Validation of the physical activity neighborhood environment scale using geographic information systems among urban men and women in regional China.

Aims: To examine the concurrent validity of the Chinese version of Physical Activity Neighborhood Environment Scale (PANES-CHN) among urban adults in regional China. Methods: With multistage sampling approaches, 801 eligible urban adults aged 35-74 years were recruited from Nanjing municipality of China between July and September of 2019. The neighbourhood built environment features were measured subjectively with PANES-CHN and objectively with geographic information system. The concurrent validity of PANES was assessed using Spearman's correlations (rs). Results: Among the total 801 participants, the mean age was 54.4 (standard deviation = 11.5), while 48.7 % were men. Overall, of all the five objectively-measurable built environment characteristics, the Spearman correlations were examined significant between subjective and objective measurements for commercial facilities (item 2) (rs = 0.19, 95CI%=0.12, 0.25), recreational facilities (item 6) (rs = 0.10, 95CI%=0.02, 0.16), traffic junctions (item 12) (rs = 0.15, 95CI%=0.07, 0.22), medical/education facilities (item 17) (rs = 0.22, 95CI%=0.15, 0.29), but not for public transport stops. Similar scenarios were observed for participants aged 35-60 years, with sufficient physical activity, men or women. The rs value for medical/education facilities (item 17) was significantly higher in participants aged 35-59 years (0.28 vs. 0.13; p = 0.04) than those aged 60 + years. Conclusions: PANES-CHN generally has an acceptable validity for assessing built environment characteristics among urban adults in China, which implies that PANES-CHN can be used to measure built environment attributes in health-related population studies.

Biaxial strain modulated electronic structures of layered two-dimensional MoSiGeN4 Rashba systems.

The two-dimensional (2D) MA2Z4 family has received extensive attention in manipulating its electronic structure and achieving intriguing physical properties. However, engineering the electronic properties remains a challenge. Herein, based on first-principles calculations, we systematically investigate the effect of biaxial strains on the electronic structure of 2D Rashba MoSiGeN4 (MSGN), and further explore how the interlayer interactions affect the Rashba spin splitting (RSS) in such strained layered MSGN systems. After applying biaxial strains, the band gap decreases monotonically with increasing tensile strains but increases when the compressive strains are applied. An indirect-direct-indirect band gap transition is induced by applying a moderate compressive strain (<5%) in the MSGN systems. Due to the symmetry breaking and moderate spin-orbit coupling (SOC), the monolayer MSGN possesses an isolated RSS near the Fermi level, which could be effectively regulated to the Lifshitz-type spin splitting (LSS) by biaxial strain. For instance, the LSS ← RSS → LSS transformation of the Fermi surface is presented in the monolayer and a more complex and changeable LSS ← RSS → LSS → RSS evolution is observed in bilayer and trilayer MSGN systems as the biaxial strain varies from -8% to 12%, which actually depends on the appearance, variation, and vanish of the Mexican hat band in the absence of SOC under different strains. The contribution of the Mo-dz2 orbital hybridized with the N-pz orbital in the highest valence band plays a dominant role in band evolution under biaxial strains, where the RSS → LSS evolution corresponds to the decreased Mo-dz2 orbital contribution. Our study highlights the biaxial strain controllable RSS, in particular the introduction and even the evolution of LSS near the Fermi surface, which makes the strained MSGN systems promising candidates for future applications in spintronic devices.

The association between alcohol drinking and glycemic management among people with type 2 diabetes in China.

