[Relationship between the percentage of energy intake from macronutrients and obesity among adult residents in 15 provinces of China in 1991-2018].

OBJECTIVE: To explore the relationship between the percentage of energy intake from macronutrients and obesity in Chinese adult residents, and analyze the cut-off values of macronutrients for predicting obesity. METHODS: Data was collected in China Health and Nutrition Survey(CHNS)in 1991-2018. Adults who participated in at least two waves of the surveys and were not obese at baseline were selected as the study subjects. Obesity was defined as body mass index(BMI)≥28.0 kg/m~2. Generalized estimating equation was used to analyze the relationship between the percentage of energy intake from macronutrients and BMI and obesity, and receiver operating characteristic curve(ROC) was used to analyze the cut-off values of percentage of energy intake from macronutrients to predict obesity. RESULTS: The percentage of energy intake from protein and fat of adult residents in 15 provinces(autonomous regions and municipalities) in China showed an increasing trend(P<0.01), and the percentage of energy intake from carbohydrate showed a decreasing trend(P<0.01) between 1991 and 2018. After adjusting for covariates, the group of percentage of energy intake from fat in 20%～30%(ß=0.05, 95%CI 0.01-0.08)and ≥30%(ß=0.15, 95%CI 0.11-0.18)were positively correlated with BMI compared with the group of percentage of energy intake from fat <20%, and the risk of obesity in 20%-30% and ≥ 30% was increased by 17%(OR=1.17, 95%CI 1.04-1.31)and 6%(OR=1.06, 95%CI 1.24-1.56), respectively. Compared with the group of the percentage of energy intake from carbohydrate < 50%, the group of 50% to 65%(ß=-0.08, 95% CI-0.11--0.05) and ≥ 65%(ß=-0.17, 95%CI-0.20--0.13) was negatively correlated with BMI, and the percentage of energy intake from carbohydrate ≥ 65% reduced the risk of obesity(OR=0.71, 95%CI 0.63-0.80). CONCLUSION: Carbohydrate intake was inversely correlated with the risk of obesity, and fat intake was positively correlated with the risk of obesity. Moderate intake of carbohydrates and reduced fat intake can prevent obesity.

Diet Mediate the Impact of Host Habitat on Gut Microbiome and Influence Clinical Indexes by Modulating Gut Microbes and Serum Metabolites.

The impact of external factors on the human gut microbiota and how gut microbes contribute to human health is an intriguing question. Here, the gut microbiome of 3,224 individuals (496 with serum metabolome) with 109 variables is studied. Multiple analyses reveal that geographic factors explain the greatest variance of the gut microbiome and the similarity of individuals' gut microbiome is negatively correlated with their geographic distance. Main food components are the most important factors that mediate the impact of host habitats on the gut microbiome. Diet and gut microbes collaboratively contribute to the variation of serum metabolites, and correlate to the increase or decrease of certain clinical indexes. Specifically, systolic blood pressure is lowered by vegetable oil through increasing the abundance of Blautia and reducing the serum level of 1-palmitoyl-2-palmitoleoyl-GPC (16:0/16:1), but it is reduced by fruit intake through increasing the serum level of Blautia improved threonate. Besides, aging-related clinical indexes are also closely correlated with the variation of gut microbes and serum metabolites. In this study, the linkages of geographic locations, diet, the gut microbiome, serum metabolites, and physiological indexes in a Chinese population are characterized. It is proved again that gut microbes and their metabolites are important media for external factors to affect human health.

[Designing effective front-of-package warning labels for prepackaged food in China:based on Delphi method].

OBJECTIVE: To design front-of-package warning labels for prepackaged food adapted to the Chinese context. METHODS: Delphi method was used to evaluate the first graft of indicatorsof the front-of-package warning labels. The front-of-package warning labels suitable for China's national conditions was selected according to the direct scoring method. RESULTS: 4 sets of front-of-package warning labels for prepackaged food were selected after two rounds of Delphi expert method. CONCLUSION: The final draft of the front-of-package warning labels for prepackaged food is in line with expectations.

[Evaluation of the front-of-package warning labels of prepackaged food in China based on focus group discussion].

