Alcohol Cessation in Late Life is Associated with Lower Risk of Cognitive Impairment among the Older Adults in China / 生物医学与环境科学（英文）

Objective@#Evidence regarding alcohol consumption and cognitive impairment is controversial. Whether cessation of drinking alcohol by non-dependent drinkers alters the risk of cognitive impairment remains unknown. This study prospectively evaluated the potential association between the history of lifetime alcohol cessation and risk of cognitive impairment.@*Methods@#This study included 15,758 participants age 65 years or older, selected from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) that covered 23 provinces in China. Current alcohol use status, duration of alcohol cessation, and alcohol consumption before abstinence were self-reported by participants; cognitive function was evaluated using Mini-mental State Examination (MMSE). Cause-specific hazard models and restricted cubic splines were applied to estimate the effect of alcohol use on cognitive impairment.@*Results@#Among the 15,758 participants, mean (± SD) age was 82.8 years (± 11.9 years), and 7,199 (45.7%) were males. During a mean of 3.9 years of follow-up, 3,404 cases were identified as cognitive impairment. Compared with current drinkers, alcohol cessation of five to nine years [adjusted @*Conclusion@#A longer duration of alcohol cessation was associated with a lower risk of cognitive impairment assessed by MMSE. Alcohol cessation is never late for older adults to prevent cognitive impairment.

Association between 24-hour urinary sodium excretion and obesity in general population aged from 18 to 69 years old / 中华疾病控制杂志

Objective To analyze the association between 24-hour urinary sodium excretion and obesity in a general Chinese population aged from 18 to 69 years old. Methods 2 400 from 18 to 69 year-old subjects were selected from four counties in Shandong Province and Jiangsu Province from 2013 to 2014 by using multi-stage stratified cluster random sampling method. Questionnaire survey, physical measurement and 24-hour urine collection were conducted. The relationship between urinary sodium and obesity was analyzed by multivariate linear regression and Logistic regression analysis. Results 2 275 subjects were finally included in the analysis. Obesity rate of the subjects was 19.1%(95% CI:17.4%-20.6%)and 24-hour urinary sodium was (166.4±71.5) mmol/d. The urinary sodium in obese, and central obesity population calculated according to waist-to-height ratio (WHtR) were higher than the normal population, respectively (All P<0.05). Multivariate linear regression analysis showed that after adjusting for relevant factors, 24-hour urinary sodium was positively correlated with body mass index (BMI), waist circumference (WC) and WHtR. Multivariate Logistic regression analysis showed that compared to population in the lowest quantile, population in highest quantile had an increased risk of being the obesity, abdominal obesity(calculated according to WC) and abdominal obesity(calculated according to WHtR) with OR(95% CI) of 1.61(1.18-2.20), 2.01(1.39-2.89) and 1.47(1.15-1.89), respectively, after adjusting for age, gender, education, smoking, alcohol consumption, physical activity, hypertension and diabetes. Conclusions High sodium is independently associated with obesity. Sodium intake is a potential and important risk factor for obesity.

Inaccuracy of Self-reported Low Sodium Diet among Chinese: Findings from Baseline Survey for Shandong & Ministry of Health Action on Salt and Hypertension (SMASH) Project / 生物医学与环境科学（英文）

This study was aimed to evaluate the agreement between the self-reported sodium intake level and 24-h urine sodium excretion level in Chinese. The 24-h urine collection was conducted among 2112 adults aged 18-69 years randomly selected in Shandong Province, China. The subjects were asked whether their sodium intake was low, moderate, or high. The weighted kappa statistics was calculated to assess the agreement between 24-h urine sodium excretion level and self-reported sodium intake level. One third of the subjects reported low sodium intake level. About 70% of the subjects had mean 24-h sodium excretion>9 g/d, but reported low or moderate sodium intake. The agreement between self-reported sodium intake level and 24-h urine sodium excretion level was low in both normotensive subjects and hypertensive subjects. These findings suggested that many subjects who reported low sodium intake had actual urine sodium excretion>9 g/d. Sodium intake is often underestimated in both hypertensive and normotensive participants in China.

