Association between fresh fruit consumption and the risk of chronic obstructive pulmonary disease-related hospitalization and death in Chinese adults: A prospective cohort study / 中华医学杂志(英文版)

BACKGROUND@#Existing evidence suggests that fruit consumption is a significant influencing factor for chronic obstructive pulmonary disease (COPD), but this is unclear in the Chinese population. We examined the association of fresh fruit consumption with the risk of COPD-related hospitalization and death in a nationwide, population-based prospective cohort from China.@*METHODS@#Between 2004 and 2008, the China Kadoorie Biobank recruited >0.5 million adults aged 30 to 79 years from ten diverse regions across China. After excluding individuals diagnosed with major chronic diseases and prevalent COPD, the prospective analysis included 421,428 participants. Cox regression was used to calculate the hazard ratios (HRs) for the association between fresh fruit consumption and risk of COPD-related hospitalization and death, with adjustment for established and potential confounders.@*RESULTS@#During a mean follow-up of 10.9 years, 11,292 COPD hospitalization events and deaths were documented, with an overall incidence rate of 2.47/1000 person-years. Participants who consumed fresh fruit daily had a 22% lower risk of COPD-related hospitalization and death compared with non-consumers (HR = 0.78, 95% confidence interval [CI]: 0.71-0.87). The inverse association between fresh fruit consumption and COPD-related hospitalization and death was stronger among non-current smokers and participants with normal body mass index (BMI) (18.5 kg/m 2 ≤ BMI < 24.0 kg/m 2 ); the corresponding HRs for daily fresh fruit consumption were 0.78 (95% CI: 0.68-0.89) and 0.69 (95% CI: 0.59-0.79) compared with their counterparts, respectively.@*CONCLUSIONS@#High-frequency fruit consumption was associated with a lower risk of COPD in Chinese adults. Increasing fruit consumption, together with cigarette cessation and weight control, should be considered in the prevention and management of COPD.

Minimal improvement in coronary artery disease risk prediction in Chinese population using polygenic risk scores: evidence from the China Kadoorie Biobank / 中华医学杂志(英文版)

BACKGROUND@#Several studies have reported that polygenic risk scores (PRSs) can enhance risk prediction of coronary artery disease (CAD) in European populations. However, research on this topic is far from sufficient in non-European countries, including China. We aimed to evaluate the potential of PRS for predicting CAD for primary prevention in the Chinese population.@*METHODS@#Participants with genome-wide genotypic data from the China Kadoorie Biobank were divided into training ( n = 28,490) and testing sets ( n = 72,150). Ten previously developed PRSs were evaluated, and new ones were developed using clumping and thresholding or LDpred method. The PRS showing the strongest association with CAD in the training set was selected to further evaluate its effects on improving the traditional CAD risk-prediction model in the testing set. Genetic risk was computed by summing the product of the weights and allele dosages across genome-wide single-nucleotide polymorphisms. Prediction of the 10-year first CAD events was assessed using hazard ratios (HRs) and measures of model discrimination, calibration, and net reclassification improvement (NRI). Hard CAD (nonfatal I21-I23 and fatal I20-I25) and soft CAD (all fatal or nonfatal I20-I25) were analyzed separately.@*RESULTS@#In the testing set, 1214 hard and 7201 soft CAD cases were documented during a mean follow-up of 11.2 years. The HR per standard deviation of the optimal PRS was 1.26 (95% CI:1.19-1.33) for hard CAD. Based on a traditional CAD risk prediction model containing only non-laboratory-based information, the addition of PRS for hard CAD increased Harrell's C index by 0.001 (-0.001 to 0.003) in women and 0.003 (0.001 to 0.005) in men. Among the different high-risk thresholds ranging from 1% to 10%, the highest categorical NRI was 3.2% (95% CI: 0.4-6.0%) at a high-risk threshold of 10.0% in women. The association of the PRS with soft CAD was much weaker than with hard CAD, leading to minimal or no improvement in the soft CAD model.@*CONCLUSIONS@#In this Chinese population sample, the current PRSs minimally changed risk discrimination and offered little improvement in risk stratification for soft CAD. Therefore, this may not be suitable for promoting genetic screening in the general Chinese population to improve CAD risk prediction.

