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Objective:To survey the awareness status and its influencing factors among parents of preschool children.Methods:Data was collected from the National Nutrition and Health Systematic Survey for 0-18 Year Children in China. A total of 2 625 children aged 3-5 years and their parents living in northern and southern regions of China were randomly selected by multi-stage stratified cluster sampling. The physical measurements were performed for the children, including height and weight; and the body mass index (BMI) and age-for-BMI Z-score (BAZ) were calculated. The questionnaire survey was conducted for the parents, including the demographic characteristics of parents and their children, the perception of their child′s nutritional status (overweight/obesity, normal, wasting) etc. According to WHO standards, the nutritional status of the children was classified as wasting, normal and overweight/obesity. The awareness of parents on their children′s nutritional status was classified as underestimated, correct, overestimated and unclear. Parents′ inability to correctly judge children′s nutritional status was defined as cognitive bias, including underestimation bias and overestimation bias. Multivariate logistic regression model was used to analyze the influencing factors of parents′ underestimation or overestimation of children′s nutritional status.Results:Among 2 625 enrolled preschool children, there were 1 312 boys (50.0%) and 1 313 girls (50.0%); and 648 (24.7%), 944 (36.0%) and 1 033 (39.3%) children aged 3, 4 and 5 years, respectively. One parent (mother, farther or others) of each child was selected for survey, and most of them were mothers (1 998(76.1%)). The prevalence rate of overweight/obesity and wasting was 10.3% (270/2 625) and 1.4% (38/2 625), respectively; and 2 317 children (88.3%) were normal. Among all parents surveyed, 1 766 (67.3%) were correct about their children′s nutritional status (correct group), 612 (23.3%) underestimated their children′s nutritional status (underestimated group), 213 (8.1%) overestimated their children′s nutritional status (overestimated group) and 34 (1.3%) were not aware of their children′s nutritional status (unclear group). The multivariate logistic regression analysis showed that girls ( OR=0.817, 95% CI: 0.678-0.984), living in rural areas ( OR=0.801, 95% CI: 0.662-0.969), large birth weight of child ( OR=0.639, 95% CI: 0.420-0.970) were protective factors for parents underestimating children′s nutritional status. Living in the northern region ( OR=1.698, 95% CI: 1.260-2.290), large birth weight of children ( OR=1.826, 95% CI: 1.149-2.902), father with overweight/obesity ( OR=1.467, 95% CI: 1.089-1.977) and maternal overweight/obesity ( OR=1.778, 95% CI: 1.308-2.417) were the risk factors for parents to overestimate the nutritional status of children. Conclusions:The survey shows that parents of preschool children have a relatively high cognitive bias on the nutritional status of their children. Parents of girls, living in rural areas or having child with large birth weight are less likely to underestimate the nutritional status of children; parents living in northern regions, having a child with large birth weight, or with overweight/obese are likely to overestimate the nutritional status of children.
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Objective:To explore the relationship between vegetarian diets and vitamin B 12 levels in Chinese pregnant women. Methods:A cross-sectional survey was used to explore the relationship between vegetarian diets and vitamin B 12 levels in Chinese pregnant women based on data from the Chinese National Nutrition and Health Surveillance (2015-2017). Maternal serum vitamin B 12 concentration was determined by electrochemiluminescence. Background and diet information of all subjects were collected using general and food frequency questionnaires. General Linear Model was used to analyze the difference in serum vitamin B 12 levels between vegetarian and non-vegetarian pregnant women and multivariate logistic regression for examining the relationship between vegetarian diets and vitamin B 12 deficiency (vitamin B 12<150 pmol/L) in pregnant women. Results:A total of 8 366 pregnant women were included in the analysis, and vegetarians accounted for 1.2% (102/8 366). The median serum vitamin B 12 concentrations were 155.8(93.6-212.4) pmol/L and 187.2(127.4-267.6) pmol/L ( Z=－4.22, P<0.001), and the vitamin B 12 deficiency rates were 48.0% (49/102) and 35.0% (2 896/8 264) in vegetarian and non-vegetarian women, respectively. The vitamin B 12 deficiency rate in vegetarian women was 0.89-fold higher than in non-vegetarians (95% CI: 1.24-2.89). Among the vegetarian and non-vegetarian pregnant women, vitamin B 12 deficiency rates during the first, second, and third trimesters were 34.8%(16/46), 54.3%(19/35), 66.7%(14/21), and 20.4%(521/2 559), 32.6%(941/2 886), 50.9%(1 430/2 807), noting for an increasing trend ( Z=23.54 and 2.57, P=0.010 and P<0.001). Conclusions:Vegetarian pregnant women are at high risk of vitamin B 12 deficiency. Compared with non-vegetarian women, vegetarian pregnant women in China have lower vitamin B 12 levels and a higher risk of vitamin B 12 deficiency. Moreover, the risk of vitamin B 12 deficiency will gradually increase during pregnancy.
