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Liu Z, Man Q, Li Y, Yang X, Ding G, Zhang J, Zhao W. Estimation of 24-hour urinary sodium and potassium excretion among Chinese adults: a cross-sectional study from the China National Nutrition Survey. Am J Clin Nutr 2024; 119:164-173. [PMID: 38176776 DOI: 10.1016/j.ajcnut.2023.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/01/2023] [Accepted: 09/12/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND High-sodium intake is one of the most important risk factors for hypertension and cardiovascular disease, yet reliable national estimates of sodium intake in Chinese adults have not been reported. OBJECTIVES We estimated 24-h urinary sodium and potassium excretion and population daily sodium and potassium intake of Chinese adults for the first time at a national level. METHODS A nationally representative cross-sectional survey was conducted to collect 24-h urine specimens from Chinese adults aged ≥18 y as part of the China National Nutrition Survey 2015. Finally, 10,114 participants (4932 males and 5182 females) with complete 24-h urine specimens were included in the analysis. Estimates of mean urinary electrolyte excretion and demographic, socioeconomic, and health characteristics were used with weighted coefficients that accounted for sample selection probabilities, poststratification weighting, and nonresponse rates. RESULTS The estimation of overall weighted mean 24-h urinary sodium excretion was 4121 mg (95% confidence interval [CI]: 3993, 4250), 4155 mg (95% CI: 3993, 4317) in males and 4081 mg (95% CI: 3953, 4209) in females (P for sex difference = 0.36). Overall mean 24-h urinary potassium excretion was 1534 mg (95% CI: 1492, 1577), 1468 mg (95% CI: 1424, 1513) in males and 1614 mg (95% CI: 1569-1660) in females (P for sex difference <0.001). Mean 24-h urinary sodium excretion was significantly higher in rural adults (4350 mg; 95% CI: 4217, 4483) than in urban residents (3909 mg; 95% CI: 3739, 4080; P < 0.001), and in northern residents (4388 mg; 95% CI: 4237, 4539) than in southern residents (3998 mg; 95% CI: 3832, 4163; P = 0.002). CONCLUSIONS The first nationwide survey with 24-h urine collection confirmed that mean sodium intake in Chinese adults was more than twice the upper limit, whereas mean potassium intake was <60% of the lower limit, recommended by the World Health Organization. Urgent measures should be taken to reduce sodium intake and increase potassium intake in China.
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Affiliation(s)
- Zhen Liu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qingqing Man
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China; Key Laboratory of Trace Element Nutrition of National Health Commission, Beijing, China
| | - Yuqian Li
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaoguang Yang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China; Key Laboratory of Trace Element Nutrition of National Health Commission, Beijing, China
| | - Gangqiang Ding
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China; Key Laboratory of Trace Element Nutrition of National Health Commission, Beijing, China
| | - Jian Zhang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China; Key Laboratory of Trace Element Nutrition of National Health Commission, Beijing, China
| | - Wenhua Zhao
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China; Key Laboratory of Trace Element Nutrition of National Health Commission, Beijing, China.
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Okada E, Nakade M, Hanzawa F, Murakami K, Matsumoto M, Sasaki S, Takimoto H. National Nutrition Surveys Applying Dietary Records or 24-h Dietary Recalls with Questionnaires: A Scoping Review. Nutrients 2023; 15:4739. [PMID: 38004132 PMCID: PMC10674720 DOI: 10.3390/nu15224739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/05/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
Development of an accurate and efficient dietary method is required for national nutrition surveys. Some countries conduct dietary surveys and combine 24-h dietary records or 24-h dietary recalls with dietary questionnaires. This scoping review aimed to summarize studies that used results from national surveys that combined detailed dietary surveys (dietary records or 24-h dietary recall) and dietary questionnaires and identify the purpose of combining the two methods. The PubMed database and manual searches were used for the literature review. We extracted 58 articles from 16 national nutrition surveys from 14 countries. Most studies used 24-h dietary recall for detailed dietary surveys and the food frequency questionnaire (FFQ) or food propensity questionnaire (FPQ) for questionnaire surveys. Among 37 studies from eight countries, the purpose of combining the two dietary survey methods was to estimate energy and nutrient intakes from detailed dietary surveys and habitual food intake from questionnaires. These findings are useful as a reference when introducing new dietary survey methods in future national nutrition surveys.
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Affiliation(s)
- Emiko Okada
- The Health Care Science Institute, 3-2-12 Akasaka, Minato-ku, Tokyo 107-0052, Japan
- Department of Nutritional Epidemiology and Shokuiku, National Institute of Biomedical Innovation, Health and Nutrition, Kento Innovation Park, NK Building, 3-17 Senrioka Shinmachi, Settsu-shi 566-0002, Japan
| | - Makiko Nakade
- Department of Food Science and Nutrition, University of Hyogo, 1-1-12 Shinzaike-Honcho, Himeji-shi 670-0092, Japan
- Research Institute for Food and Nutritional Sciences, 1-1-12 Shinzaike-Honcho, Himeji-shi 670-0092, Japan
| | - Fumiaki Hanzawa
- Department of Food Science and Nutrition, University of Hyogo, 1-1-12 Shinzaike-Honcho, Himeji-shi 670-0092, Japan
- Research Institute for Food and Nutritional Sciences, 1-1-12 Shinzaike-Honcho, Himeji-shi 670-0092, Japan
| | - Kentaro Murakami
- Department of Social and Preventive Epidemiology, School of Public Health, University of Tokyo, Tokyo 113-0033, Japan
| | - Mai Matsumoto
- Department of Nutritional Epidemiology and Shokuiku, National Institute of Biomedical Innovation, Health and Nutrition, Kento Innovation Park, NK Building, 3-17 Senrioka Shinmachi, Settsu-shi 566-0002, Japan
| | - Satoshi Sasaki
- Department of Social and Preventive Epidemiology, School of Public Health, University of Tokyo, Tokyo 113-0033, Japan
| | - Hidemi Takimoto
- Department of Nutritional Epidemiology and Shokuiku, National Institute of Biomedical Innovation, Health and Nutrition, Kento Innovation Park, NK Building, 3-17 Senrioka Shinmachi, Settsu-shi 566-0002, Japan
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Yang Y, Piao W, Cai S, Huang K, Yuan C, Cheng X, Zhang L, Li Y, Zhao L, Yu D. Comparison of data-driven identified hypertension-protective dietary patterns among Chinese adults: based on a nationwide study. Eur J Nutr 2023; 62:2805-2825. [PMID: 37335360 DOI: 10.1007/s00394-023-03195-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/09/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE Diet pattern (DP) is a key modifiable and cost-effective factor in hypertension (HTN) management. The current study aimed to identify and compare the hypertension-protective DPs among Chinese adults. METHODS 52,648 participants aged over 18 years were included from China Nutrition and Health Surveillance (CNHS) 2015-2017. Reduced rank regression (RRR) and partial least square regression (PLS) was applied to identify the DPs. Multivariable-adjusted logistic regression was used to assess the association between the DPs and HTN. RESULTS DPs derived by RRR and PLS were both featured by higher consumption of fresh vegetables and fruits, mushrooms and edible fungi, seaweeds, soybeans and related products, mixed legumes, dairy products, fresh eggs, and lower of refined grain consumption. Compared to the lowest quintile, participants in the highest quintile had lower odds of HTN (RRR-DP: OR = 0.77, 95% CI = 0.72-0.83; PLS-DP: OR = 0.76, 95% CI = 0.71-0.82; all p < 0.0001). Simplified DP scores were observed the same protective tendencies (Simplified RRR-DP: OR = 0.81, 95% CI = 0.75-0.87; Simplified PLS-DP: OR = 0.79, 95% CI = 0.74-0.85; all p < 0.0001) and showed effective extrapolation in subgroups defined by gender, age, location, lifestyle, and different metabolic conditions. CONCLUSIONS The identified DPs had high conformity with East Asian dietary habits, and significantly negative associations with HTN among Chinese adults. The simplified DP technique also indicated the potential for improving the extrapolation of the results of DP analysis related to HTN.