Genetic and healthy lifestyle factors in relation to the incidence and prognosis of severe liver disease in the Chinese population / 中华医学杂志(英文版)

BACKGROUND@#Severe liver disease (SLD), including cirrhosis and liver cancer, constitutes a major disease burden in China. We aimed to examine the association of genetic and healthy lifestyle factors with the incidence and prognosis of SLD.@*METHODS@#The study population included 504,009 participants from the prospective China Kadoorie Biobank aged 30-79 years. The individuals were from 10 diverse areas in China without a history of cancer or liver disease at baseline. Cox regression was used to estimate adjusted hazard ratios (HRs) for incident SLD and death after SLD diagnosis associated with healthy lifestyle factors (smoking, alcohol, physical activity, and central adiposity). Additionally, the contribution of genetic risk for hepatitis B virus (HBV, assessed by genetic variants in major histocompatibility complex, class II, DP/DQ [ HLA - DP / DQ ] genes) was also estimated.@*RESULTS@#Compared with those with 0-1 healthy lifestyle factor, participants with 2, 3, and 4 factors had 12% (HR 0.88 [95% confidence interval [CI] 0.85, 0.92]), 26% (HR 0.74 [95%CI: 0.69, 0.79]), and 44% (HR 0.56 [95%CI: 0.48, 0.65]) lower risks of SLD, respectively. Inverse associations were observed among participants with both low and high genetic risks (HR per 1-point increase 0.83 [95%CI: 0.74, 0.94] and 0.91 [95%CI: 0.82, 1.02], respectively; Pinteraction = 0.51), although with a non-significant trend among those with a high genetic risk. Inverse associations were also observed between healthy lifestyle factors and liver biomarkers regardless of the genetic risk. Despite the limited power, healthy lifestyle factors were associated with a lower risk of death after incident SLD among participants with a low genetic risk (HR 0.59 [95%CI: 0.37, 0.96]).@*CONCLUSIONS@#Lifestyle modification may be beneficial in terms of lowering the risk of SLD regardless of the genetic risk. Moreover, it is also important for improving the prognosis of SLD in individuals with a low genetic risk. Future studies are warranted to examine the impact of healthy lifestyles on SLD prognosis, particularly among individuals with a high genetic risk.

Multimorbidity patterns and association with mortality in 0.5 million Chinese adults / 中华医学杂志(英文版)

BACKGROUND@#Few studies have assessed the relationship between multimorbidity patterns and mortality risk in the Chinese population. We aimed to identify multimorbidity patterns and examined the associations of multimorbidity patterns and the number of chronic diseases with the risk of mortality among Chinese middle-aged and older adults.@*METHODS@#We used data from the China Kadoorie Biobank and included 512,723 participants aged 30 to 79 years. Multimorbidity was defined as the presence of two or more of the 15 chronic diseases collected by self-report or physical examination at baseline. Multimorbidity patterns were identified using hierarchical cluster analysis. Cox regression was used to estimate the associations of multimorbidity patterns and the number of chronic diseases with all-cause and cause-specific mortality.@*RESULTS@#Overall, 15.8% of participants had multimorbidity. The prevalence of multimorbidity increased with age and was higher in urban than rural participants. Four multimorbidity patterns were identified, including cardiometabolic multimorbidity (diabetes, coronary heart disease, stroke, and hypertension), respiratory multimorbidity (tuberculosis, asthma, and chronic obstructive pulmonary disease), gastrointestinal and hepatorenal multimorbidity (gallstone disease, chronic kidney disease, cirrhosis, peptic ulcer, and cancer), and mental and arthritis multimorbidity (neurasthenia, psychiatric disorder, and rheumatoid arthritis). During a median of 10.8 years of follow-up, 49,371 deaths occurred. Compared with participants without multimorbidity, cardiometabolic multimorbidity (hazard ratios [HR] = 2.20, 95% confidence intervals [CI]: 2.14 - 2.26) and respiratory multimorbidity (HR = 2.13, 95% CI:1.97 - 2.31) demonstrated relatively higher risks of mortality, followed by gastrointestinal and hepatorenal multimorbidity (HR = 1.33, 95% CI:1.22 - 1.46). The mortality risk increased by 36% (HR = 1.36, 95% CI: 1.35 - 1.37) with every additional disease.@*CONCLUSION@#Cardiometabolic multimorbidity and respiratory multimorbidity posed the highest threat on mortality risk and deserved particular attention in Chinese adults.

