalence rate was also conducted among participants from the 2018 follow-up survey. survey.ResultsFrom 1993 to 2018, the waist circumference and prevalence rate of central obesity of adults aged 18-35 in 15 provinces (autonomous regions and municipalities) significantly increased by year (P

Abstract Background The Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) are the most commonly used scales to detect mild cognitive impairment (MCI) in population-based epidemiologic studies. However, their comparison on which is best suited to assess cognition is scarce in samples from multiple regions of China. Methods We conducted a cross-sectional analysis of 4923 adults aged ≥55 years from the Community-based Cohort Study on Nervous System Diseases. Objective cognition was assessed by Chinese versions of MMSE and MoCA, and total score and subscores of cognitive domains were calculated for each. Education-specific cutoffs of total score were used to diagnose MCI. Demographic and health-related characteristics were collected by questionnaires. Correlation and agreement for MCI between MMSE and MoCA were analyzed; group differences in cognition were evaluated; and multiple logistic regression model was used to clarify risk factors for MCI. Results The overall MCI prevalence was 28.6% for MMSE and 36.2% for MoCA. MMSE had good correlation with MoCA (Spearman correlation coefficient = 0.8374, p

ObjectiveBody fat percentage (BF%) might be an alternative index of obesity which is the major risk factor for developing type 2 diabetes (T2D). We aim to longitudinally evaluated the relationship between BF% and risk of T2D.MethodsA sample of 5,595 adults aged 18–65 who participated in two waves of China Health and Nutrition Survey (CHNS 2015 and 2018) was analyzed. Two level mixed-effects modified Poisson regression with robust estimation of variance stratified by sex was used to evaluate the risk ratios (RRs) for T2D according to quintiles of BF%, and the curves of receiver operating characteristic (ROC) were plotted to identify the optimal total and trunk BF% cut-off points for predicting an increased T2D risk.ResultsIn males, compared with subjects in the first quintile of total BF%, those in the third (RR = 2.03, 95% CI 1.09–3.79), fourth (RR = 2.56, 95%CI 1.46–4.48), and fifth (RR = 2.16, 95%CI 1.22–3.82) quintile had higher risk of T2D after adjusting for all potential confounders (p-trend < 0.001). For females, the RR (95% CI) was 1.92 (1.14, 3.24) in the fifth quintile (p-trend = 0.014). Males and females with a trunk BF% >25.5 and 34.4% (≥ quintile 4), respectively, were at significantly increased risk of T2D (p-trend = 0.001). Besides, the optimal cut-off values of total and trunk BF% were 21.9 and 25.2% for males, and 36.7 and 30.3% for females, respectively.ConclusionsThe incident risk of T2D significantly increased over specific level of total and trunk BF% in both Chinese males and females, and the optimal BF% cut-off values were valuable for clinical application of BF% based on sex difference, which may be a cost-effective implementation for prevention and treatment of T2D in China.

ObjectiveTo explore the association between egg intake and cardiometabolic factors (CMFs) in Chinese adults.MethodThe subjects were 6,182 adults aged 18–64 who had complete survey data and had no CMFs at baseline. Egg intake was assessed with 3 days−24 h dietary recalls in all waves of the China Health and Nutrition Survey (CHNS). Multivariate Cox proportional risk regression model and restricted cubic spline (RCS) model were used to analyze the association and dose-response relationship between egg intake and CMFs.ResultsOf the 6,182 participants who did not have metabolic syndrome (MetS) at baseline, 1,921 developed this disease during an average follow-up of 5.71 years, with an incidence of 31.07%. Central obesity, elevated TG, decreased HDL-C, elevated blood pressure and elevated plasma glucose were 38.65, 26.74, 30.21, 40.64, and 30.64%, respectively. After adjusting for demographic characteristics, lifestyle, energy and BMI, using the lowest quintile (Q1) as a reference, the risk of central obesity, elevated TG, decreased HDL-C, and elevated plasma glucose in the highest quintile (Q5) were reduced by 15% (HR = 0.85, 95% CI = 0.73–0.98, P = 0.16), 33% (HR = 0.67, 95% CI = 0.57–0.78), 25% (HR = 0.75, 95% CI = 0.63 0.90, p = 0.05), and 28% (HR = 0.72, 95% CI = 0.63–0.83, p < 0.05), respectively. The risk of elevated blood pressure was reduced by 26% in the fourth quintile (HR = 0.74, 95% CI = 0.64–0.85, P = 0.85). RCS analysis show that the overall correlation and nonlinear relationship between egg intake and CMFs were statistically significant (P < 0.05). When the intake was lower than 20 g/days, the risk of MetS, central obesity, elevated blood pressure and elevated plasma glucose were negatively correlated with egg intake, while elevated TG was negatively correlated with eggs when the intake was lower than 60 g/days. There was no statistically significant association between egg intake and CMFs at higher egg intake.ConclusionThere was a U-shaped association between egg intake and CMFs in Chinese adults.

