Dietary Balance Index-07 and the Risk of Anemia in Middle Aged and Elderly People in Southwest China: A Cross Sectional Study

Uncovering a New Concept of Foodnality in Diet Recommendations for Chinese Aging Populations Based on Systematic and Bibliometric Review

China is grappling with significant aging challenge, and food patterns play an important role in the health of aging populations. A comprehensive bibliometric analysis with regard to systematically examined population-based studies published between 1 June 2014 and 31 May 2024, and 83 eligible studies, including 43 cross-sectional, 34 longitudinal, and 6 case-control studies, was conducted to investigate the correlations among foods, dietary patterns, and healthy aging concepts. An interesting conclusion from cohort studies was that foods recommended for intake in certain diets might not be recommended in other diets, i.e., food items in various diets showed different contributions. This dual character of foods exhibited in the diet is termed foodnality, a new concept proposed in this study. Foodnality was partially related to the origins, quality, and processing of foods, as well as individual physical status. Therefore, recommended foods with positive foodnality and unrecommended foods with negative foodnality were summarized, and four-dimensional diet recommendations were further proposed, including choosing a suitable dietary pattern, evaluating positive foodnality, upgrading foodnality to a premium diet, and cultivating healthier dietary concepts. This review plays a pivotal role in evaluating the guidelines on food intake and dietary patterns among elderly residents in China.

Correlation between Vegetable and Fruit Intake and Cognitive Function in Older Adults: A Cross-Sectional Study in Chongqing, China

OBJECTIVE

To explore the correlation between different types of vegetable and fruit intake and cognitive function among the older adults in Chongqing, China, and to provide a scientific basis for developing efficient lifestyle interventions for the prevention of Mild Cognitive Impairment (MCI).

METHOD

Approximately 728 older adults in urban and rural areas of Chongqing were surveyed using face-to-face questionnaires. Cognitive function was assessed with the Montreal Cognitive Assessment-Basic (MoCA-B) scale, and the vegetable and fruit intake groups were investigated with the Simple Food Frequency Counting Survey Scale. Binary logistic regression was used to explore the effect of the vegetable and fruit intake group on cognitive function. Subgroup analysis was used to demonstrate the robustness of the results.

RESULT

Of the 728 participants in the study, 36.40% were likely to have MCI, which is higher than the national average for this condition. After adjusting for confounders, compared to the Q1 group, fruit and root vegetable intake was a protective factor for MCI, showing a dose-response relationship (p < 0.05). Only lower intake (Q2) of total vegetables, medium intake (Q2, Q3) of solanaceous vegetables, and medium-high intake (Q2, Q4) of fungi and algae was protective against MCI, whereas the leafy vegetables showed no relation to MCI. Apart from this, participants who were older, female, unmarried, non-smoking, and engaged in physical labor, and who had an average monthly income of less than 3000 RMB were more likely to suffer from cognitive impairment.

CONCLUSION

This suggested that the fruit-intake groups and some vegetable-intake groups showed a protective effect on cognitive function, and might behave differently depending on their different intake and demographic characteristics. A sensible, healthy diet can help prevent MCI.

Social capital and healthy eating among two ethnic minority groups in Yunnan Province, Southwest China: the mediating role of social support and nutrition knowledge

Background

Although social capital has been linked to dietary intake particularly in disadvantaged populations, little is known about the mechanisms. This study aimed to investigate whether social support (SS) and nutrition knowledge (NK) mediate the association between social capital and healthy eating habits.

Methods

A probability sample of two ethnic minority groups in Yunnan Province, Southwest China were included (n = 1,033, mean age 47.5 ± 14.7 years). Bonding and bridging social capital (BOC and BRC) were assessed with the Personal Social Capital Scale (PSCS-16). Dietary data were evaluated with the Chinese Healthy Eating Index (CHEI), a measure of diet quality which reflects adherence to the Chinese Dietary Guidelines. NK and SS were measured with a validated questionnaire and scale, respectively. Structural Equation Modeling was used to calculate the direct, indirect and total effects of social capital on CHEI scores.

