Joint associations of dietary pattern and television viewing with CVD risk factors among urban men and women in China: a cross-sectional study

Dietary patterns and cardiovascular diseases among Chinese high-risk population aged 35 years and older: A 6-year cohort study

This study aims to investigate the dietary patterns of Chinese individuals aged 35 years and older who are at high risk of cardiovascular disease (CVD) and to explore the correlation between these dietary patterns and the risk of CVD. A total of 28,747 high-risk participants in China PEACE in Zhejiang Province from 2014 to 2019 were included in the analysis Dietary data were obtained using the Food Frequency Questionnaire, and dietary patterns were extracted through factor analysis. Cox regression was used to examine the relationship between the dietary patterns and CVD risk in the high-risk groups. Four dietary patterns were identified. The "Bean, egg, milk and pickle" dietary pattern was associated with an increased risk of CVD (HR = 1.29; 95% confidence interval (CI):1.09, 1.54; p＜0.05), after adjusting for confounders. In contrast, the "Seafood and animal meat", "Wheat and coarse cereals", and "Rice and vegetable" dietary patterns did not show a significant impact on CVD risk. These findings provide valuable insights for dietary guidance in high-risk groups and have significant implications for the prevention and management of CVD.

Identification of Chinese dietary patterns and their relationships with health outcomes: a systematic review and meta-analysis

OBJECTIVE

China has been undergoing a rapid nutrition transition in the past few decades. This review aims to characterise commonly reported dietary patterns in Chinese populations and their associations with health outcomes.

DESIGN

We searched PubMed, Embase and CNKI from inception to June 2020 to identify observational studies reporting dietary patterns or the associations between dietary patterns and health outcomes. Information regarding dietary patterns, their association with health outcomes and other related items was collected.

SETTING

Chinese population and Chinese immigrants.

PARTICIPANTS

Not applicable.

RESULTS

Results from 130 studies with over 900 000 participants were included. Six dietary patterns were identified: traditional whole-grain diet (Traditional WG), traditional non-whole-grain diet (Traditional NWG), plant-based diet (Plant-based), animal food diet (Animal-food), Western energy-dense diet (Western) and other unclassified diets (Unclassified). The Plant-based diet was associated with a reduced risk of CVD and cancer from prospective studies, reduced risk of diabetes, hypertension, cognitive impairment and depressive symptoms from all study designs. The Traditional WG diet was associated with a reduced risk of diabetes and hypertension. Animal-food diet is associated with a range of metabolic diseases, and Western diet was associated with increased risks of obesity and depressive symptoms.

CONCLUSION

Multiple dietary patterns identified reflect the diversity and transitioning of the Chinese diet. A healthy Chinese diet, comprising both the Traditional WG and Plant-based diets, was associated with reduced risks of specific undesirable health outcomes. Promoting this healthy diet will improve public health among the Chinese populations.

Association between daily screen time and risk of stroke among middle-aged and elderly people: research based on China health and nutrition survey

Background

We aimed to explore the independent associations between screen time and the risk of stroke among Chinese adults based on the China Health and Nutrition Survey (CHNS).

Methods

Data on Chinese adults aged older than 40 years from the CHNS in during 2004-2009 were selected. A total of 4,587 individuals were included in 2009, including screen time and the risk of stroke. Simultaneously, we traced the previous screen time to 2004 for those with outcome measures in 2009 (n = 2,100). Basic information, lifestyle, and screen behavior were obtained through face-to-face interviews and self-completed questionnaires. Anthropometric data collected included blood pressure, body weight, height, hip circumference, and waist circumference. Fasting blood was obtained for measurements of lipid and glucose levels. Cross-sectional analysis and cohort analysis were both performed using multivariate logistic regression.

