Waning immunity and potential asymptomatic infection in 3-7 years old children who received one dose of measles-mumps-rubella vaccine: A 4-year prospective study.

BACKGROUND: Mumps outbreaks in adolescents who received two doses of measles-mumps-rubella vaccine (MMR) during childhood have been reported worldwide. In China, one dose of MMR administered in children aged among 18-24 months has a limited effect on the mumps epidemic. There are limited prospective studies evaluating the mumps immunity profile of children aged 3-7 years who received one dose of MMR. This study aimed to describe mumps immunity profile over a span of 4-years in kindergarten and primary school children. METHODS: An observational, prospective study on one-dose MMR in children aged 3-7 years who underwent blood sample collection in 2015, 2016, and 2018 was conducted from 2015 to 2018. The seropositivity and geometric mean concentration of mumps IgG antibodies over time were analyzed. RESULTS: A total of 3346 eligible children aged 3-7 years who underwent three rounds of blood sample collection were included. The overall seropositivity (79.6%) in 2015 was significantly higher than those recorded in 2016 (73.1%) and 2018 (71.4%). Approximately 11.6-15.9% of the participants were seropositive for mumps in 2015, and converted to negative in 2016. Meanwhile, 11.1-14.6% of the participants were seropositive for mumps in 2016, and the results converted to negative in 2018. Over 6.1-7.4% of the participants had asymptomatic infection from 2015 to 2016, while 9.0-9.9% of the participants were infected without clinical symptoms from 2016 to 2018. CONCLUSIONS: Kindergarten and primary school children who only received one dose of MMR were at higher risk of developing mumps. Waning immunity, seronegative conversion, and asymptomatic infection coexist in children who received one dose MMR. Determining the optimal age for administering the second dose of MMR in children should be prioritized to improve the control and prevention of mumps in China.

Dietary patterns and the incidence of hyperglyacemia in China.

OBJECTIVE: Epidemiological studies have examined associations between dietary patterns and the risk of type 2 diabetes. However, information on dietary patterns and the risk of type 2 diabetes in Chinese populations is scarce. The aim of the present study was to identify dietary patterns and examine their association with incident hyperglycaemia in Nanjing, China. DESIGN: A community-based prospective cohort study. Dietary assessment was carried out using a validated eighty-seven-item FFQ. Dietary patterns were identified by exploratory factor analysis. Participants were categorized into tertiles of dietary factor score for each dietary pattern. The relationship between dietary patterns and hyperglycaemia risk was analysed using multivariable linear and Cox regression. SETTING: Seven communities from two urban districts in Nanjing, China. SUBJECTS: A total of 2900 of Chinese local residents aged 30 years or above, free of hyperglycaemia and other serious diseases, who participated in the baseline survey from June to September 2007 were followed up 3 years later from June to September 2010 for the development of hyperglycaemia. Fasting blood samples were collected at both baseline and 3-year follow-up surveys. Hyperglycaemia was defined as fasting plasma glucose concentration of ≥6·1 mmol/l or already taking oral hyperglycaemia agents for treatment of type 2 diabetes. RESULTS: Five major dietary patterns were identified: (i) the 'condiments' pattern; (ii) the 'animal and plant protein' pattern; (iii) the 'healthy traditional' pattern; (iv) the 'fruits, eggs and juice' pattern; and (v) the 'alcohol, milk and tea' pattern. A total of 2093 (72·2 %) individuals completed the follow-up survey and the 3-year cumulative incidence of hyperglycaemia was 7·5 % (158/2093). A 1-unit increase in the score for the 'healthy traditional' pattern was associated with a decrease of 0·054 mmol/l in fasting plasma glucose (P=0·017), while a 1-unit increase in the 'fruits, eggs and juice' pattern score was associated with an increase of 0·050 mmol/l in fasting plasma glucose (P=0·023) by multivariable linear regression. For men, tertile 3 of the 'fruits, eggs and juice' pattern was associated with an 88 % greater risk (hazard ratio=1·88; 95 % CI 1·04, 3·54) of hyperglycaemia than tertile 1 of this pattern. Being in tertile 3 of the 'alcohol, milk and tea' pattern was associated with a 35 % greater risk (hazard ratio=1·35; 95 % CI 1·04, 2·16) relative to tertile 1 in women, while for the ''healthy traditional' pattern tertile 3 was associated with a 41 % lower risk (hazard ratio=0·59; 95 % CI 0·35, 0·99) compared with tertile 1. The 'condiments' and the 'animal and plant protein' patterns were not independently associated with hyperglycaemia. CONCLUSIONS: Our findings suggest that modifying dietary patterns could reduce hyperglycaemia incidence in the mainland Chinese adult population.