OBJECTIVE: To understand the public's perceptions and preferences on the designed front-of-package warning labels of prepackaged food, and to evaluate and identify the effective warning label. METHODS: A total of 116 participants were recruited from six provinces(autonomous regions/municipalities) in China. Focus group discussions were conducted with four types of warning labels on prepackaged food. And the score of attitude on different warning labels were compared. RESULTS: There was no difference in the total score of the four warning labels. Total score of black shield label was higher in citizen participants and college education level participants than in their respective counterparts(P<0.05). Parents or primary caregiver of children under 16 years old gave higher scores to each labels than their respective counterparts(P<0.05). The black shield label was most likely to attract the attention of the respondents, most likely to influence the decision on eating and drinking, and most likely to have an unhealthy warning effect. The yellow hexagonal label was least likely to attract the attention of the respondents, least likely to affect the decision to eat and drink food, and least likely to have an unhealthy warning effect. CONCLUSION: Black shield warning label is the most effective.

[Relationship between physical activity and muscle mass loss among people aged 60 and above in 15 provinces of China in 2015].

OBJECTIVE: To analyze the relationship between physical activity and muscle mass loss among Chinese elderly aged 60 years and above in 15 provinces. METHODS: Data was collected from 2015 China Nutritional Transition Cohort Study. Information on demographic characteristics and physical activity was investigated by questionnaire. Dietary intake was estimated from three consecutive 24-h recalls for each individual. Appendicular skeletal muscle mass(ASM) was assessed using the bioelectrical impedance analysis(BIA). Skeletal muscle mass(SMI) loss was diagnosed according Asian working group of sarcopenia(AWGS) 2019 recommendation(male: SMI <7.0 kg/m~2, female: <5.7 kg/m~2). A total of 4565 participants aged 60 years and above from 15 provinces in China with complete information were included in the final analysis. Different domains(occupational, domestic, travel and leisure), light physical activity(<3.0 METs), moderate physical activity(3.0-5.9 METs) and vigorous physical activity(≥6.0 METs) of physical activity among elderly adults were evaluated. Logistic multilevel model was used to analyze the relationship between low muscle mass and different intensity of physical activity duration. RESULTS: Among all participants aged 60 years and above in 15 provinces of China in 2015, women's participation rate in domestic physical activity was 91.7%, which was higher than men's rate of 62.3%. However, men's participation rate in occupational, travel and leisure physical activity were higher than those of women. The participation rate, duration of light physical activity and moderate physical activity were higher in women than in men(light physical activity: female duration 11.0 h/week vs. male duration 3.5 h/week; female participation rate 89.9% vs. male participation rate 62.8%; moderate physical activity: female duration 7.0 h/week vs. male duration 4.7 h/week; female participation rate 90.6% vs. male participation rate 75.2%). The median vigorous physical activity was 0 h/week in both male and female group. The prevalence of muscle mass loss was 13.9% among subjects. The median weekly light physical activity and moderate physical activity in muscle mass loss group were 5.8 h and 4.7 h, which were lower than in non-muscle mass loss group(9.3 h and 6.0 h). The OR of muscle mass lass was 0.71(95%CI 0.42-0.98, P<0.05) for the male with 3.5-6.9 hours of moderate physical activity per week, compared to moderate physical activity less than 3.5 h/week. And OR of the female was 0.67(95%CI 0.47-0.95, P<0.05). CONCLUSION: The vast majority of physical activity in China among the elderly is domestic and light physical activity. Light physical activity and moderate physical activity duration increments in female and moderate physical activity duration increments in male were associated with decreased risk of muscle mass loss.

The Mediation and Moderation Effect Association among Physical Activity, Body-Fat Percentage, Blood Pressure, and Serum Lipids among Chinese Adults: Findings from the China Health and Nutrition Surveys in 2015.