Results

Of all participants, 3,004 (65.49%) participants spent more than 2 h per day on screen time. Taking the men who spent less than 2 h on screen per day as reference, the crude odds ratio (OR) of the high risk of stroke was 1.53 [95% confidence interval (CI), 1.20-1.95] for the men who spent 2-3 h per day on screen and 2.37 (95% CI, 1.78-3.16) for the men who spent more than 3 h per day on screen. This difference remained significant after adjusting for confounding factors. No association was observed among women. However, in the cohort analysis with screen time in 2006 as the independent variable, the association between screen time and stroke risk was found both in men [OR, 1.83 (95% CI, 1.19-2.82)] and women [OR, 1.48 (95% CI, 1.10-1.99)]).

Conclusion

We found that the high screen time was associated with an increased stroke risk, which was pronounced in men, warranting a universal need to limit screen time in order to improve health.

Dietary Patterns and Obesity in Chinese Adults: A Systematic Review and Meta-Analysis

Certain dietary patterns are associated with an increased risk of obesity and its comorbidities. However, these associations vary across populations. The prevalence of obesity has been rising amid a drastic nutrition transition in China during the country’s rapid economic growth. This systematic review and meta-analysis were conducted to summarize how dietary patterns are associated with obesity in the Chinese population. We searched for articles from 1 January 2000 to 1 February 2022 in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus that assessed the relationship between dietary patterns and obesity outcomes. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using a random effects model. From the 2556 articles identified from the search, 23 articles were included in the analysis. We found that the traditional Chinese dietary pattern was associated with a lower risk of overweight/obesity (OR = 0.69, 95% CI: 0.57, 0.84, p < 0.001), whereas the Western dietary pattern was associated with a higher OR of overweight/obesity, but not reaching statistical significance (OR = 1.34, 95% CI: 0.98, 1.84, p = 0.07). There were inconsistent results for other dietary patterns, such as meat/animal protein and plant/vegetarian patterns. In conclusion, the traditional Chinese diet characterized by vegetables, rice, and meat was associated with a lower risk of obesity. The heterogeneity in characterizing dietary patterns contributes to the inconsistency of how dietary patterns are associated with obesity in the Chinese population.

Dietary patterns and cardiovascular disease risk among Chinese adults: a prospective cohort study

BACKGROUND AND OBJECTIVE

We aimed to examine the prospective association between dietary patterns and cardiovascular disease (CVD) risk in Chinese adults.

METHODS

Adults aged ≥20 years in the China Health and Nutrition Survey (open cohort) were followed between 1991 and 2011. Participants may enter the cohort at any wave. Dietary intakes were obtained from a 3-day, 24-h recall combined with household weighing for oil and condiments. CVD was defined as having either myocardial infarction or stroke. Two sets of dietary patterns were derived using reduced rank regression and factor analysis. Iron-related dietary pattern (IDP) was generated using iron intake as a response variable. Multivariable Cox regression was used to analyse the relation between dietary patterns and CVD risk.

RESULTS

In total, 13,055 adults were followed for a median of 9 years. During 115,368 person years of follow-up, 502 participants developed CVD. Two dietary patterns were derived and labeled as traditional dietary pattern (high intake of rice, pork, fish, poultry, and fresh vegetable but low intake of wheat) and modern dietary pattern (high intake of fruit, soymilk, and fast food). Across the quartiles of intake, the hazard ratio (95% CI) for CVD were 1.0, 0.84 (0.64-1.10), 0.57 (0.42-0.77), and 0.58 (0.42-0.79) for traditional pattern (p for trend <0.001) and 1.0, 1.56 (1.16-2.09), 1.56 (1.13-2.14), and 1.68 (1.16-2.44) (p for trend = 0.118) for modern pattern. IDP was characterised by high intake of fresh vegetable, wheat, legume, beverage, offal, rice, and whole grain. IDP intake was not associated CVD. Comparing extreme quartiles, high rice intake was associated with halved while wheat intake was associated with a doubled risk of CVD.

CONCLUSIONS

Traditional dietary pattern and rice intake are inversely but modern dietary pattern and wheat is directly associated with CVD risk. IDP is not related to CVD in Chinese adults.

