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Li S, Xia R, Gong X, Wang C, Liu H, Dong H, Su Z, Liang Y, Wang S, Yang T. Mediating effect of TyG index on the association between glucose-lipid metabolism-related dietary pattern and T2DM: a propensity score-matched analysis. BMC Endocr Disord 2025; 25:114. [PMID: 40275221 PMCID: PMC12020057 DOI: 10.1186/s12902-025-01892-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2024] [Accepted: 02/27/2025] [Indexed: 04/26/2025] Open
Abstract
OBJECTIVE This study aimed to investigate the association of dietary patterns (DPs) with risk of T2DM, emphasizing the intermediary role of HOMA or TyG indices among a Chinese adult population. RESEARCH DESIGN AND METHODS Directed acyclic graphs combined with propensity score matching were used to minimize confounding, resulting in 1330 subjects for final analysis. Principal component analysis and reduced rank regression, applied to eleven food groups. Multivariable logistic regression and restricted cubic spline regression models were used to assess associations between there DPs with prevalent T2DM, as well as insulin resistance and β-cell function (HOMA-TyG). Mediation analyses were conducted to evaluate whether the HOMA-TyG index mediated the relationship between DPs and T2DM. RESULTS The DP1, characterized by high intakes of poultry, meat, and preserved foods, was associated with elevated body mass index, triglycerides, and hemoglobin A1c. Both PCA-DP1(ORQ4VsQ1 = 2.15, 95% CI: 1.53-3.03) and RRR-DP1 (ORQ4VsQ1 = 1.69, 95% CI: 1.82-3.58) were significantly positively correlated with T2DM. RRR-DP1 additionally demonstrated a dose-dependent relationship with HOMA-insulin resistance and TyG. Furthermore, the TyG index mediated approximately 19.51% of the relationship between RRR-DP1 and T2DM. CONCLUSIONS These findings indicate that glucose-lipid metabolism-related dietary pattern, notably high in animal fat, exacerbates insulin resistance and heightens T2DM risk. Tailoring dietary interventions to modify this pattern may be an effective strategy for preventing and managing T2DM.
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Affiliation(s)
- ShuShu Li
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, PR China
- Changzhou Center for Disease Control and Prevention, 203 Taishan Road, Changzhou, 213022, PR China
| | - Rong Xia
- Key Lab of Modern Toxicology of Ministry of Education, Center for Global Health, School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing, 211166, PR China
- Department of Respiratory & Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, PR China
| | - Xing Gong
- Key Lab of Modern Toxicology of Ministry of Education, Center for Global Health, School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing, 211166, PR China
| | - Chao Wang
- Key Lab of Modern Toxicology of Ministry of Education, Center for Global Health, School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing, 211166, PR China
| | - Hechun Liu
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, PR China
| | - Huibin Dong
- Changzhou Center for Disease Control and Prevention, 203 Taishan Road, Changzhou, 213022, PR China
| | - Zhangyao Su
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, PR China
| | - Yucheng Liang
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, PR China
| | - Shoulin Wang
- Key Lab of Modern Toxicology of Ministry of Education, Center for Global Health, School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing, 211166, PR China.
| | - Tao Yang
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, PR China.
