National Nutrition and Health Systematic Survey for Children 0–17 Years of Age in China

The main purpose of the National Nutrition and Health Systematic Survey for children 0-17 years of age in China(CNHSC)was to collect basic data on the nutrition,development,and health status for children in different regions across China using evidence-based,reliable,and cost-effective approaches.Children and their parents or guardians from seven regions(south,southwest,north,northwest,eastern,central,and northeast China)in China were recruited.A multi-stage stratified randomized sampling method was used.Two provinces were randomly sampled from each of the seven regions,from which one urban district and one rural country were also randomly sampled,resulting in a total of 28 survey counties/districts.Dietary surveys,health examinations,laboratory testing,and questionnaires were used to collect dietary intake,nutritional status,child development,and health status information.Nutrition,health,and lifestyle assessment of children and their parents was determined using the Knowledge Attitude Practice(KAP)survey.Greater than 100,000 children(38,000 children<6 years of age and 66,000 children6-17 years of age)completed the survey.The survey provided comprehensive data on child nutrition and health status for future studies and will serve as the basis for an integrated nutrition and health improvement strategies proposal for children in China.

Status of Serum Uric Acid and Hyperuricemia among Adults in China:China Nutrition and Health Surveillance(2015)

Objective The purpose of this study was to determine the serum uric acid levels and the prevalence of hyperuricemia among Chinese adults in 2015 and compare the differences between urban and rural areas,as well as the differences between eastern,central,and western regions.Methods A national representative sample of 180,208 participants were included using a stratified,multistage,and random sampling method.The demographic characteristics and blood samples were collected to determine the serum uric acid levels and prevalence of hyperuricemia among subgroups using complicated sampling weight.A t-test or ANOVA was used for normally-distributed data.The Kruskal-Wallis rank test was used for skewed-distributed data.The Mantel-Haenszel chi-square test was used to compare the difference in categorical variables.Results The weighted mean uric acid level in Chinese adults was 310.4μmol/L(317.5μmol/L in urban areas and 302.9μmol/L in rural areas).The weighted average values of uric acid in eastern,central,and western China were 315.5μmol/L,303.5μmol/L,and 310.4μmol/L,respectively.The weighted prevalence of hyperuricemia in Chinese adults was 14.6%,with a prevalence of 16.5%in urban areas and12.5%in rural areas.The weighted prevalence of hyperuricemia in eastern,central,and western China was 16.0%,12.5%,and 14.8%,respectively.Conclusion The uric acid level in Chinese adults is relatively high.Effective actions are warranted to improve this metabolic abnormality.

A Comparative Study of Blood Lead Levels in Urban Children in China: The China Nutrition and Health Survey(CNHS) 2002 and 2012

Pb is a well-known toxic metal that has attracted considerable attention because of its ubiquitous distribution in the environment owing to the recent industrialization and rapid urbanization in China. In general, Pb from contaminated food, water, and dust enters the body through different channels,spreads throughout the body, combines with multiple amino acids, and interferes with normal physical activity.

The Evolution and Mechanisms of Healthy Aging:Future Precision Nutrition Intervention

The aging of the global population is accelerating,and the ques-tion of how to extend the human life span-especially a healthy life span-has become a hot research topic at home and abroad.As people age,the structure and function of various tissues and organs in the body will successively undergo varying degrees of decline;the rate and manifestation of the aging of each tissue and organ also differ.This decline is the root cause of the poor disease resis-tance of older people,making them prone to infections and various chronic diseases.Although studies have reported the 12 classic hallmarks of aging,and many cutting-edge research methods have been used to map the cellular atlas of aging,scholars have not been able to elucidate the specific changes in and molecular mecha-nisms of the aging of specific organs or the interactions between various tissues and organs,limiting the implementation of precise interventions against aging.