[Study on the prevalence of depressive symptom and the association of parental occupational status with depression among high school students in Nanjing].

OBJECTIVE: To learn the prevalence of depressive symptom and to analyze the relationship between parental occupational status and depression among high school students in Nanjing. METHODS: With a stratified cluster random sampling method, the baseline survey was conducted in 2202 high school students chosen 53 classes from 5 schools (3 junior high schools and 2 senior high schools) in baixia district chosen from 6 urban districts in 2009. The same samples were followed up in 2010 and 2011. Depressive symptoms were assessed using Zung Self-rating Depression Scale (SDS). Parental occupational status was categorized into four groups, both employed, father unemployed, mother unemployed, and both unemployed. The total number of respondents was of 2160 in the baseline survey, with a response rate of 98.1%, in which 2118 (98.1%) and 2032 (94.1%) were followed up in 2010 and 2011, respectively. RESULTS: There was no significant difference in the positive rate of depressive symptom in the baseline and consecutive 2-year follow-up surveys (P = 0.108), while the proportions of moderate and severe depression were most highest in 2011 (P = 0.002). SDS index score and the positive rate of depression were most highest in students with parents both unemployed. Multivariate logistic analysis indicated that parental occupational status was significantly linked to depressive symptoms among students. The regression coefficients of generalized estimating equation (GEE) were statistically significant between parental occupational status and depression. CONCLUSION: Depressive symptoms is a common in high school student in Nanjing. Parental occupational status may be associated to depressive symptoms and much attention should be paid by health officers and instructive staff.

[Relationship between dietary pattern and excess body weight among urban residents: a three-year follow-up study in Nanjing].

OBJECTIVE: To examine the relationship between the duration of diet and the risk related to excess body weight in residents of Nanjing city. METHODS: With multi-stage cluster random sampling method, a total number of 3376 local residents aged 30 and over in 7 communities from 2 urban districts were involved in this survey. Through diet balance index (DBI), nine dietary patterns were identified. Subjects with normal BMI in the baseline survey were selected to participate in the follow-up survey. Multiple linear regression and multivariate logistic regression analysis were used to estimate the incidence risks on overweight and obesity. RESULTS: Of 1898 eligible subjects with normal BMI in the baseline survey, 1347 of them completed the 3-year follow-up survey, with a follow-up rate of 71.0%. By multiple linear regression method, on average, an increase in DBI_DQD of 1 unit was seen and associated with a 0.028 increase in BMI. DBI_DQD were also associated with BMI (ß = 0.022, P < 0.001) after adjusted for the covariates. By logistic regression, when compared with the group of healthy dietary pattern, the relative risk for excessive body weight was 1.37 for those with unhealthy dietary patterns. After adjusting the possible confounding factors, the excessive body weight was also associated with significantly increased risk (RR = 1.51, 95%CI: 1.09 - 2.09). CONCLUSION: Results from this study provided evidence, showing that unhealthy dietary patterns could predict the increase risk of excessive body weight, suggesting that healthy dietary pattern was important in controlling the excessive body weight.

[Dietary patterns and hyperglycemia in a follow-up study in Nanjing city].