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Affiliation(s)
- Yuxiang Yang
- Department of Nutrition Surveillance, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, No. 29 Nanwei Road, Beijing, 100050, China
| | - Wei Piao
- Department of Nutrition Surveillance, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, No. 29 Nanwei Road, Beijing, 100050, China
- NHC Key Laboratory of Trace Element Nutrition, Chinese Center for Disease Control and Prevention, No. 29 Nanwei Road, Beijing, 100050, China
| | - Shuya Cai
- Department of Nutrition Surveillance, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, No. 29 Nanwei Road, Beijing, 100050, China
| | - Kun Huang
- Department of Nutrition Surveillance, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, No. 29 Nanwei Road, Beijing, 100050, China
| | - Changzheng Yuan
- School of Public Health, Zhejiang University School of Medicine, 866 Yuhangtang Road, Hangzhou, 310058, China
| | - Xue Cheng
- Department of Nutrition Surveillance, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, No. 29 Nanwei Road, Beijing, 100050, China
| | - Ling Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No. 10 Xitoutiao, Youanmenwai, Beijing, 100069, China
| | - Yuge Li
- Department of Nutrition Surveillance, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, No. 29 Nanwei Road, Beijing, 100050, China
| | - Liyun Zhao
- Department of Nutrition Surveillance, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, No. 29 Nanwei Road, Beijing, 100050, China.
- NHC Key Laboratory of Trace Element Nutrition, Chinese Center for Disease Control and Prevention, No. 29 Nanwei Road, Beijing, 100050, China.
| | - Dongmei Yu
- Department of Nutrition Surveillance, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, No. 29 Nanwei Road, Beijing, 100050, China.
- NHC Key Laboratory of Trace Element Nutrition, Chinese Center for Disease Control and Prevention, No. 29 Nanwei Road, Beijing, 100050, China.
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Wan Q, Qian Y, Xia MJ, Tan L, Lv XY, Meng XQ, Ding YB, Zhong ZH, Geng LH. Young obese patients may benefit from GnRH-a long protocol contributing to higher implantation rate and live birth rate of fresh IVF-ET cycles. Heliyon 2023; 9:e20016. [PMID: 37810820 PMCID: PMC10556590 DOI: 10.1016/j.heliyon.2023.e20016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Obesity has detrimental influences on women reproductive health. There is little experience in optimizing controlled ovarian hyperstimulation (COH) protocols to treat Chinese obese patients who are undergoing in vitro fertilization and embryo transfer (IVF-ET) therapy. Methods The clinical outcome differences were retrospectively analyzed among obese patients who received gonadotrophin-releasing hormone agonist (GnRH-a), GnRH antagonist (GnRH-ant), micro dose GnRH-a (mGnRH-a) and GnRH-a long protocol in IVF-ET cycle at Chengdu Jinjiang Hospital for Women's and Children's Health from January 2014 to December 2019. Results The transplantation rate of the GnRH-a long protocol group (59.1%) was higher than that of the GnRH-ant (25.9%) and mGnRH-a (36.7%) groups. The total live birth rate of the GnRH-a long protocol group (46.2%) was higher than that of the GnRH-a group (25.9%) and GnRH-ant group (40.3%). The total number of frozen embryos in the GnRH-ant group was higher than in the other groups (P < 0.05). After adjusting for confounding factors, the logistic regression analysis showed that the GnRH-a long protocol group had higher probabilities of biochemical pregnancy, clinical pregnancy, and live birth than the GnRH-a protocol group. The Gn dose in the mGnRH-a group was higher than the other three groups. Whether single or twin, there were similar neonatal outcomes among the four groups including premature birth rate, Apgar score, newborn weight, and length. Conclusion For young obese patients undergoing IVF-ET, the GnRH-a long protocol for COH gives better pregnancy outcomes.
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Affiliation(s)
- Qi Wan
- Chengdu Jinjiang Hospital for Women's and Children's Health, Chengdu, 610011, China
- Department of Gynecology and Obstetrics, West China Second Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, China
| | - Yue Qian
- Department of Epidemiology, School of Public Health and Management, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, 400016, China
| | - Ming-Jing Xia
- Chengdu Jinjiang Hospital for Women's and Children's Health, Chengdu, 610011, China
| | - Li Tan
- The Department of Reproductive Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xing-Yu Lv
- Chengdu Jinjiang Hospital for Women's and Children's Health, Chengdu, 610011, China
| | - Xiang-Qian Meng
- Chengdu Jinjiang Hospital for Women's and Children's Health, Chengdu, 610011, China
| | - Yu-Bin Ding
- Joint International Research Laboratory of Reproduction and Development of the Ministry of Education of China, School of Public Health and Management, Chongqing Medical University, Chongqing, 400016, China
- Department of Pharmacology, Academician Workstation, Changsha Medical University, Changsha, 410219, China
| | - Zhao-Hui Zhong
- Department of Epidemiology, School of Public Health and Management, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, 400016, China
| | - Li-Hong Geng
- Chengdu Jinjiang Hospital for Women's and Children's Health, Chengdu, 610011, China
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Tian Y, Zhao Z, Cao X, Kang Y, Wang L, Yin P, Song Y, Zhang L, Wang X, Chen Z, Zheng C, Liu M, Fang Y, Zhang M, He Y, Hu Z, Cai J, Gu R, Huang Y, Pei X, Yu X, Wang Z, Zhou M. Rapid increasing burden of diabetes and cardiovascular disease caused by high body mass index in 1.25 million Chinese adults, 2005-2018. MED 2023; 4:505-525.e3. [PMID: 37369198 DOI: 10.1016/j.medj.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/19/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Temporal trends and geographical variations in disease burden for diabetes mellitus (DM) and cardiovascular disease (CVD) attributable to high body mass index (BMI) in China have not been fully elucidated. METHODS We estimated deaths and years of life lost (YLLs) for DM and CVD attributable to high BMI by age, sex, year, and region from 2005 to 2018 based on pooled data of 1.25 million adults. FINDINGS Approximately 497,430 (95% uncertainty interval [UI], 470,520-525,720) deaths for DM and CVD were attributable to high BMI in China in 2018, with 453,750 deaths from CVD and 43,700 deaths from DM. Between 2005 and 2018, there was a 17.35% increase in age-standardized mortality rate for DM and CVD attributable to high BMI. The high BMI-related DM and CVD YLL rates increased from 127.46 (95% UI 108.70-148.62) per 100,000 people aged 20-24 years to 5,735.54 (95% UI 4,844.16-6,713.53) per 100,000 people aged ≥80 years, respectively. The highest age-standardized mortality rate for high BMI-related DM and CVD in northeast, northwest, and circum-Bohai Sea regions of China. CONCLUSION The disease burden for DM and CVD attributable to high BMI increased substantially between 2005 and 2018. Urgent measures are required at both national and regional levels for resource mobilization to slow the growing burden. FUNDING The work was supported by the National Key Research and Development Program of China, China National Science & Technology Pillar Program, and National Health Commission of the People's Republic of China.
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Affiliation(s)
- Yixin Tian
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 102308, China
| | - Zhenping Zhao
- National Center for Chronic Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Xue Cao
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 102308, China
| | - Yuting Kang
- Office of National Clinical Research for Geriatrics, Beijing Hospital, National Center of Gerontology, Beijing, 100730, China; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Limin Wang
- National Center for Chronic Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Peng Yin
- National Center for Chronic Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Yuxin Song
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 102308, China
| | - Linfeng Zhang
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 102308, China
| | - Xin Wang
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 102308, China
| | - Zuo Chen
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 102308, China
| | - Congyi Zheng
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 102308, China
| | - Mingbo Liu
- Division of Health Information, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 102308, China
| | - Yuehui Fang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Mei Zhang
- National Center for Chronic Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Yuna He
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Zhen Hu
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 102308, China
| | - Jiayin Cai
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 102308, China
| | - Runqing Gu
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 102308, China
| | - Yilin Huang
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 102308, China
| | - Xuyan Pei
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 102308, China
| | - Xue Yu
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 102308, China
| | - Zengwu Wang
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 102308, China.
| | - Maigeng Zhou
- National Center for Chronic Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China.