INTRODUCTION: To investigate the association between alcohol drinking and glycemic management among adult patients with type 2 diabetes in regional China. MATERIALS AND METHODS: In this cross-sectional survey conducted in Nanjing Municipality of China in 2018, adult type 2 diabetes patients were randomly selected from urban and rural communities. The outcome variable was the glycemic management status. The explanatory measure was alcohol drinking. Mixed-effects regression models were employed to estimate odds ratios (ORs) and 95% confidence interval (95% CI) for examining the associations of alcohol drinking with glycemic management among type 2 diabetes patients. RESULTS: Among the overall 5,663 participants, the glycemic management rate was 39.8% (95% CI = 38.5, 41.1), with 41.2% (95% CI = 39.7, 42.7), 43.9% (95% CI = 38.9, 48.8), and 34.1% (95% CI = 31.5, 36.7) for non-drinkers, mild/moderate drinkers, and heavy drinkers, respectively. After adjustment for potential confounders and community-level clustering effect, heavy and mild/moderate alcohol drinkers were at 0.76 (95% CI = 0.66, 0.89) and 1.04 (95% CI = 0.87, 1.28) times odds to have glycemia under control than non-drinkers among the overall participants. Furthermore, when stratified separately by gender and use of anti-diabetes agents, the scenario within men, either regular or irregular users of anti-diabetes agents was the same as that for overall participants, while the association between alcohol drinking and glycemic management became non-significant among women. CONCLUSIONS: Heavy alcohol drinking might have a negative effect on glycemic management among patients with type 2 diabetes irrespective of the use of anti-diabetes agents in regional China. This study has important public health implications regarding precision intervention on patients' glycemia control for type 2 diabetes management.

Joint associations of sleep duration and physical activity with cognitive impairment among rural elderly over 65 years old: a cross-sectional study.

BACKGROUND: During the long preclinical phase of dementia, accelerated cognitive impairment is regarded as a cardinal marker. Thus, the identification of risk factors for cognitive impairment is of great significance for dementia prevention. This study aims to examine the joint associations of sleep duration and physical activity with cognitive impairment among rural elderly over 65 years old, and provide suggestions for improving the cognitive function in rural elderly over 65 years old. METHODS: A cross-sectional study was conducted in rural Nanjing by recruiting 1147 individuals aged above 65 years. Cognitive function was assessed using the brief community screening instrument for dementia. Physical activity was assessed using the Global Physical Activity Questionnaire. Data were analyzed by multivariate logistic regression models, and a significant difference was set at P < 0.05. RESULTS: Compared with participants with proper sleep duration and sufficient physical activity, participants with short sleep duration and insufficient physical activity (odds ratio (OR): 1.820; 95% CI: 1.265 ~ 2.618), long sleep duration and sufficient physical activity (OR: 2.428; 95% CI: 1.137 ~ 5.183) showed an increased likelihood of cognitive impairment. CONCLUSIONS: Inappropriate sleep duration combined with insufficient physical activity was associated with a significantly higher likelihood of cognitive impairment in rural elderly over 65 years old.

Alloying Reversed Anisotropy of Thermal Transport in Bulk Al0.5Ga0.5N.

Anisotropic heat transfer is crucial for advanced thermal management in nanoelectronics, optoelectronics, thermoelectrics, etc. Traditional approaches modifying thermal conductivity (κ) mostly adjust the magnitude but disregard anisotropy. Herein, by solving the Boltzmann transport equation from first principles, we report κ anisotropy modulation by alloying gallium nitride (GaN) and aluminum nitride (AlN). The alloyed Al0.5Ga0.5N demonstrates reversed κ anisotropy compared to the parent materials, where the preferred thermal transport direction shifts from cross-plane to in-plane. Moreover, the κ anisotropy (κin-plane/κcross-plane) in the Al0.5Ga0.5N alloy is enhanced to 1.63 and 1.51 times that in bulk GaN and AlN, respectively, which can be further enhanced by increased temperature. Deep analysis attributes the alloying reversed κ anisotropy of Al0.5Ga0.5N to the structure distortion-driven phonon group velocity, as well as phonon anharmonicity. The alloying reversed κ anisotropy as reported in this study sheds light on future studies in advanced heat dissipation and intelligent thermal management.