Dietary sodium intake and its impact factors in adults of Shandong province / 生物医学与环境科学（英文）

Dietary sodium intake and its impact factors in 2 140 adults aged 18-69 years were analyzed. The mean daily sodium intake was 5745.0 (5427.6-6062.5) mg per day, which was higher in males than in females (P<0.01). After having been adjusted for gender, age and urban/city areas, the mean daily sodium intake was significantly higher in participants with a lower education level, drinkers and smokers than in those with a higher education level, nondrinkers and nonsmokers (P<0.01). The dietary sodium intake in adults of Shandong Province is higher than the recommended standards.

Study on waist circumference and hip circumference of 7 - 18 year-old children and adolescents in Shandong province / 中华流行病学杂志

<p><b>OBJECTIVE</b>To study the development of waist circumference (WC) and hip circumference (HC) in children and adolescents in Shandong province, and to provide scientific data for developing related reference values for screening central obesity in Chinese children and adolescents.</p><p><b>METHODS</b>Using data from 'Student physical fitness and health surveillance 2010 project' in Shandong province, a total of 42 275 students aged 7 - 18 years were selected to participate in this study. WC, HC, waist-to-hip ratio (WHR) and wrist-to-stature ratio (WSR) of subjects were measured. Comparison of data from the current study and other similar studies was made.</p><p><b>RESULTS</b>The mean values of WC increased with age, and boys all significantly higher than girls in all age categories (P < 0.01). There were two crosses on gender regarding the HC curves: before the age of 11 years, with mean HC higher in boys than in girls, but girls were higher than boys between the age of 12 to 14 while boys were also higher than girls after the age of 15 years. The 50(th) percentiles (P(50)) of WC of children and adolescents aged 7 to 18 years in Shandong appeared above the figures by 1.3 - 3.1 cm (boys) and 1.2 - 2.0 cm (girls) from 15 provinces in China as well as above the data from Hong Kong by 1.9 - 5.4 cm (boys) and 2.0 - 6.5 cm (girls), respectively. Overall, 20.20% of the boys and 16.57% of the girls had a WC of ≥ 90(th) percentile and 15.73% and 7.38% of the boys and girls had a WHtR of ≥ 0.5 which both showed significant differences between genders (P < 0.01).</p><p><b>CONCLUSION</b>Children and adolescents from Shandong province had a high level of WC.</p>

Field observation on the effect of low-sodium and high-potassium salt substitute on blood pressure in the rural community-based population in China / 中华流行病学杂志

Objective To investigate the effect of commercial low-sodium and high-potassium salt substitutes on blood pressure in the rural community-based population in China.Methods We conducted a quasi-experiment on 411 adults, who were 30 to 60 years of age, in 2 rural communities from Laiwu city in Shandong province of China on data from blood pressure screening.The subjects were divided into 2 groups: high blood pressure (HBP) and non-HBP (NHBP). Both groups and their family members took a low-sodium and high-potassium salt substitute for 3 months to replace the normal salt in their bodies. Blood pressure (BP) and 24-hour urinary sodium and potassium were measured regularly in the 2 groups. Results There was a continuously decreasing trend for BP at the end of the first month. Three months later, the mean BP decreased by 7.4 mm Hg (1 mm Hg=0.133 kPa, t=10.096, P=0.000) for SBP and 3.8 mm Hg (t=8.017, P=0.000) for DBP in the HBP group,when compared to a 1.2 mm Hg(t=2.507,P=0.007) decrease on SBP and 1.0 nun Hg(t=2.987, P=0.002) on DBP in the NHBP group. The mean urinary sodium had a decrease of 15.5 mmol/24 h (t=1.803,P=0.037) ,but the urinary potassium increased by 4.2 mmol/24 h (t' =2.132, P=0.018). The result of urinary sodium appepared to be as follows:potassium ratio (Na+/K+ ) decreased by 1.2 (t=2.786,P=0.003) in the HBP group. However,in NHBP group,the mean urinary sodium decreased by 1.7 mmol/24 h (t=0.211, P=0.417) and urinary potassium increased by 3.7 mmol/24 h (t' =2.207,P=0.015) ,together with the decrease ofNa+/K+ by 0.7 (t=1.818, P=0.036). Conclusion Results from our study clearly demonstrated that the intake of low-sodium and high-potassium salt substitute could effectively reduce the BP with good compliance among adults in the rural community-based population in China. This was an effective but non-medical method to prevent and control the high blood pressure.