Health management needs standardization / 中华预防医学杂志

This article illustrates that health management, as one of the tools of health service, plays an important role in the control and treatment of chronic diseases as well as the history of health management development in China. It was pointed out that currently the concept of health management is not well established in China and the practice of health management in the Chinese market is quite in a mess. Therefore, there is an urgent need for the standardization of health management practice. The China Health Management Association released an organizational standard entitled "Standard for Chronic Disease Health Management" in November, 2019. It is comprehensive, science-based, easy to use and fit into the Chinese situation and it is expected that it will facilitate the development of health management in China.

Frequency of bowel movements and risk of Parkinson’s disease: a prospective cohort study in adults in China / 中华流行病学杂志

Objective@#To evaluate the association between the frequency of bowel movement (BMF) and the risk of Parkinson’s disease (PD).@*Methods@#In this study, 510 134 participants from the China Kadoorie Biobank (CKB) were included after excluding those who reported to had been diagnosed with cancer at baseline survey. The baseline survey was conducted from 2004 to 2008. The study used the data from the baseline survey and follow-up until December 31, 2016. Cox proportional hazards regression models were used to estimate the HRs and the 95%CIs of risk of PD diagnosis with BMF.@*Results@#During an average follow-up period of (9.9±1.9) years, 808 participants were diagnosed with PD. Compared with participants who had bowel movements every day, the multivariable-adjusted HR (95%CI) for those who had bowel movements<3 times/week, once every 2-3 days, and>1 time/day were 3.62 (2.88-4.54), 2.13 (1.74-2.60), and 0.81 (0.63-1.05), respectively. The linear trend test results of the association between BMF and risk of PD diagnosis was significant (P<0.001). Compared with the participants who had bowel movements ≥1 time/day, the multivariable-adjusted HR (95%CI) for those who had bowel movements<1 time/day was 3.13 (2.32-4.23) within the 5 years of follow- up and was 2.48 (2.05-3.01) beyond the 5 years of follow-up. The gender specific results were similar. The association of BMF<1 time/day with risk of PD diagnosis was stronger in older participants.@*Conclusions@#The participants with low BMF at baseline survey would have higher risk for PD diagnosis in the subsequent 10 years on average. Since abnormal decrease of BMF is easy to be found, programs could be set up for the early screening of PD in older people, along with other early symptoms of PD.

Family History, Tobacco Smoking, and Risk of Ischemic Stroke / 대한뇌졸중학회지

BACKGROUND AND PURPOSE: Both genetic factors and smoking are associated with ischemic stroke (IS) risk. However, little is known about the potential interaction of these factors. We aimed to assess whether smoking and a positive family history interact to increase the risk of IS. METHODS: The nationwide prospective study recruited 210,000 men and 300,000 women in 2004 to 2008 at ages 30 to 79 years. During 9.7 years of follow-up, we documented 16,923 and 20,656 incident IS cases in men and women without major chronic diseases at baseline, respectively. Multivariable Cox regression models were used to examine associations between family history and IS. Likelihood ratio tests were used to test the smoking-family history interactions on IS. RESULTS: About 67.8% (n=135,168) of men ever smoked regularly compared with 2.7% (n=7,775) of women. Among men, a significant interaction between family history and smoking on IS was observed (P for interaction=0.03), with more pronounced association between family history and IS among ever-regular smokers (hazard ratio [HR], 1.21; 95% confidence interval [CI], 1.16 to 1.27) than among never-smokers (HR, 1.11; 95% CI, 1.01 to 1.23). The association between family history and IS among ex-smokers after more than 10 years of cessation (HR, 1.01; 95% CI, 0.85 to 1.20) appeared similar to that among never-smokers. Among women, a similar but not significant interaction between family history and smoking on IS was observed. Ever-regular smokers who had a family history of stroke had the highest risk of IS. CONCLUSIONS: Among Chinese men, the association of family history with IS was accentuated by smoking, and such accentuation tended to be lowered by cessation.

