Predictive Ability of Hypertriglyceridemic Waist,Hypertriglyceridemic Waist-to-Height Ratio,and Waist-to-Hip Ratio for Cardiometabolic Risk Factors Clustering Screening among Chinese Children and Adolescents

Objective Hypertriglyceridemic waist(HW),hypertriglyceridemic waist-to-height ratio(HWHtR),and waist-to-hip ratio(WHR)have been shown to be indicators of cardiometabolic risk factors.However,it is not clear which indicator is more suitable for children and adolescents.We aimed to investigate the relationship between HW,HWHtR,WHR,and cardiovascular risk factors clustering to determine the best screening tools for cardiometabolic risk in children and adolescents.Methods This was a national cross-sectional study.Anthropometric and biochemical variables were assessed in approximately 70,000 participants aged 6–18 years from seven provinces in China.Demographics,physical activity,dietary intake,and family history of chronic diseases were obtained through questionnaires.ANOVA,χ2 and logistic regression analysis was conducted.Results A significant sex difference was observed for HWHtR and WHR,but not for HW phenotype.The risk of cardiometabolic health risk factor clustering with HW phenotype or the HWHtR phenotype was significantly higher than that with the non-HW or non-HWHtR phenotypes among children and adolescents(HW:OR=12.22,95%CI:9.54-15.67;HWHtR:OR=9.70,95%CI:6.93-13.58).Compared with the HW and HWHtR phenotypes,the association between risk of cardiometabolic health risk factors(CHRF)clustering and high WHR was much weaker and not significant(WHR:OR=1.14,95%CI:0.97-1.34).Conclusion Compared with HWHtR and WHR,the HW phenotype is a more convenient indicator with higher applicability to screen children and adolescents for cardiovascular risk factors.

Report on Childhood Obesity in China (4) Prevalence and Trends of Overweight and Obesity in Chinese Urban School-age Children and Adolescents, 1985-2000

Objective To describe the nationwide prevalence of childhood overweight/obesity, and their group variations and trends over the past 20 years in the Chinese urban population. Methods Data sets of boys and girls at the age of 7-18 years collected from the series of Chinese national surveillance on students＇ constitution and health （CNSSCH） between 1985 and 2000 were divided into five socioeconomic and demographic groups, while BMI classification reference proposed by Working Group on Obesity in China （WGOC） was used as screening reference to calculate the prevalence and trends of overweight/obesity in these groups. Results In 2000, the prevalence of obesity and overweight in boys aged 7-18 years was 11.3% and 6.5% in Beijing, 13.2% and 4.9% in Shanghai, 9.9% and 4.5% in coastal big cities, and 5.8% and 2.0% in coastal medium/small-sized cities, respectively, while the prevalence of of obesity and overweight in girls of the same age group was 8.2% and 3.7% in Beijing, 7.3% and 2.6% in Shanghai, 5.9% and 2.8% in coastal big cities, and 4.8% and 1.7% in coastal medium/small-sized cities, respectively. The prevalence of obesity was low in most of the inland cities at an early stage of epidemic overweight. The epidemic manifested a gradient distribution in groups, which was closely related to status （SES） of the study population. However, a dramatic and steady increasing trend was witnessed among all sex-age subgroups in the five urban groups, and such a trend was stronger in boys than in girls, and much stronger in children than in adolescents. Conclusion Although China is at an early stage of epidemic obesity by and large, the prevalence of obesity in her urban population, particularly in coastal big cities has reached the average level of developed countries. The increasing trend has been rapid since early 1990s, and the increments in obesity and overweight are exceptionally high. The prospect of epidemic obesity in China is in no way optimistic. Therefore, preventive program should be focused on the improvement of the balance between caloric intake and energy expenditure, and interventions aimed at changing children＇s life styles.

