Experience and practice of the Emergency Operations Centerz Chinese Center for Disease Control and Prevention:a case study of response to the H7N9 outbreak

Background:Emergency Operations Center(EOC)is a place to provide response to public health emergencies.Chinese Center for Disease Control and Prevention(China CDC)'s EOC was officially established in 2016,which has been the core department for the public health emergencies and risk response.In recent years,we have been continuously improving the function of EOC through many incidents.In the study,we hope to share the construction status,operation management experience of China CDC's EOC and the response process in the human avian influenza A(H7N9)outbreak.Main text:The China CDC's EOC mainly focus on building the five core elements including sites/places and facilities,information and data,plans and procedures,training and exercises,and logistics.Based on summarizing previous emergency respons巳the China CDC's EOC established its own incident management and the standardized response procedures.The event-specific data,context-specific data and event management data could be obtained through various source.The logistics department of the EOC also provides comprehensive support.The well-trained staff is another necessary conditions for its operation.Through sharing the response process of H7N9 outbreak,it further explains the EOC's functions in the five phases of outbreak response,such as the formulation of the incident response framework,monitoring,personnel dispatch and resource mobilization.Conclusions:The EOC con tributes to faster and more efficient responses during emergencies which en able a greater reduction in morbidity and mortality.Compared with the traditional incident response process,under the command and coordination of China CDC's EOC,each group involved in the response has a clearer goal,responsibilities and tasks at each stage.Meanwhile,each group also gave full play to its own expertise and advantages.As a whole,incident response tended to be more specialized and precise,which generally improves the efficiency of incident response.However,different countries and regions have different response processes to the events.We still suggested that appropriate emerge ncy operati on plan should be made according to the complexity of in cident response in the region when constructing response mechanism,through our experience.And the China CDC's EOC is still at growing and groping phase.

Seventy years’ achievements of international cooperation by the National Institute of Parasitic Diseases at the Chinese Center for Disease Control and Prevention

Background: With the promotion of national control programs on parasitic and tropical diseases in China,the National Institute of Parasitic Diseases(NIPD),Chinese Center for Disease Control and Prevention has gained significant experience in the global health arena through international cooperation over the last seven decades allowing a multilateral impact in the elimination of major endemic diseases.Methods:: The achievements of NIPD since 1950 has been analyzed with emphasis on the various stages that started with research and control of the endemic parasitic and other tropical diseases at the national level and progressed via international cooperation into a global presence.Results: The major achievements contributed by NIPD consist of(i)improving technical capability;(ii)promoting control and elimination of parasitic and tropical diseases;(iii)participating in global health governance and cooperation;and(iv)developing a cooperation model for technical assistance and global public health development.It is expected that NIPD’s experience of international cooperation will be essential for the dissemination of China's successful experience in global health governance,emergency response and development,with focus on malaria and neglected tropical diseases such as schistosomiasis,soil-borne and food-borne helminthiases and echinococcosis.Conclusions: NIPD’s new tasks will not only continue to promote national control of endemic parasitic infections and disease elimination programs in China,but also play a leading role in global health and disease elimination programs in the future.

Examining Inequality in the Public Health Workforce Distribution in the Centers for Disease Control and Prevention(CDCs) System in China, 2008–2017

Objective Allocation of human resources to address inequalities in the public health system has increasingly attracted societal and political attention.Using the Centers for Disease Control and Prevention(CDCs)system of China as an example,we evaluated inequality in the public health workforce distribution across different regions in China between 2008 and 2017,with the aim of providing information for policymakers to support resource allocation and address growing health inequities.Methods We used three standard public health workforce inequality indices-Gini coefficient,Theil L,and Theil T-and spatial autocorrelation analysis to explore spatial clusters of the workforce in different provinces,visualized with geographical tools.Results The aggregate workforce-to-population ratio decreased from 1.47 to 1.42 per 10,000 population from 2008 to 2017,and was consistently lower than the National Health Commission’s(NHC)recommended critical shortage threshold of 1.75.The workforce distribution inequality indices varied by regional socioeconomic and health system development.Geographic clustering of CDCs workforce distribution was evident,with H–H and L–L clusters in western China and the Guangdong-Fujian region,respectively.Conclusions Our study addressed key issues for government and policymakers in allocation of public health human resources.There is an urgent need for careful identification of analytic questions that will help carry out public health functions in the new era,alongside policy implications for an equitable distribution of the public health workforce focusing on the western region and low–low cluster areas.