OBJECTIVE: To investigate the association between dietary patterns and the risk of developing hyperglycemia in Nanjing. METHODS: Using multi-stage stratified random cluster sampling, the baseline survey was conducted on local residents older than 30 years in 7 communities from 2 urban districts from June to September 2007 in Nanjing. The total eligible subjects were 3376. Excluding the 476 previously diagnosed hyperglycemia patients, 2900 non-hyperglycemia subjects were used as the baseline sample for the follow-up survey from June to September 2010. Using specially designed food frequency questionnaire (FFQ), factor analysis was applied to identify food patterns. Multivariable linear and Cox regression models were used to analyze the association between different dietary patterns and risk of hyperglycemia. RESULTS: The follow-up rate was 72.2%, with 2093 subjects participated the follow-up survey in 3 years. Three-year cumulative incidence of hyperglycemia was 7.5% (158/2093). The incidence rate was 7.1% (62/873) for males and 7.9% (96/1220) for females, but the differences were not statistically significant (χ(2) = 0.43, P = 0.513). Five dietary patterns were identified by factor analysis: condiment, animal and plant protein, traditional healthy, sweet food and alcohol drinking. By multivariable linear regression, on average, an increase in traditional healthy pattern and sweet food pattern of 1 unit was associated with a -0.054, 0.050 mmol/L increase in fasting blood glucose, respectively, and the differences were both statistically significant (t = -2.38, 2.27, respectively, P values were both less than 0.05). By multivariable Cox regression, the pattern sweet food was positively significantly associated with hyperglycemia risk in men. The incidence of hyperglycemia was 4.7% (14/295) for the lowest tertile of the factor score (T1), and 9.7% (26/269) for the highest tertile of the factor score (T3) (T3:T1: RR = 1.88, 95%CI: 1.04 - 3.54). The pattern traditional healthy was inversely associated with hyperglycemia risk in women. The incidence of hyperglycemia was 10.7% (45/421) for T1 and 6.3% (21/335) for T3 (T3:T1: RR = 0.59, 95% CI: 0.35 - 0.99). Conversely, a statistically significant positively association was observed for the pattern alcohol drinking in women. The incidence of hyperglycemia was 8.1% (38/472) for T1 and 11.1% (33/297) for T3 (T3:T1: RR = 1.35, 95%CI: 0.84 - 2.16). CONCLUSION: Dietary patterns are associated with hyperglycemia. The sweet food pattern is a risk factor for hyperglycemia in men. In women, healthy dietary pattern is healthy and the alcohol drinking pattern is a risk factor for hyperglycemia.

Comparison of anthropometric indices of obesity in predicting subsequent risk of hyperglycemia among Chinese men and women in Mainland China.

BACKGROUND: Obesity is a strong risk factor for hyperglycemia. However, the performance of waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), waist circumference (WC) and body mass index (BMI) in predicting hyperglycemia was inconclusive; and ethnic differences may exist in the associations. OBJECTIVE: The objective was to compare WHtR, WC, WHR and BMI in predicting hyperglycemia among Chinese adults and identify optimal cut-off points. DESIGN: A community-based prospective cohort study was conducted during 2004-2007 in Nanjing China. WHtR, WC, WHR, BMI, fasting capillary blood glucose, covariates and potential confounders were assessed at baseline and third year of follow-up. RESULTS: The overall cumulative incidence of hyperglycemia was 8.6% (8.0% in men, 9.0% in women). Relative risks across quartiles of WHtR, WHR, WC and BMI were 1.00, 1.33, 1.67, 3.40; 1.00, 2.38, 2.53, 3.87; 1.00, 1.29, 1.75, 2.90; and 1.00, 1.45, 1.49, 2.41 in men, and 1.00, 1.24, 1.99, 2.87; 1.00, 1.14, 2.28, 2.66; 1.00, 1.32, 1.80, 3.14; and 1.00, 1.39, 1.50, 2.08 in women, respectively. p for trend was <0.01 for each marker and gender. Adjustment for potential confounders did not change such dose-response relationships materially. ROC analysis indicated that WHtR had the best sum of sensitivity and specificity compared to the other measures .Optimal cut-offs for WHtR, WHR, WC and BMI were 0.51, 0.92, 85 and 24 for men, while 0.55, 0.86, 82 and 25 for women, respectively. CONCLUSION: WHtR, WHR, WC and BMI were positively associated with subsequent hyperglycemia. WHtR and WC best predicted hyperglycemia among Chinese adults.