The Association of Overweight and Obesity with Blood Pressure among Chinese Children and Adolescents

Objective To examine the association between obesity and high blood pressure （BP） in Chinese children and adolescents. Methods Body mass index （BMI） and blood pressure measurements of 197 191 children aged 7-17 years were obtained from a Chinese national survey in 2010. Obesity and high BP were defined according to the reference values for Chinese children. Adjusted odds ratios （ORs） and 95% confidence intervals （CIs） of different BMI categories for high BP, as well as the population attributable risk percent （PAR%）, were also calculated. Results The prevalence of high BP was 16.1% for boys and 12.9% for girls in 2010. Overweight and obese children had a significantly higher prevalence of high BP than non-overweight children in both boys and girls in each age group. ORs （95% CI） for high BP were 4.1 （3.9, 4.4） in obese boys and 4.0 （3.7, 4.3） in obese girls. The overall PAR% for high BP due to overweight and obesity was 14.4%. Conclusion Overweight and obese children have a significantly higher risk of high BP than non-overweight children. Eliminating overweight and obesity could reduce 14.4% of high BP cases.

Secular Change in Stature of Urban Chinese Children and Adolescents, 1985-2010

Objective Research evidence shows a secular trend in Chinese physical growth in recent years.The aim of this study was to analyze and assess changes in stature of children and adolescents during the 25 years from 1985‐2010,using national data.Methods Data came from successive cycles of the Chinese National Survey on Students＇ Constitution and Health（CNSSCH）.Subjects were 7‐ to 18‐year‐old children and adolescents.Results An overall positive secular trend occurred in urban China during 1985‐2010.The overall average rates of increment were 2.4 and 1.7 cm/decade for boys and girls,respectively.Total increases in adult stature for boys and girls were 2.6 and 1.7 cm,yielding rates of 1.0 and 0.7 cm/decade,respectively.Cities with different socioeconomic levels had different characteristic trends.Mean stature increases in big cities were larger than those in moderate and small cities,and boys and girls in moderate and small cities showed greater potential for growth in stature.Conclusion An overall positive secular growth trend was associated with socioeconomic progress and differed with area socioeconomic levels.School policies and strategies should be developed based on increased stature,and should continue narrowing the inequity between different socioeconomic populations.

Secular Changes of Stature in Rural Children and Adolescents in China, 1985-2010

Objective To analyze and assess secular change in stature in rural children and adolescents in China from 1985 to 2010. Methods Data were obtained from the 6 rounds of the Chinese National Survey on Student＇s Constitution and Health. The subjects enrolled in the study were children and adolescents aged 7-18 years in rural areas of provincial capitals. Results An overall positive secular trend in stature occurred in rural areas of provincial capitals in China from 1985 to 2010. The overall average increase rates were 3.1 and 2.4 cm/decade for boys and girls, respectively. The total body height increases for grown up boys and girls were 3.6 and 2.3 cm and the increase rates were 1.4 and 0.9 cm/decade, respectively. There were differences in body height increase among eastern, central and western regions. The average body height of the children or adolescents in eastern region was highest, followed by central region and western region. The overall increase rates in central region were highest among the three regions. The difference between eastern/central region and western region was obvious. 〈br〉 Conclusion Positive secular trend in stature of children or adolescents has occurred in rural area of China, and rural boys and girls showed a great potential for continuous growth. More attention should be paid to the differences in children＇s body height between western region and eastern/central region.

Secular Changes on the Distribution of Body Mass Index among Chinese Children and Adolescents, 1985-2010

Objective To analyze the change in Body Mass Index （BMI） distribution among Chinese children and adolescents for the development of more effective intervention for childhood obesity. Methods Data on the national students＇ constitution and health survey between 1985 and 2010 was used for this study. Subjects were students aged 7-18 randomly selected from 30 provinces in China. BMI for-age curves were developed by LMS method, and the trend of BMI distribution was determined by comparing the upper BMI percentiles and analyzing the skew shift of distribution between 2985 and 2010. Results An overall positive swift trend of BMI between 1985 and 2010 was observed among the Chinese school-age children and adolescents. The average median of the BMI increased from 16.8 and 17.0 ks/m2 to 18.2 and 17.9 kg/m2 in 25 years, with increments 0.56 and 0.36 kg/m2 per decade for males and females, respectively. The more obvious increments were found at the high BMI. The total increments of BMI in this period were 4.03 and 2.20 kg/m2 at the 85th, 6.24 and 3.57 kg/m2 at the 95th, and 6.99 and 4.27 kg/m2 at the 97th percentiles, for males and females, respectively. Conclusion Obvious increments were observed at high BMI of the Chinese children and adolescents. More effective interventions should be taken for control and prevention of obesity and its health consequence for these subgroups. It is necessary to establish a risk-complex system consisting of the identification of BMI scope, the screen of the disease risk factors and the assessment of excessive adiposity.

