[Consumption status and growth trends of dairy products among children and adolescents in China from 1991 to 2018].

OBJECTIVE: To explore the dairy consumption among children and adolescents aged 7-17 in China. METHODS: 10 rounds of follow-up data from the "China Health and Nutrition Survey" from 1991 to 2018 were collected, and individuals aged 7-17 were selected as the study subjects. Dietary data was collected by using 3-day 24-hour dietary review method and household weighing accounting method(edible oils and seasonings). Dairy consumption was calculated by converting various dairy products into liquid milk intake using the China Food Composition. After excluding those with missing demographic information, missing data from the "3 days and 24 hours" dietary survey, and abnormal daily energy intake, 18 529 participants were included in the final analysis. Joinpoint regression model was used to analyze the trend of changes in dairy intake. RESULTS: The dairy consumption rate increased from 2.8% in 1991 to 42.3% in 2018, while it increased from 8.4% to 58.8% in urban and from 0.9% to 32.1% in rural areas. Meanwhile, the proportion of people whose dairy intake reaches the recommended intake(300 g/d) increased from 0.2% to 3.0%, and the proportion in rural area was 2.0%, which was lower than that in urban areas(4.9%). From 1991 to 2018, dairy intake increased at a rate of 12.97%(P=0.02), and the growth rate of urban and rural areas were 9.79%(P=0.03) and 15.67%(P<0.01), respectively. There was a faster growth trend from 1991-2004 compared to 2004-2018. The growth rate in urban and rural areas also showed different growth trends. CONCLUSION: The dairy intake of children and adolescents aged 7-17 in China improved significantly from 1991 to 2018, with higher consumption rate in urban areas than in rural areas, but it still need to be improved for health.

[Analysis of food carbon footprint and its socio-demographic disparities in China in 2018].

OBJECTIVE: To analyze food carbon footprint and its socio-demographic disparities among adults in China. METHODS: A total of 12 777 adults aged 18 years and above from the China Health and Nutrition Survey in 2018 who have completed dietary and socio-demographic data were analyzed. The information of food intake were collected by 24 h recalls combined with the weighing of household seasonings. Food consumption was converted into energy intake by the China Food Composition Table. Carbon footprint of 26 food groups were calculated by the food carbon footprint database based on life-cycle assessment(LCA), multinomial logit model was used to analyze the association of socio-demographic factors and food carbon footprint. RESULTS: Average food carbon footprint were decreased with increasing age while increased with increasing income and education levels, and was higher among male than that among female, was higher among urban residents than that among rural residents, was higher in the south than that in the north. Multinomial logit analysis showed that compared with people aged 18-44, the likelihood of occurring high carbon footprint in 60y and above group were 29%(OR=0.71, 95%CI 0.61-0.83) lower than that occurring low carbon footprint. Women were 11%(OR=0.89, 95%CI 0.81-0.99) and 25%(OR=0.75, 95%CI 0.67-0.84) less likely to appear medium and high carbon footprint than low carbon footprint, compared with their male counterparts. In comparison to people living in cities, rural dwellers were 24%(OR=0.76, 95%CI 0.69-0.85) and 38%(OR=0.62, 95%CI 0.55-0.70) less likely to appear medium and high carbon footprint than low carbon footprint. People in the south were 3.89 times(95%CI 3.52-4.30) and 11.35 times(95%CI 10.01-12.88) more likely to occur medium and high carbon footprint than low carbon footprint, compared with people in the north. Participants were more likely to occur medium carbon footprint and high carbon footprint with the increasing income level(OR>1), and were more likely to occur high carbon footprint with the increasing education level(OR>1). CONCLUSION: The food carbon footprint of adults in China in 2018 show different socio-demographic disparities, gender, income and education level are significant factors.

[Change of dietary pattern among young people aged 18-35 in China from 1989 to 2018].