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Objective@#To analyze the status of gestational weight gain (GWG) among Chinese mothers who gave singleton and full-term births, and to look at optimal GWG ranges.@*Methods@#In 2013, using the multi-stage stratified and population proportional cluster sampling method, we investigated 8 323 mother-child pairs at their 0-24 months postpartum from 55 counties (cities/districts) of 30 provinces (except Tibet) in mainland China. Questionnaire was used to collect data on body weight before pregnancy and delivery, diseases during gestation, hemorrhage or not at postpartum, child birth weight and length, and other information about pregnant outcomes. We measured mother's body weight and height, and child's body weight and length. Based on 'Chinese Adult Body Weight Standard’, we divided mothers into four groups according to their body weight before pregnancy: low weight (BMI<18.5 kg/m2), normal weight (BMI 18.5-23.9 kg/m2), overweight (BMI 24.0-27.9 kg/m2) and obesity (BMI≥28.0 kg/m2). The status of GWG was assessed by IOM optimal GWG guidelines. Chinese optimal GWG ranges were calculated according to the association of GWG with pregnant outcomes and anthropometry of mothers and children, and according to P25-P75 of GWG among mothers who had good pregnant outcomes and good anthropometry, and whose children had good anthropometry. The status of GWG was assessed by the new optimal ranges.@*Results@#P50 (P25-P75) of GWG among the 8 323 mothers was 15.0 (10.0-19.0) kg. According to the proposed optimal GWG ranges of IOM, the proportions of inadequate, optimal and excessive GWG accounted for 27.2% (2 263 mothers), 36.2% (3 016 mothers) and 36.6% (3 044 mothers). The optimal GWG ranges for low weight, normal weight, overweight and obesity were 11.5-18.0, 10.0-15.0, 8.0-14.0 and 5.0-11.5 kg. Based on these optimal GWG ranges established in this study, the rates of inadequate, optimal and excessive GWG were 15.7% (1 303 mothers), 45.0% (3 744 mothers) and 39.3% (3 276 mothers), and these rates were significantly different from that defined by the IOM standards (χ2=345.36, P<0.001).@*Conclusion@#The median of GWG among Chinese mothers is 15.0 kg, which is at a relatively higher level. This study suggests the optimal GWG ranges for Chinese women who give singleton and full-term babies, which appears lower than IOM's.
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Objective@#To examine the status and related factors for gestational weight gain of Chinese pregnant women at different trimesters in 2010-2012.@*Methods@#Participants were from Chinese National Nutrition and Health Surveillance in 2010-2012. Using a multi-stage stratified cluster random sampling method, we recruited 2 805 singleton pregnant women with gestational age 13 weeks or more from 31 provinces of China. A standard questionnaire was used to collect general information and pre-pregnancy weight; body weight and height of pregnant women were measured using a unified weighing scale and stadiometer, dietary intake during the previous year was collected using a food frequency questionnaire. A multiple logistic regression was used to analyze potential factors associated with appropriate gestational weight gain.@*Results@#Among 2 805 pregnant women, 1 441 were in the second (13-27 weeks) and 1 364 in the third trimesters (≥28 weeks) . In the 2nd trimester, 229 cases (15.9%), 440 cases (30.5%) and 772 cases (53.6%) were insufficient gestational weight gain, appropriate gestational weight gain and excessive gestational weight gain respectively. So were 256 cases (18.8%), 474 cases (34.8%), 634 cases (46.5%) in the 3rd trimester respectively. In the multivariate unconditional logistic model, less fruit intake was associated with insufficient weight gain for women in the 2nd trimester (OR (95%CI): 1.58 (1.06-2.34)). Pregnant women with Han ethnicity who live in the small/medium city had lower risk of insufficient weight gain in the 3rd trimester (OR (95%CI): 0.58 (0.34-0.98)). Those pregnant women with physical activity <1 hour/day had a higher risk of excessive weight gain (OR (95%CI): 1.33 (1.02-1.73)).@*Conclusion@#The prevalence of appropriate gestational weight gain was low in China. Our study suggests that pregnant weight gain is associated with fruit intake, types of residential area and physical activity.