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Qian Y, Su Q, Liu W, Ma L, Ma M, Ma L. The influence of socioeconomic status on intelligence in school-age children in Xuyong County: a mediation analysis of nutrition literacy and dietary diversity. Eur J Nutr 2025; 64:100. [PMID: 39987304 DOI: 10.1007/s00394-025-03599-9] [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: 07/07/2024] [Accepted: 01/27/2025] [Indexed: 02/24/2025]
Abstract
PURPOSE While children's nutrition in rural areas has garnered attention, the most studies focus on underweight, obesity and anemia, neglecting the importance of intelligence in children's current academic performance and future success. This study aimed to examine how food and nutrition literacy (FNLIT) and dietary diversity score (DDS) mediate the impact of socioeconomic status (SES) on the intelligence development, offering insights for improving childhood nutrition. METHODS This cross-sectional study employed a stratified cluster random sampling method and included 1704 children aged between 8 and 16 years. Questionnaires was used to collect demographic data, FNLIT, DDS and Raven's Standard Progressive Matrices (SPM) scores. SES was constructed using principal component analysis. Linear regression analysis was used to explore the interrelationship between the variables. RESULTS The mean scores for FNLIT, DDS, and SPM were 58.06 ± 7.00, 6.25 ± 1.64, and 37.60 ± 8.91, respectively. SES is positively correlated with SPM (B = 0.434, p < 0.01); FNLIT mediates the relationship between SES and SPM (B = 0.065, 95% CI: 0.035, 0.098). Among participants with DDS ≤ 6, DDS mediates the relationship between SES and SPM (B = 0.017, 95% CI: 0.0002, 0.044). For students with DDS ≤ 6, FNLIT + DDS has a positive mediated (B = 0.003, 95% CI: 0.0004, 0.007), while for primary students, it show a negative effect (B = - 0.003, 95% CI: - 0.008, - 0.001). CONCLUSION Both FNLIT and DDS have impacts on children intelligence. Nutrition education and dietary interventions should prioritize children with low SES and inadequate DDS to enhance intellectual development.
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Affiliation(s)
- Youhui Qian
- Department of Nutrition and Food Hygiene, School of Public Health, Southwest Medical University, Luzhou, 646000, China
| | - Qin Su
- Department of Health Surveillance, Luzhou City Center for Disease Control and Prevention, Luzhou, 646000, China
| | - Wenda Liu
- Department of Health Section, Xuyong County Center for Disease Control and Prevention, Luzhou, 646400, China
| | - Lilai Ma
- Department of Nutrition and Food Hygiene, School of Public Health, Southwest Medical University, Luzhou, 646000, China
| | - Mengting Ma
- Department of Nutrition and Food Hygiene, Sichuan Center for Disease Control and Prevention, Chengdu, 610041, China.
| | - Ling Ma
- Department of Nutrition and Food Hygiene, School of Public Health, Southwest Medical University, Luzhou, 646000, China.
- Environmental Health Effects and Risk Assessment Key Laboratory of Luzhou, School of Public Health, Southwest Medical University, Luzhou, 646000, China.
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Liu J, Lu W, Lv Q, Wang Y, Xu X, He Y, Chang H, Zhao Y, Zhang X, Zang X, Zhang H. Impact of Dietary Patterns on Metabolic Syndrome in Young Adults: A Cross-Sectional Study. Nutrients 2024; 16:2890. [PMID: 39275205 PMCID: PMC11397102 DOI: 10.3390/nu16172890] [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: 07/02/2024] [Revised: 07/24/2024] [Accepted: 07/26/2024] [Indexed: 09/16/2024] Open
Abstract
Metabolic syndrome has become a significant public health concern. This study aims to investigate the impact of dietary patterns on metabolic syndrome in young adults and how physical activity modulates this effect. A cross-sectional study was conducted at a health management center in Tianjin, China, from September 2022 to March 2023. Participants aged 18-35 years were recruited using convenience sampling. Dietary intake was assessed using a validated food frequency questionnaire. Logistic regression models evaluated associations between these patterns and metabolic syndrome, adjusting for potential confounders. Among 442 participants, four dietary patterns were identified: Legume-Nut, Alcohol-Meat, Sugar-Processed, and Egg-Vegetable. The Legume-Nut dietary pattern was associated with a higher risk of metabolic syndrome (OR = 2.63, 95% CI: 1.08-6.37), while the Egg-Vegetable dietary pattern was associated with a lower risk (OR = 0.26, 95% CI: 0.10-0.70). No significant associations were found for the Sugar-Processed and Alcohol-Meat patterns. Subgroup analysis revealed that the Legume-Nut pattern increased the risk of metabolic syndrome among those with irregular physical activity, whereas the Egg-Vegetable pattern decreased the risk. These findings highlight the significant influence of dietary patterns on the risk of metabolic syndrome in young adults and the modifying effect of regular physical activity, underscoring the need for targeted dietary and lifestyle interventions to prevent metabolic syndrome in this population.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Xiaonan Zhang
- School of Nursing, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin 300070, China; (J.L.); (W.L.); (Q.L.); (Y.W.); (X.X.); (Y.H.); (H.C.); (Y.Z.)