OBJECTIVE: To analyze the dietary patterns changes of young people aged 18-35 in 15 provinces(autonomous regions, municipalities) from 1989 to 2018. METHODS: Using the data of China Health and Nutrition Survey, a total of 25 400 young people aged 18-35 with complete dietary and sociodemographic information from 1989 to 2018 in 15 provinces(autonomous regions, municipalities) were selected as the research objects. Nutrition survey was carried out by using 3 consecutive days of 24-hour review method combined with weighing accounting method. Energy and nutrient intake was calculated based on food composition list. The principal component cluster analysis was used to select food groups and K-mean cluster was uesd to extract dietary patterns. Dwass-Steel-Critchlow-Fligner was used to test the difference of food intake in different dietary patterns. Cochran-Armitage trend test was to analyze the change of dietary patterns with the years. Chi-square test was to analyze the difference of people with different dietary patterns in 2018. RESULTS: The dietary patterns of young people aged 18-35 in 15 provinces(autonomous regions, municipalities) were mainly divided into three categories: "traditional rice", "traditional pasta" and "high-quality protein". In 2018, the proportion of "traditional rice" dietary patterns was higher for men than for women, and the proportion of "high-quality protein" dietary patterns was lower than for women. The proportion of "traditional pasta" dietary pattern in people aged 25-35 was higher than that aged 18-24, and the proportion of "high-quality protein" dietary pattern was lower than that aged 18-24. The proportion of people in urban with "traditional rice" dietary pattern was lower than that in rural areas, and the proportion of "high-quality protein" dietary pattern was higher than that in rural areas. The northern region was dominated by "traditional pasta" dietary pattern, while the southern region was dominated by "traditional rice" dietary pattern, and the proportion of people with "high-quality protein" dietary pattern was higher in the northern region than in the southern region. With the increase of education level and income level, the proportion of people with "high-quality protein" dietary pattern showed an increasing trend. From 1989 to 2018, the "traditional rice" dietary pattern had always maintained a high proportion among young people aged 18-35 in 15 provinces(autonomous regions, municipalities) in China, and the "traditional pasta" dietary pattern had been decreasing since 2009, and the "high-quality protein" dietary pattern had significantly increased since 2011. CONCLUSION: From 1989 to 2018, the proportion of young people aged 18-35 with reasonable dietary pattern has increased in 15 provinces(autonomous regions, municipalities), but the traditional dietary pattern still needs to be improved.

[Application of Delphi method in the revision of dietary quality index in the elderly].

OBJECTIVE: To revise the dietary evaluation method of the elderly, and scientifically evaluate the dietary quality. METHODS: Delphi method was used to revise a diet quality evaluation method for the elderly according to expert consultation and statistical analysis. The recommended recipes in The Dietary Guidelines for Chinese Residents(2016) were selected for preliminary verification. RESULTS: Two rounds of expert consultation were conducted, 25 experts in the industry were invited. The withdraw rate of two rounds were 100% and 84%, respectively. The authoritative coefficient were 0.82 and 0.80, the degree of familiarity was 0.92, and the basis for determination were 0.73 and 0.70, respectively. The coordination coefficient W value were 0.095 and 0.098 respectively. CONCLUSION: Delphi method had some advantages in the revision of dietary index for the elderly. Dietary quality index had some practicability, but it still needs further verification and improvement.

[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.

[Analysis of differentiated regional dietary patterns of adults aged 18-64 years in 15 provinces( autonomous regions, municipalities) in 2018].

OBJECTIVE: To analyze the dietary patterns of Chinese adults in 15 provinces and cities in China. METHODS: A total of 9208 adults aged 18-64 from the "China Health and Nutrition Survey" in 2018 were selected as subjects. Food consumption data were collected through 3 d-24 h dietary recalls and weighing household cooking oil and condiments, and the average daily dietary nutrient intake was calculated by the food composition table. Clustering analysis was used to analyze dietary patterns in different regions, and data from the 2009 China Health and Nutrition Survey were used for comparison. RESULTS: Three dietary patterns were obtained in this study, including northern pattern, coastal pattern and southern pattern. The analysis of demographic characteristics showed that the intake of cereals, vegetables and livestock were statistically different among different age groups, and livestock and poultry intake was higher in the 18-49 years; Fruit and milk were higher in women and other foods were higher in men; The intakes of cereals, tubers, legumes and vegetables were higher in rural areas, people with low income and low education levels, and other foods were higher in urban areas, people with high income and high education levels, especially milk. Compared with the dietary guidelines, it was found that the proportion of insufficient intake of dark vegetables, fruits and nuts in three patterns and milk, eggs in the southern pattern and aquatic products in the northern pattern was up to 80%, the other food intake was in 50%-80%; The proportion of excessive intake of livestock and poultry meat in the southern mode was significantly higher, reaching 78%. Nutrient analysis showed that the intake of carbohydrate, dietary fiber and carbohydrate energy ratio, vitamin E, magnesium and manganese were higher in the northern pattern; The intakes of protein, protein energy ratio, riboflavin, potassium, sodium, calcium, phosphorus, copper and selenium were higher in the coastal pattern; The southernpattern had a higher intake of energy, fat, fat energy ratio, niacin, retinol, zinc and vitamin C. In addition, the comparison between 2009 and 2018 showed that the intake of most foods except milk has decreased to varying degrees in the past decade, while the intake of some foods has increased. CONCLUSION: The 15 provinces in China were divided into three dietary patterns. Unbalanced intake of food and nutrients was common among them, and the intake was influenced by different demographic characteristics. In addition, most food intake has declined over the past decade.

