Cardiovascular Disease Burden Attributable to High Sodium Intake in China: A Longitudinal Study from 1990 to 2019.

BACKGROUND: Overconsumption of sodium has been identified as a key driving factor for diet-related cardiovascular diseases (CVDs). China, being a country bearing a hefty burden of CVD, has a large population with diverse cultural traditions and ethnic beliefs, which complicates the patterns of dietary sodium intake, necessitating a systematic investigation into the profile of the high sodium intake (HSI)-related burden of CVD within its subregions. This study aims to estimate the evolving patterns of HSI-induced CVD burden across China from 1990 to 2019. METHODS: The methodology used in the Global Burden of Disease Study was followed to assess deaths and disability-adjusted life years (DALYs) by age, sex, region, and socio-demographic index (SDI). The estimated annual percentage change (EAPC) was calculated to quantify the secular changes in the age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR). RESULTS: In 2019, 0.79 million deaths and 1.93 million DALYs of CVD were attributed to HSI, an increase of 53.91% and 39.39% since 1990, respectively. Nevertheless, a downward trend in ASMR (EAPC: -1.45, 95% CI: -1.55, -1.35) and ASDR (EAPC: -1.61, 95% CI: -1.68, -1.53) was detected over time. ASMR and ASDR were higher for males, individuals aged ≥60 years, and regions with low-middle SDI. A markedly negative association between the EAPC in both ASMR and ASDR and the SDI was found in 2019 (ρ = -0.659, p < 0.001 and ρ = -0.558, p < 0.001, respectively). CONCLUSIONS: The HSI-induced CVD burden is gender-, age-, and socioeconomic-dependent. Integrated and targeted strategies for CVD prevention are anticipated in the future throughout China.

The Burden of Gastric Cancer Attributable to High Sodium Intake: A Longitudinal Study from 1990 to 2019 in China.

BACKGROUNDS: Excessive intake of sodium is a crucial risk factor of gastric cancer. However, it is still unclear whether the profile of gastric cancer burden is attributable to high sodium intake in China. This study aims to evaluate the levels and trends of gastric cancer burden attributable to high sodium intake across China from 1990 to 2019. METHODS: We acquired data from the GBD (Global Burden of Disease Study) 2019 via the Global Health Data Exchange query tool. The details of regions from 1 January 1990 to 31 December 2019 from the China National Center for Food Safety Risk Assessment were also used. We conducted an integrated analysis on the gastric cancer burden attributable to high sodium intake among Chinese residents. The gastric cancer-related deaths, disability-adjusted life years (DALYs), age-standardized mortality rate (ASMR), and age-standardized DALYs rate (ASDR), all being calculated to be attributable to sodium intake, were reckoned as separated by age, sex, SDI, and regions. Then, the estimated annual percentage change (EAPC) was regarded as the secular trends of gastric cancer's ASMR and ASDR due to high sodium intake from 1990 to 2019. We further explored the associations between SDI (Socio-demographic index) and the ASMR and ASDR. The rates were calculated per 100,000 population as age-standardized rates. RESULTS: Briefly, the number of gastric cancer-related deaths and DALYs being attributed to high sodium intake were 37,131.48 (95% UI: 833.14 to 138,478.72) and 873,813.19 (95% UI: 19,283.13 to 3,220,231.82) in 2019; both have increased by a third since 1990. However, the ASMR decreased with an EAPC of -1.72% (95% CI: -2.11% to -1.33%), while ASDR increased with an EAPC of 0.36% (95% CI: 0.08% to 0.68%), respectively. The age-specific numbers and rates of deaths, as well as DALYs of gastric cancer being attributed to high sodium intake, elevated gradually with age. And, they were higher in males than in females. The gastric cancer burden being attributed to high sodium intake in 2019 and its temporal trends from 1990 to 2019 varied greatly by SDI quintile and geographic locations. There was a strong negative association between the EAPC in ASMR and SDI in 2019 (ρ = -0.642, p < 0.001). The EAPC in ASDR and SDI also exhibited a negative connection in 2019 (ρ = -0.538, p = 0.0012). CONCLUSIONS: Overall, using a longitudinal sample from different regions, the study presented that gastric cancer burden attributed to high sodium intake still exists seriously and varies remarkably by regions, sex, and age across China. The disparity of socioeconomic status on disease burden also exists. Integrated and precise approaches for gastric cancer prevention are anticipated in the future.