Epidemiological characteristics and correlated factors of habitual snoring among Chinese aged 30 to 79 year-old / 中华流行病学杂志

Objective@#To describe the characteristics of habitual snoring among adults from 10 regions engaged in the China Kadoorie Biobank (CKB) study.@*Methods@#The baseline survey of CKB was conducted from 2004 to 2008. Data was collected regarding the information on socio- demographic characteristics, lifestyle, sleeping habits, and results from the physical examination of the participants. Logistic regression models were used to compare the regional differences and to estimate the associations of other baseline characteristics on snoring habit.@*Results@#A total of 512 713 participants were included in this study. The overall prevalence of habitual snoring was 21.2%, higher among men, in south regions and urban areas, but no difference observed among people with different socioeconomic status after adjusting for age, regions, BMI, waist circumference or lifestyle factors. Results showed that the prevalence of habitual snoring under the multivariable adjusted model increased among current and ever smokers, also among current and ever alcohol consumers. The risk of habitual snoring was increased by 19% per 1 kg/m2 and 6% per 1 cm increment in BMI or waist circumference, respectively. Among participants with similar BMI, central obese individuals were more likely to be habitual snorers. For individuals with similar waist circumference, the prevalence of habitual snoring was higher among those with higher BMI.@*Conclusion@#The prevalence of habitual snoring varied across regions. Substantial differences in habitual snoring were also seen among people with different lifestyles and body sizes.

Analysis on adulthood weight change in adults in China / 中华流行病学杂志

Objective@#To understand the characteristics of adulthood weight change through the analysis on data from China Kadoorie Biobank (CKB) Study of 0.5 million adults from ten areas in China.@*Methods@#An electronic questionnaire was used to collect the information about the body weight at age 25 years, social-demographic characteristics and lifestyle of the study subjects and their body weight were measured. After excluding the adults with self-reported histories of coronary heart disease, stroke, cancer or diabetes and those who had no data of body weight at age 25 years and those aged outside of 35-70 years, a total of 360 903 adults were included in the analysis. Adulthood weight change were defined as difference value between current body weight and body weight at age 25 years.@*Results@#The mean adulthood weight change of the participants was 4.9 kg. The adults living in urban area showed more body weight increase compared with those living in rural area, so did the adults in northern area compared with those in southern area. Among the ten areas in China, Qingdao reported the highest adulthood weight increase (9.3 kg), and Gansu reported the lowest adulthood weight increase (1.5 kg). Older adults had higher BMI at early adulthood (25 years old), but the adults aged 45-50 years had the highest adulthood body weight increase. Adults with higher educational level, higher household income level, but lower physical activity level had more body weight increase, while current smokers, farmers and workers had less body weight increase. BMI at age 25 years was negatively associated with adulthood body weight change, but current BMI was positively associated with adulthood body weight change (P<0.001).@*Conclusion@#Adulthood body weight change varied greatly among population with different demographic characteristics and lifestyle and in ten areas in China.

Association between the frequency of bowel movements and the risk of colorectal cancer in Chinese adults / 中华流行病学杂志

Objective@#To examine the association between the frequencies of bowel movement (BMF) and the risk of colorectal cancer (CRC).@*Methods@#In this study, 510 134 participants from the China Kadoorie Biobank (CKB) were included, after excluding those who reported as having been diagnosed with cancer at the baseline survey. The baseline survey was conducted from June 2004 to July 2008. The present study included data from baseline and follow-up until December 31, 2016. We used the Cox proportional hazards regression models to estimate the HR and the 95%CI of incident CRC with BMF.@*Results@#During an average follow-up period of 9.9 years, 3 056 participants were documented as having developed colorectal cancer. In the site-specific analysis, 1 548 colon cancer and 1 475 rectal cancer were included. Compared with participants who had bowel movements on the daily base, the multivariable-adjusted HR (95%CI) for those who had more than once of BMF were 1.24 (1.12-1.39) for CRC, 1.12 (0.95-1.31) for colon cancer, and 1.37 (1.18-1.59) for rectal cancer. We further examined the association between BMF and CRC, according to the stages of follow-up, the corresponding HR (95%CI) for CRC, colon and rectal cancer were 1.59 (1.36-1.86), 1.43 (1.14- 1.80), and 1.76 (1.41-2.19) for the first five years, while such associations became statistically insignificant in the subsequent follow-up (P for all interactions were <0.05), as time went on. As for CRC, colon or rectal cancers among participants who had lower bowel movements, the risks were not significantly different from those who had bowel movements everyday.@*Conclusions@#Participants who had BMF more than once a day, appeared an increased risk of CRC in the subsequent five years. Since abnormal increase of bowel movements is easily recognizable, programs should be set up on health self- management and early screening for CRC.