Results

The mean score of CHEI was 57.4 ± 9.8, which was significantly lower in men and older people. Low adherence to dietary guidelines were to observed in the consumption of dairy, beans, nuts, animal-source food vegetables and fruits. BOC and BRC were positively associated with CHEI score (β = 0.37 and 0.38, all p < 0.05). Social support and nutrition knowledge mediated 45.9 and 39.5% of the total effect of social capital on CHEI score, respectively.

Conclusion

Social capital appears to enhance adherence to dietary guidelines by improving nutrition knowledge and social support. Nutrition promotion programs therefore should consider incorporating strategies that foster social capital development, particularly in disadvantaged populations.

Healthy Diet-Related Knowledge, Attitude, and Practice (KAP) and Related Socio-Demographic Characteristics among Middle-Aged and Older Adults: A Cross-Sectional Survey in Southwest China

Objective This study aimed to investigate the current status and influencing factors of healthy diet knowledge, attitude, and practice (KAP) among middle-aged and older adults aged 45-75 in Southwest China. Methods A questionnaire survey was conducted among 1822 middle-aged and older adults in Southwest China (including Guizhou, Sichuan, Yunnan, and Chongqing) from February to May 2021. Results The average score of healthy diet knowledge was (4.82 ± 2.98), with a passing rate of 7.6%. The mean score of healthy diet attitude was (21.26 ± 4.18), with a passing rate of 69.5%. The average score of healthy diet practice was (13.76 ± 2.84), with a passing rate of 55.5%. The score for healthy diet KAP was (39.85 ± 7.21), with a passing rate of 41.2%. Univariate analysis showed that the scores of healthy diet KAP were significantly different among participants of different ages, genders, ethnicities, residences, education levels, monthly household incomes, and regions, as well as varying according to whether several generations have lived in the same area (p < 0.05). The results of multiple linear regression showed that the healthy diet KAP of participants was influenced by age, gender, residence, education level, monthly household income, and region (p < 0.05). Conclusion The healthy diet KAP of middle-aged and older adults aged 45-75 in Southwest China shows room for improvement. The knowledge regarding healthy diet was relatively low, and certain specific healthy diet practices were not up to the standard. However, there was a positive trend in the attitude towards a healthy diet. Healthy diet education should be promoted for middle-aged and older adults.

Detection of the peripheral blood antigens and clinical value in recurrent aphthous ulcer: A cross-section study

Abstract Background/purpose

Recurrent aphthous ulcer (RAU) is one of the most common diseases of oral mucosa, which is generally believed to be related to immunity, though the etiology is still unclear. It is suspected that allergies are directly related to RAU. So we sought to explore the relationship between hypersensitivity and RAU.

Materials and methods

40 RAU patients who were in ulceration period and 40 people who were in good health were selected from Jan 2016 to Feb 2017, matched in age and sex. The peripheral blood antigens of 40 RAU patients and 40 healthy people was tested, and serum specific IgE (sIgE) with 6 groups of antigens and total IgE (tIgE) analysis was performed to identify IgE-mediated allergic reaction possibly affecting RAU. We then investigated the food intolerance and IgG levels to discover the correlation between non-IgE mediated allergic reaction and RAU.

Results

The positive cases and rate of sIgE in RAU group was higher than that of control, but the difference was not statistically significant (P＞0.05). Positive grade of animal fur scraps (EX1), house dust mixed (HX2) and the serum tIgE concentration of the RAU group were significantly higher than the control group (P＜0.05).The number of food intolerance in RAU group was significantly higher than that in control group (P＜0.05).

Conclusion

Our findings suggested certain correlation between RAU and anaphylaxis. Daily contact allergens and food intolerance may be one of the causes of RAU. Moreover, this provides reference value for clinical diagnosis and treatment.