Evaluation on the effectiveness of community intervention on hypertension related knowledge in mid-western rural area of Shandong province / 中华预防医学杂志

<p><b>OBJECTIVE</b>To evaluate the intervention effect of health education on hypertension knowledge in mid-western rural area of Shandong province.</p><p><b>METHODS</b>A project was launched on chronic disease control in mid-western rural area of Shandong province from 2007 to 2010. The baseline survey was performed using multi-stage random sampling method in 8 counties of mid-western rural area of Shandong province in April, 2007. A total of 20 087 participants aged 25 and above were recruited in the survey to study the relationship between awareness of hypertension and diet, smoking, obesity. Health education focusing on balance diet, physical activity promotion and tobacco control was performed among intervention population. The final evaluation survey using same questionnaire was performed in 2010, classified in intervention (4071 participants) and control (2145 participants) group. Control group was selected from non-intervention town in same county. Intervention and control group shared the same baseline data in 2007 for evaluation. By comparing the changes of hypertension knowledge before and after intervention, the intervention effect was evaluated.</p><p><b>RESULTS</b>Awareness of the relationship between hypertension and diet rose from 34.0% (6830/20 087) at baseline in 2007 to 69.3% (2821/4071) (χ(2) = 1757.30, P < 0.01) of intervention group and 44.8% (961/2145) (χ(2) = 99.30, P < 0.01) of control group in 2010. Awareness of hypertension associated to smoking rose from 25.6% (5142/20 087) at baseline in 2007 to 55.2% (2247/4071) (χ(2) = 1396.59, P < 0.01) in intervention group, 30.9% (662/2145) (χ(2) = 27.83, P < 0.01) in control group in 2010. Awareness of hypertension related to obesity rose from 37.2% (7472/20 087) of the baseline in 2007 to 68.3% (2780/4071) (χ(2) = 1339.27, P < 0.01) in intervention group, 45.1% (967/2145) (χ(2) = 51.14, P < 0.01) in control group in 2010.</p><p><b>CONCLUSION</b>Community comprehensive intervention showed significant effects on hypertension related knowledge improvement in mid-western rural area of Shandong province.</p>

Burden of disease on road traffic injuries in Penglai city, Shandong province, in 2006-2007 / 中华流行病学杂志

Objective To evaluate the burden of road traffic injury (RTI) from perspectives both on the health of population and on social economic status so as to provide scientific evidence for policy making. Methods The status of mortality and disability caused by traffic accident in Penglai county was estimated, based on data from death registration and a sampling survey from 2006 to 2007.Together with the disability weights gained from global burden of disease (GBD) , health burden (DALY) was measured with GBD formula. The economic burden of RTI was evaluated. Results Average loss of the health life years (HLY) related to RTI was 31 373.04 per year. 70.59 HLY were lost per 1000 persons. Loss among the males was higher than females. The loss of DALY among the age group 15-44 years ranked the first place (39 209.71 HLY) which accounted for 62.42% of the total DALY. 79.45% of the total DALY were caused by disability. In 2006 and 2007 ,the economic loss caused by RTI was as high as 2.19 billion RMB, which accounted for 4.89% of the total amount of GDP while the indirect economic costs (2.15 billion RMB) accounted for 98.45% of the total costs in Penglai city. The economic loss of the males was obviously higher than the females and the loss by the group aged 15-59 years old accounted for 97.65% of the total. Conclusion RTI had severely influenced the health of the residents in Penglai city and brought heavy burden to the individuals,families as well as the society.