The Influence of Secular Trends in Body Height and Weight on the Prevalence of Overweight and Obesity among Chinese Children and Adolescents

Objective To explore the influence of secular trends in body height and weight on the prevalence of overweight and obesity among Chinese children and adolescents. Methods The data were obtained from five cross-sectional Chinese National Surveys on Students＇ Constitution and Health. Overweight/obesity was defined as BMI-for-age Z-score of per the Wold Health Organization （WHO） reference values. Body height and weight for each sex and age were standardized to those reported in 1985 （standardized height＂ SHY, standardized weight： SWY） and for each sex and year at age 7 （standardized height： SHA; standardized weight： SWA） using the Z-score method. Results The prevalence of overweight/obesity in Chinese children was 20.2% among boys and 10.7% among girls in 2010 and increased continuously from 1985 to 2010. Among boys and girls of normal weight, SHY and SHA were significantly greater than SWY and SWA, respectively （P 〈 0.001）. Among boys and girls with overweight/obesity, SHY was significantly lower than SWY （P 〈 0.001）, and showed an obvious decreasing trend after age 12. SHA was lower than SWA among overweight boys aged 7-8 years and girls aged 7-9 years. SHY/SHW and SHA/SWA among normal-weight groups were greater than among overweight and obese groups （P 〈 0.001）. Conclusion The continuous increase in the prevalence of overweight/obesity among Chinese children may be related to a rapid increase in body weight before age 9 and lack of secular increase in body height after age 12.

Association of the Common Genetic Variant Upstream of INSIG2 Gene with Obesity Related Phenotypes in Chinese Children and Adolescents

Objective To study the association between the rs7566605 variant of INSIG2 and obesity-related phenotypes in Chinese children and adolescents. Methods The study sample consisted of two independent cohorts of Chinese children and adolescents. Anthropometric indices, lipids, blood pressure, fasting glucose, insulin and percentage of fat mass were determined. PCR with restriction fragment length polymorphism analysis was performed for genotyping the rs7566605 variant. Results In each of the two independent cohorts, no significant association was observed between rs7566605 and obesity under additive, dominant or recessive model. We also did not detect any difference in the genotype frequency between all the obese children and controls. Furthermore, we did not find evidence of an association between body composition indices and metabolic phenotypes in all children. However, the triglyceride level of CC homozygotes was significantly higher than that of GG＋GC genotypes in obese children （P=0.022）. Additionally, we observed a non-significant trend of severe obesity in a post-hoc test. Conclusion INSIG2 rs7566605 variant is not associated Chinese childhood obesity in two independent cohorts. Further study is needed to verify the effect of rs7566605 on triglyceride in obese children.

Vulnerability to HIV Infection and Related Health Risk Behaviors of the Out of School Adolescents Migrated with Their Parents to Beijing

Objective To explore the vulnerability to HIV infection and related risk behaviors of the out-of-school adolescents who migrated with their parents from rural areas to cities. Methods From September to October 2005, 260 out-of-school adolescents aged 14-20 years were interviewed through a questionnaire. Results Out-of-school adolescents lacked HIV/AIDS knowledge and related life skills, and their psychosocial competency was relatively low. The interviewed adolescents were open in their sexuality, showing a low rate of condom use. Their attitudes towards people living with HIV/AIDS and HIV/AIDS prevention competency were positively correlated with family well-being, harmonious relations between their parents, a stable job, knowledge, life skill, and psychosocial competency for emotion control and empathy. Conclusion Out-of-school adolescents are highly vulnerable to HIV/AIDS infection and transmission. Practical and feasible health and life skill education and psychosocial competency are the keys to effective HIV/AIDS prevention among out-of-school adolescent migrants.