AimsTo examine longitudinal associations of obesity profiles, continuous BMI, and waist circumference (WC) with the risk of type 2 diabetes in Chinese adults.MethodsData were derived from three waves (2009, 2015, and 2018) of the China Health and Nutrition Survey, and 3,595 adults aged 18–65 years who participated in at least two waves of the survey and had completed data were analyzed. Obesity profiles included BMI- or WC-related single obesity and combined obesity. Combined obesity was categorized into six groups including Group 1 with normal BMI and WC, Group 2 with normal BMI but pre-abdominal obesity, Group 3 with normal BMI but abdominal obesity, Group 4 with abnormal BMI (overweight and general obesity) and normal WC, Group 5 with abnormal BMI and pre-abdominal obesity, and Group 6 with abnormal BMI and abdominal obesity. Three-level mixed-effects logistic regressions with random intercept stratified by gender and restricted cubic splines were performed to examine ORs and 95%CIs for the risk of type 2 diabetes.ResultsIn men, compared with subjects of Group 1, those in Group 3 had higher risk, with an OR of 4.83 (95% CI: 1.99–11.74), followed by those in Group 6 (OR = 4.05, 95%CI: 2.32–7.08) and Group 5 (OR = 2.98, 95%CI: 1.51–5.87) after adjusting for all potential confounders. For women, the subject of Group 6 had highest risk (OR = 8.79, 95%CI: 4.04–19.12), followed by Group 3 (OR = 3.30, 95%CI: 1.23–8.86) and Group 5 (OR = 3.16, 95%CI: 1.21–8.26). No significant association between abnormal BMI and normal WC (Group 4) was observed in both genders. Type 2 diabetes risk increased steeply at BMI of 23.5 kg/m2 and 22.5 kg/m2 or higher, and WC of 82.0 cm and 83.0 cm or higher in Chinese adult men and women, respectively (p for overall

Visual perception is profoundly modulated by spatial attention, which can selectively prioritize goal-related information. Previous studies found spatial attention facilitated the efficacy of neuronal communication between visual cortices with hierarchical organizations. In the primary visual cortex (V1), there is also a hierarchical connection between simple (S) and complex (C) cells. We wonder whether and how spatial attention modulates neuronal communication within V1, especially for neuronal pairs with heterogeneous visual input. We simultaneously recorded the pairs’ activity from macaque monkeys when they performed a spatial-attention-involved task, then applied likelihood-based Granger causality analysis to explore attentional modulation of neuronal interactions. First, a significant attention-related decrease in Granger causality was found in S-C pairs, which primarily displayed in the S-to-C feedforward connection. Second, the interaction strength of the feedforward connection was significantly higher than that of the feedback under attend toward (AT) conditions. Although information flow did not alter as the attentional focus shifted, the strength of communications between target- and distractor-stimuli-covered neurons differed only when attending to complex cells’ receptive fields (RFs). Furthermore, pairs’ communications depended on the attentional modulation of neurons’ firing rates. Our findings demonstrate spatial attention does not induce specific information flow but rather amplifies directed communication within V1.