[Double burden of malnutrition among children and adolescents aged 6-17 years in 15 provinces (autonomous regions, municipalities) of China in 1991-2015].

OBJECTIVE: To analyze the status and the trends of the double burden of malnutrition among children and adolescents aged 6-17 years in 15 provinces(autonomous regions and municipalities) of China in 1991, 2000, 2009 and 2015. METHODS: The data of China Health and Nutrition Surveys in 1991, 2000, 2009 and 2015 were used, children and adolescents aged 6-17 years were selected as the research objects. After excluding those with missing demographic, dietary data and physical measurement data, 2464, 2094, 929 and 1555 children and adolescents were included in the study in each year. The subjects were divided into lean, normal, overweight and obese groups. The dietary information was collected by 3-day 24-hour dietary recall, and edible oil and condiment intakes were collected by weighing method. The dietary micronutrient intake of children and adolescents was calculated according to the food composition table. The estimated average requirement(EAR) was used as the cut-offs of dietary micronutrient intake insufficiency to analyze the situation of micronutrient intake deficiency and double burden of malnutrition. RESULTS: The prevalence of underweight of children and adolescents aged 6-17 years in 15 provinces(autonomous regions and municipalities) during 1991-2015 showed a downward trend, while the prevalence of overweight and obesity showed an upward trend(all P<0.05). The prevalence of double burden of malnutrition increased from 6.5% in 1991 to 24.6% in 2015. In 1991, 2000, 2009 and 2015, 94.2%, 92.8%, 97.2% and 93.4% of children and adolescents had insufficient dietary micronutrient intake. In 1991 and 2000, 81.6% and 73.7% of children and adolescents had insufficient intake of 3-7 dietary micronutrients at the same time; In 2009 and 2015, 81.8% and 80.7% of children and adolescents had insufficient intake of 3-9 dietary micronutrients at the same time. CONCLUSION: The prevalence of overweight and obesity of children and adolescents in 15 provinces(autonomous regions and municipalities) of China was on the rise, the prevalence of insufficient intake of dietary micronutrients is higher, and the double burden of malnutrition was serious.

[Situation and trends in dietary minerals intakes of adults aged 18-35 years in 15 provinces (autonomous regions, municipalities) of China in 1989-2018].