The Effect of a Multifaceted Intervention on Dietary Quality in Schoolchildren and the Mediating Effect of Dietary Quality between Intervention and Changes in Adiposity Indicators: A Cluster Randomized Controlled Trial

Some studies have found associations between dietary quality and obesity and their concurrent changes were observed in a few interventions. The present study aimed to assess the effect of a multifaceted intervention for childhood obesity on dietary quality and examine the mediating effect of dietary quality between the intervention and changes in adiposity indicators. Based on the social ecological model, the cluster randomized controlled trial included five components (three targeted children and two targeted their environment). In total, 1176 children from three cities in China participated in a baseline (2018) and end-of-trial (2019) examination, including 605 children in the intervention group and 571 in the control group. Self-reported behavior and anthropometric measures were collected at both time points. The Diet Balance Index Revision (DBI-07) was calculated to assess dietary quality. Generalized linear mixed models were used to estimate the intervention effect on dietary quality and its mediating effects were examined. Compared to the controls, the proportion of sugar-sweetened beverage (SSB) intake (OR = 0.27, p < 0.001, corrected p < 0.001) decreased in the intervention group. Higher bound scores (HBS) of the DBI-07 indicating over-intake decreased in the intervention group compared to the controls (mean difference = −1.52, p = 0.005, corrected p = 0.015). Changes in the HBS partially mediated the associations between the intervention and changes in body mass index, waist circumference, and body fat percentage. Future intervention should promote knowledge, attitudes, and behaviors related to dietary quality.

Anaemia and associated factors among older adults in an urban district in China: a large-scale cross-sectional study

OBJECTIVE

Anaemia leads to poor health outcomes in older adults; however, most current research in China has focused on younger adults. This study aimed to investigate the prevalence of anaemia and its associated factors in older adults in an urban district in China.

DESIGN

A cross-sectional study.

SETTING

An urbanised region, Shenzhen, China.

PARTICIPANTS

A total of 121 981 participants aged ≥65 years were recruited at local community health service centres in Shenzhen from January to December 2018.

PRIMARY OUTCOMES

The prevalence of anaemia was analysed and potential associated factors were evaluated.

RESULTS

The mean haemoglobin level was 136.40±16.66 g/L and the prevalence of anaemia was 15.43%. The prevalences of mild, moderate and severe anaemia were 12.24%, 2.94% and 0.25%, respectively. Anaemia was positively associated with older age, being underweight (adjusted OR (AOR) 2.06, 95% CI 1.93 to 2.20), diabetes (AOR 1.23, 95% CI 1.19 to 1.28) and chronic kidney disease (AOR 1.41, 95% CI 1.36 to 1.46), and inversely with higher education level, current-smoker (AOR 0.84, 95% CI 0.78 to 0.89), non-habitual drinker (AOR 0.86, 95% CI 0.81 to 0.92), habitual drinker (AOR 0.81, 95% CI 0.75 to 0.87), overweight (AOR 0.67, 95% CI 0.64 to 0.70), obesity (AOR 0.57, 95% CI 0.53 to 0.61), central obesity (AOR 0.86, 95% CI 0.82 to 0.89), hypertension (AOR 0.86, 95% CI 0.83 to 0.89) and dyslipidaemia (AOR 0.81, 95% CI 0.78 to 0.84).

CONCLUSION

Anaemia is prevalent among people aged 65 years and older in China. Screening of high-risk populations and treatment of senile anaemia should be a top priority in Shenzhen, and should be listed as important public health intervention measures for implementation.