Abstract Background The Perceived Stress Scale (PSS) is a globally used and self-report scale measuring perceived stress. Three versions of PSS (PSS-14, PSS-10 and PSS-4) are available which comprise 14, 10 and 4 items respectively. However, the Chinese version of the PSS has not yet been validated in a large community-based general population. The aims of this study were to evaluate the psychometric properties of the Chinese PSS in a large community-based general population and to compare the appropriateness of the three versions of PSS. Methods A total of 9507 adults with at least a junior high school education and completed PSS-14 from the China Health and Nutrition Survey were involved in this study. The internal consistency reliability of PSS was assessed using Cronbach’s alpha coefficient and confirmatory factor analysis was employed to test the construct validity. Modification index was used for model extension and the critical ratio was used for model restriction. Results The internal consistency coefficients were satisfactory for PSS-14 and PSS-10, but not for PSS-4. The corresponding Cronbach’s alpha were 0.830, 0.754 and 0.473 respectively. A 2-factor structure was confirmed for the PSS-14 and PSS-10, and all items’ standardized factor loadings exceeded 0.4 for either negative or positive factors. Given that item 12 loaded on both negative and positive factors for PSS-14 and the goodness of fit for PSS-14 was not acceptable, PSS-13 (PSS-14 excluding item 12) was studied. The construct validities of PSS-13 and PSS-10 were satisfactory, but the goodness of fit for PSS-10 were better than that for PSS-13. Conclusions PSS-13 (PSS-14 excluding item 12) and PSS-10 have satisfactory psychometric properties. PSS-10 are more applicable to measure the perceived stress than PSS-13 in a large community-based general population in China.

BackgroundThe intake of certain food and nutrients may play a crucial role in cognitive health. However, research on the relationship between dietary patterns and cognitive function is limited. This study aims to investigate the associations between dietary patterns and multi-dimensional cognitive functions, such as global cognitive status and related domain profiles, mild cognitive impairment (MCI), and four major subtypes of Chinese adults.MethodsUsing the baseline data from the Community-based Cohort Study on Nervous System Diseases (2018–2019), we selected 4,309 Chinese adults aged 55 years and older as subjects with complete diet, cognition, and other related data. We collected food data for the past 12 months with a valid semi-quantitative food frequency questionnaire. Diving 49 food items into 13 subgroups, we used factor analysis to derive the main dietary patterns. We evaluated cognitive functions based on the scores of the Montreal Cognitive Assessment (MoCA) and used quantile regression and multivariable logistic regression to examine the relationship between dietary patterns and cognitive-related outcomes.ResultsWe identified four dietary patterns, explaining 50.11% of the total variance: “meat-preferred” pattern, “plant-preferred” pattern, “eggs- and dairy-preferred” pattern, and “grain-preferred” pattern. After adjusting for all potential confounders, the “meat-preferred” pattern and the “plant-preferred” pattern were associated with higher scores of global cognition and several cognitive domains (p

The prevalence of metabolic syndrome (MetS) is increasing and the relationship between ultra-processed food (UPF) consumption and MetS remains uncertain in Chinese adults. This study aimed to examine the longitudinal association of UPF consumption with the risk of MetS and its components in Chinese adults. Adults aged 18 years and above who participated in at least two waves of the China Health and Nutrition Survey (CHNS) in 2009, 2015, and 2018 were included in this analysis. Dietary intake data were collected by three consecutive 24 h dietary recalls and weighing household foods and condiments. Depending on the purpose and extent of food processing, UPFs were classified using the NOVA food classification system. A multivariate Cox proportional risk model was used to explore the association between UPF consumption (grouped by quartile: quartile 1 (Q1), quartile 2 (Q2), quartile 3 (Q3), and quartile 4 (Q4)) and risk of MetS and its components. A total of 5147 adults were included. During a median (IQR) 6.0 (3.0, 9.0) year follow-up with 31,878 person-years, 1712 MetS cases were identified, with an incidence of 33.26%. After multivariable adjustment, the risk of MetS was increased by 17% in the highest quartile with UPF consumption (HR: 1.17, 95% CI: 1.01–1.35, p trend: 0.047), with the lowest quartile as a reference. For the components of MetS, the risk of central obesity, raised triglycerides (TG), reduced high-density lipoprotein cholesterol (HDL-C), and raised blood pressure (BP) was increased by 33% (HR: 1.33, 95% CI: 1.18–1.51, p trend: p trend: 0.003), 25% (HR: 1.25, 95% CI: 1.07–1.46, p trend: 0.007), and 16% (HR: 1.16, 95% CI: 1.03–1.32, p trend: 0.018) in the highest quartile with UPF consumption, respectively. Adults aged 45–59 years and living in urban areas with higher UPF consumption had higher odds of MetS. These results indicate that higher long-term UPF consumption was associated with an increased risk of MetS in Chinese adults. Further studies such as intervention trials are needed to confirm the mechanism of correlation between UPF consumption and health-related outcomes. Nutritional education actions are warranted to promote a balanced diet and improve the overall dietary quality of residents to reduce the risk of MetS effectively.