Oral health status of Chinese residents and suggestions for prevention and treatment strategies

Objective:To understand the oral health status of urban and rural residents in China,the Fourth National Oral Health Epidemiological Survey (FNOHES) was conducted in 2015.Materials and methods:Based on the principles of multi-stage,stratified,equal capacity,and random sampling,the subjects included five groups of residents aged 3-5,12-15,35-44,55-64,and 65-74 years in all 31 provinces,municipalities,and autonomous regions except Hong Kong,Macao,and Taiwan.The total sample size was 172,425.The survey covered two areas,namely oral health status and knowledge,attitude and oral health behavior.Results:Residents in China had serious caries and poor periodontal condition.The prevalence of caries was above 50% in all age groups,subjects without periodontal disease accounted for <50%,and fewer than 50% of subjects brushed their teeth twice a day.Based on the results of the FNOHES,the following suggestions were proposed for improving the oral health in China in the future:to establish and improve the comprehensive prevention and control system for oral diseases,implement a comprehensive prevention and control strategy for priority groups,strengthen the oral health education for all people to improve oral health literacy,enhance dynamic monitoring to scientifically evaluate oral health status,and coordinate multi-party resources to establish and improve the oral health service security system.Conclusion:The oral health status of Chinese residents and their oral health behavior habits need to be improved.With the support of the administrative departments of the government and unremitting efforts of the oral health staff,all sectors of society must be coordinated to strengthen oral health education for the whole population.Furthermore,comprehensive prevention and control measures must be implemented for priority groups.

Report on Childhood Obesity in China (2) Verification of BMI Classification Reference for Overweight and Obesity in Chinese Children and Adolescents

Objective To verify Working Group for Obesity in China （WGOC） recommended body mass index （BMI） classification reference for overweight and obesity in Chinese children and adolescents using the data of 2002 China Nationwide Nutrition and Health Survey. Methods PediaWic metabolic syndrome （MetS） and abnormality of each risk factor for MetS were defined using the criteria for US adolescents. Definition of hyper-TC, LDL, and dyslipidemia in adults was applied as well. The average level and abnormality rate of the metabolic indicators were described by BMI percentiles and compared with general linear model analysis. Receiver operating characteristic analysis was used to summarize the potential of BMI to discriminate between the presence and absence of the abnormality of these indicators. Results There was neither significantly increasing nor significantly decreasing trend of biochemical parameter levels in low BMI percentile range （〈65th）. Slight increasing trend from the 75th and a significant increase were found when BMI≥85th percentile. In general, the prevalence of the examined risk factors varied slightly when BMI percentile〈75th, and substantial increases were consistently seen when BMI percentile≥75th. As an indicator of hyper-TG, hypertension and MetS, the sensitivity and specificity were equal at the point of BMI〈75th percentile, and the Youden＇s index of risk factors also reached peak point before 75th percentile except for MetS. When the BMI percentile was used as the screening indicator of MetS, Youden＇s index reached peak point at 85th percentile, just the point in the ROC graph that was nearest to the upper left comer. Conclusion The BMI classification reference for overweight and obesity recommended by WGOC is rational to predict and prevent health risks in Chinese children and adolescents. Lower screening cut-off points, such as 83th percentile or 80th percentile, should not be excluded when they are considered as overweight criteria in future intervention or prevention studies.

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.