Perilipin 5 regulates hepatic stellate cell activation and high-fat diet-induced non-alcoholic fatty liver disease.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases globally. Hepatic stellate cells (HSCs) are the major effector cells of liver fibrosis. HSCs contain abundant lipid droplets (LDs) in their cytoplasm during quiescence. Perilipin 5 (PLIN 5) is a LD surface-associated protein that plays a crucial role in lipid homeostasis. However, little is known about the role of PLIN 5 in HSC activation. METHODS: PLIN 5 was overexpressed in HSCs of Sprague-Dawley rats by lentivirus transfection. At the same time, PLIN 5 gene knockout mice were constructed and fed with a high-fat diet (HFD) for 20 weeks to study the role of PLIN 5 in NAFLD. The corresponding reagent kits were used to measure TG, GSH, Caspase 3 activity, ATP level, and mitochondrial DNA copy number. Metabolomic analysis of mice liver tissue metabolism was performed based on UPLC-MS/MS. AMPK, mitochondrial function, cell proliferation, and apoptosis-related genes and proteins were detected by western blotting and qPCR. RESULTS: Overexpression of PLIN 5 in activated HSCs led to a decrease in ATP levels in mitochondria, inhibition of cell proliferation, and a significant increase in cell apoptosis through AMPK activation. In addition, compared with the HFD-fed C57BL/6J mice, PLIN 5 knockout mice fed with HFD showed reduced liver fat deposition, decreased LD abundance and size, and reduced liver fibrosis. CONCLUSION: These findings highlight the unique regulatory role of PLIN 5 in HSCs and the role of PLIN 5 in the fibrosis process of NAFLD.

Ultra-high thermal conductivity of two-dimensional C23.

High thermal conductivity is of great interest due to the novel applications in high-performance heat dissipation for microelectronic devices. Two-dimensional (2D) materials with graphene as a representative have attracted tremendous interest due to the excellent properties, where C23is an emerging 2D allotrope of carbon with a large bandgap. In this paper, by solving the Boltzmann transport equation based onstate-of-the-artfirst-principles calculations, the C23is predicted to have an ultrahigh thermal conductivity of 2051.47 Wm-1K-1, which is on the same order of magnitude as graphene. Based on the comparative analysis among C23, graphene, and penta-graphene, it is shown that the unique spatial structure and the orbital hybridization of C23lead to weak anharmonicity, which results in the large relaxation time of phonons and finally results in ultrahigh thermal conductivity. Our study is expected to promote the comprehensive understanding of thermal transport in C23and shed light on future exploration of novel materials with high thermal conductivity.

Activated Lone-Pair Electrons Lead to Low Lattice Thermal Conductivity: A Case Study of Boron Arsenide.

Reducing thermal conductivity (κ) is of great significance to lots of applications, such as thermal insulation, thermoelectrics, etc. In this study, we propose an effective approach for realizing low κ by introducing lone-pair electrons or making the lone-pair electrons stereochemically active through bond nanodesigning. By cutting at the (111) cross section of the three-dimensional cubic boron arsenide (c-BAs), the κ is lowered by more than 1 order of magnitude in the resultant two-dimensional graphene-like BAs (g-BAs). The underlying mechanism of activating lone-pair electrons is analyzed based on the comparative study on the thermal transport properties and electronic structures of g-BAs, c-BAs, graphene, and diamond (c-BAs → g-BAs vs diamond → graphene). The proposed approach for realizing low κ and the underlying mechanism uncovered in this study would largely benefit the design of advanced thermal functional materials, especially in future research involving novel materials for energy applications.

An In-Situ Formed Tunneling Layer Enriches the Options of Anode for Efficient and Stable Regular Perovskite Solar Cells.

Perovskite solar cells (PSCs) are taking steps to commercialization. However, the halogen-reactive anode with high cost becomes a stumbling block. Here, the halogen migration in PSCs is utilized to in situ generate a uniform tunneling layer between the hole transport materials and anodes, which enriches the options of anodes by breaking the Schottky barrier, enabling the regular PSCs with both high efficiency and stability. Specifically, the regular PSC that uses silver iodide as the tunneling layer and copper as the anode obtains a champion power conversion efficiency of 23.24% (certified 22.74%) with an aperture area of 1.04 cm2. The devices are stable, maintaining 98.6% of the initial efficiency after 500 h of operation at the maximum power point with continuous 1 sun illumination. PSCs with different tunneling layers and anodes are fabricated, which confirm the generality of the strategy.