Levels of skeletal muscle mass and handgrip strength in adults from 10 regions of China / 中华流行病学杂志

Objective@#To describe the regional and population-related differences in skeletal muscle mass and handgrip strength across the 10 regions of China.@*Methods@#24 533 participants aged 38-88 years from the second resurvey of China Kadoorie Biobank were included in our analyses. Appendicular and trunk skeletal muscle mass were assessed using the bioelectrical impedance analysis (TANITA). Handgrip strength was measured using Jamar hand-held dynamometer. Low muscle mass and low muscle strength were defined as the lowest quintile of height-adjusted appendicular muscle mass or handgrip strength according to the Consensus Report of the Asian Working Group for Sarcopenia. We analyzed the mean value of absolute muscle mass, height-adjusted muscle mass, weight-adjusted muscle mass and handgrip strength. We also reported the prevalence of low muscle mass and low muscle strength.@*Results@#The average appendicular and total skeletal muscle mass were (22.0±0.02) kg and (49.7±0.05) kg in men, which were higher than in women [(15.9±0.02) kg and (37.2±0.04) kg, respectively]. The handgrip strength was (32.6±0.06) kg in men, which was higher than (19.9±0.05) kg in women. The absolute muscle mass was higher in north area and urban region (P<0.001). The weight-adjusted muscle mass showed reverse patterns of regional difference compared with height-adjusted muscle mass. Both muscle mass and handgrip strength decreased by age (trend P<0.001), with a larger decline observed in handgrip strength. According to AWGS criteria, the proportions of low muscle mass and strength increased by age. Among participants over 80 years old, the prevalence of low muscle mass and strength were 56.2% and 74.5% in men, and 35.7% and 66.0% in women.@*Conclusions@#Levels of skeletal muscle mass and strength varied greatly among people from 10 regions and among participants with different demographic characteristics. The prevalence of low muscle mass and strength was extremely high in elderly.

Association of body mass index and waist circumference with major chronic diseases in Chinese adults / 中华流行病学杂志

Objective@#To examine the association of BMI with major chronic diseases morbidity and all-cause mortality in Chinese adults.@*Methods@#This study is based on China Kadoorie Biobank. Anthropometric indexes were objectively measured at the baseline survey during 2004-2008. After excluding participants with heart disease, stroke, cancer, COPD and diabetes, 428 113 participants aged 30 to 79 years were included in the analysis. Cox regression models were used to investigate the associations of BMI and waist circumference with incidence of major chronic diseases (including cardiovascular disease, cancer, COPD, and type 2 diabetes) and all-cause mortality.@*Results@#Over an average of 10 years, 131 454 participants developed any one of major chronic diseases. A total of 26 892 all-cause deaths were reported. The risk of major chronic diseases increased with BMI. Compared with normal BMI (18.5-24.0 kg/m2), the HR (95%CI) of overweight (BMI 24.0-28.0 kg/m2) and obesity (BMI≥28.0 kg/m2) were 1.26 (95%CI: 1.24-1.27) and 1.59 (95%CI: 1.57-1.62) respectively. Underweight and obesity were both associated with risk of all-cause mortality. Waist circumference was positively associated with risk of major chronic diseases and all-cause mortality. According to recommended cut-off points of BMI and waist circumference for Chinese adults, maintaining a healthy body weight would prevent 12% incident cases of major chronic diseases.@*Conclusion@#General and central obesity were risk factors for major chronic disease among Chinese adults.