Food Frequency Questionnaire for Chinese Children Aged 12-17 Years: Validity and Reliability

Objective The primary objective of this study was to examine the validity and reliability of a semi-quantitative food frequency questionnaire(FFQ) among Chinese children aged 12-17 years. Methods A semi-quantitative 72-food item FFQ was developed for children aged 12-17 years. The reliability and validity of this FFQ were evaluated against 24-h dietary recalls(24 h DRs) to measure the consumption of foods and nutrients. We administered two FFQs and three DRs to children(N = 160) over a period of 1 month to evaluate the reliability and validity. Reliability was examined by quartile agreement and intraclass correlation coefficients(ICCs), and validity was examined by quartile agreement, Bland-Altman plots and correlation with DRs. Results For reliability, the ICCs between the two FFQs ranged from 0.21 to 0.76 for foods and nutrients, and the quartile agreement ranged from 70.0% to 95.0% in the same or adjacent quartiles. Spearman’s correlation coefficients of foods and nutrients between the second FFQ and the 24 h DRs ranged from-0.04 to 0.59. The Bland-Altman plots demonstrated good agreement across the range of intakes among nutrients. The quartile agreement ranged from 50.0% to 100.0%, with infrequent misclassification. Conclusion The FFQ assessment of dietary intakes demonstrated acceptable relative validity and high reproducibility for Chinese children aged 12-17 years.

Seroepidemiological Investigation of Lyme Disease and Human Granulocytic Anaplasmosis among People Living in Forest Areas of Eight Provinces in China

Objective Lyme disease and Human granulocytic anaplasmosis are tick-borne diseases caused by Borrelia burgdorferi and Anoplasrna phagocytophilum respectively. We have investigated infection and co-infection of the two diseases in the population of forest areas of eight provinces in China by measuring seroprevalence of antibodies against B. burgdorferi and A. phagocytophilum. Methods Forest areas in 8 provinces were chosen for investigation using whole sampling and questionnaire survey methods. 3 669 serum samples from people in the forest areas were tested for the presence of antibodies by indirect immunofluorescent assay （IFA）. Results Seroprevalence against B. burgdorferi was 3% to 15% and against A. phagocytophilum was 2% to 18% in the study sites in the 8 provinces in China. We also found co-infection of B. burgdorferi and A. phagocytophilum in 7 of the 8 provinces （the exception being the Miyun area in Beijing）. The seroprevalence for both B. burgdorferi and A. phagocytophilum was significantly higher among people exposed to ticks than among people who were not exposed to ticks. Conclusion We conclude that both pathogens are endemic in the forest areas in the eight provinces, but the prevalence of B. burgdorferi and A. phagocytophilum differs between the provinces.

Validity and Reliability of Chinese Physical Activity Questionnaire for Children Aged 10-17 Years

Objective This study is aimed to report the development,the reliability and validity of the Chinese Children Physical Activity Questionnaire(CCPAQ)which was designed for the assessment of physical activity pattern in young population in China.Methods The CCPAQ was administered for two times in 119 children(mean age 13.1±2.4 years;boys 47%)to examine reliability by using intraclass correlation coefficients.Validity was determined in 106 participants by agreement with the CCPAQ measures and the objective method,the ActiGraph accelerometer.Data on physical activity patter n including time spe nt on d iff ere nt intensi ties and total physical activity,sedentary behavior as well as physical activity energy expenditure were used to assess the validity with Spearman's correlation coefficient and the Bland-Altman plots.Results The reliability coefficient of the CCPAQ ranged from 0.63-0.93(Intra-class correlation coefficient).Spearman's correlation coefficient for validity of time spent on total physical activity and sedentary behavior were all 0.32(P<0.001),and for physical activity energy expenditure was 0.58(P<0.001).Time spent on moderate-to-vigorous physical activity and light physical activity showed a relatively low correlation with the accelerometer(rho=0.20,P=0.040;rho=0.19,P=0.054).Conclusion The CCPAQ appears to be a promising and feasible method to assess physical activity pattern in Chinese children.

Effect of Na Fe EDTA-Fortified Soy Sauce on Anemia Prevalence in China: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Objective To assess the effect of sodium iron ethylenediaminetetraacetate （NaFeEDTA）-fortified soy sauce on anemia prevalence in the Chinese population. Methods A systematic review was performed to identify potential studies by searching the electronic databases of PubMed, Cochrane Library, WHO Library, HighWire, CNKI, and other sources. The selection criteria included randomized controlled trials that compared the efficacy of NaFeEDTA-fortified soy sauce with that of non-fortified soy sauce. Anemia rates and hemoglobin levels were the outcomes of interest. Inclusion decisions, quality assessment, and data extraction were performed by two reviewers independently. A total of 16 studies met the inclusion criteria for anemia rate analysis, of which 12 studies met the inclusion criteria for hemoglobin analysis. All included studies assessed the effect of NaFeEDTA-fortified soy sauce on anemia rates and hemoglobin concentrations. Results After the intervention, the hemoglobin concentration increased and anemia rates decreased significantly as compared with the non-fortified soy sauce groups. For anemia rates, data from 16 studies could be pooled, and the pooled estimate odds ratio was 0.25 （95% CI 0.19-0.35）. For hemoglobin concentrations, data from 12 studies could be pooled, and the pooled weighted mean difference was 8.81 g/L （95% CI 5.96-11.67）. Conclusion NaFeEDTA-fortified soy sauce has a positive effect on anemia control and prevention in the at-risk population.