Waist Circumference Reference Values for Screening Cardiovascular Risk Factors in Chinese Children and Adolescents

Objectives To explore the optimal threshold values of waist circumference （WC） for detecting cardiovascular （CV） risk factors among Chinese children and adolescents. Methods Association of WC with CV risk factors was studied among 65 898 children aged 7-18 years whose data were pooled from nine previous studies in China. CV risk factors in this study included hypertension （blood pressure above 95 percentile levels）, dyslipidemia （with one or more of the following three indexes： TG ≥ 1.7 mmol/L, TC ≥ 5.18 mmol/L, and HDL-C ≤ 1.04 mmol/L） and elevated glucose level （fasting plasma glucose ≥5.6 mmol/L）. Receive-operating characteristic analysis （ROC） and logistic regression were employed to derive optimal age- and sex-specific waist circumference references for predicting CV risk factors. Results A slight increasing trend of CV risk factors was observed starting from the 75th percentile of waist circumference in the study population, while a remarkable increasing trend occurred from the 90th percentile. The optimal waist circumference thresholds for predicting high blood pressures were at the 75th percentile for both boys and girls, which was at the 90th percentiles for detecting at least two of the above three CV risk factors. In comparison with children with waist circumference below the 75th percentile, the odds ratio of two CV risk factors doubled among children with waist circumference between the 75th and the 90th percentile, and increased by 6 times among children with waist circumference above the 90th percentile. The trend of high blood pressure increasing with waist circumference remained significant after having been stratified by BMI category. Conclusion The 75th and the 90th percentiles of WC are the optimal cut-off points for predicting an increased and a substantially increased risk of CV factors in Chinese children and adolescents, respectively.

Parental Anxiety and Quality of Life of Epileptic Children

Objective To investigate the prevalence of parental anxiety associated with epileptic children, and to explore whether and how this specific condition affects children＇s quality of life （QOL）, and what are the significant determinants for parental anxiety. Methods Three hundred and forty parents whose children were affected with known epilepsy were enrolled in the study. Questionnaires for quality of life in childhood epilepsy （QOLCE）, and hospital anxiety and depression （HAD） of parents were used to collect demographic data of both children and their parents, as well as clinical manifestations of epilepsy and family status. Results Parental anxiety （of any severity） was observed in 191 subjects at interview, giving a prevalence rate of 56.2%. Of the 191 subjects, 18.5% reported mild anxiety, 24.4% moderate anxiety, and 13.2% severe anxiety. Factors associated with parental anxiety included frequency of seizure in children, average monthly income per person and parents＇ knowledge about epilepsy （P〈O.05）. Parental anxiety significantly （P--O.O00） correlated with quality of life of children with epilepsy. Conclusion Parents of children with epilepsy are at high risk of having anxiety. Factors associated with parental anxiety originate both from children and from parents. Parental anxiety is significantly related with children＇s QOL. It is important for experts concerned to recognize such a relationship to improve the QOL of children and their parents.

Malnutrition Prevalence in Lasa Xizang Children and Adolescents

Objective To assess the prevalence of malnutrition among children and adolescents in Xizang （Tibet）. Methods We analyzed data from the Chinese National Survey on Students＇ Constitution and Health for the years 1995, 2000, 2005, and 2010 pertaining to Tibetan children and adolescents in Lase （Lhasa）, aged 7-18 years old. Numbers of survey subjects for these years were：2 393, 2 754, 2 397, and 2 643, respectively. Results Our results indicated that the rate of occurrence of stunting in Tibet has evidenced a gradual decline：for boys, from 26.8%in 2000 to 9.3%in 2010;and for girls, from 25.8%in 2000 to 10.8%in 2010. In general, the wasting rate for both boys and girls in Tibet has gradually decreased over time：for boys, from 17.7%in 1995 to 4.6%in 2005;and for girls from 12.5%in 1995 to 2.3%in 2005. The stunting rates of boys aged 7-13 years old and of girls aged 7-11 years old were 67.5%and 53.1%, respectively, while these rates for boys aged 14-18 years old and girls aged 12-18 years old were 32.5%and 46.9%, respectively. Conclusion Stunting and wasting rates of Tibetan children and adolescents indicate a gradual declining trend over time. The stunting rates of both boys and girls during early puberty were significantly higher than those during late puberty.