The association of free sugars intake with metabolic syndrome (MetS) is controversial. This study aimed to examine the association between free sugars intake and risk of MetS in Chinese adults. The data were from seven waves of the China Health and Nutrition Survey (2000–2018), a longitudinal and open prospective cohort study. Dietary intake was calculated based on the data collected by consecutive 3-day 24-h dietary recalls combined with household weighing for foods or condiments. Cox proportion hazard regressions and restricted cubic spline (RCS) were performed to explore the associations between free sugars intake and the risk of MetS. The present study selected 12,048 adults aged 18 years and above. During a median (IQR) follow-up of 9.0 (7.0, 15.0) years with 131,844.0 person-years, 3970 (32.95%) MetS occurred. After adjusting for all potential confounders, compared to adults with free sugars intake of 20 g/day and the risk of MetS (HR, 1.011; 95% CI, 0.800–1.277). There is an urgent need to pay attention to the intake of free sugars and comprehensive measures such as the improvements in the processing of sugary foods, and sugar composition should be included on food nutrition labels to control intake of free sugars in China.

Abstract Background The China Dietary Guidelines Index (CDGI) is a diet quality evaluation index that can present the overall diet quality and is comparable between individuals. The aim of this study was to revise CDGI for Chinese adults according to the Chinese Dietary Guidelines 2016 (CDG-2016), evaluate adherence to recommended diets between 1991 and 2015, and analyze the trend, variation, and determinants of diet quality. Methods Food, cooking oil, and condiment intakes were estimated based on twenty-four-hour dietary recalls over three consecutive days and the household weighing method. Based on the food and nutrients recommendations for people with different energy requirements in CDG-2016, CDGI was revised as China Dietary Guidelines Index (2019)-Adults (CDGI(2019)-A) by equal weight continuity scoring. Three-level random intercept-slope growth models were applied to analyze the trend, variation, and determinants at both the community and individual levels. Results CDGI(2019)-A, the sum of fourteen component scores with a range of 0–110 points, increased significantly from 38.2 in 1991 to 47.3 in 2015. Components with a score of less than half were milk (91.6%), fruits (72.0%), nuts (82.5%), other cereals and beans (82.6%), and seafood (77.7%). Between-individual accounted for 25.6% of the total score variation, of which 87.4% derived from the community level. CDGI(2019)-A score displayed a positive association with being female, having higher education, having higher income, living in an urban area, and knowing the CDG-2016 recommendations. The impact of income and awareness of CDG-2016 varied significantly across communities. Conclusions Although quality of diet has been improving in China, overall quality remains poor, primarily because of inadequate intake of milk and dairy products, nuts, fruits, other cereals and miscellaneous beans, and seafood. Intervention at the community level may improve diet quality more efficiently than at the individual level, and the most effective intervention should be selected in different communities according to local conditions.