The cut-off points of body mass index and waist circumference for predicting metabolic risk factors in Chinese adults / 中华流行病学杂志

Objective@#To assess the association of BMI and waist circumference (WC) with metabolic risk factors, and confirm the appropriate cut-off points of BMI and WC among Chinese adults.@*Methods@#After excluding participants with missing or extreme measurement values, as well as individuals with self-reported histories of cancer, a total of 501 201 adults in baseline and 19 201 adults in the second re-survey from the China Kadoorie Biobank were included. The associations of BMI and WC with metabolic risk factors were estimated. Receiver operating characteristic (ROC) analyses were conducted to assess the appropriate cut-off values of BMI and WC to predict the risk of hypertension, diabetes, dyslipidemia and clustering of risk factors.@*Results@#The prevalence of hypertension, diabetes, dyslipidemia and clustering of risk factors all presented ascending trends with the increasing levels of BMI or WC. Defined as the points on the ROC curve where Youden’s index reached the highest, the appropriate overweight cut-off points of BMI were around 24.0 kg/m2 both in men and women, and the points of WC were around 85 cm in men and 80 to 85 cm in women. With specificity 90% for identification of risk factors, the appropriate obese cut-off points of BMI were around 28.0 kg/m2 both in men and women, with the range of 27.0 to 28.9 kg/m2.@*Conclusions@#The cut-off points for overweight and obesity recommended by Coorperative Meta-analysis Group of China Obesity Task Force was verified in the large sample survey conducted more recently. The cut-off points of BMI were 24.0 and 28.0 kg/m2 for overweight and obesity, and the cut-off point of WC was 85 cm in men and 80 to 85 cm in women for central obesity.

Prevalence of'healthy lifestyle'in Chinese adults / 中华流行病学杂志

Objective To examine the prevalence of'healthy lifestyle'from data extracted from the China Kadoorie Biobank (CKB) of 0.5 million adults from ten areas across China.Methods After excluding participants with self-reported histories of coronary heart disease,stroke or cancer,a total of 487 198 participants at baseline (2004-2008) and 22 604 participants at second survey (2013-2014),were included for analysis.'Healthy lifestyle'was defined as haing the following characteristics:a) never smoking or having stopped smoking for reasons other than illness;b) alcohol drinking ＜25 g/day (men)/＜ 15 g/day (women);c) diet rich in vegetables,fruits,legumes and fish,but low in red meat;d) upper quarter of the physical activity level;e) body mass index of 18.5-23.9 kg/m2 and waist circumstance ＜85 cm (men)/80 cm (women).We calculated the healthy lifestyle scores (HLS) by counting the number of all the healthy lifestyle factors,with a range from 0 to 6.Results At baseline,prevalence rates of the above five healthy lifestyles (except physical activity) were 70.6％,92.6％,8.7％,52.6％ and 59.0％,respectively,with the mean HLS being 3.1± 1.2.Most participants (81.4％) had 2-4 healthy components,while only 0.7％ (0.2％ in men and 1.0％ in women) of all the participants had all six healthy lifestyles.Participants who were women,at younger age,with more schooling and rural residents,were more likely to adhere to the healthy lifestyle.After ten years,the mean HLS showed a slight decrease.Conclusion The prevalence of optimal lifestyles in Chinese adults appeared extremely low.Levels of'healthy lifestyle'varied greatly among those populations with different socio-demographic characteristics across the ten areas in China.

Relationship between educational level and long-term changes of body weight and waist circumference in adults in China / 中华流行病学杂志

Objective To evaluate the association of educational level with anthropometric measurements at different adult stages and their long-term changes in adults who participated in the second re-survey of China Kadoorie Biobank (CKB).Methods The present study excluded participants who were aged ＞65 years,with incomplete or extreme measurement values,or with major chronic diseases at baseline survey or re-survey.The weight at age 25 years was self-reported.Body height,body weight and waist circumference at baseline survey (2004-2008) and re-survey (2013-2014) were analyzed.Results The present study included 3 427 men and 6 320 women.Both body weight and waist circumference (WC) increased with age.From age 25 years to baseline survey (mean age 45.2 ± 6.5),the mean weight change per 5-year was (1.70 ± 2.63) kg for men and (1.27 ± 2.10) kg for women.From baseline survey to re-survey (53.2± 6.5),the mean changes per 5-year for body weight were (1.12±2.61) kg for men and 0.90±2.54) kg for women;and that for WC was (3.20±3.79) cm for men and (3.83 ± 3.85) cm for women.Among women,low educational level was consistently associated with higher body mass index (BMI) and WC at age 25 years,baseline survey and re-survey.Among men,low educational level was associated with higher BMI at age 25 years.At baseline survey and re-survey,the educational level in men was not statistically associated with BMI;but men who completed junior or senior high school showed slight higher WC and increase of WC from baseline survey to re-survey than other male participants.Conclusions Body weight and WC increased with age for both men and women.The associations of educational level with BMI and WC were different between men and women.