| | - Xiaoying Zang
- School of Nursing, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin 300070, China; (J.L.); (W.L.); (Q.L.); (Y.W.); (X.X.); (Y.H.); (H.C.); (Y.Z.)
| | - Hua Zhang
- School of Nursing, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin 300070, China; (J.L.); (W.L.); (Q.L.); (Y.W.); (X.X.); (Y.H.); (H.C.); (Y.Z.)
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Gou R, Qin J, Pang W, Cai J, Luo T, He K, Xiao S, Tang X, Zhang Z, Li Y. Correlation between dietary patterns and cognitive function in older Chinese adults: A representative cross-sectional study. Front Nutr 2023; 10:1093456. [PMID: 37081915 PMCID: PMC10110985 DOI: 10.3389/fnut.2023.1093456] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/13/2023] [Indexed: 04/22/2023] Open
Abstract
Objective The objective of this study was to investigate the relationship between dietary patterns and cognitive function in older adults (≥60 years old). Methods Food intake was quantitatively assessed by the Food Frequency Questionnaire (FFQ), and cognitive function was assessed by the Chinese version of the Simple Mental State Examination Scale (MMSE). Four major dietary patterns were identified by the factor analysis (FA) method. The relationship between dietary patterns and cognitive function was evaluated by logistic regression. Results A total of 884 participants were included in the study. Four dietary patterns (vegetable and mushroom, oil and salt, seafood and alcohol, and oil tea dietary patterns) were extracted. In the total population, Model III results showed that the fourth quartile of dietary pattern factor scores for the vegetable and mushroom pattern was 0.399 and 7.056. The vegetable and mushroom dietary pattern may be a protective factor for cognitive function, with p-value = 0.033, OR (95% CI): 0.578 (0.348, 0.951) in Model III (adjusted for covariates: sex, ethnic, marital, agricultural activities, smoking, drinking, hypertension, diabetes, dyslipidemia, BMI, and dietary fiber). In the ethnic stratification analysis, the scores of dietary pattern factors of the vegetable and mushroom among the Yao participants were 0.333 and 5.064. The Vegetable and mushroom diet pattern may be a protective factor for cognitive function, p-value = 0.012, OR (95% CI): 0.415 (0.206, 0.815). Conclusion The fourth quartile of the vegetable and mushroom dietary pattern scores showed dose-dependent and a strong correlation with cognitive function. Currently, increasing vegetable and mushroom intake may be one of the effective ways to prevent and mitigate cognitive decline. It is recommended to increase the dietary intake of vegetables and mushroom foods.