[Comparative study on the essential composition content of commercial infant formula with the requirements in the new national food safety standard in China from 2017 to 2022].

OBJECTIVE: In order to understand the distribution of the essential nutrients content in commercial infant formula in China, and to compare its conformity with the new national standard(GB 10765-2021). METHODS: A total of 477 infant fomulas with production data from January 2017 to June 2022 were collected in China. Information in the product labels was recorded and the distribution of nutrient contents was analyzed, compare with the national food safety standard. RESULTS: Compared with GB 10765-2010, the new standard had 12 essential nutrients content revised, and 10 of which had lower limit values adjusted and 5 of which had upper limit values adjusted. Both the lower and upper limits were increased for three items, including vitamin D, choline and selenium. Compared with the newly revised 12 essential nutrients in the national food safety standard, the coincidence rate of 3 items was 100%, and the coincidence rate of 3 items was more than 80%. The coincidence rate of the actual content of essential nutrients in some products was low, the reason was that they did not meet the lower limit requirements of the new national standard, for example, the non-coincidence rate of vitamin D was as high as 99.79%. In addition, the national food safety standard adjusts choline from an selectable nutrient to an essential one, and the proportion of choline added to commercial products was 84.7%. CONCLUSION: The change of the content of essential nutrients in the new standard has little influence on the products sold in our country. There are a few essential nutrient in the products on the market that need to be adjusted to raise the nutrient level.

[Comparative study on the essential composition content of commercial follow-up formula for young children with the requirements in the new national food safety standard in China from 2017 to 2022].

OBJECTIVE: To understand the distribution of the essential composition content of commercial follow-up formula for young children in China, to analyze the differences with the new requirements of national food safety standard, and to promote the implementation of the new national standard(GB 10767-2021). METHODS: The label information on the total of 483 follow-up formula for young children permitted from January 2017 to June 2022 were collected and recorded, the distribution of essential compositions were analyzed and compared with the new national food safety standard. RESULTS: Compared with GB 10767-2010, 23 essential compositions were revised in the new national standard, 2 new essential compositions, α-linolenic acid and carbohydrates, were required, and 8 minimum requirements and 4 maximum requirements were revised, 16 new maximum requirements were developed. The whole change of the new standard was major. Comparing with GB 10767-2021, there were 8 essential compositions in commercial products with 100% compliance rate and 9 with more than 95% compliance rate, the discordance rate of pantothenic acid, folic acid, vitamin C and Vitamin D was more than 20%, Vitamin D has the highest discordance rate 97.10%. CONCLUSION: Although the revision of the essential composition requirements in the new national standard is major, the compliance rate of almost essential compositions is high. A few of individual essential compositions in some commercial products cannot meet the new standards requirements, the main reason is those can not reach the increased new minimum requirements, especially on vitamin D.

Machine-learning prediction of BMI change among doctors and nurses in North China during the COVID-19 pandemic.

Objective: The COVID-19 pandemic has become a major public health concern over the past 3 years, leading to adverse effects on front-line healthcare workers. This study aimed to develop a Body Mass Index (BMI) change prediction model among doctors and nurses in North China during the COVID-19 pandemic, and further identified the predicting effects of lifestyles, sleep quality, work-related conditions, and personality traits on BMI change. Methods: The present study was a cross-sectional study conducted in North China, during May-August 2022. A total of 5,400 doctors and nurses were randomly recruited from 39 COVID-19 designated hospitals and 5,271 participants provided valid responses. Participants' data related to social-demographics, dietary behavior, lifestyle, sleep, personality, and work-related conflicts were collected with questionnaires. Deep Neural Network (DNN) was applied to develop a BMI change prediction model among doctors and nurses during the COVID-19 pandemic. Results: Of participants, only 2,216 (42.0%) individuals kept a stable BMI. Results showed that personality traits, dietary behaviors, lifestyles, sleep quality, burnout, and work-related conditions had effects on the BMI change among doctors and nurses. The prediction model for BMI change was developed with a 33-26-20-1 network framework. The DNN model achieved high prediction efficacy, and values of R 2, MAE, MSE, and RMSE for the model were 0.940, 0.027, 0.002, and 0.038, respectively. Among doctors and nurses, the top five predictors in the BMI change prediction model were unbalanced nutritional diet, poor sleep quality, work-family conflict, lack of exercise, and soft drinks consumption. Conclusion: During the COVID-19 pandemic, BMI change was highly prevalent among doctors and nurses in North China. Machine learning models can provide an automated identification mechanism for the prediction of BMI change. Personality traits, dietary behaviors, lifestyles, sleep quality, burnout, and work-related conditions have contributed to the BMI change prediction. Integrated treatment measures should be taken in the management of weight and BMI by policymakers, hospital administrators, and healthcare workers.