Physical activity (PA) is of benefit and particularly important for cardiovascular disease risk factors as being sedentary becomes a lifestyle habit. Research into Chinese complex association among physical activity, body-fat percentage (BF%), blood pressure, and serum lipids is limited. The present study is based on an observational study among adults (>18 years old) residing in fifteen provinces in China. Data of 10,148 adult participants in the 2015 China Health and Nutrition Survey (CHNS) were analyzed. The simple mediation effect models with covariates were utilized to assess the association among PA and blood pressure or serum lipids, and BF% was played as a mediator. The serial multiple-mediator models with covariates were constructed to the further analysis of the relationship between PA and blood pressure, and BF% was the mediator 1 and blood lipids were the mediator 2. Based on the above hypothesis, the moderated mediation models with covariates were used to analyze the association among PA, BF%, and blood pressure; in addition, BF% was used as the mediator and blood lipids played as the moderator. In the simple mediation models, the model with a dependent variable was high-density lipoprotein cholesterol (HDL-C) or low-density lipoprotein cholesterol (LDL-C); BF% was played as the partly mediation effect and the proportion of contribution was 0.23 and 0.25, respectively. In the serial multiple-mediator models, blood lipids, as the second mediator, played the mediation effect; however, the effect was smaller than the BF%. In the moderated mediation model, blood lipids had the moderation effect as the moderator variable. HDL-C played a moderating role in the latter pathway of the "PA→BF%→SBP/DBP" mediation model, and LDL-C/TC played a moderating role in the direct effect of the "PA→BF%→DBP". In conclusion, BF% played a mediating role in the relationship between PA and blood pressure. HDL-C, LDL-C, and TC were more likely to act as moderating variables in the mediation model "PA→BF%→SBP/DBP". PA could directly and indirectly benefit to control the CVD risk factors simultaneously.

[Development and validation of the nutrient-rich food index for China].

OBJECTIVE: To select the nutrient-rich food(NRF) index applicable to the food characteristics of Chinese residents through population-based dietary quality validation. METHODS: Sixteen NRF indices were constructed based on the Chinese Food Composition Table and the Chinese Food Labelling Nutrient Reference Values, using 100 g as the base amount of food for calculation. The NRF indices were validated by the China Prime Diet Quality Score(CPDQS), a dietary quality assessment index, using food intake data collected from 14 068 adult residents in 15 provinces in 2018 under the China Health and Nutrition Survey. The CPDQS was used as the dependent variable and the dietary NRF index score was used as the independent variable. The multiple linear regression models were performed after adjusting the covariates and the NRF index with the largest coefficient of determination R~2 was used as the most appropriate index. RESULTS: Regression analysis showed that the R~2 of NRF8.2 index was the largest, which was 0.16. Dried legumes, fungi and algae, nuts, vegetables, eggs and aquatic products scored higher on the NRF8.2 index. The high scoring subgroups had higher average daily intakes of cereals and potatoes, vegetables, fruits, soybeans and nuts, dairy, eggs and aquatic products, as well as lower consumption of livestock and poultry meat, beverages, salt and cooking oil, compared to the low scoring subgroup on the Dietary NRF8.2 Index. In terms of nutrient intake, the medium and high NRF8.2 subgroups had relatively high intakes of energy, protein, vitamins and minerals and relatively low intakes of fat and sodium. CONCLUSION: The NRF8.2 index explains the maximum variation in CPDQS and is a relatively suitable NRF index for the Chinese population.

Spatial Distribution and Temporal Trends of Dietary Niacin Intake in Chinese Residents ≥ 5 Years of Age between 1991 and 2018.

Limited knowledge exists on trends in niacin consumption and the prevalence of inadequate intakes in China. Understanding trends and the spatial distribution of the prevalence of inadequate niacin intake is crucial to identifying high-risk areas and sub-populations. The dietary intakes of niacin between 1991 and 2018 were analyzed using the China Health and Nutrition Survey (CHNS) data. The estimated average requirement cut point was applied to estimate inadequacy. The geographic information system's ordinary kriging method was used to estimate the spatial distribution of the prevalence of inadequate niacin intakes. However, between 1991 and 2018, the prevalence of inadequate niacin intake increased from 13.00% to 28.40% in females and from 17.75% to 29.46% in males. Additionally, the geographically significant clusters of high and low prevalence were identified and remained stable over almost three decades. The high prevalence of insufficient niacin intake was more pronounced in Henan and Shandong over 27 years. Further, effective and tailored nutrition interventions are required to address inadequate niacin intake in China.

Multiple Trajectories of Body Mass Index and Waist Circumference and Their Associations with Hypertension and Blood Pressure in Chinese Adults from 1991 to 2018: A Prospective Study.