Report on Childhood Obesity in China (7) Comparison of NCHS and WGOC

Objective To test the validity of Working Group on Obesity in China （WGOC） reference in screening childhood obesity using obesity-related metabolic syndrome （MS） and its components as disease risk evidence. Methods A total of 2020 adolescents （1007 boys and 1013 girls） aged 14-16 years were sampled in Beijing, China. Anthropometric and biochemical measurements, as well as blood pressure parameters were available. Prevalence of overweight/obesity and related MS risk factors were analyzed across different body mass index （BMI） categories. The sensitivity and specificity of the WGOC cut-offs were compared with those of National Central Health Statistics （NCHS）. Results Significantly high prevalence of MS and its components were found both in the obesity and overweight groups, which were classified by the WGOC and NCHS references. Similar distribution pattern of MS risk factors existed among different BMI categories, but the frequency and clustering of these factors in the obesity group classified by the NCHS were much higher. Owing to its irrelevant high cut-offs for overweight/obesity （especially for girls since the mid- adolescence）, the NCHS reference had a high specificity but a low sensitivity. By contrast, the WGOC reference with a high sensitivity （90.1% for boys and 89.2% for girls） and a relative high specificity （96.4% and 92.8% for obese boys and girls, 78.1% and 68.9% for overweight boys and girls respectively） was more suitable to support the need for early screening, intervention, and treatment of childhood obesity in China. Conclusion High sensitivity is more important than specificity in choosing appropriate screening tools for childhood obesity. Validity test demonstrates that it is rational to use the WGOC reference, established on the basis of the Chinese own reference population as a uniform screening tool for childhood obesity, which can effectively overcome the unnecessary treatment and psychosociai implications of stigmatization caused by misclassification.

Autism and Mental Retardation of Young Children in China

To understand the prevalence and rehabilitation status of autism and mental retardation in China. Methods Screening test and clinical assessment were conducted for the diagnosis of autism and mental retardation. The assessment included investigation of the histories of medical conditions and development of these two disorders, utilization and needs for the rehabilitation service, and related intellectual and behavioral appraisal. Results Among the 7345 children investigated, the prevalence of autism disorder was 1.10 cases per 1000 children aged 2-6 years （95% CI=0.34 to 2.54）, and the prevalence of mental retardation was 10.76 cases per 1000 children （95% CI=8.40 to 13.12）. All the children suffering from autistic disorder were intellectually disabled, whereas 31.0% of the non-autism mental retardates had other disabilities. The medical conditions prior to birth and perinatal period were important potential factors for autism. Half of the autistic children and 84% of the children with non-autism mental retardation had never received any rehabilitative service. Conclusions The prevalence of autistic disorder in children aged 2-6 years in Tianjin is rather high. It is urgent to improve the status of the autistic and intelligently disabled young children in China. In order to upgrade the level of early diagnostic and improve the intervention to autism and mental retardation, public awareness and training courses should be heightened.

Comparison of Changes in Body Composition during Puberty Development of Obese and Normal-weight Children in China

Objective To compare the changes in body composition, including fat mass index （FMI） and fat free mass index （FFMI） during puberty development of obese and normal-weight children in China, and to explore the effect of age and gender on body composition. Methods A total of 356 children at the age of 7-15 years were enrolled in this study. Body composition of 10 normal-weight and obese children in each age group was measured by dual-energy x-ray absorptiometry （DEXA）. FFMI and FMI were calculated according to the following formula： FFMI （kg·m^-2）=FFM（kg）/ height^2（m^2） and FMI（kg·m^-2）=FM （kg）/ height^2（m^2）. Results The fat mass and fat free mass of obese children were significantly higher than those of normal-weight children （P〈0.05）. The FMI and FFMI of obese children increased significantly with age and were higher than those of the same sex, gender, and age normal-weight children （P〈0.05）. Conclusion The levels of fat mass, fat free mass, FMI, and FFMI are different in obese and normal-weight children, and gender effects are significant in boys having higher levels of these indicators than in girls. FFMI and FMI can be used as monitoring indexes in weight control of obese children.