Prevalence of'healthy lifestyle'in Chinese adults / 中华流行病学杂志

Objective To examine the prevalence of'healthy lifestyle'from data extracted from the China Kadoorie Biobank (CKB) of 0.5 million adults from ten areas across China.Methods After excluding participants with self-reported histories of coronary heart disease,stroke or cancer,a total of 487 198 participants at baseline (2004-2008) and 22 604 participants at second survey (2013-2014),were included for analysis.'Healthy lifestyle'was defined as haing the following characteristics:a) never smoking or having stopped smoking for reasons other than illness;b) alcohol drinking ＜25 g/day (men)/＜ 15 g/day (women);c) diet rich in vegetables,fruits,legumes and fish,but low in red meat;d) upper quarter of the physical activity level;e) body mass index of 18.5-23.9 kg/m2 and waist circumstance ＜85 cm (men)/80 cm (women).We calculated the healthy lifestyle scores (HLS) by counting the number of all the healthy lifestyle factors,with a range from 0 to 6.Results At baseline,prevalence rates of the above five healthy lifestyles (except physical activity) were 70.6％,92.6％,8.7％,52.6％ and 59.0％,respectively,with the mean HLS being 3.1± 1.2.Most participants (81.4％) had 2-4 healthy components,while only 0.7％ (0.2％ in men and 1.0％ in women) of all the participants had all six healthy lifestyles.Participants who were women,at younger age,with more schooling and rural residents,were more likely to adhere to the healthy lifestyle.After ten years,the mean HLS showed a slight decrease.Conclusion The prevalence of optimal lifestyles in Chinese adults appeared extremely low.Levels of'healthy lifestyle'varied greatly among those populations with different socio-demographic characteristics across the ten areas in China.

Relationship between educational level and long-term changes of body weight and waist circumference in adults in China / 中华流行病学杂志

Objective To evaluate the association of educational level with anthropometric measurements at different adult stages and their long-term changes in adults who participated in the second re-survey of China Kadoorie Biobank (CKB).Methods The present study excluded participants who were aged ＞65 years,with incomplete or extreme measurement values,or with major chronic diseases at baseline survey or re-survey.The weight at age 25 years was self-reported.Body height,body weight and waist circumference at baseline survey (2004-2008) and re-survey (2013-2014) were analyzed.Results The present study included 3 427 men and 6 320 women.Both body weight and waist circumference (WC) increased with age.From age 25 years to baseline survey (mean age 45.2 ± 6.5),the mean weight change per 5-year was (1.70 ± 2.63) kg for men and (1.27 ± 2.10) kg for women.From baseline survey to re-survey (53.2± 6.5),the mean changes per 5-year for body weight were (1.12±2.61) kg for men and 0.90±2.54) kg for women;and that for WC was (3.20±3.79) cm for men and (3.83 ± 3.85) cm for women.Among women,low educational level was consistently associated with higher body mass index (BMI) and WC at age 25 years,baseline survey and re-survey.Among men,low educational level was associated with higher BMI at age 25 years.At baseline survey and re-survey,the educational level in men was not statistically associated with BMI;but men who completed junior or senior high school showed slight higher WC and increase of WC from baseline survey to re-survey than other male participants.Conclusions Body weight and WC increased with age for both men and women.The associations of educational level with BMI and WC were different between men and women.