OBJECTIVE: To analyze the current situation and long term trends in minerals intakes from 1989 to 2018 in adults aged 18 to 35 years in 15 provinces(autonomous regions, municipalities) of China. METHODS: Based on the data of China Health and Nutrition Survey from 1989 to 2018. Adults aged 18 to 35 were selected as study subjects. According to the dietary survey result of 3-day 24-hour dietary review method and weighing accounting method, the mineral intake was calculated and analyzed. Nonparametric statistical method was used to analyze the trend of dietary minerals intake with years. Comparing the dietary minerals intake with the dietary reference intakes, the trend of the proportion of people at risk of insufficient dietary minerals intake was analyzed by Cochran-Armitage trend test. According to the different demographic characteristics in 2018, the minerals intake status and the proportion of people with insufficient dietary minerals intake were analyzed. RESULTS: In 2018, the median intakes of dietary minerals of adults were 302.96 mg/d of calcium, 887.91 mg/d of phosphorus, 1451.69 mg/d of potassium, 3760.09 mg/d of sodium, 238.50 mg/d of magnesium, 19.40 mg/d of iron, 9.91 mg/d of zinc, 43.54 µg/d of selenium, 1.41 mg/d of copper and 4.59 mg/d of manganese, respectively, with significant gender differences(P<0.05). The intakes of dietary calcium, phosphorus, magnesium, potassium, selenium and copper in urban areas were significantly higher than those in rural areas(Z values were 3.00, 2.04 and 3.10, respectively, P<0.05). The dietary intakes of calcium, phosphorus, magnesium, potassium, selenium and copper showed significant differences among regions, education levels and income levels. From 1989 to 2018, the dietary mineral intake of calcium, phosphorus, potassium, sodium, magnesium, iron, zinc, copper and manganese of adults aged 18-35 in 15 provinces(autonomous regions and municipalities) of China showed a downward trend, only selenium intake showed an upward trend, and the intake of men was higher than that of women. The proportion of people at risk of inadequate intake of dietary phosphorus, magnesium, iron, zinc and copper showed an increasing trend year by year. In each survey year, the proportion of people at risk of insufficient calcium intake was more than 90%. CONCLUSION: From 1989 to 2018, there was a risk of insufficient intake of minerals in adults aged 18-35 in 15 provinces(autonomous regions, municipalities) in China, and the problem of inadequate calcium intake was serious.

Association between Ultra-Processed Food Consumption and Metabolic Syndrome among Adults in China-Results from the China Health and Nutrition Survey.

The prevalence of metabolic syndrome (MetS) is increasing and the relationship between ultra-processed food (UPF) consumption and MetS remains uncertain in Chinese adults. This study aimed to examine the longitudinal association of UPF consumption with the risk of MetS and its components in Chinese adults. Adults aged 18 years and above who participated in at least two waves of the China Health and Nutrition Survey (CHNS) in 2009, 2015, and 2018 were included in this analysis. Dietary intake data were collected by three consecutive 24 h dietary recalls and weighing household foods and condiments. Depending on the purpose and extent of food processing, UPFs were classified using the NOVA food classification system. A multivariate Cox proportional risk model was used to explore the association between UPF consumption (grouped by quartile: quartile 1 (Q1), quartile 2 (Q2), quartile 3 (Q3), and quartile 4 (Q4)) and risk of MetS and its components. A total of 5147 adults were included. During a median (IQR) 6.0 (3.0, 9.0) year follow-up with 31,878 person-years, 1712 MetS cases were identified, with an incidence of 33.26%. After multivariable adjustment, the risk of MetS was increased by 17% in the highest quartile with UPF consumption (HR: 1.17, 95% CI: 1.01-1.35, p trend: 0.047), with the lowest quartile as a reference. For the components of MetS, the risk of central obesity, raised triglycerides (TG), reduced high-density lipoprotein cholesterol (HDL-C), and raised blood pressure (BP) was increased by 33% (HR: 1.33, 95% CI: 1.18-1.51, p trend: <0.001), 26% (HR: 1.26, 95% CI: 1.08-1.48, p trend: 0.003), 25% (HR: 1.25, 95% CI: 1.07-1.46, p trend: 0.007), and 16% (HR: 1.16, 95% CI: 1.03-1.32, p trend: 0.018) in the highest quartile with UPF consumption, respectively. Adults aged 45-59 years and living in urban areas with higher UPF consumption had higher odds of MetS. These results indicate that higher long-term UPF consumption was associated with an increased risk of MetS in Chinese adults. Further studies such as intervention trials are needed to confirm the mechanism of correlation between UPF consumption and health-related outcomes. Nutritional education actions are warranted to promote a balanced diet and improve the overall dietary quality of residents to reduce the risk of MetS effectively.

Longitudinal relationship between body fat percentage and risk of type 2 diabetes in Chinese adults: Evidence from the China Health and Nutrition Survey.