Consumption of aquatic products and meats in Chinese residents: A nationwide survey.

Objective: To provide the most recent national estimates for the consumption of aquatic products and meats among Chinese residents. Methods: This study was conducted in 14 provinces of China, using a multi-stage stratified random cluster sampling method and a population-proportional sampling procedure. Aquatic products and meats consumption was measured by a 3-day, 24-h dietary recall. Chinese residents aged 3 years and above (n = 24,106) completed a face-to-face dietary interview. Results: The average daily consumption of meat and aquatic products for the all-aged population was 70.9 g and 48.0 g, respectively, which aligned with Dietary Guidelines (40-75 g/d) for Chinese Residents (2016). On the one hand, intake of aquatic products among Chinese people was relatively insufficient, especially for adolescents and elder people (<40 g/d). On the other hand, males, mainly aged 19-60, generally consumed too much meat (>80 g/d), and 19-44 grouping consumed more than 70 g/d of red meat. Besides, urban residents and individuals with higher socioeconomic status (SES) have exhibited comprehensively healthy dietary preferences than rural ones and those with a lower SES do. Women and the higher SES group tend to be closer to the dietary guidelines for the Chinese. Conclusions: The consumption of meat and aquatic products varied with age, gender, region and SES. Detecting patterns in consumption is particularly relevant for policy makers, researchers and health professionals in the formulation of dietary recommendations and estimating potential health outcomes.

Trans fatty acid intake among Chinese population: a longitudinal study from 1991 to 2011.

OBJECTIVE: This study was aimed to roughly describe individual Trans Fatty Acids (TFAs) intake and the percentage of energy intake(E%), and identify major food sources in the Chinese population, taking gender, age, and regional distribution into the consideration, as well as examining temporal changes over the course of 20 years. METHOD: This multi-center study, covering nine provinces among populations aged ≥ 3 in China, was conducted to collect food consumption information from 1991 to 2011. A classical assessment method was used to estimate the level of dietary TFA intake. RESULTS: Over the 20-year period, the intake of TFAs in Chinese populations had increased, but remained at a relatively lower level (from 0.25 g/d(0.11% for E%) to 0.53 g/d(0.24% for E%)) compared with that of other countries and the World Health Organization (WHO) recommended level. Collectively, males and participants aged 19-60 generally consumed more TFA-containing foods. People in eastern regions consumed more TFAs and had a higher E% than those in western area. Industrial sources of TFAs, especially vegetable oil, ranked as the principal food sources of TFAs in the Chinese population. Natural sources of TFAs have gradually increased in proportion among children and adolescents. CONCLUSIONS: TFA intake and the E% are commonly under the recommended level in the general population in China. Presently, restriction of vegetable oil could be a crucial method to reduce TFA intake. It would be critical to facilitate and promote public health that food recommendations might be based on the dietary preferences for population separated by different ages and regions.

Di-(2-ethylhexyl)-phthalate induces apoptosis via the PPARγ/PTEN/AKT pathway in differentiated human embryonic stem cells.