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

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

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

Metabolic syndrome (MetS) is increasingly prevalent, and the relationship between dietary magnesium and MetS remains controversial. Therefore, we aimed to explore the association and dose-response relationship between dietary magnesium intake and MetS and its single component. The sample was adults aged 18 years and above who participated in at least two follow-up surveys in 2009, 2015 and 2018. Food consumption data were collected from three consecutive 24-h dietary recalls. The multivariate Cox proportional risk regression model and restricted cubic spline (RCS) model were used to analyze the association and dose-response relationship between dietary magnesium intake and MetS and its components. In our study, 6104 subjects were included, with a total follow-up of 37,173.36 person-years, and the incidence was 33.16%. Cox regression analysis showed that the multivariable-adjusted Hazard Ratio (HR) for MetS comparing the highest to the lowest quintile of dietary magnesium intake was 0.84 (95% confidence intervals [CI] = 0.71–0.99). Central obesity, elevated TG, elevated blood pressure and elevated blood glucose were reduced by 18%, 41%, 20% and 42%, respectively. The risk of decreased HDL-C was reduced by 23% in the third quintile of dietary magnesium intake, with a slightly increased risk in the highest group. RCS analysis showed that the overall and non-linear associations between dietary magnesium and MetS and its components were statistically significant, the risk of them decreased significantly when magnesium intake was lower than 280 mg/day, and then the curve leveled off or slightly increased.

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

Abstract Background Vitamin A plays an important role in human functions, which mainly come from foods. This study aims to examine dietary vitamin A intake and major food sources of Chinese adults. Methods We analyzed the cross-sectional data from 12,246 adult aged 18 to 64 years old in 2015 China Nutritional Transition Cohort Study. Three consecutive 24-h dietary recalls combined with household weighing method were used to assess dietary vitamin A intake. Results The average dietary vitamin A intakes were 480.9 μg retinol equivalents (RE) or 307.2 μg retinol activity equivalents (RAE). The carotenes and retinol intake of subjects were 2084.7 μg/day and 133.5 μg/day, respectively. Approximately 87% of adults consumed less vitamin A than the Chinese Estimated Average Requirement (EAR), and only 6% of adults consumed more than Chinese Recommended Nutrient Intake (RNI). Chinese adults derived vitamin A mainly from plant source foods, which is supplied as carotenes (67.4% RE or 56.4% RAE). Dark- and light- vegetables and fruits were major contributors of carotenes (accounted for 84.2%). The most import food sources of retinol were egg, meats and meat products, poultry, fish and milk, representing 94.7% of retinol intake. The major four contributors of total vitamin A (as both RE and RAE) were dark vegetables, egg, light vegetables, and meats and meat products. In conclusion, dietary vitamin A remains a problem for Chinese adults. Conclusions Public health actions are needed to increase vitamin A intake in China.

Abstract Background The prevalence of childhood overweight and obesity in developed countries appears to be plateauing. The purpose of this study was to provide the most recent data on the prevalence and trends in overweight and obesity among Chinese children and adolescents from 2011 to 2015. Methods We used data collected in the China Health and Nutrition Survey (CHNS) and China Nutritional Transition Cohort Study (CNTCS). We used two waves of the survey in 12 provinces conducted in 2011 (aged 7–18 years; n = 1458) and 2015 (aged 7–18 years; n = 1084) to perform a trend analysis. We used data collected in 15 provinces (aged 7–18 years; n = 1617) to estimate the prevalence of overweight and obesity among Chinese children and adolescents in 2015. Results In 2015, based on the Working Group for Obesity in China (WGOC) criteria, the prevalence of overweight and obesity were 14.0% (95% CI, 11.6–16.3) and 10.5% (95% CI, 8.4–12.6) in boys, and 9.7% (95% CI, 7.7–11.8) and 7.1% (95% CI, 5.2–8.9) in girls, respectively. The increase in BMI z-scores from 2011 to 2015 was statistically significant among adolescents (p = 0.0083), but not among children. No significant changes were observed in prevalence of overweight and obesity between 2011 and 2015, excepting adolescents aged 12–18 years (p = 0.0086). Conclusions Since 2011, overweight has remained stable, and obesity has stabilized in children, though not in adolescents. Although levels of childhood overweight and obesity in China are not high compared to other developed countries, they remain concerning enough that effective policies and interventions need to be sustained and intensified for lowering rates of childhood overweight and obesity.