Objective: Body fat percentage (BF%) might be an alternative index of obesity which is the major risk factor for developing type 2 diabetes (T2D). We aim to longitudinally evaluated the relationship between BF% and risk of T2D. Methods: A sample of 5,595 adults aged 18-65 who participated in two waves of China Health and Nutrition Survey (CHNS 2015 and 2018) was analyzed. Two level mixed-effects modified Poisson regression with robust estimation of variance stratified by sex was used to evaluate the risk ratios (RRs) for T2D according to quintiles of BF%, and the curves of receiver operating characteristic (ROC) were plotted to identify the optimal total and trunk BF% cut-off points for predicting an increased T2D risk. Results: In males, compared with subjects in the first quintile of total BF%, those in the third (RR = 2.03, 95% CI 1.09-3.79), fourth (RR = 2.56, 95%CI 1.46-4.48), and fifth (RR = 2.16, 95%CI 1.22-3.82) quintile had higher risk of T2D after adjusting for all potential confounders (p-trend < 0.001). For females, the RR (95% CI) was 1.92 (1.14, 3.24) in the fifth quintile (p-trend = 0.014). Males and females with a trunk BF% >25.5 and 34.4% (≥ quintile 4), respectively, were at significantly increased risk of T2D (p-trend = 0.001). Besides, the optimal cut-off values of total and trunk BF% were 21.9 and 25.2% for males, and 36.7 and 30.3% for females, respectively. Conclusions: The incident risk of T2D significantly increased over specific level of total and trunk BF% in both Chinese males and females, and the optimal BF% cut-off values were valuable for clinical application of BF% based on sex difference, which may be a cost-effective implementation for prevention and treatment of T2D in China.

Association between Free Sugars Intake and Risk of Metabolic Syndrome in Chinese Adults: Results from the China Health and Nutrition Survey, 2000-2018.

The association of free sugars intake with metabolic syndrome (MetS) is controversial. This study aimed to examine the association between free sugars intake and risk of MetS in Chinese adults. The data were from seven waves of the China Health and Nutrition Survey (2000−2018), a longitudinal and open prospective cohort study. Dietary intake was calculated based on the data collected by consecutive 3-day 24-h dietary recalls combined with household weighing for foods or condiments. Cox proportion hazard regressions and restricted cubic spline (RCS) were performed to explore the associations between free sugars intake and the risk of MetS. The present study selected 12,048 adults aged 18 years and above. During a median (IQR) follow-up of 9.0 (7.0, 15.0) years with 131,844.0 person-years, 3970 (32.95%) MetS occurred. After adjusting for all potential confounders, compared to adults with free sugars intake of <5 g/day group, adults with free sugars intake of 5−20 g/day were associated with a higher risk of MetS (HR, 1.094; 95% CI, 1.009−1.186). No significant association was observed between free sugars intake of >20 g/day and the risk of MetS (HR, 1.011; 95% CI, 0.800−1.277). There is an urgent need to pay attention to the intake of free sugars and comprehensive measures such as the improvements in the processing of sugary foods, and sugar composition should be included on food nutrition labels to control intake of free sugars in China.

Association of egg intake with risks of cardiometabolic factors among adults in China.

Objective: To explore the association between egg intake and cardiometabolic factors (CMFs) in Chinese adults. Method: The subjects were 6,182 adults aged 18-64 who had complete survey data and had no CMFs at baseline. Egg intake was assessed with 3 days-24 h dietary recalls in all waves of the China Health and Nutrition Survey (CHNS). Multivariate Cox proportional risk regression model and restricted cubic spline (RCS) model were used to analyze the association and dose-response relationship between egg intake and CMFs. Results: Of the 6,182 participants who did not have metabolic syndrome (MetS) at baseline, 1,921 developed this disease during an average follow-up of 5.71 years, with an incidence of 31.07%. Central obesity, elevated TG, decreased HDL-C, elevated blood pressure and elevated plasma glucose were 38.65, 26.74, 30.21, 40.64, and 30.64%, respectively. After adjusting for demographic characteristics, lifestyle, energy and BMI, using the lowest quintile (Q1) as a reference, the risk of central obesity, elevated TG, decreased HDL-C, and elevated plasma glucose in the highest quintile (Q5) were reduced by 15% (HR = 0.85, 95% CI = 0.73-0.98, P = 0.16), 33% (HR = 0.67, 95% CI = 0.57-0.78), 25% (HR = 0.75, 95% CI = 0.63 0.90, p = 0.05), and 28% (HR = 0.72, 95% CI = 0.63-0.83, p < 0.05), respectively. The risk of elevated blood pressure was reduced by 26% in the fourth quintile (HR = 0.74, 95% CI = 0.64-0.85, P = 0.85). RCS analysis show that the overall correlation and nonlinear relationship between egg intake and CMFs were statistically significant (P < 0.05). When the intake was lower than 20 g/days, the risk of MetS, central obesity, elevated blood pressure and elevated plasma glucose were negatively correlated with egg intake, while elevated TG was negatively correlated with eggs when the intake was lower than 60 g/days. There was no statistically significant association between egg intake and CMFs at higher egg intake. Conclusion: There was a U-shaped association between egg intake and CMFs in Chinese adults.