Body mass index (BMI) and waist circumference (WC) have been suggested to be involved in the etiology of hypertension. The present study aimed to determine multiple trajectories of BMI and WC, then examined their associations with the risks of hypertension and high blood pressure in Chinese adults. The study used China Health and Nutrition Survey data from 1991 to 2018. The sample included 9651 adults aged 18 years or older. We used group-based multi-trajectory modeling to identify trajectories. We estimated the relationships between the trajectories and the risks of hypertension with a Cox proportional hazards regression model and the trajectories' relationships with blood pressure levels with a generalized linear model. We identified four trajectories for each gender: low stable BMI, low increasing WC (group 1); medium increasing BMI, medium increasing WC (group 2); increasing BMI to overweight, increasing WC to central obesity (group 3), increasing BMI to obesity, increasing central obesity WC (group 4). Group 1 was the reference group. Among males in groups 2, 3, and 4, the adjusted hazard ratios (HR) and 95% confidence intervals (95% CI) of hypertension were 1.30 (1.15-1.48), 1.86 (1.58-2.18), and 2.60 (2.02-3.34), respectively. The systolic blood pressure (SBP) and diastolic blood pressure (DBP) of males in group 4 increased by 11.90 mm of mercury (mmHg) and 7.75 mmHg, respectively. Among females in groups 2, 3, and 4, the HR and 95% CI of hypertension were 1.35 (1.18-1.54), 1.92 (1.62-2.26), and 2.37 (1.85-3.03), respectively. The SBP and DBP of females in group 4 increased by 8.84 mmHg and 5.79 mmHg, respectively. These data indicated that increases in BMI and WC were associated with unfavorable hypertension risks. Attention to both BMI and WC trajectories has the potential to prevent hypertension.

Consumers' Perceptions of the Design of Front-of-Package Warning Labels-A Qualitative Study in China.

The warning label is identified as a simple front-of-package labeling format that assists consumers in making healthier food choices at the point of purchase. The color and/or shape of the design elements of the packaging labels can influence the understanding and purchase intention outcomes. This study aimed to explore the perceptions of consumers regarding differently designed warning labels (WLs) to identify a possibly suitable warning label design in the Chinese context. Using a qualitative approach, we collected data through 12 focus group discussions consisting of 116 participants residing in 6 provinces. Participants were selected by purposive sampling. Data were coded following inductive thematic analysis and summarized into three themes: (1) perceived preference for the appearance of the WLs, (2) perceived benefits of the WLs, and (3) suggestions for promoting the WLs. Participants preferred the black shield label showing a high content of the nutrients of concern (e.g., sodium, added sugar, and saturated fat) in both Chinese and English. Consumers generally agreed that the WLs were easy to understand and offered a simple method for choosing healthier foods. They anticipated that WLs could encourage the food industry to reformulate their products. Our study results will support the design and facilitate the use of WLs in China.

Association of Dietary Protein Intake with Muscle Mass in Elderly Chinese: A Cross-Sectional Study.

Most data regarding the association between dietary protein intake and muscle mass come from developed Western countries. This cross-sectional study investigates the association between the amount and distribution of dietary protein intake and muscle mass in elderly Chinese adults. This analysis includes 4826 participants aged 60 years and above from the dataset of the China Health and Nutrition Survey (CHNS) 2018. Protein intake data were assessed using 3-day, 24 h dietary recalls. Appendicular skeletal muscle mass (ASM) was obtained using the bioelectrical impedance analysis (BIA). Two-thirds of dietary protein intake comes from plant sources in the elderly Chinese population. The median total dietary protein intake was 60.5 g/d in low muscle mass participants for males and 52.5 g/d for females, which was lower than for their respective counterparts. Compared to the lowest quartile of protein intake, the highest total protein intake group had increased muscle mass by 0.96 kg among men and by 0.48 kg among women (p < 0.0001), and the highest vegetable protein intake group had increased muscle mass by 0.76 kg among men and by 0.35 kg among women (p < 0.0001). The amount of dietary protein intake with each meal was less than 20 g. High total protein intake and high plant-based protein intake were positively associated with higher muscle mass. A U-shape was observed between total dietary protein intake and low muscle mass risk in elderly Chinese adults. It should be encouraged to increase total daily protein intake to maintain muscle health.