Few studies have examined the secular trend of energy intake distribution. This study aims to describe trajectories of energy intake distribution and determine their association with dyslipidemia risk. Data of 2843 adult participants from the China Health and Nutrition Survey (CHNS) were analyzed. Trajectory groups of energy intake distribution were identified by multi-trajectory model over 27 years. Multilevel mixed-effects modified Poisson regression with robust estimation of variance was used to calculate risk ratio for incident dyslipidemia in a 9-year follow-up. Four trajectory groups were identified: “Energy evenly distributed group” (Group 1), “Lunch and dinner energy dominant group” (Group 2), “Dinner energy dominant group” (Group 3), “breakfast and dinner energy dominant group” (Group 4). Compared with Group 1, Group 3 was associated with higher risk of dyslipidemia (RR = 1.48, 95% CI = 1.26, 1.75), hypercholesterolemia (RR = 1.96, 95% CI = 1.37, 2.81) and high low-density lipoproteins cholesterols (LDL-C) (RR = 2.41, 95% CI = 1.82, 3.20). A U-shape was observed between cumulative average proportion of dinner energy and dyslipidemia risk (p for non-linear = 0.01), with stronger relationship at 40% and above. Energy intake distribution characterized by higher proportion of dinner energy, especially over 40% was associated with higher dyslipidemia risk in Chinese adults.

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

An amendment to this paper has been published and can be accessed via the original article.

Poor dietary habits have been shown to be associated with a range of chronic diseases and can potentially be a major contributor to non-communicable diseases (NCDs) mortality. We therefore aimed to identify the prevailing dietary patterns among Chinese adults and to evaluate trends in dietary patterns from 1991 to 2015. We used data collected in the China Health and Nutrition Survey (CHNS). Dietary patterns were identified using factor analysis of data from three consecutive 24 h dietary recalls. We studied 29,238 adults aged 18 and above with complete demo-graphic and dietary data. Three distinct dietary patterns were identified: southern (high intakes of rice, vegetables, and pork), modern (high intakes of fruits, dairy products, cakes, cookies, and pastries), and meat (high intakes of organ meats, poultry, and other livestock meat). The southern pattern score decreased (mean ± SD scores in 1991: 0.11 ± 1.13; scores in 2015: −0.22 ± 0.93). The modern pattern score (mean ± SD scores in 1991: −0.44 ± 0.59; scores in 2015: 0.21 ± 1.01) and meat pattern score (mean ± SD scores in 1991: −0.18 ± 0.98; scores in 2015: 0.27 ± 0.91) increased. We observed that China has experienced a shift from traditional dietary patterns to western dietary patterns.

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

Evidence shows time-of-day of energy intake are associated with health outcomes; however, studies of time-of-day energy patterns and their health implication are still lacking in the Asian population. This study aims to examine the time-of-day energy intake pattern of Chinese adults and to examine its associations with nutrient intakes, diet quality, and insulin resistance. Dietary data from three 24-h recalls collected during the 2015 China Health and Nutrition Survey (CHNS) were analyzed (n = 8726, aged ≥ 18 years). Time-of-day energy intake patterns were determined by latent class analysis (LCA). General Linear Models and Multilevel Mixed-effects Logistic Regression Models were applied to investigate the associations between latent time-of-day energy intake patterns, energy-adjusted nutrient intakes, diet quality score, and insulin resistance. Three time-of-day energy intake patterns were identified. Participants in the “Evening dominant pattern” were younger, had higher proportions of alcohol drinkers and current smokers. The “Evening dominant pattern” was associated with higher daily energy intake and a higher percentage of energy from fat (%) (p < 0.001), as well as higher insulin resistance risk (OR = 1.21; 95% CI: 1.05, 1.40), after adjusting for multivariate covariates. The highest diet quality score was observed in participants with “Noon dominant pattern” (p < 0.001). A higher proportion of energy in the later of the day was associated with insulin resistance in free-living individuals.