Trends in Dietary Carbohydrates, Protein, and Fat Intake and Diet Quality Among Chinese Adults, 1991-2015: Results from the China Health and Nutrition Survey.

OBJECTIVE: Dietary transitions in China have undergone rapid changes in over the last three decades. The purpose of this study to describe trends in the macronutrient consumption, the sources of those nutrients, and the diet quality among Chinese adults. DESIGN: Longitudinal China Health and Nutrition Survey (CHNS) cohort analysis. Main outcomes are dietary energy intake from total carbohydrate, protein and fat and their subtypes, as well as food sources of carbohydrates, protein, and fat, and the China Dietary Guidelines Index 2018 (CDGI-2018). SETTING: CHNS (1991, 2000, 2009, 2015). PARTICIPANTS: Data from the longitudinal 1991, 2000, 2009, and 2015 China Health and Nutrition Survey (CHNS) of adults aged 18 years or older, who had complete demographic information. RESULTS: The estimated mean energy intake from total carbohydrate decreased from 62.6% to 50.6% between 1991 and 2015, while the mean energy intake from total protein increased from 12.6% to just 13.1% and the mean energy intake from total fat significantly increased from 24.0% to 35.8% (P < 0.001 for trend). Decreases were observed in evaluated mean energy from low-quality carbohydrates (from 53.6% to 41.7%) and incomplete protein (from 9.3% to 7.5%), while increases were seen in estimated mean energy from high-quality protein (from 3.3% to 5.5%), high-quality fat (from 9.1% to 16.7 %), and low-quality fat (from 14.9% to 19.0%). Low-quality carbohydrates, primarily those derived from refined grains, decreased from 52.2% to 36.2%. The diet quality as measured by CDGI-2018 improved, with the estimated mean increasing from 41.7 to 52.4 (P < 0.01 for trend). CONCLUSION: For Chinese adults, there was a significant change in the macronutrient composition over the previous few decades. The percentage of energy consumed from carbohydrates significantly decreased, however the percentage of energy consumed from total fat significantly increased. Additionally, the diet quality remains suboptimal.

Association of obesity profiles with type 2 diabetes in Chinese adults: Findings from the China health and nutrition survey.

Aims: To examine longitudinal associations of obesity profiles, continuous BMI, and waist circumference (WC) with the risk of type 2 diabetes in Chinese adults. Methods: Data were derived from three waves (2009, 2015, and 2018) of the China Health and Nutrition Survey, and 3,595 adults aged 18-65 years who participated in at least two waves of the survey and had completed data were analyzed. Obesity profiles included BMI- or WC-related single obesity and combined obesity. Combined obesity was categorized into six groups including Group 1 with normal BMI and WC, Group 2 with normal BMI but pre-abdominal obesity, Group 3 with normal BMI but abdominal obesity, Group 4 with abnormal BMI (overweight and general obesity) and normal WC, Group 5 with abnormal BMI and pre-abdominal obesity, and Group 6 with abnormal BMI and abdominal obesity. Three-level mixed-effects logistic regressions with random intercept stratified by gender and restricted cubic splines were performed to examine ORs and 95%CIs for the risk of type 2 diabetes. Results: In men, compared with subjects of Group 1, those in Group 3 had higher risk, with an OR of 4.83 (95% CI: 1.99-11.74), followed by those in Group 6 (OR = 4.05, 95%CI: 2.32-7.08) and Group 5 (OR = 2.98, 95%CI: 1.51-5.87) after adjusting for all potential confounders. For women, the subject of Group 6 had highest risk (OR = 8.79, 95%CI: 4.04-19.12), followed by Group 3 (OR = 3.30, 95%CI: 1.23-8.86) and Group 5 (OR = 3.16, 95%CI: 1.21-8.26). No significant association between abnormal BMI and normal WC (Group 4) was observed in both genders. Type 2 diabetes risk increased steeply at BMI of 23.5 kg/m2 and 22.5 kg/m2 or higher, and WC of 82.0 cm and 83.0 cm or higher in Chinese adult men and women, respectively (p for overall <0.001). Conclusion: Chinese adults with pre-abdominal or abdominal obesity had a relative high risk of type 2 diabetes independent of BMI levels. Lower BMI (≤23.5 kg/m2 for men and ≤22.5 kg/m2 for women) and lower WC (82.0 cm for men and ≤83.0 cm for women) values than the current Chinese obesity cut-offs were found to predict the risk of type 2 diabetes. These findings urge to inform WC modification and optimization of early screening guidelines.