Association of Red Meat Usual Intake with Serum Ferritin and the Risk of Metabolic Syndrome in Chinese Adults: A Longitudinal Study from the China Health and Nutrition Survey

Objective The present study aimed to investigate the association of red meat usual intake with metabolic syndrome(Met S),and explore the contribution of red meat usual intake to serum ferritin.Methods Based on the data from the longitudinal China Health and Nutrition Survey(CHNS),2,797 healthy adults aged 18–75 years without hypertension,diabetes,and Met S were selected in 2009 as subjects and follow-up studies were carried out till 2015.We used the National Cancer Institute(NCI)method to estimate the usual intake of foods.Multivariable logistic regressions were performed to evaluate the association between red meat usual intake and the risk of Met S.Quantile regression analysis was used to study the relationship between red meat consumption and serum ferritin levels.Results After adjusting for potential confounders,red meat,and fresh red meat were positively associated with the risk of Met S(RR=1.41,95%CI:1.05–1.90 and RR=1.37,95%CI:1.02–1.85,respectively).These relationships showed increasing trend(P<0.05).The level of serum ferritin increased significantly with the number of Met S components(P<0.05).The quantile regression analysis showed that red meat and fresh red meat usual intake had a significant positive association with serum ferritin levels across the entire conditional serum ferritin distribution(P<0.05).Processed red meat did not exhibit a similar association.Conclusion Higher red meat usual intake was associated with an increased risk of Met S and elevated serum ferritin levels.

A Scan of Obesogenic Environments and a Spatial Inference of Obesity Prevalence in Chinese Children and Adolescents: Based on the Chinese Health and Nutrition Survey 2011 Data

Objective To identify the characteristics of Chinese obesogenic environments at a provincial level, infer a spatial distribution map of obesity prevalence in 31 provinces, and provide a foundation for development of policy to reduce obesity in children and adolescents. Methods After scanning obesity data on subjects aged 7-17 years from 12 provinces in the China Health and Nutrition Survey 2011 and environmental data on 31 provinces from the China Statistical Yearbook 2011 and other sources, we selected 12 predictors. We used the 12 surveyed provinces as a training sample to fit an analytical model with partial least squares regression and prioritized the 12 predictors using variable importance in projection. We also fitted a predictive model with Bayesian analysis. Results We identified characteristics of obesogenic environments. We fitted the predictive model with a deviance information criterion of 61.96 and with statistically significant（P 〈 0.05） parameter estimates of intercept [95% confidence interval（CI）： 329.10, 963.11], log（oil）（CI： 13.11, 20.30）, log（GDP）（CI： 3.05, 6.93）, log（media）（CI：-234.95,-89.61）, and log（washing-machine）（CI： 0.92, 5.07）. The total inferred average obesity prevalence among those aged 7-17 was 9.69% in 31 Chinese provinces in 2011. We also found obvious clustering in occurrences of obesity in northern and eastern provinces in the predicted map. Conclusion Given complexity of obesity in children and adolescents, concerted efforts are needed to reduce consumption of edible oils, increase consumption of vegetables, and strengthen nutrition, health, and physical activity education in Chinese schools. The northern and eastern regions are the key areas requiring intervention.

China Nutrition and Health Surveys(1982−2017)

The status of nutrition and health among residents is one of the important indicators reflecting the developing level in a country or a region.China’s government initiated the first China National Nutrition Survey in 1959.The Second National Nutrition Survey and the Third National Nutrition Survey were then conducted in 1982 and 1992,respectively(1-2).The China National Nutrition and Health Survey(2002)combined the nutrition and chronic diseases survey and became the fourth survey(3).

The Future Landscape and Framework of Precision Nutrition

The concept of precision nutrition was first proposed almost a decade ago.Current research in precision nutrition primarily focuses on comprehending individualized variations in response to dietary intake,with little attention being given to other crucial aspects of precision nutrition.Moreover,there is a dearth of comprehensive review studies that portray the landscape and framework of precision nutrition.This review commences by tracing the historical trajectory of nutritional science,with the aim of dissecting the challenges encountered in nutrition science within the new era of disease profiles.This review also deconstructs the field of precision nutrition into four key components:the proposal of the theory for indi-vidualized nutritional requirement phenotypes;the establishment of precise methods for measuring dietary intake and evaluating nutritional status;the creation of multidimensional nutritional interven-tion strategies that address the aspects of what,how,and when to eat;and the construction of a pathway for the translation and integration of scientific research into healthcare practices,utilizing artificial intel-ligence and information platforms.Incorporating these four components,this review further discusses prospective avenues that warrant exploration to achieve the objective of enhancing health through pre-cision nutrition.