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Fang Y, Xia J, Lian Y, Zhang M, Kang Y, Zhao Z, Wang L, Yin P, Wang Z, Ye C, Zhou M, He Y. The burden of cardiovascular disease attributable to dietary risk factors in the provinces of China, 2002-2018: a nationwide population-based study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 37:100784. [PMID: 37693878 PMCID: PMC10485670 DOI: 10.1016/j.lanwpc.2023.100784] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/04/2023] [Accepted: 04/18/2023] [Indexed: 09/12/2023]
Abstract
Background The burden of cardiovascular diseases (CVDs) is on the rise in China, yet a comprehensive and systematic understanding of the temporal trends and distribution of CVD burden attributable to dietary factors across the provinces remains elusive. This study endeavors to provide a comprehensive depiction of the burden of CVDs attributable to dietary risk factors across China's geographical regions from 2002 to 2018. Methods Data from the China National Nutrition Surveys, the China Chronic Disease and Risk Factor Surveillance, the Hypertension Survey, and the Chinese Centre for Disease Control and Prevention cause-of-death reporting system were used to estimate the intake of dietary factor, the number of deaths, and disability-adjusted life years (DALYs), mortality rate, for ischemic heart disease (IHD), ischemic stroke (IS), hemorrhage and other stroke (HOS) attributable to dietary factors at national and provincial levels in China from 2002 to 2018. Using a comparative risk assessment approach, we estimated the proportion of CVDs burden attributable to suboptimal intake of seven dietary factors, both individually and collectively, among Chinese citizens aged 20 years or older. Finding The mean consumption of whole grains, soybeans, nuts, vegetables, fruits, red meat, and sugar-sweetened beverages (SSBs) exhibited an upward trend from 2002 to 2018. However, with the exception of red meat and SSBs, the average intake remained below the levels recommended levels outlined in the Chinese national dietary guidelines. Inadequate fruit, whole grain, and vegetables intake were the leading dietary risk factors for IHD, IS and HOS in China, while nuts, soybean and SSB were only associated with IHD mortality. From 2002 to 2018, the number of deaths and mortality rate for CVDs attributable to suboptimal diet among Chinese males were greater than that of females. With increasing age, the diet-related mortality rate for CVDs increased substantially. In 2018, the nationwide mortality rate attributable to diet was found to be 77.9 (95% UI, 77.5-78.1) per 100,000 population for IHD, 34.1 (95% UI, 33.8-34.2) for IS, and 32.8 (95% UI, 32.4-32.8) for HOS. Suboptimal diet was responsible for 16.0 million (95% UI, 13.8-18.4) DALYs and 1137.1 (95% UI, 980.4-1312.3) DALYs per 100,000 population for stroke, and 13.9 million (95% UI, 11.8-16.3) DALYs and 990.2 (95% UI, 841.2-1158.6) DALYs for IHD. Across the provinces of China, in 2018, the highest age-standardized mortality rates of all diet-related deaths were observed in Shandong (92.8 [95% UI, 89.9-93.3]) for IHD, Heilongjiang (38.1 [95% UI, 36.2-38.8]) for IS, and Tibet (68.3 [95% UI, 65.0-70.1]) for HOS. The highest diet related DALYs were observed in Henan (1.4 million [95% UI, 1.2-1.6] for IS, and 1.3 million [95% UI, 1.1-1.5] for IHD). Interpretation This study provides a comprehensive picture of the geographic variation and temporal trends of the burden of CVDs attributable to dietary risk factors at the national and provincial levels from 2002 to 2018 in China, highlighting the need for geographically targeted intervention strategies to improve the quality of diet and reduce the diet-related burden of CVDs. Funding National Key Research and Development Program of China (2018YFC1315303), National Natural Science Foundation of China (82103966).
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Affiliation(s)
- Yuehui Fang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Juan Xia
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing 100069, China
| | - Yiyao Lian
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Mei Zhang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Yuting Kang
- Office of National Clinical Research for Geriatrics, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Zhenping Zhao
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Limin Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Peng Yin
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Zengwu Wang
- Division of Prevention and Community Health, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 102308, China
| | - Chen Ye
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Maigeng Zhou
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Yuna He
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
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7
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Liu X, Zhang H, Zhang Y, Wang J, Tan H, Piao J, Yang L, Yang X. The Time Trend of Blood Lead and Cadmium Levels in Rural Chinese Children: China Nutrition and Health Survey 2002 and 2012. Biol Trace Elem Res 2023; 201:2162-2169. [PMID: 35725995 DOI: 10.1007/s12011-022-03333-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/14/2022] [Indexed: 11/27/2022]
Abstract
This study was to investigate blood lead (Pb) and cadmium (Cd) levels and time trend in rural Chinese children derived from the China Nutrition and Health Survey 2002 and 2012 (CNHS 2002, CNHS 2012). In total, 1698 and 1581 of rural Chinese children were selected from the CNHS 2002 and the CNHS 2012 databases, respectively. The blood Pb and Cd levels were determined by inductively coupled plasma mass spectrometer (ICP-MS), whilst the prevalence of blood Pb levels >5 µg/dL and blood Cd levels >0.5 µg/L and the corresponding reference values (RV95s: the upper limit of 95% confidence interval of 95th percentile) were together calculated. From the CNHS 2002 to the CNHS 2012, median concentrations in blood were severally decreased from 6.3 to 3.1 µg/dL for Pb and from 0.64 to 0.39 µg/L for Cd. The prevalence of blood Pb levels >5 µg/dL had decreased from 63.6 to 14.2%, together with blood Cd levels >0.5 µg/L prevalence from 62.7 to 33.5%, respectively. The RV95s of blood Pb and Cd levels were 15.2 µg/dL and 1.54 µg/L in the CNHS 2002, as well as 6.3 µg/dL and 1.12 µg/L in the CNHS 2012. In conclusion, blood Pb and Cd levels had been obviously improved in rural Chinese children during the past 10 years. However, the risks of Pb and Cd exposure are still serious and required to have continuous health monitoring and evaluation, even call for greater collaboration of the government and society.
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Affiliation(s)
- Xiaobing Liu
- National Institute for Nutrition and Health of Chinese Center for Disease Control and Prevention, Beijing, 100050, China.
| | - Huidi Zhang
- National Institute for Nutrition and Health of Chinese Center for Disease Control and Prevention, Beijing, 100050, China
| | - Yu Zhang
- Chinese Center for Disease Control and Prevention, Beijing, 102206, China
| | - Jun Wang
- School of Food and Drug, Shenzhen Polytechnic, Shenzhen, Guangdong, 518055, China
| | - Hongxing Tan
- Shenzhen Center for Chronic Disease Control, Shenzhen, 518020, Guangdong, China
| | - Jianhua Piao
- National Institute for Nutrition and Health of Chinese Center for Disease Control and Prevention, Beijing, 100050, China
| | - Lichen Yang
- National Institute for Nutrition and Health of Chinese Center for Disease Control and Prevention, Beijing, 100050, China
| | - Xiaoguang Yang
- National Institute for Nutrition and Health of Chinese Center for Disease Control and Prevention, Beijing, 100050, China.
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8
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Luo M, Liu Y, Ye P, Cai S, Yao Z, Zhao L, Luo J, Yu D. Weight-Control Behaviors and Dietary Intake in Chinese Adults: An Analysis of Three National Surveys (2002–2015). Nutrients 2023; 15:nu15061395. [PMID: 36986125 PMCID: PMC10051790 DOI: 10.3390/nu15061395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 03/18/2023] Open
Abstract
Weight control through dietary management is becoming increasingly common worldwide. This study aimed to evaluate and compare the dietary intake and diet quality between Chinese adults with and without weight-control behaviors. Data were collected from the China National Nutrition Survey 2002, 2012, and 2015. Dietary intake was assessed using a combination of 24 h dietary recall of three consecutive days and a weighing method. Diet quality was calculated based on China healthy diet index (CHDI). A total of 167,355 subjects were included, of which 11,906 (8.0%) adults reported attempting to control weight within the past 12 months. Participants with weight control had lower daily total energy intake, as well as lower percentages of energy from carbohydrates, low-quality carbohydrates, and plant protein, but higher percentages of energy from protein, fat, high-quality carbohydrates, animal protein, saturated fatty acids, and monounsaturated fatty acids than those without weight control. Additionally, the CHDI score in the weight-control group was higher than those without (53.40 vs. 48.79, p < 0.001). Fewer than 40% of participants in both groups met the requirement for all specific food groups. Chinese adults who reported weight-control behaviors had an energy-restricted diet characterized by reduced carbohydrate intake and overall higher diet quality compared with those without dietary-control behaviors. However, both groups had significant room for improvement in meeting dietary recommendations.
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Affiliation(s)
- Miyang Luo
- Xiangya School of Public Health, Central South University, Changsha 410008, China; (M.L.); (Y.L.); (Z.Y.)
| | - Yixu Liu
- Xiangya School of Public Health, Central South University, Changsha 410008, China; (M.L.); (Y.L.); (Z.Y.)
| | - Ping Ye
- Yuxi Center for Disease Control and Prevention, Yuxi 653100, China;
| | - Shuya Cai
- Key Laboratory of Trace Element Nutrition of National Health Commission, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (S.C.); (L.Z.)
| | - Zhenzhen Yao
- Xiangya School of Public Health, Central South University, Changsha 410008, China; (M.L.); (Y.L.); (Z.Y.)
| | - Liyun Zhao
- Key Laboratory of Trace Element Nutrition of National Health Commission, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (S.C.); (L.Z.)
| | - Jiayou Luo
- Xiangya School of Public Health, Central South University, Changsha 410008, China; (M.L.); (Y.L.); (Z.Y.)