Nutrition in Chinese-Korean Children and Adolescents

Objective To study the nutrition habits among Chinese-Korean children and adolescents in Yanbian Autonomous Prefecture, Jilin, China. Methods Data were obtained from the Chinese National Survey on Students＇ Constitution and Health in 1995, 2000, 2005, and 2010 for Chinese-Korean children and adolescents aged 7-18 years. The number of the subjects included was 4789, 4704, 5875, and 5315, respectively. Results The rate of the occurrence of stunting showed a declining trend from 1995 to 2010 （for boys： urban, 6.3%; rural, 12.7% in 1995 and 3.5% for both in 2010. For girls： urban, 7.8%; rural, 13.4% in 1995 and 4.2% and 5.5%, respectively, in 2010）. Although the ratio of wasting did not show significant differences between the urban and rural children and adolescents in 1995, 2000, 2005, and 2010 respectively, the ratio of occurrence of overweight or obesity increased （for boys： urban, 7.3% and 1.3% in 1995, 17.6% and 12.9% in 2010; rural, 7.0% and 1.3% in 1995, 14.6% and 12.8% in 2010, respectively. For girls： urban, 8.1% and 1.0% in 1995, 17.3% and 8.6% in 2010; rural 5.7% and 0.7% in 1995, 16.4% and 7.4% in 2010, respectively）. Conclusion The ratio of malnutrition in children and adolescents in Chinese-Korean areas declined from 1995 to 2010, and the distinction in malnutrition between the urban and rural areas was negligible in 2010. Further, the ratio of overweight and obesity increased over this period.

The Mediating Effect of Body Dissatisfaction in Association between Obesity and Dietary Behavior Changes for Weight Loss in Chinese Children

Objective The aim of this study was to analyze the mediating effect of body dissatisfaction in correlation between obesity and dietary behavior changes for weight loss(DBCWL).Methods A total of 680 primary and middle school students were included in this study. Their body height, weight, and waistline were effectively measured, and they were also evaluated to assess their body dissatisfaction, perception of dietary behaviors, and DBCWL. The correlation among these factors was analyzed using mediating effect models.Results The prevalence of overweight/obesity and abdominal obesity was significantly higher in males than in females(P < 0.05). Overweight/obesity, abdominal obesity, and body dissatisfaction significantly increased the risk for DBCWL(OR = 2.57, 2.77, and 1.95, respectively). Overweight/obesity and abdominal obesity significantly increased the risk for body dissatisfaction(OR = 6.00 and 4.70,respectively). Significant mediating effects of body dissatisfaction were observed in correlation between overweight/obesity and DBCWL and between abdominal obesity and DBCWL(OR = 2.20 and 1.92,respectively;P < 0.05), and the proportions of mediating effects among the total effects were 48.89% and 46.60%, respectively.Conclusion Body dissatisfaction might play an important mediating effect in association between DBCWL and obesity, which indicates that guiding children to correctly recognize their body might be more conducive than promoting obese children toward weight loss through dietary behavior changes.