Envisioning the Intersectionality and Synergy of Precision Nutrition and Engineering

The traditional approach with nutritional supplements is"one size fits all,"which has its limitations due to a lack of consideration of individual variations,including genetic background,health con-dition,lifestyle,and dietary intake.Depending on individual char-acteristics,the exact same nutritional supplementation could be beneficial,have no effect,or even be harmful.Precision nutrition has emerged as a new horizon,with the aim of carefully assessing individual nutritional and health needs and designing individually tailored diet and nutritional supplements.Engineering may play a significant role in each step of precision nutrition research and translation,including big data collection and management,nutri-tional and environmental assessment,data analyses,prediction,biomedical engineering,and nutritional engineering.The integra-tion of precision nutrition and engineering could enhance our abil-ity to best serve all people’s nutritional and health needs.

Iodine Nutrition, Thyroid-stimulating Hormone, and Related Factors of Postpartum Women from three Different Areas in China: A Cross-sectional Survey

Objective Studies on the relationship between iodine,vitamin A(VA),and vitamin D(VD)and thyroid function are limited.This study aimed to analyze iodine and thyroid-stimulating hormone(TSH)status and their possible relationships with VA,VD,and other factors in postpartum women.Methods A total of 1,311 mothers(896 lactating and 415 non-lactating)from Hebei,Zhejiang,and Guangxi provinces were included in this study.The urinary iodine concentration(UIC),TSH,VA,and VD were measured.Results The median UIC of total and lactating participants were 142.00µg/L and 139.95µg/L,respectively.The median TSH,VA,and VD levels in all the participants were 1.89 mIU/L,0.44μg/mL,and 24.04 ng/mL,respectively.No differences in the UIC were found between lactating and non-lactating mothers.UIC and TSH levels were significantly different among the three provinces.The rural UIC was higher than the urban UIC.Obese mothers had a higher UIC and a higher prevalence of excessive TSH.Higher UICs and TSHs levels were observed in both the VD deficiency and insufficiency groups than in the VD-sufficient group.After adjustment,no linear correlation was observed between UIC and VA/VD.No interaction was found between vitamins A/D and UIC on TSH levels.Conclusion The mothers in the present study had no iodine deficiency.Region,area type,BMI,and VD may be related to the iodine status or TSH levels.

Associations of Sedentary Time and Physical Activity with Metabolic Syndrome among Chinese Adults:Results from the China Health and Nutrition Survey

Objective This study aimed to determine the independent and joint associations of sedentary time(ST)and physical activity(PA) with metabolic syndrome(MetS) and its components among Chinese adults.Methods The study analyzed data from 4,865 adults aged ≥ 18 years who participated in the 2009 and2015 China Health and Nutrition Surveys(CHNS). Four types of leisure ST and three types of PA selfreported at baseline were collected. Multivariable logistic regressions were used to determine the independent and joint associations of ST and PA with the odds of MetS or its components.Results For independent effects, higher levels of television time and total leisure ST was associated with higher MetS risk [odds ratio(OR) 1.3, 95% confidence interval(CI) 1.1–1.6, P < 0.001;OR 1.4, 95% CI1.2–1.8, P < 0.001, respectively]. The MetS risk in the computer time > 7 hours/week(h/w) group was higher than that in the < 7 h/w group in(OR 1.5, 95% CI 1.2–1.9). Higher levels of moderate-to-vigorousintensity physical activity(MVPA) and total PA were associated with a lower MetS risk(OR 0.7, 95% CI0.6–0.9, P < 0.001;OR 0.8, 95% CI 0.7–0.9, P < 0.001, respectively). For the joint effects, compared with those reporting the lowest level of total leisure ST(< 14 h/w) and the most active tertile of MVPA(≥ 61.0 MET-h/w), participants reporting the most total leisure ST(≥ 35 h/w) and the lowest level of MVPA(0 MET-h/w) had the highest odds of MetS(OR 2.0;95% CI 1.4–2.7). Except for people reporting ST(14–21 h/w) within the most active tertile of MVPA, the associations in all other groups were significant.With the increase of TV time and decreased MVPA, the odds of MetS almost showed a curve acceleration.Conclusions MVPA and total PA have independent preventive effects, and sedentary behavior(mainly watching TV) has an unsafe effect on MetS and its components. Strengthening the participation of MVPA and combining the LPA to replace the TV-based ST to increase the total PA may be necessary to reduce the prevalence of MetS in Chinese adults.