Time trends on the prevalence of cancer during 1970 - 2005 in Shandong province / 中华流行病学杂志

Objective To analyze time trend of cancer during 1970-2005 in Shandong province so as to develop strategies for control and prevention of cancer at the community level. Methods Data was from 4 retrospective surveys regarding all causes of death during 1970-- 1974, 1985-1989, 1990- 1992 and 2004-2005, in Shandong province. Other than one set of data collected in 1985-1989 by Shandong province itself, the other 3 set of data were from the national surveys, in which the survey-point sampling of choice was based on data of 1970-1974 for assessing its representativeness. The observing indices would include standardized mortality and mortality. A join-point regression model was used to analyze the changing rate of tumor. Results The mortality rate of the entire tumor increased 143.15 percent in 2005 than in 1970. The changing slope of standardized rate of all tumors in the regression model showed that the inter-annual growth rate were 0.54 and 1.24 percent from 1970 to 1984 and from 1985 to 1992. The rate of increase since 1992 had been 0.18 percent. During 2004-2005, the main malignant cancers were lung, stomach, liver, esophageal, coiorectal, leukemia, breast and cervical cancer, in order. Lung cancer rose from the 4th ranking to the first while cervical cancer dropped from the fifth ranking to the 8th place. Esophageal cancer and cervical cancer were decreased annually while gastric cancer was increased in the early days but decreased later on. The rest of the cancers were on the rise year by year. Rates of lung and breast cancers were higher while gastric and esophageal cancers were lower seen in the urban than in rural areas. Conclusion In Shandong province, a marked increase was seen in the mortality rate of tumors in the past 35 years. Evidence showed that the spectrum of death among main malignant tumors had changed which might provide a scientific basis for the development of a community-based prevention and control program on cancer.

Changes of mortality and causes of death from 1970 to 2005 and decomposition analysis in Shandong province / 中华流行病学杂志

Objective To describe the trend of overall mortality and major causes of death in Shandong population from 1970 to 2005,and to quantitatively estimate the influential factors.Methods Trends of overall mortality and major causes of death were described using indicators such as mortality rates and age-adjusted death rates by comparing three large-scale mortality surveys in Shandong province.Difference decomposing method was applied to estimate the contribution of demographic and nondemographic factors for the change of mortality.Results The total mortality had had a slight change since 1970s,but had increased since 1990s.However,both the mortality rates of age-adjusted and age-specific decreased significantly.The mortality of Group Ⅰ diseases including infectious diseases as well maternal and perinatal diseases decreased drastically.By contrast,the mortality of non-communicable chronic diseases (NCDs)including cardiovascular diseases(CVDs),cancer and injuries increased.The sustentation of recent overall mortality was caused by the interaction of demographic and non-demographic factors which worked oppositely.Non-demographic factors were responsible for the decrease of Group Ⅰ disease and the increase of injuries.With respect to the increase of NCDs as a whole.demographic factors might take the full responsibility and the non-demographic factors were the opposite force to reduce the mortality.Nevertheless,for the increase of some leading NCD diseases as CVDs and cancer,the increase was mainly due to non-demographic rather than demographic factors.Conclusion Through the interaction of the aggravation of ageing population and the enhancement of non-demographic effect,the overall mortality in Shandong would maintain a balance or slightly rise in the coming years.Group Ⅰ diseases in Shandong had been effectively under control.Strategies focusing on disease control and prevention should be transferred to chronic diseases,especially leading NCDs,such as CVDs and cancer.

Study on the risk factors of hypertension among rural residents in mid-west areas of Shandong province, using the classification tree analysis methodology / 中华流行病学杂志

<p><b>OBJECTIVE</b>To explore the risk factors of hypertension and risk population for adults aged > or = 25 in the mid-western rural areas of Shandong province and to provide evidence for development of intervention measure.</p><p><b>METHODS</b>Subjects aged > or = 25 were selected by multi-stage stratified random sampling method. All participants were interviewed with a standard questionnaire and physically examined on height, weight, waist circumference, blood pressure and fasting plasma glucose (FPG). Classification tree analysis was employed to determine the risk factors of hypertension and high risk populations related to it.</p><p><b>RESULTS</b>The major risk factors of hypertension would include age, abdominal obesity, overweight or obesity, family history and high blood sugar. The major populations at high risk would include populations as: a) being elderly, b) at middle-age but with: high blood sugar or with abdominal obesity/overweight, or with family history, c) people at middle-age but with family history and abdominal obesity. Through classification tree analysis, sensitivity, specificity and overall correct rates were 71.87%, 66.38% and 68.79%, respectively on 'learning sample' while 70.70%, 65.84% and 67.97% respectively on 'testing sample'.</p><p><b>CONCLUSION</b>Efforts on both weight and blood sugar reduction were common prevention measures for general population. Different kinds of prevention and control measures should be taken according to different risk factors existed in the targeted high-risk population of hypertension. Community-based prevention and control for hypertension measures should be integrated when targeting the population at high risk.</p>