The construction of Chinese indicator system on public health field investigation and short-term study hub:experience and implications

Background:The increasing of exchange activities among public health institutes and experts globally calls for a standardized operation to construct public health field investigation and short-term study hub(Field Study Hub).This can funcion as a platform to share experience in public health development in an accurate and comprehensive manner that would benefit global practices.This research aims to establish a supportive indicator system to guide the construction work.Methods:Delphi method including two rounds of surveys were conducted among 82 senior public health experts.A structured questionnaire was designed to collect the opinions of the experts on the necessity of setting and feasibility of measurement for proposed 5 dimensions of 49 indicators and 7 additionally proposed ones.Percentage and score were used to describe the assessments,χ^(2)and t tests to compare differences,Kappa and Cronbach’s alpha values to assess intra-rater and inter-rater reliabilities.Significance levelαwas 0.05.Bonferroni adjustment was used in the comparison of experts’judgment basis.Results:The percentages of experts choosing“Very good”or“Good”for necessity and feasibility in rounds 1 and 2 were 73.1-97.6%(85.8%±7.5%),64.6-93.9%(82.8%±6.7%),73.8-100%(91.0%±6.2%)and 72.5-100%(89.2%±7.3%)respectively.The scores of necessity were higher than those of feasibility,and the differences in the dimensions of“Key experience”,“Capacity for logistic support”and the total were statistically significant(t_(11)=2.920,t_(12)=3.035,t_(31)=4.448,t32=2.664,t_(t1)=3.794,t_(t2)=3.007,P<0.05).The fourteen most necessary indicators were identified.The judgment bases of“Theory”and“Experience”were higher than“Knowledge”and“Intuition”statistically significantly(round 2:χTK^(2)=39.020,χEK^(2)=67.692,χTI^(2)=45.823,χEI^(2)=76.515,P<0.0125).The Kappa values exceeded 40 with the maximum as 75 and the Cronbach’s alphas exceeded 0.8000 with the maximum as 0.9732.Conclusions:A set of 5 dimensions of 56 indicators with good necessity and feasibility were developed to technically support and well evaluate the construction of field study hub in public health institutions.This was of high significance because it tended to provide a preliminary baseline for the standardized practice in global health.Also,the present research might serve as a methodological reference for the development of other indicator sets.

An Objective Measure to Evaluate Actual Body Shape among Children and Adolescents in China

Objective The purpose of this study was to explore an objective measure to assess actual body shape of children and adolescents in China. Methods Based on the Chinese National Survey on Student＇s Constitution and Health （CNSSCH） in 2005, 210 927 children and adolescents＇ （7-18 years） body height, body weight, chest circumference, sitting height, chest circumference-height ratio, chest circumference-sitting height ratio, chest circumference-low limb ratio, and sitting height-low limb ratio measurements were used to develop an objective measure by using transformation variables and explored factor analysis （EFA）. Discrimination power of the objective measure was evaluated based on BMI reference and Receiver Operating Characteristic curves （ROC）. Results The objective measure included four dimensions scores：transverse dimension （TD） indicating weight and chest circumference; length dimension （LD） indicating height and sitting height;transverse-length ratio dimension （TLD） indicating chest circumference-height ratio, chest circumference-sitting height and chest circumference-low limb ratio; proportion dimension （PD） indicating sitting height-low limb ratio. The whole dimension （WD） indicating the whole body shape was showed by the average of four dimensions scores. Four dimensions and WD scores were approximately 80 in children and adolescents with normal weight, and higher than those of overweight, obesity, and underweight （all P-values〈0.001）. Areas under ROC of overweight and obesity compared with normal weight ranged from 0.88 to 1.00 for scores of TD, TLD, and WD. Conclusion The objective measure which included four dimensions was explored, and TD, TLD, and WD had significant discrimination power.

Improving Child and Adolescent Mental Health Comprehensively in Challenging Times

Mental health,an integral component of well-being,encompasses more than the mere absence of illness(1).Improving the mental health of the next generation is essential,as it not only affects their health in adolescence and adulthood but also enables them to thrive in various aspects of life,such as learning,working,forming relationships,and contributing to society(2–3).Currently,China faces growing concerns regarding mental health issues among children and adolescents(4).Recognizing the gravity of this situation,the government has implemented various policies,including the Special Action Plan for Comprehensively Strengthening and Improving the Mental Health Work of Students in the New Era(2023–2025)(5).However,regional disparities and the complex interplay of factors influencing youth mental development are posing challenges to the effective implementation of these policies,highlighting the need for more integrated and impactful interventions.