Nutrition and Health Monitoring and Evaluation of the NIPRCES in China

Good nutritional status in childhood serves as the foundation for lifelong health.Malnutrition during childhood can not only impede children’s growth and development,but also lead to a higher incidence of chronic diseases in adulthood,thereby increasing the socioeconomic burden.In order to improve the nutritional and health status of children living in economically underdeveloped rural areas,the Chinese government implemented the Nutrition Improvement Program for Rural Compulsory Education Students(NIPRCES)in November 2011(1).The central government provides nutritional meal subsidies to rural compulsory education students in underdeveloped counties.Initially,NIPRCES covered rural area of 699 national pilot counties across 22 provincial-level administrative divisions(PLADs)in the central and western regions of China.By 2021,the program expanded to encompass 727 national pilot counties and 1,010 local pilot counties spanning 28 provinces in the eastern,central,and western regions of China,serving more than 36 million students.

Dairy Consumption and Associations with Nutritional Status of Chinese Children and Adolescents

Objective This study aimed to describe frequency and quantity of total dairy consumption of Chinese children and adolescents and explore the associations between dairy consumption and nutrition status, including stunting, wasting, overweight, and obesity. Methods Participants included 28,250 children and adolescents aged 6-17 years old. A food frequency questionnaire(FFQ) including 100 kinds of food was used to collect information about frequency and quantity of dairy consumption. Determination of stunting was with a height cutoff value for age and gender, and determination for wasting, overweight, and obesity was with BMI for age and gender. Results Of the total sample, 36.1% of children aged 6-17 reported consuming dairy food more than once per day(≥ 1/day). The average total dairy intake of all the participants was 126.7 g/day. For boys, dairy consumption had an inverse correlation with stunting and wasting after controlling for confounders. For girls, dairy consumption was negatively associated with stunting and obesity after controlling for confounders as above. Conclusion Dairy consumption in Chinese children and adolescents was relatively lower than that in developed countries, and was negatively associated with stunting and wasting for boys and with stunting and obesity for girls.

Probiotics and gut health:A special focus on liver diseases

Probiotic bacteria have well-established beneficial ef-fects in the management of diarrhoeal diseases.Newer evidence suggests that probiotics have the potential to reduce the risk of developing inflammatory bowel diseases and intestinal bacterial overgrowth after gut surgery.In liver health,the main benefits of probiotics might occur through preventing the production and/or uptake of lipopolysaccharides in the gut,and therefore reducing levels of low-grade inflammation.Specific immune stimulation by probiotics through processes involving dendritic cells might also be beneficial to the host immunological status and help prevent pathogen translocation.Hepatic fat metabolism also seems to be influenced by the presence of commensal bacteria,and potentially by probiotics;although the mechanisms by which probiotic might act on the liver are still unclear.However,this might be of major importance in the fu-ture because low-grade inflammation,hepatic fat infil-tration,and hepatitis might become more prevalent as a result of high fat intake and the increased prevalence of obesity.

Comparison of Undernutrition Prevalence of Children under 5 Years in China between 2002 and 2013

Objective To describe the undernutrition status of children under 5-year in China, and study the trend between 2002 and 2013. Methods The study was based on two national surveys. Undernutrition was determined against WHO＇s 2006 growth standards. The prevalence in 2013 and 2002 was weighted by China sixth National Population Census （2010）. The relationship between undernutrition and gender/age groups/different areas use weighted logistic regression. Results The results indicated the overall prevalence of stunting, underweight, and wasting of Chinese children under S-year was 8.1%, 2.4%, and 1.9% in 2013, respectively. The prevalence of stunting was higher for children aged 12-47 month, while underweight was higher for children aged 48-59 month. The prevalence of undernutrition was higher in rural areas than in urban areas, especially in poor rural areas. There was a decline of stunting, underweight, and wasting between 2002 and 2013 among the children, with greater reduction in rural areas than in urban areas. Conclusion The prevalence of undernutrition of children under 5-year remains high in rural areas especially in poor rural areas in China. It is urgent to take action to control undernutrition in the vulnerable areas and subgroups.