Sedentary Behavior Research in the Chinese Population: A Systematic Scoping Review

Background: The negative effects of sedentary behavior (SB) on public health have been extensively documented. A large number of studies have demonstrated that high prevalence of SB is a critical factor of all-cause mortality. Globally, the frequency of SB research has continued to rise, but little is known about SB in the Chinese population. Therefore, this review was conducted to scope the research situation and to fill the gaps related to the effects of SB in the Chinese population. Methods: Using a scoping review based on York methodology, a comprehensive search of published journal articles and grey literature was carried out through 12 databases. The literature research was conducted by two authors in July 2019, and included journal articles that targeted on the Chinese population were published between 1999 and 2019. The two authors screened the records independently and included those research topics related to SB in the Chinese population. Results: The number of included studies increased from 1 to 29 per year during the analyzed period, during which, a remarkable climb happened from 8 in 2013 to 19 in July 2019. Out of the 1303 screened studies, a total of 162 studies (81 English and 81 Chinese journal articles) met the inclusion criteria in this review. Most of the included studies (66.0%) reported the overall estimated prevalence of SB, in which, 43.2% of studies reported the average time of SB, and 40.0% of studies reported the cutoff point of SB. Besides this, 54.9% and 23.5% of studies focused on the outcomes and correlates/determinants of SB, and the proportions of studies based on testing the validation of measurement tools and on interventions were 3.7% and 4.9%, respectively. Nearly all of the reviewed articles used data from cross-sectional studies (75.9%) and longitudinal studies (13.6%), while intervention trials are less developed. The majority of the studies (64.8%) used self-reported surveys, and only 3.7% studies used device-based measurement tools. Furthermore, 35.8% of the included studies were focused on children and adolescents, while only a few studies investigated infants/toddlers and older adults. Both female and male were examined in most studies, and non-clinical populations were investigated in the context of SB in a relatively large number of studies. Conclusions: The number of research articles on SB in the Chinese population published per year has increased year by year, indicating a growing interest in this research area. More studies using population subgroup samples are needed, particularly among infants/toddlers, older adults, and clinical populations. To provide stronger evidence of the determinants and outcomes of SB, longitudinal studies using device-based measures of SB are required.

Effectiveness of a clinic-based randomized controlled intervention for type 2 diabetes management: an innovative model of intensified diabetes management in Mainland China (C-IDM study)

OBJECTIVES

Highly efficient diabetes management programs are needed for tackling diabetes in China. This study aimed to assess the effectiveness of a clinic-based intensified diabetes management model (C-IDM) in Mainland China.

RESEARCH DESIGN AND METHODS

A 2-year clinic-based randomized controlled trial was conducted among patients with type 2 diabetes in Nanjing, China. The C-IDM intervention components comprised four domains (disease targeting management, express referral channel, expert visit, patients' self-management) and an integrated running system (disease control centers, general hospitals and local clinics). Control group participants received their usual care, while intervention participants received both the C-IDM package and the usual services. The primary outcome variable was change of hemoglobin A1c (HbA1c). Mixed-effects models were used to compute effect estimates and 95% CI with consideration of both individual and cluster-level confounders.

RESULTS

Overall, 1095 of 1143 participants were assessed at study completion. The mean change in HbA1c was significantly greater in the intervention group than in the control group (mean difference (MD)=-0.57, 95% CI -0.79 to -0.36). Similar results were observed for change in body mass index (MD=-0.29, 95% CI -0.49 to -0.10). Participants in the intervention group were more likely to achieve normal HbA1c and body weight compared with their counterparts in control group after adjusting for potentially confounding variables (adjusted OR=1.94, 95% CI 1.35 to 2.81 and 1.79, 95% CI 1.13 to 2.85, respectively).

CONCLUSIONS

The C-IDM model is feasible and effective in large-scale management of patients with type 2 diabetes in China. It has public health implications for tackling the burden of diabetes in China.

TRIAL REGISTRATION NUMBER

ChiCTR-IOR-15006019.