Unfavorable Dietary Quality Contributes to Elevated Risk of Ischemic Stroke among Residents in Southwest China: Based on the Chinese Diet Balance Index 2016 (DBI-16)

Background: Little is known about the effects of dietary quality on the risk of ischemic stroke among Southwest Chinese, and evidence from prospective studies is needed. We aimed to evaluate the associations of ischemic stroke with dietary quality assessed by the Chinese Diet Balance Index 2016 (DBI-2016). Methods: The Guizhou Population Health Cohort Study (GPHCS) recruited 9280 residents aged 18 to 95 years from 12 areas in Guizhou Province, Southwest China. Baseline investigations, including information collections of diet and demographic characteristics, and anthropometric measurements were performed from 2010 to 2012. Dietary quality was assessed by using DBI-2016. The primary outcome was incident ischemic stroke diagnosed according to the International Classification of Diseases 10th revision (ICD-10) until December 2020. Data analyzed in the current study was from 7841 participants with complete information of diet assessments and ischemic stroke certification. Cox proportional hazards models were used to estimate the risk of ischemic stroke associated with dietary quality. Results: During a median follow-up of 6.63 years (range 1.11 to 9.53 years), 142 participants were diagnosed with ischemic stroke. Participants with ischemic stroke had a more excessive intake of cooking oils, alcoholic beverages, and salt, and had more inadequacy in meats than those without ischemic stroke. (p < 0.05). Compared with participants in the lowest quartile (Q1), those in the highest quartile (Q4) of the higher bound score (HBS) and of the dietary quality distance (DQD) had an elevated risk for ischemic stroke, with the corresponding hazard ratios (HRs) of 3.31 (95%CI: 1.57−6.97) and 2.26 (95%CI: 1.28−4.00), respectively, after adjustment for age, ethnic group, education level, marriage status, smoking and waist circumference, and the medical history of diabetes and hypertension at baseline. In addition, excessive intake levels (score 1−6) of cooking oils, excessive intake levels (score 1−6) of salt, and inadequate intake levels (score −12 to −7) of dietary variety were positively associated with an increased risk for ischemic stroke, with the multiple HRs of 3.00 (95%CI: 1.77−5.07), 2.03 (95%CI: 1.33−3.10) and 5.40 (95%CI: 1.70−17.20), respectively. Conclusions: Our results suggest that unfavorable dietary quality, including overall excessive consumption, excessive intake of cooking oils and salt, or under adequate dietary diversity, may increase the risk for ischemic stroke.

A Systematic Review of Diet Quality Index and Obesity among Chinese Adults

Diet quality scores are designed mainly based on Western-style dietary patterns. They were demonstrated to be good indicators of obesity in developed but not developing countries. Several diet quality scores were developed based on the Chinese dietary guidelines, yet no systematic review exists regarding how they were related to obesity. We searched research articles published between 2000 and 2021 in PubMed, CINAHL, and Scopus databases. Both cross-sectional and prospective studies that examined the relationship between a diet quality score and weight, body mass index, obesity, or waist circumference conducted in a Chinese population were selected. From the 602 articles searched, 20 articles were selected (12 are cross-sectional studies and 8 are prospective cohort studies). The relationship between internationally used scores and obesity was inconsistent among studies. Scores tailored to the Chinese diet demonstrated a strong relationship with both being underweight and obesity. The heterogeneity of the populations and the major nutrition transition in China may partially explain the discrepancies among studies. In conclusion, diet quality scores tailored to the Chinese diet may be associated with both undernutrition and overnutrition, as well as being underweight and obesity outcomes.

Perceived social support and diet quality among ethnic minority groups in Yunnan Province, Southwestern China: a cross-sectional study

Background

Social support is an important health determinant and may affect dietary behaviors. The purpose of this study was to examine the relations between perceived social support and the Chinese Diet Balance Index-16 (DBI-16) among ethnic minority groups in Southwest China.

Methods

This cross-sectional study was conducted between May 2019 and August 2020 among six ethnic minority groups native to Yunnan Province (n = 3564). Perceived social support from family, friends and significant others were measured with the Multi-dimensional Scale of Perceived Social Support (MSPSS). Dietary data were obtained using a 100-item Food Frequency Questionnaire (FFQ) and a lifestyle questionnaire. Lower Bound Score (LBS), Higher Bound Score (HBS) and Diet Quality Distance (DQD) which represent inadequate, excessive and unbalanced food intake respectively were calculated to measure the compliance with the recommendations of the Dietary Guidelines for Chinese 2016.