[OBJECTIVE]: Di(2-ethylhexyl) phthalate (DEHP), a widely used plasticizer, may act as an endocrine disruptor and cause developmental toxicity. Differentiated human embryonic stem cells (hESCs) were used to investigate the underlying mechanism of the embryotoxicity induced by DEHP. [Materials and Methods] H9-hESCs were treated with DEHP at different concentrations for 10 days, and the cytotoxicity of DEHP on cell proliferation was determined using a cell-microelectronic sensing technique (Real-Time Cellular Analysis: RTCA). Based on the 50% inhibitory proliferation concentration (IC50), differentiated H9-hESCs were treated with DEHP at 0, 50, 100, and 200 µg/ml for 120 h, followed by measurement of its toxic effects on the transcriptome by mRNA microarray and QuantiGene Plex (QGP). Proteins were detected by the iTRAQ-based proteomics method and the proteins related to the PPARγ/PTEN/Akt pathways were measured by western blotting. The progression of the cell cycle and apoptosis were characterized using flow cytometry (FCM). In other experiments, hESCs were pre-treated with GW9662 (20 µM), a specific PPARγ inhibitor, for 30 min, followed by exposure to GW9662 (20 µM) and DEHP (200 µg/ml) for 120 h to observe the underlying mechanism of DEHP's embryotoxicity. [RESULTS]: DEHP inhibited H9-hESC cell proliferation in a dose-dependent manner, with an IC50 of 165.78 µg/ml. FCM results showed that DEHP could markedly induce cell cycle arrest and increase apoptosis. Gene microarray and QPG array analyses indicated that the peroxisome proliferator-activated receptor γ (PPARγ) was an apparent target for DEHP. We further demonstrated that DEHP could activate the PPARγ and upregulate the expression of PTEN downstream genes, and then play a negative role in the AKT signaling pathway. Cells pretreated with PPARγ inhibitor, GW9662, were shown to restore the effect of DEHP on the PPARγ/PTEN/AKT signaling pathway, and induce the recovery of cell cycle arrest and apoptosis. [CONCLUSION]: DEHP inhibited cell proliferation, promoted cell cycle arrest, and induced apoptosis through the PPARγ/PTEN/AKT signaling pathway in differentiated human embryonic stem cells. It suggested that DEHP exposure possibly cause reproductive or developmental toxicity in humans through the PPARγ signaling pathway.

[Dietary intake and risk assessment of diisononyl phthalate (DINP) in Chinese population].

OBJECTIVE: To study DINP concentration level in the main food, evaluate DINP dietary intake level in Chinese population and its potential health risks. METHODS: Based on the deterministic assessment model, using concentration level of 25 kinds of food in 2011 - 2013 and Chinese national nutrition and health survey data in 2002, to calculate dietary intake of DINP in Chinese population. RESULTS: The average DINP concentration level in 24 kinds of foods was 0. 24 mg/kg, and the maximum value was 9. 55 mg/kg. In whole population, average dietary intake of DINP was 4. 39 µg/kg bw per day, only 2. 93% of TDI. The dietary intake of DINP in children aged 2 to 6 years old was highest, with an average of 8. 91 µg/kg bw per day, 5. 94% of the TDI. The dietary intake of DINP in children aged 7 to 12 years old was lower than 2 to 6 years old children, with an average of 6.53 µg/kg bw per day, 4. 35% of TDI. The dietary intake of DINP in high consumer(P97. 5) in all population was 8. 35 µg/kg bw per day, 5. 57% of the TDI. The range of dietary intake of DINP in high consumer (P97. 5) in each group (grouping by gender and age) was from 13. 84 to 5.44 µg/kg bw per day, which were all lower than the TDI. CONCLUSION: The dietary intake of DINP in different populations is considerably below the TDI and any health risk that would be expected to occur at this intake level is negligible.

[Assessment of dietary iodine intake of population in non-high-iodine areas in China].

OBJECTIVE: To assess the potential risk of dietary iodine insufficiency of population in non-high-iodine areas (water iodine < 150 microg/L) in China. METHOD: The dietary iodine intake of 13 age-sex population groups were estimated by combining the data of iodine intake from food, table salt and drinking water. Two conditions were considered: consuming iodized salt or non-iodized salt. The data of food and table salt consumption were derived from the Chinese National Nutrition and Health Survey in 2002. Water consumption was calculated as the recommended water intake. Iodine contents of food, table salt and water were calculated from China Food Composition Table and iodine surveillance data. RESULTS: Under the condition of consuming iodized salt, the average iodine intake of all population groups was higher than the Recommended Nutrient Intake (RNI), while the iodine intakes of individuals above Upper Limits (UL) and below RNI were 5.8% and 13.4% respectively, and the iodine intake of individuals lower than the Estimated Average Requirement (EAR) was 9.4% in adults above 18 years of age (including pregnant and lactating women). If non-iodized salt was consumed, the average iodine intake of most sex-age population groups was higher than RNI, but the iodine intake of 97.6% of individuals would be lower than RNI, while the iodine intake of 97.4% of adults would be lower than EAR. The contribution of iodine from table salt was much higher than that from drinking water and food in the condition of consuming iodized salt, while food was the predominant contributor of dietary iodine in the condition of consuming non-iodized salt. CONCLUSION: The health risk of iodine deficiency was higher than that of iodine excess in areas where water iodine was < 150 p.g/L in China, and the risk of iodine insufficiency was much higher if non-iodized salt was consumed. Iodized salt should be the main sources of dietary iodine intake for population in areas where water iodine was < 150 microg/L in China.