Associations of dietary diversity with the gut microbiome, fecal metabolites, and host metabolism: results from 2 prospective Chinese cohorts.

BACKGROUND: Dietary diversity is essential for human health. The gut ecosystem provides a potential link between dietary diversity, host metabolism, and health, yet this mechanism is poorly understood. OBJECTIVES: Here, we aimed to investigate the relation between dietary diversity and the gut environment as well as host metabolism from a multiomics perspective. METHODS: Two independent longitudinal Chinese cohorts (a discovery and a validation cohort) were included in the present study. Dietary diversity was evaluated with FFQs. In the discovery cohort (n = 1916), we performed shotgun metagenomic and 16S ribosomal ribonucleic acid (rRNA) sequencing to profile the gut microbiome. We used targeted metabolomics to quantify fecal and serum metabolites. The associations between dietary diversity and the microbial composition were replicated in the validation cohort (n = 1320). RESULTS: Dietary diversity was positively associated with α diversity of the gut microbiota. We identified dietary diversity-related gut environment features, including the microbial structure (ß diversity), 68 microbial genera, 18 microbial species, 8 functional pathways, and 13 fecal metabolites. We further found 332 associations of dietary diversity and related gut environment features with circulating metabolites. Both the dietary diversity and diversity-related features were inversely correlated with 4 circulating secondary bile acids. Moreover, 16 mediation associations were observed among dietary diversity, diversity-related features, and the 4 secondary bile acids. CONCLUSIONS: These results suggest that high dietary diversity is associated with the gut microbial environment. The identified key microbes and metabolites may serve as hypotheses to test for preventing metabolic diseases.

[Multilevel study on the effects of dietary nutrients on body mass index of Chinese children and adolescents aged 7-17].

OBJECTIVE: Analyze the relationship between dietary nutrients and body mass index of children and adolescents aged 7-17 in China. METHODS: The data comes from the "China Health and Nutrition Survey", and 5562 children and adolescents aged 7-17 who participated in at least one round(2000, 2006, 2011 and 2015) of the survey and had complete dietary and physical measurement survey data were selected as the research objects. A three-level(community-individual-observation level) linear random intercept mixed effect model of body mass index was constructed to analyze the influence of dietary nutrient intake of children and adolescents of different genders in urban and rural areas on their body mass index(BMI).24 hours for 3 consecutive days and family weight accounting were used to evaluate the dietary nutrient intake. RESULTS: BMI of urban children and adolescents is higher than that of rural children and adolescents. The BMI of children and adolescents aged 12-17 is higher than that of children and adolescents aged 7-11. BMI of boys was higher than that of girls, but the difference was statistically significant only in 2011 and 2015. After controlling for confounding factors such as individual level(survey year, age, physical activity and family per capita income) and community level(community urbanization index), the three-level model showed that the BMI of rural boys increased with the increase of cholesterol intake(P<0.01). BMI of urban girls increased with the increase of vitamin B_1 intake(P<0.05) and iron intake(P<0.01). BMI of rural girls increased with the increase of vitamin E intake(P<0.001) and sodium intake(P<0.05). CONCLUSION: There are some differences in dietary nutrients that affect the BMI level of 7-17 years old children and adolescents between urban and rural areas.

[Trends of overweight and obesity among children and adolescents aged 7-17 in 16 provinces of China from 2000 to 2018].

OBJECTIVE: To analyze the distribution characteristics and trends of overweight and obesity in children and adolescents aged 7-17 years in 16 provinces of China. METHODS: Data were collected from China health and nutrition survey in 2000, 2006, 2011, 2015 and 2018, 8398 children and adolescents aged 7-17 with complete data were selected as the research objects. Overweight and obesity were classified by body mass index(BMI) reference norm for screening overweight and obesity in Chinese children and adolescents. The distribution and trend of overweight and obesity among children and adolescents aged 7-17 in 16 provinces of China were analyzed by using Cochran-Armitage trend test and two-level random intercept model. RESULTS: The prevalence of overweight and obesity in children and adolescents aged 7-17 in China showed an upward trend from 2000 to 2018(P<0.05). The prevalence of overweight increased from 5.42% in 2000 to 12.92% in 2018, and the prevalence of obesity increased from 2.45% in 2000 to 12.36% in 2018. The result of multilevel model analysis showed that gender and urban and rural areas had significant effects on centralized BMI(P<0.05), the BMI increase value of boys was greater than that of girls(ß=0.2824), the BMI increase value of children and adolescents in rural areas was greater than that in urban areas(ß=0.5902). CONCLUSION: The prevalence of overweight and obesity among children and adolescents aged 7-17 in 16 provinces of China are increasing.