Change of BMD after Weaning or Resumption of Menstruation in Chinese Women with Different FokI VDR-genotypes:A Randomized,Placebo-controlled,Calcium Supplementation Trial

Objective To investigate the effect of calcium supplementation on bone mineral density （BMD） in Chinese women with different Fokl vitamin D receptor （VDR） genotypes （FF, Ff, and ff） after weaning or resumption of menstruation during lactation. Methods A total of 40 subjects with the same Fokl VDR genotype were randomly divided into two groups： one received calcium tablet （600 mg once daily as CaCO3） and the other placebo tablet once daily for 1 year. At baseline, BMD was measured by dual-energy X-ray absorptiometry at lumbar spine （L2-L4） and at left hip whereas serum PICP, serum OC, and urinary CTX, serum 25（OH）VitD3, and serum estradiol were measured at weaning and I year thereafter. Results After the intervention, BMD at lumbar spine and at left hip increased significantly in all these women with a trend among different Fokl VDR genotypes such as FF 〉 Ff 〉 ff （P〈O.05, 〈0.01, and 〈0.001, respectively）. BMD at lumbar spine in women with FF VDR genotype increased much more rapidly than in those with ff VDR genotype （P〈0.05）. Compared with the control group women with the FF genotype regained more BMD after calcium supplementation （P〈0.05）. Conclusion Daily calcium 600 mg supplementation has beneficial effect on the bone health of women with FF VDR genotype.

Joint Association of Metabolic Health and Obesity with Ten-Year Risk of Cardiovascular Disease among Chinese Adults

Objective This study aims to investigate the association of metabolic phenotypes that are jointly determined by body mass index(BMI)or fat mass percentage and metabolic health status with the tenyear risk of cardiovascular disease(CVD)among Chinese adults.Methods Data were obtained from a cross-sectional study.BMI and body fat mass percentage(FMP)combined with the metabolic status were used to define metabolic phenotypes.Multiple linear regression and logistic regression were used to examine the effects of metabolic phenotypes on CVD risk.Results A total of 13,239 adults aged 34-75 years were included in this study.Compared with the metabolically healthy non-obese(MHNO)phenotype,the metabolically unhealthy non-obese(MUNO)and metabolically unhealthy obese(MUO)phenotypes defined by BMI showed a higher CVD risk[odds ratio,OR(95% confidence interval,CI):2.34(1.89-2.89),3.45(2.50-4.75),respectively],after adjusting for the covariates.The MUNO and MUO phenotypes defined by FMP showed a higher CVD risk[OR(95%CI):2.31(1.85-2.88),2.63(1.98-3.48),respectively]than the MHNO phenotype.The metabolically healthy obese phenotype,regardless of being defined by BMI or FMP,showed no CVD risk compared with the MHNO phenotype.Conclusion General obesity without central obesity does not increase CVD risk in metabolically healthy individuals.FMP might be a more meaningful factor for the evaluation of the association of obesity with CVD risk.Obesity and metabolic status have a synergistic effect on CVD risk.