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Affiliation(s)
- Ruoyu Gou
- Department of Environmental Health and Occupational Medicine, School of Public Health, Guilin Medical University, Guilin, Guangxi, China
- The Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Heath, Guilin, Guangxi, China
| | - Jian Qin
- Department of Environmental and Occupational Health, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Weiyi Pang
- Department of Environmental Health and Occupational Medicine, School of Public Health, Guilin Medical University, Guilin, Guangxi, China
- The Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Heath, Guilin, Guangxi, China
| | - Jiansheng Cai
- Department of Environmental and Occupational Health, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Tingyu Luo
- Department of Environmental Health and Occupational Medicine, School of Public Health, Guilin Medical University, Guilin, Guangxi, China
- The Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Heath, Guilin, Guangxi, China
| | - Kailian He
- Department of Environmental Health and Occupational Medicine, School of Public Health, Guilin Medical University, Guilin, Guangxi, China
- The Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Heath, Guilin, Guangxi, China
| | - Song Xiao
- Department of Environmental Health and Occupational Medicine, School of Public Health, Guilin Medical University, Guilin, Guangxi, China
- The Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Heath, Guilin, Guangxi, China
| | - Xu Tang
- Department of Environmental and Occupational Health, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Zhiyong Zhang
- Department of Environmental Health and Occupational Medicine, School of Public Health, Guilin Medical University, Guilin, Guangxi, China
- The Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Heath, Guilin, Guangxi, China
- *Correspondence: Zhiyong Zhang
| | - You Li
- Department of Environmental Health and Occupational Medicine, School of Public Health, Guilin Medical University, Guilin, Guangxi, China
- The Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Heath, Guilin, Guangxi, China
- You Li
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Wang X, Li T, Ding H, Liu Y, Liu X, Yu K, Xiao R, Xi Y. The role of dietary patterns and erythrocyte membrane fatty acid patterns on mild cognitive impairment. Front Nutr 2022; 9:1005857. [PMID: 36407514 PMCID: PMC9673906 DOI: 10.3389/fnut.2022.1005857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
Background Dietary fatty acids have been shown to be associated with the development of cognition. However, research on the role of fatty acid intake in dietary patterns and fatty acid patterns (FAPs) in the development of cognitive function is limited. The aim of this study was to explore the correlation between dietary patterns and FAPs and to provide available evidence for preventing mild cognitive impairment (MCI) through these patterns. Materials and methods The 973 participants aged between 65 and 85 were recruited from 2020 to 2021 for this multicenter research in Beijing. Neuropsychological tests were used for cognitive evaluation, and data of dietary intake in the past 12 months were collected with semi-quantitative food frequency questionnaire. The erythrocyte membrane fatty acid profile was tested by chromatography and mass spectrometry lipid profiling. Factor analysis was used to derive the main dietary patterns and FAPs. Pearson’s correlation or Spearman’s correlation was used to explore the association between dietary patterns and FAPs. Binary logistic regression was applied to examine the relationship between patterns and cognitive function. Results Six dietary patterns and six FAPs were identified, explaining 53.4 and 80.9% of the total variance separately. After adjusting all potential confounders, T3 of the pattern 1 and FAP2 were the independent protect factors for MCI, respectively (OR 0.601, 95% CI [0.395, 0.914]; OR 0.108, 95% CI [0.019, 0.623]). Rich of SM (26:0), SM (24:1), and SM (26:1) is the characteristic of FAP2. A positive correlation was found between component scores of dietary pattern1 and FAP2 (r = 0.441, p = 0.001). People who adhered to a reasonable intake of animal flesh consumed more various long-chain fatty acids as well. Conclusion The erythrocyte membrane metabolites, SM (26:0), SM (24:1), and SM (26:1), might function as early biomarkers for predicting or monitoring of cognitive aging in the elderly. The dietary pattern with recommended animal flesh consumption was significantly associated with FAP characterized by very long-chain SMs. This dietary pattern affected FAP, which might achieve the ultimate goal of neuroprotection through the very long-chain SMs. A rational intake of dietary fatty acids might be an effective way on preventing MCI in the elderly.