Associations of residential density with adolescents' physical activity in a rapidly urbanizing area of Mainland China.

In the context of recent social and economic transitions in China, lack of physical activity among adolescents is an emerging health risk, particularly so in rapidly expanding urban areas. Evidence from Western countries suggests that built environment attributes can influence the physical activity participation of young people, but whether or not this is the case for China is unknown. We recruited high school students from ten urban districts in Nanjing, Mainland China (n = 2,375; mean age = 13.9 +/- 1.0 years old; 46% boys; survey response rate = 89%). The outcome variable was self-reported recreational physical activity time; the primary explanatory variable was the residential density of the urban districts. Analysis was conducted using mixed-effects logistic regression models. After adjustment for potential confounding variables, including sedentary behavior and green space, there was a consistent and graduated association between residential density and physical activity; residential density was significantly negatively associated with recreational physical activity time for students from the higher tertile of residential density (OR; 95% CI = 0.64; 0.42 to 0.97) compared to those from the lower tertile. The direction and magnitude of the negative association between residential density and physical activity was similar for boys and girls. It should be a public health priority to identify the particular urban environment attributes that can encourage and support young people's participation in physical activity.

Residential density and adolescent overweight in a rapidly urbanising region of Mainland China.

OBJECTIVE: This study investigated the association of residential density with overweight among adolescents in an urban area of China. METHODS: Using multistage proportional sampling methods, a population-based cross-sectional study was conducted in Nanjing between September and November 2004 (n=2375; mean age=13.9 ± 1.0 years old; 46.2% boys; survey response rate=89.3%). Body mass index was calculated from self-reported body weight and height. Overweight, the main outcome variable, was defined as a BMI ≥85 percentile value for age- and gender-specific reference data according to the recommendation for Chinese adolescents. The primary explanatory variable was the residential density of the urban districts. Mixed-effects logistic regression models were used for the analysis. RESULTS: Students in the higher and middle tertiles of residential density had a 2.17-fold (95% CI 1.41 to 3.33) and 1.89-fold (95% CI 1.22 to 2.92) higher likelihood of being overweight, respectively, compared with those in the lower tertile. The associations were slightly attenuated but still significant after adjusting for time spent in recreational physical activity and sedentary behaviour (viewing TV and sitting for academic study). CONCLUSIONS: Residential density was positively associated with overweight among urban Chinese adolescents. Our findings warrant further research examining attributes of urban environments associated with adolescents' obesity in China and potential mechanisms between them.

[The relationship between body mass index, waist circumference, waist-to-hip ratio, waist-to-height ratio and hyperglycemia: a three-year follow-up study in Nanjing].