The record low thermal conductivity of monolayer cuprous iodide (CuI) with a direct wide bandgap.

Two-dimensional materials have attracted significant research interest due to the fantastic properties that are unique to their bulk counterparts. In this paper, from the state-of-the-art first-principles, we predicted the stable structure of a monolayer counterpart of γ-CuI (cuprous iodide) that is a p-type wide bandgap semiconductor. The monolayer CuI presents multifunctional superiority in terms of electronic, optical, and thermal transport properties. Specifically, the ultralow thermal conductivity of 0.116 W m-1 K-1 is predicted for monolayer CuI, which is much lower than those of γ-CuI (0.997 W m-1 K-1) and other typical semiconductors. Moreover, an ultrawide direct bandgap of 3.57 eV is found in monolayer CuI, which is even larger than that of γ-CuI (2.95-3.1 eV), promising for applications in nano-/optoelectronics with better optical performance. The ultralow thermal conductivity and direct wide bandgap of monolayer CuI as reported in this study would promise its potential applications in transparent and wearable electronics.

The joint association of physical activity and sedentary behavior with health-related quality of life among children and adolescents in Mainland China.

Objectives: The objective of this study was to investigate the joint association of physical activity (PA) and sedentary behavior (SB) with health-related quality of life (HRQoL) among children in Mainland China. Methods: Children were randomly recruited from primary, junior, and senior high schools (graders 4-12) in Nanjing municipality of China in this cross-sectional survey in 2018. The outcome variable, HRQoL, was assessed using the validated Chinese version of Child Health Utility 9D (CHU9D-CHN) instrument. PA and SB were measured using a validated Physical Activity Scale and Food Frequency Questionnaire for Chinese school-aged children. The associations of PA and SB with HRQoL were assessed using mixed-effects linear regression models and reported as mean difference (MD) and 95% confidence interval (CI). Results: Totally, 4,388 participants completed the survey (response rate = 97.6%). After adjustment for potential confounders and class-level clustering effects, relative to those with insufficient PA and prolonged SB, students with insufficient PA and shortened SB (MD = 0.054, 95%CI = 0.018, 0.089), or children with sufficient PA and prolonged SB (MD = 0.034, 95%CI = -0.030, 0.098), or students with sufficient PA and shortened SB (MD = 0.083, 95%CI = 0.045, 0.120), respectively, reported increased HRQoL scores. Conclusion: PA was positively associated with HRQoL, and SB was in negative relation to HRQoL. Furthermore, sufficient PA and shortened SB might exert additive influence on HRQoL among children and adolescents in China. This study has public health implications that PA promotion and SB reduction are encouraged to be considered simultaneously for the purpose to maximally improve HRQoL in population-based behavior intervention campaigns among children and adolescents.

Significantly suppressed thermal transport by doping In and Al atoms in gallium nitride.

Thermal transport plays a key role in the working stability of gallium nitride (GaN) based optoelectronic devices, where doping has been widely employed for practical applications. However, it remains unclear how doping affects thermal transport. In this study, based on first-principles calculations, we studied the doping effect on the thermal transport properties of GaN by substituting Ga with In/Al atoms. The thermal conductivities at 300 K along the in-plane(out-of-plane) directions of In- and Al-doped GaN are calculated to be 7.3(8.62) and 12.45(11.80) W m-1 K-1, respectively, which are more than one order of magnitude lower compared to that of GaN [242(239) W m-1 K-1]. From the analysis of phonon transport properties, we find that the low phonon group velocity and small phonon relaxation time dominate the degenerated thermal conductivity, which originated from the strong phonon anharmonicity of In/Al-doped GaN. Furthermore, by examining the crystal structure and electronic properties, the lowered thermal conductivity is revealed lying in the strong polarization of In-N and Al-N bonds, which is due to the large difference in electronegativity of In/Al and N atoms. The results achieved in this study have guiding significance to the thermal transport design of GaN-based optoelectronic devices.