Results

One thousand four hundred ninety-six men and two thousand sixty-eight women were included. 51.2% of the subjects had moderate or high levels of inadequate intake; 21.3% had moderate or high levels of excessive intake; and 74.0% had moderate or high levels of unbalanced dietary intake. With potential confounders adjusted, support from family was negatively associated with inadequate intake, while support from friends was positively associated with inadequate and excessive intake. No significant associations were found between perceived social support from significant others and diet quality indicators.

Conclusions

An unbalanced diet is common among adults of the ethnic minority groups in Yunnan Province, Southwest China. Social support should be taken into account in designing nutrition interventions rather than focusing solely on individuals.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11787-5.

Association of Healthy Eating Index and the Alternative Healthy Eating Index with the cell blood count indices

OBJECTIVES

There is an association between diet quality and markers of inflammation. We aimed to investigate the relationship between diet quality with cell blood count (CBC) and inflammatory indices such as red cell distribution width (RDW) and white blood cell count (WBC).

STUDY DESIGN

A total of 367 male subjects aged 20-69 yrs, who were employees of Shahid Hasheminejad Gas Processing Company (SGPC) completed the study.

METHODS

All participants completed a questionnaire that contained questions about demography. Standard protocols were used for measuring anthropometric indices in all subjects. Blood samples were collected after a 12 hrs fast from all participants. Biochemical parameters were determined in all participants using an auto-analyzer (Eppendorf, Germany). Systolic and diastolic blood pressure were measured using a standard mercury sphygmomanometer. CBC was measured using the Sysmex auto analyser system (KX-21 N). The HEI/AHEI scores extracted from a validated food frequency questionnaire (FFQ) to evaluate the diet quality. Data analyses were performed using SPSS 16 (SPSS Inc., IL, and USA).

RESULTS

A total of 674 men (aged 43.68±9.09 yrs) completed the study. The CBC indices were not significantly different between the HEI/AHEI classifications among the Iranian men (p-value >0.05 for all variables). Moreover, there was no association between HEI/ AHEI with the CBC indices in our population (p-value >0.05 for all variables).

CONCLUSIONS

In summary, there was no association between the diet quality with the cell blood count parameters among Iranian men.

Association of fourteen years diet quality trajectories and type 2 diabetes mellitus with related biomarkers

Diet quality fluctuates throughout one’s adulthood, yet it remains unclear how long-term diet quality changes are related to type 2 diabetes mellitus (T2DM) and its biomarkers. We aimed to examine the association of long-term diet quality with T2DM and its biomarkers. Diet quality was assessed by the revised DBI-07, in which diet quality distance levels (DQD) represented the overall diet quality. Participants were clustered into classes sharing similar DQD levels using latent class mixed model. We used Cox regression and random effect linear regression to assess DQD trajectories’ association with T2DM and its biomarkers. Three DQD trajectories were derived: moderate to gradual decrease, high to moderate, high stable DQD level representing 2.14%, 6.18% and, 91.68% of the population. Compared to class 1, class 2 and 3 were associated with an increased risk of T2DM [HR=4.40; 95%CI: 2.02-9.59]; [HR=3.68; 95% CI: 2.11-6.43]. When class 3 was used as a reference, class 1 was also associated with an increased risk of TDM [HR=2.71; 95%CI: 1.55-4.73]. Our findings suggest that a long-term unhealthy diet is associated with an increased risk of T2DM. Gradually reducing DQD level may not make a difference, which establishes the importance of promoting healthy eating habits at early adulthood.