OBJECTIVE: To explore whether the increase of body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) can predict a higher risk of developing hyperglycemia. METHODS: A population-based cross-sectional study was conducted on local residents above 35 years of age in three urban districts and one rural county in July 2004. The subjects who were non-hyperglycemia in the baseline survey were selected to follow the survey in July 2007. Multivariable logistic regression analysis and area under curve (AUC) of receiver-operating characteristics (ROC) were used to evaluate the predictive value of BMI, WC, WHR and WHtR. RESULTS: Of 3727 subjects without hyperglycemia who had completed in the baseline survey, 3031 of them participated in the follow-up survey, with a follow-up rate of 81.3%. The Three-year cumulative incidence of hyperglycemia was 6.7%, with male 6.3% and female 7.0%. By multiple linear regression, on average, an increase in BMI, WC, WHR, WHtR of 1 unit was associated with a 0.015 mmol/L, 0.023 mmol/L, 1.923 mmol/L, 2.382 mmol/L increase in fasting plasma glucose, respectively. The risk of developing hyperglycemia increased along with the increase of all the four indexes. When compared with other three indexes, the group which WHtR was more than 0.5, had the highest risk (male OR = 1.998, 95% CI: 1.231-3.212, female OR = 1.832, 95% CI: 1.157-2.902) of developing hyperglycemia. Data from ROC curve analysis showed that the AUC of WHtR was the highest in both males and females. CONCLUSION: The increase of BMI, WC, WHR and WHtR could predict the higher risk causing the development of hyperglycemia. WHtR might serve as a simple but most effective index of hyperglycemia.

Physical activity inversely associated with the presence of depression among urban adolescents in regional China.

BACKGROUND: An inverse relationship between physical activity (PA) and depression among adolescents has been reported in developed communities without consideration of sedentary behaviors (SB, including sitting for course study, viewing TV, and sleeping). We explored the association between recreational PA time (hr/wk) and depression after adjustment with SB and other possible confounders among Chinese adolescents. METHODS: A population-based cross-sectional study was conducted in Nanjing municipality of China in 2004 using a multi-stage cluster sampling approach. A total of 72 classes were randomly selected from 24 urban junior high schools and all students completed the structured questionnaire. Adolescent depression was examined by the Children's Depression Inventory (CDI) of Chinese version with cutoff point value of 20 or above as the presence of depression. Recreational PA time was measured by a question on weekly hours of PA outside of school. Descriptive statistics, multivariate logistic and linear regression models were used in analysis. RESULTS: The overall prevalence of depression was 15.7% (95%CI: 14.3%, 17.1%) among 2,444 eligible participants. It was found that physical activity was negatively associated with depression. After adjustment for sedentary behaviors and other potential confounders, participants who spent 1-7 hr/wk, 8-14 hr/wk and 15+ hr/wk for recreational PA, respectively, had odds ratios of 0.70 (95% CI = 0.57, 0.86), 0.68 (95% CI = 0.53, 0.88) and 0.66 (95% CI = 0.50, 0.87) for likelihood of being depressive, compared to their counterparts who spent 0-0.9 hr/wk for PA. This inverse relationship between PA time and depression remained statistically significant by gender and grade. CONCLUSION: This study, conducted among Chinese adolescents, strengthened the evidence that physical activity was inversely associated with depression. Our study has important implications for health officers and public health professionals to pay much attention to the relationship between physical activity and depression in Mainland China.

[A case-control study on depression and anxiety in hypertensive patients].

OBJECTIVE: To study the current situation of depression and anxiety from patients with hypertension as well as to provide reference for the development of control and prevention program. METHODS: Participants older than 35-year including both hypertensive patients and healthy controls were randomly selected in 2 communities of Pukou district in Nanjing through Health Behavior Survey. All the subjects were assessed by the Zung's self-rating depression scale (SDS) and the Zung's self-rating anxiety scale (SAS). RESULTS: Raw score and index score of SDS and SAS were both significantly (P < 0.01) greater in hypertensive patients than in healthy control group. The prevalence of depression of 17.9% and anxiety of 9.5% in patient group were found significantly higher than that in healthy control group as 11.5% and 4.3%. Data from logistic regression model analysis showed that depression and anxiety were possible risk factors of hypertension (OR = 1.677, 95% CI: 1.013-2.776; OR = 2.451, 95% CI: 1.228-4.894). There was a combined effect seen between depression and anxiety (OR = 5.238, 95% CI: 2.356-11.664) but interaction did not appear. CONCLUSION: Depression and anxiety were possibly associated with hypertension and more attention needs to be paid to the mental health situation of hypertensive patients in order to improve their quality of life.