- Correspondence: (J.L.); (D.Y.)
| | - Dongmei Yu
- Key Laboratory of Trace Element Nutrition of National Health Commission, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (S.C.); (L.Z.)
- Correspondence: (J.L.); (D.Y.)
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9
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Dietary Fat Intake among Chinese Adults and Their Relationships with Blood Lipids: Findings from China Nutrition and Health Surveillance and Comparison with the PURE Study. Nutrients 2022; 14:nu14245262. [PMID: 36558420 PMCID: PMC9788542 DOI: 10.3390/nu14245262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/03/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
Dietary fat intake in the Chinese population has increased. The PURE (prospective urban rural epidemiology) study concluded the potential advantage of total fat and saturated fats (SFA) over carbohydrates on blood lipids with the inaccurate assessment of dietary fats. We investigated the dietary fat profile among 48,315 participants (aged 30−70 years, national representative) from the China Nutrition and Health Surveillance (2015−2017), determined the relationship of various fats with blood lipid biomarkers in the selected 39,115 participants, and compared the results with the PURE study. Dietary fat intake was calculated by using 3 days of 24 h recalls and food inventory. Serum lipid biomarkers were assessed at morning fasting state by health professionals. Plant fats (21.5% of total energy (TE)) dominated in total fat intake (69.5 g/day, 35.6% TE), with monounsaturated fats (MUFA) in the largest (13.8% TE) portion and plant oils as the major source (43.7%). Two thirds of the population consumed more than 30% TE from dietary fats and nearly half more than 35%, while 26.4% of them exceeded 10% TE from SFA. Total fat was positively associated with total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), but also high-density lipoprotein cholesterol (HDL-c), and negatively with triglyceride (TG)-to-HDL-c ratio (TGHDL) (all p-trend < 0.05). Replacing total fat with carbohydrate yielded adverse changes in most biomarkers (higher LDL-c, TG, and TGHDL, lower HDL-c, all p < 0.05) when total fat was low (<34.9% TE). Regardless of fat intake level, replacing plant fat or polyunsaturated fats (PUFA) with carbohydrate yielded the most adverse changes (higher TC, LDL-c, TG, TC-to-HDL-c ratio (TCHDL), and TGHDL, but lower HDL-c, all p < 0.01), while replacing animal fat/SFA with plant fat/PUFA yielded the most favorable changes (lower all biomarkers, all p < 0.01). The results suggested a less harmful effect of carbohydrate on blood lipids when total fat was high, and more beneficial effect of unsaturated fats, than the PURE. In conclusion, dietary fat intake in Chinese adults had reached quite a high level, but with a different profile from Western populations. Replacement of SFA (animal fat) with PUFA (plant fat) could most effectively improve blood lipids, while replacement with carbohydrate could slightly benefit only when total fat was high. The present results may be more applicable to the Chinese population than the PURE study.
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10
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Self-Reported Dietary Management Behaviors and Dietary Intake among Chinese Adults with Diabetes: A Population-Based Study. Nutrients 2022; 14:nu14235178. [PMID: 36501208 PMCID: PMC9740534 DOI: 10.3390/nu14235178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/25/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
Few studies have analyzed the implementation of dietary management in Chinese adults with diabetes. Thus, we assessed and compared dietary intake and diet quality between diabetic patients with and without dietary management behaviors (DPDM vs. NDPDM), and evaluated the adherence to dietary guidelines in both groups of patients. The data were obtained from the 2002, 2010-2013, and 2015 China National Nutrition Survey. A total of 69,583, 67,177, and 96,631 subjects participated in the 2002, 2010-2013, and 2015 survey rounds, respectively. The dietary intake data were measured using 3-day 24 h dietary recalls and weighed records of household condiments. The China Healthy Diet Index (CHDI) was used to evaluate diet quality. The study included 6229 patients with diabetes, of which 78% had dietary management behaviors. The diabetic patients with dietary management behaviors showed higher percentages of energy from high-quality carbohydrates, animal protein, saturated fatty acids, and unsaturated fatty acids and lower percentages from low-quality carbohydrates and plant protein than NDPDM. The diabetic patients with dietary management behaviors also had lower intakes of cereals and tubers and higher intakes of vegetables than NDPDM. The total CHDI score of DPDM was higher than NDPDM (56.3 ± 12.7 vs. 54.1 ± 12.3). The proportion of DPDM meeting the recommended intake for different food items ranged from 3.3% to 42.8% and from 3.0% to 39.2% in NDPDM. The diabetic patients with dietary management behaviors showed better adherence to dietary guidelines and higher diet quality scores than NDPDM, while the overall adherence was poor in both groups of patients. Our findings suggested that measures are needed to promote and refine dietary management behaviors, which can help to improve disease management in diabetic patients.
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11
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Zhao R, Zhao L, Gao X, Yang F, Yang Y, Fang H, Ju L, Xu X, Guo Q, Li S, Cheng X, Cai S, Yu D, Ding G. Geographic Variations in Dietary Patterns and Their Associations with Overweight/Obesity and Hypertension in China: Findings from China Nutrition and Health Surveillance (2015-2017). Nutrients 2022; 14:nu14193949. [PMID: 36235601 PMCID: PMC9572670 DOI: 10.3390/nu14193949] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/14/2022] [Accepted: 09/21/2022] [Indexed: 02/07/2023] Open
Abstract
Regional dietetic cultures were indicated in China, but how dietary patterns geographically varied across China is unknown. Few studies systematically investigated the association of dietary patterns with overweight/obesity and hypertension and the potential mechanism with a national sample. This study included 34,040 adults aged 45 years and older from China Nutrition and Health Surveillance (2015−2017), who had complete outcome data, reliable intakes of calorie and cooking oils, unchanged diet habits, and without diagnosed cancer or cardiovascular disease. Outcomes were overweight/obesity and hypertension. By using the Gaussian finite mixture models, four dietary patterns were identified—common rice-based dietary pattern (CRB), prudent diversified dietary pattern (PD), northern wheat-based dietary pattern (NWB), and southern rice-based dietary pattern (SRB). Geographic variations in dietary patterns were depicted by age−sex standardized proportions of each pattern across 31 provinces in China. We assessed the association of these dietary patterns with outcomes and calculated the proportion mediated (PM) by overweight/obesity in the association of the dietary patterns with hypertension. Evident geographic disparities in dietary patterns across 31 provinces were observed. With CRB as reference group and covariates adjusted, the NWB had higher odds of being overweight/obese (odds ratio (OR) = 1.44, 95% confidence interval (CI): 1.36−1.52, p < 0.001) and hypertension (OR = 1.07, 95%CI: 1.01−1.14, p < 0.001, PM = 43.2%), while the SRB and the PD had lower odds of being overweight/obese (ORs = 0.84 and 0.92, 95%CIs: 0.79−0.89 and 0.85−0.99, p < 0.001 for both) and hypertension (ORs = 0.93 and 0.87, 95%CIs: 0.87−0.98 and 0.80−0.94, p = 0.038 for SRB and p < 0.001 for PD, PMs = 27.8% and 9.9%). The highest risk of overweight/obesity in the NWB presented in relatively higher carbohydrate intake (about 60% of energy) and relatively low fat intake (about 20% of energy). The different trends in the association of protein intake with overweight/obesity among dietary patterns were related to differences in animal food sources. In conclusion, the geographic distribution disparities of dietary patterns illustrate the existence of external environment factors and underscore the need for geographic-targeted dietary actions. Optimization of the overall dietary pattern is the key to the management of overweight/obesity and hypertension in China, with the emphasis on reducing low-quality carbohydrate intake, particularly for people with the typical northern diet, and selection of animal foods, particularly for people with the typical southern diet.
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Affiliation(s)
- Rongping Zhao
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Liyun Zhao
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Xiang Gao
- Department of Nutritional Sciences, The Pennsylvania State University, State College, PA 16802, USA
| | - Fan Yang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China
| | - Yuxiang Yang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Hongyun Fang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Lahong Ju
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Xiaoli Xu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Qiya Guo
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Shujuan Li
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Xue Cheng
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Shuya Cai
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Dongmei Yu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
- Correspondence: (D.Y.); (G.D.)
| | - Gangqiang Ding
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
- Correspondence: (D.Y.); (G.D.)