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

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

Thirty strains of Aspergillus niger, including 27 intended used in the food industry of China, were studied for their ochratoxin A (OTA) production on the three natural substrates—corn, rice, and wheat bran—at different time intervals by high-performance liquid chromatography. It was found that the frequencies of OTA for the studied 27 industrial strains ranged from 14.8% (4/27) at day 28 to 25.9% (7/27) at day 7 on corn, 14.8% (4/27) at day 7 to 33.3% (9/27) at day 21 on rice, and 22.2% (6/27) at day 7, 14, and 28 to 44.4% (12/27) at day 21 on wheat bran, respectively. The average concentrations of OTA produced by the studied 27 industrial strains ranged from 5.1 μg/kg at day 28 to 8.7 μg/kg at day 21 on corn, 4.2 μg/kg at day 7 to 17.9 μg/kg at day 14 on rice, and 4.5 μg/kg at day 7 to 7.2 μg/kg at day 21 on wheat bran, respectively. Furthermore, the OTA production in the studied 27 industrial strains of A.niger was strongly associated with their function (or application), culture substrate, and time. The saccharifying enzyme producers produced higher levels of OTA, compared with the organic acid producers, the tannase producers, and the β-galactosidase producer, while concentration differences were also observed in OTA production among strains of A.niger with the same application. In a word, some strains of A.niger intended used in the Chinese food industry indeed have the capability of producing OTA, elevating the risks to food safety associated with their use.

Vitamin C is essential for human health. It is important to estimate the dietary vitamin C intake in the Chinese population to examine the effects of the nutritional transition occurred in recent decades. The present study aimed to estimate the dietary vitamin C intake in Chinese adults by using cross-sectional data from the 2015 China Nutritional Transition Cohort Study and selecting those aged 18–65 years with complete records of sociodemographic characteristics and dietary measurements (n = 11,357). Wilcoxon rank-sum test, Kruskal-Wallis analysis, Chi-squared test, and multiple logistic regression were employed to analyze the daily dietary vitamin C intake on the basis of three-day 24 h dietary recalls and food sources in relation to demographic factors, to evaluate vitamin C intake status using the estimated average requirement cut-off point, and to explore underlying influencing factors. The mean (SD (standard deviation)) and median (interquartile range) levels of the dietary vitamin C intake in adults were 78.1 (54.6) and 65.4 (61.4) mg/day, respectively. Light vegetables, dark vegetables, fruits, and tubers were the top four food sources, contributing a combined 97.3% of total daily dietary vitamin C intake in the study population. The prevalence of risk of insufficient dietary vitamin C intake was 65.1%. Both the distribution of vitamin C intake and the prevalence of risk of insufficient dietary vitamin C intake differed by several demographic factors. Educational level, residence area, geographic location, vegetable consumption, and total energy intake were independent determinants of the risk of insufficient dietary vitamin C intake. In conclusion, dietary vitamin C intake is inadequate in Chinese adult population, and an increase in vitamin C intake should be recommended especially to the population at risk for vitamin C insufficiency.

There are a total of 30 strains including 27 strains of Aspergillus niger intended used in Chinese food industry, two strains used as control and one strain isolated from corn for fumonisin (FB) production on 3 media. It was found that FB2 production by A. niger was function-dependent and highly related to culture media, as well as incubation time. All strains studied were unable to produce FB1 and FB3. Almost all strains were found to produce FB2 on corn, rice and wheat bran. Based on their intended use in the food industry, the higher level of FB2 producers were strains used for saccharifying enzyme (n = 13) production, followed by organic acid (n = 6), tannase (n = 7) and β-galactosidase (n = 1) production, with the FB2 mean level of 3553–10,270 μg/kg, 1059–12,036 μg/kg, 3–7 μg/kg and 2–4 μg/kg on corn, 5455–9241 μg/kg, 559–2190 μg/kg, 4–9 μg/kg and 6–10 μg/kg on rice, 5959–7709 μg/kg, 9491–17,339 μg/kg, 8–14 μg/kg and 120–222 μg/kg on wheat bran, respectively. Comparatively, strains of Fusarium verticillioide were capable of producing fumonins simultaneously with broader spectrum including FB1, FB2 and FB3, but at a much lower level. In conclusion, it is necessary to evaluate FB2 production by A. niger before intended use in the food processing industry.