Application of 'waist circumference cutoff point' in screening diabetes mellitus among rural residents in mid-western area of Shandong province,China / 中华流行病学杂志

Objective To determine the value and the optimal cutoff point of waist circumference (WC) in screening diabetes mellitus (DM) and to provide evidence for DM prevention and identifying population at risk in mid-western rural areas of Shandong province.Methods A sample consisting 16 341 rural residents was selected and studied.All participants were physically examined on height,weight,WC and fasting plasma glucose (FPG).Oral glucose tolerance test (OGTT) was performed for subjects with FPG valued from 6.1 to 7.0 mmol/L.DM was defined according to the criteria set by WHO in 1999.Area under the curve (AUC),sensitivity,specificity and Youden index were computed based on the receiver operating characteristic (ROC) curve analysis.Optimal cutoff point was determined by the maximum of Youden index.Results The prevalence rates of DM for males and females increased along with the rise of WC (trend test X2=72.01,122.65,P＜0.01 ).It appeared significantly higher in those with WC 85 cm in females and≥80 cm in males,with those WC ＜85 cm for females and ＜80 cm for males,in particular.AUCs were 0.639 and 0.655 for males and females respectively and both had significant differences (t=7.22,11.07,P ＜0.01 ).However,the AUCs did not show significant difference (t=0.70,P ＞ 0.05) between males and females.The Youden index reached maximum when WC approached 85 cm for females (24.90%) and 80 cm for males (24.39%).The sensitivity and specificity were 58.04%and 66.86%for males,and 67.08%and 57.31%for females.Conclusion WC seemed to be an effective indicator for screening the DM.The optimal cutoff point of WC would be 85 cm for females and 80 cm for males in screening DM and defining the population at risk in this area.

Estimation on the mortality and disease burden attributed to selected risk factors in Shandong province / 中华流行病学杂志

Objective To determine the major health related risk factors and provide evidence for policy-making,using health burden analysis on selected factors among general population from Shandong province.Methods Based on data derived from the Third Death of Cause Sampling Survey in Shandong. Years of life lcrat(YLLs),yearS Iived with disability(YLDs)and disability-adjusted life years(DALYs) were calculated according to the GBD ethodology.Deaths and DALYs attributed to the selected risk factors were than estimated together with the PAF data from GBD 2001 study.The indirect method was employed to estimate the YLDs.Results 5i.09%of the total dearlls and 31.83%of the total DALYs from the Shandong population were resulted from the 19 selected risk factors.High blood pre.ure,smoking,low fruit and vegetable intake,aleohol consumption,indoor smoke from solid fuels,high cholesterol,urban air pollution,physical inactivity,overweight and obesity and unsafe injections in health care settings were identified as the top 10 risk faetors for mortality which together caused 50.21%of the total deaths.Alcohol use,smoking,high blood pressure,Low fruit and vegetable intake,indoor smokc from solid fuels,overweight and obesity,high cholesterol,physical inactivity,urban air pollution and iron-deficiency anemia were proved as the top 10 risk factors related to disease burden and were responsible for 29.04%of the total DALYs.Conclusion Alcohol use.smoking and high blood pressure were determined as the major risk factors which influencing the health of residents in Shandong.The mortality and burden of disease could be reduced significantly if these major factors were effectively under control.