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12
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Chen F, Zhang Y, Chen S, Si A, Hu W. Cardiovascular Disease Mortality Attributable to Low Whole-Grain Intake in CHINA: An Age-Period-Cohort and Joinpoint Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127096. [PMID: 35742345 PMCID: PMC9222971 DOI: 10.3390/ijerph19127096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/31/2022] [Accepted: 06/08/2022] [Indexed: 11/21/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of death worldwide. Low whole-grain intake is found to be one of the most important risk factors for cardiovascular disease development and progression. In this study, we focused on exploring the long-term trends of low whole-grain intake attributed to cardiovascular disease mortality in China during 1990–2019 and relative gender differences. Study data were obtained from the Global Burden of Disease (GBD) 2019 study. We used the age-period-cohort model to estimate the adjusted effect of age, period, and cohorts. Annual and average annual percentage changes were estimated by joinpoint regression analysis. We observed an increasing trend with a net drift of 1.208% for males and 0.483% for males per year. The longitudinal age curve suggested that the attributed rate increased for both genders. Period and cohort effects all suggested that the risk for males showed an increased trend that was higher than that of females. Our findings suggest that males and senior-aged people were at a higher risk of cardiovascular disease mortality attributed to low whole-grain intake. Effective strategies are needed to enhance people’s health consciousness, and increasing whole-grain intake may achieve a better preventive effect for cardiovascular disease.
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Affiliation(s)
- Fangyao Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, No. 76 Yanta Xilu Road, Xi’an 710061, China; (Y.Z.); (S.C.); (A.S.); (W.H.)
- Department of Radiology, First Affiliated Hospital of Xi’an Jiaotong University, No. 277, Yanta Xilu Road, Yanta District, Xi’an 710061, China
- Correspondence: ; Tel.: +86-29-82655104-202
| | - Yuxiang Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, No. 76 Yanta Xilu Road, Xi’an 710061, China; (Y.Z.); (S.C.); (A.S.); (W.H.)
| | - Shiyu Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, No. 76 Yanta Xilu Road, Xi’an 710061, China; (Y.Z.); (S.C.); (A.S.); (W.H.)
| | - Aima Si
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, No. 76 Yanta Xilu Road, Xi’an 710061, China; (Y.Z.); (S.C.); (A.S.); (W.H.)
| | - Weiwei Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, No. 76 Yanta Xilu Road, Xi’an 710061, China; (Y.Z.); (S.C.); (A.S.); (W.H.)
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13
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Ding C, Fan J, Yuan F, Feng G, Gong W, Song C, Ma Y, Chen Z, Liu A. Association between Physical Activity, Sedentary Behaviors, Sleep, Diet, and Adiposity among Children and Adolescents in China. Obes Facts 2022; 15:26-35. [PMID: 34784593 PMCID: PMC8820170 DOI: 10.1159/000519268] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 08/25/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Physical activity (PA), sedentary behaviors (SB), sleep, and diet are related to adiposity among children and adolescents. However, there may be interactions between PA, SB, sleep, and diet, and these lifestyle behaviors may work together to affect body weight. The purpose of this study was to explore the impact of multiple lifestyle behaviors of PA, SB, sleep, and diet on childhood adiposity (body mass index z-score and overweight/obesity), and to investigate the effect of meeting multiple guidelines on adiposity among children and adolescents in China. METHODS Cross-sectional results were based on 28,048 children aged 6-17 years from the China National Nutrition and Health Surveillance in 2010-2012. Information about PA, SB, and sleep was measured through interview-administered questionnaire. Dietary intake was assessed with food frequency questionnaire. The associations between multiple lifestyle behaviors and BMI z-score and overweight/obese were examined. RESULTS The prevalence of overweight/obesity in the participants was 19.2%. The average time of moderate-to-vigorous PA (MVPA), leisure SB, and sleep was 76.7 ± 45.5 min, 2.9 ± 1.4 h, and 8.5 ± 1.1 h per day, respectively. The China Dietary Guidelines Index for Youth (CDGI-Y) score was 62.6 ± 11.0. Sleep duration and diet score were negative associated with BMI z-score (both p < 0.001). MVPA and SB time were positive associated with BMI z-score (p = 0.041, 0.004). Meeting the SB, sleep, and diet guidelines had a lower BMI z-score (all p < 0.01) and lower odds of overweight/obesity (all p < 0.05). There were significant interactions between PA and diet. Compared with meeting no guidelines, those who met multiple guidelines had a lower risk of overweight/obesity (all p < 0.01). The more guidelines the participants met, the lower odds of overweight/obesity (p for trend <0.001). CONCLUSIONS PA, SB, sleep, and diet are important behaviors associated with adiposity among children and adolescents. Attaining adequate amounts of appropriate multiple behaviors provided an additional benefit. It is important for children to meet recommended behavioral guidelines or recommendations. Interventions that aim to improve awareness of and compliance with these guidelines are needed in future.
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Affiliation(s)
- Caicui Ding
- Department of Nutrition and Health Education, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China,
| | - Jing Fan
- Department of Nutrition and Health Education, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Fan Yuan
- Department of Nutrition and Health Education, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ganyu Feng
- Department of Nutrition and Health Education, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Weiyan Gong
- Department of Nutrition and Health Education, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chao Song
- Department of Nutrition and Health Education, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yanning Ma
- Department of Nutrition and Health Education, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zheng Chen
- Department of Nutrition and Health Education, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ailing Liu
- Department of Nutrition and Health Education, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
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14
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Bromage S, Batis C, Bhupathiraju SN, Fawzi WW, Fung TT, Li Y, Deitchler M, Angulo E, Birk N, Castellanos-Gutiérrez A, He Y, Fang Y, Matsuzaki M, Zhang Y, Moursi M, Kronsteiner-Gicevic S, Holmes MD, Isanaka S, Kinra S, Sachs SE, Stampfer MJ, Stern D, Willett WC. Development and Validation of a Novel Food-Based Global Diet Quality Score (GDQS). J Nutr 2021; 151:75S-92S. [PMID: 34689200 PMCID: PMC8542096 DOI: 10.1093/jn/nxab244] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Poor diet quality is a major driver of both classical malnutrition and noncommunicable disease (NCD) and was responsible for 22% of adult deaths in 2017. Most countries face dual burdens of undernutrition and NCDs, yet no simple global standard metric exists for monitoring diet quality in populations and population subgroups. OBJECTIVES We aimed to develop an easy-to-use metric for nutrient adequacy and diet related NCD risk in diverse settings. METHODS Using cross-sectional and cohort data from nonpregnant, nonlactating women of reproductive age in 10 African countries as well as China, India, Mexico, and the United States, we undertook secondary analyses to develop novel metrics of diet quality and to evaluate associations between metrics and nutrient intakes and adequacy, anthropometry, biomarkers, type 2 diabetes, and iteratively modified metric design to improve performance and to compare novel metric performance to that of existing metrics. RESULTS We developed the Global Diet Quality Score (GDQS), a food-based metric incorporating a more comprehensive list of food groups than most existing diet metrics, and a simple means of scoring consumed amounts. In secondary analyses, the GDQS performed comparably with the Minimum Dietary Diversity - Women indicator in predicting an energy-adjusted aggregate measure of dietary protein, fiber, calcium, iron, zinc, vitamin A, folate, and vitamin B12 adequacy and with anthropometric and biochemical indicators of undernutrition (including underweight, anemia, and serum folate deficiency), and the GDQS also performed comparably or better than the Alternative Healthy Eating Index - 2010 in capturing NCD-related outcomes (including metabolic syndrome, change in weight and waist circumference, and incident type 2 diabetes). CONCLUSIONS The simplicity of the GDQS and its ability to capture both nutrient adequacy and diet-related NCD risk render it a promising candidate for global monitoring platforms. Research is warranted to validate methods to operationalize GDQS assessment in population surveys, including a novel application-based 24-h recall system developed as part of this project.