Effects of glutamine-containing total parenteral nutrition on phagocytic activity and anabolic hormone response in rats undergoing gastrectomy

AIM: To investigate the effect of glutamine (Gln)-containing parenteral nutrition on phagocytic activity and to elucidate the possible roles of Gln in the secretion of anabolic hormones and nitrogen balance in rats undergoing a gastrectomy. METHODS: Rats with an internal jugular catheter were divided into 2 experimental groups and received total parenteral nutrition (TPN). The TPN solutions were isonitrogenous and identical in nutrient compositions except for differences in amino acid content. One group received conventional TPN (control), and in the other group, 25% of the total amino acid nitrogen was replaced with Gin. After receiving TPN for 3 d, one-third of the rats in each experimental group were sacrificed as the baseline group. The remaining rats underwent a partial gastrectomy and were killed 1 and 3 d, respectively, after surgery. Plasma, peritoneal lavage fluid (PLF), and urine samples were collected for further analysis. RESULTS: The Gln group had fewer nitrogen losses 1 and 2 d after surgery (d1, 16.6±242.5 vs-233.4±205.9 mg/d, d2, 31.8±238.8 vs-253.4±184.6 mg/d, P<0.05). There were no differences in plasma growth hormone (GH) and insulin-like growth factor-1 levels between the 2 groups before or after surgery. The phagocytic activity of peritoneal macrophages was higher in the Gln group than in the control group 1 d after surgery (A 1185±931 vs323±201, P<0.05). There were no differences in the phagocytic activities of blood polymorphonuclear neutrophils between the 2 groups at the baseline or on the postoperative days. No significant differences in interleukin-1β or interleukin-6 concentrations in PLF were observed between the 2 groups. However, tumor necrosis factor-α level in PLF was significantly lower in the Gln group than in the control group on postoperative d 3. CONCLUSION: TPN supplemented with Gln can improve the nitrogen balance, and enhance macrophage phagocytic activity at the site of injury. However, Gin supplementation has no effect on phagocytic cell activity in the systemic circulation, GH and insulin-like growth factor-1 might not be responsible for attenuating nitrogen losses in rats with a partial gastrectomy.

Physical activity,sedentary behaviors,physical fitness,and their relation to health outcomes in youth with type 1 and type 2 diabetes:A review of the epidemiologic literature

Diabetes is a leading chronic disease of childhood and adolescence. In addition to the well-known auto-immune, insulin-dependent diabetes mellitus （type 1 diabetes （T 1D））, the past two decades have witnessed the emergence of type 2 diabetes （T2D） in children and adolescents, which previously was only seen in middle-aged or older adults. One of the key components of diabetes management is physical activity （PA）. The beneficial effects of increased PA and decreased sedentary behavior are extremely important in youth with diabetes because of the markedly increased long-term risk of cardiovascular disease in this population compared to persons without diabetes. This review aims to comprehensively summarize the epidemiologic, observational research published and listed in PubMed between 1970 and 2012 on PA and sedentary behaviors, as well as physical fitness in children and adolescents with T1D and T2D. Additionally, we describe briefly the state of knowledge on perceived barriers of PA in persons with diabetes, with a focus on hypoglycemia. Finally, we provide an overview of the epidemiological literature pertaining to health benefits of increased PA in youth with TID and T2D and briefly discuss the topic of exercise-related hypoglycemia, Copyright ~ 2012, Shanghai University of Sport. Production and hosting by Elsevier B.V. All rights reserved.