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Objective@#To investigate the prevalence of anemia and related risk factors for pregnant women in China.@*Method@#Based on Chinese National Nutrition and Health Surveillance 2010-2012, a total of 3 501 pregnant women were investigated from 150 counties of 31 provinces, municipalities and autonomous regions in China, using a multi-stage stratified cluster randomization sampling method. General information of pregnant women, health status, and food intake during the gestation, was collected through a questionnaire investigation. 6 ml fasting venous blood was collected for the determination of hemoglobin concentration. Data were analyzed using multiple logistic regression to investigate the prevalence of anemia and the related influencing factors.@*Results@#The 605 of 3 501 pregnant women had anemia. The prevalence of anemia was 17.2%; and mild anemia accounted for about 61.0% (369/605). Compared with the pregnant women living in the large cities, the OR (95%CI) of those living in the poor rural areas was 1.46 (1.08-1.98). Compared with the pregnant women living in the south area of China, the OR (95%CI) of those living in the north area of China was 1.39 (1.15-1.68); Compared with the pregnant women in the first trimester, the OR (95%CI) of those in the second trimester and the third trimester were 1.79 (1.33-2.43) and 2.11 (1.56-2.85), respectively. The OR (95%CI) of pregnant women who had used folic acid supplementation within the 6 months prior to gestation was 0.76 (0.63-0.93) compared with those who had not used.@*Conclusion@#From 2010 to 2012, the epidemic characteristics of anemia was mild for the pregnant women in China, and pregnant women residential areas, periods of pregnancy and whether to take folic acid were related to anemia.
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Objective@#To investigate the prevalence of calf muscle cramps and possible influencing factors for pregnant women in China.@*Methods@#Using a multi-stage stratified probability proportional to size cluster randomization sampling method during 2010-2012. A total of 3 582 pregnant women were investigated at 150 counties from 31 provinces in China mainland. Information on calf muscle cramps, demographic socio-economic status, pregnancy information, and the physical activities was collected through questionnaires. The semi-quantitative food frequency questionnaire (FFQ) was used to collect food intake of pregnant women. Dynamic cluster analysis was used to assess dietary pattern. Multiple logistic regression was used to investigate the possible influencing factors for calf muscle cramps.@*Results@#The prevalence of calf muscle cramps was 32.9% (1 180/3 582) in Chinese pregnant women, which was 11.6% (87/748), 28.2% (420/1 492), and 50.2% (673/1 342), respectively, during the first, second and third trimester. There were significant differences between them (χ2=349.16, P<0.001). Dietary patterns of the pregnant women were classified into three groups, which called relatively balanced pattern, high vegetables and fruits pattern, and high dairy pattern. Among the three groups, the prevalence of calf muscle cramps was 32.0% (952/2 971), 37.2% (186/500), and 37.8% (42/111), with significant differences (χ2=6.39, P=0.041). The OR (95%CI) values of calf muscle cramps in the second and third trimester was 2.96 (2.28-3.83), and 8.02 (6.16-10.44), respectively, comparing with the first trimester. The OR (95%CI) values of calf muscle cramps in the women taking calcium before pregnant was 1.45 (1.19-1.76), comparing with the one who was not taken. The OR (95%CI) values of calf muscle cramps in the women who had been diagnosed by pregnancy-induced hypertension was 5.76 (2.06-16.12), comparing with the one who had not been diagnosed. The OR (95%CI) values of calf muscle cramps in the high vegetables and fruits pattern and high dairy pattern was 1.13 (0.91-1.41), and 1.18 (0.76-1.81), respectively, comparing with the relatively balanced pattern.@*Conclusion@#The prevalence of calf muscle cramps was relatively high in Chinese pregnant women, which was significantly different among three trimesters. The residential areas, occupation, and pregnancy-induced hypertension might be related to the prevalence of calf muscle cramps. However, there was no significant difference among different dietary patterns.