Association between Selenium in Soil and Diabetes in Chinese Residents Aged 35–74 Years:Results from the 2010 National Survey of Chronic Diseases and Behavioral Risk Factors Surveillance

Objective To explore the association between soil selenium levels and the risk of diabetes in Chinese adults aged 35–74 years.Methods Data for this study were derived from the China Chronic Diseases and Behavioral Risk Factors Surveillance 2010 survey.Selenium concentrations in soil were obtained from the Atlas of Soil Environmental Background Values in China.A two-level binary logistic regression model was used to determine the association between soil selenium concentrations and the risk of diabetes,with participants nested within districts/counties.Results A total of 69,332 participants aged 35–74 years,from 158 districts/counties were included in the analysis.Concentrations of selenium in soil varied greatly across the 158 districts/counties,with a median concentration of 0.219 mg/kg(IQR:0.185–0.248).The results showed that both Quartile 1(0.119–0.185 mg/kg)and Quartile 4(0.249–0.344 mg/kg)groups were positively associated with diabetes compared to a soil selenium concentration of 0.186–0.219 mg/kg(Quartile 2),crude odds ratios(ORs)(95%CI)were 1.227(1.003–1.502)and 1.280(1.048–1.563).The P values were 0.045 and 0.013,for Quartile 1 and Quartile 4 groups,respectively.After adjusting for all confounding factors of interest,the Quartile 1 group became non-significant,and the Quartile 4 group had an adjusted OR(95%CI)of 1.203(1.018–1.421)relative to the reference group(Quartile 2),the P values was 0.030.No significant results were seen for the Quartile 3 group(0.220–0.248 mg/kg)compared to the reference group.Conclusion Excessive selenium concentrations in soil could increase the risk of diabetes among Chinese adults aged 35–74 years.

Geographic Variations in the Prevalence,Awareness,Treatment,and Control of Dyslipidemia among Chinese Adults in 2018–2019:A Cross-sectional Study

Objective To investigate the spatial patterns of the prevalence,awareness,treatment,and control rates of dyslipidemia at the provincial level in China.Methods A national and provincial representative cross-sectional survey was conducted among 178,558 Chinese adults in 31 provinces in China's Mainland in 2018–2019,using a multi-stage,stratified,cluster-randomized sampling design.Subjects,as households,were selected,followed by a home visit to collect information.Both descriptive and linear regression procedures were applied in the analyses.Results The overall prevalence of dyslipidemia was 35.6%,and wide geographic variations of prevalence,treatment,and control rates of dyslipidemia were identified among 178,558 eligible participants with a mean age of 55.1±13.8 years.The highest-lowest difference regarding the provincial level prevalence rates were 19.7%vs.2.1%for high low-density lipoprotein cholesterol,16.7%vs.2.5%for high total cholesterol,35.9%vs.5.4%for high triglycerides,and 31.4%vs.10.5%for low high-density lipoprotein cholesterol.The treatment rate of dyslipidemia was correlated with the socio-demographic index(P<0.001),urbanization rate(P=0.01),and affordable basic technologies and essential medicines(P<0.001).Conclusion Prevailing dyslipidemia among the Chinese population and its wide geographic variations in prevalence,treatment,and control suggest that China needs both integrated and localized public health strategies across provinces to improve lipid management.

Development of an Internally Controlled Reverse Transcription Recombinase-aided Amplification Assay for the Rapid and Visual Detection of West Nile Virus

West Nile virus(WNV)causes West Nile fever and West Nile encephalitis.Because infection by WNV creates serious public health problems,its simple,rapid,and visual detection is very important in clinical practice,especially in resource-limited laboratories.We have developed a rapid,specific,and highly sensitive internally controlled reverse transcription recombinase-aided amplification(RTRAA)assay to detect WNV,using both real-timefluoresce nee and the lateral flow dipstick(LFD)at39.0°C for 30 min.The analytical sensitivity of theRT-RAA assay was 10 plasmid copies and 1.6 pfu perreacti on with real-time fluoresce nee,and 1,000plasmid copies per reaction with the LFD.No crossreactionwith other control viruses was observed.Compared with the RT-qPCR assay,the RT-RAA assaydemonstrated 100%sensitivity and 100%specificityfor WNV.