Association of socioeconomic status with hypertension prevalence and control in Nanjing: a cross-sectional study.

BACKGROUND: The role of socioeconomic status (SES) on hypertension prevalence and hypertension control has gotten much attention but with conflicting results. This paper aimed to quantify the association of SES with both hypertension prevalence and hypertension control rate in Nanjing, China. METHODS: A community-based cross-sectional study was conducted using multistage random sampling on 60,283 adults aged more than 18 years between March 2017 and June 2018. Hypertension was defined as systolic blood pressure (BP) ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg or self-reported diagnosis of hypertension or respondent's report of taking antihypertensive medications. The controlled hypertension was defined by systolic BP < 140 mmHg and diastolic BP of < 90 mmHg among the subjects that self-reported exhibiting hypertensive and taking antihypertensive medications. The associations between SES with hypertension prevalence and hypertension control were quantified using generalized mixed model regression analysis and reported as odds ratios (ORs) and 95% confidence interval (CI). RESULTS: There was a high prevalence of subjects with primary educational level (49.6%) or unemployed and retired (49.5%) or lower annual household income level (44.9%) in each SES group, respectively. After adjustments for potential confounding factors, there were higher odds of hypertension among those with primary educational level (OR = 1.56), but lower odds for controlled BP (OR = 0.51). Higher odds of hypertension could be found among unemployed and retired, and higher odds of controlled BP was observed in the mental laborers or students (OR = 1.30), compared with the other categories, respectively. The lower-income group was more likely to be hypertensive (OR = 1.35) and less likely to have controlled hypertension (OR = 0.73). CONCLUSION: Socioeconomic status played an important role in hypertension prevalence and hypertension control among adults in Nanjing, China. Strategies for hypertension prevention and control should especially focus on people in the vulnerable lower SES groups.

Accessing negative Poisson's ratio of graphene by machine learning interatomic potentials.

The negative Poisson's ratio (NPR) is a novel property of materials, which enhances the mechanical feature and creates a wide range of application prospects in lots of fields, such as aerospace, electronics, medicine, etc. Fundamental understanding on the mechanism underlying NPR plays an important role in designing advanced mechanical functional materials. However, with different methods used, the origin of NPR is found different and conflicting with each other, for instance, in the representative graphene. In this study, based on machine learning technique, we constructed a moment tensor potential for molecular dynamics (MD) simulations of graphene. By analyzing the evolution of key geometries, the increase of bond angle is found to be responsible for the NPR of graphene instead of bond length. The results on the origin of NPR are well consistent with the start-of-art first-principles, which amend the results from MD simulations using classic empirical potentials. Our study facilitates the understanding on the origin of NPR of graphene and paves the way to improve the accuracy of MD simulations being comparable to first-principle calculations. Our study would also promote the applications of machine learning interatomic potentials in multiscale simulations of functional materials.

Joint associations of fresh fruit intake and physical activity with glycaemic control among adult patients with diabetes: a cross-sectional study.