[Fat intake from pre-packaged foods among Chinese residents of 16 provinces in 2018].

OBJECTIVE: To investigate the impact of prepackaged food consumption on fat intake in 16 provinces of China in 2018. METHODS: Data used in present study was derived from the eleventh round of China Health and Nutrition Survey(CHNS), 17312 residents aged 6 and over were selected and their consumed information of pre-packaged food was collected. The consumption of pre-packaged food and fat intake from pre-packaged food in urban and rural areas, different age groups, different regions and different genders were calculated and compared. RESULTS: The median intake of fat from pre-packaged food among subjects and consumers were 33.6 g/d and 34.7 g/d, respectively.73.5% of the intake of fat from pre-packaged food comes from vegetable oil. CONCLUSION: Vegetable oil was the main source of fat from pre-packaged food for Chinese residents.

[Secular trends in food intakes among the elderly aged 60 and older in nine provinces in China from 1991 to 2015].

OBJECTIVE: To analysis the status and trend of food intake of elderly aged 60 and older years old in nine provinces of China. METHODS: The data of China Health and Nutrition Survey from 1991 to 2015 were used, which elderly ≥60 years old were selected as the subjects. The dietary survey used compared. The 3-consecutive day-24-hour dietary recall was used to collect information on food intake, the condiment intake was collected by weighting and bookkeeping method. RESULTS: The intakes of cereals and tubers and vegetables among the elderly were 363.3 g/d and 249.1 g/d, respectively in 2015, decreased by 65.4 g/d and 17.6 g/d as compared with those in 1991. The intakes of meat, egg, and edible oil were 56.7 g/d, 19.2 g/d and 27.5 g/d respectively and increased by 7.5 g/d, 19.2 g/d and 2.5 g/d as compared to those with 1991. The intakes of eggs, soybeans and nuts were higher among the elderly people having high income or living in urban areas. In 2015, the proportion of elderly in nine provinces of China whose intake of vegetables, fruits, soybeans, milk and dairy products was lower than the recommended amount was relatively high. The proportion of meat higher than the recommended value is higher than that of aquatic products and eggs. Oil, salt and other limited flavoring intake of less than and above the limit was nearly 50 percent of the population. CONCLUSION: There are three problems in the diet of the elderly in nine provinces in China: the structure of diet is not rational; low intake of the food rich in high quality protein and low fat such as aquatic products, eggs, dairy products and so on; the problem of excessive oil and salt in food.

[Snacking behaviors of Chinese female adults aged 18 to 49 years old in 2004-2015].

OBJECTIVE: To describe shift in snacking behavior among Chinese female adults aged 18 to 49 years old in 2004-2015, and to analyze the contribution of snacks to energy and nutrients among them. METHODS: The present study used data from "China Health and Nutrition Health" where a multistage stratified cluster design was employed to select a stratified probability sample. A total of 12 523 female participants aged 18-49 years old who participated in surveys conducted in 2004-2015 with completed data of demographic characteristics and dietary measurementswere selectedas subjects. There were 2376, 2149, 2142, 2844 and 3012 subjects in waves of 2004, 2006, 2009, 2011, and 2015, respectively. Multivariate Logistic regression model was used to analyze the relationship between socioeconomic factors and snack consumption. Generalized linear model was used to analyze the energy and nutrient intake of snack consumers and non-snack consumers, as well as the contribution of snacks to energy and nutrients. RESULTS: The consumption rate of snacking for women aged 18 to 49 years old had an increasing trend over time(P<0.05), and the rate was 14.24% in 2015, 3.5 times as high as that in 2004. Participants aged 18 to 29 years old whose snake consumption rates were relatively higher compared to those of other aged groups in general waves; also, female adults from the higher education group, the higher yearly income group, and the higher urbanicity index group, and those with the history of smoking or the alcohol use tended to consumed snacks. The change of the influential factors in relation to the consumption of the participant's snack was observed, and age, income level, education level, living area, and the behavior of smoking and drinking were all important factors of snacking. The daily energy and nutrient intake of female snack consumers aged 18 to 49 years old was higher than that of non-snack consumers. The contribution rate of snacks to energy and nutrients varies significantly between survey years; and the contribution of snacks to energy and main nutrients was more than 20% in 2011. CONCLUSION: Snacks have become an important part of the diet of Chinese women aged 18 to 49 years old. Future health promotion programs should be targeted on nutrition education and intervention to guide a reasonable diet structure.