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Affiliation(s)
| | | | - Shilpa N Bhupathiraju
- Harvard T.H. Chan School of Public Health, Boston, MA, USA,Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Wafaie W Fawzi
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Teresa T Fung
- Harvard T.H. Chan School of Public Health, Boston, MA, USA,Department of Nutrition, Simmons University, Boston, MA, USA
| | - Yanping Li
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Megan Deitchler
- Intake - Center for Dietary Assessment, FHI Solutions, Washington, DC, USA
| | - Erick Angulo
- National Institute of Public Health, Cuernavaca, Mexico
| | - Nick Birk
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Yuna He
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yuehui Fang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Mika Matsuzaki
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yiwen Zhang
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mourad Moursi
- Intake - Center for Dietary Assessment, FHI Solutions, Washington, DC, USA
| | - Selma Kronsteiner-Gicevic
- Harvard T.H. Chan School of Public Health, Boston, MA, USA,London Centre for Integrative Research on Agriculture and Health, London, United Kingdom
| | - Michelle D Holmes
- Harvard T.H. Chan School of Public Health, Boston, MA, USA,Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Sheila Isanaka
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sanjay Kinra
- London School of Hygiene and Tropical Disease, London, United Kingdom
| | - Sonia E Sachs
- Center for Sustainable Development, Columbia University, New York, NY, USA
| | - Meir J Stampfer
- Harvard T.H. Chan School of Public Health, Boston, MA, USA,Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Dalia Stern
- National Institute of Public Health, Cuernavaca, Mexico
| | - Walter C Willett
- Harvard T.H. Chan School of Public Health, Boston, MA, USA,Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
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15
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Wang L, Zhou B, Zhao Z, Yang L, Zhang M, Jiang Y, Li Y, Zhou M, Wang L, Huang Z, Zhang X, Zhao L, Yu D, Li C, Ezzati M, Chen Z, Wu J, Ding G, Li X. Body-mass index and obesity in urban and rural China: findings from consecutive nationally representative surveys during 2004-18. Lancet 2021; 398:53-63. [PMID: 34217401 DOI: 10.1016/s0140-6736(21)00798-4] [Citation(s) in RCA: 223] [Impact Index Per Article: 74.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/11/2021] [Accepted: 03/29/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND In China, mean body-mass index (BMI) and obesity in adults have increased steadily since the early 1980s. However, to our knowledge, there has been no reliable assessment of recent trends, nationally, regionally, or in certain population subgroups. To address this evidence gap, we present detailed analyses of relevant data from six consecutive nationally representative health surveys done between 2004 and 2018. We aimed to examine the long-term and recent trends in mean BMI and prevalence of obesity among Chinese adults, with specific emphasis on changes before and after 2010 (when various national non-communicable disease prevention programmes were initiated), assess how these trends might vary by sex, age, urban-rural locality, and socioeconomic status, and estimate the number of people who were obese in 2018 compared with 2004. METHODS We used data from the China Chronic Disease and Risk Factors Surveillance programme, which was established in 2004 with the aim to provide periodic nationwide data on the prevalence of major chronic diseases and the associated behavioural and metabolic risk factors in the general population. Between 2004 and 2018 six nationally representative surveys were done. 776 571 individuals were invited and 746 020 (96·1%) participated, including 33 051 in 2004, 51 050 in 2007, 98 174 in 2010, 189 115 in 2013, 189 754 in 2015, and 184 876 in 2018. After exclusions, 645 223 participants aged 18-69 years remained for the present analyses. The mean BMI and prevalence of obesity (BMI ≥30 kg/m2) were calculated and time trends compared by sex, age, urban-rural locality, geographical region, and socioeconomic status. FINDINGS Standardised mean BMI levels rose from 22·7 kg/m2 (95% CI 22·5-22·9) in 2004 to 24·4 kg/m2 (24·3-24·6) in 2018 and obesity prevalence from 3·1% (2·5-3·7) to 8·1% (7·6-8·7). Between 2010 and 2018, mean BMI rose by 0·09 kg/m2 annually (0·06-0·11), which was half of that reported during 2004-10 (0·17 kg/m2, 95% CI 0·12-0·22). Similarly, the annual increase in obesity prevalence was somewhat smaller after 2010 than before 2010 (6·0% annual relative increase, 95% CI 4·4-7·6 vs 8·7% annual relative increase, 4·9-12·8; p=0·13). Since 2010, the rise in mean BMI and obesity prevalence has slowed down substantially in urban men and women, and moderately in rural men, but continued steadily in rural women. By 2018, mean BMI was higher in rural than urban women (24·3 kg/m2vs 23·9 kg/m2; p=0·0045), but remained lower in rural than urban men (24·5 kg/m2vs 25·1 kg/m2; p=0·0007). Across all six surveys, mean BMI was persistently lower in women with higher levels of education compared with women with lower levels of education, but the inverse was true among men. Overall, an estimated 85 million adults (95% CI 70 million-100 million; 48 million men [95% CI 39 million-57 million] and 37 million women [31 million-43 million]) aged 18-69 years in China were obese in 2018, which was three times as many as in 2004. INTERPRETATION In China, the rise in mean BMI among the adult population appears to have slowed down over the past decade. However, we found divergent trends by sex, geographical area, and socioeconomic status, highlighting the need for a more targeted approach to prevent further increases in obesity in the Chinese general population. FUNDING China National Key Research and Development Program, China National Key Project of Public Health Program, and Youth Scientific Research Foundation of the National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention.
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Affiliation(s)
- Limin Wang
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Bin Zhou
- MRC Centre for Environment and Health & Abdul Latif Jameel Institute for Disease and Emergency Analytics, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Zhenping Zhao
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ling Yang
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Mei Zhang
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yong Jiang
- National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yichong Li
- Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, China
| | - Maigeng Zhou
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Linhong Wang
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhengjing Huang
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiao Zhang
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Liyun Zhao
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Dongmei Yu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chun Li
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Majid Ezzati
- MRC Centre for Environment and Health & Abdul Latif Jameel Institute for Disease and Emergency Analytics, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Zhengming Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jing Wu
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Gangqiang Ding
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Xinhua Li
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China; People's Medical Publishing House, Beijing, China.
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Pan XF, Wang L, Pan A. Epidemiology and determinants of obesity in China. Lancet Diabetes Endocrinol 2021; 9:373-392. [PMID: 34022156 DOI: 10.1016/s2213-8587(21)00045-0] [Citation(s) in RCA: 566] [Impact Index Per Article: 188.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 01/15/2021] [Accepted: 02/12/2021] [Indexed: 12/11/2022]
Abstract
Obesity has become a major public health issue in China. Overweight and obesity have increased rapidly in the past four decades, and the latest national prevalence estimates for 2015-19, based on Chinese criteria, were 6·8% for overweight and 3·6% for obesity in children younger than 6 years, 11·1% for overweight and 7·9% for obesity in children and adolescents aged 6-17 years, and 34·3% for overweight and 16·4% for obesity in adults (≥18 years). Prevalence differed by sex, age group, and geographical location, but was substantial in all subpopulations. Strong evidence from prospective cohort studies has linked overweight and obesity to increased risks of major non-communicable diseases and premature mortality in Chinese populations. The growing burden of overweight and obesity could be driven by economic developments, sociocultural norms, and policies that have shaped individual-level risk factors for obesity through urbanisation, urban planning and built environments, and food systems and environments. Substantial changes in dietary patterns have occurred in China, with increased consumption of animal-source foods, refined grains, and highly processed, high-sugar, and high-fat foods, while physical activity levels in all major domains have decreased with increasing sedentary behaviours. The effects of dietary factors and physical inactivity intersect with other individual-level risk factors such as genetic susceptibility, psychosocial factors, obesogens, and in-utero and early-life exposures. In view of the scarcity of research around the individual and collective roles of these upstream and downstream factors, multidisciplinary and transdisciplinary studies are urgently needed to identify systemic approaches that target both the population-level determinants and individual-level risk factors for obesity in China.
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Affiliation(s)
- Xiong-Fei Pan
- Department of Epidemiology and Biostatistics and Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Limin Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - An Pan
- Department of Epidemiology and Biostatistics and Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Effects of School-Based Interventions on Reducing Sugar-Sweetened Beverage Consumption among Chinese Children and Adolescents. Nutrients 2021; 13:nu13061862. [PMID: 34070736 PMCID: PMC8226445 DOI: 10.3390/nu13061862] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/23/2021] [Accepted: 05/27/2021] [Indexed: 11/17/2022] Open
Abstract
We set up a series of school-based interventions on the basis of an ecological model targeting sugar-sweetened beverage (SSB) reduction in Chinese elementary and middle schools and evaluated the effects. A total of 1046 students from Chinese elementary and middle schools were randomly recruited in an intervention group, as were 1156 counterparts in a control group. The interventions were conducted in the intervention schools for one year. The participants were orally instructed to answer all the questionnaires by themselves at baseline and after intervention. The difference in difference statistical approach was used to identify the effects exclusively attributable to the interventions. There were differences in grade composition and no difference in sex distribution between the intervention and control groups. After adjusting for age, sex, and group differences at baseline, a significant reduction in SSB intake was found in the intervention group post intervention, with a decrease of 35.0 mL/day (p = 0.034). Additionally, the frequency of SSB consumption decreased by 0.2 times/day (p = 0.071). The students in the elementary schools with interventions significantly reduced their SSB intake by 61.6 mL/day (p = 0.002) and their frequency of SSB consumption by 0.3 times/day (p = 0.017) after the intervention. The boys in the intervention group had an intervention effect of a 50.2 mL/day reduction in their SSB intake (p = 0.036). School-based interventions were effective in reducing SSB consumption, especially among younger ones. The boys were more responsive to the interventions than the girls. (ChiCTR, ChiCTR1900020781.)