OBJECTIVE: To investigate the joint associations of fresh fruit intake and physical activity with glycaemic control in adult patients with diabetes mellitus (DM). DESIGN: It was an observational study involving adult patients with DM through a face-to-face questionnaire survey, physical measurements and laboratory examinations. Data were analysed by introducing a generalised linear mixed model, and a significant difference was set at p<0.05. SETTING: Nanjing, Jiangsu, China. PARTICIPANTS: A total of 5663 adult patients with DM from the 2017 Nanjing Chronic Disease and Risk Factor Surveillance were recruited. RESULTS: Based on the food frequency questionnaire, fresh fruit intake was classified as 'not eat', '1~99 g/day' and '≥100 g/day'. Physical activity level was calculated based on the data of Global Physical Activity Questionnaire and classified into insufficient physical activity (<600 MET-min/week) and sufficient physical activity (≥600 MET-min/week). The likelihood of glycaemic control in adult patients with DM with fresh fruit intake ≥100 g/day was 37.8% (OR: 1.378; 95% CI: 1.209 to 1.571) higher than those with fresh fruit intake <100 g/day, which was 26% (OR: 1.260; 95% CI: 1.124 to 1.412) higher in adult patients with DM with sufficient physical activity than those with insufficient physical activity. Adult patients with DM with fresh fruit intake ≥100 g/day and sufficient physical activity presented the greatest likelihood of glycaemic control (OR: 1.758; 95% CI: 1.471 to 2.102) compared with those with both fresh fruit intake <100 g/day and insufficient physical activity. CONCLUSIONS: Fresh fruit intake ≥100 g/day combined with sufficient physical activity is associated with a significantly higher likelihood of glycaemic control in adult patients with DM.

Role of Plin5 Deficiency in Progression of Non-Alcoholic Fatty Liver Disease Induced by a High-Fat Diet in Mice.

Characterized by steatosis, inflammation and fibrosis, non-alcoholic fatty liver disease (NAFLD) is a metabolic disorder. As a major lipid droplet-binding protein, Plin5 has been reported to have multiple effects on metabolism, but the effect of Plin5 deficiency on NAFLD is unknown. Plin5 knockout mice and wild-type mice were used to investigate the role of Plin5 in the progression of NAFLD by feeding a high-fat diet (HFD) for 20 weeks. Plin5 deficiency improved obesity induced by the HFD and altered glucose tolerance. Histological examination revealed that Plin5 deficiency alleviated hepatic steatosis and fibrosis induced by the HFD. Plin5 deficiency was also associated with a significant change in lipid metabolism-associated molecules. Further studies of these molecules indicated that Plin5 deficiency activated the expression of AMP-activated protein kinase and inhibited the core regulator of lipogenesis, sterol regulatory element binding protein 1 and its downstream lipid synthesis-related genes. These findings suggest that Plin5 deficiency ameliorates NAFLD by regulating lipid metabolism and inhibiting lipogenesis, and may provide a new strategy for the treatment of NAFLD.

The relationship between health literacy and health-related quality of life among school-aged children in regional China.

OBJECTIVES: To examine the association between health literacy (HL) and health-related quality of life (HRQoL) among primary and high school students in Nanjing, China. METHODS: A cross-sectional study was conducted among randomly selected primary (graders 4-6), junior (graders 7-9) and senior (graders 10-12) high school students in 2018 in Nanjing Municipality of China. HRQoL, the outcome variable, was assessed with the validated Chinese version of Child Health Utility 9D (CHU9D) and used as continuous variable, while HL, our independent variable, was measured with the validated Chinese Students' Health literacy Assessment Scale and treated as categorical variable ("adequate" or "inadequate") in the analysis. Mixed-effects linear regression models were introduced to calculate mean difference and 95% confidence interval (CI) for examining the association between HL and HRQoL. RESULTS: Totally, 4388 of 4498 students completed the survey. Among these responders, the mean score of CHU9D was 0.78 ± 0.17, and the proportion of participants with adequate HL was 85.8% (95% CI = 84.7%, 86.8%). After adjustment for potential confounders and class-level clustering effects, participants who had adequate HL were observed having, on average, an elevated HRQoL score of 0.08 (95% CI = 0.06, 0.11) units compared to their counterparts with inadequate HL. Such a positive HL-HRQoL association was also identified among each stratum of participants' age, gender and residence. CONCLUSIONS: HL was positively associated with HRQoL score among primary and high school students in China. It has public health implications that HRQoL may be improved through school-based health literacy intervention among children and adolescents in China.