Associations between family history of major chronic diseases and healthy lifestyles in Chinese adults / 中华流行病学杂志

Objective To examine the associations between family history of major chronic diseases and healthy lifestyle in adults in China.Methods Data were from the baseline and second survey of China Kadoorie Biobank study,which were conducted during 2004-2008 and 2013-2014,respectively.After excluding participants with self-reported histories of coronary heart disease,stroke,cancer or diabetes,a total of 461 213 adults from baseline survey and 20 583 adults from second survey were included in the current study.Participants who reported a family history of acute myocardial infarction,stroke,cancer,or diabetes of any first-degree relative (i.e.,biological father,mother,or siblings) were defined as having a family history of majoi chronic diseases.Healthy lifestyles were defined as current nonsmoking,non-excessive alcohol drinking,eating vegetables and fruits daily,upper quarter of physical activity level,body mass index (BMI) of (18.5-23.9) kg/m2,and waist-to-hip ratio (WHR) ＜0.90 (man)/＜0.85 (women).Results At baseline survey,36.5％ of the participants had family history of major chronic diseases.Proportions of the above six healthy lifestyles were 70.5％,93.0％,18.0％,25.0％,53.4％,and 43.5％,respectively.Compared with participants without family history,the proportions of current nonsmoking,non-excessive drinking,normal BMI,and normal WHR were lower in participants with family history of major chronic diseases,while the proportions of eating vegetables and fruits daily,and being physically active,were higher.In general,the absolute differences in these proportions between participants with and without a family history were only slight.Similar results were observed when other family history status (the type or number of disease,the category or number of affected family members) were analysed.The association between family history of major chronic diseases and healthy lifestyles was consistently observed in the second survey 10 years later.Conclusion In Chinese population,adults with family history of major chronic diseases did not adopt healthier lifestyles.

Epidemiological characteristics of household fuel use in 10 areas of China / 中华流行病学杂志

Objective To describe the characteristics of cooking and heating fuel use in participants from the China Kadoorie Biobank (CKB) study.Methods The CKB study recruited 512 891 adults from 10 areas in China during 2004-2008.Information on cooking fuel and heating fuel was collected using a questionnaire in baseline survey.The proportions of various fuels used in different areas,in different populations,and at different time points were calculated and compared.Results Overall,52.1％ participants used solid fuel for cooking or heating.Rural areas had higher prevalence of solid fuel use than urban areas.The percentage of participants using solid fuel for cooking was 36.1％ (coal 20.1％,wood/charcoal 16.0％);The percentage of participants using solid fuel for heating was 36.7％ (coal 22.7％,wood/charcoal 14.0％).The prevalence of solid fuel use and the fuel type mainly used varied widely across 10 areas.The proportion of clean fuel use was lower in less-educated and lower-income people.Household coal and wood/charcoal use showed a declining trend,which was more remarkable in urban areas.Conclusion There are still a large number of rural residents and people with low income relying on solid fuel in China,which is a serious public health concern.

Association between central obesity and risk for heart disease in adults in China: a prospective study / 中华流行病学杂志

Objective To understand the association between central obesity,assessed by waist circumference,and the risks for ischemic heart disease (IHD),major coronary event (MCE),and IHD death.Methods After excluding participants with heart disease,stroke,cancer,COPD,and diabetes at baseline survey,we included a total of 428 595 participants from the China Kadoorie Biobank for the analysis.The baseline survey was conducted from June 2004 to July 2008.We used Cox proportional hazards model to estimate the hazard ratio (HR) and 95％CI.Results During an average 9.1 years of follow-up (3 803 637 person-years),we documented 26 900 incident cases of IHD,4 320 cases of MCE,and 2 787 of deaths from IHD.After adjustment for possible confounders and BMI,central obesity was found to be associated with increased risks for IHD,MCE,and IHD death.The adjusted HRs (for the participants who had waist circumference of 85.0-89.9 cm in men and 80.0-84.9 cm in women were 1.13 (95％CI:1.09-1.17) for IHD,1.15 (95％CI:1.05-1.26) for MCE and 1.11 (95％ CI:0.98-1.24) for IHD death.The respective HRs for those central obese participants (men ≥90.0 cm,women ≥85.0 cm) were 1.29 (95％ CI:1.24-1.34),1.30 (95％ CI:1.17 1.44) and 1.32 (95％CI:1.16 1.5 1).Further stratification analysis according to BMI showed that the risks for incident IHD,MCE,and IHD death increased along with the increase of waist circumference even in the participants with normal weight.Conclusion This large-scale prospective study revealed that central obesity was an independent risk factor for IHD in adults in China,and the risk of IHD would increase with the increase of waist circumference.