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Yu D, Zhao L, Zhang J, Yang Z, Yang L, Huang J, Fang H, Guo Q, Xu X, Ju L, Ding G. China Nutrition and Health Surveys (1982-2017). China CDC Wkly 2021; 3:193-195. [PMID: 34595042 PMCID: PMC8393036 DOI: 10.46234/ccdcw2021.058] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 02/25/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Dongmei Yu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Liyun Zhao
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jian Zhang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhenyu Yang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lichen Yang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jian Huang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hongyun Fang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qiya Guo
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaoli Xu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lahong Ju
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Gangqiang Ding
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
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Gao C, Xu J, Liu Y, Yang Y. Nutrition Policy and Healthy China 2030 Building. Eur J Clin Nutr 2020; 75:238-246. [DOI: 10.1038/s41430-020-00765-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 06/23/2020] [Accepted: 09/22/2020] [Indexed: 12/12/2022]
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Sun D, Li H, Cao M, He S, Lei L, Peng J, Chen W. Cancer burden in China: trends, risk factors and prevention. Cancer Biol Med 2020; 17:879-895. [PMID: 33299641 PMCID: PMC7721090 DOI: 10.20892/j.issn.2095-3941.2020.0387] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/21/2020] [Indexed: 12/15/2022] Open
Abstract
As the most populous country in the world, China has made strides in health promotion in the past few decades. With the aging population, the burden of cancer in China continues to grow. Changes in risk factors for cancer, especially diet, obesity, diabetes, and air pollution, continue to fuel the shift of cancer transition in China. The burden of upper gastrointestinal cancer in China is decreasing, but still heavy. The rising burden of colorectal, prostate, and breast cancers is also significant. Lung cancer became the top cause of cancer-related deaths, together with smoking as the most important contributor to cancer deaths. The Chinese government has taken several approaches to control cancer and cancer-related risk factors. Many achievements have been made, but some challenges remain. Health China 2030 is ambitious and depicts a bright vision of the future for cancer control in China. The decrease in the cancer burden in China will require cross-sector collaboration and coordinated efforts on primary and secondary preventions by governments, public health organizations, and individuals. In this review, we describe the trends of cancer burden and discuss cancer-related risk factors in China, identifying strategies to reduce the burden of cancer in China.
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Affiliation(s)
- Dianqin Sun
- Department of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - He Li
- Department of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Maomao Cao
- Department of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Siyi He
- Department of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Lin Lei
- Department of Cancer Prevention and Control, Shenzhen Center for Chronic Disease Control, Shenzhen 518020, China
| | - Ji Peng
- Department of Cancer Prevention and Control, Shenzhen Center for Chronic Disease Control, Shenzhen 518020, China
| | - Wanqing Chen
- Department of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Wang M, Xu PS, Liu W, Zhang C, Zhang X, Wang L, Liu J, Zhu Z, Hu J, Luo PX, Wang PW. Prevalence and changes of BMI categories in China and related chronic diseases: Cross-sectional National Health Service Surveys (NHSSs) from 2013 to 2018. EClinicalMedicine 2020; 26:100521. [PMID: 32984787 PMCID: PMC7492818 DOI: 10.1016/j.eclinm.2020.100521] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/29/2020] [Accepted: 08/05/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND China has experienced rapid economic growth and reduced poverty, but the associated changes of BMI categories of the Chinese population in recent years are unclear. METHODS We collected data from two-round cross-sectional National Health Service Surveys (NHSSs) conducted in China in 2013 and 2018. All family members with BMI available from the households sampled in NHSSs were included. We analyzed the standardized prevalence and changes of obesity and overweight by year, age, sex, and urban-rural area, and further identified risk factors for obesity and overweight. FINDINGS 273,688 individuals were included in 2013 and 25,6304 included in 2018. The standardized prevalence of obesity and overweight in adults were 19.3% (95%CI 19.1-19.4%) in 2013 and 25.6% (95%CI 25.3-25.8%) in 2018, versus 19.4% (95%CI 19·1-19.8%) in children and adolescents in 2013 and 15.8% (95%CI 15.5-16.1%) in 2018. The standardized prevalence of obesity and overweight was 16.9% (95%CI 16.0-17.3%) in young adults aged 19-29 in 2018, 48.2% higher than that in 2013 (11.4% [95%CI 11.0-11.6%]). Although the obesity and overweight prevalence was higher in urban areas, the growth rate in rural areas was 1.8 times higher than that in urban areas. Low education levels, low-income quintiles, marital status, alcohol consumption and former-smoking status were associated with higher obesity and overweight prevalence in adults. INTERPRETATION The rapidly increasing prevalence in young adults may lead to the growing chronic disease burden in the future, to the detriment of recent economic gains of rural families. FUNDING National Health Commission of the People's Republic of China.
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Affiliation(s)
- Minghuan Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Prof Shabei Xu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenhua Liu
- Clinical Research Centre, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chenyan Zhang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoxiang Zhang
- Clinical Research Centre, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Computer Centre, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liang Wang
- Department of Computer Centre, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jian Liu
- Department of Translational Medicine Centre, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhou Zhu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianping Hu
- Centre for Health Statistics Information, National Health Commission of the People's Republic of China, China
| | - Prof Xiang Luo
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Corresponding author.
| | - Prof Wei Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Corresponding author.
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Yu D, Zhao L, Zhao W. Status and trends in consumption of grains and dietary fiber among Chinese adults (1982-2015). Nutr Rev 2020; 78:43-53. [PMID: 32728754 DOI: 10.1093/nutrit/nuz075] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 07/25/2019] [Indexed: 11/14/2022] Open
Abstract
The objectives of this review were to investigate the status and characteristics of national grain consumption and dietary fiber intake among Chinese adults (aged ≥20 years) and to examine trends in consumption from 1982 to 2015. Data from 5 national surveys that collected dietary information using a household food weighing method and 24-hour dietary recall over 3 consecutive days were analyzed. In 2015, mean grain consumption was 281.1 g/per capita/d (rice 145.6 g, wheat flour 120.7 g, other grains 14.8 g). Total dietary fiber intake was 9.7 g/per capita/d, of which 3.8 g/per capita/d came from grains and accounted for nearly 40% of total dietary fiber intake for adults. The other major sources of dietary fiber were vegetables and fruits. The data indicates consumption of grains and dietary fiber in the Chinese population has been continuously declining since 1982 and the consumption of refined grains has increased. In order for the Chinese population to meet dietary recommendations for whole grain and dietary fiber intake, increasing the availability of more appealing whole grain products and public education are recommended.
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Affiliation(s)
- Dongmei Yu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Liyun Zhao
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Wenhua Zhao
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
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Zhu Z, Yang X, Fang Y, Zhang J, Yang Z, Wang Z, Liu A, He L, Sun J, Lian Y, Ding G, He Y. Trends and Disparities of Energy Intake and Macronutrient Composition in China: A Series of National Surveys, 1982-2012. Nutrients 2020; 12:nu12082168. [PMID: 32707793 PMCID: PMC7468974 DOI: 10.3390/nu12082168] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/18/2020] [Accepted: 07/20/2020] [Indexed: 12/27/2022] Open
Abstract
Background: China’s diet transition might offer guidance to undeveloped countries on the way to prosperity. This report describes the trends and disparities in energy and macronutrient composition among Chinese adults, and between subpopulations. Methods: Data for the current study were obtained from the 1982, 1992, 2002, and 2010–2012 China National Nutrition Survey (CNNS) rounds, which were nationally representative cross-sectional surveys. We applied 24-h dietary recall and food weighing to assess dietary intake. Results: There were 204,877 participants aged 20 years or older included in the current analysis. From 1982 to 2012, the estimated energy intake declined from 2614.7 kcal to 2063.9 kcal. The trend in the estimated percentage of energy intake from fat showed a spike. It increased from 16.3% to 33.1% (1992 vs. 1982 difference, 7.6%; 95% CI 7.4% to 7.7%; 2002 vs. 1992 difference, 7.7%; 95% CI 7.6% to 7.9%; 2012 vs. 2002 difference, 1.6%; 95% CI 1.4% to 1.7%; p < 0.01 for trend). The trends coincided in all the subgroups (all p < 0.01 for trend) except for the subgroup of those educated over 15 years, whose percentage of energy intake from fat declined from 37.4% to 36.6% (2012 vs. 2002 difference, −0.8%; 95% CI −1.6% to 0.0%). The estimated percentage of energy intake from carbohydrates declined from 74.0% to 55.0%. The ranges of the estimated percentage of energy intake from fat, within population subgroups stratified by education level, area and Gross national product (GNP) level, were narrowed. Conclusions: Quick improvements in society and the economy effectively curbed undernutrition, but easily triggered overnutrition. Disparities persistently existed between different subpopulations, while the gaps would narrow if comprehensive efforts were made. Education might be a promising way to prevent overnutrition during prosperous progress. The low-social profile populations require specific interventions so as to avoid further disease burdens.