Estimation of disability weights on malignant neoplasms in Shandong province / 中华流行病学杂志

Objective To determine stage-specific and average disability weights (DWs) of malignant neoplasm and provide support and evidence for study on burden of cancer and policy development in Shandong province. Methods Health status of each cancer patient identified during the cancer prevalence survey in Shandong, 2007 was investigated. In line with the GBD methodology in estimating DWs, the disability extent of every case was classified and evaluated according to the Six-class Disability Classification version and then the stage-specific weights and average DWs with their 95 % confidence intervals were calculated, using SAS software. Results A total of 11 757 cancer cases were investigated and evaluated. DWs of specific stage of therapy, remission, metastasis and terminal of all cancers were 0.310, 0.218, 0.450 and 0.653 respectively. The average DW of all cancers was 0.317(95 % CI:0.312-0.321). Weights of different stage and different cancer varied significantly, while no significant differences were found between males and females. DWs were found higher (>0.4) for liver cancer, bone cancer, lymphoma and pancreas cancer. Lower DWs (<0.3) were found for breast cancer, cervix uteri, corpus uteri, ovarian cancer, larynx cancer, mouth and oropharynx cancer. Conclusion Stage-specific and average DWs for various cancers were estimated based on a large sample size survey. The average DWs of 0.317 for all cancers indicated that 1/3 healthy year lost for each survived life year of them. The difference of DWs between different cancer and stage provide scientific evidence for cancer prevention strategy development.

Study on Dietary Pattern and Nutrition Status among Rural Residents in Midwestern Rural Area of Shandong Province / 中国慢性病预防与控制

Objective To determine the dietary nutritional status of rural residents in Midwestern Shandong Province,in order to improve the dietary pattern and health status of them.Method 11 987 residents,from 10 273 households,were included in this study by multi-stage randomized cluster sampling in 8 counties located in Midwestern Shandong Province.Questionnaire of Food Frequency (QFF) was applied to collect the information about the amount and frequency of food consumed by the subjects in the past year.Results The average intake of cereal,vegetable,fruit,meat,egg,milk,bean,oil and salt per reference man per day was 553.9 g,310.6 g,58.2 g, 36.3 g,50.1 g,16.7 g,34.4 g,44.8 g and 12.3 g,respectively.The average intake of energy,carbohydrate,protein,fat and dietary fiber per reference man per day was 12 095.6 kJ,451.8 g,85.6 g,78.8 g and 18.7 g as well Cereal food provides 66.1% of total energy; however,the meat provides only 6.6% of that.Carbohydrate,protein and fat amount to around 63.2%,12.0% and 24.8% of total energy, respectively.24.0% of fat intake was from animal food,while 76% of that was from vegetable food.Conclusions The intake of energy, protein,fat was sufficient for these subjects;however,the intake of vegetable,fruit,bean and meat was lower than the dietary reference intake.Moreover,oil and salt intake in these subjects was much higher than Chinese Recommended Nutrient Intakes.Thus,the amelioration of dietary pattern in rural residents will be an important task for nutrition workers in rural area of Midwestern part of Shandong Province in the future.

Study on the molecular mechanism of apoptosis in esophageal cancer cells induced by soybean isoflavone / 中华流行病学杂志

<p><b>OBJECTIVE</b>To investigate the function of apoptosis in esophageal cancer cells induced by soybean isoflavone, and the relation between this apoptosis and expression of bcl-2 and bax.</p><p><b>METHODS</b>In vitro experiments, MTT assay was used to determine the cell growth inhibitory rate. Transmission electron microscope and TUNEL staining method were used to quantitatively and qualitatively detect the apoptosis status of esophageal cancer cell line EC-9706 before and after the soybean isoflavone treatment. Immunohistochemical staining and reverse transcription-polymerase chain reaction were used to detect the expression of apoptosis-regulated gene bcl-2 and bax.</p><p><b>RESULTS</b>Soybean isoflavone inhibited the growth of esophageal cancer cell line EC-9706 in a dose- and time-dependent manner. Soybean isoflavone induced EC-9706 cells to undergo apoptosis with typically apoptotic characteristics, including morphological changes of chromatin condensation, chromatin crescent formation, nucleus fragmentation and apoptotic body formation by transmission electron microscope and staining positive cells, using TUNEL assay. Soybean isoflavone reduced the expression of apoptosis-regulated gene bcl-2, and improving the expression of apoptosis-regulated gene bax.</p><p><b>CONCLUSION</b>Soybean isoflavone seemed to be able to induce the apoptosis in esophageal cancer. This type of apoptosis might be mediated by down-expression of apoptosis-regulated gene bcl-2 and up-expression of apoptosis-regulated gene bax.</p>