[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.

High Diet Quality Is Linked to Low Risk of Abdominal Obesity among the Elderly Women in China.

How diet as a whole impacts the risk of general overweight and abdominal obesity among the Chinese elderly is unclear. The present study aimed to examine the association of overall diet quality with general overweight and abdominal obesity in the Chinese elderly. Using data from the China Health and Nutrition Survey (CHNS) from 1993 to 2015, an ongoing cohort study, we selected participants aged 60 and older who were not generally overweight, but who had abdominal obesity at baseline and who had participated in at least two waves of the survey as subjects. The China Elderly Dietary Guidelines Index (CDGI-E) was used, based on the critical diet-related recommendations of the 2016 Chinese Dietary Guideline (CDG-2016), to assess overall diet quality. Consecutive 3 d, 24 h recalls and household weighing for seasonings and edible oils were used to collect dietary data and calculate the CDGI-E scores. Three-level (community-individual-wave) random intercept logistic regression models were used to analyze the impact of diet quality on the risk of general overweight and abdominal obesity in the elderly. The results showed that the older women in the top sixtiles of the CDGI-E scores had a 38% reduction -0.62, 95% CI (0.41, 0.92)-in the risk of abdominal obesity, as compared to those in the bottom sixtiles after adjusting for all potential confounders, while the null association was observed in the older men. The relationship between CDGI-E score and the risk of overweight/general obesity in the Chinese elderly has not been found. It was concluded that a high diet quality was associated with a reduced risk of abdominal obesity among elderly women in China. Our findings will help to improve the understanding of the relationship between the overall effect of diet and health. It may provide a new avenue for obesity intervention policy formulation from the aspect of improving overall dietary quality.

A Comparison between Dietary Consumption Status and Healthy Dietary Pattern among Adults Aged 55 and Older in China.

The nutrition and health of middle-aged and elderly people is crucial to the long-term development of a country. The present study aimed to analyze the dietary consumption status in Chinese adults by using baseline and follow-up data from the community-based Cohort Study on Nervous System Diseases between 2018−2020 and selecting those aged 55 and older (n = 23,296). Dividing 65 food items into 17 subgroups on the basis of a valid semi-quantitative food frequency questionnaire, we analyze the consumption amount and consumption rate of foods in relation to wave and sociodemographic factors by employing the Wilcoxon rank sum test, Kruskal−Wallis analysis, the Chi-squared test, and the Cochran−Armitage trend test and evaluate food intake status using the Chinese Dietary Guidelines Recommendations (2022). Compared to 2018, the median daily intake of livestock meat, poultry, and eggs increased in 2020 (p < 0.05), while the median daily intake of wheat, other cereals, tubers, legumes, fruits, and fish and seafood decreased (p < 0.05). The proportion of subjects with excessive intake of grain, livestock and poultry, and eggs was 46.3%, 36.6%, and 26.6%, respectively, while the proportion of subjects with insufficient intake of whole grains and mixed beans, tubers, legumes, dairy products, fruits, vegetables, and fish and seafood were 98.4%, 80.3%, 74.0%, 94.6%, 94.3%, 75.8%, and 86.5%, respectively, and more than 50% of subjects were non-consumers of dairy products, nuts, and whole grains and mixed beans. In conclusion, the problem of unhealthy dietary structure is prominent among adults aged 55 and older in China; insufficient or excessive intakes of various types of foods are common; and excessive consumption of edible oil and salt remains a serious problem.

[Intakes of energy and macronutrient from Chinses 15 provinces (autonomous regions, municipalities) adults aged 18 to 35 in 1989-2018].