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<p><b>OBJECTIVE</b>To examine the relationship between complementary feeding behaviors (CFB) and anemia for infants and young children in Sichuan, Yunnan and Guizhou province of China.</p><p><b>METHODS</b>A total 3 410 children aged 6-24 months were recruited from 12 survey sites in the urban and rural areas of Sichuan, Yunnan and Guizhou provinces by stratified random cluster sampling in 3 age groups (6-8 months, 9-11 months and 12-24 months) from March to July in 2011. The information of CFB for them was collected through a specific questionnaire. According to the comprehensive evaluation method of CFB(including content of food preparation and selection, caregivers' behavior, infants' behavior, feeding environment and environmental hygiene), the scores of CFB were calculated and grouped as low ( < 60% of total score), moderate (60%-80% of total score) and high level ( > 80% of total score). Twenty microliter of fingertip blood was extracted to measure the hemoglobin concentration and anemia rate was calculated. Distribution of CFB level and rate of anemia were compared between urban/rural areas and different age groups. Difference of anemia rate for infants and young children between low/moderate/high CFB level groups was compared.</p><p><b>RESULTS</b>8.0% (273/3 410) of the children were in low CFB level group, and 56.9% (1 940/3 410) and 35.1% (1 197/3 410) in moderate and high CFB level group respectively. The difference of CFB levels between urban and rural areas was significant (Z = -21.17, P < 0.05), the proportion of high level in urban area was 53.0% (829/1 565) , which was higher than that in rural area (20.0% (368/1845) ). The difference of CFB levels between different age groups was also significant (H = 43.82, P < 0.05). The proportion of high level decreased by increasing age, which was 41.0% (417/1 017) and 29.9% (389/1 300) in 6-8 months and 12-24 months respectively. The average hemoglobin concentration for infants was (119.3 ± 13.8)g/L, and the total anemia rate was 22.4% (765/3 410) . The hemoglobin concentration for infants in urban area ( (123.3 ± 11.3) g/L) was higher than rural area ((115.9 ± 14.8) g/L) (t = 16.75, P < 0.05) and the rate of anemia in urban area (10.5% (165/1 565)) was lower than that in rural area (32.5% (600/1845) ) (χ² = 235.03, P < 0.05) significantly. The rate of anemia was decreased by increasing CFB level(χ² = 73.94, P < 0.05). The rate of anemia in the low CFB level group was the highest (33.7% (92/273) ) while in the high CFB level group was 14.5% (174/1 197), which was the lowest.</p><p><b>CONCLUSION</b>The level of complementary feeding behavior for infants and young children in Sichuan, Yunnan and Guizhou province of China is relatively low and their prevalence of anemia is relatively serious. Complementary feeding behavior is closely associated with anemia for infants and young children.</p>
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Humans , Infant , Age Factors , Anemia , China , Epidemiology , Infant Nutritional Physiological Phenomena , Prevalence , Rural Population , Surveys and Questionnaires , Urban PopulationABSTRACT
Objective To understand the status and difference of breastfeeding behavior in urban and rural areas of Southwest China.Methods From March to July in 2011,3659 infants aged 6-24 months were selected by stratified cluster randomized sampling method in urban and rural areas of three provinces of Southwest China (Sichuan,Yunnan and Guizhou),including 1801 (49.2％)infants from urban areas and 1858(50.8％) from rural areas.Basic information of these infants,their families and breastfeeding was obtained by a questionnaire for the mothers or baby-carers.Descriptive analysis and survival analysis (Kaplan-Meier method) were used to describe breastfeeding behavior.Chi-square test and Log-Rank test were used to identify the differences of breastfeeding behavior between urban and rural areas.Results Early breastfeeding initiation rate within one hour after birth was 10.7％(355/3315),and the numbers of urban and rural areas were 12.3％(198/1604) and 9.2％ (157/1711),respectively,x2 =8.691,P＜0.05.Totally,20.3％(725/3575) of all infants were initially fed by breast milk after delivery,and 25.1％ (440/1754) in urban areas and 15.7 ％ (285/1821) in rural areas,x2 =49.192,P＜0.05.The exclusive breastfeeding rate and breastfeeding rate within four months after birth were 35.5％ (27.4％ in urban and 43.6％ in rural areas,x2=88.678,P＜0.05)and 76.2％ (68.5％ in urban and 84.3％ in rural areas,x2 =124.702,P＜0.05),respectively.However,the exclusive breastfeeding rate and breastfeeding rate within six months after birth reduced to 11.3％ (7.9％ in urban and 14.4％ in rural areas,x22 =18.001,P＜0.05) and 65.0％ (54.0％ in urban and 76.3％ in rural areas,x2 =199.662,P＜0.05),respectively.The median breastfeeding duration was 8.0 months (7.0 months in urban and 9.0 months in rural areas,x2 =96.780,P＜ 0.05).The most common reason of weaning was insufficient breast milk which accounting for 48.7 ％ of families [56.9％ (1161/2385) in urban and 39.9％(462/1157) in rural areas,x2=68.840,P＜0.05].Conclusions In Southwest China,intervention program should be implemented to improve the breastfeeding status.Breastfeeding behaviors are different between urban and rural areas in Southwest China.The initiation of breastfeeding in urban area is better,but the sustainability of breastfeeding is better in rural area.