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Affiliation(s)
- Xuan Wang
- Beijing Key Laboratory of Environmental Toxicology, School of Public Health, Capital Medical University, Beijing, China
| | - Tiantian Li
- Beijing Key Laboratory of Environmental Toxicology, School of Public Health, Capital Medical University, Beijing, China
| | - Huini Ding
- Beijing Key Laboratory of Environmental Toxicology, School of Public Health, Capital Medical University, Beijing, China
| | - Yuru Liu
- Fangshan District Center for Disease Control and Prevention, Beijing, China
| | | | - Kang Yu
- Peking Union Medical College Hospital, Beijing, China
| | - Rong Xiao
- Beijing Key Laboratory of Environmental Toxicology, School of Public Health, Capital Medical University, Beijing, China
| | - Yuandi Xi
- Beijing Key Laboratory of Environmental Toxicology, School of Public Health, Capital Medical University, Beijing, China
- *Correspondence: Yuandi Xi,
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Buawangpong N, Aramrat C, Pinyopornpanish K, Phrommintikul A, Soontornpun A, Jiraporncharoen W, Pliannuom S, Angkurawaranon C. Risk Prediction Performance of the Thai Cardiovascular Risk Score for Mild Cognitive Impairment in Adults with Metabolic Risk Factors in Thailand. Healthcare (Basel) 2022; 10:healthcare10101959. [PMID: 36292406 PMCID: PMC9602158 DOI: 10.3390/healthcare10101959] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 11/04/2022] Open
Abstract
Individuals with metabolic risks are at high risk of cognitive impairment. We aimed to investigate whether the Thai Cardiovascular Risk (TCVR) score can be used to predict mild cognitive impairment (MCI) in Thai adults with metabolic risks. The study was conducted using secondary data of patients with metabolic risks from Maharaj Nakorn Chiang Mai Hospital. MCI was indicated by an MoCA score of less than 25. Six different TCVR models were used with various combinations of ten different variables for predicting the risk of MCI. The area under the receiver operator characteristic curve (AuROC) and Hosmer–Lemeshow goodness of fit tests were used for determining discriminative performance and model calibration. The sensitivity of the discriminative performance was further evaluated by stratifying by age and gender. From a total of 421 participants, 348 participants had MCI. All six TCVR models showed a similar AuROC, varying between 0.58 and 0.61. The anthropometric-based model showed the best risk prediction performance in the older age group (AuROC 0.69). The laboratory-based model provided the highest discriminative performance for the younger age group (AuROC 0.60). There is potential for the development of an MCI risk model based on values from routine cardiovascular risk assessments among patients with metabolic risks.
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Affiliation(s)
- Nida Buawangpong
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Chanchanok Aramrat
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Kanokporn Pinyopornpanish
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai 50200, Thailand
- Correspondence: ; Tel.: +66-53935462
| | - Arintaya Phrommintikul
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Atiwat Soontornpun
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Wichuda Jiraporncharoen
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Suphawita Pliannuom
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Chaisiri Angkurawaranon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai 50200, Thailand
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A Comparison between Dietary Consumption Status and Healthy Dietary Pattern among Adults Aged 55 and Older in China. Nutrients 2022; 14:nu14132778. [PMID: 35807958 PMCID: PMC9268783 DOI: 10.3390/nu14132778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 06/30/2022] [Accepted: 06/30/2022] [Indexed: 11/17/2022] Open
Abstract
The nutrition and health of middle-aged and elderly people is crucial to the long-term development of a country. The present study aimed to analyze the dietary consumption status in Chinese adults by using baseline and follow-up data from the community-based Cohort Study on Nervous System Diseases between 2018−2020 and selecting those aged 55 and older (n = 23,296). Dividing 65 food items into 17 subgroups on the basis of a valid semi-quantitative food frequency questionnaire, we analyze the consumption amount and consumption rate of foods in relation to wave and sociodemographic factors by employing the Wilcoxon rank sum test, Kruskal−Wallis analysis, the Chi-squared test, and the Cochran−Armitage trend test and evaluate food intake status using the Chinese Dietary Guidelines Recommendations (2022). Compared to 2018, the median daily intake of livestock meat, poultry, and eggs increased in 2020 (p < 0.05), while the median daily intake of wheat, other cereals, tubers, legumes, fruits, and fish and seafood decreased (p < 0.05). The proportion of subjects with excessive intake of grain, livestock and poultry, and eggs was 46.3%, 36.6%, and 26.6%, respectively, while the proportion of subjects with insufficient intake of whole grains and mixed beans, tubers, legumes, dairy products, fruits, vegetables, and fish and seafood were 98.4%, 80.3%, 74.0%, 94.6%, 94.3%, 75.8%, and 86.5%, respectively, and more than 50% of subjects were non-consumers of dairy products, nuts, and whole grains and mixed beans. In conclusion, the problem of unhealthy dietary structure is prominent among adults aged 55 and older in China; insufficient or excessive intakes of various types of foods are common; and excessive consumption of edible oil and salt remains a serious problem.
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