Novel optimization perspectives for thermoelectric properties based on Rashba spin splitting: a mini review.

The energy problem has recently become increasingly more serious, therefore the rational use of heat energy and conversion into electrical energy is particularly important. The thermoelectric (TE) field is closely related to human life, as heat from automobiles, heat dissipation from high-power electrical appliances, or other electrical products that produce a lot of heat, can all be transformed with TE materials. The search for TE materials with an excellent performance and effective TE optimization strategies (STs) has attracted significant attention owing to the fact that thermal energy can be directly converted into electric energy. In contrast to the common TE-optimized STs, such as constructing point defects or reducing dimensionality, spin-related optimization STs have emerged from previous published research, such as the spin Seebeck effect or the Rashba effect, in which the Rashba effect shows an effective method to break through the bottleneck of ZT optimization. In this review, typical high ZT materials, common traditional optimized STs, Rashba-type TE materials and their corresponding ZT values are comprehensively discussed. The TE performance of Rashba-type materials is analysed, such as BiTeX (X = I, Br), GeTe, BiSbSeTe2, and the BiSb monolayer. Moreover, the TE optimization mechanisms (band engineering, phonon engineering, and Rashba spin-split engineering) are summarised. Finally, the development and challenges of Rashba spin-split combined with TE in breaking the bottleneck in ZT optimization are highlighted.

The Main Progress of Perovskite Solar Cells in 2020-2021.

Perovskite solar cells (PSCs) emerging as a promising photovoltaic technology with high efficiency and low manufacturing cost have attracted the attention from all over the world. Both the efficiency and stability of PSCs have increased steadily in recent years, and the research on reducing lead leakage and developing eco-friendly lead-free perovskites pushes forward the commercialization of PSCs step by step. This review summarizes the main progress of PSCs in 2020 and 2021 from the aspects of efficiency, stability, perovskite-based tandem devices, and lead-free PSCs. Moreover, a brief discussion on the development of PSC modules and its challenges toward practical application is provided.

Lifestyle-related behaviors and health-related quality of life among children and adolescents in China.

PURPOSE: To investigate associations of five typical lifestyle-related behavioral risk factors (insufficient physical activity, prolonged screen viewing, deprived sleeping, consumption of fast food and sugar-sweetened beverage) with health-related quality of life (HRQoL) among school students in China. METHODS: Students aged 9-17 years (grades 4-12) were randomly selected from primary and high schools in Nanjing, China, to participate in this cross-sectional study in 2018. The outcome variable, HRQoL, was assessed using the Child Health Utility 9D (CHU9D) instrument and scored from 0 (worst) to 1 (best). Physical activity (including screen viewing and sleeping) and dietary intake were measured using a validated Physical Activity Scale and Food Frequency Questionnaire, respectively. Lifestyle-related behaviors were categorized as sufficient/insufficient or no/yes, and their associations with HRQoL were assessed using mixed-effects linear regression models. RESULTS: Overall, 4388 participants completed the questionnaire (response rate = 97.6%). Students with insufficient physical activity [mean difference (MD) = - 0.03; 95% confidence interval (CI) = - 0.04, - 0.01], prolonged screen time (MD = - 0.06; 95% CI = - 0.07, - 0.04), insufficient sleeping time (MD = - 0.04; 95% CI = - 0.07, - 0.02), consumption of sugar-sweetened beverage (MD = - 0.02; 95% CI = - 0.03, - 0.01) or fast food intake (MD = - 0.03; 95% CI = - 0.04, - 0.02) reported significantly lower HRQoL scores. When considered additively, each additional lifestyle-related risk factor was associated with an average decrease of 0.03 units (95% CI: - 0.03, - 0.02) CHU9D score. CONCLUSIONS: For Chinese students, HRQoL was positively associated with physical activity and sleep duration, but negatively with screen time and consumption of sugar-sweetened beverage and fast food. Moreover, lifestyle-related behaviors may have an additive effect on HRQoL.