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Affiliation(s)
- Zhenni Zhu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing 100050, China; (Z.Z.); (X.Y.); (Y.F.); (J.Z.); (Z.Y.); (Z.W.); (A.L.); (L.H.); (J.S.); (Y.L.); (G.D.)
- Division of Health Risk Factors Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, 1380 West Zhongshan Road, Shanghai 20036, China
| | - Xiaoguang Yang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing 100050, China; (Z.Z.); (X.Y.); (Y.F.); (J.Z.); (Z.Y.); (Z.W.); (A.L.); (L.H.); (J.S.); (Y.L.); (G.D.)
| | - Yuehui Fang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing 100050, China; (Z.Z.); (X.Y.); (Y.F.); (J.Z.); (Z.Y.); (Z.W.); (A.L.); (L.H.); (J.S.); (Y.L.); (G.D.)
| | - Jian Zhang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing 100050, China; (Z.Z.); (X.Y.); (Y.F.); (J.Z.); (Z.Y.); (Z.W.); (A.L.); (L.H.); (J.S.); (Y.L.); (G.D.)
| | - Zhenyu Yang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing 100050, China; (Z.Z.); (X.Y.); (Y.F.); (J.Z.); (Z.Y.); (Z.W.); (A.L.); (L.H.); (J.S.); (Y.L.); (G.D.)
| | - Zhu Wang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing 100050, China; (Z.Z.); (X.Y.); (Y.F.); (J.Z.); (Z.Y.); (Z.W.); (A.L.); (L.H.); (J.S.); (Y.L.); (G.D.)
| | - Ailing Liu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing 100050, China; (Z.Z.); (X.Y.); (Y.F.); (J.Z.); (Z.Y.); (Z.W.); (A.L.); (L.H.); (J.S.); (Y.L.); (G.D.)
| | - Li He
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing 100050, China; (Z.Z.); (X.Y.); (Y.F.); (J.Z.); (Z.Y.); (Z.W.); (A.L.); (L.H.); (J.S.); (Y.L.); (G.D.)
| | - Jing Sun
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing 100050, China; (Z.Z.); (X.Y.); (Y.F.); (J.Z.); (Z.Y.); (Z.W.); (A.L.); (L.H.); (J.S.); (Y.L.); (G.D.)
| | - Yiyao Lian
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing 100050, China; (Z.Z.); (X.Y.); (Y.F.); (J.Z.); (Z.Y.); (Z.W.); (A.L.); (L.H.); (J.S.); (Y.L.); (G.D.)
| | - Gangqiang Ding
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing 100050, China; (Z.Z.); (X.Y.); (Y.F.); (J.Z.); (Z.Y.); (Z.W.); (A.L.); (L.H.); (J.S.); (Y.L.); (G.D.)
| | - Yuna He
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing 100050, China; (Z.Z.); (X.Y.); (Y.F.); (J.Z.); (Z.Y.); (Z.W.); (A.L.); (L.H.); (J.S.); (Y.L.); (G.D.)
- Correspondence: ; Tel.: +86-10-6623-7233
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Zaccardi F, Davies MJ, Khunti K. The present and future scope of real-world evidence research in diabetes: What questions can and cannot be answered and what might be possible in the future? Diabetes Obes Metab 2020; 22 Suppl 3:21-34. [PMID: 32250528 DOI: 10.1111/dom.13929] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/18/2019] [Accepted: 11/18/2019] [Indexed: 12/16/2022]
Abstract
The last decade has witnessed an exponential growth in the opportunities to collect and link health-related data from multiple resources, including primary care, administrative, and device data. The availability of these "real-world," "big data" has fuelled also an intense methodological research into methods to handle them and extract actionable information. In medicine, the evidence generated from "real-world data" (RWD), which are not purposely collected to answer biomedical questions, is commonly termed "real-world evidence" (RWE). In this review, we focus on RWD and RWE in the area of diabetes research, highlighting their contributions in the last decade; and give some suggestions for future RWE diabetes research, by applying well-established and less-known tools to direct RWE diabetes research towards better personalized approaches to diabetes care. We underline the essential aspects to consider when using RWD and the key features limiting the translational potential of RWD in generating high-quality and applicable RWE. Only if viewed in the context of other study designs and statistical methods, with its pros and cons carefully considered, RWE will exploit its full potential as a complementary or even, in some cases, substitutive source of evidence compared to the expensive evidence obtained from randomized controlled trials.
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Affiliation(s)
- Francesco Zaccardi
- Diabetes Research Centre, Leicester Diabetes Centre, Leicester, UK
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, Leicester Diabetes Centre, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, Leicester Diabetes Centre, Leicester, UK
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, Leicester, UK
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He Y, Li Y, Yang X, Hemler EC, Fang Y, Zhao L, Zhang J, Yang Z, Wang Z, He L, Sun J, Wang DD, Wang J, Piao J, Liang X, Ding G, Hu FB. The dietary transition and its association with cardiometabolic mortality among Chinese adults, 1982-2012: a cross-sectional population-based study. Lancet Diabetes Endocrinol 2019; 7:540-548. [PMID: 31085143 PMCID: PMC7269053 DOI: 10.1016/s2213-8587(19)30152-4] [Citation(s) in RCA: 125] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/02/2019] [Accepted: 04/03/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Few studies have used nationally representative data to describe dietary trends and the related cardiometabolic mortality burden in China. Thus, we aimed to characterise the trends in disease-related dietary factors as well as their associated disease burden among Chinese adults from 1982 to 2012. METHODS For this cross-sectional population-based study, we analysed a nationally representative sample of 204 802 adults aged 20 years or older, using data from the 1982, 1992, 2002, and 2010-12 China National Nutrition Surveys (CNNS). We did a comparative risk assessment, in which the effects of suboptimal intakes of 12 dietary factors, individually and collectively, on cardiometabolic mortality were estimated by calculating the population attributable fraction (PAF) to estimate the proportional reduction in cardiometabolic deaths that would occur if exposure to each dietary risk factor was reduced to an alternative optimal level. FINDINGS The overall PAF of mortality from cardiovascular disease and type 2 diabetes that was associated with suboptimal dietary quality was 62·2% in 1982, 57·9% in 1992, 56·2% in 2002, and 51·0% in 2010-12, which accounted for 21·6% of total mortality in China in 1982, 16·6% in 1992, 17·6% in 2002, and 20·8% in 2010-12. The estimated number of cardiometabolic deaths associated with suboptimal dietary intakes was 1·07 million in 1982, 0·93 million in 1992, 1·18 million in 2002, and 1·51 million in 2010-12. Of all 12 dietary factors examined, high sodium intake (17·3%), low fruit consumption (11·5%), and low marine omega-3 fatty acids (9·7%) were associated with the largest numbers of estimated cardiometabolic deaths in 2010-12. INTERPRETATION We observed an improvement in several dietary factors in China in the past few decades. However, current intakes of these dietary factors remain suboptimal. Poor diet quality is estimated to be associated with a substantial proportion of deaths from heart disease, stroke, and type 2 diabetes in China. FUNDING Ministry of Health, China, and Ministry of Science and Technology, China.
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Affiliation(s)
- Yuna He
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yanping Li
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Xiaoguang Yang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Elena C Hemler
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Yuehui Fang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Liyun Zhao
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jian Zhang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhenyu Yang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhu Wang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Li He
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jing Sun
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Dong D Wang
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jingzhong Wang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jianhua Piao
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaofeng Liang
- Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Gangqiang Ding
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Frank B Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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