OBJECTIVE: To analyze the dietary energy and macronutrient intake status and changing trends of adults aged 18 to 35 in 15 provinces(autonomous regions, municipalities) in China from 1989 to 2018. METHODS: Based on the data from 11 rounds of follow-up survey conducted by "China Health and Nutrition Survey" between 1989 and 2018, a multi-stage stratified cluster sampling method was used to analyze the dietary data of 25 400 adults aged 18 to 35. The dietary survey was conducted by using 24-hour dietary recall in three consecutive days and household weighing accounting. The food consumption was converted into energy and nutrient intake by using the food nutrient data in the food composition list. RESULTS: The dietary energy intake of adults aged 18 to 35 in China showed an overall downward trend. The intake of dietary fat showed an upward trend, while the intake of protein and carbohydrate showed a downward trend. From the perspective of the macronutrients energize, the contribution of carbohydrates had gradually decreased while the contribution of protein and fat increased. Meanwhile, among the surveyed population, the proportion of dietary protein intake below estimated average requirement, the proportion of fat energize contribution higher than 30%, and the proportion of carbohydrate energize contribution less than 50% were gradually increasing. CONCLUSION: The dietary macronutrient structure of Chinese adults aged 18 to 35 is becoming more and more reasonable, but there is still a gap with the recommended intake.

Relationship between Dietary Magnesium Intake and Metabolic Syndrome.

Metabolic syndrome (MetS) is increasingly prevalent, and the relationship between dietary magnesium and MetS remains controversial. Therefore, we aimed to explore the association and dose-response relationship between dietary magnesium intake and MetS and its single component. The sample was adults aged 18 years and above who participated in at least two follow-up surveys in 2009, 2015 and 2018. Food consumption data were collected from three consecutive 24-h dietary recalls. The multivariate Cox proportional risk regression model and restricted cubic spline (RCS) model were used to analyze the association and dose-response relationship between dietary magnesium intake and MetS and its components. In our study, 6104 subjects were included, with a total follow-up of 37,173.36 person-years, and the incidence was 33.16%. Cox regression analysis showed that the multivariable-adjusted Hazard Ratio (HR) for MetS comparing the highest to the lowest quintile of dietary magnesium intake was 0.84 (95% confidence intervals [CI] = 0.71-0.99). Central obesity, elevated TG, elevated blood pressure and elevated blood glucose were reduced by 18%, 41%, 20% and 42%, respectively. The risk of decreased HDL-C was reduced by 23% in the third quintile of dietary magnesium intake, with a slightly increased risk in the highest group. RCS analysis showed that the overall and non-linear associations between dietary magnesium and MetS and its components were statistically significant, the risk of them decreased significantly when magnesium intake was lower than 280 mg/day, and then the curve leveled off or slightly increased.

Differential Associations of Intakes of Whole Grains and Coarse Grains with Risks of Cardiometabolic Factors among Adults in China.

There is a lack of studies on the association between whole grain intake and cardiometabolic risk factors in China and the current definition of whole grains is inconsistent. This study defined whole grains in two ways, Western versus traditional, and examined their associations with the risks of major cardiometabolic factors (CMFs) among 4706 Chinese adults aged ≥18 years, who participated in surveys both in 2011 and in 2015. Diet data were collected by consecutive 3 d 24 h recalls, together with household seasoning weighing. Whole grains were defined as grains with a ratio of fiber to carbohydrate of ≥0.1, while coarse grains were defined as grains except for rice and its products, and wheat and its products. Multivariable logistic regressions were modeled to analyze the associations of intakes of whole grains and coarse grains, respectively, with risks of major CMFs including obesity-, blood pressure-, blood glucose- and lipid-related factors, which were defined by International Diabetes Federation and AHA/NHLBI criteria. After adjusting for potential confounders, the odds of elevated LDL-C decreased with the increasing intake levels of whole grains (OR 0.64, 95% CI 0.46−0.88, p-trend < 0.05). Moreover, adults with the whole grain intake of 50.00 to 150.00 g/day had 27% lower odds of overweight and obesity (OR 0.73, 95% CI 0.54−0.99) and 31% lower odds of elevated LDL-C (OR 0.69, 95% CI 0.49−0.96), as compared with non-consumers. In conclusion, given the significant nutrient profiles of whole grains and coarse grains, the adults with higher intakes of whole grains only may have a lower risk of LDL-C and overweight and obesity.