Nutrition Transition with Accelerating Urbanization? Empirical Evidence from Rural China

Although rapid urbanization is often considered as one of the most important drivers for changing dietary patterns, little attention has been paid to rural areas despite the profound transformation they have undergone. Using longitudinal data from the China Health and Nutrition Survey (CHNS) for the period from 2004 to 2011, this study seeks to better understand the relationship between the urbanization of rural areas and dietary transition, with the focus on nutrition intake and dietary quality. Our results suggest that with increasing urbanization, rural residents tend to have on average lower calorie intakes but higher dietary quality. Specifically, increasing urbanization consistently reduces carbohydrate consumption and reduces fat consumption after a turning point; protein consumption first decreases and then increases after the turning point with increasing urbanization. Urbanization shows a significant and positive effect on the Healthy Eating Index (HEI). In addition to sociodemographic changes, we find that changing consumer preferences and knowledge serve as important determinants in explaining the dietary transition in rural China from 2004 to 2011. In our study, urbanization appears to positively affect rural residents’ healthy food preferences and dietary knowledge. This study is a first attempt for better understanding the nutrition transition resulting from accelerating urbanization in rural China; several limitations and areas for future research have been highlighted.

Associations between malnutrition and cognitive impairment in an elderly Chinese population: an analysis based on a 7-year database

AIM

This study aimed to elucidate whether malnutrition is associated with cognitive impairment in an older Chinese population.

METHODS

A cross-sectional study was conducted in 2365 participants aged 60 years or older from January 2013 to September 2019. Nutritional status was measured by using the Mini Nutritional Assessment Short Form (MNA-SF). Cognitive function was assessed with the Mini-Mental State Examination (MMSE). The relationship between malnutrition or each Mini Nutritional Assessment Short Form domain and cognitive impairment was examined with univariate and multivariate logistic regression analysis.

RESULTS

The prevalence of malnutrition, risk of malnutrition, and cognitive impairment was 5.54%, 33.45%, and 36.74%, respectively. The prevalence was higher in those 80 years and older: 7.88%, 40.75%, and 53.65%, respectively. The Mini-Mental State Examination score was positively correlated with the Mini Nutritional Assessment Short Form score (r = 0.364, P < 0.001). After adjustment for age, gender, education, marital status, and living alone, malnutrition (odds ratio (OR) = 3.927, 95% confidence interval (CI): 2.650-5.819), anorexia (OR = 1.454, 95%CI: 1.192-1.774), weight loss (OR = 1.697, 95%CI: 1.406-2.047), impaired mobility (OR = 4.156, 95%CI: 3.311-5.218), and psychological stress (OR = 1.414, 95%CI: 1.070-1.869) were significantly associated with an increased risk of cognitive impairment.

CONCLUSIONS

Our results suggest that the prevalence of malnutrition and cognitive impairment is relatively high and increases with age. Malnutrition, anorexia, weight loss, impaired mobility, and psychological stress are significantly associated with an increased risk of cognitive impairment. Therefore, clinicians should assess the nutritional and cognitive status of the elderly regularly to improve early detection and timely intervention.

Prevalence of anaemia among 6- to 59-month-old children in India: the latest picture through the NFHS-4

India is the highest contributor to child anaemia among developing countries. To see the latest picture of child anaemia in India, data for 6- to 59-month-old children were taken from the fourth round of the National Family Health Survey conducted in 2015-16 (NFHS-4). The study sample consisted of 1,37,347 children. The dependent variable was the anaemia status of the child. The objectives of the study were to assess (i) the distribution of anaemia prevalence by child age group, (ii) the prevalence of child anaemia by zone and state and (iii) the relation of child anaemia prevalence with social, demographic and economic variables, including maternal nutritional status and low birth weight. The study found that in India in 2015-16, 56% of 6- to 59-month-old children were anaemic - a decrease of only 13.5 percentage points since the NFHS-3 study conducted in 2005-06. It is well known that iron supplementation is necessary for child growth and brain development. This study suggests that, in addition, the socioeconomic conditions of households in India need to be improved to prevent child anaemia. Low birth weight and low maternal nutritional status are also responsible for the high prevalence of anaemia among children in India.