Malnutrition in Relation with Dietary, Geographical, and Socioeconomic Factors among Older Chinese

Objective Nutrition is closely related to the health of the elderly population. This study aimed to provide a comprehensive picture of the nutrition status of elderly Chinese and its related dietary,geographical, and socioeconomic factors.Methods A total of 13,987 ≥ 60-year-old persons from the 2010–2013 Chinese National Nutrition and Health Survey were included to evaluate various aspects of malnutrition, including underweight,overweight or obesity, and micronutrient inadequacy.Results Overall, the prevalence of obesity, overweight, and underweight was 12.4%, 34.8%, and 5.7%,respectively, with disparities both geographically and socioeconomically. The prevalence of underweight was higher among the older old(≥ 75 years), rural residents and those with low income, with low education status, and residing in undeveloped West areas. More than 75% of the elderly do not meet the Dietary Reference Intakes for vitamins A, B1, B2, and E, folate, calcium, selenium, potassium, biotin,and choline, with the prevalence of inadequate intake increasing with age for most nutrients. At the population level, the mean intakes of numerous food groups did not meet the recommendations by the Chinese Dietary Guideline.Conclusions Obesity epidemic, inadequacy of micronutrient intake, and high prevalence of underweight and anemia in susceptible older people are the major nutrition challenges for the rapidly aging population in China.

Hypertension Screening and Follow-up Management by Primary Health Care System among Chinese Population Aged 35 Years and Above

Objective To describe hypertension screening and follow-up management among Chinese population aged 35 years and above within the primary health care system. Methods Data from 2010 China Chronic Disease and Risk Factor Surveillance System were used. We investigated previous hypertension diagnosis, screening, and follow-up assessments within the primary health care system. The prevalence of self-reported and criterion-based hypertension, screening rates, demographic and socioeconomic characteristics associated with screening, and patterns of follow-up assessments were recorded. The SAS software system was used for statistical analyses. Results About 17.1% reported a previous hypertension diagnosis. The rate difference between the two measures of prevalence was 27.2%. Among those without self-reported hypertension, 27.7% reported never visiting a clinic during the past I year and 60.4% of those attending a clinic reported ever being screened. Younger age group was associated with lower screening proportion; odds ratios of 35-, 45-, 55-, and 〉65 years were 1.7 （95% CI： 1.5-1.9）, 1.5 （95% CI： 1.3-1.7）, 1.3 （95% CI： 1.2-1.4）, and 1.0, respectively. About 35.1% of the patients had undergone follow-up assessments four or more times during the past I year. Conclusion Majority of the Chinese population aged 35 years and above, particularly the less educated, elderly population, and rural residents were unaware of that they were suffering from hypertension. Most patients did not receive enough management services by the primary health care system. Thus, strengthening both the screening and follow-up management is needed.

Prevalence of Undernutrition and Related Dietary Factors among People Aged 75 Years or Older in China during 2010-2012

Objective Undernutrition is highly prevalent among older people. The aim of this study was to estimate the prevalence of undernutrition in elderly Chinese residents and explore the relationship between undernutrition and dietary factors. Methods Data were collected from 2,552 elderly people aged 75 years and over from the Chinese Nutrition and Health Surveillance during 2010-2012 using questionnaires, anthropometric measurement, and individual consecutive 3-day 24-hour dietary records. Results The present study showed that 10.5% of participants had undernutrition. The prevalence was higher among the population living in rural areas, those living in the South region, those who smoked, and those with low income levels. Most participants failed to meet the Chinese Dietary Reference Intakes for energy（66.1%） and protein（72.1%）. When comparing quartiles of food intake, high rice consumption [odds ratio（OR） = 2.44, 95% confidence interval（CI）： 1.35-4.40）], animal oil intake（OR = 1.60, 95% CI： 1.18-2.17）, and high fat intake from animal sources（OR = 1.56, 95% CI： 1.06-2.31） were positively associated with underweight whereas high wheat consumption（OR = 0.44, 95% CI： 0.26-0.74）, a proper proportion（24%-32%） of energy intake from fat（OR = 0.54, 95% CI： 0.35-0.83）, and high fat intake from plant sources（OR = 0.67, 95% CI： 0.46-0.99） were inversely related.Conclusion The prevalence of undernutrition was high among elderly Chinese people, especially in rural areas. Dietary factors, such as high consumption of rice, were associated with undernutrition.