Prevalence of Major Cardiovascular Risk Factors and Cardiovascular Disease in Women in China: Surveillance Efforts

In this study, we aimed to assess the relationship of socioeconomic status and acculturation with cardiovascular disease （CVD） risk profiles and CVD and examine the CVD risk factors associated with CVD. We used data from the 2010 China Chronic Disease and Risk Factor Surveillance surveys, which consisted of a nationally representative sample of women. The following prevalence was found： myocardial infarction （MI）：

Low Selenium and Low Protein Exacerbate Myocardial Damage in Keshan Disease by Affecting the PINK1/Parkin-mediated Mitochondrial Autophagy Pathway

Objective Keshan disease(KD)is a myocardial mitochondrial disease closely related to insufficient selenium(Se)and protein intake.PTEN induced putative kinase 1(PINK1)/Parkin mediated mitochondrial autophagy regulates various physiological and pathological processes in the body.This study aimed to elucidate the relationship between PINK1/Parkin-regulated mitochondrial autophagy and KD-related myocardial injury.Methods A low Se and low protein animal model was established.One hundred Wistar rats were randomly divided into 5 groups(control group,low Se group,low protein group,low Se+low protein group,and corn from KD area group).The JC-1 method was used to detect the mitochondrial membrane potential(MMP).ELISA was used to detect serum creatine kinase MB(CK-MB),cardiac troponin I(cTnI),and mitochondrial-glutamicoxalacetic transaminase(M-GOT)levels.RT-PCR and Western blot analysis were used to detect the expression of PINK1,Parkin,sequestome 1(P62),and microtubule-associated proteins1A/1B light chain 3B(MAP1LC3B).Results The MMP was significantly decreased and the activity of CK-MB,cTnI,and M-GOT significantly increased in each experimental group(low Se group,low protein group,low Se+low protein group and corn from KD area group)compared with the control group(P<0.05 for all).The mRNA and protein expression levels of PINK1,Parkin and MAP1LC3B were profoundly increased,and those of P62 markedly decreased in the experimental groups compared with the control group(P<0.05 for all).Conclusion Low Se and low protein levels exacerbate myocardial damage in KD by affecting the PINK1/Parkin-mediated mitochondrial autophagy pathway.

Challenges Brought about by Rapid Changes in Chinese Diets: Comparison with Developed Countries and Implications for Further Improvement

Given developments in urbanization, agricultural, and technological practices, the diet and lifestyle of developed countries has changed dramatically over the course of the last century[1].

Association of Serum Folate and Vitamin B_(12) Concentrations with Obesity in Chinese Children and Adolescents

Objective This study aimed to evaluate the associations of serum folate and/or vitamin B12 concentrations with obesity among Chinese children and adolescents.Methods A cross-sectional study was conducted including 3,079 Chinese children and adolescents,aged 6 to 17 years,from Jiangsu,China.Anthropometric indices,such as,children's body mass index(BMI),BMI z-scores,waist circumference,and waist-to-height ratio were utilized.Multivariable linear regression and generalized additive models were used to investigate the associations of serum folate and vitamin B12 levels with anthropometric indices and odds of obesity.Results We observed that serum vitamin B12 concentrations were inversely associated with all anthropometric indices and the odds of general obesity[odds ratio(OR)=0.68;95%confidence interval(CI)=0.59,0.78]and abdominal obesity(OR=0.68;95%CI=0.60,0.77).When compared to participants with both serum vitamin levels in the two middle quartiles,those with both serum folate and vitamin B12 levels in the highest quartile were less prone to general(OR=0.31,95%CI=0.19,0.50)or abdominal obesity(OR=0.46,95%CI=0.31,0.67).Conversely,participants with vitamin B12 levels in the lowest quartile alongside folate levels in the highest quartile had higher odds of abdominal obesity(OR=2.06,95%CI=1.09,3.91).Conclusion Higher serum vitamin B12 concentrations,but not serum folate concentrations,were associated with lower odds of childhood obesity.Children and adolescents with high levels of vitamin B12 and folate were less likely to be obese.

Interpretation of the Standards of Basic Dataset of Chronic Diseases Behavior Risk Factor Surveillance in Adults

BACKGROUND China’s Behavioral Risk Factor Surveillance System(BRFSS)originated from the World Bankfunded HealthⅦLoan Project in the 1990s,which conducted behavioral risk factor surveillance in seven cities and one province^([1]).Drawing on the World Health Organization’s(WHO)STEPwise approach to surveillance(STEPs)and the U.S.Behavioral Risk Factor Surveillance System(BRFSS)^([2,3]).