Association of gut microbiota with glycaemic traits and incident type 2 diabetes, and modulation by habitual diet: a population-based longitudinal cohort study in Chinese adults.

AIMS/HYPOTHESIS: The gut microbiome is mainly shaped by diet, and varies across geographical regions. Little is known about the longitudinal association of gut microbiota with glycaemic control. We aimed to identify gut microbiota prospectively associated with glycaemic traits and type 2 diabetes in a geographically diverse population, and examined the cross-sectional association of dietary or lifestyle factors with the identified gut microbiota. METHODS: The China Health and Nutrition Survey is a population-based longitudinal cohort covering 15 provinces/megacities across China. Of the participants in that study, 2772 diabetes-free participants with a gut microbiota profile based on 16S rRNA analysis were included in the present study (age 50.8 ± 12.7 years, mean ± SD). Using a multivariable-adjusted linear mixed-effects model, we examined the prospective association of gut microbiota with glycaemic traits (fasting glucose, fasting insulin, HbA1c and HOMA-IR). We constructed a healthy microbiome index (HMI), and used Poisson regression to examine the relationship between the HMI and incident type 2 diabetes. We evaluated the association of dietary or lifestyle factors with the glycaemic trait-related gut microbiota using a multivariable-adjusted linear regression model. RESULTS: After follow-up for 3 years, 123 incident type 2 diabetes cases were identified. We identified 25 gut microbial genera positively or inversely associated with glycaemic traits. The newly created HMI (per SD unit) was inversely associated with incident type 2 diabetes (risk ratio 0.69, 95% CI 0.58, 0.84). Furthermore, we found that several microbial genera that were favourable for the glycaemic trait were consistently associated with healthy dietary habits (higher consumption of vegetable, fruit, fish and nuts). CONCLUSIONS/INTERPRETATION: Our results revealed multiple gut microbiota prospectively associated with glycaemic traits and type 2 diabetes in a geographically diverse population, and highlighted the potential of gut microbiota-based diagnosis or therapy for type 2 diabetes. DATA AVAILABILITY: The code for data analysis associated with the current study is available at https://github.com/wenutrition/Microbiota-T2D-CHNS.

Stressed females, rather than males, tend to eat away from home.

OBJECTIVES: The aim of this study is to examine the association between perceived stress and multifarious eating away from home among Chinese adults in different genders. METHODS: We examined cross-sectional data from the China Health and Nutrition Survey conducted in 2018 among Chinese adults aged 18-59 years. A self-reported questionnaire involving the perceived stress scale with 10 items (PSS-10), and the food frequency questionnaire about eating away from home were used. Adjusted two-level zero-inflated Poisson regression models were used to explore the association. RESULTS: There were 3161 males and 3599 females in the study. The median PSS-10 score was 16.0 and the frequencies of eating 1) breakfast, 2) lunch or supper, and 3) three main meals away from home were 12, 10, and 49 times per year, respectively. In males, PSS-10 score was not associated with eating away from home. In females, PSS-10 score was significantly positively associated with eating 1) lunch or supper, 2) three main meals, 3) Chinese food away from home, and 4) eating at stalls/restaurants (ß1 = 0.016, P1 = 0.006; ß2 = 0.014, P2 = 0.002; ß3 = 0.015, P3 = 0.013; ß4 = 0.014, P4 = 0.015 respectively). But there was not association between PSS-10 score and the frequency of eating breakfast away from home in females (ß = 0.006, P = 0.325). CONCLUSIONS: Stressed females tend to eat away from home, but the effects are very small.